Physiotherapy Theory and Practice最新文献

Background: Lower levels of patient physical activity in hospital are associated with poorer functional outcomes. Physiotherapists may influence physical activity outside of therapy time through nursing workforce training.

Objective: To estimate physical activity levels in acute inpatients after the Risk Assessment for Moving Individuals SafEly (RAISE) manual handling training intervention for nurses. The secondary aims evaluated nurse experiences of training and the extent to which nurses learnt RAISE skills and incorporated them in clinical practice.

Methods: Using a pre-post design, nurses from an acute neurological and medical ward participated in a physiotherapy-led, 4-hour training session teaching dynamic risk assessment to safely move patients. Patient physical activity and clinical observation audits of patient transfers were assessed prior to, and 1-week following, training. Surveys evaluated nurse experiences of training.

Results: Among 26 patients, there was a non-significant, moderate positive effect size favoring increased daily steps by 43% (g=.35, MD 208, 95% CI -263 to 679, p = .370). There was no change in sit-to-stand transitions (g=-.02, MD -0.4, 95% CI -16 to 15, p =.963) or daily sedentary hours (g=.05, MD 0.05, 95% CI -0.8 to 0.9, p=.908). Training was well received by all nurse participants, and the physical risk assessment was implemented into practice 89% of the time post training (X²(1) = 5.00, p = .025).

Conclusion: A physiotherapy-led manual handling training program involving dynamic risk assessment may help hospital inpatients to increase physical activity outside of therapy time.

Background: Parkinson's Disease (PD) is a neurodegenerative disease that produces balance and gait disorders. Action observation (AO) and motor imagery (MI) therapies appear to facilitate motor planning influencing balance and gait relearning.

Objective: To investigate the effectiveness of AO and MI in isolation or combined (AO-MI), compared to sham interventions for the improvement of freezing of gait (FOG), speed, physical function and balance among individuals with PD.

Methods: PubMed, Web of science, PEDro, Scopus and Cochrane Library were searched from inception to January 2024. Studies included were randomized controlled trials (RCTs). The study quality and risk of bias were assessed with PEDro scale and the Cochrane tool, respectively. The certainty of evidence was evaluated with GRADEpro GDT.

Results: Eight RCTs were included, with a methodological quality ranged from fair to high. There were statistically significant results in FOG at follow-up when comparing AO to sham intervention (SMD= -0.50, 95% CI -0.88, -0.11; I²: 0%) 3 studies, 107 participants). Interventions based on MI compared to sham intervention were statistically significant in speed at post-treatment (MD = -0.06, 95% CI -0.04, -0.08; I²: 0%) and balance at post-treatment (SMD = -0.97; 95% CI -1.79, -0.15).

Conclusions: Very low certainty of evidence was found proposing that: AO produce improvements in FOG at follow-up; and MI produce improvements in speed and balance at post-treatment.

Background: Occult scaphoid fractures are difficult to diagnose radiographically. Evidence regarding prevalence and diagnostic accuracy of clinical tests is growing; however, gaps in knowledge remain and further research is needed.

Purpose: This study aimed to determine the prevalence of occult scaphoid fractures and other hand/wrist fractures, plus any clinical/demographic findings diagnostic of scaphoid fractures.

Methods: Prognostic prospective cohort study. Patients referred with diagnosis of occult scaphoid fractures, non-diagnostic radiographs, and one or more positive provocative test for scaphoid fractures were included. Clinical data were compared to reduce sequence magnetic resonance imaging. Univariate logistic regression was used to determine significance. Multivariable logistic regression was used to determine the effect size of these variables.

Results: Of 197 included participants, 43(22%) had a scaphoid fracture and 59(30%) had an occult fracture other than scaphoid. Average age of patients with confirmed occult scaphoid fractures was 22 years old. Distal pole fractures were the most common scaphoid fracture (n = 28/65.1%, average age 16.9 years). Three clinical tests (pain with ulnar-deviation, anatomical snuffbox swelling and pain-free grip) plus two demographics (age <23 and male) resulted in accuracy of 81.7%, positive predictive value of 73.3%, and negative predictive value of 82.4% in diagnosing scaphoid fractures.

Conclusion: This study confirms a high prevalence of occult fractures in our population. Patients demonstrating the relevant demographics and positive clinical tests may be appropriate to treat as scaphoid fractures without advanced imaging. Most patients will present with differing clinical findings and/or demographics, and routine use of magnetic resonance imaging is recommended.

Background: The Activities-specific Balance Confidence Scale was developed for testing the balance confidence of elderly individuals, and it has been used extensively for evaluating various patients. No such scale has been adapted for the Hungarian population.

Objective: To translate and culturally adapt the Activities-specific Balance Confidence Scale and test the reliability and validity of the Hungarian version.

Methods: The study included 167 independently mobile subjects, of whom 39 filled in the questionnaire twice, 1 week apart. Beaton's six-step principle was applied for cross-cultural adaptation. Reliability was assessed by internal consistency measured by Cronbach's alpha and through test-retest analysis. Types of validity evaluated were concurrent validity using the Berg Balance Scale and cross-cultural validity.

Results: Excellent internal consistency was shown by Cronbach's alpha = 0.977. Test-retest analysis resulted in an Intra-Class Correlation Coefficient of 0.962 (0.865-0.961, 95% CI, p < .001) for the whole test; no floor or ceiling effects were found. The convergent validity of the scale was tested by Spearman's rank correlation analysis using the Berg Balance scale for external validation and showed a strong positive correlation (Rho = 0.755, p < .001). Receiver Operating Characteristic curve analysis showed an Area Under the Curve of 0.821 (CI 95% 0.75, 0.892). Mean detectable change based on the 95% confidence interval was 10.49% on the scale ranging from 0 to 100%.

Conclusions: The Hungarian version of the Activities-Specific Balance Confidence Scale provides a valid and reliable picture of the patients' self-assessed balance. It is recommended both for clinicians and for clinical studies.

Introduction: The aim of direct access (DA) physiotherapy practice in Finland is the treatment of musculoskeletal (MSK) conditions by physiotherapists who have completed continuing DA education. It is difficult to pinpoint the competencies of DA physiotherapists as their roles and scope of practice varies.

Purpose: The present study aimed to explore the competencies and education of DA physiotherapists through the perceptions of DA educators.

Methods: Data were collected through individual semi-structured interviews of eleven Finnish physiotherapy educators who described their perceptions of DA physiotherapists' competencies and their continuing DA education. The interviews were recorded and transcribed verbatim and then examined using a reflexive thematic analysis.

Results: Two main themes were formulated on the basis of the data, conveying the educators' perceptions. The first theme, Interaction as grounds for meaningful clinical reasoning, had two subthemes: Meaningful encounter and Rationally and safely locating the core of the client's problem. The second theme, Continuing professional development in an expert role, had four subthemes: Continuous learning, Self-reflection, Deep understanding and Taking responsibility for one's own expertise.

Conclusion: The present study revealed how DA educators perceive the competencies of DA physiotherapists. The findings highlight the perceived significance of the physiotherapists' interaction with the client as a ground for meaningful clinical reasoning, and their responsibility for their own continuing professional self-development.