Physiotherapy Practice and Research - Volume 45, issue 1

Authors: Mazy, David | Manche, Eric | Geulette, Bernard | Beckers, Gautier

Article Type: Research Article

Abstract: BACKGROUND: Knee swelling is common after total knee arthroplasty (TKA). However, there is limited literature on its clinical implications. OBJECTIVE: The study aimed to determine whether a correlation exists between increased postoperative knee circumference, pain, functional score and range of motion. METHOD: Between November 2019 and June 2020, 114 patients were retrospectively enrolled in this study. Primary endpoints included the correlation between knee circumference change (KCC, and 1) postoperative pain 2) Oxford Knee Score, and 3) postoperative range of motion. These data were collected on day 2 and at 6 months postoperatively. RESULTS: The …mean knee circumference (KC) increase on postoperative day 2 was 9.27%. No statistically significant correlation was found between KCC and pain (p  = 0.853), KCC and patient-controlled analgesia (PCA) consumption (p  = 0.265), KCC and knee flexion (p  = 0.729) and extension (p  = 0.157). At 6 months postoperatively, no statistically significant correlation was found between KCC and pain (p  = 0.909), and Oxford Knee score (p  = 0.137). However a statistically significant correlation was observed between increased KC of more than 10% and extension deficit at 6 month postoperatively (p  = 0.012), as well as between KCC on day 2- and at 6 months postoperatively. CONCLUSION: After TKA the average increase in KC is around 10%. Increased postoperative knee effusion is neither an indicator for increased pain nor for unfavorable functional scores. At 6 months postoperatively, a correlation exists between increased KC and extension deficit for knees with more than 10% KCC. This study addresses common patient inquiries to physiotherapists regarding knee swelling following TKA. Show more

Keywords: Joint effusion, knee effusion, knee swelling, knee circumference, total knee arthroplasty Study design: retrospective cohort study. Level III of evidence

DOI: 10.3233/PPR-230795

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 1-5, 2024

Authors: Oliveira, Felipe Augusto da Silva | Calixtre, Letícia Bojikian | Santos, Laís Regina de Holanda | Pitangui, Ana Carolina Rodarti | Araújo, Rodrigo Cappato de

Article Type: Research Article

Abstract: BACKGROUND: Daily activities that involve upper limb movements require muscle activation from different body parts by transferring forces and energy along the functional kinetic chain. The scapulae connect and transfer forces between the trunk and the upper limbs, so scapular dyskinesis may compromise the performance of the kinetic chain. OBJECTIVE: To assess the relationship between core muscle performance and shoulder pain and function in individuals with shoulder pain, with and without scapular dyskinesis. METHODS: Data was collected from 77 non-athlete adults aged between 18 and 50 years with shoulder pain, 45 had scapular dyskinesis. Core muscle …performance was measured using the prone bridging test (PBT). Shoulder pain and disability were measured by the Shoulder Pain and Disability Index (SPADI), and the upper limbs’ stability was assessed by the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). The peak torque of shoulder external and internal rotators was measured using an isokinetic dynamometer. Multiple linear regression models evaluated the relationship between the PBT and CKCUEST, SPADI, and shoulder rotator strength. RESULTS: Significant correlations were found between the PBT and the SPADI total score (r  = – 0.522), pain domain (r  = – 0.513), and disability domain (r  = – 0.501); normalized score (r  = 0.593), and the power (r  = 0.624) of the CKCUEST; and peak torque for external (r  = 0.256) and internal (r  = 0.292) rotations. Scapular dyskinesis did not influence the magnitude of the correlations and predictive values. CONCLUSION: The PBT was correlated with shoulder pain and function, but scapular dyskinesis did not affect the magnitude of these relationships. Show more

Keywords: Scapula, abdominal muscles, kinetic chain, physical functional performance

DOI: 10.3233/PPR-230840

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 7-16, 2024

Authors: Corcoran, Siobhan | Murphy, Terence | Lynch, Karen | Goulding, Katherine | Cleary, May

Article Type: Research Article

Abstract: BACKGROUND: The prevalence of knee osteoarthritis is increasing due to population growth, ageing and other risk factors. However, the majority of patients can successfully manage their symptoms using conservative management strategies with only a minority requiring surgery. In 2019, a patient waited four years to be seen if deemed routine for an elective orthopaedic out-patient appointment in a large acute hospital in Ireland. OBJECTIVE: To establish a Fast-Track Knee Pathway in an Irish healthcare setting, creating a more efficient channel into elective orthopaedics for patients requiring surgical intervention whilst providing community-based care for those with non-surgical needs. …METHODS: a) Establishment of a dedicated community-based physiotherapy and dietetic service for knee osteoarthritis, b) implementation of a Rapid Access Knee Clinic in elective orthopaedic clinics, and c) economic evaluation of the Fast-Track Knee Pathway’s cost effectiveness compared with the traditional pathway. RESULTS: 403 patients with knee osteoarthritis were removed from physiotherapy waiting lists with 9 patients requiring referral onwards to the Rapid Access Knee Clinic. On average there was a 64% reduction in wait time to access an orthopaedic consultant across 4 pilot sites. An incremental cost-effectiveness ratio of € 22,535.03 per QALY was estimated. Comparing this to the national accepted threshold of € 45,000 per QALY the Fast-Track Knee Pathway can be considered cost-effective. CONCLUSION: The Fast-Track Knee Pathway provides a fully integrated pathway of care for patients with knee osteoarthritis, facilitating earlier access to orthopaedic intervention. An economic evaluation concluded that this model of care is more cost-effective than the traditional pathway. Show more

Keywords: Quality improvement, access to care, economic evaluation

DOI: 10.3233/PPR-230802

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 17-23, 2024

Authors: Moore, Doreen | Gallagher, Jackie

Article Type: Research Article

Abstract: BACKGROUND: The term sarcopenia, referring to declining function with age, has no universally agreed definition. Sarcopenia develops from multifactorial interactions, resulting in health problems such as frailty and increased falls risk; and for which screening may enable timely intervention. As sarcopenia screening equipment recommended by The European Working Group on Sarcopenia in Older People (EWGSOP2) is not always available in primary care, alternate screening strategies are needed. OBJECTIVE: To investigate the efficacy of the SARC-CalF questionnaire for sarcopenia screening in primary care and agreement between SARC-CalF and SARC-F questionnaires, with EWGSOP2 cut-off values. METHODS: Fifty community-dwelling …adults aged 65yrs and over completed the SARC-CalF and EWGSOP2 strength and physical performance outcome measures. Calculations for probability of sarcopenia and skeletal muscle mass were completed. Agreement between operational definitions and outcome measures were assessed to establish screening accuracy. RESULTS: Prevalence of probable sarcopenia ranged from 10–48% depending on outcome measure; SARC-CalF increased prevalence by 55% compared to SARC-F. Questionnaires agreed more strongly with probable sarcopenia as measured by leg than grip strength. Gait speed agreed significantly with strength and physical performance measures. CONCLUSIONS: In community-dwelling adults aged 65yrs and over, outcome measure used influenced rates of probable sarcopenia. Within primary care, equations may enable assessment of muscle mass, while formulae may enable assessment of the probability of sarcopenia. Gait speed is recommended for quantification of sarcopenia severity. Show more

Keywords: Sarcopenia, screening, primary care, elderly, SARC-CalF, muscle strength

DOI: 10.3233/PPR-230764

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 25-35, 2024

Authors: Padbidri, Puja | Joshi, Shruti | Kelkar, Pallavi | Bhat, Aparna | Shiralkar, Madhura

Article Type: Editorial

DOI: 10.3233/PPR-239002

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 37-39, 2024

Authors: Dsilva, Cherishma | Gatty, Aishwarya | Mascarenhas, Don | Jean-Pierre, Baeyens | Dsouza, Fiona | Sidhpuria, Sameeksha

Article Type: Research Article

Abstract: BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. Mucus accumulation, a common impairment in COPD affects lung function, exacerbations and quality of life. Physiotherapy measures including positive expiratory pressure devices like lung flute form the non-pharmacologic treatment options for the same. Although not a primary airway clearance device, inspiratory muscle trainer (IMT) plays a role in it. The aim of this study was to compare the effectiveness of lung flute and IMT as methods for sputum clearance in COPD. METHOD: Participants with COPD were recruited from the Department of Pulmonology and screened for eligibility. …Block randomization was used to divide the participants into three groups: Inspiratory muscle training (IMT), lung flute (LF), and routine physiotherapy (RP). Supervised 30 minutes of in-patient intervention was delivered to all the groups for 6 days, once a day. Total sputum volume analysis (TSV) was conducted before and after 6 days of intervention. Descriptive statistics were presented as median and quartiles. Kruskal Wallis H test and Wilcoxon signed rank test were applied. RESULTS: 60 participants aged 55 to 65 years with mild to moderate COPD were included in the study. Median TSV for RP, LF and IMT were 8.50, 20.50 and 25.75 ml respectively. Pair-wised comparisons for TSV revealed significant differences for the means of the rank scores between RP and LF (LF dominant) (p  < 0.001), RP and IMT (IMT dominant) (p  < 0.001) and LF and IMT (IMT dominant) (p  = 0.002). CONCLUSION: IMT performed superiorly in terms of sputum clearance in patients with COPD. Show more

Keywords: COPD, Airway clearance, bronchial hygiene, IMT

DOI: 10.3233/PPR-230827

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 41-47, 2024

Authors: Motley, Kate | Parab, Tanvi | Jordan, Mary | Kelly, Maura | Noone, Vanessa | O’Malley, Nicola | Clifford, Amanda M.

Article Type: Research Article

Abstract: BACKGROUND: Falls have a detrimental effect on Ireland’s ageing population and result in a significant personal and healthcare cost burden. Evidence-based falls prevention programmes reduce the harmful effects of falls. The Covid-19 pandemic disrupted in-person programme delivery and necessitated a shift to telerehabilitation. The feasibility and acceptability of falls prevention telerehabilitation needs further investigation. OBJECTIVE: The objective of this study was to explore the opinions of participants and physiotherapists about a falls prevention telerehabilitation programme, and identify key barriers and facilitators to improve the quality of future similar programmes. METHODS: A qualitative study design was used, …13 semi-structured one-to-one telephone interviews (n  = 11 participants, n  = 2 physiotherapists) were performed. Data were coded and thematic analysed. RESULTS: Four inter-related themes were identified: technical considerations for change in mode of programme delivery to online and blended; facilitators and barriers for effective delivery of the online and blended programmes; factors promoting programme engagement and progress; significance of supportive interpersonal relationships. CONCLUSIONS: Participants and physiotherapists reported improvements in strength, balance and confidence, and willingness to continue the exercises long-term. Telerehabilitation had some advantages over in-person including flexibility and convenience; however, these gains must be considered against the drawbacks of less social interaction and group cohesion. Key insights identified regarding satisfaction with the technology, format and delivery can be used to improve the quality of future online and blended programmes. Show more

Keywords: Falls prevention, older adults, telerehabilitation, Covid-19 pandemic, qualitative analysis

DOI: 10.3233/PPR-230779

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 49-58, 2024

Authors: Genç, Hazal | Atılgan, Esra

Article Type: Research Article

Abstract: BACKGROUND: Squat exercise, in which eccentric and concentric contractions are present simultaneously in different muscle groups, is one of the closed kinetic chain exercises commonly used in knee rehabilitation. OBJECTIVE: In the scope of the study, our objective is to determine the effectiveness of a structured squat-based exercise approach in patients with knee osteoarthritis. METHODS: In this study, 75 patients diagnosed with knee osteoarthritis were randomly assigned to three distinct groups: isoinertial exercise, a combination of home exercise and electrotherapy, and exercise solely. The assessment encompassed the application of the Western Ontario and McMaster Universities Osteoarthritis …Index (WOMAC), the Time Up and Go test, evaluation of quadriceps and hamstring muscle strength and activation levels, along with pain threshold assessment. The treatment program was administered three days a week over a span of eight weeks and was assessed both prior to and following the intervention. RESULTS: Across all groups, considerable enhancements were noted in the majority of parameters. Particularly noteworthy were the substantial improvements observed in the first group, specifically concerning WOMAC total score (p = 0.001), muscle strength, activation levels (p = 0.001), and pain tolerance (p = 0.05). CONCLUSIONS: In the group in which we applied isoinertial exercise, a positive increase was observed in most of the parameters.We suggest that isoinertial exercise applications, which are generally encountered in sports fields, should be used in different fields in future studies. Show more

Keywords: Osteoarthritis, knee, squat, isoinertial

DOI: 10.3233/PPR-240847

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 59-66, 2024

Authors: Liao, Jiaquan | Wu, Bo | Yang, Zhen | Tang, Changmin

Article Type: Research Article

Abstract: BACKGROUND: An increasing amount of research has supported the positive role of repetitive transcranial magnetic stimulation(rTMS) in improving functional impairments in Parkinson’s patients. PURPOSE: To explore the effectiveness of using rTMS n and Balance Apparatus training to improve the balance function of Parkinson’s patients. METHODS: Patients were divided into 3 groups of 20 patients in each. All patients received routine rehabilitation training. The rTMS group received low-frequency rTMS therapy, while the balance apparatus group incorporated balance apparatus exercises. The observation group received both interventions. The three groups of patients were assessed at baseline and after 8 …weeks of treatment using the Unified Parkinson’s Disease Rating Scale (UPDRS) motor section, Berg balance scale (BBS), Time up and go test (TUGT), and Activities-Specific Balance Confidence (ABC) scales. Additionally, all participants were tested for movement ellipse area, and Average Trace Error (ATE) using the balance apparatus. RESULTS: The observation group achieved better treatment results. The UPDRS score was better than that of the balance apparatus group after treatment, and the ABC score was superior to other two group. Moreover, the observation group outperformed the other two group in terms of motion length, and open-eye elliptical area, with statistical significance. CONCLUSION The combined application of TMS and Balance Apparatus training effectively improves enhances balance function, and boosts self-confidence in balance perception among Parkinson’s patients. Show more

Keywords: Low-frequency repetitive transcranial magnetic stimulation, balance training, Parkinson’s disease

DOI: 10.3233/PPR-230842

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 67-75, 2024

Authors: Mansfield, Michael | Kumar, Veneta | Stephens, Gareth

Article Type: Research Article

Abstract: OBJECTIVE: To investigate whether pre-operative Quantitative Sensory Testing (QST) can identify patients who experience persistent post-operative knee pain following Total Knee Replacement (TKR). DATA SOURCES: PubMed, EMBASE, CINAHL, EBSCO and grey literature. STUDY SELECTION: 1056 studies were retrieved. The title and abstracts were screened by two independent reviewers, of which 45 were retrieved for full text analysis and 16 studies were included. Studies of any design were included if they recruited adults who underwent TKR; completed any component of the German Research Network on Neuropathic Pain QST or conditioned pain modulation testing preoperatively and assessed post-surgical …joint pain using a self-reported outcome measure at a minimum of three months post TKR. DATA EXTRACTION: Data was independently extracted by two researchers. Disagreements were resolved through consensus. The extracted data was recorded in a predefined spreadsheet. Domains included demographic data, type and site of QST, pain outcome measure, follow up duration, statistical methods and associative data. Two independent reviewers assessed the quality of studies using Quality in Prognosis risk of bias tool and the certainty of evidence using the GRADE framework. DATA SYNTHESIS: Sixteen cohort studies met the eligibility criteria (n  = 2051 patients). Data was analysed narratively because of the heterogeneity across the QST procedures (mechanical and thermal detection and pain thresholds, conditioned pain modulation and temporal summation of pain), measures of reporting pain (Western Ontario and McMaster Universities Osteoarthritis Index, visual analogue scale and numeric pain rating score) and follow up time points (3 to 18 months). CONCLUSIONS: Due to the heterogeneity and low-moderate quality studies included, it remains unclear whether QST can identify patients who are likely to experience persistent postoperative joint pain following TKR. Show more

Keywords: Quantitative sensory testing, total knee replacement, postoperative pain, systematic review

DOI: 10.3233/PPR-240892

Citation: Physiotherapy Practice and Research, vol. 45, no. 1, pp. 77-93, 2024