Physiotherapy Assessment Research Articles

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.

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.

Coverage of physical therapy assessments in the Observational Medical Outcomes Partnership Model common data model.

High-value care aims to enhance meaningful patient outcomes while reducing costs and is accelerated by curating data across healthcare systems through common data models (CDMs), such as Observational Medical Outcomes Partnership Model (OMOP). Meaningful patient outcomes, such as physical function, must be included in these CDMs. However, the extent that physical therapy assessments are covered in the OMOP CDM is unclear. Examine the extent that 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. We quantified agreement within the reviewer team 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 we examined agreement and the average number of concept ID numbers per assessment. 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 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.

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.

Evidence-based physiotherapy interventions: evaluation of current practice in a palliative care service

Maintaining independence and quality of life are significant issues for patients with a life-limiting illness and physiotherapists play an essential role in the palliative care multidisciplinary team in maintaining, restoring, and improving physical function and quality of life (QOL). This study aims to describe current physiotherapy interventions utilized in a palliative care service and compare it to the evidence base of physiotherapy interventions in palliative care. An audit was conducted of all inpatient and community palliative care patients referred for physiotherapy review and intervention, over a 4-week period. A literature search was conducted and the level of evidence for individual physiotherapy interventions was assessed. The audit identified 35 patients referred to the Physiotherapist for the assessment and management of mobility, falls risk management and prevention, lymphoedema management and assessment of functional decline. The most frequently performed physiotherapy assessments and interventions were for mobility and transfer (94.3%), falls prevention and management (74.3%), reconditioning and strengthening (57.1%), and exercise prescription (48.6%). Physiotherapy in the palliative care setting is becoming more accepted to help benefit the function and QOL of patients with advanced progressive diseases. This audit highlights the importance of these interventions in assisting patients to manage their symptoms and function at home.

Physiotherapy assessment of people with neurological conditions in Australia: A national survey.

Currently there are approximately one billion people worldwide affected by a neurological condition. These conditions may result in a variety of impairments that require assessment and management from a physiotherapist. However, there is a lack of consensus in the literature as to what domains physiotherapists working in clinical settings include in their assessment of this population, with only five domains identified in a recent systematic review. This study aimed to explore current physiotherapy assessments in people with neurological conditions, including barriers, enablers, and influencing factors. A National online survey of Australian physiotherapists who assessed adults with neurological conditions in their clinical practice. A total of 212 respondents from all states in Australia completed the survey. The mean (SD) age was 35.7 (9.6) years, and the majority were female (85.4%). Respondents worked across various settings assessing stroke most frequently (58.0%). Study results demonstrated variability in assessment practice, with a number of assessment domains being assessed more commonly including balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, co-ordination, activity tolerance, postural alignment and symmetry, and the upper limb. Experienced physiotherapists and those in rural and remote settings included fewer domains in their assessments. On the other hand, physiotherapists in the community setting included certain domains more frequently than those in other settings. Barriers and enablers were related to therapist caseload, knowledge, and intrinsic patient factors. There is variability in domains assessed by Australian physiotherapists, with an emerging consensus for a number of assessment domains. Study results suggest that clinical experience, geographical location, and clinical setting may play a role in the assessment patterns observed. There is little evidence to support what physiotherapists assess in practice, in different settings, in different states within Australia. This study indicates that experience, geographical location, and clinical setting affect the number and types of domains included in the assessment. Further research is needed to develop a consensus on best practices.

CSP2023: 55 - Telehealth Versus In-person Musculoskeletal Physiotherapy Assessment: A Comparison of Specific Outcomes

CSP2023: 55 - Telehealth Versus In-person Musculoskeletal Physiotherapy Assessment: A Comparison of Specific Outcomes

Physical impairments, activity limitations, and participation restrictions of childhood acute lymphoblastic leukemia survivors with and without hip osteonecrosis: a PETALE cohort study.

Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe physical impairments, activity limitations, and participation restrictions in a high-risk subgroup of cALL survivors of the PETALE cohort. This cross-sectional study, using observational data from the PETALE cohort, included a subgroup of survivors who presented high-risk criteria for late effects. Outcomes measures consisted of hip magnetic resonance imaging, maximal isometric muscle strength (MIMS) or torque (MIMT), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST), and health-related quality of life. Descriptive statistics and regression analyses were performed. Survivors (n = 97, 24.2 ± 6.7years old) showed limited grip strength, FTSST, and NTB performance compared to reference values (p < 0.001). Thirteen participants (14.6%, 18 hips) had hip osteonecrosis (ON) (53.8%male). Higher severity hip ON was found in female survivors (66.7% vs. 22.2%). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p < 0.05). Relationships were found between MIMS and ROM outcomes (r = 0.32, p < 0.01) and with 6MWT (r = 0.39-0.41, p < 0.001). Our multiple linear regression model explained 27.6% of the variance of the 6MWT. Survivors in our subgroup had clinically significant physical impairments and activity limitations, and those with hip ON showed worst hip impairment outcomes. These findings emphasize the importance of long-term follow-up including physical therapy assessment to help early identification and management of physical impairments and activity limitations in survivors of cALL.

The Application of Infrared Thermography in the Assessment of BEMER Physical Vascular Therapy on Body Surface Temperature in Racing Thoroughbreds: A Preliminary Study.

The study aimed to evaluate the impact of BEMER (Physical Vascular Therapy) on body surface temperature using infrared thermography (IRT) in the distal parts of the forelimbs in Thoroughbreds. The study tested the hypothesis that BEMER therapy leads to an increase in body surface temperature and blood vessel diameter in the distal parts of the forelimbs. The study involved 16 horses, split into 2 groups: active BEMER (n = 8) and sham (n = 8). The active BEMER group had BEMER boots applied to the distal parts of the forelimbs, whereas the sham group had BEMER boots applied without activation of the device. Both groups underwent IRT examination to detect changes in body surface temperature, followed by ultrasonographic examination to assess changes in vein and artery diameter before (BT) and just after (JAT) therapy. The IRT examination was repeated 15 min after BEMER therapy (15AT). There were no significant body surface temperature differences between BT and JAT in any regions of interest (ROIs) in either group. In the active BEMER group, the ROIs did not change significantly at 15AT, compared to the temperatures measured at BT (except for the hooves). At 15AT the temperature of all the ROIs (except the fetlock bone) dropped significantly in the sham group. In the ultrasonographic examination, there was a significant increase in vein and artery diameter in the study group JAT, whereas the sham group had a significant increase only in artery diameter JAT. These results suggest an effect of BEMER on stimulating blood circulation in the distal parts of the forelimbs in clinically healthy horses. IRT did not identify changes in skin surface temperature after BEMER therapy at the distal parts of the forelimbs.

The effect of a six-week home physiotherapy program on symptoms and activities of daily living in post-COVID-19 patients following hospital discharge

Introduction: Patients following the acute stage of Severe Acute Respiratory Syndrome Coronavirus 2 were shown to present with persisting symptoms including fatigue, dyspnea, joint pain, and chest pain. The aim of this study was to investigate the effect of a 6-week home physiotherapy program on the psychological and physical symptoms, as well as the physical abilities to perform activities of daily living in post-COVID-19 patients. Methods: The subjects were 39 adult patients who had been diagnosed with COVID-19 and had been hospitalized at the University Clinical Center of Kosovo. Patients initially underwent a physiotherapy assessment 2-3 weeks after discharge from the hospital, including sociodemographic data, psychological and physical symptoms, and functional performance in daily activities using the Patient-Specific Functional Scale (PSFS). Based on their functional capacity, the patients received two types of brochures for a home physiotherapy program that was carried out over the next 6 weeks. Upon the completion of the physiotherapy program, 23 patients reported for the second physiotherapy assessment. The Mann–Whitney Wilcoxon test was used for comparison of the variables obtained during the first and second assessments. Results: Pre–post analysis showed that the symptoms including excessive fatigue, difficulty breathing, and insomnia were significantly less present following the home physiotherapy program (p = 0.005; p = 0.008; p = 0.034). On the PSFS scale, the mean score increased from 5.2 (2.1) to 7.8 (0.5) for stair climbing, from 5.5 (1.8) to 8.8 (1.6) for walking longer distances, and from 3.7 (3.2) to 4.0 (5.6) for running. Conclusion: Although limited by the absence of a control group, the findings from this study indicate that home physiotherapy intervention can be feasible and effective in enhancing psychological and physical symptoms, as well as activities of daily living in post-COVID-19 patients following hospitalization.

IMPACT OF REGIONALIZATION OF MAJOR TRAUMA SERVICES ON HIP FRACTURE CARE IN ENGLAND: A COMPARATIVE STUDY

Following the establishment of regional Major Trauma Networks in England in 2012, there were concerns that pressures regarding resource allocation in Major Trauma Centres (MTCs) may have a detrimental impact on the care of patients with hip fractures in these hospitals. This study aimed to compare outcomes in hip fracture care between MTCs and trauma units (TUs).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, consultant supervision in theatre, Best Practice Tariff (BPT) compliance, discharge to original residence, and mortality. Data was pooled and weighted for MTCs and remaining hospitals (TUs).A total of 487,089 patients with hip fractures were included from 167 hospitals (23 MTCs and 144 TUs). MTCs achieved marginally higher rates of orthogeriatrician assessment within 72 hours of admission (91.1% vs 90.4%, p&lt;0.001) and mobilisation out of bed by first postoperative day (81.9% vs 79.7%, p&lt;0.001). A lower proportion of patients underwent surgery by the day after admission in MTCs (65.2% vs 69.7%, p&lt;0.001). However, there was significantly higher consultant surgeon and anaesthetist supervision rates during surgery in MTCs (71.8% vs 61.6%, p&lt;0.001). There was poorer compliance with BPT criteria in MTCs (57.3% vs 60.4%, p&lt;0.001), and proportionately fewer MTC patients were discharged to their original residence (63.5% vs 60.4%, p&lt;0.001). There was no difference between MTCs and TUs in 30-day mortality (6.8% vs 6.8%, p=0.825).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, as their mortality rates are similar to TUs. These findings suggest that the regionalisation of major trauma in England has not significantly compromised the overall care of hip fracture patients.