Physiotherapy Practice and Research

Two key factors will determine the demand on the physiotherapy profession in contemporary Ireland in the future. Firstly, the shift towards primary care, with a focus on prevention and health promotion and secondly, the chronic conditions that will dominate illness care for the foreseeable future are incontestable given lifestyle profiles and changing life expectancies. For physiotherapists to become effective first contact primary care providers, their role must change from one exclusively geared towards illness, disease and disability to one that provides greater emphasis on the health and wellness, and prevention of 21st century health concerns, specifically, lifestyle related diseases. Modifying lifestyle practices (risk factors) such as tobacco use, excessive alcohol consumption, poor nutrition, weight gain and physical inactivity is listed as a major priority by the Health Services Executive (HSE), given that an escalating number of children, as well as over half Irish adults have one or more manifestations of lifestyle related conditions. Research has shown that a successful assault on lifestyle conditions is more likely achieved by addressing lifestyle rather than primarily focusing on symptom reduction, indicating that health assessment and risk factor modification, undoubtedly, warrant being 21st century physiotherapy competencies. Based on historical precedent and evidence, this article highlights how physiotherapists, by exploiting interventions such as health education, physical activity and exercise, can play a major role in prevention and in some cases, reversing the tide of lifestyle related conditions. Furthermore, the current transition to primary care, with a focus on prevention and health promotion, will facilitate Irish physiotherapists to affect public health practice in every person and patient. Physiotherapy in Ireland could lead the way globally by serving as a model of change.

Background: Altered proprioception may be a factor in low back pain (LBP). Sustained end-range flexion appears to reduce proprioceptive acuity, as assessed by joint reposition sense, in healthy subjects. However, no study has investigated whether this occurs with shorter periods of lumbo-pelvic flexion or extension. The aim of this study was to examine the effects of a brief period (180 seconds) of sustained lumbo-pelvic spine extension and flexion on repositioning sense in pain-free subjects, compared to immediate repositioning sense (5 seconds). Methods: Lumbo-pelvic repositioning sense was measured in 17 pain-free subjects. Participants were required to replicate a defined target position of the lumbo-pelvic region after: (a) lumbo-pelvic extension of 5 seconds and 180 seconds; and (b) lumbo-pelvic flexion of 5 seconds and 180 seconds. Results: Two-way ANOVA's (duration x direction) found no significant differences (p>0.05) in repositioning accuracy, in terms of either absolute error (AE) or constant error (CE). There were no significant effects for direction (AE, p=0.244; CE, p=0.298), duration (AE, p=0.756; CE, p=0.657) or their interaction (AE, p=0.340; CE, p=0.288). Conclusions: Lumbo-pelvic repositioning sense was not altered after a brief period of either sustained extension or flexion. The duration which the postures were sustained for may have been insufficient to alter repositioning sense. While prolonged end-range lumbo-pelvic postures may increase vulnerability to pain and injury, it is unclear what constitutes a safe duration of exposure to end-range postures.

Aims: To explore the attitudes of people with COPD to exercise and reasons for non-concordance with exercise maintenance post-pulmonary rehabilitation. Methods: A qualitative study using a focus group of six people recruited through the patient support group Breathe Easy. Mean age = 69.3 years. COPD disease severity, as defined by GOLD, ranged from moderate (n=4) to severe (n=1) to very severe (n=1) with Medical Research Council dyspnoea scores of 2 (n=5) and 4 (n=1). All subjects had completed a pulmonary rehabilitation programme and were exercising at the time of the study. The data was analysed using inductive thematic analysis and the results subjected to peer and member checking. Results: From the focus group discussion, three main themes were identified: • effects of exercise • facilitators of exercise • barriers to exercise The effects of exercise were perceived to be mainly positive, although tiredness was also mentioned. Facilitators of exercise included encouragement, company, professional support, goal setting, personal attributes, and availability of a range of exercise options. Barriers to exercise included changing health status, fear, lack of support, and environment. Conclusion: The above themes may guide service providers in planning maintenance exercise sessions and in assisting people with COPD to strengthen exercise facilitators and overcome barriers to exercise. As individuals have different needs and their health status and circumstances change, communication needs to be ongoing and the exercise maintenance adaptable. A range of exercise options need to be available and combined with professional support, goal setting, encouragement, company and a suitable environment.

Patients with PCL injuries may present with vague knee symptoms, or may be asymptomatic and unaware they have had a ligament injury. The PCL can be injured in a variety of ways, but the two predominant mechanisms are motor vehicle accidents and athletic injuries. Accurate diagnosis of the injury is of paramount importance in ensuring the correct management plan. Partial tears will generally be managed conservatively, whereas complete and combined ligamentous injuries will usually require surgical intervention. Outcomes from PCL injuries can be good to excellent providing an accurate diagnosis is made and an appropriate management plan is followed.

Background: People with spinal cord injury (SCI) are exposed to the development of comorbidities secondary to a decreased ability to exercise and pathological complications. Aerobic exercise has been advocated as a means of preventing the development of these illnesses. Previous research has indicated that functional electrical stimulation (FES) provides an appropriate aerobic stimulus in an SCI population to provide cardiovascular fitness gains. However, FES devices are time consuming for both clients and medical staff in a rehabilitation and home setting with devices often expensive. Our research group have developed a novel neuromuscular electrical stimulation (NMES) system which may provide an alternative to FES and elicit a similar response. Methods: A 40 year old male with a T6 incomplete SCI, undertook 6 weeks of NMES training for one hour, five days per week. Pre and post intervention measures include a treadmill VO2 peak test, a DXA scan and subjective feedback regarding the NMES device and training stimulus. Results: Improvements in VO₂ peak, heart rate and exercise tolerance were observed with minor decreases in total body fat mass. The participant reported that the NMES was an acceptable form of cardiovascular training. Conclusion: Our pilot case study has indicated that our NMES system is capable of eliciting an aerobic training effect in people with SCI, which could potentially improve their cardiovascular fitness. Further study with a greater number of participants is warranted in this population using a similar training program.