Pub Date : 2024-08-22DOI: 10.1016/j.physio.2024.101422
Catherine J. Minns Lowe , Jack Rose , Susan Roscoe , Nicola Heneghan
Pre-registration student placements have traditionally been based in clinical settings. Recently, practice-based learning has evolved to include additional settings, including research, leadership and management. The KNOWBEST (Knowledge, Behaviours And Skills Required of the Modern Physiotherapy Graduate) project incorporated research placements for five pre-registration students. The aims of this project were to develop, implement and evaluate research placements within a UK pre-registration physiotherapy program, to add to the limited information available for HEI and supervisors. The paper includes placement content, reflections and evaluations from the perspective of the students, supervisors and Practice Team Lead. Students and staff were highly positive about research placements. Student’s spoke of the importance of their immersive experience on placement, valuing the variety of learning experiences, opportunities to lead and the development of transferable skills. Students found that research and clinical placements, whilst different, were also similar in important ways. Students appreciated how research placements developed their abilities to provide evidence-based practice as clinicians. This paper does not provide definitive placement guidance, it provides information gleaned from direct experience for teams planning research placements. It identifies and reports areas the team found challenging, to facilitate discussion and debate as the profession actively diversifies and expands practice-based learning.
{"title":"Pre-registration student research placements within KNOWBEST: a service evaluation","authors":"Catherine J. Minns Lowe , Jack Rose , Susan Roscoe , Nicola Heneghan","doi":"10.1016/j.physio.2024.101422","DOIUrl":"10.1016/j.physio.2024.101422","url":null,"abstract":"<div><div>Pre-registration student placements have traditionally been based in clinical settings. Recently, practice-based learning has evolved to include additional settings, including research, leadership and management. The KNOWBEST (Knowledge, Behaviours And Skills Required of the Modern Physiotherapy Graduate) project incorporated research placements for five pre-registration students. The aims of this project were to develop, implement and evaluate research placements within a UK pre-registration physiotherapy program, to add to the limited information available for HEI and supervisors. The paper includes placement content, reflections and evaluations from the perspective of the students, supervisors and Practice Team Lead. Students and staff were highly positive about research placements. Student’s spoke of the importance of their immersive experience on placement, valuing the variety of learning experiences, opportunities to lead and the development of transferable skills. Students found that research and clinical placements, whilst different, were also similar in important ways. Students appreciated how research placements developed their abilities to provide evidence-based practice as clinicians. This paper does not provide definitive placement guidance, it provides information gleaned from direct experience for teams planning research placements. It identifies and reports areas the team found challenging, to facilitate discussion and debate as the profession actively diversifies and expands practice-based learning.</div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"126 ","pages":"Article 101422"},"PeriodicalIF":3.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1016/j.physio.2024.101425
André Pontes-Silva
{"title":"Is aquatic therapy more effective than land-based therapy for fibromyalgia? A randomised controlled trial discussion","authors":"André Pontes-Silva","doi":"10.1016/j.physio.2024.101425","DOIUrl":"https://doi.org/10.1016/j.physio.2024.101425","url":null,"abstract":"","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"399 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1016/j.physio.2024.101424
Ron Feldman , Tamar Pincus , Noa Ben Ami
<div><h3>Objective</h3><div>The Enhanced Transtheoretical Model Intervention (ETMI) is based on behavioral models and focuses on guiding Chronic Low Back Pain (CLBP) patients to self-manage symptoms and engage in recreational physical activity. While there is promising evidence that ETMI benefits patients, it is unclear how challenging it might be to implement widely. This investigation focused on the perceptions of physiotherapists trained to deliver ETMI for CLBP.</div></div><div><h3>Design</h3><div>A Qualitative study comprised of semi-structured interviews (July to November 2023). Interviews were audio-recorded, transcribed, coded, and analyzed thematically by two independent researchers.</div></div><div><h3>Setting</h3><div>Data were obtained as part of a large implementation study evaluating the uptake and impact of ETMI amongst physiotherapists in a large public healthcare setting.</div></div><div><h3>Participants</h3><div>22 physiotherapists trained to deliver the ETMI approach and chose to use it with at least one patient.</div></div><div><h3>Results</h3><div>While physiotherapists acknowledged the evidence base behind ETMI and the clarity of the approach, they struggled to adapt it to routine delivery. Exploration of the reasons for this identified an overarching meta-theme, ‘A challenge to my professional identity’, and three main themes consisting of 1) interventions such as ETMI contradicted my training. 2) I am ambivalent/ do not accept evidence that contradicts my habitual practice, and 3) I am under-skilled in psychological and communication skills.</div></div><div><h3>Conclusion</h3><div>This study highlights the reluctance of physiotherapists to implement evidence-based interventions such as ETMI, which fundamentally challenge their traditional practice and therapeutic identity. The shift from over-management by experts seeking cures to supporting self-management was not palatable to physiotherapists. The challenge of embracing a new professional identity must be addressed to enable a successful implementation of the approach.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>This study highlights the reluctance of physiotherapists to implement evidence-based interventions such as ETMI, which fundamentally challenge their traditional practice and therapeutic identity.</div></span></li><li><span>•</span><span><div>The shift from overdiagnosis (weak cores, bad postures, unstable back, or disc sliding) and over-management (specific exercises, modalities, or special techniques) by experts seeking cures to support self-management was not palatable to physiotherapists.</div></span></li><li><span>•</span><span><div>The findings could lead to a reevaluation of professional development programs for physiotherapists, with an emphasis on updating skills and knowledge to align with evidence-based practices, ultimately aiming to enhance the quality of care provided to patients.</div></span></li></ul></di
{"title":"‘A challenge to my professional identity’- resisting the shift from over-management to self-management for back pain within an implementation trial: a qualitative study","authors":"Ron Feldman , Tamar Pincus , Noa Ben Ami","doi":"10.1016/j.physio.2024.101424","DOIUrl":"10.1016/j.physio.2024.101424","url":null,"abstract":"<div><h3>Objective</h3><div>The Enhanced Transtheoretical Model Intervention (ETMI) is based on behavioral models and focuses on guiding Chronic Low Back Pain (CLBP) patients to self-manage symptoms and engage in recreational physical activity. While there is promising evidence that ETMI benefits patients, it is unclear how challenging it might be to implement widely. This investigation focused on the perceptions of physiotherapists trained to deliver ETMI for CLBP.</div></div><div><h3>Design</h3><div>A Qualitative study comprised of semi-structured interviews (July to November 2023). Interviews were audio-recorded, transcribed, coded, and analyzed thematically by two independent researchers.</div></div><div><h3>Setting</h3><div>Data were obtained as part of a large implementation study evaluating the uptake and impact of ETMI amongst physiotherapists in a large public healthcare setting.</div></div><div><h3>Participants</h3><div>22 physiotherapists trained to deliver the ETMI approach and chose to use it with at least one patient.</div></div><div><h3>Results</h3><div>While physiotherapists acknowledged the evidence base behind ETMI and the clarity of the approach, they struggled to adapt it to routine delivery. Exploration of the reasons for this identified an overarching meta-theme, ‘A challenge to my professional identity’, and three main themes consisting of 1) interventions such as ETMI contradicted my training. 2) I am ambivalent/ do not accept evidence that contradicts my habitual practice, and 3) I am under-skilled in psychological and communication skills.</div></div><div><h3>Conclusion</h3><div>This study highlights the reluctance of physiotherapists to implement evidence-based interventions such as ETMI, which fundamentally challenge their traditional practice and therapeutic identity. The shift from over-management by experts seeking cures to supporting self-management was not palatable to physiotherapists. The challenge of embracing a new professional identity must be addressed to enable a successful implementation of the approach.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>This study highlights the reluctance of physiotherapists to implement evidence-based interventions such as ETMI, which fundamentally challenge their traditional practice and therapeutic identity.</div></span></li><li><span>•</span><span><div>The shift from overdiagnosis (weak cores, bad postures, unstable back, or disc sliding) and over-management (specific exercises, modalities, or special techniques) by experts seeking cures to support self-management was not palatable to physiotherapists.</div></span></li><li><span>•</span><span><div>The findings could lead to a reevaluation of professional development programs for physiotherapists, with an emphasis on updating skills and knowledge to align with evidence-based practices, ultimately aiming to enhance the quality of care provided to patients.</div></span></li></ul></di","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"125 ","pages":"Article 101424"},"PeriodicalIF":3.1,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1016/j.physio.2024.101423
Joyce M.C.V. O’ Riordan , Ruth McCullagh , Paul J. Murphy , Grainne Sheill , Frances Horgan , Helen P. French
Objective
To synthesise available evidence on the effects of a prescribed exercise programme in People with Metastatic Breast Cancer (PwMBC).
Data sources
Medline, Embase, CINAHL, Web of Science and Scopus were searched up to January 2024.
Study selection
Randomised controlled trials (RCTs) recruiting PwMBC to an exercise intervention were included. The primary outcome was Quality of Life (QOL). Secondary outcomes included physical performance, muscle health, cancer-related fatigue (CRF) and physical activity (PA).
Study appraisal and synthesis methods
Meta-analysis was not possible due to the low number of included studies. We calculated the effect size (ES), with 95% confidence intervals (95% CIs) of individual studies, adjusting for small sample size. Cohen’s criteria for small (0.2 to 0.5), moderate (0.5 to 0.8) and large (>0.8) describe the size of the effect. Risk of bias (ROB) was assessed using the Cochrane (ROB) version 1 tool.
Results
Three RCTs (n = 149 PwMBC) were included. Results showed no significant between-group effects in the primary outcome, QOL. Whilst effects in favour of prescribed exercise were observed in CRF (ES 1.3, 95% CI 0.06 to 2.35) and PA (ES 0.83, 95% CI 0.14 to 1.42) in two separate studies, as the lower bound of the 95% CI did not reach Cohen’s threshold, there is considerable uncertainty regarding the treatment effect.
Conclusions
There is currently insufficient evidence to support the use of prescribed exercise to improve QOL, physical performance, muscle health, CRF and PA in PwMBC. Further high-quality trials are required to investigate the effectiveness of exercise interventions in PwMBC.
Systematic Review Registration Number
PROSPERO CRD42022304528.
Contribution of the Paper
•
Despite guidelines and recommendations on the positive role of exercise, the evidence for prescribed exercise programmes for PwMBC is limited.
•
This systematic review of three trials found insufficient evidence to support the use of prescribed exercise to improve QOL, physical performance, muscle health, CRF and PA in PwMBC.
•
Further high-quality, adequately powered trials are required to investigate the effectiveness of exercise interventions on QOL, CRF, PA, physical performance and muscle health in PwMBC.
数据来源Medline、Embase、CINAHL、Web of Science 和 Scopus，检索时间截至 2024 年 1 月。研究选择纳入了招募转移性乳腺癌患者参加运动干预的随机对照试验（RCT）。主要结果为生活质量（QOL）。研究评估和综合方法由于纳入的研究数量较少，因此无法进行荟萃分析。我们计算了各项研究的效应大小（ES）和 95% 置信区间（95% CI），并对小样本量进行了调整。科恩标准中的小效应（0.2 至 0.5）、中效应（0.5 至 0.8）和大效应（0.8）描述了效应的大小。使用 Cochrane (ROB) 第 1 版工具评估了偏倚风险 (ROB)。结果显示，在主要结果 QOL 方面，组间效应不明显。虽然在两项单独的研究中观察到处方运动在 CRF（ES 1.3，95% CI 0.06 至 2.35）和 PA（ES 0.83，95% CI 0.14 至 1.42）方面的效果，但由于 95% CI 的下限未达到 Cohen 临界值，因此治疗效果存在相当大的不确定性。结论目前没有足够的证据支持使用处方运动来改善 PwMBC 的 QOL、身体表现、肌肉健康、CRF 和 PA。系统综述注册号PROSPERO CRD42022304528.Contribution of the Paper--尽管指南和建议都指出了运动的积极作用，但针对男性和女性乳腺癌患者的处方运动计划证据有限。-本文对三项试验进行了系统性回顾，发现没有足够的证据支持使用处方运动来改善男性和女性残疾人的 QOL、身体表现、肌肉健康、CRF 和 PA。
{"title":"The effects of a prescribed exercise programme in people with metastatic breast cancer: a systematic review","authors":"Joyce M.C.V. O’ Riordan , Ruth McCullagh , Paul J. Murphy , Grainne Sheill , Frances Horgan , Helen P. French","doi":"10.1016/j.physio.2024.101423","DOIUrl":"10.1016/j.physio.2024.101423","url":null,"abstract":"<div><h3>Objective</h3><div>To synthesise available evidence on the effects of a prescribed exercise programme in People with Metastatic Breast Cancer (PwMBC).</div></div><div><h3>Data sources</h3><div>Medline, Embase, CINAHL, Web of Science and Scopus were searched up to January 2024.</div></div><div><h3>Study selection</h3><div>Randomised controlled trials (RCTs) recruiting PwMBC to an exercise intervention were included. The primary outcome was Quality of Life (QOL). Secondary outcomes included physical performance, muscle health, cancer-related fatigue (CRF) and physical activity (PA).</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Meta-analysis was not possible due to the low number of included studies. We calculated the effect size (ES), with 95% confidence intervals (95% CIs) of individual studies, adjusting for small sample size. Cohen’s criteria for small (0.2 to 0.5), moderate (0.5 to 0.8) and large (>0.8) describe the size of the effect. Risk of bias (ROB) was assessed using the Cochrane (ROB) version 1 tool.</div></div><div><h3>Results</h3><div>Three RCTs (<em>n</em> = 149 PwMBC) were included. Results showed no significant between-group effects in the primary outcome, QOL. Whilst effects in favour of prescribed exercise were observed in CRF (ES 1.3, 95% CI 0.06 to 2.35) and PA (ES 0.83, 95% CI 0.14 to 1.42) in two separate studies, as the lower bound of the 95% CI did not reach Cohen’s threshold, there is considerable uncertainty regarding the treatment effect.</div></div><div><h3>Conclusions</h3><div>There is currently insufficient evidence to support the use of prescribed exercise to improve QOL, physical performance, muscle health, CRF and PA in PwMBC. Further high-quality trials are required to investigate the effectiveness of exercise interventions in PwMBC.</div></div><div><h3>Systematic Review Registration Number</h3><div>PROSPERO CRD42022304528.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>Despite guidelines and recommendations on the positive role of exercise, the evidence for prescribed exercise programmes for PwMBC is limited.</div></span></li><li><span>•</span><span><div>This systematic review of three trials found insufficient evidence to support the use of prescribed exercise to improve QOL, physical performance, muscle health, CRF and PA in PwMBC.</div></span></li><li><span>•</span><span><div>Further high-quality, adequately powered trials are required to investigate the effectiveness of exercise interventions on QOL, CRF, PA, physical performance and muscle health in PwMBC.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"125 ","pages":"Article 101423"},"PeriodicalIF":3.1,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.physio.2024.101421
Catherine J. Minns Lowe, Ben Clements, Nicola Heneghan, Karen Atkinson, Reena Patel, Karen Beeton
{"title":"Content analysis of current role/job descriptors for Band 5/junior physiotherapists and mapping of these to Physiotherapy Professional standards of practice","authors":"Catherine J. Minns Lowe, Ben Clements, Nicola Heneghan, Karen Atkinson, Reena Patel, Karen Beeton","doi":"10.1016/j.physio.2024.101421","DOIUrl":"https://doi.org/10.1016/j.physio.2024.101421","url":null,"abstract":"","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"2 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.physio.2024.101419
Caroline Soares de Paula , Gabrielle Donlevy , Juliana Cardoso , Kayla M.D. Cornett , Rachel Kennedy , Eppie M. Yiu , Ana Claudia Mattiello-Sverzut , Joshua Burns
Background
Implementing scientific knowledge in clinical practice is a challenge. In this context, the effective dissemination of scientific findings is of utmost importance.
Objective
The aim of this study was to develop a Practice Brief in Portuguese, Spanish and English based on a previously published Clinical Practice Guideline to promote safe and effective exercise for children and young people with Charcot-Marie-Tooth disease and related neuropathies (CMT).
Methods
The Practice Brief was developed by eight health professionals from Brazil and Australia with English, Portuguese, and Spanish translations. The target audience chosen were the medical and allied health professionals involved in the rehabilitation of paediatric CMT. The content was based on the world first “Clinical Practice Guideline for the management of paediatric Charcot-Marie-Tooth disease” [1]. The layout of the Practice Brief was designed according to the criteria for the development of educational materials. The disclosure plan for the Practice Brief involves its publication on University and Hospital websites, www.ClinicalOutcomeMeasures.org and through social media platforms such as ResearchGate, Instagram, Facebook and Twitter, as well as in print format for CMT patient care centres.
Results
The English, Portuguese and Spanish versions of the Practice Brief is organised into six sections about assessment, exercise and physical rehabilitation, of which one is focused on progressive resistance exercises for the foot dorsiflexor muscles.
Conclusion
We developed a Practice Brief in three languages (English, Portuguese and Spanish), synthesising the main recommendations for exercise and related rehabilitative therapies for paediatric CMT from a published clinical guideline.
{"title":"Translating a Clinical Practice Guideline to a Portuguese, Spanish and English Practice Brief to promote exercise therapy for paediatric Charcot-Marie-Tooth disease","authors":"Caroline Soares de Paula , Gabrielle Donlevy , Juliana Cardoso , Kayla M.D. Cornett , Rachel Kennedy , Eppie M. Yiu , Ana Claudia Mattiello-Sverzut , Joshua Burns","doi":"10.1016/j.physio.2024.101419","DOIUrl":"10.1016/j.physio.2024.101419","url":null,"abstract":"<div><h3>Background</h3><div>Implementing scientific knowledge in clinical practice is a challenge. In this context, the effective dissemination of scientific findings is of utmost importance.</div></div><div><h3>Objective</h3><div>The aim of this study was to develop a Practice Brief in Portuguese, Spanish and English based on a previously published Clinical Practice Guideline to promote safe and effective exercise for children and young people with Charcot-Marie-Tooth disease and related neuropathies (CMT).</div></div><div><h3>Methods</h3><div>The Practice Brief was developed by eight health professionals from Brazil and Australia with English, Portuguese, and Spanish translations. The target audience chosen were the medical and allied health professionals involved in the rehabilitation of paediatric CMT. The content was based on the world first “Clinical Practice Guideline for the management of paediatric Charcot-Marie-Tooth disease” <span><span>[1]</span></span>. The layout of the Practice Brief was designed according to the criteria for the development of educational materials. The disclosure plan for the Practice Brief involves its publication on University and Hospital websites, <span><span>www.ClinicalOutcomeMeasures.org</span><svg><path></path></svg></span> and through social media platforms such as ResearchGate, Instagram, Facebook and Twitter, as well as in print format for CMT patient care centres.</div></div><div><h3>Results</h3><div>The English, Portuguese and Spanish versions of the Practice Brief is organised into six sections about assessment, exercise and physical rehabilitation, of which one is focused on progressive resistance exercises for the foot dorsiflexor muscles.</div></div><div><h3>Conclusion</h3><div>We developed a Practice Brief in three languages (English, Portuguese and Spanish), synthesising the main recommendations for exercise and related rehabilitative therapies for paediatric CMT from a published clinical guideline.</div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"125 ","pages":"Article 101419"},"PeriodicalIF":3.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.physio.2024.101420
Lijiang Luan , Dominic Orth , Phillip Newman , Roger Adams , Doa El-Ansary , Jia Han
Objective
To determine if individuals with chronic ankle instability (CAI) demonstrate altered lower extremity kinematics and kinetics during walking.
Data sources
Relevant studies were sourced from PubMed, Embase, Cochrane Library, Web of Science, EBSCO and PEDro.
Study selection
Kinematic and kinetic studies involving joint angle and/or joint moment measured in individuals with CAI were included.
Study appraisal and synthesis methods
The Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool was used to assess literature quality. Weighted mean differences (WMDs) in joint angles and moments between CAI and controls were analyzed as continuous variables.
Results
1261 articles were screened, with a final selection of 13 studies involving 729 participants. Compared to non-CAI controls, CAI participants showed significantly greater ankle inversion angle (degree) (WMD: 3.71, 95% CI: 3.15 to 4.27, p < 0.001), hip adduction angle (degree) (WMD: 1.60, 95% CI: 0.09 to 3.11, p = 0.04), and knee valgus moment (N m/kg) (WMD: 0.07, 95% CI: 0.01 to 0.13, p = 0.02) during walking. Additionally, there were no consistent findings or specific altered patterns in other lower extremity joint angles, or moment changes, regardless of the motion plane (sagittal, coronal, horizontal), for CAI compared with controls.
Conclusions
This review provides further evidence of altered lower limb kinematics and kinetics in the frontal plane in CAI participants during certain walking phases, which may partially explain the high level of recurrent ankle sprains observed in the CAI population, and support hip abduction and ankle eversion motor control exercises for CAI rehabilitation.
Systematic Review Registration Number
Systematic Review Registration Number PROSPERO CRD42023420418.
Contribution of the Paper
•
Individuals with CAI exhibit greater ankle inversion and hip adduction angles during certain phases of walking compared to non-CAI controls.
•
There may be an increase in the knee valgus moment of individuals with CAI.
•
Altered lower extremity kinematics and kinetics may be associated with the occurrence of recurrent ankle sprains in CAI.
数据来源相关研究来自 PubMed、Embase、Cochrane 图书馆、Web of Science、EBSCO 和 PEDro。研究选择纳入涉及 CAI 患者关节角度和/或关节力矩测量的运动学和动力学研究。结果筛选了1261篇文章，最终选出了13项研究，涉及729名参与者。与非 CAI 对照组相比，CAI 参与者在行走过程中的踝关节内翻角（度）（WMD：3.71，95% CI：3.15 至 4.27，p <0.001）、髋关节内收角（度）（WMD：1.60，95% CI：0.09 至 3.11，p = 0.04）和膝关节外翻力矩（N m/kg）（WMD：0.07，95% CI：0.01 至 0.13，p = 0.02）均明显增大。此外，与对照组相比，无论在哪个运动平面（矢状面、冠状面、水平面），CAI 患者的其他下肢关节角度或力矩变化都没有一致的发现或特定的改变模式。结论本综述进一步证明，CAI 参与者在某些步行阶段的前方平面上的下肢运动学和动力学发生了改变，这可能部分解释了在 CAI 群体中观察到的高复发性踝关节扭伤，并支持在 CAI 康复中进行髋关节外展和踝关节外翻运动控制练习。系统综述注册号系统综述注册号PROSPERO CRD42023420418.论文贡献-与非CAI对照组相比，CAI患者在行走的某些阶段表现出更大的踝关节内翻和髋关节外展角度。
{"title":"Do individuals with ankle instability show altered lower extremity kinematics and kinetics during walking? A systematic review and meta-analysis","authors":"Lijiang Luan , Dominic Orth , Phillip Newman , Roger Adams , Doa El-Ansary , Jia Han","doi":"10.1016/j.physio.2024.101420","DOIUrl":"10.1016/j.physio.2024.101420","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if individuals with chronic ankle instability (CAI) demonstrate altered lower extremity kinematics and kinetics during walking.</div></div><div><h3>Data sources</h3><div>Relevant studies were sourced from PubMed, Embase, Cochrane Library, Web of Science, EBSCO and PEDro.</div></div><div><h3>Study selection</h3><div>Kinematic and kinetic studies involving joint angle and/or joint moment measured in individuals with CAI were included.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>The Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool was used to assess literature quality. Weighted mean differences (WMDs) in joint angles and moments between CAI and controls were analyzed as continuous variables.</div></div><div><h3>Results</h3><div>1261 articles were screened, with a final selection of 13 studies involving 729 participants. Compared to non-CAI controls, CAI participants showed significantly greater ankle inversion angle (degree) (WMD: 3.71, 95% CI: 3.15 to 4.27, <em>p</em> < 0.001), hip adduction angle (degree) (WMD: 1.60, 95% CI: 0.09 to 3.11, <em>p</em> = 0.04), and knee valgus moment (N m/kg) (WMD: 0.07, 95% CI: 0.01 to 0.13, <em>p</em> = 0.02) during walking. Additionally, there were no consistent findings or specific altered patterns in other lower extremity joint angles, or moment changes, regardless of the motion plane (sagittal, coronal, horizontal), for CAI compared with controls.</div></div><div><h3>Conclusions</h3><div>This review provides further evidence of altered lower limb kinematics and kinetics in the frontal plane in CAI participants during certain walking phases, which may partially explain the high level of recurrent ankle sprains observed in the CAI population, and support hip abduction and ankle eversion motor control exercises for CAI rehabilitation.</div></div><div><h3>Systematic Review Registration Number</h3><div>Systematic Review Registration Number PROSPERO CRD42023420418.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>Individuals with CAI exhibit greater ankle inversion and hip adduction angles during certain phases of walking compared to non-CAI controls.</div></span></li><li><span>•</span><span><div>There may be an increase in the knee valgus moment of individuals with CAI.</div></span></li><li><span>•</span><span><div>Altered lower extremity kinematics and kinetics may be associated with the occurrence of recurrent ankle sprains in CAI.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"125 ","pages":"Article 101420"},"PeriodicalIF":3.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141929859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the optimal dose and short-term effectiveness of kinesiotaping (KT) on pain intensity and disability in pregnant women with lumbo-pelvic pain.
Data sources
MEDLINE (via PubMed Central), CINAHL, Epistemonikos, Scopus, and Web of Science from inception to 21st March 2023.
Study selection
We included randomized controlled trials (RCT) conducted on pregnant women with lumbo-pelvic pain treated with KT.
Data extraction
The outcomes included pain intensity and disability. ROB-2 and GRADE were used to assess the risk of bias and the certainty of the evidence, respectively. A random effects meta-analysis was performed using the standardized mean difference (SMD) and the corresponding 95% confidence interval (CI). The dose-response association was evaluated using a restricted cubic spline model.
Data synthesis
Seven RCTs involving 527 patients were included. Meta-analysis revealed a statistically significant effect in favor of KT on pain intensity (SMD = −1.71; 95% CI = −2.51 to −0.90; P = <0.001) and on disability (SMD = −1.15; 95% CI = −2.29 to −0.02; P = <0.001). The total duration of KT use ranged from 5 to 35 days. It was estimated that a dose of 5–10 days exceeded the minimal clinically important difference (MCID) for pain intensity (mean difference at 10 days = −2.63; 95% CI = −3.05 to −2.22). Low certainty of evidence was identified for both outcomes.
Conclusions
In pregnant women with lumbo-pelvic pain, the use of KT for 5 to 10 days produces a short-term reduction in pain intensity that exceeds the MCID, with a low certainty of evidence.
Systematic Review Registration Number
Systematic Review Registration Number PROSPERO CRD42023388174.
Contribution of Paper
•
The meta-analysis showed that KT reduces pain intensity and improves disability in women with lumbo-pelvic pain.
•
A duration of 5 to 10 days of KT is sufficient to exceed the minimal clinically important difference (MCID) for pain intensity.
•
Studies of high methodological quality with longer follow-up are needed.
数据来源MEDLINE（通过PubMed Central）、CINAHL、Epistemonikos、Scopus和Web of Science（从开始到2023年3月21日）。研究选择我们纳入了对腹盆腔疼痛孕妇进行KT治疗的随机对照试验（RCT）。采用 ROB-2 和 GRADE 分别评估偏倚风险和证据的确定性。采用标准化平均差（SMD）和相应的95%置信区间（CI）进行随机效应荟萃分析。数据综合纳入了涉及 527 名患者的七项研究。Meta分析显示，KT对疼痛强度（SMD = -1.71; 95% CI = -2.51 to -0.90;P=<0.001）和残疾（SMD = -1.15; 95% CI = -2.29 to -0.02;P=<0.001）的影响具有统计学意义。使用 KT 的总时间从 5 天到 35 天不等。据估计，5-10 天的剂量超过了疼痛强度的最小临床重要差异 (MCID)（10 天的平均差异 = -2.63；95% CI = -3.05 至 -2.22）。结论在患有腹盆腔疼痛的孕妇中，使用 KT 5 至 10 天可在短期内减轻疼痛强度，其效果超过了最小临床意义差值（MCID），但证据的确定性较低。系统综述注册号系统综述注册号 PROSPERO CRD42023388174。论文贡献--荟萃分析表明，KT可减轻腹盆腔疼痛妇女的疼痛强度并改善残疾状况--持续5至10天的KT足以超过疼痛强度的最小临床意义差异（MCID）--需要方法学质量高且随访时间更长的研究。
{"title":"Optimal days of application of kinesiotaping for the treatment of lumbo-pelvic pain during pregnancy. A systematic review and dose-response meta-analysis","authors":"Joaquín Salazar-Méndez , Rodrigo Núñez-Cortés , Iván Cuyul-Vásquez , Sergio Sazo-Rodriguez , Joaquín Calatayud , Eduardo Guzmán-Muñoz , Anyela Aguayo , Benjamín Carrasco , Areli González , Luis Suso-Martí","doi":"10.1016/j.physio.2024.101418","DOIUrl":"10.1016/j.physio.2024.101418","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the optimal dose and short-term effectiveness of kinesiotaping (KT) on pain intensity and disability in pregnant women with lumbo-pelvic pain.</div></div><div><h3>Data sources</h3><div>MEDLINE (via PubMed Central), CINAHL, Epistemonikos, Scopus, and Web of Science from inception to 21st March 2023.</div></div><div><h3>Study selection</h3><div>We included randomized controlled trials (RCT) conducted on pregnant women with lumbo-pelvic pain treated with KT.</div></div><div><h3>Data extraction</h3><div>The outcomes included pain intensity and disability. ROB-2 and GRADE were used to assess the risk of bias and the certainty of the evidence, respectively. A random effects meta-analysis was performed using the standardized mean difference (SMD) and the corresponding 95% confidence interval (CI). The dose-response association was evaluated using a restricted cubic spline model.</div></div><div><h3>Data synthesis</h3><div>Seven RCTs involving 527 patients were included. Meta-analysis revealed a statistically significant effect in favor of KT on pain intensity (SMD = −1.71; 95% CI = −2.51 to −0.90; <em>P</em> = <0.001) and on disability (SMD = −1.15; 95% CI = −2.29 to −0.02; <em>P</em> = <0.001). The total duration of KT use ranged from 5 to 35 days. It was estimated that a dose of 5–10 days exceeded the minimal clinically important difference (MCID) for pain intensity (mean difference at 10 days = −2.63; 95% CI = −3.05 to −2.22). Low certainty of evidence was identified for both outcomes.</div></div><div><h3>Conclusions</h3><div>In pregnant women with lumbo-pelvic pain, the use of KT for 5 to 10 days produces a short-term reduction in pain intensity that exceeds the MCID, with a low certainty of evidence.</div></div><div><h3>Systematic Review Registration Number</h3><div>Systematic Review Registration Number PROSPERO CRD42023388174.</div></div><div><h3>Contribution of Paper</h3><div><ul><li><span>•</span><span><div>The meta-analysis showed that KT reduces pain intensity and improves disability in women with lumbo-pelvic pain.</div></span></li><li><span>•</span><span><div>A duration of 5 to 10 days of KT is sufficient to exceed the minimal clinically important difference (MCID) for pain intensity.</div></span></li><li><span>•</span><span><div>Studies of high methodological quality with longer follow-up are needed.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"125 ","pages":"Article 101418"},"PeriodicalIF":3.1,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141929856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-03DOI: 10.1016/j.physio.2024.101417
Silvia Salvalaggio , Silvia Gianola , Martina Andò , Luisa Cacciante , Greta Castellini , Alex Lando , Gianluca Ossola , Giorgia Pregnolato , Sebastian Rutkowski , Anna Vedovato , Chiara Zandonà , Andrea Turolla
Background and purpose
To date, factors with predictive value for upper limb (UL) recovery after stroke are acknowledged, but little is known on clinical features predicting outcome in response to rehabilitation. The purpose of this review is to investigate whether any factor allows identification of Responders to rehabilitation, and whether clinically important recovery of motor function relies on modalities and dose of intervention received, at different times after stroke.
Methods
A systematic review with proportional meta-analysis was conducted. Longitudinal single-cohort studies on patients undergoing rehabilitation after stroke were included. Predictive features investigated in the included studies were reported. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity, and effect sizes (ES) of different rehabilitation doses were calculated.
Results
Only 6% of the included studies (n = 141) investigated predictive factors. Studies providing more than 30 hours of therapy induced small to large clinical effect (ES from 0.38 to 0.88). Task-oriented approach led to the largest effect, both in the subacute (ES = 0.88) and chronic (ES = 0.71) phases. Augmenting interventions provided higher effect in the chronic rather than subacute phase. Integrity of the corticospinal tract, preservation of arm motor function and specific genetic biomarkers were found to be associated with motor recovery
Discussion and conclusions
Trials on motor recovery after stroke should incorporate analysis of factors associated with rehabilitation outcomes. Task-oriented interventions should be delivered more than 30 hours (high dose) to induce the greatest improvement.
Systematic Review Registration Number
Systematic Review Registration Number PROSPERO CRD42021258188.
Contribution of the Paper
•
Demographic characteristics of patients are not associated with rehabilitation-induced upper limb motor outcomes after stroke.
•
Brain lesion characteristics and residual motor function were found to be the main potential predictive factors of rehabilitation-induced upper limb recovery after stroke.
•
Task-oriented interventions had the most significant clinical effect, both in the subacute and chronic phases after stroke.
•
Augmenting interventions are useful in the chronic phase after stroke, if delivered for a minimum of 10 hours.
•
Priming interventions are more useful in the chronic phase after stroke when 10 to 30 hours of treatment are delivered.
背景和目的迄今为止，对中风后上肢（UL）恢复具有预测价值的因素已得到公认，但对预测康复效果的临床特征却知之甚少。本综述旨在研究是否有任何因素可以识别康复反应者，以及在中风后的不同时期，运动功能的临床重要恢复是否取决于所接受干预的方式和剂量。研究纳入了对脑卒中后接受康复治疗的患者进行的纵向单队列研究。报告了所纳入研究的预测特征。结果仅有 6% 的纳入研究（n = 141）调查了预测因素。治疗时间超过 30 小时的研究产生了由小到大的临床效果（ES 从 0.38 到 0.88）。以任务为导向的方法在亚急性期（ES = 0.88）和慢性期（ES = 0.71）的疗效最大。增强干预在慢性期比亚急性期的效果更高。讨论与结论有关中风后运动恢复的试验应包括对康复结果相关因素的分析。系统综述注册号系统综述注册号 PROSPERO CRD42021258188.Contribution of the Paper-患者的人口统计学特征与中风后康复诱导的上肢运动结果无关。-脑损伤特征和残余运动功能是脑卒中后康复诱导上肢恢复的主要潜在预测因素。-以任务为导向的干预在脑卒中后的亚急性期和慢性期均具有最显著的临床效果。
{"title":"Predictive factors and dose–response effect of rehabilitation for upper limb induced recovery after stroke: systematic review with proportional meta-analyses","authors":"Silvia Salvalaggio , Silvia Gianola , Martina Andò , Luisa Cacciante , Greta Castellini , Alex Lando , Gianluca Ossola , Giorgia Pregnolato , Sebastian Rutkowski , Anna Vedovato , Chiara Zandonà , Andrea Turolla","doi":"10.1016/j.physio.2024.101417","DOIUrl":"10.1016/j.physio.2024.101417","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To date, factors with predictive value for upper limb (UL) recovery after stroke are acknowledged, but little is known on clinical features predicting outcome in response to rehabilitation. The purpose of this review is to investigate whether any factor allows identification of Responders to rehabilitation, and whether clinically important recovery of motor function relies on modalities and dose of intervention received, at different times after stroke.</div></div><div><h3>Methods</h3><div>A systematic review with proportional meta-analysis was conducted. Longitudinal single-cohort studies on patients undergoing rehabilitation after stroke were included. Predictive features investigated in the included studies were reported. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity, and effect sizes (ES) of different rehabilitation doses were calculated.</div></div><div><h3>Results</h3><div>Only 6% of the included studies (<em>n</em> = 141) investigated predictive factors. Studies providing more than 30 hours of therapy induced small to large clinical effect (ES from 0.38 to 0.88). Task-oriented approach led to the largest effect, both in the subacute (ES = 0.88) and chronic (ES = 0.71) phases. Augmenting interventions provided higher effect in the chronic rather than subacute phase. Integrity of the corticospinal tract, preservation of arm motor function and specific genetic biomarkers were found to be associated with motor recovery</div></div><div><h3>Discussion and conclusions</h3><div>Trials on motor recovery after stroke should incorporate analysis of factors associated with rehabilitation outcomes. Task-oriented interventions should be delivered more than 30 hours (high dose) to induce the greatest improvement.</div></div><div><h3>Systematic Review Registration Number</h3><div>Systematic Review Registration Number PROSPERO CRD42021258188.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>Demographic characteristics of patients are not associated with rehabilitation-induced upper limb motor outcomes after stroke.</div></span></li><li><span>•</span><span><div>Brain lesion characteristics and residual motor function were found to be the main potential predictive factors of rehabilitation-induced upper limb recovery after stroke.</div></span></li><li><span>•</span><span><div>Task-oriented interventions had the most significant clinical effect, both in the subacute and chronic phases after stroke.</div></span></li><li><span>•</span><span><div>Augmenting interventions are useful in the chronic phase after stroke, if delivered for a minimum of 10 hours.</div></span></li><li><span>•</span><span><div>Priming interventions are more useful in the chronic phase after stroke when 10 to 30 hours of treatment are delivered.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"125 ","pages":"Article 101417"},"PeriodicalIF":3.1,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141929864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1016/j.physio.2024.101414
Fatima Abdul Rashid, Ram Prasad M
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