title: Effects of whole body vibration training and mental training on mobility, neuromuscular performance, and muscle strength in older men INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training Meaningful change and responsiveness in common physical performance measures in older adults. The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study Cortical Plasticity Following Motor Skill Learning During Mental Practice in Stroke Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial Motor Imagery during Action Observation of Locomotor Tasks Improves Rehabilitation Outcome in Older Adults after Total Hip Arthroplasty Guided Imagery for Total Knee Replacement: A Randomized, Placebo-Controlled Pilot Study. A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial. Reliability of the PEDro scale for rating quality of randomized controlled trials. Effect of guided relaxation and imagery on falls self-efficacy: a randomized controlled trial. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis.
abstract: This study was design ed to evaluate the effects of whole body vibration ( WBV ) exercise , mental training ( MT ) , and the concurrent effect of WBV and MT on lower body balance , neuromuscular performance , and leg muscle strength in elderly men . In a r and omized control trial study with parallel group design , 42 older men ( mean±st and ard deviation age , 68±5.78 years ) were r and omly divided into four groups : WBV ( n=11 ) , MT ( n=12 ) , WBV+MT ( n=10 ) , and control ( n=9 ) groups . The protocol of training consisted of three sessions per week for 8 weeks and about 30 min for each session . The WBV exercise was performed on a vibration machine . In MT group , participants were asked to mentally visualize to do the Timed Up and Go and relaxation technics . postural stability , the Timed Up and Go test , 5-repetition chair-rising test , 6-m t and em gait test , 10-m walking , and leg isometric strength were measured in baseline and after 8-week intervention . Repeated measures - analysis of variance followed by post hoc was used to analyses the data . The results of this study showed that there were significant improvements ( P<0.05 ) in postural stability , Timed Up and Go , 5-repetition chair-rising , 6-m t and em gait test , 10-m walking , and leg isometric strength  in WBV , MT , and WBV+MT in comparison with baseline and in comparison with control group . It seems that older adults can take benefit from WBV and MT and WBV+MT exercise as a cost-effective and practical way without side effects to improve postural control , mobility , and functional performance & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy For consciously performed motor tasks executed in a defined and constant way , both motor imagery ( MI ) and action observation ( AO ) have been shown to promote motor learning . It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment . The present study therefore investigated the influence of MI balance training ( MI_BT ) and a balance training combining AO and MI ( AO+MI_BT ) on postural control of undisturbed and disturbed upright stance on unstable ground . As spinal reflex excitability after classical ( i.e. , physical ) balance training ( BT ) is generally decreased , we tested whether non-physical BT also has an impact on spinal reflex circuits . Thirty-six participants were r and omly allocated into an MI_BT group  , in which participants imagined postural exercises , an AO+MI_BT group , in which participants observed videos of other people performing balance exercises and imagined being the person in the video , and a non-active control group ( CON ) . Before and after 4 weeks of non-physical training , balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance . Soleus H-reflexes were recorded during stable and unstable stance . The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT . Spinal reflex excitability remained unchanged . This is the first study showing that non-physical training ( MI_BT and AO+MI_BT ) not only promotes motor learning of “ rigid ” postural tasks but also improves performance of highly variable and unpredictable balance actions . These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change Abstract Purpose : The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty .  Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries . Yet , whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study . Method : Twenty volunteers were r and omly assigned to either a motor imagery or a control group .  Pain , range of motion , knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test . Results : The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth , a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group . No effects of motor imagery on Timed Up and Go Test scores were observed . Conclusion : Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty . According to this pilot study , motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty . Partial effect-sizes should be conducted in the future . Implication s for rehabilitation Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty : • Enhances quadriceps strength . • Alleviates pain . • Enhances range of motion . • Does not have any effect on basic functional mobility . • Does not have any effect on knee girth Background and purpose . Mental practice ( MP ) , which involves cognitive rehearsal of physical movements , is a noninvasive , inexpensive method of enabling repetitive , task-specific practice ( RTP ) . Recent , r and omized controlled data suggest that MP , when combined with an RTP therapy program , increases affected arm use and function significantly more than RTP only . As a next step , this 10-subject case series examined the possibility that cortical plasticity is a mechanism underlying the treatment effect of MP when combined with RTP . Method . Ten chronic stroke patients ( mean = 36.7 months ) exhibiting stable , moderate motor deficits received 30-minute therapy sessions for their affected arms , occurring 3 days/week for 10 weeks , and emphasizing valued activities of daily living ( ADLs ) . Directly after therapy , subjects received 30-minute MP sessions , which required MP of the ADLs performed during therapy . Behavioral outcomes were blindly evaluated using the Action Research Arm Test ( ARAT ) and the Fugl-Meyer Assessment ( FM ) .  Functional magnetic resonance imaging ( fMRI ) was administered before and after intervention to assess cortical changes . Results . Before intervention , subjects exhibited stable motor deficits . After intervention , subjects exhibited ARAT and FM score increases ( + 5.3 and + 4.2 , respectively ) and clinical ly significant gains in ADLs . Postintervention fMRI revealed significant increases in activation to wrist flexion and extension of the affected h and in the premotor area and primary motor cortex ipsilateral and contralateral to the affected h and , as well as in superior parietal cortex ipsilateral to the affected h and . Decreased activation was noted in parietal cortex of the hemisphere ipsilateral to the affected h and . These changes correlated with anatomical regions in which behavioral changes were observed in the ARAT and FM . Conclusions . MP is an easy to use , cost-effective strategy that was again shown to improve affected arm outcomes after stroke . This is the first study to demonstrate alteration in the cortical map in response to MP training Purpose To investigate the influence of a single session of locomotor-based motor imagery training on motor learning and physical performance . Patients and methods Thirty independent adults aged > 65 years took part in the r and omized controlled trial . The study was conducted within an exercise science laboratory . Participants were r and omly divided into three groups following baseline locomotor testing : motor imagery training , physical training , and control groups . The motor imagery training group completed 20 imagined repetitions of a locomotor task , the physical training group completed 20 physical repetitions of a locomotor task , and the control group spent 25 minutes playing mentally stimulating games on an iPad .  Imagined and physical performance times were measured for each training repetition . Gait speed ( preferred and fast ) , timed-up- and -go , gait variability and the time to complete an obstacle course were completed before and after the single training session . Results Motor learning occurred in both the motor imagery training and physical training groups . Motor imagery training led to refinements in motor planning result ing in imagined movements better matching the physically performed movement at the end of training . Motor imagery and physical training also promoted improvements in some locomotion outcomes as demonstrated by medium to large effect size improvements after training for fast gait speed and timed-up- and -go . There were no training effects on gait variability . Conclusion A single session of motor imagery training promoted motor learning of locomotion in independent older adults .  Motor imagery training of a specific locomotor task also had a positive transfer effect on related physical locomotor performance outcomes This study aim ed at determining whether the combination of action observation and motor imagery ( AO + MI ) of locomotor tasks could positively affect rehabilitation outcome  after hip replacement surgery . Of initially 405 screened participants , 21 were r and omly split into  intervention group ( N = 10 ; mean age = 64 y ; AO + MI of locomotor tasks : 30 min/day in the hospital , then 3 × /week in their homes for two months ) and  control group ( N = 11 , mean age = 63 y , active controls ) . The functional outcomes ( Timed Up and Go , TUG ; Four Step Square Test , FSST ; and single- and dual-task gait and postural control ) were measured before ( PRE ) and 2 months after surgery ( POST ) . Significant interactions indicated better rehabilitation outcome for the intervention group as compared to the control group : at POST , the intervention group revealed faster TUG ( p = 0.042 ) , FSST ( p = 0.004 ) , and dual-task fast-paced gait speed ( p = 0.022 ) , reduced swing-time variability ( p = 0.005 ) , and enhanced cognitive performance during dual tasks while walking or balancing ( p < 0.05 ) . In contrast , no changes were observed for body sway parameters ( p ≥ 0.229 ) . These results demonstrate that AO + MI is efficient to improve motor-cognitive performance after hip surgery . Moreover , only parameters associated with locomotor activities improved whereas balance skills that were not part of the AO + MI intervention were not affected , demonstrating the specificity of training intervention . Overall , utilizing AO + MI during rehabilitation is advised , especially when physical practice is limited OBJECTIVES To determine the effect of guided imagery ( GI ) on functional outcomes of total knee replacement ( TKR ) , explore psychological and neuroimmune mediators , and assess feasibility of study implementation . DESIGN Investigator-blinded , r and omized , placebo-controlled pilot study . SETTING S Hospital , surgeon 's office , participant 's home . PARTICIPANTS 82 persons undergoing TKR . INTERVENTIONS Audiorecordings of TKR-specific GI scripts or placebo-control audiorecordings of audiobook segments . OUTCOME MEASURES Gait velocity and Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) Function scale . RESULTS Outcomes for 58 participants ( 29 receiving GI and 29 controls ) were analyzed at 6 months after surgery . The most frequent reason for noncompletion was protocol -driven exclusion at 6 months for having the contralateral knee replaced before the study endpoint ( n = 15 ) . With imaging ability as a moderator , gait velocity , but not WOMAC Function score , was significantly improved at 6 months in the GI group . Participants in the GI group , but not the control group , had lower WOMAC Pain scores at 3 weeks after surgery than at baseline . Hair cortisol concentration was significantly lower at 6 months after surgery than at baseline in the GI group but not the control group . GI group participants had lower treatment adherence but greater treatment credibility than the control group . CONCLUSION R and omized controlled trials of GI in the TKR population are feasible , but inclusion /exclusion criteria influence attrition . Further studies are needed to elaborate this study 's findings , which suggest that guided imagery improves objective , but not patient-reported , outcomes of TKR . Hair cortisol concentration results suggest that engagement in a time-limited guided imagery intervention may contribute to stress reduction even after the intervention is terminated . Further investigation into optimal content and dosing of GI is needed QUESTION What is the effect of a multifactorial intervention on frailty and mobility in frail older people who comply with their allocated treatment ? DESIGN Secondary analysis of a r and omised , controlled trial to derive an estimate of complier average causal effect ( CACE ) of treatment . PARTICIPANTS A total of 241 frail community-dwelling people aged ≥ 70 years . INTERVENTION Intervention participants received a 12-month multidisciplinary intervention targeting frailty , with home exercise as an important component . Control participants received usual care . OUTCOME MEASURES Primary outcomes were frailty , assessed using the Cardiovascular Health Study criteria ( range 0 to 5 criteria ) , and mobility measured using the 12-point Short Physical Performance Battery . Outcomes were assessed 12 months after r and omisation . The treating physiotherapist evaluated the amount of treatment received on a 5-point scale . RESULTS 216 participants ( 90 % ) completed the study .  The median amount of treatment received was 25 to 50 % ( range 0 to 100 ) . The CACE ( ie , the effect of treatment in participants compliant with allocation ) was to reduce frailty by 1.0 frailty criterion ( 95 % CI 0.4 to 1.5 ) and increase mobility by 3.2 points ( 95 % CI 1.8 to 4.6 ) at 12 months . The mean CACE was substantially larger than the intention-to-treat effect , which was to reduce frailty by 0.4 frailty criteria ( 95 % CI 0.1 to 0.7 ) and increase mobility by 1.4 points ( 95 % CI 0.8 to 2.1 ) at 12 months . CONCLUSION Overall , compliance was low in this group of frail people . The effect of the treatment on participants who comply with allocated treatment was substantially greater than the effect of allocation on all trial participants . TRIAL REGISTRATION Australian and New Zeal and Trial Registry ANZCTRN12608000250336 . [ Fairhall N , Sherrington C , Cameron ID , Kurrle SE , Lord SR , Lockwood K , Herbert RD ( 2016 ) A multifactorial intervention for frail older people is more than twice as effective among those who are compliant : complier average causal effect analysis of a r and omised trial . Journal of Physiotherapy63 : 40 - 44 ] BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVES To examine the effects of guided relaxation and imagery ( GRI ) on improvement in falls self-efficacy in older adults who report having a fear of falling . DESIGN R and omized , controlled trial with allocation to GRI or guided relaxation with music of choice . SETTING General community . PARTICIPANTS Ninety-one men and women aged 60 to 92 . INTERVENTION Participants were r and omized to listen to a GRI audio compact disk ( intervention group ) or a guided relaxation audio compact disk and music of choice ( control group ) twice a week for 6 weeks for 10 minutes per session . MEASUREMENTS Primary outcome measure was the Short Falls Efficacy Scale-International ( FES-I ) . Secondary outcome measures were the Leisure Time Exercise Question naire ( LTEQ ) and the Timed Up and Go ( TUG ) mobility test . RESULTS GRI participants reported greater improvements on the Short FES-I ( P = .002 ) and LTEQ ( P = .001 ) scores and shorter time on the TUG ( P = .002 ) than the guided relaxation and music-of-choice group . CONCLUSION GRI was more effective at increasing falls self-efficacy and self-reported leisure time exercise and reducing times on a simple mobility test than was guided relaxation with music of choice . GRI is an effective , simple , low-cost tool for older adults to improve falls self-efficacy and leisure time exercise behaviors OBJECTIVES To evaluate the effect of an exercise-based model of hospital and in-home follow-up care for older people at risk of hospital readmission on emergency health service utilization and quality of life . DESIGN R and omized controlled trial . SETTING Tertiary metropolitan hospital in Australia . PARTICIPANTS One hundred twenty-eight patients ( 64 intervention , 64 control ) with an acute medical admission , aged 65 and older and with at least one risk factor for readmission ( multiple comorbidities , impaired functionality , aged > or=75 , recent multiple admissions , poor social support , history of depression ) . INTERVENTION Comprehensive nursing and physiotherapy assessment and individualized program of exercise strategies and nurse-conducted home visit and telephone follow-up commencing in the hospital and continuing for 24 weeks after discharge . MEASUREMENTS Emergency health service utilization ( emergency hospital readmissions and visits to emergency department , general practitioner ( GP ) , or allied health professional ) and health-related quality of life ( Medical Outcomes Study 12-item Short Form Survey ( SF-12v2 ) collected at baseline and 4 , 12 , and 24 weeks after discharge . RESULTS The intervention group required significantly fewer emergency hospital readmissions ( 22 % of intervention group , 47 % of control group , P=.007 ) and emergency GP visits ( 25 % of intervention group , 67 % of control group , P<.001 ) . The intervention group also reported significantly greater improvements in quality of life than the control group as measured using SF-12v2 Physical Component Summary scores ( F ( 3 , 279)=30.43 , P<.001 ) and Mental Component Summary scores ( F ( 3 , 279)=7.20 , P<.001 ) . CONCLUSION Early introduction of an individualized exercise program and long-term telephone follow-up may reduce emergency health service utilization and improve quality of life of older adults at risk of hospital readmission Objective : Falls , loss of health-related quality of life and physical capacity , reduced participation in activities of daily living , and increased fear of falling are all potential outcomes for older adults discharged from hospital . A low-cost video based exercise programme may address this . Design : This study was a r and omized controlled trial with blinded outcomes assessment and a six-month follow-up . Subjects and setting : Participants were older adults ( > 65 years ) using a mobility aid discharged from a tertiary hospital in Brisbane , Australia , without referral for community-based rehabilitation services . Intervention : A digital video disk-based programme encompassing six exercise types each with six levels of difficulty . A home visit from a project physiotherapist was conducted to ensure patient safety . Control group patients received usual care . Main measures : Falls , health-related quality of life , participation in activities of daily living , physical capacity and fear of falling . Results : Study participants ( n = 53 , 19 intervention , 34 control ) experienced decreasing health-related quality of life , several falls ( 72 ) , and lower levels of participation in activities of daily living over the six-month follow-up . The intervention group did not differ significantly from the control group in terms of the outcomes examined , though a non-significant reduction in the rate of falls was observed . Intervention group participants complied with the exercise programme well during the first two weeks following discharge from hospital but then reduced their compliance levels thereafter . Conclusions : The intervention may be beneficial for reducing the rate of falls in this patient population though further research with a larger sample size is indicated STUDY DESIGN Prospect i ve cohort study . OBJECTIVES To establish the major clinical ly important improvement ( MCII ) of the timed up- and -go test ( TUG ) , 40-meter self-paced walk test ( 40-m SPWT ) , 30-second chair st and ( 30 CST ) , and a 20-cm step test in patients with hip osteoarthritis ( OA ) undergoing physiotherapy treatment . As a secondary aim , a comparison of methods was employed to evaluate the effect of method on the reported MCII . BACKGROUND Minimal clinical ly important difference scores are commonly used by rehabilitation professionals to determine patient response following treatment . A gold st and ard for calculating MCII has yet to be determined , which has result ed in problems of interpretation due to varied results . METHODS As part of a r and omized controlled trial , 65 patients were r and omized into a physiotherapy treatment group for hip OA , in which they completed 4 physical performance measures at baseline and 9 weeks . Upon completion of physiotherapy , patients assessed their response to treatment on a 15-point global rating of change scale ( GRCS ) . MCII was estimated using 3 variations of an anchor-based method , based on the patient 's opinion . RESULTS A comparison of 3 methods result ed in the following change scores being best associated with our definition of MCII : a reduction equal to or greater than 0.8 , 1.4 , and 1.2 seconds for the TUG ; an increase equal to or greater than 0.2 , 0.3 , and 0.2 m/s for the 40-m SPWT ; an increase equal to or greater than 2.0 , 2.6 , and 2.1 repetitions for the 30 CST ; an increase equal to or greater than 5.0 , 12.8 , and 16.4 steps for the 20-cm step test . CONCLUSION The variation in methods provided very different results . This illustrates the importance of comparing method ologies and reporting a range of values associated with the MCII , as such values vary , depending upon the methodology chosen
target: Motor imagery training improves balance and mobility in older adults who do not have a neurological condition .
  These results suggest that motor imagery training could be an adjunct to st and ard physiotherapy care in older adults , although it is unclear whether or not the effects are clinical ly worthwhile .
background: QUESTION Does motor imagery training improve measures of balance , mobility and falls in older adults without a neurological condition ?