Showing papers in "Physiotherapy Theory and Practice in 2021"
TL;DR: Alternative models such as home-based CR programs, positively evaluated by the participants, can be used to overcome barriers and logistical factors were the major barriers to participation in rehabilitation programs.
Abstract: Purpose: The mortality rate of cardiovascular diseases in such developing countries as Iran is on the rise. Despite sufficient evidence pointing to its efficacy, cardiac rehabilitation (CR) approach is only employed to a limited extent. In the present study, barriers to participation in center-based cardiac rehabilitation programs and patients' attitude toward home-based cardiac rehabilitation model were examined. Methods: In this study, 204 eligible patients for CR visiting an academic hospital were examined during the first three months of 2017. Patients had either abandoned rehabilitation programs midway through or had not attended one in the first place. Data about perceived barriers were collected using the modified Cardiac Rehabilitation Barriers Scale. Also, Patients' attitude toward home-based CR was collected using a pre-validated researcher-made questionnaire. Results: The results revealed that the most effective barriers were transportation problems (70%), travel costs (70%), considerable distance to the rehabilitation center (67%), and lack of insurance coverage for rehabilitation costs (64%), respectively. Patients with longer than 30-minute drive time were less likely to attend in training sessions in the center. In addition, the important patient expectations about home-based CR programs included: communication with specialists, training before entering the rehabilitation program, and making periodic visits to maintain motivation and adhere to the home-based CR programs. Conclusions: The results revealed that logistical factors were the major barriers to participation in rehabilitation programs. Alternative models such as home-based CR programs, positively evaluated by the participants, can be used to overcome these barriers.
43 citations
TL;DR: The results of this systematic review support the conclusion that utilizing pain education strategies in conjunction with interventions provided by physical therapists demonstrates a moderate to large effect sizes on pain and disability constructs but lack pooled statistical significance.
Abstract: Study Design: Systematic Review with meta-analysis.Background: Rehabilitation providers have begun to incorporate pain education into their treatment protocols to influence the patient’s ex...
39 citations
TL;DR: Physiotherapists could benefit from tailored instruction regarding psychosocial strategies at a level appropriate to, and within their scope of practice, which could enhance their practice from a biopsychosocial perspective, subsequently improving outcomes for their patients.
Abstract: Background: Research has addressed the usefulness of psychosocial strategies within physiotherapy, as part of a biopsychosocial model. A lack of current research in Australia concerning the views o...
31 citations
TL;DR: In this article, the authors explored the barriers and facilitators for the establishment of a person-centered relationship, based on the experience of physiotherapy patients, and found that participants focused on aspects concerning the health professional, both regarding their characteristics as well as their relational skills, meaning that the physiotherapist may be responsible for using several strategies in order to put the person at the center of care.
Abstract: Introduction: Person-centered care has emerged as a key principle in the provision of health and rehabilitation services. To implement this approach, health professionals must strive to develop a person-centered therapeutic relationship. The aim of this study was to explore the barriers and facilitators for the establishment of a person-centered relationship, based on the experience of physiotherapy patients. Methods: A qualitative study was conducted based on four focus groups including 31 participants. The focus group discussions were audiotaped, transcribed verbatim and analyzed thematically using the method of constant comparisons. Results: Patients described specific traits, characteristics and behaviors relating to the health professional, the patient and the environment, that they felt may hinder or favor the establishment of therapeutic person-centered relationships. Some participants focused on aspects concerning the health professional, both regarding their characteristics as well as their relational skills, meaning that the physiotherapist may be responsible for using several strategies in order to put the person at the center of care. Conclusions: Person-centered care and the therapeutic relationship are important aspects in the field of rehabilitation, requiring further studies to improve our understanding of the same, and to inform both health professionals, and managers of health institutions.
24 citations
TL;DR: This analysis interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient.
Abstract: Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described.Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization.Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.
24 citations
TL;DR: Implementing strategies to increase functional mobility, self-efficacy for physical activity, social support, and enjoyment of physical activity might facilitate persons with PD beginning and/or maintain different physical activities.
Abstract: Objective: To analyze the multivariate associations between self-rated level of physical activity and demographic characteristics, self-efficacy for physical activity, fall-related self-eff...
22 citations
TL;DR: The effect sizes suggest that physiotherapy interventions can positively impact body image and trunk flexion strength.
Abstract: Purpose: To explore the feasibility of two physiotherapy interventions for the management of diastasis recti abdominis (DrA): abdominal binding and targeting trunk exercises.Methods: A pilot random...
21 citations
TL;DR: Personal conflicts were identified between clinicians’ descriptions of their wishes to “sell” their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients’ beliefs.
Abstract: Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However, no previous studies have explored clinicians' experiences of communicating their understanding of this diagnosis to their patients.Methods: A qualitative research design, using hermeneutic phenomenological methodology, was employed. Five participants were purposively recruited for the research and data collected via semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Emergent, super-ordinate and master themes were developed to help convey the qualitative significant meanings of the lived-through experiences.Findings: Three master themes were identified, with each comprising two sub-themes. These were: 1) Patient-centeredness (1a. Understanding the patient; and 1b. emotional awareness and adaptability); 2) Getting patients "on board" (2a. the "selling" process; and 2b. paternalism and the clinician's perspective); and 3) Dealing with conflict and uncertainty (3a. fear of interpersonal conflict; and 3b. personal doubts and uncertainty).Conclusions: Personal conflicts were identified between clinicians' descriptions of their wishes to "sell" their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients' beliefs. Building a good initial rapport, showing empathy and adapting approaches in response to perceptions of patients' reactions were perceived as strategies to help mitigate the risks of failed communication, but this was something for which participants felt unprepared by their prior training.
19 citations
TL;DR: Backward walking as a rehabilitation technique improved knee proprioception after ACL reconstruction and increasing the angle of the treadmill during exercise improved the efficacy of rehabilitation.
Abstract: Objective: The present study aimed to assess proprioception of the knee to evaluate the effectiveness of backward walking for rehabilitation after anterior cruciate ligament (ACL) reconstruction. Methods: Patients (n = 52) who underwent ACL reconstruction in a single knee divided randomly into four experimental groups (A-D) and a control group, who all practiced a systematic rehabilitation exercise program. The patients in the experimental groups underwent backward walking using different treadmill angles: group A (0°), B (5°), C (10°) and D (15°). The whole training period comprised 4 weeks. Outcomes for the joint were assessed using the Angle Reproduction Test (ART) and Passive Motion Perception Test (PMPT). Results: Compared with the pre-training recorded parameters, significant differences were found in the ART and PMPT scores among all training groups and between the control group and the training groups. When the four training groups were compared with each other, there was no difference in the ART results between groups A and B, but significant differences were found between group A and groups C and D. Conclusion: Backward walking as a rehabilitation technique improved knee proprioception after ACL reconstruction. Increasing the angle of the treadmill during exercise improved the efficacy of rehabilitation.
19 citations
TL;DR: This study explored how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to initial encounters and provides empirical evidence on communication patterns in physiotherapy practice.
Abstract: Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient's perspective as part of the treatment process. 'Agenda setting' has been introduced as the key to understanding patients' concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analyzed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients' concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. On occasions, patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.
19 citations
TL;DR: Physical activity is not yet seen as a structural part of hospital care by both patients and health-care professionals, and does not have priority within current daily routines.
Abstract: Background: A lack of physical activity during hospitalization can lead to adverse outcomes like complications and loss of physical function. More insight into factors that influence physical activity during a hospital stay is needed to develop strategies to change the mobility culture in hospitals. Objective: To give an overview of factors that influence physical activity of patients by exploring the perspectives of both patients and health-care professionals regarding physical activity during hospital stay. Method: Semi-structured interviews with patients and health-care professionals were conducted at a university hospital in the Netherlands. Patients were interviewed about their daily activities during their hospital stay and the factors that were of influence. Health-care professionals were asked about their perceptions regarding their responsibilities in promoting physical activity during hospitalization. Results: In total eight patients and nine health-care professionals participated. Patients and health-care professionals stated that low physical activity levels were mostly caused by a poor physical status, patients' expectations to lie in bed during hospitalization, and the lack of knowledge on the importance of physical activity. Lack of time was the main barrier for health-care professionals to promote physical activity. Conclusion: Physical activity is not yet seen as a structural part of hospital care by both patients and health-care professionals, and does not have priority within current daily routines. To increase physical activity levels of hospitalized patients, more knowledge and tools should be available for both patients and health-care professionals.
TL;DR: With support, an application could be adapted for older adults to manage, motivate, and adhere to fall prevention exercise and to achieve long-term adherence to health behavior changes.
Abstract: Background: With the rapidly growing aging population, older adults need to stay healthy and active for a longer time. Mobile health (mHealth) solutions could help support, prevent, or delay functi ...
TL;DR: The Persian-versions of the Activities-specific Balance Confidence (ABC) scale and Fall Efficacy Scale-International (FES-I) are reliable, valid, and responsive measures to quantify balance confidence and fear of falling in PwMS at both clinical and research settings.
Abstract: Background and Purpose: Balance impairment and fear of falling are two common risk factors for falls in people with multiple sclerosis (PwMS). Clinicians should use valid, reliable, and responsive ...
TL;DR: Rec rehabilitation with VRT has no advantage over conventional training for enhancing function, resolving pain, or increasing patient satisfaction after total knee replacement, and findings suggest that an augmented VRT physical therapy intervention that is specifically-oriented to enhance balance could be more effective for overcoming balance limitations than standard physical therapy.
Abstract: Purpose. To assess the effects of training with virtual reality tools (VRT) during rehabilitation of patients after total knee replacement (TKR). Methods. Systematic review. Six databases w...
TL;DR: It was impossible to conclude whether individuals with LBP have impaired hamstring flexibility and stiffness due to very low quality of evidence for meta-analyses because the validity of measures for hamstring flexibility was problematic and GRADE scores for all measures in the meta-Analyses were very low.
Abstract: Background: There is no robust evidence on the contribution of reduced hamstring flexibility to the development of low back pain (LBP) in cohort studies.Purpose: To investigate whether individuals ...
TL;DR: In this paper, the knowledge and confidence of physiotherapists in managing knee osteoarthritis and patellofemoral pain (PFP) and explore their learning behaviors and preferences related to the management of these knee conditions.
Abstract: Aim: To determine the knowledge and confidence of physiotherapists in managing knee osteoarthritis (OA) and patellofemoral pain (PFP); and explore their learning behaviors and preferences related to the management of these knee conditions.Methods: One hundred and sixteen Australian and Canadian Physiotherapists were recruited via social media, e-mail, and an online course. Part 1: Quantitative involved an online survey evaluating knowledge of evidence and confidence in providing treatments for knee OA and PFP. Part 2: Qualitative involved semi-structured interviews with 13 participants exploring current practice and learning needs, that were analyzed using an initial framework structured on interview questions, followed by inductive approach to identify additional themes.Results: Awareness regarding evidence supporting exercise for knee OA and PFP was good (89-96%), and qualitative themes indicated physiotherapists emphasized exercise-therapy and education. Perceived value of passive treatments and surgery varied. Preference for face-to-face workshops to address learning needs, alongside describing time and cost barriers to access them, emerged from qualitative findings. Online learning formats were viewed as convenient, but not as effective as face-to-face learning.Conclusion: Knowledge and confidence related to interventions for knee OA and PFP of Australian and Canadian physiotherapist participants broadly aligns with guidelines. Knowledge translation strategies focused on face-to-face workshops, supported by online education may help to bridge evidence-to-practice gaps.
TL;DR: It is suggested that IMT was able to reduce dyspnea during activities of daily living, as well as improve inspiratory muscle function, and quality of life in patients with ADL, and these benefits were sustained for 3 months.
Abstract: Aim: To evaluate the effects of an inspiratory muscle training (IMT) program on dyspnea during activities of daily living, inspiratory muscle function, functional capacity, and quality of life in p...
TL;DR: A short duration of bilateral FES in conjugation with treadmill walking contributed to significant improvement in gait speed, functional mobility, functional ambulation, range of motion and step length in post-stroke survivors.
Abstract: Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4 = male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ± 4.3; since onset of stroke: 30.8 ± 10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and 1 month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (P< .05), while ankle plantar flexors spasticity (P = .135), and knee extensors spasticity (P = .368) did not show any significant decrease. Conclusions: A short duration of bilateral FES in conjugation with treadmill walking contributed to significant improvement in gait speed, functional mobility, functional ambulation, range of motion and step length in post-stroke survivors. In contrast, no significant decreases were identified in the spasticity of the ankle plantar flexors and knee extensors muscles.
TL;DR: In the short-term DAT may increase awareness of and decrease negative attitudes associated with disability and effective strategies highlighted for raising awareness and improving attitudes were contact with PWD and education.
Abstract: Background: Worldwide over a billion people live with a disability including 400,000 people in Ecuador. People with disabilities (PWD) face barriers to full participation in society. Barriers are generated by negative attitudes created through socio-cultural experiences. Awareness about disability can be facilitated through disability awareness training (DAT). Studies examining outcomes on DAT exist in high-resourced countries but are nonexistent in Ecuador. Study purposes:1) create a DAT using community input and conduct the training; 2) examine the impact of the DAT on attitudes toward and awareness of PWD; and 3) explore community perceptions regarding the impact of the DAT on action. Methods: Community-based participatory evaluation was employed to design and assess the impact of a DAT with 60 community members from Latacunga, Ecuador. The DAT incorporated a multi-modal approach (interactive discussion, problem-solving, hands-on activities) and was informed by the theory of planned behavior. Data sources were the Multidimensional Attitudes Scale (MAS) (Spanish version) administered pre- and post-DAT and interviews conducted with nine DAT participants. Results: Mann Whitney U revealed significant changes in two of four MAS constructs: emotion p = .005 and cognition p = .003. Five themes emerged from the interviews: 1) view of disability; 2) contact; 3) attitude; 4) training impact; and 5) action. Conclusion: In the short-term DAT may increase awareness of and decrease negative attitudes associated with disability. Effective strategies highlighted for raising awareness and improving attitudes were contact with PWD and education. Education leads to more positive perceptions of the barriers PWD face and their ability to participate in society.
TL;DR: The goal-setting framework presented in this paper may help pediatric therapists to create meaningful goals in collaboration with patients and families and promotes the use of the ICF in therapeutic practice.
Abstract: Background:Collaborative goal-setting is a fundamental component of developmental physical and occupational therapy practice. Evidence suggests, however, that therapists struggle to elicit patient and family goals, and they often establish goals that are not reflective of patient and caregiver functional preferences. Training and efficiency also act as barriers to collaborative goal-setting. A number of solutions have been proposed to enhance the goal-setting process, but none specifically address relevant areas of functioning within the International Classification of Functioning, Disability and Health (ICF), a robust, multidimensional tool that emphasizes the importance of function. To support pediatric therapists in the collaborative establishment of functionally relevant goals, an ICF-inspired goal-setting tool was developed through the assimilation of a large body of existing scientific evidence, ICF Core Sets, and expert consensus. Objective:The aims of this paper are to: 1) describe an ICF-inspired framework for collaborative goal-setting in developmental rehabilitation that seeks to reduce the methodological challenges frequently associated with goal-setting; and 2) discuss the conditions for the use of the framework in daily therapeutic practice. Conclusions:The goal-setting framework presented in this paper may help pediatric therapists to create meaningful goals in collaboration with patients and families. Importantly, the goal-setting framework described promotes the use of the ICF in therapeutic practice.
TL;DR: People after stroke who were physically able to walk independently still described multiple barriers to gait-related participation in all components of the ICF framework.
Abstract: Background: An important focus of post-stroke physical therapy is to improve walking and walking capacity. However, many people after stroke experience difficulties with gait-related participation,...
TL;DR: Maybe migrants who are living in the host country for longer length of time do not need culturally adapted therapies due to cultural integration, while these adaptations might be essential for the recent migrants or the autochthonous population in Turkey.
Abstract: Purpose: To compare the effectiveness of culture-sensitive and standard pain neuroscience education (PNE) on pain knowledge, pain intensity, disability, and pain cognitions in first-generation Turk
TL;DR: Turkish version of PDDS presented high validity and test-retest reliability in pwMS, and a narrow range of the limits of agreement indicated that PDDS had high stability and low variation between first and second assessments.
Abstract: Background: Patient Determined Disease Steps (PDDS) scale is a patient-reported outcome measure to assess disability in persons with multiple sclerosis (pwMS). This scale can be used as an alternative to Expanded Disability Status Scale (EDSS) as it is a costly, more time-consuming, and clinician-based method. This study aimed to conduct Turkish translation and cross-cultural adaptation of PDDS and investigate its psychometric properties. Methods: Turkish translation and cross-cultural adaptation of PDDS was conducted. Its psychometric properties including validity (i.e. content, criterion, and construct) and test-retest reliability (relative and absolute) were investigated in 100 pwMS. Results: PDDS had a significant strong correlation with EDSS (rs = 0.61, p .05). Relative test-retest reliability was found high [ICC = 0.99 (95%CI = 0.99, 0.99)]. Absolute test-retest reliability was high as the Bland-Altman analyses showed no significant systematic bias between the repeated assessments. A narrow range of the limits of agreement indicated that PDDS had high stability and low variation between first and second assessments. Conclusion: Turkish version of PDDS presented high validity and test-retest reliability in pwMS.
TL;DR: The application of dry needling equilibration theory (DNET) for individuals with CAI may provide a mechanistic explanation for improved descending cortical output, resulting in enhanced sensorimotor function.
Abstract: Patients with chronic ankle instability (CAI) experience a dynamic interplay between impaired mechanical structures and sensorimotor deficiencies that contribute to recurrent sprains and sensations...
TL;DR: The standardized isotonic protocol with computerized dynamometry was reliable in assessing quadriceps power in COPD and correlates best with functional capacity, indicating higher relevance than static measures when investigating determinants of function.
Abstract: Background: Muscle power declines with age and is a stronger determinant of physical function than strength. Muscle power using computerized dynamometry has not been investigated in COPD.Objectives: To determine: 1) test-retest reliability of quadriceps power using a standardized protocol with computerized dynamometry; and 2) associations between quadriceps strength and power, and functional capacity.Design/Setting: Prospective observational study in four Canadian research labs.Participants: People with mild to very severe COPD.Methods: Tests were conducted on two days. Quadriceps muscle maximal strength was evaluated during a static maneuver using maximal voluntary isometric contractions (MVIC). Rate of torque development (RTD) during MVIC was used to assess explosive force. Muscle power was measured using a dynamic, isotonic protocol from which peak and average power and peak velocity were derived. Functional capacity was assessed with the Short Physical Performance Battery (SPPB). Reliability was assessed using intraclass correlation coefficients (ICC), standard error of measurements (SEM), and Bland Altman plots. Spearman and Pearson correlation coefficients were used for associations.Results: 65 patients (age 69 ± 8 years; FEV1 48 ± 21% of predicted) were included. ICC was 0.77 for RTD and 0.87-0.98 for isotonic power measures (95%CI 0.63-0.99, p 30% for RTD. SPPB had moderate correlation with average power, but not with MVIC or RTD.Conclusion: The standardized isotonic protocol with computerized dynamometry was reliable in assessing quadriceps power in COPD. Our data highlights that average power correlates best with functional capacity, indicating higher relevance than static measures when investigating determinants of function.
TL;DR: Breast cancer survivors who were 0–5 years post-treatment appeared to exhibit similar static postural stability compared to controls, while some aspects of dynamic balance appeared altered.
Abstract: Objectives: Balance in breast cancer survivors is understudied. Increased understanding of how postural control is affected when the body is stationary, moving, or engaged in a concurrent cognitive...
TL;DR: Both neurofeedback and physical activity could be considered as useful alternative for postural stability and balance improvement in elderly women; however, Neurofeedback training was more effective than physical activity.
Abstract: Study Design: This was a single-blind randomized controlled trial. Background: Fall and postural instability are common undesirable consequences of the elderly. Although the benefits of exercise for fall prevention have been demonstrated, the majority of the elderly are physically inactive due to several physical and mental limitations they may face. Another alternative treatment such as neurofeedback with providing additional sensory information may enhance movement performance and so decrease the risk of fall. Objectives: To compare the effects of physical activity and neurofeedback training on postural stability and risk of fall in elderly women. Methods: Forty-five physically independent women who were older than 65 years old, living in the Fereshtegan Elderly Care Center in Shiraz, were recruited and randomly divided into three groups including control, physical activity, and neurofeedback training (15 people in each group). Participants in experimental groups trained for 12 weeks (3 days per week/30 minutes per session). Fall risk and postural stability of participants in all three groups were evaluated before and after intervention using the Biodex Balance System. Results: A mixed model design ANOVA comparing neurofeedback training and physical activity exhibited a significantly greater improvement in both risk of fall and postural stability compared to control (P < .05). Results of post-hoc analysis further indicated that neurofeedback training compared to physical activity can be superior beneficial in reducing risk of fall (P = .005) and improving postural stability (P = .005). There were also significant interactions between group and time of fall risk (P = .0005, ηp2 = 0.97) and postural stability (P = .001, ηp2 = 0.79). Conclusion: Both neurofeedback and physical activity could be considered as useful alternative for postural stability and balance improvement in elderly women; however, neurofeedback training was more effective than physical activity.
TL;DR: There is evidence that MDT has an association with improving fear-avoidance beliefs, pain self-efficacy, depression, and psychological distress, which should be interpreted with caution as further high-quality randomized control trials addressing this topic are necessary.
Abstract: Study Design: Systematic Literature Review.Background: The McKenzie Method (MDT) is a comprehensive conservative approach commonly used for the management of low back pain (LBP); however, its association with psychosocial outcomes in this population is less clear.Objectives: Evaluate whether MDT has an association with psychosocial outcomes for individuals with LBP.Methods: The following electronic databases were searched: Medline, Pubmed, Cochrane, CINAHL, Embase and AMED. They were systematically searched from the date of inception to August 2019. Included studies had to have participants experiencing LBP who were over 18 years old, utilize MDT as an assessment or intervention, and report outcomes for at least one psychosocial variable. Three reviewers independently evaluated methodological quality of randomized control trials (RCT) using the PEDro scale and observational studies using the GRACE scale.Results: The initial search resulted in 181 articles to review. After screening abstracts, then full articles, a total of 16 studies were included, 5 of which were RCTs rated 5-8/10 on the PEDro scale. A qualitative review was performed and the studies' results were synthesized into five main findings: fear-avoidance beliefs, depression symptoms, pain self-efficacy, psychological distress, and return to work (RTW).Conclusions: There is evidence that MDT has an association with improving fear-avoidance beliefs, pain self-efficacy, depression, and psychological distress. These results should be interpreted with caution as further high-quality randomized control trials addressing this topic are necessary due to the varying methodological and statistical constructs of the included studies.
TL;DR: Evidence is provided that dry needling results in a significant increased activity of the sympathetic nervous system for up to 18 minutes, which could assist clinicians in clinical decision making to determine needle placement time.
Abstract: Study design: Pilot study. Background: Dry needling has been an emerging treatment option for physical therapists over the last decade. Despite the fact that studies have demonstrated the overall benefit of dry needling, there is no clear understanding how long needles should be left in place (situ). This pilot study investigated the effects of needles remaining in situ based on autonomic responses over time. Methods: A convenience sample of 21 subjects were recruited for this study. Automated pupillometry was utilized to obtain a direct measure of autonomic nervous system activity. Directly following a baseline measurement, 8 type J Seirin Acupuncture needles were inserted paravertebral at the C7-T3 segments. A total of 8 post-needling 60 seconds pupil measurements were taken at 3 minutes intervals for 24 minutes post needling. Outcomes: A statistical significant difference in mean pupil diameter was found following the needle intervention (p < .01), which implies an increased sympathetic activity. This subject sample had a statistically significantly larger mean pupil diameter immediately after the needling, which lasted until measure point 7, at 18 minutes (P < .05). At measure point 8 there was no longer a statistical significant difference compared to the premeasurement measure. Discussion: The results of this study provide evidence that dry needling results in a significant increased activity of the sympathetic nervous system for up to 18 minutes. Between 18 and 21 minutes autonomic activity returned to a non-significant difference compared to baseline. The results of this study could assist clinicians in clinical decision making to determine needle placement time.
TL;DR: New-graduate physiotherapists reflect strongly on challenges associated with the complexity of chronic pain and subsequent management to foster confidence and perceived competency in this area.
Abstract: Background: Chronic pain management is a challenging area of practice for new graduate physiotherapists entering the workforce. Understanding the readiness and experience of new graduates entering this area of practice is important for informing requirements for preparation for practice.Objective: The aim of this study was to understand the readiness of new graduate physiotherapists in the area of chronic pain management and their experiences in entering clinical practice.Methods: A qualitative study with an inductive thematic approach was used. Semi-structured interviews of 15 new-graduate physiotherapists working in the area of chronic pain were undertaken.Results: Four themes emerged from the semi-structured interviews: 1) the reality of the complex nature of chronic pain; 2) negotiating management with the patient; 3) the role of direct experience; and 4) importance of workplace systems and further training.Discussion and Conclusion: New-graduate physiotherapists reflect strongly on challenges associated with the complexity of chronic pain and subsequent management. Readiness to manage chronic pain is strongly linked to direct experience and workplace support to foster confidence and perceived competency in this area.