MedWorm: Physiotherapy

A systematic review of posture and psychosocial factors as contributors to upper quadrant musculoskeletal pain in children and adolescents.

Physiotherapy Theory and Practice — Wed, 25 Jun 2008 23:30:18 +0100

A systematic review of posture and psychosocial factors as contributors to upper quadrant musculoskeletal pain in children and adolescents.

Physiother Theory Pract. 2008 Jul-Aug;24(4):221-42

Authors: Prins Y, Crous L, Louw Q

Musculoskeletal pain has become a major symptomatic complaint among children and adolescents and is increasingly occurring at a younger age. This systematic review was done to evaluate the evidence for the contribution of posture and psychosocial factors to the development of upper quadrant musculoskeletal pain in children and adolescents. The review describes the measurement tools used to assess musculoskeletal pain, sitting posture, and psychosocial factors. Two independent reviewers searched seven databases for observational studies that included prospective and cross-sectional study designs. Ten studies were extracted and assessed by two reviewers using the Critical Appraisal Form-Quantitative Studies (Law et al, 1998). The studies measured upper quadrant musculoskeletal pain as an outcome measure. Five studies evaluated sitting posture and found an association between the duration of static sitting and upper quadrant musculoskeletal pain. Six studies measured psychosocial factors of which depression, stress, and psychosomatic symptoms were the factors most commonly found to influence the development of upper quadrant musculoskeletal pain. The eligible studies used different pain measurement tools and different measurement tools to assess sitting posture and psychosocial factors. This review concludes that the duration of sitting posture and psychosocial factors may influence the experience of musculoskeletal pain among children and adolescents.

PMID: 18574749 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Norwegian psychomotor physiotherapy and patients with chronic pain: patients' perspective on body awareness.

Physiotherapy Theory and Practice — Wed, 25 Jun 2008 23:30:15 +0100

Norwegian psychomotor physiotherapy and patients with chronic pain: Patients' perspective on body awareness.

Physiother Theory Pract. 2008 Jul-Aug;24(4):243-54

Authors: Dragesund T, Råheim M

This study has explored the experience of body awareness in patients with chronic pain as well as possible changes in this phenomenon as a consequence of Norwegian psychomotor physiotherapy (NPMP), were explored in the present study. Four focus group interviews were performed. Two groups consisted of patients on waiting lists for NPMP, whereas the other two were patients receiving NPMP. The interview material was analysed according to an ad hoc meaning generation. The interviews brought out three main themes of body awareness: being aware of one's own body; associations about one's own body; and feelings for one's own body. The differences and similarities in body awareness described by those receiving treatment and those on waiting lists are presented and discussed, as well as differences between participants within the groups. The patients' experiences ranged from a reduction of symptoms and coping quite well with chronic pain, to a feeling of being totally stuck in pain, followed by either a new body awareness or being preoccupied by pain. The participants receiving long-term NPMP-with one exception-experienced new body awareness, described as essential to increasing their ability to cope with pain.

PMID: 18574750 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Single dose of inhaled procaterol has a prolonged effect on exercise performance of patients with copd.

Physiotherapy Theory and Practice — Wed, 25 Jun 2008 23:30:12 +0100

Single dose of inhaled procaterol has a prolonged effect on exercise performance of patients with COPD.

Physiother Theory Pract. 2008 Jul-Aug;24(4):255-63

Authors: Sukisaki T, Senjyu H, Oishi K, Rikitomi N, Ariyoshi K

The aim of this study was to examine the prolonged effect of procaterol, a short-acting bronchodilator, on lung function and exercise performance in patients with moderate to severe COPD. A randomized crossover trial was conducted. We recruited 19 patients with COPD aged 71.6+/-5.5 years. Patients were randomly assigned to receive either 20 mug inhaled procaterol followed by no-treatment or no-treatment followed by 20 mug inhaled procaterol separated by a washout period of 3+/-2 days. Lung function and exercise performance, using the incremental shuttle walking test (ISWT), were measured at baseline and 4 hours after receiving each treatment. Baseline forced expiratory volume in 1 second (FEV(1)) was 38.5%+/-17% predicted. There were no significant changes in FEV(1) following inhaled procaterol. However, walking distance increased by 294+/-113 meters at baseline to 331+/-119 meters after inhaled procaterol (p<0.001). These findings support the beneficial effects of inhaled procaterol on exercise performance in the absence of any change in FEV(1) when measured at 4 hours following inhalation in subjects with moderate to severe COPD. The inhaled procaterol may be useful for enhancing the effects of exercise training in patients with COPD.

PMID: 18574751 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Transversus abdominis: changes in thickness during an incremental upper limb exercise test.

Physiotherapy Theory and Practice — Wed, 25 Jun 2008 23:30:09 +0100

Transversus abdominis: Changes in thickness during an incremental upper limb exercise test.

Physiother Theory Pract. 2008 Jul-Aug;24(4):265-73

Authors: McEvoy MP, Cowling AJ, Fulton IJ, Williams MT

The aim of this study was to measure transversus abdominis (TrA) during an incremental fatiguing task. Using real-time ultrasound, TrA thickness was measured in 26 healthy subjects (18-25 years, 9 male) during an unsupported upper limb exercise test (UULEX). Repeatability of changes in TrA thickness during the UULEX was established by using a test-retest process (n=9, intraclass correlation coefficient=0.62 (95% CI 0.38-0.82), standard error of measurement approximately 1 (95% CI 0.87-1.08)). Using mixed model analysis with time as an independent variable, TrA thickness changed significantly throughout the UULEX (p < 0.05). Measures of TrA thickness at minutes 10, 11, and 12 were significantly greater than at baseline (p=0.006 (95% CI 0.23-1.35), 0.001 (95% CI 0.45-1.61), and <0.0001 (95% CI 0.77-2.03), respectively). Transversus abdominis was shown to be continuously and increasingly active over the 12 minutes of an incremental bilateral upper limb test in young healthy adults. As increases in TrA thickness occurred at the points of greatest postural and ventilatory demands, these findings may have implications for subjects with musculoskeletal or respiratory impairments who are often challenged by upper limb tasks.

PMID: 18574752 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Physiotherapy in cervical dystonia: six experimental single-case studies.

Physiotherapy Theory and Practice — Wed, 25 Jun 2008 23:30:06 +0100

Physiotherapy in cervical dystonia: Six experimental single-case studies.

Physiother Theory Pract. 2008 Jul-Aug;24(4):275-90

Authors: Zetterberg L, Halvorsen K, Farnstrand C, Aquilonius SM, Lindmark B

The aim of the study was to explore the outcome of a physiotherapy program targeted to improve the quality of life of people with cervical dystonia (CD) by reducing pain, improving awareness of postural orientation, increasing muscle strength, and reducing the effort of moving the head and neck. In six single case studies, the primary outcome measure for each case was the Cervical Dystonia Questionnaire (CDQ) to measure the impact of the program on the individuals' quality of life. Secondary outcome measures were identified for the different components of the physiotherapy program: Visual Analogue Scale (pain); Postural Orientation Index (postural orientation awareness); and Movement Energy Index (effort of moving head and neck). Each of the cases had the severity of their problems scored on the Toronto Western Spasmodic Torticollis Scale. The study period was 26 weeks: 2 weeks' baseline period, 4 weeks' treatment period, and 20 weeks' follow-up. All measures except the Movement Energy Index (MEI) and CDQ-24 were taken three times per week for the first 6 weeks of the study and then once at 3 and 6 months. The MEI was taken once a week during the pretreatment and the treatment periods and during the first 2 weeks of follow-up and also after 3 and 6 months of follow-up. The CDQ-24 was taken once in the pretreatment period, once after completion of treatment, once 2 weeks after treatment, and once at 3 and 6 months of follow-up. Five of the six case studies reported an increase in quality of life at 6-month follow-up, as measured on the CDQ-24. Three of the six cases reported a reduction in pain and severity of the dystonia and had improved scores on the postural orientation measure at 6-month follow-up. All six patients had a reduction in the movement energy scores, but this was not significant. The outcomes of the six case studies would suggest that further investigation is required to show the effectiveness of physiotherapy programs in the management of CD.

PMID: 18574753 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Medial calcaneal nerve entrapment as a cause for chronic heel pain.

Physiotherapy Theory and Practice — Wed, 25 Jun 2008 23:30:04 +0100

Medial calcaneal nerve entrapment as a cause for chronic heel pain.

Physiother Theory Pract. 2008 Jul-Aug;24(4):291-8

Authors: Diers DJ

Clinicians often have difficulty correctly identifying the etiology of heel pain. The purpose of the case report was to demonstrate differential diagnosis and possible interventions for heel pain. The article describes the diagnosis and management of a 36-year-old female patient with an 8-year history of heel pain. After all mechanical etiologies were ruled out, it was determined that her heel pain was the result of entrapment of the medical calcaneal branch of the tibial nerve. Correct diagnosis led to an intervention that resulted in complete symptom relief. The case presents an example for how careful differential diagnosis of heel pain is essential for achieving the desired intervention outcomes.

PMID: 18574754 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Management of the basal joint of the thumb following interposition arthroplasty for pain and instability.

Physiotherapy Theory and Practice — Wed, 25 Jun 2008 23:30:00 +0100

Management of the basal joint of the thumb following interposition arthroplasty for pain and instability.

Physiother Theory Pract. 2008 Jul-Aug;24(4):299-309

Authors: Beatus J, Beatus RA

Derangement of the carpometacarpal (CMC) joint of the thumb secondary to osteoarthritis (OA) or rheumatoid arthritis (RA) is a source of pain and disability in many postmenopausal women. If surgery becomes necessary, the goals of postsurgical management are directed to relief of pain, joint protection and rest, and restoration of functional activity. This article describes the successful postsurgical rehabilitation of two patients with CMC joint arthritis of differing etiologies, and medical complexity, OA and RA, respectively, and different levels of medical complexity. Basal joint protection, passive range of motion, and gentle active exercise resulted in rapid functional recovery for these two patients.

PMID: 18574755 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Collegiality in musculoskeletal therapy, a strength and a tool.

Manual Therapy — Wed, 25 Jun 2008 23:21:36 +0100

Collegiality in musculoskeletal therapy, a strength and a tool.

Man Ther. 2008 Aug;13(4):277

Authors: Moore A, Jull G

PMID: 18573476 [PubMed - as supplied by publisher]

(Source: Manual Therapy)

The pain self-efficacy questionnaire.

Aust J Physiother — Wed, 25 Jun 2008 20:38:07 +0100

The Pain Self-Efficacy Questionnaire.

Aust J Physiother. 2008;54(1):77

Authors: Tonkin L

PMID: 18567187 [PubMed - in process]

(Source: Aust J Physiother)

The impact of event scale (ies).

Aust J Physiother — Wed, 25 Jun 2008 20:38:07 +0100

The Impact of Event Scale (IES).

Aust J Physiother. 2008;54(1):78

Authors: Sterling M

PMID: 18567188 [PubMed - in process]

(Source: Aust J Physiother)

The invisible reality of arthritis: a qualitative analysis of an online message board

Musculoskeletal Care — Sat, 21 Jun 2008 04:00:00 +0100

Background and aim: Living with a chronic illness, such as arthritis, creates many psychosocial stressors, which can be difficult to cope with. Exploring the interactions which take place on an online message board for people with arthritis may provide insight into both the social support offered, as well as highlighting the groups' needs that perhaps are not being met in a more formal 'offline' setting. The aim of this study was to investigate how and why an arthritis online message board was used.Methods: A retrospective three-month period of discussions posted on an online message board for people who have arthritis was downloaded into a word document. Collecting data in this manner ensured that completed discussions were captured. Eighty-seven initial messages and 981 replies were analysed. The discussions were analysed using interpretive phenomenological analysis.Results: Four master themes were identified. Firstly, the invisible reality of the condition; secondly, information exchange, whereby users of the message board were shown to be both seeking and providing information; thirdly, while users praised the support they received from family and friends, the support offered and received online was considered to provide additional benefits. Finally, the message board allowed users to share (primarily negative) emotions which they felt unable to express in their offline worlds.Conclusion and implications: Patients do not always understand the information being offered by health care professionals, and they do not have the confidence to ask for clarification. Health care professionals need to ensure that they find a way of checking levels of patient understanding. Failure to do so means that patients may turn to alternative sources, which may not provide accurate information. The study also showed that people with arthritic conditions find it difficult to express how they are feeling in their offline world; furthermore, they find it difficult to ask for support from their significant others, preferring instead to 'suffer in silence' and seek support from the online community, potentially further isolating them from the support of those in their offline world. There is scope for such patients to be both empowered and educated, so that they are better able to ask for the help they need, which in turn will help to counteract the danger of isolation. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

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Mechanical or inflammatory low back pain. what are the potential signs and symptoms?

Manual Therapy — Thu, 12 Jun 2008 04:00:00 +0100

Mechanical or inflammatory low back pain. What are the potential signs and symptoms?

Man Ther. 2008 Jun 12;

Authors: Walker BF, Williamson OD

Non-specific low back pain (NSLBP) is commonly conceptualised and managed as being inflammatory and/or mechanical in nature. This study was designed to identify common symptoms or signs that may allow discrimination between inflammatory low back pain (ILBP) and mechanical low back pain (MLBP). Experienced health professionals from five professions were surveyed using a questionnaire listing 27 signs/symptoms. Of 129 surveyed, 105 responded (81%). Morning pain on waking demonstrated high levels of agreement as an indicator of ILBP. Pain when lifting demonstrated high levels of agreement as an indicator of MLBP. Constant pain, pain that wakes, and stiffness after resting were generally considered as moderate indicators of ILBP, while intermittent pain during the day, pain that develops later in the day, pain on standing for a while, with lifting, bending forward a little, on trunk flexion or extension, doing a sit up, when driving long distances, getting out of a chair, and pain on repetitive bending, running, coughing or sneezing were all generally considered as moderate indicators of MLBP. This study identified two groups of factors that were generally considered as indicators of ILBP or MLBP. However, none of these factors were thought to strongly discriminate between ILBP and MLBP.

PMID: 18555728 [PubMed - as supplied by publisher]

(Source: Manual Therapy)

Reliability of intra- and inter-rater palpation discrepancy and estimation of its effects on joint angle measurements.

Manual Therapy — Thu, 12 Jun 2008 04:00:00 +0100

Reliability of intra- and inter-rater palpation discrepancy and estimation of its effects on joint angle measurements.

Man Ther. 2008 Jun 12;

Authors: Moriguchi CS, Carnaz L, Silva LC, Salasar LE, Carregaro RL, Sato TD, Coury HJ

This study presents data on the intra- and inter-rater reliability of palpation on normal and overweight subjects and shows the influence of palpation discrepancy on angular variability for a collected data set, using computer simulation. Thirty healthy males were recruited. Two physiotherapists identified 12 anatomical landmarks that enabled measurement of eight joint angles. Palpation discrepancy was determined by photographic recordings under ultraviolet light. Angular discrepancies were determined from photos of the subject's orthostatic posture. A computer simulation was developed to predict expected angular variation according to observed palpation discrepancy. The results showed that the inter-rater reliability was lower than the intra-rater reliability for both palpation and angle measurements. Palpation of the greater trochanter (GT), anterior superior iliac spine (ASIS), seventh cervical vertebra (C7) and femoral epicondyle (FE) showed larger discrepancies. The overweight group presented a significant difference in palpation discrepancy for ASIS (P<0.03). Angular variations were associated with palpation discrepancies for trunk flexion (TF), hip flexion (HF) and pelvic inclination (PI). Therefore, measurements should be performed by a single rater, rather than by different raters, if reliable angular measurements are intended. Specific anatomical landmarks require careful identification. Simulation was useful for providing estimates of variations due to palpation discrepancy.

PMID: 18555729 [PubMed - as supplied by publisher]

(Source: Manual Therapy)

Relationships between prolonged neck/shoulder pain and sitting spinal posture in male and female adolescents.

Manual Therapy — Thu, 12 Jun 2008 04:00:00 +0100

Relationships between prolonged neck/shoulder pain and sitting spinal posture in male and female adolescents.

Man Ther. 2008 Jun 12;

Authors: Straker LM, O'Sullivan PB, Smith AJ, Perry MC

Neck/shoulder pain (NSP) is a common problem for adolescents and posture has been suggested as an important risk factor. The aim of this cross sectional study was to examine the relationship between prolonged NSP and habitual sitting posture in adolescents. The habitual sitting postures of 1593, 14-year-old adolescents with and without prolonged NSP were assessed using sagittal plane digital photographs. Cervicothoracic and lumbopelvic posture angles were calculated from the digital images using motion analysis software. Adolescents reported experience of NSP by questionnaire. Differences between postures of males and females and those with and without prolonged NSP were examined using independent t-tests. The relationships between cervicothoracic and lumbopelvic postures and presence of prolonged NSP were investigated using logistic regression models controlling for gender. Prolonged NSP was reported by 5.3% of the adolescents, with females reporting a higher prevalence rate (6.5%) than males (4.2%). Females also sat more erect with a more lordotic lumbar posture than males. Adolescents with prolonged NSP had more flexed cervicothoracic posture, more erect trunk and more lumbar lordosis. When gender was controlled, only lumbar lordosis was related to the presence of prolonged NSP.

PMID: 18555730 [PubMed - as supplied by publisher]

(Source: Manual Therapy)

Reliability of accessory motion testing at the carpal joints.

Manual Therapy — Thu, 12 Jun 2008 04:00:00 +0100

Reliability of accessory motion testing at the carpal joints.

Man Ther. 2008 Jun 12;

Authors: Staes FF, Banks KJ, De Smet L, Daniels KJ, Carels P

The testing of accessory motion has become a very important part of manual therapy practice. Its value is in assessing whether joint mobility is ideal or impaired. Despite its use, there is little evidence in the literature to support the reliability of such testing. Most of the research carried out on accessory motion testing has focused on the spine. In view of this we decided to evaluate the intra- and interrater reliability of accessory motion testing of carpal joints. Two skilled therapists tested the available motion and the end-feel response of carpal joints in 30 students and 15 patients on two separate occasions. Pain scores were also obtained. In students a moderate to good percentage of agreement [67-97%] was obtained for motion testing. In patients the percentage of agreement ranged from 60% to 100% and weighted kappa values were between 0.33 and 1.0. Intrarater reliability was better than interrater reliability in both groups. Intra- and interrater agreement on end-feel was very good. Overall, the reliability of accessory motion testing of carpal joints was acceptable. The results suggest that this form of testing can be valuable in the training of manual therapists and in clinical practice.

PMID: 18555731 [PubMed - as supplied by publisher]

(Source: Manual Therapy)

Lack of uniformity in diagnostic labeling of shoulder pain: time for a different approach.

Manual Therapy — Thu, 12 Jun 2008 04:00:00 +0100

Lack of uniformity in diagnostic labeling of shoulder pain: Time for a different approach.

Man Ther. 2008 Jun 12;

Authors: Schellingerhout JM, Verhagen AP, Thomas S, Koes BW

Diagnostic labels for shoulder pain (e.g., frozen shoulder, impingement syndrome) are widely used in international research and clinical practice. However, about 10 years ago it was shown that the criteria to define those labels were not uniform. Since an ongoing lack of uniformity seriously hampers communication and does not serve patients, we decided to evaluate the uniformity in definitions. Therefore, we compared the selection criteria of different randomised controlled trials (RCTs). This comparison revealed some corresponding criteria, but no uniform definition could be derived for any of the diagnostic labels. Besides the lack of uniformity, the currently used labels have only a fair to moderate interobserver reproducibility and in systematic reviews none of the separate trials using a diagnostic label show a large benefit of treatment. This, altogether, seems sufficient reason to reconsider their use. Therefore, we strongly suggest to abolish the use of these labels and direct future research towards undivided populations with "general" shoulder pain. Possible subgroups with a better prognosis and/or treatment result, based on common characteristics that are easily and validly reproducible, can then be identified within these populations.

PMID: 18555732 [PubMed - as supplied by publisher]

(Source: Manual Therapy)

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The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study

Physiotherapy Research International — Thu, 12 Jun 2008 04:00:00 +0100

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°, 95% CI 17-75, p = 0.005) and six weeks (30°, 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. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

Increasing intensity during treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study.

Aust J Physiother — Thu, 05 Jun 2008 15:24:48 +0100

Increasing intensity during treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study.

Aust J Physiother. 2008;54(1):49-54

Authors: Kuys SS, Brauer SG, Ada L, Russell TG

QUESTION: Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability? DESIGN: A within-participant, repeated measures experimental study. PARTICIPANTS: 18 individuals with a first stroke who were undergoing inpatient rehabilitation. INTERVENTION: Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session. OUTCOME MEASURES: During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale. RESULTS: Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity. CONCLUSION: Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.

PMID: 18298359 [PubMed - indexed for MEDLINE]

(Source: Aust J Physiother)

Physical findings in patients with dizziness undergoing a group exercise programme

Physiotherapy Research International — Wed, 28 May 2008 04:00:00 +0100

Background and Purpose. Although there have been studies on patients with persistent dizziness, physical findings have not been formerly focused. The aim of this study was to investigate localization and extent of physical dysfunctions in patients with long-lasting dizziness. To investigate physical change, we re-examined patients who had completed a vestibular rehabilitation (VR) programme. Methods. A longitudinal design was used. Patients with peripheral vestibular dysfunction were examined with the Global Physiotherapy Examination (GPE-52) and the Vertigo Symptom Scale-short form (VSS-SF). The GPE-52 consists of 52 standardized items within posture, respiration, movement, muscle and skin. Initially, 32 patients were included; 20 completed the VR programme. The programme, based upon traditional VR exercises combined with a body awareness approach, was administered as group sessions taking place once weekly for nine weeks. Results. The majority of patients had a flexed head posture, and their respiration was restricted. Reduced flexibility, reduced ability to relax, measured with passive movements, and restricted range of motion (ROM) were found in about half of the patients in the neck, jaw, shoulder girdle and thorax. On palpation of muscles, 70-94% of the patients had reduced stretch in the abdominals/diaphragm, upper trapezius, sternocleidomastoid and medial gastrocnemius muscles. After the VR programme, significant improvements (p < 0.05) were shown in the following areas: respiration, flexibility and passive movement tests in the shoulder and cervical region, and ROM in the neck and jaw. Significant improvement (p < 0.05) was also reported in the balance subscale of the VSS-SF. Conclusions. This study documents that postural changes, restricted respiration, lack of flexibility, ability to relax and reduced muscular stretch seem quite common in patients with dizziness. A modified VR comprising body awareness significantly improved respiration and movements in the upper body as well as self-reported balance. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

Real-time ultrasound measurements of changes in suboccipital vertebral artery diameter and blood flow velocity associated with cervical spine rotation

Physiotherapy Research International — Tue, 27 May 2008 04:00:00 +0100

Background and Purpose. The vulnerability of the vertebral artery (VA) to distortion with sustained, full-range cervical spine rotation, resulting in compromised blood flow and possible vertebrobasilar ischaemia, is well recognized. However, few studies have measured such blood flow changes in the parts of the VA downstream from the region of maximum cervical spine rotation: the suboccipital (VA3) and intracranial vertebral arteries. The purpose of this experimental study was to visualize the VA3 and record the changes in its blood flow associated with cervical spine rotation. Method. VA3 diameters and blood flow velocities were measured in the neutral cervical spine position and with active full-range rotation to the left and right, in 35 healthy female subjects, using colour-coded real-time ultrasound. Results. Both left and right VA3 diameters and blood flow velocities decreased significantly on ipsilateral rotation. These values increased non-significantly in the left VA3 and decreased non-significantly in the right VA3 on contralateral rotation. Conclusions. The results of this study suggest that the distortion or compression of VA3 demonstrated by the reduction in diameter on ipsilateral cervical spine rotation, particularly, was sufficient to result in compromised blood flow. A significant stretching effect of VA3, on contralateral rotation, was not demonstrated in these subjects. Nevertheless, these findings add evidence to support the recommendation that sustained, full-range cervical spine rotation should be avoided in professional practice. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

Physiotherapy education - what are the costs?

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Physiotherapy education - what are the costs?

Aust J Physiother. 2008;54(2):85-6

Authors: McMeeken J

PMID: 18491998 [PubMed - in process]

(Source: Aust J Physiother)

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Home-based exercise increases exercise capacity but not quality of life in people with chronic heart failure: a systematic review.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Home-based exercise increases exercise capacity but not quality of life in people with chronic heart failure: a systematic review.

Aust J Physiother. 2008;54(2):87-93

Authors: Chien CL, Lee CM, Wu YW, Chen TA, Wu YT

Questions: Does home-based exercise improve exercise capacity and quality of life in people with chronic heart failure? Is it safe? Design: Systematic review with meta-analysis. Participants: Adults with heart failure > 3 months duration. Intervention: Home-based aerobic exercise with or without resistance exercise. Outcome measures: Exercise capacity (measured at the impairment level by peak VO(2) and at the activity level by 6-min Walk Test), quality of life (measured by disease-specific scales), and adverse events (measured as death, hospitalisation). Results: 10 randomised controlled trials with 648 participants of New York Heart Association Class II or III were included. Most participants were male >/= 50 years old with an ejection fraction </= 40%. The exercise programs ranged from 6 weeks to 9 months at low to moderate intensity (40-70% of maximum heart rate or heart rate at 70% peak VO(2)). Home-based exercise increased 6-min walking distance by 41 m (WMD, 95% CI 19 to 63) and peak VO(2) by 2.71 ml/kg/min (WMD, 95% CI 0.67 to 4.74) more than usual activity. It did not improve scores on the Minnesota Heart Failure Questionnaire (WMD 0.5 points out of 105, 95% CI -4.4 to 5.4) or increase the odds of hospitalisation (OR 0.75, 95% CI 0.19 to 2.92) more than usual activity. Conclusions: Home-based exercise increased exercise capacity safely but did not improve quality of life in patients with chronic heart failure. It could therefore be used to improve the management of people with chronic heart failure who do not have access to hospital-based exercise.

PMID: 18491999 [PubMed - in process]

(Source: Aust J Physiother)

No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial.

Aust J Physiother. 2008;54(2):95-101

Authors: van Eijsden-Besseling MD, Staal JB, van Attekum A, de Bie RA, van den Heuvel WJ

Question: Are postural exercises delivered by Mensendieck/Cesar therapists more effective in decreasing pain, reducing disability and improving health-related quality of life in visual display unit workers with early non-specific work-related upper limb disorders than strength and fitness exercises delivered by physiotherapists? Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: Eighty-eight (6 drop-outs) visual display unit workers with early non-specific work-related upper limb disorders. Intervention: One group received 10 weeks of postural exercises while the other group received 10 weeks of strength and fitness exercises. Outcome measures: Pain was measured with a 10-cm visual analogue scale, disability was measured with the Disabilities of Arm, Shoulder and Hand questionnaire, and health-related quality of life was measured with the Short Form-36. Number of participants experiencing upper limb complaints was also collected. Outcome measures were collected at baseline and again at 3, 6, and 12 months. Results: There was no significant difference in decrease in pain between the groups at 3 months (0.6 cm, 95% CI 0.0 to 1.2), 6 months (0.2, 95% CI -0.3 to 0.7), or at 12 months (0.1, 95% CI -0.6 to 0.8). Differences between the groups in upper limb complaints, disability, and health related quality of life were also small and not significant at any measurement occasion. Conclusion: Postural exercises did not result in a better outcome than strength and fitness exercises. However, 55% of visual display unit workers with early non-specific work-related upper limb disorders reported being free of complaints one year after both interventions were commenced. Trial registration: ISRCTN15872455.

PMID: 18492000 [PubMed - in process]

(Source: Aust J Physiother)

Short-term progressive resistance exercise may not be effective at increasing wrist strength in people with tetraplegia: a randomised controlled trial.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Short-term progressive resistance exercise may not be effective at increasing wrist strength in people with tetraplegia: a randomised controlled trial.

Aust J Physiother. 2008;54(2):103-8

Authors: Glinsky J, Harvey L, Korten M, Drury C, Chee S, Gandevia SC

Questions: Is an 8-week progressive resistance exercise program effective for increasing strength in the wrist muscles of people with tetraplegia? Is it effective for improving muscle endurance and participants' perceptions about use of their hands for activities of daily living? Design: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Thirty-two people with tetraplegia and neurological weakness of their wrist flexor or extensor muscles. Intervention: The wrist muscles of one randomly-chosen hand were trained 3 times a week for 8 weeks. The control group received no intervention. Outcome measures: The primary outcome was strength measured as maximal voluntary isometric torque in Nm. The secondary outcomes were muscle endurance measured as fatigue resistance and participants' perceptions about use of their hands using the Canadian Occupational Performance Measure. Results: The mean effect on maximal voluntary isometric torque was 0.2 Nm (95% CI -0.5 to 0.8). This represents an 8% increase of mean initial strength; less than the 20% deemed clinically worthwhile at the commencement of the study. The mean effect on fatigue resistance was 0.1 (95% CI 0.0 to 0.2). The mean effect on participants' perceptions of performance was -0.3 (95% CI -1.9 to 1.2) and satisfaction was -0.3 (95% CI -1.6 to 1.0). Conclusion: The results indicate that progressive resistance exercise has no effect on participants' perceptions about hand function. However, it is not yet clear whether progressive resistance exercise programs improve strength and endurance in muscles with neurologically-induced weakness following tetraplegia.

PMID: 18492001 [PubMed - in process]

(Source: Aust J Physiother)

Exercise class participation among residents in low-level residential aged care could be enhanced: a qualitative study.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Exercise class participation among residents in low-level residential aged care could be enhanced: a qualitative study.

Aust J Physiother. 2008;54(2):111-7

Authors: Guerin M, Mackintosh S, Fryer C

Question: What do residents in low-level residential care perceive as motivators and barriers to participating in exercise classes at the facility? Design: Qualitative study using focus groups. Participants: Residents, nursing staff and allied health staff of a low-level residential care facility. Results: Key motivators for residents to attend the exercise classes included personal benefits, such as improved health and opportunities to socialise, and the support and encouragement that they received from family members and health professionals. The barriers to participating in the exercise classes included: health issues like pain, incontinence, and hearing impairments; external constraints such as the location of the classes and the early morning time; and internal constraints associated with a lack of knowledge about the classes and the benefits of exercising. While the key themes that arose from this study are consistent with findings from studies of community-dwelling adults, several of the barrier subthemes were unique. Conclusion: Recommendations from our findings to enhance exercise class participation include careful consideration of: class scheduling; class location; social aspects associated with exercise classes; support of social networks and health providers; health issues perceived to limit exercise; and marketing of classes.

PMID: 18492002 [PubMed - in process]

(Source: Aust J Physiother)

The risk of postoperative pulmonary or pleural complications after aortic valve replacement is low in elderly patients: an observational study.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

The risk of postoperative pulmonary or pleural complications after aortic valve replacement is low in elderly patients: an observational study.

Aust J Physiother. 2008;54(2):119-24

Authors: Mistiaen W, Vissers D

Question: What factors predict postoperative pulmonary and pleural complications following aortic valve replacement? Design: Retrospective study. Participants: One thousand consecutive patients who underwent aortic valve replacement with a pericardial valve between 1986 and 2006. Of these, 610 underwent also coronary artery surgery. Outcome measures: Thirty putative predictors were investigated. Postoperative pulmonary complications (defined as respiratory failure, pneumonia, atelectasis) and postoperative pleural complications (defined as pleural effusion, pneumothorax, haemothorax, empyema) within 30 days of surgery were identified. Results: 58 (6%) patients developed pulmonary complications and 45 (5%) developed pleural complications. None of the pleural and only 3 of the pulmonary complications were fatal if they occurred alone. Postoperative heart failure (OR 4.7, 95% CI 1.8 to 11.9), previous pacemaker implant (OR 4.4, 95% CI 1.8 to 11.2) and chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.0 to 3.1) independently predicted postoperative pulmonary complications. Postoperative bleeding (OR 7.4, 95% CI 1.8 to 29.9), carotid artery disease (OR 2.8, 95% CI 1.4 to 5.5), previous coronary artery surgery (OR 2.7, 95% CI 1.1 to 6.4), chronic obstructive pulmonary disease (OR 1.9, 95% CI 1.0 to 3.8) and cardiac conduction defect (OR 1.9, 95% CI 1.0 to 3.7) independently predicted postoperative pleural complications. Conclusions: Postoperative pulmonary and pleural complications were rare. A history of cardiac and/or pulmonary problems are risk factors for pulmonary complications after aortic valve replacement. Further study is needed to reveal if preventive physiotherapeutic intervention in these patients is effective.

PMID: 18492003 [PubMed - in process]

(Source: Aust J Physiother)

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Sitting spinal posture in adolescents differs between genders, but is not clearly related to neck/shoulder pain: an observational study.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Sitting spinal posture in adolescents differs between genders, but is not clearly related to neck/shoulder pain: an observational study.

Aust J Physiother. 2008;54(2):127-33

Authors: Straker LM, O'Sullivan PB, Smith AJ, Perry MC, Coleman J

Question: Is neck/shoulder pain in adolescents related to their sitting spinal posture, taking account of gender? Design: Cross-sectional survey and direct observation. Participants: 1597 adolescents from the 'Raine' birth cohort study (781 females, 816 males) with a mean age of 14.1 years (SD 0.2). Outcome measures: Neck/shoulder pain prevalence and gender was measured by survey. Spinal posture (7 angles) during sitting was measured from photographs. Results: Life, month, and point prevalence for neck/shoulder pain among adolescents were 47%, 29%, and 5% respectively. Life prevalence was 10% higher in females than in males and month prevalence was 12% higher. When looking straight ahead, females sat with 2 degrees (95% CI 1 to 3) less neck flexion, 2 degrees (95% CI 0 to 3) less craniocervical angle, 7 degrees (95% CI 6 to 8) less cervicothoracic angle, 13 degrees (95% CI 12 to 14) less trunk angle, 10 degrees (95% CI 8 to 12) less lumbar angle, and 9 degrees (95% CI 7 to 11) more anterior pelvic tilt than males. Adolescents with neck/shoulder pain sat with 2 degrees (95% CI 1 to 3) less trunk angle, and 1 degree (95% CI 0 to 2) less cervicothoracic angle than those without pain. After controlling for gender, OR for neck/shoulder pain ever predicted by any angle ranged from 0.99 to 1.00 (range of 95% CI 0.98 to 1.01). Conclusion: Neck/shoulder pain is highly prevalent in Australian adolescents. Sitting spinal posture differs between males and females and differs slightly between those with and without neck/shoulder pain. However, posture was not predictive of neck/shoulder pain ever after controlling for gender.

PMID: 18492004 [PubMed - in process]

(Source: Aust J Physiother)

More options and better job security required in career paths of physiotherapist researchers: an observational study.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

More options and better job security required in career paths of physiotherapist researchers: an observational study.

Aust J Physiother. 2008;54(2):135-40

Authors: Bernhardt J, Tang LS

Question: What career paths have physiotherapist researchers taken? What should career paths for physiotherapist researchers look like? Design: Observational study with questionnaire. Participants: Australian physiotherapists who had a completed a Doctor of Philosophy degree by 2006. Results: Fifty-six of 87 physiotherapists with a doctorate degree (response rate 64%) completed the questionnaire. Over half had completed the doctorate since 2000. An interest in clinical research was the strongest driver for undertaking a doctorate degree. Of the respondents, 52% worked in traditional academic roles while those who pursued other mixed clinical/research or pure research paths reported a lack of job security; 38% continued to work clinically, with a further 43% reporting they would like to but had insufficient time or a career structure that did not allow clinical work. 54% felt that the profession valued research, while 63% felt that research was valued by clinicians. The four main suggestions for improving current research career paths were: 1) develop research careers that allow mixed clinical/research and academic/clinical roles; 2) improve funding for training, particularly post-doctoral positions, and secure appropriately funded physiotherapy research positions; 3) improve co-operation between academic (university) and clinical researchers; and 4) develop more flexible research careers to accommodate private practitioner researchers and others wishing to combine clinical work with teaching and research. Conclusion: Physiotherapist researchers need broader career options and seek greater opportunity to link with clinical practice. Encouraging a vibrant research culture should foster professional excellence and enhance our reputation in the community.

PMID: 18492005 [PubMed - in process]

(Source: Aust J Physiother)

Outcomes 12 months after a constraint induced movement therapy program were maintained for an additional year.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Outcomes 12 months after a constraint induced movement therapy program were maintained for an additional year.

Aust J Physiother. 2008;54(2):141

Authors: Askim T, Indredavik B

PMID: 18492006 [PubMed - in process]

(Source: Aust J Physiother)

Nipsv for acute cardiogenic pulmonary oedema does not increase the risk of myocardial infarction compared to cpap.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

NIPSV for acute cardiogenic pulmonary oedema does not increase the risk of myocardial infarction compared to CPAP.

Aust J Physiother. 2008;54(2):142

Authors: Masip J

PMID: 18492007 [PubMed - in process]

(Source: Aust J Physiother)

Hydrotherapy and tai chi each provide clinical improvements for older people with osteoarthritis.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Hydrotherapy and Tai Chi each provide clinical improvements for older people with osteoarthritis.

Aust J Physiother. 2008;54(2):143

Authors: Mackintosh S

PMID: 18492008 [PubMed - in process]

(Source: Aust J Physiother)

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No difference in cost-effectiveness of intensive group training for chronic back pain compared with usual physiotherapy care.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

No difference in cost-effectiveness of intensive group training for chronic back pain compared with usual physiotherapy care.

Aust J Physiother. 2008;54(2):144

Authors: Haas M

PMID: 18492009 [PubMed - in process]

(Source: Aust J Physiother)

The functional rating index.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

The functional rating index.

Aust J Physiother. 2008;54(2):145

Authors: Gabel P

PMID: 18492010 [PubMed - in process]

(Source: Aust J Physiother)

The brachial plexus provocation test.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

The brachial plexus provocation test.

Aust J Physiother. 2008;54(2):146

Authors: Stone A, Sterling M

PMID: 18492011 [PubMed - in process]

(Source: Aust J Physiother)

Oxygen concentration is a dilemma.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Oxygen concentration is a dilemma.

Aust J Physiother. 2008;54(2):150

Authors: Morrow B

PMID: 18492012 [PubMed - in process]

(Source: Aust J Physiother)

Oxygen concentration during recruitment manoeuvre.

Aust J Physiother — Thu, 22 May 2008 14:24:43 +0100

Oxygen concentration during recruitment manoeuvre.

Aust J Physiother. 2008;54(2):150

Authors: Salihoglu Z

PMID: 18492013 [PubMed - in process]

(Source: Aust J Physiother)

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Physiotherapy and thoracic surgery: thinking beyond usual practice

Physiotherapy Research International — Mon, 12 May 2008 04:00:00 +0100

No abstract. (Source: Physiotherapy Research International)

Influence of patellofemoral bracing on pain, knee extensor torque, and gait function in females with patellofemoral pain.

Physiotherapy Theory and Practice — Thu, 01 May 2008 04:00:00 +0100

Influence of patellofemoral bracing on pain, knee extensor torque, and gait function in females with patellofemoral pain.

Physiother Theory Pract. 2008 May-Jun;24(3):143-50

Authors: Powers CM, Doubleday KL, Escudero C

Our purpose was to evaluate the effects of a patellofemoral brace on pain response, knee extensor torque production, and gait function in females with patellofemoral pain (PFP). Sixteen females between the ages of 14 and 46 with diagnosis of PFP participated. Knee extensor torque was measured by using a LIDO isokinetic dynamometer. Pain levels were documented by using the Visual Analog Pain Scale. Stride characteristics during the conditions of free walk, fast walk, ascend stairs, descend stairs, ascend ramp, and descend ramp were obtained with a stride analyzer unit. EMG activity of the vasti musculature was recorded by using indwelling, bipolar, wire electrodes. Knee joint motion was assessed by using a VICON motion analysis system. All testing was performed with and without the Bauerfeind Genutrain P3 patellofemoral brace. There were no significant differences in torque production, pain levels, and stride characteristics between braced and non-braced trials. In addition, there were no significant differences in mean vasti EMG between braced and non-braced trials. When averaged across all conditions, a small but statistically significant increase in knee flexion was found during the braced trials. Although the current study did not find significant improvements in the clinical measures evaluated, 8 of the 16 subjects did experience a decrease in knee pain. This finding suggests that certain patients with PFP may respond favorably to bracing, and criteria must be established to determine which patients would best benefit from such an intervention.

PMID: 18569852 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Best practice: e-model--prescribing physical activity and exercise for individuals with fibromyalgia.

Physiotherapy Theory and Practice — Thu, 01 May 2008 04:00:00 +0100

Best practice: E-Model--prescribing physical activity and exercise for individuals with fibromyalgia.

Physiother Theory Pract. 2008 May-Jun;24(3):151-66

Authors: Busch AJ, Thille P, Barber KA, Schachter CL, Bidonde J, Collacott BK

Fibromyalgia (FM) is a serious and debilitating condition, encompassing a wide range of symptoms. Physical therapists often advocate the incorporation of leisure time physical activity (exercise training or recreational physical activity) as an important management strategy for individuals with FM. Decisions about physical activity prescription in clinical practice are informed by a variety of sources. This topical review considers physical activity prescription using the E-Model as a framework for best practice decision making. We examine findings from randomized trials, published experts, and qualitative studies through the lens of the model's five Es: 1) evidence, 2) expectations, 3) environment, 4) ethics, and 5) experience. This approach provides a robust foundation from which to make best practice decisions. Application of this model also facilitates the identification of gaps and discrepancies in the literature, future opportunities for knowledge exchange and translation, and future research.

PMID: 18569853 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Individuals' experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty.

Physiotherapy Theory and Practice — Thu, 01 May 2008 04:00:00 +0100

Individuals' experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty.

Physiother Theory Pract. 2008 May-Jun;24(3):167-81

Authors: Hall M, Migay AM, Persad T, Smith J, Yoshida K, Kennedy D, Pagura S

This study investigated the physical and psychosocial consequences of living with osteoarthritis (OA) in daily life and peoples' views of total knee arthroplasty (TKA) and the role of physiotherapy. In-depth interview data were used from a prospective qualitative study conducted by the senior author (KY). Participants were 15 volunteers with knee OA who were awaiting TKA at a specialized orthopaedic tertiary care facility in Toronto. A modified grounded theory method approach was used to analyze the interview data. The findings showed that experiences for the participants with OA were conceptualized as a "breakpoint." The breakpoint was centred on the experiences/processes of living with unremitting pain, the limitations of mobility, leisure and social activities, and the resulting consequences to the participant's physical and psychological well-being. In addition to the above experiences, participants also discussed their perceptions of TKA surgery. The findings showed that expectations of TKA were linked to participants' knowledge of the procedure and its outcomes. The participants listed acquaintances, friends, family members, and doctors as the main sources of knowledge for TKA. On the basis of the above analysis, recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery.

PMID: 18569854 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Clinical reasoning and population health: decision making for an emerging paradigm of health care.

Physiotherapy Theory and Practice — Thu, 01 May 2008 04:00:00 +0100

Clinical reasoning and population health: decision making for an emerging paradigm of health care.

Physiother Theory Pract. 2008 May-Jun;24(3):183-93

Authors: Edwards I, Richardson B

Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.

PMID: 18569855 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke.

Physiotherapy Theory and Practice — Thu, 01 May 2008 04:00:00 +0100

Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke.

Physiother Theory Pract. 2008 May-Jun;24(3):195-204

Authors: Fulk GD, Echternach JL, Nof L, O'Sullivan S

The 6-minute walk test (6MWT) is commonly used to measure walking ability. The purpose of this study was to determine the test-retest reliability and concurrent and construct validity of the 6MWT in patients who were actively undergoing inpatient rehabilitation poststroke. Thirty-seven patients undergoing inpatient rehabilitation after a stroke participated; mean age was 66.3 years and mean time since stroke was 33.7 days. Patients underwent two 6MWT trials with 1-3 days between trials. Additional outcome measures taken were gait speed and the Functional Independence Measure (FIM). The 6MWT exhibited high test-retest reliability; ICC(2,1) 0.973 (95% CI=0.925-0.988) and a minimal detectable change (MDC(90)) of 54.1 m. The 6MWT was strongly to moderately correlated with gait speed (r=0.89), locomotion (walk) FIM (r=0.69), and motor FIM (r=0.52). The 6MWT is a clinically useful measure of walking ability poststroke. It is reliable and is related to other measures of walking ability and function that are commonly used during rehabilitation after stroke.

PMID: 18569856 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Inter- and intrarater reliability of the modified modified ashworth scale in patients with knee extensor poststroke spasticity.

Physiotherapy Theory and Practice — Thu, 01 May 2008 04:00:00 +0100

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity.

Physiother Theory Pract. 2008 May-Jun;24(3):205-13

Authors: Ansari NN, Naghdi S, Younesian P, Shayeghan M

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (kappa=0.72, SE=0.14, p<0.001) between raters and very good (kappa=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.

PMID: 18569857 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

Determining meaningful changes in hip abductor muscle strength obtained by handheld dynamometry.

Physiotherapy Theory and Practice — Thu, 01 May 2008 04:00:00 +0100

Determining meaningful changes in hip abductor muscle strength obtained by handheld dynamometry.

Physiother Theory Pract. 2008 May-Jun;24(3):215-20

Authors: Youdas JW, Mraz ST, Norstad BJ, Schinke JJ, Hollman JH

This study quantified the minimal detectable change (MDC), defined as the smallest change that falls outside the expected range of error, for isometric hip abductor muscle strength in healthy persons obtained with a handheld dynamometer (HHD). Ninety volunteers (45 males and 45 females) between the ages of 22 and 70 years participated in the study. Bilateral measurements of isometric hip abductor muscle force were obtained with a digital HHD using a "make" test with the subject in supine. All measurements were obtained by one female examiner. The muscle force measurements were normalized to a volunteer's body weight (BW). Intratester reliability of hip abductor muscle force was estimated by using an intraclass correlation coefficient (ICC(3,1)) and calculated to be 0.96. The standard error of measurement (SEM) was 2 Newtons. The MDC was calculated by using an appropriate formula that included a 95% level of confidence. The MDC(95) was 5.4% BW for males and 5.3% BW for females. If a person's isometric hip abductor muscle force production changes less than the MDC(95) value between measurements, then the muscle force production is within measurement error, and it can be determined there has been no change in the strength of hip abductor muscles.

PMID: 18569858 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

The six-minute walk test in outpatients with obesity: reproducibility and known group validity

Physiotherapy Research International — Thu, 01 May 2008 04:00:00 +0100

Background and Purpose. To assess the reproducibility and validity of the six-minute walk test (6MWT) in men and women with obesity in order to facilitate evaluation of treatment outcome. Method. A test - retest design was used to test reproducibility and a comparative design to test known group validity. Forty-three obese outpatients (16 male), mean age 47 (21-62) years, mean body mass index (BMI) 40 (3-62)kg-m-2 performed the 6MWT twice within one week. Intraclass correlation (ICC1.1) and measurement error (Sw) were calculated from the mean square values derived from a one-way repeated-measures ANOVA (fixed effect model). The reproducibility was also analysed by means of coefficient of variation (CV) and the Bland Altman method including 95% limits of agreement. The variance of the distance walked was analysed by means of regressions. The known group validity of the 6MWT (distance walked and the work of walking) in obese participants was shown by comparisons with 41 lean participants (18 male), mean age 47 (24-65) years, mean BMI 22.7kg-m-2 (19-25). Results. The obese group walked 534 m (confidence interval [CI] 508-560 the first and 552 m (CI 523-580) the second walk (p < 0.001). Sw was 25 m, CV 4.7%, ICC1.1 was 0.96. The limits of agreement were -46 m+80 m. The validity tests showed that they walked 162 m shorter (p < 0.001) and performed much heavier work (p < 0.001) than the lean group. In the obese group, BMI alone explained 38% of the variance of the distance walked. Conclusions. The 6MWT showed good reproducibility and known group validity and can be recommended for evaluating walking ability in subjects with obesity. For individual evaluation, however, an improved walking distance of at least 80 m was required to make the difference clinically significant. Despite shorter walking distance the obese participants performed heavier work than the lean. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

Specialization in musculoskeletal physiotherapy--the australian model.

Manual Therapy — Tue, 15 Apr 2008 21:25:35 +0100

Specialization in musculoskeletal physiotherapy--the Australian model.

Man Ther. 2008 Jun;13(3):181-2

Authors: Jull G, Moore A

PMID: 18407051 [PubMed - in process]

(Source: Manual Therapy)

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Educator skills for musculoskeletal therapy practice: do we use these skills effectively and how and when are they used?

Manual Therapy — Sat, 22 Mar 2008 22:33:09 +0100

Educator skills for musculoskeletal therapy practice: Do we use these skills effectively and how and when are they used?

Man Ther. 2008 May;13(2):91-2

Authors: Moore A, Jull G

PMID: 18355730 [PubMed - in process]

(Source: Manual Therapy)

Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndrome

Musculoskeletal Care — Tue, 18 Mar 2008 04:00:00 +0100

Background: Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS.Aim: To investigate the between-days repeatability of joint proprioception and muscle torque in these groups.Methods: Twenty children (10 healthy and 10 with HMS), aged eight to 15 years, were assessed on two separate occasions (one week apart) for joint kinaesthesia (JK), joint position sense (JPS), and the extensor and knee flexor muscle torque of the knee. JK was measured using threshold to detection of passive movement. JPS was measured using the absolute angular error (AAE; the absolute difference between the target and perceived angles). Knee extensor and flexor muscle torque was normalized to body weight.Results: Intra-class correlation coefficients (ICC) for JK, extensor and flexor muscle torque were excellent in both groups (range 0.83 to 0.98). However, ICC values for JPS tests were poor to moderate in the two groups (range 0.18 to 0.56). 95% limits of agreement (LOA) were narrow in both cohorts for JK and muscle torque (indicating low systematic error) but wide for the JPS tests. 95% LOA also demonstrated that the measuring instruments used in this study had low between-days systematic error.Conclusions: Based on ICC and 95% LOA, the repeatability of JK and muscle torque measurements was excellent in both healthy children and those with HMS. The JPS test can only be assessed with poor to moderate repeatability. The use of the JPS test in these children should be undertaken with caution. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

The integrated continence system: a manual therapy approach to the treatment of stress urinary incontinence.

Manual Therapy — Tue, 11 Mar 2008 04:00:00 +0100

The integrated continence system: A manual therapy approach to the treatment of stress urinary incontinence.

Man Ther. 2008 Mar 11;

Authors: Grewar H, McLean L

Stress urinary incontinence (SUI) constitutes a large-scale public health concern. The integrated continence system (ICS) developed by the authors is an evidence-based model that demonstrates how urinary incontinence is maintained through the interaction of three structural systems (intrinsic urethral closure, urethral support, and lumbopelvic stability) and three modifiable factors (motor control, musculoskeletal and behavioral). The purpose of the ICS is first, to demonstrate the important role that manual physiotherapists can play in the treatment of SUI and second, to guide clinical practice decisions in order to improve clinical outcomes among women with SUI.

PMID: 18339574 [PubMed - as supplied by publisher]

(Source: Manual Therapy)

Interobserver reliability of physical examination of shoulder girdle.

Manual Therapy — Fri, 07 Mar 2008 05:00:00 +0100

Interobserver reliability of physical examination of shoulder girdle.

Man Ther. 2008 Mar 7;

Authors: Nomden JG, Slagers AJ, Bergman GJ, Winters JC, Kropmans TJ, Dijkstra PU

The object of this study was to assess interobserver reliability in 23 tests concerning physical examination of the shoulder girdle. A physical therapist and a physical therapist/manual therapist independently performed a physical examination of the shoulder girdle in 91 patients with shoulder complaints of varying severity and duration. The observers assessed 23 items in total: active and passive abductions, passive external rotation, hand in neck (HIN) test, hand in back (HIB) test, impingement test according to Neer, springing test of the first rib and joint play test of the acromioclavicular joint. The interobserver reliability was evaluated by means of a Cohen's Kappa, the weighted Kappa and the intraclass correlation (ICC). Criteria for acceptable reliability were: Kappa value>/=0.60, ICC>/=0.75 or an absolute agreement>/=80%. The results showed that Kappa values varied from 0.09 (springing test first rib, stiffness) to 0.66 (springing test first rib, pain), weighted Kappa varied from 0.35 (pain during HIB) to 0.73 (range of motion HIB) and ICC varied from 0.54 (abduction passive starting point painful arc) to 0.96 (active and passive ranges of motion in abduction). In total 11 (48%) items fulfilled the criteria of acceptable reliability. In conclusion, there appears to be a great deal of variation in the reliability of the tests used in the physical examination of the shoulder girdle. Over 50% of the tests did not meet the statistical criteria for acceptable reliability.

PMID: 18329943 [PubMed - as supplied by publisher]

(Source: Manual Therapy)