Physiotherapy Theory and Practice最新文献

Background: Recent research has identified six domains of work readiness: Practical Wisdom, Interpersonal Capabilities, Personal Attributes, Organisational Acumen, Profession Specific Knowledge and Skills, and Professionally Relevant Experiences.

Objective: Using a case study, the aim of this study was to demonstrate the process of curriculum mapping to evaluate the alignment of a university program to the work readiness framework.

Methods: A retrospective audit of curriculum material for one cohort of Macquarie University's Doctor of Physiotherapy (DPT) was undertaken. Curriculum was categorized as declared, delivered, or assessed, mapped to the six work readiness domains through qualitative content analysis, and then quantitatively scored and expressed as percentages of maximum possible scores per unit, and average units scores per semester.

Results: Mapping curriculum to a six domain work readiness framework revealed declared, delivered, and assessed curriculum within all six work readiness domains, with varying contributions across the degree. Mapping revealed that the Profession Specific Knowledge and Skills domain had the highest coverage of declared (M = 63%, SD = 12), delivered (M = 88%, SD = 11) and assessed (M = 80%, SD = 7) curriculum, highlighting a strength of the program. The Personal Attributes domain had the lowest coverage of declared (M = 5%, SD = 5), delivered (M = 48%, SD = 24) and assessed (M = 29%, SD = 20) curriculum, highlighting opportunities for development.

Conclusion: Mapping curriculum to a work readiness framework allows universities to consider alignment, and the strength and opportunities for the improvement of work readiness within its curriculum.

Introduction: Systemic sclerosis (SSc) is a rare connective tissue disease causing pain, reduced mobility and decreased health-related quality of life (HRQoL). Studies suggest that exercise is a necessary adjunct to the medical treatment.

Purpose: To examine the feasibility of a 12-week home-based exercise program for SSc patients, and evaluate changes in physical function, HRQoL and SSc-related symptoms.

Methods: Twenty patients were enrolled in the study. Feasibility was measured by adherence, adverse events, and exercise task self-efficacy. At baseline and follow-up patients completed the 6-minute walk test, 30-second sit-to-stand test, 30-second arm curl, SSc Impact of Disease (ScleroID) and 36-item short form survey (SF-36).

Results: Median adherence to the intervention was 36 (interquartile range 27-36) out of a total of 36 exercise sessions. Fifteen patients completed the intervention, with three dropouts. Patients' exercise task self-efficacy was 98%, 93% and 78%, for one, two and three weekly exercise sessions, respectively. There were no adverse events related to the exercise sessions. Improvements were observed in all physical tests, and minor improvements in HRQoL and SSc-related symptoms.

Conclusion: This study suggests that a home-based exercise intervention is feasible for patients with SSc. The results suggest improvements in physical function, HRQoL and SSc-related symptoms.

Introduction: Digital options for osteoarthritis (OA) treatment are increasingly available with high patient satisfaction and acceptability. Little is, however, known about physical therapists' (PT) perception of this treatment modality.

Objective: To investigate PT's experience of delivering digital treatment for hip and knee OA using a smart-phone application.

Method: Nine PTs (mean age 36 years, women n = 5) with 3-24 months experience of delivering digital OA treatment were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using content analysis.

Results: Four main categories arose; 1) A feeling of being part of the future, 2) Making an osteoarthritis diagnosis in a digital setting, 3) Facilitators and barriers of digital OA management and 4) Where to go from here? PTs were in general positive for digital treatment delivery but felt that a lack of visual assessments and physical examinations to enhance exercise evaluations and diagnosis accuracy was sometimes a disadvantage.

Conclusion: Digital treatment delivery was in general perceived as a time-efficient way of providing high-quality care that may increase patient motivation and adherence without violating the therapeutic alliance. Future implementations of digital OA treatment programs should consider the possibility of including real-time video calls for visual assessment.

Background: Physical therapy educators strive to achieve excellence in education and develop clinicians who are prepared to meet the health needs of society. Previous research has focused on describing the traits, beliefs, and experiences of exemplary educators and clinicians to inform didactic and clinical curricula and serve as a model for expert practice. However, no studies have explored the experiences and perspectives of exemplary students.

Purpose: The aim of this phenomenological study was to describe the traits, beliefs, and experiences of exemplary physical therapist (PT) students in clinical education.

Methods: A phenomenological design was utilized to gather data through semi-structured interviews with 26 students from the United States who met the criteria for exemplary and were completing their terminal clinical experience or were within six months of graduation. Data were analyzed using constant comparison and methodological rigor was maintained using an inquiry audit, peer debriefing, member checking, and pilot interviewing.

Results: A Desire to Serve emerged as an overarching theme. The essence of being exemplary was further elucidated through the following themes: (1) Being adaptable (2) Being reflective (3) Embracing challenges and seeking opportunities (4) Valuing a collaborative relationship with their CI (5) Importance of self-care, and (6) Coming into my own as a PT.

Conclusion: Given the emphasis on excellence in physical therapy education, these results can provide insights for defining the necessary qualities for achieving excellence in both classroom and clinical environments. Additionally, these findings can assist educators in fostering excellence-driven attributes among entry-level students.

Background: Ankle osteoarthritis (OA) is a disease involving pain and decreased physical function which can attenuate the tolerance to perform high-load resistance training. Low-load blood flow restriction (BFR) training has been demonstrated to improve muscle strength, muscle size, and physical function in patients suffering from OA.

Objective: We examined the effects of 12 weeks of BFR-training performed 4 times a week in an individual with Kellgren-Lawrence (KL) grade 4 ankle OA.

Case description: A 32-year-old woman with KL grade 4 right ankle OA subsequent to a clubfoot repair in childhood performed 12 weeks of BFR-training. Four exercises with concurrent blood flow restriction (60% of arterial occlusion pressure) targeting the lower leg were performed 4 times/week. The following outcome measures were collected at baseline and 12 weeks after BFR-training: The Foot and Ankle Outcome Score (FAOS), calf circumference, maximal isometric muscle strength, single-leg heel raise test, single-leg stance test, and lateral side-hop test.

Outcomes: Adherence to the training was 93.75%. The patient demonstrated improvements in FAOS subscale symptoms, pain, and sports/recreational activities by 19-47 points (minimal detectable change (MDC) = 18-21.5 points); maximal muscle strength in plantarflexion (36%), eversion (55%), and inversion (38%) (MDC for plantarflexion = 16.81-29.97%). The single-leg heel raise test and the lateral side-hop test improved with 66% and 51%, respectively. Calf circumference was maintained.

Conclusion: BFR-training improved patient-reported outcomes, lower leg muscle strength, and physical function in an individual suffering from KL grade 4 ankle OA following childhood clubfoot repair.

Introduction: The introduction of physiotherapists working with advanced scope of practice has contributed to improvements in healthcare services.

Objective: This qualitative study explores the views of physiotherapist managers on the Advanced Practice Physiotherapy role and the barriers and enablers to progression of this career pathway.

Methods: A qualitative focus group study was conducted online with 10 purposefully sampled physiotherapist managers. The focus groups were audio-recorded, transcribed and thematically analyzed.

Results: Three main themes were identified; 1) Physiotherapists working in advanced practice are recognized as experts and strong advocates for the physiotherapy profession; 2) Barriers to Advanced Practice Physiotherapy in Ireland include inconsistent role definition and protection, a lack of legislation and uncertainty concerning clinical governance; and 3) Physiotherapist managers can support Advanced Practice Physiotherapy through mentoring and resource provision, and implementation of the Advanced Practice Competency Framework.

Conclusion: Physiotherapist managers recognized the value of Advanced Practice Physiotherapy to the Irish health service but suggest that the role and reporting structures need to be clarified. They highlighted barriers preventing the full potential of this these roles being realized and provided suggestions to support the progression of this healthcare model.

Background: Overall spinal curvature is evaluated by calculating the difference between the angles of lumbar lordosis (LL) and thoracic kyphosis (TK) and is expressed as LL minus TK (LL-TK). It is unclear whether LL-TK is associated with physical function in community-dwelling older adults and whether it is more relevant than TK or LL alone.

Objective: This study aimed to identify whether LL-TK is associated with physical function in community-dwelling older adults, and whether it is strongly associated than TK or LL alone.

Methods: The participants comprised 1,674 community-dwelling older adults who underwent physical assessments (women, n = 1,099; mean age, 67.4 ± 5.3 years). As spinal alignment indices, TK and LL were measured using skin surface methods, and LL-TK was calculated as the difference between them. Decreased LL-TK indicated increased overall spinal curvature. Physical function was determined by measuring single-leg standing, five-times chair-stand, and usual gait speed. Stepwise multiple regression analyses were performed with each physical function as the dependent variable and spinal alignment indices as the independent variables, with adjustments.

Results: Multiple regression analyses showed that single-leg standing (β = 0.092, 95% confidence interval [CI] = 0.071 to 0.214, p < .001) and five-times chair-stand (β=-0.142, 95% CI = -0.037 to -0.019, p < .001) were significantly associated with LL-TK, but not LL. Both LL-TK (β = 0.121, 95% CI = 0.001 to 0.004, p < .001) and LL (β = 0.087, 95% CI = 0.001 to 0.003, p = .003) were significant determinants of usual gait speed.

Conclusions: This study showed that decreased LL-TK may be associated with poor physical function. This association may be stronger than that observed for TK or LL alone.

Background: Augmented reality gait adaptive training (ARGAT) and repetitive transcranial magnetic stimulation (rTMS) have both demonstrated efficacy in improving lower limb motor function in survivors of stroke.

Purpose: To investigate the effects of combining rTMS and ARGAT on motor function in survivors of stroke.

Methods: The experimental group received a combination of rTMS and ARGAT, while the control group received ARGAT alone. The interventions comprised a total of 20 sessions, conducted over four weeks with five consecutive daily sessions. Outcome measures included three-dimensional gait analysis (3DGA), surface electromyography (sEMG), Fugl-Meyer assessment for the lower extremity (FMA-LE), and the Berg Balance Scale (BBS).

Results: Following the intervention, both groups showed significant improvements in walking speed, symmetry index, affected step length, affected stride length, FMA-LE, and BBS scores (p < .05). Furthermore, the experimental group demonstrated greater improvements in walking speed (F = 4.58, p = .040), cadence (F = 5.67, p = .023), affected step length (F = 5.79, p = .022), affected stride length (F = 4.84, p = .035), FMA-LE (Z = 2.43, p = .019), and BBS (F = 4.76, p = .036) compared to the control group. The experimental group demonstrated a significant improvement in the co-contraction index (CCI) of the knee joint (F = 14.88, p < .001), a change not observed in the control group (F = 2.16, p = .151). However, neither group showed significant alterations in CCI of the ankle joint (F = 1.58, p = .218), step width (F = 0.24, p = .630), unaffected step length (F = 0.22, p = .641), or unaffected stride length (F = 2.99, p = .093).

Conclusion: The combination of low-frequency rTMS and ARGAT demonstrated superior effects on motor function recovery compared to ARGAT alone in survivors of stroke.

Background: The Programa d'Atenció Integral pels Pacients amb Dolor Crònic (PAINDOC) is a multimodal and multidisciplinary group-based program that integrates pain neuroscience education, mindfulness meditation, pain psychotherapy, Empowered Relief, and therapeutic exercise. It serves as a therapeutic option for individuals with chronic low back pain, providing them with comprehensive adaptive strategies for pain management.

Objective: This qualitative study explores participants' retrospective acceptability of the PAINDOC Program.

Methods: To ensure demographic variability and information power, a purposive sampling approach was applied. Twelve participants were interviewed through three focus groups, supplemented with four individual semi-structured interviews. Data was analyzed using reflexive thematic analysis and evaluated based on the Therapeutic Framework of Acceptability.

Results: Participants provide positive feedback regarding active pain coping strategies and improved self-management. While certain aspects of the Program were more emphasized, participants integrated tools from all components. Strategies included pain reconceptualization, positive self-talk, or problem-solving. The Program's ethicality was closely linked to individual values and may also be influenced by time constraints of certain program elements, the immediate effects of specific approaches, participant perceptions, and individual preferences.

Conclusions: The findings provide valuable insights into the acceptability of the PAINDOC Program, guiding future improvements and the development of similar interventions.