Showing papers in "Physiotherapy Theory and Practice in 2008"
TL;DR: The test-retest reliability and concurrent and construct validity of the 6MWT in patients who were actively undergoing inpatient rehabilitation poststroke was determined to be reliable and related to other measures of walking ability and function that are commonly used during rehabilitation after stroke.
Abstract: The 6-minute walk test (6MWT) is commonly used to measure walking ability. The purpose of this study was to determine the test-retest reliability and concurrent and construct validity of the 6MWT in patients who were actively undergoing inpatient rehabilitation poststroke. Thirty-seven patients undergoing inpatient rehabilitation after a stroke participated; mean age was 66.3 years and mean time since stroke was 33.7 days. Patients underwent two 6MWT trials with 1-3 days between trials. Additional outcome measures taken were gait speed and the Functional Independence Measure (FIM). The 6MWT exhibited high test-retest reliability; ICC(2,1) 0.973 (95% CI=0.925-0.988) and a minimal detectable change (MDC(90)) of 54.1 m. The 6MWT was strongly to moderately correlated with gait speed (r=0.89), locomotion (walk) FIM (r=0.69), and motor FIM (r=0.52). The 6MWT is a clinically useful measure of walking ability poststroke. It is reliable and is related to other measures of walking ability and function that are commonly used during rehabilitation after stroke.
214 citations
TL;DR: The high correlations obtained in this study suggest that the inclinometer and the goniometer are reliable instruments for measuring hip extension flexibility and indicate that the two instruments can be used interchangeably for measuring hips extension flexibility.
Abstract: Our objectives were to examine interrater reliability for inclinometer and goniometric measurements of hip extension flexibility and the intra- and interrater reliability between instruments when measuring hip extension flexibility with the modified Thomas test. The modified Thomas test is frequently used by clinicians to assess hip extension flexibility. Studies examining the reliability of measures of the modified Thomas test are limited. This study included 42 healthy subjects. The modified Thomas test was performed on each subject to quantify hip extension flexibility by using an inclinometer and a goniometer. High interrater reliability was determined for each instrument (r = 0.91-0.93; ICC = 0.89-0.92). High intrarater parallel-forms reliability was found for each examiner between the instruments (r = 0.089-0.92; ICC = 0.91-0.93). High interrater parallel-forms reliability also was found between instruments (r = 0.86-0.93; ICC = 0.86-0.92). The high correlations obtained in this study suggest that the inclinometer and the goniometer are reliable instruments for measuring hip extension flexibility. The results also indicate that the two instruments can be used interchangeably for measuring hip extension flexibility.
132 citations
TL;DR: The Movement Quality Model (MQM) is illuminating essential features and characteristics of the phenomenon, seeing movement quality as biomechanical, physiological, psycho-socio-cultural, and existential, all interacting processes.
Abstract: Movement quality is a phenomenon frequently used by physiotherapists in oral language, written text, and clinical practice, with little clarification. The purpose was to investigate the lived experiences of a group of expert physiotherapists, searching for essential features and characteristics of the phenomenon. A phenomenological study, using in-depth interviews was chosen. Ten copies of Fine Art were used to stimulate the description of the phenomenon. The informants were 15 peer-designated physiotherapists, five from each field of neurology, psychosomatic/psychiatry and primary health care. They were nominated by physical therapist leaders in the region. The interviews were audiotaped and transcribed. Giorgis' recommendation concerning analysis of the interview data was followed. Four main themes were developed, seeing movement quality as biomechanical, physiological, psycho-socio-cultural, and existential, all interacting processes. Each theme includes preconditions to movement quality and movement characteristics. Movement quality in general was seen as a unifying phenomenon, representing a synthesis of the four themes. The outcome of the study is the Movement Quality Model (MQM) illuminating essential features and characteristics of the phenomenon. Further research is needed for clarification and application in clinical practice.
98 citations
TL;DR: It is concluded that the duration of sitting posture and psychosocial factors may influence the experience of musculoskeletal pain among children and adolescents.
Abstract: Musculoskeletal pain has become a major symptomatic complaint among children and adolescents and is increasingly occurring at a younger age. This systematic review was done to evaluate the evidence for the contribution of posture and psychosocial factors to the development of upper quadrant musculoskeletal pain in children and adolescents. The review describes the measurement tools used to assess musculoskeletal pain, sitting posture, and psychosocial factors. Two independent reviewers searched seven databases for observational studies that included prospective and cross-sectional study designs. Ten studies were extracted and assessed by two reviewers using the Critical Appraisal Form-Quantitative Studies (Law et al, 1998). The studies measured upper quadrant musculoskeletal pain as an outcome measure. Five studies evaluated sitting posture and found an association between the duration of static sitting and upper quadrant musculoskeletal pain. Six studies measured psychosocial factors of which depression, stress, and psychosomatic symptoms were the factors most commonly found to influence the development of upper quadrant musculoskeletal pain. The eligible studies used different pain measurement tools and different measurement tools to assess sitting posture and psychosocial factors. This review concludes that the duration of sitting posture and psychosocial factors may influence the experience of musculoskeletal pain among children and adolescents.
83 citations
TL;DR: A clinical reasoning and decision-making framework is proposed to meet the challenge of population and community-based management of chronic conditions and provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice.
Abstract: Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners’ understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies rela...
69 citations
TL;DR: Evaluated the test-retest reliability of the cervicocephalic relocation test to the neutral head position and determined the number of trial recordings required to ensure reliable measurements, which show that the CRT to NHP has a fair to excellent reliability.
Abstract: Considering the important role of the cervical joint position sense on control of human posture and locomotion, accurate and reliable evaluation of neck proprioceptive abilities appears of great importance. Although the cervicocephalic relocation test (CRT) to the neutral head position (NHP) usually is used for both research and clinical purposes, its test-retest reliability has not been clearly established yet. The purpose of the present experiment was to 1) evaluate the test-retest reliability of the CRT to NHP and 2) to determine the number of trial recordings required to ensure reliable measurements. To this aim, 40 young healthy adults performed the CRT to NHP on two separate occasions. Ten trials were performed for each rotation side. Absolute and variable errors, processed along their horizontal, vertical, and global components, were used to assess the cervical joint repositioning accuracy and consistency, respectively. Mean difference between test and retest with 95% confidence interval, intraclass correlation coefficient, and Bland and Altman graphs with limits of agreement were used as statistical methods for assessing test-retest reliability. Results show that the CRT to NHP when executed in its original form (i.e., 10 trials) has a fair to excellent reliability (ICC ranged from 0.52 to 0.81 and from 0.49 to 0.77, for absolute and variable errors, respectively); the test-retest reliability of this test increases as the number of trials used to establish subject's repositioning errors increases; and using the mean of eight trials is sufficient to ensure fair to excellent reliability of the measurements (ICC ranged from 0.39 to 0.78 and from 0.44 to 0.78, for absolute and variable errors, respectively).
67 citations
TL;DR: The MMAS has very good interrater reliability for the assessment of wrist flexor muscle spasticity in adult patients after upper motoneuron lesions resulted in hemiplegia.
Abstract: The measurement of spasticity is part of the neurological examination of patients with disorders of the central nervous system. Recently, the Modified Modified Ashworth Scale (MMAS) was developed for the characterization of muscle spasticity. The purpose of this study was to determine the interrater reliability of the MMAS in the assessment of wrist flexor muscle spasticity in adult patients after upper motoneuron lesions resulted in hemiplegia. Thirty hemiplegic patients (17 males and 13 females) with a mean age of 55.6+/-7.8 years participated in this study. The wrist flexor spasticity was assessed according to MMAS by two female physiotherapists. The raters gave 23 patients the same spasticity score (weighted percentage agreement=97.4%). The most agreement occurred for scores 3 (46.7%) and 0 (16.7%), respectively. The agreement between raters was very good (weighted kappa=0.92, SE=0.03, p<0.0001). In conclusion, the MMAS has very good interrater reliability for the assessment of wrist flexor muscle spasticity.
62 citations
TL;DR: The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity and the reliability and the validity of the scale.
Abstract: Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (kappa=0.72, SE=0.14, p<0.001) between raters and very good (kappa=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.
60 citations
TL;DR: Recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery.
Abstract: This study investigated the physical and psychosocial consequences of living with osteoarthritis (OA) in daily life and peoples' views of total knee arthroplasty (TKA) and the role of physiotherapy. In-depth interview data were used from a prospective qualitative study conducted by the senior author (KY). Participants were 15 volunteers with knee OA who were awaiting TKA at a specialized orthopaedic tertiary care facility in Toronto. A modified grounded theory method approach was used to analyze the interview data. The findings showed that experiences for the participants with OA were conceptualized as a "breakpoint." The breakpoint was centred on the experiences/processes of living with unremitting pain, the limitations of mobility, leisure and social activities, and the resulting consequences to the participant's physical and psychological well-being. In addition to the above experiences, participants also discussed their perceptions of TKA surgery. The findings showed that expectations of TKA were linked to participants' knowledge of the procedure and its outcomes. The participants listed acquaintances, friends, family members, and doctors as the main sources of knowledge for TKA. On the basis of the above analysis, recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery.
58 citations
TL;DR: The patients' experiences ranged from a reduction of symptoms and coping quite well with chronic pain, to a feeling of being totally stuck in pain, followed by either a new body awareness or being preoccupied by pain, as well as differences between participants within the groups.
Abstract: This study has explored the experience of body awareness in patients with chronic pain as well as possible changes in this phenomenon as a consequence of Norwegian psychomotor physiotherapy (NPMP), were explored in the present study. Four focus group interviews were performed. Two groups consisted of patients on waiting lists for NPMP, whereas the other two were patients receiving NPMP. The interview material was analysed according to an ad hoc meaning generation. The interviews brought out three main themes of body awareness: being aware of one's own body; associations about one's own body; and feelings for one's own body. The differences and similarities in body awareness described by those receiving treatment and those on waiting lists are presented and discussed, as well as differences between participants within the groups. The patients' experiences ranged from a reduction of symptoms and coping quite well with chronic pain, to a feeling of being totally stuck in pain, followed by either a new body awareness or being preoccupied by pain. The participants receiving long-term NPMP--with one exception--experienced new body awareness, described as essential to increasing their ability to cope with pain.
47 citations
TL;DR: Test-retest reliability of elbow-JPS and elbow-TDPM can only be recommended to a minor degree for absolute error, but for consistency of error it is not reliable and can therefore not be recommended.
Abstract: Proprioception is an important effect measure in neuromuscular function training in physiotherapy. Reliability studies of methods for measuring proprioception are few on joint position sense (JPS) and threshold to detection of a passive movement (TDPM) on the elbow. The aim was to study test-retest reliability of elbow-JPS and elbow-TDPM. A total of 45 healthy subjects participated in the study (mean age 33 years, range 18-57 years). In the active-active test-retest of JPS 26 subjects and in test-retest of TDPM 19 subjects participated. The duration between test and retest was approximately 30 minutes. There was no significant difference (p<0.05) between test and retest. The intraclass correlation coefficients, (ICC, model 2.1) of test-retest on absolute error were 0.59 and 0.69 for JPS and TDPM, respectively, indicating a fair to good reliability. ICCs of variable error were 0.45 for TDPM, indicating a fair to good reliability, whereas for JPS it was 0.007, indicating poor reliability. TDPM can be recommended as an examination tool for absolute error, but to a minor degree for consistency of error. JPS can only be recommended to a minor degree for absolute error, but for consistency of error it is not reliable and can therefore not be recommended.
TL;DR: The outcomes of the six case studies would suggest that further investigation is required to show the effectiveness of physiotherapy programs in the management of CD.
Abstract: The aim of the study was to explore the outcome of a physiotherapy program targeted to improve the quality of life of people with cervical dystonia (CD) by reducing pain, improving awareness of postural orientation, increasing muscle strength, and reducing the effort of moving the head and neck. In six single case studies, the primary outcome measure for each case was the Cervical Dystonia Questionnaire (CDQ) to measure the impact of the program on the individuals' quality of life. Secondary outcome measures were identified for the different components of the physiotherapy program: Visual Analogue Scale (pain); Postural Orientation Index (postural orientation awareness); and Movement Energy Index (effort of moving head and neck). Each of the cases had the severity of their problems scored on the Toronto Western Spasmodic Torticollis Scale. The study period was 26 weeks: 2 weeks' baseline period, 4 weeks' treatment period, and 20 weeks' follow-up. All measures except the Movement Energy Index (MEI) and CDQ-24 were taken three times per week for the first 6 weeks of the study and then once at 3 and 6 months. The MEI was taken once a week during the pretreatment and the treatment periods and during the first 2 weeks of follow-up and also after 3 and 6 months of follow-up. The CDQ-24 was taken once in the pretreatment period, once after completion of treatment, once 2 weeks after treatment, and once at 3 and 6 months of follow-up. Five of the six case studies reported an increase in quality of life at 6-month follow-up, as measured on the CDQ-24. Three of the six cases reported a reduction in pain and severity of the dystonia and had improved scores on the postural orientation measure at 6-month follow-up. All six patients had a reduction in the movement energy scores, but this was not significant. The outcomes of the six case studies would suggest that further investigation is required to show the effectiveness of physiotherapy programs in the management of CD.
TL;DR: It was found that adults with Asperger's disorder performed significantly worse than the normal comparison group in six of eight subtests in the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP).
Abstract: In the original description of Asperger's disorder (AD), clumsiness was an associated feature. Several studies of children have shown deficits in motor control, whereas research regarding adults is scarce. The aim of the present study was to compare motor function in adults with AD, with a normal comparison group. Gross and fine motor skills were examined by a standardized, norm referenced test developed for children, but also used in young adults, the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). In addition, a questionnaire regarding the participants' physical activity during leisure time was administered. We found that adults (age 21-35) with AD (N = 15) performed significantly worse than the normal comparison group (N = 29) in six of eight subtests in the BOTMP. Males with AD were less physically active than males in the comparison group. Among females, physical activity did not differ between the groups. There was a positive association between physical activity and gross motor function in the AD group. Participants with AD were encouraged by the assessments. Physical coaching may be an important future field for improving quality of life in adults with AD.
TL;DR: It is indicated that passive stretching beyond five repetitions results in insignificant gains in hamstring length (measured via knee extension ROM) and are probably unnecessary.
Abstract: The purpose of this study was to determine the minimal number of cyclic passive stretch repetitions required to induce an acute increase in hamstring length via an indirect measure of hamstring length. Eighteen healthy males (aged 19-37 years) were placed in a standardized position. Knee flexion range of motion (ROM) measurements were recorded following ten 15-second passive stretch repetitions. Analysis of variance measures (p < 0.05) and post hoc analysis showed that significant increases in knee extension ROM diminished at the fifth stretch repetition. The greatest single increase in knee extension ROM occurred after the first stretch. The results of this study indicate that passive stretching beyond five repetitions results in insignificant gains in hamstring length (measured via knee extension ROM) and are probably unnecessary.
TL;DR: The social humanistic perspective of health views health as an ability to function in relationship to goals, resources, and social context and diseases or disorders within this perspective are seen as physical or mental processes that contribute to ill health by limiting the ability of an individual to function normally.
Abstract: According to the biomedical model, health is the absence of a disease, and diseases are equivalent to pathoanatomical findings divergent from what is considered normal or natural functioning (Boors...
TL;DR: The current study did not find significant improvements in the clinical measures evaluated, but 8 of the 16 subjects did experience a decrease in knee pain, suggesting that certain patients with PFP may respond favorably to bracing, and criteria must be established to determine which patients would best benefit from such an intervention.
Abstract: Our purpose was to evaluate the effects of a patellofemoral brace on pain response, knee extensor torque production, and gait function in females with patellofemoral pain (PFP). Sixteen females between the ages of 14 and 46 with diagnosis of PFP participated. Knee extensor torque was measured by using a LIDO isokinetic dynamometer. Pain levels were documented by using the Visual Analog Pain Scale. Stride characteristics during the conditions of free walk, fast walk, ascend stairs, descend stairs, ascend ramp, and descend ramp were obtained with a stride analyzer unit. EMG activity of the vasti musculature was recorded by using indwelling, bipolar, wire electrodes. Knee joint motion was assessed by using a VICON motion analysis system. All testing was performed with and without the Bauerfeind Genutrain P3 patellofemoral brace. There were no significant differences in torque production, pain levels, and stride characteristics between braced and non-braced trials. In addition, there were no significant differences in mean vasti EMG between braced and non-braced trials. When averaged across all conditions, a small but statistically significant increase in knee flexion was found during the braced trials. Although the current study did not find significant improvements in the clinical measures evaluated, 8 of the 16 subjects did experience a decrease in knee pain. This finding suggests that certain patients with PFP may respond favorably to bracing, and criteria must be established to determine which patients would best benefit from such an intervention.
TL;DR: This ethnographic study explores from the therapists’ perspectives how therapist/patient interactions influence success or contribute to meeting the patients’ goals on a pain management program.
Abstract: Changes in health care brought about by the increased incidence of chronic conditions have resulted in an increased focus on patient self-directed care This ethnographic study explores from the therapists' perspectives how therapist/patient interactions influence success or contribute to meeting the patients' goals on a pain management program A team of physiotherapists were observed individually with their patients over a period of 6 months Their interactions were audiotaped, transcribed, analysed, and cross-referenced to the field notes and the follow-up interviews with the therapists after each observation The analysis was iterative, guided by questions and contextualised Codes, categories, and evolving patterns of behaviour were documented, and three major themes were identified The therapist/patient interactions demonstrated certain consistent standpoints toward the purpose of the program The team judged those who achieved positive outcomes, as having entered into interactions typified by assertiveness, negotiation, and critical reflection However, even the most able team of therapists will not be able to create a collaborative framework unless their patients are willing to grasp the opportunity offered to them, and they judged their least successful patients as having adopted unwilling and unrealistic interactions Interactions of resistance or an inability to carry over problem solving skills into their lives resulted in a negative outcome for the patients and a stunting of the team's potential
TL;DR: Benefits of 5-Form, Yang Style Tai Chi were sustained at 6 months, but only functional strength and mobility remained improved at 12 months postintervention.
Abstract: This study investigated the effects of 5-Form, Yang Style Tai Chi (TC) on balance confidence, balance performance, functional strength, mobility, and incidence of falls among individuals with or at risk for developing osteoporosis. This was a pilot outcomes study in which participants served as their own controls. Thirty-one independent, community-dwelling women (mean age of 67.3 years) attended TC sessions twice a week for 12 weeks and practiced at least 1 day a week on their own. A specific TC instruction video was used to facilitate home practice. Baseline, immediate postintervention, and 6 and 12 months postintervention data were recorded. Outcome measures included the Activities-specific Balance Confidence (ABC) Scale, One-Legged Stance Test (OLST) for both legs, Repeated Chair Stands (RCS), and the Timed Up and Go Test (TUG). Exercise performance and falls were tracked during the study by using daily diaries. Balance performance, functional strength, and mobility significantly improved (p < 0.05) immediately postintervention. Most benefits were sustained at 6 months, but only functional strength and mobility remained improved at 12 months postintervention. Most participants reported exercising at the 6- and 12-month follow-up. However, very few individuals continued to practice TC on a regular basis (more than once a week) beyond the 12-week intervention. Balance confidence or incidence of falls did not improve.
TL;DR: This topical review considers physical activity prescription using the E-Model as a framework for best practice decision making, and examines findings from randomized trials, published experts, and qualitative studies through the lens of the model's five Es.
Abstract: Fibromyalgia (FM) is a serious and debilitating condition, encompassing a wide range of symptoms. Physical therapists often advocate the incorporation of leisure time physical activity (exercise training or recreational physical activity) as an important management strategy for individuals with FM. Decisions about physical activity prescription in clinical practice are informed by a variety of sources. This topical review considers physical activity prescription using the E-Model as a framework for best practice decision making. We examine findings from randomized trials, published experts, and qualitative studies through the lens of the model's five Es: 1) evidence, 2) expectations, 3) environment, 4) ethics, and 5) experience. This approach provides a robust foundation from which to make best practice decisions. Application of this model also facilitates the identification of gaps and discrepancies in the literature, future opportunities for knowledge exchange and translation, and future research.
TL;DR: The conclusion of this study was that the FES(S) is not to be recommended as a single measurement in the acute phase of stroke because it does not measure actual balance function.
Abstract: It is well known that patients who have suffered a stroke have problems with balance and have feelings of unsteadiness. The aim of this study was to analyse the correlation between how patients estimate their perceived confidence in task performance without falling and the objective assessment of balance made by a physiotherapist, and whether the Falls Efficacy Scale (FES(S)) is to be recommended for use in patients in the acute phase of stroke. Sixty patients divided into two groups assessed their belief to perform daily life activities without fear of falling using the FES(S) and were assessed by using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) by a physiotherapist. Group 1 assessed themselves before, whereas Group 2 assessed themselves after the objective assessment. The correlation between the FES(S) and the TUG was moderate to good, but these two scales consider different aspects and dimensions of balance, ability, and belief and are therefore not interchangeable. The correlation between FES(S) and BBS was low to moderate. The conclusion of this study was that the FES(S) is not to be recommended as a single measurement in the acute phase of stroke because it does not measure actual balance function.
TL;DR: The STS repetitions recorded by the counter in this study provide an estimate of the number of STSs that community-dwelling adults perform daily, significantly higher on weekdays than weekends.
Abstract: No information exists about how many sit-to-stands (STSs) are performed daily by community-dwelling adults. We, therefore, examined the feasibility of using a tally counter to document daily STSs, documented the number of daily STSs performed, and determined if the number of STSs was influenced by demographic or health variables. Ninety-eight community-dwelling adults (19-84 years) agreed to participate. After providing demographic and health information, subjects used a tally counter to document the number of STSs performed daily for 7 consecutive days. All but two subjects judged their counter-documented STS number to be accurate. Excluding data from these and two other subjects, the mean number of STSs for subjects was 42.8 to 49.3, depending on the day. The number was significantly higher on weekdays than weekends. No demographic or health variable was significantly related to the number of STSs in univariate or multivariate analysis. In conclusion, this study suggests that a tally counter may be a practical aid to documenting STS activity. The STS repetitions recorded by the counter in this study provide an estimate of the number of STSs that community-dwelling adults perform daily.
TL;DR: This article presents an overview of the philosophy of science and applies such philosophical theory to clinical practice within physiotherapy, demonstrating the possibilities of relating the logical basis of this field of study to the clinical setting.
Abstract: This article presents an overview of the philosophy of science and applies such philosophical theory to clinical practice within physiotherapy. A brief history of science is followed by the theories of the four most commonly acknowledged philosophers, introduced in the context of examples from clinical practice. By providing direct links to practical examples, it demonstrates the possibilities of relating the logical basis of this field of study to the clinical setting. The relevance to physiotherapy is that, by relating this theory, clinicians can better understand and analyse the fundamental logic behind their practice. The insight this provides can benefit professional development in several ways. For the clinician, it permits more comprehensive and coherent reasoning and helps to relate evidence with respect to individual patients. On a larger scale, it encourages reflective discussion between peers around the virtues of alternative treatment approaches. Thus, this topic has the potential to guide clinical practice toward being more scientific and may help raise the credibility of the profession as a whole.
TL;DR: Recent research suggests that the cerebellum may also have a role in the later stages of motor learning, including the automation of movement patterns, although conflicting research in this area means that there is as yet no consensus.
Abstract: Motor learning is the means by which we acquire skilled movements and consign them to permanent memory. Multiple brain areas are involved, and patients with neurological damage often experience difficulty when attempting to relearn previously learned skills. For these patients, the location of the lesion may be critical in influencing their motor skill relearning. The cerebellum has been described as an “on-line” comparator and corrector of movement, but recent research suggests that the cerebellum may also have a role in the later stages of motor learning, including the automation of movement patterns, although conflicting research in this area means that there is as yet no consensus. This knowledge may have implications for the way physiotherapists treat patients with cerebellar lesions. Some treatments in regular use by physiotherapists are discussed, and possible implications for practice are considered.
TL;DR: It is concluded that delisting policies may have long-term consequences on uninsured or underinsured clients and that evidence-based policy planning is warranted to ensure that the goals of reform are aligned with the desired outcomes at the client, provider, and system levels.
Abstract: Publicly funded community-based physical therapy (PT) services in Canada's most populous province of Ontario were partially delisted, or deinsured, in April 2005 Two previous studies examined the short-term effects from the client and provider perspectives; and in this study, we follow up with participants from these preceding studies to assess long-term consequences of this policy Sixteen of 18 providers (89%) and 64 of 98 clients (65%) agreed to participate in a follow-up telephone interview Our results indicate that 12 months following delisting, and despite government assurances that access would be preserved, clients rendered ineligible for publicly funded services report ongoing access barriers across Ontario Clients in this study also express concern about their overall health and report an increased use of other insured health professionals (eg, physicians) and services (eg, hospitals) On the other hand, providers within the network of publicly funded clinics report an important decrease in demand for PT services, whereas those from other settings report little change We conclude that delisting policies may have long-term consequences on uninsured or underinsured clients and that evidence-based policy planning is warranted to ensure that the goals of reform are aligned with the desired outcomes at the client, provider, and system levels
TL;DR: The findings suggest that people with asymptomatic or symptomatic hypermobility perform the hand to floor test with the same relative contribution from the lumbar spine and hip joints and with a greater relative hip flexion range than a control group.
Abstract: The ability to place the hands to the floor forms part of the assessment of joint hypermobility. The test may be symptom free, or in the case of joint hypermobility syndrome, may be associated with pain in the spine, hip, and knee. The aim of this study was to identify the relative amount of movement at the lumbar spine and hip during this test in people with asymptomatic and symptomatic hypermobility compared with a control group. Thirty-six female subjects (10 asymptomatic hypermobility, 13 symptomatic hypermobility, and 13 control) ranging between 18 and 60 years of age participated in the investigation. Measurements were made by using digital photography and inclinometers. Measurement reliability was established prior to the investigation. There was a significant difference (p<0.05) between hip flexion range in the two hypermobility groups compared to the control group; there was no significant difference in lumbar spine movement between the three groups. The findings suggest that people with asymptom...
TL;DR: A high level of intrarater reliability was found for the clinical educators, with a difference in section scores of one mark or less on 93.4% of occasions, and further research should be undertaken to reevaluate the reliability of this clinical assessment tool following training.
Abstract: Educational institutions providing professional programs such as physiotherapy must provide high-quality student assessment procedures. To ensure that assessment is consistent, assessment tools should have an acceptable level of reliability. There is a paucity of research evaluating the reliability of clinical assessment tools used for physiotherapy students. This study evaluated the inter- and intrarater reliability of an assessment tool used for physiotherapy students during a clinical placement. Five clinical educators and one academic participated in the study. Each rater independently marked 22 student written assessments that had been completed by students after viewing a videotaped patient physiotherapy assessment. The raters repeated the marking process 7 weeks later, with the assessments provided in a randomised order. The interrater reliability (Intraclass Correlation Coefficient) for the total scores was 0.32, representing a poor level of reliability. A high level of intrarater reliability (percentage agreement) was found for the clinical educators, with a difference in section scores of one mark or less on 93.4% of occasions. Further research should be undertaken to reevaluate the reliability of this clinical assessment tool following training. The reliability of clinical assessment tools used in other areas of physiotherapy education should be formally measured rather than assumed.
TL;DR: The minimal detectable change (MDC), defined as the smallest change that falls outside the expected range of error, for isometric hip abductor muscle strength in healthy persons obtained with a handheld dynamometer (HHD), is quantified.
Abstract: This study quantified the minimal detectable change (MDC), defined as the smallest change that falls outside the expected range of error, for isometric hip abductor muscle strength in healthy persons obtained with a handheld dynamometer (HHD). Ninety volunteers (45 males and 45 females) between the ages of 22 and 70 years participated in the study. Bilateral measurements of isometric hip abductor muscle force were obtained with a digital HHD using a “make” test with the subject in supine. All measurements were obtained by one female examiner. The muscle force measurements were normalized to a volunteer's body weight (BW). Intratester reliability of hip abductor muscle force was estimated by using an intraclass correlation coefficient (ICC3,1) and calculated to be 0.96. The standard error of measurement (SEM) was 2 Newtons. The MDC was calculated by using an appropriate formula that included a 95% level of confidence. The MDC95 was 5.4% BW for males and 5.3% BW for females. If a person's isometric hip abdu...
TL;DR: Supine cervical traction may be more effective for increasing posterior vertebral separation than seated cervical traction.
Abstract: This study was performed for the purpose of comparing the magnitude of cervical vertebral separation during cervical traction in supine and seated positions using home traction units. A repeated measures design with two within-subject factors (type of traction and time) was used. Seventeen asymptomatic volunteers received cervical traction in seated and supine position. Subjects received 5 minutes of static traction in sitting or supine using a force of 13.6 kg while in 15 degrees of neck flexion. A lateral radiograph of the cervical spine was taken before traction force was applied and after five minutes of static traction. Anterior and posterior distances between the inferior border of C2 and the superior border of C7 were measured by a radiologist. After supine traction there were significant increases (p ¼ 0.001) in posterior cervical vertebral separation compared to any changes after seated traction. There were no significant changes in anterior vertebral separation during either supine or seated traction positions (p ¼ 0.769). Supine cervical traction may be more effective for increasing posterior vertebral separation than seated cervical traction.
TL;DR: Modest diversity in physical therapy educational and professional issues appears to exist among countries except for accreditation, licensure, and specialization.
Abstract: Very little information exists regarding physical therapy educational and professional issues in various regions of the world. A better understanding may facilitate physical therapy (PT) practice, education, and research around the globe. The purpose of this study was to gain a worldwide perspective of physical therapy educational and professional issues in 40 separate countries. Forty countries known to provide PT were chosen from a World Confederation for Physical Therapy (WCPT) list of affiliates based on language, geography, and presumed PT practice. An English survey consisting of 22 items and four primary areas (accreditation of PT educational programs, licensure, specialization, and earning potential) was translated into five different languages (Spanish, French, Portuguese, Japanese, and Korean). The survey was administered electronically to key WCPT contacts in the 40 countries. The response rate was 42.5% and revealed modest diversity in physical therapy educational and professional issues among countries with the exception that 1) all but one country had an accreditation process for PT educational programs; 2) all but one country had licensure for PTs; and 3) all but five countries had a specialization process that included a written examination. Modest diversity in physical therapy educational and professional issues appears to exist among countries except for accreditation, licensure, and specialization.
TL;DR: Findings support the beneficial effects of inhaled procaterol on exercise performance in the absence of any change in FEV1 when measured at 4 hours following inhalation in subjects with moderate to severe COPD.
Abstract: The aim of this study was to examine the prolonged effect of procaterol, a short-acting bronchodilator, on lung function and exercise performance in patients with moderate to severe COPD. A randomized crossover trial was conducted. We recruited 19 patients with COPD aged 71.6+/-5.5 years. Patients were randomly assigned to receive either 20 mug inhaled procaterol followed by no-treatment or no-treatment followed by 20 mug inhaled procaterol separated by a washout period of 3+/-2 days. Lung function and exercise performance, using the incremental shuttle walking test (ISWT), were measured at baseline and 4 hours after receiving each treatment. Baseline forced expiratory volume in 1 second (FEV(1)) was 38.5%+/-17% predicted. There were no significant changes in FEV(1) following inhaled procaterol. However, walking distance increased by 294+/-113 meters at baseline to 331+/-119 meters after inhaled procaterol (p<0.001). These findings support the beneficial effects of inhaled procaterol on exercise performance in the absence of any change in FEV(1) when measured at 4 hours following inhalation in subjects with moderate to severe COPD. The inhaled procaterol may be useful for enhancing the effects of exercise training in patients with COPD.