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Albishi AM. Knowledge, attitudes, and perceptions of physical therapists towards conventional physical therapy-across-sectional study. Ann Med Surg (Lond) 2024; 86:1942-1949. [PMID: 38576907 PMCID: PMC10990403 DOI: 10.1097/ms9.0000000000001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 04/06/2024] Open
Abstract
Background Conventional physical therapy (CPT) is widely used in clinical practice and known to contribute beneficially to patient's health conditions but remains loosely defined. Research has shown inconsistency in the definition and utilization of CPT among physical therapists in clinical and research settings, limiting its generalisability and reproducibility. Therefore, this study evaluates physical therapists' knowledge, attitudes, and perceptions toward CPT. Methods A cross-sectional study using a self-administered questionnaire containing 36 questions was distributed among 238 licensed physical therapists. Descriptive and inferential statistics were used to measure the physical therapists' knowledge, attitudes, and perceptions towards CPT. Results Physical therapists showed limited knowledge of CPT in rehabilitation (4.09±1.698, 51%). However, the knowledge scores were significantly associated with age (P=0.002), educational levels (P=0.006), and years of work experience (P=0.001). Nevertheless, physical therapists showed an overall positive attitude towards CPT and perceived it as essential to rehabilitation. Conclusion Most physical therapists have low knowledge about CPT but positive attitudes and perceptions. Therefore, customized medical education is necessary to incorporate CPT theories and applications into physical therapists' rehabilitation programs.
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Affiliation(s)
- Alaa M. Albishi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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2
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Hsiao PC, Wang YC, Huang YJ, Hsueh IP, Chen MH, Hsieh CL. Correlations between subjective rating and objective assessment of balance function in individuals with stroke. Disabil Rehabil 2020; 43:3757-3763. [PMID: 32372705 DOI: 10.1080/09638288.2020.1751313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To examine the relationships among therapist-reported, patient-reported, and objective assessment scores of balance function.Methods: Inpatients with stroke and occupational therapists were recruited. The objective balance scores were measured using the Balance Computerized Adaptive Testing (Balance CAT) system. The therapist and patient-reported scores were evaluated using a visual analogue scale (VAS) and Likert-type scale.Results: Eighty-eight patients and 16 therapists participated. The correlations (r= 0.64 and 0.65; R-squared about 0.42 at baseline and follow-up assessments, respectively) between the therapist-reported VAS scores and the Balance CAT system were larger than those (r = 0.31 and 0.21) between the patient-reported VAS scores and the Balance CAT system. Low correlations (r = 0.27 and 0.26 for VAS and Likert-type scores, respectively) were found between the therapist-reported and patient-reported change scores. Low correlations (r = 0.12-0.17) were found between the change scores of therapist- and patient-reported ratings and those of the Balance CAT system.Conclusions: The therapists' judgments explained <50% of variance of the Balance CAT system scores. Neither therapist-reported nor patient-reported change scores reflected the changes demonstrated by the objective assessments. Further studies are warranted to confirm our findings.Implications for RehabilitationNeither therapist- nor patient-reported balance function and change could effectively reflect the scores resulting from objective assessments.The routine use of objective balance assessments should not be replaced by therapists' subjective judgments.Communications regarding the balance function measured by objective assessments between therapists and patients can help patients to better understand their balance function and progress.
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Affiliation(s)
- Pei-Chi Hsiao
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Ching Wang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jing Huang
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hsiang Chen
- Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan.,Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Male AJ, Ramdharry GM, Grant R, Davies RA, Beith ID. A survey of current management of Benign Paroxysmal Positional Vertigo (BPPV) by physiotherapists' interested in vestibular rehabilitation in the UK. Physiotherapy 2018; 105:307-314. [PMID: 30389100 DOI: 10.1016/j.physio.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness. Extensive research has identified the best assessment and treatment manoeuvres for each subtype of BPPV. Education in vestibular rehabilitation (VR) is inconsistent. It is unclear if the evidence has been adopted by UK physiotherapists in clinical practice and no research has investigated this specifically. DESIGN An online survey with closed- and open-text answers. PARTICIPANTS A purposive sample of physiotherapists interested in VR. A response rate of 67% (100/150) was obtained, from which 20 responses were excluded. RESULTS Participants had good evidence-based awareness in assessment (79/80, 99%) and treatment (72/80, 90%) of posterior BPPV. Horizontal BPPV assessment awareness was lower than treatment (37/80, 46% vs 60/80, 75%). Differential diagnosis was poor in subjective (20/80, 25%) and objective stages of assessment (34/80, 43%). Thirty six percent (29/80) were able to list ≥3 test precautions with all three nystagmus characteristics described by 29% (23/80). Eighty one percent (65/80) encourage activity restrictions post-treatment. Only 28% (22/80) were aware of practice guidelines or Cochrane reviews in BPPV. External courses were rated the top method for learning how to manage BPPV. Lack of peer support (26/77, 34%) was the main challenge faced whilst learning. Recommendations for improving BPPV education included more external courses (23/87, 26%) and competency guidelines (13/87, 15%). CONCLUSIONS Good awareness of research evidence was observed in some aspects of BPPV management but many areas require development. Translation and implementation of evidence remains poor and suggests changes in education and knowledge dissemination are warranted.
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Affiliation(s)
- A J Male
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom; Therapy Services, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom.
| | - G M Ramdharry
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - R Grant
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - R A Davies
- Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom
| | - I D Beith
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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4
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Brun-Cottan N, McMillian D, Hastings J. Defending the art of physical therapy: Expanding inquiry and crafting culture in support of therapeutic alliance. Physiother Theory Pract 2018; 36:669-678. [DOI: 10.1080/09593985.2018.1492656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Danny McMillian
- School of Physical Therapy, University of Puget Sound, Tacoma, WA, USA
| | - Jennifer Hastings
- School of Physical Therapy, University of Puget Sound, Tacoma, WA, USA
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Jang HY, Kim YL, Lee SM. Perception and use of balance measures for stroke patients among physical therapists in South Korea. J Phys Ther Sci 2017; 29:255-260. [PMID: 28265152 PMCID: PMC5332983 DOI: 10.1589/jpts.29.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/04/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study looked into physical therapists’ perception and use
of balance measures for stroke patients. [Subjects and Methods] Three hundred eighty two
physical therapists who understood the purpose of this study, agreed on their
participation in this study, were treating or treated stroke patients. A Cross-sectional
study based on self-administered questionnaire that had a total of 41 questions was
performed in South Korea. 382 questionnaires were used for analysis. [Results] Regarding
the questions about their perception and of personal measures, 287 persons
(75.1%) replied that Single Leg Stance test was the most useful.
According to the data analysis on their use of balance measures, Single Leg Stance Test
was used by 254 persons (66.5%, the highest percentage), Functional Reach
Test by 199 (52.1%). Also, stepwise multiple regression analysis was
conducted. As a result, the most influential factor was physical therapists’ perception of
personal measures, and their use was also influenced by their comprehensive perception of
measurement and their perception of balance factors. [Conclusion] This study revealed
physical therapists’ perception and use of balance measures for stroke patients and showed
that their perception of balance measures for stroke patients affected their use of
personal measures.
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Affiliation(s)
- Ho Young Jang
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - You Lim Kim
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Suk Min Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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6
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Harper C, Maher J. Investigating Philosophies Underpinning Dietetic Private Practice. Behav Sci (Basel) 2017; 7:E11. [PMID: 28257036 PMCID: PMC5371755 DOI: 10.3390/bs7010011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 11/25/2022] Open
Abstract
There is limited theory or knowledge regarding dietitians' practice philosophies and how these philosophies are generated and incorporated into their professional practices. For the purposes of this study, a conceptual framework will explain and define the 'philosophies' as three different types of knowledge; episteme, techne, and phronesis. This study aimed to develop an explanatory theory of how dietitians in private practice source, utilise, and integrate practice philosophies. A grounded theory qualitative methodology was used to inform the sampling strategy, data collection, and analytical processes. Semi-structured interviews with dietitians in private practice were undertaken and data were collected and analysed concurrently. The results show that dietitians form collaborative relationships with their clients, in order to nurture change over time. They use intrinsic and intertwined forms of episteme, techne, and phronesis, which allow them to respond both practically and sensitively to their clients' needs. The learning and integration of these forms of knowledge are situated in their own practice experience. Dietitians adapt through experience, feedback, and reflection. This study highlights that private practice offers a unique context in which dietitians deal with complex issues, by utilising and adapting their philosophies.
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Affiliation(s)
- Claudia Harper
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Level 2, Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW 2006, Australia.
| | - Judith Maher
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia.
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7
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Abstract
Occupational therapists are under increasing pressure to incorporate standardised assessments into clinical practice, but little evidence of the actual uptake has been published to date. This paper begins to address this knowledge gap by reporting the results of a United Kingdom survey of the uptake of standardised hand assessments by occupational therapists in hospital-based rheumatology services. A purpose-designed postal questionnaire was mailed to ‘The Senior Occupational Therapist in Rheumatology’ at every hospital in the United Kingdom where a consultant rheumatologist was known to practise, seeking information on participants' knowledge about, use of and attitudes towards standardised hand assessments. The overall response rate was 80% (160/200). The 118 respondents who returned completed questionnaires reported a very low uptake of standardised hand assessments, with fewer than 10% using measures of observed task performance. The reasons for preferring non-standardised instruments clustered under six themes: advantages of non-standardised measures, access, delivery of care, training, barriers and exceptions. The barriers to increasing the uptake of standardised hand assessments by occupational therapists working in rheumatology need to be addressed. Initiatives are recommended to assist clinicians in selecting suitable standardised hand assessments, but occupational therapists must also accept their individual responsibility for implementing standardised assessments.
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8
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Peek K, Carey M, Sanson-Fisher R, Mackenzie L. Aiding patient adherence to physiotherapist-prescribed self-management strategies: an evidence-based behavioural model in practice. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2016.1226537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Baeza JI, Boaz A, Fraser A. The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland. Soc Sci Med 2016; 155:15-23. [DOI: 10.1016/j.socscimed.2016.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 11/26/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
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10
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Peek K, Sanson-Fisher R, Mackenzie L, Carey M. Patient adherence to physiotherapist prescribed self-management strategies: A critical review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.11.535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kerry Peek
- Research physiotherapist and PhD candidate, Health Behaviour Research Group, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Australia
| | - Robert Sanson-Fisher
- Laureate Professor and Director, Health Behaviour Research Group, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Australia
| | - Lisa Mackenzie
- Hunter Medical Research Institute Post-Doctoral Researcher, Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, Australia
| | - Mariko Carey
- Hunter Medical Research Institute Senior Research Fellow, Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, Australia
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11
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Milanese S, Grimmer K. Evidence-based practice in sonography - the basics. SONOGRAPHY 2015. [DOI: 10.1002/sono.12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Steven Milanese
- International Centre for Allied Health Evidence, School of Health Science; University of South Australia; Adelaide Australia
| | - Karen Grimmer
- International Centre for Allied Health Evidence, School of Health Science; University of South Australia; Adelaide Australia
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12
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Payne C, Michener LA. Physiotherapists use of and perspectives on the importance of patient-reported outcome measures for shoulder dysfunction. Shoulder Elbow 2014; 6:204-14. [PMID: 27582938 PMCID: PMC4935060 DOI: 10.1177/1758573214532436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 03/28/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Many patient-reported outcome measures (PROs) for shoulder dysfunctions have acceptable psychometric properties. The present study examined current PRO usage and perceived importance. METHODS Delegates at the 2010 International Congress of Shoulder and Elbow Therapists were invited to participate in this cross-sectional observational study. Research Electronic Data Capture (REDCap) web-based tools were used to design an online questionnaire, which was e-mailed to participants. RESULTS Participants (n = 101) reflected an 84% response rate. PRO use was considered 'extremely' or 'very' important by the majority of clinicians (76%) and researchers (98%). Most commonly used as a primary outcome by clinicians and researchers, respectively, were the Disabilities of the Arm Shoulder Hand Questionnaire (DASH) (40%, 44%) and the Oxford Shoulder Scale (OSS) (36%, 22%) and, as secondary outcomes, the DASH (33%, 28%), OSS (17%, 8%), the Shoulder Pain and Disability Index (SPADI) (8%,18%), and American Shoulder and Elbow Surgeons standardized assessment form (ASES) (8%, 13%). Psychometric properties were rated as 'extremely' or 'very' important by 86% to 96% of participants. CONCLUSIONS The majority of shoulder therapists consider PRO use to be very important and psychometric properties to be critical in PRO selection. The DASH, OSS, SPADI and ASES are most commonly used in clinical practice and research studies.
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Affiliation(s)
- Carol Payne
- Physiotherapy Department, Norfolk &
Norwich University Hospital, Norwich, Norfolk, UK,Carol Payne, Physiotherapy Department, Level 2,
Out-patients East, Norfolk & Norwich University Hospital, Norwich, Norfolk NR4 7UY,
UK.
| | - Lori A Michener
- Department of Physical Therapy, Virginia
Commonwealth University, Richmond, VA, USA
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13
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An S, Lee Y, Lee G. Validity of the performance-oriented mobility assessment in predicting fall of stroke survivors: a retrospective cohort study. TOHOKU J EXP MED 2014; 233:79-87. [PMID: 24850058 DOI: 10.1620/tjem.233.79] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Falling is one of the most common complications in stroke survivors. It is therefore important to evaluate the risk of falls. In this study, we investigated the usability of the performance-oriented mobility assessment (POMA) for predicting falls in stroke patients. The POMA examines the level of balance and mobility. Data were collected on the number of falls and physical functions from 72 stroke survivors. Physical functions were measured using the POMA balance subscale, One Leg Stand test (OLS), Sit To Stand test (STS), 10-m Walk Test (10WT), Fugl-Meyer assessment (FM), and Trunk Impairment Scale (TIS). Since the accuracy of the POMA balance subscale was moderate, the cutoff value used for predicting falls was 12.5 points (sensitivity: 72%; specificity: 74%), and the area under the curve was 0.78 (95% confidence interval: 0.66-0.91, p < 0.001). When comparing the physical functions (i.e., OLS, STS, 10WT, FM, and TIS) to the cutoff value for the POMA balance subscale, the physical functions of the group over 12.5 points for the subscale were significantly higher than those in the group below 12.5 points (p < 0.05). The muscle strength shown in the STS was the most important factor affecting the performance in the POMA balance subscale (β = -0.447). For the group below 12.5 points on the POMA balance subscale, the risk of falling increased by 0.304 times more than the group over 12.5 points. The POMA balance subscale is a valid tool for assessing the physical function and fall risk of stroke survivors.
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Affiliation(s)
- SeungHeon An
- Department of Physical Therapy, National Rehabilitation Center
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14
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Brossart DF, Vannest KJ, Davis JL, Patience MA. Incorporating nonoverlap indices with visual analysis for quantifying intervention effectiveness in single-case experimental designs. Neuropsychol Rehabil 2014; 24:464-91. [DOI: 10.1080/09602011.2013.868361] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Dannapfel P, Peolsson A, Ståhl C, Öberg B, Nilsen P. Applying self-determination theory for improved understanding of physiotherapists’ rationale for using research in clinical practice: a qualitative study in Sweden. Physiother Theory Pract 2013; 30:20-8. [DOI: 10.3109/09593985.2013.814185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Swinkels A, Cochrane K, Burt A, Johnson L, Lunn T, Rees AS. Exercise interventions for non-specific low back pain: an overview of systematic reviews. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x452917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Dizon JMR, Grimmer-Somers KA, Kumar S. Current evidence on evidence-based practice training in allied health: a systematic review of the literature. INT J EVID-BASED HEA 2013; 10:347-60. [PMID: 23173659 DOI: 10.1111/j.1744-1609.2012.00295.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is essential that allied health practice decisions are underpinned by the best available evidence. Therefore, effective training needs to be provided for allied health professionals to do this. However, little is known about how evidence-based practice training programs for allied health professionals are delivered, the elements contained within them, how learning outcomes are measured or the effectiveness of training components in improving learning outcomes. METHODS We conducted a systematic literature review to identify effectiveness of evidence-based practice training programs and their components for allied health professionals. Key words of evidence-based practice programs OR journal clubs OR critical appraisal AND allied health OR physiotherapists OR occupational therapists OR speech pathologists AND knowledge OR skills OR attitudes OR behaviour were applied to all available databases. Papers were critically appraised using the Joanna Briggs Institute and McMaster tools and the checklist of recommendations for educational interventions. Data were extracted on participants, training program components and underpinning theories, methods of delivery and learning outcomes. Data were synthesised using a combination of narrative and realist synthesis approaches. RESULTS Six relevant studies (four randomised controlled trials and two before-and-after studies) reported on the effectiveness of evidence-based practice training programs for evidence-based practice for groups of health professionals. Specifically, only three of these studies (one randomised controlled trial and two before-and-after studies) reported on allied health professionals (physiotherapists, occupational therapists and social workers). Among these three studies on allied health, outcomes were variably measured, largely reporting on knowledge, skills, attitudes and/or behaviours. Significant changes in knowledge and skills were reported in all studies. Only the social work study, which reassessed outcomes after 3 months, reported significant changes in attitudes and behaviours. Training took from 3 hours to 2 days. While there was information on training program components, there was no evidence of effectiveness related to learning outcomes. CONCLUSION Overall, there is limited research regarding training of allied health professionals in evidence-based practice and learning outcomes. From the limited evidence base, there was consistent evidence that any training significantly influenced knowledge, skills and attitudes, irrespective of the allied health discipline. There was little information, however, regarding how to change or measure behaviours. This review cannot recommend components of training for allied health professionals in evidence-based practice, which significantly improve learning outcomes.
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Affiliation(s)
- Janine Margarita Roy Dizon
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia.
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18
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Dannapfel P, Peolsson A, Nilsen P. What supports physiotherapists' use of research in clinical practice? A qualitative study in Sweden. Implement Sci 2013; 8:31. [PMID: 23497502 PMCID: PMC3610206 DOI: 10.1186/1748-5908-8-31] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 03/08/2013] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice. Methods Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis. Results Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education). Conclusions Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.
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Affiliation(s)
- Petra Dannapfel
- Department of Medicine and Health, Linköping University, Linköping, SE 581 83, Sweden.
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Graham JE, Karmarkar AM, Ottenbacher KJ. Small sample research designs for evidence-based rehabilitation: issues and methods. Arch Phys Med Rehabil 2012; 93:S111-6. [PMID: 22580169 DOI: 10.1016/j.apmr.2011.12.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/18/2011] [Accepted: 12/16/2011] [Indexed: 02/02/2023]
Abstract
Conventional research methods, including randomized controlled trials, are powerful techniques for determining the efficacy of interventions. These designs, however, have practical limitations when applied to many rehabilitation settings and research questions. Alternative methods are available that can supplement findings from traditional research designs and improve our ability to evaluate the effectiveness of treatments for individual patients. The focus on individual patients is an important element of evidenced-based rehabilitation. This article examines one such alternate approach: small-N research designs. Small-N designs usually focus on 10 or fewer participants whose behavior (outcomes) are measured repeatedly and compared over time. The advantages and limitations of various small-N designs are described and illustrated using 3 examples from the rehabilitation literature. The challenges and opportunities of applying small-N designs to enhance evidence-based rehabilitation are discussed.
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Affiliation(s)
- James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555-1137, USA
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20
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Connell LA, Tyson SF. Clinical reality of measuring upper-limb ability in neurologic conditions: a systematic review. Arch Phys Med Rehabil 2012; 93:221-8. [PMID: 22289230 DOI: 10.1016/j.apmr.2011.09.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 09/16/2011] [Accepted: 09/17/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To review the psychometric properties and clinical utility of upper-limb measurement tools in people with neurologic conditions to provide recommendations for practice. DATA SOURCES MEDLINE, CINAHL, EMBASE, PEDro, and AMED. STUDY SELECTION Independent reviewers searched, selected, and extracted data from articles that assessed reliability, validity, ability to detect change, and clinical utility of measures of the upper limb in adult neurologic conditions. DATA EXTRACTION Measures with good psychometrics and 8 or higher (out of 10) clinical utility scores were recommended. DATA SYNTHESIS The searches identified 31 measures of the upper limb. However, only 2 measures fulfilled all of the psychometric and clinical utility criteria; the Box and Block Test and the Action Research Arm Test. CONCLUSIONS The Box and Block and the Action Research Arm Tests produce robust data and are feasible for use in clinical practice. Future development of new or existing measures should ensure the construct and content validity of the measure is clearly identified, standardized guidelines are easily available, and ensure that it is individualized and contemporary. Attention to measures of upper-limb activity for people who are unable to grip objects is also needed.
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Affiliation(s)
- Louise A Connell
- Clinical Practice Research Unit, University of Central Lancashire, Preston, UK.
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Hanekom SD, Brooks D, Denehy L, Fagevik-Olsén M, Hardcastle TC, Manie S, Louw Q. Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence. BMC Med Inform Decis Mak 2012; 12:5. [PMID: 22309427 PMCID: PMC3395830 DOI: 10.1186/1472-6947-12-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 02/06/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. METHODS The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR)<0.5-were collated into the algorithm. RESULTS The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. CONCLUSION An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.
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Affiliation(s)
- Susan D Hanekom
- Department of Interdisciplinary Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Francie van Zyl Drive, Tygerberg 7505 South Africa
| | - Dina Brooks
- Department of Physical Therapy 160-500 University Avenue, Toronto, Ontario M5G 1V7 Canada
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Parkville Melbourne, 3010 Australia
| | - Monika Fagevik-Olsén
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - Timothy C Hardcastle
- Trauma Surgery and Trauma ICU, Inkosi Albert Luthuli central Hospital & University of KwaZulu-Natal 800 Bellair Rd Mayville Durban 4058 South Africa
| | - Shamila Manie
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, University of Cape Town, Old Main Building, Groote Schuur Hospital, Observatory Cape Town 7925 South Africa
| | - Quinette Louw
- Department of Interdisciplinary Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Francie van Zyl Drive, Tygerberg 7505 South Africa
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Hanekom S, Berney S, Morrow B, Ntoumenopoulos G, Paratz J, Patman S, Louw Q. The validation of a clinical algorithm for the prevention and management of pulmonary dysfunction in intubated adults--a synthesis of evidence and expert opinion. J Eval Clin Pract 2011; 17:801-10. [PMID: 20630012 DOI: 10.1111/j.1365-2753.2010.01480.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary dysfunction (PDF) in intubated patients remains a serious and costly complication of intensive care unit care. Optimal cardiopulmonary therapy strategies to prevent and manage PDF need clarification to reduce practice variability. The purpose of this paper is to report on the content validation of an evidence-based clinical management algorithm (EBCMA) aimed at the prevention, identification and management of PDF in critically ill patients. METHODS Forty-four draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by research clinicians (n = 7) in an electronic three-round Delphi process. Statements which reached a priori defined consensus [semi-interquartile range (SIQR) <0.5] were collated into the EBCMA. RESULTS One hundred per cent response rate. Forty-four statements were added after round one. Consensus was reached on rating of 83% (73/88) statements. Differences in interpretation of the existing evidence base, and variations in accepted clinical practice were identified. Four themes were identified where panel failed to reach consensus. CONCLUSION The internationally agreed hierarchical framework of current available evidence and clinical expertise developed through this Delphi process provides clinicians with a tool to inform clinical practice. This tool has the potential to reduce practice variability thereby maximizing safety and treatment outcome. The clinical utility of the EBCMA requires further evaluation.
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Affiliation(s)
- Susan Hanekom
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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Dizon JM, Grimmer-Somers K, Kumar S. Effectiveness of the tailored EBP training program for Filipino physiotherapists: a randomised controlled trial. BMC MEDICAL EDUCATION 2011; 11:14. [PMID: 21489229 PMCID: PMC3100239 DOI: 10.1186/1472-6920-11-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/13/2011] [Indexed: 05/02/2023]
Abstract
BACKGROUND Evidence implementation continues to challenge health professionals most especially those from developing countries. Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice, take direction from a doctor, on treatment options. Lack of autonomy in decision-making challenges their capacity to deliver evidence-based care. However, this scenario should not limit them from updating and up-skilling themselves on evidence- based practice (EBP). EBP training tailored to their needs and practice was developed to address this gap. This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists, in improving knowledge, skills, attitudes and behaviour to EBP. Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients. METHODS/DESIGN A double blind randomised controlled trial, assessing the effectiveness of the EBP training intervention, compared with a waitlist control, will be conducted. An adequately powered sample of 54 physiotherapists from the Philippines will be recruited and randomly allocated to EBP intervention or waitlist control. INTERVENTION The EBP program for Filipino physiotherapists is a one-day program on EBP principles and techniques, delivered using effective adult education strategies. It consists of lectures and practical workshops. A novel component in this program is the specially-developed recommendation form, which participants can use after completing their training, to assist them to negotiate with referring doctors regarding evidence-based treatment choices for their patients.Pre and post measures of EBP knowledge, skills and attitudes will be assessed in both groups using the Adapted Fresno Test and the Questions to EBP attitudes. Behaviour to EBP will be measured using activity diaries for a period of three months. DISCUSSION Should the EBP-training program be found to be effective in improving EBP-uptake in Filipino physiotherapists, it will form the basis of a much needed national intervention which is contextually appropriate to Filipino physiotherapists. It will therefore form the genesis for a model for building EBP capacity of other health professionals in the Philippines as well as physiotherapists in developing countries. TRIAL REGISTRATION Current Controlled Trials: ISRCTN74485061.
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Affiliation(s)
- Janine Margarita Dizon
- International Centre for Allied Health Evidence University of South Australia City East Campus, North Terrace Adelaide 5000, Australia
- University of Santo Tomas Manila 1015 Philippines
| | - Karen Grimmer-Somers
- International Centre for Allied Health Evidence University of South Australia City East Campus, North Terrace Adelaide 5000, Australia
| | - Saravana Kumar
- International Centre for Allied Health Evidence University of South Australia City East Campus, North Terrace Adelaide 5000, Australia
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Novak I, McIntyre S. The effect of Education with workplace supports on practitioners’ evidence-based practice knowledge and implementation behaviours. Aust Occup Ther J 2010; 57:386-93. [DOI: 10.1111/j.1440-1630.2010.00861.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bannigan K, Moores A. A Model of Professional Thinking: Integrating Reflective Practice and Evidence Based Practice. The Canadian Journal of Occupational Therapy 2009. [DOI: 10.1177/000841740907600505] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Internationally, occupational therapists operate in increasing complex health and social care settings. To function in this environment, high-level thinking skills are required. Reflective practice and evidence-based practice are two key skills that shape the way occupational therapists think. Purpose To integrate reflective practice and evidence-based practice so that their complementary qualities form part of a model of professional thinking. Key issues Reflective practice and evidence-based practice skills both contribute to clinical reasoning. The “model of professional thinking” can enable occupational therapists to integrate these two skills into their professional thinking. Implications Rather than teaching reflective practice and evidence-based practice as discrete subjects, “professional thinking” should be taught as an overarching topic within curricula. This may mean changes to the organisation and delivery of curricula, including practice placements. This model of professional thinking will need to be evaluated.
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Affiliation(s)
- Katrina Bannigan
- Research Centre for Occupation and Mental Health, Faculty of Health and Life Sciences, York St. John University, Lord Mayor's Walk, York, YO31 7EX, UK
| | - Alis Moores
- Occupational Therapist, former Senior Lecturer, and Teaching Fellow, Faculty of Health and Life Sciences, York St. John University, Lord Mayor's Walk, York, YO31 7EX, UK
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Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil 2009; 23:1018-33. [DOI: 10.1177/0269215509339004] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To identify psychometrically robust and clinically feasible measures of walking and mobility in people with neurological conditions Data sources: MEDLINE, CINAHL, EMBASE, PEDro and AMED. Review methods: Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change or clinical utility of measures of walking and mobility in adult neurological conditions. Measures with ‘good’ psychometrics and 9/10 clinical utility scores were recommended. Results: Seventeen measures were selected. Of these, the 5-m and 10-m walk tests, six-minute walk test, High Level Mobility Assessment Tool (HiMAT) and the Rivermead Mobility Index (RMI) reached the required standards and are usable in clinical practice. None of the recommended measures assessed wheelchair mobility. The least frequently assessed property was sensitivity to change. Further measures could be recommended if the minimal detectable change were demonstrated. Conclusion: The 5-m, 10-m and six-minute walk test, High Level Mobility Assessment Tool and the Rivermead Mobility Index are psychometrically robust measures of walking and mobility and are feasible for use in clinical practice.
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Affiliation(s)
- Sarah Tyson
- Centre for Rehabilitation and Human Performance Research and Physiotherapy Directorate, University of Salford,
| | - Louise Connell
- Division of Physiotherapy Education, University of Nottingham, Nottingham, UK
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Tyson SF, Connell LA. How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions. Clin Rehabil 2009; 23:824-40. [PMID: 19656816 DOI: 10.1177/0269215509335018] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify psychometrically robust and clinically feasible measurement tools of balance activity in people with neurological conditions to recommend for use in clinical practice. DATA SOURCES MEDLINE, CINAHL, EMBASE, PEDro and AMED. REVIEW METHODS Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change and clinical utility of measures of balance activity in adult neurological conditions. Quality assessment was based on Jorstad et al. Measures with 'good' psychometrics and > or =9/10 clinical utility scores were recommended. RESULTS Nineteen measurement tools were selected. Of these, the Brunel Balance Assessment, Berg Balance Scale, Trunk Impairment Scale, arm raise and forward reach tests in sitting and standing, weight shift, step/tap and step-up tests reached the required standards and are usable in clinical practice. The Brunel Balance Assessment and its associated functional performance tests have the additional advantages of being a hierarchical scale with established lack of redundancy. CONCLUSION The measurement tools identified above are psychometrically robust and feasible to use in clinical practice. Future objective measure development should consider the theoretical construct of the measure, the minimal detectable change and use in clinical populations other than stroke.
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Affiliation(s)
- S F Tyson
- Centre for Rehabilitation and Human Performance Research, University of Salford, Frederick Road Campus, Salford M6 6PU, UK.
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Tyson S, Watson A, Moss S, Troop H, Dean-Lofthouse G, Jorritsma S, Shannon M. Development of a framework for the evidence-based choice of outcome measures in neurological physiotherapy. Disabil Rehabil 2009; 30:142-9. [PMID: 17852285 DOI: 10.1080/09638280701216847] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Neurological physiotherapists recognize the need to include standardized outcome measures (OMs) in clinical practice but lack of information about the OMs available hampers utilization. This paper reports on the first stage of a project to identify the most robust OMs for use in neurological physiotherapy. OBJECTIVE To identify what physiotherapists perceive that they need to measure during a neurological assessment. METHODS Three separate workshops were held using patient vignettes to represent the acute, rehabilitation and community settings. Thirty senior neurological physiotherapists participated and were asked: 'What would you observe, test or measure if assessing this patient?' Data were analysed using thematic content analysis performed independently by each of the authors. Internal and external member checking ensured validity. In addition, the authors produced definitions of the items and domains identified in the data collection and subsequent content analysis. RESULTS Items from the data collection were classified into 16 domains that physiotherapists need to measure: Weakness; range of movement/contracture; pain; muscle tone/spasticity; sensation; ataxia/co-ordination; personal fatigue; oedema; subluxation; postural and balance impairment; walking impairment; upper limb; balance disability; walking disability; mobility disability and falls. CONCLUSIONS The domains that physiotherapists need to measure during clinical assessment were identified. In the second stage of the project these domains will inform systematic reviews to identify the most robust outcome measures for use in clinical practice.
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Affiliation(s)
- Sarah Tyson
- Physiotherapy Directorate, University of Salford, UK.
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A treatment schedule of conventional physical therapy provided to enhance upper limb sensorimotor recovery after stroke: Expert criterion validity and intra-rater reliability. Physiotherapy 2009; 95:110-9. [DOI: 10.1016/j.physio.2008.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/30/2008] [Accepted: 11/26/2008] [Indexed: 11/21/2022]
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French HP, Cusack T, Brennan A, White B, Gilsenan C, Fitzpatrick M, O'Connell P, Kane D, Fitzgerald O, McCarthy GM. Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial. BMC Musculoskelet Disord 2009; 10:9. [PMID: 19152689 PMCID: PMC2653461 DOI: 10.1186/1471-2474-10-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 01/19/2009] [Indexed: 01/22/2023] Open
Abstract
Background Osteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. Management options aim to reduce pain and improve or maintain physical functioning. Current evidence indicates that therapeutic exercise has a beneficial but short-term effect on pain and disability, with poor long-term benefit. The optimal content, duration and type of exercise are yet to be ascertained. There has been little scientific investigation into the effectiveness of manual therapy in hip OA. Only one randomized controlled trial (RCT) found greater improvements in patient-perceived improvement and physical function with manual therapy, compared to exercise therapy. Methods and design An assessor-blind multicentre RCT will be undertaken to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only, and a waiting-list control on physical function in hip OA. One hundred and fifty people with a diagnosis of hip OA will be recruited and randomly allocated to one of 3 groups: exercise therapy, exercise therapy with manual therapy and a waiting-list control. Subjects in the intervention groups will attend physiotherapy for 6–8 sessions over 8 weeks. Those in the control group will remain on the waiting list until after this time and will then be re-randomised to one of the two intervention groups. Outcome measures will include physical function (WOMAC), pain severity (numerical rating scale), patient perceived change (7-point Likert scale), quality of life (SF-36), mood (hospital anxiety and depression scale), patient satisfaction, physical activity (IPAQ) and physical measures of range of motion, 50-foot walk and repeated sit-to stand tests. Discussion This RCT will compare the effectiveness of the addition of manual therapy to exercise therapy to exercise therapy only and a waiting-list control in hip OA. A high quality methodology will be used in keeping with CONSORT guidelines. The results will contribute to the evidence base regarding the clinical efficacy for physiotherapy interventions in hip OA. Trial Registration Number: NCT00709566
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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Abstract
AIM To provide a critical analysis of key concepts associated with evidence-based nursing (EBN) to substantiate an operational definition for nurses to use in practice. BACKGROUND Despite the plethora of literature surrounding what evidence-based nursing is and is not and how it differs from its cousins, evidence-based medicine and evidence-based practice, nurses still struggle to get evidence into practice. Several reasons for this have been reported, for example, a lack of understanding about what evidence-based nursing means or time to engage with and apply the evidence into practice. DESIGN An in-depth critical review and synthesis of literature was undertaken. METHOD Using the key words; evidence-based nursing, evidence-based medicine and evidence-based practice 496 articles were yielded. These articles were limited to 83. Using Burns and Grove's (2001) phased approach to reviewing the literature the articles were critically reviewed and categorised into key concepts and themes. RESULTS The in-depth critical review and synthesis of the literature demonstrated that evidence-based nursing could be defined as a distinct concept. The review clearly shows that for evidence-based nursing to occur, nurses need to be aware of what evidence-based nursing means, what constitutes evidence, how evidence-based nursing differs from evidence-based medicine and evidence-based practice and what the process is to engage with and apply the evidence. CONCLUSION The in-depth critical review and synthesis of the evidence-based nursing literature reinforces the need to consolidate a position for nursing in the evidence-based field. The review confirms that evidence-based nursing can be defined and conceptualised; however, for nurses to engage and apply with the evidence-based processes they need to be informed of what these are and how to engage with them in practice. RELEVANCE TO CLINICAL PRACTICE This paper examines the concept of evidence-based nursing and its application to clinical practice.
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Affiliation(s)
- Kay Scott
- School of Health and Social Care, University of Teesside, Middlesbrough, UK.
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Syme G, Rowe P, Martin D, Daly G. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening. ACTA ACUST UNITED AC 2008; 14:252-63. [PMID: 18436468 DOI: 10.1016/j.math.2008.02.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 02/06/2008] [Accepted: 02/18/2008] [Indexed: 11/29/2022]
Abstract
This study was a prospective single blind randomised controlled trial to compare the effects of rehabilitation with emphasis on retraining the vastus medialis (VMO) component of the quadriceps femoris muscle and rehabilitation with emphasis on general strengthening of the quadriceps femoris muscles on pain, function and Quality of Life in patients with patellofemoral pain syndrome (PFPS). Patients with PFPS (n=69) were recruited from a hospital orthopaedic clinic and randomised into three groups: (1) physiotherapy with emphasis on selectively retraining the VMO (Selective); (2) physiotherapy with emphasis on general strengthening of the quadriceps femoris muscles (General); and (3) a no-treatment control group (Control). The three groups were then compared before and after an eight-week rehabilitation period. The Selective and General groups demonstrated statistically significant and 'moderate' to 'large' effect size reductions in pain when compared to the Control group. Both the Selective and General groups displayed statistically significant and 'moderate' and 'large' effect size improvements in subjective function and Quality of Life compared to the Control group. Knee flexion excursion during the stance phase of gait, demonstrated that there were no statistical significant differences and only 'trivial' to 'small' effect size differences between the Selective or General groups and the Control group. A large number of PFPS patients can experience significant improvements in pain, function and Quality of Life, at least in the short term, with quadriceps femoris rehabilitation, with or without emphasis on selective activation of the VMO component. Both approaches would seem acceptable for rehabilitating patients with PFPS. It may be appropriate to undertake exercises involving selective activation of the vastus medialis early in the rehabilitation process, however, clinicians should not overly focus on selective activation before progressing rehabilitation, especially in more chronic cases with significant participation restrictions.
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Affiliation(s)
- G Syme
- Department of Orthopaedic Surgery, St. John's Hospital in Howden, Livingston, United Kingdom.
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Manns PJ, Darrah J. Linking research and clinical practice in physical therapy: strategies for integration. Physiotherapy 2006. [DOI: 10.1016/j.physio.2005.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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