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Biomedical subjects

Robert D Herbert

Publications and source records attributed to Robert D Herbert.

At least 19 recordsLinked to original sources
PubMed2007

Passive dorsiflexion flexibility after cast immobilization for ankle fracture.

Ankle fracture is frequently managed with cast immobilization, but immobilization may produce ankle contracture (loss of flexibility). We aimed to quantify recovery of ankle dorsiflexion flexibility in people treated with cast immobilization after ankle fracture, and to determine if initial orthopaedic management was associated with recovery. Ankle flexibility was measured in 150 people with plantarflexion contracture who had been referred for outpatient physical therapy following cast immobilization for ankle fracture. We obtained measurements using an instrumented footplate within 5 days of cast removal and then 4 weeks and 3 months later. Data were compared with published normative data. Both stiffness and the torque corresponding to the peak dorsiflexion angle at baseline decreased during the 3 month recovery period, but recovery was still incomplete 3 months after cast removal. Surgical fixation was associated with higher stiffness, preload and torque values. Passive ankle flexibility does not return to normal values within 3 months of cast removal after ankle fracture. Recovery of normal ankle dorsiflexion flexibility typically takes longer than the initial period of immobilization.

Ankle Injuries↗
PubMed2006

Effects of splinting on wrist contracture after stroke: a randomized controlled trial.

BACKGROUND AND PURPOSE: Splints are commonly applied to the wrist and hand to prevent and treat contracture after stroke. However, there have been few randomized trials of this intervention. We sought to determine whether wearing a hand splint, which positions the wrist in either a neutral or an extended position, reduces wrist contracture in adults with hemiplegia after stroke. METHODS: Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated. They were randomized to either a control group (routine therapy) or 1 of 2 intervention groups (routine therapy plus splint in either a neutral or an extended wrist position). Splints were worn overnight for, on average, between 9 and 12 hours, for 4 weeks. The primary outcome, measured by a blinded assessor, was extensibility of the wrist and long finger flexor muscles (angle of wrist extension at a standardized torque). RESULTS: Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles. After 4 weeks, the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4 degrees (95% CI, -5.4 degrees to 8.2 degrees), and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3 degrees (95% CI, -4.9 degrees to 2.4 degrees) compared with the control condition. CONCLUSIONS: Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke. These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued.

Aged↗
PubMed2006

Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial.

BACKGROUND: Plantar fasciitis is one of the most common foot complaints. It is often treated with foot orthoses; however, studies of the effects of orthoses are generally of poor quality, and to our knowledge, no trials have investigated long-term effectiveness. The aim of this trial was to evaluate the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis. METHODS: A pragmatic, participant-blinded, randomized trial was conducted from April 1999 to July 2001. The duration of follow-up for each participant was 12 months. One hundred and thirty-five participants with plantar fasciitis from the local community were recruited to a university-based clinic and were randomly allocated to receive a sham orthosis (soft, thin foam), a prefabricated orthosis (firm foam), or a customized orthosis (semirigid plastic). RESULTS: After 3 months of treatment, estimates of effects on pain and function favored the prefabricated and customized orthoses over the sham orthoses, although only the effects on function were statistically significant. Compared with sham orthoses, the mean pain score (scale, 0-100) was 8.7 points better for the prefabricated orthoses (95% confidence interval, -0.1 to 17.6; P = .05) and 7.4 points better for the customized orthoses (95% confidence interval, -1.4 to 16.2; P = .10). Compared with sham orthoses, the mean function score (scale, 0-100) was 8.4 points better for the prefabricated orthoses (95% confidence interval, 1.0-15.8; P = .03) and 7.5 points better for the customized orthoses (95% confidence interval, 0.3-14.7; P = .04). There were no significant effects on primary outcomes at the 12-month review. CONCLUSIONS: Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device. The customized and prefabricated orthoses used in this trial have similar effectiveness in the treatment of plantar fasciitis.

Equipment Design↗
PubMed2006

Prognosis of acute low back pain: design of a prospective inception cohort study.

BACKGROUND: Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration) in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain. METHODS/DESIGN: The study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression. DISCUSSION: This study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients.

Acute Disease↗
PubMed2006

The effect of an exercise intervention on aerobic fitness, strength and quality of life in children with haemophilia (ACTRN012605000224628).

BACKGROUND: Children with haemophilia have lower levels of fitness and strength than their healthy peers. We present the protocol of a study designed to determine whether an exercise intervention improves quality of life, aerobic fitness and strength in children with haemophilia. METHODS/DESIGN: The study will be a randomised, assessor-blinded, controlled trial of exercise treatment. Seventy children aged between 6 and 18 years with haemophilia or von Willebrand disease will be recruited from two paediatric haemophilia clinics in NSW. Each participant will be allocated to an exercise group or a control group using a concealed allocation procedure. The control group will receive usual medical care while the intervention group will receive usual medical care plus an exercise program for 12 weeks. Outcomes (VO2peak, knee extensor strength and quality of life) will be measured at baseline and on completion of the exercise program by a blinded assessor. The primary analysis will be conducted on an intention to treat basis. The effects of the exercise intervention on each of the three primary outcomes will be estimated from between-group differences in the mean outcome adjusted for baseline scores. DISCUSSION: This study will be the first randomised controlled trial to examine the effects of a structured exercise program on fitness and quality of life in children with haemophilia.

Journal Article↗
PubMed2006

Effectiveness of joint mobilisation after cast immobilisation for ankle fracture: a protocol for a randomised controlled trial [ACTRN012605000143628].

BACKGROUND: Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence. The primary aim of this trial is to determine if adding joint mobilisation to a standard exercise programme is effective and cost-effective after cast immobilisation for ankle fracture in adults. METHODS/DESIGN: Ninety participants will be recruited from the physiotherapy departments of three teaching hospitals and randomly allocated to treatment or control groups using a concealed procedure. All participants will perform an exercise programme. Participants in the treatment group will also receive joint mobilisation twice a week for four weeks. Blinded follow-up assessments will be conducted four, 12 and 24 weeks after randomisation. The primary outcome measures will be the Lower Extremity Functional Scale and the Assessment of Quality of Life. Secondary outcomes will include measures of impairments, activity limitation and participation. Data on the use of physiotherapy services and participants' out-of-pocket costs will be collected for the cost-effective and cost-utility analyses. To test the effects of treatment, between-group differences will be examined with analysis of covariance using a regression approach. The primary conclusions will be based on the four-week follow-up data. DISCUSSION: This trial incorporates features known to minimise bias. It uses a pragmatic design to reflect clinical practice and maximise generalisability. Results from this trial will contribute to an evidence-based approach for rehabilitation after ankle fracture.

Ankle Injuries↗
PubMed2006

Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study.

QUESTION: What is the relationship between vibration of the chest wall and the resulting chest wall force, chest wall circumference,intrapleural pressure, and expiratory flow rate? Is the change in intrapleural pressure during vibration the sum of the intrapleural pressure due to recoil of the lung, chest wall compression, and chest wall oscillation? DESIGN: Randomised, within-subject,experimental study. PARTICIPANTS: Seven experienced cardiopulmonary physiotherapists and three healthy adults. INTERVENTION: Vibration (compression + oscillation), compression alone, and oscillation alone were applied manually to the chest walls of healthy participants during passive exertion and compared with passive expiration alone. OUTCOME MEASURES: Chest wall force, chest wall circumference, intrapleural pressure, and expiratory flow rate. RESULTS: During vibration, coherence was high(r2 > 0.97) between external chest wall force, chest wall circumference, intrapleural pressure, and expiratory flow. The mean change in intrapleural pressure during vibration was 9.55 cmH2O (SD 1.66), during chest compression alone was 8.06 cmH2O(SD 1.65), during oscillation alone was 7.93 cmH2O (SD 1.57), and during passive expiration alone was 6.82 cmH2O (SD 1.51). During vibration, compression contributed 13% of the change in intrapleural pressure, oscillation contributed 12%, and lung recoil contributed the remaining 75%. CONCLUSIONS: During vibration the chest behaves as a highly linear system. Changes in intrapleural pressure occurring during vibration appear to be the sum of changes in pressure due to lung recoil and the compressive and oscillatory components of the technique, which suggests that all three components are required to optimise expiratory flow.

Adult↗
PubMed2006

Specific stabilisation exercise for spinal and pelvic pain: a systematic review.

The aim of this study was to conduct a systematic review of the efficacy of specific stabilisation exercise for spinal and pelvic pain. Randomised clinical trials evaluating specific stabilisation exercise were identified and retrieved. Outcomes were disability, pain, return to work, number of episodes, global perceived effect, or health-related quality of life. A single trial reported that specific stabilisation exercise was more effective than no treatment but not more effective than spinal manipulative therapy for the management of cervicogenic headache and associated neck pain. Single trials reported that specific stabilisation exercise was effective for pelvic pain and for prevention of recurrence after an acute episode of low back pain but not to reduce pain or disability associated with acute low back pain. Pooled analyses revealed that, for chronic low back pain, specific stabilisation exercise was superior to usual medical care and education but not to manipulative therapy, and no additional effect was found when specific stabilisation exercise was added to a conventional physiotherapy program. A single trial reported that specific stabilisation exercise and a surgical procedure to reduce pain and disability in chronic low back pain were equally effective. The available evidence suggests that specific stabilisation exercise is effective in reducing pain and disability in chronic but not acute low back pain. Single trials indicate that specific stabilisation exercise can be helpful in the treatment of cervicogenic headache and associated neck pain, pelvic pain, and in reducing recurrence after acute low back pain.

Acute Disease↗
PubMed2006

Vibration and its effect on the respiratory system.

Vibration is a manual technique used widely to assist with the removal of pulmonary secretions. Little is known about how vibration is applied or its effect on the respiratory system. The purpose of this study was to describe mechanical consequences of vibration on the chest wall of a normal subject and the effects of vibration on expiratory flow rates and volumes. The effects of vibration were compared to other interventions of chest wall compression, chest wall oscillation, cough, huff from high lung volume, inspiration to total lung capacity with relaxed expiration, tidal breathing, and sham. Sixteen physiotherapists applied vibration and other interventions in a randomised order to the chest wall of a healthy adult female subject. The magnitude and direction of the force and the frequency of vibration were measured by an instrumented bed with seven load cells. Inductive plethsysmography measured the change in chest wall circumference with vibration. A heated pneumotachometer measured inspiratory and expiratory flow rates, which were integrated to provide volumes. Vibration was applied with a mean resultant force of 74.4 N (SD 47.1). The mean (SD) change in chest wall circumference and frequency of vibration were 0.8 cm (SD 0.4) and 5.5 Hz (SD 0.8) respectively. The mean peak expiratory flow rate was 0.97 l/s (SD 0.27). Peak expiratory flow rates with vibration were less than 20% of those achieved with cough or huff from high lung volume but greater than with chest wall compression, chest wall oscillation, relaxed expiration from total lung capacity, sham treatment or tidal breathing.

Adult↗
PubMed2006

Contralateral effects of unilateral strength training: evidence and possible mechanisms.

If exercises are performed to increase muscle strength on one side of the body, voluntary strength can increase on the contralateral side. This effect, termed the contralateral strength training effect, is usually measured in homologous muscles. Although known for over a century, most studies have not been designed well enough to show a definitive transfer of strength that could not be explained by factors such as familiarity with the testing. However, an updated meta-analysis of 16 properly controlled studies (range 15-48 training sessions) shows that the size of the contralateral strength training effect is approximately 8% of initial strength or about half the increase in strength of the trained side. This estimate is similar to results of a large, randomized controlled study of training for the elbow flexors (contralateral effect of 7% initial strength or one-quarter of the effect on the trained side). This is likely to reflect increased motoneuron output rather than muscular adaptations, although most methods are insufficiently sensitive to detect small muscle contributions. Two classes of central mechanism are identified. One involves a "spillover" to the control system for the contralateral limb, and the other involves adaptations in the control system for the trained limb that can be accessed by the untrained limb. Cortical, subcortical and spinal levels are all likely to be involved in the "transfer," and none can be excluded with current data. Although the size of the effect is small and may not be clinically significant, study of the phenomenon provides insight into neural mechanisms associated with exercise and training.

Adaptation, Physiological↗
PubMed2005

The effect of motor control exercise versus placebo in patients with chronic low back pain [ACTRN012605000262606].

BACKGROUND: While one in ten Australians suffer from chronic low back pain this condition remains extremely difficult to treat. Many contemporary treatments are of unknown value. One potentially useful therapy is the use of motor control exercise. This therapy has a biologically plausible effect, is readily available in primary care and it is of modest cost. However, to date, the efficacy of motor control exercise has not been established. METHODS: This paper describes the protocol for a clinical trial comparing the effects of motor control exercise versus placebo in the treatment of chronic non-specific low back pain. One hundred and fifty-four participants will be randomly allocated to receive an 8-week program of motor control exercise or placebo (detuned short wave and detuned ultrasound). Measures of outcomes will be obtained at follow-up appointments at 2, 6 and 12 months after randomisation. The primary outcomes are: pain, global perceived effect and patient-generated measure of disability at 2 months and recurrence at 12 months. DISCUSSION: This trial will be the first placebo-controlled trial of motor control exercise. The results will inform best practice for treating chronic low back pain and prevent its occurrence.

Chronic Disease↗
PubMed2005

Training with unilateral resistance exercise increases contralateral strength.

Evidence that unilateral training increases contralateral strength is inconsistent, possibly because existing studies have design limitations such as lack of control groups, lack of randomization, and insufficient statistical power. This study sought to determine whether unilateral resistance training increases contralateral strength. Subjects (n = 115) were randomly assigned to a control group or one of the following four training groups that performed supervised elbow flexion contractions: 1) one set at high speed, 2) one set at low speed, 3) three sets at high speed, or 4) three sets at low speed. Training was 3 times/wk for 6 wk with a six- to eight-repetition maximum load. Control subjects attended sessions but did not exercise. Elbow flexor strength was measured with a one-repetition maximum arm curl before and after training. Training with one set at slow speed did not produce an increase in contralateral strength (mean effect of -1% or -0.07 kg; 95% confidence interval: -0.42-0.28 kg; P = 0.68). However, three sets increased strength of the untrained arm by a mean of 7% of initial strength (additional mean effect of 0.41 kg; 95% confidence interval: 0.06-0.75 kg; P = 0.022). There was a tendency for training with fast contractions to produce a greater increase in contralateral strength than slow training (additional mean effect of 5% or 0.31 kg; 95% confidence interval: -0.03-0.66 kg; P = 0.08), but there was no interaction between the number of sets and training speed. We conclude that three sets of unilateral resistance exercise produce small contralateral increases in strength.

Adolescent↗
PubMed2005

Passive stretching does not enhance outcomes in patients with plantarflexion contracture after cast immobilization for ankle fracture: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of short- and long-duration passive stretches with a control treatment for the management of plantarflexion contracture after cast immobilization for ankle fracture. DESIGN: Assessor-blinded, randomized controlled trial. SETTING: Hospital physical therapy outpatient departments. PARTICIPANTS: Adults with plantarflexion contracture (N=150) after cast immobilization for ankle fracture. All subjects were weight bearing or partial weight bearing. INTERVENTIONS: Exercise only, exercise plus short-duration passive stretch, and exercise plus long-duration passive stretch. All subjects had a 4-week course of exercises. In addition, subjects in the short-duration stretch plus exercise group completed 6 minutes of stretching per day, and subjects in the long-duration stretch plus exercise group completed 30 minutes of stretching per day. MAIN OUTCOME MEASURES: Lower Extremity Functional Scale and passive dorsiflexion range of motion with the knee bent and straight at baseline, and at 4 weeks and 3 months postintervention. RESULTS: One hundred thirty-nine (93%) subjects completed the 4-week assessment and 134 (89%) subjects completed the 3-month assessment. There were no statistically significant or clinically important between-group differences for the primary outcomes. CONCLUSIONS: The addition of passive stretching confers no benefit over exercise alone for the treatment of plantarflexion contracture after cast immobilization for ankle fracture.

Adult↗
PubMed2005

Searching the LILACS database for Portuguese- and Spanish-language randomized trials in physiotherapy was difficult.

OBJECTIVE: Evidence-based practice requires access to systematic reviews and randomized controlled trials; however, most literature databases index primarily English-language journals. We sought to determine the extent and quality of Portuguese- and Spanish-language reports of randomized trials relevant to physiotherapy by searching the LILACS database (Literatura Latino Americana e do Caribe em Ciências da Saúde). A secondary aim was to compare the sensitivity of three strategies for searching for Portuguese- and Spanish-language randomized trials in physiotherapy. STUDY DESIGN AND SETTING: The LILACS database was searched for randomized trials using three search strategies. RESULTS: Three search strategies returned 5,262 records, of which only 47 were randomized trials. Most trials reported treatments for pain or cardiopulmonary disease, and most were of moderate to high quality. The sensitivity of the three search strategies varied from 2% to 53%. CONCLUSION: A small number of moderate- to high-quality randomized trials in physiotherapy are published in Spanish and Portuguese languages, but they are difficult to find.

Bibliometrics↗
PubMed2005

Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries?

The purpose of this study was to determine the effects of a 12-week standing program on ankle mobility and femur bone mineral density in patients with lower limb paralysis following recent spinal cord injury. An assessor-blinded within-subject randomised controlled trial was undertaken. Twenty patients with lower limb paralysis following a recent spinal cord injury were recruited. Subjects stood weight-bearing through one leg on a tilt-table for 30 minutes, three times each week for 12 weeks. By standing on one leg a large dorsiflexion stretch was applied to the ankle and an axial load was applied to the bones of the weight-bearing leg. Ankle mobility and femur bone mineral density of both legs were measured at the beginning and end of the study. Ankle mobility (range of motion) was measured with the application of a 17 Nm dorsiflexion torque. Femur bone mineral density was measured using dual energy X-ray absorptiometry (DEXA). The effect of standing was estimated from the difference between legs in mean change of ankle mobility and femur bone mineral density. The results indicated a mean treatment effect on ankle mobility of 4 degrees (95% CI 2 to 6 degrees) and on femur bone mineral density of 0.005 g/cm(2) (95% CI -0.015 to 0.025 g/cm(2)). Tilt-table standing for 30 minutes, three times per week for 12 weeks has a small effect on ankle mobility, and little or no effect on femur bone mineral density. It is unclear whether clinicians and patients would consider such effects to be clinically worthwhile.

Adult↗
PubMed2005

Resistance training for strength: effect of number of sets and contraction speed.

PURPOSE: To compare effects on strength in the early phase of resistance training with one or three sets and fast or slow speeds. METHODS: A total of 115 healthy, untrained subjects were randomized to a control group or one of four training groups: one set fast (approximately 140 degrees.s(-1)), three sets fast, one set slow (approximately 50 degrees.s(-1)), or three sets slow. All subjects attended training 3 x wk(-1) for 6 wk. Subjects in the training groups performed unilateral elbow flexion contractions with a target six- to eight-repetition maximum load. Control subjects sat at the training bench but did not train. One repetition maximum strength, arm circumference, and biceps skinfold thickness were measured before and after training. RESULTS: One slow set increased strength by 25% (95% CI 13-36%, P < 0.001). Three sets of training produced greater increases in strength than one set (difference = 23% of initial strength, 95% CI 12-34%, P < 0.001) and fast training resulted in a greater increase in strength than slow training (difference = 11%, 95% CI 0.2-23%, P = 0.046). The interaction between sets and speed was negative (-15%) and of borderline significance (P = 0.052), suggesting there is a benefit of training with three sets or fast speeds, but there is not an additive benefit of training with both. CONCLUSIONS: Three sets of exercise produce twice the strength increase of one set in the early phase of resistance training. Training fast produces greater strength increases than training slow; however, there does not appear to be any additional benefit of training with both three sets and fast contractions.

Adaptation, Physiological↗