Physiotherapy Practice and Research - Volume 41, 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: PURPOSE: Abnormal breathing patterns, decrease in respiratory muscle strength and endurance are some of the alterations, which are observed in non-specific low back pain (NS-LBP). The purpose of this study was to determine the efficacy of the Feldenkrais method (FM) on respiratory muscle strength, Maximum Voluntary Ventilation (MVV), Total Faulty Breathing Scale (TFBS), Cloth Tape Measure (CTM) and core stability among NS-LBP participants. METHODS: Participants were recruited from a rehabilitation clinic and randomized either to experimental group (EG) or the control group (CG). For the EG (FM and routine physiotherapy), and for the CG routine physiotherapy alone were…carried out three days per week over a period of 8 weeks. Outcome measures including Respiratory Muscle Strength, MVV, TFBS, Numeric Rating Scale (NRS), CTM, and Pressure biofeedback device (PBU) were evaluated at baseline and 8 weeks. RESULTS: Forty participants were assigned to an EG (n = 20) and CG (n = 20) based on the study criteria. There was a significant increase in inspiratory muscle strength (MIP) (p = 0.004) for the EG, but no significant change in the CG (p = 0.455). There was also a significant increase in the expiratory muscle strength (MEP) for the EG (p = 0.001), but no changes in the CG (p = 0.574). In addition, decrease in pain, increase in xiphoid process chest expansion and improvement in core stability were observed in EG and improvement in MVV was observed in CG. CONCLUSIONS: FM is a potential training program that can improve respiratory variables among NS-LBP.
Keywords: Back pain, feldenkrais, respiratory, physiotherapy
Abstract: INTRODUCTION: Approximately 20% of patients are not satisfied following Total knee arthroplasty (TKA). The ability to identify patients at risk of poor outcomes in the early-postoperative period following TKA could inform the development of targeted treatments with the ability to improve outcomes for these patients. This prospective cohort study aimed to identify early post-operative, prognostic factors for patients experiencing dissatisfaction and poor outcomes at 12-months post TKA. METHODS: Patients (n = 185) were recruited from TKA waiting lists at a single site, completed measures of pain intensity, neuropathic pain, anxiety, depression, generic and disease specific health related quality of…life (HRQoL), satisfaction and expectations, at discharge from hospital; three weeks post-surgery and again at 1 year. ROC curve analysis identified which variables best predicted patients experiencing dissatisfaction (VAS < 5/10) and poor outcomes (Western Ontario and McMaster Universities Arthritis Index (WOMAC)<40) at 12-months. RESULTS: The strongest prognostic factors for dissatisfaction were low HRQoL (EQ5D3L) at both day of discharge (AUC = 0.812) and three weeks post-surgery (AUC = 0.810), and high pain levels (WOMAC pain sub-scale) at 3-weeks post-TKA (AUC = 0.796). The strongest prognostic factors for poor outcomes were poor function (WOMAC function sub-scale) at three weeks post TKA (AUC = 0.815); low HRQoL (EQ5D3L) at three weeks post-TKA (AUC = 0.783) and high levels of pain (WOMAC pain sub-scale) at 3 weeks post-TKA (AUC = 0782). Anxiety and depression at 3-weeks were also prognostic factors for dissatisfaction (AUC = 0.629 & AUC = 0.686) and poor outcomes (AUC = 0.632 & 0.713) at 12-months. CONCLUSION: This single site cohort study suggests that patients with low HRQoL, high pain levels, poor function, anxiety, and depression in the first three weeks following TKA are at risk of dissatisfaction and poor outcomes at one-year post-surgery.
Keywords: Total knee arthroplasty, outcome, prognosis
Abstract: BACKGROUND AND PURPOSE: Fractures of the proximal humerus are characterised by slow recovery and ongoing disability. We aimed to describe the recovery of patients referred to community physiotherapy after proximal humeral fracture and determine if activity thresholds based on the Shoulder Function Index (SFInX) could inform physiotherapist decision-making. METHODS: Using a prospective observational cohort design, patients referred to community rehabilitation for physiotherapy were assessed for activity limitation (SFInX, DASH), quality of life (EQ-5D), pain levels (VAS), global rating of change, and shoulder range of movement at weeks 0, 6, 12 and 26. A focus group explored treating physiotherapists’…perceptions of using the SFInX. Characteristics of participants meeting SFInX clinically meaningful activity thresholds (+Δ 17 units, score ≥73 units) were compared to those who did not. RESULTS: Participants (n = 38, mean age 78 years, 29 women, 29 conservatively managed) commenced physiotherapy a median of 12 (min 4, max 62) weeks after proximal humeral fracture and received a median of 8 (min 3 max 17) sessions over 8 weeks. N = 18 achieved +Δ SFInX ≥17 units by week 6. N = 15 achieved SFInX ≥73 units by week 26. Shoulder flexion range of 112° predicted +Δ SFInX ≥17 units at week 6 (AUC 0.74, 95% CI 0.58 to 0.90). Physiotherapists reported not basing management decisions on the SFInX. CONCLUSIONS: Patients after proximal humeral fracture make clinically meaningful improvements in shoulder activity after referral to physiotherapy. Decision-making based on SFInX activity thresholds or achievement of shoulder flexion of at least 112° may be informative but physiotherapists preferred making decisions based on individual goal-attainment.
Keywords: Shoulder fractures, rehabilitation, physical therapy modalities, activities
of daily living
Abstract: BACKGROUND: Little or no research currently exists investigating musculoskeletal strength, joint flexibility and cardiopulmonary capacity post-operative adolescent idiopathic scoliosis (AIS) patients. PURPOSE: To explore if AIS patients following spinal fusion surgery have deficiencies in strength, endurance joint flexibility and pulmonary capacity (>12-month post-operative) compared to a matched sample of the general population. METHODS: This retrospective case control study; AIS group (n = 20) and control group (n = 20) matched for gender, age and anthropometrics. Participants underwent standardised tests to establish pulmonary capacity via spirometry, upper and lower limb strength via manual muscle testing, upper and lower limb…endurance via press-up and wall squat tests and joint flexibility via manual goniometry. Within session reliability and reproducibility of variables were assessed. RESULTS: No significant differences between AIS and control cohorts were identified for mass (57.1±9.0 vs. 62.8±9.0kg), height (164.7±6.3 vs. 165.6±6.0cm) or BMI (21.2±4.0 vs. 22.9±2.7). Pulmonary and musculoskeletal deficiencies in the AIS cohort were identified, including significantly lower forced vital capacity (FVC; 2.6±0.5 vs. 3.3±0.5L, P < 0.001) and forced expiratory volume in 1 second (FEV1 , 2.8±0.6 vs. 3.3±0.5L, P < 0.001); restrictions in shoulder flexion (P < 0.01) and internal rotation (P < 0.001) weaker bilateral pinch grip (P < 0.01) and bilateral hip adductor strength (P < 0.01). CONCLUSION: The results highlight that AIS patients still have major pulmonary and musculoskeletal impairments over a year after spinal fusion surgery. Clinicians should consider periodic assessment of pulmonary and musculoskeletal function with comparison to these age-matched reference values in order to improve the post-operative rehabilitation process.
Abstract: BACKGROUND: A coma is a prolonged unconscious state in which there is no response to various stimuli. In response, sensory stimulation was designed to stimulate brain plasticity and to promote brain regeneration. The effects of sensory stimulation intervention on comatose patients following traumatic brain injury (TBI) remain unclear. OBJECTIVES: This study aimed to examine the effects of sensory stimulation on the level of consciousness (LOC) after TBI and to identify the effective treatment dosage. METHODS: We searched PubMed, REHABDATA, EMBASE, CINAHL, MEDLINE, PEDro, SCOPUS, and Web of Science from inception to February 2020. Experimental studies investigating…the influence of sensory stimulation on the LOC in the comatose patients (Glasgow coma scale < 8) following TBI were selected. The Physiotherapy Evidence Database scale (PEDro) was used to evaluate the methodological quality. RESULTS: Eleven studies met the inclusion criteria. Six were randomized controlled trials (RCTs), clinical controlled trials (CCTs) (n = 2), and pilot studies (n = 3). A total of 356 comatose patients (<8 on GCS) post-TBI were included in this study with sample sizes ranging from 5–90 patients. The sample sizes for the selected studies ranged from 5 to 90 patients. The scores on the PEDro scale ranged from three to eight, with a median score of seven. The multimodal sensory stimulation showed beneficial effects on the LOC in the comatose patients following TBI. The evidence for the effects of unimodal stimulation was limited, while the optimal treatment dosage remains unclear. CONCLUSIONS: The multimodal sensory stimulation intervention improves the LOC in patients with coma after TBI compared with unimodal stimulation. Further high-quality studies are needed to verify these findings.
Abstract: BACKGROUND: Functional mobility requires an ability to adapt to environmental factors together with an ability to execute a secondary task simultaneously while walking. A complex dual-tasking gait test may provide an indication of functional ability and falls risk among community-dwelling older adults. PURPOSE: The aim of this cross-sectional study is to investigate age-related differences in dual-tasking ability and to evaluate whether dual-tasking ability is related to executive function. METHODS: Forty-one community-dwelling healthy older and forty-one younger adults completed a dual-tasking assessment in which concurrent tasks were incorporated into the Functional Gait Assessment (FGA). The manual dual-task…involved carrying a glass of water (FGA-M) while the cognitive dual-tasks involved numeracy (FGA-N) and literacy (FGA-L) related tasks. FGA scores under single (FGA-S) and dual-task conditions together with associated dual-task costs and response accuracy were determined. Executive function was assessed using The Behavioural Assessment of the Dysexecutive Syndrome (BADS). RESULTS: FGA-N and FGA-L scores were adversely affected in both groups compared to FGA-S (p ≤0.001). However, score reductions and dual-task costs were significantly greater for older adults compared to younger adults on FGA-N (p ≤0.05) and FGA-L (p ≤0.001), with older adult performance on FGA-N associated with falls risk (p ≤0.05). Executive function did not appear to be related to dual-tasking ability. CONCLUSION: Findings suggest that cognitively demanding tasks while walking, have a deleterious effect on dynamic balance and could place older adults at a greater risk of falls.
Keywords: Dual-task, dynamic balance, gait, aging, executive
Abstract: BACKGROUND: Unimanual activities are suggested as an effective intervention for the moderately or severely affected chronic stroke patients and bimanual activities for mildly affected cases in mirror therapy. OBJECTIVE: To observe the feasibility of unimanual mirror therapy to improve the motor skills of the effected hand in mild chronic stroke patients. METHODS: In this is case series study, n = 20 mildly affected chronic stroke patients were screened for participation in a nursing home setting. They were 45–60 years of stroke included ischemia (n = 3) and aneurysm (n = 1) of anterior cerebral artery, median time:3 years. The…gross (Fugl-Meyer Assessment test), fine motor (Box and Block Tests) skills, the tripot pinch grip power (JTech Commander PichTrack) were assessed at baseline and post intervention. The intervention supervised included unimanual activities of the non-affected hands for 30 min, 5 days/week for 6 weeks. RESULTS: N = 4 participants were recruited from a nursing home setting; median age: 45, Gender: 3M; 1W. The causes of stroke included ischemia (n = 3) and aneurysm of anterior cerebral artery (n = 1). The median years of stroke was 3 years. The improvement in the gross motor skills (25%) of affected sides after unimanual training may be considered as feasable. There were also increase in tripot pinch grip power of the non-affected (34%) and affected hands (17%). The improvement in fine motor skills were 19% in affected hands the 10% in non-affected hands. CONCLUSIONS: The unimanual mirror therapy resulted in improvements in gross and fine motor skills and tripod pinch grip power of the affected hands of mild chronic stroke patients. This case series provides further evidence that mirror therapy is effective to improve function in patients with mild chronic stroke.
Keywords: Visual illusion, gross motor skills, fine motor skills, tripod pinch grip.
Abstract: BACKGROUND: The upper cervical spine should be assessed in patients with complaints of dizziness or vertigo [1–3 ]. The supine cervical flexion-rotation test (SupCFRT) reliably assesses for the presence of upper cervical spine dysfunction (UCSD) [4 ]. UCSD has been linked to symptoms often seen in those diagnosed with dizziness or vertigo. Patients diagnosed with dizziness/vertigo often do not tolerate the supine testing position necessary to perform the SupCFRT, but often tolerate sitting well. PURPOSE: To determine if UCSD can be assessed in sitting as reliably as in supine. METHODS: Forty-five college age students (23.7±3.3 years…old) acted as controls while forty-six subjects (56.71±14.6 years old) who were referred for physical therapy services by their medical provider acted as the patient group. The SupCFRT was performed first, [4 ] the Seated Cervical Flexion-Rotation Test (SeatCFRT) was performed next by positioning the subjects seated with their back against a high-backed chair, the head was flexed maximally, then rotated maximally left and right. The SupCFRT [4 ] and SeatCFRT were considered positive if range of motion limitations were found. Results for each test was compared using McNamar X 2 . RESULTS: There was no difference, p > 0.05, between SupCFRT and SeatCFRT for all conditions; all subjects (n = 91), control subjects n = 45, subjects referred to physical therapy for treatment of dizziness or vertigo, n = 46. DISCUSSION: The SeatCFRT reliably identifies the presence of UCSD, in controls and patients diagnosed by a referring medical provider for dizziness or vertigo. Patients, who do not tolerate the supine position, can be evaluated for UCSD in the seated position.