Physiotherapy Practice and Research - Volume 31, 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: Background: A phase III cardiac rehabilitation program has recently been developed in an acute hospital in Ireland. This study aimed to determine the effect of the program on physical, functional and quality of life outcomes and to evaluate the clients' perspectives on the program. Methods: A convenience sample of 12 participants from the cardiac rehabilitation program was assessed utilising independent assessors. Blood pressure (BP), body mass index (BMI), incremental shuttle walk test (ISWT) and Short Form 36 version two (SF36v2) health survey were assessed before and after a six week exercise and education intervention. Quantitative analyses were based on the…non-parametric Wilcoxon Signed Rank tests. Two focus groups were conducted which were video and audio taped, transcribed and subject to thematic content analysis. Results: Quantitative results revealed no statistical difference (p>0.05) for BP and BMI. A statistically significant difference was found for the ISWT (p=0.017) and the SF-36v2 (physical component summary, p=0.005; mental component summary, p=0.05). Qualitatively patients perceived numerous benefits including increased confidence, education, sense of well-being and support. Patients suggested potential improvements that could be made to the program relating to the education session presentations, follow-up, parking and psychosocial input. Conclusion: This research reveals the effectiveness of the cardiac rehabilitation program in increasing physical and functional capacity, knowledge of lifestyle management and quality of life. Patients perceived numerous benefits and suggested areas for improvement in order to improve service delivery and ultimately patient care
Keywords: service provision, evaluation, cardiac rehabilitation, focus group, qualitative
Abstract: Background: Neck and shoulder pain are recognized complications of surgery for head and neck cancer. As such, a need for a dedicated out-patient physiotherapy service was identified and this service was established in February 2008. The following is an audit of this physiotherapy service from February 2008 – January 2009. Methods: Patients reporting neck and shoulder pain following neck dissection were referred to a dedicated physiotherapist who performed a comprehensive musculoskeletal assessment including shoulder and neck range of motion (ROM), Neck Dissection Impairment Index (NDII), Shoulder Disability Questionnaire (SDQ) and the University of Washington Quality of Life Questionnaire (UWQOL). Patients…received physiotherapy treatment including an exercise program, scar management and advice. They were asked to repeat the above questionnaires six months later. Results: Data from the first 12 patients enrolled into the study was collated. Of this 12, 83% of subjects stated their shoulder to be the most important issue affecting quality of life. A mean deficit in ROM of shoulder flexion and abduction was noted (18° and 28° respectively) between affected and non-affected side. Initial mean (SD) SDQ, NDII and UWQOL scores were 32% (24), 37 (17) and 32 (13) respectively, where a higher score indicated greater disability. Following six months of treatment no improvements in shoulder ROM were observed. Mean SDQ, NDII and UWQOL scores improved to 23% ± 27%, 39 ± 28 and 28 ± 13. Conclusion: The results indicate an improvement in shoulder function and quality of life following physiotherapy intervention. This audit highlights the critical importance of physiotherapists working as part of the multidisciplinary team during the diagnosis and management of patients with head and neck cancers.
Abstract: Background: Low back pain (LBP) is a very common musculoskeletal disorder. Lumbar range of motion (ROM) and posture are parameters which are commonly assessed in LBP research. Reliable methods of measuring lumbar spine ROM and posture are needed. The CODA motion analysis system has several potential advantages over other motion analysis systems; however its reliability for lumbar spine analysis has not been examined. This study investigated the reliability of the CODA system for measuring lumbar spine sagittal plane ROM and posture. Methods: Twelve participants were tested by two investigators on two occasions. Ten trials of lumbar ROM and usual sitting…posture were performed. The reliability of upper lumbar, lower lumbar, and pelvic sagittal plane motion was assessed using intra-class correlation coefficients (ICC) and Bland and Altman methods, including evaluation of the mean difference and limits of agreement. Results: Levels of association were very good for ROM, for both intra-rater and inter-rater measurements (all ICC >0.7). However, agreement was more variable, with some lower lumbar and pelvic regions displaying large mean differences and wide limits of agreement. Overall, greater reliability was obtained for the upper lumbar region angles, and for intra-rater comparisons. Conclusion: Reliability of the CODA system varied from very good to fair, depending on the parameters assessed. While good association was found between most parameters, the level of agreement was only fair to moderate. Recommendations are made to improve the protocol used to assess spinal motion, which may improve reliability.
Keywords: coda, lumbar spine, posture, range of motion, reliability
Abstract: Background: Nerve palpation is advocated as an examination technique for the identification of neural tissue involvement in lower limb pain disorders. Pressure algometry, used to determine pressure pain thresholds (PPTs), is a mechanical means of nerve palpation. This study investigated the PPTs of the sciatic, tibial and common peroneal nerves in asymptomatic subjects. Methods: A cross-sectional study design was used to investigate reliability and normative data of lower limb nerve palpation in asymptomatic subjects. An algometer was used to measure PPTs in 27 female and 12 male volunteer subjects. Measurements were taken twice by one examiner (intra-rater reliability) and once…by a second examiner (inter-rater reliability). Results: Intraclass correlation coefficients for intra-rater reliability for the sciatic, tibial and common peroneal nerves were 0.83, 0.94 and 0.94 respectively, while those for inter-rater reliability were 0.86, 0.88 and 0.88 respectively. Mean PPTs and standard deviations for all three nerves on both sides in males and females are presented. There were no significant differences in mean PPTs between males and females for any of the tested sites (p>0.05). There was a significant difference in PPTs between sides at the sciatic (p=0.03) and tibial (p=0.03) sites, but not at the common peroneal site (p=0.15); these differences may have been due to an order effect. Conclusion: PPTs at the sciatic, tibial and common peroneal nerve sites tested demonstrated good to excellent intra-rater and inter-rater reliability. Normative values have also been documented.
Keywords: Pressure pain threshold, sciatic, tibial, common peroneal, nerve, reliability
Abstract: Background: This study aimed to investigate the effectiveness of night splints in the management of Achilles tendinopathy, and to test the feasibility of conducting a larger randomised controlled trial (RCT) in this area. Methods: Eleven participants with Achilles tendinopathy (6M, 5F) were randomly assigned to a control group (eccentric exercise only) or an intervention group (eccentric exercise and night splint). Participants were assessed at baseline and after 12 weeks using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire and a functional heel-rise test. Results: Both groups recorded an increase in the mean VISA-A score (intervention group 28.8, control group 21.3),…and the mean number of heel raises performed (intervention group 4.0, control group 4.3), from baseline to follow-up 12 weeks later. The changes suggest greater improvements for the intervention group over control group, the however, the small sample size did not permit between group analysis. Compliance with night splints did not present as a problem for participants. Conclusion: This study demonstrated that eccentric exercise combined with a night splint can improve outcomes in Achilles tendinopathy; however the extent to which outcomes are better than eccentric exercises alone needs further study.
Keywords: Night Splints, Achilles Tendinopathy, Physiotherapy
Abstract: Background: St Vincent's Working Backs Project (WBP) represents one of the first comprehensive strategies for the implementation of the UK guidelines for the management of LBP in the workplace. From the experiences of this project which ran over four years, the aims of this paper are: to identify barriers and facilitators in the implementation of the UK occupational LBP guidelines, and to devise a series of recommendations for organisations wishing to implement a guideline-based occupational LBP management strategy The main findings of the WBP are published elsewhere. Methods: The WBP had three key phases which ran between 2003 and 2007;…baseline, intervention and evaluation. Participant observation research methods were utilised and data sources included pre and post intervention staff, clinician and line manager surveys, project leader organisational review and progress notes, minutes of meetings, and email communications. Conclusions: Barriers and facilitators of change were identified leading to the development of a series of recommendations for organisations wishing to implement guideline based LBP management strategies within work organisations.
Keywords: Low back pain, workplace, occupational guidelines, barriers, facilitators
Abstract: Objectives: To identify the prevalence of low back pain in undergraduate students with different educational exposures, and to investigate whether undergraduate study which involves physical manual handling is a risk factor for developing low back pain. Design: Cross sectional survey utilising a previously validated questionnaire. Setting: Peninsula Allied Health Centre, University of Plymouth. Participants: All physiotherapy (n=180) and dietetic (n = 126) undergraduate students enrolled at the University of Plymouth. Results: 77% of students responded. Lifetime low back pain prevalence was 62.3% for physiotherapy students and 65.1% for dietetic students; with no significant difference between the two groups (p>0.05). Similarly,…no significant differences were demonstrated between the groups in terms of the risk of developing low back pain across a range of prevalence measures (one year, one month, one week). Trends were observed however, with educational exposure to physical manual handling techniques such as “practicing techniques on someone” (relative risk = 3.62, 95% confidence interval 0.39-34) and “having techniques practiced on you” (relative risk = 2.41, 95% confidence interval 0.22 – 26.03) being identified as an increased risk factor for one month prevalence of low back pain in physiotherapy students. Conclusion: In this sample the prevalence of self reported low back pain was similar amongst physiotherapy and dietetic undergraduate students. The percentage of students reporting back pain was comparable with reported rates within the general population. Exposure to physical manual handling techniques, which are an integral part of physiotherapy undergraduate education, did not impact significantly on the risk of physiotherapy students experiencing low back pain.
Keywords: Low Back Pain, Physiotherapists, Work related musculoskeletal disorders, Undergraduate Students