Physiotherapy Practice and Research - Volume 39, 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: Unilateral resistance training not only strengthens muscles on the trained side but also the homologous muscles on the untrained side. This phenomenon is called cross-education and was first observed in 1894. Since then, many studies have been conducted in neurologically intact persons but the potential of cross-education for people with unilateral orthopaedic and neurological impairments remains largely unexplored. In this commentary, we highlight the potential of cross-education in the rehabilitation after stroke. Current clinical practice in stroke rehabilitation is to train the more-affected side but people with a severe hemiparesis are often not able to train this side due to…muscle weakness and limited range of motion. Resistance training of the less-affected side might be a great tool to improve muscle strength and motor function of the more-affected side. Mirror therapy, where a mirror reflection of the less-affected side creates the illusion that the more affected side is exercising, could even further augment these cross-education benefits. Three functional networks (i.e., attentional resources, the mirror-neuron system, and the motor network) play a role in cross-education with and without a mirror and induce neuroplasticity in the brain that can help people who have had a stroke in their recovery. The use of inter-limb mechanisms in the rehabilitation from unilateral impairments has to be exploited further and should be incorporated in the standard protocols for neurologic and musculoskeletal rehabilitation.
Abstract: Femoroacetabular impingement (FAI) is being increasingly diagnosed as a cause of hip pain among young and middle-aged adults, and is now recognised as a likely cause of early osteoarthritis (OA) of the hip. There are two main forms, “cam” impingement and “pincer” impingement, although the vast majority of cases have a combination of both forms known as “mixed” impingement. Over time, repetitive abnormal contact between the femoral head and acetabulum can result in chondral, labral, and eventually osseous pathology. A detailed history and physical examination in conjunction with radiological imaging help in the diagnosis of FAI. Diagnosis is made difficult…by the fact that many asymptomatic patients have the characteristic features of FAI on imaging. Most patients should have a trial of conservative management prior to consideration for surgery. Arthroscopic and open surgical treatments are available, with neither showing superior outcomes. In general, early outcomes of surgical treatment appear to be favourable, however these outcomes are limited to a hip joint with little or no evidence of OA. Further high quality research is required to investigate the optimal approach to diagnosing and managing this complex condition.
Abstract: BACKGROUND: Low back pain (LBP) is a common cause for disabilities and reduced autonomy in older adults. Exercise therapy has shown to be effective in the reduction of the symptoms of LBP with bridging exercises as a commonly used intervention. Exercise therapy can be supported with biofeedback-based methods in order to further improve motor control. The availability of relatively inexpensive devices like the Nintendo Wii opens up new methods for the treatment for biofeedback-based exercises for patients with LBP. METHODS: We conducted a 3-armed randomized controlled trial (biofeedback, standard care and control) with 62 older adults aged 66…to 89 years and an intervention period of twelve weeks with 2 sessions/week. Primary outcome was the perceived disability using the Oswestry Disability Index (ODI). Additionally, we evaluated usability and user acceptance of the feedback system. RESULTS: The biofeedback group demonstrated significantly lower levels of perceived disability compared to the control group. Additionally, the Biering-Sørensen test was significantly better in the standard care group compared to both other groups. Usability and user-acceptance for the biofeedback system was low, mostly because of connectivity and comfort problems during exercising. CONCLUSIONS: The biofeedback system was able to significantly improve perceived disability and back extensor muscle endurance in older people with subacute low back pain. As the user-acceptance issues were mostly based on technical reasons, higher levels of comfort and dependability of the system could provide an effective method to perform bridging exercises to alleviate the consequences of episodes of low back pain.
Keywords: Low back pain, exercise therapy, older adults, biofeedback
Abstract: BACKGROUND: There is an age-related increase in lower limb amputation (LLA) secondary to dysvascular disease, however, the effectiveness of Multi-Disciplinary Team (MDT) is unknown. PURPOSE: The aims of the study were to investigate if a) individuals with primary lower limb amputation (IPLLAs) attending a regional outpatient prosthetic rehabilitation service achieve successful mobility outcomes, b) to examine the multi-disciplinary team’s ability to accurately predict mobility outcome in this cohort and c) to evaluate how pre-amputation mobility levels affect mobility outcomes of IPPLAs attending an outpatient rehabilitation service. METHODS: This retrospective observational cohort study included 93 primary, unilateral…and bilateral IPPLAs at or proximal to the transtibial level. Pre-rehabilitation (baseline) data was collected between one and six weeks after amputation when clients attended for their pre-rehabilitation MDT Assessment. This data (including Specialist Interest in Amputee Medicine (SIGAM) Score and Pre-Amputation Mobility Status) was gathered to establish their rehabilitation needs. Pre-amputation mobility was characterised as 1) Ambulatory (independent ambulation out of house); 2) Ambulatory/homebound (ambulatory in the home only), 3) Nonambulatory/transfer, 4) Nonambulatory/bedridden. Peri- and post-rehabilitation data (Timed Walking Test (TWT), Locomotor Capabilities Index 5 (LCI-5) and SIGAM Score) was collected at six weeks, six months and twelve months after delivery of prosthesis to the client. RESULTS: Fifty-six percent of participants who completed the 12 month post rehabilitation assessment (n = 68) achieved mobility success. (success was defined as returning to or exceeding baseline mobility scores on the SIGAM for those scoring C-F, and for those who scored A or B at baseline, moving up one category (i.e. going from A to B, or B to C). The pre-rehabilitation SIGAM score was used as a predictor of the IPLLAs expected mobility outcome. There was a highly significant correlation between pre-rehabilitation and 12 month post-rehabilitation SIGAM scores, (r = 0.89, n = 68, p < 0.001) demonstrating that the MDT’s predictions significantly correlated to the post-rehabilitation SIGAM scores. There was a highly significant association between pre-amputation mobility levels and mobility success post-rehabilitation at 12 month follow-up (χ 2 (3) = 26.43 , p < 0.001), such that those who were ambulatory independently pre-amputation were significantly more likely to achieve mobility success post-rehabilitation. CONCLUSION: IPLLAs attending an outpatient rehabilitation service can achieve successful mobility outcomes. The MDT was found to be accurate in its predictions of mobility outcome in this cohort. Greater pre-amputation mobility was significantly associated with successful mobility outcomes.
Abstract: BACKGROUND: Despite clinical intervention, people with chronic inflammatory demyelinating polyneuropathy (CIDP) experience difficulties in gait and balance on a daily basis. However, the effects on these variables of a tailored home based exercise programme for this population have not been investigated. PURPOSE: This case series aims to investigate the effects of a home based tailored exercise programme on gait and balance in people with CIDP. METHODS: Case series of seven people with CIDP from a neurology department of a local hospital. Participants took part in a 6 week Otago exercise programme, which include walking, strengthening and…balance tasks. Participants were assessed 10 times; 3 times prior, 3 times during an exercise intervention, 3 times post intervention and once at three months follow up. The outcome measures were Berg Balance scale, 10 meter walk test, fatigue severity scale and EQ-5D-5L. RESULTS: Participants showed an increase in walking speed and balance after the exercise intervention and most kept these improvements at 3 months follow up. CONCLUSION: This study shows that exercise can be beneficial for gait and balance in people with CIDP. These findings are in line with literature from related diseases such as Guillain-Barre Syndrome. However studies with a larger sample size are needed to confirm these findings in the population.
Abstract: BACKGROUND: Constraint induced movement therapy (CIMT) has been found to be an effective intervention for the treatment of upper extremity motor disabilities in people with stroke. There are many concerns around practicality and resource issues with CIMT, consequently there are various modifications in CIMT in terms of duration of constraint and type of constraints used. PURPOSE: The main objective of the study was to compare the effectiveness of voluntary constraint and hand mitt use in modified CIMT (mCIMT) in people with chronic stroke. METHODS: The study was a pre-post experimental design. A total of 20 participants…were allocated randomly to two groups, with 10 participants in each group. The outcome measures used were the Wolf Motor Function Test (WMFT, time and functional ability scale, FAS) and a Motor Activity Log (MAL), amount of use (AOU) and quality of movement (QOM). The total duration of the intervention was 4 weeks with frequency of 5 days per week. The participants in group 1 were asked to do voluntary constraint and in group 2 a hand mitt was used to restrain the use of normal hand function during the training. The activities used in hand function training were the same for both the groups. RESULTS: There was no significant difference between groups after the intervention for WMFT time (t = 0.63, p = 0.5), WMFT FAS (t = –0.22, p = 0.8), MAL AOU (t = –0.25, p = 0.8) and MAL QOM (t = –0.28, p = 0.7). However there was a significant difference between pre-post scores in both groups for WMFT time group 1: t = 31.4, group 2: t = 23.9, p = 0.001 p = 0.001), WMFT FAS (t = –13.5, p = 0.01, group 2: t = –16.54, p = 0.001), MAL AOU (group 1: t = –10.7, p = 0.001, group 2: t = –9.9, p = 0.001) and MAL AOU QOM (group 1: t = –8.04, p = 0.001, group 2: t = –6.7, p = 0.001). CONCLUSION: Voluntary restraint can be an effective alternative constraint technique used in mCIMT to improve the hand function of the affected arm in people with stroke.
Keywords: Function, impairment, modified constraint induced movement therapy, stroke, physiotherapy
Abstract: BACKGROUND: Physical inactivity is the fourth leading cause of global mortality and is a significant independent risk factor for a range of chronic conditions. Advice from a healthcare professional can increase activity levels in adults. Current literature does not identify whether UK physiotherapy undergraduate students are prepared to promote physical activity (PA) for health. PURPOSE: The aim of this study was to determine the knowledge, confidence and role perception of final-year UK Physiotherapy undergraduate students to promote physical activity for health. METHODS: An online cross-sectional survey was used. 19 UK undergraduate Physiotherapy courses participated. Descriptive statistics…explored knowledge, confidence and role-perception. Inferential statistics tested the relationships between variables. RESULTS: Response rate was 16.6% (n = 158). The majority of respondents (82% n = 129) had received training in promoting PA for health. 66% (n = 73) of this group correctly specified a duration, frequency and intensity for current UK PA recommendations for 19–64 year olds. Role perception was extremely high (99%) in the surveyed population. Students reported being confident in giving general PA advice (92%, n = 144). Confidence scores were significantly correlated with training in the promotion of PA for health (β = 0.38 p < 0.001). CONCLUSION: Final-year UK Physiotherapy students perceive a professional role in promoting physical activity for health; and demonstrate good but variable knowledge of this subject. Confidence domain scores were best predicted by training in the promotion of PA for health.
Keywords: Physiotherapy, physical activity, health, physiotherapy students
Abstract: PURPOSE: There is limited evidence to guide the delivery of rehabilitation during ward-based recovery post intensive care (ICU). The aim of this study was to explore the feasibility of augmenting usual care physiotherapy with the REhabilitation after Critical illness Assisted discharge Pack (RECAP) in the initial 3 weeks after ICU discharge and to explore the feasibility of conducting a fully powered RECAP trial. METHODS: Twenty patients with an ICU stay greater than 4 days and referred to physiotherapy were randomized to receive usual care or usual care plus RECAP. The Functional Independence Measure (FIM) and State Anxiety Inventory…(SAI) were used to measure physical and psychological function respectively, with blinded assessments completed at weeks 1 and 3 after ICU discharge. Patient satisfaction with rehabilitation was explored with a short questionnaire. RESULTS: A recruitment rate of 72% (21/29 eligible patients) was observed. The intervention was successfully delivered to n = 8 patients with a median of 4.0 (IRQ 2.0–4.0) sessions. 45% of study participants were discharged before the study endpoint. The intervention group reported higher satisfaction scores (44.5/50 +/–5.9 vs 42.8/50 +/–7.6). No adverse events were reported. Intervention delivery appeared feasible and aspects to further enhance the intervention were identified. CONCLUSION: RECAP is a short, safe intervention to deliver in combination with ward-based rehabilitation after ICU discharge. Further research is required to optimise RECAP before exploring any effects on physical or psychological function. Methods to overcome challenges to conducting future trials, including defining standards of usual care and choice of appropriate outcome measure could be further explored.
Abstract: PURPOSE: The aim of this study was to compare the magnitude and pattern of lower limb muscular activity during the sit-to-stand (STS) task with and without upper limb immobilization. METHODS: The activity of six muscles from each lower limb (Rectus Femoris, Vastus Medialis, Biceps Femoris, Tibialis Anterior, Gastrocnemius Medialis and Soleus) were recorded while 19 young healthy participants performed the STS task with and without an arm sling on their dominant side. Myoelectric signals were collected using BioPlux Research device, and two Bertec force platforms were used to determine different phases of the STS task. The peak of…muscular activity and muscle onset times were calculated, two general linear models with an alpha of 0.05 were used between the conditions with and without upper limb immobilization. RESULTS: We found no statistically significant differences in the onset of lower limb muscular activity, and we observed decreased peak of muscular activity in the Rectus Femoris at the immobilized side and an increased peak in the Vastus Medialis at the side opposite to the upper limb immobilized compared to the control condition. CONCLUSIONS: We did observe differences in the magnitude of ipsilateral Rectus Femoris and contralateral Vastus Medialis as a consequence of upper limb immobilization.