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Christensen N, Black L, Gilliland S, Huhn K, Wainwright S. The Role of Movement in Physical Therapist Clinical Reasoning. Phys Ther 2023; 103:pzad085. [PMID: 37418230 DOI: 10.1093/ptj/pzad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/27/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The purpose of this study was to explore how physical therapists use movement as a component of their clinical reasoning. Additionally, this research explored whether movement as a component of clinical reasoning aligns with the proposed signature pedagogy for physical therapist education, human body as teacher. METHODS The study utilized qualitative, descriptive methods in a multiple case studies design (each practice setting represented a different case for analysis purposes) with cross-case comparisons. Researchers conducted 8 focus groups across practice settings including acute care, inpatient neurological, outpatient orthopedics, and pediatrics. Each focus group had 4 to 6 participants. Through an iterative, interactive process of coding and discussion among all researchers, a final coding scheme was developed. RESULTS Through exploration of the research aims, 3 themes emerged from the data. These primary themes are: (1) movement drives clinical reasoning to optimize function; (2) reasoning about movement is multisensory and embodied; and (3) reasoning about movement relies on communication. CONCLUSIONS This research supports a description of movement as the lens used by physical therapists in clinical reasoning and the integral role of movement in clinical reasoning and in learning from and through movement of the human body while learning from clinical reasoning experiences in practice. IMPACT As the understanding of the ways physical therapists use and learn from movement in clinical reasoning and practice continues to emerge, it is important to continue exploring ways to best make this expanded, embodied conception of clinical reasoning explicit in the education of future generations of physical therapists.
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Affiliation(s)
- Nicole Christensen
- Department of Physical Therapy, Samuel Merritt University, Oakland, California, USA
| | - Lisa Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, USA
| | - Sarah Gilliland
- Department of Physical Therapy, Tufts University, Seattle, Washington, USA
| | - Karen Huhn
- School of Physical Therapy, Husson University, Bangor, Maine, USA
| | - Susan Wainwright
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Ahola S, Piirainen A, Vuoskoski P. Perceptions of learning and teaching human movement in physiotherapy: A systematic review and metasynthesis of qualitative studies. Int J Qual Stud Health Well-being 2023; 18:2225943. [PMID: 38016038 PMCID: PMC10294735 DOI: 10.1080/17482631.2023.2225943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/12/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Human movement is essential for health and well-being. Understanding human movement is pivotal in physiotherapy, but also an important element of physiotherapy education. This review identified, critically appraised, and synthesized the available evidence on learning and teaching human movement in physiotherapy as perceived by students, therapists, and instructors. METHODS The databases MEDLINE, CINAHL, ERIC, PsycINFO, MEDIC and FINNA, were searched. The search was conducted in March/April 2020 and updated in March 2022. The systematic review followed the JBI methodology for systematic reviews of qualitative evidence and was conducted in accordance with an a priori protocol. RESULTS The overall quality of the 17 included studies was scored low on ConQual but dependability and credibility were rated as moderate. Four synthesized findings aggregated from 17 categories and 147 findings described the perceived significance of 1) being present in movement, 2) movement quality, 3) movement transfer, and 4) contextual factors for the learning or teaching of human movement in physiotherapy. CONCLUSION The synthesized findings indicate that the perceived significance of contextual factors, movement quality and transfer, and being present in movement should be considered in all learning and teaching of movement in physiotherapy. However, the evidence of the review findings was evaluated as low-level, which should be considered when applying these results to physiotherapy education or practice.
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Affiliation(s)
- Sirpa Ahola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
- Physiotherapy, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
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Sebelski CA, Hoogenboom BJ, Hayes AM, Held Bradford E, Wainwright SF, Huhn K. The Intersection of Movement and Clinical Reasoning: Embodying "Body as a Teacher" to Advance the Profession and Practice. Phys Ther 2020; 100:201-204. [PMID: 31595947 DOI: 10.1093/ptj/pzz137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/05/2019] [Accepted: 06/09/2019] [Indexed: 02/09/2023]
Affiliation(s)
- Chris A Sebelski
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline Mall Ste 1026, St Louis, MO 63104 (USA)
| | - Barbara J Hoogenboom
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan
| | - Ann M Hayes
- Department of Physical Therapy and Athletic Training, Saint Louis University, St Louis, Missouri
| | | | - Susan F Wainwright
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Huhn
- School of Physical Therapy, Husson University, Bangor, Maine
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Williams A, Rushton A, Lewis JJ, Phillips C. Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical reasoning on patient outcome: A stepped wedge cluster randomised controlled trial. PLoS One 2019; 14:e0220110. [PMID: 31365565 PMCID: PMC6668791 DOI: 10.1371/journal.pone.0220110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of clinical mentoring on postgraduate physiotherapists have been explored, but its impact on patient outcomes is unknown. The objective of this trial was to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes. METHODS In a stepped-wedge cluster RCT in the musculoskeletal physiotherapy outpatient departments of a large NHS organisation, 16 physiotherapists were randomised by cluster to receive the intervention-150 hours of mentored clinical practice-at one of 3 time periods; control was usual training. 441 patients submitted outcome measures: Patient-Specific Functional Scale (PSFS) (primary outcome measure), EQ-5D-5L, patient activation and patient satisfaction (secondary outcome measures). A further secondary outcome measure of physiotherapist performance was collected by an independent assessor observing the physiotherapists practice. RESULTS 80.0% of intervention patients achieved clinically significant PSFS scores compared with 63.8% of control patients. Binary logistic regression analysis modelling for time, cluster and patient characteristics showed strong statistical evidence for this difference (p = 0.023; odds ratio 4.24, 95%CI 1.22, 14.79). Physiotherapist performance scores improved from a mean of 47.8% (SD 3.60) pre-intervention to a mean of 56.0% (SD 4.24) (p<0.001). There was no statistical evidence for differences between groups on other secondary outcomes. CONCLUSION This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention positively impacts patient outcomes and physiotherapist performance. This provides a basis for further research in education across other healthcare disciplines and outcome measures.
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Affiliation(s)
- Aled Williams
- University Hospital of Wales Physiotherapy Department, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - James J. Lewis
- Y Lab (Public Services Innovation Lab for Wales), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ceri Phillips
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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Huhn K, Gilliland SJ, Black LL, Wainwright SF, Christensen N. Clinical Reasoning in Physical Therapy: A Concept Analysis. Phys Ther 2019; 99:440-456. [PMID: 30496522 DOI: 10.1093/ptj/pzy148] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/29/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research. OBJECTIVE The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research. DESIGN/METHODS The design included a systematic concept analysis using Rodgers' evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified. RESULTS Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management. LIMITATIONS Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded. CONCLUSIONS A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.
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Affiliation(s)
- Karen Huhn
- School of Physical Therapy, Husson University, Bangor, ME 04401-2999 (USA)
| | | | - Lisa L Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska
| | - Susan F Wainwright
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicole Christensen
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
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Ahlsen B, Mengshoel AM, Bondevik H, Engebretsen E. Physiotherapists as detectives: investigating clues and plots in the clinical encounter. MEDICAL HUMANITIES 2018; 44:40-45. [PMID: 28912383 DOI: 10.1136/medhum-2017-011229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
This article investigates the clinical reasoning process of physiotherapists working with patients with chronic muscle pain. The article demonstrates how physiotherapists work with clues and weigh up different plots as they seek to build consistent stories about their patient's illness. The material consists of interviews with 10 Norwegian physiotherapists performed after the first clinical encounter with a patient. Using a narrative approach and Lonergan's theory of interpretation, the study highlights how, like detectives, the therapists work with clues by asking a number of interpretive questions of their data. They interrogate what they have observed and heard during the first session, they also question how the patient's story was told, including the contextual and relation aspects of clue production, and they ask why the patient's story was told to them in this particular way at this particular time. The article shows how the therapists configure clues into various plots on the basis of their experience of working with similar cases and how their detective work is pushed forward by uncertainty and persistent questioning of the data.
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Affiliation(s)
- Birgitte Ahlsen
- Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
- Department of Health Science, University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Anne Marit Mengshoel
- Department of Health Science, University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Hilde Bondevik
- Department of Health Science, University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Eivind Engebretsen
- Department of Health Science, University of Oslo, Institute of Health and Society, Oslo, Norway
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Abstract
A phenomenological approach was used to explore the experiences of 11 adults attending Awareness Through Movement lessons in the Feldenkrais Method to manage chronic-episodic back pain. Semistructured interviews were analyzed. The results suggest improving self-efficacy through somatic education and awareness potentially offers a way forward given the back pain epidemic.
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A qualitative grounded theory study of the conceptions of clinical practice in osteopathy – A continuum from technical rationality to professional artistry. ACTA ACUST UNITED AC 2014; 19:37-43. [DOI: 10.1016/j.math.2013.06.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/21/2013] [Indexed: 11/23/2022]
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Harman K, Bassett R, Fenety A, Hoens AM. Client Education: Communicative Interaction between Physiotherapists and Clients with Subacute Low Back Pain in Private Practice. Physiother Can 2011; 63:212-23. [PMID: 22379262 PMCID: PMC3076921 DOI: 10.3138/ptc.2009-52p] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore, through focus-group interviews, client education provided by physiotherapists in private practice who treat injured workers with subacute low back pain (SA-LBP). METHODS Six focus-group interviews were held in the fall of 2006 to explore treatment practices of physiotherapists for this population. Each of the 44 physiotherapists who volunteered attended one of six regional sessions. RESULTS Three overarching themes emerged: the critical importance of education; education: a multidimensional concept; and the physiotherapist-client relationship. In this study, we found that education provides continuity by tying together the separate tasks occurring during one treatment session. Our participants said that time is of the essence in private practice and described how they provide education seamlessly, making this type of delivery efficient. CONCLUSIONS Education is a highly valued aspect of practice for physiotherapists. Verbal, tactile, and visual information obtained from the client as assessment and treatment progress is explored, expanded, and contextualized in conversation with the client. In a communicative, interactive process, client fears, other contextual information, and physiotherapist information about procedures and techniques, exercises, and anatomy are collaboratively interrelated.
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Affiliation(s)
- Katherine Harman
- Katherine Harman, PT, PhD: Associate Professor, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia
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Wright AA, Abbott JH, Baxter D, Cook C. The ability of a sustained within-session finding of pain reduction during traction to dictate improved outcomes from a manual therapy approach on patients with osteoarthritis of the hip. J Man Manip Ther 2010; 18:166-72. [PMID: 21886428 PMCID: PMC3109683 DOI: 10.1179/106698110x12640740712536] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES THE OBJECTIVES OF THIS STUDY WERE TO: (1) determine the association of a within-session finding after traction of the hip with self-report of well-being, pain, and self-report of function at 9 weeks; and (2) to determine if the interactions between the within-session finding and the outcome measure are different between groups of patients with hip OA who receive and who do not receive manual therapy. METHODS Data were retrospectively analysed in 70 subjects who were part of a randomized control trial. Correlation analyses of within-session findings from the initial visit after traction of a concordantly painful hip were compared to self-report measures for function, pain, and well-being at 9 weeks. A comparison of slope coefficients between manual therapy and non-manual therapy groups was performed to determine the interactive aspects of the within-session finding. RESULTS Although the correlations for the manual therapy group were higher than for the supervised neglect group, none of the correlational analyses for both groups was strong or significant. Significant differences in the slope coefficients for well-being and pain were found, suggesting that the interactions between the within-session findings and the targeted outcomes were different in the manual therapy group versus supervised neglect group. DISCUSSION These findings suggest that within-session findings during the initial evaluation are not strongly related to a positive outcome after manual therapy, although the interaction of the finding of a within-session change and the use of manual therapy is more compelling than the finding in a sample of patients who did not receive manual therapy.
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Affiliation(s)
- Alexis A Wright
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Garrison JC, Shanley E, Thigpen C, Hegedus E, Cook C. Between-session changes predict overall perception of improvement but not functional improvement in patients with shoulder impingement syndrome seen for physical therapy: An observational study. Physiother Theory Pract 2010; 27:137-45. [DOI: 10.3109/09593981003743283] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tuttle N. Is it reasonable to use an individual patient's progress after treatment as a guide to ongoing clinical reasoning? J Manipulative Physiol Ther 2009; 32:396-403. [PMID: 19539124 DOI: 10.1016/j.jmpt.2009.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 03/22/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
Systematic assessment of a patient's progress after an intervention is frequently used to inform decision making in ongoing conservative management of patients with musculoskeletal symptoms. Although reassessment of impairments immediately after treatment is commonplace in clinical practice, relatively little research has considered whether this method is reasonable. The history of, rationale behind, and evidence for the use of patient responses to inform clinical reasoning are explored in this commentary. Although the evidence is not conclusive, an argument is presented suggesting it is more reasonable to use a patient's response to treatment to inform ongoing clinical reasoning than to follow predetermined protocols. A methodical approach that considers change in parameters such as patient impairments is likely to be a useful guide for decision making during ongoing patient management but only when the change being reassessed can be directly linked to functional goals. Changes in active range of movement or centralization of pain appear to be better indicators of treatment effectiveness than changes in either pain intensity or assessment of joint position. There is limited evidence to support the use of changes in segmental stiffness to guide ongoing management. Although reassessment of some impairments has been found to be useful, the author suggests that care is required in the selection of reassessments used to guide ongoing management. The usefulness of any reassessment is considered to rely on how well a change in the selected impairment predicts that individual patient's ability to achieve their goals.
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Affiliation(s)
- Neil Tuttle
- School of Physiotherapy and Exercise Science, Griffith University, Queensland, Australia.
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May S, Greasley A, Reeve S, Withers S. Expert therapists use specific clinical reasoning processes in the assessment and management of patients with shoulder pain: a qualitative study. ACTA ACUST UNITED AC 2009; 54:261-6. [PMID: 19025506 DOI: 10.1016/s0004-9514(08)70005-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
QUESTION What are the key items in the clinical reasoning process which expert clinicians identify as being relevant to the assessment and management of patients with shoulder pain? DESIGN Qualitative study using a three-round Delphi procedure. PARTICIPANTS Twenty-six experts in the UK consented to be involved and were contactable, of whom 20 contributed, with 12, 15, and 15 contributing to the different rounds. RESULTS Clinical reasoning was mostly about diagnostic reasoning, but also involved narrative reasoning. Diagnostic reasoning involved both pattern recognition and hypothetico-deductive reasoning. Diagnostic reasoning emphasised general history items, a constellation of signs and symptoms to identify specific diagnostic categories, and standard physical examination procedures. Narrative reasoning was highlighted by the communication involved in expert history taking, seeing patients in their functional and psychological context, and collaborative reasoning with the patient regarding management. CONCLUSIONS These expert clinicians demonstrated the use of diagnostic pattern recognition, and hypothetico-deductive and narrative clinical reasoning processes. The emphasis was on the history and basic physical examination procedures to make clinical decisions.
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Affiliation(s)
- Stephen May
- Sheffield Hallam University, Sheffield, S10 2BP, United Kingdom.
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Schenkman ML, Jordan S, Akuthota V, Roman M, Kohrt WM, Hearty T, Cleary C, Backstrom KM. Functional movement training for recurrent low back pain: lessons from a pilot randomized controlled trial. PM R 2008; 1:137-46. [PMID: 19627887 DOI: 10.1016/j.pmrj.2008.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 10/06/2008] [Accepted: 10/13/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite considerable effort to reduce low back pain (LBP), approximately 60% of patients have recurrence after their first episode. The high rate of recurrence suggests that more effective intervention approaches are needed. This randomized, controlled feasibility trial was designed to compare disability, physical functional capacity, and pain outcomes at 2, 6, and 12 months for 2 conventional and 1 novel physical therapy (functional movement training) intervention for recurrent LBP. DESIGN Randomized, controlled feasibility trial. SETTING University hospital outpatient physical therapy clinic. PARTICIPANTS Sixty-one participants (60% female) with recurrent LBP. INTERVENTIONS Subjects were randomized to 1 of 3 intervention groups: group 1 had a single session consisting of standard back pain education; group 2 had 6 sessions in 8 weeks of conventional physical therapy; and group 3 had 6 sessions in 8 weeks of a novel method of functional movement training. Change from baseline was used to determine within-group changes and between-group differences for participants who finished each time point (2, 6, and 12 months). Changes were evaluated using analysis of variance and Newman-Keuls post hoc analysis. MAIN OUTCOME MEASURES The primary outcome measure was the novel Continuous Scale Physical Functional Performance test (CS-PFP), a measure of actual physical functional capacity. Secondary measures included the revised Oswestry Disability Index, a measure of pain-related disability, the Roland Morris Disability Questionnaire, and a standard visual analogue pain scale. RESULTS Of the participants, 67% provided data at 2 months and 44% provided information at 12 months. Raw change scores were evaluated at 2, 6, and 12 months. While no statistical significance was reached with any outcome measure, the trends suggested little change for group 1 (education) and suggested that greatest improvement in function may occur in group 3 (functional movement training). In particular, at 2 months, the CS-PFP change scores revealed a trend (P=.072) toward greater improvement in groups 2 (conventional physical therapy) and 3 (functional movement training) compared with group 1. At 12 months, Oswestry Disability Index and CS-PFP scores also trended toward significance for groups 2 and 3 (P=.7 and .9, respectively). Mean change scores were also calculated and revealed groups 2 and 3 had improved by 2 months and this improvement remained stable at the 1-year mark. Trends in the direction of best improvement occurred for those in the functional movement training group. CONCLUSION A large-scale randomized, controlled trial is warranted to determine whether an intervention based on functional movement training is superior to conventional, impairment-based intervention for individuals with recurrent LBP.
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Affiliation(s)
- Margaret L Schenkman
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO, USA
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Smith M, Higgs J, Ellis E. Physiotherapy decision making in acute cardiorespiratory care is influenced by factors related to physiotherapist and the nature and context of the decision: a qualitative study. ACTA ACUST UNITED AC 2008; 53:261-7. [PMID: 18047461 DOI: 10.1016/s0004-9514(07)70007-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
QUESTIONS What factors influence the decision making of cardiorespiratory physiotherapists in acute care? How do cardiorespiratory physiotherapists manage multiple factors in their decision making? DESIGN Qualitative study using observation and semi-structured interviews. PARTICIPANTS Fourteen physiotherapists working in acute cardiorespiratory care. RESULTS Cardiorespiratory physiotherapy decision making was affected by factors related to the nature of the decision itself (such as the complexity and difficulty of the decision), factors related to the context in which the decision occurred (such as physical, organisational and socio-professional factors), and factors related to the physiotherapists themselves (such as decision making capabilities, physiotherapy frames of reference, and level of clinical experience). CONCLUSION Optimising the quality of decision making in the context of health care today requires an awareness and consideration of a range of factors influencing decision making.
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Affiliation(s)
- Megan Smith
- School of Community Health, Charles Sturt University, Albury, NSW, 2640, Australia.
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Laser literature watch. Photomed Laser Surg 2006; 24:424-53. [PMID: 16875454 DOI: 10.1089/pho.2006.24.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tuttle N, Laasko L, Barrett R. Change in impairments in the first two treatments predicts outcome in impairments, but not in activity limitations, in subacute neck pain: an observational study. ACTA ACUST UNITED AC 2006; 52:281-5. [PMID: 17132123 DOI: 10.1016/s0004-9514(06)70008-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
QUESTION Does change in impairments within and between the first two manual therapy treatments predict change in activity limitations by the end of treatment in patients with subacute neck symptoms? DESIGN Longitudinal, observational study. PARTICIPANTS 29 people with neck pain for more than two weeks who subsequently received >or= three treatments. OUTCOME MEASURES Impairments measured were active neck ROM in six directions (total ROM), most limited direction of ROM (limited ROM), pain intensity, and pain location. Activity limitations were measured using the Neck Disability Index and the Patient Specific Functional Scale. Patients' perceptions of change were measured using the Global Perceived Effect Scale. Impairments and patients' perceptions were measured before and after the first two treatments and before the final treatment whereas activity limitations were measured only before the first and last treatments. RESULTS All measures improved by the end of treatment.Between-treatment change in limited ROM predicted change in limited ROM (rs2 = 0.53 and 0.57) and total ROM (rs2 = 0.26) by the end of treatment. Within- and between-treatment change in pain location predicted change in pain location (rs2 = 0.24, 0.27,0.28, and 0.57) by the end of treatment. No significant relationships were found between change in any impairments in the first two treatments and change in activity limitations by the end of treatment. CONCLUSIONS Change in impairments predicts change in the same impairment by the end of treatment, but not in other impairments or activity limitations. It is recommended that there assessments used to guide and refine treatment be individualised and related to the specific goals for that patient.
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