Hong Kong Physiotherapy Journal

Published by Elsevier
Online ISSN: 1013-7025
Publications
Article
This pilot study attempted to examine the additional efficacy of interferential therapy in reducing the symptoms of urinary stress and urge incontinence. Twenty-four subjects were randomly allocated to the experimental group, which received interferential therapy plus pelvic floor exercises, or the control group, which received pelvic floor exercises only. Treatment was given three times a week for 4 weeks. Subjects were given urinary diaries to record urinary symptoms (including frequency of passing urine and number of times woken by desire to pass urine) for 5 days prior to and after treatment. Perineometer readings, pad weighing test and start/stop test were also performed in a physiotherapy clinic before and at completion of treatment regimes. Significant improvements were observed in all the outcome variables in the experimental group, but in only the perineometer readings in controls. When the changes from pre- to post-treatment were compared between the two groups, four of the dependent variables did not reach statistical significance. Power analysis indicated that the sample size for each group needed to be 70 for all results to be statistically significant. This study shows that interferential therapy plus pelvic floor exercise appears to be a more effective treatment modality than pelvic floor muscle strengthening exercise alone for incontinence, but a larger trial with longer follow-up is needed before definitive conclusions can be reached.
 
Article
It is a challenge for physiotherapists and fitness instructors to promote adherence to regular physical activity/exercise in people with physical disabilities. Although there has been emerging awareness of this in recent years, this topic remains relatively underexplored. The literature has shown that multiple factors affect the initiation and maintenance of participation in regular physical activity in this population, and relevant behavioural strategies are useful in this regard. The main theme of the present review is to provide frontline exercise professionals a wide picture for understanding participation in and adherence to physical activity for people with physical disabilities. The objectives are as follows: (1) to explore the need for regular physical activity/exercise for people with physical disability; (2) to sum up the correlates between people with disabilities and physical activity participation, as well as physical activity adherence; (3) to review strategies for increasing physical activity participation and adherence in people with disabilities; and (4) to point out the practical difficulties and implications from the reviewed papers concerning the improvement of physical activity/exercise participation and adherence.
 
Article
Few studies have sought to gain insight into the determinants of endurance capacity of the back extensor muscles. This study investigated the influence of body fat on the endurance of the back extensor muscles using different measures of adiposity in apparently healthy Nigerian adults. Three hundred and seventy-six consecutive adults aged 38.9 ± 13.5 years participated in the study. The participants performed the Biering-Sørensen test of static muscular endurance, and their height, weight and percentage body fat (PBF) were measured using standard procedures. Body mass index (BMI), lean body mass and body fat mass were calculated. Descriptive statistics of mean and standard deviation, ANOVA and multiple regression analysis were used. The a level was set at 0.05. A significant difference (p = 0.000) was found in the isometric holding time (IHT) of the underweight (131.04 ± 49.61 seconds), normal (125.52 ± 46.3 seconds), overweight (85.61 ± 37.24 seconds) and obese (73.02 ± 41.67 seconds) categories using the BMI definition. Significant differences (p = 0.000) were found in the IHT among the lean, acceptable, moderately overweight and overweight categories for males and females using the PBF classification. After controlling for age, sex and other anthropometric factors, BMI was significantly associated (p = 0.000) with IHT, accounting for approximately 40% of the variability in back muscle endurance; PBF was significantly associated (p = 0.000) with IHT for males and accounted for approximately 50% of the variability in males and females. Overweight and obesity are important factors in the aetiology of decreased back extensor muscle endurance. Approaches to reduce decreased back muscle endurance and the risk of low back pain may include prevention of overweight and obesity.
 
Timing on commencement of activities for patella
Article
Rehabilitation protocols for injuries to the anterior cruciate ligament (ACL) change rapidly. The first local study was conducted 8 years ago, and there is a need to review our local practice in order to evaluate our services. Questionnaires were sent to local hospitals and rehabilitation centres asking about their management regimens for ACL cases from 1 January to 31 December 2003. Most (89.3%) ACL injuries occurred during sports, with 74.1% in males aged 18-30 years. Thirty-four centres returned answered questionnaires, of which only 28 contained valid answers; 21 centres (75%) had a defined rehabilitation protocol for surgical cases but only 10 (35.7%) had a defined protocol for non-surgical cases. Patients were usually managed with patella tendon or hamstring autografts, and 25% of the centres had separate rehabilitation protocols for these grafts. Local protocols were comparable to the accelerated rehabilitation programme for patella tendon autografts, except that they showed slower progress in agility training and return to sports. The protocols for hamstring autografts were generally in line with overseas programmes, but started hamstring exercises earlier. The timing of muscle training and sports-specific activities varied among centres. Treatment outcome might be improved by therapists spending more time with patients. Compared with the previous study, more centres had defined rehabilitation protocols for surgical ACL cases, but not for non-surgical cases. The practice of ACL rehabilitation in Hong Kong is generally comparable to that reported from overseas.
 
Article
The purpose of this study was to investigate the characteristics of activity participation of community- dwelling older people in Hong Kong by using the Frenchay Activities Index (FAI) questionnaire. Although FAI data have clinical values and has been commonly used in clinical studies, age- or gender-referenced norms of FAI scores have not been established locally. This pilot study interviewed 62 subjects (19 males, 43 females; mean age, 74.4 ± 6.7 years) in two community centres. Subjects completed two interviewer-administered questionnaires, one on demographic information and the other on 13 questions of the original 15-item FAI. The Mann-Whitney U test and the Kruskal-Wallis test were used to test the differences in mean FAI scores between genders and among four age groups, respectively. Difference in the total FAI score was significant between genders (p < 0.05) and in the domestic domain (p < 0.01) but not among age groups (p = 0.24). Similarities and differences of the results are discussed with reference to two other reports in the literature. Norm references in FAI should be established with a larger sample of older people in the Hong Kong community.
 
Article
This pilot study aimed to assess the feasibility and effectiveness of a falls-prevention programme for older people with dementia from predominantly an Italian background. The study had a single group pretest- posttest design and enrolled 64 community-dwelling older people with dementia; 6-month follow-up data were available for 32 participants. The falls-prevention programme was embedded in a healthy lifestyle dementia respite programme, which combined day respite with preventative health programmes. A comprehensive falls risk assessment was conducted for each client to develop an individualised falls and injury management plan that included a tailored exercise programme to improve strength and balance. Outcome measurements were fall status, cognitive function (Mini Mental State Examination, MMSE), balance (Berg Balance Scale, BBS) and aerobic capacity (6-minute walk test). There were no significant differences between baseline and 6-month measures for the number of fallers, BBS, MMSE or 6-minute walk test (n = 32; p > 0.05), indicating that participants neither improved nor declined significantly. A feasible method of delivering falls prevention services to older people with dementia has been developed. There is a need for further investigation to establish the effectiveness of this method.
 
Article
This study proposes the application of a strengthening index to quantify the effect of training, by functional electrical stimulation (FES), on the force capacity of the quadriceps in spinal cord injury (SCI) subjects. The index is based on evaluating the average muscle force per unit area. This measure is shown to express the overall increase in the muscle force capacity, while accounting for the changes taking place in muscle geometry. The proposed index is demonstrated on one subject with SCI, on whom a longitudinal follow-up was conducted. The measurements included the knee extension torque, from which the force in the quadriceps muscle was evaluated. Additionally, in vivo magnetic resonance imaging of the thigh was used to obtain the muscle anthropometry. In the training period followed-up in this study, the average force per unit area was found to increase from 27 N/cm2 in the pretrained muscle to 40 N/cm2 after eight weeks of training by FES. The major increase in the physiological cross-sectional area of the muscle took place during the first four-week period; 12% of the total 13.5%. Conversely, only a minor change in the average force per unit area of the muscle was observed during the first four weeks of training (28 N/cm2 at the end of the fourth week). Thus, the major increase (43%) in the ratio of peak force to muscle physiological cross-sectional area was observed during the second four-week period of training. This latter response is attributed to neural adaptation of the axons and neuromuscular junction rather than to an increase in the muscle fibre specific tension.
 
Article
Pain is an important clinical factor that can limit movement at a joint and inhibit the functional use of a limb after stroke. Incidence of musculoskeletal pain (MSP) and its impact on motor performance among community-dwelling stroke survivors were investigated in this descriptive study. The study sample comprised 102 (51 men and 51 women) freely consenting stroke survivors (mean age, 52.92 ± 10.24 years) receiving physiotherapy on outpatient basis as part of their rehabilitation programme. They were interviewed and physically assessed for pain, and for those who had MSP, the intensity of their pain and motor performance were assessed using Numerical Box-21 Scale and Stroke Rehabilitation Assessment of Movement, respectively. Data were analysed using Spearman correlation coefficient at alpha value of 0.05. Results showed that 81 (42 men and 39 women) or 79.4% of the sample had pain symptoms, with 23.5% of these having the pain pre-dating stroke onset. Pain distribution by type revealed that MSP and central post-stroke pain was equally distributed (30.9%), whereas the remaining 38.3% presented with mixed type of pain. Among those with MSP, 25.9% had pain at shoulder only, 12.0% at the elbow only, and 2.5% at the ankle joints only. A statistically significant negative correlation (rho = −0.29, p = 0.009) was observed between the Numerical Box-21 Scale and Stroke Rehabilitation Assessment of Movement scores. MSP after stroke is as common as central post-stroke pain, and presence of MSP is associated with lower motor performance. There is a need for physiotherapists treating post-stroke individuals to take care of this type of pain to enhance the recovery of motor function.
 
Characteristics of the 53 participants and results of the 6MWTs.
Linear regression models for predicting 6MWD.
Article
The 6-minute walk distance (6MWD) is used as a measure of functional exercise capacity in clinical populations and research. Reference equations to predict 6MWD in different populations have been established, however, available equations for Chinese population are scarce. This study aimed to develop regression equations to predict the 6MWD for a Hong Kong Chinese population. Fifty-three healthy individuals (25 men, 28 women; mean age = 69.3 ± 6.5 years) participated in this cross-sectional study. Each participant performed two 6-minute walk tests (6MWTs) in accordance with a standard protocol. Heart rate (HR) was continuously monitored throughout the 6MWTs and the maximum HR was recorded. Measurements from the 6MWT that resulted in the highest 6MWD were used for regression analysis. The mean 6MWD was 563 ± 62 m and was significantly correlated with age (r = −0.62), height (r = 0.39), and percentage of predicted maximal HR (%predHRmax; r = 0.50). A regression equation derived from the data showed that age, gender, and %predHRmax were independent contributors and together explained 65% of the variance in 6MWD. When HR was excluded, the equation explained 52% of the variance. Application of these equations to a Chinese population living in different parts of China warrants further investigation.
 
The testing set-up for ultrasound machine power output. A = = ultrasound machine; B = = retort stand; C = = wattmeter; D = = ultrasound head in degassed water.  
Percentage of tests found to be inaccurate at the various subgroups.
Percentage of timers found to be inaccurate.
Article
Ultrasound machines are frequently used by physiotherapists. Thus, it is imperative that machines are accurate for safe and effective treatments. This study aimed to examine the accuracy of therapeutic ultrasound machines in terms of power output and timing function, and to determine factors that relate to the degree of machine accuracy. An observational design was used. Sixty-four machines were sampled. Machines were tested at three power settings, two frequencies, and pulsed and continuous modes. Timers were assessed for 5- and 10-minute durations. Ultrasound machines were considered inaccurate if they deviated by more than ± 20% and timers if they deviated by ± 10%. Fifty-nine percent (291/492) of power tests were inaccurate, with 79% of these producing less power output than depicted on the dial. Thirty-seven percent of timers were inaccurate, with mechanical timers more inaccurate than digital timers (p < 0.05). Older ultrasound machines were more likely to be inaccurate (p < 0.05). Length of time since machine calibration was also associated with machine inaccuracy at 3 MHz (p < 0.05). There is a high level of power and timer inaccuracy in machines that may be related to machine age and frequency of calibration. This study highlights the need for therapists to be aware of the potential for machine inaccuracy and for stricter guidelines on machine calibration to be introduced.
 
Article
xvi, 233 leaves : ill. ; 30 cm. PolyU Library Call No.: [THS] LG51 .H577P RS 2001 Huang Early screening of the developmental dysplasia of the hip in neonates still presents problem, especially in developing countries. This study attempts to develop an acoustical technique for the screening of DDH in neonates with the hope that early intervention would prevent disability resulting from this defect. This acoustical technique based on a system analysis approach was applied to examine the acoustic transmission in the hip joints. Special experimental instrumentation has been set up to measure the acoustic signals transmitted along a path from the driving point at the sacrum to the greater trochanters on both sides. A random vibratory force (pink noise) up to 800 Hz was applied to the sacrum in the antero-posterior direction at S2, while acoustic signals were picked up by a pair of adult-size stethoscope-microphone assembly held by a compressive force at the greater trochanters on both sides. A dual-channel signal analyser was employed for data acquisition. The acoustical technique was shown to be reliable and repeatable in quantifying the transmitted sound signals across both hips, and in performing a comparative measurement to identify asymmetry of the anatomical configuration of the hip joints. Two key parameters have been identified. The high coherence confirmed the validity of a model proposed for the sacrum-pelvis-hip complex. Discrepancy defined from a modified form of transfer function was found useful in the identification of structural asymmetry between both hips. The baselines for the groups of normal adults, pre-school children and neonates have been established. The most optimal and effective testing frequencies were found in the frequency bands of 200, 250 and 315 Hz, in which there was a high coherence (y²> 0.9) of signals and a small discrepancy (D < 3 dB) between both hips. The results obtained from 90 normal neonates showed a more reliable baseline in which there was the highest coherence (y² > 0.94) and the smallest discrepancy (D < 2 dB) in the frequency range of interest, which can be used for clinical reference. Seventeen patients with unilateral DDH were examined by the acoustical technique. The results suggested that the coherence consistently below 0.8 in at least one of the frequency bands of 200, 250 and 315 Hz was definitely indicative of structural asymmetry between both hips. The discrepancy estimated for the patients were found to be clearly different from the normal figures. It was confirmed that any structural changes in joint congruity, concentricity and coverage of the femoral head would result in an asymmetrical acoustic transmission across the hip joints. Discriminative analysis has shown a significant difference between the groups of normal neonates and patients with unilateral DDH in the frequency bands of 200, 250 and 315 Hz. By setting the cut-off discrepancy at 2.0 dB, the best sensitivity of 100% and specificity of 75% would be achieved. Based on these figures and the baseline of the normal neonates, the acoustical technique could be used as a screening tool for DDH in neonates. The technique has served the purpose of a screening test for DDH in neonates by meeting the basic requirements of any screening tool. The objective measurement of discrepancy was also in good agreement with the clinical findings. The findings from this study suggest that the acoustical technique can be developed further to a non-provocative, objective and non invasive screening tool for early detection of DDH, or asymmetry in the bone and joint configuration. A screening protocol has been established for DDH. An integrated system has been proposed for dedicated use in routine screening of dysplastic hips in a wider-scale application. Ph.D., Dept. of Rehabilitation Sciences, The Hong Kong Polytechnic University, 2001
 
Participant demographics. 
Study flowchart. 
Comparison of the mean radial error in the various blocks of the acquisition, retention, and transfer phases within each group. 
Article
The purpose of this study was to evaluate the effectiveness of external focus of attention and internal focus of attention in different phases of motor learning in people with Parkinson's disease (PD). Twenty-four patients (17 men and 7 women) with idiopathic PD participated in the study. The participants were randomly assigned to either the internal focus of attention group (n = 12) or the external focus of attention group (n = 12). The task was to throw darts at the centre of a target. The attention of the patients in the internal focus group was directed at the movements of upper extremity joints, whereas the attention of the patients in the external focus group was directed at the target, dart, and dart course. The results showed that the external focus group had significantly less mean radial error for the acquisition phase (fifth block, p = 0.005) and the transfer phase (p = 0.005). In summary, an external focus of attention enhanced learning in the last block of the acquisition phase and the whole transfer phase, whereas an internal focus of attention resulted in no improvement. External focus of attention may be the preferred method for facilitating the learning of motor skills in patients with PD.
 
Testeretest reliability and internal consistency of the PFPS Severity Scale 
Testeretest reliability of each item of the PFPS Severity Scale
Correlations between the scores of PFPS Severity Scale and KOS-ADLS 
Article
The purpose of this study was to cross-culturally adapt and validate the Greek version of the Patellofemoral Pain Syndrome (PFPS) Severity Scale, a self-reported instrument used for patients with PFPS. Four bi-lingual translators were involved in the translation and cultural adaptation procedures. Eighty-seven patients with PFPS (51 women and 36 men) participated in the study. To establish test–retest reliability, the patients were asked to complete the PFPS Severity Scale twice at initial visit; before and after physiotherapy treatment. The Greek version of the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) was also administered once. Internal consistency of the translated instrument was measured using Cronbach α. An intraclass correlation coefficient was used to assess the test–retest reliability of the PFPS Severity Scale. Concurrent validity was measured by correlating the PFPS Severity Scale scores with the KOS-ADLS scores using Pearson’s correlation coefficient. The results showed that the Greek PFPS Severity Scale has good internal consistency (Cronbach α = 0.949), test–retest reliability (ICC = 0.946) and concurrent validity (r > 0.7). In conclusion, the Greek version of PFPS Severity Scale is a reliable and valid measure when administered to patients with PFPS.
 
Article
The objective of the study was to cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) into a regional Indian language (Tamil) and to test the reliability and linguistic validity of the index in Tamil-speaking Indian participants. Cross-cultural adaptation and psychometric testing of SPADI was undertaken at the Outpatient Physiotherapy Department of the Sri Ramachandra University Hospital in Chennai, India. The Test-retest reliability was quantified using the interclass correlation coefficient (ICC) and Cronbach alpha was calculated to assess internal consistency of the Tamil questionnaire. The construct validity was assessed using Spearman rank correlation coefficients. The reliability of the total Tamil SPADI and its subsets (Intraclass correlation coefficient >0.90) were found to be higher than that of the English SPADI and the German SPADI in this population. The internal consistency of the Tamil SPADI (Cronbach's alpha >0.95) was slightly higher than the English and the German versions. Thus, the cross-culturally adapted version of the English SPADI into a regional Indian language (Tamil) is easy to use and is a reliable and valid measure of shoulder pain and disability in the Tamil speaking population.
 
Article
Previous studies have suggested that different durations of taekwondo (TKD) training may result in different lower limb muscle strengths. The objective of this study was to explore the relationship between the duration of TKD training (i.e., number of hours spent training per week) and lower limb muscle strength (at both fast and slow testing speeds) in adolescents. Isokinetic concentric knee and ankle muscle strengths were measured in 20 TKD practitioners (mean age: 15.8 years) at two different speeds (60°/second and 240°/second). Pearson’s correlation coefficient (two-tailed) showed that the number of TKD training hours per week was positively correlated with the peak torque of the knee extensors (r = 0.639, p = 0.002) and knee flexors (r = 0.472, p = 0.036) at 240°/second. This study did not show any significant correlation between TKD training duration and the peak torque of the knee flexors and extensors at slower speeds (60°/second) or the ankle plantar flexors at any speed. Our results support the notion that the more time one spends in TKD training the greater the muscle strength one could gain and that any subsequent improvements in knee muscle strength is velocity specific. Further study is needed to confirm the optimal amount of training and training parameters required to develop knee muscle strength in TKD athletes.
 
Article
Osteoporosis is a worldwide health concern for individuals of all ethnic and racial groups. The number of individuals diagnosed with osteoporosis and the rate of osteoporotic fractures increases significantly with age. Some variation in the development of osteoporosis can also be related to gender and race, with both genetic and lifestyle factors influencing bone development. Both non-modifiable and modifiable risk factors have been identified as contributing to the development of osteoporosis. Modifiable risk factors are related to diet, smoking, alcohol use and activity level. By understanding the development of the skeletal system and the lifestyle choices that maximize bone development, the risk of development of osteoporosis can be minimized. Physical activity contributes to development of the skeletal system in all age and ethnic groups. Maintaining high levels of physical activity is important across the life span to increase the peak bone mass developed and optimize bone mass during the bone remodelling phases of older adulthood. Bone development and remodelling are influenced by the mechanical strain placed upon the bone during physical activity. By understanding how mechanical forces influence bone development, exercise programmes can be developed that will most effectively stimulate bone growth. The focus of this review will be to discuss factors influencing the life span development of the skeletal system, theoretical frameworks related to bone growth in response to mechanical forces, and the development of osteoporosis prevention programmes for individuals of all ages.
 
Article
This study is an epidemiological report of the medical records of amputees in Kolkata, West Bengal, India. This retrospective study included 155 amputees who had undergone an amputee physiotherapy rehabilitation program and prosthetic training at the National Institute for the Orthopaedically Handicapped in Kolkata, West Bengal, from January 2008 to January 2010. The paper reports on the prevalence, aetiology, and levels of amputation. The causes of amputation classified under vascular diseases, trauma, and carcinoma are discussed. The most common cause of amputation was trauma (70.3%), the second most common cause being peripheral vascular disease. Lower limb amputation, more common than amputation at the upper limb, accounted for 94.8% of all amputations.
 
Article
A psychometrically sound and easily applicable mobility outcome measure is crucial for evaluating patient performance and efficacy of rehabilitative treatment. The Modified Functional Ambulation Classification (MFAC) is an assessment tool designed to categorize functional ambulation ability. This study aimed to evaluate the reliability and concurrent validity of the MFAC in patients with hip fracture in a rehabilitation hospital setting. A total of 122 patients with hip fracture, aged 81.3 ± 6.5 years, were evaluated using the MFAC and Elderly Mobility Scale (EMS). Inter-rater reliability was assessed by administering the MFAC to the same patients by two independent raters. Intraclass correlation (2,1) was used to calculate inter-rater reliability, and the Spearmen correlation was used to assess the correlation between MFAC and EMS scores (i.e., concurrent validity). The results revealed that the MFAC categories provided by the two raters were highly reliable (intraclass correlation coefficient (ICC) = 0.960, 95% confidence interval: 0.942-0.972, p < 0.001). The MFAC scores were also significantly correlated with the EMS scores (ρ = 0.814, p < 0.001). In conclusion, the MFAC demonstrated good reliability and concurrent validity in patients with hip fracture.
 
CONSORT diagram showing the flow of the study participants through each stage of the randomized trial. PNF Z proprioceptive neuromuscular facilitation; TPT Z traditional prosthetic training.
Comparison of outcome measurements between the two treatment groups
Article
The objective of this randomized controlled trial was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) techniques in comparison to traditional prosthetic training (TPT) in improving ambulatory function in transtibial amputees. Thirty study participants (19 men and 11 women) with unilateral transtibial amputation participated in the study. They were randomly allocated to either the traditional training group (i.e., TPT) (n = 15) or the PNF training group (n = 15). The treatment in the TPT group consisted of weight-bearing, weight-shifting, balance, and gait exercises for 30 minutes daily for 10 treatment sessions. In the PNF group, the same activities were performed by employing PNF principles and techniques. The outcome measures were gait parameters (e.g., stride width, step length, and stride length) and the Locomotor Capabilities Index (LCI). The between-group comparisons at the end of the trial showed that the PNF group showed significant improvement in gait parameters and in the LCI, compared to the TPT group (p < 0.05). The results of the study suggested that prosthetic training based on proprioceptive feedback is more effective than the traditional prosthetic programme in improving ambulatory function.
 
Physical characteristics of participants.
Correlation of 6MWD with age, height, weight, and BMI in combined, male, and female participants.
Stepwise regression analysis of the predictors of 6MWD in combined participants.
Comparison of measured distance in Nigerian participants with predicted distance from foreign regression equations.
Article
The aims of this study were to determine the 6-minute walk distance (6MWD), establish prediction equations for the 6MWD in apparently healthy Nigerians, evaluate any effects regarding participant sex, and compare measured 6MWDs with the predicted 6MWD from reference equations derived from other populations. Four hundred and twenty two (422) apparently healthy Nigerians participated in the study. The 6-minute walk test was carried out according to the American Thoracic Standard-standardised protocol. The 6MWD obtained from the study was compared with reference values from other foreign populations. There were no significant differences between the mean age and mean weight of the male and female participants. However, significant difference existed in the mean height and mean body mass index (BMI; p < 0.001) of these participants. Male participants covered a statistically significant longer distance than female participants (p < 0.001). The mean 6MWD measured in Nigerian participants (517.6 ± 72.2 m) was statistically lower than 6MWD in Americans, Brazilians, and Tunisians and was higher than in Arabians (p ≤ 0.002), respectively. The 6-MWD in healthy Nigerians cannot be predicted by established reference equations from other populations. The regression equations established in this study may better predict the distance for Nigerians.
 
Baseline demographics of the participants
Combination of approach and competency of physiotherapist
Clinical experience and special training of case physiotherapists in the three groups
Article
This retrospective study compared the functional outcomes among stroke patients who had received rehabilitation based on different physiotherapy treatment approaches. The participants were divided into three groups according to the physiotherapist in charge of their treatment. The primary treatment approaches applied in Group A, Group B, and Group C were the functional approach, the Bobath approach, and the motor learning approach, respectively. For each participant, the Berg's Balance Scale score, the Modified Barthel Index, and the Modified Rivermead Mobility Index were compared among these three groups prior to and after the stroke rehabilitation programme. Within-group analysis showed that Group A, Group B, and Group C participants had a statistically significant improvement in their Modified Barthel Index (p < 0.017). Group A and Group C participants had statistically significant improvements in their Modified Rivermead Mobility Index (p < 0.017). Only Group C participants had a statistically significant improvement in their Berg's Balance Scale score (p < 0.017). However, between-group analysis showed no statistically significant difference between the outcomes (p > 0.05). In summary, this study showed that different combinations of treatment approaches may induce similar improvement in functional outcomes after stroke rehabilitation.
 
Participant ratings on the correlates of patient satisfaction 
Article
Patient satisfaction is an important indicator of the quality of care provided to recipients of health services. In Sri Lanka, there is a dearth of research on patient satisfaction, particularly in the arena of physiotherapy services. Such research is important to address any issues in the physiotherapy service, such that patients' needs are better catered for, as well as to improve the marketability of physiotherapy services. The present study aimed to investigate patient satisfaction with the physiotherapy treatment received at a large government hospital in Sri Lanka. A cross-sectional survey study was conducted on a sample of 150 patients receiving physiotherapy treatment using a self-administered questionnaire. This was followed by a focus group discussion. Results indicated that the majority of patients were satisfied with the treatment received. Information on selected correlates of patient satisfaction such as physiotherapist-related factors, patient-related factors, nature of the physiotherapist–patient interaction, professionalism of the service provided, and the logistics of the treatment environment was discussed.
 
Article
Thoracic kyphosis is one of the manifestations of spinal osteoporosis. Since kyphosis is associated with patient symptoms and is a risk factor for loss of function, it would be beneficial to have simple, noninvasive measurement techniques that can be applied in clinical practice. The purpose of this study was to assess the test–retest reliability of the measurement of thoracic kyphosis using the flexicurve ruler in individuals with osteoporosis. Twenty-six females (mean age, 67 yr) diagnosed with osteoporosis had measurements of kyphosis taken in standing by aligning a flexible drafting ruler before and after a 12-week exercise program. The time period was chosen to be consistent with the duration of a physiotherapy intervention. Measures of kyphosis height (cm), length (cm), and an index of kyphosis (height/length) were recorded. Data analysis (intraclass correlation coefficients [ICC]) indicated that the reliability between the trials of the measurement of kyphosis height (0.89) and index of kyphosis (0.93) were high; however, the reliability estimate of kyphosis length was less with an ICC value of (0.54). This study supports the use of the flexicurve ruler for the measurement of kyphosis in elderly women with osteoporosis based on reliability outcomes and the fact that it is noninvasive, inexpensive, and easy to use in a clinical setting. The measurement of kyphosis may be used to determine the response to a therapeutic intervention and in monitoring kyphotic progression.
 
Characteristics of participants. 
Article
The purpose of this study was to determine the effects of augmented reality (AR)-based postural control training on balance and gait function in stroke patients. Twenty-one stroke patients were assigned to either an experimental group (n = 10) or a control group (n = 11). Patients in both groups received a general physical therapy program for a duration of 30 minutes per session, 5 days per week, for a period of 4 weeks. Participants in the experimental group received additional AR-based postural control training for 30 minutes per day, 3 days per week, for a period of 4 weeks. Patients were assessed with the timed up-and-go test, Berg Balance Scale test, and spatiotemporal parameters using the GAITRite system. Results of repeated-measures analysis of covariance showed a significant main effect of time on timed up-and-go test, Berg Balance Scale, velocity, cadence, step length and stride length of paretic and nonparetic sides. In addition, walking velocity, step length, and stride length on both the paretic and nonparetic sides showed a significant group × time interaction effect. The results of this study provide evidence in support of incorporating an AR environment into postural control training for improving gait of stroke patients.
 
Article
Depression has been identified as a risk factor for falls, and a change in balance ability over time has yet to be investigated. This study aimed to identify if, over a 3-year period, balance ability changed in 26 women who were on medication for depression, compared to 26 non-depressed women. The two groups were matched for age, number of co-morbidities, activity level, medications, and height. All participants were simultaneously enrolled in a larger, longitudinal study of ageing. Balance measures included the Functional Reach (FR) test, Lateral Reach (LR) test, Step Test (ST), Timed Up and Go, and the Modified Clinical Test of Sensory Integration and Balance, Unilateral Stance (ULS) and Limit of Stability (LOS) laboratory tests. Results showed a significant difference between the groups on ST, right ULS (eyes closed) and forward end point excursion of the LOS. There was no difference in the number of falls between groups. Analysis of the depressed group alone showed that right FR declined significantly and left and right LR tended towards decline, but not differently between groups. There was no between-group differences for these measures. There was no significant decline in non-depressed women for any measurement. Depressed women have less ability to maintain their balance than non-depressed women, and should be encouraged to participate in appropriate activities known to improve or maintain balance.
 
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