Archives of physiotherapy最新文献

Background: A new advanced practice model of care enables French physiotherapists to perform medical acts for low back pain (LBP) patients as first-contact physiotherapists (FCPs).

Objective: The aim of this study is to determine the self-perceived competency of FCPs and to further explore factors underpinning this feeling.

Methods: A mixed-methods explanatory sequential design was conducted. A survey was used to self-assess the perceived competency of FCPs in performing medical tasks. Semi-structured interviews were then performed to explore determining factors of perceived competency. Inductive thematic analysis was performed.

Results: Nine FCPs answered the survey and were interviewed (mean age 40.1, standard deviation [SD]: ±10.0). FCPs felt very competent with making medical diagnosis (3.44/4, SD: ±0.53), analgesic prescription (3.11, SD: ±0.78) and referring onward to physiotherapy (3.78, SD: ±0.55). They did not feel competent with nonsteroidal anti-inflammatory drug prescription (2.78, SD: ±0.67) and issuing sick leave certificate (2.67, SD: ±1.0). The main identified influencing factors were previous FCPs' experience, training, knowledge, collaboration with family physicians, high responsibility and risk management associated with decision-making.

Conclusion: French FCPs appeared to have the necessary skills to directly manage LBP patients without medical referral. Future training focusing on analgesic prescription and issuing sick leave certificate is however needed.

Background: Recovery of overhead mobility after shoulder surgery is time-consuming and important for patient satisfaction. Overhead stretching and mobilization of the scapulothoracic and glenohumeral (GH) joints are common treatment interventions. The isolated GH range of motion (ROM) of flexion, abduction, and external rotation required to move above 120° of global shoulder flexion in the clinical setting remains unclear. This study clarified the GH ROM needed for overhead mobility.

Methods: The timely development of shoulder ROM in patients after shoulder surgery was analyzed. Passive global shoulder flexion, GH flexion, abduction, and external rotation ROM were measured using goniometry and visually at 2-week intervals starting 6-week postsurgery until the end of treatment. Receiver operating characteristic curves were used to identify the GH ROM cutoff values allowing overhead mobility.

Results: A total of 21 patients (mean age 49 years; 76% men) after rotator cuff repair (71%), Latarjet shoulder stabilization (19%), and arthroscopic biceps tenotomy (10%) were included. The ROM cutoff value that accurately allowed overhead mobility was 83° for GH flexion and abduction with the area under the curve (AUC) ranging from 0.90 to 0.93 (p < 0.001). The cutoff value for GH external rotation was 53% of the amount of movement on the opposite side (AUC 0.87, p < 0.001).

Conclusions: Global shoulder flexion above 120° needs almost full GH flexion and abduction to be executable. External rotation ROM seems less important as long as it reaches over 53% of the opposite side.

Introduction: Hip microinstability has become a recognized cause of non-arthritic hip pain and disability in young patients. However, its pathophysiology remains unclear. We want to (1) present an overview of the evidence of hip microinstability and of its association with femoroacetabular impingement (FAI), (2) map out the type of evidence available, and (3) make recommendations for future research.

Methods: A deductive analysis and extraction method was used to extract information. In addition, diagnostic accuracy statistics were extracted or calculated.

Results: Of the 2,808 identified records, 123 were eligible for inclusion. Different definitions for microinstability exist. A standardized terminology and clear diagnostic criteria are lacking. FAI and microinstability may be associated and may aggravate each other. Conservative treatment strategies for FAI and microinstability are similar. The reported prevalence of microinstability in combination with FAI ranges from 21% to 42% in adults undergoing hip arthroscopy or magnetic resonance arthrography (MRA) of the hip.

Conclusion: Hip microinstability and FAI may be associated, occur together, or exacerbate each other. To better address this topic, a standardized terminology for microinstability is essential. Achieving consensus on physical examination and diagnosis is also necessary. Initial efforts to establish uniform diagnostic criteria have been made, but further work is needed. Specifically, randomized controlled trials are required to evaluate the effectiveness of training programmes aimed at reducing symptoms in individuals with microinstability, with or without FAI. Such studies will enable clinicians to manage microinstability with greater confidence within this context.

Introduction: Worldwide many countries provide direct access in physiotherapy. The aim of this scoping review was to synthesize the available evidence on the quality of primary care musculoskeletal physiotherapy from different perspectives.

Methods: Systematic searches were conducted in three databases up to September 2022. Studies were included when regarding assessment of at least one of the following perspectives: patient (quality of Life, patient satisfaction, pain, functioning, adverse events), provider (treatment compliance, responsibility, liability, status, prestige, job satisfaction), and society (number of referrals, amount of medical imaging, medication use, number of sessions needed for rehabilitation, and overall costs and cost-effectiveness). Selection and methodological quality assessment of systematic reviews were performed. Data extraction and analysis were performed separately for systematic reviews and individual primary studies.

Results: Five systematic reviews as well as 17 primary studies were included. From a patient perspective, no significant effect of direct access was found for pain and a tendency in favour of direct access was found for quality of life, functioning, and well-being. Concerning providers, higher treatment compliance was found in direct access to physiotherapy and decision-making was more accurate. From a societal perspective, significant differences in favour of direct access physiotherapy were found for waiting time, prescribed medication, and medical imaging. In addition, there was a tendency towards lower health care costs.

Conclusions: Emerging evidence suggests that direct access physiotherapy could provide at least equal quality of care for patients and better opportunities for providers and the society on selected outcomes.

Introduction: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ) has good psychometric properties. However, we have recently modified the FFABQ (mFFABQ) to improve the clarity of the questions and Likert responses. This study aimed to examine the reliability and validity of this modified version in older adults and people with Parkinson's disease (PD).

Methods: A total of 88 participants, 39 with PD (age = 72.2 ± 9.5; 29 males, 10 females) and 49 older adults (age = 72.8 ± 5.0; 13 males, 36 females), answered the mFFABQ twice, separated by 1 week, for test-retest reliability. Construct validity was evaluated through correlational analyses with fall history, Activities-Specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Timed Up and Go, 30-Second Sit to Stand, Sensory Organization Test, Zung Anxiety Scale, Beck Depression Inventory, Consequences of Falling Questionnaire (CoFQ), and average daily activity levels using an activity monitor.

Results: The mFFABQ had good overall test-retest reliability (intraclass correlational coefficient [ICC] = 0.822; older adult ICC = 0.781, PD ICC = 0.806). The mFFABQ correlated with fall history (r = -0.430) and exhibited high correlation with the ABC (rho = -0.804) and moderate correlations with CoFQ (rho = 0.582) and BBS (rho = -0.595). The mFFABQ also correlated with time stepping (rho = -0.298) and number of steps (rho = -0.358).

Conclusion: These results provide supportive evidence for the reliability and validity of the mFFABQ in older adults and people with PD, which supports its suitability as a clinical and research tool for the assessment of fear of falling avoidance behavior.

Introduction: Manual therapy is an often-utilized intervention for the management of knee osteoarthritis (OA). The interpretation of results presented by these trials can be affected by how well the study designs align applicability to real-world clinical settings.

Aim: To examine the existing body of clinical trials investigating manual therapy for knee OA to determine where they fall on the efficacy-effectiveness spectrum.

Methods: This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials that investigated manual therapy treatments for adults with knee OA were retrieved via searches of multiple databases to identify trials published prior to April 2023. The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool was used to objectively rate the efficacy-effectiveness nature of each trial design. The Cochrane Risk of Bias 2.0 assessment tool (RoB-2) was used to assess the risk of bias across five domains.

Results: Of the 36 trials, a higher percentage of trials had a greater emphasis on efficacy within all four domains: participant characteristics (75.0%), trial setting (77.8%), flexibility of intervention (58.3%), and clinical relevance of experimental and comparison intervention (47.2%). In addition, 13.9% of the trials had low risk of bias, 41.7% had high risk of bias, and 44.4% had some concerns regarding bias.

Conclusions: While many trials support manual therapy as effective for the management of knee OA, a greater focus on study designs with an emphasis on effectiveness would improve the applicability and generalizability of future trials.

Background: Primary health care systems have a key role in meeting health needs of community, including function. The aim of this paper is to describe the population involved in the Community Physiotherapist project and their health outcomes over a one-year period.

Methods: The Community Physiotherapist is an on-call service which requires a request by general practitioners or medical specialists. Reason for prescription, waiting time for service delivery, diagnostic categories, provided intervention, number of interventions and outcomes were recorded for everyone included in the project. Possible differences in characteristics between individuals referred by medical specialists and general practitioners were also investigated.

Results: From January to December 2022, 409 individuals were referred to the Community Physiotherapist pathway. Functional goals were achieved in 79.5% of interventions, without reported adverse events. In most cases physiotherapists provided counselling or caregiver training and 3.3% of individuals needed a full rehabilitation program. The groups of individuals referred by the two types of prescribers showed no significant differences, apart, as expected, from their median age.

Conclusions: The introduction of the Community Physiotherapist model within the primary care setting allows to provide appropriate, effective and safe interventions. Sharing the project among all the health professionals helped to support its appropriateness and effectiveness. Results also indicate that a new organizational model, such as the Community Physiotherapist, will take a long time to be implemented.

Background: The role of rehabilitation after surgery in patients with low back pain is well recognized. The aim of this systematic review is to summarize and update the existing evidence according to the type of clinical condition and rehabilitation approach.

Methods: This systematic review included RCTs on the effectiveness of rehabilitation after surgery for lumbar disc herniation, spinal stenosis, and spondylolisthesis. We searched the literature for randomized controlled trials indexed in MEDLINE, Embase, CINHAL, CENTRAL, Scopus, PEDro, and Web of Science databases, up to April 15, 2023. We used Cochrane Risk of Bias 2.0 tool to assess each study. We conducted a quantitative synthesis when population, intervention, control, and outcome were sufficiently homogeneous; otherwise, we conducted a qualitative analysis.

Results: Forty-five studies (3.036 subjects) were included and analyzed according to the population considered: lumbar stenosis (1 trial), spondylolisthesis (3 trials), and disc herniation (41 trials). Regarding lumbar stenosis, a supervised active exercise program appears to improve outcomes related to pain, disability, and quality of life both in the short- and mid-term (1 study, n = 60). Concerning spondylolisthesis, kinesiophobia is reduced in the home exercises group compared to usual care, at 3-months follow-up (3 studies, n = 98). For disk herniation, supervised exercises are better than non-supervised exercises to reduce pain (MD -1.14; 95% CIs -1.65, -0.62; 5 trials, n = 250) and disability (SMD -0.70; 95% CIs -1.14, -0.26; 4 trials, n = 175). Supervised exercises are better than advice in reducing pain (SMD -0.91; 95% CIs -1.61, -0.21; 5 trials, n = 341) and disability (SMD -0.80; 95% CIs -1.59, -0.01; 4 trials, n = 261), in the short-term. Supervised exercises are equal to no treatment in reducing pain and disability, at 3 and 6 months after intervention (2 trials, n = 166). These results are supported by a very low to low quality of evidence.

Conclusions: Our research suggests that supervised exercise may be effective in improving patient's pain and disability after lumbar surgery, but RCTs regarding lumbar spinal stenosis and lumbar spondylolisthesis are still scarce, with significant heterogeneity of proposed interventions.

Background: Evidence based medicine (EBM) should be an endeavor within all healthcare professions. Knowledge and understanding of science are important prerequisites of EBM.

Objective: The aim was to examine and compare perspectives on science and perceived inhibiting and facilitating factors for the assimilation and implementation of scientific information among clinically working specialist- and non-specialist physiotherapists in Sweden.

Methods: A cross-sectional survey study was conducted via a web-based questionnaire. Clinically active physiotherapists in Sweden were invited to participate. Attitudes and perspectives were compared between physiotherapists with completed or on-going specialist training, and non-specialists.

Results: In total, 1165 physiotherapists responded to the survey (75.5%, (n = 870) women, mean age 44.8 (SD 12.1), whereof 25.5% (n = 319) with completed or ongoing specialist training). The majority of participants had a high interest in science but did not consider a general scientific approach to be applied within physiotherapy. The main perceived inhibiting factor for a clinical practice more based on scientific evidence was lack of time. Specialists had in general higher interest and ability to interpret and evaluate science, and prioritized scientific evidence to a higher extent.

Conclusion: Among respondents, a scientific approach was considered valuable within physiotherapy but not considered fully applied in practice. The higher interest and perceived ability to interpret science among specialists indicates that further education and specialist training can increase both interest and understanding of science among physiotherapists.

Background: Evidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP. The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy.

Methods: This is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript.

Results: Forty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021-2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses. The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%).

Conclusions: The prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus for increasing investment in the teaching of EBP in Italian physiotherapy degree courses, thereby improving educational standards.