Associations between gait kinematics, gross motor function and physical activity among young people with cerebral palsy: A cross sectional study

INTRODUCTION: The aim of this study was to investigate the association between gait parameters, gross motor function and physical activity (PA) in young people with cerebral palsy (CP). METHODS: Thirty-eight adolescents aged between 10–19 years with spastic CP in GMFCS levels I-III (mean [standard deviation] age 13.7 [2.4] yr; 53%female) were included in this cross-sectional study. Hip, knee and ankle joint excursion and stance time was assessed using 3D gait analysis. Self-selected walking speed was assessed during a timed 10 m overground walk and treadmill walking. Gross motor function was assessed using dimensions D and E of the Gross Motor Function Measure (GMFM-66). Moderate-to-vigorous PA, light PA and step-count were assessed using an accelerometer. Linear regression was used to examine associations. RESULTS: After adjusting for age, sex and GMFCS level, percentage stance time was associated with dimension E of the GMFM-66 (β= –0.29, 95%CI –0.54 to –0.05). There was no evidence that any other gait parameters were associated with GMFM-66 dimensions D or E. There was also no evidence that gait parameters or GMFM-66 dimensions D or E were associated with step-count or time in PA after adjusting for age, sex and GMFCS level. DISCUSSION: The findings provide an insight into the complexity of the relationship between gait quality or ability at the impairment level, function as measured in a controlled environment, and the performance of habitual PA, which is essential for health among children with CP.

Does a bespoke education session change levels of catastrophizing, kinesiophobia and pain beliefs in patients with patellofemoral pain? A feasibility study

OBJECTIVES: To assess the feasibility of a 30-minute education session for patients with patellofemoral pain on levels of catastrophizing and kinesiophobia. DESIGN: Randomised feasibility study SETTING: Three sites within a single NHS Organisation in England. PARTICIPANTS: Thirty-one adult patients were screened for inclusion, resulting in twenty-four who had a clinical diagnosis of patellofemoral pain being randomised equally to either the intervention or control group. INTERVENTION: Participants were randomised to either control or intervention conditions; both received standardized physiotherapy while the intervention/experimental group received a 30-minute educational session addressing causes of pain, beliefs about noise that comes from the joint, the impact of the pain on activity, the influence of other family members’ experience and beliefs about knee pain. Intervention participants were also given an education leaflet: ‘Managing My Patellofemoral Pain’. MAIN OUTCOMES: recruitment, retention, intervention fidelity. Patient reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF), Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK). RESULTS: The study was successful in recruiting and retaining participants and was delivered as intended. In addition, sufficient clinical data were generated to calculate the required sample size for a future study of efficacy CONCLUSIONS: This study which featured a 30-minute education session targeting levels of catastrophizing and kinesiophobia is feasible and identified that the TSK may be the most appropriate PROMs for a future study of efficacy of this intervention. Allowing for a drop out of 20%as identified in similar studies, 86 participants (per arm) in a two-arm study would be required for a traditional randomised controlled trial design.

The association between recently diagnosed cancer and incidence of falling in older adults: An exploratory study

INTRODUCTION: More than one in three older adults (≥65 years) fall within a two-year period. Over one third of cancer diagnoses are among people aged ≥75 years. Falls research in the UK cancer population is limited and contradictory. The aim of this study was to explore the association between a cancer diagnosis and incidence of falls in older adults in England. METHODS: Data were extracted from the English Longitudinal Study of Ageing (an ongoing panel study) collected between 2002 and 2014, consisting of a representative cohort of older adults living in England. Baseline data were collected within two-years of a cancer diagnosis. Falls data were extracted from the subsequent two-year period. The unexposed group included those with no chronic conditions. The fully adjusted logistic regression analysis model included age, sex, wealth, and education level as covariates. We defined odds ratios between 0.67 and 1.5 as the region of practical equivalence. RESULTS: A total of 139 people had a type of cancer (exposed group) (Breast = 18.7%, Colon, Rectum or Bowel = 14.4%, Melanoma or Skin = 7.2%, Lung = 4.3%, Somewhere else = 51.8%) (70.6±7.1 years; 58.3%male) with 3,899 in the unexposed group (69.5±7.3 years; 54.6%male). The fully-adjusted odds ratio was 1.21 (95%CI: 0.81 to 1.82; P = 0.348). The probability of falling among the exposed group was 22.7%versus 19.5%for the unexposed group. CONCLUSION: The cancer and control groups were not statistically equivalent for falls incidence, and a meaningful positive association between cancer and falls cannot be ruled out. Further research is required to elucidate this relationship.

Airway clearance techniques for patients experiencing acute exacerbations of chronic obstructive pulmonary disease in the Republic of Ireland

BACKGROUND AND OBJECTIVES: Airway clearance techniques (ACTs) are used by physiotherapists with the purpose of clearing sputum from bronchial airways. They are commonly prescribed for patients experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPD), however large variability in practice is commonly observed. This study aimed to explore current physiotherapy practice regarding ACTs for people with AECOPD in the Republic of Ireland. METHOD: An online survey was distributed to physiotherapy clinicians via direct email and the Irish Society of Chartered Physiotherapists. Main survey themes, identified from previous studies using the same survey tool, included current practice in relation to use of ACTs, perception of their effectiveness, clinical reasoning and awareness of the literature and guidelines. For the purpose of this study, ACTs were defined as techniques used by a physiotherapist for the purpose of clearing sputum from patients’ airways. RESULTS: 202 surveys were distributed and seventy responses (35%) were received. The majority of respondents (n = 56, 80%) reported prescribing ACTs for more than 60%of patients with AECOPD, the most common techniques being physical activity (n = 65, 93%) and active cycle of breathing techniques (n = 53, 90%). Sputum management (n = 66, 94%) was the most commonly reported indicator for use of ACTs. The majority of physiotherapists (n = 42, 60%) reported being unsure of the literature regarding ACTs in AECOPD. CONCLUSION: The response rate to this survey was low, however results show that physiotherapists in the Republic of Ireland regularly prescribe ACTs for patients with AECOPD. Physical activity and active cycle of breathing techniques were the most commonly used ACTs and perceived to be the most effective techniques in AECOPD, with sputum management the most commonly reported indicator for use. Further research is required to explore not only physiotherapists clinical reasoning in relation to the use of ACTs for AECOPD and the perceptions of their effectiveness, but also the lack of awareness of the literature and guidelines.

Physiotherapists are knowledgeable about sport-related concussion

PURPOSE: Sport-related concussions (SRC) are common, especially in rugby (3.00 incidents per 1000 athletic exposures) and American football (0.08 per 1000 athletic exposures). Physiotherapists should be aware of how to assess and manage cases with SRC. The purpose of this study was to assess the knowledge of SRC among physiotherapists. METHODS: The self-administered survey consisted of 16 questions related to physiotherapists’ knowledge in managing SRC patients, case identification, and preventive measures. Countries were divided into regions based on World Physiotherapy regions. Data were analysed using a one-way Analysis of Variance (ANOVA) with Tamhane’s T2 post hoc test. RESULTS: A total of 276 male (53.4 %) and 241 female (46.6%) physiotherapists participated. The survey scores ranged from 40%to 100%, with an average score of 62.7%. A master’s degree was the highest educational qualification (46.4%) recorded. There was a difference in the score based on participant qualifications (Welch’s F (4, 58.37) = 15.03, p < 0.001). Participants with a Doctor of Philosophy (PhD) degree (73.8±14.6%) or a fellowship (73.0±19.5%) or a masters’ degree (MSc) (62.7±18.5%) obtained greater scores than participants holding a bachelors’ degree (56.7±13.8%, p < 0.001). Furthermore, there was no difference in the survey score based on participants’ region (Welch’s F (4, 143.3) = 0.08, p = 0.988). CONCLUSIONS: The results suggested that many physiotherapists worldwide are aware of the current SRC assessment and management guidelines.

Older adults’ experience of active computer gaming for falls prevention exercise: A mixed methods study

PURPOSE: This mixed methods study explored older adults’ experience using a bespoke active computer gaming (ACG) system designed to deliver falls prevention exercise. METHODS: Usability, acceptability and safety were evaluated through observation of system use, questionnaires, in-system ratings, and semi-structured interviews. Quantitative and qualitative data were synthesised concurrently to provide a deeper understanding of older adults’ experience with the system. RESULTS: N = 7 older adults (aged 73–88 years, most with increased fear of falling, and over half with reduced physical functioning) completed up to six uses of the system. Observations and qualitative feedback suggested that older adults’ experience with the system was influenced by physical health changes associated with ageing. Overall feedback after using the system was positive. Social support, from either the clinician or a peer, was a key theme influencing experience. CONCLUSIONS: Findings suggested that autonomous use of the system may not be feasible given the requirement and preference for social support.

Attitudes of nurses, physiotherapy assistants and masseurs towards low back pain treatment

PURPOSE: We evaluated the attitudes of nurses compared to physiotherapy assistants and medical masseurs (PAMs) regarding various treatment modalities used in the treatment of low-back pain (LBP) as their opinions might influence the patients’ attitudes to therapy. DESIGN: Cross sectional self-reported questionnaire survey. METHODS: 175 Hungarian health care providers completed questionnaires evaluating their opinions on the importance of various therapeutic interventions and the need for initiation of LBP treatment. Their personal LBP history and fear-avoidance beliefs (FABQ) were also investigated. FINDINGS: The importance of exercise therapy (p = 0.024) and massage (p < 0.01) was evaluated higher by the PAMs, while medication (p = 0.04) was scored higher by the nurses. Those who experienced moderate or severe LBP were more positive about pain medication than to those with mild pain (p = 0.048). Years in health care work had only a weak association with opinions. The nurses reported more fear-avoidance beliefs than the PAMs about both physical activity (p = 0.024) and work (p = 0.021). Those who experienced moderate or severe LBP had higher FABQ scores (p = 0,076), however the difference was significant only for FABQ activity (p = 0.035). CONCLUSIONS: Our study confirmed that professional background and years of experience can influence the attitudes towards the importance of certain therapies, although these differences were small. Experiencing moderate or severe LBP increased the fear-avoidance beliefs about work and physical activity independently of the professional background. CLINICAL RELEVANCE: Our study draws the attention to the importance of standardization of the information to be passed to the patients and to the need of discussing personal experiences and beliefs during professional training.

Exercise as a treatment for clinical depression in adults and progressing the physiotherapists role: A systematic review and meta-analysis

BACKGROUND: There has been extensive literature examining the efficacy of exercise interventions in the treatment of depression over the past few decades. However, there is ongoing debate regarding the optimal dosage and the implications of utilising physiotherapists for the management of clinically depressed adults using exercise has not been examined. OBJECTIVES: This review aimed to examine the effectiveness of exercise as a treatment for depression (without comorbidities) and to determine the most effective dosage/mode to treat this population. This review strived to appraise the literature for a potential role for physiotherapists in depression management. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, a search for randomized controlled trials was conducted on the nine databases. All studies were appraised for quality using the Physiotherapy Evidence Database (PEDro) scale and Cochrane Risk of Bias Tool (RoB). Data was manually extracted, and pre- and post-intervention depression scores and program variables were analysed. RESULTS: Of the 5036 papers retrieved, 7 papers met this review’s inclusion criteria. The results of the meta-analysis reveal that exercise as a sole treatment and as an add-on is significantly effective in reducing depressive symptoms. The findings support the use of moderate intensity aerobic exercise for three sessions per week. CONCLUSIONS: Exercise was shown to significantly improve depressive symptoms in depressed adults. This review adds to the growing body of evidence regarding the important role of physiotherapists in the treatment of psychiatric disorders in the design and implementation of exercise interventions.

Prevalence of urinary incontinence in a cohort of women with obesity

INTRODUCTION: Urinary incontinence (UI) is frequently associated with obesity. The prevalence of the different UI types in women with obesity remains scarcely investigated and controversial. OBJECTIVE: The goal of this study was to investigate the prevalence of the different types of UI (stress urinary incontinence, SUI, urge, UUI, or mixed, MUI) in a large sample of female patients with obesity by means of a specific questionnaire and non-invasive tests. METHODS: In this observational study, 248 obese female patients (BMI≥30 Kg/m2, age: 62.8 + 10.9 years) admitted to hospital from April 2019 to September 2019 for a multidisciplinary rehabilitation program were recruited for this study. The International Consultation on Incontinence Questionnaire - short form (ICIQ-sf) was used to screen the presence of symptoms of UI and to differentiate the different UI types. Patients with ICIQ-sf score≥4, were asked to undertake the Pad Test for quantifying urine leaks under stress. RESULTS: 61.69%of our sample presented UI symptoms. The prevalence of UI appears to be lower in younger age groups (57%in 31–46 years of age and 52%in 47–62 years of age) and higher (69%) between 63 and 79 years of age. MUI was the most frequent form (57.5%), followed by UUI (21.5%) and SUI (20.9%). SUI was most prevalent in younger participants (31–46 years old). CONCLUSION: This study demonstrated that UI has a high prevalence in females with obesity and it is not an exclusive concern of older women. This high prevalence calls for specific rehabilitation interventions within multidisciplinary programs.