Physiotherapy Practice and Research - Volume 43, 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: INTRODUCTION: Physiotherapists in Irish hospitals with critical care units deliver physiotherapy services 24 hours a day, seven days a week. There is a perceived lack of consistency in the level of clinical competence, required skills and content of training between hospitals, compounded by the absence of a national policy, procedure or clinical framework for physiotherapists working in critical care. The study aimed to identify the minimum standards of clinical practice expected of physiotherapists working in critical care settings in Ireland. METHODS: A modified Delphi technique was used to survey a panel of senior and clinical specialist physiotherapists working…in critical care units in Ireland to obtain consensus of items. The questionnaire of 214 items was completed over three rounds. Items were determined ‘Essential/Not Essential/Unsure’ by participants. Items that did not reach consensus were included in the subsequent round with additional items suggested by participants. RESULTS: 25/46(54%) physiotherapists completed the first round, with 17 and 13 completing round 2 and round 3 respectively. A total of 220 items were included, 120 of which were deemed essential for a minimum standards of independent clinical practice in Irish critical care units. Fifty-six items were considered not essential while consensus was not reached on 44 items. CONCLUSIONS: This study identified 120 items of knowledge and clinical skills considered essential as a minimum standard by physiotherapists working in Irish critical care units. Further discussion is required to determine how these results can be applied to guide clinical practice for physiotherapists working in critical care in Ireland.
Keywords: Critical care, physiotherapy, on-call, minimum standards, education
Abstract: INTRODUCTION: Poor cardiopulmonary fitness is associated with an increased risk of morbidity and mortality following major surgery. Targeted prehabilitation interventions with adequate intensity improve cardiopulmonary function. Several systematic reviews have noted the variation in outcomes for prehabilitation, providing poor evidence due to inadequate patient numbers and poor compliance. Our aim was to assess the outcomes of the Preoperative Education and Prehabilitation Program (PrEPP) for patients undergoing major abdominal or thoracic surgery. METHODS: PrEPP is a supervised education and exercise training program twice a week and an at-home exercise program three times a week for up to four weeks.…A comparison of outcomes was made using the data collected on each patient in PrEPP with a historical control group. RESULTS: There were 370 patients, 185 in each group. They were matched for age (+/- 10 years), gender, and surgery type. There were significant reductions in prolonged ventilation (>48 hours) from 5.4% to 1.1% (p = 0.03) and mean length of stay (LOS) from 10.2 days to 8.5 days (p = 0.04) in the PrEPP group. The incidence of superficial surgical site infection was also found to be less in the PrEPP group (p = 0.02). There were no significant differences in the incidence of pneumonia (3.8% to 2.7%), unplanned re-intubation (3.8% to 1.6%), readmission rate (12.4% to 9.7%), cardiac events or other post-surgical infections. CONCLUSION: The PrEPP was associated with reduced ventilation days and LOS. Further studies are required to confirm these results.
Abstract: BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) is one of the neurophysiological techniques aimed at reducing pain and disability. This systematic review objective addresses the current evidence on PNF techniques’ effectiveness in chronic low back and neck pain. METHODS: Literature search in PubMed, Scopus, Cochrane, Wiley and Ovid databases were searched until 2021. The content of the titles and the abstracts were analysed to gather information about the effects of PNF in chronic back and neck pain with outcomes of pain and disability. The quality of the studies was analysed by the Joanna Briggs Institute (JBI) critical appraisal score. Meta-analysis…was performed on Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) for chronic low back pain and Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ) for disability. RESULTS: Nine studies addressed the different PNF based interventions on chronic low back pain, with a total of 416 participants. The intervention period ranged 3–6 weeks, and two studies conducted 12-weeks follow-up. Many studies measured pain using a VAS and NRS, whereas the disability through ODI and RMDQ. The JBI score ranged from 6/13 to 11/13. None of the PNF studies treated chronic neck pain. CONCLUSION: PNF might be beneficial for reducing low back pain and related disability. The long term effects of PNF on chronic low back pain, and also to determine its benefits on chronic neck pain are warranted in future studies.
Abstract: BACKGROUND: Neurodynamic tests (NDT) have shown to be useful in evaluating neural tissue involvement. Clinicians evaluate NDT using range of motion, sensory responses like location or quality of symptoms, Nerve conduction values and compare its results with normal values. Currently, there are no studies in lumbar radiculopathy patients that define the normal response to peroneal neurodynamic test (NDTPER ) PURPOSE: To study the sensory responses to neurodynamic testing of peroneal nerve in patients with lumbar radiculopathy. DESIGN: A cross sectional study design. METHODS: NDTPER was performed on 57 patients with lumbar radiculopathy. Hip…flexion angle was taken at the onset of symptoms (P1) and point of maximally tolerated symptoms (P2), quality and distribution of symptoms were recorded. Sensory nerve conduction velocity measure (SNCV) was also noted in those patients. MAIN RESULTS: The descriptor of nature of sensory responses most often used by patients was tingling (28.07%) in the lateral foot (26.32%). Hip flexion was significantly higher at P2 than P1 (mean difference: 22.54±3.73°; 95% CI: 21.55°, 23.54°; p < 0.0001). The SNCV of affected limb was marginally reduced but not statistically significant compared to contralateral limb (mean difference: –1.467±0.8013; 95% CI: –3.054, 0.1209; p = 0.0698). CONCLUSION: This study describes the hip angle at which symptoms are reproduced, nature and distribution of sensory responses to the NDTPER in patients with lumbar radiculopathy. However, the sensory nerve conduction velocity of affected limb was reduced marginally but not statistically significant as compared to unaffected limb.
Abstract: INTRODUCTION: Previous research has shown that 40% of people who suffer an ankle sprain will develop chronic ankle instability (CAI). Both mechanical insufficiencies and functional insufficiencies contribute to the development of CAI. In order to reduce the incidence of CAI and to provide the highest standard of care to patients, physiotherapists must be able to identify these insufficiencies in order to develop an appropriate treatment pathway. METHODS: We designed an online survey which the Irish Society of Chartered Physiotherapists sent to members within particular subgroups. The survey allowed us to determine the competencies of Chartered Physiotherapists in conducting…a comprehensive clinical ankle assessment, their knowledge of CAI and their self-rated confidence in treating and assessing an ankle injury. RESULTS: From the emails distributed, 263 people chose to take part. Of those, 87 people completed the survey, yielding a response rate of 33%. Of the 87 respondents, 49% could not identify any mechanical impairments, and 40% could only identify one. 47% could not identify any functional impairments, 21% identified one and 25% identified two. 62% of participants did not include ankle joints arthrokinematics in their clinical assessments of ankle injury, and 60% did not include patient reported outcome measures. Therefore the majority of Irish physiotherapist’s are not meeting the minimally accepted standards of ankle injury assessments. Despite this, 86% of participants rated themselves as 6/10 or greater in their own clinical assessment proficiency. CONCLUSION: Our results highlight that Irish physiotherapist have a limited understanding of the mechanical and functional insufficiencies contributing to the development of CAI.
Abstract: BACKGROUND: Injuries are frequent in hurlers and injury prevention exercise programmes implemented during their warm-up could play a role in reducing injury risk. OBJECTIVES: To determine whether a ten-week Activate GAA warm-up intervention improves outcomes (landing mechanics, dynamic postural control, quality of movement and hamstring and adductor strength) in hurlers. METHODS: A non-randomized controlled trial was implemented in adult male non-elite hurlers (intervention n =58; control n =59) and players were eligible if they were uninjured and currently playing with a non-elite hurling team. The landing error scoring system (LESS), Y balance test, overhead squat, single…leg squat, hamstring strength test and adductor break test were assessed by one Certified Athletic Therapist pre- and post-intervention. The intervention group completed the Activate GAA warm-up prior to all training and games. Two participants were unable to complete post-testing due to injury in the control group only. RESULTS: The ANCOVA analysis revealed that the intervention group’s landing mechanics (LESS total score: p <0.0001, η p 2 =0.34), postural control (Y balance test composite score: p <0.0001, η p 2 =0.23), and quality of movement (Overhead squat: p <0.0001, η p 2 =0.21; single leg squat dominant: p =0.04, η p 2 =0.0.04; single leg squat non-dominant: p <0.0001, η p 2 =0.12) were significantly better than the control group. Adductor and hamstring strength were not significantly improved (p >0.05). CONCLUSIONS: These findings support the use of the Activate GAA warm-up in non-elite adult male hurlers with improvements observed in landing mechanics, dynamic postural control and quality of movement. Randomised controlled trials to examine its effect on injury incidence along with consideration of long-term compliance are required.
Abstract: BACKGROUND: Badminton depends on key factors like reaction time, agility and core endurance to deliver a powerful and precise stroke. The purpose of this study is to explore the associations between agility and core endurance on visual reaction time among adult male amateur badminton players. MATERIALS AND METHODS: Amateur male badminton players between 12–25 years were recruited and assessed on visual reaction time, agility and core endurance using deary liewald reaction time software, T test and prone bridge test respectively. Pearson correlation test was used to analyze the data for correlation while Mann Whitney U test was…used to find the difference, if any, between the adolescent and adult players in terms of reaction time, agility and core endurance. Data analysis was done using SPSS software version 23. RESULT: Ninety amateur male badminton players in the age group of 12–25 years were included in the study. Data analysis was done for adolescent players (n = 45 of 12–17 years) and young adult players (n = 45 of 17–25 years). A positive correlation was obtained between reaction time and agility in both adolescents’ and young adults and the entire population with r value 0.413, 0.082, and 0.244 respectively. A negative correlation was seen between reaction time and core endurance in adolescents, young adults and whole group with r value –0.283, –0.267, –0.272 respectively. CONCLUSION: Amateur badminton players who had good agility displayed faster reaction time while those having poor core endurance showed slower reaction time.
Keywords: Agility, Core endurance, reaction time, amateur badminton players
Abstract: INTRODUCTION: Knowledge of the risk factors for falls is necessary for the prevention of falls in older adults. This study aimed to identify the levels of knowledge of the risk factors of falls among physiotherapy students in Malaysia. METHODS: A total of 239 physiotherapy students from seven institutions completed a two-section questionnaire about their sociodemographic information and knowledge regarding risk factors for falls (balance/gait disorders, muscle weakness, environmental hazards, postural hypotension, sensory/perceptive deceptive, multiple medications, impaired cognitive and foot/footwear problems) that were answered on a Likert scale ranging from “Not very important (1)” to “Very important (5)”.…RESULTS: Analysis indicated that only two factors scored means of > 4, namely balance/gait disorders and muscle weakness, with 82.8% and 65.7% responded “very important”, respectively. The factors with the lowest means were postural hypotension (3.41±1.40) and multiple medications (2.97±1.21), in which the majority of the participants responded as “somewhat unimportant” or “moderately important. Students studying full-time and those with no working experience were significantly better than part-time students and those with working experience, respectively, in the level of knowledge of risk factors of falls (Both p < 0.05). CONCLUSION: This study suggests that physiotherapy students in Malaysia may have insufficient knowledge about the risk factors of falls as all factors should be deemed very important. The higher education providers should design a comprehensive curriculum considering all factors, especially postural hypotension and multiple medications.
Keywords: Falls, Malaysia, physiotherapy, prevention strategies
Abstract: BACKGROUND: Balance-based torso-weighting has improved gait and balance performance in people with multiple sclerosis (MS) in a single session with torso-weights on, demonstrating an orthotic effect. Daily use of torso-weighting may promote motor learning and more enduring therapeutic effects but has not yet been studied. PURPOSE: Confirm orthotic effects and compare therapeutic effects of daily torso-weighting versus shape/sham-weighting or no weighting. We hypothesized that daily torso-weighting would result in positive effects on gait and balance, tested without weights. METHODS: Five participants with MS experienced three conditions for 2-4 weeks each: no weights first, then double-blinded randomization…to torso-weighting or shape-weighting first then cross-over to the alternate condition. Personalized torso-weighting on a vest-like garment countered individual reactive balance responses following manual perturbations. Postural sway recorded orthotic effects with/without torso-weights while standing on a force plate with eyes open/closed. Clinical measures recorded therapeutic effects while unweighted: gait parameters, 6-Minute Walk Test (6MWT), and Sensory Organization Test (SOT). Weighting conditions were compared using paired t -tests with one-tailed alpha at 0.05. RESULTS: Postural sway decreased significantly with torso-weights. Cadence and step width improved significantly after torso-weighting versus shape-weight periods. Average gait parameters showed no improvement after shape-weight periods. Velocity, 6MWT, and SOT tended to improve with torso-weighting, averaging improvements of+15%,+16%, and+13.8%, respectively. CONCLUSIONS: Findings support both orthotic and therapeutic effects of torso-weighting. Daily use of torso-weights for multiple weeks may promote motor learning of gait parameters and balance. Further research is warranted to examine sensory augmentation as a potential mechanism.
Keywords: Postural control, gait, multiple sclerosis, rehabilitation, motor learning, torso-weighting
Abstract: OBJECTIVE: To evaluate the literature on children and young people with symptomatic hypermobility using a developmental framework. METHODS: A search was conducted in EMBASE, Medline, CINAHL, Web of Science and grey literature. Full text articles reporting children and young people (birth to 24 years) with a confirmed diagnosis of symptomatic hypermobility (including Hypermobility Spectrum Disorder or hypermobile Ehlers-Danlos syndrome) using internationally recognised criteria or equivalent diagnoses were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews methodology was followed. RESULTS: Of the 1619 studies screened, 163 were included in the…scoping review. Studies were published from 1967-2021, 30% were narrative reviews and 24% were case reports, from a range of journals. Musculoskeletal and cutaneous characteristics were common in all developmental stages. Cardiovascular characteristics including autonomic dysfunction, fatigue, and gastrointestinal issues were reported more frequently by adolescents. Young adult studies were scarce and included mostly case reports. Varied diagnostic criteria and assessment methods were identified. The Beighton Score was frequently used (93%), but rarely standardised (12%) and lacked consensus regarding the cut-off point of hypermobility. CONCLUSIONS: This novel systematic scoping review identifies the changing phenotype of symptomatic hypermobility from childhood to adolescence, and the unique stage of young adulthood. There is a lack of guidance regarding the utilisation of standardised tools to assess hypermobility in clinical practice and research. Numerous and inconsistent diagnostic criteria and assessment methods limit the data analysis. Case control and longitudinal studies using defined, bespoke criteria and assessments are needed.
Keywords: Joint hypermobility, symptoms, paediatrics, adolescent health
Abstract: BACKGROUND: Head trauma can cause secondary benign paroxysmal positional vertigo (BPPV). BPPV is a common peripheral condition which can lead to significant morbidity, psychosocial impact and increased medical costs [1 ]. CASE DESCRIPTION: A patient post fall with an associated head trauma presented to the emergency department with severe vertigo, nausea, and decreased mobility. The patient was assessed and treated by a vestibular trained physiotherapist. The patient was treated with one Epley repositioning manoeuvre and had complete resolution of symptoms and was discharged home the same day. CONCLUSION: BPPV can be successfully identified and treated by…vestibular trained physiotherapists in the emergency department. Early access to vestibular trained physiotherapy in the emergency department resulted in diagnosis and evidence-based treatment of BPPV which prevented hospital admission and improved this patient’s outcome. The patient had complete resolution of symptoms post the repositioning manoeuvre and was discharged to home.
Keywords: BPPV, vestibular physiotherapy, emergency department, case study
Abstract: OBJECTIVE: The satisfaction and acceptance of telehealth by the Irish physiotherapy service user is currently unclear. This study aims to evaluate the Irish service users’ experience of physiotherapy delivered totally or partially via telehealth, using a cross-sectional self-reported anonymous postal survey. METHODS: Service users (n = 250) of the Cavan Monaghan physiotherapy department, Health Service Executive (HSE), Republic of Ireland were surveyed. Data was collected on demographics, experience with technology, experience and satisfaction with physiotherapy delivered via telehealth. Qualitative thematic analysis of the free-text responses was completed. RESULTS: A response rate of 40% was achieved. Participants attended…physiotherapy for an average of 2.65 months. Upper limb complaints comprised 29% of participants, 27% had a back complaint, 21% had a lower limb complaint and 14% attended for a women’s health issue. Those who received their physiotherapy consultation over the phone comprised 78%, while 15% received it virtually and 85% were highly or somewhat satisfied with the telehealth physiotherapy they received. However, 49% prefer blended care (combination of telehealth and face-to-face), 41% prefer face-to-face consultations only and 10% are satisfied with telehealth solely. The recipients of virtual calls were all satisfied. In the future, 60% of these participants would prefer blended care, 20% would prefer face-to-face care only and 20% would be satisfied with telehealth solely. CONCLUSION: The physiotherapy telehealth services were well received. There was a greater acceptance of future telehealth usage by video call recipients compared to those who received a phone call only. Engagement with appropriate service users and their needs will be required to ensure the longevity and success of telehealth.
Keywords: Telehealth, COVID-19, physiotherapy, healthcare delivery, blended care
Abstract: PURPOSE: The aim of our study is to evaluate effects of early rehabilitation treatment in hospitalized patients with severe COVID-19, in order to improve patients’ autonomy and quality of life. METHODS: This observational study has been performed in hospitalized patients with severe COVID-19. All patients were evaluated at T0 using specific scales: Modified Barthel Index (MBI) for autonomy in ADL, Mini Mental State Examination (MMSE) for cognitive status, Borg scale for dyspnoea, EQ5D scale for quality of life. In absence of contraindications for the rehabilitation treatment, patients start early a rehabilitation protocol consisting of one session (30 minutes)…per day, for 2 to 3 weeks; these scales have been repeated at patient’s demission (T1). RESULTS: 70 patients (37 women and 33 men, with average age of 71 years) with severe COVID-19 were included in the study. After rehabilitation treatment, MBI increases statistically significantly from T0 to T1 (39.8±35.0 with 95% CI 31.6–48, vs 69.8±38.1 with 95% CI 60.8–78.7, p < 0.001); besides MBI at T0 correlates inversely and statistically significantly with all EQ-5D variables at T0, similarly at T1 (p < 0.001), indicating the improvement of autonomy and therefore of the quality of life. The MMSE correlates statistically significantly with MBI at T0 and T1 (r = 0.569, r = 0.747 respectively, p < 0.001), indicating that an adequate cognitive status is connected with a greater increase in autonomy in ADL after rehabilitation treatment. MBI correlates directly and significantly with the PaO2/FiO2 value both at T0 and T1 (r = 0.263 with p = 0.039, r = 0.389 with p = 0.023 respectively), indicating that improving the oxygen exchanges also improves the patient’s autonomy. CONCLUSIONS: An early rehabilitation treatment should promote autonomy and a better quality of life in patients with COVID-19.
Keywords: Rehabilitation, COVID-19, quality of life
Abstract: BACKGROUND & OBJECTIVE: The treatment outcome is influenced by the relationship between health care providers and patients. So far, there is no validated tool/scale in Hindi which can be used in the Indian population to gather data on empathy and holistic care provided by the healthcare professionals during their consultation. The primary goal of the study is to translate and cross-culturally adapt the CARE scale to Hindi. Also, to determine its content validity and reliability so that further research can be done on the Hindi speaking Spinal Cord Injury population. METHODS: The study was conducted in three phases,…namely Translation-Cultural Adaptation, Content Validity, & Reliability. The CARE measure was translated into Hindi and qualitative and quantitative content validation through the expert opinion and the content validity ratio (CVR) method was tested on a purposive sample of 30 spinal cord injury (SCI) individuals in two rehabilitation centres in New Delhi, India. Item analysis was conducted (on 50 SCI individuals) to determine internal consistency reliability. RESULTS: The Hindi CARE measure high has high internal consistency reliability (Cronbach’s alpha = 0.924). CVR and qualitative review done by the panels of experts validated the content of the CARE measure. CONCLUSION: The CARE measure- Hindi version is a validated and reliable tool to be used in Hindi speaking Spinal Cord Injury population context. Further work is required to establish test-retest reliability and studies on bigger sample size.
Keywords: Empathy, patient-centred care, holistic approach, spinal cord injury, validation
Abstract: BACKGROUND: Engagement in continuing professional development (CPD) has recently become a mandatory requirement for practice in Jordan. This was part of the Jordanian government strategy to advance healthcare. AIMS The study aimed to draw the landscape of CPD for Jordanian physiotherapists. The activities, attitudes, and workplace environment related to CPD were explored. METHODS: A quantitative web-based survey was used to collect data. The survey was open for potential participants for three months from 29/01/2020. Only physiotherapists practicing in Jordan; and involved in direct patient care were invited to take part. Descriptive analysis was performed.…RESULTS: Eighty-six Physiotherapists representing multiple cities in Jordan completed the survey. The percentage of female participants was 52.3%. Most participants were general physiotherapists (N = 42). Around 13% held a post graduate qualification. Most participants fulfilled the required number of CPD hours. The main driver for engagement in CPD was advancing knowledge (N = 47, 55%), followed by improving patients’ care (N = 22, 26%), and maximising opportunities for employment or promotion. Participants engaged with local workshops, reading articles in medical journals, and attending theoretical lectures in the workplace. The main barriers to engage with CPD were the high financial burden (N = 65, 76%), inability to travel (N = 40, 47%), and time limitations (N = 33, 38%). CONCLUSION: This study is the first to provide evidence of the activities, motivators, and barriers to CPD in a sample of Jordanian physiotherapists. Findings are important in informing healthcare policymaking. It offers directions to maximise the impact of CPD.
Keywords: Physiotherapy, continued education, continuing professional development, lifelonglearning, The Hashemite Kingdom of Jordan
Abstract: INTRODUCTION: Low back pain (LBP) is the top global cause of disability, and physiotherapy interventions are used to manage it. However, understanding of the practice pattern of physiotherapists dealing with LBP patients in low- and middle-income countries (LMICs) is limited. This study aimed to explore the LBP practice pattern of LMIC’s (i. e., Bangladesh) physiotherapists by their demographic and professional factors. METHODS: This cross-sectional study sent a survey to randomly selected physiotherapists via email. RESULTS: Data of 423 illegible physiotherapist were analyzed. The majority of the physiotherapists (54.8%) were nongovernment service holders, and 87.7% worked in…an urban setting. Recommended interventions were frequently used by only 12.3%, occasionally used by 66.2%, and 21.5% did not offer those interventions. Partially recommended interventions were frequently used by 33.3%, occasionally used by 43.7%, and never used by 23% of physiotherapists. For not recommended interventions, 69.3% occasionally, 13.5% frequently, and 17.3% never used such interventions. CONCLUSION: The study explored the practice pattern of physiotherapists of an LMIC by comparing available evidence-based practice guidelines for LBP. The findings of this study may provide an LMIC database to inform future research, clinical practice and education to ensure adherence to evidence-based LBP physiotherapy management.
Keywords: Bangladesh, low back pain, physiotherapists, low-and middle-income countries, practice pattern.