Physiotherapy Practice and Research - Volume 40, 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: Fear of falling (FOF) is often reported post-hospitalization and has been associated with functional decline. Identifying the determinants of FOF during hospitalization and patients’ perception of FOF can help guide their managements. To inform a planned future intervention study, this study aimed to evaluate (1) the effects of acute hospitalization on FOF among older adults, (2) older adults’ perception of risk factors, interventions and coping strategies for FOF. METHODS: Thirty-two older inpatients were recruited in an acute teaching hospital. This was a mixed methods study. FOF was measured quantitatively using the Single-item question “Are you afraid of…falling?” and Fall-Efficacy Scale-International (FES-I), self-reported for premorbid status (retrospectively), on admission and again at discharge. Patients with FOF completed a questionnaire exploring their perception of FOF, possible coping strategies and interventions they believed may help. RESULTS: No significant changes in FES-I scores were detected over time, suggesting acute hospitalization did not change FOF in this cohort. A change in FOF (FES-I) score was associated with the history of falls in previous year. Perceived risk factors included balance problems (n = 10), breathlessness (n = 5), reduced lower limb muscle strength (n = 5) and history of falls (n = 4). To cope with FOF, most would avoid activity, seek help and slow their pace. Exercises and education were perceived as effective interventions to reduce FOF. CONCLUSIONS: Fear of falling did not appear to develop or change during hospitalization. Patients had faith in education and exercise prescription as effective treatments for FOF post-hospitalization.
Keywords: Fear of falling, hospitalization, older adults, perception, FES-I
Abstract: BACKGROUND: There is growing evidence to support the benefits of Acceptance and Commitment Therapy for people with chronic pain. Despite this, there is limited qualitative research published in this field. PURPOSE: The aim of this qualitative study was to explore individuals’ perspectives related to ‘acceptance’, following participation in an eight-week multidisciplinary pain management programme (PMP) based on the psychological approach Acceptance and Commitment Therapy (ACT). METHODS: Twenty-six participants attended one of five focus groups. Interviews were audio-recorded and transcribed verbatim. Transcripts were imported into NVivo 11 and were analysed using an interpretative phenomenological approach.…RESULTS: Three broad themes emerged, representing different stages of acceptance: (1) perception of acceptance as a step towards better living with chronic pain, (2) contemplation of acceptance and (3) non-acceptance. The participants in this study who appeared to have reached a point of acceptance, or were contemplating acceptance, reported positive behaviour changes that led to enhanced fulfilment and quality of life. However not all participants believed that acceptance of chronic pain was possible. Factors emerging as relevant to participants’ perceptions of acceptance included attitudes towards finding a cure, self-identity, self-efficacy, contact with personal values, feelings of loss and perceived injustice. CONCLUSION: This qualitative study highlights the complexity of acceptance and provides new and unique insights in relation to the views of people with chronic pain on the concept of acceptance, following participation in a multidisciplinary ACT-based PMP.
Abstract: PURPOSE: Present study aimed to determine the effects of muscular relaxation and visualisation exercises on psycho-emotional state in women after breast cancer surgery during a 4-week individualised intervention. METHODS: The sample size of 51 women was chosen to perform the investigation. Women had undergone surgical treatment (radical mastectomy by Madden) for breast cancer. Participants reported anxiety and depression using the Hospital Anxiety and Depression Scale at baseline, and 4-week post-intervention. They were randomly assigned for the group A (n = 26) that received progressive muscular relaxation and visualization exercises in addition to individualised physical rehabilitation intervention, and the group…B (n = 25) only received individualised physical rehabilitation intervention. RESULTS: It was found that psycho-emotional parameters steadily improved in both groups during a 4-week individualised intervention. However, based on the results of the 4-week monitoring, it has been established that using progressive muscular relaxation and visualization exercises in addition to the individualised physical intervention are more effective for reducing self-reported anxiety in women at hospital inpatient department. The post-intervention level of anxiety was statistically lower in women of the group A compared with the group B by 2.52 points (p < 0.05). CONCLUSIONS: These findings showed that progressive muscular relaxation and visualization exercises were effective interventions that had a favorable impact on anxiety in women after breast cancer surgery.
Keywords: Anxiety, rehabilitation, breast cancer, psychological distress
Abstract: INTRODUCTION: Patellar mobility is often routinely assessed in people with patellofemoral pain (PFP) in clinical practice. This study assessed the stability of the data when measuring patellar mobility using the total medial-lateral patellar glide test across multiple repetitions. It also compared patellar mobility of people with healthy knees to people with PFP and within subgroups of PFP. METHODS: Twenty-two people without knee problems underwent five repetitions of the total medial-lateral patellar glide test. Differences in mean value for each repetition and the intra-class correlations (ICC) between the first assessment and the average values of additional repetitions were calculated.…Mean patellar mobility was compared with 127 participants with PFP who took part in a previously published subgrouping study. Differences between the healthy knee group and PFP subgroups were also explored using a one-way ANOVA with pairwise comparisons. RESULTS: The mean patellar mobility in healthy individuals was 16.4 mm (SD 5.3), difference in mean patellar mobility across repetitions was minimal and the ICC ranged between 0.93 and 0.95. People with PFP had significantly lower patellar mobility than the healthy knee group. Two of three PFP subgroups had statistically significantly lower mean patellar mobility (difference in mean –5.6 mm and –6.5 mm; P < 0.001). DISCUSSION: A single medial-lateral patellar glide test appears as informative as repeated tests in practice. One off measures of patellar mobility using the total medial-lateral patellar glide test may identify subgroups of PFP to help guide treatment in clinical practice. Further work is needed to assess other reliability parameters for this measure.
Abstract: PURPOSE: Complete whitening of one half of the thorax on a chest radiograph (CXR) is termed an opaque hemithorax. It often indicates the presence of significant pathology resulting in respiratory compromise. There are numerous causes of an opaque hemithorax, but these are not immediately apparent on CXR. Thoracic ultrasound (TUS) has a higher accuracy to differentiate between opacities on CXR and may help to correctly identify underlying pathologies. The purpose of this literature review is to report the causes of an opaque hemithorax, identify how TUS can assist diagnosis and explore the role physiotherapy has opaque hemithorax management.…METHODS: A systematic search was conducted (PubMed, Medline, Embase, CINAHL, AMED and BNI) up until March 2018. Inclusion: Adults. Primary research reporting a complete opaque hemithorax on CXR. RESULTS: 1117 papers were identified in search. Following inclusion and exclusion criteria: 58 papers were selected. 54 papers were case reports and four were observational studies. The causes of the opaque hemithorax were collated and divided into 16 categories. Eight studies included the use of TUS to differentiate the cause of the opaque hemithorax. Two studies reported the involvement of physiotherapy in opaque hemithorax. CONCLUSIONS: Numerous pathologies can cause an opaque hemithorax on CXR making differential diagnosis difficult. Even when mediastinal shift is present it does not appear to be a reliable way to identify the underlying cause. Thoracic ultrasound has the potential to much more accurately differentiate between pathologies. This would assist physiotherapists to identify patients amenable to physiotherapy treatment techniques.
Abstract: INTRODUCTION: Physiotherapy can aid the removal of secretions following a whole lung collapse, presenting as an opaque hemithorax or “whiteout” on chest radiograph (CXR). Identifying the cause of an opaque hemithorax can prove difficult due to low sensitivity of chest radiography (CXR). Thoracic ultrasound (TUS) is a diagnostic technique able to differentiate between pathologies. The aim of this report is to highlight the impact of TUS on physiotherapy practice. CASE PRESENTATION: A 63-year-old patient underwent elective cardiac surgery. Post-operatively he sustained a cerebral artery infarct with a dense hemiplegia and an ineffective cough. He required nasal pharyngeal suction…and use of a cough-assist machine. Increased oxygen requirements prompted a CXR showing an opaque hemithorax. Physiotherapy was requested to aid sputum removal and lung recruitment. Prior to initiating physiotherapy treatment TUS showed a large pleural effusion. Despite this new information a bronchoscopy elicited no significant sputum plug. A second TUS scan showed no change in the effusion. A chest drain was inserted which elicited 3500 mls within an hour. A third TUS showed an absence of any pleural effusion. Following physiotherapy treatment a final TUS scan showed normal aeration. DISCUSSION: An opaque hemithorax can be caused by a significant pleural effusion even when sputum retention is suspected. When patients are referred to physiotherapy TUS can highlight pathologies not amenable to physiotherapy treatment. It seems reasonable to address the pleural effusion first and then implement physiotherapy treatment. TUS will also allow rapid repeated imaging to assess whether treatments have been successful immediately after being administered.
Keywords: Opaque hemithorax, whiteout, thoracic ultrasound, physiotherapy, case report
Abstract: BACKGROUND: A large proportion of patients with chronic stroke have permanent lower limb functional disability leading to reduced levels of independent mobility. Individually, both cross-education of strength and mirror therapy have been shown to improve aspects of lower limb functioning post-stroke. OBJECTIVES: This case report examined whether the novel combination of both therapies could be a feasible intervention leading to improvements in lower limb impairments and functional ability for a post-stroke individual. METHODS: The participant was a 66-year-old male and was six months’ post-stroke. Due to hemiparesis and spasticity he had lower limb motor impairment. The…participant engaged in a combination of cross-education strength training plus mirror therapy three days per week for four weeks. Outcome measures included Maximal Voluntary Contraction, Modified Ashworth Scale, 10 Metre Walk Test, Timed Up and Go and London Handicap Scale. Intervention adherence, adverse effects and subjective feedback were also recorded. RESULTS: Maximal Voluntary Contraction increased in both limbs. Improvements were also seen in the Modified Ashworth Scale, 10 Metre Walk Test and Timed Up and Go. Improvements in function were reflected in a positive increase in self-perceived participation scores. The intervention was well received and no adverse effects were noted for the participant. DISCUSSION: The positive outcomes from this new combination therapy for this participant are encouraging and indicate the potential benefit of mirror therapy as an adjunct to cross-education training for improving lower limb strength, spasticity and motor function post-stroke.
Abstract: BACKGROUND: The prevalence of Achilles tendinopathy is greatest in activities including middle and long distance running, tennis, badminton, volleyball, and its incidence is increasing. However, currently no gold standard treatment for Achilles tendinopathy exists, although eccentric exercises are commonly recommended. PURPOSE: This study aimed to investigate the changes in clinical scores when administering a) acupuncture and b) sham acupuncture to the Achilles tendon in patients diagnosed with Achilles tendinopathy who did not respond to modified eccentric exercises. METHODS: Twenty-two patients were randomised and received either acupuncture or the control sham acupuncture treatment. VISA-A, NPRS, EQ-5D and…GRC were recorded before treatment at week 0, then at week 2, week 4 with a final follow-up review at week 12. MAIN RESULTS: Acupuncture resulted in significant differences between groups and time points in VISA-A, NPRS, EQ-5D and GRC. The Acupuncture group reached the minimum clinically important difference (MCID) threshold for important difference, when compared to sham acupuncture. The difference between treatments would suggest a beneficial response following the use of acupuncture to the Achilles tendon in Achilles tendinopathy. PRINCIPAL CONCLUSIONS: The overall findings suggest the use of a standardised acupuncture protocol to the Achilles tendon is a viable treatment alternative, which could be used as a second line treatment in patients diagnosed with Achilles tendinopathy who did not respond to eccentric exercises. However, in view of the small sample size, the results of this feasibility study should be viewed with caution.
Abstract: BACKGROUND: Anterior cruciate ligament (ACL) injuries are considered to be among the most disabling knee injuries. The proprioception function affected due to ACL injuries results in functional instability as neuromuscular control is altered in consequence. PURPOSE: To compare proprioceptive training outcomes following ACL reconstruction with and without stump removal. METHODS: Thirty male patients received a three months rehabilitation program, including an integral proprioceptive training component, after having autogenous hamstring tendon ACL reconstruction. Fifteen patients had done stump shaving technique (group A), and fifteen patients with stump preservation (group B). Mean age was (32.87±7.51 years) for group…A and (31.53±6.46 years) for group B. Clinical evaluation included functional performance measured by Lysholm scale, dynamic balance measured by Biodex balance system test (overall stability index), and sense of position measured by active and passive repositioning tests (absolute angular error) on Biodex system 3 isokinetic dynamometer. RESULTS: No significant differences were detected for active and passive repositioning tests and overall stability index of affected and non-affected legs between groups. Moreover, Lyshlom scores between both groups revealed no significant difference. Pairwise comparisons of affected and non-affected legs within either groups were also non- significant (p < 0.05). CONCLUSION: Proprioceptive training after arthroscopic ACL reconstruction showed similar effects on function, dynamic balance, and sense of position in patients operated by stump shaving or preservation techniques.
Keywords: ACL reconstruction, proprioceptive training, balance, residual stump, joint position sense
Abstract: BACKGROUND: Pregnancy includes a series of changes to posture and gait. PURPOSE: The aim of this study is to investigate the short-term effect of proprioceptive training on the postural balance of pregnant women. METHODS: This is a randomized controlled trial with blinding of participants and examiners conducted in physician practices at the obstetric department of the hospital. Thirty-nine pregnant women with age between 25–30 years at 20 weeks gestation (WG) were randomized into blocks and allocated to either the intervention group with proprioceptive exercises (PEG; n = 20) or the control group (CG; n = 19). All outcomes…(anteroposterior (AP), mediolateral (ML) and global postural sway (GPS) indices were measured by the Biodex Balance System® -BBS at 20, 24, and 32 WG. RESULTS: After 4 weeks’ intervention, the PEG showed decreased sway (AP, ML, and GPS indices) compared to the CG, indicating an improvement in postural balance due to the intervention. With pre- and post-intervention (between 20 and 24 WG), the PEG showed decreased AP and GPS sway. In the CG, without intervention, no sway was different between the pre and post period. After 8 weeks of follow-up (32 WG), the PEG demonstrated the maintenance and improvement of all the index of postural sway. In the CG, these index of postural sway has significantly increased. CONCLUSION: The proprioceptive training is effective in the reduction of postural sway during pregnancy. This improvement was maintained after 8 weeks of follow-up.