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Investigation of mood disorders in polio survivors—a retrospective audit of patients attending polio services Victoria, Melbourne, Australia
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Polytechnic University reviewed and approved the experiment. http://dx.doi.org/10.1016/j.physio.2015.03.198 Research Report Poster Presentation Number: RR-PO-06-19-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 DOES AGING AFFECT THE COORDINATION OF JOINT MOVEMENTS DURING SIT-TO-STAND MOTION? M. Anan 1 , K. Shinkoda 1 , M. Takahashi 1 , K. Tanimoto 2 , H. Hattori 3 , Y. Wakimoto 4 , T. Ibara 5 , N. Kito 6 1 Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan; 2 Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan; 3 Kurashikiheisei Hospital, Kurashiki, Japan; 4 Midorii Orthopaedics Joint Reconstruction and Arthroscopy, Hiroshima, Japan; 5 Kawashima Orthopaedic Hospital, Nakatsu, Japan; 6 Department of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
Background: The human body accomplishes tasks using redundant degrees of freedom, which coordinate each body segment. Fundamental activities of daily living include sit-tostand (STS), a dynamic motion that requires extensive joint movement in the lower extremities and trunk. STS consists of two components: (1) transition the center of mass (COM) from a wide base of support (BOS) provided by the buttocks, thighs, and feet to a narrow BOS provided by feet alone, and (2) lifting COM from the height in the sitting position to that of standing. The STS requires the coordination of multiple body segments. Some studies have shown the aging process increases or decreases joint coordination. Purpose: The purpose of this study was to investigate whether aging affects the coordination of joint movements required to achieve STS using the uncontrolled manifold (UCM) analysis. We hypothesized that older adults would increase joint coordination in the horizontal, but decrease that in the vertical direction. Methods: We recruited 23 older subjects who had no musculoskeletal and/or neuromuscular conditions that affect STS and 21 healthy young subjects. All subjects provided written consent to participate, and the study was approved by the institutional ethics committee. Subjects performed five STS trials from a chair with the seat height adjusted to the length of their lower leg at a self-selected motion speed. Kinematic data were collected using a three-dimensional motion
eS73
analysis system. COM coordinates, segment angles, and segment lengths were calculated using Bodybuilder software. UCM analysis was performed to assess the effects of segment angle variance (elemental variable) on COM stability (performance variable) with Matlab R2014a. We calculated the variance in segment angles that does not affect COM (VUCM ), the variance that affects COM (VORT ), and the synergy index (V) in the horizontal and vertical directions. These data from the motion initiation to termination were normalized to 100%, and the buttocks-off time was defined as 50%. A two-sample t-test was used to compare two groups, with the level of significance set at 0.05. Results: No significant difference was found in VORT and V in the horizontal direction between two groups. In contrast, VORT in the vertical direction for 60–100% of motion time was higher in the older group than in the young group, and V in the vertical direction for 60–80 and 90–100% of motion time was lower in the older group than in the young group. Conclusion(s): Older adults showed no change in their joint coordination pattern to control COM in the horizontal direction, and less coordinated joint pattern to control COM in the vertical direction after buttocks-off. This suggested that joint coordination in older adults contributes to control of COM in the horizontal direction than in the vertical direction. Implications: This study quantitatively showed a deficit of joint coordination in older adults during STS using the UCM analysis. An assessment of joint coordination could serve as an indicator of risk of falls in older adults. Keywords: Uncontrolled manifold analysis; Sit-to-stand; Aging Funding acknowledgements: Our work was unfunded. Ethics approval: All procedures were approved by the Ethics Committee of Hiroshima University Graduate School of Health Sciences prior to the study. http://dx.doi.org/10.1016/j.physio.2015.03.199 Special Interest Report Poster Presentation Number: SI-PO-07-15-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 INVESTIGATION OF MOOD DISORDERS IN POLIO SURVIVORS—A RETROSPECTIVE AUDIT OF PATIENTS ATTENDING POLIO SERVICES VICTORIA, MELBOURNE, AUSTRALIA R. Anbiah Polio Services Victoria, St Vincent’s Hospital, Melbourne, Australia Background: Polio Services Victoria (PSV) located in Melbourne, Australia, is a state-wide service offering an assessment and referral pathway for patients with a history
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
of polio. The service offers a multidisciplinary service for assessment and management of individual patient’s health care needs. During patient assessments, the focus has been on physical assessments and meeting the physical needs of individual patients with minimal intervention for psychological needs. Literature supports the information that polio patients have complex health care issues due to the long-term effects of polio and ageing. Anecdotally, clinicians have identified that patients struggle to make lifestyle changes to manage their long-term health care needs. This may be attributed to the emotional burden that is carried by the patient and is often not acknowledged. This has further exposed the need to explore emotional syndromes and their relationship with long-term disability. Purpose: In order to provide a holistic assessment, PSV has been using the Depression Anxiety and Stress Scale (DASS 21) to measure emotional distress. This is a validated quantitative measure and is completed by the patient prior to their assessment. The scores are discussed with the patient and if required, the individual is educated to seek medical help through their General Practitioner or a counselling service in the community. Methods: A retrospective audit was done after gaining approval through the quality assurance subcommittee at St Vincent’s Hospital, Melbourne. A total of 100 patient records were audited. Results: Results indicated that the scores were indicative of depressive mood in 46% of patients and of anxious mood in 62%. In order to identify whether the factors of age, gender, interpreter status were associated with presence of depressed mood (>4 on DASS21), logistic regression was performed using SPSS. None of these variables contributed significantly to the regression model (age; p = 0.34, gender p = 0.57, interpreter status p = 0.93). No significant correlation was found between the variables of age and DASS21 depression score (range 0–2) (p = 0.47). Similar findings were observed for anxious mood, where none of the variables reached significance in the regression model (age; p = 0.24, gender; p = 0.31, interpreter status; p = 0.78). The correlation between age and DASS21 anxiety score (range 0–21) was also investigated, with no significant correlation found between these variables (p = 0.99). Conclusion(s): The service has developed referral pathways to refer patients to local service providers to assist in managing their emotional needs. It is expected that patient engagement will assist in making lifestyle changes as their needs are complex. Implications: Future research incorporating other variables such as employment status, past trauma, extent of disability, financial burden, quality of life and clinical symptoms experienced may shed more light on mood disorders for this complex patient group. A research application has been submitted through St Vincent’s Health to investigate the use of the above mentioned variables and patient engagement with local service providers for managing their emotional
needs. If funding is approved, further research as discussed above will commence in February 2015. Keywords: Polio; Depression; Anxiety Funding acknowledgements: Nil. Ethics approval: Approval by the Quality Assurance SubCommittee, St Vincent’s Hospital, Melbourne. http://dx.doi.org/10.1016/j.physio.2015.03.200 Special Interest Report Poster Presentation Number: SI-PO-18-19-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 SPECIALTIES IN PHYSICAL THERAPY, ENSURING THE PROFESSIONAL LEGITIMACY IN DENMARK B.A.S. Andersen University College Capital, Department of Physiotherapy, Hillerød, Denmark Background: The Danish Society of Physical Therapy (DSPT) was established in 2013 with the purpose of providing a common forum that stimulates the cooperation and coordination between all specialties and groups within Physical Therapy (PT) in Denmark. The aim was also to draw a clear profile of these groups within the community, partners and cross-functional team works. Furthermore the stimulation of research in PT in Denmark and creating an optimal cooperation concerning evidence based physiotherapy practice were a chief aim. In this way Denmark is showing a clear distinction between on one side politics and on the other side professional competency in Danish PT. Specialties in PT have existed since 2000 with the vision of systematically developing the clinical competence with the integration of both practical and theoretical knowledge. 9 specialties were established within: Musculoskeletal, Sports, Neurology, Pediatrics, Geriatrics, Mental Health, Rehabilitation, Cardiorespiratory, Occupational Health and Ergonomics. These specialties have a PT society within DSPT, except Rehabilitation. With the establishment of DSPT the first mission to carry out was to revise the specialties. The challenge about Specialties in PT has been that is has not been accepted or recognized by the Health Authority in DK. Anyway PTs in DK have continued educating and developing their competences within the associated societies. Purpose: To define and implement new PT specialities in DK. Methods: The work was started-up at a meeting including all societies. External collaborators were invited to contribute to the debate, amongst others Emma Stokes, who incited DSPT to submit an abstract about the process for WCPT, Singapore 2015 in order to facilitate the international debate about specialisations in PT. A committee was elected representing a wide range of the societies within DSPT. The
Polytechnic University reviewed and approved the experiment. http://dx.doi.org/10.1016/j.physio.2015.03.198 Research Report Poster Presentation Number: RR-PO-06-19-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 DOES AGING AFFECT THE COORDINATION OF JOINT MOVEMENTS DURING SIT-TO-STAND MOTION? M. Anan 1 , K. Shinkoda 1 , M. Takahashi 1 , K. Tanimoto 2 , H. Hattori 3 , Y. Wakimoto 4 , T. Ibara 5 , N. Kito 6 1 Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan; 2 Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan; 3 Kurashikiheisei Hospital, Kurashiki, Japan; 4 Midorii Orthopaedics Joint Reconstruction and Arthroscopy, Hiroshima, Japan; 5 Kawashima Orthopaedic Hospital, Nakatsu, Japan; 6 Department of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
Background: The human body accomplishes tasks using redundant degrees of freedom, which coordinate each body segment. Fundamental activities of daily living include sit-tostand (STS), a dynamic motion that requires extensive joint movement in the lower extremities and trunk. STS consists of two components: (1) transition the center of mass (COM) from a wide base of support (BOS) provided by the buttocks, thighs, and feet to a narrow BOS provided by feet alone, and (2) lifting COM from the height in the sitting position to that of standing. The STS requires the coordination of multiple body segments. Some studies have shown the aging process increases or decreases joint coordination. Purpose: The purpose of this study was to investigate whether aging affects the coordination of joint movements required to achieve STS using the uncontrolled manifold (UCM) analysis. We hypothesized that older adults would increase joint coordination in the horizontal, but decrease that in the vertical direction. Methods: We recruited 23 older subjects who had no musculoskeletal and/or neuromuscular conditions that affect STS and 21 healthy young subjects. All subjects provided written consent to participate, and the study was approved by the institutional ethics committee. Subjects performed five STS trials from a chair with the seat height adjusted to the length of their lower leg at a self-selected motion speed. Kinematic data were collected using a three-dimensional motion
eS73
analysis system. COM coordinates, segment angles, and segment lengths were calculated using Bodybuilder software. UCM analysis was performed to assess the effects of segment angle variance (elemental variable) on COM stability (performance variable) with Matlab R2014a. We calculated the variance in segment angles that does not affect COM (VUCM ), the variance that affects COM (VORT ), and the synergy index (V) in the horizontal and vertical directions. These data from the motion initiation to termination were normalized to 100%, and the buttocks-off time was defined as 50%. A two-sample t-test was used to compare two groups, with the level of significance set at 0.05. Results: No significant difference was found in VORT and V in the horizontal direction between two groups. In contrast, VORT in the vertical direction for 60–100% of motion time was higher in the older group than in the young group, and V in the vertical direction for 60–80 and 90–100% of motion time was lower in the older group than in the young group. Conclusion(s): Older adults showed no change in their joint coordination pattern to control COM in the horizontal direction, and less coordinated joint pattern to control COM in the vertical direction after buttocks-off. This suggested that joint coordination in older adults contributes to control of COM in the horizontal direction than in the vertical direction. Implications: This study quantitatively showed a deficit of joint coordination in older adults during STS using the UCM analysis. An assessment of joint coordination could serve as an indicator of risk of falls in older adults. Keywords: Uncontrolled manifold analysis; Sit-to-stand; Aging Funding acknowledgements: Our work was unfunded. Ethics approval: All procedures were approved by the Ethics Committee of Hiroshima University Graduate School of Health Sciences prior to the study. http://dx.doi.org/10.1016/j.physio.2015.03.199 Special Interest Report Poster Presentation Number: SI-PO-07-15-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 INVESTIGATION OF MOOD DISORDERS IN POLIO SURVIVORS—A RETROSPECTIVE AUDIT OF PATIENTS ATTENDING POLIO SERVICES VICTORIA, MELBOURNE, AUSTRALIA R. Anbiah Polio Services Victoria, St Vincent’s Hospital, Melbourne, Australia Background: Polio Services Victoria (PSV) located in Melbourne, Australia, is a state-wide service offering an assessment and referral pathway for patients with a history
eS74
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
of polio. The service offers a multidisciplinary service for assessment and management of individual patient’s health care needs. During patient assessments, the focus has been on physical assessments and meeting the physical needs of individual patients with minimal intervention for psychological needs. Literature supports the information that polio patients have complex health care issues due to the long-term effects of polio and ageing. Anecdotally, clinicians have identified that patients struggle to make lifestyle changes to manage their long-term health care needs. This may be attributed to the emotional burden that is carried by the patient and is often not acknowledged. This has further exposed the need to explore emotional syndromes and their relationship with long-term disability. Purpose: In order to provide a holistic assessment, PSV has been using the Depression Anxiety and Stress Scale (DASS 21) to measure emotional distress. This is a validated quantitative measure and is completed by the patient prior to their assessment. The scores are discussed with the patient and if required, the individual is educated to seek medical help through their General Practitioner or a counselling service in the community. Methods: A retrospective audit was done after gaining approval through the quality assurance subcommittee at St Vincent’s Hospital, Melbourne. A total of 100 patient records were audited. Results: Results indicated that the scores were indicative of depressive mood in 46% of patients and of anxious mood in 62%. In order to identify whether the factors of age, gender, interpreter status were associated with presence of depressed mood (>4 on DASS21), logistic regression was performed using SPSS. None of these variables contributed significantly to the regression model (age; p = 0.34, gender p = 0.57, interpreter status p = 0.93). No significant correlation was found between the variables of age and DASS21 depression score (range 0–2) (p = 0.47). Similar findings were observed for anxious mood, where none of the variables reached significance in the regression model (age; p = 0.24, gender; p = 0.31, interpreter status; p = 0.78). The correlation between age and DASS21 anxiety score (range 0–21) was also investigated, with no significant correlation found between these variables (p = 0.99). Conclusion(s): The service has developed referral pathways to refer patients to local service providers to assist in managing their emotional needs. It is expected that patient engagement will assist in making lifestyle changes as their needs are complex. Implications: Future research incorporating other variables such as employment status, past trauma, extent of disability, financial burden, quality of life and clinical symptoms experienced may shed more light on mood disorders for this complex patient group. A research application has been submitted through St Vincent’s Health to investigate the use of the above mentioned variables and patient engagement with local service providers for managing their emotional
needs. If funding is approved, further research as discussed above will commence in February 2015. Keywords: Polio; Depression; Anxiety Funding acknowledgements: Nil. Ethics approval: Approval by the Quality Assurance SubCommittee, St Vincent’s Hospital, Melbourne. http://dx.doi.org/10.1016/j.physio.2015.03.200 Special Interest Report Poster Presentation Number: SI-PO-18-19-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 SPECIALTIES IN PHYSICAL THERAPY, ENSURING THE PROFESSIONAL LEGITIMACY IN DENMARK B.A.S. Andersen University College Capital, Department of Physiotherapy, Hillerød, Denmark Background: The Danish Society of Physical Therapy (DSPT) was established in 2013 with the purpose of providing a common forum that stimulates the cooperation and coordination between all specialties and groups within Physical Therapy (PT) in Denmark. The aim was also to draw a clear profile of these groups within the community, partners and cross-functional team works. Furthermore the stimulation of research in PT in Denmark and creating an optimal cooperation concerning evidence based physiotherapy practice were a chief aim. In this way Denmark is showing a clear distinction between on one side politics and on the other side professional competency in Danish PT. Specialties in PT have existed since 2000 with the vision of systematically developing the clinical competence with the integration of both practical and theoretical knowledge. 9 specialties were established within: Musculoskeletal, Sports, Neurology, Pediatrics, Geriatrics, Mental Health, Rehabilitation, Cardiorespiratory, Occupational Health and Ergonomics. These specialties have a PT society within DSPT, except Rehabilitation. With the establishment of DSPT the first mission to carry out was to revise the specialties. The challenge about Specialties in PT has been that is has not been accepted or recognized by the Health Authority in DK. Anyway PTs in DK have continued educating and developing their competences within the associated societies. Purpose: To define and implement new PT specialities in DK. Methods: The work was started-up at a meeting including all societies. External collaborators were invited to contribute to the debate, amongst others Emma Stokes, who incited DSPT to submit an abstract about the process for WCPT, Singapore 2015 in order to facilitate the international debate about specialisations in PT. A committee was elected representing a wide range of the societies within DSPT. The