Patient-Specific Functional Scale Research Articles

Cross-cultural adaptation and psychometric properties of the Italian version of the Patient-Specific Functional Scale (PSFS) in subjects with shoulder pain

Purpose To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Italian and study its classic psychometric properties in subjects with shoulder pain (SP). Materials and Methods The PSFS was translated into Italian and administered to 109 SP subjects. Acceptability (time to administer, floor and ceiling effects), reliability (internal consistency [Cronbach’s alpha], test-retest reliability [Intraclass Correlation Coefficient (ICC)], and measurement error [Standard Error of Measurement (SEM), Minimal Detectable Change, (MDC)]), were assessed. Moreover, construct validity was investigated through a-priori hypothesis testing, comparing the PSFS with the Disability of the Shoulder, Arm and Hand (DASH) scale, 36-item Short Form Health Survey (SF-36) and Numeric Pain Rating scale (NPRS). Results The PSFS was successfully adapted into Italian, and its acceptability was satisfied. Internal consistency was high (Cronbach’s alpha = 0.925), and test-retest reliability was good (ICC = 0.866, 95% CI = 0.749–0.931). A SEM of 0.7 points and an MDC of 1.9 points were obtained. We observed moderate evidence for construct validity, with 4/6 correlations between other measures being respected. Conclusion This study provided reliability and validity of the PSFS in a sample of Italian SP subjects. Future studies should assess the responsiveness of using the PSFS as an outcome measure to capture clinical changes after treatment.

EXERCISE PHYSIOLOGIST-LED PAIN SCIENCE COACHING VIA TELEHEALTH IMPROVED PAIN AND FUNCTION IN LIFE INSURANCE CLAIMANTS: A PRAGMATIC COHORT STUDY

INTRODUCTION & AIMS Personal injury and illness compensation claimants are more likely to experience persistent pain and poorer clinical/vocational outcomes than non-compensated clients. Evidence supports the effectiveness of pain science coaching to help people understand and re-train their pain system. This consequently reduces pain intensity, improves function and quality of life. However, the effectiveness of telehealth-delivered, exercise physiologist-led pain science coaching is yet to be evaluated. This study aimed to determine the effectiveness of an accredited exercise physiologist-led pain science coaching intervention via telehealth in Australian life insurance claimants. METHODS This pragmatic cohort study included 1,275 claimants receiving a pain science coaching intervention supported by life insurance compensation. Ethics was approved via Deakin University Human Research Ethics Committee (2023-347). Outcome measures were pain intensity (11 item numerical pain rating scale, range: 0-10 points) and function (two 11-item patient-specific functional scale, range: 0-20 points). Linear mixed models determined within-group change over time. RESULTS Clients (female: 75%, male: 25%) had a mean (SD) age of 50 (10) years (range: 20-69 years) and claim duration of 2 (2) years (range: 0-20 years). Mean (SD) intervention duration was 10 (6) weeks (range: 3-41 weeks), financial cost was A$1,149 (A$202; range: A$510-A$2,040) and included 5 (1) hours (range: 2-11 hours) of pain science coaching. Following the intervention, pain intensity decreased 25% (estimated marginal mean change [95%CI]: -1.49 [-1.59, -1.40] points, P<0.001) and function increased 76% (4.41 [4.21, 4.62] points, P<0.001). Changes surpassed established clinically meaningful effect thresholds for pain intensity (1.17 points) and function (2.6 points). Client Net Promotor Score was +60 (Australian Healthcare Index benchmark ≥ +30) and 91% were satisfied with the intervention. CONCLUSION An exercise physiologist-led pain science coaching intervention resulted in clinically meaningful improvements in pain intensity and function in compensation claimants. Clients reported high satisfaction rates.

VIRTUAL-REALITY PAIN SCIENCE POSITIVELY IMPACTS PAIN AND FUNCTION, RETURN TO WORK, CUSTOMER EXPERIENCE AND RETURN ON INVESTMENT: A CASE STUDY

CASE SETTING 52-year-old male client referred for post-operative cervical-spine two-level fusion rehabilitation, two-years following a motor accident. History of prior motor accident five-years earlier with cervical-spine discectomy resolving symptoms. Referred under compensable insurance policy with 13-years claim benefit remaining. Referral objective to restore health and function for return-to-work (RTW). Experiencing intolerable neck pain with reduced left arm function, pain medication side effects, and low mood. Loss of hope resulting from significant pain post-operatively, whereas prior surgery resolved similar symptoms. Not working at referral. Pre-disability work was full-time self-employed barista. TREATMENT/REHABILITATION PROVIDED Six hours of EXPHYS BETTER Pain VR program, consisting of virtual-reality (VR) pain science coached by an exercise physiologist (AEP) over 10-weeks, face-to-face, within the pain mechanism and bio-psycho-social models. Learning consisted of VR modules and workbook with practical application of six key target pain concepts: pain is always real, doesn’t accurately measure tissue health, relies on context, is a protector, has a buffer zone, and can be retrained. Two functional goals of self-care and cooking were established, and RTW. RESULTS Validated inventories demonstrated self-reported improvements in; pain intensity: 11 item numerical pain rating scale, range: 0-10 points [8 referral; 1 closure]; and function; two 11-item patient-specific functional scale [self-care, cooking], range: 0-20 points) [2 referral; 16 closure]. Work mindset improved from pre-contemplation [referral] to maintenance [closure]. Work capacity improved from no capacity to full capacity. Work status improved from not working to working pre-disability hours and duties. Insurance claim closed. Direct return-on-investment of $300 for every $1 spent on the EXPHYS BETTER Pain VR Program. Client net promotor score (NPS) was promoter (10/10), and customer satisfaction (CSAT) was very satisfied (5/5). REFLECTIONS/LEARNINGS Virtual-reality pain science, delivered by an AEP within the pain mechanisms model, positively impacts pain and function, RTW, and customer experience, with demonstrated return-on-investment.

FATIGUE SCIENCE INFORMING LONG COVID RECOVERY: A CASE STUDY

CASE SETTING 42-year-old female client referred for unmanaged long covid symptoms, six months following severe acute COVID-19 infection. Referred by an occupational therapist under Life Insurance to restore health and function for return to work (RTW). Experiencing cognitive and physical fatigue, muscular aches, breathlessness, post-exertional malaise, reduced cognitive capacity and exacerbated asthma symptoms at referral. Reduced functional capacity to perform activities of daily living and usual work duties and hours. TREATMENT/REHABILITATION PROVIDED 14 hours of exercise physiology was delivered by telehealth over nine months, during fortnightly or monthly consultations. Additional multidisciplinary collaboration occurred with occupational therapist, return to work co-ordinator, and general practitioner. The intervention consisted of educational coaching sessions on the physiology of fatigue, pacing strategies, individualised wellness strategies (sleep, mindfulness/relaxation, exercise, diet), relapse planning, and RTW planning. A commercially available wearable device obtained 24/7 biometric data, which tracked resting heart rate variability (rHRV), resting heart rate, respiratory rate, and sleep performance. rHRV objectively measured fatigue. Wellness strategies were coached from analysing the impact of client behaviours on rHRV trends. Two functional goals of housework and socialising were established. RESULTS Validated inventories measured self-reported improvements in; fatigue symptoms: 12-item SPHERE-12, range: 0-68 points [42 baseline; 4 final]; function: two 11-item patient-specific functional scale [housework, socialising], range: 0-20 points [5 baseline; 19 final]; and quality of life: 16-item quality of life scale, range: 0-112 [54 baseline; 79 final]. rHRV improved [10ms baseline, 56ms final]. RTW improved from four days/week to five days/week in her pre-disability role as a client manager. REFLECTIONS/LEARNINGS rHRV provided an objective marker of fatigue. The subject responded positively to rHRV monitoring. Real time biometric data enables individualised fatigue coaching including behaviour change, wellness and planning/pacing strategies. This approach improved fatigue and restored function to perform daily activities and RTW.

Implementation of a Patient-Reported Outcome Measure: A Quality Improvement Project.

Patient-reported outcome measures (PROMs) are seen as increasingly beneficial to patient-centered clinical practice, but implementation of routine collection and utilization into clinical care can be challenging. Our interdisciplinary quality improvement (QI) team used the Institute for Health Care Improvement Model for Improvement methodology to address this problem in our outpatient neurorehabilitation program. We used a participatory approach to identify the PROM rehabilitation stakeholders found to be most appropriate to implement in the outpatient settings; chart audits were conducted to determine the extent to which clinicians implemented the PROM and documented a PROM-related goal. Opportunistic clinician feedback was collected to determine single PROM usefulness and acceptability. Our 4-month initiative demonstrated increased collection of a PROM, the Patient-Specific Functional Scale (PSFS), and incorporation into patient-centered goal. Use of QI methodology was beneficial when planning and executing our initiative. Future work is needed to examine factors to sustain PSFS use, incorporation into patient-centered goal setting, and maximize meaningful patient outcomes.

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

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

Developing a shortened spine functional index (SFI-10) for patients with sub-acute/chronic spinal disorders: a cross-sectional study

BackgroundBrief whole-spine patient-reported outcome measures (PROMs) provide regional solutions and future directions for quantifying functional status, evidence, and effective interventions. The whole-spine regional Spine Functional Index (SFI-25) is used internationally in clinical and scientific contexts to assess general sub-acute/chronic spine populations. However, to improve structural validity and practicality a shortened version is recommended. This study developed a shortened-SFI from the determined optimal number of item questions that: correlated with criteria PROMs being highly with whole-spine, moderately with regional-spine, condition-specific and patient-specific, and moderately-low with general-health and pain; retained one-dimensional structural validity and high internal consistency; and improved practicality to reduce administrative burden.MethodsA cross-sectional study (n = 505, age = 18-87 yrs., average = 40.3 ± 10.1 yrs) of sub-acute/chronic spine physiotherapy outpatients from an international sample of convenience. Three shortened versions of the original SFI-25 were developed using 1) qualitative ‘content-retention’ methodology, 2) quantitative ‘factorial’ methodology, and 3) quantitative ‘Rasch’ methodology, with a fourth ‘random’ version produced as a comparative control. The clinimetric properties were established for structural validity with exploratory (EFA) and confirmatory (CFA) factorial analysis, and Rasch analysis. Criterion validity used the: whole-spine SFI-25 and Functional Rating Index (FRI); regional-spine Neck Disability Index (NDI), Oswestry Disability Index (ODI), and Roland Morris Questionnaire (RMQ), condition-specific Whiplash Disability Questionnaire (WDQ); and patient-specific functional scale (PSFS); and determined floor/ceiling effect. A post-hoc pooled international sub-acute/chronic spine sample (n = 1433, age = 18-91 yrs., average = 42.0 ± 15.7 yrs) clarified the findings and employed the general-health EuroQuol-Index (EQ-5D), and 11-point Pain Numerical Rating Scale (P-NRS) criteria.ResultsA 10-item SFI retained structural validity with optimal practicality requiring no computational aid. The SFI-10 concept-retention-version demonstrated preferred criterion validity with whole-spine criteria (SFI-25 = 0.967, FRI = 0.810) and exceeded cut-off minimums with regional-spine, condition-specific, and patient-specific measures. An unequivocal one-dimensional structure was determined. Internal consistency was satisfactory (α = 0.80) with no floor/ceiling effect. Post-hoc analysis of the international sample confirmed these findings.ConclusionThe SFI-10 qualitative concept-retention version was preferred to quantitative factorial and Rasch versions, demonstrated structural and criterion validity, and preferred correlation with criteria measures. Further longitudinal research is required for reliability, error, and responsiveness, plus an examination of the practical characteristics of readability and administrative burden.

Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial

QuestionIs remotely delivered physiotherapy as good or better than face-to-face physiotherapy for the management of musculoskeletal conditions? DesignRandomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis. ParticipantsA total of 210 adult participants with a musculoskeletal condition who presented for outpatient physiotherapy at five public hospitals in Sydney. InterventionOne group received a remotely delivered physiotherapy program for 6 weeks that consisted of one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at 2 and 4 weeks, and an individualised home exercise program delivered through an app. The other group received usual face-to-face physiotherapy care in an outpatient setting. Outcome measuresThe primary outcome was the Patient Specific Functional Scale at 6 weeks with a pre-specified non-inferiority margin of –15 out of 100 points. Secondary outcomes included: the Patient Specific Functional Scale at 26 weeks; kinesiophobia, pain, function/disability, global impression of change and quality of life at 6 and 26 weeks; and satisfaction with service delivery at 6 weeks. ResultsThe mean between-group difference (95% CI) for the Patient Specific Functional Scale at 6 weeks was 2.7 out of 100 points (–3.5 to 8.8), where a positive score favoured remotely delivered physiotherapy. The lower end of the 95% CI was greater than the non-inferiority margin. Whilst non-inferiority margins were not set for the secondary outcomes, the 95% CI of the mean between-group difference ruled out clinically meaningful differences. ConclusionRemotely delivered physiotherapy with support via phone, text and an app is as good as face-to-face physiotherapy for the management of musculoskeletal conditions. Trial registrationACTRN12619000065190.

The Adolescent Patient Perspective on Activity Limitations Following Sport-Related Concussion.

Assessment of sport-related concussion (SRC) has begun to include patient- reported outcome measures (PROMs). However, there is a limited understanding of which health limitations are most meaningful to adolescents following SRC. To explore patient-perceived activity limitations following SRC and throughout recovery to return-to-play (RTP) and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. Longitudinal. Secondary school athletic training facilities. Fifty patients (41 males, 5 females, 4 sex not reported, age=14.9±3.5 years, grade=10.2±0.93 level) with a medically diagnosed SRC. The Patient Specific Functional Scale (PSFS) was used to assess changes in the patient's condition and the impact the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) following SRC and at RTP. Activities impacted by injury were coded into common categories and themes by a three-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. A total of 157 different activities were identified at D3 and coded into 28 categories that fit into six themes: activities of daily living (ADLs), cognitive and school (COG), sports and physical activity (SPA), screen time (SCR), sleep (SLP) and social (SOC). On D3, all patients (50/50) identified at least one activity limitation. The majority related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation (AP) domain. Our primary findings suggest that sport-related concussion influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.

Comparison of General Exercises, Motor Control Exercises and Spinal Manipulation in Chronic Low Back Pain Patients

Objective: To compare the effects of motor control exercises, general exercises and spinal manipulative therapy on pain, functional status and disability in chronic low back pain patients. Study Design: Randomized Clinical Trial (IRCT:20200511047391N1) Place and Duration of Study: Riphah International University, Islamabad Pakistan, from Jun to Nov 2020. Methodology: Study was conducted on 36 chronic low back pain patients aged 18-50 years. All were randomly allocated to three groups: general exercises group, motor control group, and manipulative therapy; all were treated with eight sessions in four weeks. Numerical pain rating scale, Patient-specific functional scale and Oswestry disability index were used. Results: Findings revealed that differences between the three groups were statistically significant (p<0.05) concerning pain score, patient-specific functional scale, and Disability index. Conclusion: It was concluded that motor control exercises are most effective in treating chronic low backache. The results of our study showed that there is a significant difference in pain, function and disability in all the groups.

RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol)

IntroductionMost simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based...

Effectiveness of an eHealth-Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial.

Our objective was to evaluate the effectiveness of a three-month physiotherapist-delivered eHealth physical activity program compared with usual care to improve function in adults with low back pain or knee osteoarthritis in rural Australia. This was a parallel, two-group, pragmatic, superiority, randomized controlled trial involving three- and six-month posttreatment follow-ups. There was a total of 156 adults with chronic nonspecific low back pain (n=97) or knee osteoarthritis (n=59) from rural Australia. The intervention involved an eHealth physical activity and an exercise program that included five to eight teleconsultations with a physiotherapist (primary time point three months) or usual care (eg, general practitioner, physiotherapy, and pain medication). The primary outcome was the Patient-Specific Functional Scale (0-30), with a three-point difference between groups being considered the minimum clinically important difference. Participants receiving the eHealth intervention (n=78) reported significantly greater and clinically worthwhile improvements in function (mean between-group difference 3.6; 95% confidence interval [CI] 1.3-5.9) compared to participants receiving usual care (n=78). Small but statistically significantly greater improvements in disability (7.2 of 100; 95% CI 2.1-12.3) and quality of life (4.5 of 100; 95% CI 0.0-9.0) also favored the eHealth group. No clinical or statistical differences between groups were found for the secondary outcomes of pain, coping skills, and physical activity levels. A physiotherapist-delivered eHealth intervention is effective and provides clinically meaningful improvements in function compared to usual care for people with musculoskeletal pain in rural communities. These findings highlight the potential for eHealth-based programs to improve access to evidence-based exercise interventions for people with musculoskeletal pain in rural communities.

Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study.

The objective was to explore the associations between patient involvement in the rehabilitation process and improvements in function and goal attainment in the first year after rehabilitation. The longitudinal multicenter study RehabNytte provided data from participants who had been referred to rehabilitation (n = 2113). Quality indicator (QI) pass rates (% yes) were used to assess patient involvement in the rehabilitation process. The Patient-Specific Functional Scale (PSFS) (10 = best possible) was used to assess function. The outcome QI on goal achievement (response options of yes/no) was used to assess goal attainment. Logistic regression and paired sample t-tests were used to examine associations and mean changes in function from rehabilitation admission up to 3, 6, and 12 months. Most participants (95%) were involved in goal-setting, which was positively associated with younger age (OR 0.97, 95% CI 0.95-0.99) and female sex (OR 1.87, 95% CI 1.15-3.02). Function improved over the follow-up period, with greater improvements in the active goal-setting group. Being involved in goal planning almost tripled the odds of goal attainment (OR 2.78, 95% CI 1.60-4.83) and involvement in the rehabilitation plan almost doubled it (OR 1.99, 95% CI 1.41-2.81). Most participants were involved in rehabilitation goal-setting/planning and being involved was associated with beneficial functional outcomes and greater goal attainment.

Study protocol for the validation of a new pictorial functional scale in patients with knee osteoarthritis: the functional activity scoring tool (FAST)

BackgroundPatient-reported outcome measures (PROMs) are required for patient-centred care. There are limited PROMs with good psychometric properties, and limitations to any language-based scale are often constrained by the written words...

Effect of a Novel Training Program in Patients With Chronic Shoulder Pain Based on Implicit Motor Learning: Pilot and Feasibility Study.

Implicit motor learning has been shown to be effective for learning sports-related motor skills. It facilitates automaticity of movements and thereby improves performance in multitasking and high-pressure environments. Motor learning to develop motor skills and neuroplastic capacities is not sufficiently incorporated in musculoskeletal rehabilitation. Especially in patients with chronic pain conditions like shoulder pain this approach might benefit over traditional exercise programs. The aim of this study was to investigate the feasibility and clinical outcome of a new implicit motor learning exercise program in a group of patients with chronic shoulder pain. Pilot and feasibility cohort study. Twenty-six patients with chronic shoulder pain performed a 6-week home exercise program with weekly remote follow up by a physiotherapist. The program comprised five exercises designed to challenge overall body balance, simultaneously engaging the upper limbs in a range of reaching tasks. The tasks included reaching above the head, at and below waist level, in various directions. No instructions on correct performance were provided to foster external focus. Feasibility was assessed by (1) recruitment rate, (2) follow up rate, (3) subjective experience, (4) self-reported adverse events and (5) self-reported adherence of subjects. Clinical effects of the program were assessed with (1) the Shoulder Pain and Disability Index (SPADI), (2) the Auto-Constant score, (3) the numeric rating scale (NRS) at rest and at night, (4) the patient specific functional scale (PSFS), (5) the avoidance endurance questionnaire (AEQ), (6) patient acceptable symptom state (PASS) and (7) a global rating of change (GROC). The study protocol was feasible in terms of follow up rate (16w for 28 patients), exercise adherence (77.1%± 29.41), and adverse events (no serious, 5 light adverse events). Statistically significant improvements were observed for SPADI (p<0.001), NRS at rest (p=0.033), at night (p=0.29), PSFS (p<0.001) and PASS (p<0.001) after only six weeks training. This study reveals promising results of another way of looking at exercise for patients with chronic shoulder pain. Both feasibility and clinical effects of the program on pain and function was acceptable. Future studies should incorporate a control group, provide longer follow up and include objective measurements. 2b.

Successful Routine Cervical Cancer Screening Facilitated by Pelvic Floor Physical Therapy for a Woman With Developmental Disability and a History of Trauma: Case Report

Background: Women with intellectual and developmental disabilities (I/DD) are not getting routine cervical cancer screens at the recommended frequency, limiting opportunities for early detection and treatment of cervical cancer. Pelvic floor physical therapy plans of care can be used to successfully address this health care disparity. Case Description: This is the case of a patient who had diagnoses of developmental delay, oppositional defiant disorder, attention-deficit disorder, unilateral hearing loss, and a history of trauma. The patient was referred by her primary care physician after a halted first pelvic examination due to tension of the patient's pelvic floor and her overall discomfort and dissociation from the session. Clinical findings revealed pelvic floor tension. Interventions were employed over the course of 18 sessions. Outcomes: Sessions focused on education, positioning, relaxation, and graded vaginal dilator insertion while keeping the patient engaged to prevent dissociation. The patient showed minimal clinically important differences on the Patient-Specific Functional Scale, met the short- and long-term goals including undergoing a pain-free pelvic examination, and had a significantly decreased pelvic floor resting tone. Discussion: For patients with I/DD, pelvic floor physical therapy can be a valuable tool to help them undergo a successful and pain-free routine cervical cancer screen. It may take longer than typical plans of care, but the outcomes justify the length of the intervention. Practices that promote self-determination are a key to success. Informed consent was obtained and signed by the patient's medical guardian. Video Abstract: Supplemental Digital Content available at: http://links.lww.com/JWHPT/A128

Effects of Multi-modal Therapeutic Approach in Cervical Radiculopathy

Objective: To determine the effect of Mechanical cervical traction and Laser therapy along with isometric neck exercises in cervical radiculopathy patients. Study Design: Quasi-experimental study. Place and Duration of Study: Kannan Physiotherapy and Spine Clinic, Lahore Pakistan, from Jul to Dec 2020. Methodology: The study included cervical radiculopathy patients with symptoms for over two weeks. The diagnosis was confirmed by the orthopaedic department. The subjects were allocated to two equal groups by lottery method. Group-A Received Laser therapy with isometric neck exercises, and Group-B received mechanical traction with isometric neck exercises. The neck disability index, numeric pain rating scale and patient-specific function scale were used to collect data, which was analyzed using SPSS-22. Results: Out of the 128 patients, 64(50%) were in each of the two groups. The overall mean age was 41.95±36.50years, and 76(59.4%) participants were male. After three weeks of treatment sessions, statistically significant improvement was found in decreasing pain within group B having mechanical traction along isometric neck exercises (p&lt;0.05). Conclusion: Our study concluded that both treatment techniques, Laser therapy with isometric neck exercises and mechanical traction with isometric neck exercises, effectively decreased pain; however, mechanical traction with isometric neck exercises was superior.

The Effect of Proprioceptive Training on Hand Function and Activity Limitation After Open Carpal Tunnel Release Surgery: A Randomized Controlled Study

ObjectiveTo investigate the effect of proprioceptive training on hand function and activity limitation in patients undergoing open carpal tunnel release surgery. DesignRandomized controlled study. SettingA university hospital. ParticipantsThirty patients were included in the study and randomized to proprioceptive training (PT) and conventional rehabilitation (CR) groups. InterventionOne week after surgery, both groups received CR for 6 weeks. All participants were asked to perform home-based exercises daily in 3 sets with 10 repetitions. For the PT group, a 6-step PT program was conducted starting from Week 6. Both groups received face-to-face interventions twice a week for 12 weeks. Main Outcome MeasuresThe outcome measures included the Purdue Pegboard Test (PPT), the joint position sense test (JPST), the Boston Carpal Tunnel Questionnaire, and the Patient-Specific Functional Scale. In total, 3 assessments were performed (at 1, 6 and 12 weeks postoperatively). ResultsIn the PT group, the results for PPT were statistically significant (P<.05). Although there was a greater decrease in the absolute angular error value (JPST) of the PT group compared to the CR group, the difference was nonsignificant (P>.05). Similar reductions in activity limitation were seen in both groups (PT: 176%, CR: 175%). Symptom severity decreased by 40% in the PT group vs 32% in the CR group. The effect sizes were larger for the changes between the second and third assessments in the PT group compared to the CR group in all parameters tested. ConclusionWhen applied after carpal tunnel release surgery, PT may potentially to improve hand functions, reduce activity limitation, increase participation in activities of daily living, and thus improve quality of life.

An EDucation and eXercise intervention for gluteal tendinopathy in an Irish setting: a protocol for a feasibility randomised clinical trial (LEAP-Ireland RCT)

Background Gluteal tendinopathy (GT) is a degenerative tendon condition characterised by pain over the greater trochanter of the hip. A randomised controlled trial (RCT) in Australia found that 14 sessions of EDucation on load management plus eXercise (EDX) delivered over 8 weeks resulted in greater improvements in global rating of change and pain outcomes at 8 and 52 weeks, compared with corticosteroid injection or ‘wait and see’. Typically, 5-6 physiotherapy sessions are provided in public and private physiotherapy settings in Ireland, therefore, the aim of this study is to examine the feasibility of conducting an RCT to investigate effectiveness of 6 sessions of the EDX programme compared to usual care. Methods We will randomly allocate 64 participants with GT to physiotherapist-administered EDX or usual care. The EDX intervention (EDX-Ireland) will be delivered in 6 sessions over 8 weeks. To determine feasibility of an RCT, we will assess recruitment and retention and outcome measure completion. The health status outcomes to be assessed at baseline, 8 weeks and 3 months include: Global Rating of Change, pain severity, the Victorian Institute of Sport Assessment-Gluteal Questionnaire (VISA-G), the Patient-Specific Functional Scale, the Pain Catastrophizing Scale, Patient Health Questionnaire (PHQ), Pain Self-Efficacy Questionnaire, the EQ-5D-5L, the Central Sensitisation Inventory and hip abductor muscle strength. We will explore acceptability of the EDX-Ireland intervention from the perspective of patients and treatment providers, and the perspective of referrers to the trial. A Study Within A Trial will be also applied to compare recording of exercise adherence using app-based technology to paper-based diary. Discussion There is a need to establish effective treatments for GT that potentially can be implemented into existing health systems. The findings of this feasibility trial will inform development of a future definitive RCT. Registration The trial is registered prospectively on ClinicalTrials.gov (NCT05516563, 27/10/2022).

An Exploration of Physical Therapy Outcomes and Psychometric Properties of the Patient-Specific Functional Scale Following an Interdisciplinary Pain Management Program.

The Patient-Specific Functional Scale (PSFS) has been used to assess physical functioning in various chronic pain populations. There is a lack evidence for its use with diverse pain populations who have high impact chronic pain (HICP). The primary aim of this study was to assess the psychometric properties of the PSFS with a heterogeneous sample of patients with HICP. A retrospective observational study of prospective functional outcomes collected before and after participation an intensive pain management program (IPMP): (PSFS, Disabilities of the Arm, Shoulder, and Hand; Lower Extremity Functional Scale; Neck Disability Index; Oswestry Disability Index), Multidimensional Patient Impression of Change, pain intensity, pain limitation, and fear avoidance from the charts of 509 IPMP completers. The reliability, validity, and responsiveness of the PSFS were analyzed using Cronbach's alpha, Pearson correlations, and receiver operating characteristic. Significant improvements were found for all outcomes following program participation (all p's <0.0001). Correlations of the PSFS with similar outcomes (convergent validity) were lower than expected (r's 0.16 - 0.33). A low correlation (r=-0.12) with an unrelated measure, fear-avoidance, supported divergent validity. PSFS change score correlations with similar outcome measures ranged from 0.46 to 0.53. The area under the curve values for the PSFS ranged from 0.801 to 0.857 suggesting a moderate ability for the PSFS to detect improvement. The psychometric properties of the PSFS showed mixed support for construct validity but good support for the responsiveness of the PSFS when used with a heterogeneous sample of patients with HICP.