Manual Therapy Journal - Volume 14, Supplement (October 2009)


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DB0 Chad Cook, PT, PhD, MBA, OCS, FAAOMPT is an Associate Professor and the Director of Outcomes Measurement at Duke University with a dual appointment in Department of Community and Family Medicine and the Department of Surgery. Dr. Cook received his Bachelors of Science in Physical Therapy at Maryville University in 1990, a Masters of Business Administration in 1999, and a Doctorate of Philosophy (PhD) at Texas Tech University in 2003. He was certified as an orthopedic manual therapist in 2001, obtained fellowship status with AAOMPT in 2007, and is an APTA board certified orthopedic specialist (2002). Dr. Cook has published over 70 peer reviewed research papers in journals such as acW^_TSXR
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0.01), but were related to motor control dysfunction (p ¼ 0.01) Discussion: The results of this study suggest that chronic LBP-patients exhibit altered breathing patterns during performances in which trunk stability muscles are challenged. It has been shown that respiratory movements represent a greater disturbance to posture in LBP-patients5 and that diaphragmal contraction enhances spinal stiffness in healthy subjects6. Clinicians should therefore evaluate the breathing pattern in LBP-patients, as they may recruit the diaphragm to enhance lumbopelvic stability, thereby disadvantaging respiration. 1. Smith MD, Russell A, Hodges PW (2006) Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. The Australian Journal of Physiotherapy 52(1): 11-16. 2. O’Sullivan P: Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005, 10(4):242-255. 3. Roussel NA, Nijs J, Truijen S, et al (2007) Low back pain: clinimetric properties of the Trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising. J Manipulative Physiol Ther 30: 270-8 4. Roussel NA, Nijs J, Mottram S, Van Moorsel A, Truijen S, Stassijns G. Altered lumbopelvic movement control but not generalised joint hypermobility is associated with increased injury in dancers: A prospective study. Manual Therapy 2009. doi:10.1016/j.math.2008. 5. Hamaoui A, Do Mc, Poupard L, et al (2002) Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects? Clin Biomech 17: 548-5506. Hodges PW, Eriksson AE, Shirley D, et al (2005) Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech 38: 1873-80 Keywords: low back pain, motor control, breathing, chronic

Oral Abstracts / Manual Therapy 14 (2009) S11–S30

[O41] Hypermobility (HM) - Influence of passive and active tone U. Stutz 1, G. Luder 1, H. Ziswiler 2, M. Stettler 3, C. Mebes 1, L. Radlinger 3. 1 Institute of Physiotherapy, Inselspital, University Hospital Bern, Switzerland; 2 RIA University Hospital of Bern, Switzerland; 3 Bern University of Applied Sciences Health, Switzerland Objective: Hypothesis: passive and active tone differ between normomobile and hypermobile women. Relevance: HM leads to joint and soft tissue troubles and physical therapy implications are more based on practical than scientific evidence (1). Diagnosis and documentation typically result from the Beighton Score (BS) (2) and manual testing. Materials /Methods: In this cross-section study women without acute trauma or operation of the lower limbs and back were included: hypermobile women (Beightonscore: 7.6  1.1; n ¼ 13) and normo-mobile women (Beightonscore 0.5  0.5; n ¼ 18). Measurements of the passive tone: angular mobility of the hip and knee (hydrogoniometer), muscle cross-section area of the thigh (ultrasound), resting tension with the straight leg raise (SLR; SLR-device) and ventral tibia-translation (TL; rolimeter). Measurements of the active tone: maximum strength and rate of force development of the knee flexion and extension (force transducer), single-leg standing (forceplate), additional recording of painful situations in daily life (questionnaires). Analysis: Descriptive statistics and comparison of two independent groups (nonparametric, Mann-Withney-U-Test) were performed using SPSS. Results: Hypermobile women had a higher mobility in the hip and knee and additionally a reduced cross-section area in the rectus femoris and hamstrings muscles. No differences were found in SLR and TL. Hypermobile women showed a higher rate of force development in knee extension and had a higher mediolateral sway during single-leg standing. They also described to have more painful limitations during daily life. Conclusions: Currently range of motion, muscle cross section, single-leg stand, rate of force development and painful situations discriminate normo-mobile from hypermobile These results and the inconsistent literature make more studies necessary. References (1) Simmonds JV, Keer RJ. J Man Th. 2007;12 (4) 298-309. (2) Hakim A, Grahame R. Best Pract Res Clin Rheumatol 2003; 17(6):989-1004. (3) Magnusson SP et al. J Rheumatol. 2001; 28(12):2720-5; (4) Gajdosik RL. Europ J Appl Physiol. 2002; 87:20-227

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Inter-rater reliability was good to excellent for group B, with ICCs ranging from 0.917 to 0.926 and from 0.957 to 0.981 for the painful and non-painful shoulders. The dominant supraspinatus is 5.6% thicker, and has 11.86% greater CSA than the non-dominant supraspinatus in group A. The non-painful dominant supraspinatus is 10.21% thicker, and has 14.97% greater CSA than the painful non-dominant supraspinatus in group B. The non-painful non-dominant supraspinatus is on average 8.86% thicker and has 11.32% greater CSA than the painful dominant supraspinatus in group B. Conclusions: Ultrasound is a reliable measure of supraspinatus size in subjects with and without shoulder pain. Differences exist in supraspinatus size between the dominant and non-dominant and painful and non-painful shoulders. Ultrasound is an appropriate and user-friendly tool to measure muscle atrophy in shoulder pain disorders.

Figure 1: US image of supraspinatus

Keywords: Supraspinatus, Real-time ultrasound, Muscle thickness & crosssectional area, reliability [O43] Two clinical tests are highly accurate when diagnosing unilateral shoulder tendinopathy: An ultrasonography study

Keywords: Hypermobility, Active Tone, Passive Tone, discrimination [O42] Reliability of real-time ultrasound measurement of supraspinatus size in normal subjects and subjects with unilateral shoulder pain A. Roche, K. McCreesh. University of Limerick, Ireland Background: Ultrasound (US) is becoming increasingly popular in measurement of muscle characteristics including cross-sectional area (CSA) and thickness. Shoulder pain is likely to result in altered size of the rotator cuff muscles. To date, limited work has been carried out on US measurement of supraspinatus. Kayatose and Magee (2001) reported ICC values of 0.93 for US measurement of normal subjects. No work has been carried out on shoulder pain populations. Methods: Ultrasound scanning was performed with a Philips Aquila realtime ultrasound machine by two raters on healthy subjects (Group A, n ¼ 20) and subjects with unilateral shoulder pain (Group B, n ¼ 18). Subjects were scanned in sitting with a 5 MHz probe at midpoint of supraspinatus length. Three scans were taken of each shoulder. CSA and T were measured using Image J. Intra-class correlation coefficients (ICC), and Bland and Altman methods of agreement assessed inter-rater reliability. Independent t-tests assessed between shoulder differences in T & CSA. Results: Inter-rater reliability was moderate to good for group A, with ICCs ranging from 0.751 to 0.808 and 0.808 to 0.898 for the left and right shoulder.

J. Joensen 1, 2, C. Couppe 3, J.M. Bjordal 1, 2. 1 Bergen University College, Norway; 2 University of Bergen, Norway; 3 University of Copenhagen, Denmark Objective: In asymptomatic, normal tendons, the difference in tendon thickness between sides is less than 15%. In this study, three tests were used to examine differences between symptomatic and asymptomatic shoulders. Design: Cross-sectional study. The three tests were performed in sequence. The observer was blinded in the maximal pain-free isometric force test (PFF). Setting: Outpatient physiotherapy clinic at Bergen University College, Norway. Participants: Sixty-four patients with an exclusive, tentative diagnose of unilateral shoulder tendinopathy. Main outcome measure: Difference in maximal pain-free isometric force (PFFdiff), tendon pain pressure (PPTdiff) and tendon thickness (TTdiff) measured by Ultrasonography. Results: This paper follows the STARD recommendations for papers on diagnostic accuracy. When cut-off values for within-subject side differences were selected at  0.8 mm for tendon thickness (TTdiff),  10 N for maximal pain-free isometric force (PFFdiff) and  0.6 kg for tendon pain pressure (PPTdiff), positive tests were found in 92% of patients. All three tests were sensitive for the detection of within-subject side differences with the selected cut-off values (TTdiff, n ¼ 60/64; PPTdiff, n ¼ 59/64; PFFdiff, n ¼ 57/64; p > 0.35). There were strong agreements between the three tests: TTdiff and PFFdiff, 0.89; TTdiff and PPTdiff, 0.83; and PFFdiff and PPTdiff,

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Oral Abstracts / Manual Therapy 14 (2009) S11–S30

0.84. When both clinical tests were positive (PFFdiff and PPTdiff), the positive predictive value was excellent (94%) for finding increased tendon thickness in the symptomatic side on Ultrasonography. Conclusion: Within the limitations of this partially blinded study, patients with unilateral shoulder tendinopathy exhibited significant differences between sides in all three tests. The combination of the two clinical tests seems to be valid for the detection of unilateral shoulder tendinopathy of other diagnoses has been excluded. Keywords: Physical examination, Tendons, Ultrasonography, Clinical tests [O44] The multiple hop test: a discriminative or evaluative instrument for chronic ankle instability? C.J. Eechaute, P.H. Vaes. The Physical Therapy Department of the Vrije Universiteit Brussel, Belgium Background: The multiple hop test is a recently validated clinical evaluation method for the assessment of the dynamic postural control in patients with chronic ankle instability1. However, when developing a new measurement instrument, one should consider whether the instrument can be used to discriminate between subjects or whether it is able to measure a change over time for the evaluation of treatments2. Methods: Twenty-nine healthy subjects and 29 patients with chronic ankle instability performed a multiple hop test twice with a one-week time interval. Subjects hopped on 10 different tape markers with one leg while trying to keep balance. The time needed to perform the test and the number of balance errors were assessed. The minimal detectable change of the outcomes was calculated based upon their standard error of measurement. The sensitivity and specificity of different cut-off points were calculated based upon a Receiver Operating Characteristic (ROC) curve at a 95% confidence interval. Results: The minimal detectable change (evaluative parameter) of the outcomes in patients is respectively 6,4 sec. and 7 errors. Considering the means of the outcomes of the patient sample (time value ¼ 41,1-41,5 sec; number of balance errors ¼ 16,3-17,2 errors) as cut-off points (discriminative parameter), the specificity is respectively 90% (sensitivity ¼ 61%; ROC area ¼ 79%) and 93 % (sensitivity ¼ 47%; ROC area ¼ 80%). Discussion: Scores should change by 15% (time value) and by 41% (balance errors) before it can be considered that the change in postural control of patients indicates a real improvement or deterioration and that it is not the result is of measurement error. When considering the mean values of both outcomes in patients as cut-off points, the probability of a false positive test is low. Conclusion: The multiple hop test may be more a discriminative rather than a evaluative test for chronic ankle instability. References 1. Eechaute C, Vaes P, Duquet W. Functional performance deficits in patients with CAI: Validity of the multiple hop test. Clin J Sports Med. 2008; 18: 124-129. 2. Devet H, Terwee C, Bouter L. Current challenges in clinimetrics. J Clin Epidemiol. 2003, 56 1137–1141. Keywords: joint instability, postural control, hop test, clinimetrics [O45] Support for modifications to the anteromedial reach test (an anterior cruciate ligament rehabilitation outcome measure) N.P. Bent 1, A.B. Rushton 1, C.C. Wright 1, M.E. Batt 2. Birmingham, UK; 2 Nottingham University Hospitals, UK

1

University of

Introduction: The Anteromedial Reach Test (ART) is a performance-based outcome measure for assessing dynamic knee stability in anterior cruciate ligament (ACL)-injured patients. Patients perform a single-legged squat while reaching as far as possible with the other leg in an anteromedial direction. Good reliability has been demonstrated in uninjured and ACLdeficient populations,1 although protocol limitations might compromise its validity, e.g. no normalisation for leg length or consideration of learning effects. The aims of this study were to determine the number of practice

trials required for familiarisation with ART, and evaluate the influence of leg length on ART scores. Methods: A repeated measures design evaluated healthy participants (n ¼ 32 to detect a moderate effect, with power ¼ 80% and significance level ¼ 5%2), 10 priorities for theses, and content analysis identified research themes. Round 2 requested participants rank the importance of each theme on a 1-5 scale, and round 3 requested ranking the importance and feasibility of the research question areas within agreed themes. Descriptive analysis and Kendall’s Coefficient of Concordance enabled interpretation of consensus. Thematic analysis explored the insights afforded by qualitative data from open questions for each round. Findings: The response rate of 68% was good, identifying 23 research themes from round 1. Round 2 agreed 14 research themes as important. Participant rating of the importance and feasibility of research question areas in round 3 supported identification of 43/159 research question areas as priorities; demonstrating discrimination of the process. The context of the postgraduate thesis was clearly communicated within the qualitative data. Discussion and conclusions: Research themes were broad, for example, reliability of assessment tools and patient focused research, and the prioritised research questions emphasise preliminary work necessary to enable subsequent research development. The priorities therefore represent dynamic and evolving areas of importance to musculoskeletal physiotherapy. The measurement validity of the research question areas was good. Establishing priorities provides a vision of how postgraduate theses can contribute to the developing evidence base. Keywords: research, priorities, musculoskeletal, postgraduate

[O51] Cognitive learning and sensorimotor function provide a protective effect from disability in low back pain S.G.T. Gibbons 1, 2. 1 Neuromuscular Rehabilitation Memorial University of Newfoundland, Canada

Institute,

Canada;

2

Introduction: It is well established that pain and disability are not directly related. Recent research shows that cognitive learning function (CLF) is associated with psychological reactions and cognitive errors such as fear or anxiety, which are linked to disability. Methods: A cross sectional study was performed on 263 individuals who had chronic low back pain (LBP) for more than a year from the age of 18-60 (147 female; 116 male). They completed the Roland Morris Disability Questionnaire (RMDQ), the Patient Specific Functional Questionnaire, the Quadruple Numerical Rating Scale, and the Motor Control Abilities Questionnaire (MCAQ). Work status was assessed with the work measure subgroup of the F4 Functional Scale. The MCAQ consists of items that rate aspects of CLF, sensorimotor function (SF). Previously determined cut off points of 20 and below and 80 or greater were used. Statistical analysis was done with a t test and rate ratio from a standard 2 x 2 table. Results: 23 Subjects who scored 20 or under on the MCAQ minimal disability associated with their pain. The mean RMDQ score was 1.7. The mean pain level was 5.7. The subjects who scored above 80 on the MCAQ (n ¼ 18) had a mean pain score of 6.8 and a mean RMDQ score of 16.8. This was significant (p < 0.05). The rate ratio of being disabled from work if the score is below 20 was 0.03. Discussion: The results from this study allow us to hypothesize that certain aspects of CLF and SF may provide a preventative effect from disability due to LBP. It is hypothesized that CLF deficits do not allow normal problem solving to develop, limit normal appraisal of the threat value of pain and contribute to the development of psychological reactions. The identification of cognitive learning abilities may be an important new sub-classification method. A larger sample size is required to confirm these findings. Keywords: disability, cognitive function, risk screening

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Interactive Poster Abstracts / Manual Therapy 14 (2009) S32–S36

[IAP01] Practical use of the Hypothesis-Orientated Algorithm for Clinicians II (HOAC II, part 1) E.J. Thoomes, M. Schmitt. SOMT, Netherlands Introduction: The use of algorithms is advocated in contemporary clinical reasoning. The Hypothesis-Orientated Algorithm for Clinicians II (HOAC II) 1 recognises 2 major types of patient problems (existing and anticipated) as well as 2 ways of identifying patient problems: Patient-identified problems (PIPs) and non-patient-identified problems (NPIPs). PIPs usually consist of functional limitations and disabilities as described in the ICF 2,3; they often exist when the therapist sees the patient. While the patient identifies the problem, the therapist needs to generate a hypothesis as to the cause of the problem and he then needs to establish testing criteria which can be used to evaluate the outcome of interventions and the correctness of the hypothesis and patient care strategies. Methods: Using a recognizable case history, we followed the algorithm, requiring us to develop a strategy for the examination that was based on initial hypotheses developed from the medical history and other data obtained prior to the examination. The examination was then tailored to identify and quantify relevant impairments that were hypothesized to be causing the problems. Next we established goals. Goals for existing problems usually represent measurable target levels (dis-)ability that a patient will be able to achieve as a result of the intervention. Each goal must have a temporal element; an expectation as to when the goal will be met. Goals are always patient centered and always represent outcomes that have value to the patient’s current quality of life or future quality of life. Then we defined testing criteria that were used to examine the correctness of the hypotheses. Testing criteria usually represent specified measurements of achievements at the impairment level that, if obtained, will result in the resolution of the problem if the hypotheses are correct. Results: We demonstrated the clinical application of HOAC II and showed how disablement terms can be integrated into patient management in a way that enhances practice. The case history was illustrative in that it demonstrated how all elements of HOAC II can be addressed for, what are considered relatively common, types of patient problems. We believe that by applying the HOAC II on an individual patient basis, therapists will be ideally positioned to apply evidence to patient care and to defend their interventions to colleagues and to third party payers. Discussion: The process of identifying PIP’s and NPIP’s, goal setting and using objective testing criteria, aid clinicians in making (manipulative) physiotherapy a more objective (multi) modality of treatment. It also stimulates EBCP in physiotherapy management of patients, necessitating a constant update of relevant knowledge with contemporary literature and research outcome of today’s physiotherapist as a health care professional. References 1. Rothstein JM, Echternach JL, Riddle DL. The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): a guide for patient management. Phys Ther. 2003 May; 83(5):455-70. 2. Steiner WA, Ryser L, Huber E, Uebelhart D, Aeschlimann A, Stucki G.Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Phys Ther. 2002 Nov;82(11):1098-107. 3. Finger ME, Cieza A, Stoll J, Stucki G, Huber EO. Identification of intervention categories for physical therapy, based on the international classification of functioning, disability and health: a Delphi exercise. Phys Ther. 2006 Sep;86(9):1203-20. Keywords: Clinical Reasoning, HOAC II, Elite Athlete, Low Back Pain [IAP02] Evaluation of the change in recruitment of Multifidis and Transversus Abdominus following manual facilitation K.J. Jones, J. Wray, M. McBride, N. Ellis, C. Harraway. Cardiff University, United Kingdom The importance of stabilising the spine is heightened in athletes with a weak core leading to less efficient movement and potential injury.

Evidence indicates that spinal stability training could prevent injury, enhance performance and accelerate post injury rehabilitation. The intervention being investigated has not previously been objectively evaluated in any population. The purpose of the present study was to investigate the effect of a manual facilitation technique on bilateral activity of Multifidis (MT), Transverse Abdominus/Internal Oblique (TA/IO), External Oblique (EO), Erector Spinae (ES) in both sitting and standing. A same subject experimental design was implemented. A healthy convenience sample (mean (SD) age 26.45 years (5.25) (n ¼ 22; 13 female) was recruited. The intervention is a specific manual facilitation applied to MT, which aims to enhance proprioceptive awareness and facilitate an active neutral alignment of the lumbar spine. This is described as the optimum alignment for efficient spinal stability and activation of the deep muscle stabilisers. Surface Electromyography was used to evaluate. Data was analysed using a repeated measures ANOVA (alpha  0.05). Local ethical approval was obtained from School of Healthcare studies, Cardiff University. The results indicate that following intervention there was a significant increase in all the target muscles with a highly significant increase of the deep muscle stabilisers, TA/IO and MT. In sitting, left MT (p ¼ 0.000), right MT (p ¼ 0.002), left ES (p ¼ 0.029), right ES (p ¼ 0.015), left TA/IO (p ¼ 0.000), right TA/IO (p ¼ 0.000), left EO (p ¼ 0.008), right EO (p ¼ 0.044). In standing, left MT (p ¼ 0.000), right MT (p ¼ 0.000), left ES (p ¼ 0.008), right ES (p ¼ 0.010), left TA/IO (p ¼ 0.000), right TA/IO (p ¼ 0.000), left EO (p ¼ 0.001), right EO (p ¼ 0.001). Clinically this technique has potential to be useful in the retraining of athletes to isolate the deep stabilisers prior to progressing on to independent exercises and integration into more challenging sporting activities. Keywords: Manual facilitation of Multifidis, Spinal stability, SEMG evaluation of deep stabilisers [IAP03] The incidence of pelvic instability in subjects with chronic groin pain R.M. O’Sullivan. Institute of Technology Carlow, Ireland The purpose of this study was to examine the incidence of pelvic instability in subjects with chronic groin pain compared to a sporting participation matched control group. Groin pain is prevalent in many sports and it is not uncommon that this pain should become chronic. There are many proposed reasons for this chronicity, including a large differential diagnosis in the region and the presence of two or more pathologies coexisting. Recently, research has begun to focus on the involvement of pelvic instability in this long-standing pain. A recent study found the action of the transversus abdominis to be delayed in patients with longstanding groin pain, and such a delay can lead to the lower limb moving through an unstable base (Cowan et al., 2004). 11 subjects (mean age 24  6.9) suffering from chronic groin pain within the last three years, and 11 subjects with no history of groin pain (mean age 20.2  2.1) were recruited. The pressure biofeedback unit (pbu) was used for quantifying of pelvic instability in three tests that challenge pelvic stability – supine knee flexion, knee drop out and leg extension. These tests were performed in random order and the changes in pressure (mmHg) as indicated by the pbu recorded for statistical purposes. A one way ANOVA found there to be a significant difference between the groups for all three tests (p < 0.05). An unpaired t-test highlighted a significant difference in the changes of pbu pressures between the affected limb in the groin group and the left leg of the control group for all three tests (p < 0.05). There was also a significant difference between the affected and the unaffected legs in the groin pain group in all three tests (p < 0.05). Therefore, the hypothesis was accepted that subjects with chronic groin pain have significantly more pelvic instability compared to a matched control group. Keywords: chronic groin pain; lumbopelvic stability; pbu

Interactive Poster Abstracts / Manual Therapy 14 (2009) S32–S36

[IAP04] A comparison of two styles of the football instep kick and their relationship to lumbopelvic stability A.R. Barr, A. Burden. Manchester Metropolitan University, United Kingdom Objectives: To investigate the differences between the follow through (FT) and non follow through (NFT) kicking techniques, their relationships with lumbopelvic stability, and to draw inferences for injury potential. Design: A VICON system measured the three-dimensional (3D) positions of 6 reflective markers on participants’ trunk to gain angular displacement of the spine during the different kicking techniques. A pressure biofeedback unit was used to measure participants’ lumbopelvic stability. Setting: The data collection area in the Department of Exercise and Sports Science, Manchester Metropolitan University, Cheshire was used for 3D motion-capture. Lumbopelvic stability testing was performed at the Bolton Wanderers FC training facility. Participants: Twelve male professional footballers with mean ( SD), age 19 ( 5) yrs, height 181.6 (18) cms and mass 78.6 (25) kg were used in the study. Main Outcome Measures: 1) Differences in motion of the lower spine between the FT and NFT kicks were analysed using paired t-tests. 2) Differences in spinal rotation and lumbopelvic stability between left and right sides were also analysed using paired t-tests. 3) Relationships between lumbopelvic stability and lower spine motion were analysed for both FT and NFT kicks using Spearman’s rank order correlation. Results: Significantly greater end ranges of spinal motion were discovered for NFT kicks compared to FT kicks (P < 0.001). Significantly greater left lower spine rotation was found compared to right rotation for both kicks. Significantly lower left rotation stability scores were found compared to right (P < 0.002). A significant inverse relationship was found between lower spine extension and extension stability for both kicks (P < 0.001). Conclusion: NFT kicks are thought to have increased risk of injury to the lumbopelvic region compared to FT kicks due to greater end ranges of spinal motion. Reduced left rotational stability is linked to increased left lower spine rotation from frequently performed right footed kicks. Poor extension stability is thought to increase the risk of lumbopelvic extension injury when kicking. Keywords: Instep Kick, Lumbopelvic stability, 3D analysis [IAP05] A comparison of metacarpophalangeal with cervical apophysial joint manipulation using high velocity low amplitude thrust (HVLAT) techniques A. Harwich. Private Practice, United Kingdom High velocity, low amplitude thrust (HVLAT) techniques are commonly used in manual therapy. There is general agreement that the ‘cracking’, which occurs on HVLAT, is due to a phenomenon known as cavitation. The precise mechanism of cavitation in synovial joints, achieved by sudden separation of the joint surfaces by manual techniques, has only been investigated for distraction of the joint surfaces of metacarpophalangeal (MCP) joints. It is assumed that in both spinal and peripheral joints any synovial joint cavitation phenomenon is essentially the same mechanism as occurs in metacarpophalangeal joints. However, HVLAT on MCP joints can be performed in many different ways and a common alternative to distraction is into flexion. Moreover, the MCP distraction HVLAT is a symmetric separation of the joint surfaces and thus cannot be the same motion as produces hyperflexion MCP HVLAT. This paper sets out to compare MCP with cervical apophysial joint manipulation using HVLAT consistent with the technique as described by several authors. By constructing an idealised, simplified graphical model of the joint, the two mechanisms, distraction and hyperflexion HVLAT of the MCP joint, were compared graphically together with a qualitative vector analysis. An important finding was that, using similar methods, HVLAT on cervical apophysial joints was shown to be the analogue of the MCP hyperflexion HVLAT. The analysis reveals aspects of HVLAT technique that have not previously been emphasised or that have been ambiguously described or erroneously reported. Although no agreed pathway has been mapped out that would

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explain the therapeutic benefits of using HVLAT technique, it is concluded that this analysis points to a much more clearly defined physiological dysfunction common to very many synovial joints that is addressed by the high velocity low amplitude thrust (HVLAT) technique. Keywords: Synovial Joint, Cavitation, high velocity low amplitude thrust, metacarpophalangeal joint [IAP06] Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain N.E. O’Connell 2, J. McAuley 3, 4, L.H. B.M. Wand 1, P. Formby 1, DeSouza 2. 1 The University of Notre Dame, Australia; 2 Brunel University, United Kingdom; 3 The George Institute for International Health, Australia; 4 University of Sydney, Australia Introduction: Studies on low back pain (LBP) patients indicate a discrepancy between self-reported disability and actual daily activity levels [1,2] and the level of agreement between performance based measures of disability and self reported measures of disability is not strong [3-7]. The purpose of this study was to establish the feasibility of using a performance-based assessment of disability in the acute LBP population, and to investigate the relationship between self reported disability and performance-based evaluation in this population. Methods: 94 patients with ALBP aged between 20 and 55 years of age undertook a battery of functional tasks and completed a self reported disability questionnaire. The tasks included timed repeated sit-to-stand, the timed up-and-go test, timed lying supine to standing, and a timed fivemetre walk. Results were combined to give an overall score. Internal consistency, the relationship between self reported disability and performance based assessment of disability and the relationships between patient profile and the two disability measures were investigated. Results: The tests were well tolerated by this group. The protocol demonstrated good internal consistency (Cronbach’s alpha ¼ 0.86). The performance base measure of disability was only moderately correlated with self report (Pearsons r ¼ 0.471 p < 0.001). Univariate and multivariate analyses demonstrate that self reported and performance based measures of disability are influenced by different clinical characteristics. Specifically, self reported disability appears to be more strongly related to the patient’s psychological status than performance based assessment. Discussion: The protocol was quick and easy to perform. It appears that self reported measures are more influenced by the patients’ psychological status than performance based assessments and may give a distorted view of the actual functional consequences of an ALBP episode. To fully understand the functional consequences of ALBP it may be advisable to use both self report and performance based assessments of disability. References 1. Verbunt JA, Westerterp KR, van der Heijden GJ, Seelen HA, Vlaeyen JW, Knottnerus JA Physical activity in daily life in patients with chronic low back pain. Arch Phys Med Rehabil. 2001; 82(6):726-30 2. Verbunt JA, Sieben JM, Seelen HA, Vlaeyen JW, Bousema EJ, van der Heijden GJ, Knottnerus JA. (2005) Decline in physical activity, disability and pain-related fear in sub-acute low back pain. Eur J Pain. 2005; 9(4):417-25 3. Alschuler KN, Theisen-Goodvich ME, Haig AJ, Geisser ME A comparison of the relationship between depression, perceived disability, and physical performance in persons with chronic pain. Eur J Pain. 2008; 12(6):757-64 4. Gross DP, Battie´ MC Construct validity of a kinesiophysical functional capacity evaluation administered within a worker’s compensation environment. J Occup Rehabil. 2003; 13(4):287-95. 5. Lee CE, Simmonds MJ, Novy DM, Jones S Self-reports and clinicianmeasured physical function among patients with low back pain: a comparison. Arch Phys Med Rehabil. 2001; 82(2):227-31 6. Novy DM, Simmonds MJ, Lee CE. Physical performance tasks: what are the underlying constructs? Arch Phys Med Rehabil. 2002; 83(1):44-7 7. Simmonds MJ, Olson SL, Jones S, Hussein T, Lee CE, Novy D, Radwan H. Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine. 1998; 23(22):2412-21 Keywords: Low Back Pain, Disability, Performance tests, Functional capacity

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[IAP07] Scapular positioning and motor control in children and adults: A casecontrol study using clinical measurements 1, 2

1, 2

1

3

1

F. Struyf , J. Nijs , S. Horsten , S. Mottram , S. Truijen , R. Meeusen 2. 1 Artesis University College Antwerp, Belgium; 2 Vrije Universiteit Brussel, Belgium; 3 Kinetic Control, United Kingdom Introduction: The scapular muscular system is the major contributor of scapular positioning. In addition, children show improvement in strength, flexibility and muscular endurance from childhood through adolescence. Thus, differences in scapular positioning and motor control between adults and children may occur. The hypothesis for this study was that the scapular positioning and motor control varies between adults and children. It also aimed to provide normative data for the use of the clinical tests for the assessment of scapular positioning in clinical practice. Methods: A case-control design was used. Ninety-two shoulders of 46 adults, their age ranging between 18 and 86 years, and 116 shoulders of 59 children, 6-17 years of age, were included in the study. Scapular positioning data were collected using a clinical assessment protocol including visual observation of titling and winging, measurement of forward shoulder posture, measurement of scapular upward rotation, and the assessment of scapular motor control. Results: The observation protocol for scapular winging and tilting did not show significant differences between adults and children or between any of the five subgroups. After controlling for body mass index, forward shoulder posture (relaxed) was significantly smaller in children than in adults (P < 0.01). In addition, children showed greater scapular upward rotation (90.8 ; SD 16.1 ) than adults (83.0 ; SD 15.8 ). No significant differences were seen between children and adults in scapular motor control. Discussion: Children and adults show significant differences in scapular upward rotation and forward shoulder posture. No difference is noted in scapular motor control. Our results provide normative data for scapular upward rotation and forward shoulder posture in children and adults. Keywords: scapular, shoulder, age, clinical [IAP08] The effect of patella taping on lower limb joint movement and anterior knee pain E. Harrington, A.M. Clifford. University of Limerick, Ireland Purpose: To investigate the effects of medial glide patella taping (MGPT) on lower-limb joint angle change and knee pain during a unilateral squat in a symptomatic population complaining of patellofemoral pain syndrome (PFPS). Relevance: MGPT, first described by McConnell1 and is an adjunct commonly used in the management of PFPS. Despite this, the mechanism behind the clinical success remains unclear. Participants: Following ethical approval, a sample of convenience of subjects with a six month history of unilateral or bilateral PFPS2 volunteered to participate in the study. Methods: Subjects were required to squat once on the symptomatic leg under three conditions (placebo tape, MGPT and control respectively). Kinematic data was recorded using the CODA mpx64 motion analysis system. A record of subjects’ pain according to the Numerical Rating Scale (NRS) under each condition was also noted. Analysis: Changes were analysed using Friedman and Wilcoxon Signed Ranks tests. Results: Fifteen symptomatic knees were analysed. MGPT resulted in a significantly greater single-legged squat depth compared to placebo tape (p ¼ 0.008) and control (p ¼ 0.0012) by a mean of 108 and 48 respectively. A statistically significant reduction in pain during a single-legged squat was found when the patellofemoral joint was glided medially compared to squatting with placebo tape (p ¼ 0.001) or control (p ¼ 0.001). This reflected a clinically significant decrease in pain by 2 points on the NRS. Conclusion: MGPT produces significant increases in squat depth with associated significant reductions in patellofemoral pain in a symptomatic population.

Implication: MGPT will enable PFPS patients to complete their rehabilitation exercises with less pain and through a greater range of movement. References 1 McConnell J. The management of chondromalaciae patellae: a long term solution. Aust J Phys Ther 1986; 32: 215-223. 2 Callaghan MJ, Selfe J. Patellar taping for patellofemoral pain syndrome in adults. Coch Data Syst Rev 2007; 3. Keywords: Anterior knee pain, Kinematics, Taping, Squat [IAP9] Are there alterations to feedback mechanisms controlling the shoulder complex in painfree subjects with hypermobility? H.M. Jeremiah 1, 3, C.M. Alexander 2. 1 UCL, United Kingdom; 2 Imperial College Healthcare NHS Trust, United Kingdom; 3 RNOH NHS Trust, United Kingdom The objective of this study was to explore joint hypermobility, the range of shoulder movement, the ability to re-position the shoulder joint and one measure of reflex control of the upper and lower fibres of trapezius in pain free people with and without joint hypermobility syndrome. With ethical approval and informed consent 24 subjects were assessed for hypermobility using the Brighton criteria. Shoulder range of movement was measured using a fluid goniometer, the ability to re-position the shoulder was measured using photographic analysis. In addition, a reflex in trapezius was evoked using electrical stimulation of the ulna nerve. Shoulder range, joint reposition sense and the reflex latency of the hypermobility group and the non hypermobile group were compared. There was a greater range of shoulder movement in the people with hypermobility when compared to the non hypermobile group (p ¼ 0.004). There was no difference in the shoulder joint repositioning test between the hypermobile and non hypermobile groups (p ¼ 0.27), however, the people with hypermobility displayed a larger degree of variability in this measure (p ¼ 0.014). Finally there was no difference in the latency of the trapezius reflexes (p ¼ 0.86). In conclusion, in a group of people with hypermobility without shoulder problems there was no difference in either the shoulder joint reposition test or this trapezius reflex latency when compared to a non hypermobile group. This suggests that some mechanisms of feedback might not be different in asymptomatic hypermobile subjects. Keywords: Hypermobility, Proprioception, Reflex, Shoulder

[IAP10] The influence of sensorimotor incongruence on musculoskeletal injuries in musicians L. Daenen 1, 2, N.A. Roussel 1, 2, P. Cras 3, J. Nijs 1,4. 1 Division of Musculoskeletal Physiotherapy, Artesis University College, Belgium; 2 Royal Conservatoire; Artesis University College, Belgium; 3 University of Antwerp & University Hospital Antwerp, Belgium; 4 Vrije Universiteit Brussel, Belgium Introduction: Musicians daily perform complex repetitive movements and are at increased risk for developing musculoskeletal symptoms1, such as pain, stiffness, muscle cramps, etc. In the majority of the symptoms, however, no specific diagnose can be made. It has been suggested that a conflict between motor activity and sensory feedback may be a persistent source of nociception in the central nervous system. Presenting incongruent information to healthy subjects induced pain and sensory disturbances in healthy individuals.2 Moreover, a sensory-motor mismatch exacerbates pain and sensory perceptions in patients with chronic pain3, suggesting a possible aetiological role for sensory-motor incongruence in the development of (chronic) pain. The purpose of this study is to determine whether a conflict between motor intention and sensory feedback may explain the musculoskeletal symptoms of upper extremities and vertebral column in professional musicians. Methods: Twenty students following a professional Master in violin performed a task simulating sensory-motor incongruence of upper extremities. All participants were asked to flex/extend both arms in a congruent/

Interactive Poster Abstracts / Manual Therapy 14 (2009) S32–S36

incongruent manner for 20-s viewing a whiteboard or mirror surface2,3. Afterwards, the subjects were asked whether any changes in sensory experience occurred during the test2,3. The investigator was blinded to the symptoms of the subjects at the moment of testing. The subjects filled in several questionnaires aiming at analyzing psychosocial characteristics and medical history. Finally, the occurrence of new injuries was registered during a 6-months follow-up. Results: Significant more musicians with current musculoskeletal injuries experienced sensory disturbances during the incongruent task (p < 0.05). A logistic regression analysis revealed that high results of the pain catastrophizing scale and a positive sensory-motor incongruence test at baseline assessment were predictive for the occurrence of new injuries during the prospective part (p < 0.05). Conclusions: Musicians sensitive to sensory-motor incongruence and demonstrating pain catastrophizing are at increased risk for developing injuries. 1. Lederman R, Muscle Nerve 2003, 27:549-561 2. McCabe CS et al, Rheumatology 2005;44:509-516. 3. McCabe CS et al, Rheumatology 2007;46:1587-1592.

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Table 1 Linear regression models1) for explaining the variance in ability to stabilize the lumbo-pelvic region during movement control tests Model equations2) Female personnel

Male personnel

R2 Motor control

¼

Motor control

¼

Motor control

¼

Motor control

¼

Keywords: pain, musicians, sensory-motor incongruences, injuries [IAP11] Prediction of the ability to stabilize the lumbo-pelvic region from physical performance tests B. Aasa 1, U. Aasa 2. 1 Norrlandskliniken, Sweden; 2 University of Umeå, Sweden The aim of the study was to evaluate the ability of female and male ambulance personnel to maintain their lumbo-pelvic region in a neutral position during movement control tests and to investigate whether physical performance and/or low back pain could explain the variance in movement control. The study was conducted at two ambulance stations and 62 of 89 personnel volunteered (22 women and 40 men). The design was a cross-sectional single-blinded study, i.e., the physiotherapist did not know how the subjects performed in the physical performance tests or if they reported back-pain. The physical capacity tests were ‘‘ability to carry weights up and down three flights of stairs’’ (outcome: heart rate [time >70% of estimated HRmax]), cardio-respiratory capacity (VO2max), isometric lifting strength (N), hand-grip strength (kg) and isometric endurance of the back muscles (s). For movement control, we used the tests ‘‘standing bow’’ and sitting bilateral knee extension to assess flexion control, supine double leg lower and prone knee flexion for extension control and sitting unilateral knee extension, prone knee flexion and prone hip rotation for rotation control. Each test scored one point (total range 0-10 points). The male personnel performed significantly higher in VO2max, lifting strength, hand grip strength and developed less fatigue during carrying weights compared to the female personnel. Significantly more female than male personnel controlled flexion and rotation. Explained variances of movement control in the linear regression (forward stepwise) analyses are presented in table 1. In conclusion, VO2max, isometric back endurance and carrying weights could significantly explain the variance in ability to stabilize the lumbo-pelvic region among the male but not among the female personnel. Since low back pain could explain the faulty movements to a high extent, especially among the women, it might be favourable to add motor control training to their traditional core strength training. Keywords: movement control, low back, physical performance tests, Ambulance personnel

1

3)

4.511 + 0.883 * VO2max (l x min ) -0.013 * Isometric back endurance + 0.013 * Heart rate (time [s] >70% of estimated HRmax) during carrying a loaded stretcher 7.405 + 0.060 * VO2max (l x min1) -0.005 * Isometric back endurance + 0.002 * Heart rate (time [s] >70% of estimated HRmax) during carrying a loaded stretcher – 3.855 * Activity limitation during the past 12 months due to low back pain

0.20

-5.743 + 1.934 * VO2max (l x min1) -0.013 * Isometric back endurance + 0.026 * Heart rate (time [s] >70% of estimated HRmax) during carrying a loaded stretcher -5.082 + 1.862 * VO2max (l x min1) -0.011 * Isometric back endurance + 0.025 * Heart rate (time [s] >70% of estimated HRmax) during carrying a loaded stretcher – 0.964 * Activity limitation during the past 12 months due to low back pain

0.36

0.63

0.38

1)

According to the regression formula: Y ¼ a + bX1 + cX2 + dX3 Among the male personnel, all predictors in the models were significant. Among the female personnel, only the variable ‘‘activity limitation during the past 12 months due to low back pain’’ was significant. 3) The squared correlation coefficient, adjusted for differences in variance between variables. 2)

[IAP12] Changes in mechanosensitivity due to lumbopelvic and ankle positioning G.M. Homstøl, B.O. Homstøl. NHP-Neuromucsuloskeletal Health & Performance, Norway Neurodynamic Release (NDR) is a new and innovative approach which explores the influence of mechanosensitivity to movement on neuromusculoskeletal health and performance. A reduction in mechanosensitivity has been found to significantly decrease pain and disability in patients with chronic neck and back pain and reduce symptom response and risk of re-injury, as well as enhance performance in athletes. The site of mechanosensitivity (stretch sensation) on movement testing directs treatment. The aim of this pilot study was hence to investigate the change in site(s) when altering the lumbopelvic and ankle position in the NDR movement test called Sitting Single Knee Extension. A convenience sample of 15 semi-professional male footballer players from a Norwegian 2nd division team was recruited. The players age ranged from 17-31 years (mean 23,9 years), height 173-193 cm (mean 182,7 cm) and weight 70-91 kg (mean 78,3 kg). They had a history of various neuromusculoskeletal complaints, but no current pain or pathology in the lower quadrant including the lumbopelvic region. The movement test was performed 4 times on each leg with different combinations (Table 1) to full knee extension. The data was analysed based on number of positive tests (stretch sensation present) and number of body regions the site(s) was present. Changes due to position was analyzed based on category of response compared to the original movement test; no change in body region, increase or decrease in body regions and change of body region (original site(s) resolved, but new site(s) present). Compared to the original test procedure there were only minor changes to the number of positive tests when sitting with the lumbopelvic region (0%) or ankle (8%) relaxed, from which only 14% and 4% changed site of mechanosensitivity. When a relaxed lumbopelvic and ankle position was combined it was the position of least positive tests.

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Interactive Poster Abstracts / Manual Therapy 14 (2009) S32–S36

Table 1: Test results

Ankle Dorsiflexed

Ankle relaxed Positive tests: 27/30

Lumbopelvic Neutral

Original test procedure

No change: 17

Positive tests: 29/30

Increased: 2 Decreased: 7 Change: 1

Positive tests: 29/30

Lumbopelvic Relaxed

Positive tests: 18/30

No change: 18

No change: 10

Increased: 3

Increased: 3

Decreased: 4

Decreased: 3

Change: 4

Change: 2

Keywords: Neurodynamic Release, Mechanosensitivity to movement, Movement sequencing, Athletes [IAP13] Relationships between disability, catastrophizing and pain thresholds in whiplash injury: A longitudinal analysis K. Rivest 1, 2, J.P. Dumas 3, S.J. De Serres 1, J.N. Coˆte´ 1, 2. 1 Jewish Rehabilitation Hospital Research Center, Canada; 2 McGill University, Canada; 3 Sherbrooke University, Canada Introduction: Recent work shows that movement dysfunction in whiplashassociated disorders (WAD) may be associated with sensory deficits. Mechanisms of sensory hypersensitivity are not well understood and may be associated with psychological features. However, it is unclear how these relationships evolve as chronicity develops. We examined relationships between disability, catastrophizing and pain thresholds in subjects with WAD over a one year period. Methods: Individuals who sustained a whiplash injury grade I-III following a motor vehicle accident were examined within one month (visit 1) and at 3 and 6 months and 1 year post-injury (visits 2 to 4). Scores on the Neck Disability Index (NDI) and Pain Catastrophizing Scale (PCS) were taken at each visit. Sensory dysfunction was assessed using a thermo testing apparatus measuring cervical spine cold pain threshold (CPT), and a pressure algometer measuring cervical (PPTcx) and distal (PPTdist) pressure pain thresholds. Results: At the first visit (n ¼ 40), both CPT (r ¼ 0.52) and PPTcx (r ¼ -0.38) were correlated with NDI but PPTdistal (r ¼ -0.06) was not. There was a low correlation between PCS and CPT (r ¼ 0.45) but no relationships between PCS and PPT (cervical, r ¼ -0.18, and distal, r ¼ -0.01). At visit 2 (n ¼ 32), similar relationships were found between CPT and PCS (r ¼ 0.43) and between CPT and NDI (r ¼ 0.45). At visits 3 and 4 (n ¼ 26 and 22, respectively), these correlations became very low and non significant. Mean NDI scores were 33 at visit 1 (moderate / severe disability), and 21, 16 and 13 at visits 2 to 4 (mild disability). Discussion: Individuals with higher neck disability and catastrophic thinking presented with hypersensitivity to cold in the acute phase. Although these relationships were still present 3-month post-injury, they seem to decrease over time. This may be explained by the average decrease in disability, although other factors may play parts in the persistence of symptoms. Keywords: whiplash, sensory dysfunction, catastrophizing, longitudinal

[IAP14] ‘‘Patient-centred care’’; It’s meaning for musculoskeletal physiotherapists and patients with low back pain – the physiotherapists perspective M.T. Sexton 1, A.P. Moore 2, C.M. Ramage 2. 1 University of Hertfordshire, United Kingdom; 2 University of Brighton, United Kingdom Introduction: Patient-centred care has become synonymous with highquality health care. Whilst the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based or how to measure it (Epstein et al., 2005). Within physiotherapy, there is some evidence that that the therapeutic relationship influences patient satisfaction (Grimmer et al, 1999) and treatment outcomes (Arnetz et al., 2004; Klaber Moffett and Richardson, 1997), however there has been minimal discussion of the concept. The aim of this research was to construct a theory of patient-centred care in musculoskeletal physiotherapy based on a Grounded Theory approach. Methods: Purposive sampling was initially used to select participants. Subsequently theoretical sampling was adopted whereby analysis of the data informed the sample selection. Individual semi-structured interviews were carried out. These were audio taped and then transcribed verbatim. Analysis involved a process of coding and categorisation of the data. This occurred simultaneously with data collection allowing the flexibility to change focus and pursue leads revealed by the ongoing analysis. Results: Analysis of the data revealed a number of key themes including individualised care, a psychosocial approach, the provision of information and the development of a therapeutic relationship. All dimensions were perceived to be adversely affected by the constraints of the modern healthcare system. Discussion: Individualised care was identified as the most important component of patient-centred care with the development of a therapeutic relationship key to optimising outcomes. The adoption of a psychosocial approach was considered as central to this process; however therapists felt ill-prepared for addressing these factors. Patient expectations were identified as an important area to address in the ultimate goal of selfmanagement. Time pressures impacted significantly on the therapist’s ability to individualise their care. The next stage in the study will be an exploration of the patient’s perspective. Keywords: Patient-centred care, Musculoskeletal physiotherapy, Low back pain

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Poster Abstracts / Manual Therapy 14 (2009) S40–S52

[P01] A preliminary investigation into the comparison of cervical range of motion between self stretching and sustained natural apophyseal glides by manual therapist in an asymptomatic population A. Yoshikawa 1, 2, R. Yanagihashi 1, T. Fujiwara 1, 2, K. Abe 2. Institute of Health Sciences, Japan; 2 ShinShu University, Japan

1

Koriyama

Introduction: Physiotherapist applies spinal manipulative therapy techniques in the clinical practice for the management of neuromusculoskeletal pain and dysfunction frequently. There is increasing number of reports encouraging clinical effects of The Mulligan’s mobilization with movement treatment techniques. However, their fundamental mechanism is not fully understood. This investigation aimed to compare the effect of the Mulligan’s sustained natural apophyseal glide (SNAGs) technique to the C5/6 intervertebral joint (with cervical flexion) and self stretching of cervical flexion in an asymptomatic population. Methods: Sixteen asymptomatic subjects, fifteen male and one female, aged from 21 to 32 (mean; 26 years), participated in a laboratory-based experiment. The research design was repeated measures design which is consisted of control (three times measurements), self stretching (self stretch five times), and the five times SNAG treatment comparisons. The measurement session was divided into two days, the control and self stretching, and the treatment. Cervical flexion angle from natural sitting position and the pressure force of the right thumb for the C5 spinous process by the expert therapist were used as indicator of the comparison between self exercise and the SNAGs treatment. Results: The mean manipulating force applied to the C5 in the SNAGs was 9.1 N (SD  2.9). The mean neck flexion angle in the sixteen subjects showed 58.6 degree (SD  10.6) at the control measurement, 61.3 degree (SD  11) at the self stretching, and 68.0 degree (SD  10.7) at the SNAGs. There were statistically significant improvements of the neck flexion between the control and the SNAGs. Discussion: The result showed the SNAG technique had more effective to improving range of motion than self exercise under the same number of trial because the accessory movement of the joint, which can be changed by manipulative intervention, might not be improved by self stretching. Keywords: manual therapy, cervical spine, mobilization with movement, joint kinematics [P02] Evaluation of ankylosing spondylitis spinal mobility using an optical motion capture system

J.L. Garrido-Castro 1, R. Medina-Carnicer 1, E. Collantes 2, A.M. Galisteo 1, C. Gonzalez-Navas 2, D. Ruiz-Vilchez 2. 1 Cordoba University, Spain; 2 University Hospital Reina Sofia, Spain Background: Assessment of spinal mobility is fundamental for the evolution and response to the treatment of ankylosing spondyltis (AS). AS produce a reduction of mobility that must be measured. BASMI index, which includes five different measurements, is the recommended instrument by ASAS nevertheless it is slightly sensitive to the determination of small changes in the measures. Motion capture is an emerging technology used to analyze the human movement and is a promising tool for an objective quantification of disease activity in the spine of AS patients. Objectives: To validate the use of an optical motion capture system for analyzing spinal mobility in patients with AS comparing the results obtained with conventional metrology measurements, radiology and self administered questionnaires. Methods: 33 AS patients and 20 healthy subjects (control group) where measured using conventional metrology by two different rheumatologists and by a motion analysis system, the SOMCAM3D [1], in three different occasions: two in the same day and another one two weeks before. Results: Measurements obtained by the system had higher reliability. ICC for conventional metrologies varies from 0.66 (Schober) to 0.96 (tragus-to-wall distance). Motion Analysis ICC’s varies from 0.91 (Schober) to 0.99 (Finger to floor distance). All similar measurements obtained by the motion analysis had higher reliability than the conventional ones. New measurements had been defined with high ICC and correlation values. In the two weeks retest reliability ICC was also excellent (0.96 to 0.99). Measurements had greater correlation with radiological parameters and with health questionnaires (ASQOL, BASFI, BASDAI). Conclusion: The system provides an accurate and practical method for measuring the reduction of ROM in AS. We are starting to use it on the evaluation of response to the biological treatments and effectiveness of rehabilitation programs. Reference 1. Castro J.L.G. et al. Design and evaluation of a new three-dimensional motion capture system based on video. Gait & Posture 24 (2006) 126–129. Keywords: motion capture, ankylosing spondylitis, spinal mobility, kinematics

Poster Abstracts / Manual Therapy 14 (2009) S40–S52

[P03] Associations between movement control tests and acuity of goaldirected arm movements to visible and invisible targets in patients with persistent neck-shoulder pain B. Aasa 1, M. Djupsjo¨backa 3, T. Rudolfsson 2, 3, U. Aasa 2. 1 Norrlandskliniken, ¨vle, Sweden Sweden; 2 University of Umeå, Sweden; 3 University of Ga The ability to position the scapula is essential for an optimal arm function and inappropriate control of the scapular positioning has been linked to neck-shoulder disorders. Further, the cervical muscle activation patterns might influence on the chronicity of neck-shoulder disorders. The present study compared the outcomes of five movement control tests and a pointing task for the right arm between 17 patients with persistent neckshoulder pain and 17 age- and gender matched healthy controls. The study was designed as a single-blinded, controlled and comparative group study. The movement control tests included ‘‘Head rotation’’ (can subject prevent chin poke/sidebending), ‘‘Cervical extension’’ (prevent forward translation), ‘‘Slow and fast arm medial rotation’’ (prevent forward tilt of the scapula and anterior translation/gleno-humeral medial rotation) and ‘‘Inner range hold of scapular protraction and upward rotation’’. The pointing task included pointing to a target 15 times in 3 separate conditions; horizontal adduction with vision, horizontal abduction with vision and horizontal abduction while the light was switched off during the movement. The starting position was always at waist height with the arm resting in front of the subject. The outcome was end-point variability in 3 dimensions (volume of a 95% CI ellipsoid). The results demonstrated a significant difference between patients and controls regarding their ability to control the movements in the movement control tests. There were no differences between groups in end-point variability, when the test was performed in full vision, but in condition 3, when pointing was performed without vision, the subjects with pain had higher end-point variability. In conclusion, an interaction between persistent pain and motor control during movement tests was shown The finding that the patients had reduced end-point precision compared to the controls only while pointing without vision may imply that they used vision to compensate for an impaired proprioceptive control of arm movements. Keywords: neck-shoulder pain, movement control, proprioception, vision [P04] Electrical muscle stimulation training for deep spinal stabilisers results in significant reductions in pain and disability scores in patients with chronic low back pain S. Coghlan, L. Crowe, U. McCarthyPersson, B. Caulfield. University College Dublin, Ireland The objective of this study was to investigate the effects of a deep spinal electrical muscle stimulation (EMS) programme on measures of pain & disability in a group of subjects with chronic low back pain. A randomised controlled pilot study was carried out with an EMS group (n ¼ 13) and a TENS group (n ¼ 9), both consisting of men and women with a chronic (> 3month) history of lower lumbar somatic back pain. The EMS group received a six week home treatment programme of EMS targeting the deep spinal and abdominal muscles whilst the TENS group underwent a programme of standard TENS treatment targeting sensory nerves over the same time period. Pain and disability levels were evaluated at baseline and follow up using the Visual Analogue Score (VAS) and Roland Disability Questionnaire (RDQ) respectively. Paired t-tests were used to compare within group means whereas independent t-tests were used to compare between groups. Results are outlined in Table 1. Significant improvements were noted in the treatment and control group following the intervention period with both showing improvements in pain and disability measures. There was a definite trend towards a larger improvement in RDQ scores in the EMS group though this did not reach the level of significance due to small subject numbers. The results of this pilot study suggest that the use of EMS training for deep spinal stabilisers is effective in improving pain and disability measures in subjects with chronic somatic low back pain. There is now a need to carry out further studies with larger numbers of subjects to confirm these findings and to

Pain - VAS Treatment group (EMS) Control group (TENS) Between group comparison (LoS) Disability - RDQ Treatment group (EMS) Control group (TENS) Between group comparison (LoS)

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Baseline

Follow up

Within group comparison (LoS)

Change

4.6 (1.0) 4.6 (1.4) 0.96

1.9 (1.3) 2.5 (1.1) 0.21

0.0001

2.7 (1.6) 2.0 (1.2) 0.27

6.7 (2.5) 8.4 (4.3) 0.28

1.6 (1.2) 4.5 (2.9) 0.01

0.001 -

0.00006 0.002 -

5.1 (2.8) 3.9 (2.7) 0.37

Table 1. Pain and disability at baseline and follow up including change for treatment and control groups (values are mean (SD)). LoS ¼ Level of Significance

investigate the concurrent training effects on spinal and abdominal muscle function. Keywords: electrical muscle stimulation, low back pain

[P05] The reliability and validity of a clinical test of passive inter-segmental lumbar flexion? C.M. Davies 1, C. McCarthy 2, J. McCluskey 3, B.J. Introwicz 1, A.D. Pandyan 1. 1 Keele University, UK; 2 St Mary’s Hospital London, UK; 3 Private Practitioner, MACP, UK Background: The Passive physiological intervertebral movement test (PPIVM) is used by Manual Therapists as part of their clinical examination when screening for spinal dysfunction. The intra-tester reliability for this examination procedure has previously been judged as fair and inter-tester poor. However, the validity of this test has not been investigated. Aim: A study to investigate inter-tester reliability and validity of lumbar flexion PPIVM for intersegmental levels of L4/5 and L5/S1 Method: A convenience sample of asymptomatic subjects. Two expert manual therapy assessors graded L4/5 and L5/S1 PPIVM tests once on each subject in a random order. Grading was noted as hypomobile, normal or hypermobile. Agreement between assessors was analysed using the Cohen’s Kappa coefficient. Separation of spinous processes at L4/L5 and L5/ S1 was measured as an angle using a geometrical method involving a flexicurve. An ANOVA was used to analyse if grades of the PPIVM test systematically varied with the flexicurve angle. The modified Scho¨ber’s test was conducted before and after all measurements, for control purposes. Results: Thirty nine adults (34 female, 5 male) mean age 21 years (range 18 – 34 years) were recruited. Inter-tester reliability was poor (k ¼ 0.03; SE ¼ 0.113 for L4/5 and k ¼ 0.016; SE ¼ 0.112 for L5/S1). Those classified as having hypo-mobility had a smaller separation than those with normal mobility or hyper-mobility at L4/5 (p < 0.05) for each individual assessor, a similar trend was not seen at L5/S1. The mean difference between the pre and post modified Scho¨ber’s test was 0.16 cm (SE ¼ 0.039). Conclusion: This study suggests that the lumbar flexion PPIVM test has poor inter-tester reliability and very limited validity when used as an outcome measure of spinal dysfunction. Future work should look at whether reliability improves if the test is investigated as an examination procedure to assist with treatment selection. Keywords: PPIVM, Reliability, Validity

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Poster Abstracts / Manual Therapy 14 (2009) S40–S52

[P06] A pilot study: Effectiveness of a lateral glide cervical spine mobilisation on Cervicobrachial (neck and arm) pain E.J. Salt 1, 2, S.M. Kelly 2, C.C. Wright 2. 1 Burton Hospital NHS Foundation Trust, UK; 2 The University of Birmingham, UK Introduction: There is some evidence to support effectiveness of the lateral glide technique for the treatment of patients with cervicobrachial pain, but no substantive studies have been completed in this area. This pilot study was planned to refine a protocol and provide data for a power calculation for a proposed RCT. Methods: The pilot was a randomised controlled study, with participants randomised to receive either a self-management programme (control group) or a self-management programme with the addition of a lateral glide technique to C5/6 (intervention group). Participants in both groups received up to six weekly sessions. Participants were aged 28-80 years, with neck pain radiating to one arm in a dermatological distribution. The assessor was blinded to group allocation; however it was not possible to blind therapists or participants. The primary outcome measures were Visual Analogue Scales (VAS) for average and for worst pain. Secondary outcome measures were the Global Rating of Change, Neck and Upper Limb Index and Short-Form 36. Outcomes were assessed at baseline and at 6 weeks. Results: Eighteen participants were recruited, with 8 randomised to receive the lateral glide treatment. There was an 83% follow up at 6 weeks. Although no statistically significant difference was identified between the groups, there was a weak indication of greater improvement for the intervention group for worst pain (p ¼ 0.15), function (p ¼ 0.77) and general health (p ¼ 0.70). No clinically important changes were identified. Discussion: The pilot study supports clinical feasibility of the protocol for use in the proposed RCT and provides data for a power calculation. The Tampa scale of kinesiophobia, the Self complete leeds assessment of neuropathic symptoms and signs, the upper limb nerve extensibility test and measurement of cervical range of movement will be included in the proposed trial to cover the WHO dimensions of functioning, disability and health. Keywords: cervicobrachial, pain, lateral glide technique, self-management

[P07] The movement dysfunction concept in the disablement model as a basis for contemporary clinical reasoning in chronic pain patients E.J. Thoomes, M. Schmitt. SOMT, Netherlands Introduction: Contemporary clinical reasoning has seen a paradigm shift from a biomedical to a biopsychosocial viewpoint. Many colleagues claim they act in accordance with it, but that is not always the case. Using the disablement model1,2 as a starting point for assessment and treatment might be more in line with current Quality of Life outcome measures for treatment. Methods: We have become increasingly aware that there is a poor correlation between pathology and functional limitations. This is even more evident in the clinical reasoning process for chronic complaints. Where there might be a correlation between pathology and impairments in acute pain, this is not often present in the chronic pain patient. In the Disablement process, the therapist, together with the patient, first defines which functions and activities in the Activities of Daily Life (ADL) are limited. These can be evaluated by using valid and reliable questionnaires, giving the opportunity to re-assess patients in an objective way. It is the expertise of the therapist to then assess which components of the functional limitations need to be addressed and which movement dysfunction(s) might underpin them. Results: The Rehabilitation Problem-Solving Form (RPS-Form)3 allows health care professionals to analyze patient problems, to focus on specific targets, and to relate the salient disabilities to relevant and modifiable variables. It was designed to address the patients’ perspectives and enhance their participation in the decision-making process, being based on the International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability4. It could provide a common

language for the description of human functioning and therefore facilitate multidisciplinary responsibility and coordination of interventions. Discussion: The use of the RPS-Form in clinical practice is demonstrated by presenting a movement dysfunction assessment of a patient with chronic low back pain, and the ensuing proposed treatment strategies and modalities. References 1. Escalante A, Del Rinco´n I. The disablement process in rheumatoid arthritis. Arthritis Rheum. 2002 Jun 15;47(3):333-42. 2. Denegar CR, Vela LI, Evans TA. Evidence-based sports medicine: outcomes instruments for active populations. Clin Sports Med. 2008 Jul;27(3):339-51, vii. 3. Steiner WA, Ryser L, Huber E, Uebelhart D, Aeschlimann A, Stucki G.Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Phys Ther. 2002 Nov;82(11):1098-107. 4. Finger ME, Cieza A, Stoll J, Stucki G, Huber EO. Identification of intervention categories for physical therapy, based on the international classification of functioning, disability and health: a Delphi exercise. Phys Ther. 2006 Sep;86(9):1203-20. Keywords: Clinical Reasoning, ICF, Chronic Pain, Movement Dysfunction [P08] Effects of proprioceptive exercises on posterior pelvic tilt strength and proprioception level in chronic low back pain G. Coskun, F. Can. Hacettepe University, Turkey This study was performed to investigate the effects of proprioceptive exercises on proprioception and posterior pelvic tilt strength in patients of chronic low back pain. Thirty patients with low back pain were included in the study. Patients were randomly divided into two groups; Group 1 underwent stabilization exercises and group 2 underwent stabilization plus proprioceptive exercises. All subjects were evaluated for pain intensity (visual analog scale), active and passive proprioceptive sensation (Biodex System Pro 3 Izokinetic System), posterior pelvic tilt strength (The Stabilizer Pressure Biofeedback Unit). Treatment program for the both groups was 3 days per week for 6 weeks. Stabilization and stabilization plus proprioception groups were assessed before and after the treatment In both Group 1 and group 2 there was significant pain relief in resting and activity (p < 0.01). In both groups pelvic tilt muscle strength improved significantly after the treatment as compared to pre-treatment (p < 0.05). Pelvic tilt strength was better in Group 1 than Group 2 but significant differences were not found. Passive extension, active extension, active flexion proprioception values improved significantly in group 2. In conclusion, both stabilization exercises and proprioception plus stabilization exercises have been found that they have beneficial effects on pain relief, pelvic tilt strength and proprioception, but proprioception exercises are needed to insert to the exercises program to be included in more benefits in proprioception. Inclusion of proprioceptive exercises has more effect on proprioception in patients with chronic low back pain. This benefit may decrease the risk of new injuries in lumbar region and to increase body awareness and trunk control of individuals with chronic low back pain. Keywords: Low back pain, trunk muscle strength, lumbar region. [P09] The influence of neurodynamic release on self perceived lumbopelvic movement control: An explorative pilot study G.M. Homstøl, B.O. Homstøl. NHP-Neuromusculoskeletal Health & Performance, Norway Neurodynamic Release (NDR) is a new and innovative approach which explores the influence of mechanosensitivity to movement on neuromusculoskeletal health and performance. To date, NDR has demonstrated clinical significant results on pain, disability and quality of life in patients with chronic non-traumatic neck or back pain and found to positively influence symptom response, risk of re-injury and performance in athletes. However, no study has investigated the onset of mechanosensitivity to the onset of self perceived lumbopelvic movement control and if NDR can change it.

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A convenience sample of 15 semi-professional male football players from a Norwegian 2nd division team participated in the explorative pilot study. The players age ranged from 17-31 years (mean 23,9 years), height 173193 cm (mean 182,7 cm) and weight 70-91 kg (mean 78,3 kg). They had a history of various neuromusculoskeletal complaints, but no current pain or pathology in the lower quadrant including the lumbopelvic region. During the NDR movement test called Sitting Single Knee Extension with the lumbo-pelvic region in neutral and ankle dorsiflexed, the onset of mechanosensitivity (stretch sensation) and loss of lumbopelvic neutral (self-perceived) was registered pre- and post a session of NDR treatment (10 minutes on each leg). The data was analysed based on category of response (Table 1) to full knee extension.

Table 1: Responses to NDR movement test

Pre- Treatment

Post- Treatment

No loss of LPN, No mechanosensitivity No loss of LPN, Mechanosensitivity Loss of LPN, No mechanosensitivity Loss of LPN, Mechanosensitivity prior to loss Loss of LPN, Mechanosensitivity at same time Loss of LPN, Mechanosensitivity after loss

3/30

13/30

0/30

0/30

2/30

3/30

3/30

2/30

19/30

8/30

3/30

4/30

LPN ¼ LumboPelvic Neutral The results indicate that NDR treatment can enhance self perceived lumbopelvic movement control. The research questions will be followed up with a randomized controlled trial in young athletes. Keywords: Neurodynamic Release, Mechanosensitivity to movement, Movement control, Athletes [P10] The analysis of neck-back muscular fatigue due to prolonged musculoskeletal load from casual computer work in different sitting postures W.H. Cho, W.Y. Lee, H. Choi. Sungkyunkwan University, Korea Recent rapid computerization of industry and business forced office workers to be seated at visual display terminals (VDTs) for a long time. Consequently, the number of people suffering from chronic fatigue in the neck-back region is increasing due to the continuous computer work. In the previous studies dealing with the muscle fatigue of office workers, the characteristics of trapezius fatigue due to VDT work have been described. However, it still remains unclear why and how serious chronic muscle fatigue is induced. In this study, a series of experiments was conducted to investigate the effects of the prolonged musculoskeletal loads on muscular fatigue and muscle activity of neck-back muscles. Six subjects (males) participated and performed the prolonged casual computer work. EMG signals from six muscles of the dominant neck-back regions were acquired and recorded by using a computerized data recording and analysis system. Power spectrum function of EMG was calculated off-line by means of a signal processing software package. Power spectrum functions were smoothed with a moving average filter of 21 points and normalized with respect to the maximal value achieved during the trials. Muscle activity and median frequencies of Sternocleidomastoid (SCM) in turtle neck posture was approximately 51%, which were less than those in normal neck posture. SCM also showed the biggest decrease in median frequency. The results from this study provide the insight into the neck-back injury mechanism of turtle neck patients. Furthermore, they will be helpful in developing rehabilitation programs for restoring patients’ neck-back functions.

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Keywords: muscular fatigue, EMG, computer work, musculoskeletal load [P11] Reliability and effects of chronic pain and movement repetition on shoulder functional outcome measures J.N. Coˆte´ 1, 2. K.V. Lomond 1, 2, Rehabilitation Hospital, Canada

1

McGill University, Canada;

2

Jewish

Introduction: Return to work (RTW) is a priority of occupational health professionals. One primary determinant of RTW is the degree of functional limitation; thus, the ability to reliably assess workers’ functional capacity is essential. Our objective was to compare shoulder functional outcomes between healthy individuals and others with neck/shoulder pain, assess reliability and examine the influence of repetitive movements on shoulder functional measures. Methods: Sixteen participants with neck/shoulder pain (intensity  3/10 for > 3 months) and an age and sex-matched control group performed flexion and abduction active range of motion (ROM), and cumulative power output (PO) in a pushing/pulling task using the Baltimore Therapeutic Equipment Simulator II (Sim-II) in two consecutive sessions. In session 1, tasks were assessed before and after subjects performed a repetitive arm task until scoring 8 out of 10 on either the Borg CR10 scale or on a 10-point numeric rating scale (NRS). Heart rate (HR) was also recorded. Results: ANOVA Group x session analyses revealed a significant interaction effect for abduction with higher ROM in session 2 in the pain group, while significant group main effects indicated higher abduction and flexion ROM in the control group. Analyses of between-session reliability showed that intra-class correlation coefficients were > 0.85 for all functional measures in both groups, except the pain group’s PO (0.53). Repetitive task duration was significantly shorter in the pain group (4 min vs 7 min). Following repetitive movements, significant group x time interactions for Borg and NRS scores indicated larger increases in the control group. Significant main time effects demonstrated increased HR and lower PO after the repetitive task. Discussion: The protocol effectively detected both pain- and time-related impairments, whereby HR and PO were sensitive to movement duration and ROM to pain. This knowledge can be implemented in designing effective RTW and workplace assessments. Keywords: chronic neck/shoulder pain, functional capacity evaluation, reliability, repetitive movements [P12] The effect of balance training on sensorimotor function in young physical therapy students - a RCT ¨ r Physiotherapie in Gru ¨ nstadt, Germany K. Beinert. Schule fu Background: Sensorimotor impairments have gained interest in musculoskeletal research. People with neck pain show disturbed postural stability and impaired joint position sense. Research has shown that influencing neck muscles and neck receptors alter postural stability. Whether postural stability can alter cervical joint position sense is not published. Design: Randomized controlled trial with unblinded treatment and blinded outcome assessment. 37 subjects, treatment for 5 weeks, with a follow up of 6 weeks 12 weeks and 3 months. Objective: To determine, whether postural stability training can improve cervical kinaesthesia in young people with mild, subclinical neck pain against a control group. Method: The intervention group participated in a individual postural stability training. Single leg stance, tandem stance and stance on a wobble board were progressed with closed eyes and head movements. A session took 15 min, one exercise 5 minutes. We trained 3 times a week. Results: Both groups improved. Absolute error to 30 Ext relocation improved statistically significant with p ¼ 0,014 in the intervention group. Absolute error for rotation was with 0,088 statistically not significant, perhaps due to the small sample size. Regression analysis showed improved postural stability in the treatment group compared to the control group in subjects, who had impaired postural stability.

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Poster Abstracts / Manual Therapy 14 (2009) S40–S52

Conclusion: Postural stability training might contribute to a better joint position sense. Further research is necessary to determine the effect of postural stability training in symptomatic subjects. Keywords: Cervical kinaesthesia, Postural stability, RCT [P13] Does age affect star excursion balance test scores over the course of one year? R.J. Butler 1, K.B. Kiesel 1, P. Gorman 2, P.J. Plisky 2. 1 University of Evansville, USA; 2 ProRehab PC, USA Introduction: With the increasing incidence of injuries in youth athletics, sports medicine practitioners are beginning to exam ways to systematically screen athletes for injury risk in order to provide appropriate training. One screening tool that has been developed is the Star Excursion Balance Test (SEBT). The SEBT measures an individual’s dynamic balance by assessing unilateral lower extremity reach in three different directions. Previous research on the SEBT has indicated that an asymmetrical anterior reach and the composite reach distance normalized to limb length are predictive of lower extremity injury. However, no studies have examined whether the SEBT scores change over the course of the year and whether age effects the change in scores. Methods: One hundred and fifty-six high school (13-17 yo) and college (age 18-20 yo) athletes were assessed for dynamic balance using the Y Balance Test Protocol at baseline and one year later. In order to assess changes in the reach scores, a repeated measures ANOVA, using age as the between subjects factor and time as the repeated factor, was utilized. The variables of interest were left and right limb differences, normalized reach distance, and normalized composite reach score. Results: There was a significant interaction for age and time for the difference in posterior lateral reach direction (p < 0.02). There was a significant main effect for age for the difference in the anterior reach direction score (p < 0.04). No significant interactions or main effects were observed for the normalized composite reach score for the left and right legs. Discussion: The results of this study suggest that the change in Y Balance Test score over the course of the year may be effected by age of the participants. Further research studies should establish normative data for different ages of the population. Keywords: injury prediction, maturation, score stability, injury risk [P14] Fundamental movement dysfunction as measured by the functional movement screen shifts the probability of predicting a musculoskeletal injury in firefighters

2

K.B. Kiesel 1, 2, P.J. Plisky 2, R.J. Bulter 1. ProRehab-PC, USA

1

University of Evansville, USA;

Introduction: Firefighters face many occupational risks including musculoskeletal injury. Injury rates of firefighters are among the highest in all occupations. Previous research has demonstrated that improving flexibility did not decrease injury incidence, but did reduce time-loss and severity of injury. Firefighters perform unpredictable awkward movements making standardized flexibility and ergonomic programs limited in utility for this population. Sports medicine professionals have begun to utilize fundamental movement testing and training programs. Because of the nature of firefighting, and the need for firefighters to stay fit as they age, a more comprehensive movement oriented testing and training program may be beneficial. A study on firefighters demonstrated that those who have been injured scored lower on a standardized functional movement test than those who have not been injured. The purpose of this study was to examine the relationship between firefighters’ scores on a fundamental movement screen, the Functional Movement ScreenÔ (FMS) and the likelihood of a time-loss injury over the course of a 16-week training academy.

Methods: A retrospective analysis was conducted examining the relationship between a subject’s composite FMS score (0-21) and their likelihood of injury. Results: A score of 13 was calculated as the cut point at which the FMS is considered positive to rule in an injury. This is the point which maximized specificity (0.82) and sensitivity (0.60). The OR was 7.1 (CI95 1.7-29.5), the LR+ was 3.5; (CI95 1.4-6.3), and the LR- was 0.48 (CI95 0.21-0.85). Based on a pre-test probability 0.27, the post-test probability was 0.56. Discussion Data revealed that firefighters with a score of 13 on the FMSÔ shifted the probability of sustaining an injury over the course of a training academy. These results should be considered as preliminary and should only serve to generate a hypothesis to be tested in a prospective study. Keywords: Fundamental Movement Testing, Injury Predication, Firefighters, Musculoskeletal Injury [P15] Pain physiology during exercise is abnormal in chronic fatigue syndrome, but not in chronic low back pain L. Daenen 1, 3, N.A. Roussel 1, M. Meeus 1, 2, S. Truijen 1, J. Nijs 1, 2. 1 Artesis University College Antwerp, Belgium; 2 Vrije Universiteit Brussel, Belgium; 3 University of Antwerp and University Hospital Antwerp, Belgium Introduction: Pain thresholds increase during physical activity in healthy individuals, due to the release of endogen opoids and growth factors1. In contrast, a decrease in pressure pain threshold (PPT) after exercise was found in a pilot study of 6 patients with Chronic Fatigue Syndrome (CFS)2. CFS patients often experience chronic widespread pain with exacerbations of pain after exercise, which could be explained by deficits in central pain mechanisms. Although decreased PPT’s have been found in patients with chronic low back pain (LBP)3, controversy exists about the functioning of central pain mechanisms in these patients. The purpose of the present study is to compare the response of a submaximal exercise challenge on pain threshold in patients with chronic LBP, CFS, and healthy subjects. Methods: Twenty-six CFS patients with chronic widespread pain, 21 chronic non-specific LBP-patients and 31 healthy matched controls volunteered for the study. A power analysis was performed to establish the sample size. All subjects underwent a submaximal exercise protocol on a bicycle ergometer. PPT’s were measured with an algometer at the hand, spine, deltoid and calf before and after exercise. A power analysis was performed to establish the sample size. Repeated measures ANOVA was used to compare the thresholds between groups. Results: At baseline assessment, CFS patients presented significant lower PPT’s compared to healthy subjects and to LBP-patients (p 0.05). Discussion: The results do not demonstrate a consistent pattern of adverse movement or loading in individual patients with chronic non-specific low back pain, suggesting that a directional pattern of aggravating factors might not be an important feature of chronic non-specific low back pain. Reference 1. Dankaerts W, O’Sullivan P, Straker L, Burnett A, Skouen J (2006b) The inter-examiner reliability of a classification method for non-specific chronic low back pain patients with motor control impairment. Manual Therapy 11: 28-39. 2. Delitto A (2005) Research in low back pain: time to stop seeking the elusive ‘‘magic bullet’’. Physical Therapy 85: 206-208. 3. McCarthy CJ, Cairns MC (2005) Why is the recent research regarding non-specific pain so non-specific? Manual Therapy 10: 239-241. 4. McKenzie R, May S (2003) The Lumbar Spine: Mechanical Diagnosis & Therapy. (2 edn). Waikanae: Spinal Publications New Zealand Limited. 5. O’Sullivan PB (2005) Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Manual Therapy 10: 242-255. 6. Sahrmann S (2002) Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, Inc. Keywords: Chronic non-specific low back pain, Classification, Physiotherapy [P21] Internal consistency of the Multidimensional Affect and Pain Survey (MAPS) in neck and back pain

2

O.M. Crummey 1, 3, D.J. Martin 1, K. Rome 2. 1 Teesside University, UK; Auckland University of Technology, New Zealand; 3 St Johns Hospital, UK

Introduction: The MAPS questionnaire uses 101 verbal descriptors of the experience of pain (Clark 1995). The descriptors are grouped into three main dimensions sensory pain, emotional pain and wellbeing, each of which is further subdivided into 30 smaller groupings –17 for sensory pain, eight for emotional pain and five for wellbeing. The aim of the study was to compare the structure of MAPS for neck pain with that for back pain.

Methods: In an observational cohort study, participants were 167 people with neck pain and 167 people with back pain referred for outpatient physiotherapy recruited by convenience sampling over a period of six months. Each received a copy of MAPS by post with a follow up after two weeks if required. For neck pain the return rate was 62%: n ¼ 104 (72 women), mean (1SD) age 51.5 (15.37) years. For back pain there was a 70% return rate: n ¼ 117 (66 women), mean (1SD) age 44.8 (13.43) years. Neck pain and back pain were analysed separately. The internal consistency of the three dimensions was assessed using Chronbach’s alpha and a discriminability index. The discriminability index (Pallant 2005; Field, 2005) for each item was calculated by correlating the item with the total score of the larger grouping: values of 0.35 or above were considered acceptable (Griswold and Clark 2005). Results: Cronbach’s Discriminability alpha index Neck: sensory 0.96 0.56 Neck: emotional 0.96 0.66 Neck: well being 0.93 0.63 Back: sensory 0.95 0.48 Back: emotional 0.95 0.62 Back: well being 0.92 0.59 Conclusion: This is the first analysis of the internal consistency of MAPS for neck pain and for back pain. The results support the basic structure of the questionnaire in both cases. MAPS is supported as a useful tool to investigate the impact of neck and back pain. Keywords: Neck, Back, MAPS, Internal consistency [P22] Condition management program – A biopsychosocial approach of dealing with physical problems of people on incapacity benefit P. Agarwal 1, 2. 1 Chartered Society of Physiotherapists, UK; 2 Manipal University, India Cognitive behavioural therapy (CBT) is a widely researched area and its use in the field of physiotherapy has been reported with positive results This presentation is an introduction to Condition Management Program (CMP) in the Pathways to Work (PtW) initiative. It will highlight the importance of clinical application of recent research in CBT and pain sciences in a specific population - people on incapacity benefit (IB). The Green paper titled ‘‘Pathways to Work – Helping people into employment’’ was issued in November 2002. Pathways to Work is a joint programme led by the Department for Work and Pensions along with the Department of Health in order to enable people with health conditions to move into work and to become independent. CMP is a health rehabilitation program delivered by qualified health care professionals like physiotherapists, occupational therapists, psychologists and others. It is an integral part of PtW project as it offers an added value to the care and treatment of patients of working age with long-term health conditions like rheumatoid arthritis, diabetes, cardiac and respiratory problems and many more. People who stay on IB for longer duration are less likely to go back to work. The main barriers identified for failure to return to work are biomechanical problems leading to faulty movement patterns, chronic pain, fear avoidance and lack of confidence and motivation. Physiotherapists work as case managers in CMP. They use CBT along with exercise programs to help people overcome fear avoidance and chronic pain factors. Three main aims of CMP are education of the client about his condition, reassurance and advice on how to best manage his condition. The main elements of CMP are pain management, individual and group CBT, education about the condition, joint protection techniques, energy conservation methods and exercise programs to name a few. Keywords: Cognitive Behavioural Therapy, Condition Management Program, Chronic Pain, Fear avoidance

Poster Abstracts / Manual Therapy 14 (2009) S40–S52

[P23] Effect of lumbar stabilization exercises as home program in treatment of young women with non specific low back pain P. Agarwa 1, 2. 1 Chartered Society Of Physiotherapists, UK; University, India

2

Manipal

Non specific low back pain (NSLBP) represents approximately 80% of primary care low back pain (LBP) presentations. NSLBP disorders exist where mal-adaptive movement and motor control impairments appear to result in ongoing abnormal tissue loading and mechanically provoked pain. Purpose: To compare the effect of lumbar stabilization exercises along with back care and ergonomic advice over back care and ergonomic advice alone, when given as a home program in young women with NSLBP. Methods: 40 subjects were included in the experimental group by purposive sampling. An age and gender matched control group of 28 subjects was selected. Setting: Outpatient department of physiotherapy, Kasturba Hospital, Manipal, India. Outcome measures: VAS, Oswestry Disability Index, Rolland Morris Disability Questionnaire. Subjects with complaints of LBP were screened for non-specific presentation. A written informed consent was obtained and physical examination of the low back and lower extremity was done to identify specific muscular imbalance. Subjects in the experimental group were given home exercise program which included lumbar stabilization exercises, flexibility training and lower extremity proximal muscle strengthening. Home programme included advice on back care and ergonomics. Subjects in the control group were given advice on back care and ergonomics. Results: The statistical significance was set at 0.05 with 95% confidence interval. The results of Wilcoxon signed rank test for the experimental group as well as for the control group suggested a statistically significant decrease in pain and disability (VAS, ODI and RMQ) at the end of 6 weeks. MannWhitney’s analysis between the groups suggested a statistically significant decrease in pain and disability. There was greater improvement in the experimental group as compared to the control group. Discussion: This significant difference in global improvement suggests that the difference can be attributed to the addition of stabilization exercises to back care and ergonomic advice. Keywords: Non specific low back pain, Stabilization exercise, Home programme, Back care [P24] The effect of performing a passive intervertebral mobilisation (PAIVM) using thumb and pisiform craniovertebral angle and lumbar spine position

accessory grip on

P. J. Coales, H. Fursman, S. Greenwood. Cardiff University, UK The relationship between low back pain, cervical injury and physical handling is established indicating posture plays an important role in spinal loading. In 2005 UK physiotherapy career prevalence rate of musculoskeletal injury was 68% (CSP, 2005) with risk factors including performing manual therapy techniques. Little research has investigated the effects of performing therapeutic techniques on therapists’ posture. The aim was to investigate the effect of performing a Passive Intervertebral Accessory Mobilisation (PAIVM) using thumb and pisiform grip on craniovertebral angle (CVA) and lumbar spine position. A same-subject cross over design used 22 healthy Cardiff University Physiotherapy students (4 males 18 females age 22.3 years þ 3.3). Reflective markers were placed over C7, T12 and L5. A video recorded each participant performing grade III PAIVMs using the thumb and pisiform randomly ordered for 30 seconds over L3. SiliconCOACH measured CVA (angle between horizontal and line drawn between C7 and tragus) and lumbar spine position (angle between vertical and line drawn between L5 and T12). A two tailed related t–test demonstrated significant differences in CVA (p ¼ 0.001) with decreased CVA using the thumb technique, and lumbar spine position (p ¼ 0.001) with increased flexion when using pisiform grip. Findings show the thumb technique produces greater forward head posture and using the pisiform grip results in increased flexion at the

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lumbar spine. Both postures are known to increase spinal loading. Many physiotherapists adapt working position to avoid injury, in this case of the thumb, but need to consider the effects of the adapted position on the cervical and lumbar spine. Due to limitations of sample size and subject experience in PAIVMs further research is required to gain more knowledge of spinal mechanics when performing PAIVMs and other therapeutic techniques in order to better understand tasks which pose increased risk of injury to physiotherapists. Keywords: Physiotherapist, working posture, PAIVM [P25] The effect of carrying a backpack with and without a waist strap on craniovertebral angle P.J. Coales, S. Evans. Cardiff University, UK Backpacks commonly used for carrying loads have been linked to increased forward head position (FHP) shown by decreased craniovertebral angle (CVA). This posture has been shown to increase strain on cervical structures including musculature. The Chartered Society of Physiotherapy (CSP) advises use of backpacks with shoulder straps and a waist strap to reduce this risk. There is a lack of evidence of the effect wearing a waist strap has on the posture of backpack users. The aim was to assess the effect on CVA of using a waist strap Twenty healthy Cardiff University Physiotherapy students (15 females, 5 males, age 22.05  4.5 years) participated in a crossover design. Each subject walked on a treadmill for two five minute periods with and without a waist strap carrying a backpack loaded to 20% bodyweight. A marker was placed on C7 and a video recording taken of the last minute of walking for each condition. Heel strike was marked on the film and SiliconCOACH software recorded the CVA (angle between horizontal and line drawn between C7 and tragus) during the last ten heel strikes and a mean CVA was calculated for each individual during both conditions. A two-tailed related T test demonstrated a significant difference between CVA with and without a waist strap (p ¼ 0.01) showing that wearing a waist strap whilst carrying a backpack significantly increases CVA, so reducing FHP, compared to no waist strap. Wearing a waist strap whilst carrying a backpack does improve head on neck position. This supports previous findings showing postural improvements when using a waist strap. Limitations of the study include the measurement of the CVA only, the small number and age range of subjects. Further research is needed to determine the extent of these limitations and the overall influence of waist strap use on trunk posture. Keywords: backpack, waiststrap, craniovertebral angle

[P26] Comparison of sitting on a gym ball alone versus sitting on a gym ball plus dynamic limb movements for chronic back pain: A 6-month follow-up clinical trial P. Pensri 1, R. Huangchumnong 2, M. Chaikumarn 1. University, Thailand; 2 Sawanpracharak Hospital, Thailand

1

Chulalongkorn

Introduction: Sitting on a gym ball can be beneficial in facilitating spinal stabilizing muscle function and activating proprioception, balance and equilibrium control.1 It may be used for the rehabilitation of patients with low back pain (LBP). However, scientific evidence to support the specific use on this condition is rare. Therefore, we compared the effects of two exercise interventions; a ‘‘sitting on a gym ball alone’’ program (program A) with a ‘‘sitting on a gym ball plus dynamic limb movements’’ program (program B) for the decrease of disability at 6 months in patients with chronic LBP. Methods: Forty subjects were randomly assigned either program A (n ¼ 20) or program B (n ¼ 20) and were asked to perform the prescribed exercise at home for at least 20 minutes per day, 5 days per week for 8 weeks. The primary outcome was change in the score on the RolandMorris Disability Questionnaire at 6 months. Results: All subjects reached 6-month follow-up. At baseline, the medians and interquartile ranges (Q1, Q3) of the disability scores were 3.5 (2, 5) for

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Poster Abstracts / Manual Therapy 14 (2009) S40–S52

the program A group and 5.5 (3, 7.8) for the program B group. The decrease in disability scores were 3 (1,4) and 5 (2.25, 7) at 6 months. When the baseline and the follow-up scores were compared, Wilcoxon signed ranks test demonstrated the statistically significant changes of disability of both groups (p < 0.05). In addition, Mann-Whitney U test showed that subjects in a program B group were more likely to have a greater decrease in disability than those in a program A group (p ¼ 0.049). Discussion: The two spinal stabilizing exercise programs; sitting on a gym ball with and without dynamic limb movements for 8 weeks; were proved to reduce disability in patients with chronic LBP. Evidently, the benefits were maintained at a long-term follow-up. Reference 1. Vera-Garcia FJ, Grenier SG, McGill SM. Abdominal muscle response during curl-ups on both stable and labile surfaces. Phys Ther 2000; 80: 564-69. Keywords: back pain, stabilisation exercise, disability, gym ball [P27] Psychosocial factors predicting functional outcome after total knee replacement: Preliminary results P.A. Roche 1, M.L. van der Linden 1, P.J. Rowe 2, R.W. Nutton 3. 1 Queen Margaret University, UK; 2 Strathclyde University, UK; 3 Royal Infirmary Edinburgh, UK Introduction: Osteoarthritis is the most common cause of disability in older people. In Scotland alone over 3000 people undergo Total Knee Arthroplasty (TKA) each year. Identifying factors that predict functional outcome is an important strategy for optimal rehabilitation following TKA. This ongoing study employs a bio-psychosocial approach and the International Classification of Functional, Disability and Health to examine the degree to which pre-operative scores in three classes of factors, predict post-operative scores of the function component of the (Western Ontario McMaster University Osteoarthritis Index (WOMAC) after TKA. Methods: Sixty patients (mean age 68 +/- 6 years) were assessed on average 38 days prior and 12 months after TKA. Pre-operative measures were grouped in three different domains; the Demographic Domain (D1) included age and Body Mass Index, the Body Function and Structures Domain (D2) included knee range of motion in long sitting, knee extensor moment, Pain VAS and the stiffness component of the WOMAC. The Personal/Psychosocial Domain (D3) included the Tampa scale assessing ‘fear of movement’; a measure of learned helplessness due to pain and the Stanford Arthritis Self-Efficacy Scale. Results: Prior to surgery, high scores of functional disability were positively and significantly associated with scores of pain, stiffness, fear of movement and learned helplessness, and negatively and significantly associated with low scores of self-efficacy (- .459, p > .05). Preliminary results of hierarchical multiple regression analysis indicate that the presurgical scores in D3 contributed significantly to scores of functional outcome 12 months after surgery. Discussion: Preliminary results indicate that pre and post surgical management of patients with end-stage osteoarthritis should include assessment of individual patient’s avoidance of movement, perceived ‘helplessness’ and perceived self-efficacy to function. Each of these factors can respond well to a bio-psychosocial model of rehabilitation for patients with Total Knee Replacement. Keywords: Bio-psychosocial, Prediction, Surgical Outcome, Osteaorhtritis [P28] Devising and adaptation to current development of a new test of balance and coordination for children with motor problems and ability to walk R. Go´mez Sales, A. Go´mez Conesa, M. D. Hidalogo Montesinos. Murcia University, Spain Introduction: Children with motor problems, like cerebral palsy or DCD (developmental coordination disorder), have coordination and balance handicaps. There are currently few reliable tools to assess balance and

coordination in children with motor problems. Furthermore, there are activities that are not well defined for children with typical development related to balance and coordination. Methods: During the development of a new test to measure balance and coordination in children with motor problems, to 5 years or more with walking capacity, the investigation analyze test items whose age of achievement is not sufficiently well documented in the literature of motor development in a sample of healthy children. A threshold of difficulty was placed at level of 75% of correct implementation, in order to make it easy to adapt to children with later motor problems. Results: After a review of scientific literature and consultation with a panel of experts, it was developed a test with 30 situational items related to balance and coordination for children from 5 to 16 years, with motor problems and the ability to walk. Each item has 4 possible levels, ranging from non-performance (1) until the correct (4). Among the 30 items, 19 are scientifically documented in the scope of motor maturity according to age, and the remaining 11 items were set for an investigation with children without motor problems, to determine whether test has the appropriate age difficulty to adapt to motor problem children. An example of one item: 29) to hop with right leg among five rings of 61 centimetres, in a straight line without placing the lift leg in the floor. 103 school-age of southeast of Spain from 5 to 8 years, and with typical development participated in the study. Discussion: Both girls and boys, had the lowest average score in 30 items (hopping with left leg). Children get an average score of 3.5510 and a standard deviation of 0.7377. In the case of girls the mean score is 3.4259 and standard deviation of 0.79151. The ANOVA tests was F: 15.40, showing a statistical significance of p (ml min $kg ) during the training of sit-to-stand transfers, hip extension when standing, weight loading of the involved leg, raising of involved leg, climbing stairs, walking 60 meters respectively and also completing these exercises continuously. RPE was asked after every exercise was finished. Results: There was a moderate correlation between HR and energy expenditure?r?0.618?P < 0.001?and a low correlation between RPE and energy expenditure(r?0.325?P < 0.001).There was one or more participants in each exercise whose heart rate could reach the targeted heart rate zone and the longest duration was 8.5 minutes, which was not reach the time duration request of aerobic exercise. The time duration in targeted heart zone of consecutive exercise is longer than interval exercises. Conclusions: Heart rate is a better index than RPE in the evaluation of exercise intensity of stroke patients. The intensity of therapeutic exercises used in convalescent and sequelae period of stroke isn’t adequate to induce a cardiovascular training effect. Keywords: therapeutic exercises, stroke, aerobic training, exercises intensity [P35] An investigation into the usefulness of clinical tests by physiotherapists at extended scope level for meniscus lesions in the knee and labral lesions in the shoulder W. V. King 1, 2, C. Mercer 1, 2. 1 Worthing and Southlands hospitals NHS trust, UK; 2 Manipulative Association of Chartered Physiotherapists, UK Purpose/Aim: To determine the use, and knowledge of the evidence underpinning a range of common tests for meniscal lesions in the knee and labral lesions in the shoulder by extended scope physiotherapists (ESPs). Methods: A questionnaire was sent to musculoskeletal ESPs . The questionnaire listed tests commonly used for knee meniscus lesions and shoulder labral tears, and asked the ESPs to comment on the usefulness and evidence base for each. Results: 14 ESPs responded to the questionnaire. 100% answered questions related to meniscal lesions of the knee; 71% answered questions relating to

Poster Abstracts / Manual Therapy 14 (2009) S40–S52

labral lesions of the shoulder. The most commonly used tests for meniscal lesions were McMurray’s (100%) and Joint Line Palpation (86%) . Other tests for meniscal lesions were used by 50% of clinicians or less. For shoulder SLAP lesions O’Brien’s test was used by 100% of clinicians; 60% used ‘‘other’’ tests. 40% of clinicians did not use clinical tests for the detection of posterior labral lesions. No test achieved more than 40%. 100% of clinicians used two tests or more to detect Meniscal and SLAP lesions with 79% of clinicians using 3 tests or more for meniscal lesions and 70% for SLAP lesions. There was a marked difference observed in the clinicians’ responses to questions relating to clinical use of the tests, clinical usefulness of the tests and opinion on the evidence behind each test. Clinicians tended to have strong views on the clinical use of the test, but progressively less opinion on clinical usefulness and evidence behind the tests. Conclusions: The results suggest that only a few select tests are consistently used by expert clinicians in order to detect meniscal and SLAP lesions. Confidence in the usefulness and evidence base of each test appears to be less consistent even at extended scope level. Keywords: Extended-scope, Labral, Meniscal, Clinical-tests [P36] The use of a weight-bearing measuring device for accurate assessment and biofeedback training following lower limb pathology Y. Kaplan. Hebrew University of Jerusalem, Israel Introduction: One of the primary objectives of early rehabilitation in patients who have undergone lower limb surgery is to return them to weight-bearing as quickly as possible. Auditory biofeedback has been utilized in stroke rehabilitation, transtibial amputation and the implantation of artificial joints in order to provide performance-relevant cues to both patient and clinician about the occurrence, duration, and location of a force component of motor performance. It has not previously been reported in sports injury rehabilitation. The aim of this paper is to present a new weight-bearing auditory and visual biofeedback insole device (SmartstepÔ) using numerous case studies in order to exhibit both the computer assessment and auditory feedback responses in patients following lower limb surgery. Methods: 80 patients who had undergone various orthopedic surgeries following trauma were tested using the new insole device. If a weightbearing discrepancy was noted on evaluation, the patient-customized auditory feedback device was employed in order to attempt to restore equal weight-bearing in bilateral limbs. All patients signed consent forms and the use of the device was approved by the Helsinki Committee. Results: Whilst using the new patient-customized auditory feedback device, accurate weight-bearing comparisons between bilateral lower limbs were recorded. In most cases, after a single session utilizing the feedback device, weight-bearing values were objectively and statistically improved and in some cases maintained, without the feedback device being further employed. Discussion: Patients need to return to full weight-bearing rapidly following lower limb surgery. Use of the new patient-customized auditory biofeedback device provided a more accurate and rapid rehabilitation tool than previous reported methods. It may further prove to be a reliable and valid instrument for evaluating athletes prior to returning to sports after injury, especially in those cases where there was a significant load difference between the affected and unaffected lower limb.

[P37] Percentage body-weight/ weight-bearing increasing speeds from walking to running

S51

(PBW/WB)

values

in

Y. Kaplan, Y. Barak, Y. Sonnenblick, G. Levin. Hebrew University of Jerusalem, Israel Introduction: Orthopedic surgeons and rehabilitation physicians frequently request limited weight-bearing for prolonged periods following certain bony or soft tissue pathologies as well as certain lower – limb surgical procedures. Jogging is a common activity that the injured athlete will seek to return to as soon as possible following injury or surgery. In order for the physician to be able to advise regarding weight-bearing in jogging, the PBW/WB values in increasing walking and jogging speeds must be known. These parameters as well as the gait distribution changes have eluded the rehabilitation community, mainly due to the technical inability to measure these paradigms. The aim of this paper is to determine the average PBW/WB values and gait distribution changes in a normal population sample during increasing speeds on a treadmill. Methods: A revolutionary weight-bearing and gait analysis system (SmartstepÔ) was utilized to accurately measure the PBW/WB values and gait distribution patterns in a sample of 10 asymptomatic subjects between the ages of 18-36 years of age (Average ¼ 27). The test measurements were conducted on a treadmill (TechnogymÔ ‘‘run excite 700’’), in order to accurately control the speed changes. The tested speeds were 4,6,8,10,12,14,16,18 and 20 km/hr consecutively. Each subject ran for a 15 second time period for each speed.

Keywords: weight-bearing, Biofeedback, Lower limb

Discussion: Whilst analyzing PBW in the entire-foot, as the speed increases, there is almost no change in the PBW from 12km/hr onwards. As speed increases from 4km/hr to 20km/hr, the PBW more than doubles itself. As opposed to the PBW on the entire-foot, the PBW on the fore-foot

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[P38] Responsiveness of a patient specific outcome measure compared with the Oswestry Disability Index V2.1 and the Roland and Morris Disability Questionnaire for patients with sub-acute and chronic low back pain H. Frost, S. Lamb, S. Stewart Brown. University of Warwick, UK Patient specific outcome measures allow individuals to select and rate the relative importance of activities they consider of greatest relevance. However, there is a paucity of research reporting the responsiveness of these measures for patient with back pain. The aim of this study was to compare the responsiveness of a patient specific outcome measure with the Oswestry Disability Index v2.1 (ODI) and the Roland and Morris Disability Questionnaire (RMDQ) for patients with mild to moderate sub-acute and chronic low back pain. Two hundred and one patients were assessed at baseline and 12 months using the patient specific activity questionnaire (PSAQ), the ODI, the RMDQ and a transition rating scale. The latter was used to categorise patients into three groups (better, same or worse). Effect size statistics, receiver operating characteristic curves and one-way between groups ANOVA were used in the analysis.

increases to a maximum of 70%. The maximum fore-foot PBW is 30% higher to that of hind-foot. As the speed increases, the stance percentage reduces by 100% at 20km/hr with a concurrent increase in the swing percentage. The swing phase only increases by 6% from 10km/hr to 20km/ hr, even though the speed increases by 100%. The main change occurs between 8km/hr and 10km/hr, as walking progresses to running. The most significant change in PBW occurs between 4km/hr and 12km/hr, as walking progresses to running. Therefore, this is what should be considered when recommending weight bearing activities to the athlete who intends returning to weight bearing following injury or surgery. Athletes can be encouraged to run at high speeds without concern of greatly increasing their PBW. Keywords: Weight-bearing, Walking, Running

Manual Therapy 14 (2009) S53

PRESENTERS’ INDEX

A AASA, B. AGARWAL, P. ALEXANDER, C. ARAB, A.M. B BALTHAZARD, P. BARBERO, M. BARCIA, M. BARR, A.R. BEINERT, K. BENT, N.P. BERQUE, P. C CAIRNS, M.C. CALLAGHAN, M. CAN, F. CAULFIELD, B. CHOI, H. CLARK, J. CLIFFORD, A.M. COALES, P. J. COMERFORD, M. COOK, C. COOK, G. ˆ TE´, J.N. CO COUGHLAN, G.F. CRUMMEY, O.M. D DAENEN, L. DANKAERTS, W. DAVIES, C.M. DIESEL, W. DIMITRIADIS, Z. E EECHAUTE, C.J. ELLIOTT, S.C. ESCORTELL, E. F FALLA, D. FEARN, J. FOSTER, N.E. FREDRIKSEN, H. FROST, H. G GALISTEO, A.M. GHASEMI, M.S. GIBBONS, S.G.T. ´ MEZ SALES, R. GO GRIMALDI, A. H HADALA, M. HARRIDGE, S.D.R. HARWICH, A. HELGADOTTIR, H. HOLMES, P. HOMSTØL, G.M. J JEAL, N.V. JEREMIAH, H.M. JOENSEN, J. JONES, K.J.

IAP12, P03 P22, P23 GL2 O06 O47 O12 P16 IAP04 P12 O45 O22 O09 GL4 O31, P08 P04 P10 O17 IAP09 P24, P25 GL6 K7 K5, CS5 IAP14, P11 O39 P21 O28, IAP11, P15 K2, CS2 P05 GL8 O02 O44 P30 O14 GL1 GL11 K9 O18 O03, P38 P02 P18, P19 O24, O27, O33, O51 P28, P29 K10, CS6 P17 K6 IAP05 O38 GL9 IAP13, P09 O26 IAP10 O43 IAP02

K KAPLAN, Y. KELLY, O. KIESEL, K.B. KING, W.V. KOOL, J. L LIN, J.-J. LUDEWIG, P.M. M MAY, S.J. MCCREESH, K. MCCRUM, C.A. MCLAUGHLIN, L. MENOTTI, F. MOSELEY, L. MOTTRAM, S. MOULAERT, P. O O’ CONAIRE, E.M. O’CONNELL, N.E. O’SULLIVAN, K. O’SULLIVAN, R.M. P PENSRI, P. PERRY, M. R ROCHE, A. ROCHE, P.A. ROTHWELL, J. RUSHTON, A. RYAN, C.G. S SAHRMANN, S. SALT, E.J. SEXTON, M.T. SHARAN, D. SPARKES, V. STRUYF, F. STUTZ, U. SWINKELS, R.A.H.M. T TEYHEN, D. THOMAS, L.C. THOOMES, E.J. TONG, W. V VAN DAELE, U. VASSELJEN, O VEEGER, D.J. (H.E.J.) W WHITTAKER, J.L. WILLETT, E. WILSON, I.M. WOBY, S. WOODHOUSE, A. Y YOSHIKAWA, A.

P36, P37 O08 P13, P14 P35 O05 O36 K4, CS4 P31, P32 O19, O46 O35 GL5 O23 K8, CS3 O25, O40 O21 O11 O10, IAP06, P20 O32 IAP03 P26 O34 O42 P27 K3 O50 O49 K1, CS1 P06 IAP15 O48 P33 O37, IAP08 O41 O30 GL3 O16 IAP01, P07 P34 O04 O13 GL10 O07, O29 O15 O01 GL7 O20 P01