Physiotherapy Practice and Research

Background: Activity levels and exercise capacity are decreased in Chronic Obstructive Pulmonary Disease (COPD) patients. Pulmonary Rehabilitation (PR) programs can be difficult to undertake, particularly for individuals with severe COPD, who experience incapacitating dyspnoea. Neuromuscular electrical stimulation (NMES) is a passive form of muscle stimulation which does not stress the ventilatory system. This study examined the effects of an 8 week NMES programon the activity levels and exercise capacity of individuals with moderate to severe COPD. Methods: This single group cohort control study was performed with 8 participants of mean (SD) age 61.5 (6.16) years with moderate to severe COPD (FEV₁/FVC range 0.35-0.79 and FEV₁ range 35%-70% predicted). Participants were instructed to carry out NMES training 5 days a week for 8 weeks and were assessed before and after the intervention for activity levels, using a triaxial accelerometer and exercise capacity, asmeasured by the 6 minute walk test (6MWT). Activity levels were expressed as vector magnitude units per min (VMU/min) and percentage of time spent above 500 VMU. Results: Activity levels failed to show statistically significant changes post intervention, but individual changes for VMU/min (p = 0.575) and time spent above 500 VMU (p = 0.327) indicated a trend towards improvement. A statistically and clinically significant improvement for 6MWT distanceswere observed (p = 0.012). No significant correlation between activity levels and exercise capacity was found. conclusions: NMES may be useful adjunct to PR for patients with moderate to severe COPD in order to improve exercise capacity and activity levels.

Background: Although evidence suggests that a previous injury can affect kinematic landing patterns in athletes, to date no research has been conducted on kinematic landing strategies in Gaelic Football players. Previous literature examining kinematic landing strategies have focused on sports other than Gaelic Football. The purpose of this study is to assess if previously injured limbs of elite male Gaelic Football players display differing kinematic landing strategies to uninjured limbs of the same population. Methods: Eleven members of the University of Limerick's Senior Male Gaelic Football panel participated. Analysis was carried out upon twelve previously injured limbs and ten uninjured limbs. Sagittal plane kinematic data were recorded for hip, knee and ankle joints when landing from a 60cm height. Results: The results of the study showed that the uninjured limbs (N=10) had significantly greater peak dorsiflexion (6.7°, p = 0.009) than the previously injured limbs (N=12). All other findings were not deemed statistically significant (p>0.05). Conclusions: The results of this study indicate that differences may exist between the landing strategies of previously injured and uninjured limbs in male Gaelic footballers which could potentially increase the risk of injury and re-injury.

Contemporary evidence shows the Single leg squat has evolved into a functional test and is now being used clinically by some practitioners. This review describes the evolution of the Single leg squat test and its role within the examination of musculoskeletal function. It examines the evidence relating clinical assessment using the Single leg squat test to the mechanics of walking and discusses the possible outcomes of the Single leg squat test and its interpretation. Papers were obtained through a search of electronic databases cinahl, medline, science direct, sport discus and ovid from inception, with various combinations of the terms “Single leg”, “Squat,” “Dip,” “Pelvis”, “Stability” and “Test.” An additional manual search was made of relevant bibliographies without limitation for year of publication.

Background: The “snapping” biceps femoris tendon is an unusual cause of lateral knee pain. Two cases, documented here, stimulated a systematic review in order to determine whether it was possible to synthesise a set of common presenting signs for this condition, and to determine the optimal intervention for this presentation. Methods: Detailed descriptions of the cases are provided. The systematic review comprised of searching MEDLINE, EMBASE, CINAHL, AMED and SportsDiscus, and citation tracking. Results: The review only generated published case reports or case series (Fourteen operated knees in total). No other forms of study on this condition exist in the literature. Synthesis of these cases revealed the following most commonly occurring signs in the presentation of this disorder: male gender; “snapping” of biceps femoris tendon over head of fibula between 75 and 120 degrees leading to lateral knee pain; atraumatic onset; failure of conservative treatment; aggravated by sport, stair climbing and squatting; normal imaging; and tenderness on palpation of tendon insertion. Conclusion: This study is the first to synthesise all currently published cases in an attempt to facilitate recognition of this disorder. There are commonly occurring signs that the clinician should be able to easily recognise. In all cases where there was a documented attempt at conservative management the subjects failed to improve with this intervention, and all responded well to surgery being pain free and asymptomatic at follow-up (Two weeks to three years) and returning to previous levels of sporting activity where documented.

Background: Renal dialysis patients are less active than the general population. However, little information exists in the literature regarding the perceived barriers experienced by renal dialysis patients which prevent them from becoming more physically active. The aims of this study were to determine both the self-reported level of physical activity of renal dialysis patients and the barriers to increased physical activity perceived by them, and to establish the level of interest among renal dialysis patients in a number of physical activity promotion measures. Methods: Postal questionnaires were sent to 171 renal dialysis patients under the care of a consultant nephrologist at Cork University Hospital, requesting information on their current level of physical activity, reasons for being unable to increase their activity level, and their interest in various suggested physical activity promotion measures. Results: Responses were received from 78 renal dialysis patients. Of these, 25 reported exercising three or more times per week; the remainder less than three times per week (eight non-replies). Feeling “too tired” was the most predominant barrier to increased physical activity reported (31 respondents). Intra-dialytic exercise (28 respondents) and a home exercise programme (23) were the most popular suggested physical activity promotion measures among respondents. Conclusion: Education on the importance of exercise in patients on renal dialysis is vital, with emphasis on the many activities that can be considered “exercise”.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used and recommended in the treatment of acute and chronic soft tissue injury. Despite some benefits in reducing inflammation and pain, these drugs can also have adverse side-effects, as well as potentially harmful effects on the rate and quality of tissue healing. The aim of this narrative review is to outline the purported effects of NSAIDs when used in the treatment of acute and chronic musculoskeletal conditions. A secondary aim of this manuscript was to illicit information about physiotherapist's knowledge of and opinions on the use of NSAIDs for acute and chronic musculoskeletal conditions.