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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ItemPerceived sleep problems after spinal cord injury: Results from a community-based survey in Switzerland(TAYLOR & FRANCIS LTD, 2021-11-02)Objective: To investigate the burden of sleep problems within the Spinal Cord injured (SCI) community with respect to the general population (GP) in Switzerland. The study further explored potential predictors for receiving treatment for sleep problems after SCI.Design: Cross-sectional study.Setting: SCI community in Switzerland.Participants: Individuals diagnosed with an SCI, aged 16 years or older that permanently reside in Switzerland (N = 1549).Interventions: Not applicable.Outcome measures: Perceived sleep problems within the SCI community and GP. For those with sleep problems and SCI, an indicator for having received treatment was measured.Results: 58.8% of survey participants indicated having a sleep problem; 69.4% of those with a sleep problem did not indicate receiving treatment. Amongst people living with an SCI, individuals between the ages of 46-60 years (adjusted Odds Ratio, OR = 3.07; 95% CI 1.54-6.16), participants reporting severe financial hardship (OR = 2.90; 95% CI) 1.69-4.96, and those that indicated having pain (OR = 5.62; 95% CI 3.52-8.98) were more likely to have a chronic sleep problem. In comparison to the Swiss GP, the prevalence of having a sleep problem was 18% higher among persons with SCI, with the largest discrepancy for males with paraplegia between the ages of 46-60 years (Prevalence ratio, PR = 1.28; 95% CI, 1.21-1.36).Conclusion: Individuals with SCI experience more sleep problems compared to the Swiss GP. Findings from this study suggest that clinical screening for sleep issues targeting high risk groups is needed to reduce the large prevalence of non-treatment in individuals with SCI.
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ItemCam morphology is associated with MRI-defined cartilage defects and labral tears: a case-control study of 237 young adult football players with and without hip and groin pain(BMJ PUBLISHING GROUP, 2021-12)OBJECTIVE: Football players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players. METHODS: For this case-control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score. RESULTS: Greater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189-0.937). CONCLUSION: Cam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.
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ItemPromoting clinical best practice in a user-centred design study of an upper limb rehabilitation robot(Taylor & Francis, 2021-01-01)Purpose: Despite their promise to increase therapy intensity in neurorehabilitation, robotic devices have not yet seen mainstream adoption. Whilst there are a number of contributing factors, it is obvious that the treating clinician should have a clear understanding of the objectives and limitations of robotic device use. This study sought to explore how devices can be developed to support a clinician in providing clinical best practice. Methods and Materials: A user-centred design study of a robotic device was conducted, involving build-then-use iterations, where successive iterations are built based on feedback from the use cycle. This work reports results of an analysis of qualitative and quantitative data describing the use of the robotic device in the clinical sessions, and from a focus group with the treating clinicians. Results and Conclusions: The data indicated that use of the device did not result in patient goal-setting and may have resulted in poor movement quality. Therapists expected a higher level of autonomy from the robotic device, and this may have contributed to the above problems. These problems can and should be addressed through modification of both the study design and device to provide more explicit instructions to promote clinical best practice. Implications for Rehabilitation: • Encouraging clinical best practice when using evaluating prototype devices within a clinical setting is important to ensure that best practice is maintained - and can be achieved through both study and device design • Support from device developers can significantly improve the confidence of therapists during the use of that device in rehabilitation, particularly with new or prototype devices • End effector-based robotic devices for rehabilitation show potential for a wide variety of patient presentations and capabilities.
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ItemTransfer of the supinator nerve to the posterior interosseous nerve for hand opening in tetraplegia through an anterior approach(SAGE PUBLICATIONS LTD, 2021-09)We report a retrospective series of 44 transfers in 26 patients in whom a functioning supinator nerve was transferred to a paralyzed posterior interosseous nerve through a single, anterior approach to re-animate hand opening in mid-cervical tetraplegia. Eighteen patients underwent concurrent nerve or tendon transfers to re-animate grasp and/or pinch through the same anterior incision. We evaluated the strength of the innervated muscle at mean follow-up of 24 months (range 12-27). The strength attained in our patients was equivalent to the strength after the transfer through a posterior approach reported in the literature. Nineteen of our patients were satisfied with the hand opening procedure. First webspace opening was the only variable to correlate with patient satisfaction. We conclude that the anterior approach yields similar results to the posterior approach and has the advantage of allowing easier access for simultaneously performing nerve or tendon transfers to reconstruct grasp and pinch.Level of evidence: IV.
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ItemExercise alone impacts short-term adult visual neuroplasticity in a monocular deprivation paradigm(ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2021-10)Adult homeostatic visual plasticity can be induced by short-term patching, heralded by a shift in ocular dominance in favor of the deprived eye after monocular occlusion. The potential to boost visual neuroplasticity with environmental enrichment such as exercise has also been explored; however, the results are inconsistent, with some studies finding no additive effect of exercise. Studies to date have only considered the effect of patching alone or in combination with exercise. Whether exercise alone affects typical outcome measures of experimental estimates of short-term visual neuroplasticity is unknown. We therefore measured binocular rivalry in 20 healthy young adults (20-34 years old) at baseline and after three 2-hour interventions: patching (of the dominant eye) only, patching with exercise, and exercise only. Consistent with previous work, the patching interventions produced a shift in ocular dominance toward the deprived (dominant) eye. Mild- to moderate-intensity exercise in the absence of patching had several effects on binocular rivalry metrics, including a reduction in the dominant eye percept. The proportion of mixed percept and the time to first switch (onset rivalry) did not change from baseline across all interventions. Thus, we demonstrate that exercise alone can impact binocular rivalry outcomes measures. We did not observe a synergistic effect between patching and exercise in our data.
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ItemNo Preview AvailableVIRTUAL FRACTURE CLINIC: A PANDEMIC-READY TOOL FOR IMPROVING THE EFFICIENCY OF FRACTURE CLINIC(AUSTRALIAN COLL HEALTH SERVICE MANAGEMENT, 2021)Background: The traditional model of care of the Orthopaedic Fracture Clinic (OFC) is labour intensive, expensive, has poor satisfaction rates, and often has minimal impact on management and outcomes of patients with minor injuries. Our aim was to implement a Virtual Fracture Clinic (VFC) for the management of minor injuries that is safe, reduces OFC clinic workload and reduces the OFC failure to attend (FTA) rate. Methods: This study was a retrospective longitudinal audit of OFC workload before (January 2012 -February 2017) and after (March 2017 – December 2019) implementation of the VFC. It was performed in an urban district general hospital in South East Queensland, Australia. The primary outcome measures included attendances per timepoint (month). Results: Overall, we observed a significant reduction in total number of patients from 1,055 (IQR 104.5) to 831 (IQR: 103) per month) coming through the OFC following the introduction of the VFC (F = 21.9; df=1; p <0.0001). The failure to attend rate was reduced by 44% from 271 (IQR: 127.3) to 151 (IQR: 72.8) (F=4.0; df=1; p = 0.047). Conclusion: The VFC implementation was successful in improving efficiency and reducing the current OFC workload, as well as reducing FTA rate. Reduction in clinic workload allows more time to be spent with complex patients, prevents clinic backlogs and overbooking, and crowding of waiting rooms. In the midst of a global pandemic that is spread by close contact, virtual clinics seem the way of the future to treat patients whilst minimising risk of COVID-19 spread.
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ItemNo Preview AvailablePatient-Facing Mobile Apps to Support Physiotherapy Care: Protocol for a Systematic Review of Apps Within App Stores(JMIR PUBLICATIONS, INC, 2021-12)BACKGROUND: Care delivered by physiotherapists aims to facilitate engagement in positive health behaviors by patients (eg, adherence to exercise). However, research suggests that behavioral interventions are frequently omitted from care. Hence, better understanding of strategies that can be used by physiotherapists to support patients to engage in positive behaviors is important and likely to optimize outcomes. Digital health interventions delivered via mobile apps are garnering attention for their ability to support behavior change. They have potential to incorporate numerous behavior change techniques (BCTs) to support goals of physiotherapy care, including but not limited to self-monitoring, goal setting, and prompts/alerts. Despite their potential to support physiotherapy care, much is still unknown about what apps are available to consumers, the BCTs they use, their quality, and their potential to change behaviors. OBJECTIVE: The primary aim of this study is to systematically review the mobile apps available in app stores that are intended for use by patients to support physiotherapy care, including the BCTs within these apps. The secondary aims are to evaluate the quality and behavior change potential of these apps. METHODS: A systematic review of mobile apps in app stores will be undertaken. This will be guided by recommendations for systematic reviews in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement but adapted to suit our app store search, consistent with similar systematic reviews of apps published in the Journal of Medical Internet Research. Apple Store and Google Play will be searched with a two-step search strategy, using terms relevant to physiotherapy, physiotherapists, and common physiotherapy care. Key eligibility criteria will include apps that are intended for use by patients and are self-contained or stand-alone without the need of additional wearable devices or other add-ons. Included apps will be coded for BCTs and rated for quality using the Mobile Application Rating Scale (MARS) and for potential to change behavior using the App Behavior Change Scale (ABACUS). RESULTS: App store search and screening are expected to be completed in 2021. Data extraction and quality appraisal are expected to commence by November 2021. The study results are expected to be published in a subsequent paper in 2022. CONCLUSIONS: Knowledge gained from this review will support clinical practice and inform research by providing a greater understanding of the quality of currently available mobile apps and their potential to support patient behavior change goals of physiotherapy care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/29047.
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ItemNo Preview AvailableChanges in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism(ELSEVIER, 2021-12)BACKGROUND: Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA). METHODS: We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. RESULTS: Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03). CONCLUSION: Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness.