Physiotherapy Practice and Research

BACKGROUND: The therapeutic effect of neuromuscular electrical stimulation (NMES) on muscle strengthening and hypertrophy depends on its dose. Patients must tolerate high doses of NMES to maximize gains in muscle function. It is unknown why some patients are able to achieve high NMES dose while others are not. Disability and psychological attributes may play a role in a patient's tolerance of NMES dose. PURPOSE: To explore if disability and psychological attributes associate with the ability to achieve high doses of NMES in patients with rheumatoid arthritis (RA). METHODS: Cross-sectional study. Forty subjects with RA participated in 2 sessions of NMES intervention to the quadriceps muscles. The highest NMES dose achieved by each subject was recorded. Dose was defined as the torque produced by the NMES as a percentage of the torque produced during a maximum voluntary isometric contraction. Subjects were then grouped in high or low NMES dose. Variables investigated in this study included disability, pain coping strategies, pain acceptance, sense of mastery or control, anxiety, and depression. Correlations were sought between these factors and NMES dose. MAIN RESULTS: In unadjusted models, disability, coping self-statements, catastrophizing, and anxiety were predictors of NMES dose. In adjusted models only disability (OR = 0.17 [95% CI: 0.04, 0.77]) and catastrophizing (OR = 0.85 [95% CI: 0.72, 0.99]) predicted NMES dose. CONCLUSION: Patients with RA with lower disability and lower catastrophising achieve higher doses of NMES. Identifying factors associated with achieving high NMES dose may guide strategies to improve effectiveness of this intervention.

BACKGROUND: Approximately 25% of people with Multiple Sclerosis (PwMS) are non-ambulatory, but little evidence exists for interventions within this population. Primary care physiotherapy in the community is a frequently used option for managing chronic conditions such as Multiple Sclerosis (MS), but access and availability is limited. A new model of care has used Exercise Buddies (paid professional carers) to exercise with PwMS under the direction of community physiotherapists. This study aims to explore the development, implementation and outcome of the programme. METHODS: Seven semi-structured interviews were carried out with the physiotherapists, Exercise Buddies, PwMS and the MS Ireland Co-ordinator who took part in the new model of care. Data were analysed using thematic analysis. FINDINGS: Analysis generated two main categories: Benefits and Communication Difficulties. Within Benefits, the main themes of Physical and Psychological Benefits for PwMS and Physical and Psychological Benefits for Carers emerged. Within Communication Difficulties, themes of Defining Roles & Expectations and Feedback & Communication During Implementation emerged. A subtheme of Insufficient Training of Buddies emerged within the theme of Defining Roles and Expectations. CONCLUSION: The Exercise Buddy system is a home-based intervention delivered at a community level, and has potential as a model of care with both physical and psychological benefits reported for PwMS and their carers. Issues discussed mostly related to communication and training. These need to be addressed for future successful development.

OBJECTIVE: To compare between selected post-operatives physical therapy modalities after transverse carpal ligament release. DESIGN: Double blind, randomized controlled trial. SETTING: Health insurance hospital outpatient clinic in Cairo, Egypt. SUBJECTS: Forty-five female patients aged 25–45 years, following transverse carpal ligament release of the dominant hand, referred to the physical therapy outpatient clinic of a health insurance hospital, Egypt. INTERVENTION: Patients were randomly allocated to three equal groups of 15: Ultrasonic group received continuous ultrasound with nerve and tendon gliding exercises, Laser group received laser therapy and the same exercises, Exercise group received the same exercises only. Treatment duration was six weeks, three times per week. MAIN MEASURE: Visual analogue scale for pain intensity, pinch dynamometer for muscle strength, motor and sensory distal latencies for median nerve. RESULTS: There was significant improvement after treatment in all groups, with no significant difference between the Ultrasonic group and the Laser group; there was a highly significant difference between the Ultrasonic group and the Exercise group, and a significant difference between the Laser group and the Exercise group. CONCLUSION: Continuous ultrasound accompanied with nerve and tendon gliding exercises is considered more effective in the post-operative treatment of transverse carpal ligament release, giving best results and percentage of improvements when compared either to Laser therapy with nerve and tendon gliding exercises or nerve and tendon gliding exercises only.

BACKGROUND: The popularity of Irish dancing has increased enormously since the success of “Riverdance, The Show”. The evolution of Irish dance to professional status has placed increased demands on dancers, yet scant investigation of musculoskeletal pain and injury among Irish dancers has been undertaken. This review examined the evidence regarding the rate of injury among Irish dancers, and the factors associated with injury risk. METHODS: Electronic databases were searched by two independent assessors. Studies were included if they examined the rate of musculoskeletal pain or injury among Irish dancers, and/or the factors associated with musculoskeletal pain or injury among Irish dancers. Study quality was assessed using the Oxford levels of evidence scale. RESULTS: Only two retrospective studies met the eligibility criteria, with no prospective studies on injury rate having been published. These studies indicate that lower limb injuries, especially in the foot and ankle, are most common in Irish dancers. There is preliminary evidence that dancers who did not complete a warm-up and cool-down, who did not use split-shoe sneakers while training, and who perform at higher levels of competition may be at greater risk of injury. CONCLUSIONS: No high quality prospective studies of injury have been completed in Irish dance. The existing retrospective studies demonstrate that foot and ankle injuries are the most common, and some potential contributing factors to injury have been identified. However, prospective studies which evaluate these risk factors for injury, as well as common injury risk factors identified in other forms of dance, are required.

BACKGROUND: Early rehabilitation has been identified as key to improving physical function and aiding in long-term recovery in critically ill patients. Surveys of physiotherapy practice have highlighted variations and issues with the provision of rehabilitation services in this patient population. However, there have been no qualitative studies exploring physiotherapist's views of implementing early rehabilitation in critically ill patients. AIM: To explore physiotherapist's understanding and experiences of early rehabilitation in critically ill patients. METHODS: A qualitative exploratory design using semi-structured interviews with six physiotherapists from one NHS hospital trust. RESULTS: Thematic content analysis identified how participants conceptualised early rehabilitation in two broad themes of adherence and collaborative working. CONCLUSIONS: Physiotherapists identified that adherence is an issue in clinical practice and collaborative working is integral to patient care. Awareness of the barriers to adherence and collaborative working and strategies that can be used to overcome them is central to improving rehabilitation in critically ill patients.

BACKGROUND: Studies of sports injury in Irish amateur sport are rare. RESEARCH QUESTION: To determine the injury incidence rates (IR) and severity in male amateur rugby and soccer. TYPE OF STUDY: A 3-month prospective observational study of collegiate rugby players (n = 54; M ± SD age 21 ± 2 yr, body mass 88.1 ± 10.7 kg, height 1.83 ± 0.52 m, body mass index 26 ± 2.6 kg.m⁻²) and soccer players (n = 21; M ± SD age 21 ± 2 yr, body mass 75.9 ± 8.0 kg, height 1.80 ± 0.57 m and body mass index 23 ± 1.9 Kg.m⁻²). METHODS: Fortnightly questionnaires detailing training and match exposure (hr) and injury status were completed under supervision, response rate was 92.7%. The study employed a time-loss injury definition. Injuries were examined by a physiotherapist, a mean ± SD time of 4.6 ± 4.3 days after onset. RESULTS: Subjects spent 2967.5 hr in training and 623.1 hr playing competitive matches. Sixty six injuries were recorded during the observation period (soccer, n = 15; rugby, n = 51). Match and training IR for soccer were 49.3 (95% CI 21.4 to 77.3) and 7.1 (95% CI 0 to 15.1) per 1000 hr and for rugby were 99.5 (95% CI 67.8 to 131.1) and 5.1 (95% CI 2.3 to 7.9) per 1000 hr, respectively. All injury types were more common in matches. In soccer, ankle sprains (ligament injury) had the highest IR, 16.5 per 1000 hr match-play (95% CI 0.3 to 32.6). In rugby acromioclavicular joint sprains had the highest IR (injury incidence rate), 15.7 per 1000 hr match-play (95% CI 3.1 to 28.3). CONCLUSION: The risk of injury in collegiate soccer and rugby is substantial, particularly in competitive matches. Rugby poses a greater risk of injury than soccer. Injury prevention strategies targeting ankle sprains in soccer, shoulder and knee sprains in rugby, and hamstring strains (muscle injury) in both sports are recommended.

BACKGROUND: Low back pain (LBP) is very common in rowing. A novel wireless method of monitoring lumbo-pelvic kinematics has recently been developed. This study aimed to determine if lumbo-pelvic kinematics; (1) can be measured reliably using this method; (2) change during a rowing session; (3) differ between rowers with and without LBP. METHODS: Two studies were completed; (a) a reliability study, and (b) a cross-sectional study. In both studies, the posture monitor was placed on the subjects' lumbo-pelvic region during testing on a Concept 2, Model D rowing ergometer. For the reliability study, seven rowers performed the first stage of an ergometer “step-test” on three occasions. For the cross-sectional study, 11 senior/elite male rowers (five = non-LBP; six = LBP) performed a standardised “step-test” with seven stages. RESULTS: The posture monitor demonstrated very high reliability (all ICC >0.8), with only small mean differences. A one-way repeated measures ANOVA revealed that there was no significant interaction between group and test stage (p = 0.541). There was no significant main effect for test stage (p = 0.257) or group (p = 0.620). CONCLUSION: This pilot study found no significant differences in lumbo-pelvic kinematics between the groups, or across the test stages. The posture monitor could be a useful tool for monitoring lumbo-pelvic kinematics in the field. Larger studies of prolonged rowing, using more homogenous subgroups of LBP subjects, who report greater levels of LBP, are required.