Physiotherapy Management Of Patients Research Articles

Efektivitas Pemberian Terapi Latihan Terhadap Aktivitas Fungsional Pada Pasien Claw Hand E.C. Morbus Hansen

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects the skin, peripheral nerves, mucosal surfaces of the respiratory tract, muscles and bones. Most leprosy patients experience paralysis of the ulnar nerve which causes partial disruption of the fingers or called clawhand where the finger is like a bird's claw. Purpose: this study is to determine the benefits of exercise therapy on functional activity in patients with Claw Hand e.c Morbus Hansen. Method: This study uses a case report method conducted at Kelet Donorejo Hospital by taking a sample of one of the leprosy patients by providing exercise therapy for 3 therapy sessions. Furthermore, measuring the first therapy and the third therapy. Results: In this study, the results of physiotherapy interventions were obtained, namely showing an increase in muscle strength even though it was not significant, showing a decrease in pain, in measuring nerve thickening there was no change, motor nerve function and functional measurements of the hand there was an increase even though it was not significant. Conclusion: Physiotherapy management in patients with claw hand e.c. multi-bacillary morbus hansen in the form of active exercise therapy, strengthening exercise and functional exercise obtained the results of increased muscle strength even though it was not significant, showed a decrease in pain, in the measurement of nerve thickening there was no change, motor nerve function and functional hand measurements there was an increase even though it was not significant.

Heel Pain - Plantar Fasciitis: Revision 2023.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain. J Orthop Sports Phys Ther 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303.

Exploring the assessment, diagnosis and conservative management of patients with neurogenic thoracic outlet syndrome (NTOS): an online survey of UK medical and allied health professionals

Objective: Neurogenic thoracic outlet syndrome (NTOS) is challenging to diagnose and manage. While physiotherapy is widely recognised as the primary treatment for NTOS, treatment specifics and target populations are poorly described. The objective of this cross- sectional survey was to explore the experiences and opinions of UK therapy and medical professionals regarding the assessment, diagnosis and physiotherapy management of patients with NTOS. Methods: An online survey was distributed through a multimodal recruitment strategy employing snowball sampling. The survey remained active for 4 weeks and targeted healthcare professionals with experience of treating NTOS, ending May 2023. Results: 46/55 (83.6%) responses were deemed eligible for analysis. 84.7% (39/46) worked in the NHS, with 41% (16/39) specialising in multidisciplinary team nerve services and most (58.7%, 27/46) having >10 years of experience treating NTOS. Key findings included: NTOS assessment (performed by >91%) involved taking a subjective history, evaluating cervical and shoulder active range-of-motion, upper limb neurological screening and assessing the patient’s understanding of NTOS. Physiotherapy treatment (provided by >94%) consisted of advice and education, range of motion exercises for the shoulder, cervical and thoracic regions, postural advice, activity modification and a home exercise plan. Three-quarters (76.1%, 35/46) of respondents reported an absence of treatment guidelines for NTOS, and 98% (45/46) expressed the need for further research into exercise and physiotherapy management for NTOS. Conclusion: While clinicians perceive NTOS as a complex condition lacking treatment guidelines, physiotherapy remains a mainstay in the current treatment pathways. Further research is warranted to enhance the understanding of NTOS and develop evidence-based management strategies.

Physical Therapy Management of Postacute Sequelae of COVID-19 in Outpatient Settings: A Scoping Review

Purpose: The devasting effects of the coronavirus disease 2019 (COVID-19) pandemic have warranted the rapid development of evidence surrounding the physical therapy (PT) management of the disease within inpatient settings. However, the medical community is still working to define the long-term effects of COVID-19, referred to as Postacute Sequalae of SARS-CoV-2 (PASC), and ways for physical therapists to manage them in outpatient settings. The primary objective of this review was to summarize the available evidence related to the PT management of PASC in outpatient settings. Methods: A systematic search in PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, Academic Search Complete, and MedLine yielded systematic and scoping reviews and randomized controlled trials, among others. Data extraction was performed independently by 2 reviewers with 8 studies included. Results: Only 3 publications were specific to the outpatient setting area, with 5 more studies that focused on outpatient practice as part of a multisetting study, or the postacute setting. Although the limited number and quality of publications creates challenges applying the interventions provided across a population, each were specific to PASC. Conclusions: This review supports the need for further research focused on the PT management of patients who are experiencing PASC in outpatient settings.

Physiotherapy and Rehabilitation Management of Musculoskeletal Affections in Canines

The present work done on physiotherapy and rehabilitation techniques of locomotor system in canine practice is very meagre, especially on physical assessment and diagnostic findings of chronic complains of locomotor affections especially musculoskeletal in dogs with failed medical treatment and no surgical intervention was possible. Nine dogs (5 in the age group of >5 years, three of age group of 1 to 5 years, and one in the age group of <1 year) ;6, males and 3 females represented with affections of the musculoskeletal system were included in the present study, amongst which 3 cases were of hind quarter weakness and 6 cases of muscles strain, wherein physiotherapy was employed. All nine clinical cases were subjected to a detailed examination, including comprehensive neurological examination, diagnostic imaging, goniometry and haemato-biochemical estimations. All patients were treated with different types of physiotherapy modalities and rehabilitation techniques and observed the effectiveness of physiotherapy. Physiotherapy management of patients had early and optimal resumptions of functions. The rehabilitation modalities provided meritorious treatment options for symptomatic pain relief in patients, resulting in improved quality of life.

Improving day one mobilisation following hip fracture

Purpose: Hip fracture is a serious, life changing injury, which typically occurs in people in their eighties with pre-existing medical conditions and subsequent complex post-operative rehabilitation needs. The Hip Sprint Audit in 2017, run by the CSP in conjunction with the NHFD (National Hip Fracture Database), provided for the first time a detailed national understanding of the wide variation in the physiotherapy management of patients following a hip fracture. Participation in this audit demonstrated the hospital was significantly below the national average for achieving day 1 mobilisation following surgery.

Physical therapy for patients with low back pain in Germany: a survey of current practice

BackgroundLow back pain (LBP) is one of the most common musculoskeletal disorders worldwide. The National Disease Management Guideline (NVL) “Non-specific LBP” is a practical decision-making aid for both physicians and non-medical professionals in Germany to improve quality of health care. Although LBP is the most frequent diagnosis resulting in physical therapy treatment, information on the current management of patients with LBP and guideline adherence is limited. The objective of this study was to evaluate the current physical therapy management of patients with LBP in Germany, and to explore guideline adherence to the NVL “Non-specific LBP” recommendations.MethodsAn online survey among physical therapists working in Germany was conducted based on the recommendations given in the NVL “Non-specific LBP”. Participants were recruited using a snowball sampling approach and invited to complete the questionnaire. Guideline adherence was evaluated by comparing the survey findings with the recommendations of the NVL.ResultsIn total, 1361 physical therapists (41 years of age (SD 11); 839 female, 514 male; 16 years of clinical experience (SD 10)) completed the survey.Fifty percent (n = 675) of our respondents adhered to the recommendations of the NVL on the therapeutic diagnostic process, and 72% (n = 973) to the recommendations concerning treatment. The guideline adherence across the entire management process (i.e., both diagnosis and treatment) of LBP was 38% (n = 513). German physical therapists predominantly provide active interventions, e.g., exercise therapy, but also use interventions with low or conflicting evidence, respectively. Massage and Kinesio Taping were frequently used despite being not recommended. Less than one third of study participants (n = 400, 29%) answered to know the NVL or had dealt with its recommendations.ConclusionsIn the management of LBP, overall guideline adherence among German physical therapists was 38% with higher adherence in the treatment section than in the physical therapeutic diagnostic process. Widespread employment of implementation strategies and removal of existing barriers against the application of evidence-based guidelines could facilitate the transfer of scientific evidence into clinical practice and contribute to optimize the quality of health care.Trial registrationGerman Clinical Trials Register (DRKS00012607). Registered 04 October 2017.

Adapting Physical Therapy Management of Patients With COVID-19 in the Acute Care Setting: A Clinical Perspective

Purpose: Using emerging evidence and information pertaining to the SARS-CoV-2 virus, a team of physical therapists (PTs) and occupational therapists (OTs) at the Duke University Hospital (DUH) created a screening algorithm to guide PT/OT evaluation readiness and treatment decisions. This article aims to discuss factors that were considered in the initial development of therapy guidelines and, in so doing, emphasizes the need for ongoing analysis of such screening algorithms and treatment guidelines as evidence continues to emerge. Summary of Key Points: The interdisciplinary team, leveraging their collective experience combined with the updated literature, changed the initial medical management for patients diagnosed with coronavirus disease 2019 (COVID-19). As a result, the screening algorithm was adapted to reflect evolving evidence-based practices. This facilitated earlier and more skillful PT intervention as well as continued PT involvement in the treatment process throughout the course of the patients' stay in the hospital. Conclusions: To guide clinical decisions regarding medical stability of patients and appropriate timing for PT intervention, the therapists at DUH considered factors including defining and identifying stages of disease severity, assessment of laboratory values, and monitoring oxygen stability. Beyond medical complexity, mobility was limited by several additional isolation barriers which presented challenges for PTs, nursing staff, and the patient.

QUALITY OF LIFE FOLLOWING PHYSIOTHERAPY MANAGEMENT IN PATIENTS WITH TOTAL KNEE REPLACEMENT

Background: Knee Osteoarthritis (OA) is a major cause of chronic pain & a leading source of functional disabilityin many individuals. Total knee Arthroplasty/Replacement (TKR) is an effective procedure for the treatment of OA. Reduction in pain, improvement in the physical function is the main expected outcomes after TKR. However, for some patients, the outcomes are not satisfactory. The functional benefits of this surgical procedure are not as convincing as large functional deficits persist in many patients.Methods: 11 patients ( four males and seven females) undergoing TKR were randomly selected from the orthopedic wards of a tertiary public sector hospital. Post written informed consent, patients were evaluated pre-operatively using EQ-5D and Knee injury and Osteoarthritis (KOOS) outcome measures. The TKR was followed by vigorous physiotherapy treatment from post-operation day 1, followed up to 6 weeks, and then patients were re-evaluated.Results: The patients who participated had a mean age of 64.36. Analysis with a paired t-test showed statistically significant improvement (p-value < 0.05) for all the domains of KOOS and also EQ-5D. The patients responded well to physiotherapy with statistically significant improvement (p-value < 0.05) in their quality of life.Conclusion: There is a significant improvement in the quality of life of patients undergoing total knee replacement surgery post physiotherapy. More intensive rehabilitation should be promoted in the sub-acute recovery period after TKR to optimize functional outcomes.

Embedding pain neuroscience education in the physical therapy management of patients with chronic plantar fasciitis: a prospective case series

ABSTRACT Objectives The purpose of this case series was to describe the effects of a biopsychosocial approach that embeds pain neuroscience education (PNE) within physical therapy for improving foot and ankle function, pain, and psychosocial factors in patients with chronic plantar fasciitis. Methods Seven female patients (mean [SD] age = 49.0 [11.4] years) receiving physical therapy for chronic plantar fasciitis were enrolled. Along with formal physical therapy, patients received six 15-minute PNE sessions. Knowledge of pain neuroscience was assessed before and after PNE with the Revised Neurophysiology of Pain Questionnaire. Patients completed questionnaires for foot and ankle function (Activities of Daily Living subscale of the Foot and Ankle Ability Measure), pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and fear of movement (Tampa Scale for Kinesiophobia) at baseline (before treatment) and 6 and 12 weeks. Local and remote pain sensitivity was assessed using a pressure algometer at baseline and 6 weeks. Results Patients attended a mean (range) of 8.7 (7 to 12) physical therapy sessions over a mean (range) of 46.7 (42 to 56) days. After PNE, six (86%) patients demonstrated increased knowledge of pain neuroscience. At 12 weeks, six (86%) patients met or exceeded minimally clinically important difference (MCID) for foot and ankle function and pain. Five (71%) patients met or exceeded MCID for pain catastrophizing and fear of movement. Local pain sensitivity was reduced in six (86%) patients. Conclusions Physical therapy integrating PNE is potentially beneficial for patients with chronic plantar fasciitis. Future studies should examine the efficacy of PNE in randomized trials with larger representative samples.

Delivering Telerehabilitation to COVID-19 Inpatients:A Retrospective Chart Review Suggests It Is a Viable Option

BackgroundGuidelines for physical therapy management of patients hospitalized with COVID-19 recommend limiting physical therapists’ contact with patients when possible. Telehealth has been viewed as “electronic personal protective equipment” during the COVID-19 pandemic; although telerehabilitation has been shown to be effective with outpatients, it is unknown whether it is a viable option for hospitalized patients.PurposeOur facility developed an algorithm for the use of a physical therapy telerehabilitation program for inpatients with COVID-19. We sought to investigate the safety and viability of the program.MethodsWe conducted a retrospective chart review of patients admitted with a diagnosis of COVID-19 who received either telerehabilitation only or a combination of telerehabilitation and in-person rehabilitation. Based on the algorithm, COVID-19 inpatients were selected to receive telerehabilitation if they could ambulate independently, could use technology, had stable vital signs, required minimal supplemental oxygen, and were cognitively intact. We analyzed data of inpatients who received telerehabilitation only, which included patient education, therapeutic exercises, and breathing techniques.ResultsOf 33 COVID-19 inpatients who received telerehabilitation, in-person rehabilitation, or a combination of the two, 12 patients received telerehabilitation only (age range, 33 to 65 years; all but one male). They demonstrated independence with their individualized home exercise programs in one to two sessions, did not require an in-person rehabilitation consultation, did not require increased oxygen, experienced no exacerbation of symptoms, and were discharged home.ConclusionsInpatient telerehabilitation appears to be a viable option for selected hospitalized patients with COVID-19 and may be a safe way of delivering inpatient rehabilitation to isolated or at-risk populations. At our hospital, the use of inpatient telerehabilitation reduced staff exposure while providing important education and services to patients. To our knowledge, no studies have investigated the use of telerehabilitation for hospitalized patients, including those with COVID-19. Our findings suggest that this innovative approach warrants further study.

Clinical course and physiotherapy intervention in 9 patients with COVID-19

Since the outbreak of the 2019 novel coronavirus (COVID-19), the role of physiotherapy for patients with COVID-19 infection has been highlighted by various international guidelines. Despite that, clinical information regarding the rehabilitation of patients with COVID-19 infection remains limited. In this case series, we provide a novel insight into the physiotherapy management in patients infected with COVID-19 in Singapore. The main findings are: (1) Respiratory physiotherapy interventions were not indicated in the majority of the patients with COVID-19 in this case series; (2) During rehabilitation, exertional or position-related desaturation is a common feature observed in critically ill patients with COVID-19 infection locally. This clinical phenomenon of exertional or positional-related desaturation has significantly slowed down the progression of rehabilitation in our patients. As such, it can potentially result in a significant burden on healthcare resources to provide rehabilitation to these patients. Based on these findings, we have highlighted several recommendations for the provision of rehabilitation in patients who are critically ill with COVID-19.

Physiotherapy management of patients with trunk trauma: A state-of-the-art review.

BackgroundTrauma injury remains a significant health risk for all on a global level. Patients with trunk trauma suffer blood loss, inflammation and hypoxia and are at risk of developing respiratory and musculoskeletal complications during their recovery. Physiotherapists are an integral part of the interprofessional team that manages patients who sustain trunk trauma.ObjectivesTo describe the physiotherapy management of adult patients with trunk trauma, their quality of life, post-discharge rehabilitation service provision, and outcome measures used in the physiotherapy management.MethodA non-systematic narrative review of published literature was performed.ResultsMobilisation, functional exercises, deep breathing exercises and active coughing are used to optimise patients’ respiratory and musculoskeletal functioning. Some physiotherapists educate patients on the use of pain management strategies to reduce discomfort from rib fractures, surgical sites and intercostal drainage bottle tubing. Survivors of trunk trauma experience limitations in physical function up to two years. Little is known about post-discharge rehabilitation service provision to these patients after discharge. Few physiotherapists use outcome measures as part of their daily clinical practice.ConclusionPhysiotherapy management of patients with blunt or penetrating trunk trauma during hospitalisation and after discharge is a field of clinical practice that is rich for high-quality research related to service provision, cost analysis and interventions used.Clinical implicationsPhysiotherapy clinicians and researchers can use the findings of this review as a guide to their management of adult patients recovering from trunk trauma.

Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review.

To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. Scoping review. We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. We performed a qualitative synthesis that identified items included in patient advice and education. Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change. J Orthop Sports Phys Ther 2020;50(6):285-293. doi:10.2519/jospt.2020.9152.

A Treatment-Based Profiling Model for Physical Therapy Management of Patients Following a Concussive Event.

Concussions are a public health concern that affects individuals across the life span. The multifaceted effects of concussion warrant an interdisciplinary management strategy that may include physical therapy. However, physical therapists may feel underprepared for clinical decision making following a concussive event. We propose a new treatment-based profiling model to help physical therapists manage patients following a concussive event. This profiling model, based on symptom type and intensity, disability status, and response to movement, prioritizes treatment emphasis on (1) symptom management, (2) movement system optimization, or (3) performance optimization. We consider contextual factors that modify treatment decision making and present examples of each treatment-based profile. J Orthop Sports Phys Ther 2019;49(11):829-841. doi:10.2519/jospt.2019.8869.

Physical Therapy Management of Patients With Chronic Low Back Pain and Hip Abductor Weakness.

Hip abductor dysfunction is common in individuals with chronic low back pain (CLBP). Previous research investigating abductor strengthening in the heterogeneous CLBP population is sparse and has failed to target those patients most likely to benefit. The aim of the current case series was to describe the physical therapy management and outcomes of 3 patients with CLBP matching a previously identified subgroup characterized by substantial hip abductor weakness. Three nonconsecutive patients with CLBP-a 77-year-old man, a 78-year-old woman, and an 85-year-old woman-were treated in an outpatient physical therapy clinic. All 3 patients matched a previously identified CLBP subgroup characterized by substantial hip abductor weakness. Patients were treated using a targeted exercise approach consisting mostly of hip abductor strengthening for 11 to 17 visits over 8 to 10 weeks. Patients received additional treatments including heel lift and pain neuroscience education when indicated. By discharge, all patients had made clinically important improvements in pain (3- to 7-point reduction on the Numeric Pain Rating Scale), function (10- to 16-point change on the Modified Oswestry Disability Index), and perceived improvement (6-7 on Global Rating of Change Scale). Lumbar range of motion was painless, and hip abductor strength was improved from 2+/5 to 3+/5 in all 3 patients. These gains were maintained at 3-month follow-up. The current case series describes the use of a targeted exercise approach consisting mostly of hip abductor strengthening in a group of patients with CLBP and hip abductor weakness. The results indicated that this approach may be effective in reducing pain and improving function, particularly for older patients.

Physiotherapy management of patients with major chest trauma: Results from a global survey

Aim Major chest trauma is associated with significant morbidity and mortality. Management of patients with major chest trauma includes pain relief, ventilatory management, surgical fixation and early rehabilitation to improve both short- and long-term outcomes. Physiotherapy is widely considered an integral component of the multidisciplinary trauma team and aims to improve respiratory status and reduce the sequelae associated with immobility and reduced physical function. Despite this there is scarce evidence describing or investigating physiotherapy interventions and how these practices vary worldwide. The aim of this study was to ascertain the current physiotherapy management of patients having sustained major chest trauma and to investigate how such practices varied internationally. Methods A purpose designed online survey was administered to a group of experienced physiotherapists who work in the field of trauma. Results Response rate was 51% ( n = 49) and respondents represented all five continents. Respondents reported focussing on active coughing ( n = 46, 96%, r = 0.5, p = 0.98), body positioning ( n = 43, 94%, r = 0.7, p = 0.41), deep breathing exercises ( n = 44, 94%, r = 0.8, p = 0.66) and early mobilisation ( n = 47, 98%, r = 1, p = 0.64). Ambulation in hospital was reported to be common ( n = 46, 98%, r = 0.2, p = 0.99) but rehabilitation to address longer term sequelae following hospital discharge was reported to be rare ( n = 4, 8%). Conclusion This survey has highlighted those practices used by physiotherapists worldwide which aim to address the complications associated with major chest trauma. Having established global practice, the study provides a platform for future research investigating the efficacy of such interventions in improving both short- and long-term outcomes for patients following major chest injury.

Assessment of knowledge, attitude, and behavior about the disease process and physiotherapy management in patients with chronic obstructive pulmonary disease: A qualitative study.

BACKGROUND:Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases; the most common are emphysema and chronic bronchitis. It is considered to be the major cause of morbidity and mortality worldwide and is considered to be one of the leading causes of deaths in India, the main reason being misconception/misinterpretation of the disease and unawareness about the risk factors which hinder early diagnosis and its treatment effectively. Therefore, the present study aimed to assess the knowledge, attitude and behavior about the disease process and physiotherapy management in patients diagnosed with COPD.MATERIALS AND METHODS:Ethical clearance was obtained before initiating the study. It was a cross-sectional, qualitative study. In total, 14 patients of COPD were recruited for the study by convenience sampling. The total study duration was 6 months. Two focused groups (n = 14) were conducted with seven COPD patients (diagnosed by chest physician on the basis of pulmonary function testing) in each after obtaining the written informed consent. Focus group contents were video graphed after obtaining the consent and a focus group discussion (FGD) guide comprising of 15 questions was used for the study. Transcripts were prepared from the audio/video recordings and were analyzed qualitatively by narrative analysis.RESULTS:The narration transcripted during both the sessions of FGD showed significant negligence about the disease process, its precipitating factors, preventive measures, and physiotherapy management among the patients suffering from COPD in the community. None of the patients were aware even about the term “chronic obstructive pulmonary disease” and only 35.71% of patients were aware of physiotherapy management as a mean of treatment for COPD.CONCLUSIONS:The present study concludes that there is a lack of knowledge, incorrect attitudes, and flawed behavioral changes which needs to be corrected among the patients with COPD. These patients require correct, detailed, and broad-based information about their condition and availability of treatment options.

Evidence-based guidelines for physiotherapy management of patients with multiple myeloma: study protocol

BackgroundPatients with multiple myeloma (MM) are often treated with chemotherapy, radiation, and, if indicated, autologous stem cell transplant. In addition to side effects of the treatment, patients with MM often have bone pain, pathological fractures, spinal cord compressions, fatigue, and muscle weakness, which negatively impact functional performance and quality of life. Currently, there are no related guidelines for safe and effective physiotherapy (PT) management. Accordingly, the aim of the present study is to develop guidelines for effective physiotherapy management of patients with MM by systematically reviewing and evaluating the available evidence followed by a consensus process to specifically describe the research questions as detailed below.Methods/designPhysiotherapy management guidelines for patients with multiple myeloma will be developed based on the results of a systematic search of the following databases: US National Library of Medicine Database (PubMed), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Elton B. Stephens Co. (EBSCO), Web of Science, Database of s of Reviews of Effects (DARE), Cochrane Database of Systematic Review, and Physiotherapy Evidence Database (PEDro). All articles will be screened for inclusion and exclusion criteria. Relevant potential articles will be identified and systematically reviewed for final phase of inclusion. Two independent reviewers will systematically review and analyze the quality of identified articles using standardized assessment tools. Scientific conclusions will be drawn and recommendations will be made based on a critical appraisal process. The guideline development will also be based on the team’s judgment about the overall quality of the studies and a consensus process.DiscussionDraft guidelines will be developed in the form of action statements based on the strength of evidence and grades of recommendations. The draft guidelines will be reviewed internally by two independent reviewers using AGREE II and externally by a methodological expert from Evidence-Based Care – Cancer Care Ontario and will be sent to the Canadian Physiotherapy Association (CPA) for feedback from physiotherapists.Systematic review registrationPROSPERO CRD42017064056

Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.