Recently, there has been an increased need for all healthcare disciplines to provide interventions that are effective and evidence based. This has led to more implementation of evidence-based practice (EBP) in clinical settings. Following this, research regarding EBP gained attention to determine its uptake into the physiotherapy profession. Although there are numerous studies to determine the attitudes and barriers of physiotherapists towards EBP, most of them were done in developed nations. As for Malaysia, little research has been carried out, much less among physiotherapists.
The purpose of this study was to identify the knowledge, attitude, and barriers towards the implementation of EBP among physiotherapists in Malaysia.
A survey was conducted among the members of the Malaysian Physiotherapy Association and other practicing therapists in Malaysia. One hundred and two responses were collected throughout a span of 2 months.
Respondents agreed that EBP is necessary to practice and that it helps in decision making as well as improving patient care. Eighty-one percent of the respondents either agreed or strongly agreed that they had received formal training in EBP. However, 61% of the respondents reported that strong evidence is lacking to support their interventions. Thirty percent of the respondents reported reading <2 articles per month, with 57% stating that they read two to five articles in a typical month. This study also found time constraints, limited access to search engines, and lack of generalizability of research evidence as the top three barriers to implementing EBP.
Physiotherapists in Malaysia had a positive attitude towards EBP and are inclined towards implementing evidence into their clinical practice. They are interested in attending courses to improve their knowledge and skills in EBP.
Poor dynamic balance, which is common after stroke, may affect gait function. In particular, spatiotemporal asymmetrical gait patterns may occur in hemiplegic patients after stroke.
This study aimed to assess the relationship between dynamic balance and spatiotemporal gait symmetry in patients with chronic hemiplegic stroke.
To calculate symmetry ratios for step length (spatial parameter) and swing time (temporal parameter), 41 patients with chronic stroke walked at a comfortable speed. The dynamic balance measures included limit of stability (LOS) during standing and heel-to-heel base of support (H-H BOS) during gait. Analysis of correlations between various measures was performed.
The overall LOS score correlated with temporal gait symmetry (r = 0.66). The forward, backward, paretic, and non-paretic direction LOS scores were related to temporal gait symmetry (r = 0.38–0.62). The H-H BOS was correlated with temporal (r = −0.63) and spatial (r = −0.36) gait symmetries. Other dynamic balance variables were not significantly correlated with spatial gait symmetry.
Thus, control of dynamic balance abilities is related to the magnitude of temporal gait symmetry. This observation suggests that rehabilitation strategies that improve dynamic balance may enhance temporal gait symmetry in post-stroke patients.
The Cobb’s method is the most accurate and reliable method for kyphosis measurement. Conventionally, a sagittal Cobb angle was commonly derived from a lateral plain film. With computer technology, a digital method is widely used in common clinical settings, but the existing reliability data involved only experienced raters.
To assess the interrater and intrarater reliability of a digital Cobb’s method using novice physiotherapists.
Fifteen participants, with an occiput wall distance of more than 0 cm, were interviewed and assessed for their demographics. Then they were filmed for lateral spinal radiography over the area of thoracic spine in a standing position, and the Cobb angle was analyzed by four raters, including an expert physician and three novice physiotherapists, using a SurgimapSpine programme.
The average Cobb angles among the four raters showed no significant difference (p = 0.984). Outcomes of their measurements had excellent intrarater and interrater reliability [intraclass correlation coefficient (ICC3,3) = 0.995–0.997] with a small range of standard errors of the measurement (<1°).
A digital Cobb’s method had excellent reliability when used by a novice health professional rater. The findings confirm the ease of using this method to detect and monitor kyphosis in general hospitals, clinics, or research facilities.
Recovery of balance and walking abilities is important for the rehabilitation of stroke patients.
To evaluate the effects of the Bad Ragaz Ring method on functional recovery in chronic stroke patients.
Twenty-two chronic stroke patients were randomly assigned to two groups: a Bad Ragaz Ring method group (the experimental group) or a control group. Stroke patients in the experimental group underwent Bad Ragaz Ring exercise and comprehensive rehabilitation therapy, whereas patients in the control group underwent comprehensive rehabilitation therapy alone. The participants in both groups received therapy 3 days per week for 6 weeks. Muscle activations, balance indices, and Timed Up and Go test results were assessed before and after the 6-week therapy period.
The experimental group showed significant improvements in activations of tibialis anterior and gastrocnemius muscles, balance index, and Timed Up and Go test results as compared with preintervention results (p < 0.05), whereas the control group showed significant improvement in Timed Up and Go test (p < 0.05). Significant differences in posttraining gains in the activations of tibialis anterior and gastrocnemius muscles and in balance index were observed between the experimental and control groups (p < 0.05). Effect sizes for gains in the experimental and control groups were strong for tibialis anterior and gastrocnemius muscles (effect sizes, 1.04 and 1.45 respectively).
The Bad Ragaz Ring method may be beneficial for improving balance and leg muscle activation of chronic stroke patients.
Oxford Knee Scale (OKS) is a commonly used instrument to assess the symptoms and functional status in people with knee osteoarthritis. However, a Chinese version of this scale is not yet available.
The objective of this study was to translate the OKS into Chinese and validate the Chinese version of OKS.
The Chinese OKS was translated from the original English version following the recommendations of the International Society for Pharmacoeconomics and Outcomes Research. One hundred Chinese reading patients with knee osteoarthritis were recruited from local hospitals and physiotherapy clinics. Psychometric properties were evaluated in terms of test–retest reliability and internal consistency. Convergent validity was examined by Spearman rank correlation coefficient tests by comparing its score with the validated Chinese version of the Western Ontario and McMaster Universities Osteoarthritis Index and Health Outcome Survey Short Form-36.
Chinese OKS demonstrated excellent reliability (intraclass correlation coefficient = 0.88). Cronbach α of individual questions was > 0.7. Strong correlation was found between the Chinese OKS and the Western Ontario and McMaster Universities Osteoarthritis Index (ρ > 0.553, p < 0.001). Fairly strong negative correlation was also found between Chinese OKS and Health Outcome Survey Short Form-36 (ρ = −0.273 to −0.666, p < 0.05).
The Chinese translated version of OKS is a reliable and valid instrument for clinical evaluation in Chinese reading patients with knee osteoarthritis.
Chronic primary headache disorders are associated with frequent, severe pain and significant functional impairment, with treatment remaining challenging.
We examined the feasibility and safety of a novel brain [transcranial direct current stimulation (tDCS)] and spinal cord stimulation [trans-spinal cord direct current stimulation (tsDCS)] treatment in chronic headache.
Nine participants (3 males; aged, 40 ± 15 years) suffering from chronic daily headache, chronic tension-type headache, or chronic migraine received the combined brain and spinal cord intervention for 5 consecutive days. Stimulation was applied for a total of 40 minutes (20 minutes of tDCS followed by 20 minutes of tsDCS) at 1 mA. Pain sensitivity and headache symptoms (frequency, severity, duration, and medications recorded via a headache diary, 4 weeks before and after treatment) were assessed.
The treatment was safe, feasible, and well tolerated. Headache frequency was reduced following the treatment (p = 0.026) in chronic tension-type headache and chronic migraine, but not in chronic daily headache. Headache severity was reduced immediately post-treatment in 67% of sessions. A trend towards a reduction in medication use was observed (p = 0.075). No changes in headache severity (p = 0.16) or duration (p = 0.34) were present.
These data suggest that combined tDCS and tsDCS intervention is safe and feasible, and may improve headache frequency in patients with chronic primary headache disorders.
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