Physiotherapy Practice and Research - Volume 42, 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: BACKGROUND: There has been extensive literature examining the efficacy of exercise interventions in the treatment of depression over the past few decades. However, there is ongoing debate regarding the optimal dosage, and the implications of utilising physiotherapists for the management of clinically depressed adults using exercise has not been examined. OBJECTIVES: This review aimed to examine the effectiveness of exercise as a treatment for depression (without comorbidities) and to determine the most effective dosage/mode to treat this population. This review strived to appraise the literature for a potential role for physiotherapists in depression management. METHODS: Following…the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, a search for randomized controlled trials was conducted on the nine databases. All studies were appraised for quality using the Physiotherapy Evidence Database (PEDro) scale and Cochrane Risk of Bias Tool (RoB). Data was manually extracted, and pre- and post-intervention depression scores and program variables were analysed. RESULTS: Of the 5036 papers retrieved, 7 papers met this review’s inclusion criteria. The results of the meta-analysis reveal that exercise as a sole treatment and as an add-on is significantly effective in reducing depressive symptoms. The findings support the use of moderate intensity aerobic exercise for three sessions per week. CONCLUSIONS: Exercise was shown to significantly improve depressive symptoms in depressed adults. This review adds to the growing body of evidence regarding the important role of physiotherapists in the treatment of psychiatric disorders in the design and implementation of exercise interventions.
Keywords: Exercise, depression, physiotherapy, intervention, mental health
Abstract: BACKGROUND: Posterior shoulder tightness as demonstrated by glenohumeral internal rotation deficit (GIRD) is a common contributor to many shoulder pathologies in overhead throwing athletes. PURPOSE: This study aimed to assess immediate effect of combining glenohumeral and scapulothoracic mobilization with stretching on improving internal rotation range of motion (ROM) in overhead athletes with GIRD METHODS: This study was a single-blind randomized controlled trial with parallel groups. The participants were 30 asymptomatic male volleyball players who had a loss of shoulder internal rotation ROM of 15 degrees or more on their dominant compared to their nondominant side. They…were randomly assigned to 1 of 2 groups: stretching only (n = 15) or stretching plus joint mobilization (n = 15). Participants in the stretching group performed cross-body stretches, and those in stretching plus mobilization group were treated with both cross-body stretching and mobilization techniques for the glenohumeral and scapulothoracic joints. Both groups received the intervention every other day for 1 week. Shoulder internal and external ROM were measured before and after the intervention. RESULTS: Before the intervention, dominant-side deficits in internal rotation ROM compared to the nondominant side were 20.11±5.27 degrees in the stretching group and 21.87±8.06 degrees in the stretching plus mobilization group. After the intervention, internal rotation ROM deficit between the dominant and nondominant side decreased to 11.28±5.82 in the stretching group (P < 0.001) and 10.85±9.19 in the stretching plus mobilization group (P < 0.001). However, the between-group difference was not statistically significant (P = 0.389). External rotation ROM remained unchanged in both groups (P > 0.05). CONCLUSION: Both interventions (stretching and stretching plus mobilization) can have the same beneficial effect in decreasing GIRD in asymptomatic overhead athletes.
Abstract: BACKGROUND: The number of rotator cuff repairs performed worldwide is increasing every year. However, there are still controversies regarding when rehabilitation after surgery should start. OBJECTIVES: To assess and to compare clinical and biomechanical outcomes of patients who were randomised and allocated to early or conservative rehabilitation after rotator cuff repairs. METHODS: Twenty patients were randomised to two treatment groups. The biomechanical assessments were performed before surgery and at three and six months, consisting of 3D kinematics and muscle activity from 5 muscles (upper trapezius, anterior deltoid, middle deltoid, posterior deltoid and biceps brachii) from six…movement tasks. In addition, the Oxford Shoulder Score and EQ-5D-5L were also recorded. At 12 months an ultrasound scan was performed to check the repair integrity. RESULTS: Overall, both groups had similar results for function and health-related quality of life. However, at six months patients in the early group had better range of motion (ROM) than those in the conservative group, especially for shoulder flexion (Early: median = 152.1° vs Conservative: median = 140.0°). The number of re-tear events was higher in the early group (5 vs 1), and of these only two patients reported symptoms at 12 months. CONCLUSION: Early rehabilitation may improve ROM but it does not seem to be superior to a conservative management in improving function and quality of life. In addition, more re-tear events were observed in the early group. However, the results should be interpreted with caution due to the small sample size.
Keywords: Rotator cuff repair, early rehabilitation, randomised controlled trial, biomechanics
Abstract: INTRODUCTION: Approximately 14,000 – 21,500 individuals per year are dissatisfied with the outcome of their Total Knee Replacement (TKR) in the UK National Health Service (NHS). National Institute of Clinical Excellence (NICE) guidelines recommend that future research should evaluate whether a ‘full programme of pre-habilitation’ can improve outcomes for patients awaiting TKR. The aim of this review was to describe current pre-habilitation practice for patients awaiting TKR in the UK NHS, to inform future research. METHODS: Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of UK NHS Trusts that included detail about…pre-habilitation for patients awaiting TKR. One reviewer extracted data, and a second reviewer verified this. RESULTS: Fifty PIS, nine information videos and one web page from 59 NHS Trusts were identified. NHS Trusts most commonly provide patients with advice on pre-operative rehabilitation via a single appointment, combined with a PIS (36/59; 61.0%). NHS Trusts use appointments, PIS and video to provide patients awaiting TKR with information regarding pain control (46/58; 79.3%), exercise therapy (46/58; 79.3%), what to expect on the day of surgery and in-patient stay (58/58; 100%), lifestyle interventions (27/58; 46.6%), and adverse events (44/58; 75.9%). CONCLUSION: NHS Trusts commonly provided patients awaiting TKR with ‘advice on pre-operative rehabilitation’, however no NHS Trust provided a comprehensive programme of pre-habilitation. The results of this study will inform the development of a comprehensive, multi-modal pre-habilitation programme, to be tested in a future high-quality randomised controlled trial.
Abstract: PURPOSE: Sport-related concussions (SRC) are common, especially in rugby (3.00 incidents per 1000 athletic exposures) and American football (0.08 per 1000 athletic exposures). Physiotherapists should be aware of how to assess and manage cases with SRC. The purpose of this study was to assess the knowledge of SRC among physiotherapists. METHODS: The self-administered survey consisted of 16 questions related to physiotherapists’ knowledge in managing SRC patients, case identification, and preventive measures. Countries were divided into regions based on World Physiotherapy regions. Data were analysed using a one-way Analysis of Variance (ANOVA) with Tamhane’s T2 post hoc test.…RESULTS: A total of 276 male (53.4 %) and 241 female (46.6%) physiotherapists participated. The survey scores ranged from 40% to 100%, with an average score of 62.7%. A master’s degree was the highest educational qualification (46.4%) recorded. There was a difference in the score based on participant qualifications (Welch’s F (4, 58.37) = 15.03, p < 0.001). Participants with a Doctor of Philosophy (PhD) degree (73.8±14.6%) or a fellowship (73.0±19.5%) or a masters’ degree (MSc) (62.7±18.5%) obtained greater scores than participants holding a bachelors’ degree (56.7±13.8%, p < 0.001). Furthermore, there was no difference in the survey score based on participants’ region (Welch’s F (4, 143.3) = 0.08, p = 0.988). CONCLUSIONS: The results suggested that many physiotherapists worldwide are aware of the current SRC assessment and management guidelines.
Keywords: Sports injuries, head trauma, awareness, rugby, young athletes
Abstract: OBJECTIVES: To assess the feasibility of a 30-minute education session for patients with patellofemoral pain on levels of catastrophizing and kinesiophobia. DESIGN: Randomised feasibility study SETTING: Three sites within a single NHS Organisation in England. PARTICIPANTS: Thirty-one adult patients were screened for inclusion, resulting in twenty-four who had a clinical diagnosis of patellofemoral pain being randomised equally to either the intervention or control group. INTERVENTION: Participants were randomised to either control or intervention conditions; both received standardized physiotherapy while the intervention/experimental group received a 30-minute educational session addressing causes of pain, beliefs…about noise that comes from the joint, the impact of the pain on activity, the influence of other family members’ experience and beliefs about knee pain. Intervention participants were also given an education leaflet : ‘Managing My Patellofemoral Pain’. MAIN OUTCOMES: recruitment, retention, intervention fidelity. Patient reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF), Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK). RESULTS: The study was successful in recruiting and retaining participants and was delivered as intended. In addition, sufficient clinical data were generated to calculate the required sample size for a future study of efficacy CONCLUSIONS: This study which featured a 30-minute education session targeting levels of catastrophizing and kinesiophobia is feasible and identified that the TSK may be the most appropriate PROMs for a future study of efficacy of this intervention. Allowing for a drop out of 20% as identified in similar studies, 86 participants (per arm) in a two-arm study would be required for a traditional randomised controlled trial design.
Abstract: BACKGROUND AND OBJECTIVES: Airway clearance techniques (ACTs) are used by physiotherapists with the purpose of clearing sputum from bronchial airways. They are commonly prescribed for patients experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPD), however large variability in practice is commonly observed. This study aimed to explore current physiotherapy practice regarding ACTs for people with AECOPD in the Republic of Ireland. METHOD: An online survey was distributed to physiotherapy clinicians via direct email and the Irish Society of Chartered Physiotherapists. Main survey themes, identified from previous studies using the same survey tool, included current practice in relation…to use of ACTs, perception of their effectiveness, clinical reasoning and awareness of the literature and guidelines. For the purpose of this study, ACTs were defined as techniques used by a physiotherapist for the purpose of clearing sputum from patients’ airways. RESULTS: 202 surveys were distributed and seventy responses (35%) were received. The majority of respondents (n = 56, 80%) reported prescribing ACTs for more than 60% of patients with AECOPD, the most common techniques being physical activity (n = 65, 93%) and active cycle of breathing techniques (n = 53, 90%). Sputum management (n = 66, 94%) was the most commonly reported indicator for use of ACTs. The majority of physiotherapists (n = 42, 60%) reported being unsure of the literature regarding ACTs in AECOPD. CONCLUSION: The response rate to this survey was low, however results show that physiotherapists in the Republic of Ireland regularly prescribe ACTs for patients with AECOPD. Physical activity and active cycle of breathing techniques were the most commonly used ACTs and perceived to be the most effective techniques in AECOPD, with sputum management the most commonly reported indicator for use. Further research is required to explore not only physiotherapists clinical reasoning in relation to the use of ACTs for AECOPD and the perceptions of their effectiveness, but also the lack of awareness of the literature and guidelines.
Abstract: PURPOSE: This mixed methods study explored older adults’ experience using a bespoke active computer gaming (ACG) system designed to deliver falls prevention exercise. METHODS: Usability, acceptability and safety were evaluated through observation of system use, questionnaires, in-system ratings, and semi-structured interviews. Quantitative and qualitative data were synthesised concurrently to provide a deeper understanding of older adults’ experience with the system. RESULTS: N = 7 older adults (aged 73–88 years, most with increased fear of falling, and over half with reduced physical functioning) completed up to six uses of the system. Observations and qualitative feedback suggested that older adults’…experience with the system was influenced by physical health changes associated with ageing. Overall feedback after using the system was positive. Social support, from either the clinician or a peer, was a key theme influencing experience. CONCLUSIONS: Findings suggested that autonomous use of the system may not be feasible given the requirement and preference for social support.
Abstract: INTRODUCTION: More than one in three older adults (≥65 years) fall within a two-year period. Over one third of cancer diagnoses are among people aged ≥75 years. Falls research in the UK cancer population is limited and contradictory. The aim of this study was to explore the association between a cancer diagnosis and incidence of falls in older adults in England. METHODS: Data were extracted from the English Longitudinal Study of Ageing (an ongoing panel study) collected between 2002 and 2014, consisting of a representative cohort of older adults living in England. Baseline data were collected within two-years…of a cancer diagnosis. Falls data were extracted from the subsequent two-year period. The unexposed group included those with no chronic conditions. The fully adjusted logistic regression analysis model included age, sex, wealth, and education level as covariates. We defined odds ratios between 0.67 and 1.5 as the region of practical equivalence. RESULTS: A total of 139 people had a type of cancer (exposed group) (Breast = 18.7%, Colon, Rectum or Bowel = 14.4%, Melanoma or Skin = 7.2%, Lung = 4.3%, Somewhere else = 51.8%) (70.6±7.1 years; 58.3% male) with 3,899 in the unexposed group (69.5±7.3 years; 54.6% male). The fully-adjusted odds ratio was 1.21 (95% CI: 0.81 to 1.82; P = 0.348). The probability of falling among the exposed group was 22.7% versus 19.5% for the unexposed group. CONCLUSION: The cancer and control groups were not statistically equivalent for falls incidence, and a meaningful positive association between cancer and falls cannot be ruled out. Further research is required to elucidate this relationship.
Keywords: Cancer, older adults, ageing, falls, english longitudinal study of ageing