Physiotherapy Practice and Research - Volume 41, 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: INTRODUCTION: The rate of force development (RFD) is increased by high-load isometric resistance training (RT), whereas not by low-load isometric RT. However, it is unknown whether low-load isometric RT with neuromuscular electrical stimulation (NMES) can increase the RFD. PURPOSE: The aim of this study was to clarify the short-term effects of low-load isometric RT with NMES on the RFD. METHOD: Twenty-four healthy subjects randomly received both low-load RT of the hip abductor muscles with NMES and sham NMES condition. The RFD of the homonymous muscles was assessed at pre- and post-intervention. Time intervals of the RFD…were set to 0–50 ms (50RFD), 0–100 ms (100RFD), 0–200 ms (200RFD), and 0–300 ms (300RFD). Two-way repeated measures analysis of variance was used to analyze the effects of time and intervention. RESULT: Low-load RT with NMES significantly increased 50 and 100RFD compared to sham NMES condition. On the other hand, 200 and 300RFD were not changed by either condition. CONCLUSIONS: The significantly increased RFD might be related to the factors affecting each RFD interval. This finding might have an important clinical implication for developing a mechanism-based effective training.
Keywords: Rate of force development, hip abductor muscles, neuromuscular electrical stimulation, low-load resistance training, healthy adults
Abstract: BACKGROUND: Shoulder pain is a common musculoskeletal complaint and disorders of the rotator cuff (RC) are widely regarded as the most common cause. Where clinical care is required, physiotherapists play an integral role. Previous studies have reported physiotherapy practice across other countries as a means of determining current practice and understanding whether practice changes over time in response to emerging research evidence. AIM: To investigate the practice of Italian physiotherapists, in order to determine current practice for the assessment and management of RC disorders. METHODS: A cross sectional online survey. A 20-item questionnaire based on one…clinical vignette was developed using Survey Monkey Software. Data were analyzed descriptively and difference in proportions between those with no specific education compared to those with a specific education (i.e. “Master’s Degree,” “1-2 days Training Course” or “Other) were analysed using the chi-squared test. RESULTS: A total of 805 participants accessed the survey with a total of 436 completed responses (54%). Fifty-five percent of respondents were male (239/436). Seventy-one percent of respondents (309/436) reported having specific education with regards to RC disorders. The methods of diagnosing RC disorders were variable across the respondents as well as the requests for imaging (184/436, 42%), the adoption of manual therapy techniques (251/436, 58%), the duration of treatment (231/436, 53% visit the patient six times at least) and the administration of physical examination tests (175/436, 40%). Advice (279/436, 64%) and some form of exercise therapy (268/436, 62%) were the most popular choices of treatment. DISCUSSION AND CONCLUSION: This current study is the first to describe Italian physiotherapy practice for RC disorders. Italian physiotherapy practice is in line with other European countries. Italian physiotherapy practice also aligns with current recommendations with regards to minimal use of imaging and prescription of therapeutic exercise. However, there is heterogeneity across the responses particularly with regards the use of manual therapy, physical examination tests, and duration of treatment. Furthermore this study is a platform for future research to explore whether Italian physiotherapy practice changes over time.
Abstract: BACKGROUND: Recent smartphones are equipped with gyroscopic functions enabling measurement of joint range of motion (ROM). Previous studies have demonstrated that the use of the iPod™ to measure shoulder ROM shows good reliability. However, evidence of concurrent validity of shoulder ROM taken with an iPod™ remains scarce. Thus, the aim of this study was to investigate the concurrent criterion validity of the gyroscopic functions of the iPod™, for the measurement of shoulder joint ROM. METHODS: A trained examiner measured shoulder ROM for the movements of flexion, abduction, extension and external rotation. For each movement, four to six trials…(repetitions) were performed at different angles, in order to obtain values for the entire available ROM. Measures were simultaneously taken with the iPod™ (5th generation) and a digital inclinometer (gold standard). Validity was estimated using the Intraclass Correlation Coefficient (ICC) and mean differences (MD), as well as 95% limits of agreement (LOA) with Bland-Altman plots. RESULTS: ROM data was collected from 28 healthy participants. We found excellent criterion validity for all four movements studied (ICCs = 0.907–0.996). In terms of accuracy, the MD between both instruments for all movements was between –1.9° and 2.0°, except for extension (MD = 3.80°–4.70°). CONCLUSIONS: This study provides evidence of validity of the gyroscopic functions of the iPod™ for the measurement of the shoulder ROM in a wide range of amplitudes. The use of an armband to position the instrument can minimize potential measurement errors compared to conventional goniometry. However, future studies should investigate ways to improve accuracy of extension measurements.
Keywords: Shoulder joint, range of motion, validity, smartphone, accuracy
Abstract: BACKGROUND: One-third of individuals with acute low back pain (LBP) experience recurrent symptoms within 12 months but the underlying mechanisms are unclear. One explanation is that individuals experiencing recurrent LBP develop altered central pain processing that predisposes to symptom recurrence. We compared central pain processing between individuals experiencing their first episode of acute LBP, recurrent acute LBP, and pain-free controls. METHODS: A cross-sectional study was conducted to evaluate central pain processing in 11 individuals experiencing their first episode of acute LBP, 11 individuals with recurrent acute LBP, and 11 pain-free controls. Outcome measures included pain and disability, pressure…and heat pain thresholds (PPTs and HPTs), nociceptive flexor withdraw reflex (NFR) and conditioned pain modulation (CPM). RESULTS: The NFR latency was shorter in individuals experiencing their first episode of acute LBP when compared with pain-free controls (p = 0.01). Descending inhibitory pain control measured by CPM was less efficient in both acute LBP groups when compared with pain-free controls. HPTs and PPTs did not differ between people with and without acute LBP. There were no differences between the two LBP groups for any outcome measure. CONCLUSIONS: These data demonstrate altered central pain processing in the acute stage of LBP. However, the degree of impairment did not differ between individuals with a first episode vs. recurrent acute LBP. These findings suggest that altered central pain processing in acute LBP is not related to a previous history of LBP.
Keywords: Acute low back pain, recurrent low back pain, central sensitisation, conditioned pain modulation, nociceptive flexor reflex
Abstract: INTRODUCTION: The symptoms and pathophysiology of multiple sclerosis (MS) could affect how exercise is perceived, including ratings of perceived exertion (RPE). The purpose of this cross-sectional study was to examine absolute and relative RPE during exercise in a large sample of persons with MS. METHODS: 135 persons with MS (Patient-Determined Disease Steps (PDDS) scale mdn = 2.0, IQR = 3.0) and 64 healthy controls completed a maximal, incremental exercise test on a cycle ergometer with open-circuit spirometry for measuring exercise variables (i.e., VO2peak ). RPE were obtained during the last 10 seconds of each minute using Borg’s 6–20 scale. Data were analyzed…in the overall sample, in a subsample of participants that continued exercise at and/or above 120 W (84 persons with MS and 57 controls), and in a sample of persons with MS (n = 55) and controls (n = 55) that were matched on age, sex, and VO2peak . RESULTS: ANOVA and post-hoc analyses revealed group differences in RPE at absolute exercise intensities (W) in the overall sample with the exception of the lowest intensity (W = 15) and in the subsample and matched sample at only at the highest intensity (W = 120). There were no statistically significant differences in RPE relative to VO2peak (mL/kg/min) in the overall sample, subsample and matched sample, such that RPE increased similarly between groups as a function of relative exercise intensity. DISCUSSION: Persons with MS reported similar RPE to exercise compared to healthy controls when data were expressed in terms of relative exercise intensity. RPE can be utilized for exercise prescriptions and documenting adaptations to exercise training in persons with MS.
Abstract: PURPOSE: We compared short- and long-time action observation training (AOT) in terms of grip strength, the Quality of Upper Extremities Skills Test (QUEST), and the ABILHAND-Kids test. METHODS: In total, 10 children with cerebral palsy (CP) participated. The children were assigned randomly to experimental group (n = 5) and control group (n = 5). The experimental group observed video tasks of goal-directed action before performing tasks, for 30 minutes per day, three times per week, for 4 weeks. The control group observed and performed the same actions, 60 minutes per day, three times per week, for 4 weeks.…RESULTS: Grip strength, QUEST, and ABILHAND-Kids test results improved significantly in both groups (p < 0.05). However, there was no significant difference between the experimental and control groups in any variable tested (p > 0.05). CONCLUSION: The 30 minutes AOT was as effective as 60 minutes AOT in improving grip strength and upper limb function in children with CP. The results of our study suggest that 30 minutes AOT is a simple and not very time-consuming therapy for improving upper limb function in children with CP. We recommend that 30 minutes AOT be used for treating upper limbs in the clinic and at home.
Abstract: INTRODUCTION: Gait engages motor and cognitive neural pathways. However, progressive deterioration of motor and cognitive function is characteristic in Parkinson’s disease (PD). We explored relationships between motor impairment, cognitive function, daily functioning, and gait in people with PD. We hypothesized there would be a stronger relationship between walking and cognitive function as gait task complexity increased. METHODS: Community-dwelling participants with PD were assessed on motor impairment [United Parkinson’s Disease Rating Scale Motor Subscale (UPDRSm)], cognitive function [Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)], daily function [Schwab & England (S&E) ADL scale] and mobility [Timed Up and…Go (TUG)] under single and dual task conditions. Analyses included Spearmans’ rank correlations coefficient to determine relational strengths between outcomes and separate forward stepwise multiple linear regressions to predict dual task gait performance. RESULTS: Forty-five participants [age Mean (M) = 68.93±7.78 years; 32 male/13 female; UPDRSm, M = 25.24±11.93] completed this study. RBANS was poorly related to TUGmotor and TUGcognitive . UPDRSm (rho = 0.524; p < 0.001) and S&E (rho = –0.589; p < 0.001) were moderately related to TUGmotor ; S&E (rho = –0.581; p < 0.001) to TUGcognitive . S&E (R2 = 0.234; F (1,43) = 13.14) and RBANS Language subscale (R2 = 0.071; F (1,42) = 4.31) were predictive of TUGmotor performance; S&E of TUGalone (R2 = 0.150; F (1,43) = 7.56) and TUGcognitive performance (R2 = 0.375; F (1,43) = 25.81). CONCLUSIONS: Daily function appears more closely related to dual task mobility than separate assessments of motor and cognitive function in this population.
Keywords: Walking, motor dysfunction, cognition, activities of daily living, dual tasking
Abstract: BACKGROUND: Muscle weakness is the most common impairment in the upper extremity (UE) after a stroke. Understanding the relationship between hand strength and functional outcomes would be advantageous in clinical settings for the development of efficient rehabilitation programs. PURPOSE: To determine the relationship of hand strength with paretic UE function and activities of daily living (ADL) performance. METHODS: Twenty-six patients with hemiparetic stroke (mean age 51.38±12.64 years) participated in this cross-sectional study. Hand strength was assessed on both the more affected and less affected sides. An electronic dynamometer and isokinetic dynamometer were used to measure static…grip and pinch strength, and dynamic grip strength, respectively. The relationships of hand strength with paretic UE function (Fugl-Meyer Motor Assessment, FMA) and ADL performance (Modified Barthel Index, MBI) were analyzed. RESULTS: Hand strength on the more affected side had a moderate to high correlation with UE function (r = 0.62–0.77, P < 0.001), in comparison hand strength on the less affected side had low correlation with UE function (r = 0.39–0.44, P < 0.05). Hand strength on the less affected side had a moderate to high correlation with ADL performance (r = 0.61–0.75, P < 0.001), while, hand strength on the more affected side had low correlation with ADL performance (r = 0.42; P = 0.03). Regression analysis showed that static grip and pinch strength on the more affected side contributed 71% of the variance in FMA scores, and static grip and pinch strength on the less affected side accounted for 73% of the variance in MBI scores. CONCLUSION: Hand strength on the more affected side is associated with paretic UE function and hand strength on the less affected side is associate with ADL performance.
Keywords: Activities of daily living, hand strength, stroke, upper
Abstract: BACKGROUND: Airway clearance therapy (ACT) is standard practice to promote pulmonary mucus clearance in children with cystic fibrosis (CF). However, the efficacy of assisted autogenic drainage (AAD) in children has not been studied. OBJECTIVES: To pilot a home-based randomized controlled trial (RCT) to compare the effects of AAD to standard ACT in children with CF aged one to eight years. METHODS: Children with CF, aged one to eight years, were randomly assigned into intervention (AAD) or control (standard ACT) groups. The ACTs were taught to parents and children, to perform twice daily for a year. Primary…outcome measures were number of hospitalizations, days of hospitalization, exacerbations and days of antibiotic therapy in one year. Secondary outcome measures included spirometry, and adherence assessed on every visit (through calendar and sticker system); parental proxy health related quality of life score (EQ-5D-Y), current clinical status (CF Clinical Score), weight-, height-, and BMI-for-age z-scores assessed at baseline and after one year; and preference of ACT and mortality rates were assessed at the end of the study. At the end of the study, a self-designed one on one subjective semi-structured interview with the parent(s)/caregiver(s) regarding physiotherapy management was conducted. RESULTS: Of 36 children screened for inclusion, 16 were enrolled. Seven were randomly allocated to the control group (median [IQR] age 5.7 [3.0–6.0] years, four male and three female), and nine to the intervention group (median [IQR] age 5.8 [5.5–6.6] years, five male and four female). There were no significant between-group differences, however number of exacerbations revealed medium (Cohen’s d = 0.55) effect sizes, favoring the intervention group. Although no significant improvements were seen within the intervention group, large effect sizes were found for the CF subjective and total clinical scores; and health related quality of life (Cohen’s d = 1.07, d = 0.87, and d = 0.86 respectively). This pilot study identified a number of concerns, mainly poor adherence to home-therapy in both arms of the study, and no participant in the intervention group solely performing AAD as per pre-set methodology, limiting interpretation of results. CONCLUSION: There is a need for confirmatory, adequately powered trials to evaluate safety and efficacy of AAD in children with CF. Future research needs to also consider measures to ensure better adherence to ACT.