Physical Therapy Clinical Practice Research Articles

Lung Point of Care Ultrasound (POCUS) in Cardiorespiratory Physiotherapy and Respiratory Therapy Practices: Current Status and Future Directions

Lung Point of Care Ultrasound (POCUS) strongly influences physiotherapy and respiratory therapy clinical decision-making in the intensive care unit (ICU). The uptake of Lung POCUS training by physiotherapists and respiratory therapists is low in some countries, often due to many barriers to its implementation. The safe and appropriate integration of Lung POCUS into physiotherapy and respiratory therapy clinical practice may be achieved by various means. This article describes the pathway for physiotherapists to become Lung POCUS-accredited in Australia, focusing on a novel fast-track approach that may apply internationally and in other professions, such as respiratory therapy. While a fast-track approach is resource intensive, such resource allocation may be justified to support the growth of Lung POCUS in physiotherapy and respiratory therapy practice where mentor support may be inconsistent, lacking, or absent.

Impact of the COVID-19 Pandemic on Physical Therapy Clinical Practice in Egypt: A Cross-Sectional Study

Impact of the COVID-19 Pandemic on Physical Therapy Clinical Practice in Egypt: A Cross-Sectional Study

Validation of a laser visual feedback and core stability exercise programme to improve lateropulsion reduction and pushing intensity in stroke patients with pusher syndrome: A Delphi study.

The patient with pusher syndrome (PS) is characterized by showing postural control alterations due to a lack of perception of his own body in the space. It appears when the patient actively pushes with his unaffected limbs towards the injured side, reacting with resistance to passive straightening towards the midline. Between 10% and 50% of strokes present PS. Nowadays, there is no clearly defined treatment for PS. To design and validate an exercise program using visual feedback and specific core stability exercises (FeViCoS) for the treatment of patients with PS. Validation was conducted by expert consensus using the Delphi method. Thirteen neurorehabilitation experts participated in the process. An online questionnaire with 18 Likert-type questions was used to evaluate the designed program. Consensus was considered reached if there was convergence between the quartile 1 and 3 values (RIQ=Q1-Q3) or if the relative interquartile range (RIR) was less than 20%. The degree of agreement between experts was measured by calculating the Fleiss' kappa coefficient. A total of 2 rounds were required to achieve 97.44% consensus with 100% participation. The RIR was less than or equal to 20% for all questions. The Fleiss' kappa index (0.831) showed that the degree of agreement between experts was excellent. Neurorehabilitation experts considered FeViCoS valid for the therapeutic approach to patients with PS. Expert consensus suggests a novel strategy in physical therapy clinical practice to improve balance and postural orientation in patients with subacute stroke and PS.

Social support from the physiotherapist and the therapeutic relationship in physiotherapy: bridging theory to practice

ABSTRACT Background/Purpose Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice. Methods This is a perspective paper drawing on examples from existing research. Key Results Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual’s social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body – which is the main point of contact with patients – and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship’s trajectory. Conclusion Social support and therapeutic relationships are complementary aspects of one’s health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes.

Efficacy of American physical therapy clinical practice guidelines in treating lower back pain among track and field athletes

Lower back pain has a significant impact on track and field athletes, affecting their performance and quality of life. This study explores the application of the American Physical Therapy Clinical Practice Guidelines (APTA Guidelines) in the management of lower back pain at this level. The physical therapy in the United States, which has a history of over 75 years, includes unarmed therapy, coordination, muscle endurance training, hip mobility therapy, stretching exercises, lower limb nerve mobility surgery, traction... It provides a solid framework for the treatment of lower back pain. In this paper, we explore these treatment methods in the context of track and field competitions and evaluate their effectiveness in meeting the specific needs of athletes. In addition, we also verified the research status of the incidence of low back pain in track and field athletes, identified its causes, and proposed an effective treatment scheme using massage, acupuncture and moxibustion treatment, therapeutic sports and other methods. The results indicate that the use of APTA guidelines can significantly alleviate athletes lower back pain, helping them better perform and recover. This study helps to further discuss how to improve clinical practice to manage specific injuries.

Physiotherapy students'attitudes toward the use of telehealth in clinical practice: A cross-sectional survey.

Provision of physiotherapy services using telehealth has drastically increased since the COVID-19 pandemic and continues to be utilized in clinical practice suggesting telehealth in physiotherapy will become common practice. Prior research has explored the attitudes of physiotherapists with many years of in-person clinical experience toward telehealth. However, little is known about the emerging workforce'sattitudes. This study aims to explore physiotherapy students'attitudes toward the use of telehealth in clinical practice. A cross-sectional online survey of physiotherapy students enrolled in the Doctor of Physiotherapy program at Macquarie University between November 2022 and February 2023. Participants rated their level of agreement across 11 statements regarding telehealth use in physiotherapy clinical practice using a 5-point Likert scale ranging from "strongly disagree" to "strongly agree."Participants answered two open-ended questions regarding when they might use telehealth in clinical practice as a physiotherapist and why they believe physiotherapists might be reluctant to use telehealth in clinical practice. A total of 118 participants completed the survey (response rate 53%). Overall, most participants believed telehealth would continue being offered post-Covid-19 (86%, n = 101), participants would use some form of telehealth in clinical practice (82%, n 96), believe a blended approach would be beneficial for patients (84%, n = 99), and were interested in further training in telehealth (90%, n = 107). We identified six broad themes, including accessibility, subsequent consultations, inability to provide manual therapies, limited training/education, perceived ineffectiveness, and digital literacy of the patient. Overall physiotherapy students believe telehealth will continue being offered in clinical practice, form part of contemporary physiotherapy practice, and are interested in further training to upskill in the delivery of care via telehealth. Given the continued use and students'demand for future training, it may be time to reimagine the inclusion of telehealth education and training in the entry-level physiotherapy curriculum.

Available rehabilitation technology with the potential to be incorporated into the clinical practice of physiotherapists: A systematic review.

The development of prototypes capable of intervening in the area of rehabilitation in physical therapy clinical practice activities that were previously carried out in a traditional way, that is, manually, demonstrates how technology is having an impact on professional careers such as physiotherapy. The purpose of this study is to present a comprehensive examination of various technologies employed in the facilitation of patient rehabilitation, with a focus on their potential integration within the clinical practice of physical therapists. We conducted a systematic search in four electronic databases (CINAHL, Embase, PEDro, and PubMed) for research on rehabilitation technologies. The eligible studies should demonstrate a clear utilization of technology in various aspects of the clinical approach to the rehabilitation process and have been published between 2000 and 2021 in either Portuguese or English. A total of 18 articles that satisfied the selection criteria were included in the study. The studies were classified into four distinct categories of rehabilitation technologies, which were determined by the specific characteristics of the technology employed and its integration with the therapeutic approach to rehabilitation. These categories include digital technologies, artificial intelligence and/or robotics, virtual technologies, and hybrid technologies. Rehabilitation technologies possess the capacity to effectively facilitate clinical activities performed by physical therapy professionals, including injury prevention, movement monitoring, and coordination of rehabilitation programs, with minimal or negligible intervention from the physical therapist. Further research is required to ascertain the precise capabilities of various technologies in collaborating with physiotherapists to deliver comprehensive care for patients' physical well-being, encompassing both therapeutic and preventive approaches. PROSPERO registration number CRD42020222288.

Development of Evaluation Items for Physical Therapy Clinical Practice

Development of Evaluation Items for Physical Therapy Clinical Practice

Developing a Collaborative Understanding of Health Justice in Physiotherapy: Findings from a National Consensus Development Conference

Introduction: Justice and health equity are necessary to ensure the health and wellness of an optimally operating society. Healthcare leaders, educators, students, and clinicians should endeavour to achieve health justice; however, there is a paucity of literature exploring health justice and similarly, a lack of accepted models or frameworks to actualize this state. There is a need to understand the tenets of health justice that can be integrated across and within the physiotherapy profession. The aims of this project were to build upon a proposed operational definition of health justice through a national consensus exercise and identify concepts related to health justice that could inform physiotherapy education and practice. Methods: A facilitated 3-hour virtual consensus development conference was held on November 25, 2022, and included three rounds of discussion and voting. A total of 34 delegates across targeted organizations consented to participate in this study. Participants represented delegates across key Canadian physiotherapy organizations, students, educational and health service administrators, and clinicians across various healthcare disciplines. Results: Facilitated discussion within conference rounds informed revisions to the originally proposed definition of health justice. Seventeen concepts met consensus to be included in a collaborative understanding of health justice. These concepts listed in alphabetical order were accessibility, affordability, availability, determinants of health, diversity, equity, inclusion, intersectionality, health, health equity, oppression, power, privilege, quality, racism, social equity, and sustainable health. A post-conference survey resulted in the inclusion of two additional concepts, bias and voice, for a total of 19 included concepts. Ten concepts requiring further exploration were identified. Conclusion: This national consensus exercise included interprofessional delegates from physiotherapy organizations, academia, and clinical practice. Conference results can inform the development of curricular content, policies, procedures, and practices by stakeholders in physiotherapy and other healthcare disciplines.

Facilitators and barriers of empathetic behaviour in physiotherapy clinical practice: A qualitative focus group study

BackgroundEmpathy is an essential competence of a person-centered approach, and a recognisable ability for providing physiotherapy quality healthcare. Empathetic communication enhances the improvement of patient outcomes and their experience of treatment. ObjectiveThe aim of the study was to present further insights considering facilitators and barriers of an empathetic communication between patients and physiotherapists. MethodsA qualitative focus group study was designed according to COREQ guidance for qualitative studies. Two focus groups were conducted. The first group included six patients and two individuals from non-governmental organizations, whereas three physiotherapists, two academic physiotherapist personnel and two undergraduate physiotherapy students participated in the second group. Both groups were audio recorded, and all data was verbatim transcribed for coding thematic analysis. Results9 themes were revealed regarding empathetic facilitators (qualities of good communication, relationship building, interprofessional collaborative practice, positive environment, love for the healthcare profession and professionalism), while 8 themes were revealed regarding barriers (challenging situations, working conditions, burn out, depreciation of empathetic communication, lack of training, lack of professionalism, lack of personal development and health professionals’ own personal problems). Conclusion(s)The enhancement of empathy can be accomplished in a trustworthy relationship between patient and clinicians where the development of proficient communication skills are prioritized. However, hindering factors associated with health professionals, patients and the health system should be surmounted. Ethical approval number339-ΣΕ8/10-1-2020.

The role of quick pain management treatments in clinical physiotherapy practice in India: Advantages, disadvantages, and recommendations

Quick pain management treatments in physiotherapy play a vital role in addressing immediate musculoskeletal or movement-related issues, providing short-term relief to patients. This article explores the reasons why patients seek quick treatments, outlines their advantages and disadvantages, and provides recommendations for a more comprehensive physiotherapy approach. The content is based on a synthesis of current literature, including scholarly articles, clinical guidelines, and textbooks in physiotherapy, pain management, and rehabilitation. Patients often seek quick treatments for reasons such as immediate relief from pain and discomfort, convenience, shorter duration, cost considerations, a preference for rapid solutions, and concerns about more invasive procedures. However, relying solely on quick treatments may mask symptoms, delay overall recovery, and increase the risk of recurrent problems. The article emphasizes the importance of education, setting realistic expectations, developing comprehensive treatment plans, empowering patients, continuous monitoring and adjustment, evidence-based practice, addressing patient concerns, and promoting long-term health goals. Physiotherapists and patients should collaborate to strike a balance between quick treatments for short-term relief and a more comprehensive approach for long-term recovery and prevention. The recommendations provided aim to enhance patient understanding, engagement, and satisfaction, ultimately contributing to improved overall outcomes in physiotherapy.

Using interactive computer play in physical therapy and occupational therapy clinical practice: an explanatory sequential mixed methods study.

This study explored the extent to which an interactive computer play system, Bootle Blast, supports motor learning in a clinical context and examined clinicians' perceptions of their therapeutic role in the system's use as an intervention tool. In this observational sequential explanatory mixed methods study, five children with cerebral palsy [mean age 9.4 years (SD, 0.5), Gross Motor Function Classification System Levels I-III] used Bootle Blast during a single video-recorded therapy session with their treating clinicians (physical therapists, occupational therapists, and therapy assistants). Children played one Bootle Blast mini game independently (without clinician involvement) before clinicians carried out therapy sessions with the game as per usual care. The type and extent of motor learning strategies (MLS) delivered by Bootle Blast and clinicians were rated from video recordings by a trained assessor using the 22-item Motor Learning Strategies Rating Instrument. Semi-structured interviews with clinicians were conducted to gain insights into MLS use and clinicians' perceived role during Bootle Blast use. Interviews were audio recorded, transcribed verbatim, and analyzed independently by two researchers using thematic analysis. Quantitative and qualitative data were merged and reported using narrative and joint display approaches. Bootle Blast provided eight MLS, with clinicians adding or enhancing another eight. Four themes reflected clinicians' perspectives: (1) Bootle Blast disguises therapy as play, (2) clinicians give Bootle Blast the human touch; (3) home use of Bootle Blast is promising; and (4) Bootle Blast is not always the right fit but some shortcomings could be addressed. Agreement was found for nine MLS and disagreement for four MLS when quantitative and qualitative findings were merged. Bootle Blast delivers several MLS as part of game play and clinicians can enhance and provide additional MLS to suit the child's needs/abilities. Further game refinements that were identified in this study may optimize its clinical use.

Ab. No. 146 Digital Revolution in Physiotherapy Clinical Practice: A Programme Built by a Physiotherapist for Physiotherapists

In clinical practise, what gets measured, gets managed. A streamlined documentation system is necessary to organise the journey of each patient from digital consent to expected timeline of recovery. Even at a single clinic, each practitioner has their own assessment methods, differential and provisional diagnoses, and treatment protocols. As a consultant, monitoring the data of each patient is tedious, which necessitated the need for the ASIYA Documentation System. American therapists spent 57 minutes/day authoring, 17 minutes/day viewing notes. Even after 2 years, notes are viewed. Nigerian report on physiotherapy documentation suggested accuracy needs to be improved to provide optimal continuity of care. 2006 study of an IPD physiotherapy department in Adelaide suggests only 4.3% records had 100% completion, highlighting need for quality in documentation. This online inbuilt programme maintains patient records for data monitoring and organised rehabilitation. This includes a comprehensive patient registration format with an informed consent document, detailed evaluation in which pictures/ videos are uploaded, estimated treatment time, short- and long-term goals, next session plan, detailed treatment including exercise dosages. Patients can log-in to view the number of sessions completed, and the home exercise videos specifically prescribed. Patients receive message and email appointment reminders. Data security measures have also been inbuilt for data protection. Separate home visit management section exists. The system is accessible, user-friendly, accurate ensuring quick information retrieval for timely decision-making and treatment planning. Analytics and reporting enable tracking of outcomes, identifying trends, and makes data-driven improvements. Helps in providing information in legal cases and insurance claims, eliminates need for a receptionist. By implementing ASIYA Clinic Management System, we have successfully addressed key administrative challenges, resulting in enhanced patient care, workflow optimization, staff efficiency, improved clinic performance, since the past 8 years. Future scope includes remote access and telehealth integration.

Development of a clinical practice guideline for physiotherapy management of adults invasively ventilated with community-acquired pneumonia

Background and settingPatients hospitalised with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit (ICU) for invasive mechanical ventilation and receive treatment by physiotherapists. However, clinical physiotherapy practice is variable for this ICU cohort. ObjectivesTo develop a clinical practice guideline for physiotherapy management of adults invasively ventilated with CAP using the best available evidence. MethodsGuideline development using evidence synthesis according to the GRADE and JBI approaches, incorporating findings from four preceding phases of a mixed-methods research program: systematic review and meta-analysis, national survey of Australian ICU physiotherapy practice, e-Delphi study to determine expert consensus, and multidisciplinary peer-review of the expert consensus statements by senior ICU clinicians to determine validity and applicability of the statements for translation into practice. ResultsThe guideline comprises 26 recommendations, encompassing physiotherapy assessment, patient selection and prioritisation, and treatment. Physiotherapy treatment covers domains of humidification, patient positioning, hyperinflation techniques, manual chest wall techniques, normal saline instillation, active treatment, and mobilisation. Recommendations are rated as strong or conditional based on JBI criteria, and certainty of evidence according to GRADE. Considerations for practice are provided within the guideline to enhance clarity and practicality, particularly for conditional recommendations where evidence is limited or conflicting. ConclusionThis guideline, based on the best available evidence for clinical physiotherapy practice for adults invasively ventilated with CAP, is intended to support clinicians with clinical decision making. Further research is required to evaluate guideline implementation into clinical practice, and incorporate the values and preferences of ICU patients and their families. Contribution of paper•This world first clinical practice guideline was developed based on the best available evidence for physiotherapy management of adults invasively ventilated with non-COVID-19 community-acquired pneumonia.•The evidence-based guideline provides 26 recommendations across nine domains of physiotherapy assessment and treatment, to guide best practice for this common ICU cohort.

Importance of biopsychosocial model in Indian clinical physiotherapy practice

The biopsychosocial model is one of the most important models in physiotherapy practice. It has been proven to be particularly useful in treating behaviorally regulated diseases that have a wide range of risk factors, such as type 2 diabetes mellitus, osteoarthritis, obesity, hypertension, and cardiac issues. Physiotherapists should be aware of their modes of action in terms of the cultural environment in which they operate and the unique needs of the patients in order to refocus Physiotherapy practice toward the whole treatment of patients without compromising professional ethics. The purpose of this paper is to provide an overview of physiotherapists' methods of action and to highlight the importance of incorporating models of disablement, the idea of rehabilitation, the biomedical model, and the biopsychosocial model into patient management strategies.

Use of key health questions for patient initial assessment in physiotherapy clinical practice

Physiotherapists are well positioned to educate patients about lifestyle behaviours to prevent, manage and in some cases reverse, non-communicable diseases. The study aimed to explore physiotherapy students’ perceptions about the physiotherapists’ role in health promotion and factors influencing students to ask key health questions about physical activity, smoking and sleep health. A mixed methods design was applied in a paper-based survey involving a 10 cm visual analogue scale (VAS) and open ended questions. Participants were University of Otago final year Bachelor of Physiotherapy students (n = 74). Participants perceived the physiotherapists’ role in health promotion to be important (87.5% in VAS strength). However, participants only asked patients about their level of physical activity, smoking status and sleep health 84.8%, 44.6% and 47.8% of the time, respectively; confidence was a significant variable influencing these percentages. Two a priori themes, ‘clinical setting’ and ‘knowledge regarding key health questions’ were established, then factors influencing students in asking key health questions were explored. The major factor influencing whether participants asked key health questions was relevance to patient presentation. Participants confirmed the physiotherapists’ role in health promotion is important and results provide a benchmark for the efficacy of health promotion content in entry level physiotherapy curricula.

Management of low back pain: a survey of physical therapists’ adherence to clinical practice guidelines in the State of Kuwait

Background/Aims Physical therapy clinical practice guidelines for the management of low back pain are accessible to most physical therapists in the State of Kuwait. However, guideline adherence remains undocumented. The aims of this study were to describe the low back pain treatment interventions and adherence to clinical practice guidelines by physical therapists in the State of Kuwait. Methods A total of 200 questionnaires were distributed to a convenience sample of physical therapists working in governmental hospitals who treat a variety of neuro-musculoskeletal conditions. The questionnaire contained questions on patients and the treatments applied. Physical therapists with less than 1 year of clinical experience were excluded. Descriptive and inferential statistics (analysis of variance) were used. Results Overall, 132 physical therapists completed the questionnaire (response rate of 66.0%). One-third of physical therapists’ caseloads included 40-50% of patients with low back pain. Physical therapy treatments most commonly included non-evidence-based treatment, such as superficial heat, interferential therapy and transcutaneous electrical nerve stimulation. Evidence-based treatment, such as exercises and passive stretching techniques, were less frequently used. There was no significant difference between the physical therapists’ years of experience, education or place of work and their treatment of choice. Conclusions Some physical therapists in the State of Kuwait deviate from clinical practice guidelines and use non-evidence-based treatment instead of evidence-based treatment in the management of low back pain. Therefore, intensive training and revision to current treatment protocols are required.

Framework to leverage physical therapists for the assessment and treatment of chemotherapy-induced peripheral neurotoxicity (CIPN).

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a highly prevalent, dose-limiting, costly, and tough-to-treat adverse effect of several chemotherapy agents, presenting as sensory and motor dysfunction in the distal extremities. Due to limited effective treatments, CIPN can permanently reduce patient function, independence, and quality of life. One of the most promising interventions for CIPN is physical therapy which includes exercise, stretching, balance, and manual therapy interventions. Currently, there are no physical therapy guidelines for CIPN, thus limiting its uptake and potential effectiveness. Utilizing the authors' collective expertise spanning physical therapy, symptom management research, oncology, neurology, and treating patients with CIPN, we propose a comprehensive clinical workflow for physical therapists to assess and treat CIPN. This workflow is based on (1) physical therapy guidelines for treating neurologic symptoms like those of CIPN, (2) results of clinical research on physical therapy and exercise, and (3) physical therapy clinical judgement. We present detailed tables of pertinent physical therapy assessment and treatment methods that can be used in clinical settings. CIPN assessment should include detailed sensory assessment, objective strength assessments of involved extremities, and validated physical performance measures incorporating static and dynamic balance, gait, and functional mobility components. CIPN treatment should involve sensorimotor, strength, balance, and endurance-focused interventions, alongside a home-based exercise prescription that includes aerobic training. We conclude with action items for oncology teams, physical therapists, patients, and researchers to best apply this framework to address CIPN. Physical therapists are in a unique position to help assess, prevent, and treat CIPN given their training and prevalence, yet there are no physical therapy clinical practice guidelines for CIPN. Our preliminary suggestions for CIPN assessments and treatments can catalyze the development of guidelines to assess and treat CIPN. We urge oncology teams, physical therapists, patients, and researchers to develop, adapt, and disseminate this framework to help alleviate the burden of chemotherapy on patients with cancer.

Movement Representation Strategies as a Tool for Educational Innovation in Physiotherapy Students: A Randomized Single-Blind Controlled-Pilot Trial.

Physiotherapy has a strictly theoretical body of knowledge, but for the most part, the physiotherapist's learning is practical. The practical part is fundamental to acquire clinical skills that the physiotherapist will later use in professional practice. The main aim of this study was to assess the effectiveness of movement representation strategies (MRS) in the improvement of manual skills of physiotherapy students as an educational innovation strategy. We randomly assigned 30 participants to an action observation practice (AOP), motor imagery practice (MIP), or sham observation (SO) group. A high velocity, low amplitude lumbar manipulation technique that is widely used in clinical physiotherapy practice was taught in one session. The primary outcomes were required time and test score. The secondary outcomes were perceived mental fatigue and perceived difficulty for learning. The outcomes were assessed preintervention and immediately after the intervention (postintervention). The main results showed that both AOP and MIP improved the total time required and the test score, as well as entailed less perceived difficulty for learning. However, both strategies showed a higher level of mental fatigue after the intervention, which was higher in the MIP group. Based on the results obtained, it seems that the application of MRS promotes greater learning of manual motor tasks in physiotherapy students and could be used as educational innovation strategies.

Utilization Outcomes for Physical Therapy Clinical Practice Guideline Recommendations for Mechanical Cervicalgia: A Retrospective Analysis

Utilization Outcomes for Physical Therapy Clinical Practice Guideline Recommendations for Mechanical Cervicalgia: A Retrospective Analysis