Bacharach Institute for Rehabilitation

Day rehabilitation (DR) is emerging in the United States as an alternative postacute rehabilitation setting. There have been no published studies focused on the efficacy of DR for a postacute orthopedic population. This study investigated the efficacy of DR as an alternative to inpatient skilled nursing facility (SNF) status post total knee arthroplasty. A retrospective chart review was conducted. Subjects were 50-75 yrs old, underwent total knee arthroplasty in 2009, and were discharged from an SNF or DR affiliated with a postacute healthcare system. The sample consisted of all DR (n = 56) and randomly selected SNF (n = 45) subjects. Upon admission, there were no differences between DR and SNF groups for age, sex, comorbidity score, pain score, knee range of motion, ambulation distance, locomotion Functional Independent Measure score, or body mass index. Upon discharge, there was no difference in knee range of motion or pain between groups. Discharge ambulation distance (P = 0.000) and locomotion Functional Independent Measure score (P = 0.001) were greater for the DR compared with the SNF group. Cost was lower (P = 0.000) and length of stay was shorter (P = 0.000) for the DR compared with the SNF group. Subjects discharged from DR had similar or improved outcomes compared with subjects discharged from SNF at a lower cost and shorter stay. Results suggest that DR delivered significant cost savings when compared with SNF without compromising patient outcomes.

Predicting one repetition maximum (1RM) strength from submaximal lifts has long been a topic of debate in strength and conditioning circles. Several equations exist that purport to accurately determine 1RM using a submaximal weight and repetitions-to-fatigue (RTF) PURPOSE: Compare the accuracy of four commonly used equations for predicting 1RM from RTF at a sub-maximal resistance for the bench press and back squat. METHODS: Division II college football players (N=62) actively participating in a strength and conditioning program served as a convenience sample with 56 completing the bench press trials and 48 completing the squat trials. Athletes were asked to perform a 1RM bench press and back squat as well as a RTF test with proper form at a self-selected weight with which they could complete approximately five repetitions using standard Olympic free weights. A separate regression analysis was performed on the bench press and squat with resulting equations being used for comparison with four previously existing methods. RESULTS: An ANOVA revealed a significant difference between the five prediction equations tested for both the bench press and squat exercises. Post-hoc pair-wise analyses confirmed the differences between the Lander and Polson equations, which tended to be the most accurate predictors, and the Epley and Brzycki equations; however, effect sizes calculated for meaningfulness of these differences suggest they are not of practical significance. Bland-Altmann plots of the predictions consistently showed very few outliers beyond the 95% confidence interval. CONCLUSIONS: Although this study found significant differences between the tested prediction equations, for practical reasons these differences can be ignored when preparing strength training programs. A change of 4-5 kg is commonly accepted for this type of testing and all of these equations are accurate within that range.

In practical settings, most athletes drink about 400 mL/hr during exercise. It is questionable whether they would gain performance benefits from liquid carbohydrate (CHO) feeding with such small volumes. It also has been well established that energy supplementation during exercise improves endurance performance. Yet, little is known about the role of energy supplementation and high intensity exercise performance. PURPOSE: The purpose of this study was to investigate if ingestion of an energy gel with a 4:1 CHO/Protein ratio will confer performance benefits during high intensity swim training. METHODS: Twelve NCAA Division II collegiate swimmers participated in this high intensity swim study (6 male, 6 female). Testing protocol was as follows: 15 minute warm up, timed 200y swim, 3 sets of 8 x 100y sprints starting at 2:00 intervals, and then a timed 200y swim. Performance was assessed by timing the 1st, 4th, and 8th 100y interval of each set. Swimmers received either the gel (AccelGel®) +120 mL water or 120 mL flavored water after the first 200y swim and then after each set of 100y sprints (total: 80 g CHO, 20 g protein). Venous blood samples were collected for the measurement of CK before training and 24 hrs post training. RESULTS: Every timed 100y sprint from the 4th sprint to the 24th sprint was significantly faster for the gel condition compared to PL. Swimmers maintained their times through 21 sprints while ingesting the gel, with the 24th sprint slower than baseline (1.6 +/−1.5 s). Swimmers on PL slowed significantly by the 4th sprint in the first set and continued slowing through the 24th sprint (3.6 +/− 1.8 s). Swimmers also demonstrated less CK change with gel than PL. NSD was observed for the 200y swim time change. CONCLUSIONS: These results demonstrate that swimmers can improve performance during short duration (about 60 sec), high intensity training when ingesting a carbohydrate/protein gel. Swimming velocity decreased significantly from the 4th to the 24th sprint during PL, but not for the gel. Swimmers on the gel treatment completed the 24th sprint 2 seconds faster than when they were on the placebo. Results indicate that ingesting a carbohydrate/protein gel may be beneficial to maintain swimming intensity and minimizing muscular stress.

Objective: Menopause is a natural age-related transition that occurs in women as hormone production and secretion decreases and eventually ceases. This hormonal transition causes a variety of symptoms. Most women experience some menopause related symptoms, but the frequency and intensity of symptoms varies among women. This paper reviews the current literature on the Menopause Transition, assessment tools, and treatment for menopause symptoms. Methods: Searches using MEDLINE, CINAHL, and HEALTH databases from 1995-2006 for English-language articles were performed. Eighty articles were reviewed; 72 were selected based on pertinence to the current topic and strength of evidence. Results: Study design of the articles included in this paper were: 15 cross sectional studies, 2 randomized controlled trials, 3 longitudinal studies, 7 cohort studies, 1 factor analyses, 1 pilot study, 1 case report, 1 summary of committee proceedings, and 38 review articles. Conclusions: The literature presents issues associated with the menopause transition, including risk factors and symptoms. Menopausal symptoms affect a woman's quality of life in a variety of ways. A number of tools exist to assess generic and disease specific quality of life. The scientific evidence on risk factors is strong and has implications for physical therapy practice. However, menopause symptoms are variable both in intensity and frequency as well as individual to each woman. Clinical Implications: Physical therapists treat many women during the menopause transition. Therefore, a physical therapist needs to be aware of menopause symptoms and how the symptoms may affect a patient's response to physical therapy intervention.

Left ventricular diastolic filling is impaired in many patients with coronary artery disease and normal left ventricular systolic function, and is improved in many patients after coronary angioplasty (PTCA). To investigate the mechanisms for this improvement, we studied regional asynchrony by radionuclide angiography in 26 patients with single-vessel coronary artery disease before and after successful PTCA. Before PTCA, all patients had normal ejection fractions at rest and normal qualitative left ventricular regional wall motion, as determined by radionuclide and contrast angiography. Quantitative left ventricular regional function was assessed by dividing the left ventricular region of interest into 20 sectors. Phase analysis was performed on each sector's time-activity curve, and the average intersector phase difference was used as an index of left ventricular regional synchrony. Before PTCA, average intersector phase difference was increased compared with normal (6.0 +/- 2.2 vs 4.0 +/- 1.7 degrees, p less than .005), indicating asynchronous regional function. After PTCA, ejection fraction at rest was unchanged, but peak left ventricular filling rate at rest increased from 2.5 +/- 0.6 to 3.0 +/- 0.6 end-diastolic volume/sec (p less than .001) and was associated with a decrease in average intersector phase difference from 6.0 +/- 2.2 to 5.1 +/- 2.3 degrees (p less than .05). Average intersector phase difference decreased in 16 of 21 patients in whom peak filling rate increased after PTCA (p less than .005), compared with one of five patients in whom peak filling rate was unchanged or decreased. Hence, improved global left ventricular filling after PTCA was associated with more synchronous left ventricular regional behavior. To identify the cause of regional asynchrony before PTCA, we then generated time-activity curves from each of four left ventricular quadrants. These data indicated that the asynchrony was caused by regional variation in timing of diastolic rather than systolic events and that PTCA resulted in reduction in regional diastolic asynchrony. These data suggest that in many patients with coronary artery disease and normal left ventricular systolic function, impaired global diastolic filling may result from asynchronous left ventricular regional diastolic function, which is a reversible manifestation of myocardial ischemia or reduced coronary flow.

To assess left ventricular (LV) function in patients with atrial septal defect (ASD), we used radionuclide cineangiography at rest and during exercise in 11 patients (ages 16-59 years, mean 36 years) without other cardiac abnormalities.All patients had normal LV ejection fraction (EF) at rest (mean 59 ± 3% vs normal 57 ± 1%; NS); during exercise, four patients increased LVEF normally, four had no change in LVEF with exercise, and three decreased LVEF to 56%, 54%, and 44% (lower limit of normal 55%).These three patients had orthopnea and paroxysmal nocturnal dyspnea; the other eight were asymptomatic or mildly symptomatic.While the LVEF response to exercise did not correlate directly with hemodynamic or echo data, the two patients with the greatest decrease in LVEF during exercise had higher pulmonary-to-systemic flow ratios than the other nine patients (mean 4.8 vs 2.0, p < 0.001).All patients had abnormalities of ventricular septal motion on echocardiography with subnormal LV diastolic dimensions secondary to the right ventricular volume overload.Six months after operation, all 11 patients were asymptomatic and all had normal rest and exercise LVEFs (mean EF 58 2% rest, 65 3% exercise, p < 0.001), including the seven patients with ab- normal preoperative LVEF responses to exercise.LV diastolic dimension by echocardiography, subnormal be- fore operation in all 11 patients, increased into the normal range in all patients postoperatively.These data suggest that diminished LV functional reserve in adult patients with ASD is related, at least in part, to reversible mechanical factors related to right ventricular volume overload with abnormal diastolic-systolic relations of the interventricular septum, rather than to intrinsic, irreversible myocardial dysfunction.ABNORMALITIES in left ventricular performance have been reported frequently in patients with ostium secundum atrial septal defect. - However, the etiology of such abnormalities is unclear.Left ventricular dysfunction may occur only as a secondary mechanical response to chronic right ventricular volume over- load, or may develop as a primary process.'Assess- ment of the reversibility of functional abnormalities after closure of the defect might help to determine the etiology of left ventricular dysfunction, but such assessments have not been reported.Various investi- gators, using contrast angiography and echocardiography, have noted subnormal left ventricular volumes, stroke volume, and ejection fraction, as well as sub- normal left ventricular distensibility.2'7However, ro- tation of the left ventricle by the large right ventricle in patients with atrial septal defect might cause inac- curacies in contrast angiographic assessment of volumes, and hence, ejection fraction.3' 8Earlier studies have been performed at rest and have not evaluated the functional reserve of the left ventricle during exercise, a sensitive index of left ventricular dysfunction in patients with other forms of heart dis-