Physiotherapy - Articles in Press

Discrete-event computer simulation methods in the optimisation of a physiotherapy clinic - Corrected Proof

J.R. Villamizar, F.C. Coelli, W.C.A. Pereira, R.M.V.R. Almeida — 2010-07-05

Abstract: Objective: To develop a computer model to analyse the performance of a standard physiotherapy clinic in the city of Rio de Janeiro, Brazil.Design and setting: The clinic receives an average of 80 patients/day and offers 10 treatment modalities. Details of patient procedures and treatment routines were obtained from direct interviews with clinic staff. Additional data (e.g. arrival time, treatment duration, length of stay) were obtained for 2000 patients from the clinic's computerised records from November 2005 to February 2006.Methods and main outcome measures: A discrete-event model was used to simulate the clinic's operational routine. The initial model was built to reproduce the actual configuration of the clinic, and five simulation strategies were subsequently implemented, representing changes in the number of patients, human resources of the clinic and the scheduling of patient arrivals.Results: Findings indicated that the actual clinic configuration could accept up to 89 patients/day, with an average length of stay of 119minutes and an average patient waiting time of 3minutes. When the scheduling of patient arrivals was increased to an interval of 6.5minutes, maximum attendance increased to 114 patients/day. For the actual clinic configuration, optimal staffing consisted of three physiotherapists and 12 students. According to the simulation, the same 89 patients could be attended when the infrastructure was decreased to five kinesiotherapy rooms, two cardiotherapy rooms and three global postural reeducation rooms.Conclusions: The model was able to evaluate the capacity of the actual clinic configuration, and additional simulation strategies indicated how the operation of the clinic depended on the main study variables.

Comments on book review of ‘Lymphoedema: Advice on Self-management’ - Corrected Proof

Karen Friett — 2010-06-03

I read with interest the book review of ‘Lymphoedema: Advice on Self-management’ in a recent issue. I am pleased that the reviewer found the book well laid out and easy to read, but feel they have fundamentally missed the purpose of this most valuable of books. The Lymphoedema Support Network (LSN) is the largest information provider about the condition in the UK, and is run by those living with the condition. Whilst the LSN is not directly involved with this publication, it is in a unique position to comment on both this book and the review.

Corrected Proof

Steve Kent — 2010-05-24

Soft Tissue Release is a practical manual describing three types of stretching, utilising locking techniques to hypothetically focus the stretch within the more inflexible part of the muscle. The content of this book from ‘The Hands-On Guides for Therapists’ series falls well within the realm of massage therapists, but may also hold some interest for other practitioners working in the fields of musculoskeletal disorders or sport and exercise.

Corrected Proof

Dean H. Watson — 2010-05-24

Tension and cervicogenic headaches are controversial syndromes, the results of various treatment approaches are inconsistent and their effects remain speculative. Therefore, the authors of this book are to be commended for undertaking a difficult task. Gerwin states eloquently… ‘Headache management remains difficult, despite significant gains made in the treatment of headache in recent years’ (p. 431). However, it is arguable whether, with the exception of the management of the acute phase of headache and migraine, significant gains have been made in the treatment of headache in recent years. Unfortunately, this text reinforces the difficulty of managing tension and cervicogenic headaches (see Chapter 34).

Strength and endurance of the pelvic floor muscles in continent women: An observational study - Corrected Proof

Emma Quartly, Taryn Hallam, Sharon Kilbreath, Kathryn Refshauge — 2010-05-07

Abstract: Objectives: To describe the maximal strength and endurance of the pelvic floor muscles in a cohort of women with no history of incontinence; and to determine the effect of age, parity, hormonal status, previous gynaecological surgery and regular performance of pelvic floor muscle exercises on the strength and endurance of these muscles.Design: Preliminary cross-sectional observational study.Setting: Faculty of Health Sciences, University of Sydney, Australia.Participants: Twenty-eight women aged 19 to 58 years, 16 of whom were under 40 years of age. Participants were excluded if they had a history of incontinence or were currently menstruating.Primary outcome measures: Pelvic floor muscle strength assessed using a perineometer, and pelvic floor muscle endurance above 60% of maximal voluntary contraction.Secondary outcome measures: The effect of age, parity, hormonal status, previous gynaecological surgery and regular performance of pelvic floor muscle exercises on the strength and endurance of these muscles.Results: Maximum strength of the pelvic floor muscles was not correlated with endurance (r=0.21, P=0.290) or age (r=−0.31, P=0.107); however, it was influenced by parity (r=−0.44, P=0.020). Endurance was significantly and positively correlated with age (r=0.38, P=0.048).Conclusions: This study provides preliminary data that age and parity may be important factors in pelvic floor muscle performance in women who are continent. A larger study that considers the variability associated with these variables will provide useful guidelines for prescription of exercise.

Evaluation of a primary care musculoskeletal clinical assessment service: a preliminary study - Corrected Proof

Ruth Sephton, Elaine Hough, Stephen A. Roberts, Jackie Oldham — 2010-05-07

Abstract: Objectives: To evaluate the clinical effectiveness of a primary care musculoskeletal clinical assessment service (MCAS). The MCAS is a triage and treatment service for the management of patients with musculoskeletal conditions.Design: Prospective observational cohort study.Participants: Consecutive patients with musculoskeletal disorders referred to the MCAS from primary care over a 6-month period.Interventions: Patients were managed within the service in accordance with usual MCAS management/treatment pathways.Main outcome measures: Previously validated self-administered questionnaires were selected as outcome measures in order to facilitate the use of postal responses. These comprised two generic health status questionnaires (Short Form 36, EuroQol EQ-5D), a pain assessment using a visual analogue scale and two measures of patient satisfaction (Perceived Improvement Evaluation, Deyo and Diehl satisfaction questionnaire). Outcome measures were taken at baseline, and 3 and 12 months after recruitment.Results: In total, 217 patients were recruited into the study. Significant improvement was demonstrated with EuroQol at 3 and 12 months (P=0.043 and 0.035, respectively) and the pain visual analogue scale at 3 and 12 months (P=0.001 and 0.002, respectively). No significant differences were demonstrated with Short Form 36 (P=0.73 and 0.87). The mean patient-perceived improvement was 33% at 3 months and 46% at 12 months. Results showed high levels of patient satisfaction, with 72% of patients indicating total satisfaction with all aspects of the MCAS.Conclusions: Nationally, models similar to the MCAS have been developed to help improve care for patients and achieve the 18-week access target. This preliminary study shows the possible benefits of adopting this model of care, and identifies the need for further research.

Responsiveness of physical function outcomes following physiotherapy intervention for osteoarthritis of the knee: an outcome comparison study - Corrected Proof

Helen P. French, Martina Fitzpatrick, Oliver FitzGerald — 2010-05-05

Abstract: Objective: To compare the responsiveness of two self-report measures and three physical performance measures of function following physiotherapy for osteoarthritis of the knee.Setting: Single centre study in acute hospital setting.Methods: Patients referred for physiotherapy with osteoarthritis of the knee were recruited. The Western Ontario and McMaster Universities (WOMAC), Lequesne Algofunctional Index (LAI), timed-up-and-go test (TUGT), timed-stand test (TST) and six-minute walk test (6MWT) were administered at first and final physiotherapy visits. Wilcoxon Signed Rank tests were used to determine the effect of physiotherapy on each outcome. Responsiveness was calculated using effect size, standardised response mean and a median-based measure of responsiveness due to some outlying data.Results: Thirty-nine patients with a mean age of 65.3 (standard deviation 6.9) years were investigated before and after a course of exercise-based physiotherapy. There was a significant improvement in all outcomes except the WOMAC scores. All measures demonstrated small effect sizes for all statistics (<0.50), except the 6MWT which was in the moderate range for one of the indices (standardised response mean 0.54). The LAI was more responsive than the WOMAC total score and the WOMAC physical function subscale for all responsiveness statistics, whilst the 6MWT was more responsive than the TST and the TUGT. The median-based effect size index produced the smallest effect sizes for all measures (0.1 to 0.43).Conclusion: These results can be used to guide decision making about which physical function outcome measures should be used to evaluate effectiveness of rehabilitation of people with osteoarthritis of the knee at group level in a clinical setting.

Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation - Corrected Proof

Benedict M. Wand, Flavia Di Pietro, Pamela George, Neil E. O’Connell — 2010-05-04

Abstract: Objectives: To investigate impairments in sensory function in chronic non-specific low back pain patients, and the relationship between any impairment and the clinical features of the condition.Design: A cross-sectional case–control study.Setting: Laboratory-based study.Participants: Nineteen chronic non-specific low back pain patients and 19 healthy controls.Main outcome measures: Tactile threshold, two-point discrimination distance and accuracy at a task involving recognising letters drawn over the skin of the lower back (graphaesthesia) were assessed over the lumbar spine in both groups. Pain duration, pain intensity, physical function, anxiety and depression were assessed by questionnaire in the back pain group.Results: No difference was found in tactile threshold between the two groups [median difference 0.0mg, 95% confidence interval (CI) −0.04 to 0.04]. There was a significant difference between controls and back pain patients for two-point discrimination (mean difference 17.9mm, 95% CI 5.9 to 29.8) and graphaesthesia accuracy (mean difference 6.1, 95% CI 1.3 to 11.0). Low back pain patients had a larger lumbar two-point discrimination distance threshold and a greater letter recognition error rate. In the back pain group, no relationship was found between clinical profile and sensory function, and no relationship was found between the sensory tests.Conclusions: These data support existing findings of perceptual abnormalities in chronic non-specific low back pain patients, and are suggestive of cortical rather than peripheral sensory dysfunction. Amelioration of these abnormalities may present a target for therapeutic intervention.

Occupational stress and coping resources in physiotherapists: a survey of physiotherapists in three general hospitals - Corrected Proof

M.C. Santos, L. Barros, E. Carolino — 2010-05-03

Abstract: Objectives: To identify occupational stressors and coping resources in a group of physiotherapists, and to analyse interactions between subjective levels of stress, efficacy in stress resolution and coping resources used by these professionals.Design: A sample of 55 physiotherapists working in three general hospitals in Portugal completed the Coping Resources Inventory for Stress, the Occupational Stressors Inventory and two subjective scales for stress and stress resolution.Main results: Most physiotherapists perceived that they were moderately stressed (19/55, 35%) or stressed (20/55, 36%) due to work, and reported that their efficacy in stress resolution was moderate (25/54, 46%) or efficient (23/54, 42%). Issues related to lack of professional autonomy, lack of organisation in the hierarchical command chain, lack of professional and social recognition, disorganisation in task distribution and interpersonal conflicts with superiors were identified as the main sources of stress. The most frequently used coping resources were social support, stress monitoring, physical health and structuring. Perceived efficacy in stress resolution was inversely related to perceived level of occupational stress (r=−0.61, P<0.01). Significant correlations were found between several coping resources and the perceived level of stress and efficacy in stress resolution. Associations between problem solving, cognitive restructuring and stress monitoring and both low levels of perceived stress and high levels of perceived efficacy were particularly strong.Implications for practice: The importance of identifying stressors and coping resources related to physiotherapists’ occupational stress, and the need for the development of specific training programmes to cope with stress are supported.

Clinical outcomes of rehabilitation for patients following lateral patellar dislocation: a systematic review - Corrected Proof

Toby O. Smith, Leigh Davies, Rachel Chester, Allan Clark, Simon T. Donell — 2010-04-26

Abstract: Objectives: Little has been published about which physiotherapy interventions are used to treat patients with instability of the patella. The purpose of this study was to review the literature systematically to determine the clinical outcomes of rehabilitation for patients following a lateral patellar dislocation.Data sources: AMED, CINHAL, Cochrane Library, EMBASE, MEDLINE, PEDro and Scopus database searches were performed from their inception to August 2009. A search of unpublished and grey literature databases was undertaken, in addition to contacting all authors of included publications.Review methods: All publications presenting the outcomes of patients following a conservatively managed lateral patellar dislocation were included. All eligible articles were appraised critically using the Critical Appraisal Skills Programme appraisal tool. Data on interventions, cohort characteristics, outcome measures and results were extracted. A narrative research synthesis method approach was adopted.Results: In total, 29 publications were eligible for inclusion in this review. Although a proportion of patients experienced recurrent instability and dislocation episodes after rehabilitation, a large proportion of patients reported acceptable outcomes following physiotherapy. No randomised controlled clinical trials were identified assessing different physiotherapy interventions. The evidence base included a number of under-powered studies which poorly described the specific physiotherapy interventions prescribed.Conclusions: Further, well-designed randomised controlled trials assessing different conservative management strategies with specific patient groups, to provide pre-intervention as well as follow-up data, are required to determine the optimal clinical outcomes of physiotherapy for patients following a lateral patellar dislocation.

Effect of chest wall vibration timing on peak expiratory ﬂow and inspiratory pressure in a mechanically ventilated lung model - Corrected Proof

H. Shannon, R. Stiger, R.K. Gregson, J. Stocks, E. Main — 2010-04-22

Abstract: Objective: To investigate the effects of chest wall vibration timing on air flow and pressure in a ventilated lung model.Design: Laboratory-based bench study.Participants: Thirty physiotherapists with experience in intensive care.Intervention: Physiotherapists applied three sets of eight chest wall vibrations to an intubated, mechanically ventilated mannequin. Vibrations were applied at the start of expiration (optimal), mid to late inspiration (early) and early to mid expiration (late). Air flow, peak pressure and volume were measured continuously. Forces applied during vibrations were recorded using a force-sensing mat, placed under the physiotherapists’ hands.Results: During optimal and early vibrations, peak expiratory flow increased significantly compared with baseline ventilation [mean difference for optimal vibrations 8.8l/minute, 95% confidence interval (CI) 6.0 to 11.6; mean difference for early vibrations 7.0l/minute, 95% CI 4.3 to 9.9]. Late vibrations did not enhance expiratory flow. Peak inspiratory pressure was significantly higher during early vibrations compared with baseline values (mean difference 5.6cmH2O, 95% CI 2.9 to 8.2). Peak inspiratory pressure generated during early vibrations was, on average, 8.4cmH2O greater than with optimal timing.Conclusion: The safety and effectiveness of respiratory physiotherapy treatments are likely to be influenced by the timing of vibrations within the breath cycle. Early vibrations generate potentially dangerous peak inspiratory pressures. Late vibrations, although not harmful, are not effective at increasing peak expiratory flow. This is an important consideration when training physiotherapists and evaluating outcomes of treatments in intensive care.

Current Australian physiotherapy management of hip osteoarthritis - Corrected Proof

Sallie M. Cowan, Meagan S. Blackburn, Kylie McMahon, Kim L. Bennell — 2010-04-20

Abstract: Objectives: Symptomatic osteoarthritis can be a painful, costly and debilitating condition. Whilst there is a substantial body of literature surrounding osteoarthritis of the knee, there is less reported research on the hip joint, especially pertaining to physiotherapy intervention. This descriptive study aimed to describe current physiotherapy management of osteoarthritis of the hip by Australian physiotherapists in private practice and acute hospital settings.Design: Cross-sectional survey.Participants: A questionnaire was administered to 364 public and private practitioners in the state of Victoria.Results: A response rate of 66% was achieved. Physiotherapists working in the private and public sectors reported frequent use of manual therapy (78% and 87%, respectively), aquatic therapy (82% and 58%, respectively) and home exercise programmes (88% and 80%, respectively). Class-based physiotherapy is employed less frequently (44% and 28%, respectively). Strengthening exercises are the most common treatment technique.Conclusions: The widespread use of exercise and manual therapy in the management of osteoarthritis of the hip is highlighted. There was little difference in overall physiotherapy management between the public and private settings. The results identify interventions commonly used in clinical practice. The need for further research to evaluate the effectiveness of frequently used interventions is also highlighted.

Feldenkrais Method balance classes are based on principles of motor learning and postural control retraining: a qualitative research study - Corrected Proof

Karol A. Connors, Mary P. Galea, Cathy M. Said, Louisa J. Remedios — 2010-04-12

Abstract: Background: Feldenkrais Method balance classes have been found to be effective in improving balance in recent studies, but there has been little research into possible mechanisms behind the effectiveness of these classes. Indeed, there has been little research into the content of any balance training classes.Objectives: To analyse the content of a series of Feldenkrais Method balance classes to gain an understanding of how the results in these studies may have been achieved and the principles through which the method may be effective.Design: Qualitative research approach (content analysis).Method: Feldenkrais Method Awareness Through Movement lessons were transcribed and the contents were analysed. An intercoder reliability study was undertaken.Results: The content analysis revealed that the classes used motor skill acquisition elements of internal feedback, repetition and variability of practice using an exploratory learning approach. Postural control skills of intersegmental coordination of ankle/hip/trunk synergies were practised, with control of the centre of mass over the base of support explored in anterior/posterior, medio/lateral, diagonal, rotational and circular directions. Key findings were the extensive involvement of trunk flexibility and control in the balance activities, and also the intensive attention to internal feedback which was linked to body awareness training.Conclusion: The Awareness Through Movement lessons contained many elements consistent with current theories of motor skill acquisition and postural control, providing a sound theoretical basis for the effectiveness of the Feldenkrais approach in improving balance. The methodology used in this study may provide a useful model for similar investigations into other balance training approaches.

Sources of stress and psychological morbidity among undergraduate physiotherapy students - Corrected Proof

J.M. Walsh, C. Feeney, J. Hussey, C. Donnellan — 2010-04-09

Abstract: Objectives: Professional education can be a stressful experience for some individuals, and may impact negatively on emotional well-being and academic performance. Psychological morbidity and associated sources of stress have not been investigated extensively in physiotherapy students. This study explored sources of stress, psychological morbidity and possible associations between these variables in undergraduate physiotherapy students.Design: A questionnaire-based survey. The Undergraduate Sources of Stress Questionnaire was used to identify sources of stress, and the General Health Questionnaire-12 (GHQ-12) was used to rate the prevalence of psychological morbidity, using a conservative GHQ threshold of 3 to 4 to determine probable ‘cases’. Uni- and multivariate tests of correlation were used to analyse the data.Setting: An Irish educational institution.Participants: One hundred and twenty-five physiotherapy undergraduate students.Results: More than one-quarter of all students (27%) scored above the GHQ threshold, indicating probable psychological morbidity. This is higher than the level of psychological morbidity reported by the general population. Regression analysis showed that academic (β=0.31, P<0.001) and personal (β=0.50, P<0.001) sources of stress subscales were significant coefficients, explaining 48% of the variance in psychological morbidity after controlling for part-time employment and hours spent studying. Individual significant items from these subscales were stressful events (β=0.24, P=0.004), mood (β=0.43, P≤0.001) and overall level of stress (β=0.35, P≤0.001).Conclusions: The results highlighted the emotional vulnerability of a significant proportion of physiotherapy students, with academic and personal issues being the greatest concern. While personal causes of stress such as stressful events and mood are more difficult to control, manipulation of curricular factors may have positive effects on academic sources of stress.

The ‘lone ranger’: a descriptive study of physiotherapy practice in Australian emergency departments - Corrected Proof

Emily Kilner, Lorraine Sheppard — 2010-04-05

Abstract: Objectives: Physiotherapy services have recently been introduced to Australian emergency departments in an attempt to address service delivery issues such as access block. This study aimed to determine the roles, including those relating to extended scope practice, currently undertaken by physiotherapists in Australian emergency departments.Design: Descriptive cross-sectional design. An Internet-based survey, containing 37 items to access demographic and perceptual data, was distributed to Australian emergency department physiotherapists between 8 February and 30 April 2009. Twenty-eight of these questions generated categorical data, which were analysed using frequency distributions. Thematic analysis was undertaken for the nine questions that generated text responses.Participants: Participants were included if they were registered Australian physiotherapists working in an emergency department as part of the multidisciplinary team, and did not provide on-call service to the emergency department. Twenty-eight Australian emergency department physiotherapists met the inclusion criteria and completed the survey.Results: The respondents were predominantly females working on a full-time basis in the emergency department. Responses indicated that the role is subject to time pressures with an emphasis on diagnosis and discharge planning. One respondent described emergency department physiotherapists as ‘lone rangers’ due to their autonomous work. Australian emergency department physiotherapists are not currently performing extended scope tasks, as many are prohibited under Australian legislation, but it is also unclear which tasks might be classified as extended scope.Conclusion: Australian emergency department physiotherapists currently perform traditional physiotherapy roles in a non-traditional work environment. The role is aligned with musculoskeletal physiotherapy; however, there is a degree of holistic care involved, particularly for elderly patients. The effect that an emergency department physiotherapy service has on health outcomes is not known, but the study participants indicated that they believe their service has system-wide benefits.

What are the perceived needs of Pakistani women in the North west of England in relation to physiotherapy, and to what extent do they feel their needs are being met? - Corrected Proof

Gillian Yeowell — 2010-04-05

Abstract: Objective: To gain an insight into the needs of female Pakistani service users in relation to physiotherapy.Design: A qualitative research design was utilised, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed and the data were analysed using thematic analysis.Setting: A venue of the service user's own choosing in one geographical area of the North west of England.Participants: Six, Pakistani, Muslim female patients who had recently received physiotherapy from a range of specialisms. Five participants came to the UK from Pakistan, and one participant of Pakistani heritage came to the UK from East Africa. An interpreter was used in four of the six interviews.Findings: Four main themes emerged from data analysis: issues of gender; language issues including the subthemes of crosscultural communication, time and materials; role of exercise; and acquiescence.Conclusions: It appears that physiotherapy provision for female patients with Pakistani backgrounds may be failing to meet their needs, which may affect compliance. In order to address these issues, culturally competent health care needs to be provided and the following points are worthy of consideration:

Pelvic floor muscle strength and body self-perception among Brazilian pregnant women - Corrected Proof

Cinara Sacomori, Fernando Luiz Cardoso, Cristiane Vanderlinde — 2010-04-05

Abstract: Objectives: To examine the relationship between pelvic floor muscle strength and body self-perception variables in pregnant women; and, more specifically, to determine the influence of the number of pregnancies (primigravidas vs multigravidas) on the strength of contraction of the pelvic floor muscles and on the body self-perception of pregnant women.Design: Comparative cross-sectional research.Setting: Public health centres from Florianópolis, Brazil.Participants: Thirty-five pregnant women (18 primigravidas, 17 multigravidas) with a mean age of 25.5 (standard deviation 5.7) years.Main outcome measures: Pelvic floor strength measured through manual palpation, and body self-perception using the Questionnaire of Corporeality and Human Sexuality.Results: Pelvic floor muscle strength was positively correlated with schooling [rho (ρ)=0.496] and body self-perception variables: finding the body beautiful (ρ=0.476), finding the body sexy (ρ=0.520), feeling that others find them sexy (ρ=0.364), finding the body proportional (ρ=0.412), touching the body generally (ρ=0.554) and recognising the smell of the body (ρ=0.454). Primigravidas found their bodies more beautiful and were more satisfied with their bodies. On a scale of 0 to 6, multigravid participants expressed a greater wish than primigravid participants to be thinner (median difference 2, 95% confidence interval 0–3, P=0.03). Pelvic floor strength did not differ between groups.Conclusions: The results suggest a relationship between pelvic floor muscle strength and body self-perception. Professionals involved in women's health may have a role in helping their patients to understand their bodies.

A national framework for supporting improvements in the physiotherapy assessment and management of low back pain: the Scottish experience - Corrected Proof

Fraser Ferguson, Lesley Holdsworth, Danny Rafferty — 2010-04-01

Abstract: Background: Similar to other countries worldwide, Scotland lacked a national view of whether the quality of the physiotherapy management of low back pain was compliant with national guidelines. Anecdotal evidence suggested that standards of care varied considerably despite the wide availability of clinical guidelines to clinicians.Aim: To develop a framework that supports National Health Service (NHS) Scotland in providing consistently applied high-quality physiotherapy assessment and management of low back pain in line with guideline recommendations.Design: Prospective, multicentred national study, data collection and improvement phase.Setting: All NHS boards in Scotland (n=14) plus two private provider sites.Participants: One hundred and eighty-six individual NHS sites and two private providers of services to patients with low back pain.Method: A national dataset was developed from evidence- and consensus-based guideline sources. All sites collected data (two 5-week periods) over 1 year (2008–2009) using a web-based database. This was interspersed by an improvement phase during which required improvements were considered and implemented. Issues were shared through a national network and national meeting.Results: Data from 2147 patients showed improvements in the documented physiotherapy management of low back pain over the two cycles. All participants developed and implemented remedial action plans based on the results of the first cycle.Conclusion: It is possible to implement a framework, which is led nationally but driven and owned locally, supporting physiotherapists in an active programme of locally determined improvement. However, although process and outcome are linked, the direct impact of this initiative on patient outcome is not known.

Low back pain and physiotherapy use of red flags: the evidence from Scotland - Corrected Proof

Fraser Ferguson, Lesley Holdsworth, Danny Rafferty — 2010-03-31

Abstract: Background: Red flags are recognised as indicators of possible serious spinal pathology, and their use is indicated by numerous guidelines. Similar to other countries worldwide, Scotland lacked a national view about the overall quality of the physiotherapy management of low back pain and the use of red flags. Anecdotal evidence suggested that practice varied considerably.Aim: To improve the use and documentation of red flags by physiotherapists during the assessment and management of low back pain.Design: Prospective, multicentred, national data collection and improvement initiative.Setting: National Health Service (NHS) health boards in Scotland (n=14) plus two private provider sites.Participants: One hundred and eighty-six individual NHS provider sites and two private provider sites, with in excess of 360 physiotherapists providing services to low back pain patients.Method: Measurement of documented practice in line with evidence- and consensus-based recommendations from guidelines collected via a web-based tool over two 5-week audit cycles interspersed with an improvement phase over 1 year (2008–2009).Results: Data from 2147 patients showed improvement in the documentation of all red flags assessed from 33% (n=709) to 65% (n=1396), and improvement in the documentation of cauda equina syndrome from 60% (n=1288) to 84% (n=1804) over the two cycles. Only two regions provided evidence of 100% documentation of all components of cauda equina syndrome, with wide variation across the country.Conclusion: This national initiative resulted in considerable improvement in the documentation of red flags. Despite this, however, one in five patients did not receive optimal management as recommended by guidance. This has significant implications for patient safety and highlights the need for ongoing education of physiotherapists in this area.

Validation of the Comprehensive ICF Core Set for Osteoarthritis: the perspective of physical therapists - Corrected Proof

Tanja Bossmann, Inge Kirchberger, Andrea Glaessel, Gerold Stucki, Alarcos Cieza — 2010-03-29

Abstract: Background and purpose: Osteoarthritis is a common chronic disease associated with functional impairments and activity limitations, as well as participation restrictions. The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Osteoarthritis is an application of the ICF and represents the typical spectrum of problems in functioning of patients with osteoarthritis.Objective: To validate the Comprehensive ICF Core Set for Osteoarthritis from the perspective of physical therapists.Methods: Physical therapists experienced in the treatment of patients with osteoarthritis were asked about patients’ problems, resources and aspects of the environmental factors treated by physical therapists in patients with osteoarthritis in a three-round, electronic-mail survey using the Delphi technique. Responses were linked to the ICF.Results: Seventy-two experts from 22 countries named 744 meaningful concepts that covered all ICF components. One hundred and fifty-two ICF categories were linked to these answers, 32 concepts were linked to the not-yet-developed personal factors component, and 14 issues were not covered by a single ICF category. Twelve ICF categories were not represented in the Comprehensive ICF Core Set for Osteoarthritis, although at least 75% of the participants rated them as important.Discussion and conclusion: The content validity of the ICF was widely supported by the physical therapists. However, several issues were raised that were not covered and need to be investigated further.

Reliability of physical examination tests used in the assessment of patients with shoulder problems: a systematic review - Corrected Proof

Stephen May, Ken Chance-Larsen, Chris Littlewood, Dave Lomas, Mahmoud Saad — 2010-03-29

Abstract: Background: Shoulder pain is a common clinical problem, and numerous tests are used to diagnose structural pathology.Objectives: To systematically review the reliability of physical examination procedures used in the clinical examination of patients with shoulder pain.Data sources: MEDLINE, PEDro, AMED, PsychInfo, Cochrane Library (2009) and CINAHL were searched from the earliest record on the database to June 2009.Study eligibility criteria: Reliability studies that included any patients with shoulder pain were analysed for their quality and reliability results.Study appraisal and synthesis methods: Pre-established criteria were used to judge the quality of the studies (high quality >60% methods score) and satisfactory levels of reliability (kappa or intraclass correlation coefficient ≥0.85, sensitivity analysis 0.70). A qualitative synthesis was performed based on levels of evidence.Results: Thirty-six studies were included with a mean methods score of 57%. Seventeen studies were deemed to be of high quality; high-quality studies were less likely to meet the pre-agreed level of reliability. The majority of studies indicated poor reliability for all procedures investigated.Limitations: Overall, the evidence regarding reliability was contradictory.Conclusions and implications: There is no consistent evidence that any examination procedure used in shoulder assessments has acceptable levels of reliability. Alternate methods of classification which are reliable should be used to classify patients with shoulder problems.

The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients - Corrected Proof

Allan D. Abbott, Raija Tyni-Lenné, Rune Hedlund — 2010-03-26

Abstract: Objectives: To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.Design: Cross-sectional, correlation study.Setting: Orthopaedic outpatient setting in a tertiary hospital.Participants: One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.Measures: Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.Results: The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.Conclusions: This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.

An investigation of the use of passive movements in intensive care by UK physiotherapists - Corrected Proof

R.C. Stockley, J. Hughes, J. Morrison, J. Rooney — 2010-03-26

Abstract: Objectives: To investigate the current use of passive movements (PMs) by National Health Service (NHS) physiotherapists working with sedated and ventilated patients in critical care settings.Design: Postal questionnaire.Setting: All open NHS critical/intensive care units in England, Northern Ireland, Scotland and Wales.Participants: Physiotherapists working in UK NHS critical/intensive care units.Results: Questionnaires were posted to 246 physiotherapists working in intensive care units; 165 (67%) were returned. One hundred and fifty-two respondents routinely treated ventilated and sedated patients, of which 151 (99%) reported utilising PMs. They were used most commonly (>70%) in patients admitted to critical care with medical, neurological or surgical problems. Respondents reported using a median of five repetitions of PMs once daily, and the majority of respondents took joints to the end of range (>78%). Joints most commonly treated included the shoulder, hip, knee, elbow and ankle. Heart rate and blood pressure were monitored by over 84% of respondents during treatment.Conclusions: Whilst there is little empirical evidence to underpin the use of PMs, this study found that PMs were used regularly by 99% of respondents working in NHS critical care settings. Further work is now needed to evaluate the immediate and long-term effects of PMs in critically ill patients to inform and develop future practice.

Comparison of the 6-minute walk distance test performed on a non-motorised treadmill and in a corridor in healthy elderly subjects - Corrected Proof

Tania Janaudis-Ferreira, Gunnevi Sundelin, Karin Wadell — 2010-02-22

Abstract: Objective: To compare the 6-minute walk distance (6MWD) test performed on a non-motorised treadmill (6MWD-T) with the 6MWD test performed in a corridor (6MWD-C) in healthy elderly subjects.Participants: Sixteen healthy elderly individuals.Design: Participants performed three 6MWD-T tests and three 6MWD-C tests on two different days.Outcome measures: Distance walked was recorded in metres. Perceived exertion and leg fatigue were rated on the modified Borg scale before and after each test.Results: Using the Bland and Altman limits of agreement analysis method, the mean difference between the two methods was 153.3m (limits of agreement: 28 to 278). The mean difference between days 1 and 2 for the 6MWD-C test was −7.2m (limits of agreement: −45.4 to 30.8), and the mean difference between days 1 and 2 for the 6MWD-T test was −1.6m (limits of agreement: −64.0 to 60.7). The mean difference between the first and second repetitions of the 6MWD-C test was −5m (limits of agreement: −41 to 31), and the mean difference between the first and second repetitions of the 6MWD-T test was −17m (limits of agreement: −85 to 51).Conclusions: The 6MWD-C and 6MWD-T tests are not interchangeable. However, the results showed good test–retest reliability between days and between test repetitions for both tests. Therefore, the 6MWD-T test may offer an alternative option to the 6MWD-C test when a 30-m corridor is not available. These findings may have implications for execution of the 6MWT-T test within cardiac and pulmonary rehabilitation.

Corrected Proof

Anna Mayhew — 2010-02-15

The authors of this book seek to help patients with lupus and their families and carers to understand the origins of the disease, the range of problems it can cause and the best ways in which to manage those problems.

Corrected Proof

Helen Fiddler — 2010-02-08

This book has been written as a practical resource for those working with more complex and high-risk patients within cardiac rehabilitation. It is a follow-up text to ‘Exercise Leadership in Cardiac Rehabilitation’ , written by a team of authors with clinical expertise in this area. Whilst the authors have acknowledged that it would be useful to use these two books in conjunction for information about the organisation and delivery of exercise to this more complex group of patients, this book does stand alone in meeting its aims. The text places more emphasis on the pathophysiology, medications and other aspects of management for these patient groups with well-organised chapters on type II diabetes, chronic heart failure, arrhythmia and implanted cardioverter defibrillators, heart transplant and comorbidity, and ageing. The current evidence base for exercise in these patients is included with suggestions and practical advice for their management, based on the clinical expertise of the contributing authors. The book is well structured and can be used to find important information quickly.

Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients - Corrected Proof

Garyfallia Pepera, Joanne McAllister, Gavin Sandercock — 2010-01-27

Abstract: Objective: The incremental shuttle walking test (ISWT) is a valuable tool for assessing changes in patients’ functional capacity during cardiac rehabilitation. However, studies have only assessed its test–retest reliability in the short term. The purpose of this study was to examine long-term test–retest reliability of the ISWT in clinically stable cardiac patients.Design: Test–retest reliability assessment.Setting: Continuous, community-based phase IV cardiac rehabilitation centre.Participants: Thirty patients with cardiovascular disease (15 males, 15 females; age 55 to 80 years) volunteered to participate in the study.Interventions: Participants undertook two ISWTs, a minimum of 8 weeks apart.Main outcome measures: ISWT performance in metres.Results: Overall, the mean distance walked in the pre-test was 502±161m and this did not differ from test to retest. The intraclass correlation coefficient was 0.80, indicating good test–retest reliability. Using the Bland and Altman method, there was a small mean test–retest difference (−7m). The 95% limits of agreement were large, ranging from −203m to 189m.Conclusions: Over long test–retest durations, there appears to be no learning effect in the ISWT, negating the need for a practice walk. The long-term random variation in the ISWT test is larger than in previous studies, probably due to greater physiological and psychological variation in the participants over 8 weeks compared with that seen in day-to-day testing. Factors influencing long-term test–retest reliability of the ISWT require further elucidation.

Influence of self-reported socio-economic status on lung function of adult Nigerians - Corrected Proof

Rufus A. Adedoyin, Gregory E. Erhabor, Akanmu Olajide, Olugbolahan J. Anifowose — 2010-01-27

Abstract: Objectives: Low socio-economic status is known to be associated with reduced lung function in childhood and early adulthood, and an increased risk of cardiovascular disease in older adults. The lung function of people in developing nations is known to be lower than that of their counterparts in developed nations. This study assessed whether childhood socio-economic status is related to lung function in adults in Nigeria.Design: Cross-sectional study.Setting: Ife central local government, Ile-Ife, Nigeria.Participants: One thousand nine hundred and thirty healthy adults aged 40 to 80 years took part in the study. Forced vital capacity (FVC) and forced expiratory volume in 1second (FEV1) were measured with a spirometer, and peak expiratory flow (PEF) was measured with a mechanical peak expiratory flow meter. The socio-economic status questionnaire gave equal importance to education, occupation and family income. Based on the score, the subjects were classified as lower, middle or higher status.Main outcome measures: Spirometry, assessment of peak flow meter and questionnaire to assess socio-economic status.Results: The results showed a difference between the group with the highest socio-economic status and the other two groups [mean (standard deviation) FVC: high 3.63l (0.33), middle 3.57l (0.41), low 3.38l (0.35)]. The mean difference between the high and middle socio-economic groups was 0.07l [95% confidence interval (CI) 0.02 to 0.11]. A similar difference existed for FEV1: high 3.16l (0.28), middle 3.06l (0.31), low 2.94l (0.34). The mean difference between the high and middle socio-economic groups was 0.11l (95% CI 0.07 to 0.15). Values for PEF were: high 404.30l/second (35.98), medium 390.56l/second (41.53), low 376.03l/second (45.81). The mean difference between the high and medium socio-economic groups was 13.74l/second (95% CI 8.42 to 19.06). There was a weak but significant association between socio-economic status and FVC (r=0.28), FEV1 (r=0.26) and PEF (r=0.25).Conclusion: Self-reported low socio-economic status is associated with lower lung function among adult Nigerians. This may increase their risk for respiratory and cardiovascular disease.

Corrected Proof

Jane Hislop — 2010-01-20

The latest book in the ‘Physiotherapy Toolbox’ series aims to provide an essential guide for students and newly qualified clinicians to measurement methods used in practice. The book provides a practical guide to measurement methods such as goniometry, manual muscle testing and spirometry. While the authors state that they do not intend to review the literature critically, they touch on the reliability and validity of the measurement tools in an introductory chapter, and provide summary tables of relevant studies in the appendix.

Experiences of new physiotherapy lecturers making the shift from clinical practice into academia - Corrected Proof

Kay M. Hurst — 2010-01-18

Abstract: Objectives: To explore the experiences of physiotherapists making the transition from practising physiotherapist to physiotherapy lecturer in higher education, and to understand these experiences in order to inform an explanation of ways of managing this transition.Design: A qualitative, interpretive research design using semi-structured interviews. The interviews were transcribed, read and thematically analysed.Participants: Using purposive sampling, eight physiotherapy lecturers within their first 4 years of teaching in higher education at one North West university were interviewed.Findings: Despite having previous successful clinical careers, participants initially struggled to make the transition, characterised by initial feelings of uncertainty and inadequacy. Participants took between 1.5 and 3 years to socialise into their new academic role, adopting a new professional identity as a physiotherapy academic. Informal learning and peer support were the most valued mechanisms of support, more so than a formally structured mentoring process. Challenges of dual professionalism and tensions emerged regarding the expected academic roles of a lecturer. Confidence in developing a pedagogy for higher education and contributing to established communities of practice were key indicators of successfully making the shift to becoming an academic.Conclusions: To meet the new physiotherapy lecturers’ needs and build up confidence in higher education, more effective induction strategies are worthy of endeavour. More formal training designed to specifically address those aspects of transition particular to clinicians making the shift from clinical practice into academia is suggested.

Corrected Proof

Laura Partridge — 2010-01-08

The authors of this book aim to deliver a comprehensive yet easy-to-read reference guide which is accessible to both students and practitioners. Within a broad context which includes health and social care, the authors use examples and experience from the healthcare setting, with occasional examples from social care. The content is not new or groundbreaking, more a well-referenced overview that delivers sound theory to underpin execution of evidence-based practice with relevance to physiotherapy.