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Does intensive sit-to-stand training in addition to usual care improve sit-to-stand ability in people who are unable to stand up independently after stroke? A multi-centre randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Thirty patients from two Sydney hospitals, < 3 months after stroke, with a mean Modified Rankin Scale score of 4 points (SD 0.5). All participants received usual care. Participants in the experimental group attended two additional sessions of physiotherapy per day for 2 weeks. These sessions were individualised to the needs of each participant in order to increase the amount and intensity of sit-to-stand training. Outcome measures were taken at baseline and at 2 weeks. The primary outcome was clinicians' impressions of sit-to-stand change, measured using videos and a 15-point Global Impressions of Change Scale. Secondary outcomes were sit-to-stand ability, composite strength of key muscles of the affected lower limb, gross lower limb extension strength, the Goal Attainment Scale, and ranking of change in ability to move from sitting to standing. All participants completed the trial. The mean between-group difference for clinicians' impressions of sit-to-stand change was 1.57/15 points (95% CI 0.02 to 3.11). The secondary outcomes that indicated a treatment effect were gross lower limb extension strength and ranking of change in ability to move from sitting to standing, with mean between-group differences of 6.2 deg (95% CI 0.5 to 11.8) and −7 (95% CI −1 to −13), respectively. Two weeks of intensive sit-to-stand training in addition to usual care improves sit-to-stand ability in people who are unable to stand up independently after stroke. ANZCTR 12616001288415. [ABSTRACT FROM AUTHOR]

Abstract Questions Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? Design Systematic review of randomised trials with meta-analysis. Participants Adults who have had a stroke. Intervention Any intervention involving repetitive practice compared with no intervention or a sham intervention. Outcome measures The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. Results Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2 = 44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2 = 50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2 = 36%) in favour of repetitive practice on lower limb activity. Conclusion Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. Review registration PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210–221] [ABSTRACT FROM AUTHOR]

Question What is the effect of adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy in people with sub-acute tetraplegia? Design A parallel group, randomised, controlled trial. Participants were randomly assigned (1:1) via a computer-generated concealed block randomisation procedure to either a control or experimental intervention. Participants Seventy people with C2 to T1 motor complete or incomplete tetraplegia within 6 months of injury. Participants were recruited from seven spinal units in Australia and New Zealand. Intervention Experimental participants received intensive training for one hand. Intensive training consisted of training with an instrumented exercise workstation in conjunction with functional electrical stimulation for 1 hour per day, 5 days per week for 8 weeks. Both groups received usual care and 15 minutes of one-to-one hand therapy three times per week without functional electrical stimulation. Outcome measures The primary outcome was the modified Action Research Arm Test reflecting arm and hand function, which was assessed at the end of the intervention, that is, 11 weeks after randomisation. Secondary outcomes were measured at 11 and 26 weeks. Results Sixty-six (94%) participants completed the post-intervention assessment and were included in the primary intention-to-treat analysis. The mean (SD) modified Action Research Arm Test score for experimental and control participants at the post-intervention assessment was 36.5 points (SD 16.0) and 33.2 points (SD 17.5), respectively, with an adjusted mean between-group difference of 0.9 points (95% CI –4.1 to 5.9). Conclusion Adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy does not improve hand function in people with sub-acute tetraplegia. Registration Australian and New Zealand Trial Registry ACTRN12609000695202 and ClinicalTrials.gov NCT01086930. [Harvey LA, Dunlop SA, Churilov L, Galea MP, Spinal Cord Injury Physical Activity (SCIPA) Hands On Trial Collaborators (2017) Early intensive hand rehabilitation is not more effective than usual care plus one-to-one hand therapy in people with sub-acute spinal cord injury (‘Hands On’): a randomised trial. Journal of Physiotherapy 63: 197–204] [ABSTRACT FROM AUTHOR]

Question Do people with musculoskeletal conditions better adhere to their home exercise programs when these are provided to them on an app with remote support compared to paper handouts? Design Randomised, parallel-group trial with intention-to-treat analysis. Participants Eighty participants with upper or lower limb musculoskeletal conditions were recruited to the trial. Each participant was prescribed a 4-week home exercise program by a physiotherapist at a tertiary teaching hospital in Australia. Participants were randomly assigned via a computer-generated concealed block randomisation procedure to either intervention (n = 40) or control (n = 40) groups. Intervention Participants in the intervention group received their home exercise programs on an app linked to the freely available website www.physiotherapyexercises.com . They also received supplementary phone calls and motivational text messages. Participants in the control group received their home exercise programs as a paper handout. Outcome measures Blinded assessors collected outcome measures at baseline and 4 weeks. The primary outcome was self-reported exercise adherence. There were five secondary outcomes, which captured functional performance, disability, patient satisfaction, perceptions of treatment effectiveness, and different aspects of adherence. Results Outcomes were available on 77 participants. The mean between-group difference for self-reported exercise adherence at 4 weeks was 1.3/11 points (95% CI 0.2 to 2.3), favouring the intervention group. The mean between-group difference for function was 0.9/11 points (95% CI 0.1 to 1.7) on the Patient-Specific Functional Scale, also favouring the intervention group. There were no significant between-group differences for the remaining outcomes. Conclusion People with musculoskeletal conditions adhere better to their home exercise programs when the programs are provided on an app with remote support compared to paper handouts; however, the clinical importance of this added adherence is unclear. Trial registration ACTRN12616000066482. [Lambert TE, Harvey LA, Avdalis C, Chen LW, Jeyalingam S, Pratt CA, Tatum HJ, Bowden JL, Lucas BR (2017) An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy 63: 161–167] [ABSTRACT FROM AUTHOR]

Question Is stretch effective for the treatment and prevention of contractures in people with neurological and non-neurological conditions? Design A Cochrane Systematic Review with meta-analyses of randomised trials. Participants People with or at risk of contractures. Intervention Trials were considered for inclusion if they compared stretch to no stretch, or stretch plus co-intervention to co-intervention only. The stretch could be administered in any way. Outcome measures The outcome of interest was joint mobility. Two sets of meta-analyses were conducted with a random-effects model: one for people with neurological conditions and the other for people with non-neurological conditions. The quality of evidence supporting the results of the two sets of meta-analyses was assessed using GRADE. Results Eighteen studies involving 549 participants examined the effectiveness of stretch in people with neurological conditions, and provided useable data. The pooled mean difference was 2 deg (95% CI 0 to 3) favouring stretch. This was equivalent to a relative change of 2% (95% CI 0 to 3). Eighteen studies involving 865 participants examined the effectiveness of stretch in people with non-neurological conditions, and provided useable data. The pooled standardised mean difference was 0.2 SD (95% CI 0 to 0.3) favouring stretch. This translated to an absolute mean increase of 1 deg (95% CI 0 to 2) and a relative change of 1% (95% CI 0 to 2). The GRADE level of evidence was high for both sets of meta-analyses. Conclusion Stretch does not have clinically important effects on joint mobility. [Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K (2017) Stretch for the treatment and prevention of contracture: an abridged republication of a Cochrane Systematic Review. Journal of Physiotherapy 63: 67–75] [ABSTRACT FROM AUTHOR]

Traumatic spinal cord injury (SCI) may result in tetraplegia (motor and/or sensory nervous system impairment of the arms, trunk and legs) or paraplegia (motor and/or sensory impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: ≥30min of moderate aerobic exercise on ≥5d/week or ≥20min of vigorous aerobic ≥3d/week; strength training on ≥2d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2d/week flexibility training, including shoulder internal and external rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain. [ABSTRACT FROM AUTHOR]

Question: Does 4 weeks of active functional electrical stimulation (FES) cycling in addition to usual care improve mobility and strength more than usual care alone in people with a sub-acute acquired brain injury caused by stroke or trauma? Design: Multi centre, randomised, controlled trial. Participants: Forty patients from three Sydney hospitals with recently acquired brain injury and a mean composite strength score in the affected lower limb of 7 (SD 5) out of 20 points. Intervention: Participants in the experimental group received an incremental, progressive, FES cycling program five times a week over a 4-week period. All participants received usual care. Outcome measures: Outcome measures were taken at baseline and at 4 weeks. Primary outcomes were mobility and strength of the knee extensors of the affected lower limb. Mobility was measured with three mobility items of the Functional Independence Measure and strength was measured with a hand-held dynamometer. Secondary outcomes were strength of the knee extensors of the unaffected lower limb, strength of key muscles of the affected lower limb and spasticity of the affected plantar flexors. Results: All but one participant completed the study. The mean between-group differences for mobility and strength of the knee extensors of the affected lower limb were –0.3/21 points (95% CI –3.2 to 2.7) and 7.5 Nm (95% CI –5.1 to 20.2), where positive values favoured the experimental group. The only secondary outcome that suggested a possible treatment effect was strength of key muscles of the affected lower limb with a mean between-group difference of 3.0/20 points (95% CI 1.3 to 4.8). Conclusion: Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear. Trial registration: ACTRN12612001163897. [de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W (2016) Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised controlled trial. Journal of Physiotherapy 62: 203–208] [ABSTRACT FROM AUTHOR]

Introduction Patients with acquired brain impairments require intensive, task-specific training to maximise upper limb recovery. Current evidence suggests, however, that they rarely achieve this. The purpose of this study was to describe the amount of practice that can be achieved by patients with acquired brain impairment during intensive upper limb treatment within a public hospital, and to examine the strategies used by therapists to maximise practice. Method A secondary analysis was conducted using data from a previously published randomised trial. The training received by 20 people with acquired brain impairment over the 6-week trial period was recorded. The strategies used by therapists to maximise practice were also noted. Results Over the 6-week period, 45 hours of upper limb training was provided. The median (interquartile range) amount of actual practice achieved by patients was 59 (54–63) minutes per day, with a median (interquartile range) of 186 (50–330) repetitions of active movement. Patients’ practice was maximised through the use of task-specific feedback, practice books, counters, environmental cues and stopwatches. In addition, therapists provided coaching as well as ensuring tasks were goal-oriented, measurable and patient-driven. Conclusion Described strategies enabled patients with acquired brain impairment to practise upper limb tasks at intensities greater than currently reported in the literature. [ABSTRACT FROM AUTHOR]

Question: What is the effect of adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy in people with sub-acute tetraplegia? Design: A parallel group, randomised, controlled trial. Participants were randomly assigned (1:1) via a computer-generated concealed block randomisation procedure to either a control or experimental intervention. Participants: Seventy people with C2 to T1 motor complete or incomplete tetraplegia within 6 months of injury. Participants were recruited from seven spinal units in Australia and New Zealand. Intervention: Experimental participants received intensive training for one hand. Intensive training consisted of training with an instrumented exercise workstation in conjunction with functional electrical stimulation for 1 hour per day, 5 days per week for 8 weeks. Both groups received usual care and 15 minutes of one-to-one hand therapy three times per week without functional electrical stimulation. Outcome measures: The primary outcome was the modified Action Research Arm Test reflecting arm and hand function, which was assessed at the end of the intervention, that is, 11 weeks after randomisation. Secondary outcomes were measured at 11 and 26 weeks. Results: Sixty-six (94%) participants completed the post-intervention assessment and were included in the primary intention-to-treat analysis. The mean modified Action Research Arm Test score for experimental and control participants at the post-intervention assessment was 36.5 points (SD 16.0) and 33.2 points (SD 17.5), respectively, with an adjusted mean between-group difference of 0.9 points (95% CI - 4.1 to 5.9). Conclusion: Adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy does not improve hand function in people with sub-acute tetraplegia. [ABSTRACT FROM AUTHOR]

Question: Does a massive open online course (MOOC) based around an online learning module about spinal cord injuries improve knowledge or confidence among physiotherapy students more than if physiotherapy students are left to work through the online learning module at their own pace. Which method of presenting the content leads to greater satisfaction among the students? Study design: Randomised controlled trial with concealed allocation and intention-to-treat analysis. Participants: Forty-eight physiotherapy students in Bangladesh. Intervention: Participants randomised to the control group were instructed to work at their own pace over a 5-week period through a physiotherapy-specific online learning module available at www.elearnSCI.org . Experimental participants were enrolled in a 5-week MOOC. The MOOC involved completing the same online learning module but experimental participants’ progress through the module was guided each week and they were provided with the opportunity to engage in online discussion through Facebook. Outcome measures: The primary outcome was knowledge, and the secondary outcomes were perceived confidence to treat people with spinal cord injuries and satisfaction with the learning experience. Results: The mean between-group difference for knowledge was 0.7 points (95% CI –1.3 to 2.6) on a 0 to 20-point scale. The equivalent results for perceived confidence and satisfaction with the learning experience were 0.4 points (95% CI –1.0 to 1.8) and 0.0 points (95% CI –1.1 to 1.2) on a 0 to 10-point scale. Conclusion: The MOOC was no better for students than working at their own pace through an online learning module for increasing knowledge, confidence or satisfaction. However, students in the MOOC group highlighted positive aspects of the course that were unique to their group, such as interacting with students from other countries through the MOOC Facebook group. Trial registration: ACTRN12614000422628. [Hossain MS, Islam MS, Glinsky JV, Lowe R, Lowe T, Harvey LA (2015) A massive open online course (MOOC) can be used to teach physiotherapy students about spinal cord injuries: a randomised trial. Journal of Physiotherapy 61: 21–27] [ABSTRACT FROM AUTHOR]

Question: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? Design: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. Intervention: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. Outcome measures: The primary outcome was passive ankle dorsiflexion with a 12 Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9 Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. Outcomemeasures were taken at baseline (Week 0), end of intervention (Week 6), and follow-up (Week 10). Results: The mean between-group differences (95% CI) for passive ankle dorsiflexion at Week 6 and Week 10 were –3 degrees (–8 to 2) and –1 degrees (–6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists’ perceived treatment credibility. Conclusion: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. [ABSTRACT FROM AUTHOR]

Question: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? Design: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. Intervention: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. Outcome measures: The primary outcome was passive ankle dorsiflexion with a 12 Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9 Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. Outcome measures were taken at baseline (Week 0), end of intervention (Week 6), and follow-up (Week 10). Results: The mean between-group differences (95% CI) for passive ankle dorsiflexion at Week 6 and Week 10 were –3 degrees (–8 to 2) and –1 degrees (–6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists’ perceived treatment credibility. Conclusion: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. Trial registration: ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014) Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial. Journal of Physiotherapy 60: 201–208] [ABSTRACT FROM AUTHOR]

Question: Does functional electrical stimulation (FES) cycling increase urine output and decrease lower limb swelling and spasticity in people with recent spinal cord injury? Design: Randomised cross-over trial. Participants: Fourteen participants with a recent motor complete spinal cord injury were consecutively recruited from two spinal cord injury units in Sydney. Intervention: Participants were randomised to an experimental phase followed by a control phase or vice versa, with a 1-week washout period in between. The experimental phase involved FES cycling four times a week for two weeks and the control phase involved standard rehabilitation for two weeks. Assessments by a blinded assessor occurred at the beginning and end of each phase. Allocation was concealed and an intention-to-treat analysis was performed. Outcome measures: The primary outcome was urine output (mL/hr) and the secondary outcomes were lower limb circumference, and spasticity using the Ashworth Scale, and the Patient Reported Impact of Spasticity Measure (PRISM). In addition, participants were asked open-ended questions to explore their perceptions about treatment effectiveness. Results: All participants completed the study. The mean between-group difference (95% CI) for urine output was 82mL/hr (–35 to 199). The mean between-group differences (95% CI) for lower limb swelling, spasticity (Ashworth), and PRISM were –0.1cm (–1.5 to 1.2), –1.9 points (–4.9 to 1.2) and –5 points (–13 to 2), respectively. All point estimates of treatment effects favoured FES cycling. Participants reported many benefits from FES cycling. Conclusion: There were no clear effects of FES cycling on urine output, swelling and spasticity even though all point estimates of treatment effects favoured FES cycling and participants perceived therapeutic effects. Trial registration: ACTRN12611000923965. [ABSTRACT FROM AUTHOR]

QUESTIONS: What is the incidence of recovery of ambulation and upper limb function six months after stroke? Can measures such as age and the National Institutes of Health Stroke Scale (NIHSS) be used to develop models to predict the recovery of ambulation and upper limb function? DESIGN: Prospective cohort study. PARTICIPANTS: Consecutive sample of 200 people with stroke admitted to a Sydney Hospital. OUTCOME MEASURES: Ambulation was measured with item 5 of the Motor Assessment Scale (MAS); patients scoring >=3 could ambulate independently. Upper limb function was measured with items 7 and 8 of the MAS; patients scoring >=5 could move a cup across the table and feed themselves with a spoonful of liquid with the hemiplegic arm. RESULTS: Of the 114 stroke survivors who were unable to ambulate initially, 80 (70%) achieved independent ambulation at six months. Of the 51 stroke survivors who could not move a cup across the table initially, 21 (41%) achieved the upper limb task at six months. Of the 56 stroke survivors who were unable to feed themselves initially, 25 (45%) could feed themselves at six months. Models containing age and severity of stroke (measured with NIHSS) predicted recovery of ambulation and ability to move a cup across the table, whilst a model containing severity of stroke predicted ability to feed oneself. All prediction models showed good discrimination (AUC 0.73 to 0.84). CONCLUSION: More than two-thirds of people after stroke recovered independent ambulation and less than half recovered upper limb function at six months. Models using age and NIHSS can predict independent ambulation and upper limb function but these prediction models now require external validation before use in clinical practice. [ABSTRACT FROM AUTHOR]

Questions: What is the incidence of recovery of ambulation and upper limb function six months after stroke? Can measures such as age and the National Institutes of Health Stroke Scale (NIHSS) be used to develop models to predict the recovery of ambulation and upper limb function? Design: Prospective cohort study. Participants: Consecutive sample of 200 people with stroke admitted to a Sydney Hospital. Outcome measures: Ambulation was measured with item 5 of the Motor Assessment Scale (MAS); patients scoring ≥3 could ambulate independently. Upper limb function was measured with items 7 and 8 of the MAS; patients scoring ≥5 could move a cup across the table and feed themselves with a spoonful of liquid with the hemiplegic arm. Results: Of the 114 stroke survivors who were unable to ambulate initially, 80 (70%) achieved independent ambulation at six months. Of the 51 stroke survivors who could not move a cup across the table initially, 21 (41%) achieved the upper limb task at six months. Of the 56 stroke survivors who were unable to feed themselves initially, 25 (45%) could feed themselves at six months. Models containing age and severity of stroke (measured with NIHSS) predicted recovery of ambulation and ability to move a cup across the table, whilst a model containing severity of stroke predicted ability to feed oneself. All prediction models showed good discrimination (AUC 0.73 to 0.84). Conclusion: More than two-thirds of people after stroke recovered independent ambulation and less than half recovered upper limb function at six months. Models using age and NIHSS can predict independent ambulation and upper limb function but these prediction models now require external validation before use in clinical practice. [ABSTRACT FROM AUTHOR]

Question: Is electrical stimulation and splinting more effective than splinting alone for the management of wrist contracture following acquired brain injury? Design: A multi-centre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Thirty-six adults with first stroke or traumatic brain injury and mild to moderate wrist flexion contractures. Intervention: The experimental group received electrical stimulation to the wrist and finger extensor muscles for 1 hour a day over 4 weeks while the control group did not. Both groups wore a splint for 12 hours a day during this 4-week period. Outcome measures: The primary outcome was passive wrist extension measured with a 3Nm torque and with the fingers in extension. Secondary outcomes included passive wrist extension, wrist and finger extensor strength, wrist flexor spasticity, motor control of the hand, and Global Perceived Effect of Treatment, and perception of treatment credibility. Outcome measures were taken at baseline, at the end of the intervention period (4 weeks), and after a 2-week follow-up period (6 weeks). Results: At 4 and 6 weeks, the mean between-group difference (95% CI) for passive wrist extension was 7 degrees (–2 to 15) and –3 degrees (–13 to 7), respectively. Secondary outcomes were statistically non-significant or were of borderline statistical significance. Conclusion: It is not clear whether electrical stimulation and splinting is more effective than splinting alone for the management of wrist contracture after acquired brain injury. Therapists’ confidence in the efficacy of electrical stimulation for contracture management is not yet justified. [ABSTRACT FROM AUTHOR]

Question Do dynamic splints reduce contracture following distal radial fracture? Design Assessor-blinded, randomised controlled trial. Participants Forty outpatients with contracture following distal radial fracture. Intervention The control group received routine care consisting of exercises and advice for 8 weeks. In addition to routine care, during the day the experimental group received a dynamic splint, which stretched the wrist into extension but allowed intermittent movement. Outcome measures The primary outcomes were passive wrist extension and the Patient Rated Hand Wrist Evaluation (PRHWE). The secondary outcomes were active wrist extension, flexion, radial deviation, and ulnar deviation, and the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM). All outcomes were measured at commencement, at the end of 8 weeks of treatment, and at 12 weeks (ie, 1 month follow-up). Results The mean between-group difference for passive wrist extension and PRHWE at 8 weeks were 4 deg (95% CI −4 to 12) and −2 points (95% CI −8 to 4), respectively. The corresponding values at 12 week follow-up were 6 deg (95% CI 1 to 12) and 2 points (95% CI −5 to 9). There were no sufficiently important between-group differences for any of the secondary outcome measures at 8 or 12 weeks. Conclusion It is unclear whether dynamic splints following distal radial fracture have therapeutic effects on passive wrist extension or PRHWE, but they clearly do not have any therapeutic effects on active wrist extension, flexion, radial or ulnar deviation, or on the performance or satisfaction items of the COPM. The ongoing use of dynamic splints following distal radial fracture is difficult to justify. Trial registration ACTRN12608000309381. [ABSTRACT FROM AUTHOR]

Question: Do dynamic splints reduce contracture following distal radial fracture? Design: Assessor-blinded, randomised controlled trial. Participants: Forty outpatients with contracture following distal radial fracture. Intervention: The control group received routine care consisting of exercises and advice for 8 weeks. In addition to routine care, during the day the experimental group received a dynamic splint, which stretched the wrist into extension but allowed intermittent movement. Outcome measures: The primary outcomes were passive wrist extension and the Patient Rated Hand Wrist Evaluation (PRHWE). The secondary outcomes were active wrist extension, flexion, radial deviation, and ulnar deviation, and the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM). All outcomes were measured at commencement, at the end of 8 weeks of treatment, and at 12 weeks (ie, 1 month follow-up). Results: The mean between-group difference for passive wrist extension and PRHWE at 8 weeks were 4 deg (95% CI −4 to 12) and −2 points (95% CI −8 to 4), respectively. The corresponding values at 12 week follow-up were 6 deg (95% CI 1 to 12) and 2 points (95% CI −5 to 9). There were no sufficiently important between-group differences for any of the secondary outcome measures at 8 or 12 weeks. Conclusion: It is unclear whether dynamic splints following distal radial fracture have therapeutic effects on passive wrist extension or PRHWE, but they clearly do not have any therapeutic effects on active wrist extension, flexion, radial or ulnar deviation, or on the performance or satisfaction items of the COPM. The ongoing use of dynamic splints following distal radial fracture is difficult to justify. Trial registration: ACTRN12608000309381. [ABSTRACT FROM AUTHOR]

The article provides high-quality data on the prognosis of participants who presented with persistent undiagnosed wrist pain and underwent arthroscopic investigation. Wrist pain a common condition resulting in significant disability and time lost from work as well as the prevalence of wrist pain varies across age groups and occupations. It offers various methods conducted through setting and participants, outcome measures and analysis. The primary outcome measure was the patient rated wrist and hand evaluation (PRWHE). It suggests that participants who underwent arthroscopic investigation for persistent wrist pain improved on average by approximately 50% at one year.

Abstract: Kwah LK, Herbert RD, Harvey LA, Diong J, Clarke JL, Martin JH, Clarke EC, Hoang PD, Bilston LE, Gandevia SC. Passive mechanical properties of gastrocnemius muscles of people with ankle contracture after stroke. Objective: To investigate the mechanisms of contracture after stroke by comparing passive mechanical properties of gastrocnemius muscle-tendon units, muscle fascicles, and tendons in people with ankle contracture after stroke with control participants. Design: Cross-sectional study. Setting: Laboratory in a research institution. Participants: A convenience sample of people with ankle contracture after stroke (n=20) and able-bodied control subjects (n=30). Interventions: Not applicable. Main Outcome Measures: Stiffness and lengths of gastrocnemius muscle-tendon units, lengths of muscle fascicles, and tendons at specific tensions. Results: At a tension of 100N, the gastrocnemius muscle-tendon unit was significantly shorter in participants with stroke (mean, 436mm) than in able-bodied control participants (mean, 444mm; difference, 8mm; 95% confidence interval [CI], 0.2–15mm; P=.04). Muscle fascicles were also shorter in the stroke group (mean, 44mm) than in the control group (mean, 50mm; difference, 6mm; 95% CI, 1–12mm; P=.03). There were no significant differences between groups in the mean stiffness or length of the muscle-tendon units and fascicles at low tension, or in the mean length of the tendons at any tension. Conclusions: People with ankle contracture after stroke have shorter gastrocnemius muscle-tendon units and muscle fascicles than control participants at high tension. This difference is not apparent at low tension. [Copyright &y& Elsevier]

Questions: What is the incidence of contractures six months after stroke? Can factors measured within four weeks of stroke predict the development of elbow, wrist, and ankle contractures six months later? Design: Prospective cohort study. Participants: : Consecutive sample of 200 adults with stroke admitted to a Sydney hospital. Outcome measures: Loss of range of motion in major joints of the body was measured using a 4-point ordfinal contracture scale. In addition, elbow extension, wrist extension, and ankle dorsiflexion range of motion were measured using torque-controlled procedures. Potential predictors of contracture were age, pre-morbid function, severity of stroke, muscle strength, spasticity, motor function, and pain. Measurements were obtained within four weeks of stroke and at six months after stroke. Results: 52% of participants developed at least one contracture. Incidence of contracture varied across joints from 12% to 28%; shoulders and hips were most commonly affected. Muscle strength was a significant predictor of elbow, wrist, and ankle joint range. Prediction models explained only 6% to 20% of variance in elbow, wrist, and ankle joint range. Conclusion: About half of all patients with stroke develop at least one contracture within six months of stroke. Incidence of contractures across all joints ranged from 12% to 28%. Muscle strength is a significant predictor of elbow, wrist, and ankle contractures but cannot be used to accurately predict contractures in these joints. [Copyright &y& Elsevier]

The article presents a study that determines how accurately physical therapists can predict the future mobility of people with spinal cord injuries (SCI) at the time of admission to rehabilitation. Results show a strong positive correlation between therapists' predictions on admission and patients' outcomes at 3 months. It concludes that ability to accurately predict future mobility is important for goal setting and to ensure appropriate therapy, discharge planning and equipment prescription.

Question: What is the diagnostic value of provocative wrist tests and magnetic resonance imaging (MRI) for suspected wrist ligament injuries? Design: Cross-sectional study. Participants: 105 people presenting to hand clinics with wrist pain and suspected wrist ligament injuries were evaluated prospectively. Outcome measures: The integrity of wrist ligaments was tested with seven provocative tests. The results were compared to the reference standard of arthroscopy. In a subgroup of 55 participants, MRI findings were also compared to arthroscopy. The provocative tests were the scaphoid shift test (SS test), lunotriquetral test (LT test), midcarpal test (MC test), distal radioulnar joint test (DRUJ test), triangular fibrocartilage complex (TFCC) stress test (TFCC test), TFCC stress test with compression (TFCC comp test), and the gripping rotatory impaction test (GRIT). Results: Most provocative tests and MRI findings were of little or no value for diagnosing wrist ligament injuries. Exceptions were the SS test (+ve LR 2.88 and –ve LR 0.28), MC test (+ve LR 2.67) and DRUJ test (–ve LR 0.30), all of which were of mild diagnostic usefulness. MRI was moderately useful for diagnosing TFCC injuries (+ve LR 5.56, –ve LR 0.15), and was mildly useful for diagnosing scapholunate (SL) ligament injuries (+ve LR 4.17, –ve LR 0.32) and lunate cartilage damage (+ve LR 3.67, –ve LR 0.33). Adding MRI to provocative tests improved the accuracy of diagnosis of TFCC injuries slightly (by 13%) and lunate cartilage damage (by 8%). Conclusion: Provocative wrist tests of SL ligament injuries and midcarpal ligament injuries are mildly useful for diagnosing wrist injuries. MRI diagnostic findings of SL ligament injuries, lunate cartilage damage, and TFCC are mildly to moderately useful. MRI slightly improves the diagnosis of TFCC injury and lunate cartilage damage compared to provocative tests alone. [Copyright &y& Elsevier]

Question: Do people with recently acquired paraplegia benefit from a six-week motor retraining program aimed at improving their ability to sit unsupported? Design: A randomised controlled trial with concealed allocation, assessor blinding, and intention-totreat analysis. Participants: 32 people with recently acquired paraplegia and limited ability to sit unsupported. Intervention: All participants undertook standard inpatient rehabilitation over a six-week period. Experimental participants received three additional 30-minute sessions per week of motor retraining directed at improving their ability to sit unsupported. Outcome measures: The three primary outcomes were the Maximal Lean Test, Maximal Sideward Reach Test, and the Performance Item of the Canadian Occupational Performance Measure (COPM). The secondary outcomes were the Satisfaction Item of the COPM, Participants’ Impressions of Change, Clinicians’ Impressions of Change, the T-shirt Test, and the Spinal Cord Injury Falls Concern Scale. Results: The mean between-group differences for the Maximal Lean Test, Maximal Sideward Reach Test and the Performance Item of the COPM were –20 mm (95% CI –64 to 24), 5% arm length (95% CI –3 to 13) and 0.5 points (95% CI –0.5 to 1.5), respectively. The secondary outcomes did not differ significantly between groups. Conclusion: People with recently acquired paraplegia do not benefit from a six-week motor retraining program directed specifically at improving their ability to sit unsupported. Their ability to sit unsupported does, however, improve over time, suggesting that the practice of activities of daily living has important carry-over effects on unsupported sitting, rendering additional training redundant. Trial registration: ACTRN12608000464369. [Copyright &y& Elsevier]

Question: Do people with recently acquired paraplegia benefit from a six-week motor retraining program aimed at improving their ability to sit unsupported? Design: A randomised controlled trial with concealed allocation, assessor blinding, and intention-totreat analysis. Participants: 32 people with recently acquired paraplegia and limited ability to sit unsupported. Intervention: All participants undertook standard inpatient rehabilitation over a six-week period. Experimental participants received three additional 30-minute sessions per week of motor retraining directed at improving their ability to sit unsupported. Outcome measures: The three primary outcomes were the Maximal Lean Test, Maximal Sideward Reach Test, and the Performance Item of the Canadian Occupational Performance Measure (COPM). The secondary outcomes were the Satisfaction Item of the COPM, Participants’ Impressions of Change, Clinicians’ Impressions of Change, the T-shirt Test, and the Spinal Cord Injury Falls Concern Scale. Results: The mean between-group differences for the Maximal Lean Test, Maximal Sideward Reach Test and the Performance Item of the COPM were –20 mm (95% CI –64 to 24), 5% arm length (95% CI –3 to 13) and 0.5 points (95% CI –0.5 to 1.5), respectively. The secondary outcomes did not differ significantly between groups. Conclusion: People with recently acquired paraplegia do not benefit from a six-week motor retraining program directed specifically at improving their ability to sit unsupported. Their ability to sit unsupported does, however, improve over time, suggesting that the practice of activities of daily living has important carry-over effects on unsupported sitting, rendering additional training redundant. Trial registration: ACTRN12608000464369. [Copyright &y& Elsevier]