QUESTIONS: Have student numbers (ie, intake and attrition) changed since the introduction of graduate entry-level physiotherapy courses in Australian universities? What is the impact of any changes in student numbers on...QUESTIONS: Have student numbers (ie, intake and attrition) changed since the introduction of graduate entry-level physiotherapy courses in Australian universities? What is the impact of any changes in student numbers on university funding? What is the impact of any changes in student numbers on the workforce? Have student characteristics (ie, gender, country of origin, background) changed? DESIGN: Demographic study of 2003 graduates, 2004 student intake, and estimated 2007 student intake. PARTICIPANTS: Eleven Schools of Physiotherapy in Australia. RESULTS: In 2003, 836 new physiotherapists graduated, and in 2004, 1108 students commenced with the percentage of graduate-entry Masters and international students increasing. Compared to the overall average 25% attrition rate of students from university, the rate for physiotherapy students was less than 5%; the funding formula thus underestimates physiotherapy student numbers across the years of the courses. While it remains the case that in undergraduate and graduate-entry programs most physiotherapy students are female, a greater proportion of males are entering graduate-entry Masters programs than undergraduate courses. International student numbers are increasing in line with trends across the sector, but representation of Aboriginal and Torres Strait Islander students in physiotherapy courses was lower than within universities generally. CONCLUSIONS: The marked overall increase in student numbers and greater retention rate in the graduate entry-level courses puts physiotherapy at a disadvantage in relation to Department of Education, Science and Training student funding. While the substantial increase in new physiotherapists may serve to ease workforce demands in the short term, significant pressure on physiotherapy academics and clinical educators was evident.
QUESTIONS: Are either severe other joint disease or obesity associated with a slower rate of recovery after total hip or knee replacement surgery? Are they associated with less absolute recovery up to one year post-surge...QUESTIONS: Are either severe other joint disease or obesity associated with a slower rate of recovery after total hip or knee replacement surgery? Are they associated with less absolute recovery up to one year post-surgery? DESIGN: Prospective, longitudinal, observational study over 12 months. PARTICIPANTS: Ninety-nine patients (knee=55, hip=44) stratified according to the presence of severe other joint disease and obesity. OUTCOME MEASURES: Pain in operated joint, and 15-m Walk Test and Timed Up and Go Test measured pre- and at 2, 6, 12, 26, and 52 weeks post-surgery. Walking aid utilisation and global improvement were measured at 52 weeks. RESULTS: For rate of recovery, the participants with severe other joint disease recovered more slowly than the non-severe group in terms of mobility (15-m Walk Test p=0.005). For absolute recovery, participants with severe other joint disease walked 0.27 m/s (95% CI 0.15 to 0.40) more slowly on the 15-m Walk Test, took 4.0 s (95% CI 2.3 to 5.8) longer on the Timed Up and Go Test, and had 6.8 times greater chance (95% CI 2.8 to 16.5) of using a walking aid than the non-severe group at 52 weeks. This profile was similar for the obese group compared with the non-obese group. At 52 weeks, the majority (95%) of participants reported significant (better/much better) global improvement. CONCLUSION: Severe other joint disease and obesity are associated with poorer recovery after surgery. Clinician and patient expectations, rehabilitation, and benchmarking can be guided by these findings.
QUESTION: Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability? DESIGN: A within-partici...QUESTION: Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability? DESIGN: A within-participant, repeated measures experimental study. PARTICIPANTS: 18 individuals with a first stroke who were undergoing inpatient rehabilitation. INTERVENTION: Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session. OUTCOME MEASURES: During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale. RESULTS: Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity. CONCLUSION: Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.
QUESTIONS: Does circuit class therapy result in a greater incidence or severity of shoulder pain compared with individual therapy? Is the incidence influenced by the degree of active shoulder control? DESIGN: Controlled...QUESTIONS: Does circuit class therapy result in a greater incidence or severity of shoulder pain compared with individual therapy? Is the incidence influenced by the degree of active shoulder control? DESIGN: Controlled trial with intention-to-treat analysis. PARTICIPANTS: Sixty-eight people (6 drop-outs) undergoing inpatient rehabilitation after stroke. INTERVENTION: Participants received either individual therapy or group circuit class therapy. OUTCOME MEASURES: Incidence of shoulder pain over the previous 24 hours was measured as a yes/no response while severity of shoulder pain was measured using a visual analogue scale at admission, Week 4, and discharge. RESULTS: There was no greater chance of participants receiving circuit class therapy having shoulder pain at Week 4 (OR 0.95, 95% CI 0.32 to 2.80) or discharge (OR 0.38, 95% CI 0.11 to 1.45) than participants receiving individual therapy. Of those participants who reported pain, there was no difference between groups in the severity of pain at Week 4 (mean difference -0.2 cm, 95% CI -3.2 to 2.7) or discharge (mean difference -2.1 cm, 95% CI -4.8 to 0.6). There was a greater chance of participants who had no active shoulder control having shoulder pain at Week 4 (OR 5.8, 95% CI 1.6 to 20.4) and at discharge (OR 3.8, 95% CI 1.0 to 13.9) than participants who had active shoulder control. CONCLUSION: The incidence and severity of shoulder pain was influenced by degree of active shoulder control but not by type of physiotherapy service delivery. Concerns regarding shoulder pain should not be a barrier to the implementation of circuit class therapy during inpatient stroke rehabilitation.
QUESTION: Is wearing a night splint as effective as standing on a tilt table in preventing ankle dorsiflexion contracture and promoting the ability to stand up early after stroke? DESIGN: Randomised trial with concealed...QUESTION: Is wearing a night splint as effective as standing on a tilt table in preventing ankle dorsiflexion contracture and promoting the ability to stand up early after stroke? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 30 patients undergoing rehabilitation who were not yet walking and within three weeks of their first stroke. INTERVENTION: For four weeks, one group wore a splint with the affected ankle at plantargrade, 7 nights per week, while the other group stood on a tilt table for 30 min with the ankle at maximum dorsiflexion, 5 times per week. This was followed by a period of no intervention for six weeks. Both groups received inpatient and outpatient rehabilitation emphasising mobility. OUTCOME MEASURES: The primary outcome was contracture measured as maximum passive ankle dorsiflexion. RESULTS: The night splint group had the same amount of ankle dorsiflexion as the tilt table group by Week 4 (mean difference 1 deg, 95% CI -5 to 7), and by Week 10 (mean difference 3.5 deg, 95% CI -3 to 10). CONCLUSION: When added to early rehabilitation, wearing a night splint on the affected ankle in stroke patients appears to be as effective as standing on a tilt table in preventing contracture at the ankle. However, since there was no control group, the prevention of contracture may have been due to other factors.
QUESTION: Is eight weeks of high-intensity strengthening of the isolated lumbar extensors more effective than low-intensity strengthening or no strengthening? Are any gains maintained 16 weeks later? DESIGN: Randomised,...QUESTION: Is eight weeks of high-intensity strengthening of the isolated lumbar extensors more effective than low-intensity strengthening or no strengthening? Are any gains maintained 16 weeks later? DESIGN: Randomised, three-arm trial with concealed allocation, assessor blinding, and intention-to-treat-analysis. Participants in the waiting list control group were randomised again, after the first 8 weeks, to either the high-intensity or the low-intensity strengthening program. PARTICIPANTS: Sixty-five army personnel with non-specific chronic low back pain. INTERVENTION: The high-intensity training group received 10 sessions of 15 to 20 repetitions for the isolated lumbar extensor muscles. The low-intensity training group received a nonprogressive, low-intensity resistance protocol. OUTCOME MEASURES: Primary outcomes were global perceived effect and disability. Secondary outcomes were health-related quality of life, fear of movement/(re-)injury, and isometric lumbar extensor muscle strength. Measures were taken before and after the training and 16 weeks later. RESULTS: At eight weeks, SF-36 overall score was on average 7% (95% CI 1 to 13) greater in the high-intensity training group compared with the low-intensity training group and the waiting list control group, and self-assessed decrease of back symptoms was on average 39% (95% CI 14 to 64) greater in the high-intensity training group compared with the waiting list control group. There was no difference in improvement between the groups for any other outcome at 8 weeks or 24 weeks. CONCLUSIONS: Although some beneficial effects were found, the results of this high-intensity strengthening program of the isolated lumbar extensor muscles do not clearly support the generally-claimed beneficial influence of exercise for chronic non-specific low back pain.
QUESTIONS: Which intervention(s) best augment early mobilisation and external support after an acute ankle sprain? What is the most appropriate method of preventing re-injury? DESIGN: A systematic review of randomised co...QUESTIONS: Which intervention(s) best augment early mobilisation and external support after an acute ankle sprain? What is the most appropriate method of preventing re-injury? DESIGN: A systematic review of randomised controlled trials published from 1993 to April 2005. PARTICIPANTS: People with an acute ankle sprain. INTERVENTION: Any pharmacological, physiotherapeutic, complementary or electrotherapeutic intervention added to controlled mobilisation with external support. Immobilisation, surgical intervention, and use of external ankle supports in isolation were excluded. OUTCOMES: Pain, function, swelling, re-injury, and global improvement; assessed at short, intermediate, and long-term follow-up. RESULTS: 23 trials were included with a mean PEDro score of 6/10. There was strong evidence that non-steroidal anti-inflammatory drugs can reduce pain and improve short-term ankle function. There was moderate evidence that neuromuscular training decreases functional instability and minimises re-injury; and that comfrey root ointment decreases pain and improves function. There was also moderate evidence that manual therapy techniques improve ankle dorsiflexion. There was no evidence to support the use of electrophysical agents or hyperbaric oxygen therapy. Very few long-term follow-ups were undertaken, and few studies focused on preventing long-term morbidity. CONCLUSIONS: Non-steroidal anti-inflammatory drugs, comfrey root ointment, and manual therapy can significantly improve short-term symptoms after ankle sprain, and neuromuscular training may prevent re-injury. More high quality studies are needed to develop evidence-based guidelines on ankle rehabilitation beyond the acute phases of injury management.
QUESTION: How often do adverse events (including adverse physiological changes) occur during physiotherapy intervention in intensive care? DESIGN: A multi-centre prospective observational study. PARTICIPANTS: Five tertia...QUESTION: How often do adverse events (including adverse physiological changes) occur during physiotherapy intervention in intensive care? DESIGN: A multi-centre prospective observational study. PARTICIPANTS: Five tertiary level university-affiliated intensive care units. OUTCOME MEASURES: All physiotherapy intervention in five intensive care units over a three month period. When certain specified changes occurred during physiotherapy intervention, details were noted including diagnosis of patient, intervention, vital signs, radiological changes, co-morbidities, chemical pathology, and fluid balance. RESULTS: 12 281 physiotherapy interventions were completed with 27 interventions resulting in adverse physiological changes (0.2%). This incidence was significantly lower than a previous study of adverse physiological changes (663 events in 247 patients over a 24-hour period); the incidence during physiotherapy intervention was lower than during general intensive care. Common factors in the patients who had an adverse physiological change were a deterioration in cardiovascular status (ie, decrease in blood pressure or arrhythmia) in patients on medium to high doses of inotropes/vasopressors, unstable baseline hemodynamic values, previous cardiac co-morbidities and intervention consisting of positive pressure or right side lying. CONCLUSION: The incidence of adverse events during physiotherapy intervention in these five tertiary hospitals was low, demonstrating that physiotherapy intervention in intensive care is safe.
QUESTIONS: Can clinical prediction rules be derived for injured Australian workers with persistent musculoskeletal pain? Are they valid? DESIGN: Longitudinal observational study. PARTICIPANTS: 847 injured workers with pe...QUESTIONS: Can clinical prediction rules be derived for injured Australian workers with persistent musculoskeletal pain? Are they valid? DESIGN: Longitudinal observational study. PARTICIPANTS: 847 injured workers with persistent musculoskeletal pain undergoing rehabilitation. OUTCOME MEASURES: At baseline, 12 putative predictors were measured. At 9 weeks, short-term outcomes such as pain (visual analogue scale), activity limitation (Functional Rating Index) and work upgrade (increase in work hours or duties) were measured. At 6 months, long-term work status (working or not working) was measured. RESULTS: Data were obtained from 85% of the participants who were followed up at both 9 weeks (720 of 847) and 6 months (247 of 290). Predictors of outcome included high baseline pain and activity limitation, long duration of previous intervention, not working, non-English speaking background, and the area of pain. Accuracy was highest for clinical prediction rules predicting pain and level of activity limitation at 9 weeks (R2 = 0.67 and 0.69 respectively) and work status at 6 months (LR- = 0.24). CONCLUSION: Accurate clinical prediction rules have been derived and validated for injured workers with persistent musculoskeletal pain, predicting activity limitation, pain, and work outcomes following exercise-based rehabilitation. Further research to validate these prediction rules in other populations and to assess the effectiveness of tailoring intervention based on the estimated prognosis would be valuable.
QUESTIONS: What factors influence the decision making of cardiorespiratory physiotherapists in acute care? How do cardiorespiratory physiotherapists manage multiple factors in their decision making? DESIGN: Qualitative s...QUESTIONS: What factors influence the decision making of cardiorespiratory physiotherapists in acute care? How do cardiorespiratory physiotherapists manage multiple factors in their decision making? DESIGN: Qualitative study using observation and semi-structured interviews. PARTICIPANTS: Fourteen physiotherapists working in acute cardiorespiratory care. RESULTS: Cardiorespiratory physiotherapy decision making was affected by factors related to the nature of the decision itself (such as the complexity and difficulty of the decision), factors related to the context in which the decision occurred (such as physical, organisational and socio-professional factors), and factors related to the physiotherapists themselves (such as decision making capabilities, physiotherapy frames of reference, and level of clinical experience). CONCLUSION: Optimising the quality of decision making in the context of health care today requires an awareness and consideration of a range of factors influencing decision making.
QUESTION: Do trunk stabilisation exercises reduce sternal separation and pain, and improve the quality and control of the performance of tasks in individuals with chronic sternal instability? DESIGN: Randomised crossover...QUESTION: Do trunk stabilisation exercises reduce sternal separation and pain, and improve the quality and control of the performance of tasks in individuals with chronic sternal instability? DESIGN: Randomised crossover study with concealed allocation and intention-to-treat analysis. PARTICIPANTS: Nine individuals with chronic sternal instability following a median sternotomy for cardiac surgery. INTERVENTION: The experimental intervention consisted of six weeks of trunk stabilisation exercises; the control intervention was no exercises. OUTCOME MEASURES: Outcomes were sternal separation measured by ultrasound in mm, pain during the performance of nine everyday tasks measured on a 100-mm visual analogue scale, and the quality and control of the performance of two tasks scored on a 100-mm visual analogue scale. RESULTS: Overall, sternal separation during the period of trunk stabilisation exercises decreased by 6.2 mm (95% CI 3.5 to 8.9) more than during the control period. Overall, pain decreased when performing everyday tasks by 14 mm (95% CI 5 to 23) more than during the control period. Overall, task performance during the period of trunk stabilisation exercises did not improve (mean difference 10 mm, 95% CI -3 to 22) more than during the control period. CONCLUSION: Trunk stabilisation exercises should be included in the rehabilitation of individuals who experience sternal instability following cardiac surgery. A larger trial is warranted to determine if stabilisation exercises are beneficial in improving the quality and control of task performance.
QUESTIONS: Does the addition of cyclic pneumatic soft-tissue compression during the 6-week immobilisation period following fracture of the distal radius result in a faster recovery of muscle strength and joint range of m...QUESTIONS: Does the addition of cyclic pneumatic soft-tissue compression during the 6-week immobilisation period following fracture of the distal radius result in a faster recovery of muscle strength and joint range of motion? Does it result in a larger recovery of muscle strength and joint range of motion immediately after the immobilisation period (at 6 weeks) or four weeks after the immobilisation period (at 10 weeks)? DESIGN: Randomised controlled trial with concealed allocation and assessor blinding. PARTICIPANTS: 21 patients with fracture of the distal radius. INTERVENTION: The experimental group received cyclic pneumatic soft-tissue compression during the 6-week immobilisation period whereas the control group received usual care. Both groups were instructed to actively make a fist 100 times per day during the 6-week immobilisation period and were given an exercise program during the 4-week post-immobilisation period. OUTCOME MEASURES: Function was measured as power grip, pinch grip, key grip, and supination strength using dynamometry from Week 1 to 10 as well as wrist flexion/extension and forearm supination/pronation range of motion using goniometry from Week 6 to 10. The outcome measures are presented as a percentage of the intact side. RESULTS: The experimental group improved significantly faster than the control group in muscle strength from Week 1 to 10 (p ? 0.001) but not in joint range of motion from Week 6 to 10 (p > 0.05). By Week 6, the experimental group was 12-26% stronger and had 8-14% more range of motion than the control group. By Week 10, the experimental group was 24-29% stronger and had 10-15% more range of motion than the control group. CONCLUSION: The findings indicate that a larger clinical trial is warranted and should incorporate direct measures of fracture healing.