Physiotherapy Theory and Practice最新文献

Background: The criteria to determine walking performance of people with mobility limitations from developed countries have been already reported. However, these criteria may not be suitable to be applied for people with mobility limitations from developing countries due to the differences in sociodemographic characteristics and environmental conditions.

Objective: To explore cutoff points of walking speed to determine walking performance of individuals with mobility limitations from a developing country.

Methods: Individuals with mobility limitations from a developing country (n = 136) were cross-sectionally interviewed and assessed for their demographics and walking performance. Then they were assessed for their walking speed using the 10-meter walk test.

Results: Walking speeds of ≥0.30 m/s, ≥ 0.40 m/s, and ≥0.65 m/s could optimally indicate the ability of outside-home walking, limited-community walking, and full-community walking, respectively (sensitivity = 78%-84%, specificity = 81%-93%, and area under the receiver operating characteristic curve [AUC] > 0.90). Moreover, a walking speed of ≥0.35 m/s could suggest the ability of functional walking (sensitivity = 78%; specificity = 83%; and AUC = 0.89).

Conclusions: With the need of standard practical measure for early screening and monitoring of functional alteration over time, the present walking speed cutoff points may be clinically applied to suggest walking performance in daily living specifically for individuals with mobility limitations from a developing country.

Background: Although the Lee Silverman Voice Treatment BIG® (LSVT BIG®) improves motor symptoms in patients with Parkinson's Disease, no reports exist for patients with Progressive Supranuclear Palsy (PSP).

Objective: To describe the effect of LSVT BIG® on the motor symptoms of a participant with PSP.

Case description: The participant was a 74-year-old man with PSP. His goals were to improve limb movement, balance ability, and festinating gait over the 4-week LSVT BIG® program.

Outcomes: All assessments of limb movement and balance ability showed improvements after intervention for the limb and gait subsections of the PSP rating scale. Scores improved from 9 to 5, and 8 to 6, respectively for the Unified Parkinson's Disease Rating Scale (UPDRS) Part 3, from 30 to 21 and for the Berg balance scale (BBS), from 45 to 50 points. The improvements in UPDRS Part 3 and BBS exceeded the minimum detectable change values (7-8 and 2 points, respectively). After intervention, improvements in festinating gait and rapid walking pace were noted on the UPDRS Part 3 (2 to 1 point) and 10-meter walk test (1.65 m/s to 1.10 m/s).

Conclusion: The intervention was effective for the participant but further studies with diverse populations are needed.

Background and purpose: The impact of the COVID-19 pandemic on physiotherapy education meant that innovative responses were needed quickly. This paper describes a scholarly approach to changes within an entry-level physiotherapy program where one of its clinical placements was replaced with a fully online unit during 2020, as well as exploring the experiences of students who completed this newly developed online unit.

Methods: A mixed methods approach was used. Sixteen of a possible 31 students responded to an online survey comprising quantitative and open-ended questions.

Results: The majority of participants were satisfied with the unit and reported that: the unit helped them to learn valuable skills; feedback from educators was helpful; and that they were able to apply to future contexts. Small numbers of students were more ambivalent about the use of online media and tools including discussion boards, the workload and being part of a learning community.

Conclusion: The online unit described in this research is evidence that non-traditional forms of clinical education might also address clinically important learning outcomes, provide sustainable options and alleviate some of the stresses that both tertiary providers and healthcare settings endure. However, these types of placement experiences require a paradigm shift from educators, the profession, accrediting bodies and even future students.

Purpose: The purpose of this case report is to provide a plan of care with an emphasis on patient education and consideration of emotional health for a patient with post-COVID fatigue in an outpatient setting.

Case description: A 50-year-old woman, ten-weeks post-COVID syndrome, participated in an examination that revealed deficits in exercise capacity, strength, breathing pattern, mild depression, emotional breakdown, and mild anxiety accompanied by "brain fog" with activity. Her primary complaint was fatigue with ordinary activities around her home that impeded her from returning to work. On examination, scores included six-minute walk test distance (6MWD): 79.5 m, UCSD Shortness of Breath Questionnaire (SOBQ): 72/120, and Patient Health Questionnaire (PHQ-9): 6/27. The patient participated in 20 biweekly sessions with a focus on patient education, supporting emotional health, aerobic training, strengthening exercises, breathing exercises, and home exercise program.

Outcomes: At discharge, the patient's exercise capacity, muscle strength, dyspnea, and depression improved, beyond the MCID/MID values, 6MWD: 335 m, SOBQ: 34/120; and PHQ-9 :1/27. The patient had no anxiety with activity and reported confidence to resume activities, allowing her to return to work safely.

Conclusion: Following an intervention that addressed emotional needs with physical symptoms, our patient with post-COVID fatigue showed substantial improvements in exercise capacity, muscle strength, dyspnea, and depression. This highlights the consideration of psychosocial well-being in our plan of care for this population.

Background: An extended group program called Mind and Body (MB), based on body awareness exercises and cognitive behavioral therapy (CBT), was offered to a subgroup of patients who had completed their traditional outpatient multidisciplinary rehabilitation and were motivated for further treatment.

Purpose: To explore how patients with multisite musculoskeletal pain experienced participation in the MB program with respect to usefulness, meaningfulness, behavioral changes, and transferability to daily life and work.

Method: The study is rooted in the phenomenological tradition. Individual, semi-structured interviews were performed with eight patients aged 29-56 years. The data were analyzed using systematic text condensation.

Results: Two main themes emerged: 1) New knowledge provided increased body awareness, new ways of thinking, and acceptance of one's own situation. This theme reflected how new knowledge and MB coping strategies were useful in the process of changing problematic thoughts, increasing body awareness, and facilitating acceptance; and 2) Implementing new habits and strategies in daily life revealed how demanding it was to alter behavior, a process that unfolded over time.

Conclusion: A combination of body awareness exercises and cognitive coping strategies was described as helpful in further improving function and coping with pain and stress in daily life and work.

Introduction: Studies analyzing postures and mobility of the thoracic spine in the context of cervicogenic headache are missing. Insight in these parameters is needed since the cervical and thoracic spine are biomechanically related.

Objective: To compare self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine between a cervicogenic headache-group and matched healthy control-group before and after a 30 min-laptop-task.

Methods: A non-randomized longitudinal design was used to compare thoracic postures and mobility between 18 participants with cervicogenic headache (29-51 years) and 18 matched healthy controls (26-52 years). Outcomes were: self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine evaluated in sitting with a 3D-Vicon motion analysis system.

Results: Habitual upper-thoracic postures in the cervicogenic headache-group were significantly (p = .04) less located toward the maximal range of motion for flexion compared to the control-group, self-perceived optimal upper-thoracic posture was significantly (p = .004) more extended in the cervicogenic headache-group compared to the control-group, and self-perceived optimal lower-thoracic posture could not be reestablished in the cervicogenic headache-group after the laptop-task (p = .009).

Conclusion: Thoracic postures differ between a cervicogenic headache-group and control-group. These differences were detected by expressing the habitual thoracic posture relative to its maximal range of motion, and by analyzing the possibility of repositioning the thoracic spine after a headache provoking activity. Longitudinal studies are needed to determine the contribution of these musculoskeletal dysfunctions to the pathophysiology of cervicogenic headache.

Introduction: Inter-individual variability may contribute to impaired cervicocephalic kinesthetic sensibility (CKS) in patients with nonspecific neck pain.

Objectives: To identify subgroups of participants with nonspecific neck pain based on cervical joint position errors (JPEs) and to determine potential factors associated with identified subgroups.

Methods: One hundred participants with nonspecific neck pain (unidentified pathoanatomical cause) and 50 controls were recruited. JPEs were measured in cervical extension and rotation, using a laser pointer. JPEs were expressed as absolute (AEs), constant (CEs), and variable (VEs) errors. Clinical characteristics were pain intensity, duration, disability, side of pain, dizziness, psychological features, and range of motion. All tests were performed within 1 day. A cluster analysis was conducted based on AEs. A logistic regression was used to identify factors associated with the cluster groups.

Results: Analysis divided neck pain participants into two groups: cluster 1 with greater impaired CKS (n = 36) and cluster 2 with lesser impaired CKS (n = 64). The AEs (all cervical movements) and CE (left rotation) were larger in cluster 1 than 2 (p ≤ .002). Overall, participants in clusters 1 and 2 had larger AEs, CEs, and VEs than controls (p ≤ .04). The presence of dizziness was a risk factor associated with cluster 1 (OR=2.5, p = .04). The other characteristics were not associated with the cluster groups (p ≥ .09).

Conclusion: The AEs identified two subgroups of patients with nonspecific neck pain. Participants in subgroup 1 had greater impaired CKS, and participants in subgroup 2 had lesser impaired CKS. Dizziness was a potential risk factor associated with greater impaired CKS.

Background: Social media offer opportunities for informal learning and are increasingly adopted by health professionals as learning tools. However, little is known of how new graduate physiotherapists engage with social media for learning.

Purpose: This study aimed to explore new graduate physiotherapists' perceptions and use of social media as learning tools during their transition into professional practice.

Methods: This study used a qualitative general inductive approach. New graduate physiotherapists (n = 16) were recruited through purposive snowball sampling and participated in semi-structured interviews. Data were subjected to a general inductive analytical method.

Results: Four themes were generated: 1) social media as tools for learning; 2) navigating and engaging with social media as a learner; 3) thinking critically about social media; and 4) relevance to practice.

Conclusion: New graduate physiotherapists use social media as adjunct learning tools which can be positioned within several frameworks, including the Situated Learning Theory. However, new graduates voice uncertainties regarding information credibility, the importance of critical thinking skills in navigating information, and concerns regarding blurred work-life boundaries. Recommendations are made for research to further understand social media as emerging learning tools, especially for new graduates who are experiencing insufficient workplace support.

Introduction: Cadaveric dissection shapes the ways in which healthcare students understand the human body and the attitudes, identities and behaviors they exhibit as health professionals. There is however a paucity of related research with physiotherapy (PT) students.

Purpose: The purpose of this interpretivist study was to investigate PT students' conceptions of the human body in relation to experiences with human cadavers in anatomy education.

Methods: Ten semi-structured interviews were conducted with PT students along with four optional written reflections completed. Data was thematically analyzed.

Results: Students engaged in a continuous process of habituation involving oscillation between "humanization" and "dehumanization" of cadavers in the anatomy lab. We describe the contextual mediators that shaped the process, the multi-sensory and emotional experience of the students, and the "interruptions" that contributed to the variability in their conceptions over time and contexts. Students ultimately habituated toward dehumanization which had multiple effects on learning and professionalization.

Conclusion: Study findings highlight the complexity of PT students' experiences and learning within the cadaver lab outside of the formal goals of anatomy education. We discuss the implications for anatomy curricula, including the potential advantages of incorporating a biopsychosocial approach.

Background: Concurrent Exercise Training (CET) is defined as an exercise training mode in which aerobic and resistance exercises are performed in the same session.

Objectives: The effects of CET in type 2 diabetes mellitus (T2DM) are inconclusive. Therefore, the objective of the present systematic review with a meta-analysis is to evaluate the effects of CET on metabolic markers, body composition, lipid profile, inflammation, and cardiorespiratory fitness (CRF) in people with T2DM.

Methods: Five electronic databases were searched from inception up to January 2023. The eligibility criteria included prospective studies that had T2DM participants aged between 35 and 65 years who performed CET at least 2 times/week for a minimum duration of 8 weeks with a control group.

Results: Seven studies were identified for qualitative review. Sufficient data were not available for one study, therefore, meta-analysis was performed in six studies. A significant effect was observed in glucose level (p < .01); glycated hemoglobin (p = .02); Homeostatic Model Assessment for Insulin Resistance (p = .02); body mass index (p = .02); %body fat (p < .01); %fat-free mass (p < .01); waist circumference (p = .03); triglyceride (p < .01); peak oxygen uptake (p < .01); and tumor necrotic factor -α (p < .01).

Conclusions: The CET is effective in improving metabolic markers, body composition, lipid profile, inflammation, and CRF in people with T2DM and can be included in the management of T2DM. The overall evidence for this conclusion may be influenced by bias in included studies.