Physiotherapy Assessment Research Articles

Exploring Physiotherapy Students’ Competencies in Clinical Setting Around the World: A Scoping Review

Clinical education is a fundamental component of physiotherapy entry-level education programs, with practice education being a core element. The aim of this scoping review is to identify and define the competencies of physiotherapy students in clinical settings. This review followed the five steps of the Arksey and O’Malley framework, employing a search strategy that utilized Mesh terms. Searches were performed in PubMed, CINAHL, Scopus, ERIC, WOS, and PsycINFO, with additional exploration of the grey literature. The inclusion criteria were defined using Peter’s concept: (population) physiotherapy students; (concept) competencies aligned with the WCPT educational framework; (context) clinical environment. A total of 1798 sources were identified, and 86 studies were finally selected. Studies originated from 14 countries, with the United States, Australia, and Canada being the most represented. Of the selected studies, 62 used specific tools to identify competencies. The “Clinical Performance Instrument” and the “Assessment of Physiotherapy Practice” were the most frequently used instruments and covered all of the World Physiotherapy competencies’ domains. “Clinical Competence” emerged as the most widely recognized and utilized term across countries. Among the WCPT domains, “Physiotherapy Assessment and Intervention”, “Ethical and Professional Practice”, and “Communication” were the most represented, whereas “Evidence-Based Practice” and “Quality Improvement” were the least mentioned.

A Physiotherapy Framework to Managing Long COVID: A Clinical Approach

Purpose: Individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can experience ongoing, often debilitating symptoms after the acute infection known as Long COVID (LC). LC has profound medical, social, and economic consequences worldwide. Prevalence estimates vary, but it is estimated that 10% to 35% of people infected with SARS-CoV-2 develop LC. The World Health Organization endorses physiotherapy as a vital component in LC symptom management and stabilization. Cardiorespiratory physiotherapists are often involved in the management of patients with LC phenotypes such as post-exertional malaise/post-exertional symptom exacerbation, post-COVID interstitial lung disease, dysautonomia, breathing pattern disorders, and chronic cough. However, specific guidance is lacking regarding physiotherapy assessment and safe intervention strategies. In this review, we describe the relevant pathophysiology of the condition, report common clinical phenotypes, and propose a clinical framework for physiotherapy assessment and safe intervention strategies.

A collaborative interdisciplinary approach for trigger finger management.

Stenosing tenosynovitis, or trigger finger, is a common cause of hand disability. This study outlines a trigger finger management protocol that redirects referrals for surgical consultations to conservative management first. The primary outcome variable was the protocol endpoint based on the resolution of trigger finger symptoms (i.e. pain and triggering). Secondary outcome measures were to identify which patient characteristics were associated with an increased need for (i) surgical management and (ii) corticosteroid injections. Retrospective chart review. The study sample included all patients referred for surgical consultation for trigger finger who were redirected to physical therapy first between the dates of August 2018 and January 2023 (n=72). Participants initially received a physical therapy assessment and three treatment sessions. Further management was determined based on patient presentation following our protocol. Descriptive analysis involved frequency calculations of studied variables. Comparison of patient characteristics and treatment modalities across different sub-groups was examined as well as associations between various patient characteristics and increased need for (i) surgical management and (ii) corticosteroid injection. Seventy-two patients were included in the study, and 60 patients completed the protocol. Of these patients, 22% (n=16) resolved with physical therapy (PT) alone, 48.5% (n=35) resolved with 1-2 corticosteroid injections following initial PT management and 12.5% (n=9) were referred back for surgical consult. Sub-group comparisons revealed no significant differences in patient characteristics and treatment modalities across patients who resolved with physical therapy alone, physical therapy plus 1-2 injections, or in cases referred back for surgical consults. The interdisciplinary care protocol in this study demonstrated that conservative management was successful in a majority of cases; facilitating timely access to evidence-based care, including corticosteroid injections and surgical management if necessary. Physical therapy treatment provides self-management and education strategies to those requiring further interventions, potentially reducing recurrence rates.

Current Physiotherapy Assessment and Treatment Practices for Low Back Pain in Nigeria: A National Survey.

Despite advances in physiotherapy care for Low Back Pain (LBP) worldwide, studies suggest that physiotherapists in Nigeria do not adhere to international guidelines, and it is not known whether recent treatment approaches developed for LBP are recognized or applied by physiotherapists in Nigeria. To evaluate the current assessment and treatment practices used by physiotherapists in Nigeria for people with recent onset, recurrent and chronic LBP. A descriptive cross-sectional electronic national survey. Two hundred and sixty-seven registered physiotherapists who treat LBP across all 36 states of Nigeria completed the survey anonymously via REDCap. Two hundred and sixty-seven physiotherapists (mean age=37.6years, SD=9.1; 53.6% female) completed the survey in full. Although most physiotherapists (>95%) regularly applied traditional assessment methods (e.g., history of presenting complaint, observation for spinal deformity, palpation), only approximately 30% screened for red flag pathology. Very few physiotherapists assessed patients with LBP for psychological distress (<8%) or risk stratification/prognostic factors (<4%). For treatment, electrophysical agents and muscle techniques (e.g., massage) predominated (>95%), while few physiotherapists used cognitive-behavioural strategies (<2%), individualised multimodal treatment programs (e.g., cognitive functional therapy, StarT Back or STOPS, <1.5%), validated outcome measures (<15%), clinical practice guidelines (<10%) or a clinical reasoning strategy/framework (<20%). Most Nigerian physiotherapists (>99%) expressed interest in learning evidence-based LBP assessment and treatment methods from international experts. There is very limited application of contemporary assessment and treatment practices for LBP by Nigerian physiotherapists; however, they are very interested in learning these methods from international experts.

Knee4Life: Empowering Knee Recovery After Total Knee Replacement Through Digital Health Protocol.

Pain and knee stiffness are common problems following total knee replacement surgery, with 10-20% of patients reporting dissatisfaction following their procedure. A remote assessment of knee stiffness could improve outcomes through continuous monitoring, facilitating timely intervention. Using machine learning algorithms, computer vision can extract joint angles from video footage, offering a method to monitor knee range of motion in patients' homes. This study outlines a protocol to provide proof of concept and validate a computer vision-based approach for measuring knee range of motion in individuals who have undergone total knee replacement. The study also explores the feasibility of integrating this technology into clinical practice, enhancing post-operative care. The study is divided into three components: carrying out focus groups, validating the computer vision-based software, and home testing. The focus groups will involve five people who underwent total knee replacement and ten healthcare professionals or carers who will discuss the deployment of the software in clinical settings. For the validation phase, 60 participants, including 30 patients who underwent total knee replacement surgery five to nine weeks prior and 30 healthy controls, will be recruited. The participants will perform five tasks, including the sit-to-stand test, where knee range of motion will be measured using computer vision-based markerless motion capture software, marker-based motion capture, and physiotherapy assessments. The accuracy and reliability of the software will be evaluated against these established methods. Participants will perform the sit-to-stand task at home. This will allow for a comparison between home-recorded and lab-based data. The findings from this study have the potential to significantly enhance the monitoring of knee stiffness following total knee replacement. By providing accurate, remote measurements and enabling the early detection of issues, this technology could facilitate timely referrals to non-surgical treatments, ultimately reducing the need for costly and invasive procedures to improve knee range of motion.

ICF based comparison of musculoskeletal health in regions of Poland and Spain

The International Classification of Functioning, Disability and Health (ICF) is the framework for describing disability. The aim of the study was to compare differences in health status between the populations of the Podkarpackie region of Poland and the Castilla y León region of Spain, using the ICF core set for post-acute musculoskeletal conditions. A total of 840 people were included in the study. The brief version of ICF core set for post-acute musculoskeletal conditions was used in the study. Information obtained from semi-structured interviews and a physiotherapy assessment was recoded into ICF qualifiers to obtain comparable data. Significant differences in functioning were found between the two samples, with a higher prevalence in all the ICF entities for the Spanish sample. Similarities were found in the ICF components ‘Body Functions’ and ‘Environmental Factors’, with the most prevalent ICF entities being ‘b280 Sensation of pain’ and ‘e225 Climate’ respectively. For ‘Activities and Participation’, differences were observed, with ‘d430 Lifting and carrying objects’ being the most common for the Spanish sample and ‘d450 Walking’ for the Polish sample. Significant differences were found between the two samples, indicating better musculoskeletal health in the Polish sample. Future research using the ICF Core Sets in practice should be expanded and carried out in other countries to improve the ability to make comparisons between populations and to develop policies for territorial equity in health.Trial registration: NCT06283407.

Presentation and physical therapy management using a neuroplasticity approach for patients with hypermobility-related upper cervical instability: a brief report.

Upper cervical instability (UCI) is a potentially disabling complication of the connective tissue disorders hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders (hEDS/HSD). UCI can impact various neurological structures, including the brainstem, spinal cord, cranial nerves, and blood supply to and from the brain, resulting in complex neurological signs and symptoms in this population. The current study was an observational study applying recent expert consensus recommendations for physical therapy assessment and management of patients with UCI associated with hEDS/HSD. This was a retrospective observational study describing how the clinical decision-making model was used to screen, examine, and treat three patients with highly irritable hEDS/HSD-related UCI, resulting in complex neurological presentation. The treatment used a neuroplasticity approach, including proprioception and motor control training emphasizing patient education and biofeedback. Outcome measures tracked progress. All patients started with significant disability associated with UCI. One patient returned to full function with intermittent flares that he was able to manage. The second patient continued to have mild-moderate irritability but returned to parenting responsibilities and full-time work. The third patient required cervical fusion and remained disabled but was better able to minimize flares. The number of initial red and yellow flags was associated with the final outcomes, suggesting that the decision-making model might be useful for predicting patient prognosis. This brief report applies recent recommendations for safely evaluating and managing hypermobility-related UCI and provides a first step in experimental studies to test both the assessment and physical therapy treatment approaches.

Multiple imputation integrated to machine learning: predicting post-stroke recovery of ambulation after intensive inpatient rehabilitation

Good data quality is vital for personalising plans in rehabilitation. Machine learning (ML) improves prognostics but integrating it with Multiple Imputation (MImp) for dealing missingness is an unexplored field. This work aims to provide post-stroke ambulation prognosis, integrating MImp with ML, and identify the prognostic influential factors. Stroke survivors in intensive rehabilitation were enrolled. Data on demographics, events, clinical, physiotherapy, and psycho-social assessment were collected. An independent ambulation at discharge, using the Functional Ambulation Category scale, was the outcome. After handling missingness using MImp, ML models were optimised, cross-validated, and tested. Interpretability techniques analysed predictor contributions. Pre-MImp, the dataset included 54.1% women, 79.2% ischaemic patients, median age 80.0 (interquartile range: 15.0). Post-MImp, 368 non-ambulatory patients on 10 imputed datasets were used for training, 80 for testing. The random forest (the validation best-performing algorithm) obtained 75.5% aggregated balanced accuracy on the test set. The main predictors included modified Barthel index, Fugl-Meyer assessment/motricity index, short physical performance battery, age, Charlson comorbidity index/cumulative illness rating scale, and trunk control test. This is among the first studies applying ML, together with MImp, to predict ambulation recovery in post-stroke rehabilitation. This pipeline reliably exploits the potential of incomplete datasets for healthcare prognosis, identifying relevant predictors.

Exploring the use of point-of-care ultrasound by pelvic health physiotherapists in the UK

National and international surveys have highlighted point-of-care ultrasound (PoCUS) as an emergent technology that is being utilized by physiotherapists across a variety of clinical specialities. It confers advantages beyond traditional physiotherapy assessment and increases treatment options for patients with pelvic health conditions. What is not known is how pelvic health physiotherapists are routinely using PoCUS, or the barriers and enablers to its use that exist specifically within this population. The aim of this service evaluation was to explore the current use of PoCUS by pelvic health physiotherapists who are part of the POGP professional network to identify barriers and enablers to wider use within clinical practice across the UK. An online survey with both multiple-choice and free-text responses was shared. Questions covered four domains of interest: (1) demographic and professional characteristics; (2) current use of PoCUS; (3) perceived barriers and enablers; and (4) training. One hundred and two pelvic health physiotherapists with varied levels of experience responded from different sectors and areas of the UK. Only 30.4% reported routine use of PoCUS in their clinical practice despite consensus that PoCUS is an important tool for the rehabilitation of pelvic health conditions. Most barriers to the use of PoCUS identified could be linked to resource limitations, training or lack of support, and were also reflected in suggestions for enablers. Most users had formal training and felt that this had been sufficient to be competent in using PoCUS in their service. Physiotherapists recognize the advantages that PoCUS offers for rehabilitation in pelvic health populations, but are often unable to access the equipment or training required. Ongoing support after training is needed to ensure that users maintain confidence and competence, especially as many work as independent practitioners and are without a direct peer network. Updates to national recommendations or guidelines to include PoCUS as a recommended tool within rehabilitation may provide the impetus needed to support its adoption across more public healthcare settings.

Understanding Barriers to Early Rehabilitation Following the Surgery for Fragility Hip Fractures: A Single-Centre Audit.

Introduction Hip fractures are amongst the most common reasons for geriatric patients' admission to the hospital; recovery of the hip fracture patient can be enhanced by an early rehabilitation program, which should start from the time of admission. This audit aims to study the hip fracture physiotherapy rehabilitation program at a local hospital to ensure compliance with the national guidelines and to identify any potential barriers to early mobilisation after a hip fracture operation. Methods The audit was approved by the trust's audit office. A retrospective study in the Queen Elizabeth The Queen Mother Hospital in Margate, Kent, UK, has been conducted including 113 patients admitted from April to August 2023 to our local hospital; the patientswere screened for the inclusion and exclusion criteria, and data collection started regarding the admitting wards and their physiotherapy assessments including the time they were first assessed by a physiotherapist and the time of first mobilisation after the hip fracture operation and any identified barriers to early mobilisation. Results There were 113 patients who underwent hip fracture surgery, including 23 males and 90 females. The mean age of the participants was 82.7 years.Ninety-three percent (n=106/113) of the patients were seen by a physiotherapist on the day or the day following the surgery for their hip fracture. Amongst the admitted patients, 40% (n=46/113) experienced delayed mobilisation. The reason for the delay was post-operative delirium (n=15/46), low haemoglobin (n=12/46), pain (n=10/46), dementia (n=2/46) and no documented reason (n=7/46). Conclusion The study outcomes emphasise the importance of admitting hip fracture patients into specialised orthopaedic wards. The study identified post-operative delirium, low haemoglobin, pain and pre-existing dementia as factors that delay rehabilitation. Most of these factors are preventable or manageable, which canfacilitate early rehabilitation and subsequently hospital discharge.

Real-World Evidence of Feasible Assessment and Intervention in Cardiovascular Physical Therapy for Older Patients With Heart Failure ― Insight From the J-Proof HF of the Japanese Society of Cardiovascular Physical Therapy ―

This study aimed to clarify the feasibility of cardiovascular physical therapy assessment and intervention in older patients with heart failure (HF) in Japan. We performed a secondary analysis of data from a nationwide multicenter registry (the J-Proof HF), and enrolled consecutive HF patients aged ≥65 years who were prescribed cardiovascular physical therapy during hospitalization from December 2020 to March 2022. Of the 9,650 enrolled patients (median age 83.0 years; 49.8% male), the availability rate of comorbidities and assessments was >95%. In the activities of daily living (ADL) assessment, the Barthel Index (BI) and Functional Independence Measure were 97.6% and 60.4%, respectively. The results of the physical therapy assessment indicated completion rates of ≥80%, with lower rates of <60% for gait speed and short-performance physical battery in the group with a BI of <85 points. In physiotherapy intervention, gait training and muscle strength training were performed by >80% of patients, whereas aerobic exercise and resistance training were performed by 35.4% and 2.6% patients, respectively. Our results in this study indicated that medical findings, such as comorbidities, echocardiography, and laboratory findings, were considered a feasible assessment that could be confirmed at all hospitals. Gait training, ADL training, and muscle strength training are much more common than exercise training in older patients with HF.

Peripheral nerve grafting

Peripheral nerve lesions often lead to significant and permanent loss of motor and sensory function. The aim of peripheral nerve grafting is to bridge nerve defects. When tension-free nerve repair is not possible, peripheral nerve grafting is indicated. Local infection, insufficient soft tissue coverage, significant muscle atrophy or joint contraction in case of "motor" nerve grafting, lack of microsurgical instruments or experience, life-threatening injuries. Exposure and preparation of the nerve stumps. Choosing and preparation of the donor nerve. Approximation. Nerve repair. Nerve reconstruction must always be tension-free as nerve repair with tension frequently leads to disruption of nerve healing and poor functional outcome. Autologous nerve grafting from various donor sites leads to excellent functional results with little sensory deficits at the donor regions. Limited immobilization, physiotherapy, ergotherapy, regular clinical and neurological assessments. Outcome of peripheral nerve grafting may, for example, depend on defect length, caliber and quality of the injured nerve, quality of the donor nerve, microsurgical expertise of the surgeon, time of reconstruction, and age of the patient.

Correlation Between Magnetic Resonance Imaging Findings and Advanced Practice Physiotherapists' Assessment Findings in Diagnosing Lumbosacral Radiculopathy, and the Impact of Imaging Findings on Treatment Plans: A Retrospective Clinical Audit.

Magnetic Resonance Imaging (MRI) is increasingly used by Advanced Practice Physiotherapists (APPs) to confirm the diagnosis of lumbosacral radiculopathy (LSR) and to exclude other spinal pathologies. There is evidence of correlation between Advanced Practice Physiotherapists' diagnosis of lumbosacral radiculopathy and positive MRI findings, but there is limited evidence regarding the correlation between the full physiotherapy assessment and MRI findings. There are also conflicting evidence regarding the effect of MRI findings on treatment planning post-imaging. This study aims to examine the extent to which Advanced Practice Physiotherapists' diagnoses of lumbosacral radiculopathy correlate with those made after MRI, and to examine Advanced Practice Physiotherapists use of the local MRI referral pathway with respect to treatment plans, including testing correlation between pre-and post-MRI treatment plans. A cross-sectional, multi-centre, retrospective audit was conducted on 482 patients (276 female, 206 male) referred for lumbosacral MRI between January 2018 and December 2019. Non-linear regression analysis was performed to examine the relationships between diagnosis and treatment plans in LSR before and after MRI. The results show a significant positive correlation (p<0.001; R=0.196) between pre- and post-MRI diagnoses of lumbosacral radiculopathy. There was a significant positive correlation between pre- and post-MRI treatment plans for LSR (p=0.001; R=0.159). On comparison of pre- and post-MRI diagnoses of LSR, there is a weak positive correlation with high statistical significance (p<0.001; R=0.196). Reliability, tested using the intraclass correlation coefficient (ICC) across the four categories, was (p=0.041; R=0.033). This shows a weak positive correlation with statistical significance. Advanced Practice Physiotherapists can confidently diagnose and treat lumbosacral radiculopathy following initial assessment, although a minority of referrals lack a clear or appropriate treatment plan.

Coverage of Physical Therapy Assessments in the Observational Medical Outcomes Partnership Common Data Model.

High-value care aims to enhance meaningful patient outcomes while reducing costs and is accelerated by curating data across health care systems through common data models (CDMs), such as Observational Medical Outcomes Partnership (OMOP). Meaningful patient outcomes, such as physical function, must be included in these CDMs. However, the extent to which physical therapy assessments are covered in the OMOP CDM is unclear. This study aimed to examine the extent to which physical therapy assessments used in neurologic and orthopaedic conditions are in the OMOP CDM. After identifying assessments, two reviewer teams independently mapped the neurologic and orthopaedic assessments into the OMOP CDM. Agreement within the reviewer team was assessed by the number of assessments mapped by both reviewers, one reviewer but not the other, or neither reviewer. The reviewer teams then reconciled disagreements, after which agreement and the average number of concept ID numbers per assessment were assessed. Of the 81 neurologic assessments, 48.1% (39/81) were initially mapped by both reviewers, 9.9% (8/81) were mapped by one reviewer but not the other, and 42% (34/81) were unmapped. After reconciliation, 46.9% (38/81) were mapped by both reviewers and 53.1% (43/81) were unmapped. Of the 79 orthopaedic assessments, 46.8% (37/79) were initially mapped by both reviewers, 12.7% (10/79) were mapped by one reviewer but not the other, and 48.1% (38/79) were unmapped. After reconciliation, 48.1% (38/79) were mapped by both reviewers and 51.9% (41/79) were unmapped. Most assessments that were mapped had more than one concept ID number (2.2 ± 1.3 and 4.3 ± 4.4 concept IDs per neurologic and orthopaedic assessment, respectively). The OMOP CDM includes some physical therapy assessments recommended for use in neurologic and orthopaedic conditions but many have multiple concept IDs. Including more functional assessments in the OMOP CDM and creating guidelines for mapping would improve our ability to include functional data in large datasets.

Comparison of kinematic parameters, muscle activity and movement timing between “good” and “poor” performers of a single-leg squat

IntroductionVisual scales offer a cost-effective alternative to complex biomechanical analysis for single-leg squat (SLS) performance. There is a lack of consensus on the relationship between visual rating and kinematic measurements in physical therapy assessments. The study aimed to compare kinematic parameters, muscle activity and timing between good and poor performers of SLS, selected based on visual evaluation of movement. MethodsForty asymptomatic male volunteers were classified based on a visual assessment of their SLS movements. For participants rated as good performers (n = 19) and poor performers (n = 8), electromyographic activity, kinematic parameters and movement timing were compared. ResultsSLS execution was significantly different in groups in terms of the hip frontal plane and spine transversal plane of movement and the timing of the hip and knee motion. There were no statistically significant differences between groups in multifidus muscle activity during SLS, frontal plane movement of the knee and squat depth. ConclusionsThe findings of this study indicate that coordination and timing of movements should be carefully considered during SLS examinations to obtain a comprehensive evaluation for planning exercise rehabilitation.

135P Use of electrophysiologic data and physical therapy assessments in SMA monitoring

135P Use of electrophysiologic data and physical therapy assessments in SMA monitoring

Enhancing Physiotherapy Services within a Community Specialist Team for Older Adults: An Evaluation Study

Abstract Background An aim of Community Specialist Teams (CSTs) is to provide integrated multidisciplinary services to older people closer to home. Physiotherapy is a key component of this service. This evaluation aims to describe current physiotherapy practices within a specific CST and identify potential areas for improvement. The CST under examination maintains a physiotherapy staffing level of 1.2 Full-Time Equivalents. Methods An evaluation was completed of the physiotherapy input provided to 71 older adults who underwent a Comprehensive Geriatric Assessment (CGA) with the CST between July and December 2023. Data encompassing service user demographics and physiotherapy specific information were anonymised and analysed using Microsoft Excel. Results The median age of clients was 84 years (range 66-95), with 84.5% aged over 75 years. 70% were female. The median Clinical Frailty Scale (CFS) was 5 (range 3-7), with 75% being classified as frail. The reasons for referral were community rehabilitation (43%), admission avoidance (20%), early supported discharge (17%) and other (20%). Median time to CGA was 18 days (range 1-64 days). 64 (94%) patients were referred to physiotherapy and received an average of 4.4 sessions. Time to physiotherapy assessment following CGA ranged from 0-41 days with a median of 6 days. 83% of clients had physiotherapy intervention in their homes, 14% attended community hubs and 3% both. Analysis of delayed discharge revealed a range of 0-99 excess days beyond the estimated discharge date, with a median delay of 6 days. Conclusion This evaluation underscores the prevalent need for physiotherapy input among the service users engaged with this CST. Concerns arise regarding the breach of the of the National Integrated Care Programme for Older Persons (NICPOP) guideline for CGA timing (2 weeks) and target discharge date (6 weeks). The findings of this review will inform future service planning and the development of integrated physiotherapy pathways for older people.

Evaluating diagnostic and management agreement between physiotherapists and ear, nose and throat specialist in a primary contact physiotherapy-led vestibular clinic: A prospective blinded inter-rater agreement pilot study

BackgroundDizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic.MethodsProspective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet’s first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT.ResultsFifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist’s management decision, based on final recommendations undertaken 11-months post data collection.ConclusionsPhysiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction.

Exploring the Association Between Clinical Characteristics and Etiopathogenesis of Tinnitus: A Cross-Sectional Study.

Background Tinnitus is the perception of internal noises like ringing or hissing, which can greatly affect quality of life. It involves increased neuronal synchrony and interactions with non-auditory brain structures. There's no universal classification system due to its varied origins and mechanisms, and current protocols often overlook physiotherapy, especially for non-otologic causes such as Cervicogenic and Temporomandibular disorders. This study seeks to link clinical features with tinnitus characteristics to better identify underlying causes and improve diagnostic protocols. Methods A prospective observational cross-sectional study was conducted from June 2022 to March 2024 in a rural hospital in Central India, involving 75 patients with tinnitus. The study included comprehensive history, clinical examination, and physiotherapy assessments to categorize tinnitus into otologic, non-otologic, or central types. Each type was analyzed to correlate its characteristics with underlying causes. The findings aim to improve diagnostic protocols and deepen understanding of tinnitus origins. Results The otologic origin of tinnitus was found in 53 (70.7%) patients. Out of 16 (21.3%) patients in the non-otologic category, three (4%) of patients had a somatosensory origin, seven (9.3%) of patients were found to have a somatosensory cervicogenic origin of tinnitus, and six (8%) of patients had a central origin of tinnitus. The remaining six (8%) were found to have mixed origins. Conclusion Otologic tinnitus was the commonest cause of tinnitus, followed by cervicogenic tinnitus. Ours is probably the first study that classifies tinnitus based on otologic and non-otologic origin, with special emphasis on cervicogenic origin tinnitus. Further research could study tinnitus chronicity, causes, and treatments using objective measures and advanced diagnostics.

682 Impact of Regionalisation of Major Trauma Services on Hip Fracture Care in England: A Comparative Study

Abstract Aim Following the establishment of Major Trauma Networks in England in 2012, there were concerns that pressures regarding resource allocation in Major Trauma Centres (MTCs) may negatively impact their care of hip fracture patients. This study aimed to compare outcomes in hip fracture care between MTCs and trauma units (TUs). Method National Hip Fracture Database data was extracted from 01/01/2015 to 31/12/2022 for all hospitals in England. Outcome measures included perioperative medical and physiotherapy assessments, time to surgery, Best Practice Tariff (BPT) compliance, discharge to original residence, and mortality. Data was pooled and weighted for MTCs and remaining hospitals (TUs). Results 487,089 patients were included from 167 hospitals (23 MTCs, 144 TUs). MTCs achieved marginally higher rates of orthogeriatrician assessment within 72 hours of admission (91.1% vs 90.4%, p&amp;lt;0.001) and mobilisation by first postoperative day (81.9% vs 79.7%, p&amp;lt;0.001). Fewer patients underwent surgery by the day after admission in MTCs (65.2% vs 69.7%, p&amp;lt;0.001). There was poorer compliance with BPT criteria in MTCs (57.3% vs 60.4%, p&amp;lt;0.001), and fewer MTC patients were discharged to their original residence (60.4% vs 63.5%, p&amp;lt;0.001). There was no difference between MTCs and TUs in 30-day mortality (6.8% vs 6.8%, p=0.825). Conclusions This study demonstrates that MTCs have greater difficulty in providing prompt surgery to hip fracture patients. However, their marginally superior perioperative care outcomes appear to compensate for this, with similar mortality rates compared to TUs. These findings suggest that the regionalisation of major trauma in England has not significantly compromised the overall care of hip fracture patients.