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Physiotherapy Research International [journal]
- Physiotherapists' Beliefs About Whiplash-associated Disorder: A Comparison Between Singapore and Queensland, Australia. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Jul 23.
Healthcare providers' beliefs may play a role in the outcome of whiplash-associated disorders (WAD), a condition which is proposed to be culturally dependent. Clinical practice guidelines recommend an active approach for the management of WAD, which is often delivered by physiotherapists. However, there is no data on physiotherapists' whiplash beliefs. Our primary objective was to determine physiotherapists' beliefs from Queensland (Australia) and Singapore, two cultures with differing prevalence of chronic musculoskeletal pain and chronic WAD.A pen and paper survey of musculoskeletal physiotherapists practicing in Queensland and Singapore was conducted. Participants completed questionnaires consisting of patient vignettes and statements inquiring knowledge and attitudes towards WAD. Chi-square tests of significance were used to compare the responses of physiotherapists from both samples.Ninety-one (response rate 45%) Queensland-based and 94 (response rate 98%) Singapore-based physiotherapists participated in the study. The beliefs in the management strategies for the patient vignettes were generally consistent with practice guidelines. A higher proportion of Queensland-based physiotherapists expected permanent disabilities for the patient vignette depicting chronic WAD (Queensland: 55% Singapore: 28% Pearson chi-sq 18.76, p < 0.005).Up to 99% of the physiotherapists from both samples believed in encouragement of physical activity, the effectiveness of exercise and multimodal physiotherapy for WAD. Significantly higher proportions of Singapore-based physiotherapists believed in ordering radiographs for acute WAD (Pearson chi-sq 41.98, p < 0.001) and also believed in a psychogenic origin of chronic WAD (Pearson chi-sq 22.57, p < 0.001).The majority of beliefs between physiotherapists in Queensland and Singapore were similar but there were specific differences. Physiotherapists' whiplash beliefs in Queensland and Singapore did not clearly reflect the difference in prevalence of chronic musculoskeletal pain or chronic WAD in Queensland and Singapore. Copyright © 2014 John Wiley & Sons, Ltd.
- Improving Hand Functional Use in Subjects with Multiple Sclerosis Using a Musical Keyboard: A Randomized Controlled Trial. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Jul 7.
Playing an instrument implies neuroplasticity in different cerebral regions. This phenomenon has been described in subjects with stroke, suggesting that it could play a role in hand rehabilitation. The aim of this study is to analyse the effectiveness of playing a musical keyboard in improving hand function in subjects with multiple sclerosis.Nineteen hospitalized subjects were randomized in two groups: nine played a turned-on musical keyboard by sequences of fingers movements (audio feedback present) and 10 performed the same exercises on a turned-off musical keyboard (audio feedback absent). Training duration was half an hour per day for 15 days. Primary outcome was the perceived hand functional use measured by ABILHAND Questionnaire. Secondary outcomes were hand dexterity, measured by Nine-Hole Peg Test, and hand strength, measured by Jamar and Pinch dynamometers. Two-way analysis of variance was used for data analysis.The interaction time × group was significant (p = 0.003) for ABILHAND Questionnaire in favour of experimental group (mean between-group difference 0.99 logit [IC95%: 0.44; 1.54]). The two groups showed a significant time effect for all outcomes except for Jamar measure.Playing a musical keyboard seems a valid method to train the functional use of hands in subjects with multiple sclerosis. Copyright © 2014 John Wiley & Sons, Ltd.
- How did the Canterbury Earthquakes Affect Physiotherapists and Physiotherapy Services? A Qualitative Study. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Jul 14.
The recent earthquakes in Canterbury New Zealand ended lives and resulted in disruption to many aspect of life for survivors, including physiotherapists. Physiotherapists often volunteer vital rehabilitation services in the wake of global disasters; however, little is known about how physiotherapists cope with disasters that affect their own communities. The purpose of this study was to investigate how the Canterbury earthquakes affected physiotherapists and physiotherapy services.We use a General Inductive Approach to analyse data obtained from purposively sampled physiotherapists or physiotherapy managers in the Canterbury region. Interviews were audio-recorded and transcribed verbatim.We analysed data from interviews with 27 female and six male participants. We identified four themes: 'A life-changing earthquake' that described how both immediate and on-going events led to our second theme 'Uncertainty'. Uncertainty eroded feelings of resilience, but this was tempered by our third theme 'Giving and receiving support'. Throughout these three themes, we identified a further theme 'Being a physiotherapist'. This theme explains how physiotherapists and physiotherapy services were and still are affected by the Canterbury earthquakes.We recommend that disaster planning occurs at individual, departmental, practice and professional levels. This planning will enable physiotherapists to better cope in the event of a disaster and would help to provide professional bodies with a cohesive set of skills that can be shared with health agencies and rescue organizations. We recommend that the apparently vital skill of listening is explored through further research in order for it to be better accepted as a core physiotherapy skill. Copyright © 2014 John Wiley & Sons, Ltd.
- Effectiveness of Task Specific Gait and Balance Exercise 4 Months After Hip Fracture: Protocol of a Randomized Controlled Trial - The Eva-Hip Study. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Jul 3.
Regular rehabilitation is not sufficient for regaining function after a hip fracture, and more targeted interventions for home-dwelling elderly hip-fracture patients are needed. This paper describes the protocol of a study assessing the effectiveness and cost effectiveness of a task specific progressive gait and balance exercise programme for hip-fracture patients, performed 4 months after the fracture.A single blind two-arm pragmatic randomised controlled trial was conducted with 142 hip-fracture patients randomized to a 10-week home-based exercise programme or to practice as usual 4 months following the surgery. Inclusion criteria were age >70 years and being home dwelling prior to the fracture. Exclusion criteria are life expectancy <3 months and inability to walk 10 m prior to the fracture. The content and organization of the programme was developed in collaboration between physiotherapy researchers and primary health-care physiotherapists. Participants were followed for 1 year post-surgery, evaluating short-term and long-term effects of the programme. The primary outcome is gait speed, and the secondary outcomes are spatial and temporal gait parameters, free living physical behaviour by activity monitoring, mobility performance, activities of daily living, fear of falling, cognitive function, depression and health-related quality of life. Cost-effectiveness analysis is planned.This paper describes a task specific exercise programme aimed to improve gait and balance after a hip fracture. Inclusion started in February 2011, and the last 1-year follow-up is performed in March 2014. Broad inclusion criteria and physiotherapy-guided home-based exercises may facilitate the participation from frail patients and thereby increase the generalizability of the findings. Development and completion of the intervention within routine clinical practice will enlighten the implementation of results into clinical practice. Results may add new insight into how physiotherapy can improve gait and thereby activity and functioning in everyday life and have implications on future content and organization of physiotherapy after a hip fracture. Copyright © 2014 John Wiley & Sons, Ltd.
- Gait Changes with Balance-Based Torso-Weighting in People with Multiple Sclerosis. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Jun 14.
People with multiple sclerosis (PwMS) commonly have mobility impairments that may lead to falls and limitations in activities. Physiotherapy interventions that might improve mobility typically take several weeks. Balance-based torso-weighting (BBTW), a system of strategically placing light weights to improve response to balance perturbations, has resulted in immediate small improvements in clinical measures in PwMS, but changes in spatiotemporal gait parameters are unknown. The purpose was to investigate the effects of BBTW on gait parameters in PwMS and healthy controls.This study is a non-randomized controlled experiment.This study included 20 PwMS and 20 matched healthy controls PROCEDURES: People with multiple sclerosis walked on an instrumented mat at their fastest speed for three trials each in two conditions: without BBTW then with BBTW. Healthy controls walked in both conditions at two speeds: their fastest speed and at velocities equivalent to their matched PwMS.Averaged gait trials showed that, with BBTW, PwMS had significantly increased velocity (p = 0.002), cadence (p = 0.007) and time spent in single-limb support (p = 0.014), with decreased time in double-limb support (p = 0.004). Healthy controls increased velocity (p = 0.012) and cadence (p = 0.015) and decreased support base (p = 0.014) in fast trials with BBTW; at matched velocities, step length (p = 0.028) and support base (p = 0.006) were significantly different from PwMS. All gait variables in healthy controls at fast speeds were significantly different from PwMS walking at their fastest speeds.All participants showed increases in gait velocity and cadence during fast walk with BBTW. Improvements in time spent in single-limb and double-limb support by PwMS with BBTW may reflect greater stability in gait. Future research might ascertain if these immediate improvements could enhance effectiveness of longer-term physiotherapy on functional mobility in PwMS. Copyright © 2014 John Wiley & Sons, Ltd.
- Functional Limitations due to Fatigue Among Independently Ambulant Stroke Survivors in Osun, South-Western Nigeria. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Jun 12.
Functional limitations in stroke survivors are sometimes associated with fatigue. This study assessed the functional limitations due to fatigue in community-dwelling stroke survivors undergoing physiotherapy. The differences in functional limitations due to fatigue were determined between sexes, stroke types, sides of affectation, age categories and levels of disability. Relationships between functional limitation due to fatigue and these variables were also determined.This was a cross-sectional study involving 63 stroke survivors (35 male survivors and 28 female survivors) with ages ranging from 45 to 79 years (mean = 53.68 ± 10.95 years). Functional limitation due to fatigue was assessed with the modified fatigue impact scale (MFIS). Modified Rankin scale was used to categorize the disability of the participants. Data were analysed using descriptive (mean, standard deviation, percentage and frequency) and inferential (Mann-Whitney U-test and Spearman correlation analysis) statistics. Significance was set at 0.05 α level.The mean MFIS score was 31.74 ± 12.39. Many participants (58.7%) had moderate functional limitations due to fatigue. The result of Mann-Whitney U-test showed significant difference in functional limitation due to fatigue between participants with slight disability and those with moderate disability (p = 0.000), with participants with moderate disability having higher MFIS scores (more functional limitations). There was also a significant correlation between functional limitation due to fatigue and level of disability (ρ = 0.625, p = 0.000).Functional limitation due to fatigue occurs frequently in stroke survivors and is related to level of disability. Functional limitations due to fatigue should be assessed frequently in all stroke survivors with varying degrees of disability and the outcome should be considered during rehabilitation and retraining of physical function. Copyright © 2014 John Wiley & Sons, Ltd.
- Reliability of the Senior Fitness Test in Community-dwelling Older People with Cognitive Impairment. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Jun 13.
In older people with cognitive impairment, we require reliable and valid measures to assess physical fitness and to measure change, for example, as a result of an exercise intervention. The purpose of our study was to determine the relative and absolute test-retest reliability of the Senior Fitness Test (SFT) in older people with cognitive impairment.A test-retest reliability study was conducted for the Senior Fitness Test in older people with cognitive impairment. Participants were tested at two time points with a time interval of 24 hours to 1 week between tests. The Intraclass Correlation Coefficient model 3.1 (ICC, 3.1) with 95% confidence intervals (CIs) was used as a measure of relative reliability. The standard error of measurement and minimal detectable change (MDC) were used to measure absolute reliability.The ICC reflected very high reliability (0.93-0.98) in all SFT items, indicating that there was no systematic error in the measurements. MDC values at the 90% CIs were calculated: chair stand test = 2.0 repetitions, armcurl test = 2.3 repetitions, chair sit and reach test = 6.0 cm, back scratch test = 4.6 cm, 2.45-m up-and-go test = 1.4 seconds and 6-minute walk test = 37.1 metres.The SFT battery showed high to very high test-retest reliability and thus may be suitable for detecting changes in physical fitness and evaluating physical fitness in older people with cognitive impairment, both in research and for clinical purposes. Copyright © 2014 John Wiley & Sons, Ltd.
- Individualized Physiotherapy in the Treatment of Patellofemoral Pain. [JOURNAL ARTICLE]
- Physiother Res Int 2014 May 22.
Patellofemoral pain (PFP) is associated with a wide range of local and global physical factors possibly contributing to pain and thus requires detailed assessment and individualized treatment. Yet, no cohort study was found that assessed the value of individualized physiotherapy, probably because this approach lends itself to clinical practice but not to scientific research. Most studies focus on a 'knee' or 'hip' treatment approach irrespective of individual global differences in lower limb alignment, movement patterns and muscle tightness. Therefore, this study aimed to determine the effectiveness of supplementing local treatment of PFP with individualized treatment targeting global contributing factors. Secondarily it aimed to subgroup the patients according to variations in lower limb alignment/laxity, movement patterns, biarticular muscle tightness and joint degeneration.Forty-one patients (60 knees) with PFP who had followed a programme of local quadriceps strengthening, quadriceps stretching and taping for one fortnight were prescribed an individualized programme based on assessment. This global assessment included lower limb postural alignment, movement patterns, muscle tightness and range of motion. Another fortnights treatment was prescribed accordingly and included specific, individualized postural and movement retraining, stretching and functional weight-bearing, strengthening exercises. Seven outcome measures, namely four pain measures, isokinetic quadriceps strength, quadriceps length and eccentric knee control, assessed improvement.All outcome measures showed further significant improvement following individualized treatment (p < 0.03). Patients fell into four broad physical subgroups: hypermobility (often with malalignment), hypomobility (with three of four tight muscle groups), faulty movement patterns (mostly dynamic knee valgus) and patellofemoral osteoarthritis.Individualized treatment supplementing local standard physiotherapy for PFP leads to further significant improvement over 2 weeks. This study highlights the importance of assessing patients globally in order to optimize treatment and ongoing improvement. Recognition of different subgroups may guide treatment that should include both local and deficit-targeted global treatment. Copyright © 2014 John Wiley & Sons, Ltd.
- The Assessment, Benefits and Delivery of Physical Activity in People with Schizophrenia: A Survey of Members of the International Organization of Physical Therapists in Mental Health. [JOURNAL ARTICLE]
- Physiother Res Int 2014 May 1.
People with schizophrenia typically die over a decade before members of the general population. Physical activity is a low cost and effective intervention that can have a multitude of beneficial effects on people with schizophrenia. Physical therapists lead in the delivery of physical activity in many of the commonly observed co-morbidities in schizophrenia, yet their role in the delivery of physical activity in patients with schizophrenia remains unclear.This study aimed to establish an international consensus on physical therapists' beliefs, potential benefits and practices in the use of physical activity in schizophrenia.All members of the International Organization of Physical Therapists in Mental Health were invited to take part in a cross-sectional online survey. All data were analysed using descriptive statistics and quantitative content and/or thematic analysis.One hundred and fifty-one physical therapists from 31 countries responded. Almost all respondents (92%) felt that physical activity benefited patients with schizophrenia, and 75.2% and 22.5%, respectively, felt that it was very important and important that physical therapists oversee in the delivery of physical activity in psychiatric services. Resultant themes established that physical activity has a plethora of beneficial effects on people with schizophrenia including physical health benefits and biopsychosocial effects such as improved mental health, socialization and quality of life. In addition, participants felt they have the necessary theoretical knowledge and clinical skills required for leading and overseeing physical activity programmes in this complex patient group.Physical therapists identified that physical activity has a plethora of benefits for patients with schizophrenia and that they have the necessary knowledge and skills to lead and oversee the successful delivery of physical activity in patients with schizophrenia in clinical practice. Copyright © 2014 John Wiley & Sons, Ltd.
- Factors Influencing Disability due to Low Back Pain Using the Oswestry Disability Questionnaire and the Quebec Back Pain Disability Scale. [JOURNAL ARTICLE]
- Physiother Res Int 2014 May 1.
The aim of this research was to compare the difference in disability caused by back pain using scores from the Oswestry Disability Questionnaire (ODQ) and the Quebec Back Pain Disability Scale (QUE) according to gender, acute and chronic low back pain (LBP) groups, specific and nonspecific LBP groups and to identify the factors influencing the degree of LBP disability.One hundred and thirty-three patients with LBP participated in this study. The Visual Analogue Scale (VAS) of ODQ and QUE were used to compare the differences between men and women, acute and chronic and specific and nonspecific LBP groups. We identified the factors influencing the disability of LBP using a stepwise multiple regression.In comparison with the nonspecific LBP group, the VAS, ODQ and QUE scores were significantly higher and the pain duration was significantly longer in the specific LBP group (P < 0.05). A multiple regression equation with VAS and LBP classification explained the 45.4% variance in ODQ and an equation with VAS, LBP classification, pain duration and gender explained 31.1% of the variance in QUE.The degree of disability from back pain assessed using the ODQ score was influenced by a pain severity and LBP type. Also, QUE score was influenced by a pain severity, LBP type, pain duration and gender. To assess the disability caused by back pain accurately using the ODQ and QUE, various factors affecting the scores of the questionnaire must be considered. Copyright © 2014 John Wiley & Sons, Ltd.