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Background. Evidence-based practice aims to improve patient care and service delivery, particularly in the management of individuals with low back pain, the largest client group seen by out-patient physiotherapists. Objective: This study determined the prevalence of use of interventions with evidence of effectiveness in the management of acute non-specific low back pain by physiotherapists. Methods. A multi-centered cross-sectional study was conducted on 100 physiotherapists working with low back pain patients. Using a telephone-administered interview, therapists described their current and desired treatment practices for a typical case of low back pain. Each intervention reported was coded according to its evidence of effectiveness (strong, moderate, limited or none) as per Van Tulder's rating system. Information on clinician, workplace and client characteristics was also obtained. Results. The prevalence of use of interventions with strong or moderate evidence of effectiveness was 68%. Almost all therapists use interventions with limited or no evidence of effectiveness or moderate evidence of ineffectiveness. Users of interventions with high evidence of effectiveness, as compared to non-users, had graduated more recently (p = 0.0098) and had taken a higher number of post-graduate clinical courses (p = 0.0091). Conclusion. Although most therapists use interventions with high evidence of effectiveness, much of their treatment programs consist of interventions that are not well studied in the literature.

A study was conducted to investigate the effects of age on functional recovery following a median and/or ulnar nerve repair. A group of 17 children was compared to a group of 17 adults with nerve injuries of similar severity and site. Motor and sensory function, tactile gnosis, manual dexterity, pain and perception of disability were assessed by an independent examiner. The results indicate a better qualitative and quantitative recovery in children than in adults, with respect to two-point discrimination, grip strength, tactile gnosis, manual dexterity and self-report of performance in daily activities. In conclusion, age at the time of injury was found to influence the extent of functional recovery following peripheral nerve injuries. Other factors, such as cortical plasticity, rate and extent of nerve regeneration, attitudes and psychological adjustment to disability, may further explain the differences observed between the two groups.

A new clinical measure of postural adaptation, the Advanced Mobility and Balance Scale (AMBS), was developed to assess balance capacities of stroke patients in standing and walking. In the first pilot study, involving 12 stroke patients and 6 healthy subjects, we found excellent interrater reliability and reasonable discriminative capacity of the AMBS. However, high-level functioning stroke subjects could not be differentiated from healthy subjects. / In order to refine the scoring of the AMBS for better discrimination, we conducted a kinematic analysis of head turning while walking in 10 stroke patients and 5 age-matched healthy subjects. Results showed that stroke patients manifested disrupted head-trunk-pelvis coordination and increased footpath deviation during head turns towards the paretic side. These abnormal patterns are likely due to compensations and altered sensorimotor integration processes.

The objectives of this study are to contribute evidence for construct validity of a self-administered questionnaire of physical activities (CHAMPS) as an indicator of the process of surgical recovery. / The surgical population is unique, as it comprises people diverse in age and functioning. The data for this study were obtained from a randomized control trial (RCT) evaluating the impact of a presurgical period of physical conditioning on surgical recovery following scheduled colonic resection, termed rehabilitation. Patients were randomized into two groups, Exercise and Control. Cross-sectional and longitudinal analyses were conducted at entry into the study, at one-day pre-surgery, and at one- and two-months post-surgery. A sample of 62 subjects participated in this study. The Short Form Health Survey (SF-36) Physical Functioning Scale (PF) and Physical Component Summary Score (PCS), VO2max and 6MWT were low to moderately correlated with the CHAMPS questionnaire at the same time points. For the Exercise group, energy expenditure as estimated using the CHAMPS questionnaire, increased significantly from 2653 to 3957 kcal.wk-1 (p<0.05). Physical activity levels dropped significantly (p<0.001) from pre-surgery (4103 kcal.wk-1) to one month post-surgery (1547 kcal.wk-1); and they were still lower (2396 kcal.wk-1) at two months post-surgery (p<0.01). Older age (>65), cancer diagnosis and female gender were associated with higher drop in physical activity levels at one-month post surgery. Evidence has been provided towards construct known groups, longitudinal (sensitivity to change and responsiveness) and convergent validity of physical activity questionnaire (CHAMPS) as an indicator of the process of surgical recovery. The information obtained from the questionnaire will allow health professionals to better plan care and develop programs to best manage the patients.

Abstract not available.

Gait speed is an ideal measure of locomotor recovery following stroke but its responsiveness and clinical terminants have received little attention. The main objectives of this prospective study were to identify the most responsive clinical measure of gait speed, and to identify predictors of gait speed recovery in the acute phase post-stroke. Fifty clients were evaluated on four tests of gait speed, and other measures of disability and impairment during the first and fifth week following a first-time stroke. Responsiveness was estimated using standardized response mean, and four other indices. Multiple linear regression was used to identify significant predictors of gait speed measured at follow-up. Walking 5 metres at a comfortable pace was identified as the most responsive method of measuring gait speed. Functional mobility and initial gait speed were significant predictors of gait speed recovery. Task-specific training may be warranted to improve this outcome.

Despite its importance in activities of daily living, little research has been done on the recovery of upper extremity (UE) function in acute stroke. The objectives of this prospective study were to quantify the recovery of UE function during the first five weeks post-stroke; to compare the recovery of UE function with the recovery of lower extremity (LE) function; and to identify predictors of recovery of UE function. / Fifty-five first-time stroke patients were evaluated using measures of UE and LE function at the first and fifth week post-stroke. Standardized response means were used to compare the recovery of UE and LE. Multiple linear regression was used to identify predictors of UE function. There was no evidence that the recovery of the UE was different from that of the LE. Measures of UE function at the first week post-stroke were the most important predictors of UE function one month post-stroke.

New treatments such as functional electrical stimulation (FES) have been developed that allow people with spinal cord injury (SCI) the ability to stand and walk. This study investigated the use of FES-assisted gait training for two subjects with incomplete spinal cord injury in a single subject, repeated measures A-B design. Average walking velocity, cadence and stride length were determined while walking with and without FES at baseline and post-treatment evaluations. Changes in parameters were analyzed statistically and explained in biomechanical terms. FES-assisted gait training affected modifications in the gait parameters. One subject, initially a non-reciprocal walker, was able to walk overground at a faster velocity, cadence and longer stride length. Both subjects showed gains in these parameters over time. This study provided positive evidence for the use of FES-assisted gait training for these individuals with incomplete SCI. This may indicate that FES is a potentially useful rehabilitative tool as a gait aid for persons with SCI.

Among spinal-cord-injured (SCI) subjects with an incomplete motor function loss that are able to walk, most have an altered walking pattern and a reduced walking speed. This doctoral project had two main objectives. One was to characterize the gait pattern of SCI subjects and compare it to that of normal subjects walking at the same speed. The other objective was to measure the adaptability of their walking pattern to changes in speed, and to find the factors that are limiting their maximal walking speed. The main gait characteristics in SCI subjects found in the first study were: a longer cycle duration, a greater hip excursion, a flexed knee at foot contact and during stance, and changes in the timing and the amplitude of muscle activity. It was showed that SCI subjects could adapt to different speeds, but that their range of speeds is limited. The hip-knee angle cyclographs showed that SCI subjects' intralimb coordination patterns were altered. In normal subjects, even at low speed, the soleus muscle showed a peak of electromyographic (EMG) activity synchronized with push-off, and this peak of activity increased with speed. SCI subjects showed a lower and a flatter profile than that of normal subjects and a diminution of a peak of activity in the soleus muscles at push-off. Increases in treadmill speed in SCI subjects resulted only in a small increase in the amplitude of soleus EMG activity. This increase was not specific to push-off, but rather spread over most of stance duration. The second article showed that maximal stride frequency was the predominant limiting factor of the maximal treadmill-walking speed in SCI subjects. At all speeds, SCI subjects spent longer time in stance, swing and double support phases. The relative time spent in single support is greater at higher walking speed and the difficulty to reduce double support time is a limiting factor. It was concluded that a better understanding of the factors limiting the maximal speed in SCI subject