Search

Objective: To evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls. Methods: A cross‐sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann‐Whitney and independent t‐tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation. Results: Sixty‐two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure. Conclusions: There was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG. Implications for physiotherapy practice: Current knowledge Maximum Effort Tests provide detailed information on physiological health and enable exercise prescription.Exercise performance could be limited in children with cystic fibrosis (CF).Exercise performance is usually associated with obstruction to expiratory airflow in CF. What this paper contributes to our knowledgeChildren with CF show preserved respiratory muscles strengthPulmonary function and respiratory muscles strength were related to exercise performance by modified shuttle walk test (MSWT).Child collaboration influences test performance. [ABSTRACT FROM AUTHOR]

Background: Tendinopathy is caused by repetitive motion, excessive stress on the tendon, overstretch, and motion past the critical angle of rotation or translation. There are various treatment options available for tendinitis, including those affecting both the upper and lower limbs and those of calcific and non‐calcific types. Hypothesis/purpose: Few reviews have analyzed the efficacy of Extracorporeal Shockwave Therapy (ESWT) in treating upper and lower limb tendinopathies while considering calcific and non‐calcific‐type tendinitis. This paper provides a review and meta‐analysis on Randomized Controlled Trials (RCTs), which compared results from a group undergoing ESWT treatment to another group under different treatments. Study design: Systematic review and meta‐analysis. Methods: A systematic search was conducted on PubMed, Web of Science, Embase, the Cochrane Central Register of Control Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) databases for articles published up to January 2022. The reference lists of identified articles were further scanned. Twenty‐two studies were included in the meta‐analysis. Results: Meta‐analysis showed no difference in pain reduction in ESWT when compared with a comparison group at 4 (p = 0.26) and 12 weeks (p = 0.33). There were no differences in DASH scores at 12 months between the two groups (p = 0.32). Conclusion: Extracorporeal Shockwave Therapy (ESWT) is effective when used to treat lower limb and calcific tendinitis. It does not yield any better results than other treatment options in managing upper limb tendinopathies and non‐calcific tendinopathies. Key points: What is known about the subjectThere are various treatment options available for tendinitis, including those affecting both the upper and lower limbs and those of calcific and non‐calcific types. The most common are extracorporeal shockwave therapy (ESWT), wait and see policy, laser therapy, ultrasound, surgical decompression, Platelet‐ Rich Plasma (PRP) injections, mucopolysaccharide supplements, autologous blood injection, paratendinous dry needling, ibuprofen tablets, intense pulsed therapy, and radiofrequency microdebridement. What this study adds to existing knowledgeThis review concluded that ESWT is better to be used to treat lower limb and calcific tendinitis. It does not yield any better results than other treatment options in the treatment of upper limb tendinopathies and non‐calcific tendinopathies. [ABSTRACT FROM AUTHOR]

Abstract: Background and Purpose: Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions. Methods: Design: This is a retrospective analysis of randomized trial data. Participants: 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands. Procedure: PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories. Results: PTs and OTs spent on average 4–7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on “moving around using transportation,” “self care,” and “household tasks” categories. Conclusions: Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm‐oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries. [ABSTRACT FROM AUTHOR]

Purpose Recent research has demonstrated that physical therapy may benefit the physical and mental health of people with eating disorders (EDs). Because this is a new and developing field, this study aimed to investigate the experience, practices and knowledge of international physical therapy experts to inform clinical practice, education and research. Methods An international cross-sectional survey design was undertaken with experienced physical therapists within the field of EDs. Physical therapist responses were analysed with descriptive statistics and thematic analysis as appropriate. Results Twenty-eight international physical therapists participated. On average, participants had 6.9 years (95% confidence interval: 3.1-10.7, n = 27) of clinical experience working in ED settings and devoted approximately 39.3% (95% confidence interval: 23.8-54.8, n = 27) of their time to treating individuals with EDs. Participants reported that physical therapy interventions have a diverse range of benefits on the physical, mental and disease-specific factors (e.g. binges) in people with EDs. The key role of physical therapists includes improving body awareness, especially during physical activity combined with psycho-education about healthy doses of physical activity. Physical therapists were able to identify a range of barriers and facilitators to physical activity in people with EDs. Discussion This paper provides a first step towards understanding the role and value of physical therapists working with individuals with EDs. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose Individuals with amputations are a core group in Australian rehabilitation units that have a long index length of stay. The Repatriation General Hospital (RGH) offers general rehabilitation services to the population of Southern Adelaide (a population of 350,000) and includes an on-site prosthetic manufacturing facility. Using a physiotherapy database at the RGH, we sought to answer the following questions: What are the demographic and clinical characteristics of patients admitted for lower limb prosthetic rehabilitation over 15 years? What are the times to rehabilitation outcomes? How have these changed over 15 years with changes in service delivery? Methods This paper is a retrospective observational study using a physiotherapy clinical database (1996-2010) of 531 consecutive individuals with lower limb amputation at one South Australian hospital (RGH). There were two changes in service delivery: 1) a multidisciplinary interim prosthetic programme (IPP) introduced in 1998 and 2) removable rigid dressings (RRDs) introduced in 2000. Outcome measures were patient demographics, clinical characteristics and time to rehabilitation outcome markers. Results Mean age was 68 years (standard deviation [SD]: 15), with 69% male, 80% dysvascular and 68% transtibial. The overall median inpatient rehabilitation length of stay (RLOS) was 39 days (interquartile range [IQR]: 26-57). Individuals with amputation entering rehabilitation each year had a higher number of co-morbidities ( β: 0.08; 95% confidence interval: 0.05-0.11). Introduction of the IPP was associated with a significant reduction in time to initial prosthetic casting, independent walking and inpatient RLOS. Introduction of RRDs was associated with a significant reduction in time to wound healing, initial prosthetic casting and independent walking. Conclusions Individuals with amputation were typically elderly dysvascular men with transtibial amputations. Introduction of the IPP and RRDs successfully reduced time to rehabilitation outcomes including independent walking, an outcome that is rarely reported but is of significance to patients and physiotherapists. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose The purpose of this paper was to determine if the Six-minute Walk Test (6MWT) was a reliable exercise test for patients referred to cardiac rehabilitation when up to three tests were performed and to determine if test scores differed according to between-test time interval. Methods Thirty adults aged 63 ± 7.9 years referred to cardiac rehabilitation participated in a repeated measures reliability trial. Participants completed three 6MWTs within a one-week period. Participants were randomly allocated to one of three groups: on the first day, Group A completed three walks, Group B completed two walks and Group C completed one walk. Relative reliability was expressed in a ratio (ICC2,1), and absolute reliability was expressed in metres (95% confidence intervals) for group and individuals. Results The 6MWT demonstrated a high level of relative reliability (intraclass correlation coefficients [ICC] = 0.94) across the three walks. There was no statistically significant difference between the test scores of the three groups. However, there was an increase in distance walked from the first to the second to the third 6MWT. Absolute reliability indicated that a change of at least 44 m would be required to be interpreted as true change in a group, and at least 95 m to be interpreted as true change in an individual with 95% confidence. Conclusion Three 6MWTs completed in relatively short timeframes were not sufficient for reliable results as there was an increase in the distance walked, and relatively large increases in distances would be required to be interpreted as change. It did not make any difference whether the tests were all completed on one day or over one week. This study highlighted problems that may arise when relying on reliability coefficients alone to interpret reliability. These results suggest that the 6MWT may not have sufficient reliability to be a suitable test to evaluate exercise tolerance in patients referred to cardiac rehabilitation. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the efficacy of basis body awareness therapy (BBAT) on functional outcomes and quality of life (QoL) in patients with mental health problems and long‐lasting conditions including musculoskeletal disorders, chronic and psychosomatic pain, and neurological conditions. Material and Methods: Randomized controlled trials (RCTs) were obtained from MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro from inception to April 1st, 2022. A random effects meta‐analysis was performed to explore the efficacy of BBAT versus non‐active and active control conditions. Results: Eight RCTs (n BBAT = 307, n controls = 428) were included. There was no evidence for reductions in anxiety (standardized mean difference [SMD] = −1.42, 95% confidence interval [CI] = −3.30 to 0.46, p = 0.14), depression (SMD = −0.82, 95% CI = −1.85 to 0.21, p = 0.12), and no improvements in global assessment of functioning for functioning (GAF‐F) (SMD = 0.58, 95% CI = −0.03 to 1.19, p = 0.06) or for symptoms (GAF‐S) (SMD = 0.76, 95% CI = −0.44 to 1.96, p = 0.21) in BBAT versus non‐active control conditions. BBAT reduced anxiety significantly more than active interventions (SMD = −0.84, 95% CI = −1.17 to −0.51, p < 0.001). No significant differences between BBAT and active control conditions were found for reduction in depression (SMD = −1.16, 95% CI = −2.74 to 0.41, p = 0.15) or in self‐reported pain (SMD = 0.08, 95% CI = −0.25 to 0.40, p = 0.65). Active control conditions were superior in improving QoL (SMD = 0.83, 95% CI = 0.49 to 1.17, p < 0.001), GAF‐F (SMD = 1.58, 95% CI = 0.29 to 2.86, p = 0.016) and GAF‐S (SMD = 1.19, 95% CI = 0.85 to 1.53, p < 0.001). Conclusions: Physiotherapists should be cautious in adopting BBAT, noting there is no high‐quality evidence to support its' use to improve functionality and QoL in patients with mental health problems and/or long‐lasting conditions. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the recovery of physical function, health related quality of life (HRQoL), and pain for people following hip fracture for the initial 12 months, and to examine whether postoperative outcome measures of physical function, HRQoL, and pain can predict physical function at 3 and 12 months. Design: A prospective single‐center observational study, as part of the HIPFRAC trial. Settings: One hospital with two associated municipalities in Norway. Subjects: 207 participants with hip fracture included in the study (140 participants transferred to a short‐term nursing home placement and 67 transferred directly home at discharge from hospital). Method: Outcome measures were Short Physical Performance Battery (SPPB), Timed Up & Go (TUG), Stair climbing test (SC), Numeric Rating Scale (NRS) for pain at rest and in activity, and EQ‐5D‐5L index and health score. Data were analysed by repeated measures of variance and multivariate regression analyses. Results: There were statistically significant improvements in physical function (SPPB total score and TUG), NRS‐pain in activity, and HRQoL (EQ‐5D‐5L) from hospital discharge to 3‐month follow‐up for the whole cohort and the two groups (p < 0.001). However, the largest improvements occurred within the first 3 months. Further statistically significant improvements occurred between 3 and 12 months (p < 0.05). The strongest predictors of physical function at 3 and 12 months post‐fracture were physical function (SPPB) at hospital discharge and pre‐fracture requirement of a walking aid. Conclusion: The recovery of physical function, HRQoL, and pain in participants after hip fracture indicates gradual improvements during the initial 12‐month follow‐up, with the largest improvements within the first 3 months. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Upper limb activity measures for children with cerebral palsy have a number of limitations, for example, lack of validity and poor responsiveness. To overcome these limitations, we developed the Children's Arm Rehabilitation Measure (ChARM), a parent‐reported questionnaire validated for children with cerebral palsy aged 5–16 years. This paper describes both the development of the ChARM items and response categories and its psychometric testing and further refinement using the Rasch measurement model. Methods: To generate valid items for the ChARM, we collected goals of therapy specifically developed by therapists, children with cerebral palsy, and their parents for improving activity limitation of the upper limb. The activities, which were the focus of these goals, formed the basis for the items. Therapists typically break an activity into natural stages for the purpose of improving activity performance, and these natural orders of achievement formed each item's response options. Items underwent face validity testing with health care professionals, parents of children with cerebral palsy, academics, and lay persons. A Rasch analysis was performed on ChARM questionnaires completed by the parents of 170 children with cerebral palsy from 12 hospital paediatric services. The ChARM was amended, and the procedure repeated on 148 ChARMs (from children's mean age: 10 years and 1 month; range: 4 years and 8 months to 16 years and 11 months; 85 males; Manual Ability Classification System Levels I = 9, II = 26, III = 48, IV = 45, and V = 18). Results: The final 19‐item unidimensional questionnaire displayed fit to the Rasch model (chi‐square p = .18), excellent reliability (person separation index = 0.95, α = 0.95), and no floor or ceiling effects. Items showed no response bias for gender, distribution of impairment, age, or learning disability. Discussion: The ChARM is a psychometrically sound measure of upper limb activity validated for children with cerebral palsy aged 5–16 years. The ChARM is freely available for use to clinicians and nonprofit organisations. [ABSTRACT FROM AUTHOR]

Background and purpose: The sustainability of physiotherapy clinical placements is an ongoing challenge, yet there is potential to increase placement capacity within the private practice sector. Barriers to hosting students, including perceived impacts on patient care, reportedly limit the uptake of hosting students within this setting. This study aimed to evaluate the effect of physiotherapy student involvement on patient‐reported Global Rating of Change (GRoC) in Australian physiotherapy private practice care. Methods: A cross‐sectional, patient survey study was conducted in three private physiotherapy practices over two 5‐week periods. At their completion of care, participants completed the survey seeking demographic information, GRoC and aspects of care including number of consultations involving students, proportion of physiotherapy time involving students and frequency of student involvement in treatment delivery. After accounting for clinic‐level differences, ordinal logistic regression analyses were performed to explore the impact of supervised student care on GRoC. Results: 119 participants across three practices completed the survey. There were no significant associations between patient‐reported GRoC and: (1) student involvement in patient care; (2) number of consultations involving students; (3) proportion of physiotherapy time involving students; or (4) frequency of student involvement in treatment delivery (p > 0.05). Conclusions: Supervised student care in private physiotherapy practice does not appear to have a detrimental impact on patient‐reported outcomes. These findings may address concerns relating to student involvement in patient care within this setting. Future research should address economic and service delivery impacts of supervised student care on private practices. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study were to i) explore the current practice, roles, and perceptions of physiotherapists who treat older people with and without dementia in Indonesia, ii) identify the characteristics of physiotherapists associated with treating older people and older people with dementia, and iii) identify the level of knowledge and attitudes about dementia among physiotherapists treating people with dementia in Indonesia. Methods: This was a cross‐sectional study in which registered physiotherapists in Indonesia were surveyed online using Qualtrics. Descriptive statistics, linear regression and univariate logistic regression were used in this study. Multiple logistic regression was conducted to identify the characteristics of physiotherapists associated with treating older people and/or people with dementia. The Dementia Knowledge Assessment Scale (DKAS) was used to assess level of knowledge and attitudes about dementia. Qualitative data from the survey were analyzed using thematic content analysis. Results: The online survey was sent to 6327 physiotherapists who met the inclusion criteria and 1061 (16.8%) returned the survey. Eight hundred and eighty‐four (83.3%) respondents worked with older patients, and 632 (59.6%) worked with people with dementia. The multiple regression analysis showed that physiotherapists who have been practicing for longer (years) (OR: 1.0, 95%CI: 1.0–1.1, p ≤ 0.001) and were working in a geriatrics area (OR: 3.0, 95%CI: 1.4–6.5, p = 0.005) were more likely to treat older people with dementia. The DKAS mean score (SD) was 32.1 (±5.1)/50 indicating some limitations in dementia knowledge by respondents, and 62% of physiotherapists reported low levels of confidence in treating older people with dementia. Conclusions: The relatively low dementia knowledge, and generally low confidence in treating people with dementia among Indonesian physiotherapists were important findings in this study. This study highlights opportunities for improvement in physiotherapist's knowledge and skills in this emerging area of practice in Indonesia. [ABSTRACT FROM AUTHOR]

Background and purpose: Due to global ageing, more people will suffer from hip fracture in the future, and many will be left with permanent physical impairments. The care burden for people post hip fracture is high. The aim of this study is to measure longitudinal changes in physical activity levels and fear of falling in people after hip fracture who return home after inpatient rehabilitation. Methods: Longitudinal observational study. Participants were recruited from three rehabilitation centres in Victoria, Australia. Self‐reported fear of falling (Short Falls Efficacy Scale – International) and physical activity levels (Human Activity Profile – Adjusted Activity Score and Frenchay Activity Index) were assessed at 2 weeks, 3 and 6 months after discharge. Mobility (walking speed) and balance (Timed Up‐and‐Go test and Step Test) were measured at discharge from rehabilitation. Results: Thirty‐four participants (mean age: 82 years [SD 8]; 62% female) with unilateral hip fracture were recruited. Participants had moderately impaired balance and mobility at discharge compared to age‐matched normative data; they were all discharged with a walking aid and were 40% slower in their walking speed. Participants had increased fear of falling and reduced physical activity 2 weeks after discharge, which improved significantly (p < 0.01) over the following 6 months, but scores were still lower than the normative values. At 6 months, participants also had moderate to high levels of fear of falling and were less active than the general population of similar age. Discussion: Although fear of falling and physical activity improved in the 6 months following discharge, both remained negatively affected compared to normative data. Rehabilitation post hip fracture should include routine assessment of fear of falling as a potential barrier for return of physical activities. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents regularly engage in screen‐based activities. Complex factors influence adolescents' growth, and habitual sitting posture. The association between over‐time changes in their sitting posture, and upper quadrant musculoskeletal pain (UQMP) is poorly understood. This study tested the association between change over 12 months in seated posture angles (neck flexion [NF]; craniocervical angle [CCA] into flexion and extension; and thoracic flexion [TF]), UQMP, and predictor variables (anxiety and depression; sport activity, music participation; computer use). Methods: A one‐year prospective longitudinal study enrolled 211 asymptomatic 15‐18‐year students. 3D motion analysis captured postural angles while students worked on desktop computers, at baseline and 12 months later. Height, weight, computing time, sport and music participation, and depression and anxiety were measured at both time periods. UQMP in the previous month was captured at 12 months. The association between over‐time change in sitting posture angles and predictor variables was determined using linear regression analysis (r2; p‐values). The association between predictor variables with UQMP, and predictor variables on the association between postural angles and UQMP was assessed using logistic regression models (Odds Ratios [95%CI]). Significant confounding effects were determined when the addition of a predictor variable to the posture‐UQMP model significantly changed the Likelihood Ratio chi square value. Results: N = 153 students (72%) completed the study (48 with UQMP). Significant associations occurred between head flexion (HF) and body mass index (BMI) (r2= 4.20, p =.01); NF and computer use (r2=2.87, p =.036) and CCA and music participation (r2=9.99, p =.047). Music participants and non‐participants in sport or music had increased risk of UQMP with CCA changes into flexion (OR 12.0) and TF changes into extension (OR 7.6) respectively. Conclusion: The association between over‐time‐change in sitting posture angles and UQMP is not influenced by anthropometrics, psychosocial factors or time spent computing. Music students, and students not participating in sport, require further postural analysis. [ABSTRACT FROM AUTHOR]

Objectives: The effects of different physiotherapy protocols on patients suffering from grade‐I spondylolisthesis have been thus far examined in a limited number of clinical trials. Therefore, the main purpose of this study was to compare the effects of lumbar segmental stabilization and general exercises on clinical and radiologic criteria in grade‐I spondylolisthesis patients. Methods: This study was a double‐blind randomized controlled trial (RCT) with a test–retest design and parallel groups. A total of 26 patients with grade‐I spondylolisthesis were thus randomly assigned to experimental group (13 patients, lumbar segmental stabilization exercises) and control group (13 patients, general exercises). Subsequently, pain, functional disability, kinesiophobia, translational motion, angular motion and slip percentage of the vertebra were investigated. Results: Of the 120 people recruited in this study, only 26 patients were eligible. According to pre/post‐intervention comparison, a statistically significant decrease was observed in the experimental group in terms of pain (p = 0.000), functional disability (p = 0.004), kinesiophobia (p = 0.002), translational motion (p = 0.043) and angular motion (p = 0.011), but not for slip percentage (p = 0.122). Considering the control group, a statistically significant decline was reported for pain (p = 0.043) and functional disability (p = 0.002). However, no significant differences were found for other variables in the control group. With regard to inter‐group comparison, there was no statistically significant difference between the two groups regarding the given variables except for kinesiophobia (p = 0.040). Conclusion: Both lumbar segmental stabilization and general exercises led to reduction in pain and functional disability of patients with grade‐I spondylolisthesis. Therefore, lumbar segmental stabilization exercises seemed to be better than general ones with reference to improving kinesiophobia and intervertebral movements. [ABSTRACT FROM AUTHOR]

Objectives: A reason for the lack of interest in physical fitness testing in mental healthcare is limited time among existing staff. This cross‐sectional study investigated the test–retest reliability of the 2‐min walk test (2MWT) and its concurrent validity with the 6‐min walk test (6MWT) in Ugandan patients with depression. We also explored practice effects and assessed the minimal detectable change (MDC) and clinical correlates with the 2MWT. Methods: This is a cross‐sectional study executed in Butabika National Referral Hospital in Kampala, Uganda. Fifty Ugandan patients with depression (15 women; median age = 29.0 years) performed twice a 2MWT, once a 6MWT, and completed the Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory‐18 (BSI‐18). Results: The median (interquartile) 2MWT score on the first and second test were 125.5 (59.2) meters and 131.0 (57.0) meters (p =.28). The intraclass correlation was.96 (95% confidence interval [0.94, 0.98]). The MDC was 23.5 m for men and 23.4 m for women. There was no evidence of a practice effect. Scores on BSI‐18 depression, SIMPAQ walking, and SIMPAQ incidental physical activity explained 66.3% of 2MWT score variance. Conclusion: The 2MWT is a reliable test, which can be conducted without any special equipment or substantial time demands, to provide a valid assessment of the functional exercise capacity in outpatients with depression. [ABSTRACT FROM AUTHOR]

Objectives: Restoration of walking is a priority for stroke survivors and key target for physical therapies. Upright pedalling (UP) can provide functional walking‐like activity using a variety of muscle synergies; it is unclear which synergies might be most useful for recovery of walking. Objectives here were as follows: to examine whether neuromuscular measures derived during UP might identify targets for walking rehabilitation after stroke andto determine test–retest repeatability and concurrent validity of the measures. Design This was a prospective correlational study. Setting: The study was carried out in a movement science laboratory. Participants The participants were 18 adults with stroke (StrS) and 10 healthy older adults (HOA). Intervention/measurement: StrS and HOA took part in two identical measurement sessions. During UP, surface electromyography and kinematic data were recorded and then processed to derive three measures: reciprocal activity of quadriceps and hamstrings;percentage muscle activity "on" according to crank angle; andsmoothness of movement. Results: HOA and StrS demonstrated differences in reciprocal muscle activity (p =.044) and quadriceps activity according to crank angle (p =.034) but pedalled similarly smoothly (p =.367). For muscle activation according to crank angle in StrS, intraclass correlation coefficients (95% confidence interval) showing acceptable repeatability were 0.46 [0.32, 0.58] affected quadriceps; 0.43 [0.28, 0.56] affected hamstrings; and 0.67 [0.56, 0.75] unaffected quadriceps. Conclusion: Muscle activation according to crank angle is a promising measure of lower limb impairment during functional activity after stroke; subsequent investigation should determine magnitude of variance between testing sessions. Reciprocal activity of quadriceps and hamstrings muscles and quadriceps activity according to crank angle are both potential targets for physical therapies to improve motor recovery. Further investigations are warranted. [ABSTRACT FROM AUTHOR]

Abstract: Background: In response for the need of a freely available, stand‐alone, validated outcome measure for use within musculoskeletal (MSK) physiotherapy practice, sensitive enough to measure clinical effectiveness, we developed an MSK patient reported outcome measure. Objectives: This study examined the validity and reliability of the newly developed Brighton musculoskeletal Patient‐Reported Outcome Measure (BmPROM) within physiotherapy outpatient settings. Methods: Two hundred twenty‐four patients attending physiotherapy outpatient departments in South East England with an MSK condition participated in this study. The BmPROM was assessed for user friendliness (rated feedback, N = 224), reliability (internal consistency and test–retest reliability, n = 42), validity (internal and external construct validity, N = 224), and responsiveness (internal, n = 25). Results: Exploratory factor analysis indicated that a two‐factor model provides a good fit to the data. Factors were representative of “Functionality” and “Wellbeing”. Correlations observed between the BmPROM and SF‐36 domains provided evidence of convergent validity. Reliability results indicated that both subscales were internally consistent with alphas above the acceptable limits for both “Functionality” (α = .85, 95% CI [.81, .88]) and ‘Wellbeing’ (α = .80, 95% CI [.75, .84]). Test–retest analyses (n = 42) demonstrated a high degree of reliability between “Functionality” (ICC = .84; 95% CI [.72, .91]) and “Wellbeing” scores (ICC = .84; 95% CI [.72, .91]). Further examination of test–retest reliability through the Bland–Altman analysis demonstrated that the difference between “Functionality” and “Wellbeing” test scores did not vary as a function of absolute test score. Large treatment effect sizes were found for both subscales (Functionality d = 1.10; Wellbeing 1.03). Conclusion: The BmPROM is a reliable and valid outcome measure for use in evaluating physiotherapy treatment of MSK conditions. [ABSTRACT FROM AUTHOR]

Introduction This replicated randomized controlled crossover case series investigated the effect of mirror-based tactile and motor training on tactile registration and perception in children with unilateral cerebral palsy (UCP). Methods Six children with UCP (6-18 years; median 10 years, five male, three-left hemiplegia, four-manual ability classification system (MACS) I, one MACS II and one MACS III) participated. They attended two 90-minute sessions - one of mirror-based training and one of standard practice, bimanual therapy - in alternated order. Tactile registration (Semmes Weinstein Monofilaments) and perception (double simultaneous or single-point localization) were assessed before and after each session. Change was estimated using reliable change index (RCI). Results Tactile perception improved in four participants (RCI > 1.75), with mirror-based training, but was unchanged with bimanual therapy (RCI < 1.0 for all participants). Neither intervention affected tactile registration. Discussion Mirror-based training demonstrates potential to improve tactile perception in children with UCP. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose Musculoskeletal disorders, such as knee pain, are common in children and adolescents, but there is a lack of high quality research that evaluates the clinical course of these conditions. The objective of this study was to evaluate the feasibility of conducting a prospective study of children and adolescents with knee pain using electronic methods of data collection. Methods Children and adolescents with knee pain that presented to primary care physiotherapy clinics were enrolled and followed-up on a weekly basis via short messaging service (SMS) until their knee pain had recovered (i.e. two consecutive weeks of no pain). Feasibility was assessed in terms of recruitment, retention and response rates to SMS and an online questionnaire. Baseline and 6-month follow-up measures included pain, disability, physical function, physical activity and health related quality of life. Kaplan-Meier survival analysis was used to estimate the median time to knee pain recovery. Results Thirty participants (mean age 13.0 ± 2.2 years, 53% boys) were recruited over 26 months. The overall response rate to weekly SMS follow-up was 71.3% (809 received/1135 sent). One third of participants stopped responding to SMS prior to recovery, and these participants typically had a much lower response rate during the time they remained in the study. At 6-month follow-up, 80% of the cohort completed the final online questionnaire, and 29% of participants still reported current knee pain (≥1/10 VAS). The median time for knee pain recovery was 8 weeks (95%CI: 5, 10). Conclusion Electronic data collection alone seems insufficient to track pain recovery in young people and may need to be supplemented with more traditional data collection methods. Researchers should consider further measures to address slow recruitment rates and high attrition when designing large prospective studies of children and adolescents in the future. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose To review the predictive/risk psychological factors at baseline that are associated with a favourable (or non-favourable) outcome following lumbar spinal fusion (LSF). Methods A computer-assisted literature search of PubMed, CINAHL complete and EMBASE for studies published between January 1, 1990 and October 1, 2014 with controlled vocabulary and key words related to LSF, degenerative lumbar spine diagnoses and appropriate terms for predictive variables. Each study was required to be a retrospective or prospective design that involved LSF (all forms). Quality assessment was conducted with the Quality In Prognosis Studies tool. A study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO# CRD42014008728). Results The majority of the eight accepted studies were observational, prospective cohorts (n = 6). High levels of baseline depression and lower SF-36 Mental Component Scores (MCS) lower quality of life were associated with non-favourable outcomes. Two studies were rated as high quality, five were moderate and one study had low quality. Conclusions At present, there are a number of psychological variables that are associated with a poorer outcome with LSF. Higher levels of depression and lower scores on the SF-36 MCS are the most commonly implicated. However, based on the results of the studies using single arm designs there is not enough evidence to determine which psychological variables are influential in predicting outcomes for LSF. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose Low-level laser therapy (LLLT) is proposed as a treatment for tendinopathies. This is the first systematic review focusing solely on LLLT treatment effects in shoulder tendinopathy. Methods A systematic review with meta-analysis and primary outcome measures pain relief on 100-mm visual analogue scale (VAS) and relative risk for global improvement. Two independent assessors rated the included studies according to the PEDro scale. Intervention quality assessments were performed of LLLT dosage and treatment procedures according to World Association for Laser Therapy guidelines. The included trials were sub-grouped by intervention quality and use of other physiotherapy interventions. Results Seventeen randomized controlled trials (RCTs) met the inclusion criteria, and 13 RCTs were of high and 4 RCTs of moderate methodological quality. Significant and clinically important pain relief was found with weighted mean differences (WMD) over placebo, for LLLT as monotherapy at 20.41 mm (95% CI: 12.38 to 28.44) and as adjunct to exercise therapy at 16.00 mm (95% CI: 11.88 to 20.12). The WMD when LLLT was used in a multimodal physiotherapy treatment regime reached statistical significance over placebo at 12.80 (95% CI: 1.67-23.94) mm pain reduction on VAS. Relative risks for global improvement were statistically significant at 1.96 (95% CI: 1.25-3.08) and 1.51 (95% CI: 1.12-2.03), for laser as monotherapy or adjunctive in a physiotherapy regime, respectively. Secondary outcome measures of shoulder function were only significantly in favour of LLLT when used as monotherapy. Trials performed with inadequate laser doses were ineffective across all outcome measures. Conclusion This review shows that optimal LLLT can offer clinically relevant pain relief and initiate a more rapid course of improvement, both alone and in combination with physiotherapy interventions. Our findings challenge the conclusions in previous multimodal shoulder reviews of physiotherapy and their lack of intervention quality assessments. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose We determined the criterion validity and the retest reliability of the ΑctivPAL™ monitor in young people with diplegic cerebral palsy (CP). Methods Activity monitor data were compared with the criterion of video recording for 10 participants. For the retest reliability, activity monitor data were collected from 24 participants on two occasions. Participants had to have diplegic CP and be between 14 and 22 years of age. They also had to be of Gross Motor Function Classification System level II or III. Outcomes were time spent in standing, number of steps (physical activity) and time spent in sitting (sedentary behaviour). Results For criterion validity, coefficients of determination were all high ( r2 ≥ 0.96), and limits of group agreement were relatively narrow, but limits of agreement for individuals were narrow only for number of steps (≥5.5%). Relative reliability was high for number of steps (intraclass correlation coefficient = 0.87) and moderate for time spent in sitting and lying, and time spent in standing (intraclass correlation coefficients = 0.60-0.66). For groups, changes of up to 7% could be due to measurement error with 95% confidence, but for individuals, changes as high as 68% could be due to measurement error. Discussion The results support the criterion validity and the retest reliability of the ActivPAL™ to measure physical activity and sedentary behaviour in groups of young people with diplegic CP but not in individuals. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose Characteristically, sciatica involves radiating leg pain that follows a dermatomal pattern along the distribution of the sciatic nerve. To our knowledge, there are no studies that have investigated risk factors associated with first time incidence sciatica. The purpose of the systematic review was to identify the longitudinal risk factors associated with first time incidence sciatica and to report incidence rates for the condition. For the purposes of this review, first time incidence sciatica was defined as either of the following: 1) no prior history of sciatica or 2) transition from a pain-free state to sciatica. Studies included subjects of any age from longitudinal, observational, cohort designs. Methods The study was a systematic review. Eight of the 239 articles identified by electronic search strategies met the inclusion criteria. Results Risk factors and their respective effect estimates were reported using descriptive analysis and the preferred reporting items for systematic reviews and meta-analyses guidelines. Modifiable risk factors included smoking, obesity, occupational factors and health status. Non-modifiable factors included age, gender and social class. Incidence rates varied among the included studies, in part reflecting the variability in the operationalized definition of sciatica but ranged from <1% to 37%. Discussion A majority of the identified risk factors associated with first time sciatica are modifiable, suggesting the potential benefits of primary prevention. In addition, those risk factors are also associated with unhealthy lifestyles, which may function concomitantly toward the development of sciatica. Sciatica as a diagnosis is inconsistently defined among studies. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose Electrical bioimpedance spectroscopy (BIS) allows the evaluation of limb extracellular fluid (R0) and total fluid (Rinf). BIS could facilitate post-surgical oedema evaluation after total knee arthroplasty (TKA), as it is easily performed and is non-invasive. However, neither its applicability in this context nor the influence of metallic implants on measurement has been evaluated. The aim of this study was to evaluate the influence of TKA implants on the BIS R0 and Rinf variables used for oedema evaluation. Method This was a prospective non-randomized comparative clinical trial. One oedema-free group of patients with TKA was compared with a group presenting similar characteristics except for the arthroplasty, to assess the influence of the implant on BIS measurement in the absence of oedema. The TKA group included 15 patients who had undergone surgery more than a year previously, and the control group included 19 patients awaiting TKA surgery. Volume and perimeter measurements served as reference criterions. The lower limb percentage differences for BIS, knee perimeter and volume were calculated. The significance of differences between groups was calculated for all measurement methods, using the Mann-Whitney test. The setting was a Department of Orthopedic Surgery and Traumatology in a university hospital. Results The differences between groups were not significant for R0, Rinf, volume and perimeter. R0 showed the smallest mean difference in limb percentage difference between groups [means (SD): TKA 3.98 (8.09), controls 3.97 (5.16)]. Conclusions The lower-leg percentage difference in the TKA group is comparable with that of healthy subjects. R0 can be used for oedema evaluation following TKA surgery, as there was no sign of alteration from the metallic implant. These findings indicate the potential for early oedema evaluation after TKA. More research is warranted to extensively validate the application of BIS for oedema evaluation after TKA. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose. This study explores the effect of vibrotactile biofeedback on gait in 20 patients with bilateral vestibular areflexia using observational gait analysis to score individual balance. Methods. A tilt sensor mounted on the head or trunk is used to detect head or body tilt and activates, via a microprocessor, 12 equally distributed vibrators placed around the waist. Two positions of the tilt sensor were evaluated besides no biofeedback in three different gait velocity tasks (slow/fast tandem gait, normal gait on foam) resulting in nine different randomized conditions. Biofeedback activated versus inactivated was compared. Twenty patients (10 males, 10 females, age 39-77 years) with a bilateral vestibular areflexia or severe bilateral vestibular hyporeflexia, severe balance problems and frequent falls participated in this study. Results. Significant improvements in balance during gait were shown in our patients using biofeedback and sensor on the trunk. Only two patients showed a significant individual gait improvement with the biofeedback system, but in the majority of our patients, it increased confidence and a feeling of balance. Conclusion. This study indicates the feasibility of vibrotactile biofeedback for vestibular rehabilitation and to improve balance during gait. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

To identify the contents of a documentation template in The Guide to Physical Therapist Practice using the International Classification of Functioning, Disability, and Health (ICF) Core Sets for rheumatoid arthritis, osteoarthritis, and low back pain (LBP) as reference. Concepts were identified from items of an outpatient documentation template and mapped to the ICF using established linking rules. The ICF categories that were linked were compared with existing arthritis and LBP Core Sets. Based on the ICF, the template had the highest number (29%) of linked categories under Activities and participation while Body structures had the least (17%). ICF categories in the arthritis and LBP Core Sets had a 37-55% match with the ICF categories found in the template. We found 164 concepts that were not classified or not defined and 37 as personal factors. The arthritis and LBP Core Sets were reflected in the contents of the template. ICF categories in the Core Sets were reflected in the template (demonstrating up to 55% match). Potential integration of ICF in documentation templates could be explored and examined in the future to enhance clinical encounters and multidisciplinary communication. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose. The deep neck flexor muscles (DNFs) stabilize the cervical spine and cervicogenic pain appears to adversely affect their endurance capacity. They are inaccessible to direct palpation, thereby making assessment difficult. However, the cranio-cervical flexion test (CCFT) provides an indirect method of assessing the endurance capacity of the DNFs. The purpose of the present study was to evaluate the intratester reliability of the CCFT in asymptomatic subjects. Method. The clinical protocol of the CCFT was measured on two occasions with 7 days between measurements. Prior to testing, participants were trained and compensation strategies were corrected. Nineteen asymptomatic participants (mean age 24.9 years; range 22–36) were recruited. Results. The test had excellent intratester reliability (intraclass correlation coefficient = 0.983; standard error of the mean = 8.94; smallest real difference = 24.7). A Bland and Altman's limits of agreement analysis confirmed the high reliability of the test. Conclusion. The CCFT results demonstrated excellent intra-tester reliability in asymptomatic subjects, thus contributing to the normative data regarding the test. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose: Spatio‐temporal parameters are commonly used in gait assessment. Advanced tools provide valid and reliable data, considered very effective for physiotherapy intervention. However, these tools may be limited in clinical usage caused by complicated applicability, inaccessibility, and high cost. Therefore, a video‐based system is an alternative choice that is easy and affordable for the clinical setting. The purpose of the study was to evaluate the concurrent validity of the video‐based system against the validated instrumented gait system (Force Distribution Measurement [FDM]) on the spatio‐temporal gait parameters in individuals with stroke. In addition, the intratester reliability of a novice tester was determined. Methods: Twenty individuals with stroke participated in the study. Gait was captured by the video‐based and FDM systems simultaneously to measure the degree of concurrent validity. Parameters composed of the affected and unaffected step lengths (cm) and step time (s), stride length (cm), gait velocity (m/s), and cadence (steps/min). Pearson correlation coefficient, paired t test, and intraclass correlation coefficient (ICC) were used to determine the concurrent validity, the difference of the data, and intratester reliability. Results: All spatio‐temporal gait parameters showed excellent degrees of correlation (rp =.94 to.99, p <.001) between the video‐based and FDM systems. No significant difference in all parameters was found between the two systems. Excellent intratester reliability (ICC3,1 = 0.91 to 0.99, p <.001) of all gait parameters were found in a novice tester. Conclusion: The video‐based system was valid and reliable for a novice tester to measure the spatio‐temporal gait parameters in individuals with stroke. [ABSTRACT FROM AUTHOR]

Objectives: Walking impairments are common in individuals with multiple sclerosis. Trunk control is a prerequisite for walking; however, knowledge regarding whether core stability and balance training influence walking is limited. This study aimed to investigate the immediate and long‐term effects of a group‐based, individualized, comprehensive core stability and balance intervention (GroupCoreDIST) compared with those of standard care on walking. Methods: This assessor‐blinded, prospective randomized controlled trial included 80 participants (Expanded Disability Status Scale scores 1–6.5) randomly allocated to GroupCoreDIST, conducted in groups of three for 60 min three times per week for 6 weeks (18 sessions) or standard care (n = 40/40). One participant attended no posttests, leaving 79 subjects for intention‐to‐treat analysis. The assessments were performed at baseline and at Weeks 7, 18, and 30. Outcomes included the 2‐min walk test (2MWT), 10‐m walk test‐preferred/fast/slow speed (10MWT), Multiple Sclerosis Walking Scale‐12 (MSWS‐12), Patient Global Impression of Change‐walking (PGIC‐walking), Rivermead Visual Gait Assessment (RVGA), and ActiGraphsWgt3X‐BT activity monitors (ActiGraph). The statistical analyses included repeated‐measures mixed models performed in IBM SPSS Version 24. Results: There were no significant between‐group differences in the outcome measurements at baseline. The mean differences between groups were significant at all follow‐up time points in favour of GroupCoreDIST for the 2MWT, 16.7 m at 7 weeks (95% CI [8.15, 25.25], 15.08 m at 18 weeks (95% CI [6.39, 23.77]) and 16.38 m at 30 weeks (95% CI [7.65, 25.12]; and the PGIC‐walking, 0.89 points at 7 weeks (95% CI [1.34, 0.45]), 0.97 points at 18 weeks (95% CI [1.42, 0.52]), and 0.93 points at 30 weeks (95% CI [1.39, 0.48]; all p ≤.001). The 10MWT‐fast speed and the MSWS‐12 showed significant between‐group differences at 7 and 18 weeks and the RVGA at 7 weeks. No between‐group differences were found regarding activity level (ActiGraph) or the 10MWT‐preferred or slow speed. Conclusion: Compared with standard care, GroupCoreDIST significantly improved walking immediately after the intervention for up to 24 weeks of follow‐up. [ABSTRACT FROM AUTHOR]

Objective: Perturbation‐evoked stepping reactions are infrequently assessed directly in clinical settings even though stepping reactions in response to a sudden loss‐of‐balance perturbation ultimately determine whether a fall occurs. Individuals with acquired brain injury (ABI) due to stroke who are ambulatory and awaiting hospital discharge have been found to exhibit delayed stepping reactions but are typically discharged without assessment of perturbation‐evoked stepping. Tests that specifically target the capacity to perform perturbation‐evoked stepping reactions are important to identify those at risk for falls and to direct intervention strategies. The aim of this study was to evaluate agreement and reliability of two assessment methods used to assess rapid stepping reactions, specifically in individuals with ABI due to stroke or other causes. A secondary aim was to compare perturbation‐triggered biomechanics of the two assessment methods. Methods: Thirty‐five participants who were less than 4 months post‐ABI were evaluated in an inpatient unit at the Toronto Rehabilitation Institute. Stepping reactions were assessed using manual release‐from‐lean and cable release‐from‐lean perturbation‐based assessment methods. Results: There was moderate agreement between the assessment scores resulting from the two assessment methods (κ = 0.55) and substantial test–retest reliability (κ's > 0.61) for both assessment methods. There was no evidence that the assessment score was affected by assessment method, test–retest, or assessment order. However, the cable release from lean resulted in a more rapid release of the lean support force (2 ms vs. 125 ms) and earlier foot‐off times (340 ms vs. 401 ms) compared with the manual release from lean. Conclusion: Delays in foot‐off time associated with the manual release‐from‐lean perturbation raise concerns that the manual assessment method may not provide a perturbation that is sufficiently challenging to reveal a patient's balance‐recovery capacity and associated fall risk. However, the manual assessment requires no equipment and the assessment score may provide a useful indication of gross reactive balance control. [ABSTRACT FROM AUTHOR]

Objectives: Parkinson's disease (PD) is characterized by visuospatial and body schema deficits. People with PD often exhibit hypometric movements and graphic hypometria (i.e., small drawing dimensions). The goal of the current study was to explore graphic‐metric representation in people with PD by assessing pelvic and clock drawing dimensions (i.e., height and width) and by investigating associations between pelvic drawing dimensions and participant characteristics. Methods: Twenty people (16 males, 4 females; M age: 65.75 ± 10.13 years) with idiopathic PD (Hoehn &Yahr Stages I–III) volunteered to participate in this study. Draw Your Pelvis and Clock Drawing tests were used for assessing drawing dimensions, which were then correlated with PD severity, stage and duration, cognitive level, side of symptoms onset, and pelvic schema score. Bivariate and multiple linear regression analyses were also used. Results: Excellent (.844–.999) interrater reliability was shown for measuring pelvic and clock drawing dimensions. Pelvic drawing dimensions did not significantly (P > .05) differ in magnitude, whereas clock drawing height was significantly (p < .01) greater than width, both suggesting graphic dysmetria (i.e., distorted graphic dimensions). Pelvic drawing width was negatively associated with PD severity and stage, was positively associated with pelvic schema score, and predicted all three parameters. Conclusion: Measuring pelvic drawing dimensions, and specifically pelvic drawing width, holds potential as an adjunct diagnostic measure in PD assessments and for detecting pelvic schema deficits or misperceptions. This test can be used by physical therapists in the clinic for assessing disease severity, stage, and pelvic schema in people with PD. The knowledge gained from this study contributes to a greater understanding of graphic‐metric representation and associated deficits in people with PD. Future studies should explore the relationship between pelvic drawing dimensions and pelvic mentally imaged estimates, and their role in motor planning, control, and execution in people with PD. [ABSTRACT FROM AUTHOR]

Background and purpose: Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disease that can cause repercussions on respiratory muscles and body composition. The aim of the current study was to evaluate inspiratory muscle strength, diaphragmatic mobility, and body composition in COPD subjects and to correlate these variables. Methods: This was a cross‐sectional study performed with 21 COPD patients. Inspiratory muscle strength (manovacuometry), pulmonary function test (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], and FEV1/FVC ratio), diaphragmatic mobility (ultrasonography), and body composition (bioelectrical impedance analysis) were examined. Results: COPD individuals in Stages II (28.9%), III (52%), and IV (19%) according to Global Initiative for Chronic Obstructive Disease were recruited, 61.9% of which were men. Inspiratory muscle weakness was found in 47.6% of subjects, who presented a lower fat‐free mass percentage (p = 0.017) and smaller fat‐free mass index (p = 0.001) and greater fat mass percentage (p = 0.029) and less diaphragmatic mobility (p = 0.007) compared with the nonrespiratory weakness group. Maximal inspiratory pressure exhibited a moderately positive relationship to the fat‐free mass index (r = 0.767, p < 0.001) and a weak positive relationship to diaphragmatic mobility (r = 0.496, p = 0.022). Conclusion: Our study showed a high prevalence of inspiratory muscle weakness based on the severity of airway obstruction and on the presence of muscular depletion. The evaluation of body composition detected important changes. It also demonstrated that not only muscular weakness was present in these patients but also this had repercussions on the mobility of the diaphragm muscle. [ABSTRACT FROM AUTHOR]

Background and Objective: Falling is a major health concern that has contributed significantly to older people's injury and loss of life worldwide, warranting the development of fall‐prevention strategies, the success of which has been attributed to the levels of knowledge and practice about fall prevention among physiotherapists and other health professionals. The objective of this study was to determine the self‐reported levels of knowledge on risk factors of fall and practices about fall prevention in older adults among physiotherapists in Nigeria. Methods: Physiotherapists (N = 237) recruited from the six geopolitical zones of Nigeria completed a three‐part structured questionnaire that asked questions about risk factors for fall and common practices for fall prevention using a 5‐point‐rated Likert scale. Data were analysed using descriptive analysis, chi‐square, and Kruskal–Wallis tests. Results: Among physiotherapists in Nigeria, 89% rated their level of knowledge about preventing falls among older adults as high, and 64% of them rated their level of practice on this topic as high. Among the individual items that measured knowledge, 40% of the participants reported a moderate level of knowledge about multiple medications as a risk factor for falls. Fifty percent of the participants reported a low level of practice of referral to other health care professionals, whereas 40% and 41% reported a moderate level of practice on documenting risk factors and treatment plans, respectively. There was no association between age, gender, or years of practice with levels of knowledge or practice. Conclusion: This study suggests that physiotherapists in Nigeria have adequate knowledge and practice for fall prevention in older adults. However, there are potential gaps in knowledge of risk factors, documentation, and referrals to other professions that may be addressed through developing context‐specific fall‐prevention clinical guidelines for practice in Nigeria. [ABSTRACT FROM AUTHOR]