Physiotherapy Management Research Articles

Current practices in physiotherapy management of COPD in Pakistan

Dear Madam, I am writing to address the usage of active cycle breathing techniques and postural drainage in the treatment of Chronic Obstructive Pulmonary Disease (COPD), with a specific emphasis on the current practices and developments in the field of pulmonary rehabilitation. COPD is a complex disease in individuals above the age of 40 with a nationwide prevalence of 2.1% 1 indicating the substantial impact of this condition that demands a multidisciplinary strategy and physiotherapy interventions including active cycle breathing techniques and postural drainage are essential in enhancing the quality of life for COPD patients in a developing country like Pakistan. Various studies have demonstrated that breathing exercises are efficacious in enhancing the strength of the muscles involved in inhalation and increasing the ability to engage in physical activity for those diagnosed with COPD.2 Physiotherapists routinely utilize the active cycle of breathing approach as a non-pharmacological method for airway clearance.3 Furthermore, the effects of oscillatory positive expiratory pressure therapy on the quality of life and objective signs of cough and sleep disturbance in COPD patients with regular sputum production have been investigated.4 The combination of postural drainage techniques and chest mobilization has been proven to effectively manage pneumonia and enhance postural alignment in patients with COPD.5 Several investigations are conducted to compare the postural alignment of COPD patients with that of healthy individuals and to establish a correlation between pulmonary function and postural alignment in the COPD group that has accounted for favorable results.6 In addition, the existing evidence suggests that active breathing strategies, such as the active cycle of breathing techniques, autogenic drainage, and forceful expiration, can be effective in managing COPD.7 At present, COPD management in Pakistan faces practical challenges such as resource limitations and training access for physiotherapists. Therefore, Cultural adaptations are needed to ensure patient acceptance and adherence. Policy support is needed to integrate physiotherapy services into healthcare systems, emphasizing long-term benefits and cost-effectiveness. Public education campaigns are crucial to raise awareness about physiotherapy interventions role in COPD management, empowering patients and families to actively participate in their care. It is crucial to acknowledge that the management of COPD necessitates a comprehensive strategy that incorporates customized physiotherapy approaches to tackle the individual difficulties encountered by patients. Physiotherapists in Pakistan have a crucial role in enhancing the results and quality of life for patients with COPD. ---Continue

Perspectives and insights on physical therapy's function in COVID-19 rehabilitation

Abstract. Physical treatment is useful in reducing the many COVID-19 problems, according to recent studies. The significance of physical therapy in the all-encompassing management of the new coronavirus has been brought to light. Physical therapy is the main body of rehabilitation therapy, including a wide range of techniques (such as sound, light, cold, heat, electricity, force (movement and pressure) and other physical factors for treatment, as well as breathing, muscle training, for local or systemic body dysfunction or lesions, The use of non-invasive, non-drug treatment, reinforcement strategy exercises, immediate relief of symptoms and overall improvement of the patients physical function and restoration of the patients original body physiological function. This integrated approach enables patients to return to their previous level of activity and quality of life by highlighting the entire context of treatment. Physiotherapy is not without its limitations, though. Physiotherapy requires patient-specific care, because there arent enough doctors or patients during a pandemic. To ensure the provision of effective rehabilitation services, creative solutions are required to address issues including the shortage of specialists, the requirement for training units, and the return of telemedicine. Furthermore, further research efforts and interdisciplinary collaboration are required to establish effective practices and improve patient outcomes related to physical therapy engagement in COVID-19 recovery programs. As a result, the pandemic has brought attention to and strengthened an important shift in the role of physical therapy in the management of post-viral syndromes, opening the door for future advancements in the field of infectious disease medicine.

Multimodal Physical Therapy Management of Subcoracoid Impingement: A Case Report With One-Year Follow-Up and Ultrasound Measurement of Coracohumeral Distance

Multimodal Physical Therapy Management of Subcoracoid Impingement: A Case Report With One-Year Follow-Up and Ultrasound Measurement of Coracohumeral Distance

BARRIERS, KNOWLEDGE AND FACILITATORS OF EVIDENCE BASED PHYSIOTHERAPY PRACTICE IN INDIA.

Background: Evidence based practice is a method to improve patient outcome by replacing the outdated practice with scientifically validated methods. Barriers, knowledge and facilitator influence evidence-based physiotherapy practice worldwide. Objective: This study was to explore the barriers, knowledge and facilitator of Evidence Based Practice (EBP) among physiotherapist in India Methods: A survey was conducted using a structured questionnaire among 50 physiotherapists, 42 responses were collected. Result: Respondents concurred that EBP is essential for practice, and it is helpful in both decision making and improving patient care. The most common barriers were time and workload constraints, lack of desire, financial incentives, weakness in English, difficulty in access to search engines, Inability to apply evidence. The facilitator includes targeting funding, access to remote, supportive staff and leadership committed to innovation and skills in EBP. The knowledge is limited to a few key terms. Conclusion: Physiotherapists in India have a positive attitude towards EBP, and it is necessary to move towards minimizing the existing barriers at the individual level by adopting effective multilateral policies. Attention is needed to improve EBP knowledge. Implication: EBP is the integration of best research evidence with clinical expertise and patient values. It provides open and thoughtful clinical decision making about physiotherapy management of patients.

Pediatric physiotherapy management of airway clearance therapy and exercise: Data from the Australian Bronchiectasis Registry.

Regular airway clearance techniques (ACTs) and exercise are recommended for children with bronchiectasis, but current clinical practice and their predictors are unknown. We aimed to describe current use of ACTs and exercise among Australian children with bronchiectasis and identify associated predictors. Physiotherapy-specific data of 397 children (median age = 8 were extracted from the Australian Bronchiectasis Registry. A multivariate analysis was undertaken to identify predictors associated with the use of regular ACTs and physical exercise. Regular ACTs were undertaken by 118 (30%) children while 192 (48%) engaged in regular exercise. Physical exercise was the most common ACT modality (n = 83, 20%). The likelihood of regular ACT increased in children whose sputum isolated Pseudomonas aeruginosa (OR = 3.88, 95% CI 1.69-8.89) and was 50% higher for every respiratory exacerbation in the previous 12-months that required hospitalization (OR = 1.50, 95% CI 1.15-1.95). For every year older in age, children had increased odds of engaging in physical exercise (OR = 1.21, 95% CI 1.08-1.34) or using an ACT device (OR = 1.21, 95% CI 1.05-1.34). Regular exercise was twice as likely in the presence of bibasal bronchiectasis (OR = 2.43, 95% CI 1.14-5.16), yet less likely in those with ≥1 hospitalizations in the previous 12-months (OR = 0.76, 0.95% CI 0.57-1.03). Approximately one-third of children with bronchiectasis undertake regular ACTs while physical exercise was undertaken in approximately one in two children. Age, frequent respiratory exacerbations requiring hospitalization and the extent of disease are predictors of undertaking regular ACTs and exercise. Identification of these factors may assist in tailoring ACT, exercise and ACT modality prescription in clinical practice.

Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024

The Academy of Orthopaedic Physical Therapy (AOPT) has an ongoing effort to create evidence-based clinical practice guidelines (CPG) for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The 2024 Achilles Pain, Stiffness, and Muscle Power Deficit: Midportion Achilles Tendinopathy Clinical Practice Guideline (CPG) is a revision of the 2018 CPG and represents the third CPG from AOPT on this topic. The goals of the revision were to provide a concise summary of the contemporary evidence and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers prevalence, pathoanatomical features, risk factors, clinical course, diagnosis, examination, imaging and physical therapy interventions for the management of midportion Achilles tendinopathy.

Penatalaksanaan Fisioterapi pada Kasus Calcaneus Spur Dextra dengan Modalitas Ultrasound, Hold Rilex dan Calf Raise di RSUD Ciereng Subang

Calcaneus spur is an abnormal bone growth on the inferior part of the os. calcaneus, from the fibrocartilaginous attachment site specifically the plantar fascia ligament, which is a common cause of calcaneus spur. To determine the physiotherapy management in reducing pain, increasing joint range of motion and increasing functional activity ability in Calcaneus Spur Dextra cases with ultrasound, hold rilex and calf raise modalities. After 6 times of therapy using VAS, it shows a decrease in silent pain T1 worth 2 to T6 worth 0, a decrease in motion pain T1 worth 5 to T6 worth 2 and a decrease in tenderness T1 worth 6 to T6 worth 3. Increased active motion LGS in the sagittal plane dextra ankle joint T1: 100- 00- 300 to T6: 200-00-400. Increased functional activity ability which can be seen from the increase in FADI score T1 worth 76% to T6 worth 87% with moderate difficulty. Ultrasound can help reduce pain, hold rilex and calf raise can help increase joint range of motion and improve functional activity ability.

Toward facilitating the collection and utilization of patient-reported outcomes in the Military Health System: Lessons learned from a pragmatic clinical trial on physical therapy management for low back pain.

Toward facilitating the collection and utilization of patient-reported outcomes in the Military Health System: Lessons learned from a pragmatic clinical trial on physical therapy management for low back pain.

Early Conservative Physical Therapy Management of Babies With Obstetric Brachial Plexus Injury to Facilitate Spontaneous Recovery.

To evaluate the effect of early immobilization and proper handling techniques in infants with Obstetric Brachial Plexus Injury (OBPI) in the first 2weeks of life. Six 1-day-old infants (2 males and 4 females) with OBPI were included. The assessments were done at baseline, post-intervention, and 3-month follow-up, which involved a physical exam, Narakas classification, Active Movement Scale, and gross and fine motor skills evaluation. All infants had upper Erb's palsy. They had statistically significant improvement in the Active Movement Scale scores post-intervention with a large effect size. These improvements were maintained at follow-up. All infants achieved age-appropriate gross and fine motor skills with the affected upper limb at 3months of age. Early conservative physical therapy management had a statistically significant effect on enhancing spontaneous recovery and preventing further nerve injury in OBPI infants.

Patient experience and barriers of using a mHealth exercise app in musculoskeletal (MSK) Physiotherapy.

Digital transformation has led to an abundance of digital health technologies (DHTs) readily available for Physiotherapists. In July 2020, the Physiotherapy department at a London NHS Trust implemented a mobile health (mHealth) exercise application (app), Physitrack. This service evaluation aims to evaluate patient experience and identify any barriers to using Physitrack/PhysiApp in musculoskeletal (MSK) Physiotherapy. An online experience survey was sent to 10,287 MSK Physiotherapy patients who had appointments between January 17th and April 9th 2022.The survey received 1,447 responses (response rate: 14.07%), with 954 (65.93%) respondents previously provided PhysiApp as part of their Physiotherapy management. Most participants used PhysiApp (83.06%), found it easy to use (82.20%) and had positive perceptions on how it added value to their Physiotherapy treatment through its functionality. However, negative impacts on patient-centred care and practical exercise demonstration were apparent in the qualitative results. Key barriers to use included suboptimal explanation, digital exclusion, registration/ login issues and opinion that PhysiApp was superfluous to Physiotherapy treatment. These differed to the main barriers of why participants stopped using/ used PhysiApp less: if they were confident exercising without it, their condition improved/ resolved, loss of motivation, their exercise programme ended or if they found their exercise programme was unsuitable. Despite multiple interdependent factors influencing patient experience and barriers of using PhysiApp, the survey results revealed the significant influence that is exerted by MSK Physiotherapists. The patient-physiotherapist interaction can positively or negatively impact upon many barriers of use and the subsequent potential added value of PhysiApp to MSK Physiotherapy treatment. Future research should focus on those at most risk of digital exclusion and health inequalities, exploring their barriers to using mHealth apps and other DHTs.

Outpatient Physiotherapy for Immune-Mediated Necrotizing Myositis With a Positive Outcome: Must Pathology Equal Dysfunction? A Case Report

BACKGROUND: Necrotizing myositis (NM) is a rare autoimmune systemic condition leading to skeletal muscle destruction visualized on magnetic resonance imaging (MRI). The prognosis is severe progressive muscle weakness leading to functional mobility decline. This case study described outpatient physiotherapy management of NM, not hitherto reported, and the unanticipated outcomes given the diagnosis and MRI findings. CASE PRESENTATION: A 77-year-old female was diagnosed with NM, confirmed on MRI significant for abnormal T2 signal in all muscular compartments of both lower extremities, after 4 months of progressive limb weakness had prevented her from walking independently. Outpatient physiotherapy began 10 months after diagnosis. Examination revealed spinal and peripheral joint hypomobility, lower limb weakness (1 repetition, 30s sit to stand-30STS), functional limitation (14/80, Lower Extremity Functional Scale [LEFS]), and slow gait with rollator. The physiotherapy diagnosis was that musculoskeletal impairments contributed to movement dysfunction, leading to 18 manual therapy and exercise treatments over 19 weeks. OUTCOMES AND FOLLOW-UP: Strength (8 repetition 30STS) and function (49/80 LEFS) improved beyond minimal clinical important differences and gait speed at discharge approximated age-sex-matched normal. DISCUSSION: For this NM case, strength and function improved despite confirmed muscle necrosis and prognosis of progressive muscle degradation after addressing modifiable musculoskeletal impairments. JOSPT Cases 2024;4(4):205-211. Epub 7 October 2024. doi:10.2519/josptcases.2024.0064

Duration, Cost, and Escalation of Care Events for Physical Therapy Management of Low Back Pain in Service Members With Limb Loss.

Physical therapy (PT) is recommended as a primary treatment for low back pain (LBP), a common and impactful musculoskeletal condition after limb loss. The purpose of this brief report is to report the duration and cost of PT care, and subsequent escalation of care events, for LBP in service members with and without limb loss. This was a retrospective cohort, descriptive study. Service members with and without limb loss (matched) who received PT for LBP at a military treatment facility from 2015 to 2017 were included. Duration of PT care, number of PT visits, and escalation of care events 1 year after PT were extracted from medical records. Escalation of care events was identified as epidural steroid injections, referrals to specialists (e.g., orthopedists, spine surgeons, and pain management), and LBP-related hospitalizations.LBP-related PT encounters were queried; duration of care, number of visits, and cost of care were quantified. Escalation of care events, including opioid prescription, epidural steroid injections, specialty referrals, and hospitalizations, were identified up to 1 year after PT care. The average course of PT care for LBP was 12.9 more visits, 48.7 days longer, and $764.50 more expensive in service members with limb loss (n = 16) vs. those without limb loss (n = 48). Higher rates of opioid prescriptions and specialty referrals were observed in service members with limb loss. This study suggests that service members with limb loss and LBP received higher quantities and longer durations of PT than those without limb loss, yielding a nearly 4 times higher cost of PT.

A successful outcome in four puppies sustained swimmer puppy syndrome.

Swimmer puppy syndrome (SPS) is a rare condition that affects neonatal animals. The affected puppies are unable to stand, remain in sternal recumbency with their legs splayed laterally and ambulate with typical swimmer-like movements. This study reports the clinical findings and discusses the treatments and outcomes in four puppies of various breeds with clinical signs of SPS. Previous medical records of the animals were reviewed for history, clinical features, radiographic findings and choice of treatment. Treatment follow-up was evaluated at 15, 30, 45 days and 6 months. In three puppies all limbs were affected. In one case only the forelimbs were affected, while the hind limbs remained normal. Clinical, orthopaedic and neurological examinations, routine laboratory findings and tidal breathing flow-volume loop measurements were normal. Concurrent problems occurred in two animals and included slightly deformed chest and ventrodorsal flattening of the thorax with a slight right displacement of the heart. For the management of SPS, chest and hobble bandages were used, as well as physiotherapy and environmental management. Three puppies recovered completely after 45 days of treatment. In one case the therapy was discontinued after 2 weeks. In this case, the puppy could stand, but mild abduction of the forelimbs and lameness were obvious after 6 months. Intensive physiotherapy contributed to positive outcomes even in older puppies. Also, to the authors' knowledge, this is the first report of tidal breathing flow-volume loop measurement for dogs with pectus excavatum.

International Burn Disaster Nursing: Care, Commitment, Compassion, and Cost.

Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care. On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance. Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation. Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues. Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity.

Navigating Lymphedema: The Impact of Indocyanine Green Lymphography on Personalized Therapy Outcomes in Breast Cancer Patients

AimTo evaluate the role of Indocyanine Green Lymphography (ICG_L) in the early diagnosis and personalized management of breast cancer-related lymphedema (BCRL) among high-risk breast cancer (BC) survivors. MethodsPatients who admitted to the UPMC Magee-Womens Hospital Lymphedema Program between October 2018 and December 2021 with episodic symptoms were enrolled into the study. Patient demographics, clinical characteristics, and outcomes were prospectively collected and retrospectively analysed. Lymphatic flow disruptions were identified and guided personalized therapeutic interventions were guided by ICG_L. ResultsAmong 154 BC survivors, 184 arms were evaluated. Initial ICG_L showed 57.1% had no lymphedema, while 42.9% were classified as stage 1 to 3 lymphedema. Early diagnosis and personalized interventions provided improved outcomes, with only 4.3% developing clinical lymphedema after a median follow-up of 27 months. Patients exhibited stable or improved symptoms with individualized treatments such as manual lymphatic drainage, compression therapies, and physiotherapy. ConclusionICG_L evaluation is essential for patients at high-risk of developing BCRL. Early diagnosis before clinical onset of lymphedema, and ICG_L guided therapy significantly enhances the clinical outcomes and improves lymphedema management.

Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy.

Congenital muscular torticollis (CMT) is a postural condition evident shortly after birth. The 2013 CMT Clinical Practice Guideline (2013 CMT CPG) set standards for the identification, referral, and physical therapy management of infants with CMT, and its implementation resulted in improved clinical outcomes. It was updated in 2018 to reflect current evidence and 7 resources were developed to support implementation. Purpose: This 2024 CMT CPG is intended as a reference document to guide physical therapists, families, health care professionals, educators, and researchers to improve clinical outcomes and health services for children with CMT, as well as to inform the need for continued research. Results/Conclusions: The 2024 CMT CPG addresses: education for prevention, screening, examination and evaluation including recommended outcome measures, consultation with and referral to other health care providers, classification and prognosis, first-choice and evidence-informed supplemental interventions, discontinuation from direct intervention, reassessment and discharge, implementation and compliance recommendations, and research recommendations.

Management of Physiotherapy in Post Stroke Patients Hemiparese Sinistra et Causa Non-Hemorrhagic with Infrared and Exercise Therapy

Stroke is a neurological deficit that occurs suddenly caused by a vascular disorder in the form of a lack of oxygen supply to the brain, resulting in damage or necrosis of brain tissue. Problems that arise in stroke sufferers include weakness on their side of the body, which causes balance disturbances until independence is reduced so that they will need the help of others. Therefore, the provision of infrared and exercise therapy interventions aims to increase muscle strength, improve body balance and restore functional activity ability. This study uses a case study approach, raises patient cases and collects data through the Physiotherapy process. The modalities provided are infrared and exercise therapy in the form of resisted exercise, CIMT, and bridging exercise. After 4 times of Physiotherapy, there was an increase in muscle strength. Still, there was no improvement in balance based on the Berg Balance Scale, and there was no increase in functional activity based on CAHAI and Barthel Index. Management of physiotherapy with infrared and exercise therapy carried out in the post-stroke hemiparese Sinistra et causa NonHemorrhagic for 4 times of therapy can increase muscle strength. Still, there has been no improvement in functional activity abilityDA.

Physiotherapy Management of Frozen Shoulder Dextra with InfraRed (IR), Transcutaneous Electrical Nerve Stimulation (TENS) and Active Exercise Modalities

Frozen shoulder, commonly called adhesive capsulitis, is a painful condition in the shoulder and results in a limited range of motion of the joint (LGS). Frozen shoulder is a condition where shoulder movement becomes limited. Frozen shoulder has varying degrees of severity, ranging from mild to severe pain, and the degree of limitation to movement of the glenohumeral joint. To reduce pain and limited joint movement, which will later increase the ability for functional activities, the role and modalities of physiotherapy can be used in the form of InfraRed, Transcutaneous Electrical Nerve Stimulation, and Active Exercise. This scientific paper is a case study that raises patient cases and collects data through physiotherapy. InfraRed, Transcutaneous Electrical Nerve Stimulation, and Active Exercise are the modalities provided. After receiving physiotherapy treatment 3 times, the results of the shoulder already appear symmetrical; there is an increase in the Joint Scope of Motion (LGS) of the shoulder dextra, a decrease in pain in the shoulder dextra, the loss of spasm of the anterior and medial deltoid muscles, and the ability of the patient's functional activities using the Shoulder Pain and Disability Index (SPADI). Conclusion: Physiotherapy treatment of Frozen Shoulder Dextra using InfraRed, Transcutaneous Electrical Nerve Stimulation, and Active Exercise modalities has been proven to eliminate spasms, increase joint range of motion (LGS), reduce pain, increase muscle strength and increase functional activity capabilities using Shoulder Pain and Disability Index (SPADI).

The effect of physiotherapy intervention on functional outcomes among COVID-19 patients: Clinical experimental study.

COVID-19 is a highly contagious virus that causes pneumonia, which quickly progresses to acute respiratory distress. In the case of COVID-19, physiotherapy is critical in non-invasive support management, postural changes, chest physiotherapy (CPT), and bed mobility. This study aims to look into the effects of physiotherapy intervention on functional outcome levels in COVID-19 patients in the acute stage. A total of 60 severe COVID-19 patients (54 males and 6 females) with a mean age of 50years were studied. The intervention group (n=30) had two daily physiotherapy sessions that included positioning, CPT, cardio exercises, breathing exercises, and early mobility, whereas the control group (n=30) received only standard medical care. Patients were tested twice at the baseline and discharge using peripheral oxygen saturation, respiratory rate (RR) test, dyspnea rate, two-min walk test, and spirometer scores, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The two groups improved significantly between the baseline and discharge ratings. The intervention group, on the other hand, significantly improved all outcome indicators at discharge (p-value=0.00). This study found that physiotherapy management improved oxygen saturation, RR, dyspnea, and lung function tests in COVID-19 patients except in FVC (p-value=0.402) and FEV1(p-value=0.114). Physiotherapist interventions with COVID-19 patients increase respiratory function and treatment time.

Physiotherapy management in anal cell carcinoma following laparoscopic surgery – A Case Report

Physiotherapy management in anal cell carcinoma following laparoscopic surgery – A Case Report