Musculoskeletal Physiotherapy Research Articles

Agreeing priority categories and items for inclusion in a future best practice delegation framework for musculoskeletal outpatient physiotherapy services: A consensus groups study

PurposeDelegation of clinical tasks from physiotherapists to physiotherapy support workers varies considerably in musculoskeletal outpatient physiotherapy services leading to variation in patient care. This study aimed to develop consensus amongst physiotherapists, support workers and managers about what components should be included in a future framework to guide effective and safe delegation of clinical tasks to physiotherapy support workers in United Kingdom's National Health Service musculoskeletal outpatient physiotherapy services. MethodsA consensus study was carried out, using Nominal Group Technique. Seven physiotherapists, ten physiotherapy support workers and ten physiotherapy operational/clinical leads from 13 musculoskeletal physiotherapy services within United Kingdom's National Health Service were recruited through the Chartered Society of Physiotherapy's professional networks and social media. Three separate, role-specific consensus groups were convened, involving participants generating, discussing and rating on a Likert scale, components for inclusion in a future delegation framework. Results32 out of 38 generated items reached consensus of ≥70%, i.e. a mean of ≥4.9 on a 7-point Likert scale, across the three groups. Items were grouped under five main categories: 1) training/Continuous Professional Development for physiotherapists and support workers; 2) need for a clear delegation process; 3) competencies 4) defining the role of support workers and 5) safety net. ConclusionKey stakeholder groups were able to reach consensus on five priority areas which will be developed into a best practice framework to standardise delegation and guide physiotherapists when delegating clinical tasks to support workers.

Physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: A randomised controlled trial.

Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT). To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients. In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2). Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI95%: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI95%: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI95%: -2.90, -0.52], p = .01; ROM = 4.61 [CI95%: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI95%: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI95%: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI95%: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p = .04) and VAS chew (χ2(1) = 11.58, p < .01). Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD. NCT03726060.

Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology

BackgroundVascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs.ObjectiveTo explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students.MethodsQualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein’s diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes).ResultsFor all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant’s clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection).ConclusionsFindings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.

Anti-TNF (adalimumab) injection for the treatment of pain-predominant early-stage frozen shoulder: the Anti-Freaze-Feasibility randomised controlled trial

ObjectiveThe Anti-Freaze-F (AFF) trial assessed the feasibility of conducting a definitive trial to determine whether intra-articular injection of adalimumab can reduce pain and improve function in people with pain-predominant early-stage...

Self-referral to musculoskeletal physiotherapy in the National Health Service (NHS): a mixed methods, four-domain analysis of 1,000 adult new patients initially assessed via telephone versus face-to-face

Introduction In some regions, NHS patients are able to self-refer to physiotherapy. Initial assessment and triage of these referrals is via telephone (PhysioDirect) or face-to-face (Physio Access Clinic). There is currently a scarcity of literature comparing both methods in physiotherapy triage. A multi-domain mixed-methods comparison was conducted to evaluate cost, outcomes & satisfaction of both methods. Method Data was collected for telephone and face-to-face self-referrals from October 2021 to February 2022 and analysed to compare patient outcome, patient satisfaction, physiotherapist perception and cost between both delivery methods. Results Outcomes were analysed across 2402 total patient contacts, with face-to-face assessment showing improved outcomes in all areas compared to telephone assessment. Patient satisfaction was greater following face-to-face assessment than telephone. Physiotherapists showed greater satisfaction, greater diagnostic confidence, greater feeling of support and improved learning with a face-to-face approach. Scaled to 150 patients per week face-to-face only was associated with an annual saving of over £40,000 compared to telephone only initial assessment. This is equivalent to 1503 physiotherapist hours and 550 administrative hours. Conclusion Patients self-referring to musculoskeletal physiotherapy via a face-to-face clinic have improved outcomes with greater reported satisfaction. Physiotherapists preferred face-to-face appointments in all facets examined within this study. A significant annual cost saving was evident through face-to-face contact which is especially relevant in the current economic climate of the NHS. Given these notable advantages of face-to-face triage over telephone triage, these findings could inform the planning of future physiotherapy provision.

A narrative synthesis of the effectiveness and acceptability of musculoskeletal first contact physiotherapy practitioner roles in primary care.

Musculoskeletal (MSK) First Contact Practitioners (FCP), diagnostic clinicians with expertise in the assessment and management of undifferentiated MSK conditions in primary care have been widely employed in the United Kingdom since 2020. The role aims to bring specialist clinical knowledge to patients at the first point of contact and reduce the burden on existing primary care services. Since the national adoption of the role, little has been published to support the effectiveness or acceptability of the role. This narrative synthesis review aims to highlight and summarise the current body of evidence. An adapted systematic review was carried out to inform thematic reporting and narrative synthesis, under the sub-themes of clinical outcomes, patient satisfaction, acceptability and cost analysis. Eight publications were included in the review, reporting improvements in clinical outcomes in patients seen by MSK FCP, patient satisfaction and general acceptability of the role. However, all data were collected from observational studies and qualitative sources, some of which were found to be of low methodological quality. Although the review identified consistent positivity relating to effectiveness, satisfaction and acceptability across the reviewed publications, conclusions are limited due to the relatively recent introduction of the FCP role leading to limited availability of relevant publications.

Physiotherapy and its service in Nepal: implementation and status reported from facility surveys and official registers

BackgroundPhysiotherapy is a growing profession in Nepal. Despite efforts to promote strengthening and development, there are still challenges in providing equitable access and availability to services, particularly in underserved areas. Updated information is needed to address challenges to provide proper planning for resource allocation.ObjectiveTo assess implementation of physiotherapy services and to explore plans, policies and the general status of physiotherapy in Nepal.MethodImplementation was assessed with a cross-sectional survey conducted in Province III containing closed-ended questions addressing physiotherapy services, human resources, charging and record-keeping systems, and accessibility. Stratified purposive sampling was used to select eligible facilities from the list of Department of Health Services. Official records were explored through visits to governing institutions and by reviews of registers and reports to obtain data and information on status, plans and policy.ResultsThe survey included 25 urban and 4 rural facilities, covering hospitals and rehabilitation centres; both public (37.9%) and non-public (62.1%). Most facilities (79.3%) employed physiotherapists with bachelor’s degrees. Average number of visits were 29.55 physiotherapy outpatients and 14.17 inpatients per day. Patient records were mainly paper based. Most (69%) used the hospital main card, while others (31%) had their own physiotherapy assessment card. Most referrals came from doctors. The most offered services were musculoskeletal, neurological, and paediatric physiotherapy. Daily basis charging was common. A single visit averaged 311 Nepalese rupees ≈ 2.33 US$. Convenience for persons with disabilities was reported as partial by 79% of outpatient departments. Official register data showed 313 master’s and 2003 bachelor’s graduates. Six colleges offered physiotherapy bachelor’s degree, whereof one also offered a master’s program. Government records revealed significant progress in physiotherapy in Nepal.ConclusionThe study highlights variations in physiotherapy services within a province owing to type, size and location, but also unwarranted variations. Despite the progress, implementation of physiotherapy services in the perspective of official records imply a need of systems for proper planning and monitoring. Physiotherapy provision in underserved areas warrants further attention.

Balancing act: Unraveling the link between muscle strength, proprioception, and stability in unilateral hip osteoarthritis.

The objectives of this study are to compare hip muscle strength, hip joint proprioception, and functional balance between individuals with unilateral hip OA and asymptomatic individuals and to examine the relationships among these variables in the hip OA population. In a prospective cross-sectional study, 122 participants (unilateral Hip OA: n = 56, asymptomatic: n = 56) were assessed at the CAMS/KKU musculoskeletal Physical Therapy laboratory. Ethical standards were upheld throughout the research, with informed consent obtained. Hip muscle strength was measured using a hand-held dynamometer, hip joint proprioception with a digital inclinometer, and functional balance using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test. Hip OA individuals exhibited significantly lower muscle strength and proprioceptive accuracy, and poorer functional balance than controls (p < 0.003). Correlation analyses revealed a positive correlation between muscle strength and BBS scores (r = 0.38 to 0.42) and a negative correlation with TUG test times (r = -0.36 to -0.41). Hip joint reposition sense (JRS) in flexion showed a negative correlation with balance (r = -0.46), while JRS in abduction was positively correlated (r = 0.46). The study highlights the clinical importance of muscle strength and proprioception in functional balance among individuals with unilateral hip OA. The results support the incorporation of muscle strengthening and proprioceptive training in interventions to improve balance and mobility in this population.

The role of patient treatment specific expectations on the outcomes of musculoskeletal physical therapy treatment: A scoping review

AbstractBackgroundIt is unknown how well patient treatment expectations are related to outcomes within musculoskeletal physical therapy. The purpose of this scoping review was to examine the association between patient treatment expectations and outcomes following physical therapy care for musculoskeletal injury and to identify gaps in the literature on this topic.Data SourcesPubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from January 2005. Concepts represented in the search included physical therapy, patient expectations, and patient outcomes, as well as their relevant synonyms.Data Extraction and SummaryA custom spreadsheet was used to chart demographic details, study design, and key findings from eligible studies. The critical appraisal skills programme (CASP) for cohort studies was used to determine reporting comprehensiveness and fit for inclusion into the review.ResultsTwelve (12) studies were included in this review representing 1855 patients across a variety of patients with musculoskeletal disorders. Studies were most commonly secondary analyses of controlled trials (n = 10) or controlled trials (n = 2) and yielded high CASP scores. A wide range of methods were used to determine patient expectations. The impact of patient treatment expectations was mixed, with some studies indicating a positive relationship between expectation fulfilment and improved outcomes, while others indicate no such relationship.ConclusionThe relationship between treatment expectations and outcomes within musculoskeletal physical therapy practice is not clear. Future studies with planned comparisons are needed to define appropriate methods to seek patient expectations and measure outcome differences between groups based on expectation fulfilment.

Investigating the Combined Effects of Fascial Distortion Model Manual Therapy and Balance-Strength Training in Individuals with Chronic Ankle Instability.

The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, and its potential effectiveness in treating chronic ankle instability (CAI) remains unexplored. A randomized controlled trial with 23 participants was conducted. Patients were randomly assigned to either the FDM + balance-strength training (BST) group (n = 8), receiving extra FDM sessions weekly in addition to two sessions of BST, or the BST group (n = 7). Healthy controls (n = 8) did not receive any treatment and participated only in pre- and post-test measurements. Objective measurements including Y-Balance Test Lower Quarter (YBT-LQ), Flamingo Balance Test (FBT), Weight-Bearing Lunge Test (WBLT), ankle joint range of motion (ROM), and Cumberland Ankle Instability Tool (CAIT) were recorded at baseline and the end of the intervention. The results demonstrated significant differences between the FDM + BST and BST groups for supination ROM (p = 0.008) and similarly for WBLT (p = 0.041), FBT (p = 0.40), YBT-LQ (p = 0.023), and CAIT score (p = 0.008). Moreover, while both groups demonstrated significant improvement at the post-test compared with their pre-test for plantarflexion and pronation ROM, WBLT, and CAIT score, the FDM + BST group demonstrated significant improvements in supination ROM, FBT, and YBT-LQ. Our study suggests that the addition of FDM concepts to a BST may lead to enhanced improvements in ankle ROM, static and dynamic balance, and self-reported outcomes in individuals with CAI compared to BST.

Effect of the Shoulder Symptom Modification Procedure on Pain and Kinesiophobia in Patients with Shoulder Pain: A Quasi-experimental Study

Introduction: Shoulder pain, ranking third among musculoskeletal issues, hampers diagnostics due to test limitations. The present study explores the potential of the Shoulder Symptom Modification Procedure (SSMP) as an intervention. Influential factors in physiotherapy outcomes, including kinesiophobia, are linked to shoulder pain. A knowledge gap remains on the impact of SSMP on pain and kinesiophobia in individuals with shoulder pain, contributing insights to musculoskeletal interventions. Aim: To investigate the effect of SSMP on pain and kinesiophobia in patients with shoulder pain. Materials and Methods: A single-blinded quasi-experimental study was conducted in the Department of Musculoskeletal Physiotherapy on 35 participants aged 40-60 years experiencing shoulder pain, recruited from R.V. College of Physiotherapy, Bengaluru, Karnataka, India, over a six month period from February 2022 to July 2022. Pain was measured using the Numerical Pain Rating Scale (NPRS), and kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK). The researcher, blinded to pre- and post-test results of TSK11 and NPRS, conducted a shoulder symptom modification assessment. The procedure’s response-guided treatment was administered twice a week for three weeks, with each session lasting 30 minutes. Pre-assessment of TSK-11 and NPRS was performed by an assessor, with the same assessor re-evaluating outcomes after three weeks. Data underwent statistical analysis using a paired t-test in R Software version 4.1.0, with significance attributed to results having a p-value &lt;0.05. Results: The mean age of the study participants was 52±7.74 years. There was a significant reduction in NPRS from 7.54±1.146 to 3.74±1.70 post-intervention and TSK-11 scores from 27.20±5.12 to 23.17±4.83 in subjects with shoulder pain after three weeks of intervention. The study showed a significant improvement in pain (p&lt;0.001*) and kinesiophobia (p&lt;0.001*) in patients with shoulder pain. Conclusion: The SSMP was found to be effective in reducing pain and kinesiophobia in patients with shoulder pain. Further research should be conducted in the future, taking large samples and varied techniques into account for the identification of optimal strategies in improving health-related outcomes.

Feasibility of 3D Body Tracking from Monocular 2D Video Feeds in Musculoskeletal Telerehabilitation.

Musculoskeletal conditions affect millions of people globally; however, conventional treatments pose challenges concerning price, accessibility, and convenience. Many telerehabilitation solutions offer an engaging alternative but rely on complex hardware for body tracking. This work explores the feasibility of a model for 3D Human Pose Estimation (HPE) from monocular 2D videos (MediaPipe Pose) in a physiotherapy context, by comparing its performance to ground truth measurements. MediaPipe Pose was investigated in eight exercises typically performed in musculoskeletal physiotherapy sessions, where the Range of Motion (ROM) of the human joints was the evaluated parameter. This model showed the best performance for shoulder abduction, shoulder press, elbow flexion, and squat exercises. Results have shown a MAPE ranging between 14.9% and 25.0%, Pearson's coefficient ranging between 0.963 and 0.996, and cosine similarity ranging between 0.987 and 0.999. Some exercises (e.g., seated knee extension and shoulder flexion) posed challenges due to unusual poses, occlusions, and depth ambiguities, possibly related to a lack of training data. This study demonstrates the potential of HPE from monocular 2D videos, as a markerless, affordable, and accessible solution for musculoskeletal telerehabilitation approaches. Future work should focus on exploring variations of the 3D HPE models trained on physiotherapy-related datasets, such as the Fit3D dataset, and post-preprocessing techniques to enhance the model's performance.

Students experienced near peer-led simulation in physiotherapy education as valuable and engaging: a mixed methods study

QuestionsWhat is the student experience of near peer-led simulation in physiotherapy education from the perspectives of students (near peer learners and near peer teachers)? What are their expectations, perceptions and engagement in this as a teaching and learning activity? Are there any short-term benefits? DesignConvergent mixed-methods study. ParticipantsFrom a graduate entry Doctor of Physiotherapy course, 111 first-year and 20 second-year students participated. InterventionNear peer-led simulation was delivered within first-year cardiorespiratory, musculoskeletal and neurological physiotherapy curricula and as a precursor to second-year clinical placements. First-year students were near peer learners. Second-year students were near peer teachers and the simulated patients. Outcome measuresFocus groups, pre/post-simulation questionnaires and direct observation. Data were triangulated and presented in overall themes. ResultsFive themes emerged: near peer-led simulation improved the students’ confidence and the opportunity to make mistakes in a supportive and safe environment was valued; peer feedback was an integral part of the learning process that enriched the learning experience; the authenticity and realism created seriousness, promoted engagement and facilitated perceived knowledge transfer; there were benefits for learning for both peer learners and peer teachers; and the anticipation and emotional impact was evident. ConclusionNear peer-led simulation was viewed by students as a valuable and engaging activity. Students perceived a broad range of benefits on their learning, especially from peer feedback (giving and receiving) on their performance, and had increased confidence following simulation. Peer-led simulation is an authentic and valuable component of entry-to-practice physiotherapy education.

‘What should we teach?’ A U.K. survey comparing clinician and academic views on content of the pre-registration musculoskeletal physiotherapy curriculum

Evolving evidence underpinning musculoskeletal physiotherapy challenges the definitions of contemporary clinical practice and pre-registration curricula. This research uses an online national survey to compare clinician (272) and lecturer (61) views on the Chartered Society of Physiotherapy’s four pillars of practice (manual therapy and therapeutic handling; exercise, movement, and rehabilitation; therapeutic and diagnostics technologies; and allied approaches, including psychologically informed approaches) with the aim of establishing their clinical and educational utility. Findings indicate that close alignment exists between practising U.K. musculoskeletal physiotherapists and U.K. pre-registration physiotherapy lecturers on the ongoing relevance of exercise therapy and psychologically informed approaches to behaviour change. The paper also shows that a mismatch exists in the clinical and educational use of both manual therapy and electrotherapy between practising physiotherapists and physiotherapy lecturers. Future research should focus on the highlighted need to continue to align pre-registration musculoskeletal curricula with both the evidence base and clinical practice for the curricular areas of electrotherapy and manual therapy. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0 .

An evaluation of the effectiveness of an advanced practice physiotherapist in the emergency department setting in Ireland.

One of the means of easing increased pressure on emergency care worldwide has been the development of advanced musculoskeletal physiotherapy practice in the emergency department setting. This model of care is in its infancy in Ireland. To evaluate the effectiveness of an advanced practice physiotherapist working as a primary contact clinician in the emergency department at St. James's Hospital, Dublin. A three-month retrospective chart review was undertaken for patients assigned the advanced practice physiotherapist as their primary clinician during their emergency department attendance. Three widely accepted measures of quality in emergency medicine were used to evaluate effectiveness, namely, time from attendance to discharge, time from triage to assessment, and unplanned reattendance within seven days. A total of 129 patients were included in this study. Time from attendance to discharge was significantly less in the APP group (mean 208.5min, standard deviation 122.4min) than in the ED group (mean 377.1min, standard deviation 314.7min) (mean difference - 168.61 (95% C.I - 191.24- - 145.98)) (p < 0.001). Time from triage to assessment was significantly less in the APP group (mean 72.1min, standard deviation 51.9min) than in the ED group (mean 94.1min, standard deviation 96.5min) (mean difference - 22.08 (95% C.I - 31.28- - 12.89)) (p < 0.001). The unplanned reattendance rate was 3.9%. No adverse events were identified. The findings of this study indicate that an advanced practice physiotherapist can provide a timely, effective, and safe service for patients attending the emergency department with musculoskeletal complaints in Ireland.

A44Simulated placement preparation: physiotherapy student acceptability of a multi-level simulated placement preparation week

Practice based learning (PBL) remains a universal mandatory experience for physiotherapy students. Challenges of placement capacity were heightened by the impact of COVID 19 as well as growing demand in response to the NHS long term plan/interim people plan for growth in AHP workforce. These challenges provided opportunity to rapidly progress sustainable PBL capacity utilizing simulation as replacement and enhancement of PBL. Having established simulation as placement replacement within the Faculty of Health &amp; Wellbeing at University of Winchester [1], the simulated placement preparation (SPP) project aimed to explore the acceptability of simulation as preparatory enhancement of PBL, delivering a week of multilevel peer assisted simulated PBL; two primary objectives of reducing demand on capacity and optimizing students’ success in PBL through preparatory simulated activities. Simulation and learning focused on the development of digital capabilities in recognition of the Topol review that reflected the requirements of NHS workforce to be digitally capable [2]. Additionally, the KNOWSBEST study [3] recommended digital capability and simulation within PBL, thus simulated activities were designed to promote core digital capabilities including training and simulation in remote consultations and presenting simulated scenarios accessed via electronic patient records. Collaborative learning in practice (CLiP) model of supervision was used to promote peer assisted learning with learning outcomes focused on communication and MDT domains of the common placement assessment form (CPAF), familiarization with digital technologies and orientation and management of scenarios in high acuity environments and enhancement of digital capabilities. The SPP week utilized mixed modality and fidelity simulated activities including ‘real play’ remote consultations, simulated patients, manikins/ventilators and virtual simulations. Students completed faculty developed questionnaires pre and post SPP relating to self-assessed communication and telehealth capability and specific clinical competence in musculoskeletal and cardiorespiratory physiotherapy. A convenience sample of students participated in focus group interviews following subsequent completion of PBL to explore their perceived impact of SPP on subsequent PBL. Thematic analysis was used to analyse focus group interviews and pre-post anaylsis conducted using repeated measures ANOVA. Results demonstrated increased capabilities in teleconsultation and appreciation of digital technologies potential. Students reported enhancement of in person and remote communication as well as clinical capabilities in high acuity environments. Students reported the SPP week as an acceptable means of replacing one week of PBL, enhancing the preparedness for clinical environments and sustainably increasing placement capacity by providing 4440 hours of simulated PBL. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The pain attitudes and beliefs scale for physiotherapists: psychometric properties of the Croatian version

Objective This study aims to create a Croatian version of the PABS-PT questionnaire and determine the psychometric properties. Design This study is a cross-sectional survey of Croatian physiotherapists. Methods The Pain Attitudes and Beliefs Scale for Physiotherapists is a questionnaire that includes 36 items. Only physiotherapists working with patients suffering from low back pain and who have been working for at least 1 year in the field of musculoskeletal physiotherapy participated in the study. The Factor and Cronbach’s alpha analyses were performed to determine the factor structure and internal consistency. Results A total of 203 physiotherapists (response rate 69.52%) completed the PABS-PT-CRO. The analysis reveals two factors, i.e. a biomedical and biopsychosocial treatment orientation. The two-factor structure explained 25.8% of the total variance, with factor 1 contributing 17.8% and factor 2 contributing 8%. Thirty-six items were reduced to fifteen, with ten items loading on factor 1 and five on factor 2. Cronbach’s alpha was 0.762 for factor 1 (biomedical scale) and 0.666 for factor 2 (biopsychosocial scale). Conclusion The Croatian version of the PABS-PT appears to be equivalent to the original Dutch version and indicates a similar internal consistency. The questionnaire is valuable and necessary in clinical work for physiotherapists.

Faktor Risiko Kejadian De Quervain Syndrome pada Pemain Game Online Mobile Legends Bang Bang

The internet is not only used to find information but also as a means of entertainment such as playing online games. One of teenagers’ most popular online games is Mobile Legends Bang Bang. Playing mobile legends bang bang games excessively can cause a risk of repeated injuries that lead to de quervain syndrome. This study aims to: determine the risk factors for the incidence of de quervain syndrome in E-sport UKM Saint NU Institute of Technology Pekalongan. This study used quantitative methods with an analytical observational research design with a cross-sectional approach. The population of members of the E-sport UKM Institut Teknologi and Saint NU Pekalongan is 60. A sample of 53 corresponds to the of inclusion and exclusion criteria of the total population. Data analysis using fisher test. The results of this study, where the age with the category of late adolescence as much as 42 (79%). The duration of playing online games is 44 (83%) in the high player category. There were 38 respondents (72%) positive for de quervain syndrome as evidenced by the finkelstein test. Based on data analysis using the Fisher test, a p value of 0.040 was obtained for the relationship of age with de quervain syndrome and a p value of 0.037, so there is a relationship between age and de quervain syndrome and there is a relationship between the duration of playing online games with de quervain syndrome. The results of this study can be a reference and understanding of ergonomic and musculoskeletal physiotherapy related to cases of de quervain syndrome caused by age and duration of playing online games.

Goal setting in physiotherapy-led adult musculoskeletal care: A scoping review.

Goal setting is a key part of rehabilitation across various fields of physiotherapy. It is less clear what evidence exists to underpin its effectiveness and to practically guide its use within musculoskeletal physiotherapy. This scoping review provides an overview of current research regarding goal setting in adult physiotherapy-led musculoskeletal care with three aims: 1) to identify and analyse any gaps in the literature, 2) to identify relevant features of goal setting theory and 3) to make recommendations for future research. The principal research question was what does the literature tell us about the role of goal setting for adults over the age of 18 with musculoskeletal pain accessing outpatient physiotherapy services? The population, concept and context framework was used to define the inclusion criteria. Key definitions were adults over the age of 18 with musculoskeletal conditions, goal setting, and physiotherapy-led interventions. This scoping review followed the guidance set out by the Joanna Briggs Institute Manual for Evidence Synthesis. Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, MEDLINE, American Psychological Association PsycInfo and the Cochrane Database of Systematic Reviews, Protocols and Trials were searched using pre-defined search criteria. Data were extracted from screened full-text articles and presented in basic statistical and narrative form. 41 articles were included in the review. Several broad themes and research methods were identified. The nature of the studies suggested that the clinical application of goal setting is complex and the depth of understanding is limited. Most studies suggested that goal setting is feasible and has a positive impact on outcomes. A common finding was a lack of clear definitions regarding goal setting terminology and approaches. Study samples were generally defined by biomedical categories, suggesting a pathoanatomical approach to researching a cognitive construct. Theoretical underpinning was lacking in many studies. No frameworks guiding goal setting in physiotherapy-led musculoskeletal rehabilitation have been identified. Goal setting is a popular tool within musculoskeletal outpatient physiotherapy. Further research is required to clarify its efficacy and provide guidance on its role and application in clinical practice.

Effect of Maitland and Mulligan mobilization on pain, range of motion and disability in patients with rotator cuff syndrome: a randomized clinical trial protocol

Background: Rotator cuff syndrome (RCS) comprises partial or whole-thickness rotator cuff tears, rotator cuff tendonitis, subacromial impingement syndrome, and bursitis. Expansion of rotator cuff arthropathy and glenohumeral degenerative disease are both made more likely by chronic rotator cuff syndrome. The maximum well-supported nonsurgical treatment for individual with rotator cuff (RC) injury appears to be musculoskeletal physiotherapy, including manual treatments and exercises. Scapular stabilisation exercises, proprioceptive neuromuscular facilitation (PNF), range of motion (ROM), rotator cuff strengthening exercises, and stretching exercises are some of the therapeutic exercises that have been shown to be useful in recovering shoulder function. The passive, expert movements known as joint mobilisation and manipulation are used by clinicians to increase joint mobility and to reduce pain. Methods: In this study we aim to find out the effect of Maitland and Mulligan mobilization on improving ROM, functional disability and pain in individuals with rotator cuff syndrome through a randomized clinical trial. 80 individuals in total will be allocated equally into two groups, and both groups will be receiving treatment for six weeks with five sessions per week. After six weeks of therapy the results will be assessed for follow-up. By mobilization there will be increased range of motion, reduction in pain and functional disability, this technique may be used to patient with rotator cuff syndrome if our study's premise is found to be significant. Conclusions: In this study, we expect that the Maitland and Mulligan mobilization on pain, range of motion and disability in patients with rotator cuff syndrome will have significant effects. CTRI Registration: CTRI/2023/05/052643.