Physiotherapy Practice and Research - Volume 41, issue 2

Authors: O’Shea, Orlagh | Moran, Jonathan

Article Type: Editorial

DOI: 10.3233/PPR-209002

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 93-93, 2020

Authors: McKee, Grace | Cronin, Catriona | Vasquez, Pedro | Burke, Dearbhla | O’Flaherty, Deirdre

Article Type: Editorial

DOI: 10.3233/PPR-209001

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 95-97, 2020

Authors: Mohan, Vikram | Paungmali, Aatit | Sitilertpisan, Patraporn | Joseph, Leonard | Ramlan, Afiqah | Ramlan, Syaza Afiqah

Article Type: Research Article

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. Show more

Keywords: Back pain, feldenkrais, respiratory, physiotherapy

DOI: 10.3233/PPR-190382

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 99-107, 2020

Authors: Stephens, Gareth | Nightingale, Peter | Mylogiannakis, Panos | Suokas, Anu

Article Type: Research Article

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. Show more

Keywords: Total knee arthroplasty, outcome, prognosis

DOI: 10.3233/PPR-200426

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 109-120, 2020

Authors: Taylor, Nicholas F. | Wintle, Elizabeth | Longden, Claire | van de Water, Alexander T.M. | Shields, Nora

Article Type: Research Article

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. Show more

Keywords: Shoulder fractures, rehabilitation, physical therapy modalities, activities of daily living

DOI: 10.3233/PPR-200412

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 121-131, 2020

Authors: Rafferty, Anthony | Donne, Bernard | Kiely, Patrick | Fleming, Neil

Article Type: Research Article

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. Show more

Keywords: Adolescent idiopathic scoliosis, spinal fusion, functional impairments, physical activity, muscle dysfunction

DOI: 10.3233/PPR-190365

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 133-141, 2020

Authors: Alashram, Anas R. | Annino, Giuseppe | Aldajah, Salameh | Bani Hamad, Sakher | Aliswed, Besan | Padua, Elvira

Article Type: Review Article

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. Show more

Keywords: Brain injury, traumatic, level of consciousness, physical stimulation, sensation, coma, rehabilitation

DOI: 10.3233/PPR-200428

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 143-153, 2020

Authors: Sulaiman, Amal Al-Shaikh | Kelly, Marie | O’Connor, Mairead | Bamiou, Doris-Eva | Pavlou, Marousa

Article Type: Research Article

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. Show more

Keywords: Dual-task, dynamic balance, gait, aging, executive function

DOI: 10.3233/PPR-190394

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 155-162, 2020

Authors: Oktar, Hatice Nur | Inal, Habibe Serap

Article Type: Research Article

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. Show more

Keywords: Visual illusion, gross motor skills, fine motor skills, tripod pinch grip.

DOI: 10.3233/PPR-190379

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 163-170, 2020

Authors: Ullucci, Paul A. | Kalach, Andrew | Reis, Brian | Avena, Soleil | Hinckley, Rebecca | Picard, Karlee | Gibson, Sandra

Article Type: Research Article

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. Show more

Keywords: Cervicogenic dizziness, cervicogenic vertigo, upper cervical spine, cervical flexion rotation test, benign paroxysmal positional vertigo

DOI: 10.3233/PPR-200398

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 171-176, 2020

Authors: Flahive, Mary | Broderick, Julie

Article Type: Research Article

Abstract: BACKGROUND: The relationship between physical function and the development of complications in people after abdominal surgery is not well known. The objective of this study was to prospectively examine the relationship between simple physical functioning tests and complications following abdominal surgery. METHODS: Participants were recruited from an elective surgery waiting list. The following variables were measured pre-surgery; functional capacity (Six Minute Walk Test, 30 Second Sit to Stand Test), grip strength (hand dynamometer), self-report physical activity [International Physical Activity Questionnaire, (IPAQ)]. At 30 and 60 days post-operatively IPAQ and self-reported recovery were collected by telephone. Data related to …complications and length of stay was extracted from the medical chart. RESULTS: Forty-nine participants (25M/18F) were recruited with a mean (SD) age of 59.5 (14.7) years. The complication rate was 41.9% (n  = 18). Factors which differed between the complications and no complications groups were; longer operating time (p  = 0.05),>2 co-morbidities (p  = 0.033), body mass index >30 (p  = 0.005), lower activity levels (p  = 0.02), VO2 Peak (p  = 0.017) and 6-minute walk distance (p  = 0.019). There was an increased length of stay (p  < 0.001) and sedentary time (p  = 0.007) in the complications group. Activity levels reduced in the whole group (p  < 0.001) even though self-report physical activity and recovery were high. CONCLUSION: A number of potentially modifiable physical functioning factors differed in the complication versus no complication groups. Future studies should evaluate whether optimizing physical functioning pre-operatively could alter complication rates and recovery in patients undergoing abdominal surgery. Show more

Keywords: Physical function, abdominal surgery, complications

DOI: 10.3233/PPR-190390

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 177-185, 2020

Authors: Omranipour, Ramesh | Alipour, Sadaf | Eslami, Bita

Article Type: Case Report

Abstract: BACKGROUND: Late occurrence of solitary soft tissue upper extremity metastasis of breast cancer is very rare. We hereby present a case of metastasis to the biceps muscle of the ipsilateral arm, detected by a physiotherapist six years after mastectomy. The aim of this report is to highlight the rarity of this presentation, to emphasize the role of the physiotherapist as a member of the multidisciplinary treatment team and the possibility of curative treatment despite the poor prognosis. CASE DESCRIPTION: A 2 * 3 cm well-defined isolated metastasis of breast cancer was diagnosed in the left arm of …a 31-year-old woman 6 years after successful treatment of her primary tumor. Tumor characteristics, diagnostic plan, and treatment options are discussed. CONCLUSION: Due to its scarcity, there is a lack of knowledge about the frequency, interval, characteristics, best diagnostic modality, adequate treatment, and prognosis of isolated breast cancer metastasis to the soft tissue, and these can be found out by proper reporting. As an important member of the multidisciplinary team in the care and treatment of breast cancer patients, physiotherapists should be aware of this type of rare presentation. Show more

Keywords: Breast cancer, metastasis, soft tissue

DOI: 10.3233/PPR-200402

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 187-191, 2020

Authors: O’Connor, Anne | McCurtin, Arlene

Article Type: Research Article

Abstract: BACKGROUND: Limited evidence exists regarding practice educators’ and practice tutors’ experience of, and training in, student supervision in the physiotherapy workplace. This knowledge would inform universities of their learning needs and help to enhance the practice-based experience for physiotherapy students. OBJECTIVE: The aim of this study was to create a profile of physiotherapy practice educators’ and practice tutors’ student supervision experience, university support available to them during practice placement and training undertaken by them. This study was undertaken in the Republic of Ireland. METHODS: An online survey was designed and circulated via the Irish Society of …Chartered Physiotherapists’ database of physiotherapy members. RESULTS: One hundred and ninety-two practice educators and 71 practice tutors participated. Findings indicate that the 1:1 model of practice education is the predominant model of practice education employed in the Republic of Ireland. 70% of practice educators currently receive support from a practice tutor. Fifty-five percent of practice educators undertake student supervision 2-3 times per year. However, 56% of practice educators and 48% of practice tutors had not undertaken training in student supervision in the year prior to the study. A decline was also noted in the uptake of student supervision among clinicians with 16–25 years clinical experience. CONCLUSION: This study provides an insightful profile of physiotherapy practice education in the Republic of Ireland. Findings are encouraging, with data highlighting that most practice educators are supported by practice tutors. Recommendations include the need for further investigation of the apparent decline in student supervision among experienced clinicians. Consideration of the learning needs of practice educators and practice tutors is encouraged as well as a review of the accessibility and flexibility of training resources provided. Show more

Keywords: Physiotherapy, practice education, practice educator, practice tutor, supervision

DOI: 10.3233/PPR-200427

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 193-199, 2020

Authors: Whelehan, Dale F. | Baily-Scanlan, Maria | Ridgway, Paul F.

Article Type: Research Article

Abstract: INTRODUCTION: Health professionals have been subject to increased levels fatigue when compared to population norms. It remains unknown if physiotherapists report high levels of sleep deprivation. This paper explores levels of sleep deprivation, and its potential impact on professional performance. METHODS: A survey was distributed through the Irish Society of Chartered Physiotherapists. The survey explored work characteristics, sleep quality using the Pittsburgh Sleep Quality Index, daytime sleepiness using the Epworth Sleepiness Scale, and the professional and non-professional causes of sleep deprivation in the profession. Pearson correlation and independent t -tests were used on SPSS to explore relationship between …variables. RESULTS: There was a total of 559 valid respondents. Females accounted for 82% and public sector employees accounted for 63% of respondents. Over half (50.1%) of respondents said they felt sleep deprivation impacted on their practice. Most physiotherapists (63.3%) of respondents said they did not feel that their practice impacted sleep. The PSQI global score was 5.6 indicating “poor” quality of sleep. The ESS global score was 6.0 indicating ‘higher normal daytime sleepiness’. Potential causes of sleep deprivation included professional issues relating to burnout and work-life balance, and non-professional reasons such as parenthood. DISCUSSION AND CONCLUSION: A mismatch exists between self-reported sleep deprivation and validated measurements of sleep indicating poor self-awareness of the impact of sleep in optimising professional performance. A work-life balance is needed to facilitate a safe and efficient workforce. Individual and organizational efforts should be made to improve sleep quantity and quality to reduce personnel fatigue and enhance physiotherapists professional performance. Show more

Keywords: Sleep deprivation, performance, fatigue, performance management

DOI: 10.3233/PPR-200400

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 201-211, 2020

Authors: Ross, Michael | Purrington, Benjamin | Zuniga, Colleen | Farnand, Brian | Pattacciato, Florianna

Article Type: Research Article

Abstract: PURPOSE: It is estimated that up to 80% of patients referred to outpatient physical therapy have diabetes, prediabetes, or diabetes risk factors; thus, physical therapists are in an optimal position to intervene as members of a multidisciplinary team working to effectively manage and reduce the diabetes epidemic. The purpose of this study is to assess the knowledge, practices, attitudes and beliefs of private practice physical therapists toward patients with prediabetes. METHODS: One thousand members of the Private Practice section of the American Physical Therapy Association were randomly selected through a random number generator to participate. Participants completed a …paper based survey that was specifically designed for this study. RESULTS: Sixty-three physical therapists (34 males, 29 females; mean age: 52.8±11.5 years; mean number of years of clinical practice: 25.7±12.3 years) agreed to participate. The majority of participants (79%) agreed that identifying prediabetes in their patients is important; only 3% identified all of the risk factors that should prompt prediabetes screening. Seventy three percent of participants identified the correct laboratory test to screen for diabetes;<10% could identify the correct laboratory parameters for diagnosing prediabetes and diabetes. Only 2% and 22% of participants could identify correct weight loss and physical activity recommendations, respectively. CONCLUSION: A number of gaps in the knowledge of private practice physical therapists were noted in this study. These results may have important implications for the education of private practice physical therapists, especially those providing care for patients without a referral who are at risk for diabetes. Show more

Keywords: Physical therapy, prediabetes, screening, management

DOI: 10.3233/PPR-190384

Citation: Physiotherapy Practice and Research, vol. 41, no. 2, pp. 213-223, 2020