Physiotherapy Practice and Research - Volume 37, 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: Individuals who suffer from ankle instability may experience restricted movement and a weakening of the muscles that support the ankle. PURPOSE: The aim of this study was to investigate the effects of functional instability of the ankle joint on static and dynamic balance performances. METHODS: Twenty-five participants (8 male, 17 female) were recruited for this study. The subjects were divided into two groups: an ankle instability and a normal ankle stability group. The static and dynamic limits of stability performance were assessed in single leg standing using the BioRescue device. In addition, the Functional Reach…Test (FRT) and the Modified Functional Reach Test (MFRT) were also recorded. RESULTS: Significant differences between the two groups were found in the moving distance and the mean velocity of the center of pressure during the single leg standing test, the pendular limits of stability test, and the MFRT. However, the FRT showed no significant difference between the two groups. The results showed that the static and dynamic balance performances were reduced in the ankle instability group compared with the control group. CONCLUSION: Both the MFRT and BioRescue were sensitive and appropriate to identify clinically important differences between the two groups. The MFRT is a quick and inexpensive clinical measure of postural instability relevant to individuals with ankle instability. Further studies should use the MFRT to determine the effectiveness of clinical interventions for ankle instability that target improvements in balance.
Keywords: Ankle instability, balance, Modified Functional Reach Test
Abstract: BACKGROUND: Establishing the incidence of injury is the first step in initiating injury prevention strategies. There is a lack of research on injury in Irish adolescents and this study paves the way for further injury prevention research, by implementing a prospective cohort study. PURPOSE: To establish the epidemiology of injury in male adolescents in Irish secondary schools in one academic year. METHODS: 452 male 4th and 5th year adolescents (aged 15.62±0.70 years) took part in a prospective epidemiology study for one academic year. Any injury sustained during training or competition resulting in restricted performance or time…lost from play was assessed weekly by an athletic rehabilitation therapist. An injury report form was completed to ensure standardisation of the injury description. RESULTS: 5.16 injuries per 1,000 hours were noted, with 35.6% at risk of injury and 27.9% of injured participants at risk of sustaining another injury that school year. Competition injuries (16.91 injuries per 1,000 hours) were more common than training injuries (2.63 injuries per 1,000 hours). Lower limb injuries predominated (73.1%) with knee (17.9%), ankle (13.5%) and hamstring (11.7%) injuries most common. Strains (29.4%), sprains (20.8%), fatigue-induced muscle disorder (14.5%) and contusions (13.1%) were frequent. Injuries were primarily minor (0–7 days) (41.6%), followed by severe (>22 days) (39.7%) and moderate (8–21 days) (18.7%). CONCLUSION: Injuries are common in adolescents in Irish secondary schools and the development and implementation of injury prevention strategies are required.
Keywords: Sport injury, musculoskeletal, injury rate, teenager
Abstract: BACKGROUND: Prolonged physical impairments are often reported post total hip replacement (THR). It is unclear which exercises should be performed to maximise rehabilitation following surgery. PURPOSE: The aim of this pilot study was to describe a method of imaging the relaxed posterior gluteus medius muscle in patients following surgery, and to measure the secondary outcome of relaxed muscle thickness of the posterior gluteus medius on the side of their THR following a rehabilitation intervention in this patient group. METHOD: This was a randomised controlled pilot study investigating the effect of functional exercise on the relaxed muscle…thickness of the posterior gluteus medius as measured by real-time ultrasound. 57 patients were randomised to either a functional exercise class or usual care group. Real time ultrasound scanning of the posterior gluteus medius muscle were undertaken in both groups at baseline (week 12) and post intervention (week 18). RESULTS: There was no significant difference found in the size of the posterior gluteus medius between the intervention and control groups over the six week period of intervention. There was a statistically significant increase in the size of the posterior gluteus medius muscle at three points with a mean difference of 0.78 (95% CI 0.53–1.03), 1.05 (95% CI 0.67–1.43), 1.01 (95% CI 0.56–1.5) on the operated side in both groups over the six week period (p < 0.000). CONCLUSION: The thickness of the posterior gluteus medius on the operated side increased over a six week period from week 12 to week 18 post THR. There was no difference found in the thickness of the posterior gluteus medius in those attending a functional exercise class twice weekly and those receiving usual care.
Keywords: Real-time ultrasound, total hip replacement, randomised controlled trial, physiotherapy
Abstract: BACKGROUND: Parkinson’s disease (PD) is a progressive neurological disorder affecting 1.2 million people in Europe. Exercise is a cornerstone treatment in the non-pharmacological management of PD. There is a dearth of exercise research looking at the advanced stages of PD. PURPOSE: The study aim was to examine the feasibility of a lower limb strength-based progressive exercise programme for people with advanced PD in a hospice setting. METHODS: A group exercise feasibility study was designed and evaluated. The intervention was a 40–60 minute progressive, lower limb strength training programme delivered weekly over six weeks, at an Irish…hospice out-patient clinic. A twice weekly home exercise programme supplemented the supervised exercise sessions. Primary outcome measure was the Six Minute Walk Test (6MWT). Secondary outcome measures included the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Parkinson’s Disease Questionnaire 39 (PDQ-39) and predicted one repetition maximum (p1-RM). RESULTS: Fourteen participants took part in the PEP-PD exercise programme with stage 3-4 PD as per Hoehn and Yahr staging of PD, average time since diagnosis was 14.1 years. Thirteen participants attended the exercise intervention and pre and post assessments. Nine participants completed the six month follow up. No significant improvement was demonstrated in the SMWT over time [F(2,16) = 1.442, p = 0.266] or the MDS-UPDRS or PDQ-39. A significant improvement was noted in all p1-RM assessments (p < 0.05) of the lower limb. CONCLUSIONS: The results suggest the PEP-PD exercise programme is feasible for this population and improves lower limb strength. However these improvements did not translate into functional gains.
Keywords: Exercise, Parkinson Disease, resistance training, palliative care
Abstract: BACKGROUND: A number of research papers and theoretical clinical models summarising how temperature of the skin over the knee may be altered according to different pathological processes have been published. Thermal imaging (TI) is generally regarded as the ‘Gold’ or ‘reference’ standard for measuring skin temperature, however this technology is not widely accessible to most musculoskeletal physiotherapists working in clinical environments. This is largely due to the time required for analysis of the thermal images and the high cost of the equipment. A digital thermometer (DT) is portable with a convenient display of results which could offer an inexpensive substitute.…PURPOSE: The aim of this study was to determine the interchangeability between thermal imaging and a digital thermometer, using Bland-Altman limits of agreement, to determine skin temperature differences between right and left knees. METHODS: Seventy-one healthy participants in the age group of 8 to 40 participated in the study. Data were collected in two phases. The first phase was as part of a public engagement event at the Lancashire Science Festival where school children were invited to learn about science. The second phase of data collection took place as part of a PhD study where staff and students at the university were recruited via electronic advert and posters displayed around the campus. All subjects were free from lower back or lower limb problems and had not had any previous lower limb surgery. RESULTS: Matched paired t tests showed no significant difference between temperature difference between right and left using DT and TI (t = 1.41, df = 69, P = 0.08). The DT and TI were interchangeable to measure knee skin temperature difference with a limit of agreement of –0.64 and 0.75; this limit of agreement is acceptable based on previous literature where skin temperature differences between affected and non-affected knees are equal to or greater than 1°C. CONCLUSION: This study concludes that an inexpensive handheld digital thermometer shows acceptable agreement with a thermal imaging camera. Clinically a handheld digital thermometer has the potential to play an important role in the localized assessment of skin temperature in physiotherapy and can offer an inexpensive substitute to thermal imaging; due to the massive difference in cost it is worth considering the adoption of digital thermometry in routine musculoskeletal physiotherapy practice.
Abstract: BACKGROUND: The Orpington Prognostic Score (OPS) is a prognostic indicator, used to assess and target rehabilitation and therapy resources for people who have had a stroke. PURPOSE: The aim of this study was to investigate the ability of the OPS, and selected clinical variables, to predict functional outcome post-stroke, as determined by the Modified Barthel Index (MBI), in a stroke rehabilitation unit. METHODS: This was a prospective observational cohort study in a stroke rehabilitation unit. All participants were assessed with the OPS on admission to the unit. All participants were assessed with the MBI on admission…and again on discharge from the unit. Participants’ level of mobility prior to discharge was measured using the ambulation subsection of the MBI. Participants’ discharge destination was also recorded. RESULTS: A total of 32 people who had complete data on the variables of interest were included in the final analysis. Based on the OPS, 19 participants (59.4% ) were classified as having had a mild stroke, 11 (34.4% ) were classified as having had a moderate stroke, with only two participants (6.2% ) classified as having had a severe stroke. OPS scores were found to be statistically significant in independently predicting discharge MBI (p < 0.05). Those participants who achieved a higher level of mobility prior to discharge from the stroke rehabilitation unit had a lower OPS score on admission to the unit, indicating a milder stroke. OPS scores were not predictive of discharge location. CONCLUSION: Results of this study indicate that assessing people, who have had a stroke, with the OPS on admission for rehabilitation may assist in predicting functional outcome. The OPS should not be used in isolation to determine who is accepted for rehabilitation, but should be included as a component in patient assessment.
Keywords: Stroke, the Orpington Prognostic Score, prognostic indicator