Physiotherapy Research International最新文献

Background and purpose: To identify the paediatric curriculum content covered in entry-level physiotherapy programs within the United Kingdom (UK), and report faculties perceived importance. Strengths, weaknesses, barriers and facilitators, to the implementation of paediatric content were explored.

Methods: A cross-sectional online questionnaire captured entry-level physiotherapy programme leaders' perceptions of paediatric programs.

Results: Fifty-five responses were submitted, providing a 67% completion rate. Faculty perceived that students' felt the inclusion of paediatric content within the curricula was 'Important' (Mean 3.60 ± SD 0.74). Of 30 diagnoses surveyed, only two were covered 'Well' within curriculums, despite 23 rated at least 'Important' by respondents. Of the 18 assessment/examination components, 13 were covered 'Well' with five 'Somewhat'. All were considered to be at least 'Important'. Perceived strengths were grouped into three main categories (1) integrated/lifespan approach, (2) links to clinical specialists, and (3) a broad/detailed curriculum. Perceived weaknesses included curriculum time pressures and paediatric placement availability.

Discussion: The majority of paediatric conditions were only somewhat covered by UK curriculums, despite respondents in the main believing they should be an important element of the entry-level syllabus. Some UK physiotherapy entry-level students may not be exposed to any paediatric teaching or clinical placements.

Background and purpose: The World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed to assess health and disability based on the biopsychosocial model. The WHODAS 2.0 has not been validated for Brazilians with chronic non-specific low back pain (LBP). We aimed to evaluate the reliability, internal consistency, and construct validity of the Brazilian version of the WHODAS 2.0 in patients with chronic LBP.

Methods: Methodological study. The Brazilian version of the WHODAS 2.0 was applied to 100 volunteers with chronic nonspecific LBP. Test-retest reliability, internal consistency, and construct validity were assessed using the Spearman correlation test, Cronbach's alpha (α) coefficient, and Spearman's correlation test between WHODAS 2.0, the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Fear Avoidance Beliefs Questionnaire (FABQ), respectively.

Results: WHODAS 2.0 showed satisfactory test-retest reliability with a moderate correlation for total WHODAS 2.0 (r = 0.75, p < 0.05). Internal consistency was adequate for all domains and total score (α = 0.82-0.96). Regarding construct validity, WHODAS 2.0, ODI (r = 0.70, p < 0.05), and WHODAS 2.0 and RMDQ (r = 0.71, p < 0.05) had significant correlations. Total WHODAS 2.0 and FABQ-Phys subscale scores correlated moderately (r = 0.66, p < 0.05).

Discussion: The Brazilian WHODAS 2.0 was proved to be a valid and reliable tool for patients with chronic LBP. The item referring to sexual intercourse had 27% and 30% of the missing values during the test and retest stage, respectively and had a high percentage of missing data for work-related questions (41% missing data) in the life activities domain; therefore, the data must be interpreted with caution.

Implications for physiotherapy practice: WHODAS 2.0 can be used as a disability assessment strategy from a biopsychosocial perspective in this population.

Background and purpose: Pressure biofeedback is a tool that can detect the movement of a structure and may be used as an indicator of muscle function. It's widely used to measure the transversus abdominis (TrA) muscle activity. Pressure biofeedback (PBU) monitors the abdominal wall movement by measuring the pressure change during abdominal hollowing and can indirectly evaluate the TrA muscle function, which is considered as a valuable tool. The evaluation of the training of core muscles, including the transversus abdominis, requires a reliable outcome. Various methods using different positions are used to evaluate the transversus abdominis muscle function. However, it is noted that a standard way of evaluation and training still needs to be improved in research and clinical practice. This technical report discusses the optimal position and technique to measure the TrA muscle activity using PBU, with discussions on the merits and demerits of the body positions.

Methods: The technical report is presented with a literature review of the PBU measurement of TrA and through observation in the clinical practice. The evaluation methods of TrA, including the position to activate and isolate, are discussed in detail.

Results: Training core muscles does not imply TrA activation, and evaluating isolated TrA and multifidus is essential before intervention. The abdominal drawing-in maneuver effectively activates TrA in various evaluation positions of the body, but when using PBUs, it would be valid in a prone position.

Discussion: Different body positions are practiced to train TrA and core muscles using PBU, commonly adopted by practice are in supine. It's noted that most of the studies lack in establishing the effectiveness of the position in evaluating the TrA muscle activity using PBU. The need for insight into an appropriate technique for evaluating TrA activity is addressed in this technical report. This report presents key points on the complete technique and concludes that the prone position is superior to other positions and recommended for measuring and recording the TrA activity using a PBU.

Purpose: Osteoarthritis (OA) is a major threat to public health worldwide and is predicted to increase. Existing interventions to implement clinical practice guidelines (CPGs) seem to be used mainly in the Western world. We conducted a structured educational program on the evidence-based management of OA (BOA) for Indian physical therapists (PT). Our study aimed to describe Indian PTs' knowledge, attitudes and confidence on evidence-based management of OA, and their perceptions of a course on this subject.

Methods: The 2-day course included didactic parts and practical skills training. Thirty-five PTs participated and answered a questionnaire. Fourteen of them participated in focus group interviews. Questionnaire data are presented as medians and full ranges. Manifest content analysis was used to analyze interview data that are presented as catagories illustrated by interview quotes. The formal ethics permission was granted.

Results: 74% of PTs agreed that radiography determines the type of treatment required, and 69% agreed that a prescription for exercise is enough to ensure adherence. PTs agreed (mean 5 on 6-point scale) that exercises increasing pain should be advised against. Confidence in guiding the physical activity was generally high (≥5 on 6-point scales). Five categories reflected participants' perceptions of the course content: Shift in management focus, Need for cultural adaptation, Importance of social support, Development of organization and collaboration, and Feelings of hesitation.

Discussion: Our results indicate that in order to facilitate the implementation of CPGs, PT curricula may consider the inclusion of knowledge on CPGs, focus more on students' own reflections on transforming theory into practice, and incorporate training of basic skills required for implementation of self-management, body awareness, and neuromuscular fitness. If given access and mandates, PTs may play a major role in the early diagnosis and treatment of OA and thus contribute to the prevention of an epidemic of OA in India.

Background and purpose: Gait disorders in individuals with Parkinson's disease (IwPD) are among the most disabling symptoms. Physical exercise has been proposed for the treatment of IwPD because it shows positive effects on gait variables. Given the importance of physical activity in the rehabilitation process of IwPD, the assessment of interventions to identify those most promising for improving or maintaining gait performance is of great relevance. Therefore, this study evaluated the effects of Mat Pilates Training (MPT) and Multicomponent Training (MCT) on the spatiotemporal variables of gait in situations of daily dual-task performance in IwPD. Gait analysis in a daily dual-task context allows the simulation of real-life conditions where individuals have a higher risk of falling than in single-task walking.

Methods: We conducted a single-blinded randomized controlled trial with 34 mild-to-moderate IwPD (Hoehn-Yahr stage 1-2). They were randomized to one of two interventions: MPT or MCT. All participants performed the training for 60 min, three times per week, for 20 weeks. Spatiotemporal gait variables were evaluated in a daily life situation to increase the ecological validity of the measurements, which included gait speed, stride time, double support time, swing time, and cadence. The individuals walked on a platform holding two bags with a load corresponding to 10% of their body mass.

Results: After the intervention, there was a significant improvement in gait speed in both groups: MPT (p = 0.047) and MCT (p = 0.015). The MPT group reduced the cadence (p = 0.005) and the MCT group increased the stride length (p = 0.026) after the intervention.

Discussion: Both groups had positive effects on gait speed with load transport resulting from the two proposed interventions. However, the MPT group showed a spatiotemporal adjustment of speed and cadence that can increase gait stability, which was not found in the MCT group.

Background and purpose: Studies that analyze gait without physical assistance recovery post-stroke are scarce. There are few of the studies that analyze longitudinally the recovery of balance during the subacute post-stroke inpatient rehabilitation. The aim of the study was to analyze the association between balance recovery during subacute stroke inpatient rehabilitation and gait without physical assistance achievement. Secondarily, to analyze the association between balance at admission of inpatient rehabilitation and gait without physical assistance achievement.

Methods: An observational, longitudinal, and retrospective cohort study was conducted. Subacute stroke subjects with an admission Berg Balance Scale below or equal to 4 points were included (n = 164). Two logistic regression models were developed. Model 1 analyzes the association between balance recovery during inpatient rehabilitation and gait without physical assistance at discharge. Model 2 analyzes the association between balance at the admission and gait without physical assistance at discharge.

Results: Of 164 severe post-stroke patients, 60 (36.5%) achieved gait without physical assistance. Although the two models developed a statistically significant association (p < 0.001), Model 1 evinced better discrimination performance (Model 1: area below the curve was of 0.987 -CI 95%: 0.975-0.998- vs. Model 2: area below the curve 2 was of 0.705 -CI 95%: 0.789-0.601-).

Discussion: Balance recovery during rehabilitation was strongly associated with gait without physical assistance achievement at the time of discharge in severe subacute post-stroke patients.

Implications for physiotherapy practice: The longitudinal analysis of motor recovery in severe subacute post-stroke patients may be helpful in the decision making process during inpatient rehabilitation.

Objective: To summarize the current evidence from randomized controlled trials (RCTs) regarding the effectiveness of Virtual Reality (VR) training and functional mobility in older adults with fear of movement. TYPE: Systematic review and meta-analysis of randomized clinical trials.

Methodology: An electronic search was performed using PubMed, Embase, Medline, SPORTDiscus, Scopus, and CINAHL. A data search from January 2015 to December 2022 and a manual electronic literature search were conducted to identify published RCTs. The effectiveness of VR-based balance training for balance and gait was evaluated in older adults with a fear of movement, which was measured by the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES). Three reviewers independently performed the study selection, and the quality assessment of the included studies was performed using the Physiotherapy Evidence Database (PEDro) scale. The reporting was based on the new Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines.

Synthesis: The search product produced 345 results, from which 23 full text articles were studied. Seven RCTs of good methodological quality, including 265 participants, were included in the review. Overall, the studies reported that VR had a significant improvement on the TUG (Cohen's d = -0.91 [-1.38; -0.44], p = 0.001), while the FES was not significantly different (Cohen's d = -0.54 [-1.80; 0.71] p = 0.40). The average for PEDro scores (6.14) was good, and the risk of bias revealed that more than one-third of the studies correctly described the random sequence generation and allocation concealment procedures.

Conclusion: VR-based training is effective on balance or gait training based on the TUG; however, there were mixed results to improve FES scores following VR intervention. These inconsistent results might be limited due to variations in the studies, including heterogeneous training paradigms, sensitive outcome measures, small sample sizes, and short intervention durations, which limit the validity of our findings. Future investigations should compare different VR protocols to help establish better guidelines for clinicians.

Background and purpose: Negative attitudes towards disability amongst healthcare professionals endanger social inclusion of people with disabilities (PwD). This study aimed to investigate the attitude of undergraduate healthcare students of various disciplines towards PwD, including specific aspects of their attitude.

Methods: We assessed the attitudes of university students, including physiotherapy, speech therapy, nursing, social work and medical students, through the Greek Interaction with Disabled Person Scale (IDPS) in a survey. Data were analysed using a two-step clustering technique.

Results: Four hundred-eighty undergraduate healthcare students (21.4 ± 5.3 years-old; 135 males, 345 females) were recruited. Two-step cluster analysis identified three homogenous subgroups labelled Least positive attitude (42.3%), Moderately positive attitude (26.9%), and Most positive attitude (30.8%) groups. Τhe main differences in healthcare students' attitudes between the three distinct groups appeared to be in feelings of sympathy, fear and susceptibility towards disability, suggesting that these aspects of attitude needed to be primarily addressed. Results also revealed that females, being in higher semester/year of studies, having completed a clinical module with PwD and having frequent contact with PwD were related to more positive attitudes.

Conclusion: Taking into account that the majority of the healthcare students' sample yielded least and moderately positive attitudes, towards PwD, further actions should be taken for promoting more positive attitudes towards disability. A social model in teaching to increase student's awareness of PwD and skills to work with these people, having PwD themselves teaching such modules, focussing on positive experiences and reminding the students of the benefits of having positive attitudes towards PwD, as well as promoting ways to increase the contact of healthcare students with PwD (such as teaching in co-operation with organisations of PwD or finding alternative clinical placements with PwD), can be beneficial in promoting more positive attitudes towards disability.

Background: There has been a growing interest in demonstrating the health benefits of exercise among people with epilepsy in recent years. Although exercise is recommended for people with epilepsy, there is uncertainty concerning the effects of yoga and aerobic exercise on multiple health outcomes in epilepsy.

Purpose: The aim of this trial was to examine the effects of yoga and aerobic exercise training on physical activity, seizure frequency, health-related physical fitness, mental, emotional, and psychological health status, and quality of life.

Methods: This study was designed as a single-center, 8-week, randomized controlled trial in a three-arm parallel group. Participants will be randomly allocated to yoga, aerobic exercise, or wait-list control groups. The primary outcome is physical activity/sedentary behavior measured by the ActiGraph GT9X accelerometer and seizure frequency. Secondary outcomes include functional capacity, lower extremity strength, balance, body composition, waist and hip circumference, cognition, depression, anxiety, perceived stress, fatigue, sleep quality, and quality of life. The outcomes will be evaluated at baseline and at 8 weeks of follow-up.

Implications of physiotherapy practice: This study is the first randomized controlled trial comparing the effects of yoga and aerobic exercise among people with epilepsy. The findings of this study could provide important information about the effects of yoga and aerobic exercise training on a variety of health conditions in people with epilepsy.

Trial registration: ClinicalTrials.gov identifier: NCT05066880, registered October 4, 2021.

Background and purpose: To improve existing clinical assessments for freezing of gait (FOG) severity, a new clinician-rated tool which integrates the varied types of freezing (FOG Severity Tool-Revised) was developed. This cross-sectional study investigated its validity and reliability.

Methods: People with Parkinson's disease who were able to independently ambulate eight-metres and understand study instructions were consecutively recruited from outpatient clinics of a tertiary hospital. Those with co-morbidities severely affecting gait were excluded. Participants were assessed with the FOG Severity Tool-Revised, three functional performance tests, the FOG Questionnaire, and outcomes measuring anxiety, cognition, and disability. The FOG Severity Tool-Revised was repeated for test-retest reliability. Exploratory factor analysis and Cronbach's alpha were computed for structural validity and internal consistency. Reliability and measurement error were estimated with ICC (two-way, random), standard error of measurement, and smallest detectable change (SDC₉₅ ). Criterion-related and construct validity were calculated with Spearman's correlations.

Results: Thirty-nine participants were enrolled [79.5% (n = 31) male; Median (IQR): age-73.0 (9.0) years; disease duration-4.0 (5.8) years], with fifteen (38.5%) who reported no medication state change contributing a second assessment for reliability estimation. The FOG Severity Tool-Revised demonstrated sufficient structural validity and internal consistency (α = 0.89-0.93), and adequate criterion-related validity compared to the FOG Questionnaire (ρ = 0.73, 95% CI 0.54-0.85). Test-retest reliability (ICC = 0.96, 95%CI 0.86-0.99) and random measurement error (%SDC₉₅  = 10.4%) was acceptable in this limited sample.

Discussion and conclusions: The FOG Severity Tool-Revised appeared valid in this initial sample of people with Parkinson's. While its psychometric properties remain to be confirmed in a larger sample, it may be considered for use in the clinical setting.