Physiotherapy - Articles in Press

The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness—a systematic review - Corrected Proof

R. Nicole Bellet, Lewis Adams, Norman R. Morris — 2012-05-18

Abstract: Background: The 6-minute walk test (6MWT) is a common outcome measurement in cardiac rehabilitation. However, a search of the literature found no established guidelines for use of the 6MWT in cardiac rehabilitation.Objectives: Systematic review of the validity, reliability and responsiveness of the 6MWT in cardiac rehabilitation.Data sources: OvidMEDLINE, SPORTdiscus, EMBASE, CINAHL, Cochrane Reviews and Cochrane Clinical Trials between January 1948 and April 2011.Eligibility criteria: Studies using 6MWTs in subjects with coronary artery disease undergoing cardiac rehabilitation on an outpatient basis, published in English, were included.Study appraisal and methods: Quantitative and qualitative analyses were conducted, including quality assessment of methodology, meta-analysis and assessment against level of evidence criteria.Results: Fifteen articles met the inclusion criteria. One high-quality study was identified for reliability, six high-quality studies were identified for validity and 11 high-quality studies were identified for responsiveness. The meta-analysis found strong evidence that the 6MWT was responsive to change in clinical status following cardiac rehabilitation, with an estimated mean difference in 6-minute walk distance of 60.43m (95% confidence interval 54.57 to 66.30m; P<0.001). Qualitative analysis indicated moderate evidence for repeatability of the 6MWT in patients undergoing cardiac rehabilitation, for a 2% to 8% learning effect between repeated 6MWTs, for a relationship between peak heart rate during the 6MWT and during cycle exercise at the ventilatory threshold, and for moderate-to-high correlation between the 6-minute walk distance and maximum metabolic equivalents achieved on symptom-limited exercise tests.Limitations: Few studies assessed similar aspects of validity for the 6MWT.Conclusion: Strong evidence suggests that the 6MWT is responsive to clinical change following cardiac rehabilitation. Intra- and intertester reliability of the 6MWT and its validity in patients undergoing cardiac rehabilitation requires further research.

Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review - Corrected Proof

Stephen May, Christine Comer — 2012-04-18

Abstract: Background: Spinal stenosis can be treated both conservatively and with decompression surgery.Objectives: To explore the effectiveness of surgery vs conservative treatment, and conservative interventions for spinal stenosis.Data sources: Medline, CINAHL, AMED, PEDro and Cochrane databases, as well as the reference lists of retrieved studies.Study selection: The search included non-English studies, and all conservative interventions were included.Study appraisal: The PEDro scale was used to assess quality, and levels of evidence were used to synthesise studies where possible.Results: Thirty-one studies met the inclusion criteria, and 18 were high-quality studies. Decompression surgery was more effective than conservative care in four out of five studies, but only one of these was of high quality. In six high-quality studies, there was strong evidence that steroid epidural injections were not effective; in four out of five studies (two of which were of high quality), there was moderate evidence that calcitonin was not effective. There was no evidence for the effectiveness of all other conservative interventions.Limitations: Further research is needed to determine if decompression surgery is more effective than conservative care, and which conservative care is most effective.Conclusion and implications: At present, there is no evidence that favours the effect of any conservative management for spinal stenosis. There is an urgent need to see if any conservative treatment can change pain and functional outcomes in spinal stenosis.

Chartered Society of Physiotherapy's identification of national research priorities for physiotherapy using a modified Delphi technique - Corrected Proof

Gabrielle Rankin, Alison Rushton, Pat Olver, Ann Moore — 2012-04-16

Abstract: Objective: To define research priorities to strategically inform the evidence base for physiotherapy practice.Design: A modified Delphi method using SurveyMonkey software identified priorities for physiotherapy research through national consensus. An iterative process of three rounds provided feedback. Round 1 requested five priorities using pre-defined prioritisation criteria. Content analysis identified research themes and topics. Round 2 requested rating of the importance of the research topics using a 1–5 Likert scale. Round 3 requested a further process of rating. Quantitative and qualitative data informed decision-making. Level of consensus was established as mean rating ≥3.5, coefficient of variation ≤30%, and ≥55% agreement. Consensus across participants was evaluated using Kendall's W.Participants: Four expert panels (n=40–61) encompassing a range of stakeholders and reflecting four core areas of physiotherapy practice were established by steering groups (n=204 participants overall).Findings: Response rates of 53–78% across three rounds were good. The identification of 24/185 topics for musculoskeletal, 43/174 for neurology, 30/120 for cardiorespiratory and medical rehabilitation, and 30/113 for mental and physical health and wellbeing as priorities demonstrated discrimination of the process. Consensus between participants was good for most topics. Measurement validity of the research topics was good. The involvement of multiple stakeholders as participants ensured the current context of the intended use of the priorities.Conclusions: From a process of national consensus involving key stakeholders, including service users, physiotherapy research topics have been identified and prioritised. Setting priorities provides a vision of how research can contribute to the developing research base in physiotherapy to maximise focus.

Effect of walkway length and turning direction on the distance covered in the 6-minute walk test among adults over 50 years of age: a cross-sectional study - Corrected Proof

Shamay S. Ng, Phoebe C. Yu, Fenny P. To, Josiben S. Chung, Tracy H. Cheung — 2012-04-13

Abstract: Objective: To examine the effect of walkway length and turning direction on the distance covered in the 6-minute walk test (6MWT) in healthy adults aged ≥50 years.Design: Cross-sectional study.Setting: University-based rehabilitation centre.Participants: Twenty-five healthy adults aged ≥50 years.Outcome measures: Distance covered in the 6MWT (6MWD) was recorded in metres. Number of turns during the test using walkways of various lengths (10, 20 and 30m) and different turning directions (turning towards dorminant and non-dorminant side), rate of perceived exertion and heart rate were recorded before and after the test.Results: The 6MWD and the number of turns differed significantly with walkway length (P<0.05). The greatest 6MWD and the lowest number of turns were recorded in the 30-m walkway. Significant increases in heart rate and rate of perceived exertion (P<0.05) were found between the pre-test and post-test for all testing conditions. No significant difference was found between the two turning directions for any distance covered.Conclusion: The length of the walkway had a significant effect on the 6MWD, but the turning direction did not. This suggests that subjects can turn in either direction without significantly affecting the results when using a standard walkway in the 6MWT.

Activity level predicts 6-minute walk distance in healthy older females: an observational study - Corrected Proof

2012-04-12

Abstract: Background: The 6-minute walk test (6MWT) is widely used in clinical practice and research. Few studies have investigated activity level as a predictor of 6-minute walk distance (6MWD), and existing predictive models do not allow for activity level.Objectives: To evaluate if knowledge of the level of physical activity enhanced the ability to predict 6MWD, and if the inclusion of activity level added to the predictive accuracy of existing models for the 6MWT in healthy older women; and to validate existent predictive models for 6MWD in a new sample.Design: Cross-sectional, observational study.Setting: Four elderly communities.Participants: A convenience sample of healthy active and sedentary older non-smoking females with no musculoskeletal or lung disorders.Main outcome measures: Age, height, weight, spirometric values and 6MWD.Results: Seventy-seven out of 154 females met the inclusion criteria [mean age 66 (standard deviation 6.5) years]: 46 were active and composed the active group and 31 were sedentary and composed the sedentary group. The active group had significantly greater 6MWD than the sedentary group (mean 44m; 95% confidence interval 14 to 73m; P<0.01). Previous published models that did not allow for activity level either over or underestimated the 6MWD in this sample. The activity level was shown to be an important independent predictor of 6MWD.Conclusion: This study demonstrates the importance of considering the level of physical activity when predicting 6MWD in older women.

Identification of a common language describing paediatric physiotherapy practice for children with additional support needs, to support communication with those outside the physiotherapy profession - Corrected Proof

2012-04-06

Abstract: Children with additional support needs (ASNs) often require physiotherapy intervention to help maximise their participation within the primary school setting. The aim of this research was to investigate paediatric physiotherapy practice in supporting primary school aged children with ASNs, in order to identify a language to describe this, which could be used to support communication with teachers, parents and others outside the profession.Design: Using a qualitative research multiple methods design, 2 focus groups and 5 structured interviews were held to investigate physiotherapy practice for this group.Participants: Senior paediatric physiotherapists (n=13) from a range of specialities, with experience of supporting primary school aged children with ASNs.Analysis: Focus groups and interviews were digitally recorded, transcribed verbatim and analysed to establish links and patterns: followed by a cyclical process of respondent validation, and expert review.Results: Eight targets for physiotherapy intervention and twelve technique headings were synthesised from the data. The language used for labelling and description of these was aimed to be easily understood by colleagues outside the profession.Conclusions: The findings clearly identified the role of the paediatric physiotherapist as being to support primary school aged children with ASNs to acquire aspects of postural control, mobility and cardio-respiratory function. By grouping the data into eight areas of challenge as the focus of intervention, and twelve commonly used techniques, the researchers generated a language which can be used by paediatric physiotherapists to support communication with teachers, parents and others outside the profession, when describing their intent and interactions regarding these children.

Computerised lung sound monitoring to assess effectiveness of chest physiotherapy and secretion removal: a feasibility study - Corrected Proof

G. Ntoumenopoulos, Y. Glickman — 2012-04-05

Abstract: Objectives: To explore the feasibility of computerised lung sound monitoring to evaluate secretion removal in intubated and mechanically ventilated adult patients.Design: Before and after observational investigation.Setting: Intensive care unit.Participants: Fifteen intubated and mechanically ventilated adult patients receiving chest physiotherapy.Interventions: Chest physiotherapy included combinations of standard closed airway suctioning, saline lavage, postural drainage, chest wall vibrations, manual-assisted cough and/or lung hyperinflation, dependent upon clinical indications.Main outcome measures: Lung sound amplitude at peak inspiration was assessed using computerised lung sound monitoring. Measurements were performed immediately before and after chest physiotherapy. Data are reported as mean [standard deviation (SD)], mean difference and 95% confidence intervals (CI). Significance testing was not performed due to the small sample size and the exploratory nature of the study.Results: Fifteen patients were included in the study [11 males, four females, mean age 65 (SD 14) years]. The mean total lung sound amplitude at peak inspiration decreased two-fold from 38 (SD 59) units before treatment to 17 (SD 19) units after treatment (mean difference 22, 95% CI of difference −3 to 46). The mean total lung sound amplitude from the lungs of patients with a large amount of secretions (n=9) was over four times ‘louder’ than the lungs of patients with a moderate or small amount of secretions (n=6) [56 (SD 72) units vs 12 (13) units, respectively; mean difference −44, 95% CI of difference −100 to 11]. The mean total lung sound amplitude decreased in the group of ‘loud’ right and left lungs (n=15) from 37 (SD 36) units before treatment to 15 (SD 13) units after treatment (mean difference 22, 95% CI of difference 6 to 38).Conclusion: Computerised lung sound monitoring in this small group of patients demonstrated a two-fold decrease in lung sound amplitude following chest physiotherapy. Subgroup analysis also demonstrated decreasing trends in lung sound amplitude in the group of ‘loud’ lungs following chest physiotherapy. Due to the small sample size and large SDs with high variability in the lung sound amplitude measurements, significance testing was not reported. Further investigation is needed in a larger sample of patients with more accurate measurement of sputum wet weight in order to distinguish between secretion-related effects and changes due to other factors such as airflow rate and pattern.

The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study - Corrected Proof

2012-04-05

Abstract: Objective: To develop a scoring system to measure physical morbidity in critical care – the Chelsea Critical Care Physical Assessment Tool (CPAx).Method: The development process was iterative involving content validity indices (CVI), a focus group and an observational study of 33 patients to test construct validity against the Medical Research Council score for muscle strength, peak cough flow, Australian Therapy Outcome Measures score, Glasgow Coma Scale score, Bloomsbury sedation score, Sequential Organ Failure Assessment score, Short Form 36 (SF-36) score, days of mechanical ventilation and inter-rater reliability.Participants: Trauma and general critical care patients from two London teaching hospitals.Results: Users of the CPAx felt that it possessed content validity, giving a final CVI of 1.00 (P<0.05). Construct validation data showed moderate to strong significant correlations between the CPAx score and all secondary measures, apart from the mental component of the SF-36 which demonstrated weak correlation with the CPAx score (r=0.024, P=0.720). Reliability testing showed internal consistency of α=0.798 and inter-rater reliability of κ=0.988 (95% confidence interval 0.791 to 1.000) between five raters.Conclusion: This pilot work supports proof of concept of the CPAx as a measure of physical morbidity in the critical care population, and is a cogent argument for further investigation of the scoring system.

Effect of aerobic dance on cardiorespiratory fitness in pregnant women: A randomised controlled trial - Corrected Proof

Silje Halvorsen, Lene A.H. Haakstad, Elisabeth Edvardsen, Kari Bø — 2012-04-04

Abstract: Objective: To evaluate the effectiveness of aerobic dance on cardiorespiratory fitness in pregnant women.Design: Randomised controlled trial.Participants: Sixty-two primiparous women with a mean age of 30.6 [standard deviation (SD) 3.7] years randomised to exercise (n=34) and (n=28) control groups.Intervention: Two aerobic dance classes per week and 30 minutes of daily self-imposed physical activity for 12 weeks.Main outcome measure: Cardiorespiratory fitness, assessed using a submaximal treadmill test to establish oxygen uptake (VO2) (ml/kg/minute) at three different levels of blood lactate. Levels 1, 2 and 3 were calculated and defined as 0.5, 1.0 and 1.5mmol/l above resting blood lactate level, respectively.Results: The women in the exercise group attended a mean of 20 (SD 12) out of 24 aerobic dance classes. Both groups had a small significant decrease in VO2 between baseline and post-intervention: the exercise group decreased from 25.8 (SD 3.3) to 24.5 (SD 3.8)ml/kg/minute and the control group decreased from 25.8 (SD 3.1) to 24.5 (SD 2.5)ml/kg/minute at Level 3 (anaerobic threshold) (mean difference in change at Level 3=0.1, 95% confidence interval −1.4 to 1.7; P=0.89). There were no differences in change between the groups at any level.Conclusion: A 12-week aerobic dance programme had no effect on cardiorespiratory fitness in pregnant women.

Airway clearance techniques in acute exacerbations of COPD: a survey of Australian physiotherapy practice - Corrected Proof

Christian R. Osadnik, Christine F. McDonald, Anne E. Holland — 2012-04-03

Abstract: Objectives: To identify airway clearance techniques (ACTs) used to treat patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and identify factors underpinning their utilisation, including therapists’ knowledge of the literature.Design: Cross-sectional postal survey using Likert scales and multiple-choice responses.Setting: 112 ‘large’ or ‘principal referral’ Australian public hospitals.Participants: 189 physiotherapists from 89 hospitals (response rate 81%).Main outcome measures: Purpose designed survey measuring self-reported rate of ACT prescription; perception of ACT indications, aims, importance and effectiveness; factors influencing ACT choice; and knowledge of the evidence.Results: Most physiotherapists (123/189, 65%) prescribed ACTs for 60–100% of patients with AECOPDs. The most frequently prescribed ACTs were physical exercise (169/189, 89%), the forced expiratory technique (153/189, 81%) and the active cycle of breathing technique (149/189, 79%). Most were rated highly effective. Physiotherapists who perceived the role of ACTs to be important to patients’ overall management (137/189, 73%) and those with less than 5 years cardiorespiratory experience (113/189, 60%) prescribed ACTs significantly more frequently than others. The main factors influencing ACT choice were precautions/contraindications to individual techniques (148/189, 78%) and degree of dyspnoea (136/189, 72%). The primary aim of ACT prescription was to clear sputum (178/189, 94%). Understanding of the evidence for ACTs in AECOPDs was mixed, with 43% citing it as supportive, 30% inconclusive and 19% unsure.Conclusions: Australian physiotherapists frequently prescribe ACTs for patients with AECOPDs and perceive their role to be important. Physical exercise is frequently prescribed for airway clearance and warrants further investigation.

A survey of physiotherapeutic provision for patients undergoing thoracic surgery in the UK - Corrected Proof

P. Agostini, J. Reeve, S. Dromard, S. Singh, R.S. Steyn, B. Naidu — 2012-03-23

Abstract: Objectives: Evaluation of physiotherapeutic provision for patients undergoing open thoracotomy and lung surgery in the UK. Timing of physiotherapy, modalities used and factors influencing practice were also investigated.Design: Survey.Setting: Tertiary centres performing thoracic surgery.Participants: Forty UK centres were identified, and senior physiotherapists were invited to participate.Methods: A postal survey was distributed to identified centres in August 2008, with further follow-up of non-responders. This was adapted from a similar study conducted in Australia and New Zealand.Results: Thirty-one responses were received (78%). Pre-operative physiotherapy was provided by 87% of respondents: 10% provided physiotherapy for all patients and 77% only provided physiotherapy for high-risk patients. Pre-operative pulmonary rehabilitation was reported in 13% of centres. Postoperative physiotherapeutic assessment was undertaken routinely by 97% of respondents: 81% provided physiotherapy to all patients, and 16% only provided physiotherapy when a specific problem was identified. The treatments given were relatively standardised. The provision of physiotherapy following hospital discharge was generally very sparse.Conclusion: This study provides a guide for physiotherapists working with patients undergoing thoracic surgery to use to compare their current practices. Postoperative physiotherapy is provided extensively to UK patients undergoing open thoracotomy. However, pre-operative provision is more variable and is mainly provided for high-risk patients. Despite the subsequent publication of pre- and postoperative pulmonary rehabilitation studies, UK physiotherapy practice remained similar to that reported in Australia and New Zealand. Further research in this field is necessary to investigate the role of pre-operative physiotherapy, the role of pre- and postoperative pulmonary rehabilitation, and the effectiveness of routine postoperative physiotherapy.

Getting fit for practice: An innovative paediatric clinical placement provided physiotherapy students opportunities for skill development - Corrected Proof

Nora Shields, Andrea Bruder, Nicholas F. Taylor, Tom Angelo — 2012-03-22

Abstract: Objectives: Negative attitudes to disability among physiotherapy students in paediatric placements might be addressed by providing clinical placement opportunities for students early in their course. The aim of this qualitative research study was to explore what physiotherapy students reported learning from an innovative paediatric placement option.Design: Qualitative research with in-depth interviews.Participants: Seventeen first and second year physiotherapy students (15 women, 2 men; mean age 19.9 (SD 1.4) years) who took part in the clinical education experience.Interventions: The experience comprised a student-led progressive resistance training programme performed twice a week for 10 weeks at a community gymnasium with an adolescent with Down syndrome.Methods: In-depth interviews were completed after the 10-week programme and were audio-recorded, transcribed verbatim and independently coded by two researchers. Data were analysed using thematic analysis.Results: Two themes emerged from the data, one about being a student mentor and the second about skill development and application. The physiotherapy students indicated the programme was a challenging yet rewarding experience, and that they gained an increased appreciation of disability. They reported developing and applying a range of communication, professional and physiotherapy specific skills.Conclusions: The results suggest that the clinical experience provided physiotherapy students with opportunities to learn clinical skills, generic professional skills, and better understand disability in young people. Many of the learning outcomes identified by the participating students align with desired graduate capabilities and required professional competencies.

Trunk muscle activity while lifting objects of unexpected weight - Corrected Proof

2012-03-14

Abstract: Objective: To determine trunk muscle activity when lifting an object of greater weight than expected, which may contribute to the development of low back pain.Design: Electromyographic evaluation of trunk muscle activity.Setting: University of Tsukuba, Spine laboratory.Participants: Eleven healthy men with a mean age of 24 (SD 2) years.Interventions: Trunk muscle activity was measured when subjects lifted an object with their right arm in immediate response to a light stimulus. Surface and wire electrodes were used to measure the activity of the rectus abdominis, external oblique and erector spinae muscles, and the transversus abdominis and lumbar multifidus muscles, respectively. The lifting tests were performed in three different settings: lifting an expected 1-kg object, lifting an unexpected 4-kg object (erroneously expected to weigh 1kg), and lifting an expected 4-kg object.Main outcome measures: The muscle activity induced when subjects lifted objects of different weights was compared by calculating the root mean square (RMS) of muscle activity at rest and % maximum voluntary contraction.Results: When the subjects were aware of the weight of the object to be lifted, the activity of the external oblique, transversus abdominis, erector spinae and lumbar multifidus muscles increased immediately after lifting. When the subjects were not aware of the weight of the object to be lifted, the increase in muscle activity was delayed (P<0.05).Conclusions: Trunk muscles may not be able to function appropriately when individuals lift an object that is much heavier than expected.

Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement: a qualitative study - Corrected Proof

Maria Constantinou, Suzanne S. Kuys — 2012-03-14

Abstract: Objective: This study evaluated physiotherapy students’ perception of a reflective journal in developing reflective thinking and practice and identified the main concepts recorded by students in the journal.Design: A mixed methods study with qualitative content analysis of student journals and quantitative analysis of questionnaire responses.Participants: 131 (74 female, 57 male) physiotherapy students undergoing their first clinical placement.Interventions: On completion of their placement, students submitted a reflective journal electronically and completed a questionnaire of closed and open ended questions.Main outcome measures: Questionnaires were analysed using frequencies for the responses of the closed questions and thematic analysis of the open ended questions. Journals were de-indentified and underwent a content analysis using Leximancer© software to obtain a concept map and frequencies of the main concepts identified in the journals, with specific examples.Results: The majority (88%, 79/90) of respondents found the journal useful in assisting them to learn from their experiences, and to develop reflective thinking and practice. 54% (49/90) indicated they would continue to use the journals. The most frequently identified concepts were residents, time and exercises; representing more than 5000 of the total concepts identified in the journals. Analysis of the reflective journals indicated that students demonstrated improvements in the three stages of reflective practice: awareness of thoughts and feelings, critical analysis of situation, and development of new perspectives.Conclusions: Guided journal writing may be a useful tool in facilitating reflective thinking and practice during clinical placements of physiotherapy students.

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.

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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.

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.

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.

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.

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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.

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.

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.

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.

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.

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.

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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.

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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.