Judgmental criteria by physical therapists for the patients receiving allogeneic hematopoietic stem cell transplantation in Japan

WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237

torque on the gleno-humeral joint in any shoulder at any degree of elevation on the scapular plane. Conclusion(s): The maximum (2.94 Nm) adduction torque on the glenohumeral joint set in this study is a value equivalent to the abduction torque which supports the whole upper limbs at a 30◦ angle with no applied load. During elevation in the scapular plane of −10 to 30◦ , the tensile force on the supraspinatus tendon which balances the adduction torque applied to the joint increased. A large moment arm of the supraspinatus tendon on the humeral head at −10 to 0◦ elevation reduces tensile force of the supraspinatus tendon, on the other hand, decreased moment arm of the supraspinatus tendon during elevation of 10 to 30◦ increased the tensile force. Moreover, adaptation of the supraspinatus tendon by upward force of the humeral head during −0 to 0◦ elevation might increase the strain of the superficial fibers. Implications: The surface layer of the supraspinatus tendon is more elongated during elevation from −10 to 0◦ , but at 10◦ or more of scapular plane elevation there was no elongation. It is appears that care must be taken isometric elevation at −10 or 0◦ as the possibility of tear in the surface layer of rotator cuff due to increased strain on the tendon. Keywords: Supraspinatus tendon 2; Tendon strain; Cadaver Funding acknowledgements: The authors thank Fujimiya M, Suzuki D, Chikenji T, Shirato R, Takata Y, Osanami Y, and Saito Y. Ethics approval: We were approved by the institutional research ethics committee in Sapporo Medical University. http://dx.doi.org/10.1016/j.physio.2015.03.1882 Research Report Poster Presentation Number: RR-PO-14-19-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 JUDGMENTAL CRITERIA BY PHYSICAL THERAPISTS FOR THE PATIENTS RECEIVING ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN JAPAN D. Miyamura 1 , J. Yaeda 2 , M. Himejima 1 , M. Ashizawa 3 , J. Kanda 3 , S. Kako 3 , Y. Kanda 3 , A. Daikoku 1 1 Saitama

Medical Center, Jichi Medical University, Department of Rehabilitation, Saitama, Japan; 2 University of Tsukuba, Graduate School of Comprehensive Human Sciences, Tokyo, Japan; 3 Saitama Medical Center, Jichi Medical University, Division of Hematology, Saitama, Japan Background: In the process of rehabilitation for allogeneic hematopoietic stem cell transplantation (allo-HSCT), physical therapists often face a difficult judgment when

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intervening with patients with painful conditions due to the regimen related toxicity and graft-versus-host disease. However, limited studies are available identifying the judgmental criteria as to when they are to intervene their professional practice as physical therapists. Purpose: The purpose of the study was to investigate the judgmental criteria by physical therapists for the patient receiving the allo-HSCT in Japan. Methods: Sixty-five hospitals where physical therapists have published relevant journal articles or made relevant conference presentations regarding allo-HSCT in the last 10 years, were selected as the sample. First, a preliminary investigation was conducted with the responsible physical therapists in 65 hospitals, asking their demographic information of the hospitals, physical therapeutic practice, how they have gained the professional knowledge about allo-HSCT, whether they feel anxious about making necessary judgment, and how they would provide specific treatment for the particular patients with allo-HSCT. Based on the preliminary investigation, the main questionnaire was developed by a medical doctor, 2 nurses, 2 physical therapists, and a clinical psychologist in a hospital where the present author works. The second mail survey was conducted with the same 65 hospitals asking whether they would agree on the statement of the judgmental criteria for allo-HSCT. An open-ended question was provided, asking the reasons of disagreement. Only the consensual items were retained as the final judgmental criteria. Results: The response rate of first survey was 75% (49 hospitals) while that of the primary survey was 61.5% (40 hospitals). Fifteen judgmental criteria for allo-HSCT were obtained. Finally, 13 items were selected for the main questionnaire by a multidisciplinary of a medical doctor, 2 nurses, 2 physical therapists, and a clinical psychologist. The final consensual items included the 5 criteria, namely anemia, vomiting, pain, leg numbness, and mental condition. (ex. #1 Anemia: Rehabilitation can be performed in a patient with anemia. However, it should be canceled when anemia progresses rapidly or a patient has unstable vital signs or has symptoms such as dizziness or headache due to anemia.). Although agreement on the other 8 items, including fever, thrombopenia, leukopenia, diarrhea, tachycardia, respiratory condition, nutriture, and use of corticosteroid was not obtained, at least 70% of hospitals agreed with them. Conclusion(s): These 5 judgmental criteria are frequently used by the physical therapists and other medical practitioners. However, the validity of these criteria should be evaluated in further study. Implications: Those 5 judgmental criteria and other criteria that were not agreed need a further study investigating the applicability and practical validity with other countries. Keywords: Allogeneic hematopoietic stem cell transplantation; Judgmental criteria; Physical therapy Funding acknowledgements: Nothing.

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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237

Ethics approval: This study is registered with the Ethics Committee of Saitama medical center Jichi Medical University (14-26). http://dx.doi.org/10.1016/j.physio.2015.03.1883 Research Report Poster Presentation Number: RR-PO-07-04-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 RELATIONSHIP BETWEEN TOE PRESSURE FORCE AND WINDLASS MECHANISM IN NORMAL AND REDUCED TOE FUNCTION CASES H. Miyazawa 1 , H. Yanagita 2 , M. Edo 3 , A. Takahashi 1 , Y. Ishida 3 1 Kamakura

Rehabilitation St. Therese’s Hospital, Rehabilitation, Kamakura, Japan; 2 Takashimadaira Chuo General Hospital, Rehabilitation, Itabasi, Japan; 3 Bunkyo Gakuin University, Physical Therapy, Fujimino, Japan Background: Toe function provides a stable standing position and high performance movement, as reduction in toe function leads to foot instability. For this stabilization, tension of the foot sole aponeurosis called as windlass mechanism may serve in addition of contractile activity of foot intrinsic muscles. Purpose: This study was aimed to clarify the relationship between the toe pressure force and the windlass mechanism in the normal or reduced foot function. Methods: Subjects were 26 healthy people (17 men and 9 women, age 21.9 ± 2.1, body mass 60.7 ± 8.9 kg), giving 52 feet. Using manual muscle meter (Mobie, Sakai Medical, Japan), toe pressure forces were measured at three metatarsophalangeal (MP) joint extension degrees of 0, 20 and 40. Using three-dimensional motion analysis system (VICONNEXUS, Vicon motion systems, UK), MP joint extension angle and medial longitudinal arch (MLA) angle were measured during the task of repetitive passive movements of MP joint with a load of 10% body mass. The index of windlass mechanism during the task performance was estimated with the linear regression coefficient between MP joint extension and MLA angles, defined as the windlass ratio (WR, MP joint extension angle/MLA angle). Statistical analysis: one-way analysis of variance, Tukey HSD test and the product-moment correlation coefficient of Pearson (significant at p < 0.05). Results: Subjects were divided into two groups of the increased pressure with increased extension (normal toe function group, 34 feet) and another group with no increase in the pressure (abnormal group, 18 feet). In normal group, toe pressure forces were 11.3 ± 3.9, 14.9 ± 5.3 and 17.3 ± 5.9 kg at MP joint extension of 0, 20 and 40 degrees in order, and the WR during the task performance was 9.8 ± 3.3. In the abnormal group, toe forces were 12.7 ± 5.2, 13.0 ± 6.0 and

13.0 ± 5.5 kg at the extension of 0, 20 and 40 degrees, and the WR during the task was 10.3 ± 3.2. When performed the task, the toe force in normal group did not have a significant relation between WR and MP extension angle. While, significant relations between them were observed in the abnormal group with r values of 0.51, 0.45 (p = 0.06) and 0.51 at MP extension 0, 20 and 40 degrees. Conclusion(s): The WR represents the magnitude of MP joint extension required for arch elevation. Larger WR means lower windlass efficiency. Present results reveal that, in the abnormal toe function group, but not in normal, toe movements with the large force require the high WR, suggesting the low windlass efficiency for producing the toe extension pressure. Presumably, the stability of the toe function is reduced in the abnormal group. Windlass mechanism is dependent on the passive tension of foot sole aponeurosis, and the toe pressure force is produced by foot intrinsic muscles. When windlass mechanism is not capable of providing the sufficient stability as observed in the abnormal group, foot intrinsic muscles may raise the activity for compensating the foot stability. Implications: For the assessment of foot intrinsic muscles the windlass mechanism should be considered especially in the case of reduced toe function. Keywords: Toe function; Windlass mechanism; Toe pressure force Funding acknowledgements: Not applicable. Ethics approval: This study was approved by the research ethical committee of the Bunkyo Gakuin University. http://dx.doi.org/10.1016/j.physio.2015.03.1884