Patient-Specific Functional Scale Research Articles

Six-Month Follow-up of Supervised Spinal Stabilization Exercises for Low Back Pain in Adolescent Idiopathic Scoliosis.

To evaluate the effectiveness of 8 weeks of weekly spinal stabilization exercises compared with 1-time treatment in participants with adolescent idiopathic scoliosis and low back pain at a 6-month follow-up. Thirty-two participants were evaluated at a 6-month follow-up. The supervised group received weekly spinal stabilization exercises. The unsupervised group received a 1-time treatment and home exercise program. Both groups improved in all outcome measures. The supervised group had significantly reduced Numeric Pain Rating Scale and Improved Global Rating of Change scores, but had no differences in the revised Oswestry Back Pain Disability Questionnaire, or Patient-Specific Functional Scale scores in comparison with the unsupervised group.

Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study

Background and aimsPatients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness. MethodsThis cross-sectional study included 200 participants with chronic neck pain: 120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p<0.01. Differences between groups for the continuous data were determined using either a Student's t-test or Mann Whitney U test. ResultsIn both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs. 138 months p=0.001).Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p=0.005, cranio-cervical flexion test p=0.007, cervical extensor test p=0.006) and cervical pressure pain threshold bilateral (p=0.002/0.004), as well on self-reported function (Neck Disability Index p=0.001 and Patient-Specific Functional Scale p=0.007), mental quality of life (mental component summary of the Short Form Health Survey p=0.004 and EuroQol-5D p=0.001) and depression (Beck Depression Inventory-II p=0.001). ConclusionsThis study showed significant differences between chronic neck pain patients when differentiated into groups based on their onset of pain. However, no specific clinical test or self-reported characteristic could differentiate between the groups at an individual patient level. ImplicationsPressure pain threshold tests, cervical muscle performance tests and patient-reported characteristics about self-perceived function and psychological factors may assist in profiling chronic neck pain patients. The need for more intensive management of those with a traumatic onset compared with those with a non-traumatic onset should be examined further.

Community-based Rehabilitation Training after stroke: protocol of a pilot randomised controlled trial (ReTrain)

IntroductionThe Rehabilitation Training (ReTrain) intervention aims to improve functional mobility, adherence to poststroke exercise guidelines and quality of life for people after stroke. A definitive randomised controlled trial (RCT) is...

Short-Term Results of a Rehabilitation Program for Service Members With Lower Leg Pain and the Evaluation of Patient Characteristics.

Lower leg pain (LLP), including medial tibial stress syndrome (MTSS) and chronic exertional compartment syndrome (CECS), remains a major problem for the military. Evaluation of patient characteristics and short-term results of the rehabilitation program for service members used in the Military Rehabilitation Centre Aardenburg. This retrospective study includes 161 service members of the Netherlands Armed Forces. Service members were grouped into the following diagnostic categories: MTSS (n = 47), conservative treatment of CECS (n = 34), and rehabilitation after operative intervention of the CECS (CECSo; n = 80). The results showed a significant improvement in all groups regarding the Patient-Specific Functional Scale (PSFS). Only the CECSo group showed significant improvement on the Numeric Pain Rating Score (NPRS). None of the patient characteristics like gender, age, military service, duration of symptoms, and treatment setting were identified to correlate with outcome results. Short-term results of the rehabilitation program for service members with LLP are successful as obtained with the PSFS. Evaluation by the NPRS seems insufficient and researchers should consider using other outcome measurements. The CECSo group seems to benefit the most from the rehabilitation program. No patient characteristics could be identified to correlate with outcome results.

Education, night splinting and exercise versus usual care on recovery and conversion to surgery for people awaiting carpal tunnel surgery: a protocol for a randomised controlled trial

IntroductionCarpal tunnel syndrome (CTS) is a prevalent upper limb condition that results in significant individual and socioeconomic costs. Large patient numbers, long outpatient waiting times and traditional referral pathways in...

Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial.

In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms? Randomised trial with concealed allocation and intention-to-treat analysis. Sixty participants with nerve-related leg pain recruited from the community. The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. Leg pain and low back pain (0, none, to 10, worst), Oswestry Disability Index (0, none, to 100, worst), Patient-Specific Functional Scale (0, unable to perform, to 30, able to perform), global perceived effect (-5 to 5) and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI). At 2 weeks, the experimental group did not have significantly greater improvement than the control group in leg pain (MD -1.1, 95% CI -2.3 to 0.1) or disability (MD -3.3, 95% CI -9.6 to 2.9). At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD -2.4, 95% CI -3.6 to -1.2) and low back pain (MD -1.5, 95% CI -2.8 to -0.2). The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2) and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8), as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5) and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9). No significant between-group differences occurred in disability at 4 weeks and location of symptoms. Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016) Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial.Journal of Physiotherapy62: 197-202].

The effects of a novel pilates exercise prescription method on people with non-specific unilateral musculoskeletal pain: a randomised pilot trial

Background: Pain alters the neuromuscular activation and results in altered movement adaptations. A new exercise prescription method proposes that we can restore the neuromuscular control by rehabilitating the deficient neural drive through Pilates exercises. This is done by identifying the postural control deficits using single-leg tests such as hopping, half squats and heel raises. The aim of this study was to find out if this method of prescribing exercises results in clinically relevant outcomes. Methods: Fifteen patients with chronic non-specific low back pain with unilateral musculoskeletal pain were recruited. Following consent, all patients were randomly assigned either to perform gym or Pilates-based individualised exercises once weekly for six weeks. The primary outcome was to measure the pain intensity using a 0–10 numerical rating scale. The secondary outcome measures were: the global perceived effect scale (GPE; 0–10), the patient-specific functional scale (PSFS; the patient-generated measure of disability) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; the condition-specific measure of disability). Results: There were statistically significant differences noted after intervention within the control group in the numerical rating scale ( P=0.041), GPE ( P=0.024), PSFS ( P=0.039) and within the experimental group in the WOMAC ( P=0.008), GPE ( P=0.007) and PSFS ( P=0.007). However, as there were clinically significant baseline differences, the within-group difference could be due to regression to the mean. There were no statistically significant results between the two groups after intervention. Conclusion: This new prescription method for Pilates-based exercises may improve disability and global perception of recovery. However, the outcomes are not different from a regular gym-based exercise programme.

Translation, Validation, and Crosscultural Adaptation of the Hebrew Version of the Neck Disability Index

The present study's design was translation and crosscultural validation of the Neck Disability Index (NDI). The aim of the study was to translate and culturally adapt the NDI into Hebrew language and to evaluate the psychometric properties of this version. As yet, no Hebrew language neck pain and disability questionnaires exist. The NDI is widely used and validated among different patient populations with neck pain. The English version of the NDI was translated into Hebrew according to the published guidelines. A total of 100 patients with neck pain participated in the study. Inclusion criteria were age 18 years and older, neck pain, and ability to read and speak Hebrew. Exclusion criteria were cancer or suspected tumor, neck pain related to vertebral fracture, or neurological disease. Participants were asked to complete the NDI-Hebrew version (NDI-H), Numeric Pain Rating Scale (NPRS), and Patient-Specific Functional Scale (PSFS). Seventy-three patients completed the NDI-H twice in an interval of 2 days. Psychometric properties included test-retest reliability (intraclass correlation coefficient), internal consistency (Cronbach α), convergent validity (Pearson correlation), and factor analysis. The NDI-H demonstrated excellent test-retest reliability (intraclass correlation coefficient ranged from 0.827 to 0.929; Pv < 0.001). Cronbach α value was excellent (0.855). A very good correlation was found between the NDI-H and NPRS scores (r = 0.611, P < 0.001) and a good correlation between the NDI-H and PSFS score (r = 0.417, P < 0.001). Factor analysis revealed a two-factor solution representing daily function and pain and symptoms. The NDI-H is a valid and reliable instrument to measure functional limitations and disability in Hebrew-speaking patients with neck pain. NA.

Impact of a person-centred community rehabilitation service on outcomes for individuals with a neurological condition

Purpose: To evaluate the impact of a person-centred, community rehabilitation service on outcomes for people with a neurological condition, in the first year of service.Method: A prospective, observational, pre-post study was conducted with 206 people who had a neurological condition and attended the rehabilitation service to restore function (e.g., Stroke); maximize recovery in an ongoing situation (e.g., Spina Bifida); or maximize function and independence while preparing for inevitable decline (e.g., Parkinson’s Disease). Outcomes were measured via self-report questionnaires, prior to, and following three months of rehabilitation. The primary outcome was achievement of self-identified goals, measured by the Patient-Specific Functional scale. Secondary outcomes included the Lawton Instrumental Activities of Daily Living (IADL) scale, EQ-5D-5L European Quality of Life scale, and ICECAP-O – Index of Capability for Older Adults and health and medical resource use.Results: Participants demonstrated significant goal achievement and a significant reduction in health and medical resource use. There were small positive changes in the Lawton IADL, EQ-5D-5L, and ICECAP-O however these changes were not significant.Conclusions: In the first year of operation, the community rehabilitation service made a significant impact on outcomes for individuals with a neurological condition. Further research is required to identify appropriate measures of activities of daily living and quality of life that reflect person-centred rehabilitation outcomes for restoring function, maximizing function, or preparing for functional decline.Implications for RehabilitationSelf-identified goals are an important guide for achievement of meaningful outcomes for individuals with a neurological condition.Person-centred outcome measures are required to evaluate the benefits of a person-centred community rehabilitation service for individuals with a neurological condition.

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Study design:Randomized clinical trial.Objectives:To investigate the immediate effects of soft tissue mobilization (STM) versus therapeutic ultrasound (US) in patients with neck and arm pain who demonstrate neural mechanical sensitivity.Background:While experts have suggested that individuals with neck and arm pain associated with neural tissue mechanical sensitivity may benefit from STM, there has been little research to investigate this hypothesis.Methods:Twenty-three patients with neck and arm pain and a positive upper limb neurodynamic test (ULNT) were randomly assigned to receive STM or therapeutic US during a single session. Outcome measures were collected immediately before and after treatment, and at 2–4 day follow-up. Primary outcomes were the Global Rating of Change (GROC), range of motion (ROM) during the ULNT, and pain rating during the ULNT. Secondary measures included the Neck Disability Index (NDI), Patient-Specific Functional Scale (PSFS), Numeric Pain Rating Scale (NPRS), and active range of shoulder abduction motion combined with the wrist neutral or wrist extension.Results:A greater proportion of patients in the STM group reported a significant improvement on the GROC immediately after treatment (P = 0·003, STM = 75%, US = 9%), and at 2–4 day follow-up (P = 0·027, STM = 58%, US = 9%). Patients who received STM demonstrated greater improvements in ROM during ULNT (P = 0·026), PSFS (P = 0·007), and shoulder active ROM combined with wrist extension (P = 0·028). Improvements in Numeric Pain Rating Scale and pain during the ULNT were observed only in the STM group. There was no difference between groups for the NDI or shoulder abduction ROM with wrist neutral.Conclusion:Patients with neck and arm pain demonstrated greater improvements in ULNT ROM, GROC, and PSFS, and pain following STM than after receiving therapeutic US.Level of evidence:Therapy, level 1b.

Effectiveness of neural mobilization with intermittent cervical traction in the management of cervical radiculopathy: A randomized controlled trial

BackgroundThe effectiveness of both neural mobilization and intermittent cervical traction (ICT) has been previously explored in some studies of generally low methodological quality. However, the effect of simultaneous application of these techniques in people with cervical radiculopathy (CR) has not been previously investigated. AimTo investigate the effect of neural mobilization with simultaneously applied ICT on pain, disability, function, grip strength and cervical range of motion in patients with CR. DesignRandomized, controlled, assessor-blinded, clinical trial. MethodsParticipants (n = 42) diagnosed with unilateral CR were randomly allocated to intervention (neural mobilization combined with ICT, n = 21) or control (n = 21) groups. Participants in the intervention group were asked to attend for 12 treatment sessions to receive 6 sets of 60s grade II–IV ICT with simultaneously applied ‘slider’ neural mobilizations with median nerve bias. Participants randomized to the control group did not receive any type of treatment and were asked to avoid prescription or over-the-counter analgesia or anti-inflammatory medication. The Neck Disability Index (NDI), the Patient-Specific Functional Scale (PSFS), the Numeric Pain Rating Scale (NPRS), and measures of grip strength (GS) and cervical spine active range of motion (CSAROM) were administered at baseline and at 4-weeks. ResultsThe intervention group demonstrated significant improvements in NDI scores (mean difference = −16.95; 95% CI = −22.47 to −11.43, ES = 0.42), PSFS scores (mean difference = 2.88; 95% CI = 2.33 to 3.43, ES = 0.66), NPRS scores (mean difference = −3.74; 95% CI = −4.92 to −2.96, ES = 0.37), GS (mean difference = 1.87 kg; 95% CI = 0.51 to 3.23; ES = 0.07), and CSAROM (except for lateral flexion), compared to the control group where significant changes were not detected. ConclusionNeural mobilization with simultaneous ICT can improve, pain, function, disability, grip strength and cervical range of motion in people with CR. Further clinical trials comparing neural mobilization with cervical traction to other standard interventions are justified.

Does changing pain-related knowledge reduce pain and improve function through changes in catastrophizing?

Evidence from randomized controlled studies shows that reconceptualizing pain improves patients' knowledge of pain biology, reduces catastrophizing thoughts, and improves pain and function. However, causal relationships between these variables remain untested. It is hypothesized that reductions in catastrophizing could mediate the relationship between improvements in pain knowledge and improvements in pain and function. To test this causal mechanism, we conducted longitudinal mediation analyses on a cohort of 799 patients who were exposed to a pain education intervention. Patients provided responses to the neurophysiology of pain questionnaire, catastrophic thoughts about pain scale, visual analogue pain scale, and the patient specific functional scale, at baseline, 1-month, 6-month, and 12-month follow-up. With adjustment for potential confounding variables, an improvement in pain biology knowledge was significantly associated with a reduction in pain intensity (total effect = -2.20, 95% confidence interval [CI] = -2.96 to -1.44). However, this effect was not mediated by a reduction in catastrophizing (indirect effect = -0.16, 95% CI = -0.36 to 0.02). This might be due to a weak, nonsignificant relationship between changes in catastrophizing and pain intensity (path b = 0.19, 95% CI = -0.03 to 0.41). Similar trends were found in models with function as the outcome. Our findings indicate that change in catastrophizing did not mediate the effect of pain knowledge acquisition on change in pain or function. The strength of this conclusion is moderated, however, if patient-clinician relational factors are conceptualized as a consequence of catastrophizing, rather than a cause.

Astym therapy improves function and range of motion following mastectomy.

Hypersensitive scar tissue formation along the incision line and drain site is a common side effect following mastectomy. If this scar tissue is not addressed, it can lead to decreased flexibility and function in the involved upper quadrant. Astym® treatment is a new approach to soft tissue injuries, and is evidenced in animal studies to promote the healing and regeneration of soft tissues. It has also been found to reduce pain and increase function in people with soft tissue dysfunction. The aim of Astym treatment is to engage the regenerative mechanisms of the body in order to resorb scar tissue, stimulate tissue turnover, and regenerate soft tissues. Handheld instrumentation is applied topically to locate and treat the underlying dysfunctional soft tissue through specific protocols for the application of particular pressures and shear forces. The purpose of this study was to examine the effects of Astym treatment on activities of daily living in women who had undergone a mastectomy following a diagnosis of breast cancer. A quasi-experiment involving 40 women, following a mastectomy, evaluated five outcome measures pre- and post-Astym treatment. All five measurement scores: Disabilities of the Arm, Shoulder, and Hand Outcome Measure; a clothing questionnaire on their ability to wear a bra; Patient-Specific Functional Scale; active range of motion of shoulder flexion; and active range of motion of abduction were also measured and all demonstrated significant changes. In this study, Astym treatment improved active range of motion in the involved quadrant and also improved function in patients following a mastectomy.

Abstract P5-12-04: Directed exercise intervention in breast cancer patients with arthralgias receiving aromatase inhibitors: A randomized pilot study

Abstract Purpose: Early discontinuation or non-adherence of AI therapy occurs in 25-50 % of patients due to treatment associated toxicities, including musculoskeletal symptoms such as arthralgias and myalgias. The goal of this pilot study is to evaluate the effect of a directed physical therapy regimen including joint mobility and stretching exercises on musculoskeletal symptoms resulting from AI therapy, in comparison to normal physical activity alone. Patients and methods: Eligibility criteria included post-menopausal women with histological evidence of hormone receptor positive breast cancer who were currently receiving adjuvant AI therapy and experiencing significant joint discomfort/stiffness when attempting activities of daily living which began or significantly increased after initiation of AI therapy. Patients were excluded if they had preexisting rheumatoid arthritis or fibromyalgia, systemic metastasis or ECOG performance status of greater than 2. Patients were randomly assigned to an 8 week directed exercise program under the supervision of a physical therapist (Group A, n=15) or were told to participate in moderate physical activity (walking) (Group B, n=12). Before beginning the study and at the end of the 8 week intervention, patients in both groups underwent a physical therapy evaluation including performance based measures such as functional lower extremity strength and grip strength and a Patient Specific Functional Scale (PSFS) to assess functional ability to complete specific activities. Additionally, all patients answered a series of questionnaires including a pain disability index (PDI), pain scale (PS) and the PHQ4 depression scale. Effects of the directed exercise regimen were evaluated using non-parametric analysis to determine differences between the two groups. Results: Significant improvement was observed in both left and right grip strength and right pinch in the intervention group (Group A) as compared to the control group (Group B). Additionally, significant improvement in lower body measures including 2-minute step tests and chair raises were observed in patients who underwent the directed exercise program compared to the control group. No significant differences were observed in PS, PDI or PHQ4 between the groups. However, Group A showed a slight improvement on the PS and PDI. Conclusions: Directed exercise regimens involving joint mobility and stretching exercises may have benefits over moderate physical activity alone for joint pain and arthralgia associated with AI therapy. Citation Format: Varadarajan R, Helm E, Arnold C, Huelsenbeck-Dill L, Ingraham-Lopresto B, Sonaad S, Swanson P, Sims-Mourtada J, Dickson-Whitmer D. Directed exercise intervention in breast cancer patients with arthralgias receiving aromatase inhibitors: A randomized pilot study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-12-04.

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial.

Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects.

Comparison of Outcome on Knee Related Function by 2 Different Mode of Progressive Resisted Exercises (PREx) Intervention in Patients with Knee Osteoarthritis

Background: Lower limb muscles strengthening are crucial in knee joint rehabilitation. Weight training as evolved by DeLorm is a more traditional robust form of Progressive resistive exercises (PREx) program in which muscles are exercised against constant resistance through the arc of motion. Use of Elastic bands is yet another tool used in strengthening exercise regimens. What popularly known as Theraband exercises, resistance varies through the arc and relies on various components such as modulus of elasticity. The characteristic differences of theses 2 modes of resisted exercise was assumed to result in different outcomes on measured knee related functions. Hence, this study has been undertaken to compare the short term effects PREx using weight cuffs versus Theraband resistance exercise in patients suffering from knee osteoarthritis. Methods: Eighty-nine participants completed this trial over the period of 14 months. Study participants were randomly allocated to 3 study groups which received PREx (DeLorm) (n=30), Theraband exercises (n=30) and conventional treatment (n=29) for 3 week period. Results: Interaction between time and function was significant when compared with control whereas both experimental groups improved equally (P>0.05) over the period of time. Post treatment Weight cuff (DeLorm) and Theraband PREx between group differences (median difference and probability of superiority (PS) is presented for 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and patient specific function are as follows. Pain: 6.5 (36%); symptoms 11(43%); ADL 5.5(45%), Sport and recreation 5(35%), QOL, PSFS 0.75(37%). Conclusion: Both the weight cuff PREx (DeLorm) and Theraband resistance exercises resulted in improvement of knee functions as measured on KOOS and patient specific functional scale in population suffering from knee osteoarthritis with better probability of superiority for weight cuff exercises.

Exploration of clinical changes following a novel mobilisation technique for treatment of chronic low back pain: A single cohort design

To explore clinical changes following a novel manual mobilisation technique, 24 participants who experienced 'moderate' to 'severe' chronic low back pain were recruited from new patients attending a suburban osteopathy clinic. The intervention was a previously undescribed side-lying mobilisation technique targeting the lumbosacral spine (median of 6 treatment sessions). After 8 weeks reductions were shown in Oswestry Disability Index of 15 points (95% CI: 9.3, 22.7; p<0.0001 for overall ANOVA); Quadruple Visual Analogue Scale of 2.0 points (95% CI: 1.0, 3.0; p<0.0001); and Patient Specific Functional Scale of 3.1 points (95% CI: 1.9, 4.3; p<0.0001). The results indicate that pain intensity, disability and function improved in most participants following treatment. Further investigation is indicated using more robust research designs to compare this approach with other treatment approaches and usual care for the treatment of chronic low back pain.

The Group Experience: Remodelling Outpatient Physiotherapy after Knee Replacement Surgery.

Purpose : To estimate responses to short-duration (4-6 weeks) group-based physiotherapy after knee replacement in terms of pain, function, and satisfaction. The study used a prospective, observational design. A total of 169 participants (111 women, 58 men) were consecutively recruited to attend a twice-weekly post-operative knee replacement class focused on mobility, strength, balance, and functional retraining. Changes in pain, function, and satisfaction were measured using the P4 pain intensity measure, the Lower Extremity Functional Scale (LEFS), a timed stair test (TST), knee range of motion (ROM), the Patient Specific Functional Scale (PSFS), and the Client Satisfaction Questionnaire (CSQ-8). Using Stata version 12.1, the data were summarized descriptively, and change scores were calculated with 95% CIs. Results : On average, participants were discharged within 11 classes, having achieved their treatment goals. More than 77% exceeded the minimal detectable change at the 90% confidence level (MDC90) on the LEFS, TST, PSFS, and ROM assessments. The mean CSQ-8 score at discharge was 31.8 (SD 1.46); 66.7% recorded a perfect score of 32. Conclusions : Patients attending a short group-based outpatient knee replacement class demonstrated significant improvements in pain and lower extremity function and were highly satisfied with their physiotherapy treatment.

Reliability, validity, and responsiveness of the Japanese version of the Patient-Specific Functional Scale in patients with neck pain.

The aims of this study were to translate and culturally adapt the Patient-Specific Functional Scale (PSFS) and validate the Japanese version of the PSFS (PSFS-J) in outpatients with neck pain. The PSFS was translated and adapted into Japanese in accordance with the published guidelines. A total of 103 outpatients with neck pain were recruited for this study. Psychometric evaluation included test-retest reliability, convergent validity by comparing the PSFS-J to the Neck Disability Index (NDI), patient's global impression of change (PGIC), and responsiveness (unpaired t test, minimal detectable change). The intraclass correlation coefficient for test-retest reliability was 0.98 (95% confidence interval = 0.95-0.99). The Pearson correlation coefficient with the NDI was -0.35. The Spearman correlation coefficient showed a strong relationship between the change score in the PSFS-J and PGIC (-0.70). The analysis of responsiveness was calculated with the unpaired t test showing a significant difference between the stable and improved patients (P < 0.01). The minimal detectable change was calculated as 0.64. The Japanese version of the PSFS is a valid, reliable, and responsive instrument to assess Japanese outpatients with neck pain.

Complementary passive hydrotherapy WATSU (WaterShiatsu) in the rehabilitation of a severely traumatized accident survivor – A prospective case report

Introduction: The implementation of complementary and alternative therapies into conventional treatment schemes is gaining popularity. However, their use is widely depending on patients’ drive. This case-report focuses on a patient’s experience of the integration of WATSU (WaterShiatsu) in rehabilitative care. Methods: Patient: A 52 year old woman survived a severe motorcycle-accident in which she sustained several fractures on the right side of her body, including ribs, pelvis, and femur. After discharge from stationary care, she independently added WATSU to her rehabilitative regimen. Treatment approach: WATSU is a passive form of hydrotherapy in warm water that aims at relaxation, pain relief, and a sense of secureness. In the reported case, an experienced WATSU-therapist who is also trained in physiotherapy and psychosomatics delivered weekly sessions of one hour duration. Measures used: Qualitative data were collected by patient’s diary. Also the therapist’s notes including The Patient Specific Functional Scale (PSFS) were considered. Results: The patient associated WATSU with trunk mobilization (followed by ameliorated breath), reconciliation with her body, and emotional discharge. She ascribed WATSU lasting effects on her body-image. The therapist employed WATSU for careful mobilization and to equalize awareness throughout the body. The PSFS displayed continuous improvement in all categories except usage of public transportation. Due to complications (elevated inflammation markers) only 6 of 8 scheduled sessions were administered. Conclusions: WATSU was experienced helpful in approaching conditions that are difficult to address by conventional physiotherapy. In early rehabilitation, additional medical/physiotherapeutic skills of contributing complementary therapists are advocated.