Evaluation Of Physiotherapy Research Articles

Physical exercise during acute exacerbations of chronic obstructive pulmonary disease: Australian physiotherapy practice.

Evidence supports an important role for pulmonary rehabilitation (PR) after acute exacerbations of chronic obstructive pulmonary disease (AECOPD); however, the role of physical exercise during hospitalisation is less clear. This study evaluated Australian physiotherapy practice and clinical perspectives regarding exercise and physical activity for patients with AECOPD. A national survey of 123 Australian public hospitals was conducted from 2016 to 2017 using a purpose-designed survey measuring self-reported physical exercise prescription, objective measure use, referral patterns and factors influencing service delivery. The response rate was 72% (88 hospitals; 176 physiotherapists). Most physiotherapists (92%) prescribed physical exercise frequently for patients with AECOPD and perceived their role to be important (81%). The most commonly prescribed modalities were ground walking (94%), sit-to-stand (89%) and non-equipment-based lower limb strengthening (79%). Only 32% of respondents offered physiotherapy evaluation during post-discharge outpatient clinic appointments at their hospital. While 71% of respondents indicated they frequently referred patients to PR after AECOPD, rates were significantly higher in those with more cardiorespiratory experience (82%) than those with less experience (66%; p = 0.026). Australian physiotherapists frequently prescribe simple physical exercise modalities for patients with AECOPD. PR referral rates appear influenced by clinician experience, which may need consideration in future remedial strategies.

A 3-Year Physiotherapy Management of a Case of Spinal Poliomyelitis Referred at Three Months Post Paralysis

Background: Poliomyelitis is known to bring about huge complications that foist debilitating disabilities on a patient with poliomyelitis. Most post-polio survivors live with disabilities throughout a lifetime with an attendant social and economic consequence.
 Objective: Based on the findings from subjective assessment and physical examination, the objective of the current study focused on early physiotherapy intervention measures for preventing complications such as contracture, joint stiffness, muscle wasting, severe gait abnormality, vertebral mal-alignment, and unusual pain.
 Case Description: A 4-month-old patient referred for physiotherapy evaluation following an inability to functionally move the two lower limbs and lifting of the left upper limb. There was no history of previous treatment before referral to physiotherapy management. The physical therapists reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use an approach combining the use of low intensity, short duration, and intermittent activity or exercise performed within patient’s limit of fatigue, weakness, and pain.
 Intervention: The child was on low-intensity exercises, electrical muscle stimulation and heat therapy 3 times per week for 12 months, 2 times per week for12 months, once a week, and once in two weeks for 6 months.
 Outcomes: Patient was able to achieve one-minute ambulation without walking aid in 33 months. Significantly, patient attained 5-minute ambulation in 36 months’ time. Also, ranges of motion were intact with no records of contracture in any tendon.
 Discussion: The outcome of this study demonstrated that early physiotherapy intervention and long-term follow-up are beneficial in preventing/reducing complications, thereby regaining of millstones and achieving functional independence in patients with acute flaccid paralysis such as polio.

AVALIAÇÃO FISIOTERAPÊUTICA EM CRIANÇA COM MALFORMAÇÃO CONGÊNITA DE MEMBRO INFERIOR: UM RELATO DE CASO

Este trabalho teve como objetivo realizar uma avaliação fisioterapêutica em um voluntário com malformação congênita do membro inferior direito, a fim de conhecer seus aspectos motores e funcionais, devido ao fato de ser um caso peculiar com incidência de 1 a cada 100.000 nascidos vivos. Tratou-se de um relato de caso, realizado na clínica escola de fisioterapia de uma universidade do interior do Estado de São Paulo. Os procedimentos consistiram em: anamnese, exame físico, escalas e instrumentos de avaliação do controle, índice de Barthel modificado, plataforma de força e avaliação postural. Pode-se observar através da avaliação fisioterapêutica alterações posturais relevantes com assimetrias entre os hemicorpos, déficit de equilíbrio e diminuição de força muscular no membro inferior direito, o que acarreta uma alteração biomecânica importante no participante avaliado. Essas informações coletadas durante as avaliações são essenciais para conhecer as alterações físicas decorrentes da malformação congênita para promover um melhor direcionamento em seu tratamento.

Evaluation of the Southampton Children's Hospital Physiotherapy led back pain clinic

Purpose: To evaluate the management of Paediatric back pain in the physiotherapy led clinic at Southampton University Hospital NHS Foundation Trust by evaluating patient experience having a physiotherapist as ‘first contact’(through questionnaire) and evaluating outcomes (measured by MYMOP and Roland Morris scores).

An evaluation of combined narrative exposure therapy and physiotherapy for comorbid PTSD and chronic pain in torture survivors.

Torture is associated with adverse health consequences, with especially high rates of PTSD, depression and chronic pain. Despite increased awareness of the relationship between pain and posttraumaticsymptoms, and the accompanying need for effective treatment strategies, few studies have examined an integrated treatment of comorbid PTSD and pain. In this study, using an A-B case series design with three and six month follow-up, six refugee torture survivors with comorbid PTSD, depression and chronic pain received 20 sessions of Narrative Exposure Therapy (NET) and 10 sessions of physiotherapy. Outcome variables included symptoms of PTSD and depression, pain intensity, physical functioning and quality of life. Symptoms of PTSD and pain were also rated after each treatment session. Two patients achieved clinically significant reduction in symptoms of PTSD. Only one patient achieved clinically significant change in depressive symptoms, and two experienced clinically significant reduction in pain intensity. Clinical descriptions of the course of treatment for all patients are provided. Despite its limitations, the study suggests that some torture survivors who suffer high symptom loads may benefit from a combined treatment of NET and physiotherapy. Appreciating individual differences and how they affect treatment can provide valuable insight and inform clinicians working with torture survivors. Directions for future researchregarding the improvement of rehabilitation strategies of torture survivors are discussed, and highlighted through descriptions from the six therapy cases.

Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain.

Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department (ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment (EPET) vs. standard care (SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back pain. A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index (NDI), Modified Oswestry Low Back Pain Disability Questionnaire (MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED visit. We identified a total of 125 patients. EPET group comprised 62 patients (mean age, 45 years; men, 63%) and SC group comprised 63 patients (mean age, 45 years; men, 43%). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their first ED visit. EPET patients had significantly lower levels of disability (9.0% vs. 33.4%, Welch t-test, P<0.001) and pain (median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC patients. Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefit from it.

Evidence for and cost-effectiveness of physiotherapy in haemophilia: a Dutch perspective.

Musculoskeletal impact of haemophilia justifies physiotherapy throughout life. Recently the Dutch Health Care Institute constrained their 'list of chronic conditions', and withdrew financial coverage of physiotherapy for elderly persons with haemophilia (PWH). This decision was based on lack of scientific evidence and not being in accordance with 'state of science and practice'. In general, evidence regarding physiotherapy is limited, and especially in rare diseases like haemophilia. 'Evidence based medicine' classifies and recommends evidence based on meta-analyses, systematic reviews and randomized controlled trials, but also means integrating evidence with individual clinical expertise. For the evaluation of physiotherapy - usually individualized treatment - case studies, observational studies and Case Based Reasoning may be more beneficial. Overall annual treatment costs for haemophilia care in the Netherlands are estimated over 100 million Euros, of which 95% is covered by clotting factor concentrates. The cost for physiotherapy assessments in all seven Dutch HTCs (seven centres for adult PWH and seven centres for children) is limited at approximately 500 000 Euros annually. Costs of the actual physiotherapy sessions, carried out in our Dutch first-line care system, will also not exceed 500 000 Euros. Thus, implementation of physiotherapy in haemophilia care the Netherlands in a most optimal way would cost less than 1% of the total budget. The present paper describes the role of physiotherapy in haemophilia care including available evidence and providing suggestions regarding generation of evidence. Establishing the effectiveness and cost-effectiveness of physiotherapy in haemophilia care is a major topic for the next decennium.

Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial

This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4–3.1; p<0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes.

Pulmonary complications after cardiac surgery: breathing down the patient’s neck

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Evaluation of physiotherapy in a prospective cohort of early axial spondyloarthritis. Data from the DESIR cohort

ObjectiveTo evaluate the effect of physiotherapy on functional limitation in an observational cohort of early axial spondyloarthritis. MethodsDesign: prospective population-based cohort study. Patients: 708 patients with early axial spondyloarthritis between 2007 and 2010 naive of TNF blockers. Intervention: early physiotherapy defined by at least eight supervised sessions of physical therapy during the first six months. Measurements: the primary outcome was functional improvement defined by a relative improvement of at least 20% in BASFI at six months. Secondary outcomes were improvement in BASFI at one and two years and ASAS20 response criteria at six months. Statistical analysis: a propensity score of having physiotherapy was developed and multivariate analysis using propensity score weighting were used to assess the effect of physiotherapy on outcome. ResultsOverall, 166 (24%) patients had physiotherapy during the first six months. After using propensity score weighting, there was no functional improvement on the primary outcome in patients treated with early physical therapy (relative risk [IC95%]: 1.15 [0.91–1.45]). No differences were observed on secondary outcomes (relative risk [IC95%]: 0.94 [0.80–1.11]). ConclusionsIt seems there is no functional benefit for patients with early spondyloarthritis to be treated early by physiotherapy in daily practice, even though the efficacy of physiotherapy has been shown in several randomized controlled studies.

G.P.128: Upper limb muscle MRI fat–water quantification and clinical functional correlation in non-ambulant Duchenne muscular dystrophy

Outcome measures in Duchenne muscular dystrophy (DMD) currently rely on invasive or functional but not very sensitive tests. Muscle MRI could offer a valuable alternative. A reliable evaluation of the upper limb could permit inclusion of non-ambulant DMD individuals not able to perform functional tests such as the 6-min walk test. 16 DMD boys and 10 age gender and age matched controls were included in this on-going study. Fat–water quantification was used to compare fat-infiltration in the forearm muscles of non-ambulant DMD patients and healthy controls. DMD individuals underwent 3T 3-point Dixon imaging of the dominant forearm to measure muscle fat-fraction (f.f.). Ten forearm muscles were segmented and mean f.f. and cross-sectional area recorded. Patients also underwent physiotherapy evaluation: Performance of Upper Limb (PUL) module; wrist extension myometry; and EK2 performance of tasks in daily life interview. Time to loss of ambulation (LOA) was recorded. To date, 8 non-ambulant DMD patients (mean age: 13.6 years; mean duration of non-ambulation 20 months) and 10 volunteers (mean age:14.6 years) have been imaged. Overall mean f.f (±SD) in DMD was significantly higher than healthy controls: (13.4 ± 11% vs 0.8 ± 0.1%, p = 0.002). Total mean area was reduced in DMD (1735 ± 331 mm2) compared to healthy controls (2398 ± 821 mm2, p = 0.04). Overall f.f. correlated with LOA (Spearman r = 0.8, p = 0.02) and wrist extension myometry (r = 0.8, p = 0.004) and less strongly with PUL (r = −0.6, p = 0.09) and with EK2 (r = 0.6, p = 0.09). Final analysis will include longitudinal change at one-year follow up. Initial results support MRI fat quantification as a potential objective biomarker to monitor disease progression in the upper limb in DMD, showing significant correlation between putative MRI pathological indices and clinically meaningful endpoints.

Gross Motor Function of A Child With Neurodegeneration With Brain Iron Accumulation (NBIA)

Introduction. Neurodegeneration with brain iron accumulation (NBIA) involves a group of progressive extrapyramidal disorders characterised by iron accumulation in the brain. Objective. to de­scribe the gross motor function of a child with clinical diagnosis of NBIA. Method. This is a case report involving a 7-year-old child and clinical diagnosis of NBIA. This study evaluated the history of the disease and the neuromotor functions of the child using a neurological physiotherapy evaluation form. The GMFM - Gross Motor Function Measure, a system of quantitative assessment of gross motor function in five broad dimensions, was applied. Case Presentation. Magnetic resonance imaging (MRI) showed the eye-of-the-tiger sign in the me­dial globus pallidus. Clinical examination presented extrapyramidal signs like dystonia, choreoathetosis, dysarthria and visual impairment. In this case, the combination of clinical and MRI findings was con­sistent with NBIA. Results. In the A dimension (down and roll) of GMFM, the child achieve a score of 39 points (76% of the gross mo­tor function); in the B dimension (sit) she achieve a total score of 60 points (30% of the function); in the C dimension (crawl and kneel) she achieve a score of 1 point (2% of the function); in the D dimen­sion (standing position) and in the E dimension (walk, run and jump) she did not score in any item. Conclusion. The significant deficit in proximal stability and frequent extensor dystonic spasms affected the child’s functional performance.

Objective Evaluation of Physiotherapy for Return-to-play :

Objective Evaluation of Physiotherapy for Return-to-play :

Gross Motor Function of A Child With Neurodegeneration With Brain Iron Accumulation (NBIA)

Introduction. Neurodegeneration with brain iron accumulation (NBIA) involves a group of progressive extrapyramidal disorders characterised by iron accumulation in the brain. Objective. to de­scribe the gross motor function of a child with clinical diagnosis of NBIA. Method. This is a case report involving a 7-year-old child and clinical diagnosis of NBIA. This study evaluated the history of the disease and the neuromotor functions of the child using a neurological physiotherapy evaluation form. The GMFM - Gross Motor Function Measure, a system of quantitative assessment of gross motor function in five broad dimensions, was applied. Case Presentation. Magnetic resonance imaging (MRI) showed the eye-of-the-tiger sign in the me­dial globus pallidus. Clinical examination presented extrapyramidal signs like dystonia, choreoathetosis, dysarthria and visual impairment. In this case, the combination of clinical and MRI findings was con­sistent with NBIA. Results. In the A dimension (down and roll) of GMFM, the child achieve a score of 39 points (76% of the gross mo­tor function); in the B dimension (sit) she achieve a total score of 60 points (30% of the function); in the C dimension (crawl and kneel) she achieve a score of 1 point (2% of the function); in the D dimen­sion (standing position) and in the E dimension (walk, run and jump) she did not score in any item. Conclusion. The significant deficit in proximal stability and frequent extensor dystonic spasms affected the child’s functional performance.

Disfunção Urinária em Paciente Portadora de Esclerose Múltipla

Purpose. Introduce the type of urinary dysfunction in one patient with multiple sclerosis assessing their quality of life. Method. This is a case conducted with a woman of 33 years. We evaluated the type of urinary dysfunction using a physiotherapy evaluation form, a physical evaluation to assess the strength of the pelvic floor muscles , and later a questionnaire for quality of life was filled, the King’s Health Ques­tionnaire (KHQ’s). Results. The urinary loss of the patient was on minimal exertion. Among the values obtained through the quality of life was filled questionnaire, was obtained in the areas of impact of in­continence a score of 66.66 points, measures of severity score of 33.33 points, general health perception score of 25 points, and physical/so­cial limitation score 16.66 points. In the other fields scored 0 points. Conclusion. Present a woman with MS and urinary dysfunction and its impact on quality of life. This type of evaluation in patients with MS is important for later direct to a physical therapy and new studies related to this subject.

Functional outcome after prosthetic rehabilitation of children with acquired and congenital lower limb loss

The purpose of this study was to compare the functional status of children with acquired and congenital lower limb loss after 3 weeks and 6 months of prosthetic rehabilitation. Forty-one children aged between 8 and 17 years participated in the study. The children underwent prosthetic fitting, prosthetic training and rehabilitation after physiotherapy evaluations. Gait patterns and weight bearing values were assessed, and the Amputee Mobility Predictor (AMP) Questionnaire was applied. The congenital group had better gait patterns, weight bearing values and AMP scores in the initial assessment and after 3 weeks. The statistical analyses of the same parameters after 6 months showed that there were no significant differences between the two groups (P>0.05). It was determined that all congenital patients and only 16 of 20 acquired patients were wearing their prostheses for more than 8 h a day. When the outcomes of the first assessments were compared, the congenital group showed a better functional level, gait pattern and weight bearing value. At the end of 6 months, an improvement was observed in the functional level, gait pattern and weight bearing value in both the groups. The functional state, gait pattern and weight bearing value of children with limb loss can be improved if they actively use their prosthesis.

Physiotherapists predict discharge destination after hip fracture

AbstractThe purpose was to investigate the predictive validity of discharge destination of two commonly used assessment tools and baseline variables in patients with femoral neck fracture. Thirty-two consecutive patients with a femoral neck fracture were assessed by an independent physiotherapist on days 3–5 post-surgery. Follow-up telephone interviews with structured questions were conducted at 3 weeks and 4 months post-surgery. The Swedish version of the Elderly Mobility Scale (Swe M-EMS) had an inverted correlation with discharge destination (rs=−0.423). Age (rs=0.389), living alone or with someone (rs=−0.593) and the physiotherapy evaluation (rs=0.516) also correlated with discharge destination. The Timed Up & Go (TUG) (rs=0.085) and pre-fracture activity level (rs=0.186) did not correlate with discharge destination. The Swe M-EMS may be considered a predictor of discharge destination in patients with a femoral neck fracture living in the community prior to fracture and with normal mental state, but n...

Real-Time Ultrasound Imaging in Physiotherapy Evaluation and Treatment of Transversus Abdominus and Multifidus Muscles in Individuals with Low-Back Pain

Clinical diagnosis and treatment of low back pain may be enhanced through the use of imaging modalities. This study investigates the use of rehabilitative ultrasound imaging in the physiotherapy management of low back pain associated with dysfunction of the transversus abdominis and multifidus muscles. Although encouraging, current evidence for integrating rehabilitative ultrasound imaging into clinical practice is weak and several knowledge gaps have been identified. In particular, the impact on clinical outcomes needs to be determined and well-designed randomized controlled trials investigating effectiveness for improving physical therapy assessment and treatment are required before endorsing transla- tion of rehabilitative ultrasound imaging into clinical practice.

Functional performance status of hematopoietic SCT recipients in the sub-acute phase of recovery

This study assessed the functional capacity of sub-acute SCT recipients using validated physical performance tests, including 6-min walk distance, repeated sit-to-stand time and 50-ft walk time, and compared these outcomes with those reported for a heterogeneous oncology population. The medical records of 80 consecutive sub-acute SCT recipients not receiving corticosteroids were retrospectively reviewed for demographic, medical and anthropometric information, and outcomes for these physical performance tests administered at the time of initial physiotherapy evaluation. Measures of central tendency, 95% confidence intervals, unpaired t-tests and correlation coefficients were calculated using a SPSS statistical package. SCT recipients completed the 50-ft walk in 10.66+/-4.43 s, repeated sit-to-stand trial in 4.16+/-1.82 s and walked 400.2 m in 6 min. For the timed tests, SCT recipients were approximately twice as fast as a heterogeneous group of oncology patients and walked approximately 50% further in 6 min. No overlap in the 95% confidence intervals for the two groups was observed for any of the tests. These results (1) suggest that reference values describing the functional capacity of a heterogeneous oncology population underestimate the functional capacity of SCT recipients and (2) provide clinically useful reference values for assessing functional capacity of sub-acute SCT recipients referred for physiotherapy.

Qualitative and quantitative aspects of pain in lateral posterior thoracotomy patients

Descriptive study that proposed to compare the qualitative and quantitative behavior of the pain in lateral posterior thoracotomy patients. The sample was consisted of 18 individuals with an average age of 44 years. The instruments used were physiotherapy evaluation form, numerical pain scale and McGill questionnaire for pain. The pain on the numerical pain scale was considered moderate(5) for both sexes. The descriptors of the McGill questionnaire choosen by the patients with higher frequency were: in the sensorial component, beat4, pointed1, shock2, final and pull2; in the afetive component, tired1, bored1, punishald1 and miserable1 and in the evaluative component was flat. The characteristics of pain in the sensorial group were more evidents on male group. No significant statistical difeferences were observed between quantitative answers concerning pain between the men and women. On the qualitative aspects , was observed an predominancy of the same descriptors of pain in afetive component for both sexes. Pain intensity was categorized as moderate. No significant statistical difference were observed between the pain on the post-operatory lateral posterior thoracotomy. These data demonstrate a necessity for an analysis with a larger study group.