Abstract Introduction Charcot-Marie-Tooth disease (CMT) is one of the most commonly inherited neuromuscular diseases – there is no effective treatment. Foot and ankle weakness is a major problem for ...children with CMT, thus interventions that focus on maintaining and increasing strength may provide a solution. Research Question Is progressive resistance strength training an effective and safe intervention to improve strength, disability, gait and quality of life of children with CMT? Participants and Setting Sixty children (6 to 17 years) with confirmed CMT who reside in Sydney, Australia will be recruited via referral from a paediatric neurologist, advertisements or the Australasian Paediatric CMT Registry. Intervention Participants will be randomised to undergo a 24-week, thrice weekly, high-intensity progressive resistance foot and ankle exercise programme (HIGH) or low-intensity foot and ankle exercise control programme (LOW). Measurements Outcome measures will be conducted at baseline, 6, 12 and 24 months. The primary outcome is isometric dorsiflexion strength measured by hand-held dynamometry. Secondary outcomes include disability, gait, quality of life, functional ankle instability and muscle volume and fatty infiltration of the anterior compartment of the lower leg (determined by MRI). Procedure Randomisation and allocation will be by a computer-generated algorithm, maintained and assigned by an external phone-based system, concealed to the investigators. Participants, parents and the outcome assessors will be blinded to group assignment. Analysis Treatment effect between groups is by intention-to-treat with a linear regression approach to analysis of covariance using 95% CI and p < 0.05. Discussion This study is the first randomised controlled trial to evaluate the risks and benefits of strengthening the affected muscles in children with CMT.
Highlights • Charcot-Marie-Tooth disease is the most common inherited neuromuscular disorder. • We compared the gait of 60 affected children and 50 norms aged 6–17 years. • Common compensations ...included external hip rotation and reduced hip abductor moment. • In this mild-moderately affected population ‘steppage-gait’ was not observed. • Subcategorising for ankle weakness severity revealed distinct gait patterns.
To generate a reference dataset of commonly performed functional outcome measures in 1,000 children and adults and investigate the influence of demographic, anthropometric, strength, and flexibility ...characteristics.
Twelve functional outcome measures were collected from 1,000 healthy individuals aged 3-101 years: 6-minute walk test, 30-second chair stand test, timed stairs test, long jump, vertical jump, choice stepping reaction time, balance (Star Excursion Balance Test, tandem stance eyes open and closed, single-leg stance eyes closed), and dexterity (9-hole peg test, Functional Dexterity Test). Correlation and multiple regression analyses were performed to identify factors independently associated with each measure.
Age- and sex-stratified reference values for functional outcome measures were generated. Functional performance increased through childhood and adolescence, plateaued during adulthood, and declined in older adulthood. While balance did not differ between the sexes, male participants generally performed better at gross motor tasks while female participants performed better at dexterous tasks. Height was the most consistent correlate of functional performance in children, while lower limb muscle strength was a major determinant in adolescents and adults. In older adults, age, lower limb strength, and joint flexibility explained up to 63% of the variance in functional measures.
These normative reference values provide a framework to accurately track functional decline associated with neuromuscular disorders and assist development and validation of responsive outcome measures for therapeutic trials.
A key role of allied health (AH) professional regulatory and professional bodies is to ensure that AH education programs provide work-integrated learning (WIL) opportunities for students. The ...requirements are outlined via the respective profession's educational accreditation standards. Although a significant component of the AH professional degrees, researchers have not explored how standards specific to WIL are developed, nor how WIL might be conceptualised through the standards. This study explored how WIL is conceptualised through comparing the WIL education standards across Australian AH professions. Using a non-experimental explanatory mixed-methods research design, a document analysis of Australian education program accreditation standards (and associated documents) for 15 AH professions was undertaken. Data analysis included inductive textual and thematic analyses to compare AH professionals' conceptualisation of WIL. This study found a high degree of variation in how AH professions describe WIL. While there was a common requirement for students to demonstrate competency in WIL, requirements for WIL quantity, assessment and supervision varied. Four key themes were identified regarding the contribution of WIL to curriculum and student learning: (1) the relationship between WIL and the program curriculum; (2) WIL as a learning process; (3) learning from diverse WIL contexts; and (4) developing competence through WIL. Overall, the diversity in the standards reflected differing understandings of what WIL is. Thus, in the absence of frameworks for designing accreditation standards, the risk is that some AH professions will continue to perpetuate the myth that the primary purpose of WIL is to provide a bridge between theory and practice.
Objectives
To assess the efficacy of whole‐body progressive resistance training (PRT) as a treatment for the symptoms of peripheral arterial disease (PAD) in older adults.
Design
Randomized ...controlled pilot trial.
Setting
University clinical weight training facility in Sydney, Australia.
Participants
Twenty‐two older adults with symptomatic PAD.
Interventions
The efficacy of supervised whole‐body high‐intensity PRT (H‐PRT) with low‐intensity nonprogressive resistance training (L‐RT) and a usual care control group that performed unsupervised walking for 6 months was compared.
Measurements
Pilot outcome measures included 6‐minute walk (6 MW) outcomes, body composition, dynamic muscle strength and endurance, and performance‐based tests of function.
Results
Mean age was 71.1 ± 7.2. Mean ankle brachial index was 0.55 ± 0.13. Exercise adherence was similar in all groups (P = .29). H‐PRT (n = 8) improved total 6MW distance (mean difference (MD) 62.6 ± 58.0 m, P = .02) significantly more than L‐RT (n = 7; MD=−48.2 ± 67.6 m) and controls (n = 7; MD=−9.9 ± 52.9 m). Change in 6MW onset of claudication was significantly and independently related to change in bilateral calf endurance (correlation coefficient (r) = 0.65, P = .03), and change in 6MW distance was significantly and independently related to change in bilateral hip extensor endurance (r = 0.71, P = .02) in all groups.
Conclusion
H‐PRT significantly improved 6MW ability in older adults with intermittent claudication from PAD, whereas L‐RT and unsupervised walking did not. Improvement in walking ability was significantly related to improvements in bilateral calf and hip extensor endurance, supporting further investigations targeted at musculoskeletal impairment in this cohort.
This study aimed to identify factors important to quality in exercise performance studies, specifically in the domains of aerobic, anaerobic and strength exercise. Factors related to diet and body ...composition were also targeted as these often influence or change with exercise.
Cross-sectional study employing focus groups and a modified Delphi method.
Academic staff and research students within the discipline of exercise science in a research-intensive university participated in focus groups to generate discipline-specific factors important to study quality. These factors were subsequently presented in a modified Delphi survey to a panel of international researchers with expertise in at least one of the domains. Item consensus was defined as >70% agreement on importance. The initial round contained all items generated from the focus groups. Subsequent rounds only presented items where consensus was not achieved, and additional items suggested by participants.
The academic staff (n = 10) and research students (n = 9) generated 22 items generic to all exercise performance studies and 71 domain-specific items. Over two Delphi survey rounds involving 18 international researchers, consensus on importance was achieved for 19 generic items. Identified factors addressed exercise testing and prescription protocols, equipment and compliance to interventions. Consensus on 66 specific items was achieved but was limited by small domain-specific participant numbers (4–8).
Numerous discipline-specific factors were identified as important to study quality. These factors can subsequently be used to inform the development of a tool to evaluate study quality in exercise performance research or inform best clinical practice.
The first step to identifying factors that increase the risk of recurrent ankle sprains is to identify impairments after a first sprain and compare performance with individuals who have never ...sustained a sprain. Few researchers have restricted recruitment to a homogeneous group of patients with first sprains, thereby introducing the potential for confounding.
To identify impairments that differ in participants with a recent index lateral ankle sprain versus participants with no history of ankle sprain.
Cross-sectional study.
We recruited a sample of convenience from May 2010 to April 2013 that included 70 volunteers (age = 27.4 ± 8.3 years, height = 168.7 ± 9.5 cm, mass = 65.0 ± 12.5 kg) serving as controls and 30 volunteers (age = 31.1 ± 13.3 years, height = 168.3 ± 9.1 cm, mass = 67.3 ± 13.7 kg) with index ankle sprains.
We collected demographic and physical performance variables, including ankle-joint range of motion, balance (time to balance after perturbation, Star Excursion Balance Test, foot lifts during single-legged stance, demi-pointe balance test), proprioception, motor planning, inversion-eversion peak power, and timed stair tests. Discriminant analysis was conducted to determine the relationship between explanatory variables and sprain status. Sequential discriminant analysis was performed to identify the most relevant variables that explained the greatest variance.
The average time since the sprain was 3.5 ± 1.5 months. The model, including all variables, correctly predicted a sprain status of 77% (n = 23) of the sprain group and 80% (n = 56) of the control group and explained 40% of the variance between groups (Formula: see text = 42.16, P = .03). Backward stepwise discriminant analysis revealed associations between sprain status and only 2 tests: Star Excursion Balance Test in the anterior direction and foot lifts during single-legged stance (Formula: see text = 15.2, P = .001). These 2 tests explained 15% of the between-groups variance and correctly predicted group membership of 63% (n = 19) of the sprain group and 69% (n = 48) of the control group.
Balance impairments were associated with a recent first ankle sprain, but proprioception, motor control, power, and function were not.
To explore and identify the predictors of ankle sprain after an index (first) lateral ankle sprain.
Prospective cohort study, Level of evidence II.
Musculoskeletal research laboratory at the ...University of Sydney.
A sample of convenience (70 controls, 30 with an index sprain) was recruited.
Potential predictors of ankle sprain were measured including: demographic measures, perceived ankle instability, ankle joint ligamentous laxity, passive range of ankle motion, balance, proprioception, motor planning and control, and inversion/eversion peak power. Participants were followed up monthly and the number of ankle sprains was recorded over 12 months.
Ninety-six participants completed the study; 10 participants sustained an ankle sprain. A combination of 10 predictors including: a recent index sprain, younger age, greater height and weight, perceived instability, increased laxity, impaired balance, and greater inversion/eversion peak power explained 27 to 56% of the variance in occurrence of ankle sprain (χ211,95=30.67, p=0.001). The regression model correctly classified 90% of cases. The strongest independent predictors were history of an index sprain (odds ratio (OR)=8.23, 95% confidence interval (CI)=1.66 to 40.72) and younger age (OR=8.41, 95%CI=1.48 to 47.96).
A recent index ankle sprain and younger age were the only independent predictors of ankle sprain. The combination of greater height or weight, feeling of instability, peak power and impaired balance predicted the occurrence of ankle sprain in almost 90% of participants. These findings could form the basis for intervention targeted at reducing recurrence of sprain after an index sprain.
PDF
