Physiotherapy - Articles in Press

Exploring the negative social evaluation of patients by specialist physiotherapists working in residential intermediate care - Corrected Proof

Di Thomson, Helen Love — 2012-01-24

Abstract: Background: Residential intermediate care represents an innovative model of care that facilitates early hospital discharge and avoids unnecessary hospital admission. It also represents an environment where patients may demonstrate emotional vulnerability following a period of acute illness or injury, and this may impact on the quality of the patient/physiotherapist relationship.Objective: To gain an understanding of the negative social evaluation of patients by specialist physiotherapists, and to explore possible coping strategies in order to engage patients in appropriately designed rehabilitation programmes.Method: Using a grounded theory approach, physiotherapists working in an intermediate care facility in a senior role were invited to participate in a focus group. Following the focus group analysis, a further four physiotherapists, with similar levels of experience to those in the focus group, were recruited to participate in semi-structured interviews to explore the emerging categories in greater depth.Results: The findings revealed some categories that the therapists believed resided with the patients (alcohol dependency, failing to adapt/accept their condition and patients whose families hindered the process of rehabilitation) and some that appeared to reside within the context of intermediate rehabilitation (labelling, the 6-week model of intermediate care and the process of transition into the service). Coping strategies cited were workforce planning, goal setting and reflective practice.Conclusion: While supportive strategies have been developed locally to assist staff in managing their anxiety related to therapeutic interactions with ‘difficult patients’, it is also recognised that they have the potential for demotivation and are a possible precursor for stress.

Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain? - Corrected Proof

C. Paul van Wilgen, Miriam W. van Ittersum, Ad A. Kaptein — 2012-01-24

Abstract: Objectives: To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain.Design: Cross-sectional study.Participants: Four hundred and two members of the general Dutch population, with and without chronic low back pain.Main outcome measures: Sociodemographics and the translated version of the Illness Perception Questionnaire-Revised, adapted for back pain.Results: Of the sample, 115 (29%) individuals had chronic low back pain (>6 months) and 287 (71%) did not have chronic low back pain. Many of the participants with chronic low back pain believed that one ‘wrong’ movement can potentially lead to more severe problems, and that X-rays or computer tomography scans can determine the cause of the pain. Many of the participants with chronic low back pain did not perceive a relationship between psychosocial factors and low back pain.Conclusions: Illness perceptions differed between individuals with and without chronic low back pain. In the subacute phase, healthcare professionals could assess illness perceptions and, if necessary, incorporate them into the management of patients with low back pain.

Corrected Proof

Charikleia Sinani — 2012-01-20

The principal theme of this book concerns the law and practice of community care. More specifically, it is about social care, health care and some housing services, provided for certain groups of people who need help or assistance. These groups include older people with various needs and disabilities, younger adults with disabilities, people with mental health needs, and people with drug and alcohol problems. Although, this book mainly refers to adults some of the legal rules and principles may be applied to children. This book is intended for students, general or novice practitioners, specialists, educators, managers, other healthcare professionals and carers. It is relevant to physiotherapists and managers working in community settings who should be aware of the issues discussed in this book. It is a very useful guide and can be used as a reference. Physiotherapy training does not address issues related to community care practice and the law, with the exception of very limited CPD schemes available in the country. At the moment this is the only book on the topic which is a quick guide.

Corrected Proof

Howard Turner — 2012-01-19

It is hard to know how widely understood is combined movement theory but its principles are simple and intuitive: where there is mechanical pain it is sensible to apply mechanical treatment and where position makes a difference to that pain it is sensible to utilise joint positioning to optimise the effect of treatment. These principles are described with clarity and depth in Dr. Chris McCarthy's new Combined Movement Theory, Rational Mobilization and Manipulation of the Vertebral Column.

Patient-centered research - Corrected Proof

Amos Peter Lee — 2012-01-19

I wish to commend the authors of the article, ‘User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke’ , for taking a somewhat different route of research compared with the norm. Their qualitative study was refreshing, in that it focused on the patient's experience of orthotic usage and documented what the patient perceived as most important and helpful. A current issue in physiotherapy is the low level of patient compliance towards professional advice such as completing a home exercise program . This lack of compliance has been estimated to be as high as 70% and has significant implications for the effectiveness of physiotherapy interventions, healthcare costs and patient outcomes. Thus, conducting research focused on the patient's point of view may help clinicians prescribe treatments that are better tolerated, and in that way, lead to more meaningful outcomes. In the case of stroke patients with lower limb weakness and foot drop, it may enable them to make a more informed decision regarding their management of the condition.

Clinical effectiveness of knee rehabilitation techniques and implications for a self-care treatment model - Corrected Proof

Kate Button, Arshi S. Iqbal, Robert H. Letchford, Robert W.M. van Deursen — 2011-12-12

Abstract: Background: Physiotherapy is a complex intervention frequently recommended for knee conditions. The International Classification of Functioning and Disability (ICF) can be used as a framework to evaluate evidence to develop care models and clinical guidelines.Objective: To evaluate the clinical effectiveness of knee rehabilitation modalities categorised according to the ICF domains.Data sources: A keyword search of Medline, Cinahl, Amed, Embase and Cochrane databases from 1996 to 2010 using terms related to the knee joint and physiotherapeutic interventions.Study selection: Reviewer assessment using inclusion/exclusion criteria and a quality assessment tool compiled from the Critical Appraisal Skills Programme Tool, Consort and Cochrane Bone Joint and Muscle Trauma Groups.Data extraction: Information about the research design, intervention and subjects was extracted. Outcome measures and findings were categorised according to ICF domains.Data synthesis: The majority of studies evaluated exercise. Findings were supportive but specific recommendations were limited due to variations in content and application. There was limited quality research to support the theory that manual therapy, electrotherapy or taping in isolation contributes to recovery. Multimodality physiotherapy programmes were found to be beneficial and to reflect clinical practice, but the effectiveness of each component is unknown. Outcome measures from the participation domain of the ICF were used least frequently and were not generally true measures of participation.Conclusion: Development of participation outcome measures is required to evaluate the long-term benefits of interventions. Rehabilitation should be based around delivery of effective exercise programmes incorporating participation outcomes to provide feedback and complement self-care for knee conditions.

Contemporary undergraduate physiotherapy education in terms of physical activity and exercise prescription: practice tutors’ knowledge, attitudes and beliefs - Corrected Proof

Grainne O’Donoghue, Tara Cusack, Catherine Doody — 2011-10-24

Abstract: Objectives: Practice tutors’ evaluation to (i) establish current physical activity and exercise promotion and prescription curriculum content and (ii) their knowledge, attitudes and beliefs concerning physical activity and exercise prescription in clinical education, in terms of contemporary and emerging health trends and priorities.Design: A cross sectional survey employing a questionnaire and focus groups.Participants: All practice tutors delivering physiotherapy undergraduate education in four physiotherapy schools in Ireland (n=38) were invited to participate. Thirty participated giving a response rate of 79%.Methods: Two methods of data collection were employed. Clinical content questionnaires were administered, the results of which informed follow-up focus groups. Focus group transcriptions were analysed using the ‘Framework Analysis’ method.Results: 66% of practice tutors were unhappy with their own knowledge and felt they required further training in the following areas: strategies for changing physical activity behaviour; exercise promotion and prescription for public health; exercise prescription for lifestyle related disease. Main themes emerging from the focus groups were (i) perceptions of the physiotherapist's role, (ii) perceptions of the practice tutor's role and (iii) facilitators and barriers to change.Conclusion: In terms of physical activity and exercise prescription education, practice tutors identified a need for further education to improve their knowledge base. However, their attitudes and beliefs relating to physiotherapists’ and educators’ role in terms of teaching contemporary and emerging health trends and priorities were mixed. Results of this study provide useful data to inform future physiotherapy curricula development in terms of physical activity and exercise content.

Influence of step length on 6-minute walk test performance in patients with chronic heart failure - Corrected Proof

2011-10-24

Abstract: Objective: To investigate the influence of gait parameters including step length and walking speed during performance of the 6-minute walking test (6MWT) in patients with chronic heart failure (CHF).Design: Observational study.Setting: Specialist heart failure clinic.Participants: Patients with CHF and aged-matched, apparently healthy controls.Interventions: Each patient and control performed a 6MWT following a standardised protocol in a 15m corridor. The number of steps (defined as step from left foot to right foot) taken every 15m was counted, and reported as minute-by-minute changes in 6MWT performance. In addition, minute-by-minute changes in time taken to complete 15m and mean walking speed throughout the test were calculated.Main outcome measures: Walking speed and step length.Results: Thirty patients with CHF {87% males; mean age 75 [standard deviation (SD) 8] years} and 10 healthy controls [80% males; mean age 77 (SD 11) years] undertook the 6MWT. For the CHF group, the mean distance walked was 309 (SD 48)m and the peak Borg score was 12 (SD 1). For the controls, the mean distance walked was 334 (SD 138)m and the peak Borg score was 12 (SD 1). Patients with CHF showed no significant minute-by-minute changes in step length or walking speed over the course of the 6MWT. In the first 5minutes, healthy controls had a longer step length and faster walking speed than patients with CHF [step length: mean difference in the first minute was 0.03m, 95% confidence interval (CI) of the difference 0.01 to 0.05m; P=0.02; walking speed: mean difference in the first minute 0.04m/second, 95% CI of the difference 0.02 to 0.07m/second; P=0.01]. A multiple linear regression analysis demonstrated that body mass index (P=0.02) was the most important predictor of 6MWT performance.Conclusion: Patients with CHF have a shorter step length and walk more slowly than controls during the 6MWT. Altered gait mechanics may contribute to limited exercise capacity in patients with CHF.

Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review - Corrected Proof

Chad Cook, Lance Mabry, Michael P. Reiman, Eric J. Hegedus — 2011-10-10

Abstract: Background: Diagnosis of patellofemoral pain syndrome (PFPS) is commonly performed using a myriad of clinical and imaging-based criteria.Objectives: The objective of this systematic literature review was to summarize the research on accuracy of individual clinical tests/findings for PFPS.Data sources: MEDLINE, ProQuest Nursing and Allied Health, Cochrane Trials, PEDro, and CINAHL.Study selection or eligibility criteria: PRISMA guidelines were followed for this review. To be considered for review, the study required: (1) a description of a clinical test or tests used for diagnosing PFPS (including a test that was combined with another finding such as patient history), (2) a report of the diagnostic accuracy of the measures (e.g., sensitivity and specificity), and (3) an acceptable reference standard for comparison.Study appraisal or synthesis methods: Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) scores were completed on each selected article. Sensitivity, specificity, and negative and positive likelihood ratios (LR−/LR+) were calculated for each diagnostic test described.Results: The systematic search strategy and hand search revealed 704 potential articles, 9 of which met the criteria for this review; analysing a total of 22 PFPS clinical tests. After assessment using the QUADAS score, 1 of the 9 articles was of high quality. The tests with the highest reported diagnostic value were also associated with studies that had the lowest QUADAS values.Conclusion: A majority of the studies that have investigated diagnostic accuracy of clinical tests for PFPS demonstrate notable design or reporting biases, and at this stage, determining the best tests for diagnosis of PFPS is still difficult.

Exercise for rotator cuff tendinopathy: a systematic review - Corrected Proof

Chris Littlewood, Jon Ashton, Ken Chance-Larsen, Stephen May, Ben Sturrock — 2011-10-07

Abstract: Background: Shoulder pain due to rotator cuff tendinopathy is a common problem. Exercise is one intervention used to address this problem but conclusions from previous reviews have been mixed.Objective: To systematically review the effectiveness of exercise, incorporating loaded exercise (against gravity or resistance), for rotator cuff tendinopathy.Data sources: An electronic search of AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro and SPORTDiscus was undertaken from their inception to November 2010 and supplemented by hand searching related articles and contact with topic experts.Study eligibility criteria: Randomised controlled trials evaluating the effectiveness of exercise, incorporating loaded exercise, in participants with rotator cuff tendinopathy.Study appraisal and synthesis methods: Included studies were appraised for risk of bias using the tool developed by the Cochrane Back review Group. Due to heterogeneity of studies, a narrative synthesis was undertaken based upon levels of evidence.Results: Five articles detailing four studies were included, all of which were regarded as presenting a low risk of bias. Overall, the literature was supportive of the use of exercise in terms of pain and functional disability.Limitations: The results should be regarded with some degree of caution due to limitations associated with the studies including lack of blinding, no intervention control groups and limitations of the outcome measures used.Conclusion and implications of key findings: The available literature is supportive of the use of exercise but due to the paucity of research and associated limitations further study is indicated.

Importance of correcting for individual differences in the clinical diagnosis of gait disorders - Corrected Proof

R. Senden, K. Meijer, I.C. Heyligers, H.H.C.M. Savelberg, B. Grimm — 2011-10-03

Abstract: Objective: To quantify the effects of subject characteristics on gait parameters using acceleration-based gait analysis.Design: Cross-sectional study with a single group cohort.Setting: Hospital setting.Participants: One hundred and twenty healthy subjects (six age decade groups of 10 men and 10 women) performed a 20-m walking test.Methods: Basic gait parameters (e.g. speed) and other clinically relevant parameters (e.g. step time asymmetry) were assessed during a 20-m walking test using a tri-axial accelerometer, attached at the level of the sacrum. Subject characteristics were recorded.Results: Between 34% and 51% of the variability in gait parameters was explained by age, height and gender. Subject characteristics contributed less to the variance in step time asymmetry (R2=0.02), gait irregularity (R2=0.07) and vertical displacement of the centre of mass (R2=0.17). Relationships identified were comparable with previous studies (e.g. faster walking speed in men, younger and taller subjects).Conclusions: Age, height and gender are determinants of basic gait parameters, while their influence on gait irregularity and step time asymmetry is minimal. This indicates that gait is variable between subjects, showing the relevance of correcting gait for subject characteristics. This study describes preliminary work to build a database of gait parameters in healthy participants, describing the effects of age, gender and height. Further studies to extend this database with patients would provide further relevance to clinical practice.

Comparison between an accelerometer and a three-dimensional motion analysis system for the detection of movement - Corrected Proof

P.Y.M. Chung, G.Y.F. Ng — 2011-10-03

Abstract: Objective: To examine the reliability and concurrent validity of an accelerometer compared with a three-dimensional (3D) motion analysis system for measuring the motor reaction time of the lower limbs, to validate a simple method for objective clinical assessment of movement onset.Design: Timing of the onset of knee extension movement in response to an audio signal was measured simultaneously with an accelerometer and a 3D VICON motion analysis system.Participants: Twelve able-bodied subjects with a mean age of 26 (standard deviation 2.3) years.Results: Good reliability was found for both instruments, although the intraclass correlation coefficient (ICC) was higher for the accelerometer (ICC3,1=0.739; P<0.001). The mean motor reaction time measured by the accelerometer and the VICON system was 205.0 and 196.9mseconds, respectively. Good agreement was found between the paired measurements (mean ICC=0.774), and the average 95% limits of agreement were −56.4 to 72.5mseconds.Conclusion: In conclusion, the accelerometer had good reliability for the measurement of movement onset time. Agreement between the measurements from the accelerometer and the VICON system was high. However, the limits of agreement covered a wide range, so absolute timings for movement onset derived from these methods should not be used interchangeably.

Corrected Proof

Louise Johnson — 2011-09-30

This book is written by a prosthetist and a medical rehabilitation clinician based in the United States. Consequently some of the terms refer to the private health system in the US are not applicable to the UK. The book is intended for students and as a reference for clinicians. An understanding of biomechanics of normal and pathological gait is assumed. The book begins with a brief and basic overview of normal gait. This may be difficult for the undergraduate to understand and provides limited detail to advance the knowledge of the practicing clinician. The chapter on early management provides a brief overview of most aspects of rehabilitation that need to be addressed by the multi-disciplinary team. It also covers the important aspects of rehabilitation of the amputee, however a lack of detail means it does not provide a comprehensive guide for physiotherapists and occupational therapists.

Test–retest reliability, smallest real difference and concurrent validity of six different balance tests on young people with mild to moderate intellectual disability - Corrected Proof

Sven Blomqvist, Anita Wester, Gunnevi Sundelin, Börje Rehn — 2011-09-14

Abstract: Objectives: Some studies have reported that people with intellectual disability may have reduced balance ability compared with the population in general. However, none of these studies involved adolescents, and the reliability and validity of balance tests in this population are not known. The purpose of this study was to examine the reliability of six different balance tests and to investigate their concurrent validity.Design: Test–retest reliability assessment.Settings: All subjects were recruited from a special school for people with intellectual disability in Bollnäs, Sweden.Participants: Eighty-nine adolescents (35 females and 54 males) with mild to moderate intellectual disability with a mean age of 18 years (range 16 to 20 years).Interventions: All subjects followed the same test protocol on two occasions within an 11-day period.Main outcomes: Balance test performances.Results: Intraclass correlation coefficients greater than 0.80 were achieved for four of the balance tests: Extended Timed Up and Go Test, Modified Functional Reach Test, One-leg Stance Test and Force Platform Test. The smallest real differences ranged from 12% to 40%; less than 20% is considered to be low. Concurrent validity among these balance tests varied between no and low correlation.Conclusion: The results indicate that these tests could be used to evaluate changes in balance ability over time in people with mild to moderate intellectual disability. The low concurrent validity illustrates the importance of knowing more about the influence of various sensory subsystems that are significant for balance among adolescents with intellectual disability.

Photogrammetry: an accurate and reliable tool to detect thoracic musculoskeletal abnormalities in preterm infants - Corrected Proof

2011-09-09

Abstract: Objective: To analyse the accuracy and reproducibility of photogrammetry in detecting thoracic abnormalities in infants born prematurely.Design: Cross-sectional study.Setting: The Premature Clinic at the Federal University of São Paolo.Participants: Fifty-eight infants born prematurely in their first year of life.Outcome measures: Measurement of the manubrium/acromion/trapezius angle (degrees) and the deepest thoracic retraction (cm). Digitised photographs were analysed by two blinded physiotherapists using a computer program (SAPO; http://SAPO.incubadora.fapesp.br) to detect shoulder elevation and thoracic retraction. Physical examinations performed independently by two physiotherapists were used to assess the accuracy of the new tool.Results: Thoracic alterations were detected in 39 (67%) and in 40 (69%) infants by Physiotherapists 1 and 2, respectively (kappa coefficient=0.80). Using a receiver operating characteristic curve, measurement of the manubrium/acromion/trapezius angle and the deepest thoracic retraction indicated accuracy of 0.79 and 0.91, respectively. For measurement of the manubrium/acromion/trapezius angle, the Bland and Altman limits of agreement were −6.22 to 7.22° [mean difference (d)=0.5] for repeated measures by one physiotherapist, and −5.29 to 5.79° (d=0.75) between two physiotherapists. For thoracic retraction, the intra-rater limits of agreement were −0.14 to 0.18cm (d=0.02) and the inter-rater limits of agreement were −0.20 to −0.17cm (d=0.02).Conclusion: SAPO provided an accurate and reliable tool for the detection of thoracic abnormalities in preterm infants.

Blowing the whistle to protect a patient: a comparison between physiotherapy students and physiotherapists - Corrected Proof

Abraham Mansbach, Itzik Melzer, Yaacov G. Bachner — 2011-08-02

Abstract: Objectives: To answer three questions: Are physiotherapists and physiotherapy students willing to take action to prevent misconduct in order to protect a patient's interests? Are they willing to report the misconduct to authorities within an organisation and/or outside of it? Are they willing to report a colleague's wrongdoing as well as that of a manager?Design: Observational questionnaire study.Participants: Two hundred and twenty-seven participants divided into two groups: 126 undergraduate students at the Department of Physical Therapy at Ben Gurion University, and 101 certified physiotherapists working in hospitals and rehabilitation centres in south and central regions of Israel.Outcome measures: Participants were presented with two vignettes – one describing a colleague's misconduct and the other describing a manager's misconduct – and asked to make a decision about whistleblowing.Results: Both groups rated their own willingness to take action to change the harmful situations very highly. The physiotherapists perceived a colleague's misconduct as being more serious than the students, and were more willing to intervene internally. The students were more prepared than the physiotherapists to take such action externally. The students perceived the manager's misconduct as being more serious than the physiotherapists, and also reported a greater readiness to intervene externally.Conclusions: Physiotherapists consider acts that are detrimental to a patient to be very serious, and are more willing to take action when the offending individual is a colleague. Students are more willing to blow the whistle externally. This article suggests tools for handling similar situations.

Problem Based Learning in physiotherapy education: a practice perspective - Corrected Proof

Hilary Gunn, Heather Hunter, Bernhard Haas — 2011-07-28

Abstract: Background: Problem Based Learning (PBL) has been integrated into a range of health education curricula; however there is limited research evaluating the application of skills developed through PBL in clinical practice.Aim: This study aimed to provide evidence of how skills gained through PBL are applied in practice by student physiotherapists, from the perspective of their placement supervisors.Method: A qualitative one-to-one semi-structured interview methodology was used, purposively recruiting a sample of 10 qualified physiotherapists with experience of placement supervision of students studying on a PBL physiotherapy undergraduate degree.Results: The supervisors felt that PBL offered positive benefits for both student education and clinical practice. There was evidence of the application of skills and attributes associated with PBL, including positive learning behaviours and a high level of motivation and self-direction. Supervisors felt that proactive students were able to apply transferable skills inherent in the PBL approach to clinical practice, including a holistic, problem-solving approach and effective team-working but that there was considerable variation between students.Conclusions: There is evidence of variable application of skills associated with PBL in clinical practice in this study group. Further research would be useful to explore the factors that enable students to successfully apply the attributes developed using a PBL approach into practice.

Does the application of an algorithm for non-invasive ventilation in chronic obstructive pulmonary disease improve the initiation process and patient outcomes? - Corrected Proof

Karen Ward, Hazel Horobin — 2011-07-18

Abstract: Objectives: Non-invasive ventilation (NIV) for acute hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) has been shown to decrease endotracheal intubation and mortality; however, little guidance exists on NIV initiation. This study aimed to explore patient outcomes and the process of NIV initiation following the introduction of an algorithm.Design: Prospective, modified time-series study. Baseline measures were performed during the control period and repeated in the algorithm phase.Setting: Acute secondary care teaching hospital, wherever NIV was commenced (accident and emergency, medical assessment unit, thoracic medicine unit).Participants: Thirty-four patients with COPD and acute hypercapnic respiratory failure.Interventions: An algorithm was devised for use when initiating NIV, highlighting four aspects of care from the evidence base: synchronisation, tidal volume, oxygenation and comfort.Main outcome measures: Arterial pH value, Borg scale rating of breathlessness, and a staff questionnaire on the process of NIV initiation.Results: No significant difference was found in changes in pH or Borg score. However, three of the four aspects of care promoted by the algorithm were reported more frequently in the intervention phase. Increased assessment of tidal volume (5/17 cases in control phase, 95% confidence interval 0.05 to 0.54; 12/17 cases in algorithm phase, 95% confidence interval 0.46 to 0.95) reached statistical significance (P=0.038, Fisher's exact test).Conclusions: This study presents an algorithm to assist the application of NIV, and has demonstrated changes in practice following its introduction. It is proposed that the algorithm is considered for use within services that initiate NIV. Further work is required to explore the effects of staff education and the promotion of ownership.

Experiences of an exercise referral scheme from the perspective of people with chronic stroke: a qualitative study - Corrected Proof

Helen Sharma, Cathy Bulley, Frederike M.J. van Wijck — 2011-07-15

Abstract: Objective: To explore stroke survivors’ experiences of undertaking exercise in the context of an exercise referral scheme for people with chronic stroke.Design: A qualitative design, using semi-structured interviews within a constructivist framework to explore the experiences of individual participants. Verbatim transcripts were thematically analysed. Rigour mechanisms included respondent validation, peer checking, and reflexivity.Setting: An exercise referral scheme, based at a leisure centre in South London.Participants: Nine community-dwelling stroke survivors took part; 5 male and 4 female, mean age 51 years (range 37–61 years); time post stroke 1–4 years, with mixed ethnic backgrounds.Findings: Participants described greater physical and psychological well-being following participation in the exercise referral scheme. Categories that emerged were: improved exercise engagement and confidence, more internalised perceptions of control and enhanced lifestyle, work and social roles. Categories linked to form a master theme, labelled: ‘Exercise Referral Scheme as a catalyst for regaining independence.’Conclusions: This study supports the value of exercise referral schemes in enabling people with stroke to engage in exercise. For participants in this study, the scheme seemed influential in the process of regaining independence.

Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care - Corrected Proof

Maria Landén Ludvigsson, Paul Enthoven — 2011-07-04

Abstract: Objectives: To evaluate primary physiotherapist assessment and management of patients with musculoskeletal disorders in primary care, and to compare patient satisfaction with primary assessment by a physiotherapist or a general practitioner (GP).Design: An observational, retrospective cohort study reviewing medical records, and a separate consecutive non-randomised study of patient satisfaction.Setting: Primary healthcare centre.Participants: Four hundred and thirty-two patients with musculoskeletal disorders, primarily assessed by a physiotherapist. Fifty-one of these patients primarily assessed by a physiotherapist and 42 patients assessed by a GP answered a patient satisfaction questionnaire.Interventions: Primary assessment and management of patients with musculoskeletal disorders.Main outcome measures: Data from medical records within 3-month after the visit, and patient satisfaction questionnaire.Results: Eighty-five percent (367/432) of patients did not need to see a GP. Serious pathologies were found among the 6% (26/432) of patients who were referred to a GP by a physiotherapist, but no serious pathologies were found among the 9% (39/432) of patients who subsequently returned for a GP appointment for the same disorder. Patients assessed by a physiotherapist were more satisfied with the information received about their disorder and self-care than patients assessed by a GP. Patients also had higher confidence in the ability of physiotherapists to assess their disorder (P<0.002).Conclusion: Physiotherapists can be considered primary assessors of patients with musculoskeletal disorders in primary care as few patients needed additional assessment by a GP, patients with confirmed serious pathologies were identified by the physiotherapists, and patients were satisfied with assessment by a physiotherapist.

Effect of a high-density foam seating wedge on back pain intensity when used by 14 to 16-year-old school students: a randomised controlled trial - Corrected Proof

2011-06-20

Abstract: Objectives: No previous randomised controlled trials had been undertaken investigating the effect of school seating on back pain in 14 to 16 year olds. This study was designed to test the effect of the use of a high-density foam wedge on normal school seating on the intensity of back pain.Design: Randomised controlled trial.Setting: Suffolk, a predominantly rural county in eastern England.Participants: One hundred and eighty-five students with back pain were recruited from 12 schools. Randomisation was stratified by school. The control and intervention groups included 92 and 83 students, respectively.Intervention: Following a 1-week baseline observation period, each student in the intervention group was given a wedge to use on their school chairs.Outcome measure: The primary outcome measure was pain intensity (numerical rating scale, 0 to 10) recorded in pain diaries over 4 weeks. Random effects models were used to analyse the pain intensity data.Results: Ninety-seven students (46 control group, 51 intervention group) completed the trial. For the intervention group, pain intensity was reduced significantly over the 3 weeks of wedge use. The average reduction in pain intensity was estimated to be 0.709 points (95% confidence interval 0.341 to 1.077), representing a 58% reduction in back pain for those in the intervention group.Conclusion: Use of a wedge reduced the intensity of back pain significantly, especially in the evenings. The results suggest that further research into the longer-term effect of seating on pain intensity in adolescents should be considered.

Understanding hope in patients with Multiple Sclerosis - Corrected Proof

Andy Soundy, James Benson, Helen Dawes, Brett Smith, Johnny Collett, Andy Meaney — 2011-06-20

Abstract: Objectives: To understand how patients with Multiple Sclerosis experience and express hope within a rehabilitation setting and use this information to help therapists in a clinical setting.Design: One guided interview was undertaken.Setting: Two locations were used for interviews: (1) a rehabilitation centre in Oxfordshire. (2) A meeting location for the MS society in London.Participants: Eleven patients with Multiple Sclerosis were selected (54.5±8.8 years). Six patients were classified as being in the secondary progressive stage and 5 were classified as relapsing remitting phase.Method: The patients selected were part of a 12-week Multiple Sclerosis rehabilitation program. One interview took place mid way through the rehabilitation program and immediately following the end of the rehabilitation program. The semi-structured interview comprised of 5 sub-sections. Categorical content analysis was used to analyse the results.Results: Three main themes were identified that related to the paradox of chronic illness: (1) defiance and the patient (2) accepting the diagnosis and prognosis and (3) accepting deterioration. These themes provide a basis for the different types of hopes expressed by patients.Conclusion: It is vital to understand the paradox of chronic illness as an expression common among patients with Multiple Sclerosis. This research illustrates the importance of listening to a patient's narrative during rehabilitation.

Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial's ‘high-risk’ intervention (StarT Back; ISRCTN 37113406) - Corrected Proof

C.J. Main, G. Sowden, J.C. Hill, P.J. Watson, E.M. Hay — 2011-06-13

Abstract: A new randomised controlled trial of intervention in low back pain has been described recently. In this trial, a screening and targeted approach was found to be more effective and cost-effective than current best practice. Nested within the intervention arm were three different interventions targeting patients identified as ‘low’, ‘medium’ or ‘high’ risk dependent on the presence of (mainly) psychosocial risk factors. In this paper, the development and content of the STarT Back trial's ‘high-risk’ intervention is described. It offers a systematic approach, termed ‘psychologically informed practice’, to the integration of physical and psychological approaches to treatment for the management of people with low back pain by physiotherapists. The term ‘disability’ is used to refer to self-reported pain-associated functional limitations, and ‘psychological’ is used to refer to the beliefs/expectations, emotional responses and behavioural responses associated with low back pain.

The care needs of Pakistani families caring for disabled children: how relevant is cultural competence? - Corrected Proof

Elizabeth J. Croot — 2011-06-07

Abstract: Objective: To identify factors that Pakistani parents living in the UK and caring for children with learning disabilities felt were important components of their care and to discuss the relevance of the concept of cultural competence in the light of these findings.Design: A qualitative study taking a constructivist approach to gain insight into participants’ experiences of health care provision. In depth interviews were used to explore the ways in which personal understandings and life experiences shaped the characteristics of the therapeutic encounter that participants identified as important. Data were analysed thematically.Setting: A Northern city in England. Interviews took place in participant's homes or work places.Participants: Eleven Pakistani parents and one grandparent from nine different families, all caring for children with learning disabilities.Findings: The study identified features of the therapeutic encounter that were important to Pakistani parents and highlighted that there is nothing to suggest that these are different to those of the majority population.Conclusions: The utility of the concept of cultural competence may be limited where it depends on concepts of ethnic groups as relatively fixed cultural groups with distinct and clearly defined sets of health beliefs and behaviours. Physiotherapists cannot prejudge health status and behaviours from an individual's ethnic status. Instead there is a need to actively seek the understandings that are relevant to practice. In addition health service providers must develop and operate systems that ensure access, use and quality of care are the same at the point of delivery regardless of patient ethnicity.

Development and delivery of an exercise intervention for rheumatoid arthritis: Strengthening and stretching for rheumatoid arthritis of the hand (SARAH) trial - Corrected Proof

2011-06-06

Abstract: This paper describes the development and implementation of a hand exercise intervention for rheumatoid arthritis (RA) as part of a large multi-centred randomised controlled trial in a UK National Health Service (NHS) setting. Participants are eligible if diagnosed with RA according to American College of Rheumatology criteria, have a history of disease activity, functional deficit or impairment in the hand and/or wrist, and have been on a stable medication regime for at least 3 months. The intervention development was informed by the current evidence base, published guidelines, clinician and expert opinion, and a pilot study. The exercise programme targets known, potentially modifiable physical impairments of the hand with 5 exercise sessions and a home exercise component over a 12 week period. The intervention will be provided to 240 participants along with usual care. A further 240 will receive usual care only as part of the control arm. Specific details of the treatments delivered are described. [ISRCTN no: 89936343].

Measurement properties of a hand-held inclinometer during straight leg raise neurodynamic testing - Corrected Proof

Benjamin S. Boyd — 2011-06-06

Abstract: Objectives: The most common lower quarter neurodynamic test is the straight leg raise (SLR) test. Quantification of limb motion during SLR testing should utilize reliable and valid measurement tools that are highly sensitive to change. The purpose of this study was to determine the psychometric properties of a hand-held inclinometer commonly utilized during SLR testing.Design: Cross-sectional measurement, intra-rater reliability and validity study.Setting: Research laboratory.Participants: Twenty individuals without pain in their low back or extremities and no history of nerve injury participated in the study.Main outcome measures: Two repetitions of the SLR were performed in each limb in two ankle positions (plantar flexion and dorsiflexion). A digital inclinometer and digital goniometer were utilized as the comparisons for range of motion measurements.Results: Intra-rater reliability for the hand-held inclinometer during SLR testing was excellent (ICCs, 0.95 to 0.98). The standard error of measurement was between 0.54° and 1.22° and the minimal detectable change was between 1.50° and 3.41°. Construct validity revealed hand-held inclinometer measurements were highly correlated with both the digital inclinometer and digital goniometer measures. The mean difference scores between hand-held inclinometer and digital inclinometer (∼1.5°) and digital goniometer (∼10°) suggest that the hand-held inclinometer better matches the construct measured by the digital inclinometer (limb elevation angle) compared to the digital goniometer (hip flexion angle).Conclusions: The hand-held inclinometer is a valid method for measuring limb elevation angle during the SLR neurodynamic test in a research setting. The hand-held inclinometer has high reliability and low minimal detectable change when used in healthy individuals.

Interferential laser therapy in the treatment of shoulder pain and disability from musculoskeletal pathologies: a randomised comparative study - Corrected Proof

2011-05-30

Abstract: Background: Interference is an important feature of the waves. When two or more in phase light waves meet, a new and reinforced wave is generated. Shoulder pain is a common clinical problem and laser is one of the treatments frequently used to relieve it.Objective: To test the safety of interferential laser therapy generated by two independent low level lasers and compare its effectiveness with conventional single laser therapy in the reduction of shoulder musculoskeletal pain and associated disability.Design: Randomised and single-blind controlled clinical trial.Setting: Physiotherapy Unit and Rehabilitation Department of Ramon y Cajal University Hospital (Madrid).Participants: 200 patients with shoulder musculoskeletal pain were randomly assigned in two groups, 100 people each.Interventions: Group I, experimental (n=100) received interferential laser, placing two probes opposite each other over the shoulder joint. Group II, control (n=100) received conventional laser therapy, using a single probe along with a second inactive dummy probe. Lasers used were GaAlAs diode (810 nm, 100 mW), in continuous emission. Laser was applied in contact mode through ten sessions, on 5 shoulder points (7 Joules/point) per session.Main Outcome Measures: Visual Analogue Scale (VAS) score and Shoulder Pain Disability index (SPADI), recorded before and after laser treatment.Results: There were no differences between both groups in the reduction of pain, either assessed by VAS scale (median difference=0, 95% CI of the difference =-.6 to .5, p=0.81) or SPADI index (median difference = .4, 95% CI of the difference =-2.9 to 3.8, p=0.80), using the Mann-Whitney U-test. Comparison between the scores recorded before and after the treatment, within each group, showed significant differences for VAS during movement (median difference=3, 95% CI of the difference =2.07 to 4, p<0.001) and SPADI index (median difference=3.5, 95% CI of the difference =2.67 to 3.85, Wilcoxon test, p<0.001), for both groups.Conclusions: In this study, the application of two low level lasers in order to generate interference inside the irradiated tissue showed to be a safe therapy. Both interferential and conventional laser therapy reduced shoulder pain and disability. Nevertheless, differences between them were not detected. Future research in this field could include applying this technique with other laser parameters or application forms.

Corrected Proof

Michael Callaghan — 2011-05-20

This is the 4th edition of a successful book which has 22 chapters and is divided into five parts. The early pages have many testimonials from readers ranging from statistics students to university professors. The author states that she has avoided the temptation to add too many new topics so it has been upgraded rather than further topics added.

Three-dimensional kinematic analysis of pelvic and lower extremity differences during trunk rotation in subjects with and without chronic low back pain - Corrected Proof

Ah Young Song, Hang Jin Jo, Paul S. Sung, Yoon Hyuk Kim — 2011-05-10

Abstract: Objective: To investigate three-dimensional angular changes of the pelvis and lower extremities during trunk axial rotation in subjects with and without chronic low back pain (LBP).Design: Repeated-measures design.Participants: Thirty volunteers participated in the study (15 with LBP, 15 without LBP). The mean age of the subjects was 44 (standard deviation 15.8) years (range 27 to 63 years).Main outcome measures: All participants were asked to perform five sets of axial trunk rotation activities with a bar in a standing position. The outcome measures included three-dimensional rotational angles of the pelvis and lower extremities (foot, calf and thigh).Results: The angular change of the pelvis in the sagittal plane differed between subjects with and without LBP (P=0.03). There were no significant differences in angular changes of the lower extremities in the frontal and transverse planes between groups.Conclusions: The angular change of the pelvis in the sagittal plane differed significantly between groups. Further research is needed to investigate the three-dimensional characteristics of biomechanical and neuromuscular aspects in subjects with LBP.

Assessment of the presence/absence of the palmaris longus muscle in different sports, and elite and non-elite sport populations - Corrected Proof

Craig Fowlie, Colin Fuller, Margaret K. Pratten — 2011-05-09

Abstract: Objectives: To investigate whether higher presence of the palmaris longus muscle is associated with sports that require hand grip.Design: Cross-sectional study.Participants: Six hundred and forty-two medical students, members of sports clubs and national athletes.Methods: Participants were invited to complete a questionnaire that assessed their main sport, elite or non-elite level of participation, and level of activity. The presence of the palmaris longus was assessed visually using a standardised test.Main outcome measures: Presence of the palmaris longus, type of hand grip required for the sport and the level of participation.Results: The presence of the palmaris longus was higher in elite athletes (21/22, 96%) than non-elite athletes (66/84, 79%; P=0.066) for sports that require a dominant-handed or two-handed cylindrical grip (18/22, 82% and 19/35, 54%, respectively; P=0.034). For both elite and non-elite athletes, the presence of the palmaris longus was higher in those participating in sustained grip sports (325/387, 84%) compared with sports that do not require a sustained grip (150/197, 76%; P=0.012).Conclusions: The palmaris longus may provide an advantage in certain types of sport that require hand grip, and for elite athletes participating in sports that require a dominant-handed or two-handed cylindrical hand grip. Orthopaedic specialists considering the use of the palmaris longus for a grafting procedure on an athlete should consider the level of participation and the type of hand grip required in the athlete's sport.

Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study - Corrected Proof

Hamid Bateni — 2011-05-02

Abstract: Objectives: To determine the effectiveness of Wii Fit training on balance control in older adults compared with physical therapy training.Design: Quasi-experimental design.Participants: Eight males and nine females aged 53 to 91 years.Materials and methods: Participants were divided into three groups: one group received both physical therapy training and Wii Fit training (PW group), one group received Wii Fit training alone (WI group), and one group received physical therapy training alone (PT group). Training consisted of three sessions per week for 4 weeks.Main outcome: Berg Balance Scale (all groups) and Bubble Test (PW and WI groups) scores.Statistical analysis: Descriptive statistics, medians, interquartile ranges and 95% confidence intervals are reported to identify trends in balance control as a result of different types of training.Results: All subjects showed improvement in the Berg Balance Scale and Bubble Test scores. The PT and PW groups tended to perform better than the WI group on the Berg Balance Scale following treatment. Although the differences in the Bubble Test score were not substantial between the PW and WI groups, the PW group performed slightly better than the WI group on the Berg Balance Scale.Conclusions: Wii Fit training appears to improve balance. However, physical therapy training on its own or in addition to Wii Fit training appears to improve balance to a greater extent than Wii Fit training alone.

Corrected Proof

Eileen Cook — 2011-04-13

This book describes how to use compressive and stretching techniques on soft tissues. It is written by a physiotherapist who specialises in massage and sports massage therapy. The text focuses on the application of deep pressure using the elbows, forearms and hands without causing pain to the client. The authors have written it for both newly qualified and experienced therapists. It is a stylish text with clear colour photographs of each technique. Part 1, which consists of two chapters, covers an introduction to the methods and benefits of deep tissue massage, expanding on how and where to use the various techniques and equipment. Safety issues, cautions and contraindications are also covered. Part 2 describes compressive techniques, including the safe use of forearms, fists, elbows and other methods of application including the use of tennis balls to apply compression. There are tables which demonstrate in which situations the techniques are of use. “Stretching Techniques” describes the method of stretching, specific to the application of deep tissue massage, which is usually performed passively by the therapist; active involvement of the client is confined to the contraction of an antagonist muscle or active joint movement while tissues are on stretch.

Corrected Proof

Patricia Smith — 2011-02-28

This is a timely and well-needed book. There are a lack of texts that describe cultural competence in such a precise and systematic manner. Cultural competence is a complex concept, and the authors provide a loose framework for cultural competence while presenting sufficient structure to allow the reader/practitioner to find their own level of understanding. This book is very relevant to physical therapy as it provides an opportunity for practitioners to examine their own cultural competence. It also provides some tools for addressing cultural competence in clinical practice.

Corrected Proof

Jill Tolfrey — 2011-02-09

This book presents an international overview of fieldwork education in physiotherapy, occupational therapy and speech and language therapy. Benefiting from contributions from multiple, high quality experts, brought together with a clear and highly readable style, the book is well structured addressing 9 key areas of innovation, allowing the reader to ‘dip in and out’ as required. These 9 sections address the changing nature of student populations and workforce needs, issues around fieldwork education management and the special skills required, models of supervision, use of IT and communication technology, alternatives to practice in the field, inter-professional field work education, student assessment and preparation of fieldwork educators, managers and students for fieldwork. The innovations presented are all critically evaluated and present a framework for the development of standards for field work education that are supportive of both the student learner and staff engaged in fieldwork education. The international, interdisciplinary nature of the work makes it unique in its contribution to developing understanding in fieldwork education, examining as it does research, theory and professional practice situated in the wider contexts of work and society.

Corrected Proof

Alison Sherwin — 2011-02-08

The authors of this book achieve their purpose in producing a ‘nuts and bolts’ resource for those working in or wishing to embark on pulmonary rehabilitation. This book is well researched and includes extensive practical advice. Updates and changes from the previous edition are a great improvement. Presentation is clear and logical, with an appealing typographical style and succinct ‘box’ figures to display key points. The chapter headings and subheadings make searching for particular topics easier and more user-friendly compared with the previous edition. References are used throughout and listed at the end of each chapter. The appendices include summary information charts, sample assessment and treatment charts, guidelines and questionnaires.

Corrected Proof

John Gormley — 2011-02-04

The role of exercise in the prevention and treatment of disease is now well recognised. This book concentrates on the secondary prevention of disease, i.e. the prevention of re-occurrence of a ‘disease-related event’. It is a comprehensive text covering a wide spectrum of diseases including endocrine/metabolic disorders, cardiovascular diseases, respiratory disease, oncology, musculoskeletal disease and neuromuscular disease.

Corrected Proof

Sue Richardson — 2010-10-25

The first edition of this laboratory guide is divided into 14 ‘labs’ to be used alongside other textbooks and laboratory brain specimens. At the beginning of each lab, the student is given clear instructions about the goal and the preparation required, and provided with a review of the previous lab to complete. There are also recommendations for lab instructors on how to structure the sessions.