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PubMed2006

Interexaminer reliability of lumbar segmental mobility tests.

The purpose of this study was to investigate the interexaminer reliability of segmental mobility tests for the lumbar flexion and extension movement. Available reliability studies are rare and investigate total segmental mobility through several tests, making the understanding of the effect of each test more difficult. There is also a risk of creating a test situation that has less resemblance to the work situation of physiotherapists if two physiotherapists who have trained and coordinated their manual techniques together in advance are studied. Three physiotherapists with step 2 of the Swedish orthopaedic manual therapy education (OMT) performed one segmental mobility test for lumbar flexion and one for lumbar extension on twenty subjects. They were not permitted to obtain additional information, apart from a standing inspection without movements. The physiotherapists had not worked together, nor did they have a chance to coordinate their manual techniques prior to the examinations. The results showed no interexaminer reliability and suggest that future research is essential if a conclusion about lumbar intersegmental mobility tests is to be reached.

Humans↗
PubMed2006

The clinical reasoning of pain by experienced musculoskeletal physiotherapists.

There is currently no research within Physiotherapy to explain the extent to which current theories and models of pain influence clinicians' reasoning related to clinical presentations of pain. The purpose of this qualitative study was to investigate the clinical reasoning of experienced musculoskeletal physiotherapists in relation to three different presentations of pain. A qualitative multiple-case studies method was used in this study. A purposive sample of seven experienced musculoskeletal physiotherapists viewed three videotaped patient-therapist clinical interviews describing three different pain presentations. An audio taped, semi-structured interview was carried out with each participant during which the participants were encouraged to verbalize their thoughts regarding aspects of each patient's pain presentation. All interviews were subsequently transcribed, coded and analysed. Results showed a dynamic, multidimensional nature to the therapists' clinical reasoning, which was found to be grounded in a number of established models of pain. Five main categories of pain-based clinical reasoning were identified. These were (i) biomedical, (ii) psychosocial, (iii) pain mechanisms, (iv) chronicity and (v) irritability/severity. Reasoning within these categories influenced therapists' prognostic decision-making as well as the planning of physical assessments and treatment. The clinical reasoning of pain by the participants in this study appeared to reflect the integration of diverse models and theories of pain into current clinical practice. Mechanisms-based clinical reasoning has not been previously observed amongst physiotherapists.

Data Collection↗
PubMed2005

Quantification of mobility impairment and self-assessment of stiffness in patients with myotonia congenita by the physiotherapist.

We investigated test-retest reliability and responsiveness in two functional measuring instruments, Timed Up&Go (TUG) and Timed-Stands Test (TST), and in three self-assessment scales, Visual Analogue Scale (VAS), Borg's Category-Ratio Scale (BorgCR10) and Myotonia Behaviour Scale (MBS) when quantifying myotonic stiffness and mobility impairment. These methods were used in the assessment of treatment efficacy of mexiletine. Six male patients with myotonia congenita followed a standardised protocol with time scoring and rest on two occasions, with and without mexiletine. Time scoring of TUG and TST and self-assessments of stiffness were performed. A 14-day stiffness diary was used at home. Timed Up&Go and TST showed very good test-retest agreement (ICC=0.87-0.95) and significant to change (P=0.005 and 0.001, respectively). All self-assessment scales revealed excellent responsiveness and good test-retest reliability. The measurement instruments possess great capacity to detect functional impairment in the myotonia congenita patient group, and sensibility to identify true changes due to treatment. When considering the results, three instruments are favoured; Timed Up&Go and BorgCR10 for short, and MBS for long-term evaluations.

Activities of Daily Living↗
PubMed2007

Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash?--A preliminary RCT.

Patients with chronic whiplash associated disorders present with varied sensory, motor and psychological features. In this first instance it was questioned whether a multimodal program of physical therapies was an appropriate management to be broadly prescribed for these patients when it was known that some would have sensory features suggestive of a notable pain syndrome. A randomised controlled trial was conducted with 71 participants with persistent neck pain following a motor vehicle crash to explore this question. Participants were randomly allocated to receive either a multimodal physiotherapy program (MPT) or a self-management program (SMP) (advice and exercise). In the randomisation process, participants were stratified according to the presence or not of widespread mechanical or cold hyperalgesia. The intervention period was 10 weeks and outcomes were assessed immediately following treatment. Even with the presence of sensory hypersensitivity in 72.5% of subjects, both groups reported some relief of neck pain and disability (Neck Disability Index) and it was superior in the group receiving multimodal physiotherapy (p=0.04). Post-hoc observations however suggested that relief was marginal in the subgroup with both widespread mechanical and cold hyperalgesia. Further research is required to test the validity of this sub-group observation and to test the effect of the intervention in the long term.

Adolescent↗
PubMed2005

Meralgia paresthetica after liver transplantation: a case report.

The focal neuropathies after orthotropic liver transplantation (OLTx) have been well documented to date. Most injuries to the peripheral nervous system involve the peroneal nerve and brachial plexus. We report the first case of lateral femoral cutaneous nerve (LFCN) injury after OLTx. The patient presented with pain and numbness on the lateral aspect of the right thigh that had progressively worsened since operation. Electrodiagnostic studies were indicative for right meralgia paresthetica (MP). The symptoms of MP improved progressively after physical therapy applications during the first 3 months. The etiology of MP in this case is unclear. However, it may be considered that ascites, surgical mechanisms, and immunosuppressive therapy were possible causative factors.

Adult↗
PubMed2005

Physiotherapy management of low back pain: does practice match the Dutch guidelines?

The purpose of this study is to explore adherence by Dutch physiotherapists to the physiotherapists' guideline for non-specific low back pain. For this study data from the National Information Service for Allied Health Care were used. This is a registration network that continuously collects information about physiotherapy patients and their treatment episodes. Within this network, adherence to the low back pain guideline was assessed by three criteria based on the guideline. These criteria concerned the number of sessions, the treatment goals, and the interventions. Data from patients with 'non-specific low back pain' as the reason for referral and a completed treatment episode were selected (n = 1254); 90 therapists in 40 practices treated these patients. The criterion concerning the number of sessions applied only for patients with acute complaints and was met in 17% of these patients. In about half of the patients the criterion for the treatment goals as well as the criterion relating to the interventions was met. Treatment goals are aimed mainly at improving mobility functions and changing body position. In more than three-quarters of the treatment episodes manual interventions (massage or manual manipulation) and exercise therapy were used frequently. As considerable variation in guideline adherence was shown to exist among therapists, there is clearly room for improvement in the quality of the care.

Adult↗
PubMed2006

The prevalence of thumb problems in Australian physiotherapists is high: an observational study.

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.

Adult↗
PubMed2006

Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial.

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.

Adult↗
PubMed2003

Factors related to thumb pain in physiotherapists.

The aim of this study was to determine whether differences exist between physiotherapists with work-related thumb pain and physiotherapists without thumb pain. Twenty-four physiotherapists with work-related thumb pain (Pain Group) and 20 physiotherapists without thumb or wrist pain (Non-pain Group), who were working at least 20 hours per week in an outpatient musculoskeletal setting, were compared on a number of attributes: generalised joint laxity, hand and thumb strength, height, weight, working environment, hand position and force applied during mobilisation, mobility at individual thumb joints, extent of osteoarthritis at the thumb and radial-sided wrist joints, and demographic data including age, gender and years of experience. All physiotherapists in the Pain Group reported their thumb pain was related to and initially caused by the performance of manual techniques, and 88% had altered their manual techniques because of pain in the thumb. There was extreme variability in hand position and force applied during mobilisation, and a slightly high prevalence of osteoarthritis (22.7%) considering the mean age of the total sample (38.6 years). Statistically significant differences between groups included increased right carpometacarpal joint laxity (6.4%, 95% CI 0.19 to 12.6), decreased right tip pinch strength (0.84 kg, 95% CI 0.01 to 1.68), and lower body mass index (2.0, 95% CI 0.11 to 3.9) for the Pain Group. Other factors were not statistically different between groups. These results indicate that work-related thumb pain affects physiotherapists ability to administer manual treatments, and suggest that decreased stability and strength of the thumb may be associated with work-related thumb pain.

Adult↗
PubMed2002

Occupational health in physiotherapy: general health and reproductive outcomes.

Physiotherapists are exposed to many risk factors in their work environment. Their general health status is largely unknown, and conflicting studies suggest possible adverse reproductive effects of electromagnetic radiation to which they may be exposed. As part of a larger study, a systematic sample of one in four physiotherapists on a state register (N = 824) was surveyed. Each subject completed an eight page questionnaire, answering questions about musculoskeletal and general health, exposure to risk factors, exposure to electrophysical agents and reproductive outcomes. The response rate was 67.8%. The incidence of congenital malformations and miscarriage among physiotherapists was lower than that in the general community. However, physiotherapists who performed hydrotherapy were more likely to report dermatitis, rashes and fungal skin infections. The prevalence of these conditions increased with the number of hours spent doing hydrotherapy. These findings suggest that physiotherapists are unlikely to have an increased risk of negative reproductive outcomes because of their exposure to electrophysical agents. Physiotherapists who perform hydrotherapy, however, have an increased risk of skin complaints.

Adult↗
PubMed2003

The effect of circuit type, volume delivered and "rapid release" on flow rates during manual hyperinflation.

Traditionally, manual hyperinflation has been performed using "rapid release" to promote a fast peak expiratory flow rate (PEFR) but rapid release has not been described. In addition, it has been demonstrated that different resuscitation circuits provide varying degrees of resistance to expiratory flow and it is known that a variety of circuits are used in Australia for manual hyperinflation. The aim of this study was to document current practice, the effect of rapid release, controlling inspiration, different volumes and circuit type on flow rates, and the inspiratory to expiratory flow rate (I:E) ratio during manual hyperinflation. Using a test lung model, 15 physiotherapists performed 11 trials using the Air Viva 2, a Mapleson-C and a Mapleson-F circuit, both with and without rapid release, and delivering two volumes. The order of the trials was randomised. Rapid release produced a faster PEFR irrespective of circuit type or volume delivered. The effect of rapid release, and the absolute PEFR, was less for the Air Viva 2 compared with the Mapleson circuits. Expiratory flow rate was faster for the larger volume. The theoretically optimal I:E ratio to move secretions was achieved delivering the lower target volume with the Mapleson circuits and using rapid release.

Clinical Competence↗
PubMed2003

The physiotherapy experience in private practice: the patients' perspective.

The aim of this study was to identify the qualities of a "good" physiotherapist and to ascertain the characteristics of good and bad experiences in private practice physiotherapy from the patients' perspective. The nominal group technique was implemented with separate groups of patients (n = 26) and revealed that communication ability, professional behaviour and organisational ability, and characteristics of the service provided were the main qualities of a "good" physiotherapist. In particular, communication ability of the physiotherapist was ranked first or second in importance by all groups of patients. Good experiences in physiotherapy were most often attributed to effective communication by the physiotherapist, while bad experiences most often related to dissatisfaction with the service followed by poor physiotherapist communication. Based on the findings from this study, we suggest physiotherapists should actively seek to involve patients in their management. To do this effectively, physiotherapists would benefit from further training in communication skills to ensure that they can successfully adopt a patient-centred approach and to optimise the physiotherapist-patient interaction in private practice physiotherapy.

Adult↗
PubMed1999

Educating patient educators: enhancing instructional effectiveness in physical therapy for low back pain patients.

The objective of this research project was to study the effectiveness of a training program for the enhancement of patient education skills in physical therapy. In this paper the improvement of five of these skills is tested. These skills are aimed at a better monitoring of adherence problems during the treatment and at enhancing self-efficacy of the patient after treatment. In order to test the effectiveness of the program, complete treatments of 19 physiotherapists have been assessed before (1142 sessions, 130 patients) and after (775 sessions, 88 patients) the training program. Information on the instructions and solutions given to the patients was obtained with a registration form, completed after each session by the physiotherapist. The patient's perception of the effectiveness and feasibility of instructions was obtained from questionnaires, completed by the patient on three occasions. After the training only a minority of the trained skills appeared to be improved. All in all, the training program was not very effective. More effort is needed to develop training programs aimed at promoting patients' self-efficacy as well as measurement instruments to assess the effects of such programs.

Attitude of Health Personnel↗
PubMed2002

[Course of Severe COPD with and without Physiotherapy with the RC-Cornet(R)].

UNLABELLED: The efficacy of respiratory physiotherapy by combined-PEP (RC-Cornet(R) in combined-PEP-position) was evaluated in a long-term study with the following set up. STUDY DESIGN: Randomized prospective clinical trial over 2 years in 50 patients with severe COPD (12 f, 38 m, 63,1 y, FEV 1 41 %, DLCO 51 % of the normal). Patients were without infection and exsmokers at begin of the trial. One group was treated only by drug therapy (theophylline, salmeterol, ipratropiumbromide, systemic steroids 5 mg prednisolone equivalent). The second group received the same drug therapy plus physical therapy with the RC-Cornet(R) (oscillating PEP; in combined PEP-position) 3 times daily at least for 5 minutes or whenever needed. Lung function data were controlled every 3 month during first year and every 4 month in the second year. The compliance was checked by theophylline and cortisol blood levels, inspection of the functionality of the RC-Cornet(R) and by questioning the patient about compliance with the therapy. RESULTS: TGV (% of normal) and airway resistance (measured by bodyplethysmography) decreased significantly in contrast to the "mere" drug therapy (p < 0.0177, p < 0.0179). VC (% of normal) increased significant p < 0.0179 in the RC-Cornet(R) therapy group. In this group significantly less patients (13/24) needed antibiotics in comparison to the "mere" drug group (Chi-Quadrat p < 0.0004). Also the need for hospital care was significantly less in the RC-Cornet(R) group (5/12) in comparison to the drug therapy group (Chi-Quadrat < 0.000765). The length of hospital stay in the two groups was not significantly different: 16.2 +/- 6.3 days in the RC-Cornet(R)-group and 18.3 +/- 4.7 days in the drug therapy-group. CONCLUSION: This study proves the efficacy of respiratory physiotherapy with combined-PEP in addition to drug therapy in the management of COPD-patients.

Female↗