Physiotherapy Practice and Research - Volume 42, 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: The mechanisms by which orthoses work has been poorly understood despite the widespread use of orthoses in the physiotherapy and podiatry professions. This lack of clarity has been largely fuelled by methodological flaws in the literature, namely, approaching orthoses in a comparative manner to itself and/or other interventions. Future research would be best served by returning to physics first principles. The ‘kinetic dose’ concept is an approach worthy of further exploration.
Abstract: Breast cancer is the most common type of cancer in women worldwide (J. Ferley et al., 2015). Breast cancer-related lymphoedema (BCRL) is a disabling complication with a long term impact on quality on life after breast cancer treatment, with an incidence of 2–5% in patients post sentinel node procedures (M. King et al., 2012) up to 40% following axillary lymph node dissection (A.C. Pereira et al., 2017). BCRL results in swelling of the arm, hand, and trunk which can lead to limb pain, heaviness, and altered sensation (Y.J. Sim et al., 2010). These symptoms can result in functional limitations, psychosocial…distress and an overall reduction in quality of life (S.J. Merchant et al., 2015). The aim of this review is to evaluate the effects of some of the more common conservative rehabilitation interventions in BCRL. Conservative interventions reviewed include early physiotherapy and exercise, complex decongestive therapy, manual lymphatic drainage, compression, electrotherapy & acupuncture, self-treatment & weight management. The review may inform policies for treatment within the health service.
Keywords: Lymphoedema, breast cancer, conservative treatment
Abstract: OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain…and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.
Keywords: Shoulder pain, exercise class evaluation, rehabilitation, rotator cuff
Abstract: BACKGROUND: Combined physical and psychological programmes (CPPP) are recommended for people with disabling low back pain (LBP). Cognitive Functional Therapy (CFT) is a physiotherapist-led low intensity CPPP with positive effects in previous studies. The clinical and cost effectiveness of CFT has not previously been evaluated in a randomised controlled trial (RCT) in the United Kingdom (UK) National Health Service (NHS). Before a definitive RCT can be completed it is necessary to determine if completing such a study is possible. PURPOSE: To determine the feasibility of completing a definitive RCT, that will evaluate the clinical and cost-effectiveness of CFT…in comparison to usual physiotherapy care for people with persistent LBP in the UK NHS. METHODS: A pragmatic two-arm parallel feasibility RCT comparing CFT with usual physiotherapy care for people with persistent LBP will be completed. Sixty participants will be randomly allocated to receive CFT or usual physiotherapy care. The primary outcome will be feasibility of completing a definitive RCT. Participant reported outcome measures will be recorded at baseline, three, six and twelve-month follow-up, including disability, pain intensity, quality of life and psychosocial function. Data will be analysed descriptively. A qualitative process evaluation will explore the acceptability of the research processes and interventions. DISCUSSION: The rationale and methodological design of a mixed methods feasibility RCT is presented. This study aims to inform the planning, design and completion of a future definitive RCT in the UK NHS. The results will be disseminated through peer reviewed open access journal publication.
Keywords: Low back pain, feasibility, RCT, cognitive functional therapy
Abstract: BACKGROUND: The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is a practical, generic and widely used tool to assess the functioning and disability in several settings and health conditions. Although the use of categorical variables is common, this choice to present data could separate persons with very close functioning profiles into different categories. PURPOSE: This study aims to compare different ways of expressing the WHODAS score and give elements for the researcher to understand and choose the most appropriate way to statistically analyse the WHODAS scores. METHODS: A methodological study with secondary data of one…hundred ninety-five women. The WHODAS score was analysed in different ways and associated with sociodemographic characteristics, lifestyle, and health aspects. The Poisson regression was chosen with the final WHODAS score in four variations (continuous, dichotomous, polytomous, and quartiles), and the presence of chronic disease. RESULTS: The analysis showed statistical significance in the univariate analysis for the adjustment variables and all the variations of the disability variable. The distribution analysis of the prevalence ratio and the AIC evidenced that the WHODAS score as a continuous variable had the lower AIC and statistical significance, as well as the most significant area under the ROC curve. CONCLUSIONS: These results show that the use of the continuous variable is the most indicated and that the categorization of the WHODAS score should be avoided.
Keywords: Data interpretation, functioning assessment, World Health Organization Disability Assessment Schedule–WHODAS
Abstract: OBJECTIVES: Injury in Irish dancing (ID) is pervasive and comparable to that in other elite dance genres. There is an absence of formalized education or training for ID teachers to understand and address this issue. This study investigated the injury prevention knowledge and beliefs of registered ID teachers internationally. METHODS: An online survey based on an existing questionnaire by the Fédération Internationale de Football Association (FIFA) was adapted to reflect relevant research in ID and other dance genres. It was piloted with seven ID teachers internationally. Participants, who were registered ID teachers were recruited through official ID governing…bodies and the networks of the Principal Investigator. RESULTS: Two hundred and thirty participants from eleven regions internationally completed the survey. A robust knowledge of the anatomical areas most often injured was displayed, with conflicting opinions on the incidence, location and causes of injuries in males and females. There was a clear appreciation of the vast array of risk factors potentially associated with injury, with warm-up, load management, physical strength, conditioning and flexibility all highly rated. There was lesser insight into important factors such as sleep, nutrition, and general and psychological health. Most teachers rated their injury prevention knowledge and practices as moderate/good but available educational resources as poor/fair. CONCLUSIONS: There is a need for education and training in numerous areas of injury prevention by multidisciplinary healthcare practitioners and other professionals, in partnership with the ID community, to ensure a clearer understanding of the biopsychosocial nature of injury prevention and performance optimisation.
Keywords: Irish dancing, injury prevention, knowledge, beliefs, health and performance
Abstract: BACKGROUND: Desensitisation to alarms, or alarm fatigue, is a concern for healthcare staff. Little is known about how physiotherapists relate to, or are affected by clinical alarms. This pilot study aimed to explore physiotherapists’ attitudes and practices towards physiologic monitor alarms (PMA) in critical care. METHODS: An online survey of physiotherapists with critical care experience working at a Model 4 Irish Hospital. A sample of convenience was used with all eligible physiotherapists invited to complete the online survey via email (n = 33). Demographic information was captured, as well as information on experiences, practices, and barriers and facilitators to…managing PMA. RESULTS: The response rate was 76% (25/33). All respondents worked on-call and weekends, with one respondent managing a current day-to-day critical care caseload. The majority of respondents (20/25, 80%) perceived all PMA as clinically important, but a workplace distraction (19/25, 76%). Negative emotions were commonly experienced by respondents on hearing PMA. All respondents (25/25, 100%) reported to notice their patient’s PMA, feeling they had a responsibility to respond. Respondents indicated varying levels of self-confidence in responding to PMA but commonly assessed the cause of the alarm (24/25, 96%) and checked the patient’s condition (24/25, 96%). Education and training was identified as a key barrier and facilitator for physiotherapists in terms of managing alarms in critical care. CONCLUSION: This study provides preliminary data on physiotherapists’ attitudes and practices towards PMA in critical care. Additional studies are necessary in order to verify the findings of this pilot study and further explore alarm fatigue amongst critical care physiotherapists.
Abstract: BACKGROUND: Several therapies are being used for the rehabilitation of stroke patients, such as Virtual Reality (VR) which has emerged as an interactive intervention to motivate and rehabilitate post-stroke patients. However, data comparison between the virtual and real environments is inconclusive. Thus, this study aimed to compare the kinematics and performance of the affected lower limb of post-stroke patients and healthy individuals during stationary walking activity between the real and virtual non-immersive environments. METHODS: A cross-sectional study was conducted with 10 stroke patients and 10 healthy individuals, matched for gender and age. The participants performed stationary walking in…a real and non-immersive virtual environment (Wii Fit Plus® –Running mode) for 3 minutes in random order. The performance was measured in both environments using the number of steps, while the kinematics was assessed by calculating the mean maximum flexion and extension of each joint (hip, knee, and ankle) of the affected lower limb. RESULTS: Post-stroke patients performed a higher total number of steps (p = 0.042), mainly in the third minute (p = 0.011), less knee flexion (p = 0.001) and total knee range of motion (p = 0.001) in the virtual compared with the real environment. CONCLUSIONS: Post-stroke patients performed more steps, with a faster cadence and smaller knee range of motion on the affected side in non-immersive virtual environment compared with the real environment.
Keywords: Cerebrovascular disorders, exercise therapy, lower extremity, psychomotor performance, video games
Abstract: INTRODUCTION: Kinesio tape (KT) is an emerging tool in paediatric physiotherapy. A small body of research suggests KT is efficacious with some children, but clinical guidelines are not yet available. The aim of this study was to gather physiotherapists’ practices and experiences using KT with children. The focus was on why, where, how, and how long physiotherapists use KT with children, and the outcomes they observe, to guide future experimental research. METHOD: Nine Australian physiotherapists, each with at least two years of experience using KT with children, were recruited. All nine physiotherapists completed a largely open-ended online survey,…and three of these physiotherapists participated in a brief follow-up telephone interview. Basic content analysis was conducted. RESULTS: The physiotherapists’ practices and experience with KT largely related to four themes: (1) taping for muscle activation; (2) gait and posture outcomes; (3) child tolerance limiting effectiveness; and (4) inconsistent application methods and treatment durations. CONCLUSION: Physiotherapists in this study used KT to serve a variety of purposes, it was mainly considered beneficial for improving gait and posture. However, there was little agreement regarding how to apply it, for how long, and the exact nature of its benefits. Empirical research is also lacking on these questions. The effectiveness of KT as an adjunct therapy for improving children’s posture and gait warrants further investigation. Research comparing specific taping application methods and durations will be valuable in guiding physiotherapists’ practice.
Abstract: BACKGROUND: People living with Parkinson’s disease (PD) are less active than healthy individuals. Ehealth is an emerging concept in healthcare which presents opportunities to promote physical activity (PA) in people with PD. The aim of this systematic review was to explore the effectiveness of ehealth in the promotion of PA in people living with PD. METHODS: Suitable articles were searched for using EMBASE, PsychInfo, Web of Science and OVID Medline databases using a combination of keywords and medical subject headings. Articles were included if they described an ehealth intervention designed to promote PA in people living with PD.…Two reviewers screened studies for suitability and extracted data. Risk of bias was assessed using the Cochrane risk of bias 2 tool and the Downs and Black risk of bias checklist. Due to the heterogeneity of studies, a narrative synthesis of study interventions and results was completed rather than a quantitative analysis. RESULTS: 1449 articles were screened. Four studies met the eligibility criteria which included 652 participants. Web and mobile applications were used to design the PA interventions. PA levels were measured using self-reported questionnaires, Fitbits, activity monitors and accelerometers. Three of the studies reported improvements in aspects of PA. However, this was not consistently reported in all study participants. No adverse effects, a high level of enjoyment and a relatively low attrition rate (∼12.5%) were reported. CONCLUSION: Ehealth is a safe and feasible intervention to promote PA in this population. It is unclear whether ehealth is effective at promoting PA in people with PD.
Keywords: Ehealth, Parkinson’s disease, physical activity, health promotion
Abstract: BACKGROUND AND PURPOSE: Physiotherapy is a key discipline in stroke rehabilitation. Physiotherapists sometimes select interventions following personal preference rather than a scientific rational. Data on physiotherapy approaches used in stroke rehabilitation may help policy makers and educators to plan education strategies and implement efficient clinical practices, thus improving rehabilitation effectiveness. We aimed to develop and test a questionnaire designed to survey physiotherapy interventions utilized in stroke rehabilitation. METHODS: We used a multistep questionnaire development method (literature review and synthesis; questionnaire drafting; expert validation; cognitive interviewing). Afterwards the survey proceeded to reliability testing; the outcomes of interest were completion…time, estimated comprehensiveness of the lists of interventions, and intraclass correlation coefficient (ICC). RESULTS AND DISCUSSION: Retrieved survey tools, their items, and a taxonomy were useful for the questionnaire development. We interviewed four experts; changes were made to the survey following their suggestions. Thirteen physiotherapists participated in cognitive interviewing and further changes were made. Thirty-five raters participated in the test-retest study. Most participants considered the list of physiotherapy interventions and assistive device exhaustive. Median compilation time and time interval between the two compilations were 7 minutes and 21 days. The observed ICC was 0.844 (95% confidence interval, 0.829/0.857). Our method provided a valid and reliable questionnaire, however further methodological considerations of sampling methods and contact delivery modes are needed. CONCLUSIONS: If adequately implemented, the questionnaire can provide information about interventions utilized in stroke rehabilitation practice by physiotherapists. Data eventually acquired could be useful for planning educational strategies and implementing effective clinical practices.