Study Design Controlled laboratory study using a cross-sectional design. Objectives To compare lower extremity force applications during a sit-to-stand (STS) task with and without upper extremity assistance in older individuals post-hip fracture to those of age-matched controls. Background A recent study documented the dependence on upper extremity assistance and the uninvolved lower limb during an STS task in individuals post-hip fracture. This study extends this work by examining the effect of upper extremity assistance on symmetry of lower extremity force applications. Methods Twenty-eight community-dwelling elderly subjects, 14 who had recovered from a hip fracture and 14 controls, participated in the study. All participants were independent ambulators. Four force plates were used to determine lower extremity force applications during an STS task with and without upper extremity assistance. The summed vertical ground reaction forces (vGRFs) of both limbs were used to determine STS phases (preparation/rising). The lower extremity force applications were assessed statistically using analysis of variance models. Results During the preparation phase, side-to-side symmetry of the rate of force development was significantly lower for the hip fracture group for both STS tasks (P<.001). During the rising phase, the vGRF impulse of the involved limb was significantly lower for the hip fracture group for both STS tasks (P = .045). The vGRF impulse for the uninvolved limb was significantly increased when participants with hip fracture did not use upper extremity assistance compared to elderly controls (P = .002). This resulted in a significantly lower vGRF symmetry for the hip fracture group during both STS tasks (P<.001). Conclusion Participants with hip fracture who were discharged from rehabilitative care demonstrated decreased side-to-side symmetry of lower extremity loading during an STS task, irrespective of whether upper extremity assistance was provided. These findings suggest that learned motor control strategies may influence movement patterns post-hip fracture. J Orthop Sports Phys Ther 2012;42(5):474–481. doi:10.2519/jospt.2012.3562
Chemotherapy-induced peripheral neuropathy (CIPN) is considered a primary mechanism of imbalance among women diagnosed with breast cancer. Recent evidence, however, suggests that cancer-related fatigue (CRF) may also influence balance.Examine the contributions of CRF and CIPN to static and dynamic balance before and after a period of fatiguing exercise.This is a secondary analysis of data examining functional differences between women with breast cancer with and without persistent CRF. Postural sway was measured during static standing and the rising phase of an instrumented sit-to-stand (ISTS) before and after exercise. Regression analyses were performed to determine how CRF and severity of CIPN predicted sway and how much variance was attributable to each.Greater CRF predicted increased pre-, p=.04, and post-exertional, p=.02, static sway in the anterior-posterior plane. CRF accounted for 10.5% and 9.5% of the variance in pre- and post-exertional sway (respectively) compared to the 0.9% and 1.4% accounted for by CIPN severity which was not a significant predictor. After exercise, greater CRF predicted smaller, more conservative, anterior weight shifting during the ISTS, p=.01, and accounted for 6.6% of the variance in sway compared to 3% attributed to CIPN which was not a significant predictor.This analysis is limited by its small and demographically homogenous sample.These results suggest that CRF may influence balance independent of CIPN symptoms. While CIPN remains a risk factor for imbalance in this population, CRF warrants consideration in clinical practice and research as a mechanism of postural instability.
Purpose: To determine whether there were significant differences in self-report and objective measures of physical fitness and function between women post–breast cancer (BC) treatment with and without clinically significant fatigue. Methods: We performed a secondary analysis of baseline data collected from 281 postmenopausal women post–BC treatment (62 ± 10 years; time since diagnosis = 5.6 ± 3.9 years) who participated in prior exercise trials. Scores on the SF-36 (36-Item Short Form Health Survey) vitality subscale (0-100) were used to identify women with clinically significant fatigue, where a score of 45 or less represents fatigue and a score of 70 or more represents no fatigue. Objectively measured function included maximal leg press strength (kg), physical function battery, timed chair stand, Unipedal Stance Test, and gait characteristics. Self-reported outcomes included physical function, pain, mental health, sensory symptoms of chemotherapy-induced peripheral neuropathy (CIPN), habitual physical activity level, and fall history. Results: Twenty percent of women (n = 57) reported clinically significant fatigue 6 years postdiagnosis, whereas 34% (n = 100) reported no fatigue. Except for leg strength, unipedal stance, step length, and base of support while walking, fatigued women had significantly worse objectively measured function than women without fatigue. Fatigued women also reported poorer physical function, greater bodily pain, and poorer mental health and were twice as likely as nonfatigued women to report symptoms of CIPN and having fallen. Conclusions: Women with a history of BC, and in particular those with CIPN, should be routinely screened for clinically significant fatigue in the survivorship period. Clinical and survivorship care plans aimed at limiting functional decline and reducing falls in survivors of BC should include fatigue-reduction strategies.
Background and Purpose: When treating older adults post-hip fracture, physical therapists routinely assess the sit-to-stand (STS) task using observational analysis. Studies have demonstrated that significant movement asymmetries in ground reaction force production of the fractured lower limb persist during STS, even though individuals may rise independently. To date, the validity of therapist judgments of lower limb force during STS has not been addressed. The purpose of this observational cohort study was to determine the accuracy of physical therapists' observational assessments of STS for detecting the involved limb and its ground reaction force contribution in older adults post-hip fracture. Methods: Eighteen home health physical therapists assessed 10 videotapes of older adults post-hip fracture rising from sitting and judged the side of involvement and the amount of ground reaction force generated by the fractured lower limb. Each videotape was synchronized with its respective force data. A wide spectrum of asymmetry in rising was represented in the test videos. Before making these judgments, the therapists viewed a separate set of training videos and received instructions in the use of specific visual cues to assist with subsequent judgments. Results and Discussion: Therapists judged the involved side correctly 74% of the time. Mean accuracy in judging ground reaction force output was 39% across all therapists. Force symmetry did not significantly influence accuracy of force judgments. Inaccurate judgments of force may limit therapeutic intensity and minimize the potential for developing motor strategies that favor force production of the involved limb. Augmenting observational analysis of STS with quantitative data could assist in optimizing restorative function. Conclusion: Judgments of lower limb ground reaction force output during STS based on observation alone are not valid and may need to be supplemented with quantitative data.
Abstract Objective To optimize learning in physical therapist education, learners need opportunities to grow from their unique starting points. Traditional grading practices like A to F grades, zero grades, and grading on timeliness and professionalism hinder content mastery and accurate competency assessment. Grading should focus on mastery of skill and content, using summative assessments for final grades, a no-zero policy, and actionable feedback. Equitable grading supports learners from all backgrounds and identities and promotes academic success. This case study provides guidance and recommendations for implementing equitable grading practices in academic physical therapist programs. Methods Over a 2-year period, a doctor of physical therapy program began implementing 5 strategies to create more equitable grading practices: (1) eliminating zero grades, (2) allowing late assignment submissions without penalty, (3) using low-stakes formative assessments throughout the semester, (4) weighing end-of-course assessments more heavily than initial ones, and (5) offering a no-stakes anatomy prep course before matriculation. Results Outcomes from implementing equitable grading practices varied. Some learners felt increased stress from fewer points opportunities, while others appreciated the reduced anxiety from low-stakes assessments. Some saw multiple attempts for peers as unfair. Faculty faced higher workloads due to detailed feedback and remediation but believed it benefited learners. Median final grades improved in some courses, remained stable in others, and slightly decreased in one. Overall, the changes had minimal impact on most learners’ grades but significantly improved outcomes and retention for struggling learners. Conclusion This case report documents the implementation of equitable grading practices in a Doctor of Physical Therapy program, offering valuable insights and recommendations for other institutions aiming to adopt similar practices. Impact Inequity in assessment widens the gap between learners entering professional programs. Equitable assessment practices level the playing field, enabling learners from diverse backgrounds and identities to succeed. Increased diversity benefits everyone, especially patients, by reducing health disparities for historically marginalized groups.
Cancer patients treated with cytotoxic chemotherapy experience fatigue and changes in body composition that can impact physical functioning and quality of life during and after treatment. Interleukin-6 (IL-6) is associated with fatigue in cancer survivors and plays an important role in the regulation of body composition. The purpose of the present study was to determine the specific role of IL-6 in cyclophosphamide-doxorubicin-5-fluorouracil (CAF)-induced changes in fatigue, food intake, and body composition using mice lacking IL-6. Female wild-type (WT) and IL-6 − /− mice were injected with four cycles of CAF or normal saline (NS) administered at 21-day intervals. Daily voluntary wheel-running activity (VWRA), used as a proxy for fatigue, and food intake were monitored daily up to 21 days after the fourth dose. Dual-energy X-ray absorptiometry (DEXA) was used to assess treatment-related changes in lean body mass (LBM), fat mass (FM), and bone mineral content (BMC). Patterns of change in fatigue and food intake did not differ between CAF-treated WT and IL-6 − /− mice. However, a Genotype × Drug interaction was observed for LBM ( p = 0.047) and FM ( p = 0.035) but not BMC ( p = .569). Whereas WT mice lost LBM and FM during CAF treatment, IL-6-deficient mice did not. Treatment-related decreases in levels of the anabolic hormone insulin-like growth factor-1 (IGF-1) may contribute to LBM and FM loss since CAF decreased IGF-1 levels in an IL-6-dependent manner. These findings implicate IL-6 and possibly IGF-1 in the regulation of body composition in breast cancer patients exposed to cytotoxic chemotherapy.
Purpose: To examine whether survivors of breast cancer (SBC) with persistent cancer-related fatigue (CRF) have greater fatigability than their nonfatigued counterparts. Methods: Measures of fatigability, including endurance, perceived exertion, lower extremity muscle force and power, and sit-to-stand time (STST), were assessed in 43 women (21 with persistent CRF) after a sit-to-stand fatigue (STSF) task. Group differences in fatigability outcomes were examined using analysis of variance. Results: SBC with persistent CRF had lower endurance ( P = .003, η p 2 = 0.205) and reported greater perceived exertion ( P < .001, η p 2 = 0.284) during the STSF task, and demonstrated lower postexertional force ( P = .035, η p 2 = 0.109), power ( P = .001, η p 2 = 0.242), and slower STST ( P = .001, η p 2 = 0.258) compared with SBC without CRF. Conclusions: SBC with persistent CRF have increased fatigability compared with those without CRF. Our findings suggest that exercise recommendations for women with persistent CRF after breast cancer treatment should include activities that increase lower limb muscle force and power, such as heavy resistance or explosive-type strength training.
