Private Physiotherapy Clinics Research Articles

Physiotherapists' Treatment Strategies and Delineation of Areas of Responsibility for People With Musculoskeletal Conditions and Comorbidities in Private Physiotherapy Practice: A Qualitative Study.

Patients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients. To identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities. Qualitative study using focus group discussions and participant observations of 13 physiotherapists working in Danish private physiotherapy clinics. Grounded theory was applied to guide the analysis. Two major themes emerged from the focus groups and the observations (1) The necessity of adapting management to the patients and their treatment trajectory; (2) The dilemma of overall responsibility for coordinating care. The physiotherapists described different elements of adapting their management, including being challenged on time, taking extra care of the patient, and having to adjust to a fluctuating course of treatment. The dilemma in coordinating care concerned whether the responsibility should lie with the physiotherapist, other healthcare professionals, or the patients, and whether to treat only the condition on the referral or to treat all the conditions the patient had. Physiotherapists use adapted strategies for diagnosing and treating patients with musculoskeletal conditions and comorbidities and are uncertain about the overall responsibility for coordinating care and whether they should focus on the index condition alone or also the other comorbidities the patient has.

The Effectiveness of Exercise Programs on Balance, Functional Ability, Quality of Life, and Depression in Progressive Supranuclear Palsy: A Case Study

Progressive supranuclear palsy is a form of atypical Parkinsonism. People living with Progressive Supranuclear Palsy have various symptoms, such as movement and cognitive disorders, which mainly affect balance and functional ability with an increased risk of falls, dexterity, and dementia. The role of exercise at the early stage of progressive supranuclear palsy remains unclear. The aim of the present study was to examine the effectiveness of an exercise program at the early stage of progressive supranuclear palsy. A patient with a diagnosis of progressive supranuclear palsy within the past year followed a supervised 12-week exercise program (two times per week) by a physiotherapist, with a session lasting about 40 min at a private physiotherapy clinic. Functional status, balance, quality of life, anxiety, and depression were assessed four times with valid instruments and tests. The results from the timed-up-and-go test demonstrated an improvement in performance (MCID value = 3.4). Improvements were observed in the scores of the Parkinson’s Disease Questionnaire-39 (MCID value = 0.6). Finally, an improvement was reported in the score of the anxiety factor of the hospital anxiety and depression scale (MCID value = 1.5). Physiotherapy appears to improve functional capacity, quality of life, and mental health. Further research is needed to confirm these results with a large sample size in combination with other complementary therapies such as mental imagery.

Prevalence and Factors Associated with Shoulder Complex Function (SCF) Among the Elderly in Private Physiotherapy Clinic in Klang Valley, Malaysia

Introduction: Shoulder problems have been a challenge among the aging population. Although reports surfaced on factors affecting shoulder dysfunction, however, such studies in relation to other factors like neck pain (NP) factor are limited especially among the elderly in the urban population. This study investigated the prevalence and factors associated with shoulder complex dysfunction among the outpatient elderly attending private physiotherapy clinics. Methods: A total of 75 elderly aged ≥ 60 years old from four private physiotherapy clinics were recruited by simple random sampling method. The elderly were evaluated using the QuickDASH questionnaire to assess shoulder complex dysfunctions and NP scale. Results: A total of 92% of participants have shoulder complex dysfunction. A positive correlation of NP to shoulder complex dysfunction ( r (75) = 0.83, p<.001) with significant associations of sex ( z= -2.549, p=0.011), smoking ( z= -2.388, p=0.017), lifestyle ( z= -5.780, p=0.000), hypertension ( z= -2.808, p=0.005), osteoarthritis ( z= -2.966, p=0.003), and NP scale ( z= -2.173, p=0.031). The predicting factor of shoulder complex dysfunction is sex (β = 0.156, t (74) = 2.240, p= 0.028) and NP scale (β = 0.704, t (74) = 7.853, p= 0.000). Conclusion: There is a high prevalence of shoulder complex dysfunction among the outpatient elderly attending private physiotherapy clinics with a predicting associating factor of sex and NP.

"I Had to Know About It, I Had to Find It, I Had to Know How to Access it": Experiences of Access to Rehabilitation Services Among People Living with Long COVID.

The aim of this qualitative study is to understand the need for, access to, and quality of rehabilitation services for people living with Long COVID. Little is known about the experiences of people living with Long COVID accessing rehabilitation services. Therefore, we explored health concerns leading people living with Long COVID to seek help to address functional concerns and their experiences with accessing and participating in rehabilitation. Interpretive description guided exploration of participants' experiences with Long COVID rehabilitation in Alberta, Canada. Semi-structured interviews were completed with 56 participants recruited from: three publicly funded Long COVID clinics, a specialized private physiotherapy clinic, a telephone-based rehabilitation advice line, and a Workers' Compensation Board-funded Long COVID rehabilitation program. Recruitment through mass media coverage allowed us to include people who did not access rehabilitation services. Data analysis was informed by Braun and Clarke's reflexive thematic analysis. Four themes were identified: (1) the burden of searching for guidance to address challenges with functioning and disability; (2) supportive relationships promote engagement in rehabilitation; (3) conditions for participation in safe rehabilitation; and (4) looking forward - provision of appropriate interventions at the right time. Our findings highlight the experiences of accessing rehabilitation services for people living with Long COVID. Results suggest approaches to Long COVID rehabilitation should be accessible, multi-disciplinary, flexible, and person-centred.

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia.

Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic. Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.

Patients with patellofemoral pain have lower soft tissue flexibility of the kinetic chain compared to healthy controls: A case-control study

IntroductionPatellofemoral pain (PFP) is a common musculoskeletal condition. Lower limb range of motion (LLROM) evaluates soft tissue flexibility over multiple joints as part of the kinetic chain. The aims were to study: 1) the reliability of a new LLROM test; 2) differences in LLROM between PFP patients and controls; and 3) the relationship between LLROM and pain-free knee function. MethodsPatients with PFP and matched controls were recruited from a university campus and private physiotherapy clinics, while observers were blinded for health status. Testing LLROM for maximal knee flexion and hip adduction and the sum of these (total ROM) were performed. Measures of reliability (ICC2,1) were established. Univariate linear regression between LLROM and health status and multivariate analysis between LLROM and knee function were performed. ResultsPatients (n = 32 (7 male/25 female, age = 22, BMI = 22.7)) and controls (n = 32 (7 male/25 female, age = 20, BMI = 22.3)) were included. The ICC's for intra- and interobserver reliability ranged from 0.83 (95%CI 0.30–0.93) to 0.89 (0.72–0.95). Symptomatic legs had 7°(3–11, p = 0.014) lower knee flexion, 6°(4–8, p ≤ 0.001) lower hip adduction and 13°(8–17, p ≤ 0.001) lower total ROM than non-symptomatic legs. Multivariate analysis revealed an association between total ROM and pain-free knee function (R2 = 0.438, F = 6.544, p ≤ 0.001). ConclusionsThe new LLROM test was found to be reliable. Patients with PFP had lower LLROM, which was associated with impaired pain-free knee function. Whether improving soft tissue flexibility results in enhanced pain-free knee function should be the subject of future research.

Cervical spine characteristics differ in competitive combat athletes compared with active control participants

BackgroundInjury to the head and neck are common in combat sport athletes. Impairments of the cervical spine have been found in some athletes who participate in sports with high forces and collisions. There is a lack of research on the effects of combat sports on the cervical spine. ObjectiveThe primary study aim was to investigate differences in cervical spine characteristics between combat athletes and a similarly aged active control group. The secondary aim was to investigate the relationship between symptom-based outcome measures and characteristics of the cervical spine. DesignCross-sectional. Method40 male adult combat sport athletes and 40 male adult control participants were recruited from 4 combat sport clubs and a university campus, Australia. Cervical spine assessments were conducted at a private physiotherapy clinic. The Neck Disability Index and the Post-Concussion Symptom Scale were used as symptom-based outcome measures. ResultsCombat sport athletes had a reduced range of cervical motion, but greater isometric strength and endurance compared with a control group (p < 0.05). The Neck Disability Index and Post-Concussion Symptom Scale were negatively correlated with cervical spine range of motion and isometric strength, meaning that higher scores correlated with a reduction in function. ConclusionsDifferences were observed in characteristics of the cervical spine in combat sport athletes compared with a control group. Higher symptom-based outcome scores correlated with reduced range of motion and strength of cervical spine muscles. Further investigation to establish clinical cut-off scores for functional impairment may be warranted.

Analysis of Private Physiotherapy Clinic Web Sites Using a Critical Perspective.

The objective of our study was to analyze visual and textual content of private physiotherapy clinic Web sites with a critical analysis framework. We analyzed 43 private physiotherapy clinics' Web sites from all regions of one Canadian province (Quebec). For each Web site, we collected and aggregated the data using a standardized extraction grid to index visual and textual content. We then conducted an analysis of the collected data using the Seven-Step Framework for Critical Analysis proposed by Nixon and colleagues. Most Web sites presented elements related to sports and active lifestyles in their names, logos, or pictures. Persons represented in the Web sites were mainly young, white, and active. Ethnic and body diversity were generally not depicted. Information encompassing manual therapy and sports injuries management largely prevailed. The textual and visual content of private physiotherapy clinic Web sites was not consistent with the physiotherapy community's commitments to upholding equity principles and to serving a wide range of individuals. To fulfill the highest professional and ethical standards, the physiotherapy community should reflect on the representation of physiotherapy services and clients on Web sites to ensure that the trend towards privatization of physiotherapy services does not perpetuate the systems of inequality present in society.

Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study

ObjectivesTo confirm what impairments are present in runners with Achilles tendinopathy (AT) and explore the variance of AT severity in an adequately powered study. DesignCase-control study. SettingTwo private physiotherapy clinics in Australia and Spain. ParticipantsForty-four recreational male runners with AT and 44 healthy controls matched by age, height, and weight. Main outcome measuresDemographics, activity (IPAQ-SF), pain and function (VISA-A), pain during hopping (Hop pain VAS), hopping duration, psychological factors (TSK-11, PASS20), and physical tests regarding lower-limb maximal strength and endurance. ResultsBody mass index (BMI), activity, VISA-A, pain, and duration of hopping, TSK-11, PASS20, standing heel raise to failure, seated heel raise and leg extension 6RM, hip extension and abduction isometric torque were significantly different between groups (P < 0.05) with varied effect sizes (V = 0.22, d range = 0.05–4.18). 46% of AT severity variance was explained by higher BMI (β = −0.41; p = 0.001), weaker leg curl 6RM (β = 0.32; p = 0.009), and higher pain during hopping (β = −0.43; p = 0.001). ConclusionRunners with AT had lower activity levels, lower soleus strength, and were less tall. BMI, pain during hopping, and leg curl strength explained condition severity. This information, identified with clinically applicable tools, may guide clinical assessment, and inform intervention development.

Mind the gap. Service evaluation and improvement: The management of children and young people in a private physiotherapy clinic

Keywords: Service evaluation; Children and Young People; Scope of practice Purpose: As autonomous practitioners, physiotherapists are responsible for assessing, developing and maintaining their competence in their areas of practice. This needs to be acknowledged by the organisations in which they work, to support and optimise the skillset of their workforce. It was identified that the number of children and young people (CYP) presenting to a large private physiotherapy company (seeing predominantly adult patients) had risen significantly in recent years, and it was unclear what competence and confidence existed among staff to be managing this cohort safely and effectively. Objective: To understand the needs of the CYP attending the clinics, and evaluate this against the competence and confidence of the physiotherapists they presented to. Methods: A multi-methods design was used. A notes audit was conducted across three one month periods: collecting data on patient age, referral source, diagnosis and subsequent pathway (immediate onward referral, discharge, further physiotherapy). This was followed by a series of focus groups involving staff in the physiotherapy clinics, to evaluate their competence and confidence in managing CYP. Physiotherapists were presented five case studies and asked to rate their perceived confidence on a 4-point Likert scale before and after a discussion around diagnosis, differential diagnoses, appropriate management and clinical reasoning. Results: 138 new-patient contacts were included in the notes audit. Over 97% over these were aged between 8 and 17 years. 35% were classified as ‘MSK pain’, 22% apophysitis, 14% sports injury/trauma and 8% orthopaedic/post fracture. ‘Outliers’ to these groups had a much higher rate of being referred onwards, or back to source (deemed an inappropriate referral): 71%, compared to <10% for all other groups. 27 physiotherapists took part in the focus groups. Open questions revealed ambiguity around expectation to accept referrals for CYP, and policies/procedures relating to CYP. The case studies highlighted a trend for confidence scores to be lower where staff were less accurate with diagnosis. Factors such as age <8 years, paediatric-specific red flags, and self-referral led to lower confidence levels. Across all case studies, confidence levels were lower following discussion. This was identified as having a positive impact on physiotherapists engagement with the projects next steps. Conclusion(s): A structured service evaluation demonstrated a disparity between the CYP attending physiotherapy, and the skillset of physiotherapists: potentially jeopardising the safety and quality of service delivered. It was agreed with key stakeholders that developing a minimum competence framework specific to the physiotherapists seeing CYP at the company would be a prudent starting point. Adjustments to policy and procedures/administrative tasks alongside this, would signpost to those referring in to the service and better reflect the capacity of all staff to manage CYP attending the clinics. Impact: The implementation of a minimum competency framework seeks to improve the lowest quality patient-physio interactions, improving safety and staff satisfaction. A secondary effect will be to improve the average interaction and ultimately create a platform from which gold–standard, effective physiotherapy can become the norm for CYP. The process may highlight the merit of a similar approach for other patient groups at risk of being marginalised. Funding acknowledgements: This work was not funded.

Emerging Challenges Faced by Private Clinic Physiotherapist in New Normal Times During the Covid-19 Pandemic in Pune City

Objective: Primary Objective: To assess the challenges faced by private clinic physiotherapists in Pune aftereasing of lockdown using validated self-reporting questionnaire.Secondary Objective:1. To assess the financial impacts on private clinics.2. To assess the foot fall in the private physiotherapy clinic in Pune after easing of lockdown.3. To assess the physiotherapy treatment limitations during this pandemic.4. To assess difficulties while following Maharashtra State Occupational Therapy and Physiotherapy Council(MSOTPT) guidelines while treating patients during covid-19 pandemic.5. To assess problems faced during tele-rehab using Validated self-reporting questionnaire.Method: A cross sectional study was done in Pune City with a sample size of 60 over the period of 3 monthsusing self-reporting validated questionnaire. Participants were picked based on inclusion and exclusion criteria.Questionnaire was circulated through the social media &amp; emailing the link of google form of questionnaire tothe participants after the approval of ethical committee. A total of 60 participants submitted the correctly filledquestionnaire. After receiving the responses, it was analysed statically and Questionnaire results was presented inthe graphical form &amp; conclusion were made according to the pie charts and graphs.Results: Through results it was sighted that the COVID-19 pandemic reinforced critical weakness and numerouschallenges for the private clinic physiotherapists. They were facing financial problems, number of patients havereduced in the clinic, they have lost their follow ups during the pandemic, many are following MSOTPT guidelineswhile treating patients and finding it difficult to follow the guidelines while treating patients and many haveshifted their mode of practice to tele-rehabilitation and having problems in that.

Patients' Expectations of Physiotherapeutic Treatment for Long-Term Side Effects After Cancer: A Qualitative Study.

ObjectiveThis study aims to explore the expectations of physiotherapeutic treatment of long-term side effects (LTSEs) after cancer among patients treated in physiotherapy clinics.MethodsThis a qualitative interview study based on a phenomenological approach. Adult patients with LTSEs after cancer were recruited through The Danish Cancer Society and a private physiotherapy clinic in Denmark. Individual semi-structured interviews were carried out using Microsoft Teams based on an interview guide piloted before the interviews. Interviews were audiotaped and transcribed verbatim. Sampling was conducted with a focus on variation in LTSE. The data were analyzed using Malterud’s principles of systematic text condensation and coded in NVivo 12.Results2 males and 8 females with an average age of 55.8 years were interviewed for between 40 and 60 minutes from October to November 2020. Four main themes emerged from the interviews1: The importance of the physiotherapist’s approach,2 the benefits of meeting patients with similar symptoms,3 the importance of receiving knowledge, and4 patients seeking to maintain their current state more often than aiming to improve their condition.ConclusionsPatients consulting a physiotherapy clinic with LTSE after cancer prefer the physiotherapist to have knowledge about cancer and to be emphatic. Furthermore, patients prefer to meet like-minded people and expect support to maintain their current condition rather than improve their condition.

The effect of a physiotherapy intervention on disability decrease and on the perceived health-related quality of life in patients with musculoskeletal disorders

IntroductionTo evaluate the effect of a physiotherapy intervention on disability decrease and the perceived health-related quality of life (HRQoL) in patients with musculoskeletal disorders.MethodsThe interventional study involved 150 patients of a public hospital and 3 private physiotherapy clinics in Greece. The study lasted 5 months (December 2016–April 2017). A composite questionnaire was used, including sociodemographic/medical data, Oswestry Disability Index (ODI), and EQ-5D-3L. The main intervention consisted in 10 physiotherapy sessions including transcutaneous electrical nerve stimulation, short-wave diathermy, high-frequency ultrasound, hand massage, and strengthening/stretching exercises. Questionnaires were completed before the first session and then after the tenth session. Analysis was performed with SPSS v. 21.0.ResultsHalf of the participants (50%) were treated in a state hospital, while the rest (50%) in a private clinic. The patients had problems in their spine and neck in the same percentage (44.7%). There was a significant decrease (mean: 19.33, SD: 13.71) in ODI score after the intervention. The decrease differed significantly depending on age, marital status, and problem location (spine, neck, chest). A significant improvement in EQ-5D-3L and visual analogue scale scores was recorded after treatment (&lt;i&gt;p&lt;/i&gt; = 0.001). The EQ-5D-3L score change differed significantly depending on age, marital status, educational level, problem location, and previous physiotherapy treatment. There was a significant positive correlation between changes in EQ-5D-3L and ODI (&lt;i&gt;r&lt;/i&gt; = 0.48, &lt;i&gt;p&lt;/i&gt; &lt; 0.001).ConclusionsThe physiotherapy intervention was beneficial for patients with musculoskeletal disorders and improved their perceived HRQoL. Several demographic and medical characteristics affected the improvement.

Do measures of physical function enhance the prediction of persistent pain and disability following a whiplash injury? Protocol for a prospective observational study in Spain

IntroductionNot all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in movement and muscle behaviour, have been investigated....

Predictors of low back disability in chiropractic and physical therapy settings

BackgroundPredicting ongoing disability for chronic non-specific low back pain (LBP) is important to avoid prolonged disability.ObjectiveDetermine predictors of disability at 6 month follow-up in patients with LBP at medium risk of ongoing disability.MethodsBaseline data was collected from 108 patients with medium-risk chronic non-specific LBP (mean age 50.4 years, SD 13.6) from six private chiropractic and physiotherapy clinics in Australia who took part in a randomised control trial. All patients received a pragmatic course of multimodal physical treatments [e.g., manual therapy (spinal manipulation or mobilization and/or soft tissue massage)] combined with advice, education and exercise. Baseline prognostic variables included sociodemographic, physical and psychological characteristics. Primary outcome was disability (Roland Morris Disability) at 6 month follow-up. Multivariable linear regression analysis was conducted.ResultsVariables remaining in the final multivariable model: lower work ability (β = − 1.05, 95% CI − 1.40 to − 0.70; p < 0.0001) and consultation with a medical specialist for back pain in the preceding 3 months (β = 3.35, 95% CI 1.14 to 5.55; p < 0.003), which significantly predicted higher disability at 6 months (unadjusted R 2 = 0.31). Those with a lower work ability (scale 1 to 10) and who had seen a medical specialist for their back pain were more likely to report greater LBP-related disability at 6 months.ConclusionPatients with chronic LBP presenting to primary care with lower work ability and recent consultation with a medical specialist for LBP are more likely to have a worse prognosis; these are indicators to clinicians that standard conservative care may not adequately manage the patients’ needs.

Patient with rheumatoid arthritis with deep vein thrombosis presenting as a calf strain: a case report

BackgroundPatients with rheumatoid arthritis experience various comorbidities, including cardiovascular disease. More data and awareness exist regarding the adverse effects of rheumatoid arthritis affecting the arterial side of the cardiovascular system, such as stroke or myocardial infarction, than regarding adverse venous complications, such as deep vein thrombosis and pulmonary embolism. Rheumatoid arthritis affects more women than men, and the risk of venous thromboembolism in rheumatoid arthritis tends to increase with age; therefore, the presentation in this case report of deep vein thrombosis in a nonsmoking, young, fit man with rheumatoid arthritis is rare. This patient was sent away from a minor injuries unit with a diagnosis of a calf strain. Further assessment at an accident and emergency department later in the day confirmed deep vein thrombosis via ultrasonography. This case report underlines the need for vigilance because deep vein thrombosis is a risk factor in rheumatoid arthritis, even in young, male, and physically fit individuals.Case presentationA nonsmoking 39-year-old Caucasian man with a 2-year history of rheumatoid arthritis presented for assessment at a private physiotherapy clinic with a 4-week history of right-sided posterior calf pain that had developed following exercise at a gym. The patient therefore believed his symptoms were due to a calf strain. Findings at physiotherapy assessment suggested that the actual cause of the patient’s symptoms were as a result of deep vein thrombosis. The patient was directed to a local minor injuries unit with a referral letter from the author outlining this diagnosis. Following clinical assessment at the minor injuries unit, the patient was told that there was no likelihood of deep vein thrombosis, and his diagnosis was a calf strain. The patient harbored concerns at this point and decided to seek further medical opinion at a nearby accident and emergency department, where deep vein thrombosis was diagnosed using ultrasonography, and the patient was commenced on anticoagulants.ConclusionsVenous thromboembolism risk in rheumatoid arthritis is stated as being less recognized as an arterial complication. This is borne out by this patient’s clinical journey, wherein his youth, fitness, athletic appearance, and onset of symptoms during exercise were said to suggest a diagnosis of a calf strain at a minor injuries unit. Ultrasonography at a different accident and emergency unit later that day ultimately was used to diagnose deep vein thrombosis.

The Relationship Between Demographic and Occupational Characteristics and Disability Severity in Patients With Knee Osteoarthritis

Purpose: Osteoarthritis is a progressive disease and the most common form of joint inflammation. Moreover, it is the most common cause of functional disability in the elderly. Among the multiple and predisposing factors influencing the disease are demographic indicators and occupational factors. The present study aimed to investigate the relationship between age, pain severity, Body Mass Index (BMI), occupation, and educational level, and the severity of functional disability in patients with Knee Osteoarthritis (KO). Methods: This descriptive study was performed on 97 KO patients referring to the Novin private physiotherapy clinic of Semnan University of Medical Sciences from April to March 2017. The study participants were selected through a simple nonprobability sampling technique. Literate individuals with the educational level of guidance school and above and diagnosed with KO were included in the study. Individuals with a history of inflammatory arthritis diseases, such as rheumatoid arthritis, soft tissue rheumatoid arthritis, fibromyalgia syndrome, bursitis, tendonitis, the neurological and vascular conditions of the lower extremity, mental problems, and malignancy were excluded from this research. The data related to the variables such as age, gender, occupation, history of osteoarthritis, pain intensity, involved side, educational level, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for knee disability were collected by a self-report questionnaire. This study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. Using SPSS, Spearman’s correlation coefficients were calculated to examine the relationship between the study variables. Results: Spearman’s correlation coefficients revealed no significant correlation between the KOOS scores and age, occupation, and educational level. The obtained results suggested a poor significant association between KOOS and BMI; however, there was a strong significant correlation between KOOS and pain intensity Visual Analogue Scale (VAS) (P&lt;0.05). Conclusion: The severity of functional disability in patients with KO based on KOOS questionnaire scores, was well correlated with pain severity, but poorly associated with age and BMI. The obtained data indicated no significant relationship between disability and occupation and educational level.

Addition of MoodGYM to physical treatments for chronic low back pain: A randomized controlled trial

BackgroundLow back pain (LBP) is prevalent, costly and disabling. A biopsychosocial treatment approach involving physical and cognitive behavioural therapy (CBT) is recommended for those with chronic LBP. It is not known if online psychological coaching tools might have a role in the secondary prevention of LBP related disability. To assess the effectiveness of an internet-delivered psychological program (MoodGYM) in addition to standard physical treatment in patients with chronic non-specific LBP at medium risk of ongoing disability.MethodsA multisite randomized controlled trial was conducted with 108 participants (aged mean 50.4 ± 13.6 years) with chronic LBP attending one of six private physiotherapy or chiropractic clinics. Disability (Roland Morris Disability Questionnaire) and self-efficacy (Patient Self-Efficacy Questionnaire), were assessed at baseline, post-treatment (8-weeks) with follow-up at six- and twelve-months. Participants were randomized into either the intervention group, MoodGYM plus physical treatments, or the control group which received physical treatments alone.ResultsNo statistically significant between group differences were observed for either disability at post-treatment (Effect size (standardised mean difference) 95% CI) RMD − 0.06 (− 0.45,0.31), 6-months RMD 0.01 (− 0.38,0.39) and 12-months − 0.20 (− 0.62,0.17) or self-efficacy at post-treatment PSEQ 0.06 (− 0.31,0.45), 6-months 0.02 (− 0.36,0.41) and 12-months 0.21 (− 0.16,0.63).ConclusionThere was no additional benefit of an internet-delivered CBT program (MoodGYM) to physical treatments in those with chronic non-specific LBP at medium risk of ongoing disability measured at post-treatment, or at 6 and 12 months.Trial registrationThis trial was prospectively registered with Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000269538.

ANÁLISE DA MARCHA EM PACIENTES COM PARALISIA CEREBRAL APÓS TREINO LOCOMOTOR EM ESTEIRA ERGOMÉTRICA

PFEIFER, S; ORIQUES DA SILVA, T.K. e TESTONI, V.G. Análise da marcha em pacientes com paralisia cerebral após treino locomotor em esteira ergométrica. Revista Científica JOPEF, Vol.28, n.1, pp.1-15, 2019. Cerebral palsy (CP) is a consequence of a static brain injury, occurring in the pre, peri or postnatal period, which affects the central nervous system (CNS) in the structural and functional maturation phase, characterized primarily by a persistent but not invariable disorders of muscle tone, posture and voluntary movement. Because of these disorders, children with CP have some changes in gait, such as decreased walking speed, insufficient force generation and higher energy expenditure during walking, which is why gait acquisition is one of the focus of attention in rehabilitation. individuals with CP, and for this purpose several approaches can be used, such as the use of the treadmill. This study aims to analyze the gait of a neurological patient, more specifically a patient with CP, before and after locomotor training on the treadmill. The research has a quantitative character, through a case study as a research instrument, being collected in a private physiotherapy clinic. Gait evaluation was performed by measuring foot and foot variables, measuring the distance between them in a brown paper, and other variables such as speed and cadence, before and after a neuropediatrician rehabilitation protocol. using the treadmill. After data analysis, the patient's locomotor training improved with a significant increase in speed and cadence variables. Exercise walking on treadmill can improve gait activity in children with CP thus achieving better functionality and quality of life for the individual. KEYWORDS: Cerebral Palsy. Locomotive Training. Gait.

Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: A single cohort feasibility study

ObjectivesTo examine the feasibility of recommended education and exercise supplemented by a hopping intervention implemented based on self-reported pain over 12 weeks for recreational runners with Achilles tendinopathy. DesignSingle cohort feasibility study. SettingOne private physiotherapy clinic in Melbourne, Australia. ParticipantsFifteen male recreational runners with midportion Achilles tendinopathy. Main outcome measuresRecruitment and adherence measures, adverse events, intervention acceptability and treatment effect trends were measured at baseline, 4 and 12 weeks. ResultsRecruitment (100%), retention (87%) and follow-up (93%) rates were high. Exercise adherence was 70% (SD = 12.7) but fidelity was 50% (SD = 13.9). Three participants suffered adverse events (undertaking activities contrary to advice). Participants reported the education package, perceived benefit, and feedback frequency as intervention enablers; while the onerous time commitment was regarded a barrier.At 12 weeks, five participants were satisfied and eight very satisfied, while VISA-A had improved 24 ± 20.65 points (μ2 = 0.740). ConclusionsA randomised control trial including recommended education and exercise with a pain-guided hopping intervention as treatment for recreational runners with midportion Achilles tendinopathy may be warranted, once strategies to improve adherence and reduce adverse events are addressed.