The Effect of a New Payment System on Physiotherapeutic Management of Patients With Low Back Pain in Primary Care

ObjectiveTo evaluate differences regarding the number of treatment sessions, costs, and outcomes (including relapses) between a regular payment-per-session system and the recently introduced product payment system in The Netherlands.DesignProspective cohort study.SettingDutch physical therapy practices in primary care over a 2-year period.Participants16,103 patients with low back pain (LBP).InterventionThe new product payment system is compared with the regular payment-per-session system.Main Outcome MeasuresPain, disability, recovery, number of physical therapy sessions, therapy duration, costs (per episode), and LBP relapse.ResultsAt baseline, we found greater pain and disability scores associated with an increased risk profile in both payment systems. With regard to the payment systems, we found greater costs (€283.8 vs €210.8) and a greater percentage of relapse (4.5% vs 2.8%) for the product payment system compared with the payment-per-session system. Comparing the 2 payment systems within each risk strata, we found no significant differences, except for a decrease in pain in the medium-risk stratum. Concerning the therapy characteristics, we found that in the payment-per-session group, the therapy took 6 days longer for low-risk patients (median 27 vs 21 days) and 7 days shorter for high-risk patients (median 42 vs 49 days) compared with the product payment group. Moreover, the mean number of sessions in the payment-per-session group was greater for low-risk patients (5.4 vs 4.8 sessions) and lower for high-risk patients (7.7 vs 8.1 sessions) compared with the payment-per-session group. Finally, the costs were significantly greater in all strata of the product payment group compared with the payment-per-session group.ConclusionsThe 2 payment systems are largely comparable regarding patient outcomes, therapy duration, and treatment sessions. Both the average cost per patient per LBP episode and the number of relapses in the product payment system are statistically significantly greater than in the payment-per-session system.     

The assessment of function. Part II: clinical perspective of a javelin thrower with low back and groin pain

Assessment of an individual’s functional ability can be complex. This assessment should also be individualized and adaptable to changes in functional status. In the first article of this series, we operationally defined function, discussed the construct of function, examined the evidence as it relates to assessment methods of various aspects of function, and explored the multi-dimensional nature of the concept of function. In this case report, we aim to demonstrate the utilization of a multi-dimensional assessment method (functional performance testing) as it relates to a high-level athlete presenting with pain in the low back and groin. It is our intent to demonstrate how the clinician should continually adapt their assessment dependent on the current functional abilities of the patients.     

Inter-day reliability of the Upper Body Test for shoulder and pelvic girdle stability in adults

BackgroundThere are a limited number of tests for the assessment of shoulder and pelvic girdle stability. Reliable instruments are important to evaluate movement dysfunction at these joints in order to provide more objective parameters.ObjectiveTo evaluate the inter-day reliability of the Upper Body Test in young adults.MethodsA reliability study was carried out with three assessments of the shoulder and pelvic girdle stability within 48-h intervals (Monday, Wednesday, and Friday). The OctoBalance® platform was used to perform the Upper Body Test in 31 active young adults (24.5 ± 8 years). Intraclass Correlation Coefficient (ICC_2,2) two-way mixed model, Coefficient of Variation, and Bland–Altman plots were used to verify the reliability of the test. The standard error of measurement (SEM) and the minimum detectable difference (MDD_95%) were calculated for clinical applicability.ResultsThe Intraclass Correlation Coefficient ranged from 0.87 to 0.94 – Featuring a mean difference of 0.89 (95%CI = −0.19–1.97) to left and 0.95 (95%CI = −0.38–2.27) for the right side, with a low variation coefficient (3.31–5.91%) between the second and third days of assessment. There was a statistically significant difference between the first assessment day and the other test sessions. The Bland–Altman analyses revealed low bias with scores within the limits of agreement. Minimum detectable difference scores were between 4.02 and 5.10, and standard error of measurement between 1.75 and 2.72, depending on the movement side.ConclusionThe Upper Body Test presented good inter-day reliability for assessing the stability of the shoulder and pelvic girdle in young active healthy adults.     

Short Physical Performance Battery: Response to Pulmonary Rehabilitation and Minimal Important Difference Estimates in Patients With Chronic Obstructive Pulmonary Disease

ObjectiveTo determine the response to a pulmonary rehabilitation (PR) program and minimal important differences (MIDs) for the Short Physical Performance Battery (SPPB) subtests and SPPB summary score in patients with chronic obstructive pulmonary disease (COPD).DesignRetrospective analysis using distribution- and anchor-based methods.SettingPR center in the Netherlands including a comprehensive 40-session 8-week inpatient or 14-week outpatient program.ParticipantsA total of 632 patients with COPD (age, 65±8y; 50% male; forced expiratory volume in the first second=43% [interquartile range, 30%-60%] predicted).InterventionsNot applicable.Main Outcome MeasureBaseline and post-PR results of the SPPB, consisting of 3 balance standing tests, 4-meter gait speed (4MGS), and 5-repetition sit-to-stand (5STS). The chosen anchors were the 6-Minute Walk Test and COPD Assessment Test. Patients were stratified according to their SPPB summary scores into low-performance, moderate-performance, and high-performance groups.Results5STS (∆=−1.14 [−4.20 to −0.93]s) and SPPB summary score (∆=1 [0-2] points) improved after PR in patients with COPD. In patients with a low performance at baseline, balance tandem and 4MGS significantly increased as well. Based on distribution-based calculations, the MID estimates ranged between 2.19 and 6.33 seconds for 5STS and 0.83 to 0.96 points for SPPB summary score.ConclusionsThe 5STS and SPPB summary score are both responsive to PR in patients with COPD. The balance tandem test and 4MGS are only responsive to PR in patients with COPD with a low performance at baseline. Based on distribution-based calculations, an MID estimate of 1 point for the SPPB summary score is recommended in patients with COPD. Future research is needed to confirm MID estimates for SPPB in different centers.     

Perceptions About the Efficacy and Acceptability of Telephone and Video-Delivered Allied Health Care for Adults With Disabilities During the COVID-19 Pandemic: A Cross-sectional National Survey

ObjectiveTo investigate and compare perceptions about the efficacy and acceptability of allied health care delivered via telephone and video call for adults with disabilities during the COVID-19 pandemic.DesignCross-sectional national survey.SettingParticipants who accessed occupational therapy, physiotherapy, psychology, or speech pathology care via telephone or via video call from June to September 2020.ParticipantsFive hundred eighty-one adults with permanent or significant disabilities, or their carers, partners, or family members, who were funded by the Australian National Disability Insurance Scheme.InterventionsNot applicable.Main Outcome MeasuresExperiences (eg, safety, efficacy, ease of use) with telephone and video-delivered care. Data were analyzed by calculating response proportions and chi-square tests to evaluate differences in experiences between allied health professions and between telephone and video modalities.ResultsResponses were obtained for 581 adults with disabilities. There was no evidence of differences between experiences with telephone or video-delivered services or across allied health professions. Overall, 47%-56% of respondents found telehealth technology easy to use (vs 17%-26% who found it difficult), 51%-55% felt comfortable communicating (vs 24%-27% who felt uncomfortable), 51%-67% were happy with the privacy and/or security (vs 6%-9% who were unhappy), 74% were happy with the safety (vs 5%-7% who were unhappy), and 56%-64% believed the care they received was effective (vs 17% who believed it was ineffective). Despite this, 48%-51% were unlikely to choose to use telephone or video consultations in the future (vs 32%-36% who were likely).ConclusionsAdults with disabilities in Australia had generally positive experiences receiving allied health care via telehealth during the COVID-19 pandemic, although some experienced difficulties using and communicating via the technology. Findings indicated no differences between satisfaction with telephone or video modalities, or between physiotherapy, speech pathology, occupational therapy, or psychology services.     

Daily Physical Activity Levels of Elementary School-Aged Children With and Without Mental Retardation

One of the goals of Healthy People 2010 is to eliminate health disparities of people with disabilities. However, there is a deficit of information on physical activity levels in children with mental retardation (MR) in both the school and out of school environments. The purpose of this study was to investigate the physical activity levels of elementary school-aged children with and without MR in both school, after-school and weekend environments. Accelerometers were used to record physical activity levels of nine children with mild MR and 33 children without (NMR). Four multiple regressions were performed to identify the difference between groups while accounting for age, gender and BMI. While at school, physical activity levels for children with MR were significantly lower during both recess and physical education, p < 0.001, p < 0.001 respectively, After school and weekend physical activity levels for children with MR were significantly lower, p < 0.001, p = 0.006 respectively. The findings of this study indicate that the disparity in physical activity in individuals with MR begins as early as the elementary school years and is measurable across environments.     

Physical fitness in children with movement difficulties

Objective

This study examined physical fitness in 9- and 10-year-old children with and without movement difficulties.

Design

The whole sample of children completed the Test of Physical Fitness, which included nine component tasks.

Setting

School sports hall of participating children.

Participants

An initial sample of 67 children was ranked on their scores from the Movement Assessment Battery for Children. The 12 children with the highest scores were designated the group with movement difficulties, and the 12 children with the lowest scores constituted the comparison group.

Results

Significant differences between the group with movement difficulties and the comparison group were found for all nine tasks and the total score for the Test of Physical Fitness.

Conclusion

The relatively poor performance of the group with movement difficulties is hypothesised to result from their lower levels of physical activity. Poor physical fitness in these children is an important concern for present and future health status.     

2型糖尿病患者锻炼自我效能与体育锻炼的相关性研究

目的描述2型糖尿病患者的锻炼自我效能，探讨锻炼自我效能与体育锻炼的相关性。方法采用锻炼自我效能量表和业余体育活动问卷，用方便抽样方法调查117例2型糖尿病患者。结果2型糖尿病患者锻炼自我效能均分为（52．42±18．30）分，患者锻炼自我效能与过去1年平均每周体育锻炼时间呈正相关（r=0．415，P〈0．01），与过去1年平均每周体育锻炼能量支出呈正相关（r=0．452，P〈0．01）。结论2型糖尿病患者锻炼自我效能处于中等水平，2型糖尿病患者锻炼自我效能越高，过去1年平均每周体育锻炼时间越多，体育锻炼能量支出越多。