1
|
Augusto DD, Scattone Silva R, Pinheiro DP, Sousa CDO. Therapeutic exercises in the clinical practice of Brazilian physical therapists in the management of rotator cuff tendinopathy: An online survey. PLoS One 2024; 19:e0301326. [PMID: 38625895 PMCID: PMC11020769 DOI: 10.1371/journal.pone.0301326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/14/2024] [Indexed: 04/18/2024] Open
Abstract
The objective of this study was to investigate how Brazilian physical therapists (PTs) use therapeutic exercises in the rehabilitation of individuals with rotator cuff (RC) tendinopathy. The study used an online survey with a mix of 62 open- and closed-ended questions divided into three sections: participant demographics, professional experience, and clinical practice in the rehabilitation of patients with RC tendinopathy. One hundred and fifty-nine Brazilian physical therapists completed the survey. Most of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was a wide variability in determining the volume of exercises, particularly with isometric exercises. Most of our sample considered patient comfort and pain levels when adjusting exercise intensity, regardless of exercise type. The majority (48.40%) recommended weekly reassessment and modification of exercises. Additionally, despite pain being a key factor for discharge and the primary adverse effect of exercise, most of our sample would not discontinue exercises in case of pain during the early and late phases of rehabilitation. Despite the lack of consensus on some aspects, the clinical practice of our sample is in line with the current literature and practice in other countries. However, further research and implementation are crucial to enhance future rehabilitation outcomes, including exploring the exercise training volume, the safety and effectiveness of exercising with pain and identifying the optimal pain level for best results.
Collapse
Affiliation(s)
- Denise Dal’Ava Augusto
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Scattone Silva
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Rehabilitation Sciences, Health Sciences College of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Débora Pereira Pinheiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Catarina de Oliveira Sousa
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
2
|
Cavaggion C, Juul-Kristensen B, Luque-Suarez A, Voogt L, Wollants G, Ó Conaire E, Struyf F. Exercise into pain in chronic rotator cuff related shoulder pain: a prospective single-group feasibility study. BMJ Open 2023; 13:e070698. [PMID: 37802620 PMCID: PMC10565173 DOI: 10.1136/bmjopen-2022-070698] [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: 01/04/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES This study evaluated the feasibility of exercising into pain in rotator cuff related shoulder pain (RCRSP), data collection procedures, feedback from physiotherapists and patients, and clinically important changes in patient-reported outcome measures (PROMs). DESIGN Unblinded non-randomised single-group study. SETTING Physiotherapy clinic in Belgium. PARTICIPANTS Twelve patients with unilateral RCRSP for minimum 3 months, aged 18-65 years. INTERVENTIONS Twelve weeks of four individualised exercises, with nine physiotherapist-led sessions with pain ratings 4-7 out of 10 on a verbal Numeric Pain Rating Scale for 9 weeks and then pain ratings 0-2 for 3 weeks. Every physiotherapy session included 15 min of manual therapy. Non-supervised exercises were: 2×/week in weeks with physiotherapy session, 3×/week in weeks without physiotherapy session. OUTCOME MEASURES Primary: adherence, where patients were considered adherent with 78% (7/9 sessions) attendance for supervised sessions and 81% (22/27 sessions) completion for non-supervised exercises, and Shoulder Pain and Disability Index (SPADI); secondary: fear-avoidance behaviour, fear of pain, physical outcomes (strength, range of motion, scapular dyskinesis); others: ultrasound (US) imaging outcomes (acromionhumeral distance, supraspinatus tendon thickness, occupation ratio), global perceived effect (GPE). PROMs were collected via online survey, except for the GPE (via closed envelope). US measures were taken after physical measures. RESULTS Adherence and adverse effects were analysed in patients who had the possibility to attend minimum seven supervised sessions (n=8): 88% of them adhered to supervised sessions, 50% to non-supervised exercises; none of them withdrew from the study, three of them obtained individual clinically important improvements in SPADI score above 20 points. The measurement protocol of physical and ultrasonographic outcomes took around 60 min. CONCLUSIONS Adherence to supervised sessions was satisfactory, the adherence to non-supervised exercises must be improved. Data collection procedures were feasible to perform, but some changes are recommended. TRIAL REGISTRATION NUMBER NCT04154345.
Collapse
Affiliation(s)
- Claudia Cavaggion
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, Universidad de Malaga, Malaga, Spain
- Universidad de Malaga, Instituto de Investigacion Biomedica de Malaga, Malaga, Spain
| | - Lennard Voogt
- Department of Physical Therapy Studies and Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Eoin Ó Conaire
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Evidence-Based Therapy Centre, Galway, Ireland
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
3
|
Brindisino F, Lorusso M, Usai M, Pellicciari L, Marruganti S, Salomon M. Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists. Arch Physiother 2023; 13:12. [PMID: 37277886 DOI: 10.1186/s40945-023-00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The incidence of Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA) is constantly increasing. As a result, the interest in post-surgical rehabilitation has grown, since it is crucial in order to achieve full recovery and successful outcomes. The first aim of this study is to investigate the Italian physiotherapists (PTs) clinical practice in the management of patients with TSA and RTSA and to compare it with the best evidence available in the literature. The second purpose of this study is to assess any existing difference between the survey answers and the different sample subgroups. MATERIALS AND METHODS This cross-sectional observation study was designed following the CHERRIES checklist and the STROBE guidelines. A 4-sections survey with a total of 30 questions was developed for investigating post-surgery rehabilitation management in patient with TSA and RTSA. The survey was sent to Italian PTs from December 2020 until February 2021. RESULTS Six-hundred and seven PTs completed the survey regarding both TSA and RTSA; 43.5% of participants (n = 264/607) stated that TSA is more likely to dislocate during abduction and external rotation. Regarding reverse prosthesis, 53.5% (n = 325/607) affirmed RTSA is more likely to dislocate during internal rotation, adduction and extension. In order to recover passive Range of Motion (pROM), 62.1% (n = 377/607) of participants reported that they gain anterior flexion, abduction, internal rotation, external rotation up to 30°, with full pROM in all directions granted at 6-12 weeks. Regarding the active ROM (aROM), 44.2% (n = 268/607) of participants stated that they use active-assisted procedures within a range under 90° of elevation and abduction at 3-4 weeks and higher than 90° at 6-12 weeks, with full recovery at a 3-month mark. Sixty-five point seven percent of the sample (n = 399/607) declared that, during the rehabilitation of patients with TSA, they tend to focus on strengthening the scapular and rotator cuff muscles, deltoid, biceps and triceps. Conversely, 68.0% (n = 413/607) of participants stated that, for the rehabilitation of patients with RTSA, they preferably focus on strengthening the periscapular and deltoid muscles. Finally, 33.1% (n = 201/607) of participants indicated the instability of the glenoid prosthetic component as the most frequent complication in patients with TSA, while 42.5% (n = 258/607) of PTs identified scapular neck erosion as the most frequent post-RTSA surgery complication. CONCLUSIONS The clinical practice of Italian PTs effectively reflects the indications of the literature as far as the strengthening of the main muscle groups and the prevention of movements, which may result in a dislocation, are concerned. Some differences emerged in the clinical practice of Italian PTs, regarding the restoration of active and passive movement, the starting and progression of muscle strengthening and the return to sport (RTS). These differences are actually quite representative of the current knowledge in post-surgical rehabilitation for shoulder prosthesis in the rehabilitation field. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Mariangela Lorusso
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | | | | | - Sharon Marruganti
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | - Mattia Salomon
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| |
Collapse
|
4
|
Powell JK, Schram B, Lewis J, Hing W. Physiotherapists nearly always prescribe exercise for rotator cuff-related shoulder pain; but why? A cross-sectional international survey of physiotherapists. Musculoskeletal Care 2023; 21:253-263. [PMID: 36089802 DOI: 10.1002/msc.1699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS This cross-sectional international survey explored the beliefs of physiotherapists regarding the possible mechanisms of benefit of exercise for rotator cuff-related shoulder pain (RCRSP). Clinical practice guidelines recommend physiotherapists use exercise as a primary treatment to help people with RCRSP, but the explanations provided to patients by physiotherapists regarding its mechanism of effect is unknown. MATERIALS AND METHODS Registered physiotherapists were surveyed about 'how and why' they believe exercise provides a clinical benefit for people with RCRSP. Information was also gathered about commonly used exercise types and preferred diagnostic labels. The survey was designed and reported in concordance with Consensus-Based Checklist for Reporting of Survey Studies guidelines. RESULTS Four hundred and eighty physiotherapists from forty-nine countries completed the survey. Psychosocial and biomedical mechanisms of exercise were evenly selected by participants. Improving muscle strength, muscle endurance, pain self-efficacy and reducing kinesiophobia, and fear avoidance beliefs were the most common individual mechanisms thought to underpin exercise therapy for RCRSP. Rotator cuff-related shoulder pain was the most commonly used diagnostic label. DISCUSSION AND CONCLUSION Physiotherapists hold beliefs regarding exercise mechanisms that is largely concordant with the current evidence base, which is commendable. Future research should consider the patients perspective and consider testing commonly selected mechanisms of exercise, such as shoulder muscle strength, pain self-efficacy and kinesiophobia as possible mediators of recovery.
Collapse
Affiliation(s)
- Jared K Powell
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Ben Schram
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Musculoskeletal Research, Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Wayne Hing
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| |
Collapse
|
5
|
Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada. BMC PRIMARY CARE 2023; 24:49. [PMID: 36797670 PMCID: PMC9933814 DOI: 10.1186/s12875-023-01999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management. METHODS A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists' referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants' responses were compared between types of providers with Fisher's exact test. RESULTS Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes. CONCLUSIONS Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders.
Collapse
|
6
|
Powell JK, Schram B, Lewis J, Hing W. "You have (rotator cuff related) shoulder pain, and to treat it, I recommend exercise." A scoping review of the possible mechanisms underpinning exercise therapy. Musculoskelet Sci Pract 2022; 62:102646. [PMID: 35964499 DOI: 10.1016/j.msksp.2022.102646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exercise is considered to be both essential and at the forefront of the management of rotator cuff-related shoulder pain (RCRSP). Despite this, many fail to substantially improve with exercise-based treatment. Hence, expanding the current knowledge about the possible mechanisms of exercise for RCRSP is critical. OBJECTIVE To synthesise the range of mechanisms proposed for exercise in people with RCRSP. DESIGN Scoping review METHODS: A systematic search of the Physiotherapy Evidence Database (PEDro) was conducted from inception to July 3, 2022. Two reviewers conducted the search and screening process and one reviewer extracted the data from each study. Randomised clinical trials using exercise for the management of RCRSP of any duration were included. The PEDro search terms used were "fitness training", "strength training", "stretching, mobilisation, manipulation, massage", "upper arm, shoulder, or shoulder girdle", "pain", and "musculoskeletal". Data were analysed using quantitative and qualitative approaches. RESULTS 626 studies were identified and 110 were included in the review. Thirty-two unique mechanisms of exercise were suggested by clinical trialists, from which 4 themes emerged: 1) neuromuscular 2) tissue factors 3) neuro-endocrine-immune 4) psychological. Neuromuscular mechanisms were proposed most often (n = 156, 77%). Overall, biomedical mechanisms of exercise were proposed in 95% of cases. CONCLUSIONS The causal explanation for the beneficial effect of exercise for RCRSP in clinical research is dominated by biomedical mechanisms, despite a lack of supporting evidence. Future research should consider testing the mechanisms identified in this review using mediation analysis to progress knowledge on how exercise might work for RCRSP.
Collapse
Affiliation(s)
- Jared K Powell
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia.
| | - Ben Schram
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Clinical Therapies, University of Limerick, Ireland
| | - Wayne Hing
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| |
Collapse
|
7
|
Mourad F, Yousif MS, Maselli F, Pellicciari L, Meroni R, Dunning J, Puentedura E, Taylor A, Kerry R, Hutting N, Kranenburg HA. Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists. Chiropr Man Therap 2022; 30:38. [PMID: 36096835 PMCID: PMC9465888 DOI: 10.1186/s12998-022-00449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objective High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries.
Methods An online survey with 41 questions was adapted from previous surveys and was distributed via a mailing list of the Italian Physiotherapists Association (March 22–26, 2020). The questionnaire was divided into 4 sections to capture information on participant demographics, utilization, potential barriers, and knowledge about SM. Questions were differentiated between spinal regions. Attitudes towards different spinal regions, attributes associated with beliefs, and the influence of previous educational background were each evaluated.
Results Of the 7398 registered physiotherapists, 575 (7.8%) completed the survey and were included for analysis. The majority of respondents perceived SM as safe and effective when applied to the thoracic (74.1%) and lumbar (72.2%) spines; whereas, a smaller proportion viewed SM to the upper cervical spine (56.8%) as safe and effective. Respondents reported they were less likely to provide and feel comfortable with upper cervical SM (respectively, 27.5% and 48.5%) compared to the thoracic (respectively, 52.2% and 74.8%) and lumbar spines (respectively, 46.3% and 74.3%). Most physiotherapists (70.4%) agreed they would perform additional screening prior to upper cervical SM compared to other spinal regions. Respondents who were aware of clinical prediction rules were more likely to report being comfortable with SM (OR 2.38–3.69) and to perceive it as safe (OR 1.75–3.12). Finally, physiotherapists without musculoskeletal specialization, especially those with a traditional manual therapy background, were more likely to perform additional screening prior to SM, use SM less frequently, report being less comfortable performing SM, and report upper cervical SM as less safe (p < 0.001). Discussion The beliefs and attitudes of physiotherapists surrounding the use of SM are significantly different when comparing the upper cervical spine to other spinal regions. An educational background in traditional manual therapy significantly influences beliefs and attitudes. We propose an updated framework on evidence-based SM. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00449-x.
Collapse
Affiliation(s)
- Firas Mourad
- Department of Physiotherapy, Exercise and Sports, LUNEX International University of Health, 4671, Differdange, Luxembourg. .,Luxembourg Health & Sport Sciences Research Institute A.S.B.L., 50, Avenue du Parc des Sports, 4671, Differdange, Luxembourg.
| | - Marzia Stella Yousif
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza" University of Rome, Rome, Italy.,Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
| | | | - Roberto Meroni
- Department of Physiotherapy, Exercise and Sports, LUNEX International University of Health, 4671, Differdange, Luxembourg.,Luxembourg Health & Sport Sciences Research Institute A.S.B.L., 50, Avenue du Parc des Sports, 4671, Differdange, Luxembourg
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA.,Montgomery Osteopractic Physiotherapy & Acupuncture Clinic, Montgomery, AL, USA
| | - Emilio Puentedura
- Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | |
Collapse
|
8
|
Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Valdés-Orrego I, Sepúlveda-Osses O. Effectiveness of supervised physiotherapy versus home exercise in subjects with rotator cuff disorders treated surgically: A systematic review and meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1942. [PMID: 35184364 DOI: 10.1002/pri.1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/06/2022] [Accepted: 01/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim is to determine the effectiveness of supervised Physiotherapy (PT) versus a home exercise program for functional outcomes in patients with rotator cuff (RC) disorders treated surgically. TYPE: Systematic review and meta-analysis of randomized clinical trials. METHODOLOGY An electronic search was performed in the MEDLINE, CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared supervised PT versus home exercises in functional outcomes, such as shoulder or upper limb function, pain intensity, and range of motion, in subjects older than 18 years with RC disorders treated surgically. SYNTHESIS Six trials met the eligibility criteria, and for the quantitative synthesis, five studies were included. At 3 months, the mean difference (MD) for the Constant-Murley questionnaire (0-100 points) was -0.76 points (95% confidence interval (CI) = -15.64 to 14.12, p = 0.92), while the MD for the visual analog scale (0-10 cm) was -0.87 cm (95% CI = -2.8 to 1.06, p = 0.38). These differences were neither clinically nor statistically significant. CONCLUSION There was very low quality of evidence towards no better benefits in shoulder pain and function of supervised PT over home exercises programs in patients older than 18 years with RC disorders treated surgically. PROSPERO REGISTRATION CRD42020185805.
Collapse
Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | | | - Cristian Olguín-Huerta
- Rehabilitation in Health Research Center (CIRES), University of the Americas, Santiago, Chile
| | - Iván Valdés-Orrego
- School of Health Sciences, Physiotherapy Department, Universidad Gabriela Mistral, Santiago, Chile
| | | |
Collapse
|
9
|
Mourad F, Lopez G, Cataldi F, Maselli F, Pellicciari L, Salomon M, Kranenburg H, Kerry R, Taylor A, Hutting N. Assessing Cranial Nerves in Physical Therapy Practice: Findings from a Cross-Sectional Survey and Implication for Clinical Practice. Healthcare (Basel) 2021; 9:1262. [PMID: 34682942 PMCID: PMC8535196 DOI: 10.3390/healthcare9101262] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Serious pathologies of the neck can potentially result in cranial nerve palsy. Knowledge about cranial nerve examination (CNE) seems sparse, and its use is still unknown. We aim to investigate the knowledge, skills, and utilization of CNE of Italian physiotherapists. MATERIALS AND METHODS An online cross-sectional survey. RESULTS 396 completed the survey, reaching the required sample size. Although Italian physiotherapists consider CNE relevant (mean ± SD = 7.6/10 ± 2.0), over half of all responders (n = 229 (57.8%)) were not trained in the fundamentals and around a third did not use it in their daily practice (n = 138 (34.8%)). Additionally, participants were unconfident and insecure in conducting (n = 152 (38.4%) and n = 147 (37.1%)), interpreting (n = 140 (35.4%) and n = 164 (41.4%)), and managing the CNE (n = 141 (35.6%) and n = 154 (38.9%)). Possessing a musculoskeletal specialization was associated with an increased value attributed to clinical practice guidelines and reduced the lack of confidence in conducting, interpreting, and managing the CNE (respectively, n = 35 (25.5%), p = 0.0001; n = 32 (23.4%) p = 0.0002; n = 32 (23.4%) p = 0.0002). Working in a direct access setting significantly increased the considered relevance of guidelines and the concerns about arterial (p = 0.004) and other serious pathologies (p = 0.021). Pain and visual disturbances were considered the main indicators to CNE, demonstrating limited knowledge of signs and symptoms' indicating CNE. Participants considered specific training in CNE as relevant (mean ± SD = 7.6/10 = 2.1). CONCLUSIONS a substantial proportion of Italian physiotherapists are not schooled in the fundamentals of cranial nerve examination. Given the number of physiotherapists who work in first contact roles, this is a professional concern.
Collapse
Affiliation(s)
- Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
| | - Giovanni Lopez
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physiotherapy, Kinesis, 70126 Bari, Italy
| | - Fabio Cataldi
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physiotherapy, Manual Therapy Laboratory—MTLab, 70123 Bari, Italy
| | - Filippo Maselli
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 16132 Savona, Italy
| | | | - Mattia Salomon
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physical Therapy, Centro Diagnostico e Polispecialistico CST S.r.l., 38121 Trento, Italy
| | - Hendrikus Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9714 CE Groningen, The Netherlands;
| | - Roger Kerry
- Division of Physiotherapy and Sport Rehabilitation, School of Health Sciences, Faculty of Medicine and Health Sciences, Nottingham University, Nottingham NG5 1PB, UK; (R.K.); (A.T.)
| | - Alan Taylor
- Division of Physiotherapy and Sport Rehabilitation, School of Health Sciences, Faculty of Medicine and Health Sciences, Nottingham University, Nottingham NG5 1PB, UK; (R.K.); (A.T.)
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands;
| |
Collapse
|
10
|
Brindisino F, De Santis A, Rossettini G, Pellicciari L, Filipponi M, Rollo G, Gibson J. Post-surgery rehabilitation following rotator cuff repair. A survey of current (2020) Italian clinical practice. Disabil Rehabil 2021; 44:4689-4699. [PMID: 33945358 DOI: 10.1080/09638288.2021.1916628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To analyse the clinical practice of Italian physiotherapists within the framework of postoperative rehabilitation of rotator cuff (RC) surgery patients, and to compare it with similar studies carried out in other countries. METHODS A web-based, voluntary, cross-sectional survey with 27 closed multiple-choice questions was developed and submitted to Italian-based physiotherapists in order to assess their clinical practice. RESULTS Data from 1160 questionnaires were then analysed. Thirty-five percent of respondents (n = 413/1160) reported that they commence passive range of motion from the first postoperative week, while 49.2% (n = 571/1160) start during the second or third week. The majority of respondents (n = 603/1160, 52.0%) introduce active mobilisation between the fourth and the sixth week after surgery and 41.1% (n = 477/1160) introduce overhead movements between the fourth and the sixth week after surgery. DISCUSSION AND CONCLUSIONS When managing the postoperative rehabilitation of RC surgery patients, Italian physiotherapists' practice is congruent with the guidelines published by American Society of Shoulder and Elbow Therapists (ASSET) and also with other UK surveys. However, while Italian physiotherapists manage immobilisation periods, active and passive mobilisation and the return to sport activities, according to evidence-based best practice guidelines, there is less consistency with respect to physical exercise, patient follow-up and referral.IMPLICATIONS FOR REHABILITATIONItalian physiotherapists' practice with patients following rotator cuff (RC) repair complies with evidence-based practice guidelines regarding immobilisation periods, passive and active mobilisation, and return to sport activities.There is less consistency between reported/declared practice and available evidence concerning physical exercise, patient follow-up, and referral.Physiotherapist with Orthopaedic Manipulative Physical Therapy (OMPT) training is more aligned with the current literature compared to physiotherapists without specific training, in terms of managing rehabilitation programmes, period of immobilisation and therapeutic exercise.More careful adherence to the international guidelines is recommended, in order to manage patients following RC repair in accordance with the evidence and to achieve the best possible outcomes.
Collapse
Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea De Santis
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Poliambulatorio Physiofit, Borgo Podgora, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,School of Physiotherapy, University of Verona, Verona, Italy
| | | | - Marco Filipponi
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Jo Gibson
- Department of Physiotherapy, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.,The School of Health Sciences, University of Liverpool, Liverpool, UK
| |
Collapse
|
11
|
Clausen MB, Merrild MB, Holm K, Pedersen MW, Andersen LL, Zebis MK, Jakobsen TL, Thorborg K. Less than half of patients in secondary care adheres to clinical guidelines for subacromial pain syndrome and have acceptable symptoms after treatment: A Danish nationwide cohort study of 3306 patients. Musculoskelet Sci Pract 2021; 52:102322. [PMID: 33485212 DOI: 10.1016/j.msksp.2021.102322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evidence-based guidelines recommend exercise-therapy as first line treatment for subacromial pain syndrome, but no previous study has mapped the content of care for subacromial pain syndrome and knowledge about adherence to clinical guidelines are lacking. We aim to describe the content and outcome of current care and investigate the relationship between content and outcome of care. METHODS We invited all patients diagnosed with subacromial pain syndrome at any Danish hospital to participate in this nationwide retrospective population-based cohort-study. Patient-reported information on content of care was collected using a validated questionnaire. Outcome of care was assessed using global impression of change (GIC) and patient acceptable symptom state (PASS). Invitations were sent 14 weeks after diagnosis. RESULTS In total, 3306 eligible patients participated. At follow-up, 45% had completed the recommended 12 weeks of exercise-therapy. From the total cohort, 12% underwent surgery without completing 12 weeks of exercise-therapy. For patients undergoing non-operative care, 43% reached PASS while 61% were improved since diagnosis at the hospital. Completing 12 weeks with exercise-therapy did not increase the odds of improvement (OR 1.05, 95%CI:0.88-1.24), but having conducted strengthening exercises did (OR 1.65, 95%CI:1.25-2.19). CONCLUSION More than half of patients diagnosed with subacromial pain syndrome in specialist care settings do not adhere to recommendations regarding duration of exercise-therapy, but this is not related to symptom improvement. Conversely, conducting strengthening exercises relates to higher chance of symptom improvement. This challenges current clinical guidelines, indicating that a time-based cut-point may not be relevant while specific types of exercises are.
Collapse
Affiliation(s)
- Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark.
| | - Mikas Bjørn Merrild
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Kika Holm
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Mads Welling Pedersen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | | | - Mette Kreutzfeldt Zebis
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Thomas Linding Jakobsen
- Section for Orthopaedic and Sports Rehabilitation (SOS-R), Health Centre Nørrebro, City of Copenhagen, Copenhagen, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| |
Collapse
|
12
|
Riera J, Smythe A, Malliaras P. French physiotherapy management of rotator cuff related shoulder pain: An observational study. Musculoskeletal Care 2021; 19:484-494. [PMID: 33666355 DOI: 10.1002/msc.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rotator cuff related shoulder pain (RCRSP) is a common and disabling cause of shoulder pain contributing to great socio-economic costs. Conservative management is recommended as first-line treatment, with studies performed in the United Kingdom, Belgium, the Netherlands and Australia finding practice generally consistent with guideline recommendations. Current French guidelines for management of RCRSP were published more than a decade ago, and it is unknown if French physiotherapists manage RCRSP in line with the current guideline recommendations. The aim of this survey is to evaluate if management delivered by French physiotherapists for RCRSP is in line with the current evidence. METHODS A cross-sectional online survey was conducted and disseminated through various social media platforms and a mailing list from December 2018 to March 2019. RESULTS Two hundred and six French physiotherapists completed the survey. The results demonstrated that the majority of physiotherapists provide care consistent with recommended guideline management, through the delivery of exercise and education. Ideology and specific parameters of treatment delivery, particularly exercise treatment, were highly variable among the cohort, but comparable to findings among physiotherapists in the United Kingdom, Belgium, the Netherlands and Australia. CONCLUSION French physiotherapists are broadly consistent with providing guideline recommended care of RCRSP; however, heterogeneity exists in the ideals and practice of specific treatment delivery, particularly within exercise management.
Collapse
Affiliation(s)
| | - Andrew Smythe
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia.,A Game Physiotherapy, Somerville, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| |
Collapse
|
13
|
Scalise V, Brindisino F, Pellicciari L, Minnucci S, Bonetti F. Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041995. [PMID: 33670831 PMCID: PMC7922196 DOI: 10.3390/ijerph18041995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/21/2022]
Abstract
The aim of this article was to investigate the knowledge, management, and clinical practice of Italian physiotherapists concerning patients with carpal tunnel syndrome (CTS). A national cross-sectional survey consisted of 24 questions was administered from December 2019 until February 2020. A Chi-squared independence test was run to study any difference between subgroups of the sample and responses to the questionnaire. Five hundred and eight respondents completed the survey. Most respondents (n = 225/508; 44.3%) are under 29 years old, female (n = 256/508; 50.4%) and have been working as physiotherapists for less than 5 years (n = 213/508; 41.9%). Most of respondents correctly knows about the cause (n = 455/508, 89.6%), main signs and symptoms of CTS (n = 415/508, 81.70%) and administer education, manual therapy, myofascial techniques and therapeutic exercises (n = 457/508, 89.88%). Three hundred and sixty-four (71.68%) respondents were aware of the influence of psychosocial factors on the patient’s outcomes. The survey showed greater adherence to evidences by physiotherapists holding a master’s degree. The results are mostly comparable with other surveys structured all over the world on the same topic. Italian physiotherapists management of the CTS was not always in line with current evidence. Interventions such as education, manual therapy, therapeutic exercise, nerve and tendon glide techniques are widely used, while the orthotic is only offered by half of the sample.
Collapse
Affiliation(s)
- Valentina Scalise
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
| | - Fabrizio Brindisino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, I-86100 Campobasso, Italy
| | - Leonardo Pellicciari
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Pisana, I-00166 Rome, Italy
- Correspondence: or ; Tel.: +39-32-8568-2656
| | - Silvia Minnucci
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
| |
Collapse
|
14
|
Smythe A, Rathi S, Pavlova N, Littlewood C, Connell D, Haines T, Malliaras P. Self-reported management among people with rotator cuff related shoulder pain: An observational study. Musculoskelet Sci Pract 2021; 51:102305. [PMID: 33249362 DOI: 10.1016/j.msksp.2020.102305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rotator cuff related shoulder pain is the most common cause of shoulder pain. Whilst guidelines recommend conservative management prior to imaging, injection or surgical management, recent findings suggest that patients experience management contrary to guideline recommendations. OBJECTIVES The aim of this study was to investigate self-reported management among people with rotator cuff related shoulder pain (RCRSP) and their beliefs towards management. MATERIALS AND METHODS Cross-sectional survey of people with RCRSP recruited when referred for imaging (n = 120). Electronic survey about demographic factors, management people had had (including imaging, injections, surgery, exercise, adjuncts), and beliefs about treatments. The frequency of various treatments was reported (separately for each cohort and traumatic onset) as well as the timing of interventions related to first-line care. RESULTS Most people had tried exercise (99/120, 82.5%) but only one in five people reported exercise was helpful, and one in six reported it was unhelpful or made their symptoms worse. Approximately a third of the cohort reported not receiving activity modification advice (34.2%, 41/120), those that did received inconsistent information. People with both traumatic (imaging 31/43, 72.1%; injections 13/24, 54.2%, surgery 8/21, 38.1%) and atraumatic onset pain (imaging 43/77, 55.8%; injections 31/51, 60.8%, surgery 4/19, 21.1%) had similarly high rates of intervention prior to trialling conservative management. Patient beliefs in regards to management showed trends towards interventionalist care. CONCLUSION Patient reported management of RCRSP is often inconsistent with guideline recommended management.
Collapse
Affiliation(s)
- A Smythe
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Building B, Peninsula Campus, Monash University, Victoria, 3199, Australia; A-Game Physiotherapy, Somerville, Victoria, 3912, Australia.
| | - S Rathi
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Building B, Peninsula Campus, Monash University, Victoria, 3199, Australia
| | - N Pavlova
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Building B, Peninsula Campus, Monash University, Victoria, 3199, Australia
| | - C Littlewood
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, M15 6GX, UK. https://twitter.com/ChrisLittlew00d
| | - D Connell
- Imaging at Olympic Park, AAMI Park, Melbourne, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - T Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Building G, Peninsula Campus, Monash University, Victoria, 3199, Australia
| | - P Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Building B, Peninsula Campus, Monash University, Victoria, 3199, Australia. https://twitter.com/DrPeteMalliaras
| |
Collapse
|
15
|
Brindisino F, Ristori D, Lorusso M, Miele S, Pellicciari L, Rossettini G, Bonetti F, Heick JD, Testa M. Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities. Arch Physiother 2020; 10:16. [PMID: 32905154 PMCID: PMC7465722 DOI: 10.1186/s40945-020-00087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM The subacromial impingement syndrome (SIS) represents a common cause of disability in approximately 74% of patients with Shoulder Pain (SP). Even if contemporary research suggests that this mechanism is not (always) the dominant driver in SP, SIS is still a source of debate among scholars and clinicians. From a clinical point of view, evidence has suggested that clinicians can use both medical and physiotherapy approaches as effective methods to treat SIS.This survey aims to investigate models of management of patients with SIS in a sample of Italian physiotherapist specialists (Orthopaedic Manipulative Physical Therapists, -OMPTs-) and orthopaedic surgeons. MATERIALS AND METHODS An online survey with 29-item questionnaire was administered to assess the knowledge of OMPTs and orthopaedic surgeons about: a) strategies of clinical examination; b) the role of imaging in the diagnostic process; c) the physiotherapy management; and d) the pharmacological and surgical management in patients with SIS. RESULTS Six-hundred and twenty-nine respondents completed the survey (511 OMPTs (79.97%) and 128 orthopaedic surgeons (20.03%)). Ninety-two percent (n = 470) of the OMPTs and 80.5% (n = 103) of orthopaedic surgeons stated that in patients with SIS, a combination of diagnostic tests produced better accuracy (p = < 0.001). Twenty point seven % of OMPTs (n = 106) and 4.7% of orthopaedic surgeon (n = 6) stated that the Lift off was the most specific test (p = < 0.001). Four-hundred-and-twenty-four OMPTs (83%) and 40 orthopaedic surgeons (31.3%) answered that the gold standard for diagnosis of a patient with SIS are history and clinical examination (p < 0.001). CONCLUSION OMPTs and orthopaedic surgeons approach patients with SIS differently during both the assessment and the treatment. OMPTs appear to be appropriate in planning and managing clinical examination and therapeutic strategies to use with patients with SIS.
Collapse
Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Simone Miele
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | | | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - John Duane Heick
- Department of Physical Therapy and Athletic Training, Northern Arizona University Flagstaff, Flagstaff, AZ USA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| |
Collapse
|
16
|
Smythe A, White J, Littlewood C, Bury J, Haines T, Malliaras P. Physiotherapists deliver management broadly consistent with recommended practice in rotator cuff tendinopathy: An observational study. Musculoskelet Sci Pract 2020; 47:102132. [PMID: 32148327 DOI: 10.1016/j.msksp.2020.102132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/02/2019] [Accepted: 02/13/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rotator cuff tendinopathy is a common and disabling cause of shoulder pain. While conservative treatment is recommended as initial management, recent findings suggest that general practitioners and rheumatologists do not consistently align with recommended care. This study aimed to survey Australian physiotherapists to explore the extent to which recommended management is being applied. METHODS A cross-sectional online survey. RESULTS Five hundred and two Australian physiotherapists completed the survey. Results demonstrated the majority of physiotherapists provide conservative management consistent with guideline recommendations, through delivery of exercise and education, comparable to management by physiotherapists in the United Kingdom, Belgium and the Netherlands. Parameters and construction of exercise treatment programs were highly variable within the cohort, qualitative analysis highlighting varied reasoning underpinning these management decisions. CONCLUSIONS Australian physiotherapists are broadly consistent with providing recommended management, however heterogeneity exists in the methods and parameters of treatment delivery.
Collapse
Affiliation(s)
- A Smythe
- A Game Physiotherapy, Somerville, Melbourne, 3912, Australia.
| | - J White
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
| | - C Littlewood
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, ST54 5BG, UK
| | - J Bury
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster Royal Infirmary, Doncaster, DN2 5LT, UK
| | - T Haines
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
| | - P Malliaras
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
| |
Collapse
|
17
|
Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review. J Orthop Sports Phys Ther 2020; 50:285-a12. [PMID: 32476583 DOI: 10.2519/jospt.2020.9152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. DESIGN Scoping review. LITERATURE SEARCH We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. STUDY SELECTION CRITERIA We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. DATA SYNTHESIS We performed a qualitative synthesis that identified items included in patient advice and education. RESULTS Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. CONCLUSION While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change. J Orthop Sports Phys Ther 2020;50(6):285-293. doi:10.2519/jospt.2020.9152.
Collapse
|
18
|
Brindisino F, Matteuzzi I, Bury J, McCreesh K, Littlewood C. Rotator cuff disorders: A survey of current (2018) Italian physiotherapy practice. ACTA ACUST UNITED AC 2020. [DOI: 10.3233/ppr-190141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F. Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
- Poliambulatorio FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, Lecce, Italy
| | - I. Matteuzzi
- MUST Sports Medicine, Physiotherapy and Rehabilitation, Colle Val D’Elsa (SI), Italy
- Physiobeat Physiotherapy Center, Poggibonsi (SI), Italy
| | - J. Bury
- Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust, Physiotherapy Department, Doncaster Royal Infirmary, Doncaster, UK
| | - K. McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - C. Littlewood
- School of Primary, Community and Social Care, Keele University, UK
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| |
Collapse
|