Hong Kong Physiotherapy Journal

A lifespan approach in prevention of osteoporosis

Marco Y.C. Pang — 2012-02-27

Osteoporosis and related fragility fractures are recognized as a major problem of public health. The global burden of osteoporosis, measured by disability adjusted life years (DALYs) lost, is immense. In 2000, the total DALYs lost due to osteoporotic fractures was approximately 5.8 million worldwide . In Europe, osteoporotic fractures accounted for more DALYs lost than most cancers (except lung cancer) . The prevalence, and hence the global burden of osteoporotic fractures, is projected to rise substantially, owing to the ageing population .

Clinical implications for the effect of glucosamine sulfate iontophoresis on fasting plasma glucose levels

Vikram Mohan, Leonard Joseph — 2012-01-18

We enjoyed reading the recently published paper “Acute effects of combination of glucosamine sulfate iontophoresis with exercise on fasting plasma glucose of participants with knee osteoarthritis” by Onigbinde et al . Glucosamine sulfate is one of the most common drugs prescribed to strengthen cartilage in patients with osteoarthritis. Due to speculation that glucosamine sulfate might increase blood glucose levels, the study by Onigbinde et al generated appreciable clinical interest among readers. However, there are certain points and suggestions that we would like to share with readers before the study’s findings are applied clinically.

Reply to “Letter to the Editor: Clinical implications for the effect of glucosamine sulfate iontophoresis on fasting plasma glucose levels”

2012-02-27

We appreciate the comments of Mohan and Joseph on our research work entitled “Acute effects of combination of glucosamine sulfate iontophoresis with exercise on fasting plasma glucose of participants with knee osteoarthritis.” We wish to reply to their comments in order.

Prevention of osteoporosis: From infancy through older adulthood

Donna Cech — 2012-02-20

Abstract: Osteoporosis is a worldwide health concern for individuals of all ethnic and racial groups. The number of individuals diagnosed with osteoporosis and the rate of osteoporotic fractures increases significantly with age. Some variation in the development of osteoporosis can also be related to gender and race, with both genetic and lifestyle factors influencing bone development. Both non-modifiable and modifiable risk factors have been identified as contributing to the development of osteoporosis. Modifiable risk factors are related to diet, smoking, alcohol use and activity level. By understanding the development of the skeletal system and the lifestyle choices that maximize bone development, the risk of development of osteoporosis can be minimized. Physical activity contributes to development of the skeletal system in all age and ethnic groups. Maintaining high levels of physical activity is important across the life span to increase the peak bone mass developed and optimize bone mass during the bone remodelling phases of older adulthood. Bone development and remodelling are influenced by the mechanical strain placed upon the bone during physical activity. By understanding how mechanical forces influence bone development, exercise programmes can be developed that will most effectively stimulate bone growth. The focus of this review will be to discuss factors influencing the life span development of the skeletal system, theoretical frameworks related to bone growth in response to mechanical forces, and the development of osteoporosis prevention programmes for individuals of all ages.

Patellofemoral pain during step descents with and without fatigue-induced hip internal rotation

Roy T.H. Cheung — 2012-02-20

Abstract: Weakness of hip external rotator muscles may cause excessive hip internal rotation during functional activity and it is associated with the development of patellofemoral pain (PFP). The aetiology of PFP is multifactorial in nature. Therefore, routine enrolment of patients into a hip-strengthening programme may not be effective and cost-effective. The present study examined the effect of fatigue-induced hip internal rotation during functional activity. Twenty subjects with PFP were asked to descend a step in barefoot before and after an isokinetic exercise protocol to induce muscle fatigue of hip external rotators. The hip motion was captured by eight high-speed cameras and analysed by a three-dimensional motion analysis system. The level of PFP during step descent and their usual PFP level were measured by validated instruments. Patients with PFP presented with more pronounced hip pathomechanics (p<0.001) and greater level of PFP (p=0.001) after muscle fatigue. The pain score after muscle fatigue during step descent better reflects the usual functional disturbance associated with PFP (rs=−0.655, p=0.002). Physical examination with induced muscle fatigue may be helpful in clinical decisions on the management programme for patients with PFP, which are related to altered hip mechanics.

Quality of life of Nigerian stroke survivors during first 12 months post-stroke

Caleb A. Gbiri, Aderonke O. Akinpelu — 2012-03-05

Abstract: There have been few studies on quality of life (QoL) of Nigerian stroke survivors and none have reported QoL over a long period. This study describes QoL in Nigerian stroke survivors over the first 12 months post-stroke. Sixty-five (33 male and 32 female) stroke survivors were recruited within 72 hours of stroke onset. QoL and depression were assessed monthly for 12 months using the Stroke-Specific Quality of Life Scale and Center for Epidemiologic Studies Depression Scale. Data were analysed using the KruskaleWallis test, Friedman test and logistic regression. Fifty-five participants (aged 57.4±14.8 years) completed this study. QoL improved significantly from onset to 6 months but nonsignificantly from 6 months to 12 months. Most (85.2%) stroke survivors had severe depression at 1 month. At 3 months, marital status and spousal support had a significant positive influence on QoL. At 6, 9 and 12 months, marital status, spousal support, educational qualification, and occupational status had a significant positive influence on QoL. Depression was a major determinant of QoL at 3, 6, 9 and 12 months. Our findings suggest that QoL of Nigerian stroke survivors is low at stroke onset, increases steadily during the first 6 months and little between 6 months and 12 months post-stroke; is influenced positively by marital status, spousal support, educational qualification and occupational status; and negatively influenced by age and depression.

Relationship between the duration of taekwondo training and lower limb muscle strength in adolescents

Shirley S.M. Fong, William W.N. Tsang — 2012-01-18

Abstract: Previous studies have suggested that different durations of taekwondo (TKD) training may result in different lower limb muscle strengths. The objective of this study was to explore the relationship between the duration of TKD training (i.e., number of hours spent training per week) and lower limb muscle strength (at both fast and slow testing speeds) in adolescents. Isokinetic concentric knee and ankle muscle strengths were measured in 20 TKD practitioners (mean age: 15.8 years) at two different speeds (60°/second and 240°/second). Pearson’s correlation coefficient (two-tailed) showed that the number of TKD training hours per week was positively correlated with the peak torque of the knee extensors (r=0.639, p=0.002) and knee flexors (r=0.472, p=0.036) at 240°/second. This study did not show any significant correlation between TKD training duration and the peak torque of the knee flexors and extensors at slower speeds (60°/second) or the ankle plantar flexors at any speed. Our results support the notion that the more time one spends in TKD training the greater the muscle strength one could gain and that any subsequent improvements in knee muscle strength is velocity specific. Further study is needed to confirm the optimal amount of training and training parameters required to develop knee muscle strength in TKD athletes.

Effect of Acu-TENS on post exercise airway resistance in healthy individuals

2012-01-25

Abstract: Transcutaneous electrical nerve stimulation on acupoints (Acu-TENS) is associated with increased exercise duration in healthy individuals and improves forced expiratory volume in 1second (FEV1) in those with respiratory illness. Whether a decrease in airway resistance (AR) is responsible for these respiratory system effects has not been investigated. This pilot study investigated the effect of a single session of Acu-TENS on AR in healthy people. Twenty individuals were invited to the laboratory twice, 1 week apart, to receive in random order either Acu-TENS or placebo-TENS (no electrical output from the TENS unit) over bilateral Lièquē (LU 7) and Dìnchuăn (EX-B1), for 45 minutes before and during a submaximal treadmill exercise test following the Bruce protocol. AR, FEV1, forced vital capacity, rate of perceived exertion and heart rate variability were recorded before, immediately after and 15minutes after exercise. Immediately after exercise the percentage decrease in AR from baseline was greater in the Acu-TENS group (−20.10±4.00%) compared to the placebo-TENS group (−7.99±3.43%) (p=0.029). We conclude that the decrease in AR seen with Acu-TENS in healthy individuals could account for the immediate improvement in FEV1. Acu-TENS may have a role in decreasing AR in patients with airflow limitation.

An evaluation of the knowledge level of Nigerian physiotherapists on topical pharmacotherapy

Ayodele Teslim Onigbinde, Matthew O.B. Olaogun, Kennedy Iroghue — 2012-02-06

Abstract: Conventional treatment for some diseases involves a combination of pharmacotherapy and physiotherapy. Most of Nigeria’s training schools have introduced the course of pharmacology in their training curriculum but its effect is still unknown. There appears to be inadequate research on physiotherapists’ knowledge of medications in Nigeria. The primary objectives of this study were to determine the knowledge of Nigerian physiotherapists regarding topical pharmacotherapy and to determine the association between knowledge of active ingredients and age, clinical experience, qualification, and work setting. A total of 135 practising physiotherapists participated in the cross-sectional survey study. A self-administered questionnaire was used for this study. Descriptive statistics and Pearson chi-square were used to analyse the data obtained. Only 55 respondents (40.7%) reported that they recently updated their knowledge on topical medications; however, this contradicted the finding that only one participant (0.7%) had very good knowledge while 57 respondents (42.2%) have poor knowledge of the active ingredients in the topical medications listed in this study. Also, 105 respondents (77.8%) indicated their awareness that physiotherapists can recommend topical drugs. The results of this study revealed that some of the sampled physiotherapists have poor knowledge about adverse reactions, contraindications, risks, and mechanisms of action of the listed drugs, and how non-steroidal anti-inflammatory drugs relieve pain. However, results also showed that the respondents had good knowledge (mean score of 2.46±1.03 out of the maximum of score of 3 allotted) of the conditions in which topical medications are indicated, although they have a poor knowledge of the common adverse reactions of topical medications applicable in physiotherapy (mean score of 1.44±1.16 out of the maximum score of 4). A total of 111 respondents (80.7%) could not explain how topical non-steroidal anti-inflammatory drugs relieve pain. The results also showed that there was a significant association between years of clinical experience and scores obtained for knowledge about active ingredients (χ2=347.903, p<0.03). The study concluded that most Nigerian physiotherapists have poor knowledge of topical pharmacotherapy they commonly use in clinical practice. This study suggests the need to organise continuing professional development programmes/seminars on pharmacotherapy as applicable to physiotherapy practice to improve the knowledge base of physiotherapists.