Brazilian Physical Therapists Research Articles

Therapeutic exercises in the clinical practice of Brazilian physical therapists in the management of rotator cuff tendinopathy: An online survey.

The objective of this study was to investigate how Brazilian physical therapists (PTs) use therapeutic exercises in the rehabilitation of individuals with rotator cuff (RC) tendinopathy. The study used an online survey with a mix of 62 open- and closed-ended questions divided into three sections: participant demographics, professional experience, and clinical practice in the rehabilitation of patients with RC tendinopathy. One hundred and fifty-nine Brazilian physical therapists completed the survey. Most of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was a wide variability in determining the volume of exercises, particularly with isometric exercises. Most of our sample considered patient comfort and pain levels when adjusting exercise intensity, regardless of exercise type. The majority (48.40%) recommended weekly reassessment and modification of exercises. Additionally, despite pain being a key factor for discharge and the primary adverse effect of exercise, most of our sample would not discontinue exercises in case of pain during the early and late phases of rehabilitation. Despite the lack of consensus on some aspects, the clinical practice of our sample is in line with the current literature and practice in other countries. However, further research and implementation are crucial to enhance future rehabilitation outcomes, including exploring the exercise training volume, the safety and effectiveness of exercising with pain and identifying the optimal pain level for best results.

Use of cupping therapy in musculoskeletal disorders: A cross-sectional study on the profile, training, and practice of Brazilian physical therapists

IntroductionCupping therapy is a widely used technique in Brazilian physical therapy for the treatment of musculoskeletal disorders. However, there is limited scientific evidence to support its effectiveness. ObjectiveTo investigate the profile, training, clinical practice, and scientific updates of Brazilian Physical Therapists who use cupping therapy as a therapeutic resource for musculoskeletal disorders. MethodsA cross-sectional study was conducted through an online questionnaire, including 646 Physical Therapists who use cupping therapy in their practice. All data were analysed descriptively. ResultsCupping therapy is a technique that has been widely adopted in clinical practice by Physical Therapists, particularly among young, female professionals who have recently graduated from private universities. The primary reason for interest in this technique among these Physical Therapists is the high demand from patients. Additionally, it is often used in conjunction with other manual therapeutic techniques. They identified easy access, low cost, and ease of use as the key factors that make cupping therapy an attractive option. However, a lack of high-quality scientific evidence, as described in the literature, was identified as a major barrier to its use. ConclusionThe Physical Therapists included in this study use cupping therapy in their clinical practice, relying heavily on their own experience and the preferences of their patients, rather than utilizing the third pillar of evidence-based practice, which is to rely on the best available evidence. This study suggests that these Physical Therapists are currently implementing a technique without current scientific recommendations for its use in the treatment of musculoskeletal disorders.

The decision-making skills of Brazilian physical therapists for patients with red flags

The decision-making skills of Brazilian physical therapists for patients with red flags

Attitudes and beliefs of Brazilian physical therapists about chronic nonspecific low back pain and its impact on clinical decision-making: An Online Survey Study

IntroductionRecent clinical practice guidelines recognize the importance of the biopsychosocial model in the management of patients with chronic nonspecific low back pain, and the attitudes and beliefs of physical therapists are believed to directly influence clinical decision-making. ObjectiveTo investigate factors associated to biomedical and biopsychosocial approaches and its impact on attitudes and beliefs to treat patients with chronic nonspecific low back pain. MethodThis was a cross-sectional study conducted online with 302 Brazilian physiotherapists who treat patients with nonspecific chronic low back pain. The HC-PAIRS and PABS-PT were used to investigate attitudes and beliefs low back pain. Descriptive statistics and bivariate analyses were performed for association tests, comparing the scores on the scales between groups. In addition, multiple linear regression analyses were also used. ResultsThe overall mean score of HC-PAIRS was 54.0 (9.0), and the biomedical and biopsychosocial factors of PABS-PT were 29.7 (9.0) and 36.2 (5.3), respectively. Significant associations were identified between gender (p = 0.04) and level of academic training (p < 0.00) and both scales, HC-PAIRS and PABSPT, respectively. ConclusionSociodemographic characteristics were associated with the beliefs of physical therapists; a higher score for treatment options for chronic low back pain based on the biomedical mode, was observed in female physiotherapist and in physios with higher education level. Variables such as age and length of professional experience indicated that the lower the age and/or length of professional experience of Brazilian physical therapists, the stronger the belief in the relationship between low back pain and tissue damage.

How are hamstring strain injuries managed in elite men's football clubs? A survey with 62 Brazilian physical therapists

ObjectiveTo describe perceptions and practices of physical therapists from elite men's football clubs on the management of athletes with hamstring strain injury (HSI). DesignCross-sectional study. SettingOnline survey. ParticipantsPhysical therapists from clubs engaged in the two main divisions of Brazilian men's football. Main outcome measuresPractices for assessment and rehabilitation of athletes with HSI. ResultsThis survey had 62 physical therapists from 35 of the 40 eligible clubs (87.5% representativeness). Despite heterogeneity on assessment practices, all respondents use imaging exams, adopt injury classification scales, and evaluate aspects related to pain, range of motion, muscle strength, and functional status of athletes with HSI. Rehabilitation programs are usually divided into 3 to 4 phases. All respondents usually apply electrophysical agents and stretching in HSI rehabilitation programs, 98.4% apply strengthening exercises (93.5% include eccentrics), 96.8% manual therapy, 95.2% exercises that mimic the functional demands of football, and 93.5% lumbopelvic stabilization exercises. Muscle strength was the most reported return to play criterion (71% of respondents). ConclusionThe present study allowed the sports physical therapy community to become aware of the approaches usually adopted for management of athletes with HSI who play in the highest level of Brazilian men's football.

Physical therapists and public perceptions of telerehabilitation: An online open survey on acceptability, preferences, and needs

BackgroundDuring the COVID-19 pandemic, telerehabilitation allowed the continuation of physical therapy care in parallel with public health measures to prevent the virus spread. However, in low- and middle-income countries including Brazil, telerehabilitation was unfamiliar to most of the population. ObjectiveTo investigate acceptability, preferences, and needs in telerehabilitation by Brazilian physical therapists and the general population. MethodsWe conducted an observational cross-sectional study with an online survey consisting of 13 multiple-choice items. Items were distributed among acceptability, preferences, and needs sections, and encompassed confidence in delivering or receiving telerehabilitation, its perceived efficacy and costs, and suitable content. ResultsA total of 1107 responses were registered, 717 from physical therapists. Half of them self-reported confidence in conducting telerehabilitation through the internet (synchronous or asynchronous). The same proportion disagreed that telerehabilitation is as effective as in-person interventions. Physical therapists agreed telerehabilitation should contain educational, self-management strategies, and exercises information, but the general population endorsed the provision of technical advice on exercise execution. The general population mostly reported that telerehabilitation could help their specific health condition (86%), but only 14% of respondents would pay the same as they pay for in-person consultations. Participants reported an overall preference for synchronous communication and concern about the lack of a hands-on approach. ConclusionPhysical therapists and the general population appear to demonstrate apprehension towards telerehabilitation. Insufficient preparation or inadequate knowledge might influence participants’ acceptance, preferences, and needs.

The Impact of Training Time on Understanding the Treatment of Adolescent Idiopathic Scoliosis According to SOSORT International Guidelines: An Online Survey Study.

The lack of knowledge by health professionals in the management of scoliosis can lead to an erroneous diagnosis. The aim of the current study was to understand the influence of length of professional experience on the knowledge of Brazilian physical therapists regarding international guidelines for the treatment of adolescent idiopathic scoliosis. The study was conducted using an online questionnaire consisting of 23 questions, divided into 8 questions on sociodemographic data and 15 questions based on information provided by the guidelines in the SOSORT 2016. In total, 506 physiotherapists were interviewed, and they comprised the study sample. The results showed that professionals who have been working for more than 6 years in the field have greater knowledge of AIS, seek to become more professional, and with that, have an understanding of AIS that is more aligned with the SOSORT. Length of experience made a difference when considering knowledge of the treatment of idiopathic scoliosis. The present study showed that a time since graduation of 6 years or more was satisfactory.

IS EVIDENCE-BASED PRACTICE (EBP) A REALITY IN THE CLINICAL ROUTINE OF BRAZILIAN PHYSICAL THERAPISTS? A SURVEY STUDY OF KNOWLEDGE, SKILLS AND BEHAVIOR.

Introduction: Evidence-Based Practice (EBP) refers to the set of attitudes from which one can know and apply the best evidence, understand patients' preferences and use clinical experience to optimize care, as well as facilitate decision making by health teams. to prole physical therapy professionals as to their unde Objectives: rstanding and application of EBP in their clinical routines. Methods: this is a survey study involving 146 physiotherapists of both genders, from all Brazilian regions. The professionals were contacted exclusively by e-mail, through their respective regional professional councils, in order to receive the electronic questionnaires, prepared for this purpose using the Google Forms platform. The questionnaires were available for 90 days, after which they were no longer accepted. Results: 74.6% of the sample was female; there was almost unanimous agreement that EBP is necessary in clinical practice. Approximately 95% agreed that EBP can be applied even in high demand settings and 84.4% said they were able to insert the guidelines of practice guides into their clinical routines. However, it is noteworthy that 98.6% said they lacked the ability to search relevant scientic literature and the main reasons for not performing EBP were: lack of time, lack of ability to search relevant scientic literature and lack of ndings on a given patient population. the authors conclude that Brazilian physical therapists recognize the im Conclusion: portance of EBP as a guide for clinical decision making and that they use it in their professional routines, however, they need adequate orientation on efcient scientic searches in order to promote treatment excellence through reliable scientic materials.

Characteristics and perceptions of telerehabilitation consultations by neuropediatric physical therapists during the COVID-19 pandemic

Abstract Introduction: The COVID-19 pandemic brought a strong discussion about telerehabilitation, especially in countries where its practice was not allowed previous the pandemic. In the neuropediatric rehabilitation field evidence of the effectiveness of this modality of assistance and data about provider and family’s perceptions are scarce. Objective: To evaluate the characteristics of telerehabilitation physical therapy consultations for children with neurological diseases during the COVID-19 pandemic and report the perceptions of physical therapists about this modality of assistance. Methods: An online survey was created and administered to Brazilian neuropediatric physical therapists. The survey consisted of demographics data, questions about the characteristics of telerehabilitation consultations, and physical therapists’ perception of telerehabilitation assistance. Results: From July to September 2020, 394 physical therapists responded to the questionnaire. The most of them took 21 to 30 minutes per telemonitoring session (26.9%), offered one session per week (61.0%), and used electronic messages as the main method of delivery (39.9%). The main difficulty reported was caregivers’ lack of understanding about handling during sessions (41.2%) and problems with internet connection (16.7%). Additionally, most of them reported that it is highly important important to provide healthcare via telerehabilitation to the economically disadvantaged. Conclusion: The findings of this study provide insight into the complex and challenging process of telerehabilitation assistance during the first wave of the COVID-19 pandemic. Despite the reported challenges, telerehabilitation can be an opportunity to better understand children’s activities and participation in home context.

An online survey of clinical practice of Brazilian physical therapists on rehabilitation following rotator cuff repair

BackgroundPhysical therapy is essential to help patients to recover their movements and function following a rotator cuff repair. However, there are uncertainties regarding how long a sling should be used for and when exercises should be started. ObjectiveTo investigate the current clinical practice of Brazilian physical therapists treating patients who had a rotator cuff repair. We also explored differences between shoulder specialists and non-specialists. MethodsAn online survey with 38 questions, including a clinical case, regarding the physical therapy clinical practice for patients having a rotator cuff repair. ResultsWe analyzed 194 responses. Majority of participants were from the Southeast of Brazil (57.5%), had up to 10 years of clinical experience (61.4%) and were not shoulder-specialists (69.8%). Majority of the respondents stated that patients have their first post-operative physical therapy session within the first three weeks (51%). Patients usually use a sling for four to six weeks (60.6%). Passive mobilization is often started in the first-week post-surgery. Fifteen percent of shoulder specialists compared to only six percent of non-shoulder specialists would allow strengthening exercises to start between the first and third weeks post-surgery. ConclusionPhysical therapists in Brazil seems to follow similar postoperative programs to other countries. Shoulder specialists allow a faster return to activities and start of strengthening exercises.

Factors associated with Brazilian physical therapists’ perception of stress during the COVID-19 pandemic: a cross-sectional survey

ABSTRACT This study aimed to evaluate the stress perception among Brazilian physical therapists (PTs) during COVID-19 pandemic and to identify which psychosocial demands, sociodemographic, professional and clinical factors do associate with the PTs’ stress perception. This cross-sectional survey was based on a convenience sample of PTs, who answered a questionnaire about: 1) sociodemographic and professional characteristics, 2) clinical characteristics and information related to COVID-19, 3) psychosocial demands, and 4) 10-item Perceived Stress Scale (PSS-10). Full responses were obtained from 417 PTs. The average PSS-10 score was 19.2 (95% CI 18.5 to 19.9), which was higher than in other Brazilians before COVID-19 and figured among the highest one observed in healthcare workers from different countries during COVID-19 pandemic. After multivariate analysis, PTs’ perceived stress remained associated with female sex, younger age, previous diagnosis of depressive or anxiety disorder, worsening in sleep patterns, large reduction in family income, housework, relationship with the partner, concern about close people/family members being infected by SARS-CoV-2, and loneliness.

The basis of information to guide clinical decision-making in knee osteoarthritis management: A survey with Brazilian physical therapists.

Several health information sources are available to assist physical therapists in the clinical decision-making process, with a notable increase in the importance of using evidence-based practice (EBP). The aim of this study is to investigate the health information sources most used by Brazilian physical therapists to guide their clinical decision making for knee osteoarthritis (OA) management, use of Physiotherapy Evidence Database (PEDro), knowledge about the existence of clinical practice guidelines (CPGs), and associated factors. A cross-sectional study using an electronic survey was conducted. Physical therapists registered in a Regional Physical Therapy Council in Brazil were invited to participate. Sociodemographic data, professional training, health information sources, frequency of use of PEDro, and knowledge about CPGs were collected. Descriptive analysis of the data was performed, and the chi square test and multinomial and binary logistic regression were used to verify association between the variables. The survey was completed by 370 professionals. The three health information sources most used by Brazilian physical therapists were clinical experience, courses, and books. Among these professionals, only 12.1% use PEDro frequently, and 60.5% know that CPGs for knee OA management exist. Level of education was associated with PEDro use and knowledge about the existence of CPGs (P < .05). The study results indicated a significant deficiency in engagement with research evidence by Brazilian physical therapists to guide their clinical decision making for knee OA. Further investigations on educational needs and the development of new strategies to narrow the gap between research evidence and clinical practice should be performed.

Achilles tendinopathy attitudes and beliefs, knowledge and clinical practice: Survey of Brazilian physical therapists

Achilles tendinopathy attitudes and beliefs, knowledge and clinical practice: Survey of Brazilian physical therapists

Functioning of women in the postpartum period: an International Classification of Functioning, Disability and Health-based consensus of physical therapists

BackgroundPhysical therapists provide treatment for pain and other common complaints for women in the postpartum period, thereby contributing to the improvement of their functioning. However, before applying any interventions, physical therapists should assess their patients to identify the desired therapeutic goals. In this context, the International Classification of Functioning, Disability and Health (ICF) may be a useful tool for documenting functioning data and operationalizing collaborative goal setting. ObjectiveTo identify ICF categories and the respective domains that should be considered in the evaluation of women postpartum. MethodsA consensus-building, three-round e-mail survey was conducted using the Delphi method. The sample included Brazilian physical therapists with expertise in women’s health. Meaningful content was analyzed in accordance to the ICF linking rules. The kappa coefficient and content validity index (CVI) were calculated. ResultsThe panel consisted of 45 participants with a median age of 33 years and more than 10 years of experience in women’s health. A total of 1261 meaningful contents were identified from the responses in the first round. After consensus was achieved, a final list of 62 items was prepared, including 53 categories (11 were on structures; 15 on body functions; 12 on activities and participation; 15 on environmental factors) and nine personal factors (CVI=0.89). ConclusionFrom the perception of physical therapists, an ICF-based postpartum assessment to describe functioning and disability must comprise 53 ICF categories and nine personal factors.

Current clinical practice and return-to-sport criteria after anterior cruciate ligament reconstruction: a survey of Brazilian physical therapists

BackgroundAdherence to the use of recommended measures/criteria for return to sport clearance after anterior cruciate ligament reconstruction is crucial for successful rehabilitation. ObjectivesThe purpose of this study was to describe the current clinical practice of Brazilian physical therapists that treat patients after anterior cruciate ligament reconstruction, including the measures/criteria used to support the decision-making process regarding return to sport. The secondary aim was to investigate factors associated with the use of the most recommended measures/criteria for return to sport. MethodsAn electronic survey questionnaire was sent to Brazilian physical therapists. The survey consisted of questions about demographics and professional and clinical practice data related to anterior cruciate ligament reconstruction postoperative rehabilitation and return to sport criteria. Descriptive statistics and chi-square tests were used for analyses. ResultsA sample of 439 professionals participated in the survey. Only 6.4% of the physical therapists use the most recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction. Professional certification in Sports Physical Therapy was the only factor associated with the use of these recommended measures/criteria (p=0.02). The measures most used for return to sport clearance were related to physical factors (65.3% to 75.1%), such as range of motion and muscle strength. A small number of professionals use questionnaires to assess functional (16.6%) and psychological (19.1%) aspects of their patients to support the decision-making process. ConclusionIn their clinical practice, most Brazilian physical therapists do not use the recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction.

Electrophysical agents in clinical practice of orthopedic and sports physical therapists in Brazil

ABSTRACT Studies have described the use of electrophysical agents (EPA) by physical therapists worldwide. However, the use of EPA by Brazilian physical therapists remains undetermined. This study aims to describe the availability, use, and perception about EPA by orthopedic and sports physical therapists in Brazil. Professionals of the area were invited to answer an online questionnaire. Demographic data and information regarding the availability, use and perception about EPA in their current clinical practice were asked. Out of 376 physical therapists included in this study, 89% declared to use EPA in clinical practice. Sensory electrotherapy with pulsed current (TENS), therapeutic ultrasound, excitomotor electrotherapy with pulsed current (FES/NMES), and cryotherapy are available for more than 3/4 of interviewees. Scientific articles and clinical experience, respectively, are the most influential factors for the choice of EPA. Ultrasound is the most frequently used EPA, followed by TENS, cryotherapy, photobiomodulation, hot packs, and FES/NMES. The top-five most useful EPA in clinical practice chosen by physical therapists are: (1) ultrasound; (2) photobiomodulation; (3) TENS; (4) cryotherapy; and (5) FES/NMES. In conclusion, EPA are widely used by orthopedic and sports physical therapists in Brazil. Therapeutic ultrasound, TENS, FES/NMES, photobiomodulation, cryotherapy, and hot packs are the most used EPA in clinical practice of these physiotherapists.

Assessment of psychological capital at work by physiotherapists.

Describe how psychological capital in the workplace impacts job satisfaction and quality life among Brazilian physiotherapists. Questionnaires were distributed to physiotherapists of the Brazilian Physical Therapists Association working in clinical or managerial positions in the public or private sector. The response rate was 12%, with 389 participants. Job satisfaction was associated with self-efficacy, hope, optimism, and resilience, showing a direct relationship between satisfaction and psychological capital in the workplace. The self-employed physiotherapists were more satisfied and had higher psychological capital in the workplace than the physical therapists employed by a company. It is relevant that managers in the physiotherapy field recognize the relevance of psychological capital in the workplace and use it in their management practices. Understanding the individual characteristics of each employee is essential in promoting the personal development of physical therapists. This finding contributes to a healthier and more challenging work environment for physiotherapists in addition to developing their careers in physical therapy units.

Personal and organizational characteristics associated with evidence-based practice reported by Brazilian physical therapists providing service to people with stroke: a cross-sectional mail survey

BackgroundAlthough evidence-based practice has been widely used by physical therapists, data variation suggests that its implementation may be influenced by a number of factors. Population-specific information is required to help enhance the use of research in clinical practice. ObjectiveTo identify the personal and organizational characteristics associated with the use of evidence-based practice by physical therapists providing services to people with stroke in Brazil. MethodsA cross-sectional mail survey was conducted. The Brazilian versions of the questionnaires “Practitioner and Organizational Barriers to Evidence-based Stroke Rehabilitation” and “Evidence-based practice self-efficacy scale” were mailed to physical therapists. Logistic regression analysis was used to explore associations between personal and organizational characteristics with education, attitudes, beliefs, interest, and perceived role, perceived support, and organizational resources for evidence-based practice. ResultsThe response rate was 36% (n=94). Ten characteristics explained 57% of the variance associated with attitudes and beliefs, and interest and perceived role for evidence-based practice. Nine characteristics explained 50% of the variance associated with perceived support and organizational resources for evidence-based practice. The most frequently cited barrier was lack of time (62%). ConclusionsAlthough participants had positive attitudes regarding evidence-based practice, there is a need to develop a supportive organizational infrastructure, in addition to enhancing skills of the evidence-based practitioner, to increase research integration in physical therapy practice for assessing and treating people with stroke. Potential strategies should include use of evidence-based practice during undergraduate programs, partnership with professional practice-oriented organizations, and investments to enable research-related activities.

Interventions used for Rehabilitation and Prevention of Patellar Tendinopathy in athletes: a survey of Brazilian Sports Physical Therapists

Objectives(1) To identify the type and frequency of interventions used by Brazilian physical therapists to treat and prevent the occurrence of patellar tendinopathy in athletes and the criteria used to return to sport; (2) to compare the interventions used to the grade of recommendation of current evidence. MethodsDesign: cross-sectional study. Setting: online survey throughout sports physical therapy association. Participants: Physical therapists who were invited to complete a structured questionnaire. Main Outcome Measures: Interventions more frequently used for treating and preventing PT in athletes and the criteria used to define return to sport. ResultsOne-hundred and twenty-one physical therapists participated in this study. Quadriceps eccentric strengthening (75.2%), education (61.2%) and lower limb joint/lumbo-pelvic stabilization/hamstrings stretching (59.5%) were more frequently cited for prevention purposes, while lower limb joint stabilization (81.8%), education (80.2%) and myofascial release (78.5%) were more frequently reported for treatment. The majority of the physical therapists based their decision of athlete discharge on a combination of pain intensity, function and functional test results (44.6%). ConclusionThere was inconsistency between interventions used in clinical practice and interventions recommended by the best available evidence.

Evidence-Based Practice: a survey of Brazilian physical therapists from the dermatology subdiscipline

BackgroundDermatology is a relatively new subdiscipline of physical therapy with growth potential. Therefore, it is important to identify whether professionals from this area have the knowledge and skills required to offer the best available service based on evidence-based practice. ObjectivesTo describe the self-reported behavior, knowledge, skills, opinion, and barriers related to the evidence-based practice of Brazilian physical therapists from the dermatology subdiscipline. MethodsAn adapted electronic questionnaire was sent by the Brazilian Association of Dermatology Physical Therapy via email to all registered members. The data were analyzed descriptively. ResultsThe response rate was 40.4% (101/250). Brazilian physical therapists from the dermatology subdiscipline reported that they update themselves equally through scientific papers and courses, and access preferentially databases that offer scientific papers in the Portuguese language. Respondents believe they have sufficient knowledge to use evidence-based practice, inform patients about treatment options and consider their choices in the decision-making process. However, there were inconsistencies in responses regarding the experience with evidence-based practice during undergraduate or postgraduate degree, as well as having discussions about evidence-based practice in the workplace. The barriers most frequently reported were difficulty to obtain full-text papers, lack of quality of the scientific papers, applicability of the findings into clinical practice, lack of evidence-based practice training and difficulty to understand the statistics. ConclusionBrazilian physical therapists from the dermatology subdiscipline have positive perceived behavior, believe that they have sufficient knowledge and skills, and have favorable opinion related to evidence-based practice. However, there are inconsistencies related to some aspects of knowledge and skills set.