Archives of physiotherapy最新文献

Introduction: Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF.

Materials & methods: This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength.

Results: Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse.

Conclusions: Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.

Introduction: The rupture of the anterior cruciate ligament (ACL) is one of the most common injuries of the knee. Women have a higher injury rate for ACL ruptures than men. Various indicators for this sex-specific difference are controversially discussed.

Aim: A systematic review of the literature that compares surface electromyography (EMG) values of adult female and male subjects to find out if there is a difference in neuromuscular activation of the knee stabilizing muscles.

Methods: This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies which examined sex-specific differences with surface EMG measurements (integral, root mean squares, mean values, analysis of time and amplitude) of the knee stabilizing muscles were retrieved via searches from the databases PubMed, CINAHL, Embase, CENTRAL and SPORTDiscus. The risk of bias of included studies was assessed with the National Heart, Lung and Blood Institute (NHLBI) study quality assessment tool. A synthesis of results was performed for relevant outcomes.

Results: Fifteen studies with 462 healthy participants, 233 women (mean age 21.9 (± 2.29) years) and 299 men (mean age 22.6 (± 2.43) years), were included in the systematic review. The methodological quality of the studies was mostly rated "fair" (40%). A significantly higher activity of the muscles vastus lateralis and vastus medialis was found in females, in three studies. Two studies found significantly lower neuromuscular activity in the muscles biceps femoris and semitendinosus in females. All other included studies found no significant differences or reported even contradicting results.

Conclusion: The controversial findings do not allow for a concluding answer to the question of a sex-specific neuromuscular activation. Further research with higher statistical power and a more homogeneous methodical procedure (tasks and data normalisation) of the included studies may provide insight into possibly existing sex-specific differences in neuromuscular activation. This systematic review could help to improve the methodical design of future studies to get a more valid conclusion of the issue.

Trial registration: CRD42020189504.

Background: There is a lack of knowledge about the ways physiotherapists around the world learn about professional code of ethics and ethical decision-making frameworks. The profession has a gap in the understanding about physiotherapists' views on factors that play a role in ethical decision-making and whether these views differ between World Physiotherapy regions.

Methods: An online survey study in English was conducted from October 2018 to October 2019. Participants included 559 physiotherapists located in 72 countries. The self-designed survey questionnaire contained 13 items asking about demographic information and means of learning about ethical codes and decision-making frameworks. A further 30 items were presented which included statements underpinned with individual, organisational, situational and societal factors influencing ethical decision-making. Participants were asked to express their level of agreement or disagreement using a 5-point-Likert-scale.

Results: Participants' highest rated responses endorsed that the professional role of physiotherapists is linked to social expectations of ethical behaviour and that ethical decision-making requires more skills than simply following a code of ethics. A recognisable organisational ethical culture was rated as supporting good ethical decisions. Comparing responses by World Physiotherapy regions showed significant differences in factors such as culture, religion, emotions, organisational values, significant others, consequences of professional misconduct and professional obligations. Entry level education was not perceived to provide a solid base for ethical decision-making in every World Physiotherapy region. Participants reported multiple sources for learning about a professional code of ethics and ethical decision-making frameworks. What's more, the number of sources differed between World Physiotherapy regions.

Conclusions: Multiple factors play a role in physiotherapists' ethical decision-making internationally. Physiotherapists' ethical knowledge is informed by, and acquired from, several learning sources, which differ in both quality and quantity amongst World Physiotherapy regions. Easily accessible knowledge and education about professional codes of ethics and ethical decision-making can foster continuing professional development for physiotherapists. The establishment of constructive ethical cultures in workplaces can improve ethical decision-making, and should acknowledge the influence of individual, organisational, situational and societal factors. The establishment of collaborative learning environments can support knowledge translation which acknowledges practice-based methods of knowing and learning.

Background: Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future.

Main body: Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users.

Conclusions: Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.

Background: The Five Times Sit-to-Stand Test (FTSST) has been found reliable, safe and valid for measuring healthy adults' lower limb muscle strength and for determining balance control, fall risk, and exercise capacity among older examinees. We believe that the FTSST has the potential to be a straightforward, low cost and valuable tool for identifying muscle disability and functional status following critical illness. The aim of our study was to establish the applicability, safety, and psychometric qualities of FTSST in patients at Intensive Care Unit (ICU) discharge.

Methods: In our study applicability was determined by assessing the percentage of patients who could perform the test at ICU discharge. Safety was assessed by examining data regarding any exacerbated haemodynamic and respiratory responses or adverse events associated with the test. For assessing FTSST reliability, intraclass correlation coefficients (ICCs), standard error of measurement (SEM) and Bland-Altman plot were used. For assessing concurrent validity handgrip strength, ICU length of stay, duration of invasive ventilation, Simplified Acute Physiology Score 3 (SAPS3) and age variables were used. For investigating predictive validity, correlations between the FTSST and measures of hospital length of stay and functional independence were evaluated.

Results: Only 30% of ICU survivors (n = 261 out of 817) were eligible to perform the FTSST and 7% of patients who performed the test (n = 10 out of 142) presented adverse events. Both inter (ICC 0.92 CI95% 0.89-0.94) and intra-rater (ICC 0.95 CI95% 0.93-0.96) reliability were excellent and higher scores were associated with lower muscle strength, longer hospital stay and greater functional impairment at hospital discharge in adult survivors of critical diseases.

Conclusion: Our results suggest that the FTSST may be applicable only to high-functioning critical care survivors. In this specifical population, FTSST is a safe, easy to perform, valid and reliable measure that can be applied to fall risk and functional recovery management.

Background: Understanding what an economic evaluation is, how to interpret it, and what it means for making choices in a health delivery context is necessary to contribute to decisions about healthcare resource allocation. The aim of this paper to demystify the working parts of a health economic evaluation, and explain to clinicians and clinical researchers how to read and interpret cost-effectiveness research.

Main body: This primer distils key content and constructs of economic evaluation studies, and explains health economic evaluation in plain language. We use the PICOT (participant, intervention, comparison, outcome, timeframe) clinical trial framework familiar to clinicians, clinical decision-makers, and clinical researchers, who may be unfamiliar with economics, as an aide to reading and interpreting cost-effectiveness research. We provide examples, primarily of physiotherapy interventions for osteoarthritis.

Conclusions: Economic evaluation studies are essential to improve decisions about allocating resources, whether those resources be your time, the capacity of your service, or the available funding across the entire healthcare system. The PICOT framework can be used to understand and interpret cost-effectiveness research.

Background: The Cervical Flexion-Rotation Test (CFRT) is widely used in the assessment of upper cervical spine mobility impairments and in the diagnosis of cervicogenic headache (CGH) by physiotherapist. Many studies investigated its different properties, and the results show that the CFRT has good construct validity in the measurement of C1-C2 rotation as well as good to excellent reliability.

Purpose: In this theoretical paper, we explore the value and point out two methodological issues associated to the CFRT, one related to the procedures and another related to its diagnostic accuracy.

Results: Our analysis indicate that there are many confounding factors that could affect the CFRT cut-off's accuracy, which are likely to overestimate the diagnosis properties of CFRT. Potential solutions are discussed. Moreover, the gold standard (manual examination) used to examine the validity of the CFRT for the diagnosis of CGH appears to be far from perfect - we could argue that the diagnostic properties of the CFRT for CGH might be biased and the likelihood ratios are likely to be overestimated. However, it could be relevant to explore if results of the CFRT could be considered as a treatment-effect modifier. Maybe the CFRT could be more valuable as a prognostic factor?

Conclusion: The quality of evidence supporting the validity of the CFRT is most likely biased. In the absence of a better gold standard, maybe the CFRT could be a more valuable test to establish the patient's prognosis and help the clinician to choose the most appropriate treatment options.

Background: Patient-reported outcome measures (PROMs) are tools to screen a population, to monitor the subjective progress of a therapy, to enable patient-centred care and to evaluate the quality of care. The QUALITOUCH Activity Index (AI) is such a tool, used in physiotherapy. This study aimed to provide reference values for expected AI outcomes.

Methods: A large data set uniting clinical routine data and AI outcomes was generated; it consisted of data of 11,948 patients. For four defined diagnoses, i.e. chronic lower back pain, tibia posterior syndrome, knee joint osteoarthritis and shoulder impingement, the AI responses related to the dimensions "maximum pain level" and "household activity" were analyzed. Reference corridors for expected AI outcomes were derived as linear trend lines representing the mean, 1st and 3rd quartile.

Results: Reference corridors for expected AI outcomes are provided. For chronic lower back pain, for example, the corridor indicates that the initial average AI value related to maximum pain of 49.3 ± 23.8 points on a visual analogue scale (VAS multiplied by factor 10) should be improved by a therapeutic intervention to 36.9 ± 23.8 points on a first follow-up after four weeks.

Conclusions: For four exemplary diagnoses and two dimensions of the AI, one related to pain and one related to limitations in daily activities, reference corridors of expected therapeutic progress were established. These reference corridors can be used to compare an individual performance of a patient with the expected progress derived from a large data sample. Data-based monitoring of therapeutic success can assist in different aspects of planning and managing a therapy.

Pain affects everyone hence one can argue that it is in each individual's interest to understand pain in order to hold correct and adaptive beliefs and attitudes about pain. In addition, chronic pain is reaching pandemic proportions and it is now well known that people living with chronic pain have a reduced life expectancy. To address and to prevent the growth of this public health disaster, we must start looking beyond adulthood. How children view pain has an impact on their behavioral coping responses which in turn predict persistent pain early in the lifespan. In addition, children who suffer from chronic pain and who are not (properly) treated for it before adolescence have an increased risk of having chronic pain during their adult life. Explaining pain to children and youth may have a tremendous impact not only on the individual child suffering from chronic pain but also on society, since the key to stop the pain pandemic may well lie in the first two decades of life. In order to facilitate the acquisition of adaptive behavioral coping responses, pain education aims to shift people's view on pain from being an apparent threat towards being a compelling perceptual experience generated by the brain that will only arise whenever the conceivable proof of danger to the body is greater than the conceivable proof of safety to the body. Nowadays a lot of pain education material is available for adults, but it is not adapted to children's developmental stage and therefore little or not suitable for them. An overview of the state-of-the-art pain education material for children and youth is provided here, along with its current and future areas of application as well as challenges to its development and delivery. Research on pediatric pain education is still in its infancy and many questions remain to be answered within this emerging field of investigation.