Physiotherapeutic Assessment Research Articles

The role of prehabilitation in reducing the incidence of postoperative pulmonary complications in patients undergoing elective cardiac surgery: Results from the Pre Surgery Check Team study.

Despite its importance, prehabilitation, has only been implemented in very few cardiac surgery centers. The Pre Surgery Check Team study was designed to evaluate the impact of comprehensive interdisciplinary assessment and implementation of the prehabilitation program on the incidence of postoperative pulmonary complications after elective cardiac surgery. 725 adult patients (338 in the study group, 387 in the control group) were included in this single-center, prospective, observational study. Multimodal prehabilitation consisted of four elements: interdisciplinary medical assessment by cardiologist, anesthesiologist and cardiac surgeon, pulmonary assessment for patients at high risk of postoperative pulmonary complications, psychological assessment, and physiotherapeutic assessment and training. The primary endpoint was the occurrence of the postoperative pulmonary complications, and the secondary outcomes were: surgical site infection, rethoracotomy, ICU length of stay and hospital length of stay. Prehabilitation reduced the number of postoperative complications by 23%. Postoperative pneumonia was almost 3 times less common (5.33% vs 14.21%), and the surgical site infection - 1.4 times less common in the PreScheck group (8.28 vs 11.37%). In the logistic regression model, prehabilitation reduced the odds of postoperative pneumonia (by 0.346) and the odds of respiratory failure (by 0.479). Prehabilitation had no direct effect on ICU length of stay. Prehabilitation according to the Pre Surgery Check Team standard reduces the incidence of postoperative pulmonary complications and the total number of postoperative complications in patients undergoing elective cardiac surgery. The main benefit of attending the PreScheck Team visit is the opportunity to perform supportive preoperative interventions.

Physiotherapeutic Assessment in Oncological Post-Mastectomy Patients

Introduction: Breast cancer is one of the most prevalent forms of cancer among women, and the medical treatment protocols are highly aggressive. In the case of mastectomy, a number of different sequelae are generated, including pain, functional limitation of the shoulder, dehiscence of the wound, decrease in joint range, decrease in muscle strength, lymphedema, and so forth. Such consequences directly impact the functionality and quality of life of the individual. Physiotherapy represents a potential avenue for addressing the sequelae resulting from the surgical procedure. Objective: The objective is to conduct a bibliographic research on the early physiotherapeutic treatment of post-mastectomy cancer patients. Methodology: A search for clinical trials from 2016 to 2023 was conducted in multiple languages, including English, Portuguese, and Spanish, across several databases: PEDro, PubMed, ScienceDirect, Cochrane, and Google Scholar. The inclusion and exclusion criteria facilitated an appropriate selection process for clinical trials, in conjunction with the PRISMA method. The selected clinical trials included a total sample of 644 individuals, in which various physiotherapeutic modalities were evaluated for the purpose of combating the various sequelae generated by mastectomy. Conclusions: Physiotherapy offers a range of beneficial therapeutic modalities, which, when applied early in post-mastectomy cancer patients, have a positive impact on these individuals. These include therapeutic exercise, hydrotherapy, and resistance aerobic exercise. Conversely, there are modalities such as manual lymphatic drainage and extracorporeal shock wave therapy that have uncertain benefits, given the lack of consensus on their evidence base.

Occurrence of Body Posture Abnormalities in Overweight and Obese Children Aged 5-6 Years-Pilot Study.

The study aimed to assess the occurrence of body posture disorders and their changes under the influence of a physioprophylactic program in children depending on body weight. In the examined children, the general and segmental body composition and body posture were determined using a physiotherapeutic assessment based on the Kasperczyk method. Mass, overall, and segmental body composition were determined using the bioelectrical impedance method using a TANITA body composition analyzer. The study group of 76 children was divided due to body weight disorders into Group I (n = 51), in which BMI and fat mass values were within the normative limits for age and gender, and Group II (n = 19), comprising children whose body weight exceeded the norm and/or fat mass exceeded normative values. The examined children underwent a physioprophylactic. The program was conducted by qualified physiotherapists for 12 weeks, once a week for 30 min. The therapeutic program was focused on physioprevention of being overweight and the correction of body posture. A distal distribution of fat mass was observed in the examined group. Asymmetry in the sagittal plane was found in 35% of children. No statistically significant differences were found in the presence of asymmetry in the sagittal plane between the groups. No statistically significant differences were found in the occurrence of posture irregularities between the groups. There were no changes in the weight and body posture of the examined children under the influence of the physiotherapy program. The lack of correlation in the examined group between body weight and posture irregularities in 5-6-year-olds may suggest the acquisition of posture defects as a consequence of the persistence of overweight or obesity.

Muscle oxygenation and pain in different types of temporomandibular disorders.

Studies exploring variations in peripheral muscle oxygenation and pressure pain thresholds (PPT) of masticatory muscles in individuals with Temporomandibular Disorders (TMDs) are limited. The purpose of this study was to compare variations in peripheral oxygenation of the masseter muscle; PPT of the masseter and temporal muscles and correlate peripheral muscle oxygenation and PPT of the masseter muscle in individuals with different types of TMDs. Cross-sectional study involving 116 participants classified into three groups: muscle group (MG, n = 32), joint group (JG, n = 30) and muscle-joint group (MJG, n = 54). Individuals aged 26.97 ± 6.93, 68.97% female, 31,03% males were included. All participants were evaluated using the Diagnostic Criteria for Temporomandibular Disorders, Near-infrared spectroscopy (NIRS) for peripheral muscle oxygenation and pressure algometer for PPT. There was no difference in masseter muscle oxygenation among groups. In the masseter muscle, a weakly positive correlation was observed between PPT and variation in tissue saturation index in the MG (rho = 0.365) and JG (rho = 0.317). In addition, the MJG expressed lower PPT (p = 0.004) than JG, demonstrating that MJG had more pain in this muscle. MJG have lower PPT in the masseter muscle. Although the PPT is dependent on the type of TMDs, the correlation between PPT and oxygenation is weak. All TMDs groups evaluated (MG, JG, MJG) showed hemodynamic similarities of the masseter muscle. Understanding pain thresholds and the hemodynamic behavior of the masticatory muscles contributes to a more assertive physiotherapeutic assessment in TMDs, serving as a basis for careful and individualized interventions.

DESCRIPTIVE STUDY ON MUSCULAR STRENGTH TESTING AND GAIT ASSESSMENTS IN PATIENTS WITH COVID-19 IN THE HYPERACUTE WARD

The early intervention of physiotherapy applied in the rehabilitative treatment of patients presenting mild and moderate symptoms of the SARS-CoV-2 virus, in hyperacute and acute wards, becomes necessary to enhance the efficiency of multidisciplinary treatment. The presented study was conducted on a total of 80 subjects divided into an experimental and a control group, over a staged period of 8 months during the years 2021-2022. Investigations highlighted the fact that the specific involvement of rehabilitative physiotherapy in these types of patients, differential aspects, from the perspective of musculoskeletal functional recovery, being correlated, with the optimization of respiratory functions. Prompt activity of the physiotherapist through the development of personalized programs according to the pathological state of the subjects resulted in the improvement of basic motor functions as well as coordinative capacities, especially of the locomotor system. Keywords: Physiotherapeutic assessment, muscular strength, gait testing, COVID-19, intensive care.

Physiotherapeutic Assessment and Treatment Strategy in Gymnastic Athletes: An Update

Introduction: Gymnastics is a sports that require early specialisation and high-intensity training. Training programs at a young age help to develop power and strength, as the sport demands explosive lowerbody power and control of the body. Physiotherapy rehabilitation protocols can be incorporated to improve the athletic performance of the gymnasts. Aim: To identify the impact of physiotherapy protocols on the subjective and objective physical fitness parameters of gymnastic athletes. Materials and Methods: The authors carried out a comprehensive literature search using different databases: PUBMED, ResearchGate, Cochrane Library, and Scopus using MESH terms rehabilitation, physiotherapy, physical fitness, gymnastics, and training. Fulltext articles written in the English language from 2013-2023 were considered, and gymnastic athletes of any gender and age group were included in the study. Results: The study included eight articles on physiotherapy rehabilitation in gymnasts, based on specific inclusion and exclusion criteria. The studies show that various types of physiotherapy rehabilitation protocols can be included in gymnasts’ training programs, leading to significant improvements in both subjective and objective physical fitness outcome measures related to athletic performance. These protocols may involve plyometric training, core training, and neuromuscular training all of which can enhance the power, agility, strength, endurance, flexibility, and balance of the gymnastic athletes. Conclusion: This review shows that different physiotherapy rehabilitation programs can lead to significant improvement in the physical fitness and overall performance of gymnastic athletes. Further studies should be conducted in this area to identify the most challenging situations of gymnastic athletes, enhance performance, and develop effective rehabilitation protocols.

Physiotherapeutic assessment in gynecology

Introduction. Gynecological disorders are often manifested by experiencing pain. Disorders on the part of the musculoskeletal system can cause symptoms that can mimic diseases of internal organs, also internal organs can mimic symptoms of dysfunction for the musculoskeletal system. An ongoing disease process within a particular internal organ can trigger a reflex response from the musculoskeletal system, such as locking of the spinal joints in the corresponding organ’s spinal segment. Objective. The purpose of this study is to present the physiotherapeutic functional diagnosis of the pelvis in relation to gynecology. Material and methods. Two independent reviewers searched medical and public databases, such as PubMed, Scopus and PEDro, using search terms and MeSH, such as physiotherapy, functional diagnosis, functional assessment, gynecology. The inclusion criterion was an article published in a peer-reviewed journal, with no restriction on the extent of the year of publication. There were no restrictions on the language of publication. Journal databases were reviewed between May and June 2023. Conclusions. There is a lack of description of functional physiotherapy examination in gynecology including postural and pelvic types in scientific publications.

Functional status and quality of life in post-COVID-19 patients two to three weeks after hospitalization: A cross-sectional study.

Extended hospitalization due to coronavirus disease 2019 (COVID-19) is associated with residual musculoskeletal and functional deficits lasting even 6 months after discharge; therefore, it is crucial that post-hospitalized patients are promptly assessed. The aim of this study was to identify post-COVID-19 patients' functional status and quality of life, as well as to investigate their inter-relatedness 2-3 weeks after hospital discharge. The study included 39 post-COVID-19 patients previously hospitalized in the Clinic for Infectious Diseases at the University Clinical Center of Kosovo (UCCK) from August to December 2021. Physiotherapeutic assessment encompassed socio-demographic and clinical data including Short Physical Performance Battery (SPPB) for physical functional performance, hand grip strength, 6-min Walk Test (6MWT) for aerobic capacity and endurance, EuroQol 5-Dimension 5-Level (EQ-5D-5L) for quality of life, Visual Analogue Scale (VAS) for pain, Borg CR10 for dyspnea, peripheral oxygen saturation and heart rate. Descriptive statistics, Pearson correlation, and multiple linear regression analysis were utilized for data processing. The median (interquartile range [IQR]) for Borg CR10, VAS pain scale, total SPPB, grip strength, and 6MWT were 1 (0-3), 3 (1-6), 9 (8-10), 30.5 (23.2-43.5) kg, 344.5 (312.7-381.7) m respectively, while the mean (SD) for EQ-5D-5L index value was 0.7 (0.2). The strongest and most significant correlation was depicted between SPPB total score and its subscales, followed by correlation with EQ-5D-5L (r = 0.719, p < 0.001), grip strength (r = 0.612 p < 0.001), Borg CR10 (r = -0.515, p = 0.001), 6MWT (r = 0.416, p = 0.02), and VAS scale (r = -0.343, p = 0.03). Using the multiple regression analysis, the grip strength, Borg-CR10, and 6MWT were found to be strongly predictive of SPPB total score. In post-COVID-19 patients' functional status and quality of life were impaired 2-3 weeks following hospitalization. SPPB showed the most frequent and significant correlation with other variables, hence it should be considered as one of the primary screening tools.

Impact of selected risk factors on motor performance in the third month of life and motor development in the ninth month.

Proper motor development can be influenced by a range of risk factors. The resulting motor performance can be assessed through quantitative and qualitative analysis of posture and movement patterns. This study was designed as the cohort follow-up of the motor assessment and aimed to demonstrate, in a mathematical way, the impact of particular risk factors on elements of motor performance in the 3rd month and the final motor performance in the 9th month of life. Four hundred nineteen children were assessed (236 male and 183 female), including 129 born preterm. Each child aged 3 month underwent a physiotherapeutic assessment of the quantitative and qualitative development, in the prone and supine positions. The neurologist examined each child aged 9 month, referring to the Denver Development Screening Test II and assessing reflexes, muscle tone and symmetry. The following risk factors were analyzed after the neurological consultation: condition at birth (5th min Apgar score), week of gestation at birth, intraventricular hemorrhage, respiratory distress syndrome, and the incidence of intrauterine hypotrophy and hyperbilirubinemia determined based on medical records. A combination of several risk factors affected motor development stronger than any one of them solely, with Apgar score, hyperbilirubinemia, and intraventricular hemorrhage exhibiting the most significant impact. Premature birth on its own did not cause a substantial delay in motor development. Nonetheless, its co-occurrence with other risk factors, namely intraventricular hemorrhage, respiratory distress syndrome, and hyperbilirubinemia, notably worsened motor development prognosis. Moreover, improper position of the vertebral column, scapulae, shoulders, and pelvis in the third month of life may predict disturbances in further motor development.

The Evaluation of Asymmetry in Isokinetic and Electromyographic Activity (sEMG) of the Knee Flexor and Extensor Muscles in Football Players after ACL Rupture Reconstruction and in the Athletes following Mild Lower-Limb Injuries.

This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 ± 3.6 years; 175 ± 4 cm; 77.3 ± 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 ± 3.7 years; 177 ± 6 cm; 74.3 ± 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 ± 2.8 years; 178 ± 6 cm; 75.8 ± 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300°/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1-G2 = 48%, 38%, 14%; G1-G3 = 49%, 25%, 14%) and hamstring muscles (G1-G2 = 36%, 35%, 18%; G1-G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1-G2 = 262 J, 157 J; G1-G3 = 219 J, 179 J) and power (G1-G2 = 34 W; 11 W; G1-G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = -0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2-3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment.

Comparing a Sensor for Movement Assessment with Traditional Physiotherapeutic Assessment Methods in Patients after Knee Surgery—A Method Comparison and Reproducibility Study

Wearable sensors offer the opportunity for patients to perform a self-assessment of their function with respect to a variety of movement exercises. Corresponding commercial products have the potential to change the communication between patients and physiotherapists during the recovery process. Even if they turn out to be user-friendly, there remains the question to what degree the numerical results are reliable and comparable with those obtained by assessment methods traditionally used. To address this question for one specific recently developed and commercially available sensor, a method comparison study was performed. The sensor-based assessment of eight movement parameters was compared with an assessment of the same parameters based on test procedures traditionally used. Thirty-three patients recovering after arthroscopic knee surgery participated in the study. The whole assessment procedure was repeated. Reproducibility and agreement were quantified by the intra class correlation coefficient. The height of a one-leg vertical jump and the number of side hops showed high agreement between the two modalities and high reproducibility (ICC > 0.85). Due to differences in the set-up of the assessment, agreement could not be achieved for three mobility parameters, but even the correlation was only fair (r < 0.5). Knee stability showed poor agreement. Consequently, the use of the sensor can currently only be recommended for selected parameters. The variation in degree of agreement and reproducibility across different parameters clearly indicate the need for developing corresponding guidance for each new sensor put onto the market.

Physiotherapeutic evaluation of patients with post COVID-19 condition: current use of measuring instruments by physiotherapists working in Austria and South Tyrol

BackgroundThe implementation of standardized assessments in physiotherapeutic practice strongly supports diagnostic and treatment plans. Previous studies reported insufficient usage of standardized assessments due to lack of time, lack of knowledge, lack of resources and other barriers. Physiotherapy in outpatient settings became essential for the rehabilitation of patients with post COVID-19 condition but it remains unknown to what extent assessments are implemented into the evaluation of these patients. In this study, we explored the current use and barriers regarding the implementation of physiotherapeutic assessments to evaluate patients with post COVID-19 condition.MethodsA cross-sectional online survey was carried out among 180 physiotherapists working in outpatient settings in Austria and South Tyrol.ResultsThe majority of physiotherapists (88%) indicated that standardized assessments are useful, though less than a fifth of participants actually implement assessments in practice. Among implementation barriers, “insufficient experience” (41.8%) and “lack of knowledge” (36.6%) were mentioned most often. Concerning specific post COVID-19 assessments, the evaluation of “physical and respiratory function”, “quality of life” and “activities of daily living” were stated to be of particular relevance.ConclusionsOur study revealed a low implementation rate and identified the main barriers regarding the non-usage of standardized assessments for post COVID-19 patients.Trial registrationThe Private University for Health Sciences and Health Technology (UMIT TIROL), and the Research Committee for Scientific Ethical Questions granted approval for the survey (RCSEQ, Hall in Tirol, Austria, Number 2834).

Konservative VKB-Rehabilitation mit spontanem Zusammenwachsen des Kreuzbandes: Eine Fallstudie

Background: Anterior cruciate ligament (ACL) ruptures are common injuries in stop-and-go sports. The successful conservative rehabilitation after a rupture of the ACL is described in the literature. There is a paucity of literature on spontaneous healing of the ruptured ACL, which can be demonstrated using magnetic resonance imaging (MRI). Aim: This case study evaluates the spontaneous healing of an ACL in everyday clinical practice with structure- and function-oriented conservative rehabilitation. Method: The physiotherapeutic conservative rehabilitation is described in a 53-year-old patient. Here, hypothesis-driven manual techniques and structure- and function-oriented advanced training were applied. Results: After a good six months of intensive rehabilitation, a continuous cruciate ligament could be shown on the MRI. The physiotherapeutic assessments carried out showed symmetrical results. Conclusion: In everyday clinical practice, spontaneous healing after ACL rupture by conservative physiotherapy could be demonstrated.

Role of physiotherapy in preventing tears rolling down the legs in an eight year old girl: A case report

Urinary incontinence in children is an underdiagnosed symptom in India with a prevalence of 7%. An appropriate diagnosis and early intervention can help prevent the progression of the disorder. Here we present a case reportof an 8-year-old girl referred for physiotherapy with the chief complaint of urinary incontinence. She had a wide bladder neck along with leaking urine and a small bladder capacity. She was managed conservatively with medications and comprehensive physiotherapeutic assessment and management that included a combination of electrotherapy, pelvic floor training, balance and postural exercises and other interventions that gave a positive outcome in terms of eliminating the dribbling episodes and improvement in her quality of life.

Smoothing Skeleton Avatar Visualizations Using Signal Processing Technology

Movements of a person can be recorded with a mobile camera and visualized as sequences of stick figures for assessments in health and elderly care, physio-therapy, and sports. However, since the visualizations flicker due to noisy input data, the visualizations themselves and even whole assessment applications are not trusted in general. The present paper evaluates different filters for smoothing the movement visualizations but keeping their validity for a visual physio-therapeutic assessment. It evaluates variants of moving average, high-pass, and Kalman filters with different parameters. Moreover, it presents a framework for the quantitative evaluation of smoothness and validity. As these two criteria are contradicting, the framework also allows to weight them differently and to automatically find the correspondingly best-fitting filter and its parameters. Different filters can be recommended for different weightings of smoothness and validity. The evaluation framework is applicable in more general contexts and with more filters than the three filters assessed. However, as a practical result of this work, a suitable filter for stick figure visualizations in a mobile application for assessing movement quality could be selected and used in a mobile app. The application is now more trustworthy and used by medical and sports experts, and end customers alike.

Determining the biomechanical changes in lumbar spine among patients with injuries around the knee joint: a systematic review protocol

The knee is one of the body's more complicated joints and is susceptible to various injuries. A closed kinetic relationship exists between the lumbar spine and knee joint and any dysfunction in knee or lumbar region may result in compensation, joint dysfunction and pain in either one or both the regions. Therefore, the above stated reason highlights the need of analyzing the spine biomechanically. So, that a new physiotherapeutic assessment and treatment approach can be developed in future to prevent permanent adaptive changes in the posture in patients with knee injuries. This systematic review protocol has been conducted by two independent reviewers who searched the articles using electronic search for publications in several databases: Google Scholar, Index Copernicus, JSTOR, PubMed/Medline, ScienceDirect, Scopus and Web of Science. After applying the selection criteria, study papers published between the years 2001 to 2019 have been selected. Studies of human participants of any age having injuries around knee joint have been eligible, and there was no restriction on type of injuries. All the study papers have been analyzed using modified Downs and Black scale and scores have been awarded for the items selected on a 27 point scale. This review has collected secondary data only; hence no ethical approval was required. The results of this review protocol will provide evidence regarding changes in lumbar spine in patients with injuries around knee and this information will be useful in planning for rehabilitation in knee and around knee injury.

Physiotherapy Assessment to Identify the ‘5 Fs’: A Concept of Innovative Pelvic Floor Training

In the recommendations of the 6th International Consultation of Incontinence (ICI) [1] physiotherapy is considered a level 1, grade A, first-line treatment for the most prevalent kinds of urinary incontinence, stress-, urgency- and mixed urinary incontinence. When the attentive reader carefully looks at the ICI algorithms regarding initial management of urinary incontinence in women, he or she will find out that the medical diagnosis is actually no more than a ‘presumed diagnosis’ [2] . So, it might be that, based on such medical data, patients will be send for treatment to a physiotherapist with unclear health problems, underlying pathology and consequences [3]. Therefore, a physiotherapeutic assessment is essential to find out if, and to what extent, physiotherapy is helpful to deal with the consequences of the health problem urinary incontinence and what treatment components are warranted [3].

National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland

BackgroundEvidence that Enhanced Recovery After Thoracic Surgery (ERAS) improves clinical outcomes is growing. Following the recent publications of the international ERAS guidelines in Thoracic surgery, the aim of this audit was to capture variation and perceived difficulties to ERAS implementation, thus helping its development at a national level.MethodsWe designed an anonymous online survey and distributed it via email to all 36 centres that perform lung lobectomy surgery in the UK and Ireland. It included 38 closed, open and multiple-choice questions on the core elements of ERAS and took an average of 10 min to complete.ResultsEighty-two healthcare professionals from 34 out of 36 centres completed the survey; majority were completed by consultant thoracic surgeons (57%). Smoking cessation support varied and only 37% of individuals implemented the recommended period for fluid fasting; 59% screen patients for malnutrition and 60% do not give preoperative carbohydrate loading. The compliance with nerve sparing techniques when a thoracotomy is performed was poor (22%). 66% of respondents apply suction on intercostal drains and although 91% refer all lobectomies for physiotherapeutic assessment, the physiotherapy adjuncts varied across centres. Perceived barriers to implementation were staffing levels, lack of teamwork/consistency, limited resources over weekend and the reduced access to smoking cessation services.ConclusionCentres across the UK are working to develop the ERAS pathway. This survey aids this process by providing insight into “real life” ERAS, increasing exposure of staff to the ESTS- ERAS recommendations and identifying barriers to implementation.

Virtual simulations in the teaching-learning process of physiotherapy: innovative proposal

Introduction: The learning process has changed its methodology as well as its tools, due to the students’ profile transformation and the advance of technology. The way the students are taught and assessed is still a challenge to the professor. In this context, Influence Diagram (ID) are appropriate to simulate many aspects of the clinical thinking. Objective: Thus, the main objective of this study is to propose a computerized simulator, structured in ID, a probabilistic network that will be built to develop and evaluate the knowledge of physiotherapeutic assessment. Method: This is a methodological study. Results: Structured simulators in ID make the abilities and knowledge training safer, in controlled environment and allows to the student a constant assess. Therefore, we proposed the building of a simulator, aiming to train the abilities and competences, in a pleasant and stimulating way to the student. Final considerations: We hope that this supporting tool to the learning methodology in the physiotherapeutic assessment could be integrated to the curricular unity to train the students, to enlarge their knowledge as well as their capacity to make decisions, and also to develop and boost the students’ competences and abilities, minimizing the problems in physiotherapeutic assessment

Changes in the functional efficiency level among handball players (15–16- y.o.) from the West Pomeranian Voivodeship

Introduction. Handball is a discipline categorised by high intensity of direct opponent contact, which upturns the risk of injuries. Contemporary sports therapy puts a lot of pressure on injury prevention in competitive sports. The key issue is prophylaxis, used to reduce the possibility of injury or the causing factors. An important element of prophylaxis is comprehensive functional physiotherapeutic assessment, which allows for early detection of asymmetry, assessment of the probability of injury and the implementation of proper corrective techniques. One of the tools used for athlete’s comprehensive functional assessment is the Functional Movement Screen test. Aim. A comparison of correct movement patterns among 15-16-year-old handball players from the West Pomeranian Voivodeship in 2016-2018 and definition of changes on the of functional fitness level supported by implemented corrective exercises. Materials and methods. The research material was of a group of 60 girls and 60 boys (15-16-y.o. amateur handball players). The research was carried out during the autumn meetings of the provincial cadre. The Functional Movement Screen test and the questionnaire were used for the study. Results. In the group of girls during the 2016–2018 period, there was a regress of 2.18 points noticed, whereas in the group of boys, this equalled 3.53 points. Considering the results of the FMS test, corrective exercises were introduced. After the 6-month correction period,progress of 1.18 points was noticed in the group of girls and 1.80 points in the boys’ group. Conclusions. 1. In the period of 2016–2018, weaker and slower results of tests assessing correct movement patterns were observed among girls and boys, which is obviously an indicator of high injury risk. 2. Implementation of corrective exercises in the training of handball players resulted in an increase of functional efficiency among the examined players.