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The COVID-19 pandemic has resulted in a total of 676 million cases of infection and 6.9 million deaths. During a pandemic, healthcare workers are exposed to psychological stressors such as high risk of infection, inadequate protection, and isolation, which could have implications for their wellbeing. The purpose of this qualitative literature review carried out systematically was to examine the views of physiotherapists who worked with COVID-19 patients during the COVID-19 pandemic to identify how physiotherapy services might be better prepared for future pandemics. A systematic search was carried out across four databases (CINAHL, MEDLINE, PsycINFO, SPORTDISCUS) to identify relevant studies. Studies were assessed for quality and data extracted and analysed using thematic synthesis. A total of 631 studies were identified through the search strategy and screened against the inclusion/exclusion criteria. Six papers met the inclusion criteria. Four themes were identified from the perspective of the physiotherapy participants: lack of resources; emotional impact; coping strategies and integration; and value within the multidisciplinary team. Overall qualitative evidence around the views of physiotherapists who worked during the COVID-19 pandemic is limited. An insight into the views of participants may help healthcare organisations support physiotherapy services to be better prepared in the event of a future pandemic, specifically addressing the need to strengthen supply chains, advocating for physiotherapy as a profession in low-income counties and psychological resilience. Future research should focus on identifying the most effective support options and strategies to build psychological resilience before a crisis occurs. [ABSTRACT FROM AUTHOR]

The biopsychosocial model of pain may aid the understanding pain and its clinical presentations. This paper presents a discussion of the past, present and future state of the biopsychosocial model of pain within physiotherapy. The biopsychosocial model of pain acknowledges the dynamic interdependent biological, psychological and social dimensions of peoples pain experiences and has been widely endorsed. However, the biopsychosocial model is not beyond criticism and its applicability to clinical practice has been questioned. Researchers have investigated how clinicians understand and apply the biopsychosocial model in clinical practice. Evidence suggests that physiotherapists demonstrate varying levels of confidence and proficiency in their psychosocially-oriented clinical knowledge and practice. Psychologically informed physiotherapy treatment approaches have been described and trialled and show inconsistent results and effect sizes with respect to patient-related outcomes. In addition, commentators suggest that the '-social' dimension of the model has been relatively neglected. While there is some evidence that the biopsychosocial model is evolving, and efforts are underway to develop and validate clinically-applicable tools, physiotherapy clinicians, educators and researchers have been invited to consider existing barriers and enablers to the implementation of the biopsychosocial model in clinical practice in order to improve its understanding and application within healthcare. The biopsychosocial model invites clinicians to understand and address the biological, psychological, and social dimensions of patients pain. Understanding and implementation of the biopsychosocial model of pain in physiotherapy is mixed. Improving education and training and developing and evaluating innovative biopsychosocial-oriented interventions appear to be important ways forward. The biopsychosocial model of pain is evolving in response to scientific and clinical developments. [ABSTRACT FROM AUTHOR]

Objectives: To identify the definitions used for treatment fidelity in the behaviour change literature and to explore the extent to which the assessment of fidelity has been reported according to the five domains by Bellg et al. Methods:Three databases (Scopus, Medline Ovid and CINAHL) were searched. Results were limited to studies published between 2012 and 2015. Definitions/summaries of treatment fidelity used were recorded. Methods for assessing/monitoring treatment fidelity were extracted, summarised and categorised according to the five domains. Results:Sixty-five papers were included for analysis. A definition of treatment fidelity was provided byn = 34 studies;n = 9 defined fidelity according to Bellget al.In the context of treatment fidelity,n = 9 (13.8%) reported on study design;n = 22 (33.8%) reported on an element of training of providers;n = 59 (90.7%) papers reported on delivery of treatment;n = 13 (20%) reported on receipt of treatment; andn = 10 (15.3%) reported on enactment of treatment skills. Conclusion: The definitions of treatment fidelity in the literature and the extent to which it has been reported were limited. Delivery of treatment was the most frequently reported component of treatment fidelity but other important aspects were poorly reported. The potential consequence of this is that translation of research interventions into clinical practice may not be optimised. [ABSTRACT FROM PUBLISHER]

Women need to engage in effective quadriceps resistance training programmes following anterior cruciate ligament reconstruction. Recent research has supported follicular phase-based resistance training for enhancing resistance training strength outcomes in eumenorrheic females. It is unclear whether research has investigated menstrual cycle phased resistance training programs in eumenorrheic females post-ACLR or whether there is a gap for further research in this area. This scoping review aims to describe what is known about menstrual cycle phased resistance training programmes in injured and non-injured eumenorrheic females, identify any existing gaps in knowledge, and propose future research. The research team will search five databases using predetermined search terms. Eumenorrheic female participants undergoing a menstrual cycle phased resistance training programme for at least one menstrual cycle length will be included. All studies must be in the English language and published in academic journals. The research team will evaluate relevant titles and abstracts against the eligibility criteria. Potentially relevant sources will be retrieved in full. The full text of selected studies will be assessed in detail against the inclusion criteria by two reviewers. The research team will extract data from included papers using a data charting form. The review will present all results in table format accompanied by a narrative summary. Results are not yet known. This will contribute to the understanding of methodologies and outcomes of menstrual cycle phased resistance training programmes, and indicate whether there is a role for future research in injured and non-injured populations. [ABSTRACT FROM AUTHOR]

A high proportion of people are insufficiently physically active. The reasons for this are complex and in part relate to social determinants of health, lifestyle choices, and deleterious environmental conditions like climate change, loss of green and outdoor environments and a concomitant loss of biodiversity. Physiotherapists, and other health professionals, may have a positive impact on these global issues, through the encouragement of active transport, and advocacy to reduce barriers to its uptake and optimize exposure to health-giving outdoor spaces. In this paper, we demonstrate how physiotherapists can promote active transport as a planetary health intervention, and provide insight into the benefits and challenges of this planetary health intervention, with direct implications to physiotherapy practice. [ABSTRACT FROM AUTHOR]

Background: Fibromyalgia (FM) is characterized by chronic, widespread musculoskeletal pain, extensive fatigue and an array of other symptoms. Cure is not expected, and patients have to learn to live with the illness. During the last years several studies have examined how it is like to live with FM from a patient's point of view. These findings may help physiotherapists to better understand the challenges faced by patients. Objective: To describe what it is like for patients to live with FM and discuss how this may inform physiotherapy practice. Design: A systematic literature search of qualitative studies up till May 2016 was conducted, and 93 papers were read. The focus was on patients' experiences of symptoms and how they managed everyday life. Results: Incomprehensible, unpredictable symptoms of FM intrude and disturb everyday life. The body is constantly monitored by patients on a day-to-day basis according to fluctuations in pain and energy levels, and habits and routines of daily life are adapted to these shifts. With other words, the connection between body, self and daily life is ruptured. In contrast, those having recovered from FM had found out what they could tolerate during a day and had spent long time in rebuiding a life worth living. Conclusion: The present paper presents an argument that living with FM calls for a rather complex personal healing process that should be recognized and supported by physiotherapists. [ABSTRACT FROM AUTHOR]

Background: Menopause is considered a risk factor for pelvic organ prolapse (POP). Although level 1 evidence exists for pelvic floor muscle training (PFMT) for reducing POP symptoms in the adult population, it is less clear whether it is as effective in post-menopausal women. Objectives: This scoping review investigates supervised PFMT for improving POP signs or symptoms in this population. Methods: Seven databases were searched in December 2023. Five articles were included in the literature review (four RCTs and one SR). Included articles were assessed for quality and risk of bias using the Physiotherapy Evidence Database (PEDro) scale. Major Findings: The included studies found small but statistically significant results in favour of PFMT compared to controls to improve either POP symptoms or signs in post-menopausal women, with no adverse events from PFMT. Further robust studies are needed. Conclusion: Clinicians can offer PFMT to post-menopausal patients presenting with POP based on evidence, sound underlying physiological principles, and a lack of adverse events. A sample pelvic floor muscle training program is described, along with recommendations for multi-disciplinary input. [ABSTRACT FROM AUTHOR]

Background: Current evidence regarding the management of and functional recovery from long COVID suggests there is no standardised, universally accepted, evidence-based physiotherapy protocol specifically tailored to long COVID patients. Objective: To assess the impact of physiotherapy, either group or individualised, on symptoms and quality of life (QoL) in working aged adults with long COVID symptoms following mild COVID-19. Methods: MEDLINE via Ovid, Embase via Ovid, Scopus, PubMed, World Health Organisation Database, CINAHL via Ebsco, and Web of Science were searched from inception up to 27th of June 2024. The protocol was registered with PROSPERO (registration number CRD42023392999). Results: Twelve studies involving 508 individuals were included. The three main categories of interventions identified were respiratory physiotherapy rehabilitation (n = 3), virtual and telerehabilitation (n = 5), and case reports with varied physical interventions (n = 4). Primary outcomes showed an improvement in the 6-min walk test following intervention (p < 0.001 in three studies, and one case study). Improvement in fatigue and breathlessness as demonstrated by modified Medical Research Council dyspnoea scale (p < 0.001), the 15-item King's Brief Interstitial Lung Disease (KBILD) (p < 0.05) and fatigue severity scale (FSS) (p < 0.05). Secondary outcome benefits of perceived wellbeing were detected in all the studies that included QoL measures. Conclusions: Physiotherapy can be an effective intervention to mitigate the most commonly reported long COVID symptoms. Some studies also show improved patient perceived wellbeing. Post-exertional symptom exacerbation (PESE) was considered in only three rehabilitation interventions for long COVID sufferers. The varied interventions employed for long COVID symptom management reflect the wide-ranging and varying symptoms described in these populations. The different categories of interventions used highlight that the rehabilitation services need to be equally wide-ranging and individualized regarding exercise planning, length and frequency of treatment sessions and overall intervention duration. [ABSTRACT FROM AUTHOR]

Background: Recent advances in technology have made possible the delivery of health services to patients remotely, and telerehabilitation for stroke survivors has emerged as a promising intervention. This systematic review assessed the clinical effectiveness of telerehabilitation (TR) programmes on quality-of-life (QoL) of stroke survivor compared to standard care. Methods: MEDLINE, CINAHL, AMED, Web of Science, and Scopus databases were searched from inception to 10 June 2022. Studies were considered eligible for inclusion if they fulfilled the following criteria: assessed the efficacy of different telerehabilitation models in poststroke patients, employed randomised controlled trial, and non-randomised design, stroke survivor adults age ≥ 18 years, health-related quality of life outcome, and full text available. Data were extracted by two independent researchers. Risk of bias was assessed by the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed among trials presenting with similar clinical characteristics. Results: A total of 11 eligible studies that met the inclusion criteria were included in the review. These studies were conducted in Brazil (n = 1), Italy (n = 2), the Netherlands (n = 1), South Korea (n = 1), Taiwan (n = 1), United Kingdom (n = 1) and United States (n = 4) between 2004 and 2020. Except for blinding of participants to study group allocation, all the studies were (>50%) at low risk of bias to considering adequate sequence generation, allocation concealment, blinding of trial personnel or outcome assessors, evaluation of incomplete outcome data, and lack of selective reporting. The meta-analysis (n = 5) included 306 individuals with duration of follow-up ranged between 4 and 12 weeks. We found that there were no statistically significant difference (SMD = 0.089, confidence interval (CI) 95% = −0.184 to 0.362, p = 0.522) for Stroke Impact Scale between the interventions and the control. Conclusion: The review provides evidence for the effectiveness of TR interventions to improve the QoL of stroke survivors in a short term. Further research studies are required to examine the effectiveness of TR interventions for stroke survivors in a long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews are potentially less biased and provide more precise estimates than primary studies of diagnostic test accuracy. Their use to inform evidence-based diagnosis is rapidly expanding. However, the extent, scope and methodologies of systematic reviews of studies of the accuracy of diagnostic tests relevant to physical therapy have not yet been described. Information about methods used in these systematic reviews could inform future reviews and subsequently improve evidence-based diagnosis in physical therapy. Objectives: To describe the systematic review methodology of diagnostic test accuracy studies relevant to physical therapy. Methods: All systematic reviews indexed on DiTA (Diagnostic Test Accuracy database) were included. Data on methodology, reporting characteristics, and review topics were extracted. A random sample was assessed for risk of bias using the Risk Of Bias In Systematic Reviews (ROBIS) tool. Results: The review included 241 reviews published between 1995 and 2022, covering all 10 major physical therapy subdisciplines, although 90% related to musculoskeletal physical therapy. In 72% of reviews, QUADAS and QUADAS-2 were used to assess the risk of bias. In a random sample of included reviews, 47% of reviews displayed a 'high' risk of bias. Conclusions: Systematic reviews of diagnostic test accuracy studies relevant to physical therapists are becoming more prevalent. There is a relatively large number of these reviews however a large proportion use methods that expose them to bias. This makes the interpretation of their results more difficult. Future research could focus on publishing methodology guidelines for physical therapy-relevant diagnostic test accuracy reviews. [ABSTRACT FROM AUTHOR]

The importance of treating the psychological well-being of patients is increasingly recognised as an integral part of physiotherapy provision and specified in the World Health Organisation (WHO) and National Institute for Health and Care Excellence (NICE) guidelines. However, the term psychology encompasses a huge variety of aspects including; communication skills, goal setting, imagery, personality theories and effective inter-disciplinary practices which need be trained. The purpose of this review is to explore the historical development of physiotherapy as a profession in the context of present standards requiring physiotherapists to manage psychological issues that impact rehabilitation. The review will focus specifically on how the role of psychology in practice has evolved and whether this is reflected in current physiotherapy training programmes. Electronic papers were identified through a rigorous search of CINAL, AMED, MEDLINE, PsychINFO and EMBASE. Due to the historical exploration of this review, no time limits were applied to the searches and articles were retrieved as far back as 1894. The history of the profession demonstrates a very ‘hands on’ approach to treatment with minimal psychology related practices. Whilst numerous studies exploring psychology training in physiotherapy have reported significant inconsistencies across UK undergraduate physiotherapy programmes. Due to shifts in the dynamics of healthcare, it is apparent that physiotherapy programmes would benefit from including psychology skills training, as a core module, to meet these ever changing demands. Future research should explore what psychological interventions physiotherapists currently utilise in daily practice, as well as practitioner feelings on the standard and relevance of the psychology content provided in their formal training. [ABSTRACT FROM PUBLISHER]

There is a growing call for healthcare to focus on person-centred practice. This can lead to improved outcomes for patients in terms of physical and psychological health. Challenges exist around how person-centredness is understood in physiotherapy. Having a physiotherapy framework would help support a shared understanding of the meaning of person-centred physiotherapy. The aim of this study was to locate and synthesise studies which have a conceptualisation of person-centred physiotherapy practice. These were used to develop an overarching conceptual framework for person-centred physiotherapy practice. The framework was developed through a systematic process involving a systematic literature search, screening studies against eligibility criteria, data extraction, data synthesis, naming and defining core constructs of person-centred physiotherapy practice, and generation of a pictorial representation of an overarching conceptual framework. The person-centred physiotherapy framework is comprised of four constructs: physiotherapist characteristics, which focuses on the knowledge and skills for clinical proficiency, attributes of the physiotherapist, reflection and self-awareness; person-physiotherapist interaction(s), which focuses on partnership, empowerment and self-management; the environment, which focuses on coordinated healthcare delivery, culture of the organisation and practice environment, and the physical environment; and the ongoing unique journey of the person and self-management. The relationships between the constructs reflect the complex nature of person-centred practice. The framework presented can be used to better understand person-centred physiotherapy with a view to enhancing practice. The framework needs to be tested further through empirical research to establish its utility. [ABSTRACT FROM AUTHOR]

Students' experiences of the clinical learning environment are crucial to learning and professional development. Earlier research using the Undergraduate Clinical Education Environment Measure shows that students' perceptions of supervision vary significantly between undergraduate programs, with physiotherapy students scoring higher than other students. We explored physiotherapy students' experiences of supervisors' preparedness, familiarity with learning outcomes, and supervision practices during their first clinical placement. Individual semi-structured interviews were conducted with 13 physiotherapy students. The interviews were analyzed using qualitative content analysis according to Graneheim and Lundman. Within the latent theme A coherent whole throughout the placement, three manifest categories were found: Establishing a relationship, Fostering active participation, and Cultivating outcome-based learning. The students valued a supervisor who was prepared for the initial meeting and wanted to establish a relationship. When the students experienced a sense of trust, they dared to ask questions. The supervisors encouraged students to move beyond the one-to-one relationship and cooperate with others in the community to develop autonomy. Self-assessment enabled the students to identify their own learning needs and enhanced the possibility of achieving intended learning outcomes. The supervisors repeatedly returned to the learning outcomes. Physiotherapy students highly regarded supervisors who established a relationship and fostered active participation by being available, promoting student autonomy, and encouraging cooperation in the community. The continual use of intended learning outcomes helped students identify their learning needs and achieve the outcomes. [ABSTRACT FROM AUTHOR]

Previous reviews have reported the efficacy of exercise interventions following total hip arthroplasty (THA), but poor inter-study comparability of low-quality studies, and outcome measure heterogeneity predominate. Conclusions regarding exercise intervention efficacy following THA are lacking. Conduct a systematic literature review with meta-analysis to report the effects of exercise following THA, using self-reported outcome measures of function and pain, and clinical tests for gait capacity. An electronic database search of CINAHL, Informit, Medline, Physiotherapy Evidence Database, Scopus, and SportDiscus was conducted. Included studies (1) reported exercise interventions in adult populations following THA; (2) reported outcomes either of physical function, pain intensity, or clinical gait capacity; (3) were randomised controlled trials published in English. Study appraisal was conducted using PEDro scale. A meta-analysis was conducted to report intervention effect size and statistical significance between experimental and control groups. Searches yielded 5,997 studies. Twenty-four studies underwent systematic review. Twelve were eligible for meta-analysis. Study quality ranged from fair to excellent (median = 7, range = 5–9/10). Exercise interventions included hydrotherapy, and progressive resistance, gait, task-based, upper-limb, and sports therapy training. Significant between-group differences in self-reported function, pain, and gait velocity were observed at short-term follow-up, favouring exercise intervention groups. At long-term follow-up, these improvements were not significant. This review identified that exercise interventions significantly improved self-reported physical function, pain intensity and gait velocity following THA in the short term. Further research is required to clarify long-term exercise effects, and the most effective exercise intervention, in studies which detail the interventions explicitly. [ABSTRACT FROM AUTHOR]

Optimum rehabilitation following Rotator Cuff Repair (RCR) remains a contentious topic. A wide range of often conflicting evidence and opinion exists regarding several aspects of the rehabilitation process. This has resulted in a wide variety of different post-operative protocols and uncertainty regarding the need for immobilisation, initiation of exercises and rehabilitation progression. In this climate of uncertainty, it appears that rehabilitation protocols have remained largely unchanged for over two decades despite the large volume of new evidence. This narrative review examines common assumptions that surround rehabilitation following RCR in the light of contemporary evidence. It is hoped this will aid clinicians when making decisions for this patient group. [ABSTRACT FROM AUTHOR]

Greater trochanteric pain syndrome (GTPS) is an umbrella term used to describe several pathologies contributing to lateral hip pain. The most prevalent pathology is gluteal tendinopathy. Conservative management of GTPS is predominantly now focused on the use of corticosteroid injections (CSIs) and gluteal exercises. To compare CSIs and gluteal exercises on pain in adults with GTPS. A systematic search of AMED, CINAHL, MEDLINE, EMBASE, TRIP and the Cochrane Library was conducted from inception to January 2021. Critical appraisal was completed using the Critical Appraisal Skills Programme tool. Data were extracted to obtain population characteristics and procedural details. Seven articles met the eligibility criteria out of a total of 336; five articles were randomised control trials (RCT) and two were cohort studies, equivalent to 758 and 70 participants, respectively. Studies generally reported significant benefits of CSIs <12 weeks and gluteal exercises >8 weeks for the reduction in lateral hip pain (p <.05). Critical appraisal demonstrated varied study quality and significant heterogeneity. CSIs appear to be a successful treatment intervention in the short-term to decrease lateral hip pain but not in the long-term. Gluteal exercises plus education on avoiding tendon compression appears to be as successful as CSIs in the short and superior in the long-term. [ABSTRACT FROM AUTHOR]

This article puts forwards a conceptual model for representing management options for people with musculoskeletal problems. The model is introduced as a dichotomy, that of symptom modifying care versus condition modifying care. From this starting point, the model is discussed and critiqued, culminating in a summary of the possible usefulness of such a model. [ABSTRACT FROM AUTHOR]

The use of the International Classification of Functioning, Disability and Health (ICF) as a framework to scaffold students' clinical reasoning is recommended to address the multifactorial context of service delivery and complexities of health issues. However the application of the ICF in clinical reasoning is still not optimal due to personal and institutional factors. To train students to use the ICF in clinical reasoning, we need to understand both the students' and the educators' perspectives on its use as a framework. The purpose was to explore and compare perspectives of physiotherapy educators and graduates toward applying clinical reasoning using the ICF as a framework. a qualitative approach adopting interpretive research paradigms was employed to understand how educators and graduates perceive the use of ICF in clinical reasoning. Two focus groups were used for data collection. Six graduates and five educators participated in the study. We identified five common themes between educators and graduates that described how the application of the ICF shaped clinical reasoning during students' final year of study. These themes represent different approaches toward practicing clinical reasoning using the ICF, namely; critical thinking, workplace environment, holistic, activity and participation, and patient-centered. results revealed that the use of the ICF in clinical reasoning helped students develop contextual awareness and adopt a holistic and patient-centered approach. Some challenges like unsupportive workplaces were reported by both educators and graduates which hindered the use of the ICF in clinical reasoning. Another challenge reported by graduates and having a negative impact on their learning was different expectations from educators. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a progressive disease causing pain and reduced range of motion (ROM), decreasing function and activity participation. Physiotherapy interventions improve symptoms and quality of life. Goniometry is one method for measuring ROM. To conduct an integrative review investigating use of ROM for participants with knee OA following physiotherapy interventions in clinical trials, including reliability, validity and responsiveness of goniometry for measuring knee ROM. Forty-two articles fulfilled the inclusion criteria. Twenty-six studies used OA patient-reported outcome measures in addition to ROM. Twenty-eight studies reported their own psychometric data, with generally excellent inter- and intra-rater reliability. Nine reported good to excellent criterion validity. Four studies reported limited and variable data on responsiveness. Knee ROM is commonly used as an outcome measure in clinical trials of people with knee OA. Goniometry is a reliable and valid way to measure knee ROM, and is a convenient, accessible outcome measure for clinical trials and physiotherapy practice. We suggest combining patient-reported outcome measures with goniometry may provide a more holistic view of the person's wellbeing, function, and participation. Further research is needed to gain a broader understanding of the validity, and responsiveness specifically for people with knee OA. [ABSTRACT FROM AUTHOR]

E-sports is becoming increasingly popular; however, participation is not without risks. Certain lifestyle factors associated with gaming may have negative effects on the wellbeing of the players. This systematic review of current studies of e-athletes' health and wellbeing, primarily focused on athletes level of physical activity. This review also aimed to gain insight on potential health promotion and management strategies for e-gamers and e-athletes. Four online databases (Medline, SCOPUS, Web of Science, and EBSCO) were searched for full-text English articles published between 2010 and April 2020. A total of six articles met the inclusion criteria and were included for review. From the six studies, five themes were identified: (1) demographics of e-sports; (2) e-athletes' level of physical activity, compared to World Health Organization (WHO) guidelines; (3) reasons to engage in physical activity; (4) physical training as a part of e-sport training; and (5) degree of sedentary time. Other findings included e-sports injuries reported by participants, broader aspects of health behaviors, along with proposals for multiple disciplinary team approaches to e-athlete management. Despite the level of sedentary behavior and e-sports related injuries from the reviewed studies, the majority of e-athletes in the studies included met WHO physical activity guidelines with health promotion as primary motivation. Other health behaviors (sleep and diet) are particularly relevant to e-athletes. More research is needed to better understand this population's health-related behavior and habits to better establish their wellbeing and health risks. [ABSTRACT FROM AUTHOR]

Telehealth services may decrease costs, improve efficiency, and increase access for health care delivery. Telehealth has been used extensively in rehabilitation of various cardiopulmonary and neurological conditions with high clinical efficacy. However, there appears to be limited information regarding the provision of telehealth for managing musculoskeletal lower limb disorders and injuries. To determine for which lower limb conditions telehealth has been used, and to describe the delivery mode and the content of that telehealth, when provided by physiotherapists. Scoping review. A computerized search of Cochrane Library, PEDro, Medline, Scopus, SPORTDiscus, Web of Science, PubMed, and CINAHL was conducted up to the 5 April 2020. A search strategy was developed and adapted to each database. Studies were included if they investigated assessment or rehabilitation of a lower limb musculoskeletal disorder and utilized real-time telehealth physiotherapy sessions. We included primary studies, randomized controlled studies, nonrandomized clinical trials, and agreement studies. Ten studies were included in the review, categorized into two groups: assessment (five studies), and intervention or rehabilitation (five studies) via telehealth. Seven of those studies included patients who had undergone hip or knee arthroplasty. Nine studies utilized synchronous internet-based videoconferencing and one study used phone interviews as the method of delivering assessment or rehabilitation information. Telehealth was used as a means of assessment of a variety of lower limb conditions, while rehabilitation via telehealth was limited to patients with hip or knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Chronic pain affects approximately 28 million people in the UK. It does not always respond to conventional curative treatments and can have a devastating impact on an individual's ability to function and perform life roles in the way they would like. Psychological approaches to pain management have been advocated for over 40 years, but it is unclear whether the addition of such approaches to physiotherapy increases treatment effectiveness. Objectives: To systematically review the literature to determine whether the addition of psychological approaches to physiotherapy is more effective in improving physical functioning and quality of life than physiotherapy alone. Methods: An electronic database search focused on randomised controlled trials comparing a physiotherapy intervention for chronic pain with a matched intervention with an additional psychological therapy component. All eligible studies were independently reviewed by two researchers and the strength of evidence and results evaluated. A meta-analysis was conducted on post-test mean data for physical functioning. Results: Eight studies were identified for inclusion. Meta-analysis of the data showed combined treatments to be superior in modifying functional outcomes (standardised mean difference −1.12 95% confidence intervals −1.94 to −0.31). This was echoed in the narrative review of the quality of life evidence. Study quality was variable and thus the findings should be interpreted with caution. Conclusions: There is evidence that combining physiotherapy and psychological approaches improves physical function in chronic pain in comparison with physiotherapy alone. Further examination of this field is required to inform changes in practice and to develop treatment methods. [ABSTRACT FROM AUTHOR]

Background:Despite no significant advantage being demonstrated for its use and no standardization of treatment guidelines, electrical stimulation is still applied by therapists to treat facial paralysis. The aim of this investigation was to determine whether electrical stimulation therapy for patients with acute or chronic facial nerve paralysis improves time to, and rates of full recovery and facial function compared with no intervention. Method:A systematic review of randomized and quasi-randomized controlled trials through Scopus, Medline, PEDro, Embase, CINAHL, Pubmed, and Cochrane Library search engines for studies published up until August 2016. Reference lists were reviewed for further studies. Review Manager was used to extract data and review quality of the studies. Studies were assessed for randomization of participants, allocation concealment, blinding of participants, assessors and physiotherapists, presence and reporting of outcome data. Results:Five studies were included for analysis – four during acute recovery and one in chronic facial nerve paralysis. In acute facial nerve paralysis, two studies found no benefit of electrical stimulation and two studies found improvement. A meta-analysis on changes in the House–Brackmann Score after treatment, rates of full recovery and time to full recovery showed no statistically significant difference between intervention and control groups. In chronic facial nerve paralysis, one study found improvements after extensive electrical stimulation on the Facial Paralysis Recovery Profile. Conclusions:There is no evidence to support the use of electrical stimulation during the acute phase of recovery after Bell’s palsy and there is low-level evidence for patients with chronic symptoms. Furthermore, there is no evidence available on the use of electrical stimulation for other causes of facial nerve paralysis. [ABSTRACT FROM AUTHOR]

Background:The capacity of physical therapists to reason effectively in patient management is essential to maximizing outcomes. Although conceptual frameworks of clinical reasoning exist, their theoretical foundations are insufficiently validated to establish those factors that are paramount in guiding physical therapists’ clinical reasoning. Studies on how physical therapists clinically reason constitute important means of identifying constructs of such reasoning. Objective:This systematic review aimed to synthesize and interpret the findings of qualitative studies designed to examine factors that are inherent in physical therapists’ clinical reasoning with respect to their knowledge, experiences, and practices. Methods:Searches of studies were carried out in four databases, gray literature, and reference lists. Two reviewers independently assessed methodological quality of the studies using the Critical Appraisal Skills Program (CASP) and performed the analysis: extraction and comparative appraisal of findings, identification of themes, reciprocal translation synthesis, and identification of categories and subcategories. Results:Ten studies were included. Four themes of factors influencing physical therapists’ clinical reasoning emerged, namely, Physical therapist as a source, Patient as a source, Elements of the reasoning process, and Context. Conclusions:The identified themes validated some constructs underlying existing clinical reasoning frameworks. Most influencing factors were related to the physical therapist, which highlights opportunities to improve effective reasoning at this level. The notion that this process is recurrent, multifaceted, and contextual lends itself to changing in accordance with the needs of the patient, consistent with a biopsychosocial perspective. How clinicians weigh biomedical and psychosocial elements in their reasoning however warrants further study. [ABSTRACT FROM AUTHOR]

Background:A recent advancement in physiotherapy in Australia has been the development of Extended Scope Physiotherapy Practitioner (ESPP) roles. However, compared to the UK, ESPP roles in Australia have generally been introduced in a piecemeal fashion. To assist with defining ESPP roles and credentialing requirements for ESPP in Australia, we felt it was important to engage with context-specific key stakeholders. This study sought to understand the perceptions of a range of key stakeholders on the ESPP role in Australia, using qualitative interview techniques. Methodology:Semi-structured interviews were held with medical, nursing and allied health professional staff employed within an Australian health directorate who had reported experience with ESPPs. Findings:There was general consensus of the value of ESPP in improving the efficacy and efficiency of health service delivery, achieving positive patient outcomes and offering opportunities for interdisciplinary learning among colleagues. Participants agreed that physiotherapists were well placed to practice in an ESPP role in musculoskeletal clinical practice (orthopaedic clinics/ emergency departments), and that future opportunities may exist in the areas of women’s health, cardiopulmonary, and neurology physiotherapy. There was consistency that postgraduate courses should be accredited and tailored to the scope of ESP trainees. Core knowledge and skills required by ESPPs included ordering/interpretation of radiology, working with and educating staff from other disciplines, and triage, screening and early identification of musculoskeletal conditions. Finally, common barriers to the ESPP role in Australia were characterised as either ‘hard’ (legislative) or ‘soft’ (jurisdictional, professionally/culturally based). [ABSTRACT FROM PUBLISHER]

Self-management strategies are regularly prescribed by physiotherapists and can play an important role in the overall treatment plan for many patients. However, patient non-adherence to self-management is recognised as a significant barrier to the integrity of prescribed treatment plans. Physiotherapists are ideally placed to encourage patient self-management and facilitate adherence to these evidence-based strategies. The translation of best evidence into clinical practice is integral to the continued development of physiotherapy. We propose a six-step behavioural model based on current evidence on how to best aid, or ‘nudge’ patient adherence to physiotherapist-prescribed self-management strategies. We also suggest ways in which this model can be incorporated into routine physiotherapy practice. [ABSTRACT FROM AUTHOR]

Background:Physiotherapists play an integral role in the provision of health care to individuals who are overweight or obese. An understanding of weight stigma is therefore important in ensuring best practice. Despite these considerations, no previous systematic reviews have investigated weight stigma in physiotherapy. Objectives:To determine if (i) physiotherapists demonstrate weight stigma through explicit or implicit means and (ii) how weight stigma is perceived by physiotherapy patients. Methods:Database searches were conducted to identify quantitative and qualitative studies published between January 1960 and September 2015. Two reviewers independently performed data extraction and assessments of methodological quality. Outcome measures included explicit attitudes, implicit attitudes and beliefs about obesity held by physiotherapists, as well as patient perceptions of obesity management. Results:Seven high-quality studies were included in the review. Six studies demonstrated the existence of explicit weight stigma, with a majority of physiotherapists describing people with increased weight as ‘noncompliant’ and ‘unmotivated’. One study demonstrated the existence of implicit weight stigma, but this did not appear to influence treatment approaches. Four studies found stigmatising beliefs about weight among physiotherapists, and one study found that physiotherapy patients believed both physical environments and paternalistic communication styles propagated weight stigmatisation. Conclusions:Explicit weight stigmatisation is common in physiotherapy and is often perceived by patients, who may feel unmotivated or ignored as a result. While implicit stigmatisation also occurs, it is unclear if this influences physiotherapy management. Future research is required to assist in the development of appropriate preventative strategies. [ABSTRACT FROM AUTHOR]