国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題

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Textbook Of Work Physiology Physiological Bases Of Exercise

LEE E. BROWN AND JOSEPH P. WEIR. ASEP Procedures Recommendation I: Accurate Assessment Of Muscular Strength And Power. JEPonline. 2001;4(3):1-21. The content of this manuscript is intended to assist the reader in collecting valid and reliable data for quantifying muscular strength and power. Various drawbacks and pitfalls of specific tests, as well as recommendations for the practitioner are also provided. The content is divided into sections covering isometric, isotonic, field tests, and isokinetic modes of exercise. Inherent in these modes are both concentric and eccentric muscle actions as well as both open and closed kinetic chain activities. For Isometric testing, contractions should occur over a four to five seconds duration with a one second transition period at the start of the contraction. At least one minute of rest should be provided between contractions. For each muscle tested at each position, at least three contractions should be performed although more may be performed if deemed necessary by the tester. For isotonic testing, the 1-RM test should be performed. After the general warm-up, the subject should perform a specific warm-up set of 8 repetitions at approximately 50% of the estimated 1-RM followed by another set of 3 repetitions at 70% of the estimated 1RM. Subsequent lifts are single repetitions of progressively heavier weights until failure. Repeat until the 1-RM is determined to the desired level of precision. The rest interval between sets should be not less than one and not more than five minutes. The optimal number of single repetitions ranges from three to five. Data and guidelines of the following field tests are also provided ; vertical jump, bench press, Wingate anaerobic cycle test (WAT), and the Margaria stair-run test. For isokinetic testing, details are provided for testing peak torque, work, power, endurance, and estimation of fiber type percentages.

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Asep procedures recommendation i: accurate assessment of muscular strength and power

In this prospective randomised study two treatments after non-traumatic medial meniscal tear diagnosed with radiological examination and magnetic resonance imaging were compared; arthroscopic partial meniscectomy followed by supervised exercise or supervised exercise alone. The aim was to evaluate knee function and physical activity. Ninety patients (mean age 56 years) were evaluated using the Knee Injury and Osteoarthritis Outcome Score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and a Visual Analogue Scale for knee pain prior to the intervention, after 8 weeks of exercise and after 6 months. According to the outcome scores arthroscopic partial medial meniscectomy combined with exercise did not lead to greater improvement than exercise alone. After the intervention both groups reported decreased knee pain, improved knee function and a high satisfaction (P < 0.0001). Forty-one per cent of the patients returned to their pre-injury activity level after 6 months. In conclusion, when evaluated with outcome scores, arthroscopic partial medial meniscectomy followed by supervised exercise was not superior to supervised exercise alone in terms of reduced knee pain, improved knee function and improved quality of life.

Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial

Purpose
The aim of this prospective randomized intervention study was to evaluate the outcome at a 2 and 5 year follow-up whether combined arthroscopic surgery followed by exercise therapy was superior to the same exercise therapy alone when treating non-traumatic, degenerative medial meniscal tears.

Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up

Background and Purpose. Controversy exists about the effectiveness of physical therapy after arthroscopic partial meniscectomy. This randomized controlled trial evaluated the effectiveness of supervised physical therapy with a home program versus a home program alone. Subjects. Eighty-four patients (86% males; overall mean age=39 years, SD=9, range=21–58; female mean age=39 years, SD=9, range=24–58; male mean age=40, SD=9, range=21–58) who underwent an uncomplicated arthroscopic partial meniscectomy participated. Methods. Subjects were randomly assigned to either a group who received 6 weeks of supervised physical therapy with a home program or a group who received only a home program. Blinded test sessions were conducted 5 and 50 days after surgery. Outcome measures were: (1) Hughston Clinic questionnaire, (2) Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and EuroQol EQ-5D (EQ-5D) questionnaires, (3) number of days to return to work after surgery divided by the Factor Occupational Rating System score, (4) kinematic analysis of knee function during level walking and stair use, and (5) horizontal and vertical hops. Results. No differences between groups were found for any of the outcomes measured. Discussion and Conclusion. The results indicate that the supervised physical therapy used in this study is not beneficial for patients in the early period after uncomplicated arthroscopic partial meniscectomy.

/pdf/effectiveness-of-supervised-physical-therapy-in-the-early-4d37gt4e37.pdf

Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy.

Altered central pain modulation is the predominant pain mechanism in a proportion of chronic musculoskeletal pain disorders and is associated with poor outcomes. Although existing studies predict poor outcomes such as persistent pain and disability, to date there is little consensus on what factors specifically predict altered central pain modulation.To review the existing literature on the predictive factors specifically for altered central pain modulation in musculoskeletal pain populations.This is a systematic review in accordance with supplemented PRISMA guidelines.A systematic search was performed by 2 mutually blinded reviewers. Relevant articles were screened by title and abstract from Medline, Embase, PubMed, CINAHL, and Web of Science electronic databases. Alternative sources were also sought to locate missed potential articles. Eligibility included studies published in English, adults aged 18 to 65, musculoskeletal pain, baseline measurements taken at the pre-morbid or acute stage, > 3-month follow-up time after pain onset, and primary outcome measures specific to altered central pain modulation. Studies were excluded where there were concurrent diseases or they were non-predictive studies. Risk of bias was assessed using the quality in prognostic studies (QUIPS) tool. Study design, demographics, musculoskeletal region, inclusion/exclusion criteria, measurement timelines, predictor and primary outcome measures, and results were extracted. Data were synthesized qualitatively and strength of evidence was scored using the grading of recommendations, assessment, development, and evaluations (GRADE) scoring system.Nine eligible articles were located, in various musculoskeletal populations (whiplash, n = 2; widespread pain, n = 5; temporomandibular disorder, n = 2). Moderate evidence was found for 2 predictive factors of altered central pain modulation: 1) high sensory sensitivity (using genetic testing or quantitative sensory tests), and 2) psychological factors (somatization and poor self-expectation of recovery), at a pre-morbid or acute stage baseline.At the times of the article publications, the current definitions and clinical guidelines for identifying altered central pain modulation were not yet available. Careful interpretation of the information provided using current knowledge and published guidelines was necessary to extract information specific to altered central pain modulation in some of the studies, avoiding unwarranted assumptions.Premorbid and acute stage high sensory sensitivity and/or somatization are the strongest predictors of altered central pain modulation in chronic musculoskeletal pain to date. This is the first systematic review specifically targeting altered central pain modulation as the primary outcome in musculoskeletal pain populations. Early identification of people at risk of developing chronic pain with altered central pain modulation may guide clinicians in appropriate management, diminishing the burden of persistent pain on patients and heath care providers alike. Systematic Review Registration no.: PROSPERO 2015:CRD42015032394.Key words: Predictive factors, pre-morbid and acute stage baselines, altered central pain modulation, chronic musculoskeletal pain, sensory processing, somatization.

What Are the Predictors of Altered Central Pain Modulation in Chronic Musculoskeletal Pain Populations? A Systematic Review.

Background
Hydrotherapy is frequently indicated for the rehabilitation of patients with rheumatoid arthritis (RA); nevertheless, there has been inadequate appraisal of its effectiveness. The potential benefits of hydrotherapy for patients with RA are to improve and/or maintain functional ability and quality of life.

Objectives
The aim of this systematic review was to evaluate the effectiveness of hydrotherapy in the management of patients with RA.

Method
AMED, CINAHL, EMBASE, MEDLINE, PubMed, Science Direct and Web of Science were searched between 1988 and May 2011. Keywords used were rheumatoid arthritis, hydrotherapy, aquatic physiotherapy, aqua therapy and water therapy. Searches were supplemented with hand searches of references of selected articles. Randomized controlled trials were assessed for their methodological quality using the Physiotherapy Evidence Database (PEDro) scale. This scale ranks the methodological quality of a study scoring 7 out of 10 as ‘high quality’, 5–6 as ‘moderate quality’ and less than 4 as ‘poor quality’.

Results
Initially, 197 studies were identified. Six studies met the inclusion criteria for further analysis. The average methodological quality for all studies was 6.8 using the PEDro scale. Most of the studies reported favourable outcomes for a hydrotherapy intervention compared with no treatment or other interventions for patients with RA. Improvement was particularly noted in reducing pain, joint tenderness, mood and tension symptoms, and increasing grip strength and patient satisfaction with hydrotherapy treatment in the short term.

Conclusions
There is some evidence to suggest that hydrotherapy has a positive role in reducing pain and improving the health status of patients with RA compared with no or other interventions in the short term. However, the long-term benefit is unknown. Further studies are needed. Copyright © 2012 John Wiley & Sons, Ltd.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/msc.1028

The Effectiveness of Hydrotherapy in the Management of Rheumatoid Arthritis: A Systematic Review

Background There is an established risk of injury to young athletes exposed to high training loads Identifying and monitoring injury risk is essential to aid prevention The aim of this study was to use the consensus statement to determine the incidence and pattern of injury in 1 English Premier League soccer academy during 1 season Methods A prospective cohort study included 181 elite academy soccer players during the 2012–2013 season Players were divided into 5 age groups between 9 and 18 years The number, type and incidence of injuries were recorded during matches and training Incidence was calculated per 1000 hours of exposure Results 127 injuries occurred during 29 346 hours of soccer exposure 72% of injuries were non-contact related Under (U)18 players sustained the highest number of match injuries U12–14 players sustained the highest number of training injuries and injuries overall U16 players sustained the highest number of severe injuries, and U18 players sustained the highest number of moderate injuries U18 players sustained the highest number of injuries/1000 hours of training and overall U15 players sustained the highest number of injuries/1000 hours of matches, the highest number of recurrent injuries and the highest incidence of recurrence The most common injuries were muscle injuries in U15 and U18 players The most common injury location was the anterior thigh, with the majority of these occurring in training Conclusions Using the consensus statement, this study used a repeatable method to identify the injury profile of elite academy-level soccer players

https://bmjopensem.bmj.com/content/bmjosem/2/1/e000132.full.pdf

Injury incidence in a Premier League youth soccer academy using the consensus statement: a prospective cohort study

In this study we aimed to determine the reliability of the surface electromyography (EMG) of leg muscles during vertical jumping between two test sessions, held 2 weeks apart. Fifteen females performed three maximal vertical jumps with countermovement. The displacement of the body centre of mass (BCM), duration of propulsion phase (time), range of motion (ROM) and angular velocity of the knee and surface EMG of four leg muscles (rectus femoris, vastus medialis. biceps femoris and gastrocnemius) were recorded during the jumps. All variables were analysed throughout the propulsion and mid-propulsion phases. Intraclass correlation coefficients (ICC) for the rectus femoris, vastus medialis, biceps femoris and gastrocnemius were calculated to be 0.88, 0.70, 0.24 and 0.01, respectively. BCM, ROM and time values all indicated ICC values greater than 0.90, and the mean knee angular velocity was slightly lower, at 0.75. ICCs between displacement of the BCM and integrated EMG (IEMG) of the muscles studied were less than 0.50. The angular velocity of the knee did not correlate well with muscle activity. Factors that may have affected reliability were variations in the position of electrode replacement, skin resistance, cross-talk between muscles and jump mechanics. The results of this study suggest that while kinematic variables are reproducible over successive vertical jumps, the degree of repeatability of an IEMG signal is dependent upon the muscle studied.

Peter C. Goodwin

Papers

Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy.

What Are the Predictors of Altered Central Pain Modulation in Chronic Musculoskeletal Pain Populations? A Systematic Review.

The Effectiveness of Hydrotherapy in the Management of Rheumatoid Arthritis: A Systematic Review

Injury incidence in a Premier League youth soccer academy using the consensus statement: a prospective cohort study

Reliability of leg muscle electromyography in vertical jumping.