Physiother Res Int. 2008 Nov 18; 13(4): 203
Jones F

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Physiother Res Int. 2008 Nov 13;
Wilson D, Williams M, Butler D

Background and Purpose. People in persistent pain have been reported to pay increased attention to specific words or descriptors of pain. The amount of attention paid to pain or cues for pain (such as pain descriptors), has been shown to be a major factor in the modulation of persistent pain. This relationship suggests the possibility that language may have a role both in understanding and managing the persistent pain experience. The aim of this paper is to describe current models of neuromatrices for pain and language, consider the role of attention in persistent pain states and highlight discrepancies, in previous studies based on the McGill Pain Questionnaire (MPQ), of the role of attention on pain descriptors. The existence of a pain neuromatrix originally proposed by Melzack (1990) has been supported by emerging technologies. Similar technologies have recently allowed identification of multiple areas of involvement for the processing of auditory input and the construction of language. As with the construction of pain, this neuromatrix for speech and language may intersect with neural systems for broader cognitive functions such as attention, memory and emotion. Method. A systematic search was undertaken to identify experimental or review studies, which specifically investigated the role of attention on pain descriptors (as cues for pain) in persistent pain patients. A total of 99 articles were retrieved from six databases, with 66 articles meeting the inclusion criteria. After duplicated articles were eliminated, the remaining 41 articles were reviewed in order to support a link between persistent pain, pain descriptors and attention. Results. This review revealed a diverse range of specific pain descriptors, the majority of which were derived from the MPQ. Increased attention to pain descriptors was consistently reported to be associated with emotional state as well as being a significant factor in maintaining persistent pain. However, attempts to investigate the attentional bias of specific pain descriptors highlighted discrepancies between the studies. As well as the diversity of pain descriptors used in studies, they were inconsistently categorized into domains of pain. A lack of consistent bias towards certain pain descriptors was observed, and may be explained simply by the fact that the words provided are not those which subjects themselves would use. Conclusion. These findings suggest that the multidimensional and individual nature of the persistent pain experience may not be adequately explained by pain questionnaires such as the MPQ. Personalized pain descriptors may communicate the pain experience more appropriately, but may also contribute to an increased sensitivity of cortical pain processing areas by capturing increased attention for that individual. The language used as part of communication between therapists and people with persistent pain may provide an, as yet, unexplored adjunct strategy in management. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Nov 10;
Landry MD, Eldarrat NA, Raman SR, Dyck T

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Physiother Res Int. 2008 Nov 10;
Morinder G, Mattsson E, Sollander C, Larsson UE, Marcus C

Background and Purpose. The six-minute walk test (6MWT) is increasingly used in clinical practice. The aims of this study were to determine the reproducibility of the 6MWT in obese children and adolescents, to describe walking capacity in this population and compare the results with values from normal-weight children (known group validity), and, finally, to describe the correlation between distance walked and estimated maximum oxygen uptake (VO(2)max). Methods. Reproducibility was determined by a test-retest design and known group validity by a comparative design. The 6MWT was first test-retested in 49 obese children (30 boys, 19 girls, 8-16 years, body mass index [BMI] 24.9-52.1 kg?m(-2)). Then, for validation, 250 obese children (126 boys, 124 girls, 8-16 years, BMI 23.2-57 kg/m(2)) and 97 normal-weight children (48 boys, 49 girls, 8-16 years, BMI 13.3-23.2 kg.m(-2)) performed the 6MWT. The obese children also performed a sub-maximal bicycle ergometry test. Results. In the test-retest, the obese children walked 571 m the first test and 57 m the second (p = 0.578). The measurement error (S(w)) was 24 m, coefficient of variation (CV): 4.3% and the intraclass correlation (ICC1:1): 0.84. Repeatability was 68 m, and limits of agreement were +71 and -65 m. In comparison mean (standard deviation), six-minute walk distance (6MWD) in the obese children was 571 m (65.5), and in the normal-weight children, 663 m (61.1) (p < 0.001). The correlation between 6MWD and estimated VO(2)max (r = 0.34) was low. Conclusions. The 6MWT showed good reproducibility and known group validity, and can be recommended for use in clinical practice in the studied population. To evaluate individual outcomes after intervention, the 6MWD needs to change by >68 m to be statistically significant. The 6MWD performed by obese children averaged 86% of the distance normal-weight children walked. In obese children, the correlation between 6MWD and estimated VO(2)max was low, hence the 6MWT cannot substitute a bicycle ergometry test. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Nov 4; 13(4): 209-222
Smith M, Higgs J, Ellis E

Background and Purpose. Physiotherapists have been increasingly interested in investigating physiotherapy clinical reasoning and decision-making processes. Cardiorespiratory physiotherapy has received little attention within this increasing body of research. This study aimed to investigate characteristics and processes of cardiorespiratory physiotherapy decision making and to contribute to the broader understanding of physiotherapy reasoning and decision making. Methods. Fourteen cardiorespiratory physiotherapists took part in the study. Qualitative research methods were used, guided by a philosophical hermeneutic approach. Participants were observed undertaking their usual daily patient care activities and were later interviewed about their decision making. In-depth, iterative hermeneutic strategies were used to interpret the texts created by these processes to identify the nature and processes of decision making. Results. Clinical decision making in cardiorespiratory physiotherapy is focused on making decisions about the nature of patients' problems, physiotherapeutic intervention and interaction, and evaluation of effectiveness of actions. Cardiorespiratory physiotherapy decisions varied in their difficulty according to the attributes of the decisions. The variable nature of decisions influenced the reasoning processes used. Clinical decision making involved complex reasoning processes that were cyclic, evolving and flexible in nature, with interdependence and interrelation between the different foci of clinical decision making. Clinical decision making was also found to be a social and collaborative process. Conclusions. This study contributes to the body of literature on physiotherapy reasoning and decision making by revealing details about the characteristics and processes of cardiorespiratory physiotherapy decision making. This research can be used to shape the education of beginning practitioners and provide practicing physiotherapists with a basis for critical appraisal of their decision making. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Oct 29; 13(4): 207-208
White LC, Dolphin P, Dixon J

Purpose. To investigate whether there was a difference in hamstring length between patients with patellofemoral pain syndrome and healthy asymptomatic control participants between 18 and 35 years old. Relevance. Short hamstrings may produce greater patellofemoral joint reaction forces. Only three studies, which had conflicting results, have measured the hamstring length in this patient group (Smith et al., 1991; Witvrouw et al., 2000; Piva et al., 2005). Subjects. Two groups were tested, one was diagnosed with patellofemoral pain syndrome (mean age 27 years, n = 11, six males, five females) and one was of asymptomatic control participants (mean age 25 years, n = 25, 13 males, 12 females). Methods. Ethical approval was granted by the Local Research Ethics Committee and a cross-sectional observational study was carried out in a hospital's physiotherapy department. Hamstring length was evaluated using the passive knee extension method and a masked universal goniometer to measure the popliteal angle. Analysis. An independent t-test was used to evaluate between-group differences. Results. Mean (standard deviation) values for hamstring length were 145.6 (8.7) degrees for the patellofemoral pain patients and 153.7 (10.1) degrees for the asymptomatic control participants. The mean (95% confidence interval) difference between the groups was 8.0 (0.8 to 15.1) degrees , and this was statistically significant (p < 0.05). Discussion. Although limited by a small sample size, these results show that hamstring length is shorter in the patellofemoral patient group than in the asymptomatic participants. It is unclear whether this is a cause or an effect of the condition. Further research should study how hamstring length changes with rehabilitation and its relationships with pain. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Oct 28; 13(4): 255-270
Van Peppen RP, Maissan FJ, Van Genderen FR, Van Dolder R, Van Meeteren NL

Objective. To investigate physiotherapists' self-reported use of outcome measures as recommended in the Dutch Clinical Practice Guideline on Physiotherapy Management of Patients with Stroke (CPGPS) and to assess perceived barriers to and facilitators for the use of outcome measures in everyday practice. Method. A 41-item survey, including the barriers and facilitators questionnaire (BFQ), was sent by post to 400 physiotherapists in each of the following settings in the Netherlands: acute care hospitals (ACH; n = 100), rehabilitation centres (RC; n = 100), nursing homes (NH; n = 100) and private physiotherapy practices (PPP; n = 100). Results. One hundred and eighty-nine physiotherapists returned the survey (47%; ACH, n = 57; RC, n = 67; NH, n = 26 and PPP, n = 39) and the surveys of 167 physiotherapists involved in stroke settings were analysed. These physiotherapists reported regularly using three (median; range 0-7) of the seven recommended outcome measures, with those working in RC or ACH reporting a significantly higher use than their colleagues in PPP (4 vs. 0 and 3 vs. 0; p < 0.001 and p = 0.02, respectively). The BFQ revealed that there were setting-specific facilitators, such as 'a positive attitude towards outcome measures' (as mentioned by 93% of the physiotherapists) and 'acquaintance with outcome measures' (90%), and barriers such as 'changing routines' (32%), 'time investment' (29%) and 'financial compensation' (21%). Conclusion. Despite an almost uniformly positive attitude, physiotherapists infrequently use the outcome measures recommended in the CPGPS. Robust setting-specific tailored implementation strategies based on the reported barriers and facilitators are needed. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Oct 23; 13(4): 201-202
Gale JR, Pfalzer L

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Physiother Res Int. 2008 Oct 10; 13(4): 271

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Physiother Res Int. 2008 Oct 3;
Kell C, Owen G

Background and Purpose. With Continuing Professional Development activity, a requirement of Allied Health Professional registration in the UK and said to be most effectively supported by practitioners who adopt a deep approach to learning, a UK university has been exploring how its pre-registration curriculum influences learner development. This paper investigates the possible influences of the clinical placement component of the curriculum that is structured as four 4-week blocks during both Years 2 and 3 of the 3-year BSc (Hons) programme. A range of placement models are used within this structure including the traditional 1:1 educator : student ratio and those that have a higher ratio of student(s) : educator(s). Methods. This phase of the larger project used a case study design framed about students from two academic year groups on one UK undergraduate, pre-registration physiotherapy programme. Three questionnaires comprising a learning approaches inventory, a demographic questionnaire and a placement self-assessment form were posted to Year 2 and 3 students during one clinical placement. The students were invited to complete the questionnaires halfway through their placement, but in advance of the first, formal placement education feedback meeting. The need for students' self-assessment prevented follow-up data collection. Results. Analysis of the data from the learning approaches inventory against the demographic variables and placement assessment scores suggest that students' learning strategies depend upon the number of students, educators and assessors involved in their placement. The paper explores the possible links between placement experience, learning strategy and academic outcome. The authors question assumptions about the perceived benefits of some placement education models. Conclusion. Increasing the ratio of student : educator or educator : student may have a detrimental effect on students' learning development when placements are of 4-week duration. If such placement models are adopted, then students and placement educators must be adequately prepared and supported so that students' learning development towards the deep-learning autonomous professionals of tomorrow can continue through placement education. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Sep 30;
Chon SC, Oh DW, Shim JH

Background and Purpose. This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke. Method. Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function. Results. All patients showed decreased scores in the TAS and RVGA after Watsu application. Conclusions. Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Sep 12; 13(4): 223-230
Pott P, Selley A, Tyson SF

Background and Purpose. Monitoring range of movement is a key aspect of managing hip problems in children with cerebral palsy. The aim of this study was to assess the clinical utility, reliability and responsiveness of a new measurement tool, the Proximat, for hip range of movement. Method. Passive hip abduction, adduction, medial and lateral rotation were measured by using the Proximat on 26 children with cerebral palsy attending three special schools: 16 of whom are boys, mean age = 7 years and 6 months (standard deviation = 4.2 years), range 2-15 years. Testing was undertaken by two physiotherapists to assess interrater reliability and repeated the following day to assess test-retest reliability. Total, random and systematic errors were calculated for interrater and test-retest. Results. The Proximat was quick and easy to use and acceptable to the children. High reliability was found for all movements (intraclass correlation coefficient = 0.83-0.93) with reasonable responsiveness; total error was 2.5-12 degrees. Most of the error was random with little evidence of systematic bias. Conclusions. The Proximat is a reliable, responsive and acceptable method of measuring passive hip movements in children with cerebral palsy in day-to-day clinical practice. A change of 8-12 degrees is needed to overcome measurement error and to indicate that a 'true' change in range of movement has occurred. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Sep; 13(3): 131-6
Mayston M

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Physiother Res Int. 2008 Sep; 13(3): 141-52
Gill S, McBurney H

BACKGROUND AND PURPOSE: Understanding the reliability of selected measurement tools is a prerequisite to understanding the effects of clinical interventions. The aim of this investigation was to determine the reliability of the 50-Foot Timed Walk (50 FTW) and 30-second Chair Stand Test (30 CST) in subjects awaiting joint replacement surgery of the hip or knee. METHODS: Eighty-two subjects participating in a 6-week exercise programme were assessed at baseline, 7 weeks and 15 weeks. Four trials of the 50 FTW and two trials of the 30 CST were completed at each assessment. Eleven trained assessors completed the assessments. RESULTS: Intra-class correlations were consistently high for the 50 FTW and 30 CST at all assessments. At the baseline assessment, trial 1 was found to be significantly different from subsequent trials for both the 50 FTW and 30 CST. This effect was not evident at the 7-week and 15-week assessments. At the baseline assessment, scores for the 50 FTW became stable after the first trial. Estimates of minimum detectable change indicated that participants needed to change by more than 3.08 seconds and 1.64 stands to be 90% confident that a real change had occurred for the 50 FTW and 30 CST, respectively. CONCLUSION: The 50 FTW and 30 CST can be reliable measures of physical performance. However, because we found a practice effect at the baseline assessment, a practice trial should be allowed before data collection begins. Because only two trials of the 30 CST were completed, further research is required to confirm whether scores at the initial assessment become stable on repeated testing. ...»

Physiother Res Int. 2008 Jul 22;
Kristensen MT, Foss NB, Kehlet H

Background and Purpose. Data on performance times for the 'timed up and go' (TUG) test with analyses of factors, that eventually could affect the result in patients with hip fracture, have not been published to date. The aims of the present study, therefore, were to assess normative reference values of TUG performances and determine the influence of individual and clinical factors on TUG-test scores in patients with hip fracture. Method. In this prospective, descriptive study, a total of 196 consecutive patients over the age of 60, and able to perform the TUG when discharged directly to their own homes from a specialized orthopaedic hip fracture unit, were evaluated. The association between TUG scores and categorical variables were examined, and linear regression was used to investigate the factors influencing performance times. Results. Univariate analysis showed significant differences between all categorical variables, except gender, but multivariate linear regression analyses showed that only a high pre-fracture function level, evaluated by the New Mobility Score (B = -11), was independently associated with having a good TUG score, while older age (B = 0.49), having an intertrochanteric fracture (B = 7), performing TUG with a walker (B = 15), and performing TUG in the later postoperative period (B = 0.39) were independently associated with having a poorer TUG score. Conclusions. These preliminary normative reference values of TUG performances in patients with hip fracture can be used as references, to which individuals can expect to perform. Multivariate testing suggests that clinicians should use age, pre-fracture function, fracture type and walking-aid specific data when interpreting the TUG test results. Physiotherapists should be aware of this if TUG scores are to be used predictively or as an outcome measure in patients with hip fracture, especially in research. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Sep; 13(3): 176-88
Oyeyemi A, Oyeyemi A, Abegunde A

BACKGROUND AND PURPOSE: Adequate knowledge, positive attitude, and willingness to provide services are important factors in rendering competent and compassionate care to patients living with Acquired Immunodeficiency Syndrome (AIDS). Inadequate knowledge and poor attitude could exclude the application of the principles of logic and scientific methods to the practice of physiotherapy, and could result in fragmented care, with a potentially negative impact on treatment outcome and patient satisfaction. The purpose of this study was (1) to investigate the Nigerian physiotherapists' global knowledge, attitude and willingness to provide care for patients living with AIDS (PLWA), and to (2) determine the relationship between socio-demographic variables and previous encounter with PLWA, and physiotherapists' knowledge, attitude and willingness to care for AIDS survivors. METHODS: Using a 90-item two-part questionnaire that elicited sociodemographic and previous AIDS encounter information, and also assessed knowledge, attitude and willingness to provide care to PLWA, physiotherapists (N = 131) practicing in Nigeria were surveyed. RESULTS: Overall, the physiotherapists showed unsatisfactory knowledge about AIDS, harbored negative attitude towards PLWA, and some were unwilling to provide care for PLWA. Previous experience caring for PLWA influenced their attitude, and modest but positive relationships were found between knowledge and attitude and between attitude and willingness. CONCLUSION: The study underscores the need to address Nigerian physiotherapists' working knowledge deficits and negative attitudes to PLWA. A comprehensive AIDS education that would assist clinicians in exploring their attitude, stereotype and bias against PLWA is warranted. ...»

Physiother Res Int. 2008 Jul 9; 13(4): 231-240
Jedrzejczak A, Chipchase LS

Background and Purpose. Real time ultrasound (RTUS) is an emerging imaging modality in physiotherapy. Anecdotal evidence suggests that it is being used as an assessment and biofeedback tool for various deep core stabilizing muscles. However, how and why physiotherapists use RTUS in the clinical setting has not yet been reported. Therefore, this study aimed to establish the availability and usage frequency of RTUS by physiotherapists in South Australia. In addition, the study aimed to describe how physiotherapists were using RTUS and how they were educated in its use. Method. A questionnaire was developed and mailed to all physiotherapists registered with the Physiotherapy Board of South Australia (n = 1328) between February and March 2007. Results. A response rate of 50% was achieved with 664 completed usable questionnaires returned. At the current time, only a small proportion of respondents used RTUS (11.6%), while slightly more had access to a machine (19.4%). RTUS was used most commonly for assessment (88.3%) and biofeedback (87.0%) of the abdominal (94.7%), pelvic floor (72.7%) and multifidus (54.5%) muscles. Of all respondents, 26.7% had trained in its use with most completing two hours or less of training. Conclusions. This is the first published study to describe how and why physiotherapists are using RTUS in clinical practice. RTUS appears to be a relatively uncommon modality potentially limited by insufficient access to equipment and educational opportunities. The findings highlight a greater need for education and training in the use of RTUS for physiotherapy practice. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Sep; 13(3): 189-99
Landry MD, Williams AP, Verrier MC, Holyoke P, Zakus D, Deber RB

BACKGROUND AND PURPOSE: The vast majority of health services within Canada's single payer universal health care system are publicly funded. Despite the highly political and controversial emphasis placed on public funding, the structure of delivery within this health care system does not require public ownership. In this research, we developed a conceptual framework for analysing the public and private mix of physical therapy (PT) delivery in the province of Ontario. We then applied this framework to examine the shifts in employment structure of physical therapists (PTs) in Ontario. METHODS: A two-phased health policy case study methodology was used. In the first phase, we reviewed publicly available documents and conducted a series of 30 key informant interviews in order to develop our framework. In the second phase, we applied the framework and performed secondary analysis of the provincial PT registration database to assess change in practice setting between 1996 and 2002. RESULTS: We identified nine models of delivery that fall into three categories of ownership structure: (a) public; (b) private not-for-profit; and (c) private for-profit. During the six-year period between 1996 and 2002, the relative proportion of PTs employed in the not-for-profit sector decreased (from 59.6% to 54.8%) whereas the share in the for-profit sector grew (from 40.4% to 45.2%). CONCLUSIONS: The shifting balance in the structure of delivery may be transforming how PT services are provided in the province. Private for-profit providers appear to be increasing their market share; however, the outcomes relative to this shift has yet to be fully explored. Further policy and health services research is warranted to more fully understand the consequences of this shift on variables such as professional autonomy, access, cost and quality of services across Canada, but also within similar and dissimilar international jurisdictions. ...»

Physiother Res Int. 2008 Jul 8;
Jaggi A, Malone AA, Cowan J, Lambert S, Bayley I, Cairns MC

Background. This pilot study assesses level of agreement between surface and fine-wire electromyography (EMG), in order to establish if surface is as reliable as fine wire in the diagnosis and treatment of abnormal muscle patterning in the shoulder. Method. Eighteen participants (11 female) with unstable shoulders were recruited after written consent and ethical approval. Anthropometric information and mean skinfold size for triceps, subscapular, biceps and suprailiac sites were obtained. Triple-stud self-adhesive surface electrodes ('Triode'; Thermo Scientific, Physio Med Services, Glossop, Derbyshire, England) were placed over pectoralis major (PM), latissimus dorsi (LD), anterior deltoid (AD) and infraspinatus (IS) at standardized locations. Participants performed five identical uniplanar standard movements (flexion, abduction, external rotation, extension and cross-body adduction). After a 20-minute rest period, a dual-needle technique for fine-wire insertion was performed and the standard movements were repeated. An experienced examiner in each technique reported if muscle activation patterns differed from agreed normal during any movement and were blinded to the other test results. Sensitivity, specificity and Kappa values for level of agreement between methods were calculated for each muscle according to the method of Altman (1991). Results. Fifteen participants were successfully tested. Sensitivity, specificity and Kappa values between techniques for each muscle were PM (57%, 50%, 0.07), LD (38%, 85%, 0.22), AD (0%, 76%, -0.19) and IS (85%, 75%, 0.6). Only IS demonstrated high sensitivity and specificity and a moderate level of agreement between the two techniques. There was no correlation between skinfold size and agreement levels. Conclusion. The use of surface EMG may help to classify types of shoulder instability and recognize abnormal muscle patterns. It may allow physiotherapists to direct specific rehabilitation strategies, avoiding strengthening of inappropriate muscles. It has a reasonable degree of confidence to evaluate IS but may have poor sensitivity in detecting abnormal patterns in PM, LD and AD. Further work is required to see if investigator interpretation may have been a factor for the poor level of agreement. Copyright (c) 2008 John Wiley & Sons, Ltd. ...»

Physiother Res Int. 2008 Sep; 13(3): 153-61
Brady B, Redfern J, MacDougal G, Williams J

BACKGROUND AND PURPOSE: Rotator cuff tears are frequently encountered in medical outpatient settings and often require surgical repair to achieve desirable functional outcomes. However, the optimal form of post-operative rehabilitation of rotator cuff repairs remains unidentified by the research literature. The aim of this study was to determine the feasibility of implementing and investigating the effect of a combined aquatic and land-based rehabilitation programme in the post-operative rehabilitation of rotator cuff tears. METHODS: A cohort of 18 subjects undergoing rotator cuff repair were examined over a treatment period of 12 weeks. Twelve subjects participated in a combined aquatic and land-based programme, while six subjects received a standard land-based protocol. Passive range of motion and the Western Ontario Rotator Cuff Index outcomes were measured pre-operatively and at three, six and 12 weeks, post-operatively. Subjective responses on patient's assurance and confidence in the value of the exercises (questionnaire using an 11-point Visual Analogue Scale (VAS)) were collected at 12 weeks for both groups. RESULTS: There was a significant improvement in both range of motion and Western Ontario Rotator Cuff scores in all subjects with treatment (p < 0.001). Furthermore, participation in aquatic therapy significantly improved passive flexion range of motion measures at three weeks (mean 46 degrees , 95% CI 17-75, p = 0.005) and six weeks (30 degrees , 95% CI 8-51, p = 0.01). There was no significant difference in the attendance rates (80% in both groups) or patients perceptions of the programmes (100% confidence and assurance in both groups). CONCLUSION: The implementation of a combined aquatic and land-based physiotherapy programme following surgical repair of the rotator cuff is feasible and presents a potential viable alternative to conventional land-based exercise with comparable outcomes. ...»