Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.702854?ai=1mo2&mi=3s94u5&af=R
Miyerkules, Enero 16, 2013
Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis – A prospective case series
Physiotherapy Theory and Practice, Volume 29, Issue 2, Page 87-95, February 2013.
Children with paralytic poliomyelitis: Utilization of physiotherapy services in Zamfara State, Nigeria
Physiotherapy Theory and Practice, Volume 29, Issue 2, Page 133-141, February 2013.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.703761?ai=1mo2&mi=3s94u5&af=R
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A brief interphase interval interposed within biphasic pulses enhances the contraction force of the quadriceps femoris muscle
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-8, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.757405?ai=1mo2&mi=3s94u5&af=R
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Preventive Health Care Among Community-Dwelling Persons with Spinal Cord Injury
Available online 9 January 2013
Publication year: 2013
Source:PM&R
Objective To describe preventive health examinations/tests and behaviors of persons with traumatic spinal cord injury (SCI). Design Survey. Setting SCI clinic and telephone contact. Participants A total of 59 persons ≥18 years of age with traumatic SCI. Intervention None. Main Outcome Measures Preventive health examinations/tests and reason for not receiving an examination or test. Results Preventive health tests/examinations received within the past year: flu vaccination (40.7%); eye examination (50.8%); dental check-up (64.4%); physical examination (61.0%); vitamin D level (56.0%); cholesterol level (25.4%); and blood glucose level (39.0%). For men, 20.0% had a prostate examination and 20.0% had a colonoscopy. For women, 25.0% had a pelvic examination and 62.5% had a mammogram in the past 2 years. The most endorsed reasons for not getting an examination/test was “It was my choice” followed by “No one told me to have [examination/test].” The number of years injured had an inverse relationship with having vitamin D level checked (r = −334) and had a positive association with having serum cholesterol level checked (r = .474). Conclusion Preventive health tests and examinations in the SCI population are being obtained at about the same rate as in the U.S. population with some exceptions (ie, cholesterol level check, colonoscopy, and pelvic examination); however, the rates are far from the goals of Healthy People 2020. Primary care and SCI clinicians should be proactive in educating their patients about the importance of preventative health, especially those who have been injured for a long time.
Publication year: 2013
Source:PM&R
Correlation between the 8-repetition maximum test and isokinetic dynamometry in the measurement of muscle strength of the knee extensors: A concurrent validity study
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-7, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.727529?ai=1mo2&mi=3s94u5&af=R
Kinesio tape management for superficial radial nerve entrapment: A case report
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-10, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.717589?ai=1mo2&mi=3s94u5&af=R
Martes, Enero 15, 2013
Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis – A prospective case series
Physiotherapy Theory and Practice, Volume 29, Issue 2, Page 87-95, February 2013.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.702854?ai=1mo2&mi=3s94u5&af=R
The Relationship Between Manual Ability and Ambulation in Adolescents with Cerebral Palsy
Physical & Occupational Therapy in Pediatrics, Volume 0, Issue 0, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.754394?ai=1ozx&mi=3s94u5&af=R
Effect of Exercise and Weight Loss in People Who Have Hip Osteoarthritis and Are Overweight or Obese: A Prospective Cohort Study
Osteoarthritis (OA) is the most common joint disorder in the world and is recognized as a substantial source of disability. For people with OA of the knee, exercise in combination with weight loss is a proven effective conservative treatment option, yet evidence is lacking for people with hip OA.
The aim of this study was to obtain preliminary evidence of the effect of a program of exercise in combination with weight loss on physical function in people who have hip OA and are overweight or obese.
This investigation was a prospective cohort study.
Thirty-five people who were 25 years or older, had clinical and radiological evidence of hip OA, and were overweight or obese (body mass index of >25 kg/m2) were included. They participated in an 8-month program of exercise in combination with weight loss. A body mass index of 40 kg/m2 was used as the upper limit. The primary outcome was self-reported physical function, as measured with a subscale of the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcome measures included pain and walking tests as quantitative measures of function.
Participation in the combination program resulted in a 32.6% improvement in self-reported physical function after 8 months, a finding that could be considered clinically relevant. Significant improvements also were seen in pain and on walking tests.
The lack of a control group was a limitation of this study.
This appears to be the first study investigating the effect of exercise and weight loss as a combination treatment in people with hip OA. The results provide preliminary evidence that this combination treatment is effective in people with hip OA.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110418v2?rss=1
Interrater Reliability of the Adapted Fresno Test across Multiple Raters
Purpose: The Adapted Fresno Test (AFT) is a seven-item instrument for assessing knowledge and skills in the major domains of evidence-based practice (EBP), including formulating clinical questions and searching for and critically appraising research evidence. This study examined the interrater reliability of the AFT using several raters with different levels of professional experience. Method: The AFT was completed by physiotherapists and occupational therapists, and a random sample of 12 tests was scored by four raters with different levels of professional experience. Interrater reliability was calculated using intra-class correlation coefficients (ICC [2, 1]) for the individual AFT items and the total AFT score. Results: Interrater reliability was moderate to excellent for items 1 and 7 (ICC=0.63–0.95). Questionable levels of reliability among raters were found for other items and for the total score. For these items, the raters were clustered into two groups—“experienced” and “inexperienced”—and then examined for reliability. The reliability estimates for rater 1 and rater 2 (“inexperienced”) increased slightly for items 2 and 5 and for the total score, but not for other items. For raters 3 and 4 (“experienced”), ICCs increased considerably, indicating excellent reliability for all items and for the total score (0.80–0.99), except for item 4, which showed a further decrease in ICC. Conclusion: Use of the AFT to assess knowledge and skills in EBP may be problematic unless raters are carefully selected and trained.
- Content Type Journal Article
- Category Advance Online Article
- Pages 1-6
- DOI 10.3138/ptc.2012-15
- Authors
- Lucylynn M. Lizarondo, International Centre for Allied Health Evidence
- Karen Grimmer, International Centre for Allied Health Evidence
- Saravana Kumar, International Centre for Allied Health Evidence
- Journal Physiotherapy Canada
- Online ISSN 1708-8313
- Print ISSN 0300-0508
Metabolic Changes in the Spinal Cord After Brachial Plexus Root Re-implantation
Objective. To investigate metabolic changes within the spinal cord using proton magnetic resonance spectroscopy (1H-MRS) and determine their relationship with clinical function in patients with complete brachial plexus avulsion who underwent reimplantation of the ventral roots. Methods. Single-voxel 1H-MRS of the cord between C1 and C3 was performed in 10 patients with normal spinal cord on MRI, who underwent reimplantation of C5 to T1 ventral roots on average 5.5 years earlier, and 19 healthy controls. The ratios of the concentrations of the following main metabolites, with respect to total creatine levels, were obtained: total N-acetyl-aspartate, choline-containing compounds, creatine and phosphocreatine (Cr), and myo-inositol (m-Ins). Patient disability was assessed using upper limb scales. Differences in metabolite concentration ratios and their correlations with disability were investigated. Results. Patients showed increased m-Ins/Cr ratio compared with controls, which was associated with the level of function of the affected arm and time from injury. Conclusions. The finding of increased m-Ins/Cr in patients suggests that reactive gliosis, perhaps in response to the degeneration of avulsed fibers, may occur in the spinal cord above the site of injury and be relevant to motor dysfunction. However, this pathological process appears to diminish with time. These insights underline the need to integrate metabolic imaging with structural and functional magnetic resonance imaging to obtain a complete view of spinal cord plasticity. Last, this study provides the first steps toward identifying markers to serve as outcome measures for trials comparing strategies of plexus repair following avulsion injury.
Source: http://nnr.sagepub.com/cgi/content/abstract/27/2/118?rss=1
Lunes, Enero 14, 2013
Comparison of Reliability, Validity, and Responsiveness of the Mini-BESTest and Berg Balance Scale in Patients With Balance Disorders
Recently, a new tool for assessing dynamic balance impairments has been presented: the 14-item Mini-BESTest.
The aim of this study was to compare the psychometric performance of Mini-BESTest and the Berg Balance Scale (BBS).
A prospective, single-group, observational design was used in the study.
Ninety-three participants (mean age=66.2 years, SD=13.2; 53 women, 40 men) with balance deficits were recruited. Interrater (3 raters) and test-retest (1–3 days) reliability were calculated using intraclass correlation coefficients (ICCs). Responsiveness and minimal important change were assessed (after 10 sessions of physical therapy) using both distribution-based and anchor-based methods (external criterion: the 15-point Global Rating of Change [GRC] scale).
At baseline, neither floor effects nor ceiling effects were found in either the Mini-BESTest or the BBS. After treatment, the maximum score was found in 12 participants (12.9%) with BBS and in 2 participants (2.1%) with Mini-BESTest. Test-retest reliability for total scores was significantly higher for the Mini-BESTest (ICC=.96) than for the BBS (ICC=.92), whereas interrater reliability was similar (ICC=.98 versus .97, respectively). The standard error of measurement (SEM) was 1.26 and the minimum detectable change at the 95% confidence level (MDC95) was 3.5 points for Mini-BESTest, whereas the SEM was 2.18 and the MDC95 was 6.2 points for the BBS. In receiver operating characteristic curves, the area under the curve was 0.92 for the Mini-BESTest and 0.91 for the BBS. The best minimal important change (MIC) was 4 points for the Mini-BESTest and 7 points for the BBS. After treatment, 38 participants evaluated with the Mini-BESTest and only 23 participants evaluated with the BBS (out of the 40 participants who had a GRC score of ≥3.5) showed a score change equal to or greater than the MIC values.
The consecutive sampling method drawn from a single rehabilitation facility and the intrinsic weakness of the GRC for calculating MIC values were limitations of the study.
The 2 scales behave similarly, but the Mini-BESTest appears to have a lower ceiling effect, slightly higher reliability levels, and greater accuracy in classifying individual patients who show significant improvement in balance function.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120171v2?rss=1
The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain
The impact of the relationship (therapeutic alliance) between patients and physical therapists on treatment outcome in the rehabilitation of chronic low back pain (LBP) has not been previously investigated.
To investigate whether the therapeutic alliance between physical therapists and chronic LBP patients predicts clinical outcomes.
Retrospective observational study nested within a randomized controlled trial.
182 patients with chronic LBP who volunteered for a randomized controlled trial that compared the efficacy of exercises and spinal manipulative therapy rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session. The primary outcomes of function, global perceived effect of treatment, pain, and disability were assessed before and after 8 weeks of treatment. Linear regression models were used to investigate if the alliance was a predictor of outcome or moderated the effect of treatment.
The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome. The therapeutic alliance moderated the effect of treatment on global perceived effect for two of three treatment contrasts (general exercise vs motor control exercise, spinal manipulative therapy vs motor control exercise). There was no treatment effect modification when outcome was measured with function, pain and disability measures.
Therapeutic alliance was measured at the second treatment session and it is likely to bias the interaction during initial stages of treatment. Data analysis was restricted to primary outcomes at 8 weeks.
Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120137v1?rss=1
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Designing and Implementing a System for Tracking Functional Status After Stroke: A Feasibility Study
Available online 14 November 2012
Publication year: 2012
Source:PM&R
Objective To determine the feasibility of tracking stroke patients' functional outcomes in an integrated health system across a care continuum using the computer version of the Activity Measure of Post-Acute Care (AM-PAC). Setting A large integrated health care system in northern California. Participants A total of 222 stroke patients (aged ≥18 years) who were hospitalized after an acute cerebrovascular accident. Methods An AM-PAC assessment was made at discharge from sites of care, including acute hospital, inpatient rehabilitation hospital, skilled nursing facility, home during home care, and outpatient settings. Assessments also were completed in the patient's home at 6 months. Data from the AM-PAC program were integrated with the health care system's databases. Main Outcome Measurements (1) AM-PAC administration time at the various sites of care; (2) assessment of a floor or a ceiling effect; and (3) administrative burden of tracking participants. Results AM-PAC assessment sessions averaged 7.9 minutes for data acquisition in 3 domains: Basic Mobility, Activities of Daily Living, and Applied Cognition. Participants answered, on average, 27 AM-PAC questions per session. A small ceiling effect was observed at 6 months, and there was a larger ceiling effect when the instrument was administered in an institution, ie, when the AM-PAC institutional item bank was used rather than the community item bank. It was feasible to track patients and to assess their function using the AM-PAC instrument from institutional to community settings. Implementation of the AM-PAC in clinical environments, and the success of the project, were influenced by instrumental, technological, operational, resource, and cultural factors. Conclusions This study demonstrates the feasibility of implementing a single functional outcome instrument in clinical and community settings to measure rehabilitation functional outcomes of stroke patients. Integrating the AM-PAC measurement system into clinical workflows and the electronic medical record could provide assistance to clinicians for medical decision making, functional prognostication, and discharge planning.
Publication year: 2012
Source:PM&R
Children with paralytic poliomyelitis: Utilization of physiotherapy services in Zamfara State, Nigeria
Physiotherapy Theory and Practice, Volume 29, Issue 2, Page 133-141, February 2013.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.703761?ai=1mo2&mi=3s94u5&af=R
Perceived value of stroke outcome measures across the post-acute care continuum: A qualitative case study
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-9, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.727205?ai=1mo2&mi=3s94u5&af=R
Oral–Motor Function and Feeding Intervention
Physical & Occupational Therapy in Pediatrics, Volume 33, Issue 1, Page 111-138, February 2013.
Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.750864?ai=1ozx&mi=3s94u5&af=R
Linggo, Enero 13, 2013
Exercise and Sport for Persons With Spinal Cord Injury
November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
This review article provides an overview of the evidence that links exercise and sports participation to physical and psychological well-being among people with spinal cord injury. Two aspects of physical well-being are examined, including the prevention of chronic disease and the promotion of physical fitness. Multiple aspects of psychosocial well-being are discussed, including mental health, social participation, and life satisfaction. The review concludes with future research recommendations and a discussion of challenges and opportunities for using exercise and sports to promote health and well-being among people living with spinal cord injury.
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
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Physical activity during and after adjuvant chemotherapy in patients with breast cancer
Available online 29 September 2012
Publication year: 2012
Source:Physiotherapy
Objectives To describe changes in physical activity levels related to health-enhancing physical activity guidelines during and after adjuvant chemotherapy in a cohort of Swedish patients with breast cancer. Design Exploratory clinical prospective longitudinal study with 6 and 12 months of follow-up. Participants Forty women treated for breast cancer with adjuvant chemotherapy were included, and 33 women completed the study. Main outcome measures The primary outcome was the proportion of participants meeting the health-enhancing physical activity guidelines, both in relative terms (perceived exertion using Borg's rate of perceived exertion scale) and absolute terms (metabolic equivalent). Results The proportion of participants meeting the guidelines when leisure-time physical activity was measured in terms of absolute intensity was 81 (25/31) to 94% (31/33) during chemotherapy, 93% (29/31) at 6-month follow-up and 87% (26/30) at 12-month follow-up. Women who had been physically active before their cancer diagnosis and women who had received information about physical activity were more physically active during chemotherapy. Conclusions Swedish patients with breast cancer are generally more physically active during adjuvant chemotherapy than has been reported previously in international studies. Physical activity habits prior to cancer diagnosis and information about the benefits of physical activity appear to be important factors for higher levels of physical activity during and after chemotherapy.
Publication year: 2012
Source:Physiotherapy
Training Memory Self-efficacy in the Chronic Stage After Stroke: A Randomized Controlled Trial
Background. Stroke patients with a low memory self-efficacy (MSE) report more memory complaints than patients with a high MSE. Objective. The aim of this study was to examine the effect of a memory-training program on MSE in the chronic phase after stroke and to identify which patients benefit most from the MSE training program. Methods. In a randomized controlled trial, the effectiveness of the MSE training program (experimental group) was compared with a peer support program (control group) in chronic stroke patients. The primary outcome was MSE, measured using the Metamemory-In-Adulthood Questionnaire. Secondary outcomes included depression, quality of life, and objective verbal memory capacity. Changes in outcomes over the intervention period were compared between both groups. Demographic and clinical variables were studied as potential predictors of MSE outcome in the experimental group. Results. In total, 153 patients were included: mean age = 58 years (standard deviation [SD] = 9.7), 54.9% male, and mean of 54 months (SD = 37) after stroke. Of these, 77 were assigned to the training and 76 to the control group. Improvement of MSE (B = 0.40; P = .019) was significantly greater in the training than in the control group. No significant differences were found for the secondary outcomes. An increase in MSE after training was predicted by a younger age (B = –0.033; P = .006) and a better memory capacity (B = 0.043; P = .009), adjusted for baseline MSE. Conclusions. MSE can be improved by the MSE training program for stroke patients. Younger patients and patients with a better memory capacity benefit most from the MSE training program (Dutch Trial Register: NTR-TC 1656).
Source: http://nnr.sagepub.com/cgi/content/abstract/27/2/110?rss=1
A new manual muscle test for assessing the entire trapezius muscle
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-7, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.718856?ai=1mo2&mi=3s94u5&af=R
Using theories of learning in workplaces to enhance physiotherapy clinical education
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-11, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.753651?ai=1mo2&mi=3s94u5&af=R
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Effect of different angles of knee flexion on leg extensor power in healthy individuals
December 2012
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 4
Objectives To investigate the effect of fixed flexion knee deformity on leg extensor power as measured by the Nottingham leg extensor power rig. Design Cross-sectional observational study. Setting Orthopaedic hospital. Participants A convenience sample of 135 adult participants. Main outcome measures: leg extensor power normalised for body weight, UCLA activity scale. Results Power values at 0° FF were found to be significantly less than power values at 15° FF [difference 0.21P P Conclusions Given the large range of pre-operative maximal extension, the validity of testing each patient at their own maximal range of pre-intervention extension and then at the same angle post-intervention is questionable. In studies assessing change in power following an intervention, the end point angle should be standardised between individuals. In future studies investigating leg extensor power on the LEP rig pre and post intervention, it could be more appropriate to standardise the angle of FF to 30°, with individuals who are unable to achieve this position excluded from the study.
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 4
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Associations between executive function and physical function poststroke: a pilot study
Available online 6 September 2012
Publication year: 2012
Source:Physiotherapy
Objectives Associations between executive function and physical function poststroke have not been extensively studied. More complex physiotherapy interventions poststroke require a greater degree of cognitive ability, especially executive function. This pilot study aimed to inform the methodology of a larger study by examining the associations between executive function and the performance of basic and complex gait tasks in people poststroke. Design A cross-sectional pilot study was conducted in a convenience sample of 20 participants recruited from a community-based voluntary stroke organisation and from the outpatient services of two urban hospitals. Main outcome measures A battery of tests was used to measure executive function (Trail Making Test, Stroop Word-Colour Test, Zoo Map test, Frontal Assessment Battery and Digit Span backward test). Basic and complex 10 Results Observational comparisons between participant executive function scores and age- and/or education-matched normative data demonstrated that executive dysfunction ranged between 55% and 100%. Poorer performance in measures of executive function was more frequently associated with poorer performance in complex gait tests compared with basic gait tests. The MAS was not significantly associated with any measure of executive function. Conclusions Executive dysfunction is a common sequel poststroke which may negatively affect physical performance. Physiotherapists should consider executive dysfunction when developing rehabilitation strategies to improve physical function poststroke.
Publication year: 2012
Source:Physiotherapy
Sabado, Enero 12, 2013
Exercise and Sports for Health Promotion, Disease, and Disability
November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
Daily Treatment Time and Functional Gains of Stroke Patients During Inpatient Rehabilitation
Available online 2 November 2012
Publication year: 2012
Source:PM&R
Objective To study the effects of daily treatment time on functional gain of patients who have had a stroke. Design A retrospective cohort study. Setting An inpatient rehabilitation hospital (IRH) in northern California. Participants Three hundred sixty patients who had a stroke and were discharged from the IRH in 2007. Interventions Average minutes of rehabilitation therapy per day, including physical therapy, occupation therapy, speech and language therapy, and total treatment. Main Outcome Measures Functional gain measured by the Functional Independence Measure, including activities of daily living, mobility, cognition, and the total of the Functional Independence Measure scores. Results The study sample had a mean age of 64.8 years; 57.4% were men and 61.4% were white. The mean total daily therapy time was 190.3 minutes, and the mean total functional gain was 26.0. A longer daily therapeutic duration was significantly associated with total functional gain (r = .23, P = .0094). Patients who received a total therapy time of <3.0 hours per day had significantly lower total functional gain than did those treated ≥3.0 hours. No significant difference in total functional gain was found between patients treated ≥3.0 but <3.5 hours and ≥3.5 hours per day. The daily treatment time of physical therapy, occupational therapy, and speech and language therapy also was significantly associated with corresponding subscale functional gains. In addition, hemorrhagic stroke, left brain injury, earlier IRH admission, and a longer IRH stay were associated with total functional improvement. Conclusions The study demonstrated a significant relationship between daily therapeutic duration and functional gain during IRH stay and showed treatment time thresholds for optimal functional outcomes for patients in inpatient rehabilitation who had a stroke.
Publication year: 2012
Source:PM&R
The intra- and inter-rater reliability of the tragus wall distance (TWD) measurement in non-pathological participants ages 18–34
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-7, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.727528?ai=1mo2&mi=3s94u5&af=R
Service users’ perceptions regarding their involvement in a physiotherapy educational programme in the UK: a qualitative study
Available online 29 October 2012
Publication year: 2012
Source:Physiotherapy
Background The impact of user involvement in allied healthcare education is complicated by a lack of understanding of this concept both practically and ideologically. It is important to analyse whether service users perceive taking part as an ‘honour’ or as ‘agents of change’. Objective This study explored service users’ perspectives of their involvement in a UK college-based physiotherapy educational programme. Method A Grounded Theory approach utilising semi-structured interviews was conducted with eight of the service users who took part in the physiotherapy programme. The analysis of the interviews was carried out according to a grounded theory framework. Results All the service users wished to foster a sense of a partnership and communicate what it was like on the ‘other side’. Their personal agendas and possible motivation for taking part were to challenge the students assumptions regarding disability, to give something back for their healthcare and to communicate their dissatisfaction with present healthcare provision. Conclusion The participants felt that they could be instrumental in a process of change. One way to address this is to include this programme as an integral element of the current move towards life-long learning that supports their professional development in a range of authentic situations. Their reflexive dialogues with the service users can be documented as part of a reflexive portfolio with the service users as mentors.
Publication year: 2012
Source:Physiotherapy
Exercise in Cardiovascular Diseases
November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
Abstract Analysis of extensive data has shown that exercise training provides significant impact on prevention and modification of cardiovascular diseases and mortality. In general, exercise recommendations for patients with cardiovascular diseases are based on individual aerobic capacity and comorbidities. Patients with acute syndromes benefit from participating in a cardiac rehabilitation program, whereas patients with chronic syndromes benefit from a life-long home-based program. In general, exercise prescription should involve aerobic activities in combination with resistance, flexibility, and balance exercises. This review will discuss an exercise prescription for patients with coronary artery disease, heart failure, and after heart transplantation. Detailed precautions for particular groups of patients will be discussed.
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
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Biyernes, Enero 11, 2013
Using digital photography to document rectus femoris flexibility: A reliability study of the modified Thomas test
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-9, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.731140?ai=1mo2&mi=3s94u5&af=R
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What Characterizes People Who Have an Unclear Classification Using a Treatment-Based Classification Algorithm for Low Back Pain? A Cross-Sectional Study
A treatment-based classification algorithm for low back pain (LBP) was created to help clinicians select treatments that a patient is most likely to respond to. To allow the algorithm to classify all people with LBP, additional criteria are provided to assist therapists' decisions for patients who do not clearly fit a subgroup (ie, unclear classifications). Recent studies have found that ~34% of LBP patients have unclear classifications.
To guide improvements to the algorithm, it is imperative to determine if these patients are different from those with clear classifications.
Secondary analysis of data from three previous studies investigating the algorithm.
Baseline data from 529 consecutively-recruited LBP patients were used (3 discrete cohorts). The primary outcome was the type of classification: ‘clear’ or ‘unclear’. Univariate logistic regression was used to determine which participant variables were related to having an unclear classification.
People who received an unclear classification had greater odds of being older (OR=1.01; 95%CI=1.003-1.033), having a longer duration of LBP(OR=1.001; 95%CI=1.000-1.001), having had previous LBP (OR=1.61; 95%CI=1.04-2.49), having less fear avoidance beliefs related to both work (OR=0.98; 95%CI=0.96-0.99) and physical activity (OR=0.98; 95%CI=0.96-0.996), and having less LBP-related disability (OR=0.98; 95%CI=0.96-0.99) than people with clear classifications.
The studies from which patient data were drawn had different inclusion criteria and clinical settings.
People receiving unclear classifications appear to be less affected by their LBP (lower disability and fear avoidance beliefs), despite typically having a longer duration of LBP. Future studies should investigate if modifying the algorithm to possibly exclude these people or provide them with a different intervention improves outcomes.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120263v1?rss=1
Evaluation of an Advanced-Practice Physical Therapist in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait Times
Purpose: To examine the role of an advanced-practice physiotherapist (APP) with respect to (1) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems; (2) wait times; and (3) satisfaction with care. Methods: This prospective study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre. Agreement was examined on seven major diagnostic categories, need for further examination and surgery, and type of surgical procedure. Wait times were compared between the APP- and surgeon-led clinics from referral date to date of initial consultation, date of final diagnostic test, and date of confirmed diagnosis and planned treatment. A modified and validated version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains. Kappa (κ) coefficients and bias- and prevalence-adjusted kappa (PABAK) values were calculated, and strength of agreement was categorized. Wait time and satisfaction data were examined using non-parametric statistics. Results: Agreement on major diagnostic categories varied from 0.68 (good) to 0.96 (excellent). Agreement with respect to indication for surgery was κ=0.75, p<0.001; 95% CI, 0.62–0.88 (good). Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points (p<0.001); the surgeon's wait time was significantly reduced over 3 years. High satisfaction was reported in all components of care received from both health care providers. Conclusions: Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction.
- Content Type Journal Article
- Category Advance Online Article
- Pages 1-10
- DOI 10.3138/ptc.2011-56
- Authors
- Helen Razmjou, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Susan Robarts, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Deborah Kennedy, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Cheryl McKnight, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Anne Marie MacLeod, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Richard Holtby, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Journal Physiotherapy Canada
- Online ISSN 1708-8313
- Print ISSN 0300-0508
Source: http://www.metapress.com/content/y784n5v333n5tr72/
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Move to Improve: The Feasibility of Using an Early Mobility Protocol to Increase Ambulation in the Intensive and Intermediate Care Settings
Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays.
The purpose of this study was to determine the effectiveness of a nurse-driven mobility protocol to increase the percentage of patients ambulating during the first 72 hours of their hospital stay.
A quasi-experimental design was used before and after intervention in a 16-bed adult medical/surgical intensive care unit (ICU) and a 26-bed adult intermediate care unit (IMCU) at a large community hospital.
A multidisciplinary team developed and implemented a mobility order set with an embedded algorithm to guide nursing assessment of mobility potential. Based on the assessments, the protocol empowers the nurse to consult physical therapists or occupational therapists when appropriate. Daily ambulation status reports were reviewed each morning to determine each patient's activity level. Retrospective and prospective chart reviews were performed to evaluate the effectiveness of the protocol for patients 18 years of age and older who were hospitalized 72 hours or longer.
In the 3 months prior to implementation of the Move to Improve project, 6.2% (12 of 193) of the ICU patients and 15.5% (54 of 349) of the IMCU patients ambulated during the first 72 hours of their hospitalization. During the 6 months following implementation, those rates rose to 20.2% (86 of 426) and 71.8% (257 of 358), respectively.
The study was carried out at only one center.
The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110400v2?rss=1
Comparing Activity Patterns, Biological, and Family Factors in Children with and Without Developmental Coordination Disorder
Physical & Occupational Therapy in Pediatrics, Volume 0, Issue 0, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.747585?ai=1ozx&mi=3s94u5&af=R
Rasch Validation of a Combined Measure of Basic and Extended Daily Life Functioning After Stroke
Background. Tools used to measure poststroke functional status must include basic and instrumental activities of daily living and reflect the patient’s and the clinician’s perspective of the disease and its effect on daily living performance. Objective. The authors combined the Functional Independence Measure (FIM) and the Nottingham Extended Activities of Daily Living (NEADL) to create a scale providing a comprehensive evaluation of ADLs functional status in patients with stroke. Methods. The study participants were 188 patients completing the FIM and the NEADL. The psychometric properties of the combined measure were examined with Rasch analysis. Results. A 3-point scale and a dichotomous scale were suggested for use in the FIM and the NEADL, respectively. The combined 40 items worked consistently to reflect a single construct, and "bladder management" and "bowel management" were highly related. After "bowel management" was removed from the combined scale, all but 3 items fit the model’s expectations, and the 39-item scale showed reasonable item difficulty hierarchy, with high reliability. The 3 misfit items were removed, and no differences in unidimensionality, differential item functioning, and reliability were found between the 36-item and 39-item scales. Conclusions. The combined measure of the FIM and the NEADL provides a comprehensive picture of ADLs. It extends the utility of the FIM and the NEADL and is recommended for use to measure the independence of patients after discharge home.
Source: http://nnr.sagepub.com/cgi/content/abstract/27/2/125?rss=1
Huwebes, Enero 10, 2013
Clinician's Commentary on Stevenson et al.1
Clinician's Commentary on Stevenson et al.1
- Content Type Journal Article
- Category Articles
- Pages 414-414
- DOI 10.3138/ptc.2011-24-CC
- Authors
- Jocelyn Harris
- Journal Physiotherapy Canada
- Online ISSN 1708-8313
- Print ISSN 0300-0508
- Journal Volume Volume 64
- Journal Issue Volume 64, Number 4 / 2012
Source: http://www.metapress.com/content/8t1n1v2234742848/
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Describing the clinical reasoning process: Application of a model of enablement to a pediatric case
Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-10, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.727204?ai=1mo2&mi=3s94u5&af=R
Exercise in the Older Adult: From the Sedentary Elderly to the Masters Athlete
November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
The diverse exercise goals of the aging population present several challenges to physicians. Whereas some Masters athletes aim to set personal time records, sedentary elderly persons may look to exercise to help maintain independence and combat functional decline. This review article examines the common cardiovascular and neuromuscular physiological changes associated with aging and how regular exercise is used to improve physiological parameters and functional abilities. Exercise precautions specific to the elderly population are discussed. Exercise recommendations for persons with osteoarthritis and after joint arthroplasty also are presented.
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
Amount and Focus of Physical Therapy and Occupational Therapy for Young Children with Cerebral Palsy
Physical & Occupational Therapy in Pediatrics, Volume 32, Issue 4, Page 368-382, October 2012.
Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.715620?ai=1ozx&mi=3s94u5&af=R
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Validity and Reliability of the Swedish Version of the Activities-specific Balance Confidence Scale in People with Chronic Stroke
Purpose: To evaluate the validity and reliability of the Swedish version of the Activities-specific Balance Confidence (ABC) scale in people >1 year after stroke. Method: In a multi-centre study design, using initial cross-sectional data collection with follow-up, the timed up-and-go (TUG) test, 10 m timed walk (10TW), and 6-Minute Walk Test (6MWT) were performed; ABC scale and Short Form 36 Health Survey (SF-36) were completed; and falls history data were collected during one session. One week later, the ABC scale was sent to participants for a second rating. Spearman correlation coefficients were calculated, and reliability was assessed via the intra-class correlation coefficient (ICC) and Cronbach alpha. Results: A convenience sample of 67 people was included (mean age 68 y). The median score for the ABC scale changed from 57 at the first rating to 43 at the second; 19 participants (28%) reported falls during the previous 3 months. Scores on the ABC scale were moderately correlated with the TUG (r=0.48), 10TW (r=0.52), 6MWT (r=0.45), and SF-36 physical component summary score (r=0.43). Internal consistency was high for the ABC scale at test and retest (α=0.95–0.97). The ICC was 0.82 (95% CI, 0.72–0.88). Conclusions: The Swedish version of the ABC scale is a valid and reliable measure for investigating balance confidence in people >1 year after stroke.
- Content Type Journal Article
- Category Advance Online Article
- Pages 1-7
- DOI 10.3138/ptc.2011-54
- Authors
- Anette Forsberg, Family Medicine Research Centre, Örebro County Council
- Ylva Nilsagård, Centre for Health Care Sciences, Örebro University Hospital
- Journal Physiotherapy Canada
- Online ISSN 1708-8313
- Print ISSN 0300-0508
A Call to Arms (and Legs): Exercise Prescription for Medical Students
November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
Publication year: 2012
Source:PM&R, Volume 4, Issue 11
Reliability of the Norwegian Version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC)
Physical & Occupational Therapy in Pediatrics, Volume 0, Issue 0, Early Online.
Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.739269?ai=1ozx&mi=3s94u5&af=R
Academic Physiatry: Vignettes of Rewarding Careers
December 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 12
Publication year: 2012
Source:PM&R, Volume 4, Issue 12
Miyerkules, Enero 9, 2013
J.K.EhranP.M.GordanP.S.VisichS.J.KeteyianClinical Exercise Physiology2nd ed.2009Human Kinetics712 pages, £54.95, ISBN 978-0736065658
December 2012
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 4
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 4
Effect of Externally Cued Training on Dynamic Stability Control During Sit-to-Stand in Patients With Parkinson Disease
Previous studies have shown that people with Parkinson's disease (PwPD) have difficulty performing the sit-to-stand task, due to mobility and stability-related impairments. Despite its importance, limited literature exists on quantification of dynamic stability control in PwPD during this task.
To examine (1) differences in the control of dynamic stability between PwPD and healthy controls, and (2) the extent to which externally-cued training can improve such control during sit-to-stand in PwPD.
Quasi-experimental controlled trial.
Performance of 21 PwPD was compared with 12 community-dwelling older adults. PwPD were randomly assigned to a non-training control group or a group receiving audio-visual-cued training for speeding up sit-to-stand performance, 3 times/week for 4 weeks. Outcome measures recorded at baseline and after 4 weeks included the center-of-mass position, its velocity, and the stability against either backward or forward balance loss (backward and forward stability) at seat-off and movement termination.
Compared to healthy controls, PwPD had a greater backward stability resulting from a more anterior center-of-mass position at seat-off and lower velocity (p < 0.05). This feature, combined with a decreased forward stability at movement termination, increased their risk of forward balance loss at movement termination. Post-training, the PwPD achieved greater backward stability (p < 0.05) by increasing their forward center-of-mass velocity at seat-off; while achieving a posterior shift in center-of-mass position to reduce their likelihood of forward balance loss at movement termination.
PwPD increase their postural stability against backward balance loss during task initiation at the expense of possible forward balance loss at task termination. Task-specific training with preparatory audio-visual cues improves their overall dynamic stability against both forward and back balance loss.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20100423v1?rss=1
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Longitudinal Evaluation of Resting-State fMRI After Acute Stroke With Hemiparesis
Background. Functional magnetic resonance imaging (fMRI) of motor impairment after stroke strongly depends on patient effort and capacity to make a movement. Hence fMRI has had limited use in clinical management. Alternatively, resting-state fMRI (ie, with no task) can elucidate the brain’s functional connections by determining temporal synchrony between brain regions. Objective. The authors examined whether resting-state fMRI can elucidate the disruption of functional connections within hours of ischemic stroke as well as during recovery. Methods. A total of 51 ischemic stroke patients—31 with mild-to-moderate hand deficits (National Institutes of Health Stroke Scale [NIHSS] motor score ≥1) and 20 with NIHSS score of 0—underwent resting-state fMRI at <24 hours, 7 days, and 90 days poststroke; 15 age-matched healthy individuals participated in 1 session. Using the resting-state fMRI signal from the ipsilesional motor cortex, the strength of functional connections with the contralesional motor cortex was computed. Whole-brain maps of the resting-state motor network were also generated and compared between groups and sessions. Results. Within hours poststroke, patients with motor deficits exhibited significantly lower connectivity than controls (P = .02) and patients with no motor impairment (P = .03). Connectivity was reestablished after 7 days in recovered (ie, NIHSS score = 0) participants. After 90 days, recovered patients exhibited normal motor connectivity; however, reduced connectivity with subcortical regions associated with effort and cognitive processing remained. Conclusion. Resting-state fMRI within hours of ischemic stroke can demonstrate the impact of stroke on functional connections throughout the brain. This tool has the potential to help select appropriate stroke therapies in an acute imaging setting and to monitor the efficacy of rehabilitation.
Source: http://nnr.sagepub.com/cgi/content/abstract/27/2/153?rss=1
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