Individual Physiotherapy Research Articles

Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective.

Multidisciplinary pain management programs (MPMP) for patients suffering from chronic back pain include a variety of treatment modalities. The patients’ perceived helpfulness of these treatment modalities remains unclear. The aims of this prospective observational cohort study were to assess (i) the patients’ perceived helpfulness of different treatment modalities, (ii) the influence of sociodemographic characteristics on the patient’s perspective and (iii) whether treatment outcomes are affected by helpfulness ratings. Treatment modalities of this three-week MPMP consisted of individual physiotherapy, group-based physiotherapy, relaxation therapy, aquatic therapy, back education, medical training therapy, biofeedback, psychological pain therapy and music therapy. The study comprised 395 patients. The main outcome was the patients’ perceived treatment helpfulness at the end of the program measured by a self-reported questionnaire ranging from 1 (not at all helpful) to 6 (extremely helpful). Secondary outcomes were treatment effects on pain, pain related disability, functional ability and level of depressive symptoms measured by self-reported questionnaires (NRS, PDI, FFbH-R, ADS-L). A total of 276 patients (22–64 years, 57% female) were available for overall analysis. Multivariate-analysis-of-variance- (MANOVA-) related results revealed that perceived treatment helpfulness (range 1–6) differed significantly between treatment modalities: individual physiotherapy (M = 5.00), group-based physiotherapy (M = 4.87), relaxation therapy (M = 4.6), aquatic therapy (M = 4.54), back education (M = 4.43), medical training therapy (M = 3.38), biofeedback (M = 3.31), psychological pain therapy (M = 3.15), music therapy (M = 3.02). Pain, pain related disability and levels of depressive symptoms significantly improved after the program (p < 0.001) whereas functional ability decreased (p < 0.01). Significant correlations were found between helpfulness ratings and sociodemographic data indicating that perceived treatment helpfulness was influenced by patient-related factors. Importantly, the degree of pain-related improvements was affected by the patients’ perceived treatment helpfulness. In conclusion, patients’ perceived treatment helpfulness differs significantly between treatment modalities and corresponds to treatment outcome.

The Role of Rehabilitation in Individuals with Coronavirus COVID-19: A Comprehensive Review

Abstract Introduction: The etiopathogenesis of COVID-19 is unacknowledged. Each individual responds different to COVID-19 and the approach for treating this disease is multidisciplinary. To analyze the possible contribution of each rehabilitation stage of COVID-19 surviving individuals including quarantine, hospital settings and isolation. We performed a literature review in order to identify studies that have analyzed the role of rehabilitation in individuals with COVID-19. Methods: We used the keywords “physiotherapy and COVID-19” or “physical rehabilitation and COVID-19” or “physiotherapy and patients with coronavirus” or “physiotherapeutic treatment of the patient with COVID-19”. Results: For adults quarantined at home, physical therapy should be mandatory. In most individuals with COVID-19, complications and disabilities could be prevented with physiotherapy. When isolated with COVID-19, the use of remote electronic devices for consultation and education can be very useful. Finally, physiotherapy in individuals who survived COVID 19 is of great importance to help them re-integrate into their daily lives. Conclusion: Physiotherapy has a positive role in individuals with COVID-19 and/or those who survived it. Therefore, it is necessary to sensitize the medical team and provide physiotherapy to individuals with and COVID-19. Keywords COVID-19; Rehabilitation; Coronavirus; Rehabilitator

Algorithm for the use of physical therapy in patients with compression-ischemic neuropathies of the upper limb

Оlena Bismak Purpose: to develop an algorithm of rehabilitation measures in people with compression-ischemic neuropathies of the upper limb. Material & Methods: the study involved 67 patients with compression-ischemic neuropathy of the upper limb, among whom were 43 (64.2%) men and 24 (35.8%) women. The duration of the disease ranged from 3 to 18 months. The age of the examined varied from 18 to 67 years, on average 42,3±9,4 years. The study was conducted on the basis of the neurological department and the physiotherapy department of the Kiev city clinical hospital No. 4 of Kyiv in the period from 2017 to 2019. We used the following research methods: analysis and synthesis of literature data, content analysis of medical records, rehabilitation examination. Results: an important condition for the treatment of tunnel neuropathies is an integrated approach, which should have the following components: a comprehensive rehabilitation examination to determine the main rehabilitation problems; statement of tasks with prediction of the final result; selection of appropriate individual and optimal physical therapy means for each patient. An algorithm of physiotherapeutic intervention has been developed, including the use of the following measures: kinesitherapy with neurodynamic mobilization, taping, stimulating massage, instrumental physiotherapy, mechanotherapy and hydrotherapy. The proposed algorithm of physical therapy measures differed from standard programs in that it allowed to formulate the goals of the rehabilitation process taking into account a differentiated approach to solving the problem of rehabilitation of patients with compression-ischemic neuropathies of the upper limb with varying severity of motor function disorders; had a comprehensive, multidisciplinary approach to solving the problems of patients with this pathology. Conclusions: the development of an algorithm of physiotherapeutic intervention for people with compression-ischemic neuropathies of the upper limb is an urgent problem due to the fact that compression-ischemic neuropathies of the upper limb often lead to a decrease in the patient's quality of life and long-term disability. When developing an algorithm of rehabilitation measures, it is necessary to take into account: individual features of the functional state of patients with this pathology, the presence and severity of motor and sensory disturbances, which depend on which particular nerve of the arm is affected (median, ulnar or radiation), the nature of the lesion, age, professional activity and patient needs.

System of control in the organization of pulmonary rehabilitation of persons with chronic obstructive pulmonary disease

The aim: to substantiate the structural components of the control system aimed at improving the physical therapist’s work during pulmonary rehabilitation (PR) of COPD persons.&#x0D; Materials and methods. Analysis and generalization of the data of the special scientific and methodological literature on the issues of physical therapy of patients with chronic obstructive pulmonary disease; method of analysis of medical records; elaboration of Internet sources, including databases of evidence based medical literature.&#x0D; Results. The control system, which is reasonable to be implemented at three stages (preliminary, current, final) of the process of physical therapy (PT) and PR of patients with COPD, is substantiated.&#x0D; The control system within the competence of the physical therapist provides for rehabilitation examination (preliminary control), monitoring (current control) and final evaluation of certain indicators. There were 5 groups of main indicators: quality of life/ activity and participation, disease course, body functions, body structures, educational competence. For the selected groups of indicators, the selection of measuring instruments was made, the features of their application at different stages were outlined, the values of the minimum clinically significant difference for the selected indicators were given.&#x0D; Conclusions. The process of pulmonary rehabilitation of people with COPD needs to be evaluated and monitored for its effectiveness in accordance with the expected results.&#x0D; The monitoring system allows to track all changes in the patient's health and functioning, regulate the intervention and its intensity, evaluate both the individual physical therapy session and the effectiveness of the entire program.&#x0D; One of the criteria of the control system is the effectiveness of PT and PR, which is evaluated on the basis of the dynamics and direction of changes of the studied indicators, their compliance with the expected result and taking into account the values of the minimal clinically significant difference for the evaluated indicators.

EFEITO DA TERAPIA COM REALIDADE VIRTUAL NO EQUILÍBRIO DINÂMICO DE INDIVÍDUOS PÓS-ACIDENTE VASCULAR ENCEFÁLICO

The aim of this study was to analyze the effect of virtual reality-based (VR) therapy on balance training of patients after stroke. 10 hemiparetic participants received twelve individual physical therapy sessions using the VR therapeutic, through Nintendo Wii® Fit Plus and Wii Sports Resort™. The analysis revealed that the Dynamic Gait Index (DGI) instrument, responsible for evaluating the dynamic balance, obtained significant difference (p=0.0085) between the basal (17.30±3.59) and final (20.30±2.94) evaluation. The Penguin Slide game had no significance between the scores (p=0.918), but there was a moderate correlation between the DGI instrument (r=0.662; p=0.037). This study obtained favorable results related to dynamic balance and also suggests that VR therapy as in general influenced the improvement of dynamic balance in individuals with hemiparesis after stroke.

Physiotherapy rehabilitation for osteoporotic vertebral fracture—a randomised controlled trial and economic evaluation (PROVE trial)

To evaluate the clinical and cost-effectiveness of different physiotherapy approaches for people with osteoporotic vertebral fracture(s) (OVF). >Prospective, multicentre, adaptive, three-arm randomised controlled trial. Six hundred fifteen adults with back pain, osteoporosis, and at least 1 OVF participated. 7 individual physiotherapy sessions over 12weeks focused on either manual therapy or home exercise compared with a single session of physiotherapy education (SSPT). The co-primary outcomes were quality of life and back muscle endurance measured by the QUALEFFO-41 and timed loaded standing (TLS) test at 12months. At 12months, there were no statistically significant differences between groups. Mean QUALEFFO-41: -1.3 (exercise), -0.15 (manual), and -1.2 (SSPT), a mean difference of -0.2 (95% CI, -3.2 to 1.6) for exercise and 1.3 (95% CI, -1.8 to 2.9) for manual therapy. Mean TLS: 9.8s (exercise), 13.6s (manual), and 4.2s (SSPT), a mean increase of 5.8s (95% CI, -4.8 to 20.5) for exercise and 9.7s (95% CI, 0.1 to 24.9) for manual therapy. Exercise provided more quality-adjusted life years than SSPT but was more expensive. At 4months, significant changes above SSPT occurred in endurance and balance in manual therapy, and in endurance for those ≤70years, in balance, mobility, and walking in exercise. Adherence was problematic. Benefits at 4months did not persist and at 12months, we found no significant differences between treatments. There is inadequate evidence a short physiotherapy intervention of either manual therapy or home exercise provides long-term benefits, but arguably short-term benefits are valuable. ISRCTN 49117867.

The perspective of people with axial spondyloarthritis regarding physiotherapy: room for the implementation of a more active approach

Abstract Objectives Physiotherapy is recommended in the management of people with axial Spondyloarthritis (axSpA), with new insights into its preferred content and dosage evolving. This study aimed to describe the use and preferences regarding individual and group physiotherapy among people with axSpA. Methods A cross-sectional survey was conducted among people with axSpA living in the Netherlands (NL) and Switzerland (CH). Results 713 people with axSpA participated (56.7% male, median age 55 years, median ASAS-Hi-score 4.2). Response rates were 45% (n = 206) in NL and 29% in CH (n = 507). 83.3% of participants were or had been using physiotherapy. Individual therapy only was or had been used by 36.7%, a combination of individual plus land- and water-based group therapy was or had been used by 29.1% and group therapy only by 5.3%. Only less than half participants attending individual therapy reported active therapy (like aerobic, muscle strength, flexibility exercises). Although the majority (75.9%) was not aware of the increased cardiovascular risk, participants showed an interest in cardiovascular training, either individually or in a supervised setting. If supervised, a majority, in CH (75.0%) more than in NL (55.7%), prefers supervision by a specialized physiotherapist. Conclusion The majority of people with axSpA uses or used physiotherapy, more often in an individual than in a group setting. The content of individual therapy should be more active; in both therapy settings aerobic exercises should be promoted. Especially, enabling people with axSpA to perform exercises independently would meet their needs and might enhance their daily physical activity.

Effects of neuromuscular training and strengthening of trunk and lower limbs muscles in women with Patellofemoral Pain: A protocol of randomized controlled clinical trial, blinded

BackgroundPatellofemoral pain (PFP) often affects young women, and the etiology is multifactorial and poorly understood. Conservative intervention has been focused on risk factors or aggravating factors and is composed of hip- and knee-strengthening exercises, as this population often has muscle weakness and poor motor control during daily and sports activities. The objective of this study was to evaluate the additional effects of neuromuscular training in a conservative treatment of trunk-, hip-, and knee-muscle strengthening on pain, function, and kinematics of the trunk, pelvis, and lower limb in women with PFP.MethodsThis is a randomised clinical trial, controlled, blinded. Ninety women who are active and engage in physical activity up to twice a week will be recruited. All participants will undergo an individual physiotherapy assessment and then will be allocated randomly into two groups. Thereafter, both groups will undergo a 12-week intervention protocol: group 1 will perform strengthening exercises for the trunk, hip, and knee muscles, while group 2 will receive the same treatment, with the inclusion of neuromuscular training exercises on the fourth week. At the end of the intervention, the volunteers will be evaluated. The primary outcomes will be pain intensity (using a Visual Analog Scale: over the last month, squat 90°, and step of 26 cm during 1 min), functional capacity (Anterior Knee Pain Scale and Activities of Daily Living Scale), and 2D kinematics of the trunk, pelvis, and lower limb during the single-leg squat. The secondary outcomes correspond to the isometric muscular strength of the lower limb and the level of satisfaction from the intervention.DiscussionThe present study was initiated on 28 January 2018 and is currently in progress, scheduled for completion in July 2019. The results of this study should contribute to the physiotherapeutic treatment of women with PFP by aggregating information on the benefits of adding neuromuscular training to strengthening of the trunk and lower-limb muscles.Trial registrationRegistro Brasileiro de Ensaios Clínicos, ID: RBR-8c7267. Registered on 2 August 2017.

Trauma and Post Traumatic Growth in Young Survivors of a Terrorist Attack: An Experiential Account of Supportive Interventions in a Tertiary Care Hospital in Pakistan

ABSTRACT In the winter of 2014, four terrorists attacked a school in Khyber Pakhtunkhwa (KPK), resulting in more than a hundred students’ death. Twenty-two survivors (aged 10–18 years) with physical injuries were admitted to a private hospital in Karachi for further surgical and psychological interventions. The aim of this paper is to share a retrospective experiential account of a trauma management plan, based on the bio-psycho-socio-spiritual model for young survivors of terrorism. In biological management, children with hyper-arousal symptoms and sleep disturbances were started on Prazosin and those meeting criteria for Post-Traumatic Stress Disorders were started on Selective serotonin reuptake inhibitors. The Psychosocial interventions included individual therapy, physical therapy, family education, and music groups. Children and their families were also encouraged to draw on their religious support. At the time of discharge, these children were evaluated through clinical interview to assess for improvement. A massive decrease in their hyper-arousal symptoms was seen as evidenced by improvements in their sleeping patterns, mood and behaviour. Moreover, signs of psychosocial development based on the principles of Post Traumatic Growth were visible. Our main limitations were the short period of time and a lack of follow up opportunity. However, this framework provides a basis to establish trauma services at tertiary care hospitals in developing countries like Pakistan where access to overall health care is limited and specifically psychiatric care is lacking in health care institutes.

Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study

ObjectivesGreater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. Limited evidence exists for the effectiveness of exercise for GTPS. This study aimed to compare the effectiveness...

Treatment of Subacromial Shoulder Pain by Individual or Group Physiotherapy Following Corticosteroid Injection

Treatment of Subacromial Shoulder Pain by Individual or Group Physiotherapy Following Corticosteroid Injection

Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study.

The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers. Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention. Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported. This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.

Group format rehabilitation is equally effective as individual therapy in patients with surgically repaired rotator cuff tears.

Does group physiotherapy methods produce different results when compared with individual physiotherapy in persons with surgically repaired rotator cuff tears? No studies to date have examined the feasibility or effectiveness of such therapy formats. Given the prevalence of rotator cuff tears, a study examining group format therapy is warranted and can produce evidence to transform care for rotator cuff tear rehabilitation. We analyzed the electronic medical records of persons that underwent rotator cuff repair surgery followed by the prescribedpost-surgical physiotherapy at Southlake Regional Health Centre. Both groups were provided standard physiotherapy intervention protocol for post-operative rotator cuff tear. Active range of motion (AROM), quick disabilities of the arm, shoulder and hand (Q-DASH) measures, and efficiency measures were examined for differences between groups. No significant differences between AROM (abduction p=.92, lateral rotation p=.64, and flexion p=1.00) and Q-DASH (p=.62) measures between groups were observed at discharge. Overall, group therapy participants required a greater number of visits (p=.000); however, when separated by age groups, only the 60- to 69-year-old participants significantly differed in number of visits between groups (p=.000), whereas no difference was observed in the 50- to 59-year-old participants (p=.14). Group format physiotherapy may be equally effective as individual formats in improving AROM and functional outcomes of participants with surgically repaired rotator cuff tears. Further research is needed to determine the optimal age range for group therapy interventions in this population.

App-based multidisciplinary back pain treatment versus combined physiotherapy plus online education: a randomized controlled trial

Non-specific low back pain (LBP) is one of the leading causes of global disability. Multidisciplinary pain treatment (MPT) programs comprising educational, physical, and psychological interventions have shown positive treatment effects on LBP. Nonetheless, such programs are costly and treatment opportunities are often limited to specialized medical centers. mHealth and other digital interventions may be a promising method to successfully support patient self-management in LBP. To address these issues, we investigated the clinical effects of a multidisciplinary mHealth back pain App (Kaia App) in a randomized controlled trial (registered at German Clinical Trials Register under DRKS00016329). One-hundred one adult patients with non-specific LBP from 6 weeks to 1 year were randomly assigned to an intervention group or a control group. In the intervention group, the Kaia App was provided for 3 months. Control treatment consisted of six individual physiotherapy sessions over 6 weeks and high-quality online education. The primary outcome, pain intensity, was assessed at 12-week follow-up on an 11-point numeric rating scale (NRS). Our per-protocol analysis showed no significant differences between the groups at baseline (Kaia App group: M = 5.10 (SD = 1.07) vs. control group: M = 5.41 (SD = 1.15). At 12-week follow-up the Kaia App group reported significantly lower pain intensity (M = 2.70 (SD = 1.51)) compared to the control group (M = 3.40 (SD = 1.63)). Our results indicate that the Kaia App as a multidisciplinary back pain app is an effective treatment in LBP patients and is superior to physiotherapy in combination with online education.

(389) Pediatric Impression of Change following Interdisciplinary Treatment

This study assessed the utility of the Multidimensional Patient Impression of Change (MPIC) questionnaire in a pediatric pain population following interdisciplinary treatment. The MPIC assesses impression of change for seven clinical domains (Pain, Sleep, Mood, Physical Functioning, Coping with Pain, Managing Flare-up pain, Medication Efficacy) in addition to Overall Status. A heterogeneous group of pediatric chronic pain patients (N = 202) participated in an interdisciplinary treatment program. Treatment programs included individual psychological counseling, relaxation training, physical therapy, occupational therapy, and physician management. Patients completed measures assessing pain, mood, development, social and physical functioning, and family functioning both prior to and at completion of their treatment programs. The MPIC was administered to the patients post-treatment. The majority of patients perceived themselves to be improved (Minimally to Very Much) in all clinical domains of the MPIC. The proportion of patients endorsing improvement ranged from 60% (Medication Efficacy) to 96% (Coping with Pain). There were statistically significant pre- to post-treatment improvements on all outcome measures (P's

Cognitive and Movement Functional Change for a Patient with Huntington`s Disease Using a Video Exercise Program at Home

Background. Huntington’s disease (HD) is a neurodegenerative, progressive central nervous system disease. Physiotherapy can affect the course of the disease, so it is important to determine the effects of physical exercises on the movement and cognitive function. Aim of the study was to evaluate the effectiveness of video exercise program at home, applied simultaneously and separately to physiotherapy, to the cognitive and motor function of a patient with HD. Methods. A 39-year-old man with HD was studied. Firstly, the patient performed a video exercise program at home. Then he did the same and participated in individual physiotherapy. The risk of falls was assessed using the “Timed up and go test”, balance was assessed using the “Berg Balance Assessment Scale” and the “Biodex” system, the gait was assessed using the “Zebris” system, cognitive functions was assessed using the “Mini-mental state examination test” and motor function was assessed using “Unifed Huntington‘s disease rating scale”. Results. After applying the video home exercise program, the risk of falls was reduced, the patient’s balance improved, posture stability, the length and width of the step have increased. The use of video home exercise program with physiotherapy signifcantly improved cognitive function. Conclusions. A structured exercise program at home is effective for balancing, improving posture stability, improving step length, width, decreasing the risk of falls, and it combined with individual physiotherapy, effectively improves the cognitive function of HD patient.Keywords: Huntington’s disease, video exercise program at home, cognitive and movement functions.

Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial.

To compare the effect of specific interventions aimed at (1) the upper thoracic spine (passive mobilization) and (2) the posterior shoulder (massage, passive mobilization, and stretching) to (3) an active control intervention in a homogeneous group with extrinsic subacromial shoulder impingement (SSI). Single-centre, prospective, double-blinded, randomized controlled trial. Eligible individuals with clearly defined extrinsic SSI were randomized to each group. Treatment duration was 12 consecutive weeks consisting of nine treatments over 6weeks, followed by 6weeks when one home exercise was performed daily. Outcomes included (1) active thoracic flexion/extension range of motion, (2) passive glenohumeral internal rotation and posterior shoulder range, (3) pain rating, and (4) shoulder pain and function disability index. Data were analysed at baseline, 6 and 12weeks. Shoulder pain and function disability index scores were investigated via email 6months after commencement of treatment. Twenty participants completed treatment in each group. No differences were identified between groups at baseline. Upper thoracic and posterior shoulder interventions, with a targeted home exercise, both significantly decreased pain and increased function scores and increased posterior shoulder range compared with active control at 12weeks, and 6months following cessation of the trial. Manual therapy treatment that addresses these extrinsic factors, of thoracic spine or posterior shoulder tightness, decreases the signs and symptoms of SSI. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR; 12615001303538).

Implementing physiotherapy services into fistula care at Panzi Hospital, Bukavu, DRC

Aims: To describe implementation of physiotherapy services in the context of fistula care and report early program observations.&#x0D; Methods: Process evaluation of treatment pathway/protocol implementation and presentation of provider observations of treatment results since January 2016.&#x0D; Results: Dedicated physician, nursing, social work and physiotherapy staff provide various aspects of rehabilitative care to women with fistula, pre- and post-operatively. Following variations in hospital census, 5-50 women participate in group exercise sessions 2-3x/week. Targeted individual physiotherapy is selectively provided to 1-15 women 1-5x/week. Staffing priorities reflect perceived importance and impact of physiotherapy services. Providers offer clinical observations of program successes, including improved post-surgical functional outcomes, and express interest in further training to cultivate advanced clinical skills.&#x0D; Conclusions: Early results indicate value of physiotherapy-informed care in a comprehensive approach to fistula care services. Improving and expanding upon these skills may prove equally useful in addressing the physical impairments associated with other reproductive morbidities, such as POP. In the future, systematic use of standardized tools, such as WHODAS 2.0 is recommended, both to quantify the burden of disability in this population, as well as to measure change with therapeutic interventions, including surgery and rehabilitation.

Physiotherapy for injured workers in Canada: are insurers\u2019 and clinics\u2019 policies threatening good quality and equity of care? Results of a qualitative study

BackgroundIn recent years, significant efforts have been made to improve the provision of care for compensated injured workers internationally. However, despite increasing efforts at implementing best practices in this field, some studies show that policies overseeing the organisation of care for injured workers can have perverse influences on healthcare providers’ practices and can prevent workers from receiving the best care possible. The influence of these policies on physiotherapists’ practices has yet to be investigated. Our objectives were thus to explore the influence of 1) workers’ compensation boards’ and 2) physiotherapy clinics’ policies on the care physiotherapists provide to workers with musculoskeletal injuries in three large Canadian provinces.MethodsThe Interpretive Description framework, a qualitative methodological approach, guided this inquiry. Forty participants (30 physiotherapists and 10 leaders and administrators from physiotherapy professional groups and workers’ compensation boards) were recruited in British Columbia, Ontario and Quebec to participate in an in-depth interview. Inductive analysis was conducted using constant comparative techniques.ResultsNarratives from participants show that policies of workers’ compensation boards and individual physiotherapy clinics have significant impacts on physiotherapists’ clinical practices. Policies found at both levels often place physiotherapists in uncomfortable positions where they cannot always do what they believe to be best for their patients. Because of these policies, treatments provided to compensated injured workers markedly differ from those provided to other patients receiving physiotherapy care at the same clinic. Workers’ compensation board policies such as reimbursement rates, end points for treatment and communication mechanisms, and clinic policies such as physiotherapists’ remuneration schemes and restrictions on the choice of professionals had negative influences on care. Policies that were viewed as positive were board policies that recognize, promote and support physiotherapists’ duties and clinics that provide organisational support for administrative tasks.ConclusionIn Canada, workers’ compensation play a significant role in financing physiotherapy care for people injured at work. Despite the best intentions in promoting evidence-based guidelines and procedures regarding rehabilitation care for injured workers, complex policy factors currently limit the application of these recommendations in practice. Research that targets these policies could contribute to significant changes in clinical settings.

SPORTS STARS study protocol: a randomised, controlled trial of the effectiveness of a physiotherapist-led modified sport intervention for ambulant school-aged children with cerebral palsy

BackgroundModified sport interventions run by physiotherapists have shown potential as cost-effective, engaging, and effective interventions to improve gross motor skills and support transition to real-world sports participation for children with cerebral palsy. At present, this population demonstrates decreased participation in physical activities and sport compared to peers due to barriers ranging from body function to accessibility challenges. Sport provides culturally relevant opportunities for social integration, community participation and physical activity and has been shown to improve the fitness, self-esteem, confidence and quality of life of children with disabilities. The Sports Stars physiotherapy group has been designed to support the development of a range of fundamental movement and sports skills through activity skill practice and participation in modified popular Australian sports.MethodsThis randomised, waitlist controlled, assessor blinded, superiority trial with two parallel groups will aim to compare the effectiveness of Sports Stars to standard care across all ICF domains. Children in the Sports Stars group are expected to demonstrate greater improvement in their individually-selected, sports related goals measured by the Canadian Occupational Performance Measure. This study will aim to assess sixty ambulant children aged six to 12 years with a diagnosis of cerebral palsy. Children will be excluded if they have had recent Botox or neurological/orthopaedic surgery. The Sports Stars intervention includes eight, one-hour, weekly physiotherapy group sessions with four to six participants and one lead physiotherapist. Outcome measures will be collected pre, post and 12 weeks post the immediate Sports Stars group to assess change immediately after, and at follow up time points.DiscussionThis will be the first study of its kind to investigate a culturally relevant sports-focussed fundamental movement skills physiotherapy group for ambulant children with cerebral palsy. The findings will add to a growing pool of evidence supporting group physiotherapy for children with cerebral palsy and the Sports Stars group will provide an avenue for children to transition from individual physiotherapy to mainstream and modified recreational and competitive sports.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12617000313336 Registered 28, February 2017.WHO Universal Trial Number: U1111–1189-3355 Registered 1, November 2016.