Patients’ perceptions of self-management of chronic low back pain: evidence for enhancing patient education and support

Objectives

To explore the extent to which physiotherapy facilitated chronic low back pain (CLBP) patients to self-manage following discharge, and to explore patients’ perceptions of their need for self-management interventions or support and their preferences in terms of delivery.

Design

Qualitative study using semi-structured interviews to explore patients’ perceptions of various aspects of physiotherapy management of CLBP.

Setting

Physiotherapy departments in one geographical area of the UK National Health Service.

Participants

Twenty-five people who had received physiotherapy for CLBP within the previous 6 months.

Results

Adoption of self-management strategies was not achieved consistently in this group of participants. There was a strongly perceived need for self-management support following discharge from physiotherapy. Exercises were reportedly the most common self-management strategy in use. However, it was common for participants to perceive that physiotherapy had little influence on their CLBP management following discharge.

Conclusions

These results suggest that CLBP patients could be better facilitated to manage their condition. Providing self-management education in addition to the patient information and education provided traditionally, and providing self-management support in the form of direct access and/or review appointments or telephone calls is worthy of further investigation in this patient group.     

Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative study

Objective

To determine patients’ perspectives of components of patient-centred physiotherapy and its essential elements.

Design

Qualitative study using semi-structured interviews to explore patients’ judgements of patient-centred physiotherapy. Grounded theory was used to determine common themes among the interviews and develop theory iteratively from the data.

Setting

Musculoskeletal outpatient physiotherapy at a provincial city hospital.

Participants

Eight individuals who had recently received physiotherapy.

Results

Five categories of characteristics relating to patient-centred physiotherapy were generated from the data: the ability to communicate; confidence; knowledge and professionalism; an understanding of people and an ability to relate; and transparency of progress and outcome. These categories did not tend to occur in isolation, but formed a composite picture of patient-centred physiotherapy from the patient's perspective.

Conclusions and practice implications

This research elucidates and reinforces the importance of patient-centredness in physiotherapy, and suggests that patients may be the best judges of the affective, non-technical aspects of a given healthcare episode.     

First impressions: an information leaflet for patients attending a musculoskeletal outpatient department

Objective

The purpose of this work was to design and evaluate an information leaflet for new patients attending a physiotherapy outpatient department. This formed part of a wider agenda of improving the patients’ experience and increasing adherence to the Chartered Society of Physiotherapy's core standards.

Design

A needs analysis was undertaken with existing patients to determine the content of the new leaflet. This was then tested for readability, reviewed by physiotherapy staff and evaluated by patients via a questionnaire.

Setting

The musculoskeletal outpatient physiotherapy department at Southampton General Hospital.

Participants

Patients referred to the outpatient physiotherapy service, plus all clinical and support staff employed in the musculoskeletal outpatient team.

Main outcome measures

Numerical Rating Scale and Gunning's Fog Index.

Results

Thirty-seven of 50 patients completed the needs analysis (74%), generating 42 ideas for the leaflet content. The definitive leaflet addressed one core standard and 16 specific criteria, and had a readability of grade 8.3, which is below the recommended maximum limit of grade 9 for health education leaflets. Using an 11-point Numerical Rating Scale, where 0 = of no benefit and 10 = extremely helpful, the mean rating for the leaflet from 29 of 100 patients was 8.6.

Conclusions

This work has produced a patient information leaflet for physiotherapy outpatients, a copy of which is freely available (electronically) from the author. The leaflet forms part of an ongoing commitment to improving the patients’ experience.     

Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive processes

Objectives

To examine whether patients with chronic low back pain exhibit changes in cognitive factors following Interactive Behavioural Modification Therapy (IBMT), delivered by physiotherapists; and to examine the association between pre- to post-treatment changes in cognitive factors (cognitive processes) and pre- to post-treatment changes in pain, disability and depression.

Design

Observational before-after study.

Setting

Outpatient physiotherapy department.

Participants

One hundred and thirty-seven patients with chronic low back pain.

Interventions

IBMT: ‘Work Back to Life’ rehabilitation programme.

Main outcome measures

Pre- to post-treatment changes in pain, disability and a range of cognitive factors.

Results

Patients demonstrated significant favourable changes for a range of cognitive factors. Furthermore, pre- to post-treatment changes in these cognitive factors explained an additional 22%, 17% and 15% of the variance in changes in pain, disability and depression, respectively, after controlling for other important factors.

Conclusions

Changes that emerge in cognitive factors are strongly related to treatment outcome within a physiotherapy treatment context. Specifically, reductions in fear of movement and catastrophising, and increases in functional self-efficacy appear to be particularly important. Modifying these cognitive factors should be seen as a priority when treating patients with chronic low back pain.     

Environmental barriers to and availability of healthy foods for people with mobility disabilities living in urban and suburban neighborhoods

Mojtahedi MC, Boblick P, Rimmer JH, Rowland JL, Jones RA, Braunschweig CL. Environmental barriers to and availability of healthy foods for people with mobility disabilities living in urban and suburban neighborhoods.

Objective

To assess the impact of the built environment on access to healthy foods for people with mobility disabilities by measuring wheelchair accessibility of grocery stores and availability of healthy affordable foods.

Design

A survey consisting of 87 questions.

Setting

A low-income, multiracial urban Chicago neighborhood with a 3-mile radius was compared with a suburban neighborhood of the same size in which the population is similar in income level and racial distribution.

Participants

Not applicable.

Interventions

Not applicable.

Main Outcome Measures

Accessibility issues outside and within grocery stores and the availability of healthy affordable food items in these grocery stores.

Results

The urban area had more stores (n=48) than the suburban area (n=34); however, only 46% of urban stores had an entrance that would allow an individual requiring a ramp or level entrance to gain access compared with 88% of suburban stores (P<.001). Wheelchair accessibility characteristics of grocery and convenience stores did not differ between the urban and suburban areas. The availability of healthy affordable foods in urban and suburban stores was relatively low, with only 33% to 40% of the 18 items available, and did not differ between urban and suburban stores.

Conclusions

People with mobility impairments are at a disadvantage in maintaining healthy food choices because of limited access to stores and healthy foods.     

A national framework for supporting improvements in the physiotherapy assessment and management of low back pain: the Scottish experience

Background

Similar to other countries worldwide, Scotland lacked a national view of whether the quality of the physiotherapy management of low back pain was compliant with national guidelines. Anecdotal evidence suggested that standards of care varied considerably despite the wide availability of clinical guidelines to clinicians.

Aim

To develop a framework that supports National Health Service (NHS) Scotland in providing consistently applied high-quality physiotherapy assessment and management of low back pain in line with guideline recommendations.

Design

Prospective, multicentred national study, data collection and improvement phase.

Setting

All NHS boards in Scotland (n = 14) plus two private provider sites.

Participants

One hundred and eighty-six individual NHS sites and two private providers of services to patients with low back pain.

Method

A national dataset was developed from evidence- and consensus-based guideline sources. All sites collected data (two 5-week periods) over 1 year (2008-2009) using a web-based database. This was interspersed by an improvement phase during which required improvements were considered and implemented. Issues were shared through a national network and national meeting.

Results

Data from 2147 patients showed improvements in the documented physiotherapy management of low back pain over the two cycles. All participants developed and implemented remedial action plans based on the results of the first cycle.

Conclusion

It is possible to implement a framework, which is led nationally but driven and owned locally, supporting physiotherapists in an active programme of locally determined improvement. However, although process and outcome are linked, the direct impact of this initiative on patient outcome is not known.     

An investigation into the alignment of a South African physiotherapy curriculum and the expectations of the healthcare system

Until 1994, physiotherapy education and training were aligned with the expectations of the South African healthcare system. Subsequent to policy shifts since 1994, the professional role of physiotherapists has expanded. In the absence of guiding strategies to support this change, physiotherapy curricula have remained relatively static.

Objective

The paper examines the discrepancies between physiotherapy education and training at a South African university post apartheid and the expectations of the healthcare system.

Design

Located within critical feminist research framings and employing narrative inquiry as the selected methodology, data were produced through multiple methods to obtain multiple perspectives and orientations.

Participants

This multisectorial data production approach involving student physiotherapists, physiotherapy academics and practising physiotherapists included in-depth focus group interviews, individual interviews, life-history biographies and open-ended questionnaires. The data were analysed separately for each group of research participants (physiotherapy students, practitioners and academics), followed by a cross-sector analysis.

Results

The analysis illustrated current disciplinary trends and shortcomings of the physiotherapy undergraduate curriculum, whilst highlighting that which is considered valuable and progressive in physiotherapy and health care. The dominant themes that emerged included issues relating to physiotherapy theory and practice, and issues that influenced the construction of relationships in the curriculum.

Conclusion

The significance of this study lies in the value of student and practitioner feedback to inform curriculum and professional development in the light of sociopolitical changes and healthcare expectations.     

The experience of spinal cord injury: using Frank's narrative types to enhance physiotherapy undergraduates’ understanding

Objectives

To consider physiotherapy students’ responses to three illness narratives common in rugby players who have suffered a spinal cord injury (SCI).

Design

A narrative vignette was provided to first and third year students reading for a Batchelor of Science degree in physiotherapy.

Setting

A university in the West Midlands during a year cohort meeting.

Participants

Seventy-seven first year students and 45 third year students took part in the study. All students were attending the university at the time of the study. None of the first year students had completed any clinical placement hours, and all of the third year students had completed the required number of clinical hours for a physiotherapy degree.

Main outcome measures

The narrative vignette consisted of nine questions relating to the vignette. Thematic content analysis was applied to the results.

Results

The role of experience appeared to influence students’ responses. The third year students’ reactions to each narrative appeared more consistent and unified as a medical voice. This appeared to support their preference for an ideal type of story and patient. Problems with each narrative were identified, although often not critiqued.

Conclusions

Students need more time to consider different illness narratives in order to accept and understand them.     

The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Neuromuscular Electrical Stimulation Training: A Safe and Effective Treatment for Facioscapulohumeral Muscular Dystrophy Patients

Colson SS, Benchortane M, Tanant V, Faghan J-P, Fournier-Mehouas M, Benaïm C, Desnuelle C, Sacconi S. Neuromuscular electrical stimulation training: a safe and effective treatment for facioscapulohumeral muscular dystrophy patients.

Objective

To investigate the feasibility, safety, and effectiveness of neuromuscular electrical stimulation (NMES) strength training in facioscapulohumeral muscular dystrophy (FSHD) patients.

Design

Uncontrolled before-after trial.

Setting

Neuromuscular disease center in a university hospital and a private-practice physical therapy office.

Participants

FSHD patients (N=9; 3 women, 6 men; age 55.2±10.4y) clinically characterized by shoulder girdle and quadriceps femoris muscle weakness.

Interventions

Patients underwent 5 months of strength training with NMES bilaterally applied to the deltoideus, trapezius transversalis, vastus lateralis, and vastus medialis muscles for five 20-minute sessions per week.

Main Outcome Measures

Plasma creatine kinase (CK) activity; scores for pain and fatigue on visual analog scales (VAS), manual muscle testing (MMT), maximal voluntary isometric contraction (MVIC), 6-minute walking tests (6MWT), and self-reported changes in daily living activities.

Results

NMES strength training was well tolerated (CK activity and pain and fatigue scores on VAS were not modified). Most of the muscle functions (shoulder flexion and extension and knee extension) assessed by MMT were significantly increased. MVIC of shoulder flexion and abduction and the 6MWT distance were also improved.

Conclusions

In FSHD, NMES strength training appears to be safe with positive effects on muscle function, strength, and capacity for daily activities.     

Predictors of Success for Physiotherapy Treatment in Women With Persistent Postpartum Stress Urinary Incontinence

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux M-C. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence.

Objective

To identify predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence (SUI).

Design

Secondary analysis of data from a single-blind randomized controlled trial comparing 2 physiotherapy intervention programs for persistent SUI in postpartum women.

Setting

Obstetric clinic of a mother and children's university hospital.

Participants

Women, ages 23 to 39 (N=57), were randomized to 1 of 2 pelvic floor muscle (PFM) training programs, 1 with and 1 without abdominal muscle training.

Intervention

Over 8 weeks, participants in each group followed a specific home exercise program once a day, 5 days a week. In addition, participants attended individual weekly physiotherapy sessions throughout the 8-week program.

Main Outcome Measures

Treatment success was defined as a pad weight gain of less than 2g on a 20-minute pad test with standardized bladder volume after 8 weeks' treatment. The relationship between potential predictive PFM function variables as measured by a PFM dynamometer and success of physiotherapy was studied using forward stepwise multivariate logistic regression analyses.

Results

Forty-two women (74%) were classified as treatment successes, and 15 (26%) were not. Treatment success was associated with lower pretreatment PFM passive force and greater PFM endurance pretreatment, but the latter association was barely statistically significant. This model explained between 23% (Cox and Snell R²) and 34% (Nagelkerke R²) of the outcome variability.

Conclusions

The results contribute new information on predictors of success for physiotherapy treatment in women with persistent postpartum SUI.     

Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control

Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.

Objectives

To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.

Design

Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.

Setting

Biomechanics laboratory.

Participants

Healthy novice wheelchair users (N=13; 6 men) from a university student population.

Interventions

Not applicable.

Main Outcome Measures

Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.

Results

Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.

Conclusions

Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition.     

What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial

Background

Recent healthcare policies have encouraged increasing interest in the concept of patient self-referral, specifically with regard to physiotherapy. However, what has not been known until recently is the efficacy of this mode of access within the National Health Service (NHS), including the cost implications on which to reliably base the provision of future service models.

Aim

To establish the costs to National Health Service (NHS) Scotland of differing modes of access to physiotherapy in primary care.

Design

Cost-minimisation analysis, multi-centred national trial.

Setting

Twenty-six general practices throughout Scotland.

Participants

Three-thousand and ten patients.

Method

Self-referral was introduced in each site in parallel with referral by a general practitioner (GP). NHS-associated cost data were collated over a full year by referral type, i.e. self-referral, GP-suggested and GP-referral groups. A cost-minimisation analysis was performed and the main outcome measures were the number of GP and physiotherapy contacts, prescribing of non-steroidal anti-inflammatory drugs and analgesics, and referral for X-ray, magnetic resonance imaging and/or secondary care. Costs were established for 2004.

Results

The data from 3010 patients identified significant associations between referral group and prescribing, referral for X-ray and to secondary care, and GP and physiotherapy contacts (P < 0.001). The average cost of an episode of care was established as £66.31 for a self-referral, £79.50 for a GP-suggested referral and £88.99 for a GP referral. Extrapolated to identify national implications, the average cost benefit to NHS Scotland was identified as being approximately £2 million per annum.

Conclusion

There are significant positive implications associated with self-referral to physiotherapy that represent added value for NHS Scotland. These implications are also of relevance to the rest of the NHS in the UK.     

Wavelet-based spectrum analysis of sacral skin blood flow response to alternating pressure

Jan Y-K, Brienza DM, Geyer MJ, Karg P. Wavelet-based spectrum analysis of sacral skin blood flow response to alternating pressure.

Objectives

To provide insight into the physiologic mechanisms associated with alternating pressure, using wavelet analysis of skin blood flow (SBF) oscillations, and to determine whether the application of alternating pressure induces myogenic responses, thereby enhancing SBF as compared with constant loading.

Design

Repeated-measures design.

Setting

University research laboratory.

Participants

Healthy, young adults (N=10; 5 men, 5 women; mean age ± standard deviation, 30.0±3.1y).

Intervention

Alternating pressure for 20 minutes (four 5-min cycles with either 60mmHg or 3mmHg) and constant loading for 20 minutes at 30mmHg on the skin over the sacrum.

Main Outcome Measures

A laser Doppler flowmeter was used to measure sacral SBF response to both alternating pressure and constant loading. Wavelet-based spectrum analysis of SBF oscillations was used to assess underlying physiologic mechanisms including endothelium-related metabolic (.008-.02Hz), neurogenic (.02-.05Hz), and myogenic (.05-.15Hz) controls.

Results

Alternating pressure stimulated an increase in sacral SBF of compressed soft tissues as compared with constant loading (P<.01). SBF during the high-pressure phase of 4 alternating pressure cycles showed an increasing trend. An increase in power in metabolic frequency range and a decrease in power in the myogenic frequency range during alternating pressure were observed compared with SBF prior to loading. Power increased in the myogenic frequency range during the low-pressure phase of alternating pressure and decreased during the high-pressure phase.

Conclusions

SBF control mechanisms, as assessed by the characteristic frequencies embedded in SBF oscillations, show different responses to 2 loading pressures with the same average pressure but different patterns. Our study suggests that optimization of operating parameters and configurations of alternating pressure support surfaces to compensate for impaired SBF control mechanisms in pathologic populations may be possible using wavelet analysis of blood flow oscillations.     

Activation of lumbar paraspinal and abdominal muscles during therapeutic exercises in chronic low back pain patients

Arokoski JP, Valta T, Kankaanpää M, Airaksinen O. Activation of lumbar paraspinal and abdominal muscles during therapeutic exercises in chronic low back pain patients. Arch Phys Med Rehabil 2004;85:823-32.

Objectives

To assess the activities of paraspinal and abdominal muscles during therapeutic exercises for the treatment of patients with nonspecific chronic low back pain (CLBP), and to study the effects of active physical rehabilitation on these activities.

Design

A cross-sectional study comparing muscle activities during 18 stabilization exercises, and a prospective follow-up of patients with CLBP during rehabilitation.

Setting

Rehabilitation clinic in university hospital in Finland.

Participants

Nine volunteers (5 men, 4 women) aged 27 to 58 years.

Intervention

Three months of active outpatient rehabilitation (4 to 6 times in a rehabilitation clinic, supplemented with self-motivated exercise at home) supervised by a physiotherapist.

Main outcome measures

Surface electromyography was recorded bilaterally from L5 level paraspinal, rectus abdominis, and obliquus externus abdominis muscles. The recorded signal was averaged and normalized to the maximal electromyographic amplitude obtained during the maximal voluntary contraction. The measurements were taken before and after the exercise treatment period.

Results

CLBP patients showed variable trunk muscle activity patterns during the different therapeutic exercises, similar to those that we reported earlier in healthy subjects. The maximal trunk isometric extension (pre, 147.3±75.9Nm; post, 170.1±72.3Nm) and flexion (pre, 72.0±37.9Nm; post, 93.5±42.5Nm) torques did not show a significant changes during the exercise period. However, trunk rotation-flexion torque (pre, 52.9±26.5Nm; post, 82.4±65.8Nm) increased significantly (35.8%) after the exercise period (P<.05). The corresponding maximal electromyographic amplitudes of back and abdominal muscles remained unchanged. Disability, as assessed by visual analog scale and Oswestry Disability Index, did not change.

Conclusions

The CLBP patients performed therapeutic exercises with similar abdominal and back extensor muscle activities in the same way as the healthy subjects in our earlier studies. In this study, active physical rehabilitation had no effect on the abdominal and back muscle activities or on pain and functional disability indices.     

Effort-reward imbalance is associated with the frequency of sickness absence among female hospital nurses: A cross-sectional study

Background

Most research on sickness absence among nurses has focused on long-term work disability. Absence from work due to short-term sickness, however, is more common and frequent short absences result in understaffing and increased workload of nursing teams.

Objectives

To investigate health and work factors in relation to the frequency of short-term sickness absence among nurses.

Design

A cross-sectional study linking self-reported health and work factors to the frequency of registered sickness absence episodes in the preceding 3 years.

Settings

A regional hospital in the Dutch province Friesland employing 1153 persons.

Participants

459 female nurses working at least 3 years in the clinical wards (n = 337) or the outpatient clinic (n = 122) of the hospital.

Methods

Perceived general health, mental health, demand/control (DC) ratio, workplace social support, effort/reward (ER) ratio, and over-commitment (i.e. the inability to withdraw from work obligations) were assessed by a self-administered questionnaire. The associations between the questionnaire results and the registered number of sickness absence episodes were analysed by negative binomial regression analysis, distinguishing between short (1-7 days) and long (>7 days) sickness absence episodes and controlling for age, hours worked, and duration of employment.

Results

328 (71%) female nurses completed their questionnaires and of these 291 were eligible for analysis. High frequent absentees perceived poorer health, had lower over-commitment scores, and reported higher ER-ratios than low frequent absentees. Esteem rewards were related to sickness absence whereas monetary rewards were not. Feeling respect from the supervisor was associated with fewer short sickness absence episodes and respect from co-workers was associated with fewer long sickness absence episodes.

Conclusions

Effort-reward imbalance was associated with frequent short sickness absence episodes among nurses. Work efforts and rewards ought to be potentially considered when managing nurses who are frequently absent from work as these factors can be dealt with by managers.     

Within-day repeatability of the endurance shuttle walk test

Objective

To determine the need for a practice walk for the endurance shuttle walk test (ESWT) following the performance of two incremental shuttle walk tests (ISWTs) - one practice and one test - on the same day.

Design

Retrospective data analysis of shuttle walk test measurements. All participants had performed two ISWTs and two ESWTs at a single visit, prior to commencing pulmonary rehabilitation.

Setting

Outpatient physiotherapy department of a university hospital.

Participants

Forty-four patients (33 males, 11 females) with a primary diagnosis of chronic obstructive pulmonary disease, referred for routine pulmonary rehabilitation.

Measurements

Shuttle walk test distance and time, Borg breathlessness score, heart rate and pulsed oxygen saturation.

Results

The mean age of the group was 67.6 years [standard deviation (SD) 9.0] and mean forced expiratory volume in 1 second was 37% predicted (SD 13). The mean times walked during ESWTs 1 and 2 were 195 and 207 seconds (SD 115 and 138), respectively. Using the analysis recommended by Bland and Altman, the mean of the individual differences (d) between Tests 1 and 2 was 12 seconds, with limits of agreement from −88 to +112 seconds.

Conclusion

A practice endurance shuttle walk is unnecessary following performance of ISWTs on the same day.     

Goals of physiotherapy interventions can be described using the International Classification of Functioning, Disability and Health

Objective

To provide an example of how goals of physiotherapy interventions and their typical patterns can be described using the International Classification of Functioning, Disability and Health (ICF).

Design

Cross-sectional study.

Setting

Acute hospital.

Participants

One hundred patients with neurological, musculoskeletal or cardiopulmonary conditions requiring physiotherapy interventions in University Hospital Zurich between January 2003 and October 2003.

Main outcome measures

The case record form consisted of two parts: a standardised questionnaire for functioning and health of the patient; and a standardised record form for physiotherapy interventions. Both parts were based on the ICF.

Results

The mean age of the subjects was 58.2 years (standard deviation 15.9), the median age was 60.5 years and 44% were female. The most frequent intervention goals in patients with neurological conditions were: muscle power functions; muscle tone functions; control of voluntary movement functions; changing basic body position; maintaining a body position; and transferring oneself. The most frequent intervention goals for cardiopulmonary patients were: functions of the cardiovascular system; and respiration functions. The most frequent intervention goals in patients with musculoskeletal conditions were: sensation of pain; stability of joint functions; muscle power functions; muscle tone functions; and muscle endurance functions.

Conclusion

By using the ICF as a framework and linguistic support, intervention goals can serve as standardised documentation for physiotherapy interventions, their evaluation and planning.     

Population-specific modifications of the short-form Mini Nutritional Assessment and Malnutrition Universal Screening Tool for elderly Taiwanese

Background

The Mini Nutritional Assessment (MNA) and the Malnutrition Universal Screening Tool (MUST) are two widely used malnutrition screening scales.

Objective

The study was to compare the grading ability of the two scales, and to determine whether adoption of population-specific anthropometric cut-points could improve the grading ability of these tools and whether calf circumference (CC) could be an acceptable alternative to BMI in these scales.

Design

Purposive sampling.

Settings

Outpatients receiving annual physical examination at an area hospital.

Participants

Community-living elderly who were 65 years or older, able to communicate orally, without acute health conditions and willing to sign a study-consent.

Methods

Subjects were measured for anthropometrics and blood biochemical indicators, and interviewed for personal data and answers to the MNA and MUST. The risk of malnutrition was evaluated with the short-form MNA (MNA-SF) and the MUST, each in three versions (the original, Taiwan version-1 (T1) which adopted population-specific anthropometric cut-points, and Taiwan version-2 (T2) which replaced BMI with CC). Long-form (LF) MNA versions served as references.

Results

Results showed that (a) in both scales, patterns of nutritional status rated with the original versions were different from those rated with respective modified versions but ratings made with two modified versions were the same, (b) the T2 versions showed the best grading ability based on agreement with the reference (MNA-LF), and (c) MNA-SF versions rated greater proportions of subjects at risk of malnutrition than the respective MUST versions.

Conclusions

(a) Adoption of population-specific anthropometric cut-points improves the grading ability of the MNA-SF and the MUST in community-living Taiwanese, (b) CC is an acceptable alternative to BMI for both MNA-SF and MUST, and (c) nutritional assessment tools should be as much population or ethnically specific as possible to account for cultural and anthropometric differences across populations.     

Indexing of randomised controlled trials of physiotherapy interventions: a comparison of AMED, CENTRAL, CINAHL, EMBASE, Hooked on Evidence, PEDro, PsycINFO and PubMed

Objective

To compare the comprehensiveness of indexing the reports of randomised controlled trials of physiotherapy interventions by eight bibliographic databases (AMED, CENTRAL, CINAHL, EMBASE, Hooked on Evidence, PEDro, PsycINFO and PubMed).

Design

Audit of bibliographic databases.

Methods

Two hundred and eighty-one reports of randomised controlled trials of physiotherapy interventions were identified by screening the reference lists of 30 relevant systematic reviews published in four consecutive issues of the Cochrane Database of Systematic Reviews (Issue 3, 2007 to Issue 2, 2008). AMED, CENTRAL, CINAHL, EMBASE, Hooked on Evidence, PEDro, PsycINFO and PubMed were used to search for the trial reports. The number of trial reports indexed in each database was calculated.

Results

PEDro indexed 99% of the trial reports, CENTRAL indexed 98%, PubMed indexed 91%, EMBASE indexed 82%, CINAHL indexed 61%, Hooked on Evidence indexed 40%, AMED indexed 36% and PsycINFO indexed 17%. Most trial reports (92%) were indexed on four or more of the databases. One trial report was indexed on a single database (PEDro).

Conclusions

Of the eight bibliographic databases examined, PEDro and CENTRAL provide the most comprehensive indexing of reports of randomised trials of physiotherapy interventions.