Volume 2:1
The Effectiveness of Virtual Reality in Controlling Pain in Patients with Burns: A Systematic Review
Stephanie Koenke, SPT
Temple University – Philadelphia, PA
Journal of Student Physical Therapy Research. 2010:2(1)1-11.
Study Design: Systematic review of the literature. Objectives: To determine if virtual reality (VR) with standard analgesics is more effective at improving patients’ reports of pain during wound dressing changes, passive stretching, and range of motion (ROM) exercises than standard analgesics alone. Background: People with burn injuries experience significant pain during rehabilitation. VR may be a means to enhance pain control during the rehabilitation period. There are no previous systematic reviews of this topic. Methods and Measures: The following databases were searched for studies applying VR in the treatment of patients with burns; Ovid Medline, Cinahl, PEDro, and Pubmed. The PEDro1 scale was used to assess methodological quality of included studies. Included studies were then synthesized for a best-level of evidence using the qualitative scale from Van Tulder.2 Results: Seven randomized controlled trials and quasi-experimental studies were included in the review. All seven studies were of moderate level quality. Six out of seven articles showed a statistically significant effect of VR on pain scores. Of the statistically significant results, two articles used the Faces Scale and demonstrated a mean reduction in pain from 4.1 to 1.39, and 5.38 to 2.8112 respectively. Two articles used a Visual Analog Scale and indicated a mean pain reduction from 69.00mm to 28.29mm6 and from 36.33mm to 14.67mm.10 Additionally, one study used a Graphic Rating Scale and showed a mean reduction in pain from 7.6 to 5.111, and the last study used a Visual Analog Thermometer and showed a mean reduction in pain from 5.52 to 2.83. 13 Moderate level evidence indicates that VR results in lower pain scores during dressing changes and physical therapy compared to analgesics alone. Conclusions: The available data suggests that VR in adjunct with standard pharmacologic analgesics produces lower pain scores during wound dressing changes and physical therapy compared to standard pharmacologic analgesics alone. Further research should address the use and effect of VR in a physical therapy specific setting, as well as the cost-effectiveness of such an intervention.
Feasibility and Benefit of Using the Nintendo Wii Fit for Balance Rehabilitation in an Elderly Patient Experiencing Recurrent Falls
Tony Pigford, DPT; A. Williams Andrews, PT, EdD, NCS
Journal of Student Physical Therapy Research. 2010:2(1)12-20.
Introduction: The purpose of this case report was to examine whether a balance training program utilizing the Nintendo Wii Fit platform could improve dynamic balance control in an elderly patient with balance impairments. Also, the investigators sought to determine whether the motivational aspect of the video games would stimulate the patient’s desire to participate in the balance rehabilitation program. Case Description: An elderly patient with a recent history of falls underwent two weeks of balance training utilizing the Wii Fit platform along with other traditional therapeutic interventions. Pre-intervention and post-intervention outcome measures were recorded. For this report, the selected outcome measures were: Berg Balance Scale, Activities-specific Balance Confidence Scale, Timed Up and Go, and gait speed. Outcomes: Post-intervention, the patient demonstrated improvements in all of the selected balance outcome measures. During the intervention, the patient demonstrated a high level of cooperation resulting in increased time spent performing balance activities. Conclusions: This case report gives insight on how the Wii Fit was combined with more traditional physical therapy interventions to enhance an elderly patient’s participation in the interventions and improve balance performance.
Reliability and validity of the sit-to-stand navicular drop test: Do static measures of navicular height relate to the dynamic navicular motion during gait?
Juli Deng, PT, DPT; Rita Joseph, PT, DPT; Christopher Kevin Wong, PT, PhD, OCS
Columbia University – New York, NY
Journal of Student Physical Therapy Research. 2010:2(1)21-28.
Study Design: A methodological study. Objectives: To be a useful assessment of gait, a static measure should be reliable and also demonstrate predictive validity of dynamic gait function. To date, predictive validity has not been established for any static arch height measure. This study sought to examine the relationship between the sit-to-stand navicular drop test (SSNDT) and dynamic navicular drop (DND) during gait as measured with motion analysis. Background: Reliable measures of midfoot function that correlate with the dynamic navicular drop during gait remain elusive. The navicular drop test (NDT) measures change in static navicular height (NH), but has variable reliability. Reliability has been affected by inconsistencies when finding subtalar joint neutral (STJN) and percent weight bearing through the lower extremity. The SSNDT addresses some issues that may negatively affect the reliability of the NDT. Currently there is no gold standard for a static measurement used within the clinic for NH. Methods and Measures: The study included 102 feet of 51 healthy volunteers (22 men, 29 women) with mean age 28.1 ± 7.1 years. Intra- and inter-rater reliability of the SSNDT was established in preliminary testing before the SSNDT was compared to DND. The reliability was established using the first six participants. Navicular height was measured in three positions: sitting with foot flat and 5% body weight on a scale, standing with 70-80% body weight, with the other foot stabilized to avoid balance reactions and STJN position in standing evenly on both legs. Results: Measures of NH in standing or sitting for all testers demonstrated good intra- and inter-rater reliability (ICC = 0.83 to 0.95). SSNDT had moderate intra- (ICC = 0.68 to 0.78) and inter-rater reliability (ICC = 0.72). Discussion: The mean navicular drop obtained using the SSNDT was consistent with previous findings reported in the literature and was more reliable than those obtained with the NDT. The SSNDT had moderate reliability and no predictive validity for the digital motion analysis of gait. Conclusions: There was no correlation between SSNDT and DND, suggesting that static measures of NH change may not predict dynamic navicular motion in gait.
The Effects of a Combination of Live and Videotaped Exercise Sessions on Functional Mobility and Falls Prevention Among Community-Dwelling Elders
Anuja H. Gandhi, SPT; Richard Cipoletti, SPT; Carol A. Maritz, PT, EdD, GCS
University of Sciences in Philadelphia–Philadelphia, PA
Journal of Student Physical Therapy Research. 2010:2(1)29-35.
Study Design: Longitudinal study. Objectives: The purpose of this program was to measure the effects of a combination of both live and videotaped exercise sessions on functional mobility and falls prevention among community-dwelling elders. Background: African American female subjects (mean age 78) who attend a local senior center participated in one 45-minute exercise class per week for ten weeks over two consecutive years. The program was based on ACSM guidelines for older adults and included 45 minutes of a combination of seated conditioning and strengthening exercises. Methods and Measures: The exercise program was designed with various levels of challenges, enabling participants to choose based on their comfort level and physical ability. The group of elders was videotaped both at the beginning and at the mid-points of the program as they gradually progressed. This videotape, which featured the program participants, was edited and copied for use at home as a supplement to the live classes. Results: To measure the effectiveness of this program, a pretest-posttest approach was used for the assessment of functional mobility using the timed up and go test (TUG) and the performance oriented mobility assessment (POMA). Data was analyzed using the paired, dependent t-test in three stages. After the first program, the POMA scores increased significantly from pretest to posttest, but TUG scores showed no significant change; however, there was a trend towards decreased performance time among participants. POMA and TUG scores measured prior to the start of the second program showed no significant differences when compared with the same measures taken at the conclusion of the first program. This suggests that participants were maintaining gains made following participation in the first session. However, the results from the third stage revealed significant differences with POMA and TUG. Conclusions: The group dynamics proved to be a strong motivator for participants to exercise, and the use of a video as a supplement to live group sessions was found to be beneficial in the short term. Perhaps the provision of ongoing support via telephone would have enabled the video to continue to serve as an adjunct to a live group-based program thereby serving as a falls prevention strategy. Future research is needed to assess the effectiveness of the telephone support.
