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Fibromyalgia syndrome is a chronic musculoskeletal disorder characterised by widespread pain, sleep disturbance, headache, stiffness and fatigue. There are a number of potential detrimental factors on bone health in patients with fibromyalgia syndrome including immobility, depression, lack of sunlight and poor nutrition. In this article, the literature relating to fibromyalgia syndrome and bone health is reviewed, and evidence is provided for the potential role of physiotherapy in treating fibromyalgia and maintaining bone health. [ABSTRACT FROM AUTHOR]

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]

The aim of this updated literature review was to evaluate the extent to which adults are documented as being capable of further motor recovery more than 6 months after a severe traumatic brain injury. This topic has high potential relevance for neurological physiotherapists, some of whom may be tasked with implementing physical treatment programmes for this challenging patient group. A revised search of relevant databases was carried out, using the previous review as a starting point. A further 10 papers were identified, extending the original total to 18 published studies. Of the 18 papers, 13 were single-case studies, with 5 being reports of subject groups (8–80 subjects; median, 20 subjects). Recovery was documented as occurring over periods which extended up to 180 months' post-injury, though more reports fell within the 60 months' post-injury period. Evidence supporting the hypothesis that subjects are readily capable of continuing and/or further change was not overwhelming; reasons for this are discussed. [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: 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]

Objective: Rheumatoid arthritis (RA) impacts the physical activity and aerobic capacity of those individuals suffering from this progressive disease. A review of the effectiveness of home exercise programmes in rheumatoid arthritis has not been attempted, thus it is questionable if programmes that involve less intense supervision delivered in the home setting would be effective. Thus the objective of this review is to evaluate the effectiveness of home exercise programmes for patients with rheumatoid arthritis. Methods: A search of seven databases was conducted using relevant search terms. Papers investigating the effect of exercise programmes on patients with RA in the home setting were included. Results: Eight papers out of eighteen returned were included. All papers had a high risk of bias. The results show that home exercise programmes are effective in improving muscle strength, joint mobility, shoulder function and self-efficacy and reducing morning stiffness, number of tender/swollen joints and pain without increasing inflammation or disease activity. Discussion: The results of this review highlight the benefits of home exercise programmes for patients with RA, which encompassed physical, functional and quality of life domains. However due to the poor methodological quality of research in this area, further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

This paper discusses the growth of physiotherapy research and professional development in New Zealand over the past 20 years. The professional association's role in facilitating changes in education and research over this time is discussed, together with the introduction of government policy to drive up research outputs. Demand for evidence-based practice from the profession's point of view and the influence of health funding authorities on evidence-based practice are considered. Reflection on various impacts of professional and political drivers on the direction of the profession provides a basis for consideration of national and global physiotherapy development trends. [ABSTRACT FROM AUTHOR]

High velocity low amplitude thrust (HVLAT) or manipulation is commonly used for the treatment of back pain. This critical review of the proposed mechanisms of action was based on a database search using the keywords: spinal manipulation, low back pain, osteopathy, physiotherapy and chiropractic. Three proposed mechanisms were highlighted – biomechanical, muscular reflexogenic, and neurophysiological. There is evidence of a mechanical gapping of the facet joints during manipulation, although the clinical significance of this is not clear. There is also evidence to support the theory that HVLAT techniques evoke spinal stretch reflexes resulting in a brief muscle contraction possibly followed by a period of reduced muscle activity. The papers also provide support for the anti-nociceptive treatment effects of HVLAT and this would have obvious benefit to the patient. In conclusion, there is support in the literature for each of the mechanisms, but it is clear that more research is needed to further our understanding of the mechanisms underlying spinal manipulation. [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]

Early discharge and home rehabilitation (EDHR) for stroke patients seems logical as an alternative to rehabilitation in stroke units, as these patients often show impaired ability to perform activities of daily living. The objective of this review is to present the effects of EDHR for stroke patients on health, quality of life and costs, and to describe the physiotherapy provided. Seventeen randomised controlled trials were included, assessed with the PEDro scale and rated using Sackett's rules of scientific evidence. The results showed that EDHR can reduce the length of time spent in hospital. It might improve basic activities of daily living, but is more likely to improve patients' instrumental activities of daily living and quality of life. The context is a core issue for the physiotherapy intervention. Early discharge and home rehabilitation seems to be cost-effective if rehabilitation at home is provided by a multidisciplinary team from a hospital. It is important to consider patients' coping capacities and possible strain on caregivers as contributing factors to the efficacy of EDHR. [ABSTRACT FROM AUTHOR]

Disorders of the infrapatellar fat pad are important to consider in the differential diagnosis of anterior knee pain. Knowledge about the microanatomy of this region and the areas which are prone to injury can aid the physiotherapist in providing appropriate management. This paper provides a brief description of the morphology, physiology and biomechanics of this important but under-recognised, anatomical entity. In addition, the enthesis organ concept is described and its relevance to physiotherapy practice outlined using the infrapatellar fat pad as an example. [ABSTRACT FROM AUTHOR]

The education of physiotherapists in Canada has undergone two major changes over the past decades. The first was the move from a diploma credential to a baccalaureate degree and the second is the recent change to the master's entry-level qualification. Changes at the University of British Columbia (UBC) are typical of many programmes in Canada. The purpose of this paper is to capture the rapidly changing physiotherapy education environment in Canada, using UBC as an example and comparator for the 13, soon to be 14, Canadian physiotherapy education programmes. [ABSTRACT FROM AUTHOR]

A lack of good outcome measures has been a barrier to the development of an evidence base for all areas of respiratory physiotherapy. Many of the clinically available outcome measures are not specifically related to the physiotherapy intervention employed and may be affected by other factors. In this paper, the outcome measures currently clinically available to UK NHS physiotherapists to assess the response to alveolar recruitment and airway clearance interventions have been reviewed. It is clear that there is an urgent need to increase the accuracy, reliability, and sensitivity of the outcome measures employed, or to develop new measures to assess the effectiveness of respiratory physiotherapy. Lung sounds provide useful, specific information, but standard auscultation is too subjective to allow them to be used as an outcome measure. Computer Aided Lung Sound Analysis (CALSA) is proposed as a new objective, non-invasive, bedside clinical measure with the potential to monitor and assess the effects of airway clearance therapy. [ABSTRACT FROM AUTHOR]

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]

Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable chronic obstructive pulmonary disease (COPD). Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management. Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means. Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to the grading of recommendations assessments, development and evaluation (GRADE) system; the remaining studies were of low quality. Although no high quality evidence was identified, the direction of effect for PLB was consistently towards benefit, with the exception of one low quality study. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate at rest and reduces time taken to recover to pre-exercise breathlessness levels. One RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB: those with moderate to severe COPD are most likely to benefit. Conclusion: High quality studies are required to identify PLB responders from non-responders and to determine whether short-term effects translate into clinically significant benefit. [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]

Objectives: Gather and analyse relevant literature on spinal manipulative therapy for low back pain through systematic review to present a balanced and impartial summary of the findings. The aim of this systematic review was to investigate the efficacy of spinal manipulative therapy in patients with low back pain. Methods: Databases searched included COCHRANE, MEDLINE, EMBASE, PEDro, PUBMED, WEB OF KNOWLEDGE, INGENTA CONNECT and GOOGLE SCHOLAR between January 2000 and January 2008. Sixteen articles were retrieved. Standardised inclusion and exclusion criteria were applied to select articles relevant to the review question. Seven studies were excluded and nine studies were included. In the next step, the methodological quality of the included studies was assessed with the PEDro scale, which rated the studies from 0 to 10. Results: Methodological quality scores ranged from 4 to 8 out of a possible 10. Spinal manipulative therapy can be preferred for short-term relief of low back pain when compared with general exercise and dynamic strengthening exercises, which is revealed by a high quality study, moderate quality studies and a low quality study. Spinal manipulative therapy combined with exercise is more effective than exercise alone, which is revealed by a high quality study. Conclusions: Further studies are needed to improve the quality of the evidence. There is evidence that spinal manipulative therapy combined with exercise is more effective than other procedures like spinal manipulative therapy, exercise or physician consultation alone. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this review are to describe the effect of exercise on body structure and function, activities and participation in people with multiple sclerosis (MS) with mild gait dysfunction, to evaluate the quality of research in this area and to guide therapists in determining which parameters of exercise programmes could be used. Methods: A systematic search of the literature was conducted. Quality was assessed using a simple method to evaluate bias. All trials since 2004 that have included people who walk with at most one stick have been included (i.e. EDSS ≤6). Results: Aerobic, progressive resistance exercise (PRE), combined exercises and other interventions appear to have positive effects on body structure and function, activities and participation in people with mild MS. No harmful effects were seen in any intervention. Both aerobic exercise and PRE have very defined and reproducible parameters. A combination of aerobic exercise and PRE is feasible and potentially offers the most favourable results in terms of the negative symptomology and physiological profile. Yoga and aqua aerobics also had positive effects and are feasible for this population. However, there is a moderate to high risk of bias in studies conducted since 2004 limiting their validity. Discussion: The effectiveness of interventions for patients with different impairments remains unclear due to the levels of bias in studies evaluating exercise in people with MS. Future studies should focus on the randomised controlled trial (RCT) paradigm. A high quality, RCT comparing a combined exercise programme, yoga and a control, with a long term follow up, is required. [ABSTRACT FROM AUTHOR]

Objectives: Physical morbidity is a well documented phenomenon of the patient confined to bed with critical illness and may persist for months following the critical care stay. Early rehabilitation activities initiated during the critical care stay may ameliorate these changes and reduce the long term burden of care associated with a critical care admission. The objective of this review is to explore the known evidence examining the issue of rehabilitation of the patient with critical illness. Methods: Database searches were performed to retrieve the search terms mobilisation, rehabilitation, exercise therapy, physiotherapy, ambulation, muscle strength, functional training, mechanical ventilation, intensive care, and critical care. Results: Physiotherapy practice varies widely throughout Europe, North America and Australasia and rehabilitation interventions for critically ill patients have received little research attention. Retrieved data was reviewed in the following categories: a) The incidence of rehabilitation practices within intensive care units, b) Safety issues associated with exercising the critically ill patient, c) The acute response to exercise in the critically ill, and d) The effects of physical training programmes in ventilator dependent subjects. Discussion: Evidence of the effectiveness of physical training within the intensive care environment remains limited to long term respiratory failure patients who may not be representative of a general critically ill population. Preliminary data from protocol initiated physiotherapy intervention initiated within 48 h of the onset of mechanical ventilation in medical patients reveal both decreased intensive care unit and hospital length of stay. It is clear that research funding should be allocated to strengthen physiotherapeutic practice in this area. In particular the relationship between muscle strength, functional scales and other measures of outcome including number of days to wean from mechanical ventilation and length of stay need to be explored. [ABSTRACT FROM AUTHOR]

Objectives: To identify what is known about the validity of real time ultrasound (RTUS) measurements of skeletal muscle size and to summarise populations and conditions that have been assessed with RTUS. Methods: Seven databases were searched for potential study inclusion. All identified studies were assessed with inclusion criteria and a quality assessment scale. Each study reported muscle size measurements with RTUS and a reference standard (either MRI or CT). Muscle sizes were measured as a muscle thickness (linear dimension), a muscle area (cross sectional area or CSA) or as a muscle volume (anatomical cross sectional area or ACSA). Results: Thirteen studies were identified for inclusion in this systematic review. Measures of correlation coefficient, coefficient of determination and mean effect size changes were determined. All of the studies in the review came to the same conclusion – that RTUS is a valid alternative to objectively measure muscle size when compared to gold standards such as MRI or CT. Discussion: All the studies in the review came to the conclusion that RTUS can provide valid measurements of skeletal muscle. The populations represented in this review were adequately varied to warrant generalisation of the results. [ABSTRACT FROM AUTHOR]

Hepatitis C infection occurs after viral exposure mainly through percutaneous means, with a world-wide prevalence of 1%. Of those infected, 50–80% progress to chronic hepatitis C, which is associated with hepatic and extra-hepatic signs and symptoms, the most serious being life-threatening liver cirrhosis and carcinoma. However, for many sufferers, it is the constellation of extra-hepatic signs and symptoms that has the most immediate impact on well-being and daily life. Significant positive associations have been found between hepatitis C virus (HCV) positivity and fatigue and musculoskeletal pain, both of which contribute to the general debility and impaired physical function associated with hepatitis C. Exercise is proposed to improve cardiovascular function, musculoskeletal fitness, reduce pain and disability, thereby leading to better health status and quality of life. The purpose of this review is to consider the effects of chronic hepatitis C infection on physical ability, and to present an argument for the inclusion of physiotherapist prescribed exercise as part of its management. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this review were to: (i) determine the effectiveness of exercise following lumbar decompression surgery; (ii) identify what the essential components of such exercise programmes should be; and (iii) evaluate the quality of research in this area based on current research initiatives. Patients and Methods: A literature search and methodological assessment identified nine high quality RCTs evaluating 1250 patients. Results: The key finding from this review was that there is strong evidence to support the long-term effectiveness of structured intensive exercise programmes, initiated 4–6 weeks post-operatively. Rehabilitation should not be precautionary; however, further research is needed to validate the earlier use of exercise. Back, abdominal and lower limb strengthening were found to offer the most positive results, but the exact parameters of an ideal exercise programme remain unknown. Encouraging activity through behavioural programmes or advice is also important. Conclusions: While the methodological quality and use of recommended outcome measures in this area has improved, future studies should be explicit about the exact details of exercises and advice programmes offered to these patients. [ABSTRACT FROM AUTHOR]

Physiotherapy is an important management option in hip osteoarthritis. Its effectiveness can be evaluated with the use of valid and reliable outcome measures in research and clinical practice. Numerous outcome measures for use in hip osteoarthritis are available and the ICF classification can be used to guide decision making to ensure that all aspects of human functioning are represented. The activity and participation components of ICF are a vital part of assessment, but are traditionally under-utilised in physiotherapy. A number of questionnaire-based outcomes that measure activity and participation can be used in clinical or research practice with hip osteoarthritis patients such as The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequense Index of Severity, Harris Hip Score (HHS), Arthritis Impact Measurement Scale (AIMS), Short Form-36 (SF-36) and European Quality of Life scale (Euroqol). These are discussed with particular reference to their psychometric properties of reliability, validity and responsiveness. To date, the WOMAC has undergone the most psychometric testing of the disease-specific measures, whilst the SF-36 is the most widely tested generic measure. Both of these measures are recommended for use in hip osteoarthritis. Further psychometric testing is required of the other measures which will enable clinicians and researchers to decide which is the most appropriate measure for use in hip osteoarthritis. [ABSTRACT FROM AUTHOR]

Lack of compliance with treatment represents a significant problem for physiotherapists in the treatment of chronic low back pain. A literature review was therefore performed in this area, with particular attention given to compliance with physiotherapy exercise and advice, given the generally positive evidence to support the effectiveness of these treatment modalities in the treatment of chronic low back pain. A variety of literature was reviewed in relation to the direct and indirect influences on compliance, including examination of the influence of exercise counselling, pain, patient attitudes and beliefs, self-efficacy, locus of control, stage of change and psychosocial issues. It was clear from this review that patient compliance with physiotherapy cannot simply be assumed. Very little literature was found on compliance with physiotherapy exercise and advice in the treatment of chronic low back pain, and further research is recommended in order to establish compliance within this patient group, and how best this can be improved. [ABSTRACT FROM AUTHOR]