Physiotherapy - Research Publications
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ItemNo Preview AvailableKnowledge, confidence, attitudes and beliefs of physiotherapists and physiotherapy students working with people with dementia: A mixed-methods systematic review(Wiley, 2021-12-01)BACKGROUND: Clinical care for people with dementia as a primary diagnosis, or as a co-morbidity, can be complex. Physiotherapists play a key role in the care of people living with dementia in multiple settings. The aim of this systematic review is to understand the attitudes, beliefs, knowledge and confidence of physiotherapists and physiotherapy students when working with people with dementia. METHOD: This was a mixed-methods systematic review that included qualitative and quantitative studies. Participants were physiotherapists working in any clinical specialty (e.g. gerontology, orthopaedic, neurological, cardio-respiratory), and physiotherapy students who had completed at least one clinical placement. If studies investigated physiotherapist and physiotherapy students' knowledge, confidence, attitudes or beliefs on working with a general population of older adults, they were excluded. The phenomena of interest and context were attitudes, beliefs, knowledge and confidence when working with people with dementia in any setting. Eleven databases were searched. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed methods systematic reviews. RESULT: 15 studies were eligible for inclusion (9 quantitative and 6 qualitative studies). There were 5 key themes: rehabilitation potential (variable outcomes, poor potential), challenges in dementia care (communication, behaviour, cognition, risk, stress and burnout), education in dementia practice (inadequate training and knowledge, importance of experience), specialised area of practice (complexity of presentation, nuance of care, importance of time, holistic approach) and unsupportive systems (environment, time, risk aversion). One code, lack of desire to provide dementia care, did not contribute to any themes. CONCLUSION: Physiotherapists and physiotherapy students have low levels of knowledge and confidence in several areas important to working with people with dementia. With higher levels of knowledge and confidence associated with more positive attitudes and beliefs, dementia education needs of physiotherapists at all levels needs to be addressed.
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ItemChanges in the kinetics and kinematics of a reactive cut maneuver after successful athletic groin pain rehabilitation(WILEY, 2021-04)Athletic groin pain (AGP) is a chronic, painful condition which is prevalent in players of field sports that require rapid changes of direction. Following successful rehabilitation, systematic changes have been observed in the kinetics and kinematics of pre-planned change of direction maneuvers, providing insight into potential foci for rehabilitation monitoring and for the assessment of interventions. However, changing direction in field sports is often reactive rather than pre-planned, and it is not known whether such post-rehabilitation changes are seen in reactive maneuvers. We analyzed the stance phase kinetics and kinematics of a 90° reactive cutting maneuver in 35 AGP patients before and after a successful exercise intervention program. Following the intervention, transverse plane rotation of the pelvis toward the intended direction of travel increased, and the body center of mass was positioned more anteriorly relative to the center of pressure. Ankle dorsiflexion also increased, and participants demonstrated greater ankle plantar flexor internal moment and power during the second half of stance. These findings provide insight into mechanical variables of potential importance in AGP, as identified during a maneuver based on a common sporting task.
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ItemThe role of acute in-patient rehabilitation on short-term outcomes after liver transplantation: A systematic review of the literature and expert panel recommendations(WILEY, 2022-09)BACKGROUND: The indication and surgical complexity of orthotopic liver transplantation underscore the need for strategies to optimize the recovery for transplant recipients. We conducted a systematic review aimed at identifying, evaluating, and synthesizing the evidence examining the effect of in-patient rehabilitation for liver transplant recipients and provide related practice recommendations. METHODS: Health research databases were systematically reviewed for studies that included adults who received liver transplantation and participated in acute, post-transplant rehabilitation. Postoperative morbidity, mortality, length of hospital stay, length of intensive care unit stay, and other markers of surgical recovery were extracted. Practice recommendations are provided by an international panel using GRADE. RESULTS: Twelve studies were included in the review (including 3901 participants). Rehabilitation interventions varied widely in design and composition; however, details regarding intervention delivery were poorly described in general. The quality of evidence was rated as very low largely owing to "very serious" imprecision, poor reporting, and limited data from comparative studies. Overall, the studies suggest that in-patient rehabilitation for recipients of liver transplantation is safe, tolerable, and feasible, and may benefit functional outcomes. CONCLUSION: Two practice recommendations related to in-patient rehabilitation following LT were yielded from this review: (1) it is safe, tolerable, and feasible; and (2) it improves postoperative functional outcomes. Each of the recommendations are weak and supported by low quality of evidence. No recommendation could be made related to benefits or harms for clinical, physiological, and other outcomes. Adequately powered and high quality randomized controlled trials are urgently needed in this area.
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ItemTowards better management of Obstructive Sleep Apnoea (OSA) in tetraplegia(Taylor & Francis, 2017)
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ItemNo Preview AvailableCircus activities as a health intervention for children, youths, and adolescents: a scoping review protocol(LIPPINCOTT WILLIAMS & WILKINS, 2022-01)OBJECTIVE: This scoping review aims to map the evidence on circus activities described and/or evaluated as a health intervention for children, youths, and adolescents. Increased understanding of how these interventions work, and gaps identified, will allow researchers and practitioners to advance the science behind these approaches. INTRODUCTION: Circus activities are proposed in the literature as a health intervention, due to their variety, non-competitive nature, and potential to develop fundamental physical and social skills. For the purposes of this review, circus activities as a health intervention are defined as aerial, acrobatic, equilibristic, and manipulation skills taught to participants to maintain, improve, or modify health, functioning, or health conditions. INCLUSION CRITERIA: English-language evidence will be considered where circus activities as a health intervention are described and/or evaluated for participants up to 24 years of age, or who are defined as children, youths, or adolescents. Literature will be excluded where the focus of the intervention is clowning, magic, or drama games, or where circus activities are not the therapeutic part of the activity. METHODS: MEDLINE (Ovid), CINAHL Complete (EBSCO), Scopus (Elsevier), PsycINFO (Ovid), ProQuest Dissertations and Theses Global, and Google Scholar will be searched for peer-reviewed and gray literature. No restriction on dates, type, methodology, or setting will be imposed, but limits will include "human" and "English language." Screening and data extraction will be performed by two independent reviewers. Reference lists of included sources will be screened. Results will be presented in diagrammatic or tabular format, alongside a narrative description, under headings aligning with the research sub-questions.
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ItemIntervencoes para promover funcao fisica de criancas e jovens com paralisia cerebral: diretriz internacional de pratica clinica(WILEY, 2022-06-21)Resumo OBJETIVO Fornecer recomendações de intervenções para promoção da função física de crianças e jovens com paralisia cerebral. MÉTODO Um painel de especialistas priorizou perguntas e desfechos importantes para o paciente. Usando o Grading of Recommendations Assessment, Development and Evaluation (GRADE), o painel avaliou a certeza das evidências e fez recomendações, com consultoria de especialistas internacionais e consumidores. RESULTADOS A diretriz compreende 13 recomendações (informadas por três revisões sistemáticas, 30 estudos randomizados e cinco estudos pré‐pós). Para alcance de objetivos funcionais, recomenda‐se que a intervenção inclua objetivos escolhidos pelo cliente, prática completa da tarefa em ambientes da vida real, suporte para empoderar as famílias e uma abordagem em equipe. Idade, habilidade e preferências da criança/família precisam ser consideradas. Para melhora da habilidade da marcha, recomenda‐se marcha no solo, que pode ser complementada com treinamento em esteira. Várias abordagens podem facilitar os objetivos relacionados ao uso das mãos: terapia bimanual, terapia de contensão induzida, treino direcionado a objetivos e abordagens cognitivas. Para auto‐cuidado, prática da tarefa completa, combinada com recursos assistivos podem aumentar a independência e reduzir a sobrecarga do cuidador. A participação em objetivos de lazer pode combinar prática da tarefa completa com estratégias direcionadas para barreiras ambientais, pessoais e sociais. INTERPRETAÇÃO Intervenção para promoção da função de crianças e jovens com paralisia cerebral precisa incluir objetivos escolhidos pelo cliente e a prática da tarefa completa dos objetivos. Os clínicos devem considerar as preferências da criança/família, idade e habilidade ao selecionarem intervenções específicas.
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ItemBest evidence for improving function in children with cerebral palsy: Success is within reach(WILEY, 2022-05)This letter to the editor is on the Clinical Practice Guide by Jackman et al. on pages 536–549 of this issue.
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ItemHip and groin pain prevalence and prediction in Elite Gaelic Games: 2703 male athletes across two seasons.(Wiley, 2022-05)OBJECTIVE: Hip and groin pain is highly prevalent in sub-elite Gaelic Athletic Association (GAA) athletes, but its prevalence at the elite level is unknown. The aims of this study were to report hip and groin pain prevalence in elite male athletes, to report changes in Copenhagen Hip and Groin Outcome Score (HAGOS) across two seasons and to assess if previous hip and groin pain or pre-season HAGOS could predict future hip and groin pain. METHODS: During the 2017 and 2018 pre-season male Gaelic Players Association (GPA) playing members were invited to complete two questionnaires. The first questionnaire collected demographic information including age, GAA code played (Gaelic football or Hurling) and prevalence of hip and groin pain in the previous season. The second questionnaire was the HAGOS. Step-wise logistic regression models were fitted to HAGOS subscales, to examine if pre-season HAGOS subscale scores could predict future hip and groin pain. RESULTS: The prevalence of hip and groin pain across the elite GAA cohort was 38%. Hip and groin pain in the previous season was the strongest predictor of future hip and groin pain (r2 =0.19, AUC=0.73, 95% CI 1.76-2.27) whereas pre-season HAGOS subscale scores had limited and no additional predictive ability (AUC 0.05-0.18). CONCLUSIONS: Hip and groin pain prevalence is high in elite male GAA, with one in three athletes reporting pain. Previous season hip and groin pain is the strongest predictor of future hip and groin pain, while pre-season HAGOS scores have limited ability to predict future hip and groin pain.
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ItemNasal Resistance Is Elevated in People with Tetraplegia and Is Reduced by Topical Sympathomimetic Administration(AMER ACAD SLEEP MEDICINE, 2016)STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is common in individuals with tetraplegia and associated with adverse health outcomes. The causes of the high prevalence of OSA in this population are unknown, but it is important to understand as standard treatments are poorly tolerated in tetraplegia. Nasal congestion is common in tetraplegia, possibly because of unopposed parasympathetic activity. Further, nasal obstruction can induce OSA in healthy individuals. We therefore aimed to compare nasal resistance before and after topical administration of a sympathomimetic between 10 individuals with tetraplegia (T) and 9 able-bodied (AB) controls matched for OSA severity, gender, and age. METHODS: Nasal, pharyngeal, and total upper airway resistance were calculated before and every 2 minutes following delivery of ≈0.05 mL of 0.5% atomized phenylephrine to the nostrils and pharyngeal airway. The surface tension of the upper airway lining liquid was also assessed. RESULTS: At baseline, individuals with tetraplegia had elevated nasal resistance (T = 7.0 ± 1.9, AB = 3.0 ± 0.6 cm H2O/L/s), that rapidly fell after phenylephrine (T = 2.3 ± 0.4, p = 0.03 at 2 min) whereas the able-bodied did not change (AB = 2.5 ± 0.5 cm H2O/L/s, p = 0.06 at 2 min). Pharyngeal resistance was non-significantly higher in individuals with tetraplegia than controls at baseline (T = 2.6 ± 0.9, AB = 1.2 ± 0.4 cm H2O/L/s) and was not altered by phenylephrine in either group. The surface tension of the upper airway lining liquid did not differ between groups (T = 64.3 ± 1.0, AB = 62.7 ± 0.6 mN/m). CONCLUSIONS: These data suggest that the unopposed parasympathetic activity in tetraplegia increases nasal resistance, potentially contributing to the high occurrence of OSA in this population.