Physiotherapy Practice and Research - Volume 30, issue 1
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Physiotherapy Practice and Research is the Official Journal of
The Irish Society of Chartered Physiotherapists. It is an international, peer-reviewed journal which aims to advance physiotherapy practice and research through scholarly publication. The journal has a clinical focus and publishes material that will improve the evidence base for physiotherapy and assist physiotherapists in the management of their patients. Contemporary physiotherapy practice incorporates a diverse range of activity and the journal aims to support physiotherapists, and publish material, fromall areas of practice, be that the clinical setting, education, research or management.
Physiotherapy Practice and Research welcomes submissions in the form of original research papers, critical reviews (systematic or state-of-the-art papers), case studies, editorials, expert commentaries and book reviews. Letters to the editor are also welcome. The journal will commission focussed or clinical reviews in areas of interest; those planning such reviews should contact the editor in the first instance. Physiotherapy Practice and Research also aims to foster research capacity within the Profession and as such supports and encourages submission from new researchers.
Physiotherapy Practice and Research is a member of and subscribes to the principles of COPE, the Committee on Publication Ethics.
Abstract: Rehabilitation has a history of being considered a necessary evil by the rest of medicine; its results are costly and its existence emphasizes the limits of medical care. Nevertheless, the field's acceptance is increasing as lifespans lengthen and the burden of chronic and disabling diseases becomes more apparent. However, with recognition comes responsibility. We can no longer merely complain about being underappreciated. Rather, we are now being forced to improve the care we provide, prioritize our goals and develop the scientific basis to support them. However, priorities are difficult to establish and maybe particularly so in rehabilitation, where the goal,…improving function, is so wide ranging and our treatments so individualized. This brief paper is designed to review the factors involved in establishing rehabilitation research priorities and note that when goals are defined broadly, a number of panels have emphasized the need for a focus on improving mobility; developing and uniformly applying better metrics; conducting better outcome studies and increasing our research infrastructure.
Abstract: Implementation of the European Working Time Directive (EWTD) has not yet been achieved for Non-Consultant Hospital Doctors (NCHDs) in Ireland. Extended scope physiotherapy practice in UK fracture clinics has had success in addressing this issue. Clinical specialisation of a physiotherapist replacing NCHDs in fracture clinic has not yet been trialled in Ireland. This pilot project evaluated the role of an experienced, specially-trained physiotherapist reviewing patients with uncomplicated fractures in a clinic setting for 6 months. One physiotherapist received additional training over a 2-month period. A caseload of 403 patients with uncomplicated fractures and soft tissue injuries were reviewed by the…Clinical Specialist Physiotherapist (CSp) in fracture clinic. Patient and doctor satisfaction ratings and patient caseload and waiting times were collected over a 4-month treatment period. Working hours of NCHDs were also recorded. There was a steady increase in patient caseload per week for the CSp in fracture clinic. The discharge rate was 54%. Specialist Registrar hours reduced from 71 hours to 64 hours per week. Feedback from patients and the orthopaedic team was that the CSp was a desirable addition to fracture clinic. With sufficient training and initial supervision, it has been demonstrated that physiotherapists could take on the role of NCHDs in fracture clinic, and this results in an improved and more efficient service. The recommendation was to establish a CSp post in the fracture clinic in Cork University Hospital. The Irish Society of Chartered Physiotherapy (ISCP) and the Chartered Society of Physiotherapy (CSP) recognise the potential for physiotherapists to extend their roles. This report supports these roles and wishes to encourage such discussion.
Keywords: Clinical Specialist Physiotherapist (CSp), fracture clinic, European Working Time Directive (EWTD)
Abstract: Shoulder pain is the third most common musculoskeletal condition presenting to primary care. The term subacromial impingement syndrome (SIS) describes a number of pathologies of the rotator cuff, from bursitis to tendinopathy. The aim of this review is to present an evidence based approach to assessing the shoulder complex in order to assist the primary care clinician in diagnosing SIS. In addition a clinical framework that outlines an examination structure to guide therapists' assessment of patients with possible SIS is also presented. Approximately 34 clinical tests exist for testing the structures of the shoulder complex for SIS, but the evidence-base…on the validity, reliability and the diagnostic accuracy is either absent or reveals data that suggests that no test alone is perfect for diagnosis. The patient's age and the presence of night pain are the two most useful features of the clinical history in establishing a pre-test probability, especially for a rotator cuff tear rotator cuff tear. As no one test of contractile tissue or impingement has perfect accuracy, it is recommended to combine a number of tests, and to use patient's history/details to help distinguish SIS from other shoulder pathologies so that appropriate management can commence. The evidence base regarding the most appropriate assessment methods for each category of secondary impingement is inconclusive.
Abstract: Superior labrum anterior to posterior (SLAP) lesions are becoming more recognised as a source of instability and pain in the shoulder joint. Four lesions were originally described based on arthroscopic findings of damage to the superior labrum and biceps complex. The improvement in imaging and arthroscopy has led to the expansion of the original classification. A variety of physical examination tests are reported in the literature to aid in the detection of SLAP lesions. Diagnosis is difficult as SLAP lesions rarely occur in isolation and the clinical picture is variable. The literature indicates that the outcome from conservative management is…poor and surgery is advocated for most SLAP lesions. Further research is necessary to address the accuracy of the clinical history and physical examination for detecting SLAP lesions.
Abstract: This paper reviews the current literature on osteochondral lesions (OLT) of traumatic origin. These injuries can be classified into five stages, and the mechanism of injury will differ depending on whether the lesion is located anterolaterally or posteromedially. Clinically, patients may present with an OLT masked by the features of an acute ankle sprain. Typically however, patients present with chronic ankle pain along with intermittent swelling and possibly weakness, stiffness, instability, or giving way and are often missed on initial presentation. Investigations will include plain radiographs and MRI. Whether to treat conservatively or operatively depends on the stage of the…lesion, the duration of symptoms and the age of the patient. Short term results of OLT are good, but long term follow up has found 50% of patients with OLT showed degeneration of the joint. In summary, it is important to consider the possibility of OLT when confronted with a patient with an ankle injury who, despite adequate rehabilitation has not progressed satisfactorily. The key to good long term prognosis from OLT is early diagnosis and treatment.
Abstract: Objectives: To examine the acute effects of the weight-bearing dorsiflexion lunge stretch (WDL) on the flexibility of the gastrocnemius muscle-tendon unit using real time ultrasound (RTUS). Participants: Ten healthy males were randomly assigned to one of two groups. Interventions: Group 1 (n=5) completed three WDL stretches on the dominant leg of 30s duration, once daily, for four days. Group 2 (n=5) completed the same programme twice daily. Participant's non-dominant leg acted as control. Outcome measures: Elongation of the stretched gastrocnemius muscle-tendon unit was recorded using RTUS before stretching, after one set of stretches, and 24 hours after the final set…of stretches. Range of motion (ROM) was recorded and torque was calculated as an index of stiffness. Results: Wilcoxon Signed Ranks tests were used to test for differences within groups. Mann-Whitney tests were used to test for differences between groups. No significant changes in length, ROM or stiffness occurred after stretching in either group although ankle stiffness appeared to decrease. No significant differences were found between groups. Conclusions: Frequently prescribed parameters, used clinically for stretching the gastrocnemius muscle, were shown to have no short-term effect on the flexibility of this muscle for a healthy sample of participants. RTUS measurements were found to be a reliable means of assessing changes in flexibility and should be considered for further research in this area. A repeat study is required, using a larger sample size and involving participants with decreased dorsiflexion ROM following injury.
Abstract: Hamstring injury is one of the most common injuries affecting Gaelic footballers, however conflict exists in the literature regarding the presence of strength deficits after hamstring injury. The aim of this study was to determine whether significant thigh muscle weakness is present in female Gaelic footballers after previous hamstring injury. Twenty members of a university senior female Gaelic football team participated in the study. Knee flexion and extension strength were assessed using an isokinetic dynamometer (Biodex) at 60, 180 and 300 degrees per second. Seven players reported a history of hamstring strain, with all injuries occurring on the dominant side.…The previously injured hamstrings were significantly stronger on multiple isokinetic comparisons, although these differences only reached statistical significance (p<0.05) at 180 degrees per second. Dominant legs were significantly stronger (p<0.05) than non-dominant legs across numerous strength variables and speeds. Interestingly, thigh muscle weakness was not observed in female Gaelic football players with a history of hamstring injury. In contrast, the hamstrings of the previously injured legs were stronger than the uninjured legs. The significant strength differences found between dominant and non-dominant legs could, however, have been a confounding variable. Rehabilitation must consider aspects other than increasing muscle strength to reduce the risk of recurrence.
Abstract: The focus of this study was on managers' perceptions of the impact of Flexible Working Practices (FWP) in the healthcare setting and their role in its management. In the literature the benefits of FWP to the establishment and the individual were clear but the need to ensure that arrangements are applied equitably across the organisation has been expressed. It also demonstrated that new forms of FWP impact on staff availability to meet with today's increased demands for health service efficiency. This creates a difficult and challenging working environment for the physiotherapy manager. A qualitative research method was used in this…study allowing a deeper exploration of managers' perceptions of FWP. Data collection was carried out using semi-structured schedule interviews with a sample of frontline managers employed within the HSE northwestern region. Analysis of quantitative data was undertaken using SPSS computer technology. Framework analysis was employed to interpret qualitative data and provide a meaningful format of evidence to answer the initial research questions. Following analysis, it was evident that managers' experience varied on customer service impact and they outlined some positive outcomes as a result of FWP. Findings on FWP benefits, impact, processes and management competencies for meeting implications in a health service context are also outlined.