Physiotherapy Practice and Research

Background: Global epidemiological trends indicate that lifestyle related conditions will dominate illness care for the foreseeable future. With physical inactivity an established risk factor for these conditions, physical activity and exercise prescription have increasing relevance to physiotherapy practice. Purpose: In terms of physical activity and exercise prescription for healthy and clinical populations, the purpose of this study was firstly, to determine senior physiotherapists' knowledge and establish whether a postgraduate qualification enhanced this knowledge and secondly, to investigate their attitudes and beliefs relating to the role of physiotherapy in contemporary practice. Methods: One hundred senior physiotherapists from 27 health care settings throughout Ireland were invited to participate. Each therapist was sent a questionnaire (specifically developed for use in this study). It included seven key sections (73 questions) relating to physical activity and exercise prescription. Three open-ended questions invited comment on priorities for the profession in terms of future practice. Quantitative data was analysed using the Statistical Package for Social Science (SPSS version 18) and a ‘Framework analysis’ methodology was utilised for qualitative analysis. Results: A 71% (n = 71) response rate was achieved. All respondents reported having a specific interest in physical activity and exercise prescription. However, just over half (55%) were aware of international guidelines for physical activity. The following were identified as areas in which the physiotherapists felt they required greater proficiency: exercise prescription for healthy sedentary populations; interventions to promote physical activity and strategies to improve physical activity adherence and exercise prescription for lifestyle-related conditions. Those with a postgraduate qualification reported were significantly more knowledgeable in this field than those without. The main themes that emerged from the open-ended questions were (i) barriers preventing physiotherapists from being experts in physical activity promotion and exercise prescription and (ii) perceptions of the role of the contemporary physiotherapist. Conclusion: Senior physiotherapists identified a need for further education in the areas of health promotion and strategies to improve physical activity adherence. Furthermore, they advocated that contemporary physiotherapists adopt a more prominent role in wellness and prevention, both in the clinical setting and the community. Results of this study provide useful data to inform future developments in physiotherapy undergraduate and postgraduate education. Physical activity and exercise have increasing relevance to contemporary practice in particular in securing a central role for physiotherapists in the prevention and management of lifestyle related conditions.

Background and purpose: The Stroke Impact Scale 16 (SIS-16) total score (TotSIS-16) as a self report of physical function has previously been associated with falls, but the relationship of individual SIS-16 items to fall history has not been examined. The purpose of this study was to examine the accuracy of individual SIS-16 items compared with TotSIS-16 in identifying falls history in people with chronic stroke. Methods: Forty-three people were categorized according to prior 6 month fall history as having either No falls (NF; n = 23) versus any fall (AF; one or more fall; n = 20). Group comparisons (AF versus NF) were made for individual SIS-16 item scores and the TotSIS-16 to identify items significantly related to fall history. Significant items were further analyzed for sensitivity (Sn) and specificity (Sp) of specific cutoff scores for identifying individuals with fall history. Results: TotSIS-16 and items related to balance, mobility and urinary continence had high Sp (0.70–0.96) useful for ruling in a history of falls while only the item “Balance while Walking” had Sn (0.89) useful for ruling out falls. Discussion and conclusions: Individual SIS-16 items may be useful for ruling falls in (high Sp) or out (high Sn), depending on the clinical need. One or two items used together may be more accurate than the TotSIS-16 score. Study of a larger sample is needed to confirm these results.

Background: A superior tibiofibular joint (STFJ) mobilisation is commonly used in the management of lower limb dysfunctions of a neural origin. Evidence for the efficacy of this treatment technique is equivocal. The aim of this study was to investigate the effect of mobilisation techniques on the plantar flexion inversion straight leg raise (PFI SLR) test, on asymptomatic subjects. Methods: The study is a prospective, within subjects' quasi-experimental design. Fifteen subjects were randomised into three groups. Each subject underwent three interventions: STFJ mobilisation, placebo mobilisation (lateral patellar glide), and a control ‘intervention’ (no treatment). The order of interventions varied according to group allocation. PFI SLR was assessed using an inclinometer by the lead researcher, who remained blinded to the group allocation. Results: There was a significant increase in range of PFI SLR following the STFJ intervention, and the placebo intervention. On comparison of the mean change in range between the three groups, the change in STFJ intervention was significant when compared to the placebo and control groups. Conclusions: Both STFJ and placebo interventions resulted in a significant improvement in PFI SLR. The mechanisms causing these effects are unknown. Further research is required with symptomatic individuals to clarify the clinical significance of these findings in different lower quadrant conditions, including back pain, referred leg pain, and ankle inversion sprains.

Objectives: Interferential therapy (IFT) is a common electrophysical agent used by physiotherapists for pain management. However, there is ongoing debate regarding the hypoalgesic and neurophysiologic mechanisms by which IFT reduces pain. This study aimed to investigate the effect of IFT on plasma beta-endorphin (BEND) levels in the rat model as a proposed analgesic mechanism of IFT. Methods: Twelve adult male Wistar rats received an intra-plantar injection of 0.15 ml of Freund's complete adjuvant (FCA) into the right hind paw under anaesthesia. Five days post FCA, the rats were anesthetized and were divided into two groups (n = 6). One group received IFT at 4 Hz for 20 minutes on the inflamed paw while the other group received sham IFT. One ml of blood was withdrawn from the tail vein of both groups before IFT application but after anaesthesia and then again at the end of the 20 minutes of IFT/sham IFT. Collected blood was centrifuged and plasma was removed for analysis of BEND. Concentrations of BEND were measured in the plasma using ELISA radioimmunoassay. Results: There was a slight increase in the BEND levels in the treatment group following 20 minutes of IFT. However, this increase was not statistically significant neither within (Z = −0.314, P = 0.753, Wilcoxon test) or between the treatment and sham groups (Z = −0.363, P = 0.79, Mann-Whitney U test). Conclusion: The findings suggested that the release of plasma BEND may not be the mechanism by which 4 Hz IFT have an analgesic effect.