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Now available at Physiotherapy Canada Online
Physiotherapy Canada Volume 62, Number 3 /2010 is now available at http://utpjournals.metapress.com/content/r201988uq821/.
This issue contains:
Stephanie A. Nixon, Shaun Cleaver, Marianne Stevens, et al.
http://utpjournals.metapress.com/content/3l1702w0r105751n/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=0
Stephanie A. Nixon, Shaun Cleaver, Marianne Stevens, et al.
http://utpjournals.metapress.com/content/kw7522w2l152773v/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=1
Patient Safety and Physiotherapy: What Does it Mean for Your Clinical Practice?
Judy King, Cathy M. Anderson
http://utpjournals.metapress.com/content/4m861n3up382x701/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=2
La sécurité des patients et physiothérapie : quelle est sa place dans votre pratique?
Judy King, Cathy M. Anderson
http://utpjournals.metapress.com/content/l1548pp552836746/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=3
Michael J.L. Sullivan, Heather Adams
Abstract: Purpose: The present study examined the profile of physical and psychosocial changes that occur in physiotherapy intervention when patients also participate in a psychosocial intervention. The psychosocial intervention, delivered by physiotherapists, was designed to target catastrophic thinking, fear of pain, perceived disability, and depression.
Methods: The study sample consisted of 48 individuals referred for the rehabilitation treatment of disabling back pain. Half the sample was enrolled in a physiotherapy intervention only; the other half was enrolled in a psychosocial intervention in addition to receiving a physiotherapy intervention.
Results: At post-treatment, the two treatment groups did not differ significantly on measures of pain severity, physical function, or self-reported disability. Patients who participated in the psychosocial intervention in addition to physiotherapy showed significantly greater reductions in pain catastrophizing, fear of movement, and depression than patients who received only the physiotherapy intervention. Reductions in psychosocial risk factors contributed to reduced use of the health care system, reduced use of pain medication, and improved return-to-work outcomes.
Conclusions: The findings of the present study suggest that a psychosocial intervention provided by physiotherapists can lead to meaningful reductions in psychosocial risk factors for pain and disability and may contribute to more positive rehabilitation outcomes.
http://utpjournals.metapress.com/content/525v7177581h26tx/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=4
Neuropathic Pain in Patients with Upper-Extremity Nerve Injury
Christine B. Novak, Joel Katz
Abstract: Purpose: The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upper-extremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients.
Summary of Key Points: A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury.
Recommendation: To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning.
http://utpjournals.metapress.com/content/mq014r0622w68n86/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=5
Evidence-Based Management of an Individual Living with HIV
Kelly K. O'Brien, Stephanie A. Nixon
http://utpjournals.metapress.com/content/w5h65wn123075j4p/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=6
Educational Needs of Patients Undergoing Total Joint Arthroplasty
Leslie J. Soever, Crystal MacKay, Tina Saryeddine, et al.
Abstract: Purpose: To identify the educational needs of adults who undergo total hip and total knee replacement surgery.
Methods: A qualitative research design using a semi-standardized interviewing method was employed. A purposive sampling technique was used to recruit participants, who were eligible if they were scheduled to undergo total hip or total knee replacement or had undergone total hip or total knee replacement in the previous 3 to 6 months. A comparative contrast method of analysis was used.
Results: Of 22 potential participants who were approached, 15 participated. Five were booked for upcoming total hip or total knee replacement and 10 had undergone at least one total hip or total knee replacement in the previous 3 to 6 months. Several themes related to specific educational needs and factors affecting educational needs, including access, preoperative phase, surgery and medical recovery, rehabilitation process and functional recovery, fears, and expectations counterbalanced with responsibility, emerged from the interviews.
Conclusions: Educational needs of adults who undergo total hip and knee replacement surgery encompass a broad range of topics, confirming the importance of offering an all-inclusive information package regarding total hip and total knee replacement.
http://utpjournals.metapress.com/content/n93216249p703773/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=7
Tom J. Overend, Cathy M. Anderson, Jennifer Jackson, et al.
Abstract: Purpose: To determine current Canadian physical therapy practice for adult patients requiring routine care following cardiac surgery.
Methods: A telephone survey was conducted of a selected sample (n=18) of Canadian hospitals performing cardiac surgery to determine cardiorespiratory care, mobility, exercises, and education provided to patients undergoing cardiac surgery.
Results: An average of 21 cardiac surgeries per week (range: 6–42) were performed, with an average length of stay of 6.4 days (range: 4.0–10.6). Patients were seen preoperatively at 7 of 18 sites and on postoperative day 1 (POD-1) at 16 of 18 sites. On POD-1, 16 sites performed deep breathing and coughing, 7 used incentive spirometers, 13 did upper-extremity exercises, and 12 did lower-extremity exercises. Nine sites provided cardiorespiratory treatment on POD-3. On POD-1, patients were dangled at 17 sites and mobilized out of bed at 13. By POD-3, patients ambulated 50–120 m per session 2–5 times per day. Sternal precautions were variable, but the lifting limit was reported as ranging between 5 lb and 10 lb.
Conclusions: Canadian physical therapists reported the provision of cardiorespiratory treatment after POD-1. According to current available evidence, this level of care may be unnecessary for uncomplicated patients following cardiac surgery. In addition, some sites provide cardiorespiratory treatment techniques that are not supported by evidence in the literature. Further research is required.
http://utpjournals.metapress.com/content/x48632u8807660g7/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=8
Tania Larsen
http://utpjournals.metapress.com/content/p0228114l51j7p13/?p=cadbd2bee6cc442d8bfb5aa87f676449&pi=9
Emilie Pashley, Ashley Powers, Nicole McNamee, et al.
Abstract: Purpose: To describe the clinical and contextual factors that influence physiotherapists' discharge decision-making processes in outpatient orthopaedic settings.
Methods: The study used a descriptive qualitative design that included three key-informant interviews and two focus groups (n=7) of orthopaedic physiotherapists (total n=10) working in the Greater Toronto Area. Interviews and focus groups followed a semi-structured interview guide that included questions pertaining to participants' discharge decision-making processes, salient contextual factors, and challenges. Data were coded and analyzed for emerging categories and themes using constant comparison techniques and group analyses.
Results: Participants indicated that a combination of factors and strategies were brought to bear on discharge decision making but that the process changed with clinical experience. Over time, further emphasis was attributed to the patient's role in his or her rehabilitation, and self-management goals were increasingly promoted. Experience affected how therapists conceptualized their roles in discharge decisions and how they negotiated goals with patients.
Conclusions: Discharge decision making is a complex process that requires integrating numerous factors and negotiating with patients. Physiotherapists' decision-making practices evolve with experience and reveal the complexity of implementing models of “client-centred care” in practice. Further research is needed to explore these findings in other settings.
http://utpjournals.metapress.com/content/0488t85652r76h26/?p=c7942593427048119c217941a6924048&pi=10
Michael A. Hunt, Stephen R. Di Ciacca, Ian C. Jones, et al.
Abstract: Purpose: The purpose of this preliminary investigation was to evaluate the effect of anterior tibiofemoral glides on maximal knee extension and selected spatiotemporal characteristics during gait in patients with knee extension deficits after anterior cruciate ligament (ACL) reconstruction.
Methods: Twelve patients with knee-extension deficits after recent ACL reconstructions underwent quantitative gait analyses immediately before and after 10 minutes of repeated anterior tibiofemoral glides on the operative limb, and again after a 10-minute seated rest period.
Results: Maximum knee extension during stance phase of the operative limb significantly increased immediately after the treatment (mean increase: 2.0°±4.1°, 95% CI: 0.6°–3.3°). Maximum knee extension decreased after the 10-minute rest period (mean decrease: 0.9°±1.8°, 95% CI: −0.1°–1.8°), although the decrease was not statistically significant. Small increases in operative limb step length, stride length, and gait speed were observed after the rest period compared to baseline values only.
Conclusions: A single session of anterior tibiofemoral glides increases maximal knee extension during the stance phase of gait in patients with knee-extension deficits. Increases in knee extension are small and short-lived, however, suggesting that continued activity is required to maintain the observed improvements.
http://utpjournals.metapress.com/content/8750qg3g31k1705h/?p=c7942593427048119c217941a6924048&pi=11
Oren Cheifetz, S. Deborah Lucy, Tom J. Overend, et al.
Abstract: Purpose: Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS.
Methods: Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery.
Results: Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (∼75–78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group.
Conclusion: Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.
http://utpjournals.metapress.com/content/118286g52075v5j1/?p=c7942593427048119c217941a6924048&pi=12
Cessation of Exercise in the Institutionalized Elderly: Effects on Physical Function
Sarah C. Marshall, Katherine Berg
Abstract: Purpose: The objectives of this study were (1) to examine the effects of a 12-week exercise cessation period separating two 12-week exercise sessions on physical variables in an elderly institutionalized population and (2) to explore overall programme effectiveness.
Methods: The functional mobility of 25 elderly institutionalized adults participating in an existing exercise programme was examined using a one-group, interrupted time-series design. Functional mobility was evaluated at four time points during two cycles of a 12-week exercise programme, alternating with a 12-week period of no formal exercise.
Results: The primary outcome was the change in functional mobility scores, assessed at baseline, 12, 24 and 36 weeks. In both the higher-functioning (HF) group and the lower-functioning (LF) group, the cessation of exercise was associated with deterioration in physical function. The overall non-continuous nature of the programming under study also seemed to be detrimental to the physical function of the LF group.
Conclusions: Findings of this small-sample study support the need to modify common practices in exercise programming for older, institutionalized people.
http://utpjournals.metapress.com/content/hg85764583417030/?p=c7942593427048119c217941a6924048&pi=13
Elizabeth Crawford, John M. Biggar, Adrienne Leggett, et al.
Abstract: Purpose: To describe international clinical internships (ICIs) for Canadian physical therapy (PT) students, explore the experiences of individuals involved in ICIs, and develop recommendations for future ICIs based on these findings.
Methods: This study employed a mixed-methods approach. An online questionnaire surveyed academic coordinators of clinical education (ACCEs, n=14) on the availability, destinations, and number of ICIs from 1997 to 2007. Semi-structured telephone interviews were then conducted with eight PT students, seven ACCEs, and three supervising clinicians to investigate their ICI experiences. Interview transcripts were coded descriptively and thematically using NVivo.
Results: ICIs are currently available at 12 of 14 Canadian PT schools. A total of 313 students participated in ICIs in 51 different destination countries from 1997 to 2007. Over this period, increasing numbers of students participated in ICIs and developing countries represented an increasing proportion of ICI destinations. Key themes identified in the interviews were opportunities, challenges, and facilitating factors.
Conclusions: ICIs present unique opportunities for Canadian PT students. Recommendations to enhance the quality of future ICIs are (1) clearly defined objectives for ICIs, (2) additional follow-up post-ICI, and (3) improved record keeping and sharing of information on ICI destination countries and host sites.
http://utpjournals.metapress.com/content/24w117907565717g/?p=c7942593427048119c217941a6924048&pi=14
Celia Pechak
http://utpjournals.metapress.com/content/ax0l8r0921123804/?p=653f0505dcfb4935941de968a0532dfe&pi=15
Hereditary Hemochromatosis: A Literature Review and Case Report
Mary K. Allen
Abstract: Purpose: To improve understanding in the physical therapy (PT) community of hereditary hemochromatosis (HH), a common but little-known iron overload disorder, symptoms of which may mimic other orthopaedic conditions. Medical management typically involves phlebotomy to remove excess iron; however, there is little specific information in the literature on PT management of patients with HH after trauma.
Case description: The patient was a 65-year-old woman with multiple fall-related traumas, including right wrist, thumb, and patellar fractures and left thigh muscle strain with significant ecchymosis and effusion. Medical history included HH. Iron-related lab values had been analyzed 9 days prior to the fall and had demonstrated a steady increase over the previous 4 months since her last phlebotomy.
Outcomes: As the level of exercise and activity increased during the course of PT treatment, the patient developed shortness of breath and increased fatigue. The exercise level in therapy was reduced to accommodate the change in the patient's response. Blood values analyzed 7 weeks after the fall demonstrated a drop in haemoglobin and hematocrit values, while serum ferritin levels had risen.
Implications: Understanding early symptoms and management of a patient with manifestations of HH will better enable physical therapists to consider this disorder as a differential diagnosis or co-morbidity that affects treatment considerations.
http://utpjournals.metapress.com/content/3568u08608877863/?p=653f0505dcfb4935941de968a0532dfe&pi=16
What Does the Cochrane Collaboration Say about Therapeutic Ultrasound?
http://utpjournals.metapress.com/content/k475942217v7t071/?p=653f0505dcfb4935941de968a0532dfe&pi=17
Practical Tips in Finding the Evidence: An Allied Health Primer
Susan R. Harris
http://utpjournals.metapress.com/content/u2lvw21pr612k023/?p=653f0505dcfb4935941de968a0532dfe&pi=18
The official journal of the Canadian Physiotherapy Association (CPA), Physiotherapy Canada is published quarterly and is a scholarly, refereed journal that promotes excellence in physiotherapy by providing an international forum for the publication and review of information generated through research findings and their application, as well as innovation in clinical practice.
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