Physiotherapy Practice and Research - Volume 35, issue 2
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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: OBJECTIVE: This study examined the association between body mass index (BMI), physical activity and cardiorespiratory fitness levels on work performance with and without neck pain in habitual computer users. METHODS: Forty participants with and without neck pain were recruited and completed a battery of measures: body composition (BMI), physical activity levels (International Physical Activity Questionnaire), cardiorespiratory fitness (Chester Step Test) and work performance (Health and Work Performance Questionnaire). MAIN RESULTS: Body mass index, physical fitness and cardiorespiratory fitness were not significantly associated with the three domains of workplace performance; absenteeism, presenteeism and critical incidents. However, a significant association was found…between neck disability and the incidence of headaches/migraines and fatigue/sleep disturbance. CONCLUSION: Mild neck pain in habitual computer users does not significantly influence work performance, although the association between the co-morbidities (headaches/migraine and fatigue/sleep disturbance) should be considered in those presenting for treatment with mild neck pain.
Abstract: PURPOSE: To investigate the feasibility of Whole Body Vibration (WBV) intervention when compared to the same duration and dose of exercise (EXS) for people with Multiple Sclerosis (MS). METHODS: Seventeen people with MS (mean age 48.76 ± 2.7) with minimal gait impairments were randomly allocated to WBV (n = 8) or EXS (n = 9). Participants were measured before and after 8 weeks of intervention with muscle power, modified Nottingham Sensory Assessment, Timed Up and Go test (TUG), Berg Balance Scale (BBS), 6 Minute Walk test (6MWT), Multiple Sclerosis Impact Scale 29 (MSIS 29), and Modified Fatigue Impact Scale (MFIS).…RESULTS: WBV group had statistically significant improvements in 6MWT (mean change 31.48, SD 28.2, p = 0.041) and BBS (median change 8, IQR 12, p = 0.027) that were not seen in the EXS group. WBV group improved significantly more on the BBS (p = 0.003) than the EXS group (median change 0, IQR 1). EXS group had a significant reduction in fatigue (mean change 12.33, SD 11.47, p = 0.012) that was not seen in the WBV group. CONCLUSIONS: The data may suggest a positive improvement due to WBV that, other than for BBS, is not significantly greater than that due to the same duration and dose of exercise. WBV plus exercise training is feasible and may have positive effects, however larger studies are required to establish whether it is more effective than or can augment traditional exercise.
Keywords: Whole body vibration, multiple sclerosis, randomised control trail, feasibility
Abstract: This case presents a 43 yr old woman with an eight-week history of progressing leg weakness set against a long history of chronic back pain. She was referred to the Orthopaedic department following referral from her General Practitioner. The weakness became so distressing to the patient that it resulted in a prior attendance at an Accident & Emergency department. The case illustrates the complexities of clinical reasoning within the area of serious pathology of the spine. It demonstrates the importance of detailed subjective history questioning in the quest for early diagnosis, which is particularly important for clinicians who work in…an autonomous or extended role.
Keywords: Spine, red flags, clinical reasoning, case study
Abstract: BACKGROUND: With the on-going reform of the Irish health service it is likely that future employment opportunities for physiotherapy graduates will be in primary care. In order to adequately prepare a future workforce, pre-registration physiotherapy programmes must respond to the change in focus of healthcare delivery. To date there has been no study that examines current entry-level physiotherapy practice placement allocations in the Republic of Ireland. AIM: To examine the profile of practice placement settings of pre-registration physiotherapy students in the Republic of Ireland, in order to ascertain what the trend of practice placement settings has been over a three…year period and whether this trend reflects the Irish health service change in focus from acute to primary care. METHOD: The four schools of physiotherapy categorised practice placement allocations under the following six headings (1) acute hospitals (2) district hospital/specialised rehabilitation (3) Primary Community & Continuing Care services (4) private hospitals/clinics (5) overseas and (6) other. This data was combined and descriptive statistics were used to analyse it. RESULTS: A total of 3142 placements were available across the four schools in the three years from 2009–2012. Of these, 74% (n = 2310) were in acute hospitals, 17% (n = 542) were in district hospitals/specialised rehabilitation services, 5% (n = 171) were in primary care services, 1% (n = 41) in private hospitals/clinics and 2 % (n = 72) were overseas placements. Primary care placements increased slightly in number over the three years, from 4% (n = 42/1041) in 2009/10 to 7% (n = 75/1067) by 2011/12. CONCLUSION: Although the allocation of practice placements to primary care services increased slightly over the three years, acute hospitals are the predominant settings for practice education in the Republic of Ireland. This does not reflect the Irish health service reform and students may not feel adequately prepared to work in the primary care sector on qualification.
Keywords: Physiotherapy, practice education, clinical settings
Abstract: INTRODUCTION: Education has been found to influence the development of physiotherapists' attitudes and beliefs regarding people with chronic low back pain (CLBP). The aims of this study were: to determine the difference in biomedical and biopsychosocial orientations between recently graduated and third year physiotherapy students, and to assess the relationship between these orientations and their adherence to evidence-based guidelines, particularly the advice they would provide to patients regarding work and activity levels. METHODS: A total of 47 students (46%) from the UCD BSc Physiotherapy programme participated in the study, completing the pain attitudes and beliefs scale for physiotherapists (PABS_PT), and…a clinical vignette via SurveyMonkey. RESULTS: The findings showed that recently graduated students were significantly less biomedically-orientated than the stage three students (z = −2.981; p = 0.003), but there was no difference between student groups in their biopsychosocial orientation (z = −1.037; p = 0.300). There was no association between PABS_PT scores and the vignettes in either group (p > 0.05). Also, no significant differences between the groups' vignette responses were found, with the majority recommending advice that was not strictly consistent with evidence-based guidelines. CONCLUSIONS: The findings indicated that while education may influence students' biomedical orientations, a relationship between these attitudes and beliefs and adherence to guidelines was not established, suggesting that more emphasis should be placed within undergraduate physiotherapy education on enhancing students' biopsychosocial orientations. Further research incorporating all taught BSc Physiotherapy programmes in the Republic of Ireland would provide definitive evidence of the impact of education on determining students' orientations.
Keywords: Low back pain, biomedical, biopsychosocial, guidelines, education
Abstract: BACKGROUND: Reduced strength and flexibility are commonly hypothesised risk factors for the development of hamstring injury, and both are improved with eccentric training in non-injured populations. However, there is a lack of studies investigating the effect of eccentric training on strength and flexibility among previously injured athletes. This study examined the effects of a modified eccentric hamstring strength program on strength and flexibility in previously injured athletes. METHODS: Ten participants (8 Male, 2 Female) ranging from 18–36 years of age were recruited from the local community to participate in the study. All participants demonstrated a previous history of hamstring injury…but had since returned to their chosen sport of Gaelic football, hurling, soccer or rugby. A single group repeated measures intervention study was carried out. Two strength parameters; peak torque (PT) and angle of peak torque (AngPT), as well as two flexibility parameters; stretch tolerance (ST) and extensibility were assessed before and after a six week eccentric hamstring strength program. Muscle soreness was recorded using a likert scale. Paired samples t-tests and Wilcoxon signed-ranks tests compared strength and flexibility before and after the eccentric program. RESULTS: There was a significant increase in eccentric hamstring PT (p < 0.001) and eccentric hamstring AngPT (p = 0.001) following the intervention. The results also indicated a significant increase in ST (p ≤ 0.001), but not extensibility (p = 0.892), following the eccentric intervention. Mean(±SD) muscle soreness with the exercise programme was minimal (1.85 ± 0.84) with 100% compliance during the eccentric programme. CONCLUSIONS: Significant changes in PT, AngPT and ST were observed after the eccentric training programme, consistent with previous research among uninjured populations. Extensibility was unchanged after the intervention. Eccentric training programmes similar to that performed in the current study have been associated with reduced injury rates when progressed gradually throughout a season. This study adds support to the hypothesis that eccentric training can improve both strength and flexibility parameters. However further well designed randomised control trials (RCTs) and field-based studies, which include injury outcomes, are needed.
Keywords: Hamstring, angle of peak torque, flexibility, eccentric exercise
Abstract: BACKGROUND: ‘Family Centred Care’ (FCC) is a best practice approach for children's disability services and is supported by local and national policy in Ireland. To date, no studies have been published that have investigated its implementation in community-based, children's disability services in Ireland. This study aimed to determine to what extent service providers working in children's disability services in one region of the Health Service Executive in Ireland believe they use FCC practices and to explore the factors influencing the use of this approach. METHODS: A modified version of the Measures of Processes of Care for Services Providers (MPOC-SP) questionnaire…was provided to 69 service providers representing a range of disciplines. Mean scores for the MPOC-SP domains were analysed and compared to results of 6 additional questions. RESULTS: 72% staff returned questionnaires (n = 49) with 69% reporting that FCC practices are important. Staff report that they practice behaviours in the domain ‘treating people respectfully’ the most often and behaviours in the domain ‘providing general information’ the least often. Higher mean scores per domain were observed in staff within the School Aged Disability Teams, from individuals who had received FCC training and from clinical psychologists. A weak positive correlation was found between the use of FCC practices and the length of time individuals have been working in a children's disability service. CONCLUSIONS: This study suggests that a gap exists between the extent to which staff working in children's disability services report the perceived importance of FCC practices and the extent to which they report they implement it, and the extent to which they report it. This study also suggests that children's disability services would benefit from improving the provision of general information to service users and by providing FCC training to all service providers.
Keywords: Family Centred Care, children's disability service, service evaluation