Physical Therapy Intervention Program Research Articles

A Longitudinal Observational Clinical Study of Neurophysiological and Patient-Reported Responses to a Program of Physiotherapy for Acute and Subacute Low Back Pain

ObjectivesThe purpose of this study was to document the baseline neurophysiological status (skin conductance activity levels) of patients presenting for physiotherapy with acute and subacute low back pain (symptoms of up to 12 weeks’ duration) and to observe the magnitude and direction of sympathetic nervous system (SNS) changes (skin conductance responses [SCRs]) occurring as a result of receiving guideline-endorsed physiotherapy treatment. MethodsA pragmatic, prospective, longitudinal, observational study recording SNS skin conductance (SC) responses and patient reported outcome measure changes to a program of guideline-endorsed physiotherapy treatment for low back pain symptoms of up to 12 weeks’ duration. Sixty patients received a guideline-endorsed physiotherapy treatment program. Continuous neurophysiological recordings of SC activity levels were taken throughout each treatment. Patient reported outcome measure data were extracted from inception, midpoint, and discharge. Within and between treatment analyses determined the nature of SC changes and correlations to longitudinal changes in pain and function. Skin conductance changes were measured within and between treatment episodes at treatment inception, midpoint, and discharge and observed correlations between the magnitude of SCRs, pain abatement (numeric pain rating scale), and functional restoration (Oswestry Disability Index). ResultsSkin conductance changes were significant during all “treatment” periods (P = .044), with the greatest magnitude of sympathoexcitatory responses occurring at inception (219%). The treatment modality providing the maximum SNS response was a high-velocity lumbar rotation manipulation. Positive correlations were identified between SCRs, Oswestry Disability Index improvements (r = 0.82, P < .0005), and pain abatement (r = 0.459, P < .0005). ConclusionsPatients with low back pain exhibited neurophysiological treatment responses indicative of a symptom-related neuroplastic state of dorsal horn sensitization that may be receptive to early manual therapy intervention.

Effectiveness of a Blended Multidisciplinary Intervention for Patients with Moderate Medically Unexplained Physical Symptoms (PARASOL): Protocol for a Cluster Randomized Clinical Trial.

BackgroundMedically unexplained physical symptoms are an important health problem in primary care, with a spectrum from mild to chronic. The burden of chronic medically unexplained physical symptoms is substantial for patients, health care professionals, and society. Therefore, early identification of patients with moderate medically unexplained physical symptoms is needed in order to prevent chronicity. The preventive screening of medically unexplained physical symptoms (PRESUME) screening method was developed using data from the electronic medical record of the patients' general practitioner and demonstrated its prognostic accuracy to identify patients with moderate medically unexplained physical symptoms. In the next step, we developed a proactive blended and integrated mental health and physical therapy intervention program (PARASOL) to reduce complaints of moderate medically unexplained physical symptoms, stimulate self-management, and prevent chronicity.ObjectiveThe primary objective of this study is to investigate the effectiveness of the blended PARASOL intervention on the impact of symptoms and quality of life in patients with moderate medically unexplained physical symptoms compared with usual care. Secondary objectives are to study the effect on severity of physical and psychosocial symptoms, general health, physical behavior, illness perception, and self-efficacy in patients with moderate medically unexplained physical symptoms as well as to determine the cost-effectiveness of the program.MethodsThis paper presents the study protocol of a multicenter cluster randomized clinical trial. Adult patients with moderate medically unexplained physical symptoms will be identified from electronic medical record data using the PRESUME screening method and proactively recruited for participation in the study. Cluster randomization will be performed at the level of the participating health care centers. In total 248 patients with moderate medically unexplained physical symptoms (124 patients per arm) are needed. The PARASOL intervention is a 12-week blended primary care program consisting of 4 face-to-face consultations with the mental health nurse and 5 physical therapy sessions, supplemented with a Web-based program. The Web-based program contains (1) information modules and videos on self-management and educative themes, (2) videos and instructions on prescribed home exercises, and (3) assignments to gradually increase the physical activity. The program is directed at patients’ perception of symptoms as well as modifiable prognostic risk factors for chronicity using therapeutic neuroscience education. It encourages self-management, as well as an active lifestyle using a cognitive behavioral approach and graded activity. Primary outcomes are impact of symptoms and quality of life. Secondary outcomes are severity of physical and psychosocial symptoms, general health, physical behavior, illness perceptions, self-efficacy, and cost-effectiveness. All measurements will be performed at baseline, 3 and 12 months after baseline. Retrospective cost questionnaires will also be sent at 6 and 9 months after baseline and these will be used for the cost-effectiveness analysis.ResultsThe intervention has been developed, and the physical therapists and mental health nurses in the participating experimental health care centers have received two days of training on the content of the blended PARASOL intervention. The recruitment of health care centers started in June 2016 and inclusion of patients began in March 2017. Follow-up assessments of patients are expected to be completed in March 2019.ConclusionsThis study is the first randomized clinical trial to determine the effectiveness (including cost-effectiveness) of a proactive, blended, and integrated mental health and physical therapy care program for patients with moderate medically unexplained physical symptoms. The findings will help to improve the treatment for patients with moderate medically unexplained physical symptoms and prevent chronicity.Trial RegistrationNetherlands Trial Register NTR6755; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6755 (Archived by WebCite at http://www.webcitation.org/6ywporY7u).

Goal directed physiotherapy treatment program for improving lower extremity function in a child with spastic paraplegic cerebral palsy. A case report

Spastic Paraplegic Cerebral Palsy (CP) involves both the lower limbs which effects balance and gait in children. These individuals are treated by physiotherapy with various means like Stretching, Strengthening, application of Neurodevelopmental Therapy (NDT), Task oriented approach and Proprioceptive Neuromuscular Facilitation (PNF) but there is no evidence on goal oriented physiotherapy program using various approaches for the treatment of spastic paraplegic CP children. Here we report a case of a 9-year-old boy diagnosed with spastic paraplegic CP, who underwent 5 months of Goal directed Physiotherapy Program. Documented improvements in muscle tone, balance and various parameters of gait reveal promising outcome. Hence we propose goal directed physiotherapy treatment might improve balance and gait in children with spastic paraplegic CP.

A pilot randomised clinical trial of physiotherapy (manual therapy, exercise, and education) for early-onset hip osteoarthritis post-hip arthroscopy

BackgroundDespite the increasing use of hip arthroscopy for hip pain, there is no level 1 evidence to support physiotherapy rehabilitation programs following this procedure. The aims of this study were to determine (i) what is the feasibility of a randomised controlled trial (RCT) investigating a targeted physiotherapy intervention for early-onset hip osteoarthritis (OA) post-hip arthroscopy? and (ii) what are the within-group treatment effects of the physiotherapy intervention and a health-education control group?MethodsThis study was a pilot single-blind RCT conducted in a private physiotherapy clinic in Hobart, Australia. Patients included 17 volunteers (nine women; age 32 ± 8 years; body mass index = 25.6 ± 5.1 kg/m2) who were recruited 4–14 months post-hip arthroscopy, with chondropathy and/or labral pathology at the time of surgery. Interventions included a physiotherapy treatment program that was semi-standardised and consisted of (i) manual therapy; (ii) hip strengthening and functional retraining; and (iii) health education. Control treatment encompassed individualised health education sessions. The primary outcome measure was feasibility, which was reported as percentage of eligible participants enrolled, adherence with the intervention, and losses to follow-up. The research process was evaluated using interviews, and an estimated sample size for a definitive study is offered. Secondary outcomes included the Hip disability and Osteoarthritis Outcome Score (HOOS) and the International Hip Outcome Tool (IHOT-33) patient-reported outcomes.ResultsSeventeen out of 48 eligible patients (35%) were randomised. Adherence to the intervention was 100%, with no losses to follow-up. The estimated sample size for a full-scale RCT was 142 patients. The within-group (95% confidence intervals) change scores for the physiotherapy group were HOOS-Symptoms 6 points (−4 to 16); HOOS-Pain 10 points (−2 to 22); HOOS-Activity of Daily Living 8 points (0 to 16); HOOS-Sport 3 points (−12 to 19); HOOS-Quality of Life 3 points (−7 to 13); and IHOT-33 7 points (−10 to 25). The within-group (95% confidence intervals) change scores for the control group were HOOS-Symptoms −4 points (−17 to 9); HOOS-Pain −2 points (−18 to 13); HOOS-Activity of Daily Living −7 points (−17 to 4); HOOS-Sport 4 points (−16 to 23); HOOS-Quality of Life −5 points (−18 to 9); and IHOT-33 −4 points (−27 to 19). Suggestions to improve study design included greater supervision of exercises and increased access to physiotherapy appointments.ConclusionsResults support the feasibility of a full-scale RCT, and recommendations for an adequately powered and improved study to determine the efficacy of this physiotherapy intervention post-hip arthroscopy to reduce pain and improve function are provided.Trial registrationAustralian Clinical Trials Registry, ACTRN12614000426684

Pain and functional outcomes after outpatient physiotherapy in patients with low back pain.

Physiotherapy treatment programs are recommended in the rehabilitation of low back pain (LBP). Rehabilitation institutions are increasingly asked to demonstrate the outcomes of their intensive physiotherapy services. To describe pain and functional outcome measures following a6-month outpatient physiotherapy treatment program in patients with LBP. A total of 85patients were analysed after being treated with acombination of physiotherapeutic treatment modalities 2-3days weekly. Pain and disability were measured before, 3 and 6months after the onset of treatment. Isometric trunk muscle strength for flexion and extension and flexibility of dorsal trunk and thigh structures were measured before and 6months after treatment. After 6months, pain at rest decreased from amedian of 4.0 to 0.0 (p< 0.01) and pain during activity from amedian of 5.5 to 2.0 on the numeric rating scale (p< 0.001). The Roland-Morris Disability (RMDQ) score decreased from amedian of 7.0 to 3.0 (p< 0.001). Mean trunk muscle flexion strength increased from 133.7 to 156.0 Nm and for extension from 235.5 to 278.3 Nm (p< 0.001). Flexibility was improved from amean of -5.9 to -1.4 cm (p< 0.001). Amoderate correlation between pain at rest and RMDQ score was found after 3 (r= 0.532, p< 0.01) and 6months (r= 0.508, p< 0.01). Patients with LBP who were treated with the physiotherapeutic treatment program showed aclinically relevant reduction of pain and disability with improved trunk muscle strength and flexibility. Reductions in pain and disability do not seem to correlate with increased trunk muscle strength and flexibility. No conclusions can be declared about long-term changes after the intervention.

Physical therapy guideline for children with malnutrition in low income countries: clinical commentary.

Physical therapy intervention along with nutritional rehabilitation has recently become an inevitable combo after recent evidences suggesting a strong interaction between malnutrition and neuro-muscular disabilities which contribute to a significant burden in global settings. Recent studies confirm that appropriate physical assessment of neuro-musculo skeletal system, developmental assessment or cognitive tools along with nutritional assessments followed by exercise rehabilitation will yield positive results in children with malnutrition. There is an obvious need to make available a simple physical therapy exercise guidelines with simple measure and exercise to be used in resource limited settings of developing countries. The purpose of this clinical commentary is to summarize simple assessment tools to evaluate activity impairment, participation restriction, gross motor activity and simple physical therapy intervention program for children with disability secondary to malnutrition.

Aquisição do controle postural por meio de posturas altas em prematuro extremo com diagnóstico de displasia broncopulmonar grave: relato de caso

Introduction: with the increased survival of immature newborns, the incidence of bronchopulmonary dysplasia is increasing, as well as a significant increase in the number of children with delayed neuropsychomotor development. Objective: To report the experiences in a physical therapy intervention program based on the neuroevolutives high positions in the development of cervical control and trunk, in a higk-risk young child diagnosed with bronchopulmonary dysplasia. Method: case report of a female child, chronological age of six months, corrected age of two and a half months, extremely premature very low birth weight, which held 28 sessions of physiotherapy. Results: after treatment, there was an increase of active movement; in the prone position was reached full cervical extension; the roll from supine to prone; in the sitting position remained good postural control; she remained in a standing position with cervical support and trunk requiring support at lower distal members. Conclusion: the high positions allowed greater interaction between child and the environment around herself, thus enabling a breakthrough in motor development for the acquisition of control cervical and trunk.

Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study

IntroductionPain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience....

Medical Rehabilitation and Occupational Therapy in Patients with Lesion of Plexus Brachialis

Summary Causes for plexus brachialis damage are versatile, and in some cases remain unknown, but mostly result from degenerative and inflammatory processes. Treatment of brachial plexus dysfunction is often conservative and is subject to a team of specialists - neurologists, traumatologists, rehabilitation physicians, kinesitherapists and occupational therapists. The objective of the research is to report the recovery of patients with lesion of plexus brachialis after a complex physiotherapy and rehabilitation treatment program that includes electrostimulation, remedial massage, kinesitherapy, electrotherapy and occupational therapy. A total of 159 patients, treated at the Clinic of Physical Therapy, University Hospital of Pleven, were included in the study. Improvement of measured indexes: pain assessment, centimetry, assessment of upper limb muscle weakness, dynamometry and functional test of activities of daily living, was registered in all patients under observation. In order to achieve good results in the rehabilitation of patients with injured plexus brachialis, timely diagnosis, good medication therapy and early start of complex physiotherapy and rehabilitation are of crucial importance, so that performance of daily living activities improves. The good results come slowly and with difficulties, but the quality of life of patients and the quality of labor performed by them, improves significantly.

The effectiveness of an ambulatory physiotherapy treatment program on pain and functional outcome measures in patients with low back pain

The effectiveness of an ambulatory physiotherapy treatment program on pain and functional outcome measures in patients with low back pain

The Use of Rehabilitation Means as a Technical Instruction Method in Ski Jumping

This research started from the necessity of instituting a physical therapy intervention program that would ensure the continuity of technical instruction in parallel with a correct and complete rehabilitation of the injured functions. The physical therapy intervention consisted in setting the short term objectives of physical therapy: reducing physical effort, diminishing the pain and the inflammatory process, increasing the range of motions in flexing the calf on the thigh (first without loading, then with loading the limb), strengthening the calf and thigh muscles (agonist and antagonist muscles), and rebuilding and increasing the antero-posterior stability of the knee, this last objective being the central element of the physical therapy intervention for consolidating the results obtained and preventing future injuries. From a technical standpoint, linked imitative performances were used (in-run – take-off – flight – landing positions), both from a fixed and from a moving position – on a wheel cart and on skis, then the training continued on a jumping hill, where there was an optimal ratio between the in-run speed, the length of the jump, and the landing surface. The results obtained at the Liberec Junior World Championship in January 2013 (19th position), the best Romanian result, confirms the success of this program.

Treatment of chronic neck pain by two combined physiotherapy programs: Comparison of phonophoresis and ultrasound

Background: Chronic neck pain is common. The value of various physiotherapy, phonophoresis, and ultrasoundis not known. Objective: We determined the short-term effect of combined physiotherapy methods on pain intensity, disability,and quality of life in patients with chronic neck pain (CNP). We also compared the short-term effectiveness ofphonophoresis (PP) and therapeutic ultrasound (US). Methods: Fifty-five patients (48 women, 7 men) aged 25 to 65 years who had neck pain at least twelve weeksparticipated in this study. The patients were randomly divided into two groups: US (n = 29) and PP (n = 26).The patients in both groups received the same combined physiotherapy treatment programme includingthermotherapy, TENS, therapeutic massage, therapeutic exercises, and recommendations for daily living activities.Additionally, the patients in the PP group received phonophoresis (5% lidocaine), and the US group receivedultrasound therapy. All patients received 14 sessions of treatment throughout three weeks. Pain intensity,disability, and quality of life were measured at baseline and after the treatment programme. Pain intensity wasassessed by using a visual analog scale, the Neck Pain Disability Index was used to assess disability andthe SF-36 Health Survey was used to assess quality of life. A Wilcoxon signed rank test, Mann-Whitney U test,and effect size were used for statistically analysis. Results: In both groups, pain intensity, disability and quality of life scores were found to have improved afterthe treatment programme (p 0.05)and the effect sizes for pain intensity, disability, and quality of life were large in both groups. Conclusion: The results suggest that phonophoresis and ultrasound combined with physiotherapy methodscan have positive effects in the management of patients with chronic neck pain. However, no superiority ofphonophoresis or ultrasound was determined. Keywords: Disability, neck pain, phonophoresis, physiotherapy, quality of life, ultrasound

Identification of cut-points in commonly used hip osteoarthritis-related outcome measures that define the patient acceptable symptom state (PASS)

To determine patient acceptable symptom state (PASS) estimates in outcome measures commonly used in hip osteoarthritis (OA). Identification of cut-points on commonly used outcome measures associated with patient satisfaction with their current state of health. As part of a randomized controlled trial, 70 patients with a clinical diagnosis of hip OA undergoing a 9-session physiotherapy treatment program completed four physical performance measures and three self-report measures at 9 weeks and 1 year. Upon completion of treatment, patients assessed their current health status according to the PASS question. Cut-points were estimated using receiver operating characteristic curves (anchor-based method), based on the patient's response to the PASS question. At 9 weeks and 1 year, identified cut-points were, respectively, ≤10 and ≤11 for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale; ≤35 and ≤40 on the WOMAC physical function subscale; ≥+5 and ≥+6 on the global rating of change score; ≤6.05 and ≤5.30 s for the timed-up-and-go; ≤28.3 and ≤24.9 for the 40-m self-paced walk test; ≥11 and ≥12 repetitions for the 30-s chair stand test; and ≥46 repetitions for the 20-cm step test. Initial target cut-points signaling patient satisfaction with their current symptom state following physiotherapy in patients with hip osteoarthritis were determined for seven outcome measures over 1 year.

The effect of vibration therapy on spasticity and motor function in children with cerebral palsy: A randomized controlled trial

As the motor system relies heavily on deep sensory stimulation, recent studies have investigated the effect of vibration stimuli. Although research suggests a positive influence of vibration on motor performance in individuals with neurological disorders, there are very limited numbers of studies in children with cerebral palsy (CP). The objective of the present study was to evaluate the effects of sound wave vibration therapy on spasticity and motor function in children with CP. In this 3-month trial, 89 children with spastic CP were randomized to either continue their physiotherapy treatment (PT) or to receive vibration therapy twice a week in addition to their PT program. The randomization was stratified according to the Gross Motor Function Classification System (GMFCS) level to ensure similar functional ability. Children were assessed at baseline and after the 12-week intervention period. The outcomes measured were spasticity level as assessed by Modified Modified Ashworth Scale (MMAS) and gross motor function as assessed by Gross Motor Function Measurement (GMFM-88). Subgroup analysis was performed for the GMFCS. Significant differences between groups were detected for changes in spasticity level and gross motor function after the three months intervention. In conclusion, vibration therapy may decrease spasticity and improve motor performance in children with CP. The results of the present trial serve as valuable input for evidence-based treatments in paediatric neurorehabilitation.

Physical Therapy for Young Children Diagnosed with Autism Spectrum Disorders–Clinical Frameworks Model in an Israeli Setting

Recent research findings suggest that many children with Autism Spectrum Disorders (ASD) demonstrate delayed and atypical motor achievements. It has now become clear that a more holistic, integrative and multi-disciplinary intervention is required to effectively address the motor-related impairments of this population. It is also crucial to ensure that this group of clients has access to early physical therapy (PT) interventions. Despite accumulating research on physical interventions, little is known about intervention model for implementation at a national level. This report introduces a model that uniquely illustrates implementation of PT services for a large number of children with ASD. The model has been operating for the past 2 years in one country (Israel), and includes an optional implementation model of PT practice settings for young children diagnosed with ASD. The Israeli setting offers a unique opportunity for implementing PT services for a multitude of children with ASD on a regular basis as an accepted/needed service. The initial outcomes of the present implementation suggest that an intensive PT intervention program might enhance therapeutic outcomes for this population, and contribute to our knowledge on the potential of PT for individuals with ASD.

Functional Status in Post-CABG Patients Following Physiotherapy- A Retrospective Analysis

Background of objectives: Following CABG, various pulmonary complications may result with significant affection of functional recovery of the patients. This adds into the cost of treatment, prolonged length of stay in the hospital, increased morbidity and mortality . Therefore present study was undertaken to determine the efficacy of physiotherapy treatment in functional recovery of the patients following Coronary artery bypass grafting surgery. Materials & Method: This was a retrospective study, total 65 participants' data were considered for the analysis, which was retrieved from the medical record department of Shree Krishna hospital. The demographic status, physiotherapy treatment program, functional recovery, average walking distance and length of stay in the hospital were analyzed. Results: In the present study, the medical record of 65 subjects (84% male and 16% female) were analyzed and average of walking distance, flight of stairs and length of stay was recorded. All the subjects were given preoperative physiotherapy which included chest physiotherapy in the form of deep breathing exercise, thoracic mobility exercise, forced expiratory technique and incentive spirometry as well as post operative physiotherapy regimen taught. Out of 65 subjects, 90% (n=58) had no post operative complications and 10% (n=7) had eventful CABG with associated complications like cardiac arrhythmias in 3 patients, uncontrolled diabetes in 1 patients, long term ionotropic support in 2 patients and pleural effusion in 1 patient etc. The average length of stay of the subjects in hospital following uncomplicated CABG was 6 PODs and 90% of the subjects were discharged by 6th POD. Conclusion: It had been concluded that all the subjects with uneventful CABG (80%) following physiotherapy became functionally independent on 6th POD, whereas subjects with eventful CABG (10%) on 11th POD.

Effects of a dual-task training on dynamic and static balance control of pre-frail elderly: a pilot study

INTRODUCTION: This quasi-experimental study is justified by the need to determine the effects of an intervention strategy aimed at improving the static and dynamic balance in pre-frail elderly women. We hypothesized that dual-task training on a treadmill, compared to simple training on a treadmill,may promote statistical difference in postural control of this group. OBJECTIVES: This study aimed to verify the measures of postural control in a group of pre-frail elderly after a physical therapy intervention program based on dual-task treadmill training. MATERIALS AND METHODS: We selected six female pre-frail elderly subjects living in the community. The research was conducted twice a week for 45 minutes, for four weeks. The simple task training consisted only in the use of a treadmill and the dual-task training consisted on the use of a treadmill associated with visual stimuli. Only the intervention group was submitted to the dual-task training. RESULTS: Groups showed improvements in the variables of balance in different tasks, especially on static balance. Both groups showed the most notable changes in the variables related to gait. The BBS scores and the baropodometric variables showed that the experimental group could keep all values similar or better even one month after completion of training, unlike the control group. CONCLUSION: The dual-task performance had no additional value in relation to the improvement of balance in general, but we observed that the effectiveness of visual stimulation seems to occur in the maintenance of short-term balance variables.

Feasibility and parent satisfaction of a physical therapy intervention program for children with acute lymphoblastic leukemia in the first 6 months of medical treatment

Children with acute lymphoblastic leukemia (ALL) are at risk for developing musculoskeletal complications during and after their medical treatment. The objective of this study was to examine the feasibility of an in-hospital physical therapy- and home exercise program during the first four phases of medical treatment, for children with newly diagnosed ALL. Nine patients, between the ages of 2-14 years old were enrolled within 2 weeks of diagnosis in the study. Each patient was evaluated at study entry, after each of the first four phases of therapy and each time patients were re-admitted to the hospital. Following the initial physical therapy evaluation an individualized home exercise program was developed, consisting of stretching, strengthening, and aerobic exercises. The following end points were measured at each evaluation: gross motor assessment as measured by gross motor function measure (GMFM), health-related quality of life as measured by the PedsQL and parent satisfaction questionnaire. This study was feasible with 98% of the evaluation sessions completed. The GMFM and PedsQL improved steadily throughout the study; however, the PedsQL slightly decreased from interim maintenance to delayed intensification. The parents reported being satisfied with the physical therapy program. We demonstrated that an in-hospital- and home exercise physical therapy program during the first four phases of medical treatments is feasible for children with ALL. Future randomized studies are needed to confirm whether an initial physical therapy program at diagnosis in children with ALL will limit functional impairments, improve overall fitness and increase health-related quality of life.

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

BackgroundHip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function.MethodsThe trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline.ConclusionsThe trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12610000439044

Perceptual and Motor Inhibition in Individuals With Vestibular Disorders

Vestibular dysfunction has been shown to be associated with altered cognitive function. The purpose of this study was to examine changes in cognitive function in participants with vestibular disease during the course of vestibular physical therapy. Twenty-two participants (mean age = 52, standard deviation = 11) with previously diagnosed vestibular disorders were tested at the beginning and end of rehabilitation. The Motor and Perceptual Inhibition Test (MAPIT) was used to assess manual reaction times when responding to various stimuli presented on a computer screen. Additional physical performance measures and questionnaires related to dizziness, fear of falling, and activities of daily living were used to quantify change during the 6-week intervention period. The repeatable battery for the assessment of neuropsychological status (a measure of memory and executive function) was used to ensure that participants did not have memory or executive function deficits. Overall, there were no significant differences in MAPIT score before versus after physical therapy intervention, however there were some participants who demonstrated improvements in motor inhibition (MI) and perceptual inhibition (PI) scores. Interstingly, 8 of the 9 participants with abnormal caloric test findings had improvements on 2 of the PI scores. Overall 50% to 64% of the participants demonstrated improvement in the 4 different MAPIT scores. There were improvements in physical performance and self-report measures at the end of the 6-week physical therapy intervention program. Individuals with vestibular disorders may show improvement in MI and PI after a 6-week physical therapy intervention program; those with abnormalities on caloric and rotational chair tests appear especially likely to experience improvement in PI. Additional study is needed to determine whether individuals with vestibular disorders have remediable deficits in MI and PI.