Research Report Abstracts - Gesundheit

WPT2011, Research Report Abstracts eS457
pre-clinical education, CR needs to be (re-)conceptualised by
incorporating recent multidimensional understandings of this
phenomenon. Limitations such as the self-reported characteristics
of focus group and interview data, lack of explorations
of underpinning curricula with their educational philosophies
and strategies are acknowledged. Further research is also
needed to integrate views and perspectives of other key people
such as students themselves or clinical educators.
Implications: Considerations of the characteristics and conceptualisations
of CR are an essential prerequisite for further
discussions of appropriate educational strategies. Furthermore
thoughts about which dimensions of CR would best
be emphasised within the classroom context and which ones
within the clinical placement settings should be included.
Making explicit the role and place of CR within pre-clinical
education might help to address some challenges of teaching
and learning CR in this early educational phase.
Keywords: Clinical reasoning; Undergraduate education
Funding acknowledgements: None.
Ethics approval: Ethical clearance provided by the ethics
committees of the two respective cantons in Switzerland.
Research Report Poster Discussion Session
Number: RR-PDS-531 Tuesday 21 June 16:00
RAI: G102-103 (Topaz)
ELECTRICAL STIMULATION COMBINED WITH
PROGRESSIVE RESISTANCE TRAINING
INCREASES STRENGTH IN PEOPLE WITH
SPINAL CORD INJURY
Harvey L. 1,2 , Fornusek C. 3 , Bowden J. 1 , Pontifex N. 1 ,
Glinksy J. 1 , Middleton J. 1 , Gandevia S. 4 , Davis G. 3
1University of Sydney, Rehabilitation Studies Unit, Sydney
School of Medicine, Sydney, Australia, 2Moorong Spinal
Unit, Royal Rehabilitation Centre Sydney, Sydney, Australia,
3University of Sydney, Clinical Exercise and Rehabilitation
Unit, Sydney, Australia, 4University of New South Wales,
Prince of Wales Medical Research Institute, Sydney, Australia
Purpose: The purpose of this study was to determine the
effectiveness of electrical stimulation (ES) superimposed
on progressive resistance training for increasing voluntary
strength in the quadriceps muscles of people with spinal cord
injuries (SCI).
Relevance: Neurologically-induced weakness of the quadriceps
muscles following SCI is common. Electrical
stimulation is routinely administered to increase voluntary
strength although it is not clear whether this treatment is
effective.
Participants: Twenty people with established SCI and
neurologically-induced weakness of the quadriceps muscles
were recruited from a community-based sample of convenience.
Methods: A randomised controlled trial with assessor blinding
and concealed allocation was undertaken. Participants
were randomised between experimental and control groups.
Participants in the experimental group received ES superimposed
on progressive resistance training to the quadriceps
muscles of one leg three times a week for eight weeks.
Participants in the control group received no intervention.
Assessments occurred at the beginning and at the end of
the eight-week period. The four primary outcomes were voluntary
strength (Nm) and endurance (fatigue ratio) as well
as the performance and satisfaction items of the Canadian
Occupational Performance Measure (COPM; points).
Analysis: Linear regressions were used to derive a point
estimate of the between-group mean differences (and 95%
confidence interval).
Results: The between-group mean differences (95% confidence
intervals) for voluntary strength and endurance were
14 Nm (1–27; p = 0.034) and 0.1 (−0.1 to 0.3; p = 0.221),
respectively. The between-group median differences (95%
confidence interval) for the performance and satisfaction
items of the COPM were 1.7 points (−0.2 to 3.2; p = 0.103)
and 1.4 points (−0.1 to 4.6; p = 0.058), respectively.
Conclusions: Electrical stimulation superimposed on progressive
resistance training improves voluntary strength,
although there is uncertainty about whether the size of the
treatment effect is clinically important. The relative effectiveness
of ES and progressive resistance training is yet to be
determined.
Implications: Decisions about adding ES to progressive
resistance training need to be based on a case-by-case assessment
after taking into account the time and cost associated
with administering ES along with the real-life implications
of a treatment effect which may be as small as 1 Nm or as
large as 27 Nm.
Keywords: Strength training; Neurological disability; Spinal
cord injury
Funding acknowledgements: NSW Office for Science and
Medical Research.
Ethics approval: Ethical approval was attained for 4 institutions
and hospitals including the University of Sydney (ref
no. 11102).