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ABSTRACT: PURPOSE: The aim of this review was to investigate the effect of initial graft tension on patient-specific functional outcomes after anterior cruciate ligament reconstruction and determine whether a particular tension is associated with superior functional outcome. METHODS: We performed a systematic review of prospective randomized trials with a National Health and Medical Research Council Australia level of evidence of III or higher published between 1950 and July 2012. Studies using a semitendinosus-gracilis or bone-patellar tendon-bone autograft that reported graft tension and postoperative functional outcomes were included. Quantitative analysis was performed on available data by calculating effect size (ES) both at various time points and across tensions (in Newtons). RESULTS: Initial search strategies returned 457 original publications, of which 5 articles fulfilled all exclusion and inclusion criteria. The mean score for quality was 5.8 (SD, 1.3), with 12 being the highest possible score. When compared with the preoperative side-to-side difference in anterior tibial displacement, 80 N and 78.9 N of tension recorded the largest effect at 2 weeks or less (ES, -2.98 [range, -3.82 to -2.14]) and 12 months or more (ES, -2.45 [range, -3.40 to -1.51]) postoperatively, respectively. When we compared tensions, the largest effect was toward 80 N when compared with 20 N at 2 weeks or less after surgery (ES, 0.76 [range, 0.17 to 1.35]). CONCLUSIONS: The objective of this review was to systematically assess the literature to determine whether a particular initial graft tension results in superior outcomes after anterior cruciate ligament reconstruction. From the review, there is a trend toward an initial graft tension of 78.5 to 90 N resulting in a reduced side-to-side difference in anterior laxity. However, there is insufficient evidence to conclude whether patient-specific function is improved at any specific tension. LEVEL OF EVIDENCE: Level II, systematic review of Level II studies.
Arthroscopy The Journal of Arthroscopic and Related Surgery 04/2013; · 3.02 Impact Factor
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ABSTRACT: We examined the validity and reliability of an Internet-based telehealth system for screening speech intelligibility and oro-motor structure, and function in children with speech disorders. Twenty children aged 4-9 years were assessed by a clinician in the conventional, face-to-face (FTF) manner; simultaneously, they were assessed by a second clinician via the videoconferencing system using a 128-kbit/s Internet connection. Speech intelligibility in conversation was rated and an informal assessment of oro-motor structure and function was conducted. There was a high level of agreement between the online and FTF speech intelligibility ratings, with 70% exact agreement and 100% close agreement (within ± point on a 5-point scale). The weighted kappa statistic revealed very good agreement between raters (kappa = 0.86). Data for online and FTF ratings of oro-motor function revealed overall exact agreement of 73%, close agreement of 96%, moderate or good strength of agreement for six variables (kappa = 0.48-0.74), and poor to fair agreement for six variables (kappa = 0.12-0.36). Intra- and inter-rater reliability measures (ICCs) were similar between the online and FTF assessments. Low levels of agreement for some oro-motor variables highlighted the subjectivity of this assessment. However, the overall results support the validity and reliability of Internet-based screening of speech intelligibility and oro-motor function in children with speech disorders.
Journal of telemedicine and telecare 05/2012; 18(4):198-203. · 0.92 Impact Factor
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ABSTRACT: A complication of total knee arthroplasty is patellar avascular necrosis. Surgical approaches for total knee arthroplasty include the medial parapatellar approach (MPa) and, less commonly, the subvastus approach (SVa). The argument that SVa retains better patellar vascularity than the MPa was investigated on 20 participants, (SVa, n = 10; MPa, n = 10) 18 months postoperatively. Outcomes were a radionuclide bone imaging technique, a new bone vascularity scale, and an anterior knee pain numerical assessment scale. Results indicated no significant difference between groups on imaging (P = .935), the components of the bone vascularity scale, or anterior knee pain (P > .999). The SVa appears to offer no benefit over the MPa in terms of patellar vascularity or anterior knee pain.
The Journal of arthroplasty 03/2012; 27(6):1123-7.e1. · 1.79 Impact Factor
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ABSTRACT: The medial parapatellar (MP) approach in total knee arthroplasty is more common, but the subvastus (SV) approach is less insulting to the quadriceps. Whether the SV approach affords better outcomes was investigated using 90 participants with knee osteoarthritis, randomized to receive either SV or MP approaches and followed for 18 months. The primary outcome was the American Knee Society Score (AKSS); secondary outcomes included pain, knee range, quadriceps lag, Oxford Knee Score, 3-m timed "Up and Go" test, days to straight leg raise, surgeon perceived difficulty, operation duration, and length of stay. Analysis (n = 76) revealed no significant difference in AKSS (P = .076) or other outcomes, except the following: AKSS Functional scores at 12 and 18 months, favoring the MP (P = .032 and P = .028 respectively); surgeon's perceived difficulty, favoring the MP (P = .001); and days to straight leg raise, favoring the SV (P = .044). This study found that the SV approach offers no clinical benefit over the MP approach.
The Journal of arthroplasty 08/2011; 27(3):347-353.e1. · 1.79 Impact Factor
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Journal of physiotherapy 01/2011; 57(1):5-7. · 1.92 Impact Factor
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ABSTRACT: total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee. Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function. Access to high-quality rehabilitation services is not always possible, especially for those who live in rural or remote areas. The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty.
this investigation was a single-blinded, prospective, randomized, controlled noninferiority trial. Sixty-five participants were randomized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and six weeks by a blinded independent assessor. Secondary outcomes included the Patient-Specific Functional Scale, the timed up-and-go test, pain intensity, knee flexion and extension, quadriceps muscle strength, limb girth measurements, and an assessment of gait. Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics.
baseline characteristics between groups were similar, and all participants had significant improvement on all outcome measures with the intervention (p < 0.01 for all). After the six-week intervention, participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion, muscle strength, limb girth, pain, timed up-and-go test, quality of life, and clinical gait and WOMAC scores. Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group (p < 0.05). The telerehabilitation intervention was well received by participants, who reported a high level of satisfaction with this novel technology.
the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation.
therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 01/2011; 93(2):113-20. · 3.27 Impact Factor
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ABSTRACT: Telehealth has the potential to improve children's access to speech-language pathology services. Validation of telehealth applications, including the assessment of childhood language disorders, is necessary for telehealth to become an accepted alternative mode of service provision. The aim of this study was to validate an Internet-based telehealth system for assessing childhood language disorders.
Twenty-five children ages 5 to 9 years were assessed using the core language subtests of the Clinical Evaluation of Language Fundamentals--4th Edition (CELF-4; Semel, Wiig, & Secord, 2003). Each participant was simultaneously assessed online and face-to-face (FTF). Assessments were administered by either an online or an FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs.
No significant difference was found between the online and FTF total raw scores and scaled scores for each subtest. Weighted kappas revealed very good agreement on the individual items, total raw scores, scaled scores, core language score, and severity level. Intra- and interrater reliability were determined for a sample of online ratings, with intraclass correlation analysis revealing very good agreement on all measures.
The results of this study support the validity and reliability of scoring the core language subtests of the CELF-4 via telehealth.
Language Speech and Hearing Services in Schools 10/2010; 41(4):445-58. · 1.32 Impact Factor
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ABSTRACT: Musculoskeletal injuries are the most common source of chronic pain and disability. The ankle joint is the most common of these injuries and without adequate rehabilitation function can be severely impaired. Access to physiotherapy rehabilitation services can be limited due to geographical remoteness and a shortage of services in rural and remote areas. Telerehabilitation is a potential solution to bridge this service delivery gap. The aim of this study was to determine the criterion validity and reliability of conducting a remote musculoskeletal assessment of the ankle joint complex using telerehabilitation technologies compared with a face-to-face assessment.
This study utilized a repeated measures design to assess 15 subjects (mean age 24.5, SD 10.8 years) presenting with ankle pain. Conventional face-to-face assessments were compared with assessments performed via a telerehabilitation system.
A similar agreement of 93.3% in patho-anatomical diagnosis and an 80% exact agreement (chi(2) = 4.267; p < 0.04) in primary systems diagnosis was found between face-to-face and telerehabilitation assessments. Clinical observations were found to have very strong agreement (k = 0.92) for categorical data and significant agreement (93.3% agreement; chi(2) = 234.4; p < 0.001) for binary data. A high level of inter- and intrarater reliability was found for the telerehabilitation assessments.
This study demonstrates the criterion validity and reliability of remote musculoskeletal assessments of the ankle joint complex using telerehabilitation.
Physiotherapy Research International 09/2010; 15(3):167-75.
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ABSTRACT: Interactive telehealth applications have potential for the assessment of reading disability in school-aged children. However, there is currently a lack of research on the validity of such applications. The aim of this study was to investigate the validity and reliability of an Internet-based videoconferencing system for the assessment of children's literacy on a battery of standardized assessments.
Twenty children aged 8-13 years were simultaneously assessed in real-time both face-to-face and over a 128-Kbps Internet link. The assessments included eight subtests of the Queensland University Inventory of Literacy (QUIL), the South Australian Spelling Test, and the Neale Analysis of Reading Ability, 3rd edition (Neale-3).
The limits of agreement for the majority of raw scores fell within predetermined clinical criteria, with the exception of the QUIL nonword reading and nonword spelling measures and the rate score of the Neale-3. Weighted kappa analyses on the tests' scaled scores indicated very good agreement for all parameters (kappa 0.92-1.00). Percentage levels of agreement were adequate (above 80%) for most measures except for the nonword reading raw score of the QUIL and the reading error classification component of the Neale-3. Very good intra- and interrater reliability was determined for all online parameters (intraclass correlation coefficient 0.98-1.00).
As issues with audio latency, break-up, and echo were observed, some modifications to the technology may improve system effectiveness and usability. However, the overall positive results of this study support the validity and reliability of the assessment of children's literacy skills via telehealth.
Telemedicine and e-Health 06/2010; 16(5):564-75. · 1.42 Impact Factor
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ABSTRACT: We investigated the validity and feasibility of online delivery of the Lee Silverman Voice Treatment (LSVT) for the treatment of the speech disorder of a patient with idiopathic Parkinson's disease. The treatment was delivered in 16 sessions to the participant's home, 90 km from the speech language pathologist. A PC-based videoconferencing system was used, operating at 128 kbit/s over the public telecommunications network. The patient achieved substantial improvements in vocal sound pressure levels during sustained vowel phonation (6.13 dB), reading (12.28 dB) and conversational monologue (11.32 dB). There were improvements in the duration of sustained vowel phonation (4 s). Improvements were also perceived in the degree of breathiness and roughness in the voice, and in overall speech intelligibility in conversation. The patient was very satisfied with the audio and video quality of the conferencing, and with the online treatment overall. He reported a preference for online sessions for the future management of his condition, rather than face-to-face treatment. Remote LSVT delivery was found to be feasible and effective.
Journal of telemedicine and telecare 12/2009; 16(2):100-4. · 0.92 Impact Factor
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ABSTRACT: A previous study revealed that reliable assessment of dysarthria was feasible. However, that study also revealed a number of system limitations and suggested that technological enhancements and improvements in study design and clinical assessment protocols were needed before validity and reliability of assessment of dysarthria via telerehabilitation could be confirmed. In the current study, improvements in technology, study design, and clinical assessment protocols were implemented in order to re-examine the validity and reliability of assessing and diagnosing dysarthria via the telerehabilitation medium. The aim of this study was to explore the validity and reliability of assessing dysarthria using both formal standardized and informal assessments via a purpose-built telerehabilitation system. Twenty-four participants with an acquired dysarthria were assessed simultaneously via telerehabilitation and face-to-face (FTF) on a battery of assessments. A custom-built telerehabilitation system enabled real-time telerehabilitation assessment over a 128 Kbps Internet connection. Data analysis included an analysis of strength of agreement between the two methods using percentage agreement and weighted ? statistics. Inter-rater and intrarater reliability were also examined for both the FTF and telerehabilitation-led assessments. Good strength of agreement was found between the FTF and telerehabilitation assessment methods. High intrarater and inter-rater reliability within both the FTF and telerehabilitation assessment methods supported these findings. Participants reported high overall satisfaction in the telerehabilitatin environment. This study describes the improvements made to the telerehabilitation system reported previously and confirms that valid and reliable assessment of dysarthria using both standardized and informal assessments over the Internet is possible using this system.
Telemedicine and e-Health 11/2009; 15(9):840-50. · 1.42 Impact Factor
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ABSTRACT: This systematic review was performed to compare the outcomes of the medial parapatellar and subvastus surgical approaches for total knee arthroplasty. Five studies, published between 1993 and 2001 met the inclusion quality standards for the review. The methodological quality of most studies was poor, and they were not sufficiently homogenous for meta-analysis. We found that the evidence was insufficient to demonstrate a clinical or statistically significant difference between the medial parapatellar and subvastus approaches to total knee arthroplasty across all outcomes. Further trials with robust methodology, objective and functional outcome measures, and follow-up beyond 6 to 12 months are required.
The Journal of arthroplasty 09/2009; 25(5):728-34. · 1.79 Impact Factor
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Trevor G Russell
The Australian journal of physiotherapy 02/2009; 55(1):5-6. · 3.48 Impact Factor
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ABSTRACT: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability?
A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days.
An inpatient rehabilitation facility.
Twenty-one participants receiving inpatient rehabilitation following stroke.
Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively.
Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5).
Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.
Clinical Rehabilitation 11/2008; 22(10-11):931-9. · 2.12 Impact Factor
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ABSTRACT: Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability?
A within-participant, repeated measures experimental study.
18 individuals with a first stroke who were undergoing inpatient rehabilitation.
Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session.
During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale.
Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity.
Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.
The Australian journal of physiotherapy 02/2008; 54(1):49-54. · 3.48 Impact Factor
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Trevor G Russell
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ABSTRACT: Telerehabilitation is the provision at a distance of rehabilitation services such as physiotherapy, speech pathology or occupational therapy. The primary aim is to provide equitable access to rehabilitation services. Broadly speaking, the technologies used for telemedicine-based physical rehabilitation can be classified as: (1) image-based telerehabilitation; (2) sensor-based telerehabilitation; and (3) virtual environments and virtual reality telerehabilitation. To date, much of the research has been technology focused, and has consisted of single case or small sample research designs. The next step is to demonstrate viable telerehabilitation services in real world environments using well controlled research methodologies with large patient cohorts. In addition, the broader issues of cost-benefit and cost-effectiveness require investigation. If this can be done, then the undoubted potential benefits of telerehabilitation, for both the patient and health-care systems, can be realized.
Journal of Telemedicine and Telecare 02/2007; 13(5):217-20. · 1.21 Impact Factor
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ABSTRACT: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment.
Using a counterbalanced, repeated measures research design, 2 speech-language pathologists assessed 19 speakers with dysarthria on a battery of perceptual assessments. The assessments included a 19-item version of the Frenchay Dysarthria Assessment (FDA; P. Enderby, 1983), the Assessment of Intelligibility of Dysarthric Speech (K. M. Yorkston & D. R. Beukelman, 1981), perceptual analysis of a speech sample, and an overall rating of severity of the dysarthria. One assessment was conducted in the traditional face-to-face manner, whereas the other assessment was conducted using an online, custom-built telerehabilitation application. This application enabled real-time videoconferencing at 128 kb/s and the transfer of store-and-forward audio and video data between the speaker and speech-language pathologist sites. The assessment methods were compared using the J. M. Bland and D. G. Altman (1986, 1999) limits-of-agreement method and percentage level of agreement between the 2 methods.
Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored.
The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.
American Journal of Speech-Language Pathology 03/2006; 15(1):45-56. · 2.03 Impact Factor
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ABSTRACT: We have designed and tested an Internet-based video-phone suitable for use in the homes of families in need of paediatric palliative care services. The equipment uses an ordinary telephone line and includes a PC, Web camera and modem housed in a custom-made box. In initial field testing, six clinical consultations were conducted in a one-month trial of the videophone with a family in receipt of palliative care services who were living in the outer suburbs of Brisbane. Problems with variability in call quality--namely audio and video freezing, and audio break-up--prompted further laboratory testing. We completed a programme of over 250 test calls. Fixing modem connection parameters to use the V.34 modulation protocol at a set bandwidth of 24 kbit/s improved connection stability and the reliability of the video-phone. In subsequent field testing 47 of 50 calls (94%) connected without problems. The freezes that did occur were brief (with greatly reduced packet loss) and had little effect on the ability to communicate, unlike the problems arising in the home testing. The low-bandwidth Internet-based video-phone we have developed provides a feasible means of doing telemedicine in the home.
Journal of Telemedicine and Telecare 02/2004; 10 Suppl 1:10-3. · 1.21 Impact Factor
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ABSTRACT: After a total knee replacement, inadequate rehabilitation is associated with poor physical outcomes and a reduced longevity of the knee prosthesis. We have developed a low-bandwidth telemedicine system to enable rehabilitation services to be delivered directly to the home of patients in rural and remote areas. We have examined the experience of clinical physiotherapists and of 31 participants who received treatment via the system. High levels of satisfaction were reported by participants (mean responses > 7 on a 10 cm visual analogue scale). The service was found to be effective, safe and easy to use, and it integrated well into current clinical practice. The study demonstrates the potential for delivering physiotherapy services via low-bandwidth Internet connections.
Journal of Telemedicine and Telecare 02/2004; 10 Suppl 1:85-7. · 1.21 Impact Factor
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ABSTRACT: We have developed a low-bandwidth, Internet-based telerehabilitation system to provide outpatient rehabilitation to patients who have undergone total knee arthroplasty. The preliminary efficacy of this treatment programme in terms of both physical and functional objective outcome measures was assessed on 21 patients. Subjects receiving a six-week rehabilitation programme were randomized to the telerehabilitation system or the usual face-to-face method. The physical and functional improvements in the telerehabilitation group were similar to those in the control group. There was a non-significant trend for greater improvements in the telerehabilitation group for most outcome measurements. The telerehabilitation programme was well received by patients. The results of this study provide evidence for the efficacy of low-bandwidth telerehabilitation consultations.
Journal of Telemedicine and Telecare 02/2003; 9 Suppl 2:S44-7. · 1.21 Impact Factor
