Physiotherapy Theory and Practice最新文献

Introduction: Ultrasound guided-percutaneous electrical nerve stimulation appears to be effective in the treatment of chronic musculoskeletal pain.

Objective: To investigate the immediate effects of one session of percutaneous electrical nerve stimulation on the radial nerve in patients with lateral elbow pain.

Methods: A randomized clinical trial was conducted. Sixty patients with chronic lateral elbow pain were allocated into real-percutaneous electrical nerve stimulation (n = 30) or sham-percutaneous electrical nerve stimulation (n = 30) where the patients received one-single session of the real or sham percutaneous stimulation on the radial nerve, respectively. Pressure pain thresholds, pain intensity, pain-free grip strength, and the self-perceived improvement were evaluated after the intervention.

Results: Significant differences between groups for pain intensity (-11.55, 95% CI -21.79 to -1.30, p < .028), but not for pressure pain threshold or pain-free grip strength, were found. Patients receiving real-percutaneous stimulation had significant improvement in pain-free grip strength on the treated side. The proportion of individuals reporting moderate to large self-perceived improvement (≥4) was significantly higher (p = .026) after real-percutaneous stimulation than after sham-percutaneous stimulation.

Conclusion: A single session of real-percutaneous electrical nerve stimulation targeting the radial nerve in subjects with lateral elbow pain decreased pain intensity between groups and increased pain-free grip strength on the treated side but not between groups.

Objective: Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy.

Methods: A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach.

Results: The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm.

Conclusions: The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction.

Background: The Mini-BESTest (Balance Evaluation Systems Test) is a standardized balance evaluation tool. The psychometric properties of the Mini-BESTest are being established around the world.

Purpose: This study aimed to evaluate the reliability and validity of the Icelandic translation of the Mini-BESTest.

Methods: Thirty rehabilitation inpatients (16/14 women/men), with mixed diagnoses and a range of self-assessed balance, were assessed with the: Mini-BESTest on two occasions; Activities-specific Balance Confidence Scale; Berg Balance Scale; Timed Up and Go test; and 10 Meter Walk Test. Statistical analyses included the Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM), Cronbach's alpha (α), Pearson's r, and the independent t-test.

Results: Relative reliability demonstrated good test-retest (ICC_3.1 = 0.84), intra-rater reliability (ICC_3.1 = 0.86), and excellent inter-rater reliability (ICC_2.1 = 0.96). Absolute reliability (SEM) was 1.607, and internal consistency (α) was 0.80. Construct validity was supported by a high correlation between the Mini-BESTest and other standardized measures (r =  ±0.6-0.73). The Mini-BESTest discriminated between patients with poor versus good self-rated balance (p ˂ 0.001), with no floor or ceiling effects.

Conclusion: The psychometric properties of the Icelandic translation of the Mini-BESTest are comparable with the original version and other translations. These results for this mixed patient group should be relevant to clinicians and researchers internationally.

Background: Elderly patients under invasive mechanical ventilation (IMV) are more susceptible to muscle weakness. In the out-of-hospital environment, there are benefits to transcutaneous electrical diaphragmatic stimulation (TEDS), which is an easy-to-apply and low-cost technique.

Objective: To evaluate the effect of TEDS on respiratory muscle strength, diaphragm thickness (DT), and IMV time in critically ill elderly patients.

Methods: This was a randomized controlled trial in which patients were divided into an experimental group (EG) and a control group (CG). TEDS started 24 h after orotracheal intubation and lasted until the end of weaning. Both groups underwent the following assessments during the spontaneous breathing test after weaning from mechanical ventilation (MV): measurement of respiratory muscle strength by pressure gauge, analysis of DT by lung ultrasound, and extubation failure prevention checklist.

Results: There were 23 participants in the EG and 21 in the CG. The median age was 66 (60-79) years. The mean values of the diaphragmatic thickening index in the EG and CG participants were 99.13 ± 26.75 and 66.88 ± 31.77, respectively (p = .001, Cohen's d = 1.094). The mean values of maximum inspiratory pressure in the EG and CG were 22.04 ± 3.41 and 19.34 ± 4.23 cmH₂O, respectively (p = .005, Cohen's d = 0.698). The Tobin index and the integrative weaning index were similar between groups (p = .584 and p = .102, respectively). The duration of MV in the EG and CG was 6.28 ± 2.68 and 9.21 ± 2.76 days, respectively (p = .001, Cohen's d = -1.075).

Conclusion: Critically ill elderly patients receiving TEDS had shorter MV time, greater inspiratory muscle strength, and greater diaphragmatic contraction capacity according to their thickness fraction.

Background: Despite efforts to support physiotherapists in integrating psychosocial aspects of care to biological ones, clinical practice remains dominated by biomechanistic priorities. To facilitate change, attention and actions need to consider not only the individual level of the therapists but also the cultural and structural levels of the profession. How these multi-layered social dynamics shape practice have not previously been investigated. The Social Identity Approach (SIA) provides a relevant framework to this exploration.

Aim: This study aimed to identify the social identity processes involved in the development of psychologically-informed physiotherapy (PIP) to understand how they may influence practice change.

Methods: Nine semi-structured interviews were conducted with self-identified psychologically-informed physiotherapists. A Reflexive Thematic Analysis informed by SIA principles enabled to consider meaning as the product of social processes.

Findings: The analysis of participants' experiences in moving from a primarily biomechanistic practice toward the integration of psychosocial aspects of health demonstrated: 1) a transformative "mind-blowing" identity journey; 2) a journey that is not made in isolation; and 3) where leadership matters.

Conclusion: Changes in clinical practice involve dynamics at the collective level of the practice environment and of the physiotherapy profession itself, rather than solely at the individual level of clinicians. An understanding of these complex social processes at a managerial level could be important to better support leaders and clinicians in implementing PIP in clinical practice.

Background: Digital health technology is progressively transforming physiotherapy practice. Despite a maturing body of literature relating to physiotherapy digital health capability, research examining digital health physiotherapy competency standards is both lacking and lagging.

Objective: Examine international professional practice competency standards for physiotherapists to identify themes common to digital health practice competency, published by international peak organizations governing physiotherapy practice.

Methods: Systematic meta-synthesis of international peak organization physiotherapy practice competency standards. The study was undertaken over nine stages. Competency statements related to digital health were extracted, and further coded into resultant themes.

Results: Eleven documents were analyzed. Fifty-two statements explicitly referenced digital health competency. Identified themes were as follows: 1) digital health data governance; 2) digital health data translation; and 3) digital health technologies. Where digital health-related competency statements do exist, they are skewed toward health information management activities.

Conclusions: Digital health practice is currently under-represented in competency standards for physiotherapists. Workforce advancement in light of the burgeoning impact of digital health will prompt further updates to professional competency standards set by our peak organizations. This will have a flow on effect, whereby education providers (e.g. universities and other professional development providers) should consider curriculum and training that prepares individuals for digitally enabled practice.

Background: Patellofemoral pain and patellofemoral osteoarthritis are highly prevalent knee disorders associated with pain and functional limitations. The subscale of the Knee Injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF) was developed to evaluate patients with patellofemoral pain and osteoarthritis.

Purpose: This study aims to translate the KOOS-PF into Turkish and assess its measurement properties.

Methods: The Turkish version of the KOOS-PF was tested for reliability and validity in a convenience sample of 55 patients with patellofemoral pain and/or osteoarthritis. Reliability analyses were conducted through a retest 7-14 days later with a subgroup of 35 patients. The KOOS-PF was compared with Kujala's Anterior Pain Scale (AKPS) and the Short Form-36 health survey (SF-36) to assess construct validity. Additionally, responsiveness analyses were performed on 29 patients who were followed up with a home-based exercise program three months later.

Results: The Turkish version of KOOS-PF has high test-retest reliability (ICC_2,1 = 0.96) and internal consistency (Cronbach's α = 0.91). It has a very good correlation with the AKPS (r = 0.77) and the SF-36 physical component summary (r = 0.64) with no floor or ceiling effects. Responsiveness is confirmed by a good correlation with the global rating of change score (r = 0.51). The minimal clinically important change is 16.5 points, and the minimal important difference is 10.2.

Conclusion: The Turkish version of the KOOS-PF is valid, reliable, and responsive for evaluating patients with patellofemoral pain and/or osteoarthritis.

Background: Patellofemoral pain (PFP) is a common multifactorial condition in young and physically active people.

Objective: The occurrence of central sensitization may play an important role in sensory disturbance. This study was designed to investigate, in patients with chronic PFP, the presence of disturbances in tactile acuity with central sensitization.

Methods: Thirty patients with chronic PFP and 30 matched healthy controls entered this cross-sectional study. Graphesthesia (numerical score), two-point discrimination (mm), and point-to-point sensation (mm) were assessed in all participants.

Results: The results of between-group comparisons showed that there were significant differences between the involved knee in patients with chronic PFP and healthy participants in graphesthesia (median = 13 [case], 19 [control]; p < .001), two-point discrimination (median = 25.8 [case], 20.3 [control]; p < .001), and point-to-point sensation (median = 14.5 [case], 6.2 [control]; p < .001). There was also a significant difference in graphesthesia between the non-involved knee in patients with chronic PFP and healthy participants (median = 17 [case], 19 [control]; p = .003). The results of within-group comparisons revealed a significant difference in graphesthesia, two-point discrimination, and point-to-point sensation between the involved and non-involved knee in patients with chronic PFP (p < .001). Moreover, there was a positive correlation between two-point discrimination and pain in patients with chronic PFP (r = 0.446, p = .014).

Conclusion: The findings of this study reveal that there is a sensory deficit in patients with chronic PFP. Because sensory information is necessary for motor control and pain perception, we can assume that clinical symptoms in these patients are related to sensory deficits.

Background: Physiotherapists who will practice in direct access model of care must acquire the required competencies to ensure adequate and safe patient care. There is no set of required competencies for French physiotherapists.

Objective: To develop a consensus on a minimum set of competencies that French physiotherapists should acquire to practice in direct access to primary care with patients with musculoskeletal disorders.

Methods: The survey was conducted by 1) definition of an initial set of competencies based on a scoping review up to September 2021, 2) implementation of a two-round Delphi survey from October 2021 to January 2022 to obtain consensus on the domains and competencies required in the French context, and 3) consultation at group meeting on February 2022 to finalize and validate the final set of competencies.

Results: Five domains and 52 competencies were identified from the scoping review. Twenty health-care professionals' experts (i.e. family physicians, emergency physicians, and physiotherapists) and two health-care users took part in the Delphi survey. A consensus was reached on 27 required competencies grouped within five domains.

Conclusion: A consensus-based, contemporary set of competencies required for direct access practice with patients with musculoskeletal disorders has been identified that may contribute to the update of entry-level and lifelong learning curricula for French physiotherapists.

Introduction: The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP.

Purpose: The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP.

Methods: Focus group interviews were conducted with physiotherapists in 2018-2019, 14-18 months after the introduction of the BetterBack MoC. Data were analyzed using qualitative content analysis.

Results: Five focus group interviews with 23 (15 female and 8 male) physiotherapists, age range 24-61 years were analyzed. A supportive organization and adaptation to the local culture, combined with health care professionals' attitudes and collaboration between physiotherapists emerged as important factors for a successful implementation and for long-term sustainability of the MoC. Physiotherapists had differing opinions if the implementation led to change in clinical practice. Improved confidence in how to manage patients with LBP was expressed by physiotherapists.

Conclusions: Several barriers and facilitators influence the implementation of a best practice physiotherapy MoC for LBP in primary care, which need to be considered in future implementation and sustainability processes.