| 1. |
- Engström, Pähr, et al.
(author)
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Botulinum toxin A does not improve cast treatment for idiopathic toe-walking - a randomized controlled trial
- 2013
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In: Journal of Bone and Joint Surgery. American volume. - 0021-9355 .- 1535-1386. ; 95:5, s. 400-407
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Journal article (peer-reviewed)abstract
- Background: There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toewalking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems. Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study. Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking. Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children were evaluated with a screening questionnaire for neuropsychiatric problems. Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were improved at both three and twelve months in both groups, even though many children still demonstrated some degree of toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems. Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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| 2. |
- Engström, Pähr, et al.
(author)
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Does Botulinum toxin A improve the walking pattern in children with idiopathic toe-walking?
- 2010
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In: Journal of Children's Orthopaedics. - : SAGE Publications. - 1863-2521 .- 1863-2548. ; 4:4, s. 301-308
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Journal article (peer-reviewed)abstract
- Background: Numerous recommendations have been made for treating idiopathic toe-walking (ITW), but the treatment results have been questioned. The purpose of this study was to investigate whether botulinum toxin A (BTX) improves the walking pattern in ITW as examined with 3-D gait analysis. Participants and methods: A consecutive series of 15 children (aged 5-13 years) were enrolled in the study. The children underwent a 3-D gait analysis prior to treatment with a total of 6 units/kg bodyweight Botox® in the calf muscles and an exercise program. The gait analysis was repeated 3 weeks and 3, 6, and 12 months after treatment. A classification of toe-walking severity was made before treatment and after 12 months. The parents rated the perceived amount of toe-walking prior to treatment and 6 and 12 months after treatment. Results: Eleven children completed the 12-month follow-up. The gait analysis results displayed a significant improvement, indicating decreased plantarflexion angle at initial contact and during swing phase and increased dorsiflexion angle during midstance at all post-treatment testing instances. According to the parents' perception of toe-walking, 3/11 children followed for 12 months had ceased toe-walking completely, 4/11 decreased toe-walking, and 4/11 continued toe-walking. After 6-12 months, the toe-walking severity classification improved in 9 of the 14 children for whom data could be assessed. Conclusions: A single injection of BTX in combination with an exercise program can improve the walking pattern in children with ITW seen at gait analysis, but the obvious goal of ceasing toe-walking is only occasionally reached.
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| 3. |
- Munters, Li Alemo, et al.
(author)
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Improvement in Health and Possible Reduction in Disease Activity Using Endurance Exercise in Patients With Established Polymyositis and Dermatomyositis : A Multicenter Randomized Controlled Trial With a 1-Year Open Extension Followup
- 2013
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In: Arthritis Care and Research. - : Wiley. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 65:12, s. 1959-1968
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Journal article (peer-reviewed)abstract
- ObjectiveTo determine the effects of a 12-week endurance exercise program on health, disability, VO2 max, and disease activity in a multicenter randomized controlled trial in patients with established polymyositis (PM) and dermatomyositis (DM), and to evaluate health and disability in a 1-year open extension study. MethodsPatients were randomized into a 12-week endurance exercise program group (EG; n = 11) or a control group (CG; n = 10). Assessments of health (Short Form 36 [SF-36]), muscle performance (5 voluntary repetition maximum [5 VRM]), activities of daily living (ADL), patient preference (McMaster Toronto Arthritis Patient Preference Disability Questionnaire), VO2 max, and disease activity (International Myositis Assessment and Clinical Studies criteria of improvement of the 6-item core set) were performed at 0 and 12 weeks. Disability assessments were performed again at 52 weeks in an open extension period. All assessments were performed by blinded observers. ResultsThe EG improved compared to the CG in SF-36 physical function and vitality (P = 0.010 and P = 0.046, respectively), ADL score (P = 0.035), 5 VRM (P = 0.026), and VO2 max (P = 0.010). More patients in the EG (7 of 11) were responders with reduced disease activity compared to none in the CG (P = 0.002). Correlations between VO2 max and SF-36 physical function were 0.90 and 0.91 at 0 and 12 weeks, respectively (P < 0.05). The EG improvement in 5 VRM was sustained up to 52 weeks compared to baseline (5.7 kg; P < 0.001), but not in ADL score or SF-36. ConclusionsEndurance exercise improves health and may reduce disease activity in patients with established PM/DM. This potentially could be mediated through improved aerobic fitness. The results also indicate sustained muscle strength up to 1 year after a supervised program.
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| 4. |
- Öhman, Anna, 1957, et al.
(author)
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The Physical Therapy Assessment and Management of Infants with Congenital Muscular Torticollis. A Survey and a Suggested Assessment Protocol for CMT
- 2013
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In: Journal of Novel Physiotherapies. - : OMICS Publishing Group. - 2165-7025. ; 3:4
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Journal article (peer-reviewed)abstract
- Background: Infants with congenital muscular torticollis (CMT) are treated with physical therapy, however the knowledge about type of assessment and treatment in current clinical practice is not clear. Aim: This study aimed to investigate the management of infants with CMT within a network of physical therapists. Settings/population: Physical therapists from a network for CMT participated in the study. Method: With permission a questionnaire from New Zealand was used. Subsequently an expert group of physical therapists developed a draft assessment protocol. Result: In general there was a high degree of consensus between the respondents in the current survey. For the assessment visual estimates were most commonly used and an evaluation of cervical muscle strength of the neck was always/often conducted. The most effective form of intervention as perceived by the respondents in the management of CMT was passive stretching, handling advice, facilitation with strengthening exercises of the neck muscle and facilitation of active cervical range of motion. There were big discrepancies in assessment of hand- and hip asymmetry. Conclusion: There seems to be a need to develop international guidelines for CMT to improve the evidence practice of assessment and treatment.
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