Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Physical therapy [journal]
- Dual Tasking With the Timed "Up & Go" Test Improves Risk-of-Fall Detection in Patients With Parkinson Disease. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 21.
Falls are a common and disabling feature of Parkinson's disease (PD). Early identification of patients at greatest risk is a key goal of physiotherapy assessment. The 'Timed up and Go' test (TUG) is a frequently used mobility assessment tool, which demonstrates moderate sensitivity and specificity in identifying falls risk.To investigate whether adding a dual task (cognitive or manual) to the TUG increases the test's utility to identify risk of falls in persons with PD.A retrospective cohort study of persons with PD (n=36).Participants were compared on the basis of self-reported falls exposure in the previous 6 months (fallers vs. non-fallers). The time taken to complete the TUG, TUG-cognitive and TUG-manual was measured in both groups. Between-group differences were calculated using Mann-Whitney U tests. The discriminative performance of the test was examined at different cut-off points and estimates of sensitivity and specificity were based on receiver operator characteristic plots.Fallers took significantly longer than non-fallers (n=19) to complete the TUG test under all three conditions (TUG p =0.005, TUG-cognitive p =0.001, TUG-manual p =0.005). The TUG-cognitive demonstrated optimal discriminative performance (AUCROC=0.81, 95% CI 0.64-0.92) at a cut-off of 14.7 seconds. The TUG-cognitive is more likely to correctly classify those at low risk (LR+=2.9) (<14.7 seconds) with higher estimates of sensitivity (0.76, 95% CI 0.52-0.90) than specificity (0.73, 95%CI 0.51-0.88) at this threshold (LR-=0.32).Retrospective classification of fallers and non-fallers was used.Addition of a cognitive dual task to the TUG enhances identification of falls risk for patients with PD. The TUG-cognitive test should be considered as a component of a multifaceted falls risk assessment in PD.
- Reproducibility and Validity of the Physical Activity Scale for the Elderly (PASE) Questionnaire in Patients After Total Hip Arthroplasty. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 21.
The assessment of physical activity is of concern in patients after total hip arthroplasty (THA). So far, no questionnaire has however demonstrated adequate reproducibility and validity for assessing physical activity in these patients.To evaluate the reproducibility and validity of the Physical Activity Scale for the Elderly (PASE) questionnaire in patients after THA.Measurement study.Fifty THA patients (25 women) aged on average 68 years were evaluated. Of these, 25 were assessed between 2 and 7 months after surgery (THAearly) and 25 between 7 and 12 months after surgery (THAlate). PASE reproducibility was evaluated by administrating the questionnaire on 2 different occasions. PASE construct validity was assessed by comparing the physical activity level reported by patients to that objectively recorded by a body-mounted accelerometer. Reproducibility was investigated with intraclass correlation coefficients (ICC2,1) for reliability and standard errors of measurement (SEM) for agreement, while validity was investigated with Pearson correlation coefficients (r).ICC2,1 for the PASE total score was .77 (95% CI: .63 to .86); SEM was 23.0% (95% CI: 19.2 to 28.7). Validity correlation for the PASE total score was 0.38 (95% CI: .12 to .60). No significant differences were found between THAearly and THAlate patients for reliability, agreement and validity outcomes.Reproducibility of the PASE questionnaire could have been underestimated since the physical activity of patients was compared between 2 consecutive but different weeks. Reliability and validity analyses were underpowered.Further study with a larger sample size is necessary to obtain precise reliability and validity estimates. Nevertheless, inadequate agreement calls into question the PASE questionnaire's ability to assess the physical activity level of patients after THA surgery.
- Do Maternal Interactive Behaviors Correlate With Developmental Outcomes and Mastery Motivation in Toddlers With and Without Motor Delay? [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 21.
Maternal interactive behaviors theoretically affect developmental outcomes and mastery motivation in young children. However, these associations are inconsistent in the literature.Three purposes were to: (1) examine the differences in maternal behaviors between toddlers with motor delay (MD) and those with typical development (TD); (2) investigate the correlation of maternal behaviors and developmental quotients (DQs) in toddlers with MD and TD; (3) examine the correlation of maternal behaviors and mastery motivation in toddlers with MD and TD.A sex- and mental-age-matched case-control study.Twenty-two mother-child dyads of toddlers with MD (ages 23-47 months) and 22 dyads of sex- and mental-age-matched TD toddlers (ages 15-29 months) were recruited. Maternal scores from the Nursing Child Assessment Teaching Scale, two indicators of motivation (Persistence and Mastery Pleasure) from individualized mastery tasks and the Dimensions of Mastery Questionnaire (DMQ), and DQs from the Comprehensive Developmental Inventory for Infants and Children were assessed.Mothers of the MD group showed significantly lower cognitive growth fostering scores than those of the TD group. Maternal total scores were significantly correlated with whole DQs in both groups. In the MD group, maternal total scores correlated significantly with DMQ mastery pleasure but not with mastery task motivation.The design makes it impossible to know the causal relationships between maternal behaviors and children's DQs and motivation.Mothers of toddlers with MD exhibited less adequate interactive behaviors than those of the TD group. Because higher quality maternal behaviors correlated with higher DQs in the MD group, clinicians should encourage parents to participate in early intervention programs and model quality parenting behavior to enhance parents' and children's outcomes.
- Factors Associated With Physical Therapists' Implementation of Physical Activity Interventions in the Netherlands. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 14.
Physical therapists play an important role in the promotion of physical activity (PA) and the effectiveness of PA interventions. However, little is known about the extent to which they implement PA interventions following the protocol and factors influencing their implementation behaviors.To investigate physical therapists' implementation fidelity regarding PA interventions, including completeness and quality of delivery, and influencing factors, using a Theoretical Domains Framework (TDF)-based questionnaire.The study was based on a cross-sectional design.A total of 268 physical therapists completed the Determinants of Implementation Behavior Questionnaire. Questions on completeness and quality of delivery were based on the components and tasks of PA interventions as described by the Royal Dutch Society for Physical Therapy. Multilevel regression analyses were used to identify factors associated with completeness and quality.Physical therapists reported high implementation fidelity, with higher completeness compared to quality of delivery scores. Physical therapists' knowledge, skills, beliefs about capabilities and consequences, positive emotions, behavioral regulation, and the automaticity of PA intervention delivery, were the most important predictors of implementation fidelity. Together, the TDF domains accounted for 23% (p < .001) of the variance in both total completeness and quality scores.The cross-sectional design precluded the determination of causal relationships. Also, use of self-report measures to assess implementation fidelity could lead to socially desirable responses possibly resulting in more favorable ratings of completeness and quality.This study enhances our understanding of how physical therapists implement PA interventions and which factors influence their behaviors. Knowledge on these factors may help develop strategies to improve physical therapists' implementation behaviors.
- Author response. [Comment, Letter]
- Phys Ther 2014 Jul; 94(7):1054-5.
- Impaired Reactive Stepping Among Patients Ready for Discharge From Inpatient Stroke Rehabilitation. [JOURNAL ARTICLE]
- Phys Ther 2014 Aug 7.
Individuals with stroke are at increased risk for falls soon after hospital discharge. The ability to react to a balance perturbation, specifically with a rapid step, is critical to maintain balance and prevent falls. The purpose of the study was to: determine the prevalence of impaired reactive stepping responses in an ambulatory group of patients with stroke who were preparing for discharge from inpatient rehabilitation and the relationship to patient performance on commonly-used clinical measures of balance, mobility and lower limb impairment.A retrospective chart review of patients with stroke who, at time of discharge, had completed a perturbation-evoked reactive stepping assessment.Ninety nine of 139 (71%) patients had impaired stepping reactions characterized by: the need for assistance, an inability to step with either lower limb, or the need for multiple step responses. There was a statistically significant difference in clinical scores between those with and without impaired stepping but groups were characterized by considerable variation in clinical profiles. For example, Berg Balance scores ranged from 25 to 55 versus 20 to 56 and gait speeds ranged from 0.17-1.43 versus 0.26 to 1.55 m/sec for patients who demonstrated a failed step versus a successful step, respectively.Impaired reactive stepping is a prevalent problem for ambulatory patients with stroke preparing for discharge which could possibly increase their risk of falling when faced with the challenges of community ambulation. Specific tests that target the capacity to perform perturbation-evoked stepping reactions may be important to identify those at risk for falls & to direct appropriate intervention strategies.
- Integrating Aerobic Training Within Subacute Stroke Rehabilitation: A Feasibility Study. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 31.
Aerobic activity positively impacts patients recovering from stroke and is part of best practice guidelines, yet this evidence has not translated to routine practice.The objective was to evaluate the feasibility of a model of care that integrated aerobic training in an in-patient rehabilitation setting for patients in the sub-acute stage of stroke recovery. Key elements of the program were personalized training prescription based on submaximal test and supervision within a group setting.Prospective cohort METHODS: Patients completed sub-maximal exercise testing prior to enrolment, which was used by their treating physical therapist for exercise prescription. Feasibility was evaluated using enrolment, class attendance, adherence to prescription, and patient perceptions.Overall, 31 of 78 (40%) patients were referred to and completed the exercise program. Cardiac co-morbidities were the main reason for non- referral to the fitness group. Program attendance was 77%; scheduling conflicts were the primary barrier to participation. The majority of participants (63%) achieved 20 minutes of continuous exercise by the end of the program. No adverse events were reported, all participants felt they benefited from the program, and 80% of participants expressed interest in continuing to exercise regularly after discharge.Cardiac comorbidities prevented enrolment in 27% of individuals and strategies for inclusion in exercise programs in this population should be explored.This individualized exercise program within a group delivery model was feasible, however, ensuring adequate aerobic targets are met was a challenge and future work should focus on how best to include individuals with cardiac comorbidities.
- Resistive Inspiratory Muscle Training in People With Spinal Cord Injury During Inpatient Rehabilitation: A Randomized Controlled Trial. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 31.
Persons with spinal cord injury (SCI) may benefit from resistive inspiratory muscle training (RIMT). Current evidence is weak and little is known about the effect on functional outcomes and long-term effects.To assess immediate and long-term effects of RIMT in persons with SCI.single-blinded randomized controlled trial.Four specialized SCI-units in the Netherlands.Forty persons with SCI (15 with motor complete tetraplegia, 16 incomplete tetraplegia, 8 motor complete paraplegia, and 1 incomplete paraplegia) who had impaired pulmonary function and were admitted for initial inpatient rehabilitation.Persons were randomized to the RIMT-group or the control-group. All persons received usual rehabilitation care. In addition, persons in the intervention group performed RIMT with a threshold trainer.Measurements were performed at baseline, after 8 weeks of intervention, 8 weeks later, and one year after discharge of inpatient rehabilitation. Primary outcome measures were: respiratory muscle function, lung volumes and flows, and perceived respiratory function. Secondary outcome measures concerned patient functioning, which included health related quality of life, limitations in daily life due to respiratory problems, and respiratory complications.During the intervention period, maximum inspiratory pressure (MIP) improved more in the RIMT-group than in the controls (11.7 cmH2O, 95%CI: 4.3 - 19.0); at follow-up this effect was no longer significant. We found no effect on other primary or secondary outcome measures, an immediate effect on mental health excepted.Sample size was insufficient to study effects on respiratory complications CONCLUSIONS: RIMT has a positive short-term effect on inspiratory muscle function in persons with SCI who have impaired pulmonary function during inpatient rehabilitation.
- Integrating Spanish Language Training Across a Doctor of Physical Therapy Curriculum: A Case Report of One Program's Evolving Model. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 31.
As the Hispanic population continues to expand in the United States, increasingly health professionals may encounter Spanish-speaking individuals with low English proficiency (LEP). Responding to these changes, various health professions educators have incorporated Spanish language training into their curricula. Of 12 Doctor of Physical Therapy (DPT) programs identified as including elective or required Spanish courses, our program is the only one integrating required Spanish language training across the curriculum. The purpose of this case report is to describe the development, implementation, and preliminary outcomes of our evolving educational model.The University of Texas at El Paso is situated immediately across the border from Mexico. Responding to the high LEP population in our community, faculty began to integrate required Spanish language training during a transition from a master level to a DPT curriculum. This Spanish language curricular pillar includes: 1) Spanish medical terminology course; 2) language learning opportunities threaded throughout the clinical courses; 3) clinical education courses; and 4) service-learning. Forty-five DPT students have completed the curriculum.Our assessment methods were limited for early cohorts. Clinically-relevant Spanish verbal proficiency was assessed by 1) a practical examination in the Spanish course, 2) a clinical instructor-rated instrument that we developed, and 3) student feedback. Preliminary data suggest that our model is improving Spanish language proficiency.Our model still is evolving. We are increasing Spanish language learning opportunities in the curriculum. Also we have recognized problems with our clinical outcome measure. We plan to better define our intended outcomes, and then validate a revised tool. We hope that this report promotes opportunities for collaboration with others who are interested in linguistic competence.
- An Overview of 5 Years of Patient Self-Referral for Physical Therapy in the Netherlands. [JOURNAL ARTICLE]
- Phys Ther 2014 Jul 31.
Self-referral to physical therapy was introduced in 2006 in the Netherlands. Internationally, debate on self-referral is still ongoing.To evaluate the effects of self-referral to physical therapy in the Netherlands, focusing on volume of general practice and physical therapy care (incidence rates and utilization of services).The study is based on monitoring data from existing data sources.Longitudinal electronic medical record data from general practitioners (GPs) and physical therapists participating in the NIVEL Primary Care Database were used, as well as public data from Statistics Netherlands. Descriptive statistics and Poisson multilevel regression analyses were used for analyzing the data.Incidence rates of (low) back, shoulder, and neck pain in general practice declined slightly from 2004 to 2009. No linear trends were found for number of contacts in GP care for (low) back and neck pain. The number of patients visiting physical therapists and the proportion of self-referrers is growing. Self-referrers receive less often treatment after initial intake than referred patients and the mean number of visits is lower.This study was based on data of various patient populations from existing data sources.The current study indicates that self-referral in the Netherlands has fulfilled most expectations held prior to its introduction, although no changes to the workload of GP care have been found. Use of physical therapy grew, but due to population aging and increasing prevalence of chronic diseases, it remains unclear whether self-referral affects health care utilization. Therefore, cost-benefit analyses are recommended.