- Email: [email protected]
Specific exercise targeting the semitendinosus in female ACL-reconstructed athletes
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
denoted Contact details of the patient, Expectations of receiving physiotherapist at rehabilitation hospitals for therapy required, Background & history including previous level of function, Assessments and function, Responsibilities & risk management including safety precautions such as unanticipated patient’s response for prescribed PT intervention. This clinical audit took the form of convenient sampling of a retrospective content audit of physiotherapy record written by physiotherapists of the district acute hospital for patients having transfer to its two rehabilitation hospitals from 1 to 30 September 2014. Results: 740 physiotherapy (PT) records, accounting for about 6% of all patients transferred to the rehabilitation hospitals from 1 October 2013 to 30 September 2014, were audited. The casemix was majority from medical specialty (64%) and others included Orthopoadic (11%), emergency medicine (10%), surgery (7%), neurosurgery (4%), Oncology (3%), Cardiothoracic surgery (1%). The compliance for all audit criteria was full except for Expectations of receiving physiotherapist for therapy required and Responsibilities & risk management including safety precautions being at about 90%. Areas for improvement were identified in documenting the detailed dosimetry of PT intervention, post-treatment response, revised problem list & planning for vulnerable or complex cases. There was no patient incident of all audited episodes of care. Conclusion(s): To ensure effective continuity of information, the current handover has balanced between comprehensiveness and efficiency and found to be structured and effective. Handover information was legibly recorded and specific to the clinical situation. Patient alert was documented for follow up. The use of standard assessment form was beneficial for content quality. Implications: Standardized handover process promoted communication and staff engagement, enhanced continuity of care and reduce adverse events in patient. Keywords: Clinical handover; Inter-hospital patient transfer; Clinical audit Funding acknowledgements: There is no funding received for this internal audit. Ethics approval: Application for ethics approval is not necessary for this routine clinical audit of the hospital. http://dx.doi.org/10.1016/j.physio.2015.03.1653
eS837
Research Report Poster Presentation Number: RR-PO-15-08-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 SPECIFIC EXERCISE TARGETING THE SEMITENDINOSUS IN FEMALE ACL-RECONSTRUCTED ATHLETES H.B. Lauridsen 1 , J. Bencke 2 , K. Thorborg 3 , L.L. Andersen 4 , S. Sonne-Holm 5 , P. Hölmich 3 , M.K. Zebis 2,6 1 Copenhagen
University Hospital at Hvidovre, Orthopedic Department, Copenhagen, Denmark; 2 Copenhagen University Hospital at Hvidovre, Gait Analysis Laboratory, Copenhagen, Denmark; 3 Copenhagen University Hospital at Amager, SORC-C, Arthroscopic Centre Amager, Copenhagen, Denmark; 4 National Research Centre for the Working Environment, Copenhagen, Denmark; 5 Copenhagen University Hospital at Hvidovre, Copenhagen, Denmark; 6 Metropolitan University College, Faculty of Health and Technology, Copenhagen, Denmark Background: The most commonly used graft in ACLreconstructions is harvested from the semitendinosus muscle (ST) which causes atrophy and reduced muscle strength in the hamstrings. As the ST serves as an important ACL agonist, exercises that causes high levels of ST muscle activity after ACL-reconstruction, is of great interest to prevent re-rupture of the ACL. Purpose: The purpose of the present study was to examine the level of neuromuscular hamstring muscle activity during two commonly used strength exercises, the two hand Kettlebell Swing (KS) and the Nordic Hamstring (NH), in previously ACL-injured female athletes reconstructed with semitendinosus graft. Methods: Recruitment is still ongoing – the study is planned to include 20 female subjects. Preliminary data from five athletes (age 28 ± 7 yrs) with a total of 6 ACLreconstructed knees are presented. In all cases, ST tendon was used as graft. The time between surgery and testing was 52 ± 47 months. Ten consecutive KS’s were performed corresponding to a maximal load (12–16 kg) where correct technique was maintained. Additional, five consecutive NH curls were executed. Muscle activity for the hamstring muscles was obtained during the exercise evaluation and during hamstring MVC using wireless surface EMG. Peak EMG of the medial (ST) and lateral (BF) hamstring during KS and NH was measured and normalized to peak EMG amplitude during MVC. Results: The exercise evaluation showed a significantly higher peak ST EMG activity during KS than NH (91 ± 23% vs. 63 ± 23%, respectively), P = 0.011. No difference was observed in peak BF EMG activity between exercises (82 ± 30% vs. 66 ± 36%, respectively), P = 0.125.
eS838
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
Conclusion(s): KS induces higher ST EMG activity than NH does. There is no difference in peak EMG activity between the two exercises in the BF. Implications: The present finding suggests that the KB exercise could be introduced in rehabilitation when aiming at enhanced ability to recruit ST during forceful movements. However, to avoid adverse effects in the early phase of rehabilitation, caution must be taken when introducing highintensity training among ACL reconstructed patients. Keywords: ACL-reconstruction; Semitendinosus; Kettlebell Funding acknowledgements: No funding supported this study. Ethics approval: The Scientific Ethical Committee in The Capital Region of Denmark approved this research project. http://dx.doi.org/10.1016/j.physio.2015.03.1654 Research Report Poster Presentation Number: RR-PO-17-07-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 PARTICIPATION IN PHYSICAL ACTIVITIES FOR CHILDREN WITH PHYSICAL DISABILITIES: FEASIBILITY AND EFFECTIVENESS OF INDIVIDUALISED PHYSICAL ACTIVITY REFERRALS K. Lauruschkus 1 , I. Hallström 1 , L. Westbom 2 , E. Nordmark 1 1 Faculty
of Medicine, Lund University, Department of Health Sciences, Lund, Sweden; 2 Faculty of Medicine, Lund University, Department of Clinical Sciences, Lund, Sweden Background: Children with physical disabilities are not physically active to the same extent as other children and are at risk to develop cardiometabolic diseases. An active lifestyle with increased habitual physical activity and reduced sedentary behaviour is recommended. The differences in frequency of participation in physical activity increase with the severity of limitations in gross motor and/or cognitive function for children with cerebral palsy (CP) aged 7–17 years according to a study using data from a National Quality Registry. Individual and focus group interviews with children with CP aged 8–11 years showed that they want to be physically active, have fun and enjoy the sensation of speed together with others. They want to self-select physical activities with the right support, while pain and fatigue or not being good enough have shown to be barriers for participation in physical activities. An effective intervention to promote a lifestyle change towards increased physical activity in adults is Physical Activity Referral (PAR). There is a lack of knowledge about PAR in children, particularly in those with disabilities.
Purpose: To evaluate the feasibility of individualised PAR for children with physical disabilities and its effectiveness on physical activity and sedentary behaviour. Methods: Fourteen children with physical disabilities, aged 7–12 years, and their parents participated in the individualised PAR, with assessments at baseline, 8 and 11 months. Sociodemographic, clinical and physical activity questionnaires were conducted at baseline; the Gross Motor Function Measure (GMFM-66), physical activity and heart rate monitors and time use diaries were used at baseline and at 8 months. Motivational Interviewing (MI), used throughout the study, and the Canadian Occupational Performance Measure (COPM) led to a written agreement between each child, its parents and the physiotherapist by using Goal Attainment Scaling (GAS). At 8 and at 11 months COPM and GAS were evaluated and PAR-evaluation, physical activity and costs & time spent questionnaires were completed. At 11 months the families got feedback of each child’s measured physical activity levels and GMFM-66 scores. Results: Each child participated in self-selected physical activities with support of the physiotherapist. The individualised PAR was involving both everyday physical activities as biking to school and organised physical activities as playing wheelchair hockey or table tennis due to individual preferences, opportunities and facilities. There were no dropouts. The intervention and several assessments were feasible, but instruments that cannot be recommended were identified. The results will be discussed. Conclusion(s): It is important to conduct a feasibility study in order to examine whether the study design answers to the aims and which instruments are accepted by children and their parents. Instruments with poor acceptability or effectiveness should be excluded or modified in future research in a randomised controlled trial, preferably in a multi-centre setting. In addition, health economic analysis should be made to show the costs and costs savings for the individual and the society. Implications: Depending on the results the individualised PAR for children with physical disabilities should be implemented in work for increased participation in physical activity and decreased sedentary behaviour. Keywords: Children; Physical disabilities; Physical activity referral Funding acknowledgements: This research was supported by Research Platform for Disability Studies in Habilitation, Sweden; Swedish National Association for Disabled Children; Promobilia. Ethics approval: The study was approved by the Regional Ethical Review Board at Lund University, Sweden (LU-Dnr 2013/521). http://dx.doi.org/10.1016/j.physio.2015.03.1655
denoted Contact details of the patient, Expectations of receiving physiotherapist at rehabilitation hospitals for therapy required, Background & history including previous level of function, Assessments and function, Responsibilities & risk management including safety precautions such as unanticipated patient’s response for prescribed PT intervention. This clinical audit took the form of convenient sampling of a retrospective content audit of physiotherapy record written by physiotherapists of the district acute hospital for patients having transfer to its two rehabilitation hospitals from 1 to 30 September 2014. Results: 740 physiotherapy (PT) records, accounting for about 6% of all patients transferred to the rehabilitation hospitals from 1 October 2013 to 30 September 2014, were audited. The casemix was majority from medical specialty (64%) and others included Orthopoadic (11%), emergency medicine (10%), surgery (7%), neurosurgery (4%), Oncology (3%), Cardiothoracic surgery (1%). The compliance for all audit criteria was full except for Expectations of receiving physiotherapist for therapy required and Responsibilities & risk management including safety precautions being at about 90%. Areas for improvement were identified in documenting the detailed dosimetry of PT intervention, post-treatment response, revised problem list & planning for vulnerable or complex cases. There was no patient incident of all audited episodes of care. Conclusion(s): To ensure effective continuity of information, the current handover has balanced between comprehensiveness and efficiency and found to be structured and effective. Handover information was legibly recorded and specific to the clinical situation. Patient alert was documented for follow up. The use of standard assessment form was beneficial for content quality. Implications: Standardized handover process promoted communication and staff engagement, enhanced continuity of care and reduce adverse events in patient. Keywords: Clinical handover; Inter-hospital patient transfer; Clinical audit Funding acknowledgements: There is no funding received for this internal audit. Ethics approval: Application for ethics approval is not necessary for this routine clinical audit of the hospital. http://dx.doi.org/10.1016/j.physio.2015.03.1653
eS837
Research Report Poster Presentation Number: RR-PO-15-08-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 SPECIFIC EXERCISE TARGETING THE SEMITENDINOSUS IN FEMALE ACL-RECONSTRUCTED ATHLETES H.B. Lauridsen 1 , J. Bencke 2 , K. Thorborg 3 , L.L. Andersen 4 , S. Sonne-Holm 5 , P. Hölmich 3 , M.K. Zebis 2,6 1 Copenhagen
University Hospital at Hvidovre, Orthopedic Department, Copenhagen, Denmark; 2 Copenhagen University Hospital at Hvidovre, Gait Analysis Laboratory, Copenhagen, Denmark; 3 Copenhagen University Hospital at Amager, SORC-C, Arthroscopic Centre Amager, Copenhagen, Denmark; 4 National Research Centre for the Working Environment, Copenhagen, Denmark; 5 Copenhagen University Hospital at Hvidovre, Copenhagen, Denmark; 6 Metropolitan University College, Faculty of Health and Technology, Copenhagen, Denmark Background: The most commonly used graft in ACLreconstructions is harvested from the semitendinosus muscle (ST) which causes atrophy and reduced muscle strength in the hamstrings. As the ST serves as an important ACL agonist, exercises that causes high levels of ST muscle activity after ACL-reconstruction, is of great interest to prevent re-rupture of the ACL. Purpose: The purpose of the present study was to examine the level of neuromuscular hamstring muscle activity during two commonly used strength exercises, the two hand Kettlebell Swing (KS) and the Nordic Hamstring (NH), in previously ACL-injured female athletes reconstructed with semitendinosus graft. Methods: Recruitment is still ongoing – the study is planned to include 20 female subjects. Preliminary data from five athletes (age 28 ± 7 yrs) with a total of 6 ACLreconstructed knees are presented. In all cases, ST tendon was used as graft. The time between surgery and testing was 52 ± 47 months. Ten consecutive KS’s were performed corresponding to a maximal load (12–16 kg) where correct technique was maintained. Additional, five consecutive NH curls were executed. Muscle activity for the hamstring muscles was obtained during the exercise evaluation and during hamstring MVC using wireless surface EMG. Peak EMG of the medial (ST) and lateral (BF) hamstring during KS and NH was measured and normalized to peak EMG amplitude during MVC. Results: The exercise evaluation showed a significantly higher peak ST EMG activity during KS than NH (91 ± 23% vs. 63 ± 23%, respectively), P = 0.011. No difference was observed in peak BF EMG activity between exercises (82 ± 30% vs. 66 ± 36%, respectively), P = 0.125.
eS838
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
Conclusion(s): KS induces higher ST EMG activity than NH does. There is no difference in peak EMG activity between the two exercises in the BF. Implications: The present finding suggests that the KB exercise could be introduced in rehabilitation when aiming at enhanced ability to recruit ST during forceful movements. However, to avoid adverse effects in the early phase of rehabilitation, caution must be taken when introducing highintensity training among ACL reconstructed patients. Keywords: ACL-reconstruction; Semitendinosus; Kettlebell Funding acknowledgements: No funding supported this study. Ethics approval: The Scientific Ethical Committee in The Capital Region of Denmark approved this research project. http://dx.doi.org/10.1016/j.physio.2015.03.1654 Research Report Poster Presentation Number: RR-PO-17-07-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 PARTICIPATION IN PHYSICAL ACTIVITIES FOR CHILDREN WITH PHYSICAL DISABILITIES: FEASIBILITY AND EFFECTIVENESS OF INDIVIDUALISED PHYSICAL ACTIVITY REFERRALS K. Lauruschkus 1 , I. Hallström 1 , L. Westbom 2 , E. Nordmark 1 1 Faculty
of Medicine, Lund University, Department of Health Sciences, Lund, Sweden; 2 Faculty of Medicine, Lund University, Department of Clinical Sciences, Lund, Sweden Background: Children with physical disabilities are not physically active to the same extent as other children and are at risk to develop cardiometabolic diseases. An active lifestyle with increased habitual physical activity and reduced sedentary behaviour is recommended. The differences in frequency of participation in physical activity increase with the severity of limitations in gross motor and/or cognitive function for children with cerebral palsy (CP) aged 7–17 years according to a study using data from a National Quality Registry. Individual and focus group interviews with children with CP aged 8–11 years showed that they want to be physically active, have fun and enjoy the sensation of speed together with others. They want to self-select physical activities with the right support, while pain and fatigue or not being good enough have shown to be barriers for participation in physical activities. An effective intervention to promote a lifestyle change towards increased physical activity in adults is Physical Activity Referral (PAR). There is a lack of knowledge about PAR in children, particularly in those with disabilities.
Purpose: To evaluate the feasibility of individualised PAR for children with physical disabilities and its effectiveness on physical activity and sedentary behaviour. Methods: Fourteen children with physical disabilities, aged 7–12 years, and their parents participated in the individualised PAR, with assessments at baseline, 8 and 11 months. Sociodemographic, clinical and physical activity questionnaires were conducted at baseline; the Gross Motor Function Measure (GMFM-66), physical activity and heart rate monitors and time use diaries were used at baseline and at 8 months. Motivational Interviewing (MI), used throughout the study, and the Canadian Occupational Performance Measure (COPM) led to a written agreement between each child, its parents and the physiotherapist by using Goal Attainment Scaling (GAS). At 8 and at 11 months COPM and GAS were evaluated and PAR-evaluation, physical activity and costs & time spent questionnaires were completed. At 11 months the families got feedback of each child’s measured physical activity levels and GMFM-66 scores. Results: Each child participated in self-selected physical activities with support of the physiotherapist. The individualised PAR was involving both everyday physical activities as biking to school and organised physical activities as playing wheelchair hockey or table tennis due to individual preferences, opportunities and facilities. There were no dropouts. The intervention and several assessments were feasible, but instruments that cannot be recommended were identified. The results will be discussed. Conclusion(s): It is important to conduct a feasibility study in order to examine whether the study design answers to the aims and which instruments are accepted by children and their parents. Instruments with poor acceptability or effectiveness should be excluded or modified in future research in a randomised controlled trial, preferably in a multi-centre setting. In addition, health economic analysis should be made to show the costs and costs savings for the individual and the society. Implications: Depending on the results the individualised PAR for children with physical disabilities should be implemented in work for increased participation in physical activity and decreased sedentary behaviour. Keywords: Children; Physical disabilities; Physical activity referral Funding acknowledgements: This research was supported by Research Platform for Disability Studies in Habilitation, Sweden; Swedish National Association for Disabled Children; Promobilia. Ethics approval: The study was approved by the Regional Ethical Review Board at Lund University, Sweden (LU-Dnr 2013/521). http://dx.doi.org/10.1016/j.physio.2015.03.1655