Effective physiotherapy.
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Accidental Falls↗
Biomedical subjects
C Sherrington
Publications and source records attributed to C Sherrington.
PEDro. A database of randomized trials and systematic reviews in physiotherapy.
This paper describes PEDro, the Physiotherapy Evidence Database. PEDro is a web-based database of randomized controlled trials and systematic reviews in physiotherapy. It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro. The database contains bibliographic details and abstracts of most English-language randomized trials and systematic reviews in physiotherapy, and of many trials and reviews in other languages. Trials on the database are rated on the basis of their methodological quality so that users of the database can quickly identify trials of high quality. Trials and systematic reviews are extensively indexed to facilitate searching. PEDro provides an important information resource to support evidence-based clinical practice.
Databases, Bibliographic↗
The Footwear Assessment Form: a reliable clinical tool to assess footwear characteristics of relevance to postural stability in older adults.
OBJECTIVE: Falls in older adults are common and may result in serious injury. Inappropriate footwear has been suggested to be a contributing factor to many falls. However no studies have been undertaken to determine whether clinicians can reliably assess footwear variables thought to influence postural stability in older adults. The aim of this study was therefore to develop a simple clinical footwear assessment form and assess its reliability, both between examiners and with repeated assessments over time. DESIGN: Two examiners assessed seven footwear variables (shoe type, heel height, heel counter stiffness, longitudinal sole rigidity, sole flexion point, tread pattern and sole hardness) in 12 different shoes, and repeated the measurements three weeks later. The examiners were blinded to each other's and their own previous results. RESULTS: Analysis using the kappa (kappa) and percentage agreement statistics revealed the examiners' footwear assessments to be generally highly reliable (kappa = 0.47-1.00 for inter-tester comparisons, kappa = 0.40-1.00 for intra-tester comparisons), with the exception of inter-tester assessment of sole hardness (kappa = 0.03-0.48). CONCLUSION: The Footwear Assessment Form is a reliable clinical tool for the assessment of shoe type, heel height, heel counter stiffness, longitudinal sole rigidity and tread pattern; however, a more objective protocol may be required to improve the reliability of sole hardness evaluation. The Footwear Assessment Form can now be used with confidence in the clinical setting and in future investigations to determine the contribution of footwear characteristics to instability and falls in older adults.
Accidental Falls↗
Increased prevalence of fall risk factors in older people following hip fracture.
BACKGROUND: Many people who suffer a hip fracture do not achieve full functional recovery. Simple tests of physical function such as quadriceps strength and postural sway may provide insight into why this population is at increased risk of experiencing further falls and fractures and assist in developing rehabilitation strategies for preventing falls. OBJECTIVE: To determine whether impairments in a range of physiological measures and specific medical conditions are more prevalent in people who have suffered a fall-related hip fracture than in a matched sample of community-dwelling people without a history of falls. METHODS: This case-control study involved 88 older people. The hip fracture group comprised 44 persons aged 64-94 years, assessed on average 7 months following a fall-related hip fracture. An age- and sex-matched control group (older persons who had not fallen in a 12-month period before recruitment) was drawn randomly from community samples. RESULTS: Compared with the control group, the hip fracture group had markedly reduced quadriceps strength and increased body sway when tested on firm and compliant (foam rubber) surfaces. Patients in the hip fracture group also had higher prevalence rates of poor vision, arthritis and stroke, were taking more medications, were less physically active and perceived themselves to be at greater risk of falling than the control group. No significant differences were apparent for cardiovascular conditions, subjective health status and psychoactive medication use between the groups. Multivariate analyses identified quadriceps strength and body sway on the compliant surface as the most important variables for distinguishing between the hip fracture and no hip fracture groups. These two variables correctly classified 92% of the cases, with equal sensitivity and specificity. CONCLUSION: The findings identify an increased prevalence of certain physical fall risk factors among older persons who have suffered a hip fracture. Decreased quadriceps strength and increased postural sway are potentially modifiable. Intervention programs designed to improve performance on these variables among this population require investigation.
Accidental Falls↗
Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial.
OBJECTIVE: To determine the effect of a home exercise program on strength, postural control, and mobility following hip fracture. DESIGN: Randomized controlled trial of 1 month's duration. SETTING: Daily exercise carried out within the subjects' home environments. PARTICIPANTS: Forty-two people 64 to 94 years of age, 35 of whom were living independently in the community and 7 of whom were residing in institutional care. Subjects were recruited on average 7 months after a fall-related hip fracture and randomly allocated to either the intervention or the control group (n = 21 each). The groups were well matched in terms of medical conditions, medication use, disability, and activity levels. INTERVENTION: A "home-based" program of weight-bearing exercise established at a visit by a physiotherapist. MAIN OUTCOME MEASURES: Quadriceps strength, postural sway, functional reach, weight-bearing ability, walking velocity, and self-rated fall risk. The subjects undertook these assessments at the beginning and end of the trial. RESULTS: At pretest, exercisers and controls performed similarly in all tests. At the end of the trial, the intervention group showed significantly greater quadriceps strength in the affected (hip-fractured) leg and increased walking velocity. The intervention subjects also improved their weight-bearing ability and reported reduced subjective falls risk. In contrast, there were no significant improvements in any of the test measures in the controls. Within the intervention group, improvements in quadriceps strength were significantly associated with improved performances in the weight-bearing test measures and with increased walking velocity. CONCLUSIONS: This exercise program improved strength and mobility following hip fracture. Further research is needed to ascertain whether the extent of this improvement in these fall risk factors is sufficient to prevent falls.
Aged↗
Diagnostic pitfall and the reporting of cerebrovascular events in patients with prosthetic heart valves.
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Cerebrovascular Disorders↗
PEDro: a database of randomised controlled trials in physiotherapy.
PEDro is a database of clinical trials designed to assist the practice of evidence-based physiotherapy. When complete, it will contain bibliographic details, abstracts and quality assessment scores of all published randomised controlled trials in physiotherapy. Trials on the database will be rated on the basis of their methodological quality, so that users of the database can be guided to those trials which provide the most methodologically sound sources of evidence. The database has been made freely available on the world wide web, where it can be searched with a powerful and user-friendly search engine.
Australia↗