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Physical therapy [journal]
- The Contribution of Conceptual Frameworks to Knowledge Translation Interventions in Physical Therapy. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 24.
There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated in clinical practice, and increasing numbers of knowledge translation interventions are being conducted. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used in physical therapy knowledge translation studies to date.Knowledge translation in physical therapy implicates multiple stakeholders and environments, and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. In this article, we argue that such frameworks are important resources to promote the uptake of new evidence in physical therapy practice settings. We identify four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions. We also consider limits related to their use. We then evaluate a sample of five conceptual frameworks and consider how they address common barriers to knowledge translation in physical therapy. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Finally, we illustrate the use of a conceptual framework through a case example.Increased use of conceptual frameworks can have a positive impact on the field of knowledge translation in physical therapy and support the development and implementation of robust and effective knowledge translation interventions that help span the research-practice gap.
- Assessment of Glenohumeral Subluxation in Poststroke Hemiplegia: Comparison Between Ultrasound and Fingerbreadth Palpation Methods. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 24.
Glenohumeral subluxation (GHS) is a common post-stroke complication. Treatment of GHS is hampered by the lack of objective, real time clinical measurements.To compare an ultrasound method of GHS measurement with the fingerbreadth palpation method using a receiver operating characteristics curve (ROC) and to report the sensitivity and specificity of this method.A prospective study.Local hospitals and day centres in the southwest of England.Patients with first time stroke (n=105, 51 men, 54 women; mean (SD) age 71(11) years) with one-sided weakness, who gave informed consent, were recruited.Ultrasound measurements of acromion-greater tuberosity (AGT) distance were used for the assessment of GHS. Measurements were undertaken on both shoulders by a research physical therapist trained in shoulder ultrasound with the patient seated in a standardized position. Fingerbreadth palpation assessment of GHS was undertaken by a clinical physical therapist based at the hospital, who also visited the day centres.The area under the ROC curve was 0.73 (95% CI 0.63-0.83) suggesting that the ultrasound method has good agreement when compared with the fingerbreadth palpation method. A cut-off point of ≥0.2cm AGT measurement difference between affected and unaffected shoulders generated a sensitivity of 68% (95% CI 51%-75%), a specificity of 62% (95% CI 47%-80%) and a positive likelihood ratio of 1.79 (95% CI (1.1-2.9).Clinical therapists involved in the routine care of patients conducted the fingerbreadth palpation method. It is likely that they were aware of the patient's subluxation status.The ultrasound method can detect minor asymmetry (≤0.5 cm) and has the potential advantage over the fingerbreadth palpation method of identifying patients even with minor subluxation.
- Rehabilitation Therapies After Botulinum Toxin-A Injection to Manage Limb Spasticity: A Systematic Review. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 24.
Botulinum toxin A (BoNT-A) injections are increasingly used to treat muscle spasticity and are often complemented by adjunctive rehabilitation therapies, however little is known about therapy effect after injection.To identify and summarize evidence on rehabilitation therapies used after BoNT-A injections to improve motor function in adults with neurological impairments.Searches in PubMed, EMBASE, CINAHL, National Research Register, Meta Registry of Controlled Trials, PEDro and OTseeker.Randomized and quasi-randomized controlled trials were considered for inclusion. Participants received BoNT-A to treat focal spasticity in limbs with rehabilitation interventions provided to experimental group/s only. Participants had neurological impairment/s. Primary outcome measures were joint mobility, function of the affected limb and spasticity. Eleven studies with 234 participants most of whom had suffered stroke were included in the review.Two reviewers extracted study details/ data.Methodological quality was rated using the PEDro scale. Both fixed- effect and random- effect models were used to calculate effect size.Studies were of variable quality: three were poor (PEDro 1 to 4) and eight were moderate (PEDro 6 to 7). No study investigated effects for longer than 24 weeks (6 months). Included trials presented nine therapy types, including ergometer cycling, electrical stimulation, stretch (casting, splinting, taping, manual or exercised induced stretch), constraint-induced movement therapy, task-specific motor training and exercise programs. Statistical findings suggest that therapy and BoNT-A is slightly more effective than BoNT-A alone.Evidence relating to impact of adjunct therapy is available, but the heterogeneity of studies limits the opportunity to demonstrate overall impact. Researchers need to consider the benefits of greater consistency in study approaches and measures so that meaningful evaluations of overall adjunct therapy effects can be made.
- Perceived Exercise Barriers Explain Exercise Participation in Australian Women Treated for Breast Cancer Better Than Perceived Exercise Benefits. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 24.
This study aimed to determine the effect of perceived exercise benefits and barriers on exercise levels among women who have been treated for breast cancer, and who were not part of formal exercise interventions.Anonymous, national online cross-sectional survey.432 women treated for breast cancer completed an online survey covering their treatment and demographic background, current exercise levels, and perceived exercise benefits and barriers. Each perceived benefit and barrier was considered in a binary logistic regression against reported exercise levels to ascertain significant relationships (p < 0.05) and associative values (odds ratio).Agreement with sixteen out of 19 exercise barriers, were significantly related to being more likely to report insufficient exercise levels, whereas agreement with 6 out of 15 exercise benefits were significantly related to being less likely to report insufficient levels of exercise. Feeling too weak, lacking self-discipline and not being a priority were the barriers with the largest association to insufficient exercise levels (OR (95% CI) = 10.97 (3.90-30.86); 8.12 (4.73-13.93); and 7.43 (3.72-14.83), respectively). Conversely, exercise enjoyment, improved feelings of well-being, and decreased feelings of stress and tension were the top three benefits associated with being less likely to have insufficient exercise levels (OR (95% CI) = (0.21 0.11-0.39), 0.21 (0.07-0.63), and 0.31 (0.15-0.63), respectively).Self-reported data measures were used to collect exercise data.Targeting exercise barriers specific to women treated for breast cancer may improve exercise participation levels in this cohort. Awareness of the impact of exercise barriers identified in the present study will enable physical therapists to better plan exercise interventions that support all women treated for breast cancer.
- Influence of Fear-Avoidance Beliefs on Disability in Patients With Subacromial Shoulder Pain in Primary Care: A Secondary Analysis. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 24.
Little information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome.To investigate the associations between pain, catastrophizing, fear, and disability, and the contribution of fear-avoidance beliefs to disability at baseline and at three months.Cross sectional and longitudinal analysis.Baseline demographic and clinical data including fear avoidance beliefs and catastrophizing of ninety patients were assessed for this analysis. Disability was measured with the shoulder pain and disability index at baseline and at three months. First, bivariate and partial correlations were calculated between pain, fear avoidance beliefs, catastrophizing, and disability, based on the fear avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at three months was analysed with hierarchical regression analyses.Correlations between clinical variables and disability were largely in line with the fear avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at three months.We investigated patients with subacromial pain syndrome; therefore results should be transferred with caution to other diagnoses. We further used a modified version of the fear avoidance beliefs questionnaire which was not validated for this patient group.Fear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after three months. Duration of complaints and baseline disability were the main influencing factors on disability change scores. Although our results help to improve our understanding of the role of fear avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain.
- The Use of a Knowledge Translation Program to Increase Use of Standardized Outcome Measures in an Outpatient Pediatric Physical Therapy Clinic: An Administrative Case Report. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 17.
Pediatric physical therapists face many challenges related to the application of research evidence into clinical practice. A multi-component knowledge translation (KT) program may be an effective strategy to support practice change. The purpose of this project was to use a KT program to improve the knowledge and frequency of use of standardized outcome measures by pediatric physical therapists practicing in an outpatient clinic.This program occurred at a pediatric outpatient facility with 1 primary clinic and 3 additional satellite clinics, and a total of 17 physical therapists. The initial underlying problem was inconsistency across staff recommendations for frequency and duration of physical therapy services. Formal and informal discussion with the department administrator and staff identified a need for increased use of standardized outcome measures to inform these decisions. The KT program to address this need spanned 6 months and included identification of barriers, the use of a knowledge broker, multiple workshop and practice sessions, online and hard copy resources, and ongoing evaluation of the KT program with dissemination of results to staff. Outcome measures included pre and post knowledge assessment and self-report surveys, and chart review data on use of outcome measures.Participants (N = 17) gained knowledge and increased the frequency of use of standardized outcome measures, based on data from self-report surveys, a knowledge assessment, and chart reviews.Administrators and others interested in supporting practice change in physical therapy may consider implementing a systematic KT program that includes a knowledge broker, ongoing engagement with staff, and a variety of accessible resources.
- Introduction to the GRADE Approach for Guideline Development: Considerations for Physical Therapist Practice. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 17.
Practice guidelines (guidelines) have an increasing role in healthcare delivery and are increasingly published. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an approach for guideline development. The GRADE approach has been adopted by multiple national and international organizations producing guidelines related to physical therapist care.The purpose of this paper is to introduce physical therapists to the GRADE approach for guideline development.GRADE provides a consistent approach for guideline development, transparency in communication of how guidelines were developed and how the recommendations were reached leading to informed choices by patients, clinicians, and policymakers in healthcare. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. The recommendation includes both the direction (for or against) and strength (weak or strong) of the recommendation. To determine the strength of the recommendation, GRADE considers: the quality of evidence, the balance of benefit and harm, the uncertainty or variability in patient values and preferences, and uncertainty if the intervention is a wise use of resources.The GRADE approach has primarily been used with interventions and clinical questions and less with questions related to diagnosis and prognosis.The publication of guidelines is increasing. To make informed choices in the healthcare system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices.
- Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 17.
Pain is a primary symptom driving patients to seek physical therapy and its attenuation commonly defines a successful outcome. A large body of evidence is dedicated to elucidating the relationship between chronic stress and pain. A physiologic stress response may be evoked by fear or perceived threat to safety, status, or well-being, and elicits the secretion of sympathetic catecholamines (epinephrine and norepinepherine) and neuroendocrine hormones (cortisol) to promote survival and motivate success. Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and modulate inflammation. Cortisol may also facilitate the consolidation of fear-based memories for future survival and avoidance of danger. While short-term stress may be adaptive, maladaptive responses (such as magnification, rumination, or helplessness) to pain or non-pain-related stressors may intensify cortisol secretion and condition a sensitized physiologic stress response that is readily recruited. Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain. While stress may be unavoidable in life and challenges are inherent to success, humans have the capability to modify what they perceive as stressful and how they respond to it. Exaggerated psychological responses (eg: catastrophizing) following maladaptive cognitive appraisals of potential stressors as threatening may exacerbate cortisol secretion by facilitating fear-based activation of the amygdala. Coping, cognitive re-appraisal, or confrontation of stressors may minimize cortisol secretion and prevent chronic, recurrent pain. Given the parallel mechanisms underlying the physiologic effects of a maladaptive response to pain and non-pain-related stressors, physical therapists should consider screening for non-pain-related stress to facilitate treatment, prevent chronic disability, and improve quality of life.
- Use of the Theoretical Domains Framework to Develop an Intervention to Improve Physical Therapist Management of Falls Risk on Discharge. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 17.
Older adults are at increased risk of falls following discharge from hospital. Guidelines to manage this falls risk are well documented but commonly not implemented. This paper aims to describe a novel approach using the Theoretical Domains Framework (TDF) to develop an intervention to change clinical behaviour of Physiotherapists.The study had 4 phases: (1) Identifying the evidence practice gap; (2) Identifying barriers and enablers that need to be overcome; (3) Identifying behaviour change techniques to overcome the barriers; and (4) Determining outcome measures to evaluate behaviour change.The evidence practice gap identified that few patients who had undergone surgery for hip fracture were recognised to have a falls risk or had a documented referral to a community agency for falls prevention follow up. Project aims aligned with best practice guidelines were established; twelve of the fourteen TDF domains were considered to be relevant to behaviours within this project and six behaviour change strategies were implemented; primary outcome measures included proportion of patients who have documentation of falls risk and are referred on for a comprehensive falls risk assessment following discharge from the hospital.The use of a systematic approach involving the TDF was useful in designing a multi-faceted intervention to improve management of discharge falls risk by Physiotherapists in an acute care setting in South Australia. This framework enabled targeted intervention strategies to be identified that were likely to influence healthcare professional behaviour. Early case note audit results reflect positive changes to reduce the evidence practice gap.
- A Comparison Study of KOOS-PS and KOOS Function and Sport Scores. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 17.
To compare the construct validity the Knee Injury and Osteoarthritis Outcome Score (KOOS) Function and Sport scales with a shorter version of the measure (KOOS-PS).Using a cross-sectional, observational design, consecutive consenting patients diagnosed with knee osteoarthritis were recruited at an assessment center visit to determine need for conservative or surgical management. Patients completed the Lower Extremity Functional Scale (LEFS), KOOS, timed up and go and 6-minute walk test. A single function-sport score (KOOS FunSportsum) and the KOOS-PS were abstracted from the KOOS. We compared Pearson's correlation coefficients between the reference standards' scores (performance measures and LEFS) and KOOS scores. KOOS-PS raw scores were compared to KOOS-PS Rasch scores.377 patients aged 64.4 (SD 10.5) years participated. The correlation between performance reference standard and KOOS-PS Rasch scores was significantly lower than with KOOS FunSportsum scores (mean difference in r [95% CI]: 0.08 [0.03, 0.11]; Z = 4.45, P1 < 0.001). A similar finding was observed with the LEFS comparison.For patients with knee osteoarthritis the KOOS-PS appears too restricted in item content to provide a comprehensive estimate of a patient's lower extremity functional status level relative to the KOOS Function and Sport scales. Pursuit of a computer-adapted test may be a productive direction for future inquiry.