Browsing by Person "Macmillan, Fiona"

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Classifying Outcome Measures According to the International Classification of Functioning, Disability and Health: a Pilot Study.
(2009-11-25) Williamson, Julia; Bulley, Catherine; Coutts, Fiona; Macmillan, Fiona
at which level of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF) (WHO 2001) a selection of low back pain outcome tools measure. The ICF describes several categories of impact, those on body systems, activity, participation in life roles as well as environmental and personal factors. These categories can be used to relate an outcome measure to the level of the intervention. The results of a study may be compromisedif the outcome measure does not correspond to the level of intervention. For example, a treatment designed to reduce pain should be measured by a tool that measures at a body systems level while an intervention designed to improve return to work needs to measure at the participation level. In order to conduct a trial examining the effects of rehabilitation strategies after lumbar surgery it has been necessary to examine the qualities of commonly used low back pain outcome measures in light of the ICF. Confusion exists as to whether the entities of activity and participation are separate (Dahl 2002). Several attempts have been made to distinguish between the two but as yet, no consensus exists (Granlund2004). It was therefore necessary to define activity and participation and to validate this with a group of qualified health practitioners. J Williamson, C Bulley, F. Coutts, F. MacMillan
Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome
(2011-03) Fatoye, F. E.; Palmer, S.; van der Linden, Marietta; Rowe, P. J.; Macmillan, Fiona
Hypermobility syndrome (HMS) is characterised by generalised joint laxity and musculoskeletal complaints. Gait abnormalities have been reported in children with HMS but have not been empirically investigated. The extent of passive knee joint range of motion (ROM) has also not been well reported in children with HMS. This study evaluated gait kinematics and passive knee joint ROM in children diagnosed with HMS and healthy controls.Thirty-seven healthy children (mean age SD. =11.5 2.6 years) and 29 children with HMS (mean age SD. =11.9 1.8 years) participated. Sagittal knee motion and gait speed were evaluated using a VICON 3D motion analysis system. Passive knee ROM was measured with a manual goniometer. Independent t-tests compared the values of sagittal knee motion and gait speed between the two groups. Mann-Whitney U tests compared passive knee ROM between groups.Passive ROM (extension and flexion) was significantly higher (both p<0.001) in children with HMS than the healthy controls. Peak knee flexion (during loading response and swing phase) during walking was significantly lower (both p<0.001) in children with HMS. Knee extension in mid stance during walking was significantly increased (p<0.001) in children with HMS. However, gait speed was not statistically (p=0.496) different between the two groups.Children with HMS had higher passive knee ROM than healthy children and also demonstrated abnormal knee motion during gait. Gait re-education and joint stability exercise programmes may be of value to children with HMS. 2010 Elsevier B.V.
Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle
(Maney Publishing, 2012-11) Barbero, Marco; Bertoli, P.; Cescon, C.; Macmillan, Fiona; Coutts, Fiona; Gatti, Roberto
Objectives: Myofascial trigger points (MTrPs) are considered the principal clinical feature of myofascial pain syndrome (MPS). An MTrP consists of spot tenderness within a taut band of muscle fibers and its stimulation can produce both local and referred pain. The clinical diagnosis of MPS depends on correct history taking and a physical examination aimed at identifying the presence of MTrP. The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle. Methods: Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values. Results: The intraclass correlation coefficient ICC(1,1) values were 0.62 (95% CI: 0.30-0.81) for X and 0.81 (95% CI: 0.61-0.91) for Y. The Bland-Altman plots for X and Y showed a mean of difference of 0.04 and -0.2 mm, respectively. Limits of agreement for X ranged from -26.3 to 26.2 mm and for Y from -27 to 26.4 mm. Discussion: The ICC(1,1) for the observed values revealed a moderate to high correlation and the Bland-Altman analysis showed means of difference very close to zero with narrow limits of agreement. An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol.
Myofascial trigger points and innervation zone locations in upper trapezius muscles
(BioMed Central, 2013-06) Barbero, Marco; Cescon, Corrado; Tettamanti, Andrea; Leggero, Vittorio; Macmillan, Fiona; Coutts, Fiona; Gatti, Roberto
Background Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Thus, it is suggested that MTrPs will be overlap the innervation zone (IZ). The purpose of this work was to describe the location of MTrPs and the IZ in the right upper trapezius. Methods We screened 71 individuals and eventually enrolled 24 subjects with neck pain and active MTrPs and 24 neck pain-free subjects with latent MTrPs. Surface electromyography (sEMG) signals were detected using an electrode matrix during isometric contraction of the upper trapezius. A physiotherapist subsequently examined the subject's trapezius to confirm the presence of MTrPs and establish their location. IZ locations were identified by visual analysis of sEMG signals. IZ and MTrPs locations were described using an anatomical coordinate system (ACS), with the skin area covered by the matrix divided into four quadrants. Results No significant difference was observed between active and latent MTrPs locations (P = 0.6). Forty-five MTrPs were in the third quadrant of the ACS, and 3 were included in second quadrant. IZs were located approximately midway between the seventh cervical vertebrae and the acromial angle in a limited area in the second and third quadrants. The mean distance between MTrP and IZ was 10.4 5.8 mm. Conclusions According to the acquired results, we conclude that IZ and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped.
Pain intensity and quality of life perception in children with hypermobility syndrome
(2012-05) Fatoye, F.; Palmer, S.; Macmillan, Fiona; Rowe, P.
Hypermobility syndrome (HMS) is a major source of morbidity in children. Impaired quality of life (QoL) has been observed recently in adults with HMS; however, this issue is yet to be investigated in children with this condition. This study compared pain intensity and QoL in children with HMS with healthy controls. It also examined the relationship between pain intensity and QoL in children with HMS. Following ethical approval, 29 children diagnosed with HMS and 37 healthy children aged 8-15 years participated. Informed written consent was obtained from participants and their parents/guardians. Average knee pain over the past week was examined using the Coloured Analogue Scale. QoL was measured via the Pediatric Quality of Life Inventory. Mann-Whitney U tests were performed to compare pain and QoL scores between the two groups. Spearman Rho correlation analysis was performed to examine the relationship between pain and QoL. Overall QoL scores in each domain were significantly lower in children with HMS (all p < 0.001) compared with the controls. Pain intensity was significantly higher in children with HMS compared with their healthy counterparts (p < 0.001). A strong negative correlation was observed between pain intensity and overall QoL and all the domains (r range = -0.614 to -0.717; all p < 0.001). In conclusion, the findings of the present study imply that pain and QoL assessment might form important components of clinical examination for children diagnosed with HMS. These children may benefit from appropriate treatment programmes to alleviate pain intensity and improve QoL. 2011 Springer-Verlag.
Patient interpretations of the term 'stiffness' prior to and following total knee arthroplasty
(2011) Lane, Judith; Simpson, Hamish; Howie, Colin; Macmillan, Fiona
Purpose: to gain further understanding of what patients mean when they say that their joint feels 'stiff' both prior to and following total knee arthroplasty. Relevance: Pain, function and joint stiffness are recommended as core outcome measures following joint replacement surgery although few studies have included stiffness . One study in patients with rheumatoid arthritis showed that the interpretation of the word 'stiffness' was varied. If groups with osteoarthritis and TKA were to demonstrate a similar variability, doubt could be cast upon the robustness of currently used measures of stiffness. Participants: Patients (n = 40) who were due to undergo TKA for osteoarthritis within 6 weeks were recruited from a pre-admission clinic. TKA patients (n = 76) were recruited from a group who had undergone primary TKA for osteoarthritis in the previous 10-14 months. Methods: Participants rated their level of perceived stiffness from 0 -100 using a visual analogue scale. They were also asked to select words that they felt best described their stiffness from a list of 21. The stiffness descriptors included words that were related to pain, difficulty with movement and sensation. Analysis: VAS stiffness was not normally distributed and therefore Mann-Whitney U tests were used to detect inter-group differences in self reported level of stiffness, number of words used. Chi-square tests were used to explore difference between the groups in the type of words used to describe stiffness. Results: The OA group had a higher median VAS stiffness score of 60.0 compared to 40.0 in the TKA group. These differences were significant (p < 0.001). The median number of words used to describe stiffness was 4.0 in the OA group compared to 1.0 in the TKA. Overall 49% of participants used words from the pain category to describe stiffness. A significantly greater proportion (2 = 19.65, p < 0.001) of participants in the OA group (78%) included words from the pain category to describe their stiffness compared to the TKA group (34%). A similar proportion of participants in the OA group (75%) included words from the difficulty with movement category compared to the TKA group (65%). A significantly higher proportion (2 = 42.88, p < 0.001) of participants in the OA group (60%) than the TKA group (5%) used words from the sensation category. The most common combination of words in the OA group was pain + stiffness+sensation (43%) whereas the largest proportion of TKA patients (41%) used the difficulty with movement category only. Conclusions: All participants were likely to use a range of words to describe stiffness but the OA group were more likely to use pain or sensation related words than the TKA group. Implications: When a patient reports stiffness either prior to and following TKA, care should be taken to explore with the patient what they mean. Many patients confused sensations of pain with sensations of stiffness and this could have implications for provision of adequate pain relief. Further work is necessary to ensure the validity of patient reported measures of stiffness.
Physical function following TKA compared to age matched healthy controls
(2011) Lane, Judith; Simpson, Hamish; Howie, Colin; Macmillan, Fiona
Purpose: to explore whether physical and functional impairments exist in those who have undergone primary TKA compared to age matched healthy controls. Relevance: Many studies have suggested that although function generally improves following TKA, patients continue to experience significant functional limitations. Most of these studies however have assessed function using self-reported measures despite recommendations that both self-report and performance based measures are required to capture the full spectrum of functional ability. Furthermore, there have been no recent studies that have comprehensively compared outcomes in TKA with those who have no knee related pathology. Therefore, the evidence to suggest that functional limitations persist cannot be considered as robust. Participants: A group of patients (n = 15) were recruited who had undergone primary TKA for osteoarthritis between 10 and 14 months previously (median age = 71 years). A group of age matched health controls (n = 12, median age = 69.5 years) were recruited from local community groups. Methods: Self reported function (0-100 scale where 0 is best), timed-up-and-go, stair ascent/descent, walking speed, leg extensor power and range of motion were compared between groups. Analysis: Mann-Whitney U-tests were used to detect inter-group differences. The alpha level was set at 0.05. Results: Maximum flexion in the TKA group (median = 110o) was significantly less (p = 0.002) than the control group (median = 120o). The TKA group reported significantly worse function (median scores TKA = 10.0, control = 0.00, p = 0.028). No significant differences (p >0.05) however were found between groups in any of the performance based measures of function (timed up and go, timed stair ascent/descent, walking speed) or in knee extensor strength. Conclusions: although individuals with TKA perceived their functional ability to be significantly worse than their healthy counterparts, there was no evidence to suggest that significant functional impairments existed in this small group. Implications: expectations of outcome in TKA have been shown to be an important factor in overall patient satisfaction with their surgery. The results of this study could help to provide improved information regarding functional ability following TKA.
Proprioception and muscle torque deficits in children with hypermobility syndrome
(Oxford University Press, 2008-12-16) Fatoye, Francis A.; Palmer, S.; Macmillan, Fiona; Rowe, P. J.; van der Linden, Marietta
Objectives. Sensorimotor deficits such as impaired joint proprioception and muscle weakness have been found in association with hypermobility syndrome (HMS) in adults. HMS is more common in children than adults, yet such deficits have not been adequately investigated in paediatric populations. It is therefore uncertain as to what sensorimotor deficits are present in children with HMS. This study investigated knee joint proprioception and muscle torque in healthy children and those with HMS. Methods. Thirty-seven healthy children (mean age S.D._11.52.6 yrs) and 29 children with HMS (mean age S.D._11.91.8 yrs) participated in this study. Knee joint kinaesthesia (JK) and joint position sense (JPS) were measured, with the absolute angular error (AAE) calculated as the absolute difference between the target and perceived angles. Knee extensor and flexor muscle torque was assessed and normalized to body mass. Mann-Whitney U-tests were performed to compare JK, JPS and muscle torque between the two groups. Results. Children with HMS had significantly poorer JK and JPS compared with the controls (both P<0.001). Knee extensor and flexor muscle torque was also significantly reduced (both P<0.001) in children with HMS compared with their healthy counterparts. Conclusions. The findings of this study demonstrated that knee joint proprioception was impaired in children with HMS. They also had weaker knee extensor and flexor muscles than healthy controls. Clinicians should be aware of these identified deficits in children with HMS, and a programme of proprioceptive training and muscle strengthening may be indicated.
Reliability of surface EMG matrix in locating the innervations zone of upper trapezius muscle
(Elsevier, 2011-10) Barbero, Marco; Gatti, Roberto; Lo Conte, Loredano; Macmillan, Fiona; Coutts, Fiona; Merletti, Roberto
The identification of the motor unit (MU) innervation zone (IZ) using surface electromyographic (sEMG) signals detected on the skin with a linear array or a matrix of electrodes has been recently proposed in the literature. However, an analysis of the reliability of this procedure and, therefore, of the suitability of the sEMG signals for this purpose has not been reported. The purpose of this work is to describe the intra and inter-rater reliability and the suitability of surface EMG in locating the innervation zone of the upper trapezius muscle. Two operators were trained on electrode matrix positioning and sEMG signal analysis. Ten healthy subjects, instructed to perform a series of isometric contractions of the upper trapezius muscle participated in the study. The two operators collected sEMG signals and then independently estimated the IZ location through visual analysis. Results showed an almost perfect agreement for intra-rater and inter-rater reliability. The constancy of IZ location could be affected by the factors reflecting the population of active MUs and their IZs, including: the contraction intensity, the acquisition period analyzed, the contraction repetition. In almost all cases the IZ location shift due to these factors did not exceed 4. mm. Results generalization to other muscles should be made with caution. 2011 Elsevier Ltd
Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndrome
(2008-03-17) Fatoye, Francis A.; Macmillan, Fiona; Rowe, P. J.; van der Linden, Marietta
Background: Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS. Aim: To investigate the between-days repeatability of joint proprioception and muscle torque in these groups. Methods: Twenty children (10 healthy and 10 with HMS), aged eight to 15 years, were assessed on two separate occasions (one week apart) for joint kinaesthesia (JK), joint position sense (JPS), and the extensor and knee flexor muscle torque of the knee. JK was measured using threshold to detection of passive movement. JPS was measured using the absolute angular error (AAE; the absolute difference between the target and perceived angles). Knee extensor and flexor muscle torque was normalized to body weight. Results: Intra-class correlation coefficients (ICC) for JK, extensor and flexor muscle torque excellent in both groups (range 0.83 to 0.98). However, ICC values for JPS tests were poor to moderate in the two groups (range 0.18 to 0.56). 95% limits of agreement (LOA) were narrow in both cohorts for JK and muscle torque (indicating low systematic error) but wide for the JPS tests. 95% LOA also demonstrated that the measuring instruments used in this study had low between-days systematic error. Conclusions: Based on ICC and 95% LOA, the repeatability of JK and muscle torque measurements was excellent in both healthy children and those with HMS. The JPS test can only be assessed with poor to moderate repeatability. The use of the JPS test in these children should be undertaken with caution. Copyright 2008 John Wiley & Sons, Ltd.