Physiotherapy Theory and Practice最新文献

Introduction: Body lateropulsion is a postural disorder characterized by involuntary leaning to one side and is a major symptom in individuals with Wallenberg syndrome. Although the hanger reflex has potential applications as a simple stimulus to control posture, there are no reports of its use in body lateropulsion cases. The case report aims to document the immediate effects of a wire hanger worn around the head on the center of foot pressure and gait pattern parameters.

Case description: The patient, a man in his 50s, exhibited no motor paralysis of the upper and lower extremities following the onset of stroke but demonstrated left lateropulsion. Assessments of center of pressure (COP) during standing, as well as evaluating spatiotemporal and kinematic factors through three-dimensional gait analysis, both with and without a hanger worn around the head.

Outcomes: The application of the hanger to the patient's head resulted in immediate improvements in postural control and walking ability. When the hanger was placed around the head, compared with the non-hanger condition, the deviation of the COP toward the lateropulsion side during the standing trial improved immediately. Additionally, placement of a hanger around the head increased hip adduction range of motion during the stance phase, decreased step width, and increased gait speed.

Discussion: This case report suggests the need for further research regarding the effect and efficacy of a hanger worn around the head as a tool for understanding the pathophysiology of body lateropulsion and for providing enhancements in both standing posture and walking ability.

Background: The development of evidence-based practitioners is an expectation of entry-level physical therapist education. Knowledge translation is a process to enhance the uptake of evidence into clinical practice. Student run pro bono clinics provide an authentic learning environment in which knowledge translation activities can be used to implement clinical practice guidelines (CPGs).

Purpose: The purpose of this case report was to describe the implementation, evaluation, and sustainment process of incorporating a physical therapy neurologic outcome measure CPG in a physical therapy student run pro bono clinic.

Methods: A mixed methods study, using the Knowledge to Action framework, was completed to standardize the outcome measures completed on patients with neurologic conditions who received services at a physical therapy student run pro bono clinic. The project was titled iKNOW (integrating KNOWledge translation) Super Six.

Results: Chart audits, surveys, and focus groups revealed success in implementing a CPG promoting standardization of practice in a student run pro bono clinic. Students reported that environmental modifications and the availability of resources were strong facilitators of completing the measures. Differences existed between cohorts in perceived usefulness of peer support. To sustain use of the neurologic outcome measures as recommended by the CPG, efforts to enhance awareness, leverage peer support, maximize environmental facilitators, along with audit and feedback will continue.

Conclusion: Student run pro bono clinics provide the environment for the implementation of CPGs. Students engaging in knowledge translation may develop the skills needed as an evidence-based practitioner.

Introduction: Standing balance is essential for physical functioning. Therefore, improving balance control is a key priority in the management of knee osteoarthritis (OA), underscoring the importance of accurately assessing standing balance.

Purpose: To assess reliability, construct validity and responsiveness of common clinical balance tests, including Step Test, Single-Leg Stance Test, and Functional Reach Test, in patients with knee OA.

Methods: In the initial session, 100 participants underwent balance tests and completed Persian-version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go Test (TUG) as comparators for evaluating the construct validity of balance tests. For test-retest reliability, a subset of 70 participants repeated balance tests 1 week after initial assessment. To examine responsiveness, a subset of 90 participants underwent tests and completed WOMAC and TUG at baseline and after completing intervention. At post-intervention assessment, participants also completed global rating of change scale.

Results: Three balance tests showed excellent test-retest reliability (intra-class correlation coefficient >0.75). All balance tests were considered valid and responsive because they confirmed 100% of priori hypotheses. Minimal detectable change (MDC) values were 2.71 steps for Step Test, 7.15 seconds for Single-Leg Stance Test, and 4.90 centimeters for Functional Reach Test. Minimal important change (MIC) values were 4.5 steps for Step Test, 13.10 seconds for Single-Leg Stance Test, and 5.5 centimeters for Functional Reach Test.

Conclusion: Three tests are reliable, valid and responsive for measuring balance in patients with knee OA. The MIC values aid clinicians and researchers in assessing the clinical relevance of changes in balance for these patients.

Background: Currently, there is conflicting clinimetric data on the patient-rated tennis elbow evaluation (PRTEE) and a paucity of evidence regarding the reliability, validity, and responsiveness of the numeric pain rating scale (NPRS), and tennis elbow function scale (TEFS) in patients with lateral elbow tendinopathy.

Objective: Perform a comprehensive clinimetric analysis of the NPRS, PRTEE, and TEFS in a sample of patients (n = 143) with lateral elbow tendinopathy.

Methods: Establish the reliability, construct validity, responsiveness, meaningful clinically important difference (MCID), and minimal detectable change (MDC₉₀) values for the NPRS, PRTEE, and TEFS at the 3-month follow-up.

Results: The NPRS [intraclass correlation coefficient (ICC_2,1): 0.54, 95% confidence interval (CI): 0.17-0.78], PRTEE (ICC_2,1: 0.62, 95% CI: 0.21-0.86), and the TEFS (ICC_2,1: 0.71, 95% CI: 0.14-0.90) exhibited moderate reliability. All three outcomes exhibited excellent responsiveness [NPRS: area under the curve (AUC): 0.94, 95% CI: 0.89-0.98]; PRTEE: (AUC: 0.96, 95% CI 0.93-0.99); TEFS: (AUC: 0.95, 95% CI: 0.91-0.98). The MCID and MDC₉₀ were 2.3 and 1.4 for the NPRS, 14.8 and 9.7 for the PRTEE, and 7.5 and 5.7 for the TEFS, respectively. All three patients reported outcome measures also demonstrated strong construct validity (Pearson's r from 0.71 to 0.83, p < .001).

Conclusion: The NPRS, PRTEE, and TEFS are clinimetrically sound patient reported outcome measures for patients with lateral elbow tendinopathy at a 3-month follow-up.

Registration at clinicaltrials.gov: NCT03167710.

Background: The term nonspecific low back pain (NSLBP) is often ambiguously defined and inconsistently used in scientific literature. Yet, there is limited discussion and reflection on the meaning of the term and how different meanings influence research and clinical practice.

Aim: The aim of this study was to critically analyze the meaning of NSLBP in scientific literature and its consequent influence on research and clinical practice.

Methodology and methods: Conducting a Foucauldian discourse analysis, we analyzed 24 articles that explicitly discussed the term's meaning. Relevant articles were retrieved through a systematic literature search of six databases, supplemented by snowballing and expert recommendations.

Findings: Our analysis identified five distinct discourses analyzing NSLBP: "Biomedical," "Neurocentric," "Rational-Multifactorial," "Complex-Multifactorial," and "NSLBP Otherwise."

Conclusion: Each identified discourse was underpinned by unique assumptions that both enable and constrain certain ways of thinking about, researching, and managing NSLBP. Most discourses were individual-centric, guiding a search for causes and solutions within the individual. An exception was the "NSLBP Otherwise Discourse," which enables a more society-centric perspective and encourages alternative views on NSLBP. Given the significant impact of NSLBP and the paucity of substantial breakthroughs in understanding and management, critical reflection on current discourses and their influence on clinical and research practices seem timely. Moreover, considering the present uncertainty surrounding NSLBP, embracing multiplicity could pave the way for a more expansive research agenda.

Background: Falls are a significant concern for hospitals and patients. The risk of falls is particularly heightened around the period of hospitalization. Physical therapy (PT) is commonly consulted for hospitalized patients at-risk for falls, yet it is unknown how the hospital context influences fall prevention practice among physical therapists.

Purpose: To explore the perspectives of acute care physical therapists on fall prevention practices within hospital settings and examine how specific contextual factors influence their practice patterns and the effectiveness ofPT interventions.

Methods: A prospective qualitative study using collaborative qualitative data analysis was conducted through semi-structured interviews with acute care physical therapists nationwide. Interviews focused on therapists' perceptions of fall prevention practices, PT intervention effectiveness, and the influence of hospital context.

Results: We derived three primary themes and ten subthemes. First, mobility promotion was identified as central to fall prevention, requiring a system-wide culture involving multidisciplinary teams, particularly nursing staff. Second, systemic factors, such as time constraints, institutional priorities, high patient volumes, staff availability, equipment availability, and the physical environment, were found to limit optimal PT practice for fall prevention. Third, the effectiveness of PT interventions was context-dependent, with therapists adapting their practices to maximize impact within systemic constraints. Notably, clinical experience seemed to mitigate some practice limitations.

Conclusions: Despite the acknowledged benefits of PT, systemic factors often prevent therapists from implementing effective fall prevention interventions. Addressing these contextual barriers and developing standards of practice may enhance patient safety and the overall success of fall prevention efforts in hospitals.

Introduction: To understand, diagnose and treat patients with musculoskeletal disorders, psychological risk factors should be assessed, and the association between psychological risk for disability and appropriateness of orthopedic surgery should be investigated.

Purpose: To investigate the association between screened psychological risk for disability and appropriateness of orthopedic surgery, and to examine a physiotherapist's ability to assess risk for disability in patients referred for orthopedic consultation.

Method: Patients (n = 192) were assessed by a physiotherapist or an orthopedic surgeon to determine the need for surgery. The Pain Belief Screening Instrument (PBSI) was used to screen for psychological risk. The physiotherapist assessed psychological risk for disability based on yellow flags. Association between PBSI risk profile and appropriateness of orthopedic surgery was analyzed using logistic regression. Sensitivity and specificity of the physiotherapist's assessment of risk was calculated using a binary classification model.

Results: Orthopedic surgery was 2.28 times more likely to be considered an appropriate intervention for patients with a high PBSI risk profile (95% CI 1.09;4.78). The physiotherapist's risk assessment correctly identified 88% of those at low risk (specificity) and 32% of those at high risk for disability (sensitivity).

Conclusion: The findings suggest that orthopedic surgery is likely to be considered appropriate for patients with a high PBSI risk profile. The high specificity of the physiotherapist's assessment implies good awareness of psychological factors. The low sensitivity suggests a need for using a screening tool such as the PBSI, to guide management decisions.Trial registration: Clinical Trials NCT02265172, retrospectively registered June 10, 2014.

Background: Understanding and assessing static and dynamic balance and their relationship with the function of the medial longitudinal arch of the foot is crucial for people with pronated feet.

Purpose: This study aimed to assess the medial longitudinal arch height and postural balance in physically active females with pronated feet.

Methods: A case-control study. The participants were divided into two groups based on their Foot Posture Index (FPI) scores: females with bilateral foot pronation (n = 33) and the control group with normal feet (n = 30). A Navicular Drop Test (NDT) and Knee-to-Wall Test (KTW) were used to assess foot and ankle function. Static balance was assessed using the Stork Balance Test (SBT) and Tandem Stance (TS). Dynamic balance was assessed using the Y-Balance Test (Y-BT). Physical activity was assessed using the total score of the short version of the International Physical Activity Questionnaire.

Results: There was a lack of differences in static balance between pronated and normal feet groups in SBT and TS. The Y-BT anterior reaching depends on foot posture in favor of a pronated foot (p = .04). Correlation also showed a significant relationship between Y-BT components and NDT (r = 0.33, p = .01) and between KTW and NDT (r = 0.30, p = .02).

Conclusion: These results may suggest that foot pronation can be associated with dynamic balance in some directions. However, given that most comparisons did not show significant differences, the relationship between foot posture and functional assessment remains unclear.

Introduction: Trauma is common and may lead to lasting adverse effects on health. Trauma-informed practice does not treat trauma but uses a strengths-based approach to encourage engagement in services.

Objective: To understand how physiotherapy attends to trauma-informed principles.

Methods: This qualitative ethnographic study was set in an Australian hospital. Three data collection methods were used, including observations of clinical practice, interactive reflexive group discussions with physiotherapists, and interviews with patients. Data analysis included an initial inductive phase followed by thematic mapping to trauma-informed principles. Critical reflexivity was used throughout to examine how the authors' perspectives and assumptions affected the analysis.

Results: Twelve observations of consultations, ten interviews with people receiving physiotherapy, and five group discussions with physiotherapists were conducted. Themes produced within each of five principles of trauma-informed care included: Safety: not just a number, uncertainty beyond managing physical risks, upbeat approach as default needs balance, pragmatic environments inadequate; Trustworthiness: touch needs further consideration, assumed consent; Choice: limited options; Collaboration: let's do it together, variable consideration of the patient as expert, task focus, pushing the "right" treatment, missing insight into power imbalance; Empowerment: extending function and independence, building nonphysical skills but lack of clarity.

Conclusion: Physiotherapy incorporates crucial aspects of trauma-informed care, but opportunities exist to enhance physiotherapists' skills and knowledge, particularly in relation to non-physical safety considerations.

Introduction: Widespread pain may be related to psychosocial aspects in several musculoskeletal conditions, but the literature on carpal tunnel syndrome (CTS) is scarce.

Objective: To determine the relationship between pain extent and psychological factors (catastrophizing, kinesiophobia, anxiety symptoms, and depression) in people with CTS.

Methods: A cross-sectional study was conducted. The independent variables were: pain intensity, disability (QuickDASH), duration of symptoms, anxiety and depressive symptoms, catastrophizing, and kinesiophobia. The main outcome was: pain extent (% of total area and categories "pain within the median nerve-innervated territory" versus "extra-median nerve pain"). Correlation analysis was performed using Spearman's correlation coefficient. A linear regression model and binary logistic regression (both with forward selection) were performed to determine the main predictors of pain extent.

Results: Forty-eight participants were included. A moderate positive correlation was found between catastrophizing (r = 0.455; p = 0.024) and disability (r = 0.448; p = 0.024) with total pain extent area. Regression models indicated that catastrophizing explained 22% of the variance in the pain extent (β = 0.003; 95% CI: 0.002-0.005), while kinesiophobia was the variable that best explained the distribution of pain in the extra-median territory (R² Nagelkerke = 0.182). Null or weak correlations were found for the rest of the associations.

Conclusion: Catastrophizing and kinesiophobia were the main indicators of pain extent in people with CTS. Clinicians are advised to use specific questionnaires to check for the presence of catastrophizing or kinesiophobia in people with CTS and wider pain extension.