Showing papers in "The Australian journal of physiotherapy in 2006"
TL;DR: Strengthening interventions increase strength, improve activity, and do not increase spasticity, suggesting that strengthening programs should be part of rehabilitation after stroke.
Abstract: Question: Is strength training after stroke effective (ie, does it increase strength), is it harmful (ie, does it increase spasticity), and is it worthwhile (ie, does it improve activity)? Design: Systematic review with meta-analysis of randomised trials. Participants: Stroke participants were categorised as (i) acute, very weak, (ii) acute, weak, (iii) chronic, very weak, or (iv) chronic, weak. Intervention: Strengthening interventions were defined as interventions that involved attempts at repetitive, effortful muscle contractions and included biofeedback, electrical stimulation, muscle re-education, progressive resistance exercise, and mental practice. Outcome measures: Strength was measured as continuous measures of force or torque or ordinal measures such as manual muscle tests. Spasticity was measured using the modified Ashworth Scale, a custom made scale, or the Pendulum Test. Activity was measured directly, eg, 10-m Walk Test, or the Box and Block Test, or with scales that measured dependence such as the Barthel Index. Results: 21 trials were identified and 15 had data that could be included in a meta-analysis. Effect sizes were calculated as standardised mean differences since various muscles were studied and different outcome measures were used. Across all stroke participants, strengthening interventions had a small positive effect on both strength (SMD 0.33, 95% CI 0.13 to 0.54) and activity (SMD 0.32, 95% CI 0.11 to 0.53). There was very little effect on spasticity (SMD –0.13, 95% CI –0.75 to 0.50). Conclusion: Strengthening interventions increase strength, improve activity, and do not increase spasticity. These findings suggest that strengthening programs should be part of rehabilitation after stroke. [Ada L, Dorsch S, Canning CG (2006) Strengthening interventions increase strength and improve activity after stroke: a systematic review. Australian Journal of Physiotherapy 52: 241–248]
395 citations
TL;DR: Pooled analyses revealed that, for chronic low back pain, specific stabilisation exercise was superior to usual medical care and education but not to manipulative therapy, and no additional effect was found when specific stabilised exercise was added to a conventional physiotherapy program.
Abstract: The aim of this study was to conduct a systematic review of the efficacy of specific stabilisation exercise for spinal and pelvic pain. Randomised clinical trials evaluating specific stabilisation exercise were identified and retrieved. Outcomes were disability, pain, return to work, number of episodes, global perceived effect, or health-related quality of life. A single trial reported that specific stabilisation exercise was more effective than no treatment but not more effective than spinal manipulative therapy for the management of cervicogenic headache and associated neck pain. Single trials reported that specific stabilisation exercise was effective for pelvic pain and for prevention of recurrence after an acute episode of low back pain but not to reduce pain or disability associated with acute low back pain. Pooled analyses revealed that, for chronic low back pain, specific stabilisation exercise was superior to usual medical care and education but not to manipulative therapy, and no additional effect was found when specific stabilisation exercise was added to a conventional physiotherapy program. A single trial reported that specific stabilisation exercise and a surgical procedure to reduce pain and disability in chronic low back pain were equally effective. The available evidence suggests that specific stabilisation exercise is effective in reducing pain and disability in chronic but not acute low back pain. Single trials indicate that specific stabilisation exercise can be helpful in the treatment of cervicogenic headache and associated neck pain, pelvic pain, and in reducing recurrence after acute low back pain.
285 citations
TL;DR: A high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older persons dependent in activities of daily living and an intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training.
Abstract: The aims of this randomised controlled trial were to determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training. One hundred and ninety-one older persons dependent in activities of daily living, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ≥ 10 participated. They were randomised to a high-intensity functional exercise program or a control activity, which included 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, self-paced and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 × 2 factorial ANCOVA, using the intention-to-treat principle. At three months, the exercise group had improved significantly in self-paced gait speed compared with the control group (mean difference 0.04 m/s, p = 0.02). At six months, there were significant improvements favouring the exercise group for Berg Balance Scale (1.9 points, p = 0.05), selfpaced gait speed (0.05 m/s, p = 0.009), and lower-limb strength (10.8 kg, p = 0.03). No interaction effects were seen between the exercise and nutrition interventions. In conclusion, a high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older persons dependent in activities of daily living. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training. [Rosendahl E, Lindelof N, Littbrand H, Yifter-Lindgren E, Lundin-Olsson L, Haglin L, Gustafson Y and Nyberg L (2006): High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: A randomised controlled trial. Australian Journal of Physiotherapy 52: 105–113]
204 citations
TL;DR: Unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain, and may be explained by physiological limitations of co-ordination of postural, respiratory and continence functions of trunk muscles.
Abstract: Although obesity and physical activity have been argued to predict back pain, these factors are also related to incontinence and breathing difficulties. Breathing and continence mechanisms may interfere with the physiology of spinal control, and may provide a link to back pain. The aim of this study was to establish the association between back pain and disorders of continence and respiration in women. We conducted a cross-sectional analysis of self-report, postal survey data from the Australian Longitudinal Study on Women's Health. We used multinomial logistic regression to model four levels of back pain in relation to both the traditional risk factors of body mass index and activity level, and the potential risk factors of incontinence, breathing difficulties, and allergy. A total of 38,050 women were included from three age-cohorts. When incontinence and breathing difficulties were considered, obesity and physical activity were not consistently associated with back pain. In contrast, odds ratios (OR) for often having back pain were higher for women often having incontinence compared to women without incontinence (OR were 2.5, 2.3 and 2.3 for young, mid-age and older women, respectively). Similarly, mid-aged and older women had higher odds of having back pain often when they experienced breathing difficulties often compared to women with no breathing problems (OR of 2.0 and 1.9, respectively). Unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain. This relationship may be explained by physiological limitations of co-ordination of postural, respiratory and continence functions of trunk muscles.
177 citations
TL;DR: It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains and functional instability, and manual mobilisation has an initial positive effect on dorsiflexion range of motion.
Abstract: This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic review of randomised controlled trials. Trials were searched electronically and manually from 1966 to March 2005. Randomised controlled trials that evaluated exercise therapy or manual mobilisation of the ankle joint with at least one clinically relevant outcome measure were included. Internal validity of the studies was independently assessed by two reviewers. When applicable, relative risk (RR) or standardised mean differences (SMD) were calculated for individual and pooled data. In total 17 studies were included. In thirteen studies the intervention included exercise therapy and in four studies the effects of manual mobilisation of the ankle joint was evaluated. Average internal validity score of the studies was 3.1 (range 1 to 7) on a 10-point scale. Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain: RR 0.37 (95% CI 0.18 to 0.74), and with functional instability: RR 0.38 (95% CI 0.23 to 0.62). No effects of exercise therapy were found on postural sway in patients with functional instability: SMD: 0.38 (95% CI -0.15 to 0.91). Four studies demonstrated an initial positive effect of different modes of manual mobilisation on dorsiflexion range of motion. It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains. Manual mobilisation has an (initial) effect on dorsiflexion range of motion, but the clinical relevance of these findings for physiotherapy practice may be limited.
173 citations
TL;DR: Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability.
Abstract: The purpose of this systematic review was to determine the quality of the research and to assess the reliability of different types of physical examination procedures used in the assessment of patients with non-specific low back pain. A search of electronic databases (MEDLINE, PEDro, AMED, EMBASE, Cochrane, and CINAHL) up to August 2005 identified 48 relevant studies which were analysed for quality and reliability. Pre-established criteria were used to judge the quality of the studies and satisfactory reliability, and conclusions emphasised high quality studies (≥ 60% methods score). The mean quality score of the studies was 52% (range 0 to 88%), indicating weak to moderate methodology. Based on the upper threshold used (kappa/ICC > 0.85) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability. When the lower threshold was used (kappa/ICC > 0.70) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability. Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability. [May S, Littlewood C and Bishop A (2006): Reliability of procedures used in the physical examination of non-specific low back pain: A systematic review. Australian Journal of Physiotherapy 52: 91–102]
165 citations
TL;DR: The findings of this study add to the known benefits of exercise for the HIV-infected population by improving self-efficacy and health-related quality of life.
Abstract: Question What is the effect of a six-month, supervised, aerobic and resistance exercise program on self-efficacy in men living with human immunodeficiency virus (HIV)? Design Randomised, controlled trial. Participants 40 (5 dropouts) men living with HIV, aged 18 years or older. Intervention The experimental group participated in a twice-weekly supervised aerobic and resistance exercise program for six months and the control group participated in a twice-weekly unsupervised walking program and attended a monthly group forum. Outcome measures The primary outcome measure was self-efficacy using the General Self-Efficacy Scale. Secondary outcome measures were cardiovascular fitness using the Kasch Pulse Recovery test, and health-related quality of life using the Medical Outcomes Study HIV Health Survey. Measures were taken by an assessor blinded to group allocation. Results By six months, the experimental group had improved their self-efficacy by 6.8 points (95% CI 3.9 to 9.7, p < 0.001) and improved their cardiovascular fitness by reducing their heart rate by 20.2 bpm (95% CI –25.8 to –14.6, p < 0.001) more than the control group. Health-related quality of life improved in only two out of the eleven dimensions: the experimental group improved their overall health by 20.8 points (95% CI 2.0 to 39.7, p = 0.03) and their cognitive function by 14 points (95% CI 0.7 to 27.3, p = 0.04) more than the control group. Conclusion The findings of this study add to the known benefits of exercise for the HIV-infected population. [Fillipas S, Oldmeadow LB, Bailey MJ, Cherry CL (2006): A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: A randomised controlled trial. Australian Journal of Physiotherapy 52: 185–190]
149 citations
TL;DR: Clinical prediction rules are research-based tools that quantify the contributions of relevant patient characteristics to provide numeric indices that assist clinicians in making predictions and can provide quick and inexpensive estimates of probability.
Abstract: Question Clinical prediction rules are research-based tools that quantify the contributions of relevant patient characteristics to provide numeric indices that assist clinicians in making predictions. Clinical prediction rules have been used to describe the likelihood of the presence or absence of a condition, assist in determining patient prognosis, and help the classification of patients for treatment. The recent rapid rise in the use of clinical prediction rules raises questions about the conditions under which they may be used most appropriately. What is the potential role of clinical prediction rules in physiotherapy practice and what are the strategies by which clinicians can determine their appropriate use for a given clinical setting? Conclusion Clinical prediction rules use quantitative methods to build upon the body of literature and expert opinion and can provide quick and inexpensive estimates of probability. Clinical prediction rules can be of great value to assist clinical decision making but should not be used indiscriminately. They are not a replacement for clinical judgment and should complement rather than supplant clinical opinion and intuition. The development of valid clinical prediction rules should be a goal of physiotherapy research. Specific areas in need of attention include deriving and validating clinical prediction rules to screen patients for potentially serious conditions for which current tests lack adequate diagnostic accuracy or have unacceptable cost and risk, and to assist in classification of patients for treatments that are likely to result in substantially different outcomes in heterogeneous groups of patients.
134 citations
TL;DR: The Movement ABC (Henderson and Sugden 1992) is the most commonly reported norm-ranked assessment used to determine the presence of Developmental Co-ordination Disorder (DCD) in school-aged children.
Abstract: The Movement ABC (Henderson and Sugden 1992) is the most commonly reported norm-ranked assessment used to determine the presence of Developmental Co-ordination Disorder (DCD) in school-aged children. The assessment provides quantitative and qualitative data about a child’s performance of age-appropriate tasks within 3 subsections: Manual Dexterity, Ball Skills, and Static and Dynamic Balance. Performance is compared with established USA norms for children aged 4 to 12 years. The Movement ABC is a minimal task set designed to screen for motor impairment rather than provide a profile of a child’s motor performance. It takes approximately 30 minutes to administer and requires no special training.
126 citations
TL;DR: Results highlight the importance of distinguishing between real and apparent increases in muscle extensibility when assessing the effectiveness of stretch, and indicate that whilst a four-week stretch program increases subjects' tolerance to an uncomfortable stretch sensation it does not increase hamstring muscle Extensibility.
Abstract: The aim of this study was to determine whether an intensive stretch program increases muscle extensibility or subjects' tolerance to an uncomfortable stretch sensation Twenty healthy able-bodied individuals with limited hamstring muscle extensibility were recruited A within-subjects design was used whereby one leg of each subject was randomly allocated to the experimental condition and the other leg was allocated to the control condition The hamstring muscles of each subject's experimental leg were stretched for 20 minutes each weekday for four weeks Hamstring muscle extensibility (angle of hip flexion corresponding with a standardised torque) and stretch tolerance (angle of hip flexion corresponding with maximal torque tolerated) were assessed on both legs at the beginning and end of the study The intervention did not increase the extensibility of the hamstring muscles (mean change in hip flexion was –1 degree, 95% CI –4 to 3 degrees) but did increase subjects' tolerance to an uncomfortable stretch sensation (mean change in hip flexion was 8 degrees, 95% CI 5 to 12 degrees) These results highlight the importance of distinguishing between real and apparent increases in muscle extensibility when assessing the effectiveness of stretch, and indicate that whilst a four-week stretch program increases subjects' tolerance to an uncomfortable stretch sensation it does not increase hamstring muscle extensibility
109 citations
TL;DR: Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.
Abstract: Question Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash? Design Cluster-randomised trial. Participants Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients (4 dropouts) who presented to them with acute whiplash. Intervention The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them. Outcome measures The primary outcome was patient disability, measured using the Functional Rating Index, collected on admission to the trial and at 1.5, 3, 6 and 12 months. Physiotherapist knowledge about the guidelines was measured using a custom-made questionnaire. Physiotherapist practice and cost of care were measured by audit of patient notes. Results There were no significant differences between groups for any of the patient outcomes at any time. The implementation patients had 0.6 points (95% CI –7.8 to 6.6) less disability than the dissemination patients at 12 months; 44% more physiotherapists in the implementation group reported that they prescribed two out of the five guideline-recommended treatments; and 32% more physiotherapists actually prescribed them. The cost of care for patients in the implementation group was $255 (95% CI –1505 to 996) less than for patients in the dissemination group. Conclusion Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected. [Rebbeck T, Maher C and Refshauge K (2006) Evaluating two implementation strategies for whiplash guidelines in physiotherapy: A cluster-randomised trial. Australian Journal of Physiotherapy 52: 165–174]
TL;DR: Mime therapy improves facial symmetry and reduces the severity of paresis in people with facial nerve paredis.
Abstract: Question What is the effect of mime therapy on facial symmetry and severity of paresis in people with facial nerve paresis? Design Randomised controlled trial. Participants 50 people recruited from the Outpatient department of two metropolitan hospitals with facial nerve paresis for more than nine months. Intervention The experimental group received three months of mime therapy consisting of massage, relaxation, inhibition of synkinesis, and co-ordination and emotional expression exercises. The control group was placed on a waiting list. Outcome measures Assessments were made on admission to the trial and three months later by a measurer blinded to group allocation. Facial symmetry was measured using the Sunnybrook Facial Grading System. Severity of paresis was measured using the House-Brackmann Facial Grading System. Results After three months of mime therapy, the experimental group had improved their facial symmetry by 20.4 points (95% CI 10.4 to 30.4) on the Sunnybrook Facial Grading System compared with the control group. In addition, the experimental group had reduced the severity of their paresis by 0.6 grade (95% CI 0.1 to 1.1) on the House-Brackmann Facial Grading System compared with the control group. These effects were independent of age, sex, and duration of paresis. Conclusion Mime therapy improves facial symmetry and reduces the severity of paresis in people with facial nerve paresis.
TL;DR: As urge incontinence and abnormal daytime sleepiness were independently associated with an increased falls risk, effective management of these problems may reduce the risk of falling in older women.
Abstract: The objectives of this cross-sectional study were: (1) To determine if night-time sleep disturbance, daytime sleepiness, or urinary incontinence were associated with an increased risk of falling in older Australian women and (2) to explore the interrelationships between daytime sleepiness, night-time sleep problems, and urge incontinence. Participants were 782 ambulatory, community-dwelling women aged 75 to 86 recruited from within the existing Calcium Intake Fracture Outcome Study, in which women above 70 years were selected at random from the electoral roll. Daytime sleepiness, night-time sleep problems, urinary incontinence and falls data were collected via self-complete questionnaires. Thirty-five per cent of participants had fallen at least once in the past 12 months and 37.7% reported at least one night-time sleep problem. However, only 8.1% of the study sample experienced abnormal daytime sleepiness (Epworth Sleepiness Scale score > 10). Pure stress, pure urge, and mixed incontinence occurred in 36.8%, 3.7%, and 32.6% of participants respectively. In forward stepwise multiple logistic regression analysis, urge incontinence (OR 1.76; 95% CI 1.29 to 2.41) and abnormal daytime sleepiness (OR 2.05; 95% CI 1.21 to 3.49) were significant independent risk factors for falling after controlling for other falls risk factors (age, central nervous system drugs, cardiovascular drugs). As urge incontinence and abnormal daytime sleepiness were independently associated with an increased falls risk, effective management of these problems may reduce the risk of falling in older women.
TL;DR: To asses the validity of three physical diagnostic tests for the demonstration of rupture of the anterior cruciate ligament (ACL): the anterior drawer test, the Lachman test, and the pivot shift test, a meta-analysis of diagnostic studies was conducted.
Abstract: Objective To asses the validity of three physical diagnostic tests for the demonstration of rupture of the anterior cruciate ligament (ACL): the anterior drawer test, the Lachman test, and the pivot shift test. Design Meta-analysis of diagnostic studies. Data sources From computerised searches of Medline (1966–2004) and Embase (1980–2004), publications were selected that were written in English, French, German, or Dutch and in which the value of at least one physical diagnostic test for rupture of the ACL was assessed in comparison with the findings from arthrotomy, arthroscopy, or MRI as the reference standard. Study selection and assessment Two investigators independently selected the publications, assessed the methodological quality, and extracted data using a standardised protocol. Outcomes Wherever appropriate and possible, an estimate was made of the (pooled) sensitivity, specificity, and positive and negative predictive value of each test with the aid of a meta-analysis. Main results There were 17 studies identified. None of these reported blinded assessment of test, and only 2 performed the gold standard in all included patients. Summary estimates of sensitivity and specificity were 62% (95% CI 42 to 78%) and 88% (95% CI 83 to 92%) for the anterior drawer test, 86% (95% CI 76 to 92%) and 91% (95% CI 79 to 96%) for the Lachman test, and 32% and 98% (95% CIs could not be calculated) for the pivot shift test, respectively. Conclusions Physical diagnostic tests may be useful in the diagnosis of ACL ruptures. The clinical relevance of the test results, however, depends largely on the prior probability of the presence of such a rupture and is therefore different for general practitioners and specialists.
TL;DR: The FABQ consists of 2 subscales, which are reflected in the division of the outcome form into 2 separate sections; however the patient should still complete all items as these items were included when the reliability and validity of the scale was initially established.
Abstract: Scoring: The FABQ consists of 2 subscales, which are reflected in the division of the outcome form into 2 separate sections. The first subscale (items 1-5) is the Physical Activity subscale (FABQPA), and the second subscale (items 6-16) is the Work subscale (FABQW). Interestingly, not all items contribute to the score for each subscale; however the patient should still complete all items as these items were included when the reliability and validity of the scale was initially established. A low FABQW score (less than 19) was one of 5 variables in a clinical prediction rule that increased the probability of success from SI region manipulation in individuals with low back pain. Each subscale is graded separately by summing the responses respective scale items (0 – 6 for each item); for scoring purposes, only 4 of the physical activity scale items are scored (24 possible points) and only 7 of the work items (42 possible points). The method to score each subscale is outlined below. (Note: It is extremely important to ensure all items are completed, as there is no procedure to adjust for incomplete items.)
TL;DR: It is demonstrated that endotracheal suctioning frequently causes an immediate drop in dynamic compliance and expired tidal volume in ventilated children with variable lung pathology, intubated with small endotrachesal tubes, probably indicating loss of lung volume caused by the suctioned procedure.
Abstract: Endotracheal suctioning is performed regularly in ventilated infants and children to remove obstructive secretions. The effect of suctioning on respiratory mechanics is not known. This study aimed to determine the immediate effect of endotracheal suctioning on dynamic lung compliance, tidal volume, and airway resistance in mechanically-ventilated paediatric patients by means of a prospective observational clinical study. Lung mechanics were recorded for five minutes before and five minutes after a standardised suctioning procedure in 78 patients intubated with endotracheal tubes ≤ 4.0 mm internal diameter. Twenty-four patients with endotracheal tube leaks ≥ 20% were excluded from analysis. There was a significant overall decrease in dynamic compliance ( p p = 0.03) following suctioning with no change in the percentage endotracheal tube leak ( p = 0.41). The change in dynamic compliance was directly related to both endotracheal tube and catheter sizes. There was no significant change in expiratory or inspiratory airway resistance following suctioning ( p > 0.05). Although the majority of patients (68.5%) experienced a drop in dynamic compliance following suctioning, dynamic compliance increased in 31.5% of patients after the procedure. This study demonstrates that endotracheal suctioning frequently causes an immediate drop in dynamic compliance and expired tidal volume in ventilated children with variable lung pathology, intubated with small endotracheal tubes, probably indicating loss of lung volume caused by the suctioning procedure. There is no evidence that suctioning reduces airway resistance.
TL;DR: In this article, low-level laser therapy (LLT) was applied to the tender points in the neck for 7 weeks to provide pain relief for patients with chronic neck pain.
Abstract: Question Does 300 mW, 830 nm low-level laser therapy (LLLT) improve pain, disability and quality of life in people with chronic neck pain? Design Randomised controlled trial. Setting Primary care (medical centre of 17 general practitioners). Participants Ninety subjects with chronic neck pain (mean duration 15.1 ± 12.6 years). Interventions The intervention group received twice-weekly treatments of LLLT (830 nm, 300 mW, at a power density of 0.67 W/ cm 2 ) applied to tender points in the neck, for 7 weeks. The control group received sham laser treatment. Outcomes The primary outcome was pain intensity (10 cm VAS scale). Other outcomes were quality of life (Short Form- 36, consisting of a Physical Component Summary and a Mental Component Summary, each scored from 0 to 100); perceived disability (Northwick Park Neck Pain Questionnaire, NPNPQ, measured on a scale of 0 to 36); neck pain intensity and interference with living (Neck Pain and Disability Scale, NPAD, measured on a scale of 0 to 100); pain (Short-Form McGill Pain Questionnaire, MPQ) and a participant rating of global assessment (self-assessed improvement, SAI, expressed as percentage change). Outcomes were measured 1 month after completion of the treatment (approximately 12 weeks from baseline). Results The between-group difference in VAS pain score at 12 weeks was –3.0 cm (95% CI –2.1 to –3.8). Measured on the McGill VAS Pain Scale, the reduction in pain intensity was –2.2 cm (95% CI –0.9 to –3.5). Self-assessed improvement (SAI) scores favoured the active LLLT group, with between group differences of 41% (95% CI 27.7 to 55.8). The NPAD disability score was reduced by a mean of –12.1 (95% CI –19.3 to –4.8). The mean change in NPNPQ score was –3.0 (95% CI –5.0 to –9.0). Negligible changes (3% to 5%) were reported in the SF-36 and MPQ (sensory and affective) scores. Conclusion LLLT, as implemented in this study, was effective in providing pain relief for patients with chronic neck pain.
TL;DR: Ten placebo techniques were developed that aimed to mimic spinal manipulative therapy as closely as possible which, while not including the active component of spinal manipulative Therapy, were still credible.
Abstract: Selecting an appropriate control group or placebo for randomised controlled trials of spinal manipulative therapy is essential to the final interpretation and usefulness of these studies. Prior to starting a randomised controlled trial of spinal manipulative therapy for acute low back pain we wanted to ensure that the placebo selected would be considered appropriate by experts in the field thereby making the results more likely to be accepted and more likely to influence clinical practice. We developed ten placebo techniques that aimed to mimic spinal manipulative therapy as closely as possible which, while not including the active component of spinal manipulative therapy, were still credible. This list of placebo techniques with detailed descriptions was sent to 25 experts in the field from Australia and New Zealand including both clinicians and academics. We asked the experts to rate whether they believed each technique was appropriate for use as a placebo in a trial of spinal manipulative therapy. Sixteen (64%) of the experts responded. There were extremely low levels of agreement between the experts on which placebos were appropriate (kappa = 0.05, 95% CI 0.01 to 0.10). For nine of the ten placebos at least one expert considered the placebo to include the active component of spinal manipulative therapy while at least one other expert believed the same placebo was not only not active but also not credible. The results of this study demonstrate the different views of experts on what constitutes an appropriate placebo for trials of spinal manipulative therapy. Different beliefs about what is the active component of spinal manipulative therapy appear to be responsible for much of the disagreement.
TL;DR: Wearing night splints does not increase ankle ROM or strength in people with Charcot-Marie-Tooth disease Type 1A.
Abstract: Question What is the effect of wearing splints at night to stretch the plantarflexors on dorsiflexion range of motion (ROM) in people with Charcot-Marie-Tooth disease? Design Randomised, assessor-blinded, cross-over trial. Participants 14 people (1 dropout) aged 7 to 30 years with Charcot-Marie-Tooth disease Type 1A and with ≤ 15 degrees dorsiflexion range of motion (ROM). Intervention A splint holding the ankle in maximum dorsiflexion was worn nightly on one leg for 6 weeks followed by the opposite leg for the subsequent 6 weeks. Outcome measures The primary outcome was dorsiflexion ROM; secondary outcomes were eversion ROM, and dorsiflexion, eversion, and inversion strength, measured before and after splinting, and three months later. Results There was no significant difference between the experimental and the control intervention in terms of ROM or strength. Wearing the splint at night increased dorsiflexion ROM by 1 degree (95% CI –3 to 4; p = 0.72) and eversion ROM by 1 degree (95% CI –1 to 3; p = 0.28) compared to not wearing the splint. Wearing the splint increased dorsiflexion strength by 41 N (95% CI –53 to 135; p = 0.38), reduced eversion strength by 6 N (95% CI –112 to 101; p = 0.92) and reduced inversion strength by 8 N (95% CI –110 to 95; p = 0.88) compared to not wearing the splint. Conclusion Wearing night splints does not increase ankle ROM or strength in people with Charcot-Marie-Tooth disease Type 1A. [Refshauge K, Raymond J, Nicholson G, van den Dolder PA (2006) Night splinting does not increase ankle range of motion in people with CharcotMarie-Tooth Disease: A randomised, cross-over trial. Australian Journal of Physiotherapy 52: 193–199]
TL;DR: Changes in intrapleural pressure occurring during vibration appear to be the sum of changes in pressure due to lung recoil and the compressive and oscillatory components of the technique, which suggests that all three components are required to optimise expiratory flow.
Abstract: Question: What is the relationship between vibration of the chest wall and the resulting chest wall force, chest wall circumference, intrapleural pressure, and expiratory flow rate? Is the change in intrapleural pressure during vibration the sum of the intrapleural pressure due to recoil of the lung, chest wall compression, and chest wall oscillation? Design: Randomised, within-subject, experimental study. Participants: Seven experienced cardiopulmonary physiotherapists and three healthy adults. Intervention: Vibration (compression + oscillation), compression alone, and oscillation alone were applied manually to the chest walls of healthy participants during passive exertion and compared with passive expiration alone. Outcome measures: Chest wall force, chest wall circumference, intrapleural pressure, and expiratory flow rate. Results: During vibration, coherence was high (r 2 > 0.97) between external chest wall force, chest wall circumference, intrapleural pressure, and expiratory flow. The mean change in intrapleural pressure during vibration was 9.55 cmH 2 O (SD 1.66), during chest compression alone was 8.06 cmH 2 O (SD 1.65), during oscillation alone was 7.93 cmH 2 O (SD 1.57), and during passive expiration alone was 6.82 cmH 2 O (SD 1.51). During vibration, compression contributed 13% of the change in intrapleural pressure, oscillation contributed 12%, and lung recoil contributed the remaining 75%. Conclusions: During vibration the chest behaves as a highly linear system. Changes in intrapleural pressure occurring during vibration appear to be the sum of changes in pressure due to lung recoil and the compressive and oscillatory components of the technique, which suggests that all three components are required to optimise expiratory flow. [McCarren B, Alison JA, Herbert RD (2006) Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study. Australian Journal of Physiotherapy 52: 267–271]
TL;DR: In this paper, the effects of vibration on the chest wall of a normal subject were compared to other interventions of chest wall compression, chest wall oscillation, cough, huff from high lung volume, inspiration to total lung capacity with relaxed expiration, tidal breathing, and sham.
Abstract: Vibration is a manual technique used widely to assist with the removal of pulmonary secretions. Little is known about how vibration is applied or its effect on the respiratory system. The purpose of this study was to describe mechanical consequences of vibration on the chest wall of a normal subject and the effects of vibration on expiratory flow rates and volumes. The effects of vibration were compared to other interventions of chest wall compression, chest wall oscillation, cough, huff from high lung volume, inspiration to total lung capacity with relaxed expiration, tidal breathing, and sham. Sixteen physiotherapists applied vibration and other interventions in a randomised order to the chest wall of a healthy adult female subject. The magnitude and direction of the force and the frequency of vibration were measured by an instrumented bed with seven load cells. Inductive plethsysmography measured the change in chest wall circumference with vibration. A heated pneumotachometer measured inspiratory and expiratory flow rates, which were integrated to provide volumes. Vibration was applied with a mean resultant force of 74.4 N (SD 47.1). The mean (SD) change in chest wall circumference and frequency of vibration were 0.8 cm (SD 0.4) and 5.5 Hz (SD 0.8) respectively. The mean peak expiratory flow rate was 0.97 l/s (SD 0.27). Peak expiratory flow rates with vibration were less than 20% of those achieved with cough or huff from high lung volume but greater than with chest wall compression, chest wall oscillation, relaxed expiration from total lung capacity, sham treatment or tidal breathing.
TL;DR: Both unsupported sitting postures require greater pelvic floor muscle activity than the supported sitting posture, and both abdominal muscles also increased but did not reach statistical significance.
Abstract: Question Do different sitting postures require different levels of pelvic floor and abdominal muscle activity in healthy women? Design Observational study. Participants Eight parous women with no pelvic floor dysfunction. Outcome measures Bilateral activity of pelvic floor muscles (assessed vaginally) and two abdominal muscles, obliquus internus abdominis and obliquus externus abdominis, during three sitting postures. Results There was a significant increase in pelvic floor muscle activity from slump supported sitting (mean 7.2% maximal voluntary contraction, SD 4.8) to both upright unsupported sitting (mean 12.6% maximal voluntary contraction, SD 7.8) ( p = 0.01) and very tall unsupported sitting (mean 24.3% maximal voluntary contraction, SD 14.2) ( p = 0.004). Activity in both abdominal muscles also increased but did not reach statistical significance. Conclusion Both unsupported sitting postures require greater pelvic floor muscle activity than the supported sitting posture.
TL;DR: Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control and step length on the unaffected side increased significantly for both speeds compared with either the control or placebo conditions.
Abstract: The aim of this study was to determine whether gluteal taping on the affected side improved hip extension during stance phase of walking for persons following stroke. Fifteen subjects who had suffered a stroke months to years previously resulting in mild to moderate gait impairments participated in the study. Their gait was measured under control, sham, and gluteal taping conditions, in random order. For each condition, subjects walked at a self-selected and a fast speed. Hip angle relative to that obtained during quiet standing, step length, stride length and walking velocity were measured. Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between gluteal and control conditions for self-selected velocity was 14.2 degrees (95% CI 8.6 to 19.8) whereas the difference between sham and control conditions was 2.0 degrees (95% CI -2.0 to 6.0). Also, for both speeds, step length on the unaffected side increased significantly with gluteal taping compared with either the control or placebo conditions. The absolute difference between gluteal taping and control conditions at self-selected velocity was 3.3 cm (95% CI 2.2 to 4.3) and between sham and control conditions was 0.6 cm (95% CI -0.8 to 1.9). Affected step length and walking velocity, however, remained unchanged. Lastly, there was no significant difference between the control and sham taping condition for any of the measured variables. Gluteal taping may be a useful adjunct to current rehabilitation gait training strategies. (Kilbreath SL, Perkins S, Crosbie J and McConnell J (2006): Gluteal taping improves hip extension during stance phase of walking following stroke. Australian Journal of Physiotherapy 52 1: 53-56)
TL;DR: Intensive stretch administered regularly over three months does not reduce thumb web-space contractures in neurological conditions.
Abstract: Question: What is the effectiveness of 12 weeks of nightly stretch in reducing thumb web-space contracture in people with neurological conditions? Design: Assessor-blinded, randomised controlled trial. Participants: Forty-four (one dropout) community-dwelling patients with a neurological condition (14 stroke, 7 traumatic brain injury, 23 spinal cord injury) who had unior bilateral thumb web-space contractures (60 thumbs). Intervention: The experimental thumbs were splinted into a stretched, abducted position each night for 12 weeks. The control thumbs were not splinted. Outcome measures: Thumb web-space was measured as the carpometacarpal angle during the application of a 0.9 Nm abduction torque before and after intervention. Results: The mean increase in thumb web-space after 12 weeks was 1 deg (95% CI, –1 to 2). Conclusion: Intensive stretch administered regularly over three months does not reduce thumb web-space contractures in neurological conditions. [Harvey L, de Jong I, Goehl G, Marwedel S (2006) Twelve weeks of nightly stretch does not reduce thumb web-space contractures in people with a neurological condition: a randomised controlled trial. Australian Journal of Physiotherapy 52: 251– 258]
TL;DR: The authors provide a brief overview of the major landmarks in physiotherapy education and celebrate some of the visionary physiotherapy leaders who have made a significant contribution to physiotherapeutic education in Australia.
Abstract: The authors provide a brief overview of the major landmarks in physiotherapy education and celebrate some of the visionary physiotherapy leaders who have made a significant contribution to physiotherapy education in Australia (non-author abstract)
TL;DR: While attitudes toward older people were positive and knowledge improved over time, the level of knowledge attained was below expectation for beginning practitioners and has implications for the education and training of physiotherapy students.
Abstract: The purpose of this study was to determine whether students' attitudes towards and knowledge of older people changed throughout the physiotherapy undergraduate program. Students' demographic information and attitudes towards and knowledge of older people were gathered via repeated question-responses over three points of time during the 4-year program. Validated instruments--the Geriatric Attitudinal Scale (GAS) and the Facts on Ageing Quiz 1 (FAQ1)--were used to measure participants' attitudes and knowledge of older people. The FAQ1 yielded two variables: knowledge as percentage of FAQ1 correct responses, and ignorance as percentage of FAQ1 Don't Know responses. The instruments were administered in Year 2 prior to the students' first clinical (Time 1), immediately after their first clinical (Time 2), and Year 4 just prior to completion of the program (Time 3). Changes over time were analysed using paired t-tests with significance set at p < 0.05. Participants initially demonstrated positive attitudes towards older people with a mean of 73.8% GAS positive responses with no significant change over time (p = 0.56). Initial knowledge about older people was poor with a mean of 43.6% FAQ1 correct responses which increased significantly over time to 51.7% (p = 0.0001). This improvement in knowledge was accompanied by a decrease in ignorance over the study period (p = 0.0001). While attitudes toward older people were positive and knowledge improved over time, the level of knowledge attained was below expectation for beginning practitioners. This finding has implications for the education and training of physiotherapy students.
TL;DR: This questionnaire is to identify difficulties that you may be experiencing because of your dizziness and restricts your travel for business or recreation.
Abstract: NAME: __________________________________________________ DATE: _______________________ INSTRUCTIONS: The purpose of this questionnaire is to identify difficulties that you may be experiencing because of your dizziness. Please answer every question. Please do not skip any questions. Yes Sometimes No P01. Does looking up increase your problem? E02. Because of your problem, do you feel frustrated? F03. Because of your problem, do you restrict your travel for business or recreation?
TL;DR: Although involvement of patients in the intervention process is already part of behavioural graded activity, it would be beneficial to emphasise the importance of active involvement by patients right from the start of the intervention.
Abstract: Question Why do some patients who have received a behavioural graded activity program successfully integrate the activities into their daily lives and others do not? Design Qualitative study. Participants 12 patients were selected according to the model of deliberate sampling for heterogeneity, based on their success with the intervention as assessed on the Patient Global Assessment. Intervention Behavioural graded activity. Outcome measures Data from 12 interviews were coded and analysed using the methods developed in grounded theory. The interviews covered three main themes: aspects related to the content of behavioural graded activity, aspects related to experience with the physiotherapist, and aspects related to characteristics of the participant. Results Interview responses suggest that two factors influence long-term adherence to exercise and activity. First, initial long-term goals rather than short-term goals seem to relate to greater adherence to performing activities in the long term. Second, active involvement by participants in the intervention process seems to relate to greater adherence to performing activities in the long term. Conclusion Although involvement of patients in the intervention process is already part of behavioural graded activity, it would be beneficial to emphasise the importance of active involvement by patients right from the start of the intervention. Furthermore, to increase the success of behavioural graded activity, physiotherapists should gain a clear understanding of the patient's initial motives in undergoing intervention.
TL;DR: The prevalence of thumb problems in Australian physiotherapists appears to be high and can be of sufficient severity to impact on careers.
Abstract: Question: What is the lifetime and current prevalence of thumb problems in Australian physiotherapists and what are the factors associated with thumb problems? Design: Survey of a random cross-section of physiotherapists. Participants: 1562 (approximately 10% of the total) registered Australian physiotherapists. Outcome measures: General questions covered demographic information, area of practice, hours worked per week, and years worked as a physiotherapist. Specific questions about thumb problems covered thumb affected, symptoms, onset of symptoms, treatment sought, relevance of work-related factors, and joint hypermobility. Results: 1102 (71%) questionnaires were returned and 961 (68%) completed. The lifetime prevalence of thumb problems was 65% and the current prevalence was 41%. Factors that were significantly associated with thumb problems included: working in orthopaedic outpatients (OR 3.2, 95% CI 1.8 to 5.8); using manual therapy (OR 2.3 to 3.4, 95% CI 1.7 to 5.1), trigger point therapy (OR 2.3, 95% CI 1.7 to 3.0) and massage (OR 2.1, 95% CI 1.6 to 2.8); having thumb joint hypermobility (OR 2.2 to 2.6, 95% CI 1.4 to 4.5); or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques (OR 4.2, 95% CI 2.9 to 5.9). Of those respondents who reported thumb problems, 19% had changed their area of practice and 4% had left the profession as a result of their thumb problems. Conclusion: The prevalence of thumb problems in Australian physiotherapists appears to be high and can be of sufficient severity to impact on careers. [McMahon M, Stiller K, Trott P (2006) The prevalence of thumb problems in Australian physiotherapists is high: an observational study. Australian Journal of Physiotherapy 52: 287–292]
TL;DR: Although compliance with the guidelines for acute ankle sprain was fair/moderate, compliance may be enhanced by improving clarity of the function score, including it in the short version and improving the attitude of physiotherapists towards guidelines in general.
Abstract: Question: What is the compliance with guidelines for acute ankle sprain for physiotherapists? Design: Survey of random sample of physiotherapists. Participants: 400 physiotherapists working in extramural health care in the Netherlands. Outcome measures: Questions covered attitude towards guidelines in general, familiarity with the guidelines for acute ankle sprain, compliance with the guidelines, advantages and disadvantages of the guidelines, and factors relating to compliance with the guidelines. Results: The majority of the physiotherapists were familiar with the content of the guidelines to some degree and 66% applied it to more than half of their patients with acute ankle sprain. The recommendations to determine both the prognosis and the necessity of treatment by using the function score were the least followed. Some physiotherapists thought the function score was not completely clear, which may have been a barrier for implementation. Factors relating positively to compliance were a positive attitude towards guidelines in general, and having colleagues who implemented the guidelines for acute ankle sprain. Conclusion: Although compliance with the guidelines for acute ankle sprain was fair/moderate, compliance may be enhanced by improving clarity of the function score, including it in the short version and improving the attitude of physiotherapists towards guidelines in general. [Leemrijse CJ, Plas GM, Hofhuis H, van den Ende CHM (2006) Compliance with the guidelines for acute ankle sprain for physiotherapists is moderate in the Netherlands: an observational study. Australian Journal of Physiotherapy 52: 293–298]