Determining the relative and absolute reliability of outcomes of physical performance tests for people undergoing hemodialysis is necessary to discriminate between the true effects of exercise interventions and the inherent variability of this cohort. The aims of this study were to assess the relative reliability of sit-to-stand-to-sit tests (the STS-10, which measures the time [in seconds] required to complete 10 full stands from a sitting position, and the STS-60, which measures the number of repetitions achieved in 60 seconds), the Six-Minute Walk Test (6MWT), the one-leg heel-rise test, and the handgrip strength test and to calculate minimal detectable change (MDC) scores in people undergoing hemodialysis. This study was a prospective, nonexperimental investigation. Thirty-nine people undergoing hemodialysis at 2 clinics in Spain were contacted. Study participants performed the STS-10 (n=37), the STS-60 (n=37), and the 6MWT (n=36). At one of the settings, the participants also performed the one-leg heel-rise test (n=21) and the handgrip strength test (n=12) on both the right and the left sides. Participants attended 2 testing sessions 1 to 2 weeks apart. High intraclass correlation coefficients (≥.88) were found for all tests, suggesting good relative reliability. The MDC scores at 90% confidence intervals were as follows: 8.4 seconds for the STS-10, 4 repetitions for the STS-60, 66.3 m for the 6MWT, 3.4 kg for handgrip strength (force-generating capacity), 3.7 repetitions for the one-leg heel-rise test with the right leg, and 5.2 repetitions for the one-leg heel-rise test with the left leg. Limitations A limited sample of patients was used in this study. The STS-16, STS-60, 6MWT, one-leg heel rise test, and handgrip strength test are reliable outcome measures. The MDC scores at 90% confidence intervals for these tests will help to determine whether a change is due to error or to an intervention.

The beliefs and attitudes of health care providers may contribute to chronic low back pain (LBP) disability, influencing the recommendations that they provide to their patients. An excessively biomedical style of undergraduate training can increase negative beliefs and attitudes about LBP, whereas instruction following a biopsychosocial model could possibly lessen these negative beliefs in health care professionals. The objectives of this study were to determine the effectiveness of 2 brief educational modules with different orientations (biomedical or biopsychosocial) on changing the beliefs and attitudes of physical therapy students and the recommendations that they give to patients. The intervention in the experimental group was based on the general biopsychosocial model, whereas the sessions in the control group dealt with the basics of the biomechanics of back pain. The participants completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and Rainville et al. Clinical Cases questionnaire before and after the interventions. The participants attending the biopsychosocial session displayed a reduction in fear-avoidance beliefs (P<.001) and Pain-Impairement beliefs (P<.001), which was strongly correlated with an improvement in clinicians' activity and work recommendations. However, the students assigned to the biomechanics sessions increased their fear-avoidance scores (P<.01), and their recommendations for activity levels worsened significantly (P<.001). Our results confirm the possibility of modifying the behaviour of students through the modification of their beliefs and attitudes. We also conclude that a strictly biomedical education exacerbates maladaptive beliefs, and consequently results in inadequate activity recommendations. The implications of this study are important for both the development of continuing medical education and the design of the training curriculum for undergraduate students.

Functional tests are commonly used for chronic kidney disease (CKD) patients undergoing hemodialysis (HD). However, the relative and absolute reliability of such physical performance-outcome assessments must first be determined in specific patient cohorts. The aims of this study were to assess the relative and the absolute reliability of the Short Physical Performance Battery (SPPB), One-Legged Stance Test (OLST), and Timed Up and Go (TUG) test, as well as the minimal detectable change (MDC) scores for these tests in CKD patients receiving HD. Seventy-one end-stage CKD patients receiving HD therapy, aged between 21 and 90 years, participated in the study. The patients completed two testing sessions one to two weeks apart and performed by the same examiner, comprising the following tests: the SPPB (n = 65), OLST (n = 62), and TUG test (n = 66). High intraclass correlation coefficients (≥0.90) were found for all the tests, suggesting that their relative reliability is excellent. The MDC scores for the 90% confidence intervals were as follows: 1.7 points for the SPPB, 11.3 seconds for the OLST, and 2.9 seconds for the TUG test. The reliability of the SPPB, OLST, and TUG test for this sample were all considered to be acceptable. The MDC data generated by these tests can be used to monitor meaningful changes in the functional capacity of the daily living-related activity of CKD patients on HD.

The objective of this study was to determine whether 24 weeks resistance training during hemodialysis could improve exercise capacity, muscle strength, physical functioning and health-related quality of life compared to a low intensity aerobic program. 27 patients (55.6 +/- 17.6 years) were recruited from two hemodialysis clinics in Valencia (Spain). Patients were randomized to resistance training (n = 19) or low-intensity aerobic training (n = 8). Resistance training consisted of three sets of 4 exercises at an intensity of 12 - 15 out of 20 at the rate of perceived exertion scale (Borg scale measuring self-rated exercise intensity) using weights and elastic bands on every session during 24 weeks. Primary outcomes included physical performance tests, evaluated by the "sit-to-stand-to-sit tests" and the 6 minutes walking test, and knee extensor muscles strength, evaluated by isometric dynamometry. Secondary outcomes included cardiorespiratory fitness, measured by time and METs (measure of energy expenditure as ml of oxygen per kg of weight and per minute; 1 MET is equal to 3.5 ml O(2)/kg/min) achieved on a graded exercise test, and quality of life, measured by the SF-36 questionnaire. No differences were noted in change-over-time between the two groups in any of the physical performance tests. However, a significant change was found in change-over-time in right knee extensor muscles dynamometry, and intragroup analysis showed a significant improvement in resistance training groups in the physical performance tests and METs. These findings suggest that resistance training during hemodialysis improves patient's physical functioning.

To investigate the effects of adding orofacial treatment to cervical physical therapy in patients with chronic migraine and temporomandibular disorders (TMD). A total of 45 participants with chronic migraine and TMD aged 18 to 65 years were randomized into two groups: a cervical group (CG) and a cervical and orofacial group (COG). Both groups continued their medication regimens for migraine treatment and received physical therapy. The CG received physical therapy only in the cervical region, and the COG received physical therapy in both the cervical and orofacial regions. Both groups received six sessions of treatment that consisted of manual therapy and therapeutic exercise in the cervical region or the cervical and orofacial regions. Scores on the Craniofacial Pain and Disability Inventory (CF-PDI) and the Headache Impact Test (HIT-6) were primary outcome variables, and the secondary outcome variables were scores on the Tampa Scale for Kinesiophobia (TSK-11), pain intensity measured on a visual analog scale (VAS), pressure pain thresholds (PPTs) in the temporal, masseter (2 points, M1 and M2) and extratrigeminal (wrist) regions, and maximal mouth opening (MMO). Data were recorded at baseline, posttreatment, and after 12 weeks of follow-up. The α level was set at .05 for all tests and two-way repeated-measures analysis of variance (ANOVA) for within- and between-group interactions. There were 22 CG participants (13.6% men and 86.4% women) and 23 COG participants (13% men and 87% women). The ANOVA analysis revealed statistically significant differences for group × time interaction in CF-PDI, HIT-6 in the last follow-up, pain intensity, PPTs in the trigeminal region, and MMO (P < .05), with a medium-large magnitude of effect. No statistically significant differences were found in the PPTs of the extratrigeminal region or in the TSK-11 (P > .05). Both groups reported a significant improvement in CF-PDI, HIT-6, and pain intensity. Cervical and orofacial treatment was more effective than cervical treatment alone for increasing PPTs in the trigeminal region and producing pain-free MMO. Physical therapy alone was not effective for increasing the PPTs in the extratrigeminal region (wrist) or decreasing the level of TSK-11.