Physical therapy [journal]
- Frida Kahlo: A Portrait of Chronic Pain. [JOURNAL ARTICLE]
- Phys Ther 2016 Aug 25.
The Mexican artist Frida Kahlo (1907 - 1954) is one of the most celebrated artists of the 20th century. Although famous for her colorful self-portraits and associations with celebrities, Diego Rivera and Leon Trotsky, less known is the fact that she suffered with lifelong chronic pain. Frida Kahlo developed polio at age 6, suffered a horrific trolley car accident in her teens and would eventually endure numerous failed spinal surgeries and ultimately limb amputation. She endured several physical, emotional and psychological traumas in her lifetime, yet through her art she was able to transcend a life of pain and disability. Of her work, her self-portraits are conspicuous in their capacity to convey her life experience, much of which was imbued with chronic pain. Signs and symptoms of chronic neuropathic pain and central sensitization of nociceptive pathways are evident when analyzing her paintings and medical history. This paper uses a narrative approach to describe how events in the life of this artist contributed to her chronic pain. The purpose of this paper is to discuss Frida Kahl's medical history and her art from a modern pain sciences perspective and to perhaps increase our understanding of the pain experience from the patient perspective.
- Development of a Prognostic Model for Patients With Shoulder Complaints in Physiotherapy. [JOURNAL ARTICLE]
- Phys Ther 2016 Aug 18.
Health care providers need prognostic factors to distinguish between patients who are likely to recover compared to the ones that do not.To describe the clinical course and identify prognostic factors of recovery, in patients with shoulder pain at 26 weeks follow-up.A prospective cohort study was carried out in the Netherlands including 389 patients consulting a physiotherapist with a new episode of shoulder pain.Patients were followed for 26 weeks. Potential predictors were selected from the literature, together with the use of diagnostic ultrasound and working alliance and evaluated in multivariable regression analysis. Multiple imputation was used to handle missing data and bootstrap methods for internal validation.Recovery rate was 60% for the total population and 65% for the working population after 26 weeks. Short duration of complaints, lower disability scores, having a paid job, better working alliance and no feelings of depression/anxiety were associated with recovery. In the working population only duration of complaints and disability remained in the final model. The area under the receiver operator curve (AUC) was 0.67 for the final model of the total population and 0.63 for the working population. After internal validation the AUC was corrected to 0.66 and 0.63.External validation should be done prior to the use in clinical practice.Results from this study indicate that several factors can predict recovery.
- "Pushing the Limits": Rethinking Motor and Cognitive Resources After a Highly Challenging Balance Training Program for Parkinson's Disease. [JOURNAL ARTICLE]
- Phys Ther 2016 Aug 11.
There is growing evidence for the positive effects of exercise training programs on balance control in Parkinson's disease (PD). To be effective, balance training needs to be specific, progressive and highly challenging. Little evidence exists however for how people with PD-related balance impairments perceive highly challenging and progressive balance training programs with dual-task components.To explore and describe perceptions of a highly challenging balance training program among people with mild to moderate PD.This study was qualitative in nature. In-depth interviews were conducted with 13 individuals with mild-moderate PD who had participated in a highly-challenging balance training program. Interview transcripts were analyzed using qualitative content analysis, with an inductive approach.The analysis revealed three sub-themes concerning participants' perceptions of highly challenging and progressive balance training: Movement to counter the disease, reflects how physical activity was used as a long and short-term strategy for counteracting PD symptoms and their progression; Dual-task training in contrast to everyday strategies, incorporates the described experiences of being maximally challenged in a secure and supportive group environment, circumstances which stood in contrast to participants' everyday lives; The struggle to maintain positive effects, describes participants' long-term struggle to maintain program effects on cognitive and physical function in the face of disease progression. Interpretation of the underlying patterns of these sub-themes resulted in one overarching theme Training at the limits of balance capacity causes a rethinking motor and cognitive resources.Findings from this study suggest that being pushed to the limits of balance capacity provoked people with mild-moderate PD to rethink their individual motor and cognitive resources, a process which was further enabled by the PD-specific group setting.
- The myMoves Program: A Feasibility and Acceptability Study of a Remotely Delivered Self-Management Program for Increasing Physical Activity Among Community-Dwelling Adults With Acquired Brain Injury. [JOURNAL ARTICLE]
- Phys Ther 2016 Aug 11.
Individuals living with acquired brain injury (ABI) are more likely to be physically inactive and highly sedentary, which increases their risk of morbidity and mortality. However, many adults with ABI experience barriers to participation in effective physical activity interventions. Remotely delivered self-management programs focussed on teaching patients how to improve and maintain their physical activity levels have the potential to improve the overall health of adults with ABI.To evaluate the acceptability and feasibility of a remotely delivered self-management program aimed at increasing physical activity among community dwelling adults with ABI.The myMoves program comprises 6 modules delivered over 8 weeks via email. Participants were provided with regular weekly contact with an experienced physiotherapist via email and telephone. The primary outcomes were feasibility (adherence, attrition, clinician time, accessibility and adverse events) and acceptability (satisfaction, worthiness of time and recommendation) of the myMoves program. Secondary outcomes examined objective physical activity data collected from accelerometers, physical activity self-efficacy, psychological distress and participation.Twenty-four participants commenced the program (20 with stroke, 4 with traumatic injury), with outcomes collected from 23 and 22 participants post-program and 3-months follow-up, respectively. The program required very little clinician contact time with an average of 32.8 minutes (SD 22.8) per participant during the 8-week program. Acceptability was very high, with more than 95% being either very satisfied or satisfied with the myMoves program and stating that it was worth their time. All participants stated they would recommend the program to others with ABI.A remotely delivered self-management program aimed at increasing physical activity is feasible and acceptable for adults with ABI. Further large-scale efficacy trials are warranted.
- Physical Activity and the Risk of Depression in Community Dwelling Korean Adults With History of Stroke. [JOURNAL ARTICLE]
- Phys Ther 2016 Aug 11.
Physical activity (PA) is believed to improve mental health, including depression. However, whether recommended PA levels have a similar impact in individuals with post-stroke depression is unclear.To apply quasi-experimental propensity score (PS) matching control for covariate differences and compare the effects of PA on reducing depression risk among people with stroke.A cross-sectional design was used for this study.Community dwelling adults (n=4,555) who reported having had a stroke were extracted from the 2013 Korean Community Health Survey. They were asked a series of questions about depression, recommend PA levels (moderate and vigorous-intensity), and chronic conditions. Multivariable regression model, Inverse Probability Weighting Adjustment, and Greedy Algorithms with 1:1 matching and covariate adjustment were used to estimate the effects of PA on risk of depression. The dependent variable was diagnosis of depression, and the primary independent variable was PA. Baseline covariates were 10 demographic and nine chronic condition variables.Without PS methods, there were significant differences in baseline covariates (16 out of 19, p < 0.05) between people who performed PA and those who did not perform PA. After applying 1:1 matching, the number of subjects in each group comparing the effect of PA numbered 1,970, and 13 covariates did not differ significantly in the two groups (all p > 0.05). PA reduced the risk of post-stroke depression by 36.1 to 42.4% (OR, 0.639-0.376, all p < 0.05) across the three methods.Unaccounted covariates may bias the results, including stroke severity, predepression status, and history of depression treatments.The findings suggest that recommended PA levels can reduce the risk of post-stroke depression.
- Advancing Evidence-Based Practice in Physical Therapy Settings: International Perspectives on Implementation Strategies and Interventions. [JOURNAL ARTICLE]
- Phys Ther 2016 Aug 11.
It is of critical importance that findings from the wealth of clinical physiotherapy research are transferred into clinical practice without unnecessary delays. There is a lack of knowledge about strategies that can be used to effectively implement physiotherapy research findings and evidence-based practices (EBP) into everyday clinical practice in different national settings and contexts. The aim of this paper is to contribute to knowledge about effective strategies for implementing evidence-based practice that have been studied in different national physiotherapy settings. We wanted to share experiences and provide a current international perspective on different approaches and strategies for implementing evidencebased practice and to highlight important considerations and implications for both research and practice. Six research studies from various settings in three countries are described and synthesized. Key characteristics of the studies and intervention components are tabulated and mapped to the Cochrane Effective Practice and Organisation of Care taxonomy. Commonalities and differences are presented. The implementation strategies described were: a theory-based guideline implementation tailored to identified barriers and facilitators; a multifaceted EBP training package; journal clubs; a multifaceted strategy comprising contextualized procedures, protocols and standardized resources; barrier identification, education, audit, feedback and reminders; and contextualized guidelines. Commonalities were the use of a multifaceted approach, educational measures and clinical guidelines. Key outcomes across the studies were increased attitudes, awareness, knowledge/skills/confidence, access to clinical practice guidelines and other EBP resources, earlier referrals and use of recommended measures. The paper can serve as a template for other physiotherapy researchers in designing implementation studies as well as to inform policies and practice for healthcare managers and decision makers who are looking for ways to implement research findings in their organizations.
- 95 Years of Progress. [Editorial]
- Phys Ther 2016 Aug; 96(8):1122-3.
- Systematic Clinical Reasoning in Physical Therapy (SCRIPT): A Tool for the Purposeful Practice of Clinical Reasoning in Orthopaedic Manual Physical Therapy. [JOURNAL ARTICLE]
- Phys Ther 2016 Jul 28.
Clinical reasoning is essential to physical therapist practice. Solid clinical reasoning processes may lead to greater understanding of the patient condition, early diagnostic hypothesis development, well-tolerated examination and intervention strategies, and mitigate the risk of diagnostic error. However, the complex and often subconscious nature of clinical reasoning can impede the development of this skill. Protracted tools have been published to help guide self-reflection on clinical reasoning but might not be feasible in typical clinical settings. The Systematic Clinical Reasoning in Physical Therapy (SCRIPT) tool, presented in the context of a clinical case, illustrates how an expedient form can be used to guide the clinical reasoning process and prompt a physical therapist to search the literature to answer a clinical question. It is a useful tool for formal mentorship sessions in post-professional physical therapy training programs.