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Background Resistance training with pneumatic machines attenuates the age-associated loss in muscle strength and function in older adults. However, effectiveness of scaled-up pneumatic machine resistance training in the community is not known. We evaluated the effectiveness of a multi-site community-delivered 12-week pneumatic machine resistance programme (Gym Tonic (GT)) on muscle strength and physical function in older adults. Methods Three hundred eighteen community-dwelling older adults aged ≥65 years were randomized into 12-week (twice/week) coach-supervised-community-based-GT-programme(n = 168) and wait-list control groups(n = 150). After 12 weeks, the intervention group continued with GT-training and the control group received supervised-GT-programme for further 12 weeks (partial-crossover-design). Fried frailty score, lower-extremity muscle strength and physical function (i.e., fast and habitual gait-speed, balance, repeated-chair-sit-to-stand, short physical performance battery (SPPB)) were determined at baseline, 12 and 24 weeks. Analysis adopted a modified-intention-to-treat-approach. Results After 12 weeks, lower-extremity muscle strength improved by 11–26%(all p < 0.05) and fast gait-speed improved by 7%(p = 0.008) in GT-intervention group(n = 132) than controls(n = 118), regardless of frailty status. Other physical function performance did not differ between control and intervention groups after 12 weeks (all p > 0.05). Frailty score improved by 0.5 in the intervention but not control group(p = 0.004). Within the intervention group, lower-extremity muscle strength and physical function outcomes improved at 24 weeks compared with baseline (all p Conclusion Community-delivered GT resistance training programme with pneumatic machines has high adherence, improves muscle strength and fast gait-speed, and can be effectively implemented at scale for older adults. Future studies could examine if including other multi-modal function-specific training to complement GT can achieve better physical/functional performance in power, balance and endurance tasks. Trial registration ClinicalTrials.gov, NCT04661618, Registered 10 December 2020 - Retrospectively registered.

Adult patients with diabetes mellitus (DM) represent one-fifth of all 30-day unplanned hospital readmissions but some may be preventable through continuity of care with better DM self-management. We aim to synthesize evidence concerning the association between 30-day unplanned hospital readmission and patient-related factors, insurance status, treatment and comorbidities in adult patients with DM. We searched full-text English language articles in three electronic databases (MEDLINE, Embase and CINAHL) without confining to a particular publication period or geographical area. Prospective and retrospective cohort and case–control studies which identified significant risk factors of 30-day unplanned hospital readmission were included, while interventional studies were excluded. The study participants were aged ≥18 years with either type 1 or 2 DM. The random effects model was used to quantify the overall effect of each factor. Twenty-three studies published between 1998 and 2018 met the selection criteria and 18 provided information for the meta-analysis. The data were collected within a period ranging from 1 to 15 years. Although patient-related factors such as age, gender and race were identified, comorbidities such as heart failure (OR=1.81, 95% CI 1.67 to 1.96) and renal disease (OR=1.69, 95% CI 1.34 to 2.12), as well as insulin therapy (OR=1.45, 95% CI 1.24 to 1.71) and insurance status (OR=1.41, 95% CI 1.22 to 1.63) were stronger predictors of 30-day unplanned hospital readmission. The findings may be used to target DM self-management education at vulnerable groups based on comorbidities, insurance type, and insulin therapy.

Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.

Objective To evaluate the relationship between caregiver nature and availability, and rehabilitation outcomes in subacute stroke. Design Retrospective cohort study. Setting Four community rehabilitation hospitals. Participants Patients with subacute, first-time stroke (N=4042; 48.5% men; mean age ± SD, 70.12±10.4y; 51.5% women; mean age ± SD, 72.54 ±10.0y). Interventions Not applicable. Main Outcome Measures Rehabilitation effectiveness, defined as the percentage of potential improvement eventually achieved with rehabilitation; and rehabilitation efficiency, defined as the rate of functional improvement during rehabilitation. Results In our cohort, 96.7% had available caregiver(s), of which 42.0% were primarily supported by foreign domestic workers (FDWs), 25.9% by spouses, 19.3% by first-degree relatives, 7.8% by other relatives, and 5.1% by other caregivers. Using quantile regression, we found that having a caregiver was independently associated with rehabilitation efficiency (β=−3.83; 95% confidence interval [CI], −6.99 to −0.66; P =.018). The relationship between caregiver availability and rehabilitation effectiveness was modified by patient sex in that the negative association was significantly greater in men (β=−22.81; 95% CI, −32.70 to −12.94; P P =.223). Having a FDW as a caregiver compared with a spousal caregiver was negatively associated with rehabilitation effectiveness (β=−3.95; 95% CI, −6.94 to −0.95; P =.01) and rehabilitation efficiency (β=−1.83; 95% CI, −3.14 to −0.53; P =.006). The number of potential caregivers was only significantly associated with rehabilitation effectiveness at the bivariate level ( P =.006). Conclusions Caregiver identity, and possibly availability, appears to negatively affect rehabilitation outcomes in subacute stroke. A better understanding of these relationships has potential implications on clinical practice and policy directions.

Entry level physiotherapy education began in Singapore in 1992 with the commencement of a three-year diploma. The yearly numbers of diploma graduates has risen over the years and currently over 100 students graduate from Nanyang Polytechnic (NYP) each year. Physiotherapy education in Ireland changed from diploma to degree level in 1986, and since the 1990s there has been a growing focus on post graduate education and research. This paper describes the background to the development of a one-year programme leading to a BSc (Physiotherapy) (from the University of Dublin, Trinity College) with recognition of the three-year diploma in Physiotherapy from NYP in Singapore. The first graduates of the one-year programme will receive their degrees in 2013.

The angiotensin-I-converting enzyme (ACE) I/D gene polymorphism has been studied for its role in determining habitual physical activity level, but there is no information from Asian populations. The objective of this study was to determine whether this ACE gene polymorphism was associated with physical activity level among Chinese in Singapore. In this cross-sectional study, 110 normotensive Chinese in Singapore, age 21–61 yr, completed the short-form version of the International Physical Activity Questionnaire and contributed buccal cell samples for genotyping of the ACE I/D gene polymorphism using polymerase chain-reaction amplification. They also provided demographic information and underwent anthropometric measurements. Physical activity level was expressed as continuous (in kcal/wk) and categorical (low, moderate, or high) data. The 3 genotypes of ACE were DD (homozygous for the deletion allele), II (homozygous for the insertion allele), and ID. Among the participants, 28.2% reported low, 49.1% moderate, and 22.7% high physical activity level. Frequencies of the genotypes were 11.8% for DD, 42.7% for ID, and 45.5% for II. ACE genotype was independently associated with physical activity level. After age, gender, and body-mass index were adjusted for, individuals with DD or ID genotypes were more likely to report insufficient or low physical activity level than those with II genotypes (odds ratio = 6.88; 95% confidence interval: 2.26, 20.94). In conclusion, the I/D polymorphism of the ACE gene is significantly associated with self-reported physical activity level in normotensive Chinese Singaporeans.

Objective: The objective of the present study was to describe stroke-related knowledge (risk factors, warning signs and emergency response), lifestyle behaviours and health beliefs among Singaporean Chinese, and to identify any factors associated with such knowledge, behaviours and beliefs. Design: This was a cross-sectional study design employing a non-probability sampling method. Setting: Participants were recruited from the community. Method: Singaporean Chinese aged 40–74 years completed an interviewer-administered questionnaire seeking demographic information, knowledge of stroke risk factors, warning signs and emergency response, lifestyle behaviours such as physical activity participation and dietary habits, and health beliefs. Results: A total of 411 questionnaires (42% men, average age 52.4 years ± 7.3) were analyzed. Most respondents were able to identify at least one correct risk factor and warning sign (88% and 78% respectively). But only 38% stated the correct emergency response. Mass media was the main source of their knowledge. Most respondents reported healthy lifestyle and have positive health beliefs, many of which were associated with age, gender, education, income, religion and whether having relatives suffering from a chronic illness. Conclusion: In conclusion, this survey identified areas for health education programmes to improve stroke-related knowledge and lifestyle behaviour change in different target groups.

The association between allelic variants and lumbar disc degenerative disease (DDD) has been investigated in Europe and Northern Asia. However, this has not been investigated in Southeast Asia. This observational study aims to compare the distribution of COL9A2 and COL9A3 gene polymorphism among male Chinese Singaporeans with and without lumbar DDD. COL9A2 gene polymorphism was investigated in p326 (tryptophan 2, Trp2 and glutamine 2, Gln2, alleles) and p335 (valine 2 or Val2 allele). COL9A3 gene polymorphism was investigated in p17 (glycine 3 or Gly3 allele) and p103 (tryptophan 3 or Trp3 allele). The Val2 allele was significantly decreased in the group with lumbar DDD (p < 0.05). No significant difference in allelic distributions of Trp2, Gln2 and Gly3 was found. The Trp3 allele was absent from all the subjects. The presence of at least one Val2 allele appears to have a protective ef fect against DDD. However, these should be interpreted with caution, given the limitations. Further investigations are warranted in order to verify such genetic predisposition prior to the potential development of preventative or therapeutic strategies in the near future.

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.

Background and Purpose Manual hyperinflation is a physiotherapy technique that improves static compliance and mobilizes secretions, but has the potential to alter haemo-dynamic function. The aim of the present study was to investigate the effects of manual hyperinflation on haemodynamic function in a healthy animal model, without the usual confounding effects inherent in an heterogeneous intensive care population. Method The study used a within-subjects design, in an animal research theatre. Nine healthy sheep (eight Border Leicester, one Merino, mean weight 39.5 kg, standard deviation (SD) 1.6 kg) completed the study. The sheep were induced (thiopentane 15–20 ml), intubated, ventilated and surgically instrumented for an arterial line and pulmonary artery catheter. Anaesthesia was maintained by 1.5% halothane/oxygen. Manual hyperinflation was delivered for two minutes with a Mapleson C circuit, using a peak inspiratory pressure of 35cmH2O and an inspiratory:expiratory ratio of 2:1. Results Mean tidal volume during manual hyperinflation was 294% (SD 22%) of the ventilator tidal volume. A paired Student's t-test demonstrated that cardiac output (thermodilution method) decreased significantly (p

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n=32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization's non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

Background and Purpose. The main indications for physical therapy for patients in intensive care units (ICUs) are excessive pulmonary secretions or atelectasis. Timely physical therapy interventions may improve gas exchange and reverse pathological progression, thereby curtailing or avoiding artificial ventilation. The purpose of this case report is to illustrate 24-hour availability of physical therapy for a patient with acute respiratory failure. Case Description. The patient was a 66-year-old man who was admitted to an ICU for acute respiratory failure. Intensive physical therapy, based on Dean's physiologic treatment hierarchy for patients with impaired oxygen transport, consisted of upright body positioning, mobilization and exercise, and active cycles of breathing techniques every 2 hours for the first 12 hours he was in the ICU. Outcomes. In total, the patient received 11 physical therapy sessions over his 48-hour stay in the ICU (6 sessions on day 1 and 5 sessions on day 2). Arterial oxygenation improved markedly with radiographic resolution of infiltrates, and planned endotracheal intubation and mechanical ventilation were avoided. Discussion. This patient with acute respiratory failure received physical therapy in a timely manner afforded by 24-hour access to physical therapy. The intensive physical therapy might be more cost-effective than if the patient had been managed with intubation and mechanical ventilation. Patients in ICUs who have excessive pulmonary secretions or atelectasis may benefit from access to physical therapy 24 hours a day.

WKY was a 32-year-old Chinese man, 180 cm in height and 55 kg in weight. Apart from chronic bilateral patellofemoral joint pain diagnosed as ‘chondromalacia patellae’ by an orthopaedic surgeon almost ten years before, and receiving no treatment, he enjoyed relatively good health. The onset of his current complaint was sudden and occurred when he was taking a shower. When he finished washing his hair, WKY extended his head abruptly and felt his neck ‘caught in the wrong position’. From that point onwards, he experienced sharp pain on movement in all directions. Several hours later, his neck movements were still severely limited by pain, described as ‘excruciating’.

The aim of this paper is to review the evidence for the use of body positioning to improve oxygenation in the mechanically ventilated patient with acute respiratory failure. The emphasis is placed on research evidence for both benefits and risks associated with the use of common body positions in this patient population. Increased regional ventilation under the influence of gravity with an overall improvement in the ventilation/perfusion ratio appears to be the main mechanism of position-induced improvement in oxygenation. Strong evidence exists for positioning with the affected lung superior in acute respiratory failure due to unilateral lung disease. Haemodynamic risks, however, have been shown to be associated with side lying position. Weak but consistent evidence supports prone positioning for improving oxygenation in patients with acute respiratory failure. No major complications arising from the prone position have been reported. Randomised clinical trials on the effects of upright and semi-recumben...

Acute respiratory distress syndrome (ARDS) is an intensive care condition first described more than three decades ago. Recent advances in the understanding of its pathology and management are reviewed. Of particular relevance to physiotherapists are the characteristic metabolic, haemodynamic and respiratory consequences of ARDS. These have implications for physiotherapy practice as chest physiotherapy has been demonstrated to have metabolic, haemodynamic and respiratory effects. Application of chest physiotherapy may exacerbate or attenuate these effects. However, there is a lack of research in this area. On the other hand, body positioning has enjoyed much attention recently. The prone position is strongly advocated as an inexpensive alternative to new mechanical ventilatory modes in improving oxygenation. Despite a large body of research on ARDS, it continues to carry a mortality rate of up to 70%. Therefore, there is a need for continuing research efforts on investigating its response to various therapeutic and supportive measures.

Background Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Methods Data from the “Evaluation of the Frails’ Fall Efficacy by Comparing Treatments” study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cut-off values of 6MWD (in meters) for GROC rating of “a little bit better” (+2), based on feedback from participants. Results The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC ≥ 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. Conclusion The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000576022

Background: Cardiac rehabilitation (CR), a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI), revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF). This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR. Methods: Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL) were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond’s checklist. Results: A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1) supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2) home-based CR was no different from centre-based CR; (3) no difference existed between inpatient and outpatient CR; and (4) home-based programs were generally cost-saving compared to no CR. Conclusions: Overall, all the studies supported the implementation of CR for MI and HF. However, comparison across studies highlighted wide variability of CR program design and delivery. Policy makers need to exercise caution when generalizing these findings to the Singapore context. Background Cardiovascular diseases are a major cause of mortality and morbidity, contributing to about 30% of all-cause mortality and 10% of the total disability-adjusted lifeyears globally [1]. Although advances in medical therapy and revascularization surgery have improved outcome, reducing risk factors associated with cardiovascular diseases remains an important strategy in lowering the global burden of disease [2]. Risk factor management is a core component of cardiac rehabilitation, which in turn forms part of the overall management of patients with cardiovascular diseases such as coronary artery disease or chronic heart failure [3,4]. Besides risk factor management (specifically control or reduction of lipids, blood pressure, body weight, diabetes mellitus and cigarette smoking), the other core components of cardiac rehabilitation include nutritional and physical activity counseling, psychosocial interventions and exercise training [4]. In particular, exercise training is often the component being examined under the umbrella

The long-term outcomes of biomedical advances in cardiology and surgery, the focus of this book, fall short of their potential unless coupled with changes in patients’ lifestyle behaviors. Within the context of a busy, resourceand time-constrained practice, this chapter presents practical and effective evidence-informed strategies for health education that can be readily implemented by the cardiologist and surgeon. Given the unequivocal link between lifestyle behaviors and ischemic heart disease, ‘healthy living’ not only promises to augment a patient’s health overall and reduce the need for drugs and surgery but, when biomedical interventions are indicated, it can augment their outcomes.

The information provided in 10 per cent of all written medical referrals received by a teaching hospital physiotherapy outpatient department in each of the years 1982 and 1989 was systematically analysed to identify any demonstrable changes in emphasis. Significant between year differences indicated fewer referrals containing a diagnosis in 1989 than in 1982, less emphasis on requests for physiotherapy modalities and a significant increase in more generalised requests and inclusion of aims of treatment. These results suggest that greater clinical autonomy is expected of physiotherapists by medical practitioners in this particular hospital setting, The method used in this study could be applied in future to monitor referral to physiotherapy to examine whether these results represent a real trend.

Background Anorexia nervosa is an eating disorder that is often preceded by excessive physical activity. As such, exercise is not often prescribed in the clinical management of individuals with anorexia nervosa. Objective To examine the effects of supervised exercise training in patients with anorexia nervosa. Data sources Five databases were searched from their inception to Week 14 of 2011 using the subject headings ‘anorexia’ and ‘exercise’ to identify relevant studies. Eligibility criteria PRISMA guidelines were followed. Studies that investigated the effects of inclusion of supervised exercise training in clinical management with usual management in patients diagnosed with anorexia nervosa were included in this review. Case reports were excluded. Data extraction and synthesis Two reviewers independently extracted data using a standardised assessment form. Quality assessment was rated for the controlled trials and single-group studies using the PEDro scale and Downs and Black scale, respectively. Fixed or random effect approaches were used to determine effect size, depending on the heterogeneity of the studies. Results Pooled randomised controlled trials and quasi-randomised studies showed no significant effect of supervised exercise training on selected anthropometric measurements, while the single-group studies showed significant improvement in weight and body fat. Although Short Form-36 revealed no training effect, distorted feelings about food and exercise were reduced. Cardiovascular fitness also improved with no decrease in weight. Limitations Heterogeneity of exercise training programmes, small sample size (n ≤ 20) for 67% of the trials, and inability to exclude publication bias. Conclusions Inclusion of supervised exercise training in the comprehensive management of patients with anorexia nervosa appears to be safe, as no detrimental effect was observed in anthropometry. Strength and cardiovascular fitness were also shown to improve.

A systematic review with meta-analysis.To compare pain and disability in individuals with persistent nonspecific low back pain who were treated with Pilates exercises compared to minimal or other interventions.Searches of Medline, CINAHL, Embase, Cochrane library, PEDro, and ProQuest Dissertations and Thesis databases were conducted. Randomized controlled trials (RCTs) were selected and reviewed if they compared pain and disability in individuals with persistent nonspecific low back pain who were treated with Pilates exercises compared to other treatment approaches. Quality of the trials was evaluated. Data for pain and disability scores were extracted. Narrative synthesis plus meta-analyses were performed, with either a fixed-effects or random-effects model, standardized mean differences (SMDs), and tests for heterogeneity.Seven RCTs were identified and included in the meta-analyses. Data pooling was performed using RevMan 5. When compared to minimal intervention, Pilates-based exercise provided superior pain relief (pooled SMD, -2.72; 95% CI: -5.33, -0.11; P = .04) but the pooled disability scores were not significantly different (pooled SMD, -0.74; 95% CI: -1.81, 0.33;P = .17). No significant differences were found when comparing Pilates-based exercise to other forms of exercise for pain (pooled SMD, 0.03; 95% CI: -0.52, 0.58; P = .92) or disability scores (pooled SMD, -0.41; 95% CI: -0.96, 0.14; P = .14).Pilates-based exercises are superior to minimal intervention for pain relief. Existing evidence does not establish superiority of Pilates-based exercise to other forms of exercise to reduce pain and disability for patients with persistent nonspecific low back pain. However, the relatively low quality of existing studies and the heterogeneity of pooled studies in this systematic review combine to suggest that these results should be interpreted with caution.Therapy, level 1a.

The aims of the present study were to describe the after-hour physiotherapy services in a tertiary general hospital, the patients and their demographics, and to determine which independent variables would predict physiotherapists' referrals to after-hour physiotherapy. A retrospective record review from April 1, 2004, to April 30, 2005, identified 992 patients (mean age 63.8 years; 95% confidence interval [CI] 62.6-65.0 years) who were either referred by daytime physiotherapists (68%) or referred by medical practitioners for urgent attendance after hours (32%). Pneumonia was formally diagnosed medically in 20% (n=197) of the patients. Of all the patients who had surgery, upper abdominal or thoracic incisions formed the majority (61%; n=236). Whether patients had upper abdominal/thoracic surgery (estimated odds ratio 3.4; 95% CI 2.3-4.9) and the presence of pneumonia (2.8; 95% CI 1.9-4.2) were two independent factors identified from a logistic regression model predicting daytime physiotherapists' referral of patients to after-hour service. This model correctly predicted 65.5% of the cases. Most patients were seen for mucociliary clearance. Referral behaviour by physiotherapists reflects the basis of their clinical decision making and has implications for practice, training, and further research.

Chest clapping, vibration, and shaking were studied in 10 physiotherapists who applied these techniques on an anesthetized animal model. Hemodynamic variables (such as heart rate, blood pressure, pulmonary artery pressure, and right atrial pressure) were measured during the application of these techniques to verify claims of adverse events. In addition, expired tidal volume and peak expiratory flow rate were measured to ascertain effects of these techniques. Physiotherapists in this study applied chest clapping at a rate of 6.2 ± 0.9 Hz, vibration at 10.5 ± 2.3 Hz, and shaking at 6.2 ± 2.3 Hz. With the use of these rates, esophageal pressure swings of 8.8 ± 5.0, 0.7 ± 0.3, and 1.4 ± 0.7 mmHg resulted from clapping, vibration, and shaking respectively. Variability in rates and “forces” generated by these techniques was 80% of variance in shaking force ( P = 0.003). Application of these techniques by physiotherapists was found to have no significant effects on hemodynamic and most ventilatory variables in this study. From this study, we conclude that chest clapping, vibration, and shaking 1) can be consistently performed by physiotherapists; 2) are significantly related to physiotherapists' characteristics, particularly clinical experience; and 3) caused no significant hemodynamic effects.