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Reliability of the Ten-metre Shuttle Walking Test in Patients with Intermittent Claudication
56
Conclusion The use of mechanically applied stretch to treat joint contractures can lead to improvements in range of motion. However, further research is needed to identify
Comparison of Standard Care Against Rehabilitation in Steroid Treatment for Multilple Sclerosis Relapse J Craig, M Boggild, G Baker, C A Young MS Team, The Walton Centre, Liverpool M Lloyd, E Thornton University of Liverpool Introduction There is evidence to support the use of intravenous methylprednisolone (IVMP) in multiple sclerosis (MS) relapse and, among others, a study by Wiles et al (2001) showed benefit of physiotherapy in the management of MS, but no studies have investigated the combination of steroids and rehabilitation together. Therapists feel steroids, given in conjunction with rehabilitation, will improve functional outcome. The aim of this study was to evaluate the benefits of IVMP with planned, comprehensive care compared to IVMP with standard care, in relation to disability and quality of life. Method Patients confirmed to have had a definite relapse of their MS severe enough to warrant IVMP (1 g intravenously daily for three days) were randomised after informed consent. Baseline assessments were carried out on both groups before IVMP began. The control group was managed according to the standard ward routine, the treatment group received planned, co-ordinated multidisciplinary team assessment and treatment, then follow-up after discharge as appropriate. Measures were repeated at one month and three months. Outcome measures used were Guy’s Neurological Disability Scale (GNDS), Amended Motor Club Assessment (AMCA),
Reliability of the Ten-metre Shuttle Walking Test in Patients with Intermittent Claudication C Rowe School of Health Sciences, University of Birmingham Introduction Exercise tests are widely used to assess disability in patients with intermittent claudication. However these tests are not ideal: treadmill walking is a particularly unfamiliar activity and potentially intimidatating test, and field walking tests lack standardisation. Physiotherapy January 2002/vol 88/no 1
which patients improve most, and how this equates to functional outcome.
Barthel Index (BI), Human Activity Profile (HAP) and Rand 36-item Short Form Health Survey (SF-36). Results Forty-one patients (F = 27) were recruited. One control patient dropped out after baseline assessment. There was no significant difference between the two groups in level of disability at baseline. The primary measures were the AMCA and GNDS. Treatment Mean SD
Control Mean SD
AMCA Baseline
56.05
15.42
47.75
13.81
One month
67.5
10.34
57.65
12.67
GNDS Baeline
21.5
7.13
21.5
7.22
One month
14.05
6.95
18.5
8.19
The secondary measures showed similar changes in mean scores. Conclusion: These results are preliminary. Full analysis, including 3-month data, is proceeding. The results are encouraging as they show a greater improvement in function in the treatment group, indicating therapy to be advantageous to patients in relapse. Wiles, C M, Newcombe, R G, Fuller, K J, Shaw, S, Furnival-Doran, J, Pickersgill, T P and Morgan, A (2001). ‘Controlled randomisation crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis’, Journal of Neurology, Neurosurgery and Psychiatry, 70, 2, 174-179.
The development of a shuttle walking test (SWT) of disability in patients with chronic obstructive pulmonary disease goes some way to overcoming these problems. The purpose of this study was to examine the reliability of the SWT in patients with intermittent claudication. Method A convenience sample of 12 male patients was recruited from a vascular outpatient clinic. Patients performed the 10-metre incremental SWT in accordance with the protocol on three occasions at weekly intervals. The end point of the test was symptom limited, requiring the patients to walk until the onset of maximal claudication pain. Before each test the ankle/brachial pressure index
Abstracts
57
(ABPI) was measured using a Doppler flow meter. The data were analysed using the Wilcoxon signed rank test and Spearman rank correlation coefficient.
SWT 1 r = 0.57, SWT 2 r = 0.67 and SWT 3 r = 0.51. indicating that disability cannot be strongly predicted from haemodynamic measurements alone.
Results The mean distance walked in each of the tests was 296, 311 and 308 metres respectively. A significant difference in performance between SWT 1 and 2 (z = –0.508, p = 0.012) was identified but not between SWT 2 and 3 (z = –0.723, p = 0.47), suggesting a small learning effect. A modest correlation was found between the maximal claudication distance and resting ABPI values for each SWT:
Conclusion: The findings of this small-scale study support the existing evidence that assessment of disability in patients with intermittent claudication cannot be predicted from physiological measurements alone, therefore direct measurements of disability are required. It has been shown that the results of the SWT, after one practice test, are relatively stable in patients with intermittent claudication and this is worthy of further investigation.
Binding CSP Periodicals A complete year’s issues for 2001 of both Physiotherapy and Physiotherapy Frontline can be bound in cloth covers with the title, volume number and badge blocked in black on the spine and front cover. The price for 12 issues of Physiotherapy will be £23.50 (inclusive of return UK postage, packing and insurance). Back numbers can be bound in the same way for £26.50, or without badge or lettering for £21.50. The price for the 23 issues of Frontline will be £25.50. Please send a complete set of issues with a postal order or cheque payable to ‘J R Harris’, for the full amount, to J R Harris, Bookbinder, 191 Sandpit Lane, St Albans, Herts AL4 OBT (tel 01727 846606). Please ensure they arrive by March 31, 2002. Please write your name and address, in pencil, on the title page of each issue, and please pack parcels carefully as we have received several parcels broken open and re-packed in GPO plastic bags, some with issues missing. It is regretted that Mr Harris cannot supply missing issues. Orders cannot be accepted unless they are pre-paid. If you do not receive your bound copies by the end of April, please contact J R Harris immediately.
Physiotherapy January 2002/vol 88/no 1
Conclusion The use of mechanically applied stretch to treat joint contractures can lead to improvements in range of motion. However, further research is needed to identify
Comparison of Standard Care Against Rehabilitation in Steroid Treatment for Multilple Sclerosis Relapse J Craig, M Boggild, G Baker, C A Young MS Team, The Walton Centre, Liverpool M Lloyd, E Thornton University of Liverpool Introduction There is evidence to support the use of intravenous methylprednisolone (IVMP) in multiple sclerosis (MS) relapse and, among others, a study by Wiles et al (2001) showed benefit of physiotherapy in the management of MS, but no studies have investigated the combination of steroids and rehabilitation together. Therapists feel steroids, given in conjunction with rehabilitation, will improve functional outcome. The aim of this study was to evaluate the benefits of IVMP with planned, comprehensive care compared to IVMP with standard care, in relation to disability and quality of life. Method Patients confirmed to have had a definite relapse of their MS severe enough to warrant IVMP (1 g intravenously daily for three days) were randomised after informed consent. Baseline assessments were carried out on both groups before IVMP began. The control group was managed according to the standard ward routine, the treatment group received planned, co-ordinated multidisciplinary team assessment and treatment, then follow-up after discharge as appropriate. Measures were repeated at one month and three months. Outcome measures used were Guy’s Neurological Disability Scale (GNDS), Amended Motor Club Assessment (AMCA),
Reliability of the Ten-metre Shuttle Walking Test in Patients with Intermittent Claudication C Rowe School of Health Sciences, University of Birmingham Introduction Exercise tests are widely used to assess disability in patients with intermittent claudication. However these tests are not ideal: treadmill walking is a particularly unfamiliar activity and potentially intimidatating test, and field walking tests lack standardisation. Physiotherapy January 2002/vol 88/no 1
which patients improve most, and how this equates to functional outcome.
Barthel Index (BI), Human Activity Profile (HAP) and Rand 36-item Short Form Health Survey (SF-36). Results Forty-one patients (F = 27) were recruited. One control patient dropped out after baseline assessment. There was no significant difference between the two groups in level of disability at baseline. The primary measures were the AMCA and GNDS. Treatment Mean SD
Control Mean SD
AMCA Baseline
56.05
15.42
47.75
13.81
One month
67.5
10.34
57.65
12.67
GNDS Baeline
21.5
7.13
21.5
7.22
One month
14.05
6.95
18.5
8.19
The secondary measures showed similar changes in mean scores. Conclusion: These results are preliminary. Full analysis, including 3-month data, is proceeding. The results are encouraging as they show a greater improvement in function in the treatment group, indicating therapy to be advantageous to patients in relapse. Wiles, C M, Newcombe, R G, Fuller, K J, Shaw, S, Furnival-Doran, J, Pickersgill, T P and Morgan, A (2001). ‘Controlled randomisation crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis’, Journal of Neurology, Neurosurgery and Psychiatry, 70, 2, 174-179.
The development of a shuttle walking test (SWT) of disability in patients with chronic obstructive pulmonary disease goes some way to overcoming these problems. The purpose of this study was to examine the reliability of the SWT in patients with intermittent claudication. Method A convenience sample of 12 male patients was recruited from a vascular outpatient clinic. Patients performed the 10-metre incremental SWT in accordance with the protocol on three occasions at weekly intervals. The end point of the test was symptom limited, requiring the patients to walk until the onset of maximal claudication pain. Before each test the ankle/brachial pressure index
Abstracts
57
(ABPI) was measured using a Doppler flow meter. The data were analysed using the Wilcoxon signed rank test and Spearman rank correlation coefficient.
SWT 1 r = 0.57, SWT 2 r = 0.67 and SWT 3 r = 0.51. indicating that disability cannot be strongly predicted from haemodynamic measurements alone.
Results The mean distance walked in each of the tests was 296, 311 and 308 metres respectively. A significant difference in performance between SWT 1 and 2 (z = –0.508, p = 0.012) was identified but not between SWT 2 and 3 (z = –0.723, p = 0.47), suggesting a small learning effect. A modest correlation was found between the maximal claudication distance and resting ABPI values for each SWT:
Conclusion: The findings of this small-scale study support the existing evidence that assessment of disability in patients with intermittent claudication cannot be predicted from physiological measurements alone, therefore direct measurements of disability are required. It has been shown that the results of the SWT, after one practice test, are relatively stable in patients with intermittent claudication and this is worthy of further investigation.
Binding CSP Periodicals A complete year’s issues for 2001 of both Physiotherapy and Physiotherapy Frontline can be bound in cloth covers with the title, volume number and badge blocked in black on the spine and front cover. The price for 12 issues of Physiotherapy will be £23.50 (inclusive of return UK postage, packing and insurance). Back numbers can be bound in the same way for £26.50, or without badge or lettering for £21.50. The price for the 23 issues of Frontline will be £25.50. Please send a complete set of issues with a postal order or cheque payable to ‘J R Harris’, for the full amount, to J R Harris, Bookbinder, 191 Sandpit Lane, St Albans, Herts AL4 OBT (tel 01727 846606). Please ensure they arrive by March 31, 2002. Please write your name and address, in pencil, on the title page of each issue, and please pack parcels carefully as we have received several parcels broken open and re-packed in GPO plastic bags, some with issues missing. It is regretted that Mr Harris cannot supply missing issues. Orders cannot be accepted unless they are pre-paid. If you do not receive your bound copies by the end of April, please contact J R Harris immediately.
Physiotherapy January 2002/vol 88/no 1