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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ItemNo Preview AvailableSpatiotemporal gait variables and step-to-step variability in preschool-aged children born < 30 weeks' gestation and at term in preferred speed, dual-task paradigm, and tandem walking(ELSEVIER IRELAND LTD, 2022-02)BACKGROUND: Children born very preterm (< 32 weeks' gestation) are at greater risk of motor impairment and executive/attentional dysfunctions than term-born children; however, little is known about how functional tasks, including walking, may be affected by very preterm birth. RESEARCH QUESTION: How does the gait pattern of preschool-age children born < 30 weeks compare with term-born controls under a variety of walking conditions? METHODS: In this prospective cohort study, children born < 30 weeks and at term were assessed at 4.5-5 years' corrected age, blinded to birth group. Four walking conditions were assessed using the GAITRite® system: preferred speed, cognitive dual-task, motor dual-task, and tandem walking. Gait variables analysed included speed, cadence, step length, step time, base of support (BOS), and single and double support time. Spatiotemporal variables were compared between groups using linear regression, adjusting for lower-limb length, corrected age at assessment, and number of trials. RESULTS: 224 children (112 < 30 weeks and 112 term-born) were assessed. Gait variables of children born < 30 weeks did not differ from their term-born peers when walking at their preferred speed, except for higher BOS variability (mean difference [MD] = 0.19 cm, 95% confidence interval [CI] 0.10, 0.27, p < 0.001). Under the motor dual-task condition, children born < 30 weeks walked faster (MD= 3.06 cm/s, 95% CI 0.14, 5.97, p = 0.040), with a longer step length (MD= 1.10 cm, 95%CI 0.19, 2.01, p = 0.018), and a wider BOS (MD= 0.37 cm, 95%CI 0.06, 0.67, p = 0.019). In cognitive dual-task and tandem conditions, children born < 30 weeks walked with a wider BOS compared with term-born peers (MD= 0.43 cm, 95%CI 0.05, 0.81, p = 0.028; and MD= 0.30 cm, 95%CI 0.09, 0.51, p = 0.005, respectively). SIGNIFICANCE: This research highlights the need to consider the walking performance of preschool-age children born < 30 weeks under challenging conditions, such as dual-task or tandem walking, when assessing gait patterns and planning interventions.
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ItemPhysical Therapist and Physical Therapist Student Knowledge, Confidence, Attitudes, and Beliefs About Providing Care for People With Dementia: A Mixed-Methods Systematic Review(OXFORD UNIV PRESS INC, 2022-05-05)OBJECTIVE: The purpose of this study was to determine physical therapists' and physical therapist students' attitudes and beliefs, knowledge, and confidence in working with people with dementia. METHODS: This was a mixed-methods systematic review. Participants included physical therapists working in any clinical specialty and physical therapist students who had completed at least 1 clinical placement. Eleven databases were searched. The evidence was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were "qualitized" using thematic analysis and synthesized with qualitative data using thematic synthesis. RESULTS: Fifteen studies were included (9 quantitative and 6 qualitative studies). Seven key themes evolved. Five related to the belief that (1) working with people with dementia is complex and challenging; (2) opportunities for education in dementia care are lacking; (3) working with people with dementia is a specialized area of practice; (4) there are unsupportive systems for working with people with dementia; and (5) people with dementia deserve rehabilitation, but their potential to improve is less certain. One theme related to knowledge (lack of knowledge in some areas of dementia care), and 1 theme related to confidence (lack of confidence in working with people with dementia). CONCLUSIONS: Physical therapists and physical therapist students believe that working with people with dementia can be challenging. The low levels of knowledge and confidence in areas important to working with people who have dementia suggest that more education about dementia is needed. IMPACT: This mixed-methods systematic review highlights that physical therapists and physical therapist students believe that working with people who have dementia is complex and challenging. Physical therapists want more training and support in this growing area of practice.
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ItemBarriers and facilitators to community participation for preschool age children born very preterm: a prospective cohort study(WILEY, 2021-06)AIM: We compared preschool age children born very preterm with term-born controls to: (1) understand the association between very preterm birth and community participation, (2) determine if motor impairment or social risk affect participation differently between groups, and (3) understand environmental barriers and supports to participation for parents. METHOD: Forty-eight children born very preterm (<30wks' gestation; 22 males, 26 females) and 96 controls (47 males, 49 females) were assessed at 4 to 5 years' corrected age for community participation using the Young Children's Participation and Environment Measure. Motor skills were assessed using the Movement Assessment Battery for Children, Second Edition and the Little Developmental Coordination Disorder Questionnaire. RESULTS: Children born very preterm participated less frequently than term-born children (difference in means=-0.28, 95% confidence interval [CI] -0.54 to -0.03, p=0.029). Social risk was associated with lower frequency (interaction p<0.001) and involvement (interaction p=0.05) in community activities for children in the very preterm group only. Parents of children born very preterm perceived more barriers (odds ratio=4.32, 95% CI 1.46-12.77, p=0.008) and environmental factors to be less supportive of participation than parents of controls (difference in medians=-6.21, 95% CI -11.42 to -1.00, p=0.02). INTERPRETATION: Children born very preterm may benefit from ongoing support to promote participation, especially in families of higher social risk.
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ItemMovement-based interventions for preschool-age children with, or at risk of, motor impairment: a systematic review(WILEY, 2020-03)AIM: To explore the efficacy of movement-based interventions to improve motor skills in preschool-age children with, or at risk of, motor impairment, including those with a diagnosis of cerebral palsy, autism spectrum disorder, and developmental coordination disorder. METHOD: Relevant electronic databases were searched for randomized or quasi-randomized controlled trials. Outcomes were classified using domains of the International Classification of Functioning, Disability and Health: Children & Youth version. Quality was assessed using the Physiotherapy Evidence Database scale. Risk of bias was assessed using the Cochrane Risk of Bias tool. Effect sizes were calculated using Cohen's d. RESULTS: Seventeen articles exploring a heterogeneity of intervention types, population groups, and outcome measures met the inclusion criteria. Movement-based interventions did not significantly improve outcomes in either the body structure and function or activity domains in most studies. No studies used a participation outcome measure. INTERPRETATION: There is a paucity of evidence exploring movement-based interventions in the preschool-age group. Although movement-based interventions showed potential for improving body structure and function and activity outcomes for children with motor impairment, results were mostly not significant. Small sample sizes, variable study quality, and risk of bias limit confidence in the results. WHAT THIS PAPER ADDS: The evidence is inconclusive to support movement-based interventions in this group. No studies used outcome measures assessing participation. Variability in intervention type and study quality limit confidence in results.
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ItemReliability and validity of the FSHD-composite outcome measure in childhood facioscapulohumeral dystrophy(PERGAMON-ELSEVIER SCIENCE LTD, 2021-08)This study aims to investigate intra-rater reliability and construct validity of the Facioscapulohumeral Dystrophy Composite Outcome Measure (FSHD-COM), in childhood FSHD. Participants included eighteen children with FSHD, and matched healthy controls. Reliability data were collected from 15 participants with FSHD over two testing sessions. Validity data were collected from all participants. Participants with FSHD completed; the FSHD-COM (and modified pediatric version), Motor Function Measure-32 (MFM-32), FSHD Severity Scales, Performance of the Upper Limb 2.0, Pediatric Quality of Life™ Neuromuscular Module and pediatric FSHD Health-Index Questionnaire. Both versions of the FSHD-COM showed excellent intra-rater reliability (ICC1,2 > 0.99, lower 95%CI > 0.98) with a Minimal Detectable Change (MDC95%) of ≤14.5%. The FSHD-COM had robust and widespread correlations with other related outcome measures. The FSHD-COM versions and 6 min walk test effectively discriminated between children with and without FSHD; the MFM-32 and 10 m walk/run test did not. Ceiling effects were not observed on either version of the FSHD-COM. Reliability and validity findings in this childhood FSHD study concord with estimates in adults. Both versions of the FSHD-COM were effective in discriminating disease in children with mild FSHD symptoms. The FSHD-COM has the potential to be a useful measure of function across the life span.
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ItemEnablers to Exercise Participation in Progressive Supranuclear Palsy: Health Professional Perspectives(FRONTIERS MEDIA SA, 2021-02-02)Background: People living with progressive supranuclear palsy (PSP) can experience considerable difficulties with movement, walking, balance, and oculomotor control. The role of exercises and physical activities in mitigating the motor and non-motor symptoms of PSP remains uncertain. Aims: The aim of this study was to identify the perspectives and beliefs of health professionals about the benefits, enablers, and barriers to participation in exercise and physical activity across the course of disease progression of PSP. Methods: Qualitative methods, within a phenomenological framework, were used to obtain nursing and allied health professional perspectives and recommendations. Focus group and in-depth interview questions were derived from a systematic review on exercise for PSP. Expert opinions also guided the interviews, which were audio-recorded, transcribed verbatim, and de-identified. Two researchers independently conducted a thematic analysis. Results: Nineteen health professionals participated from the disciplines of nursing, physiotherapy, occupational therapy, and speech pathology. Four main themes emerged: (i) exercise and physical activities are important for living well with PSP; (ii) provision of information about the benefits of exercise and physical activities facilitates uptake; (iii) interdisciplinary teams work together to improve outcomes; and (iv) care partners can assist with the implementation of exercise and physical activities. Conclusion: Health professionals advocated physical therapies for people living with PSP. The expectation is that structured exercises and physical activities can help to optimize health and well-being, enabling people to continue to participate in social roles. The actual merits of such interventions must now be tested in large-scale controlled clinical trials.
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ItemFactors associated with improved walking in older people during hospital rehabilitation: secondary analysis of a randomized controlled trial(BMC, 2021-01-31)BACKGROUND: Older people are often admitted for rehabilitation to improve walking, yet not everyone improves. The aim of this study was to determine key factors associated with a positive response to hospital-based rehabilitation in older people. METHODS: This was a secondary data analysis from a multisite randomized controlled trial. Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) who were admitted to geriatric rehabilitation wards with a goal to improve walking were recruited. Participants were randomized to receive additional daily physical therapy focused on mobility (n = 99), or additional social activities (n = 99). Self-selected gait speed was measured on admission and discharge. Four participants withdrew. People who changed gait speed ≥0.1 m/s were classified as 'responders' (n = 130); those that changed <0.1m/s were classified as 'non-responders' (n = 64). Multivariable logistic regression explored the association of six pre-selected participant factors (age, baseline ambulation status, frailty, co-morbidities, cognition, depression) and two therapy factors (daily supervised upright activity time, rehabilitation days) and response. RESULTS: Responding to rehabilitation was associated with the number of days in rehabilitation (OR 1.04; 95% CI 1.00 to 1.08; p = .039) and higher Mini Mental State Examination scores (OR 1.07, 95% CI 1.00 - 1.14; p = .048). No other factors were found to have association with responding to rehabilitation. CONCLUSION: In older people with complex health problems or multi-morbidities, better cognition and a longer stay in rehabilitation were associated with a positive improvement in walking speed. Further research to explore who best responds to hospital-based rehabilitation and what interventions improve rehabilitation outcomes is warranted. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740 .
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ItemAn Examination of Parent-Reported Facilitators and Barriers to Organized Physical Activity Engagement for Youth With Neurodevelopmental Disorders, Physical, and Medical Conditions(FRONTIERS MEDIA SA, 2020-09-29)Organized physical activity (OPA) is an important contributor to physical, social, and emotional health and well-being; however, young people with disabilities are participating at lower rates than their peers without disabilities. This study aimed to (1) compare facilitators and barriers to OPA for young people with disabilities who currently do and do not participate in OPA and (2) to assess whether groups differed in the type of internal and external assets they reported. Parents of 218 young people (41% with a primary diagnosis of autism spectrum disorder) with a diverse representation of disabilities completed an online survey. Young people were categorized as either participants in OPA (n = 131) or non-participants (n = 87) by parent report. Non-participation was significantly predicted by the barrier "there are no activities my child enjoys" and by a lack of children's motivation and happiness during OPA. Significant internal assets differentiating participants from non-participants were the ability to understand simple instructions, love of sport, and meeting physical activity guidelines. Significant external assets were parent and sibling participation in OPA, school type, and household income. The findings from this study have important implications for the design of public health interventions that aim to promote OPA in young people with disabilities, highlighting the need to make activities enjoyable, promote participation of siblings and parents, and support low-income families to participate.
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