QUESTION: What career paths have physiotherapist researchers taken? What should career paths for physiotherapist researchers look like? DESIGN: Observational study with questionnaire. PARTICIPANTS: Australian physiothera...QUESTION: What career paths have physiotherapist researchers taken? What should career paths for physiotherapist researchers look like? DESIGN: Observational study with questionnaire. PARTICIPANTS: Australian physiotherapists who had a completed a Doctor of Philosophy degree by 2006. RESULTS: Fifty-six of 87 physiotherapists with a doctorate degree (response rate 64%) completed the questionnaire. Over half had completed the doctorate since 2000. An interest in clinical research was the strongest driver for undertaking a doctorate degree. Of the respondents, 52% worked in traditional academic roles while those who pursued other mixed clinical/research or pure research paths reported a lack of job security; 38% continued to work clinically, with a further 43% reporting they would like to but had insufficient time or a career structure that did not allow clinical work. 54% felt that the profession valued research, while 63% felt that research was valued by clinicians. The four main suggestions for improving current research career paths were: 1) develop research careers that allow mixed clinical/research and academic/clinical roles; 2) improve funding for training, particularly post-doctoral positions, and secure appropriately funded physiotherapy research positions; 3) improve co-operation between academic (university) and clinical researchers; and 4) develop more flexible research careers to accommodate private practitioner researchers and others wishing to combine clinical work with teaching and research. CONCLUSION: Physiotherapist researchers need broader career options and seek greater opportunity to link with clinical practice. Encouraging a vibrant research culture should foster professional excellence and enhance our reputation in the community.
QUESTION: Is neck/shoulder pain in adolescents related to their sitting spinal posture, taking account of gender? DESIGN: Cross-sectional survey and direct observation. PARTICIPANTS: 1597 adolescents from the 'Raine' bir...QUESTION: Is neck/shoulder pain in adolescents related to their sitting spinal posture, taking account of gender? DESIGN: Cross-sectional survey and direct observation. PARTICIPANTS: 1597 adolescents from the 'Raine' birth cohort study (781 females, 816 males) with a mean age of 14.1 years (SD 0.2). OUTCOME MEASURES: Neck/shoulder pain prevalence and gender was measured by survey. Spinal posture (7 angles) during sitting was measured from photographs. RESULTS: Life, month, and point prevalence for neck/shoulder pain among adolescents were 47%, 29%, and 5% respectively. Life prevalence was 10% higher in females than in males and month prevalence was 12% higher. When looking straight ahead, females sat with 2 degrees (95% CI 1 to 3) less neck flexion, 2 degrees (95% CI 0 to 3) less craniocervical angle, 7 degrees (95% CI 6 to 8) less cervicothoracic angle, 13 degrees (95% CI 12 to 14) less trunk angle, 10 degrees (95% CI 8 to 12) less lumbar angle, and 9 degrees (95% CI 7 to 11) more anterior pelvic tilt than males. Adolescents with neck/shoulder pain sat with 2 degrees (95% CI 1 to 3) less trunk angle, and 1 degree (95% CI 0 to 2) less cervicothoracic angle than those without pain. After controlling for gender, OR for neck/shoulder pain ever predicted by any angle ranged from 0.99 to 1.00 (range of 95% CI 0.98 to 1.01). CONCLUSION: Neck/shoulder pain is highly prevalent in Australian adolescents. Sitting spinal posture differs between males and females and differs slightly between those with and without neck/shoulder pain. However, posture was not predictive of neck/shoulder pain ever after controlling for gender.
QUESTION: What factors predict postoperative pulmonary and pleural complications following aortic valve replacement? DESIGN: Retrospective study. PARTICIPANTS: One thousand consecutive patients who underwent aortic valve...QUESTION: What factors predict postoperative pulmonary and pleural complications following aortic valve replacement? DESIGN: Retrospective study. PARTICIPANTS: One thousand consecutive patients who underwent aortic valve replacement with a pericardial valve between 1986 and 2006. Of these, 610 underwent also coronary artery surgery. OUTCOME MEASURES: Thirty putative predictors were investigated. Postoperative pulmonary complications (defined as respiratory failure, pneumonia, atelectasis) and postoperative pleural complications (defined as pleural effusion, pneumothorax, haemothorax, empyema) within 30 days of surgery were identified. RESULTS: 58 (6%) patients developed pulmonary complications and 45 (5%) developed pleural complications. None of the pleural and only 3 of the pulmonary complications were fatal if they occurred alone. Postoperative heart failure (OR 4.7, 95% CI 1.8 to 11.9), previous pacemaker implant (OR 4.4, 95% CI 1.8 to 11.2) and chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.0 to 3.1) independently predicted postoperative pulmonary complications. Postoperative bleeding (OR 7.4, 95% CI 1.8 to 29.9), carotid artery disease (OR 2.8, 95% CI 1.4 to 5.5), previous coronary artery surgery (OR 2.7, 95% CI 1.1 to 6.4), chronic obstructive pulmonary disease (OR 1.9, 95% CI 1.0 to 3.8) and cardiac conduction defect (OR 1.9, 95% CI 1.0 to 3.7) independently predicted postoperative pleural complications. CONCLUSIONS: Postoperative pulmonary and pleural complications were rare. A history of cardiac and/or pulmonary problems are risk factors for pulmonary complications after aortic valve replacement. Further study is needed to reveal if preventive physiotherapeutic intervention in these patients is effective.
QUESTION: What do residents in low-level residential care perceive as motivators and barriers to participating in exercise classes at the facility? DESIGN: Qualitative study using focus groups. PARTICIPANTS: Residents, n...QUESTION: What do residents in low-level residential care perceive as motivators and barriers to participating in exercise classes at the facility? DESIGN: Qualitative study using focus groups. PARTICIPANTS: Residents, nursing staff and allied health staff of a low-level residential care facility. RESULTS: Key motivators for residents to attend the exercise classes included personal benefits, such as improved health and opportunities to socialise, and the support and encouragement that they received from family members and health professionals. The barriers to participating in the exercise classes included: health issues like pain, incontinence, and hearing impairments; external constraints such as the location of the classes and the early morning time; and internal constraints associated with a lack of knowledge about the classes and the benefits of exercising. While the key themes that arose from this study are consistent with findings from studies of community-dwelling adults, several of the barrier subthemes were unique. CONCLUSION: Recommendations from our findings to enhance exercise class participation include careful consideration of: class scheduling; class location; social aspects associated with exercise classes; support of social networks and health providers; health issues perceived to limit exercise; and marketing of classes.
QUESTIONS: Is an 8-week progressive resistance exercise program effective for increasing strength in the wrist muscles of people with tetraplegia? Is it effective for improving muscle endurance and participants' percepti...QUESTIONS: Is an 8-week progressive resistance exercise program effective for increasing strength in the wrist muscles of people with tetraplegia? Is it effective for improving muscle endurance and participants' perceptions about use of their hands for activities of daily living? DESIGN: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Thirty-two people with tetraplegia and neurological weakness of their wrist flexor or extensor muscles. INTERVENTION: The wrist muscles of one randomly-chosen hand were trained 3 times a week for 8 weeks. The control group received no intervention. OUTCOME MEASURES: The primary outcome was strength measured as maximal voluntary isometric torque in Nm. The secondary outcomes were muscle endurance measured as fatigue resistance and participants' perceptions about use of their hands using the Canadian Occupational Performance Measure. RESULTS: The mean effect on maximal voluntary isometric torque was 0.2 Nm (95% CI -0.5 to 0.8). This represents an 8% increase of mean initial strength; less than the 20% deemed clinically worthwhile at the commencement of the study. The mean effect on fatigue resistance was 0.1 (95% CI 0.0 to 0.2). The mean effect on participants' perceptions of performance was -0.3 (95% CI -1.9 to 1.2) and satisfaction was -0.3 (95% CI -1.6 to 1.0). CONCLUSION: The results indicate that progressive resistance exercise has no effect on participants' perceptions about hand function. However, it is not yet clear whether progressive resistance exercise programs improve strength and endurance in muscles with neurologically-induced weakness following tetraplegia.
QUESTION: Are postural exercises delivered by Mensendieck/Cesar therapists more effective in decreasing pain, reducing disability and improving health-related quality of life in visual display unit workers with early non...QUESTION: Are postural exercises delivered by Mensendieck/Cesar therapists more effective in decreasing pain, reducing disability and improving health-related quality of life in visual display unit workers with early non-specific work-related upper limb disorders than strength and fitness exercises delivered by physiotherapists? DESIGN: Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: Eighty-eight (6 drop-outs) visual display unit workers with early non-specific work-related upper limb disorders. INTERVENTION: One group received 10 weeks of postural exercises while the other group received 10 weeks of strength and fitness exercises. OUTCOME MEASURES: Pain was measured with a 10-cm visual analogue scale, disability was measured with the Disabilities of Arm, Shoulder and Hand questionnaire, and health-related quality of life was measured with the Short Form-36. Number of participants experiencing upper limb complaints was also collected. Outcome measures were collected at baseline and again at 3, 6, and 12 months. RESULTS: There was no significant difference in decrease in pain between the groups at 3 months (0.6 cm, 95% CI 0.0 to 1.2), 6 months (0.2, 95% CI -0.3 to 0.7), or at 12 months (0.1, 95% CI -0.6 to 0.8). Differences between the groups in upper limb complaints, disability, and health related quality of life were also small and not significant at any measurement occasion. CONCLUSION: Postural exercises did not result in a better outcome than strength and fitness exercises. However, 55% of visual display unit workers with early non-specific work-related upper limb disorders reported being free of complaints one year after both interventions were commenced. TRIAL REGISTRATION: ISRCTN15872455.
QUESTIONS: Does home-based exercise improve exercise capacity and quality of life in people with chronic heart failure? Is it safe? DESIGN: Systematic review with meta-analysis. PARTICIPANTS: Adults with heart failure >...QUESTIONS: Does home-based exercise improve exercise capacity and quality of life in people with chronic heart failure? Is it safe? DESIGN: Systematic review with meta-analysis. PARTICIPANTS: Adults with heart failure > 3 months duration. INTERVENTION: Home-based aerobic exercise with or without resistance exercise. OUTCOME MEASURES: Exercise capacity (measured at the impairment level by peak VO2 and at the activity level by 6-min Walk Test), quality of life (measured by disease-specific scales), and adverse events (measured as death, hospitalisation). RESULTS: 10 randomised controlled trials with 648 participants of New York Heart Association Class II or III were included. Most participants were male > or = 50 years old with an ejection fraction < or = 40%. The exercise programs ranged from 6 weeks to 9 months at low to moderate intensity (40-70% of maximum heart rate or heart rate at 70% peak VO2. Home-based exercise increased 6-min walking distance by 41 m (WMD, 95% CI 19 to 63) and peak VO2 by 2.71 ml/kg/min (WMD, 95% CI 0.67 to 4.74) more than usual activity. It did not improve scores on the Minnesota Heart Failure Questionnaire (WMD 0.5 points out of 105, 95% CI -4.4 to 5.4) or increase the odds of hospitalisation (OR 0.75, 95% CI 0.19 to 2.92) more than usual activity. CONCLUSIONS: Home-based exercise increased exercise capacity safely but did not improve quality of life in patients with chronic heart failure. It could therefore be used to improve the management of people with chronic heart failure who do not have access to hospital-based exercise.