Physiotherapy (PHYSIOTHERAPY)

Publications in this journal

• Article: Predictors of shuttle walking test performance in patients with cardiovascular disease.

  G Pepera, M J D Taylor, A Peristopoulos, G R H Sandercock
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  ABSTRACT: OBJECTIVE: The incremental shuttle walking test (ISWT) is used to estimate cardiorespiratory fitness, but data from healthy individuals suggest that demographic and anthropometric measures account for much of the variance in test performance. The aim of this study was to determine whether anthropometric, demographic and selected gait measures also predict ISWT performance (i.e. distance walked) in patients with cardiovascular disease. DESIGN: Observational study. SETTING: A community-based cardiac rehabilitation centre (Cohort 1) and a hospital outpatient cardiac rehabilitation programme (Cohort 2). PARTICIPANTS: Sixteen patients with clinically stable cardiovascular disease (Cohort 1) and 113 patients undergoing cardiac rehabilitation (Cohort 2). INTERVENTIONS: Patients in Cohort 1 performed the ISWT on two occasions. Anthropometric data and walking and turning variables were collected. Linear regression analyses were used to identify the predictors of test performance. The authors subsequently attempted to validate the equation created by comparing predicted and actual ISWT values in a larger (n=113) validation sample (Cohort 2). MAIN OUTCOME MEASURES: Distance walked during ISWT, step length and height. RESULTS: No gait or turning measures were significantly associated with ISWT performance. Distance walked correlated most strongly with step length (r=0.83, P<0.05) and height (r=0.74, P<0.05). Given the similarity of these correlations and the rarity of step length assessment in clinical practice, ISWT performance was predicted using patient's height; this explained 55% of the variance in ISWT performance. Height was also the best predictor in Cohort 2, explaining 17% of test variance (P<0.01). Body mass index explained an additional 3% of variance (P<0.05) in ISWT performance. CONCLUSIONS: Routine clinical measures, particularly patient's height, are predictive of ISWT performance. The findings of the present study are in partial agreement with similar studies performed in healthy individuals, and it remains unclear whether the ISWT performance of patients with cardiovascular disease is influenced by the same factors as the ISWT performance of healthy individuals.
  Physiotherapy 04/2013;
• Article: Recruitment to clinical trials of exercise: challenges in the peripheral arterial disease population.

  M Guidon, H McGee
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  ABSTRACT: OBJECTIVES: To describe recruitment to a randomised controlled trial of a 12-week (twice-weekly) supervised exercise programme for patients with peripheral arterial disease (PAD). PAD is a chronic, progressive disease with a significant cardiovascular and cerebrovascular risk burden, and exercise is an effective primary management approach. METHOD: Potential patients were identified from the Non-Invasive Vascular Laboratory records and invited to participate in the study. On successful completion of an incremental treadmill exercise test, patients were allocated at random to a control (usual care) or an exercise group. RESULTS: Between November 2006 and June 2009, 548 patients were identified. Of the 156 patients who met the inclusion criteria, 40 (26%) declined to participate. Of the 71 patients who underwent exercise testing, 23 (32%) did not complete the test. The final enrolment number was 44 (44/156; 28%). Eleven patients (11/28; 39%) subsequently withdrew from the exercise programme. CONCLUSION: Recruitment to clinical trials of exercise presents significant challenges in the PAD population due to the presence of co-existing cardiovascular and cerebrovascular disease, a reluctance to exercise due to leg pain, and an acceptance of reduced mobility as part of ageing. Early identification in primary care before the onset of significant comorbidity may ameliorate some of these issues.
  Physiotherapy 03/2013;
• Article: 'Isn't it all Whites?' Ethnic diversity and the physiotherapy profession.

  Gillian Yeowell
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  ABSTRACT: AIM: To explore physiotherapists' perceptions, views and experiences of ethnic diversity in relation to the physiotherapy profession. DESIGN: Qualitative research study, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed verbatim and the data were analysed using thematic analysis. Several verification procedures were incorporated into the design to ensure quality. SETTING: Venues chosen by the participants in North West England. PARTICIPANTS: A purposive sample of 22 physiotherapists (five students, seven clinicians and 10 academics) with a range of ethnicities. FINDINGS: Most participants' experiences and perceptions were of a lack of ethnic diversity within the profession. Further findings related to the impact of this included: the perception that physiotherapy is a White profession; some Black and Minority Ethnic (BME) physiotherapists felt 'out of place' on occasions; and failure to meet patients' needs. The potential benefits of increased ethnic diversity and the possible risks of valuing BME staff solely in terms of their ethnicity were also illuminated by the findings. CONCLUSIONS: This study of the perceptions and experiences of physiotherapists identified a lack of ethnic diversity within the profession. It is argued that a lack of ethnic diversity may result in a failure to meet patients' needs. A workforce that is reflective of the population it serves can have greater cultural knowledge, and is more likely to understand and respond to patients' needs.
  Physiotherapy 03/2013;
• Article: Direct access and patient/client self-referral to physiotherapy: a review of contemporary practice within the European Union.

  T J Bury, E K Stokes
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  ABSTRACT: BACKGROUND: Direct access refers to service users being able to refer themselves to physiotherapy without a third-party referral. It represents a model of practice supported globally by the profession, growing research evidence and health policy in some health systems. To the authors' knowledge, no research has been reported to ascertain the extent to which direct access is available within the physiotherapy profession within the European Union (EU). OBJECTIVES: To survey member organisations of the World Confederation for Physical Therapy (WCPT); establish the number of member states within the EU where it is possible for individuals seeking physiotherapy services to self-refer; describe the legislative/regulatory and reimbursement contexts in which physiotherapy services are delivered; examine if physiotherapy practice is different in member states where direct access is permitted compared with member states where direct access is not permitted; and to describe the barriers and facilitators to direct access perceived by member organisations of the WCPT. DESIGN: Cross-sectional, online survey using a purposive sample. PARTICIPANTS: Member organisations of the WCPT in the EU. RESULTS: Direct access is not available in all member states of the EU, despite the majority having legislation to regulate the profession, and entry-level education programmes that produce graduates with the requisite competencies. Key barriers perceived are those that can influence policy development, including the views of the medical profession and politicians. Support of service users and politicians, as well as professional autonomy, are seen as key facilitators. CONCLUSION: These results represent the first report of a comprehensive mapping of direct access to physiotherapy and contexts within the EU. In over half of member states, service users can self-refer to physiotherapists. These results provide insights to further individuals' understanding about the similarities and differences in working practices and service delivery factors, such as reimbursement across and within EU member states. The synergies between barriers and facilitators indicate the importance of targeted advocacy strategies in the introduction of direct access/self-referral to physiotherapy.
  Physiotherapy 03/2013;
• Article: Preliminary evidence for the features of non-reducible discogenic low back pain: survey of an international physiotherapy expert panel with the Delphi technique.

  A Y P Chan, J J Ford, J M McMeeken, V E Wilde
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  ABSTRACT: OBJECTIVES: The lumbar intervertebral disc is a known source of low back pain (LBP). Various clinical features of discogenic pain have been proposed, but none have been validated. Several subgroups of discogenic pain have been hypothesised, with non-reducible discogenic pain (NRDP) proposed as a relevant clinical subgroup. The objectives of this study were to obtain consensus from an expert panel on the features of discogenic low back pain, the existence of subgroups of discogenic LBP, particularly NRDP, and the associated features of NRDP. DESIGN: Three-round Delphi survey. PARTICIPANTS: Twenty-one international physiotherapists with expertise in LBP. METHODS: Panellists listed and ranked features that they believed to be indicative of discogenic pain and NRDP. On completion of Round 3, features with ≥50% agreement between panellists were deemed to have reached consensus. RESULTS: After three rounds, 10 features of discogenic LBP were identified. Nineteen of the panellists believed that NRDP was a subgroup of discogenic LBP, and nine features of NRDP were identified. CONCLUSION: This study provides preliminary validation for the features associated with discogenic LBP. It also provides evidence supporting the existence and features of NRDP as a separate clinical subgroup of discogenic LBP.
  Physiotherapy 03/2013;
• Article: "Six sessions is a drop in the ocean": an exploratory study of neurological physiotherapy in idiopathic and inherited ataxias.

  Gavin Daker-White, Julie Greenfield, John Ealing
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  ABSTRACT: OBJECTIVE: An exploratory study to examine specialist neurological physiotherapy service provision and utilisation for people with progressive ataxia. DESIGN: Qualitative study involving thematic analysis of accounts in semi-structured interviews with physiotherapists and patients. SETTING: People with ataxia and specialist neuro-rehabilitation physiotherapists in Greater Manchester, UK. PARTICIPANTS: 38 people with ataxia and 8 neurological-physiotherapists working in academic and hospital and community-based services in NHS and private settings. Recruiting physiotherapists experienced in working with the patient group was a challenge. INTERVENTIONS: One hour cross-sectional semi-structured interview at physiotherapists' workplaces or in patients' own homes. RESULTS: Neurological physiotherapy was experienced by 25 (66%) of the 38 people with ataxia. The overarching themes emerging from the analysis were 'making a difference,' engagement and service provision. A majority of both samples felt that services should be organised so as to provide longer term therapy and support that goes beyond short care packages followed by provision of home exercise programme. Engagement with services was linked to patient expectations, adherence and perception of outcomes. The most predominant codes in the data set were encapsulated by the theme 'making a difference,' which further included concerns about how to measure perceived clinical improvement (as experienced by patients) in the context of progressive decline. CONCLUSIONS: The findings suggest a model of idealised service provision involving a holistic, open-access service including research efforts to improve the evidence base. Special attention needs to be paid to measuring improvements following therapy.
  Physiotherapy 03/2013;
• Article: An innovative approach to therapy.

  David Lewis
  Physiotherapy 03/2013;
• Article: Prevalence of low bone mineral density in inpatients with traumatic brain injury receiving neurobehavioural rehabilitation: a postoperative, observational study.

  Nicola Banham-Hall, Krishna Kothwal, Jane Pipkin, Judith Bentley, Geoffrey L Dickens
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  ABSTRACT: BACKGROUND: Osteoporosis is characterised by low bone mineral density (BMD) leading to an increased risk of fracture. Patients who have sustained a significant traumatic brain injury may have an increased risk of secondary reduced BMD as a result of immobility and other factors. OBJECTIVES: To describe BMD in a cohort of patients recovering from traumatic brain injury, and to discuss the implications of the findings for physiotherapy practice. DESIGN: Prospective, observational. SETTING: Specialist, residential unit providing care for individuals with brain injury, many with a history of severe challenging behaviour. PARTICIPANTS: Current inpatients (n=51, 80% male) with the capacity to provide consent, as judged by their responsible clinician. The median age was 41 years (range 20 to 60 years), and the median time since the brain injury was sustained was 22 years (range 4 to 54 years). METHODS: Participants' BMD was measured at the radius and tibia using quantitative ultrasound. Various clinical and demographic details were collected. RESULTS: Participants had suboptimal BMD measurements that were generally low for their age and gender. Nine (18%) participants met the criteria for osteopenia measured at the radius, and 26 (51%) participants met criteria for osteoporosis or osteopenia measured at the tibia. CONCLUSIONS: Some participants had reduced BMD, putting them at risk of fracture or of developing such risk in the future. This group is at particular risk because they frequently display challenging aggressive behaviours that may be met with responses including proportionate use of manual restraint. Physiotherapists should bear this increased risk in mind when devising exercise programmes assessing risk in neurobehavioural rehabilitation settings.
  Physiotherapy 03/2013;
• Article: Development of a self-managed loaded exercise programme for rotator cuff tendinopathy.

  Chris Littlewood, Peter Malliaras, Sue Mawson, Stephen May, Stephen Walters
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  ABSTRACT: This paper describes a self-managed loaded exercise programme which has been designed to address the pain and disability associated with rotator cuff tendinopathy. The intervention has been developed with reference to current self-management theory and with reference to the emerging benefit of loaded exercise for tendinopathy. This self-managed loaded exercise programme is being evaluated within the mixed methods SELF study (ISRCTN 84709751) which includes a pragmatic randomised controlled trial conducted within the UK National Health Service.
  Physiotherapy 03/2013;
• Article: Respiratory physiotherapy during an acute exacerbation - evidence versus practice.

  Sally Singh
  Physiotherapy 02/2013;
• Article: Physiotherapy students' experiences of bullying on clinical internships: an exploratory study.

  Brendon Stubbs, Andy Soundy
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  ABSTRACT: OBJECTIVES: To consider the prevalence and type of bullying behaviours experienced whilst on clinical placement in a cohort of final-year BSc undergraduate students. DESIGN: Cross-sectional survey. SETTING: University in the West Midlands, UK. PARTICIPANTS: Fifty-two final-year undergraduate students. MAIN OUTCOME: Prevalence of incivility and bullying behaviours. RESULTS: Twenty-five percent of students reported at least one incident of bullying behaviour. The perpetrator of the bullying behaviour was most often the clinical educator (8/13, 62%). Despite the negative effects caused, the majority of students (11/13, 84%) did not report this experience to the university. CONCLUSION: Bullying behaviour may take many forms and can have a negative effect on the well-being of students. It should be addressed by all stakeholders including universities, National Health Service trusts and researchers. Possible strategies to move forwards and better protect the future of the physiotherapy profession are briefly considered.
  Physiotherapy 02/2013;
• Article: The biomechanics of step descent Comparing an elasticated tubular Bandage with neutral patellar taping in Patellofemoral pain patients.

  James Selfe, Jim Richards, Ambreen Chohan, Renuka Erande, Dominic Thewlis, Stephen Hill
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  ABSTRACT: 2011
  Physiotherapy 02/2013; 97(s1):es316.
• Article: Video games: increasing activity in sedentary individuals.

  J H Templar
  Physiotherapy 02/2013;
• Article: The development of an activity pacing questionnaire for chronic pain and/or fatigue: a Delphi technique.

  Deborah Antcliff, Philip Keeley, Malcolm Campbell, Jackie Oldham, Steve Woby
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  ABSTRACT: OBJECTIVE: Activity pacing is frequently advised as a coping strategy for the management of chronic conditions (such as chronic low back pain, chronic widespread pain and chronic fatigue syndrome/myalgic encephalomyelitis). Despite anecdotal support for activity pacing, there is limited and conflicting research evidence into the efficacy of this strategy. There is no consensus on the interpretation of 'pacing' due to diverse descriptions, including strategies that encourage both increasing and decreasing activities. Furthermore, at present, there are few validated scales to measure how patients pace their activities. The aim of this study was to undertake the first stage in the development of a comprehensive tool that assesses the multi-faceted nature of pacing among patients with chronic conditions. DESIGN: Three-round Delphi technique. PARTICIPANTS: Expert panel based in the UK including patients and clinicians. RESULTS: The 42 participants who completed three rounds of Delphi included 4 patients, 3 nurses, 26 physiotherapists and 9 occupational therapists. The 38 questions that reached consensus to be included in the questionnaire encompassed a number of different facets of pacing, for example, breaking down tasks, not over-doing activities, and gradually increasing activities. CONCLUSIONS: To our knowledge, this is the first study that has engaged both patients and clinicians in a Delphi technique to develop an activity pacing questionnaire. In contrast to existing pacing scales, our questionnaire appears to contain a number of distinct facets of pacing. Further study is being undertaken to engage patients in the exploration of the validity, reliability and acceptability of the questionnaire.
  Physiotherapy 02/2013;
• Article: Algorithm for NIV in chronic obstructive pulmonary disease: could this be applicable for every scenario?

  A M Esquinas Rodriguez, C Kirakli
  Physiotherapy 01/2013;
• Article: Response to Letter to the Editor.

  K Ward
  Physiotherapy 01/2013;
• Article: A survey investigation of UK physiotherapists' use of online search engines for continuing professional development.

  Nicholas Harland, Benjamin T Drew
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  ABSTRACT: OBJECTIVES: The purpose of this study was to discover the frequency and type of use of online resources for continuing professional development displayed by physiotherapists in the UK. Therapists' skills, needs and frustrations using these resources were explored. With the relatively recent release and saturated use of the internet the potential presence of a skills gap between therapists at different stages of their career was also investigated. DESIGN: National online survey study. SETTING: The online survey was carried out using the international online service 'Survey Monkey'. PARTICIPANTS: 774 physiotherapists from students to band 8c completed the survey. INTERVENTIONS: The online survey was advertised through Frontline, the Interactive Chartered Society of Physiotherapy, Journal of Physiotherapy Pain Association and cascade email through research and other networks. RESULTS: Most physiotherapists reported using the internet for professional purposes daily (40%) or 2 to 4 times a week (37%), with only 8% of respondents using it less than once a week. Overall the results suggest band 6 and 7 physiotherapists had the least skills and most frustrations when using online search engines. CONCLUSIONS: History and the nature of rapid technological advancement, specifically of the internet, appears to have created a generational skills gap within the largest group of the physiotherapy workforce band 6 and 7 therapists. Students, band 5 and band 8a therapists appear to most successfully use online resources and the reasons for this are explored.
  Physiotherapy 01/2013;
• Article: Usage evaluation of a resource to support evidence-based physiotherapy: the Physiotherapy Evidence Database (PEDro).

  Tarcísio F Campos, Paula R Beckenkamp, Anne M Moseley
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  ABSTRACT: OBJECTIVES: The Physiotherapy Evidence Database (PEDro) is a free, web-based database of reports of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy. The objective of this study was to describe the usage of PEDro over a 2-year period, including the number of visits and searches performed, the number of countries and territories from which users accessed PEDro, and amount of usage from each country. DESIGN: Survey of web-site and database log files. MAIN OUTCOME MEASURES: Usage of the PEDro home-page (www.pedro.org.au) and the search function were logged for a 2-year period. Visit and search data were used to calculate the number of visits and searches each month. Domain data were used to calculate the total number of countries accessing PEDro and the amount of usage from each country and territory. RESULTS: The PEDro home-page received 921,181 visits from 205 countries and territories in 2010 and 2011, with 3,350,740 new searches performed. On average, a new search was initiated every 19seconds. The highest usage was from the United States of America (15%), Australia (13%) and Brasil (8%). Highest normalised usage was from Peru (255 searches/physiotherapist), Chile (154) and Columbia (90), and from Australia (19,883 searches/million-population), New Zealand (13,267) and Switzerland (11,361). CONCLUSIONS: There was substantial use of the PEDro resource by the global physiotherapy community during 2010 and 2011. The provision of the PEDro search function in languages other than English may enhance accessibility.
  Physiotherapy 01/2013;
• Article: Measurement of lower limb volume: agreement between the vertically-oriented perometer and a tape measure method

  Tan C-W, Coutts F, Bulley C
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  ABSTRACT: OBJECTIVE: To investigate the agreement between lower limb volume measurements for the vertically oriented perometer and a tape measure method. DESIGN: Between-methods agreement and test-retest reliability study. SETTING: University setting. PARTICIPANTS: Thirty university staff and students were recruited using convenience sampling with no participant drop-outs. INTERVENTIONS: All participants' dominant lower limb volumes were measured using the vertically oriented perometer and a tape measure method. MAIN OUTCOME MEASURES: The Bland-Altman difference plot was reported for determining the bias between the two methods and its 95% confidence interval. Test-retest reliability and the measurement error for the perometer method were determined using the ICC(2,1) model and within-subject standard deviation (s(w)) respectively. RESULTS: There was a lack of agreement between the tape measure and perometer method. The Bland-Altman difference plot showed that the tape measure method overestimated limb volume by 157ml compared to the perometer method. A 95% confidence interval of -834ml to 519ml was observed. The test-retest reliability of the perometer method was ICC(2,1)=0.99. The measurement error of the perometer method was clinically acceptable (s(w)=121ml). CONCLUSIONS: There was a lack of agreement between the two methods investigated. Therefore the perometer and tape measure methods are not interchangeable. It is recommended that future validity and reliability studies for the vertically oriented perometer are conducted on clinical populations.
  Physiotherapy 01/2013; in press.