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Physiotherapy Research International [journal]
- Using the International Classification of Functioning, Disability and Health in Physiotherapy in Multidisciplinary Vocational Rehabilitation: A Case Study of Low Back Pain. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Apr 15.
Multidisciplinary teamwork is increasingly recognized as a critical factor of success in vocational rehabilitation. Although its clinical implementation is still challenging, the International Classification of Functioning, Disability and Health (ICF) has shown to be a useful framework to facilitate communication between stakeholders, to help structure rehabilitation plans and for setting goals and clarifying team roles. With this in mind, the objective of this teaching case study is to illustrate an application of ICF-based tools in a multidisciplinary return to work (RTW) program for patients with non-specific low back pain (NLBP) from the perspective of the physiotherapist.The participant is a 42-year-old kindergarten teacher, who was on sick leave for 10 weeks due to NLBP.This case study describes the use of ICF-based tools such as the Rehabilitation Management Sheet (RehabManagement-Sheet) to guide the rehabilitation process and facilitate team-based and physiotherapist goal setting and documentation in a multidisciplinary RTW program for NLBP.Utilizing ICF tools, we defined long-term and short-term goals, documented improvements in the patient's impairments, activity limitations, and participation restrictions and formulated action steps.The use of ICF-based tools in multidisciplinary rehabilitation allows for a comprehensive assessment, common goal setting and coordinated intervention planning. ICF-based tools like the RehabManagement-Sheet support the physiotherapist's role within the rehabilitation team by enhancing transparency in goal setting and intervention planning across disciplines. Copyright © 2014 John Wiley & Sons, Ltd.
- 'Tell Me About Your Troubles': Description of Patient-Physiotherapist Interaction During Initial Encounters. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Apr 8.
Communication skills are essential for physiotherapy practice. It has been shown that patients, especially those with chronic pain problems, are more satisfied with services when therapists communicate adequately. The objective of this study was to explore how French-speaking physiotherapists and patients with low back pain explore and assess the patient's pain experience during initial encounters.The initial consultation of six consenting patients with low back pain and two physiotherapists was videotaped. Conversation analysis was used to describe and analyse the communication practices related to pain assessment.When physiotherapists explored patients' pain experience, they specifically focused on the impact of pain on function. The observed physiotherapists used the following communication strategies: 1) using yes/no questions and 'okay' as a resource to shift to a new topic; 2) following documentation quite stringently without allowing digression; 3) building the next question on the basis of the patient's discourse; 4) inviting the patient to talk using formulations such as 'tell me about your troubles?'; and 5) using gaze and nodding as continuers. The physiotherapists used two different approaches to close the encounter. While one therapist chose to summarize the consultation, including a prognostic assessment, the other one ended the consultation by organizing the follow-up consultation.This exploratory study examines the interaction between patients and physiotherapists during initial encounters and identifies assumptions underlying pain assessment that shape the therapists' exploration of patients' pain experience. It also shows evidence of the physiotherapists' difficulties to inquire about the patient's perspective. Copyright © 2014 John Wiley & Sons, Ltd.
- General Practitioners' Views About an Orthopaedic Clinical Assessment Service. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Apr 4.
General practitioners' (GP) views about orthopaedic clinical assessment services (OCAS) managed by physiotherapists in the NHS have seldom been sought, yet GPs are likely to be key referrers to such a service.This study aims to review GP views about an OCAS and how they believed the service could be improved.Fifteen consenting GPs were interviewed utilizing semi-structured interviews and a standardized topic guide.Interviews were recorded, transcribed and analysed for emergent themes. Interviews were analysed sequentially by date performed until saturation. Themes were discussed, and disagreements evaluated until agreement was found between the two main authors. The third author then analysed randomly selected interview transcripts and found no additional themes.The study found GPs refer to specialist services, including this OCAS, because of wait times, locality, patient experience, GP experience and knowledge of available services. No GP identified they knew all possible orthopaedic referral routes.GPs saw OCAS as another referral choice for patients suffering orthopaedic pathologies. GPs identified some difficulty in understanding the different services including the various professional roles involved. To assist with their understanding, they described requesting advertising of the different services and the clinicians involved or streamlining of services by provider services. Further detailed research addressing the limitations in this research design is indicated to investigate GP's thoughts and behaviours in relation to referral patterns especially as GPs in the UK took on commissioning for services from April 2013. Copyright © 2014 John Wiley & Sons, Ltd.
- Immediate Effects of Talocrural and Subtalar Joint Mobilization on Balance in the Elderly. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Mar 29.
The aim of the present study was to evaluate the immediate effects of therapeutic mobilization of the talocrural and subtalar joints on ankle mobility and postural control in elderly subjects.Nineteen subjects (83.1 ± 6 years, 159 ± 1 cm; 56.1 ± 9.7 kg - mean ± standard deviation) participated in this study. The centre of pressure (COP) displacements along the anterior-posterior and medial-lateral axes was recorded in static and dynamic conditions on a force platform before and after therapeutic mobilization of the feet and ankles without blinding the subjects.In static conditions, the sway area is reduced contrarily to dynamic conditions where the sway area is increased. In the two experimental sessions, subjects showed comparable COP displacements and the total length of the oscillations. Results demonstrated a significant improvement immediately after mobilization for ankle range of motion in dorsal flexion (right +4.7°; left +3.2°) and plantar flexion (right 5.2°; left +4.2°).These results suggested that postural control is improved in static conditions and decreased in dynamic conditions. Therapeutic mobilization of feet and ankles in the elderly provides an immediate improvement in joint range of movement in dorsal and plantar flexion. Copyright © 2014 John Wiley & Sons, Ltd.
- Huntington's Disease: Characteristics of Fallers. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Feb 10.
Individuals with Huntington's disease have a high prevalence of falls, but the specific factors that may increase the risk of falling have not been clearly identified in this clinical population. This study aimed to identify the characteristics of individuals with early to mid-stage Huntington's disease who had a history of falls, compared with a cohort with no history of falls.Twenty-four participants (10 non-fallers and 14 recurrent fallers) with a diagnosis of early to mid-stage Huntington's disease were included in this study. Falls data were collected using retrospective survey analysis. Participants were assessed using measures of balance (Berg Balance Scale), mobility (Rivermead mobility index [RMI]), fear of falling (Activity-specific Balance Confidence Scale) and gait (6-min walk test; 10-m walk test self-paced and dual tasking).There was no difference in severity of disease state between fallers (Unified Huntington Disease Rating Scale [UHDRS] motor 25.33) and non-fallers (UHDRS motor 25.13) (p = 0.97). The prevalence of falls was high with 66.7% of participants reporting at least one fall and 58.3% reporting two or more falls in the past 12 months. There was no difference in age or gender between recurrent fallers and non-fallers. Recurrent fallers had significantly lower scores on the Activity-specific Balance Confidence Scale (p < 0.01) and the RMI (p < 0.05). The probability of falling increases rapidly with a RMI score of less than 10.Recurrent falls are common in people with Huntington's disease. Individuals with a history of falls were found to have a greater fear of falling and lower functional mobility performance than those who did not have a history of falls. These measures may be useful in the identification of individuals with Huntington's disease who might benefit from a falls prevention programme. Copyright © 2014 John Wiley & Sons, Ltd.
- Evidence-based Practice Exposure and Physiotherapy Students' Behaviour during Clinical Placements: A Survey. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Mar 24.
Physiotherapists are expected to practice in an evidence-based way. Evidence-based practice (EBP) should be an integral part of the curriculum to ensure use of the five EBP steps: asking clinical questions, searching for and appraising research evidence, integrating the evidence into clinical practice and evaluating this process. The aim of this study was to compare self-reported EBP behaviour, abilities and barriers during clinical placements reported by five cohorts of final year physiotherapy students' with different EBP exposure across the 3-year bachelor programme.A cross-sectional study was conducted among five cohorts (2006-2010) with third year physiotherapy students at a University College in Norway. In total, 246 students were eligible for this study. To collect data, we used a questionnaire with 42 items related to EBP behaviour, ability and barriers. Associations were investigated using the Spearman's rho (r).In total, 180 out of 246 third year physiotherapy students, who had recently completed a clinical placement, filled out the questionnaire (73 %). The association between the level of EBP exposure and students' self-reported EBP behaviour, abilities and barriers was low for most items in the questionnaire. Statistically significant correlations were found for eight items, related to information need, question formulation, use of checklists, searching and perceived ability to search for and critically appraise research evidence. The strongest correlation was found between the level of EBP exposure and ability to critically appraise research evidence (r = 0.41, p < 0.001).An association between the level of EBP exposure and physiotherapy students' EBP behaviour was found for elements such as asking and searching, ability to search for and critically appraise research evidence, and experience of critical appraisal as a barrier. Further research need to explore strategies for EBP exposure throughout the curriculum, regarding content, timing, amount and type of training. Copyright © 2014 John Wiley & Sons, Ltd.
- Management of Low Back Pain in Ghana: A Survey of Self-reported Practice. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Mar 21.
Practice variation exists in the physiotherapy management of low back pain (LBP) across several countries. Previous studies indicate that treatment strategies used may not always be in line with evidence-based practice. Most of these studies however were conducted in developed countries. This study sought to investigate the management of LBP in Ghana in order to add to the emergent literature regarding practice in developing nations.A web-based self-report questionnaire was made available to all eligible members of the Ghana Physiotherapy Association.The survey achieved a response rate of 67%. Over 60% of physiotherapists in Ghana had less than 5 years of practice experience, worked in large facility hospitals and had no post-graduate further training. Most LBP patients seen were chronic, and over 60% of treatment sessions used multiple therapies and included exercises, advice, massage, electrotherapy and manual therapy.This first mapping of physiotherapy management of LBP in Ghana shows an overt multimodal approach. There was potential good practice with the high use of exercise and advice, the equally high utilization of passive treatments however showed variance to recommendations of guidelines. The findings of this study have implications for clinical practice and physiotherapy education and research. Copyright © 2014 John Wiley & Sons, Ltd.
- Measuring Physical Activity in Young People with Cerebral Palsy: Validity and Reliability of the ActivPAL™ Monitor. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Mar 14.
We determined the criterion validity and the retest reliability of the ActivPAL™ monitor in young people with diplegic cerebral palsy (CP).Activity monitor data were compared with the criterion of video recording for 10 participants. For the retest reliability, activity monitor data were collected from 24 participants on two occasions. Participants had to have diplegic CP and be between 14 and 22 years of age. They also had to be of Gross Motor Function Classification System level II or III. Outcomes were time spent in standing, number of steps (physical activity) and time spent in sitting (sedentary behaviour).For criterion validity, coefficients of determination were all high (r(2) ≥ 0.96), and limits of group agreement were relatively narrow, but limits of agreement for individuals were narrow only for number of steps (≥5.5%). Relative reliability was high for number of steps (intraclass correlation coefficient = 0.87) and moderate for time spent in sitting and lying, and time spent in standing (intraclass correlation coefficients = 0.60-0.66). For groups, changes of up to 7% could be due to measurement error with 95% confidence, but for individuals, changes as high as 68% could be due to measurement error.The results support the criterion validity and the retest reliability of the ActivPAL™ to measure physical activity and sedentary behaviour in groups of young people with diplegic CP but not in individuals. Copyright © 2014 John Wiley & Sons, Ltd.
- Efficacy of the Star Excursion Balance Test in Detecting Reach Deficits in Subjects with Chronic Low Back Pain. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Mar 12.
The study design is a case control study.The objective of this study is to evaluate how chronic low back pain (CLBP) affects the performance of Star Excursion Balance Test (SEBT).Chronic low back pain is associated with paraspinal and other trunk muscle weakness and reduction in coordination of low back muscles. This reduction in muscular strength and coordination contributes to decreased postural stability, balance and neuromuscular control in subjects with CLBP. SEBT is a simple, reliable and valid method of dynamic performance and is an alternative to more sophisticated instrumented methods. However, no study has evaluated the effect of SEBT on CLBP patients.Ten patients with CLBP (localized back pain, lasting more than 6 months and radiating no further than the buttock with normal neurological examination) and 10 normal age and sex matched subjects (mean age 34.30 + 8.67(range 22-50) participated in this study. All participants completed the SEBT on their dominant leg, and distance measures were collected and compared between groups.The dependant variable was analysed using independent t-test with p < 0.05. The CLBP group demonstrated significant reductions in excursion distances for all directions of the SEBT compared with the control group, except for the posterior (P) direction (0.281) CONCLUSION: Star Excursion Balance Test is an effective and simple tool to identify and measure reach deficits in patients with CLBP. We recommend using SEBT as an outcome measure to identify dynamic balance, multi-planar excursion and postural control in patients with CLBP. Copyright © 2014 John Wiley & Sons, Ltd.
- Inter-Rater Reliability of Modified Modified Ashworth Scale in the Assessment of Plantar Flexor Muscle Spasticity in Patients with Spinal Cord Injury. [JOURNAL ARTICLE]
- Physiother Res Int 2014 Mar 12.
Spasticity occurs in disorders of the central nervous system such as stroke, spinal cord injury (SCI), multiple sclerosis and traumatic brain injury. The recently developed clinical measurement for the measurement of spasticity is the Modified Modified Ashworth Scale (MMAS) PURPOSE OF STUDY: The purpose of this study is to determine the inter-rater reliability of the MMAS in the assessment of plantar flexor spasticity in patients with SCI.Thirty-eight subjects (32 males and six females, mean age 31.9 + 12.6 years) were recruited for the study. Excluded from the study were patients with contracture in the lower limb and where passive movements were contraindicated.Each patient was assessed by two raters in a single session. After the performance of the procedure by the first assessor and rating of the patient's muscle tone with the MMAS, the same procedure was repeated by the second assessor after 1 hour. The evaluation was carried out in side-lying position. The extent of agreement was analysed by non-weighted Cohen kappa.The agreement between the raters was good (soleus - ĸ: 0.75, SE = 0 .084, p < 0.0001, gastrocnemius - ĸ:0.70, SE = 0.105, p < 0.0001).The MMAS has good inter-rater reliability in the assessment of plantar flexor muscle spasticity in patients with SCI. Copyright © 2014 John Wiley & Sons, Ltd.