Archives of physiotherapy最新文献

Background: Osteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP.

Methods: Patients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1-5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0-12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations.

Results: One hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05).

Conclusions: Health-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP.

Trial registration: ClinicalTrials.gov. Identification number: NCT02974036. First registration 28/11/2016, retrospectively registered.

Background: People with neuropathic-like symptoms had more unfavourable pain features than people with nociceptive. Moreover, deficient conditioned pain modulation is common in people with neuropathic-like symptoms. PainDETECT questionnaire have been used to assess the central sensitisation sign and symptoms. However, whether the painDETECT questionnaire can identify the conditioned pain modulation's impairment is still unknown. Therefore, the current study aimed to evaluate the diagnostic accuracy of the painDETECT questionnaire in detecting the impairment of conditioned pain modulation in people with musculoskeletal pain.

Methods: We conducted a diagnostic accuracy comparing the painDETECT questionnaire (index method) with the cold pressor test, the psychophysical test used to assess the conditioned pain modulation (reference standard). We determined diagnostic accuracy by calculating sensitivity, specificity, predictive values, and likely hood ratios.

Results: We retrospectively enrolled 308 people with musculoskeletal pain in outpatient departments. Most participants were female (n 20 = 220, 71.4%) and had a mean age of 52.2 (± 15.0) years. One hundred seventy-three (56.1%) participants were classified as nociceptive pain, 69 (22.4%) as unclear, and 66 (21.4%) as neuropathic-like symptoms. According to the cold pressor test, 60 (19.4%) participants presented impairment of conditioned pain modulation. The cutoff point of 12 of the painDETECT questionnaire showed values of diagnostic accuracy below 70% compared to the cold pressor test, except for a negative predictive value [76.9 95% Confidence Interval (CI) 71.7 to 81.5]. The cutoff point 19 showed high specificity (78.6%, 95% CI 73.0 to 83.5), high negative predictive value (80.5%, 95% CI 78.1 to 82.7), and accuracy of 67.5% compared to the cold pressor test.

Conclusion: The painDETECT questionnaire seems valuable for ruling out people with musculoskeletal pain and impairment of conditioned pain modulation.

Background: Learning more about the physiotherapists' experience, perceived role and perception of events during the COVID-19 crisis, as well as their recovery and projection into the post-crisis future, may be useful to inform stakeholders about the impact of the crisis. The objective of this study was to investigate the experience of physiotherapists working in a university hospital in Switzerland during the 1^st wave of the COVID-19 crisis, more specifically their subjective experience, professional involvement, perception of management and perceived implications for the future.

Methods: This interpretative qualitative study investigated the subjective experience of a purposeful sample of 12 physiotherapists using two 2 h semi-directive focus group interviews conducted by a physiotherapist in June 2020. Data were recorded, transcribed, and analysed using a thematic analysis approach. The report was approved by participants and the study was audited by a health anthropologist.

Results: The most impressive points were the unprecedented nature of the crisis, the health threat, the hospital's capacity to reorganise on a large scale and the solidarity between colleagues. Participants expressed a high level of commitment to their role despite the potentially serious repercussions at an individual level. Pride and stress coexisted for those directly involved in the crisis, while those working in a reduced activity department felt anxious and idle. The need for immediacy in decision-making and action led to a flattening of hierarchies and an increase of uncertainties. Communication management was seen as the main area for improvement. Physiotherapists hoped that their involvement would improve recognition of the profession but feared that working conditions would deteriorate after the crisis.

Conclusions: The physiotherapists expressed high dedication to their profession and pride to be part of the "war effort" during the crisis. The stress level was partly tempered by the solidarity amongst health professionals and distraction by engaging in action. Despite the mental load, this situation was also seen as an opportunity to grow at a personal and professional level. The healthcare system capacity having not been exceeded in Switzerland, less distress related to death and powerlessness were expressed than in other studies investigating healthcare professionals' experience of the COVID-19 crisis.

Background: Neck pain is one of the leading causes of years lived with disability, and approximately half of people with neck pain experience recurrent episodes. Deficits in the sensorimotor system can persist even after pain relief, which may contribute to the chronic course of neck pain in some patients. Evaluation of sensorimotor capacities in patients with neck pain is therefore important. No consensus exists on how sensorimotor capacities of the neck should be assessed in physiotherapy. The aims of this systematic review are: (a) to provide an overview of tests used in physiotherapy for assessment of sensorimotor capacities in patients with neck pain; and (b) to provide information about reliability and measurement error of these tests, to enable physiotherapists to select appropriate tests.

Methods: Medline, CINAHL, Embase and PsycINFO databases were searched for studies reporting data on the reliability and/or measurement error of sensorimotor tests in patients with neck pain. The results for reliability and measurement error were compared against the criteria for good measurement properties. The quality of evidence was assessed according to the modified GRADE method proposed by the COSMIN group.

Results: A total of 206 tests for assessment of sensorimotor capacities of the neck were identified and categorized into 18 groups of tests. The included tests did not cover all aspects of the sensorimotor system; tests for the sensory and motor components were identified, but not for the central integration component. Furthermore, no data were found on reliability or measurement error for some tests that are used in practice, such as movement control tests, which apply to the motor component. Approximately half of the tests showed good reliability, and 12 were rated as having good (+) reliability. However, tests that evaluated complex movements, which are more difficult to standardize, were less reliable. Measurement error could not be evaluated because the minimal clinically important change was not available for all tests.

Conclusion: Overall, the quality of evidence is not yet high enough to enable clear recommendations about which tests to use to assess the sensorimotor capacities of the neck.

Background: Mechanisms reflect the steps or processes through which an intervention unfolds and produces change in a specified outcome variable. Mechanisms are responsible for determining "how treatments work" which has emerged as a critical question for both developing theory and enhancing treatment efficacy. Studies that evaluate "how" treatments work, not just "if" treatments work are of considerable importance.

Discussion: Specific and shared mechanisms research is a promising approach which aims to improve patient outcomes by tailoring treatments to the specific needs of each patient. Mechanisms research is an underexplored area of research requiring a unique research design.

Conclusion: Although mechanisms research is still in its infancy, prioritizing the study of the mechanisms behind manual therapy interventions can provide valuable insight into optimizing patient outcomes.

Background and purpose: In neurorehabilitation clinical practice, assessment is usually more oriented to evaluate patient's present status, than to plan interventions according to predicted outcomes. Therefore, we conducted an extensive review of current prognostic models available in the literature for recovery prediction of many functions and constructs, after stroke. We reported results in the form of a practical guide for clinicians, with the aim of promoting the culture of early clinical assessment for patient stratification, according to expected outcome. To define a roadmap for clinicians, a stepwise sequence of five actions has been developed, from collecting information of past medical history to the adoption of validated prediction tools. Furthermore, a clinically-oriented organization of available prediction tools for recovery after stroke have been proposed for motor, language, physiological and independency functions. Finally, biomarkers and online resources with prognostic value have been reviewed, to give the most updated state of the art on prediction tools after stroke.

Recommendations for clinical practice: Clinical assessment should be directed both towards the objective evaluation of the present health status, and to the prediction of expected recovery. The use of specific outcome measures with predictive value is recommended to help clinicians with the definition of sound therapeutic goals.

Background: Clinically, neck pain disorders (NPD) and non-specific low back pain (NS-LBP) are respectively the fourth and first most common conditions associated with the greatest number of years lived with disability. Remote delivery of care may benefit healthcare sustainability, reduce environmental pollution, and free up space for those requiring care non-virtual care.

Methods: A retrospective analysis was performed on 82 participants with NS-LBP and/or NPD who received exercise therapy delivered solely in the metaverse using virtually reality. The study was to determine if this was achievable, safe, had appropriate outcome measures that could be collected, and if there was any early evidence of beneficial effects.

Results: The study demonstrated that virtual reality treatment delivered via the metaverse appears to be safe (no adverse events or side effects). Data for more than 40 outcome measures were collected. Disability from NS-LBP was significantly reduced (Modified Oswestry Low Back Pain Disability Index) by 17.8% (p < 0.001) and from NPD (Neck Disability Index) by 23.2% (p = 0.02).

Conclusions: The data suggest that this method of providing exercise therapy was feasible, and safe (no adverse events reported), that complete reports were obtained from a large selection of patients, and that software acquired outcomes were obtainable over a range of time points. Further prospective research is necessary to better understand our clinical findings.

Background: The reaching-transporting task as an essential daily activity impacts balance control and falling in older women. This study investigated the different muscle strategies during the head/knee level of the functional reaching-transporting task in postmenopausal women with osteoporosis.

Methods: 24 postmenopausal volunteers were classified into two groups based on the lumbar T-score: osteoporosis (≤ -2.5, n = 12) and non-osteoporosis (> -1, n = 12). Using a custom-designed device, participants randomly performed 12 reaching-transporting tasks at the head and knee levels. Electromyography signals were collected while reaching and transporting phases with a wireless system. The peak of the root means square (PRMS) and time to PRMS (TPRMS) were measured. In addition, the isometric muscle strength and the fear of falling were assessed.

Results: The isometric muscle strength in the osteoporotic group was significantly lower than in the non-osteoporotic group (P < 0.05), except for vastus lateralis (VL). The PRMS of VL, (P = 0.010) during the reaching phase and VL (P = 0.002) and gastrocnemius lateralis (GL) (P < 0.001) during transporting phase was greater than the non-osteoporotic group. The PRMS value of the muscles was greater for reaching-transporting at the knee level than the head level; this increase was significant just for VL and biceps femoris during the transporting phase (P = 0.036 and P = 0.004, respectively).

Conclusion: Osteoporotic women have more muscle activities during the reaching-transporting task, especially at the knee level, compared to the head level. Their muscle weakness may lead to insufficient stability during the task and cause disturbance and falling, which requires further investigation.

Background: The purpose of this study was to describe the diagnostic performance of the Neuropathic Pain Subscale of McGill [NP-MPQ (SF-2)] and the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire in differentiating people with neuropathic chronic pain post total joint arthroplasty (TJA).

Methods: This study was a survey of a cohort of individuals who had undergone primary, unilateral total knee, or hip joint arthroplasty. The questionnaires were administered by mail. The time interval from operation to the completion of the postal survey varied from 1.5 to 3.5 years post-surgery. Receiver Operating Characteristic (ROC) analysis was used to assess the overall diagnostic power and determine the optimal threshold value of the NP-MPQ (SF-2) in identification of neuropathic pain.

Results: S-LANSS identified 19 subjects (28%) as having neuropathic pain (NP), while NP-MPQ (SF-2) subscale identified 29 (43%). When using the S-LANSS as the reference standard, a Receiver Operating Characteristic (ROC) analysis for NP-MPQ (SF-2) had an area under the curve of 0.89 (95% CI: 0.82, 0.97); a cut off score of 0.91 NP-MPQ (SF-2) maximized sensitivity (89.5%) and specificity (75.0%). Correlation between the measures was moderate (r = 0.56; 95% CI: 0.40, 0.68).

Conclusion: These finding suggest some conceptual overlap but some variability in diagnosis of NP which may relate to scale-tapping into different dimensions of the pain experience, or the different scoring metrics.