Int J Sports Phys Ther. 2013 Apr; 8(2): 84-90
Myers H, Davis A, Lazicki R, Martinez C, Black D, Butler RJ

Quadriceps function is an important outcome following lower extremity injury and surgery. Measurements of quadriceps function are particularly helpful initially post surgery, however traditional quadriceps strength measures like isokinetic testing are contraindicated during this time period. Inclusion of dynamic musculoskeletal ultrasound imaging in the clinical setting has been beneficial in understanding quadriceps activation specifically rectus femoris (RF) contraction; however, there is a paucity of literature in this area. The purpose of the current study was to describe the cross-sectional area (CSA) of the RF across varying knee flexion angles.Forty-five adult recreational athletes were recruited for the study (21 males, 24 females). All subjects underwent tests of maximal volitional isometric contractions of the knee extensors at 0, 30, 60 and 90 degrees of knee flexion. During the trials, musculoskeletal ultrasound images of the RF at 15 cm from the superior pole of the patella were taken at rest and during contraction for each of the angular positions. Mixed model ANOVAs (angle x sex) were utilized to examine the differences between males and females for different angular positions. These analyses were conducted for the resting CSA, active CSA, and the contractile index (resting – active).RF cross-sectional area increased with increasing angles of knee flexion for both the resting and active conditions. The contractile index consistently decreased as knee flexion angle increased. No statistically significant interactions or main effects for sex were observed, although differences were observed in the trajectories of the data sets for males and females.RF CSA is dependent on knee flexion angle in both males and females. As a result, the assessment of RF CSA should be conducted in a standardized position if this variable is to be utilized as a meaningful measure of muscle size during rehabilitation. Additional research should seek out which factors are associated with clinically relevant factors that effect RF CSA across the range of knee flexion.3b. HubMed – rehab


Daily Step Count Predicts Acute Exacerbations in a US Cohort with COPD.

PLoS One. 2013; 8(4): e60400
Moy ML, Teylan M, Weston NA, Gagnon DR, Garshick E

COPD is characterized by variability in exercise capacity and physical activity (PA), and acute exacerbations (AEs). Little is known about the relationship between daily step count, a direct measure of PA, and the risk of AEs, including hospitalizations.In an observational cohort study of 169 persons with COPD, we directly assessed PA with the StepWatch Activity Monitor, an ankle-worn accelerometer that measures daily step count. We also assessed exercise capacity with the 6-minute walk test (6MWT) and patient-reported PA with the St. George’s Respiratory Questionnaire Activity Score (SGRQ-AS). AEs and COPD-related hospitalizations were assessed and validated prospectively over a median of 16 months.Mean daily step count was 5804±3141 steps. Over 209 person-years of observation, there were 263 AEs (incidence rate 1.3±1.6 per person-year) and 116 COPD-related hospitalizations (incidence rate 0.56±1.09 per person-year). Adjusting for FEV1 % predicted and prednisone use for AE in previous year, for each 1000 fewer steps per day walked at baseline, there was an increased rate of AEs (rate ratio 1.07; 95%CI?=?1.003-1.15) and COPD-related hospitalizations (rate ratio 1.24; 95%CI?=?1.08-1.42). There was a significant linear trend of decreasing daily step count by quartiles and increasing rate ratios for AEs (P?=?0.008) and COPD-related hospitalizations (P?=?0.003). Each 30-meter decrease in 6MWT distance was associated with an increased rate ratio of 1.07 (95%CI?=?1.01-1.14) for AEs and 1.18 (95%CI?=?1.07-1.30) for COPD-related hospitalizations. Worsening of SGRQ-AS by 4 points was associated with an increased rate ratio of 1.05 (95%CI?=?1.01-1.09) for AEs and 1.10 (95%CI?=?1.02-1.17) for COPD-related hospitalizations.Lower daily step count, lower 6MWT distance, and worse SGRQ-AS predict future AEs and COPD-related hospitalizations, independent of pulmonary function and previous AE history. These results support the importance of assessing PA in patients with COPD, and provide the rationale to promote PA as part of exacerbation-prevention strategies. HubMed – rehab


Economic evidence on integrated care for stroke patients; a systematic review.

Int J Integr Care. 2012 10; 12: e193
Tummers JF, Schrijvers AJ, Visser-Meily JM

Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integrated care arrangements for stroke patients compared to usual care. Integrated care was defined as a multidisciplinary tool to improve the quality and efficiency of evidence-based care and is used as a communication tool between professionals to manage and standardize the outcome-orientated care.A systematic literature review of cost analyses and economic evaluations was performed. Study characteristics, study quality and results were summarized.Fifteen studies met the inclusion criteria; six on early-supported discharge services, four on home-based rehabilitation, two on stroke units and three on stroke services. The follow-up per patient was generally short; one year or less. The comparators and the scope of included costs varied between studies.Six out of six studies provided evidence that the costs of early-supported discharge are less than for conventional care, at similar health outcomes. Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes. Care in stroke units is more expensive than conventional care, but leads to improved health outcomes. The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs. For future research we recommend to focus on the moderate and severely affected patients, include stroke severity as variable, adopt a societal costing perspective and include long-term costs and effects. HubMed – rehab


The Effects of Abnormal Blood Pressure on Arterial Sampler Filling Times.

Respir Care. 2013 Apr 16;
Cortes AL, Dalessandro CM, Glade TM, Shirdon SA, Uhlir JJ, Douce FH

BACKGROUND:Sampler filling time begins with the initial flash of blood in the needle hub until the preset sampler volume is obtained. Previous studies have shown statistically significant differences between arterial and venous sampler filling times but included only a few patients with abnormal blood pressures.Purpose: To determine if the time required to fill a vented arterial sampler is an accurate indication of a successful arterial blood sample in adults with abnormal blood pressure.Hypotheses: MAP and arterial sampler filling time will have a negative correlation; venous sampler filling time will be significantly longer than arterial filling time.METHODS:We studied 40 subjects, 25 arterial subjects and 15 venous subjects. The arterial subjects included three groups: hypertensive, hypotensive or normal. During the arterial and venipuncture procedures, we measured sampler filling time and recorded blood volume; the PO2 of the samples was measured. Additionally, BP and SpO2 were measured for the arterial groups. We used a Pearson correlation coefficient to determine the relationship between MAP and sampler filling rate. We determined if there was a significant difference between arterial and venous groups using ANOVA with an alpha level of .05 and Tukey’s post hoc.RESULTS:The mean sampler filling times were 220.4 sec/mL for venous and 18.1sec/mL for all three arterial groups combined. There were significant differences between each mean arterial sampler filling rate and mean venous filling rate (P <.001). There were no significant differences in mean sampler filling rates between arterial subgroups (P = .997). The correlation between MAP and filling rates was 0.062 (P = .384).CONCLUSION:There is a significant difference between arterial and venous filling rates. There was no relationship between filling times and abnormal MAPs. Regardless of arterial blood pressure, arterial sampler filling time can be used as an indicator of a successful arterial puncture at the bedside. HubMed – rehab


New developments in the law for obesity discrimination protection.

Obesity (Silver Spring). 2013 Mar; 21(3): 469-471
Pomeranz JL, Puhl RM

BACKGROUND: Obese individuals are frequent targets of weight-based discrimination, particularly in the employment setting. Victims of weight discrimination have sought legal restitution like others who have suffered from different forms of discrimination. However, in the vast majority of the United States, body weight is not a protected class and weight-based employment discrimination does not provide a basis for a legal claim. Some have attempted to seek legal recourse under the Rehabilitation Act of 1973 or the Americans with Disabilities Act of 1990 (collectively, the ADA), which protect against discrimination based on mental or physical disabilities in a variety of settings. Until recently, claims of weight discrimination under the ADA have also been largely unsuccessful. However, Congress recently passed the ADA Amendments Act, expanding the definition of what constitutes a disability and incorporating a broad view of ADA’s coverage. OBJECTIVE: This short communication provides an update of the law as it relates to employment based discrimination of obese people. The authors propose a legislative direction for future legal recourse. DESIGN AND METHODS: The authors conducted legal research into the ADA Amendments Act, and synthesized this work relating to discrimination against weight in the employment context. RESULTS: In light of the ADA Amendments Act, courts and the Equal Employment Opportunity Commission have provided protection for severely obese people from discrimination based on actual or perceived disability in the employment context. CONCLUSION: The authors discuss this positive legal development and additionally propose a targeted solution to address weight discrimination in the employment setting. National polling suggests there is considerable public support for such a measure. The authors thus recommend the implementation of a “Weight Discrimination in Employment Act” modeled after the Age Discrimination in Employment Act to adequately address this pervasive and damaging injustice toward individuals who are affected by obesity. HubMed – rehab