Specialist Physiotherapist Research Articles

A mixed methods service evaluation of a pilot functional electrical stimulation clinic for the correction of dropped foot in patients with chronic stroke

To undertake a service evaluation of the pilot Lothian functional electrical stimulation (FES) clinic using both quantitative and qualitative methods and clinical practice reflection. Clinical guidelines recommend that FES, for the management of dropped foot after stroke, is delivered by a specialist team. However, little detail is provided about the structure and composition of the specialist team or model of service delivery. A pilot Lothian FES clinic was developed to explore the clinical value of providing such a service to stroke patients with dropped foot and identify any service modifications. Mixed methods were used to evaluate the service and included quantitative, qualitative and reflective components. Phase 1: Before and after service evaluation of patients attending the FES clinic between 2003 and 2007. Outcomes of gait velocity and cadence were recorded at initial clinic appointment and 6 months after application of FES. Phase 2: Qualitative research exploring patients with stroke and carers' experiences of the FES clinic. Data were collected via semi-structured interviews. Phase 3: A reflection on the service delivery model. Phase 1: 40 consecutive out-patients with stroke; Phase 2: 13 out-patients with stroke and 9 carers; Phase 3: Three specialist physiotherapists engaged in running the FES clinic. Statistically significant improvements (p < 0.001) were demonstrated in gait velocity and cadence. Qualitatively, one super-ordinate theme 'The FES clinic met my needs' emerged. Within this were four sub-themes, namely 1. 'Getting to grips with FES wasn't difficult'; 2. 'It's great to know they're there'; 3. 'Meeting up with others really helps' and 4. 'The service is great but could be better'. On reflection, minor modifications were made to the service delivery model but overall the service met user needs. This dedicated FES clinic produced positive physical outcomes and met the needs of this chronic stroke population.

Multidisciplinary grand rounds clinical session: Upper limb, cervical and thoracic spine

This Multidisciplinary expert panel will include Specialist Physiotherapists and Sports Physicians discussing real and complex patient presentation. Particularly in the upper quadrant differential diagnosis is vitally important however can at times be confusing with overlapping signs and symptoms. Real case studies will be presented that lend themselves to the Multidisciplinary treatment model, with differential diagnosis and treatment strategies discussed. This session aims to be both very clinical and interactive between the expert panel members and the audience.

P248 Measuring physical recovery in the critical care population: development of the Chelsea critical care physical assessment tool (CPAx)

IntroductionThe secondary physical effects of critical illness, for example, muscle atrophy, can be detrimental to functional outcome and quality of life in critical care survivors. To minimise these problems early...

P225 First national survey of the respiratory physiotherapy workforce

In 2008, the RCP/BTS COPD Audit reviewed the multidisciplinary workforce provided by acute Trusts in managing the care of patients with COPD: the results showed that nationally, the median number...

Self-efficacy beliefs and confidence of rural physiotherapists to undertake specialist paediatric caseloads: a paediatric example

Rural physiotherapists are faced with unique challenges, one of which is the necessity to extend their skills and knowledge to areas that would be covered by a specialist physiotherapist in an urban setting. The effects of this on the physiotherapist's confidence and self-belief has not been studied. The present study aimed to measure the self-efficacy and confidence of rural physiotherapists who undertake service delivery in the specialist field of paediatrics. A descriptive, cross-sectional design survey was made of rural and remote physiotherapists working in north-west Queensland, Australia. Responses were coded and analysed using descriptive statistics and cross tabs to compare existing relationships among variables. Twenty-three (of 56) completed surveys were returned (41% response rate). Rural and remote physiotherapist's are likely to be sole practitioners or part of a small group of clinicians, working full time in a hospital or private practice. These physiotherapists reported less peer support than urban physiotherapists and were required to treat multiple cases across specialist areas. Physiotherapists working in such a demanding, unsupported environment have a low belief in their abilities and poor coping strategies, causing them to develop low self-efficacy. Rural physiotherapists having low self-efficacy can mean they have low levels of confidence in their ability to practise, and hold the belief that they lack the skills and attributes to practice. This could mean a conflict with professional conduct and ethical standards. Early identification of low self-efficacy gives time to review, develop and sustain strategies to help address the problems faced by the rural physiotherapist workforce, and to re-develop this workforce into one that is more stable and supportive.

Highlights of the North American Cystic Fibrosis Conference 2008.

The North American Cystic Fibrosis Conference (NACFC) is the world's largest international CF conference. It presents a superb opportunity for the CF professional community to join together to hear results of the latest therapeutic studies, the latest advances in basic science and to further their understanding of CF care. The 2008 conference was held in Orlando, Florida, and with over 3500 delegates, it did not disappoint. The majority of those attending the NACFC are naturally from North America, but there is a sizeable minority from Europe and Australasia. Five members of our team (two consultants, two clinical nurse specialists and one specialist physiotherapist) attended, and we willingly took up the invitation to report our highlights on our return to the RSM conference. Attending an overseas international conference is often not an easy undertaking, not least financially. Including travel, accommodation and conference registration, our attendance cost approximately £5000, a significant sum when there is appropriate limitation of commercial sponsorship. It is therefore a relevant exercise to consider one's reasons to attend an overseas conference, and to regard participation once there with apt seriousness. Although this may be obvious to some, we have listed in Box 1 what we considered our motivation. We tell our patients and their families each year when we are going to the NACFC and they are always interested, and in particular they see this as a way that we can connect with new therapies and keep ourselves up to date. Knowing that we were going to report on the conference provided an extra stimulus, and this is perhaps a good lesson for all CF teams. Box 1 Motivation for attending overseas conferences Presenting our own work Keeping ourselves up to date with new practice Allowing our practice to be influenced by others within our field Hearing about developing therapies Meeting other teams from our own country and internationally Refreshing our enthusiasm to provide first‐rate care Team bonding

The Danish anal sphincter rupture questionnaire: Validity and reliability

To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. SETTING AND BACKGROUND: Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth. The original questionnaire was revised and a pilot test was performed among health care personnel, followed by an expert panel discussion. Ten women were interviewed about their understanding and attitude toward answering the questionnaire and it was pre-tested on 52 women with ASR. The questionnaire was revised five times during the validation process. The final version was test-retested among 20 women with ASR. The questionnaire revealed typical problems after ASR. The length, use of language, and the way the questionnaire was constructed, was deemed appropriate. The reliability test showed good to very good correlation (Kappa values from 0.733 to 0.923) in all main questions but one. Two questions needed further explanation. Seven women made minor errors. The validated Danish questionnaire has a good construct, content and face validity. It is a well accepted, reliable, simple and clinically relevant screening tool. It reveals physical problems including sexual problems, impact on quality of life and need for treatment among women 6-8 months after ASR.

A 6-month evaluation of a clinical specialist physiotherapist's role in a fracture clinic

A 6-month evaluation of a clinical specialist physiotherapist's role in a fracture clinic

Is there a role for a specialist physiotherapist in the multi-disciplinary management of women with stress incontinence referred from primary care to a specialist continence clinic?

SummaryOur objective was to assess the benefit of additional pelvic floor exercises, supervised by specialist physiotherapists, in the secondary care management of urinary stress incontinence. This is a retrospective cohort study in a UK University teaching hospital. A total of 317 women were referred from primary care to a specialist continence clinic for management of urinary stress incontinence. The cases were identified from the clinic database and a case note review performed. Data were collected on initial clinical assessment, suitability for pelvic floor exercises and outcome of treatment. The main outcome measures were adherence to primary care guidelines, suitability for further pelvic floor exercises and outcome of exercises. In total, 201 women were deemed suitable for a trial of further pelvic floor exercises, of whom 82 had previously attempted this in the primary care setting. After completing a course of physiotherapist supervised exercises, 105 women were able to be discharged from secondary care as a result of their symptoms improving. Of these women, 46 had previously attempted pelvic floor exercises in the community. It was seen that the primary care guidelines are poorly adhered to and where pelvic floor exercises are attempted in the community, the outcomes appear to be suboptimal. In appropriately selected women, a trial of additional physiotherapist-supervised exercises is beneficial and can reduce the urodynamic and surgical workload by 33%.

Cauda equina syndrome: The development of a citywide physiotherapy pathway of care

Cauda Equina Syndrome (CES) is a very rare condition in patients with low back pain (LBP), however, the discovery of CES is seen as a surgical emergency. With the rapid rolling out of patient self-referral to outpatient physiotherapy, there is an increased likelihood of physiotherapists being exposed to this condition. However, the literature to date has focused on CES from a medical perspective and clear physiotherapy guidelines have not been reviewed. To improve and standardize the citywide management of such patients a pathway of care was developed. Clinical specialist physiotherapists oversaw the development guided by orthopaedic and neurosurgery consultants. The results of a three-cycle audit suggest this evidence-based pathway of care is an effective tool in identifying patients with CES.

Definitions for haemophilia prophylaxis and its outcomes: The Canadian Consensus Study

The creation of acceptable standard definitions for terms used in the care and assessment of haemophilia patients has become increasingly important, as a growing number of international clinical studies have been initiated. The Delphi approach has been used in health research to reach consensus in large groups and can be used to develop definitions by using several iterations of surveys eliciting opinions from specialists in the field. Three consecutive surveys were designed based on the Delphi approach and distributed to specialist physicians, nurses and physiotherapists in order to develop definitions for seven haemophilia terms: 'primary prophylaxis', 'secondary prophylaxis', 'target joint', 'joint bleed', 'significant soft-tissue bleed', 'superficial soft-tissue bleed' and 'mucosal bleed'. Suggestions were solicited, compiled into a subsequent survey and fed back to the group to rank-order the importance of each suggested component of the definition. Final definitions were created using the top-ranked suggestions and sent back to the experts for approval. Five of the seven terms were highly endorsed with greater than 90% agreement. Some differences in agreement were found when analysed by profession. Haemophilia terms were successfully defined using the Delphi approach. Further refinement from members of the international haemophilia community will ensure that comprehensive standard definitions can be used in multicentre studies in the future.

Routine airway clearance in asymptomatic infants and babies with cystic fibrosis in the UK: obligatory or obsolete?

Advances in medical management of children with cystic fibrosis has resulted in a cohort of apparently healthy infants who, nevertheless, have a life-long multisystem disorder. Physiotherapy approaches need to keep pace by adapting and developing techniques which are appropriate for families caring for seemingly asymptomatic babies. However, in the era of evidence-based medicine, adopting new approaches without a substantial evidence base risks the loss of potentially beneficial elements of traditional treatments. Early diagnosis (particularly neonatal screening), early aggressive prophylactic antibiotic therapy, and attention to nutrition have contributed to a significant change in the clinical status of many newborn infants and babies with cystic fibrosis. Most babies and young children attending cystic fibrosis centres now have good nutritional status, with a body mass index within normal limits. Physiotherapists caring for babies with cystic fibrosis face the dilemma of instigating routine therapy on diagnosis or waiting until the baby shows signs of respiratory symptoms. This issue has caused much disagreement amongst specialist physiotherapists internationally. This debate explores the arguments for and against new ideas in the physiotherapy management of asymptomatic infants and young children with cystic fibrosis.

Pelvic-floor exercises for incontinence

Most women have little or no idea of where their pelvic-floor muscles are, what they do or how they can be exercised. Assessment and instruction by a specialist physiotherapist should be the first line of treatment for women with stress or urge incontinence or genital prolapse. Without expert instruction a woman may exercise conscientiously but entirely ineffectually. Correct pelvic-floor exercise has been shown to be cost-effective, to have no side effects, and to help women who wish to avoid surgery as well as those who wish to build up the strength of their muscles before surgery. The teaching of effective pelvic-floor exercise is described, and common faults identified. Periodic review by the physiotherapist ensures that the exercises continue to be performed properly, and can help to sustain motivation. Correctly performed pelvic-floor exercise is extremely beneficial and should be continued for life.

Postpartum stress incontinence

Urinary stress incontinence may affect up to 50% of women in their postpartum period. This is often present during pregnancy with 54.3% of sufferers experiencing an impact on quality of life antenatally and 71.1% postnatally. Antenatal stress incontinence is caused by a combination of factors including anatomical factors and connective tissue changes. Changes have been shown in the bladder neck, functional urethral length and intravaginal and intra-anal pressures in relation to pregnancy and childbirth. Postpartum incontinence occurs for these reasons and additionally, delivery-related factors. Whilst vaginal delivery is a risk factor for the subsequent development of postnatal symptoms, the evidence of a protective effect of performing caesarean sections is less compelling. Evidence regarding delivery factors and their influences on the development of stress incontinence varies regarding infant weight, mode of delivery, head position, duration of labour and use of epidural analgesia. Eighty percent of women have partial denervation of their pelvic floor after their first vaginal delivery. The relationship between epidural analgesia and postpartum stress incontinence has become a contentious issue and as anaesthetic techniques have changed, the literature is no longer valid. It is not clear whether pelvic-floor exercises will prevent stress incontinence. There are many barriers to women receiving pelvic-floor education. Specialist physiotherapists are best placed to supervise this. Over 60% of women with leakage do not seek help and healthcare workers must be aware of the significant and common problem of stress incontinence so that they can offer appropriate advice and referral as necessary. Management options also include surgery, drug treatment and containment products. Women having antenatal stress incontinence have double the risk of having stress incontinence 15 years later.

Specialist Physiotherapists In Orthopaedic Triage - The Results Of A Military Spinal Triage Clinic

Changes in professional boundaries have allowed many of the tasks traditionally undertaken by doctors to be delegated to Nurses and Allied Health professionals. The employment of an appropriately experienced specialist...

Community physiotherapy for children with cystic fibrosis: A family satisfaction survey

Background and purpose Input of a specialist physiotherapist is integral to the management of children with cystic fibrosis (CF). In recent years, many regional centres have developed specialist physiotherapy posts based in the community. The aim of this study was to ascertain the effectiveness of the community physiotherapy service in Newcastle upon Tyne, from the families' point of view. Methods The current service was reviewed and a questionnaire was developed and sent to all families with a child/children attending the regional paediatric centre for full care. It was adapted from a standardised patient satisfaction survey and included both open and closed questions. Results One hundred and six questionnaires were sent with a response rate of 50%. Eighty-nine percent of respondents had been reviewed by the community physiotherapist. Ninety-one percent were satisfied with the overall service provided. They felt involved in the treatment plan (94%) and understood the reasons for follow up visits (92%). Eighty-five percent of respondents had a contact number for the community physiotherapist. Comments from parents were generally positive. Many families requested increased input in the home as they found it more beneficial than review in the clinic setting. Conclusions There was a high rate of satisfaction with specialist physiotherapy support in the community for children with CF among families who responded to the patient satisfaction survey.

Satisfaction levels in orthopaedic out-patients

It is important that patients are satisfied with an out-patient consultation. This ensures compliance with treatment and attendance for follow-up. The aim of this study was to identify factors regarding out-patient consultation associated with patient satisfaction. A two-part questionnaire identifying expectations of, and subsequent satisfaction with, a new out-patient consultation was completed by 106 out-patients. There was no correlation between not seeing the clinician anticipated and reduced satisfaction (P = 0.17). Using more information sources was associated with less satisfaction (P = 0.02). Patients were less satisfied if their expectations of either treatment or outcome were changed. Meeting patients' expectations is an essential part of effective communication. The use of specialist physiotherapists and general practitioners with a special interest is an effective way of seeing more new patients.

Physiotherapy for people with Parkinson's disease in the UK: an exploration of practice

The aim of this study of physiotherapy in Parkinson's disease was to identify current baseline activity and opinion on best practice to inform a model for future evaluations. The two-phase study comprised a Delphi survey of specialist physiotherapists (n=49) followed by case studies of best practice sites (n=9), involving interviews with professionals (n=29) and patients (n=30) and a documentary analysis of patients' notes. There was strong consensus that physiotherapy was optimized within a multidisciplinary context, that treatment (which was eclectic in nature) aimed to maximize functional ability and that outcome should be assessed at this level. Patients and carers were able to identify physical, psychological and social benefits of physiotherapy. This study was a first step in a coordinated drive to link research to practice. The subsequent development and review of Guidelines for Physiotherapy Practice in Parkinson's Disease will inform the current National Institute for Clinical Excellence Parkinson's disease guidelines exercise.

Stress fractures of the lumbar pars interarticularis in athletes: a review based on long-term results of 18 professional cricketers

The physical demand of the modern game of cricket on the fast bowler is known to cause stress fractures of the lumbar spine. Between 1983 and 2001, we diagnosed pars interarticularis defects in 18 professional cricketers contracted to a single English County Cricket Club. Eight of these players were treated conservatively, with rest, supervised rehabilitation, bowling action analysis and re-education where necessary. The remaining 10 were treated operatively, 9 by Buck’s repair of the spondylolytic lesion. All 18 players returned to professional sport. We recommend treatment of this select group of sportsmen in a unit consisting of a specialist physiotherapist, a bowling coach and a spinal surgeon. Should conservative measures fail, we recommend Buck’s repair as the operation of choice.

The Developing Role of Hand Therapists within the Hand Surgery and Medicine Services: An Exploration of Doctors’ Views

Extended scope practitioners (ESPs) are specialist occupational therapists and physiotherapists working beyond their recognised scope of practice. Thirty-five hand therapists were identified as working in this role in Britain, primarily in pre- and post-operative settings. A postal survey of the 31 consultants with whom they worked investigated their views on the nature of this role and service; the facilitating and constraining factors to this development; and on required qualifications, training and supervision. Seventeen consultants, all hand surgeons, replied. They reported that the principle reasons for the development of ESPs were the need to reduce the waiting list and the consultants’ workload. A variety of roles had been created, reflecting the different service needs and the skills of the therapists. Training was largely experiential. Extended scope practitioners had had a significant impact on waiting lists. There was variation in the surgeons’ views regarding further development of these posts. Concerns were identified regarding these posts, such as professional isolation, the transferability of skills, inappropriate extension of the role and the potential for litigation.