Physiotherapy Practice and Research

INTRODUCTION: Falls among community-dwelling older adults are a common yet often preventable occurrence. Clinicians frequently use task-based assessment tools to evaluate clients' balance and mobility with the aim of predicting falls and providing targeted fall prevention interventions, but no consensus exists on the optimum tool(s) to use for this purpose. This review aims to identify the task-based assessment tools that can best predict falls among community-dwelling older adults. METHODS: Online databases Academic Search Complete, AMED, Biomedical Reference Collection: Expanded, CINAHL Plus, MEDLINE, General Science, and SPORTDiscus were searched from 1983 to 2013 to identify prospective studies assessing the performance of specific tasks in order to predict falls. Following screening, the methodological quality of studies included for review was appraised using a checklist based on the Critical Appraisal Skills Programme tool for cohort studies [1]. RESULTS: Thirty-seven studies, dating from 1996 to 2013 and largely of high methodological quality, were included in this review. A range of task performance-based assessment tools suitable for use in both clinical and laboratory settings were identified. CONCLUSIONS: Strong evidence in favour of using the Timed Up-and-Go test, Five Times Sit-to-Stand test and assessments of gait speed to predict falls among this population in clinical settings was found, along with weaker evidence for tests of standing balance and reaching task performance. Laboratory-based assessments of postural sway and gait variability were also found to predict falls. Incorporating the recommended assessment tools into comprehensive assessments of community-dwelling older clients can lead to improved falls prediction by clinicians.

BACKGROUND: In order to develop the necessary falls and fracture prevention strategies a review of current services is required. METHODS: All 32 Primary Care Local Health Offices (LHO) in Ireland were surveyed. AIMS: To profile physiotherapy-led bone health and falls prevention services operating within the primary care structure in Ireland. RESULTS: Seventy nine per cent (n = 23) of LHOs had at least one programme operating managed in all cases by senior physiotherapists. Falls prevention programmes (72%) were most prevalent while (35%) of programmes targeted bone health. General Practitioners (87.5%) were the most common referral source and prior fall the principal referral reason. A majority of programme participants were in the 70–80 year age range. Exercise components reflected clinical guidelines, focusing on balance and strength training. Interventions were modelled on the Otago (50%), Later Life Training / FaME (29%) programmes. The absence of client follow-up post programme for measurement of falls or fracture incidence or health service utilisation was notable. Barriers to programme development included inappropriate venues, lack of patient transport, financial and staffing restraints. CONCLUSIONS: Most LHOs provided some form of evidence-based programme however it is unlikely that current service levels meet population needs. Barriers to service expansion were identified.

BACKGROUND: Extended Scope Physiotherapist (ESP) posts have been set up to reduce long waiting lists in orthopaedic clinics. The purpose of this study was to evaluate the activity and outcomes of an ESP clinic within the Irish health care system. The specific aims were to: (i) examine the proportion of patients managed independently by the ESP, (ii) analyse the accuracy of an ESP's clinical diagnosis, and (iii) to calculate the conversion rate to surgery of patients referred for orthopaedic consultation. METHODS: All knee pain patients referred to the Knee Screening Clinic (KSC) from November 2010 to December 2011 were included in this audit. A prospective audit was carried out in relation to patient demographics, baseline clinical characteristics and a KSC clinical care pathway. Medical records were reviewed retrospectively of patients referred onward for orthopaedic consultation, to investigate their outcomes. RESULTS: 140 patients were included in the study. The ESP independently managed 59.3% of patients. The remaining 40.7% of patients were referred on for orthopaedic surgical consultation. Of these, 84% underwent surgery. ESP clinical diagnostic accuracy was ‘substantial’ (percentage agreement = 88%; κ = 0.795 (95% CI, 0.58–1.00)). CONCLUSIONS: The majority of patients (59.3%) referred to the orthopaedic clinic did not need to see an Orthopaedic Surgeon. The ESP clinical diagnostic accuracy was ‘substantial’ and the high conversion rate to surgery suggests that appropriate patients were referred on for orthopaedic consultation. The results of this study provide some evidence supporting the role of ESPs in orthopaedic triage.

Accurate assessment of pain or sensory function in clinical practice is challenging. Quantitative Sensory Testing (QST) is a standardized approach to measuring pain and sensory thresholds or tolerances as a means of assessing the functionality of neural pathways from the receptors along the afferent fibers to the brains. This paper reviews two simple QST techniques potentially useful to clinical practice: the Cold Stress Test and Ten Test. The background, evidence for clinical measurement properties and feasibility issues are considered.

Pregnancy-related lumbopelvic pain is a term used to describe pain emanating from the lumbar spine or pelvic girdle that develops either during pregnancy or in the immediate post-partum period. Although it is estimated that up to 70% of pregnant women will report lumbopelvic pain at some point during their pregnancy, there is a paucity of literature pertaining to the prevention of the condition. This study was therefore undertaken in order to explore the feasibility of a larger-scale study into the prevention of pregnancy-related lumbopelvic pain using a single exercise and advice-based physiotherapy intervention in early pregnancy. Several aspects of feasibility were addressed and it was highlighted that several modifications would have to be made to the protocol in order to ensure successful completion of a larger-scale study. The tendency towards improved outcomes in the study group was however an encouraging finding and supports the need for further research in this field.

BACKGROUND: Post-stroke fatigue is common in chronic stroke survivors. Improving gait and balance performance are important in stroke rehabilitation. For optimal rehabilitation, it is important to know how these are associated with post-stroke fatigue. This study explored the relationship of functional limitations due to post stroke fatigue with gait and balance performance in stroke survivors undergoing physiotherapy. METHODS: This was a cross-sectional study involving 70 stroke survivors (41 males, 29 females) with ages ranging from 42 to 76 years (mean 53.7 ± 11 years). Fatigue was assessed with Modified Fatigue Impact Scale (MFIS); gait speed and cadence were assessed with observational gait analysis; balance performance was assessed with Berg Balance Scale (BBS); and fall efficacy was assessed with Fall Efficacy Scale (FES). RESULTS: The mean MFIS score, gait speed, cadence, BBS score and FES score were 37.94 ± 11.78, 0.32 ± 0.23 m/s, 58.32 ± 28.35 steps/minute, 45.64 ± 6.62, 36.42 ± 26.21 respectively. Twenty six (37.1%) participants often experienced functional limitations due to fatigue. MFIS scores had no relationship (p > 0.05) with gait (gait speed and cadence) and balance (balance performance and fall efficacy). CONCLUSION: This study concluded that fatigue, which occurs frequently, is not related to gait and balance performance. Fatigue should be assessed in all stroke survivors during rehabilitation without considering their physical function, such as walking ability and balance.

The overall objective of this study was to evaluate current Irish undergraduate physiotherapy education in relation to the promotion and prescription of physical activity and exercise for healthy and clinical populations and to devise recommendations for future education in this field to ensure professional entry-level physiotherapists are optimally prepared for contemporary practice. The evaluation consisted of a content analysis of current Irish BSc Physiotherapy programmes (n = 4) and four additional studies involving key stakeholders; final year students (n = 62) clinical educators (n = 30), academic educators (n = 27) and experienced physiotherapy clinicians (n = 72). Four key areas were identified as requiring attention in order to optimise physical activity and exercise education. These key areas are (i) curriculum content, (ii) curriculum context (relating to where the curriculum is delivered), (iii) teaching and learning strategies (and levels of learning) and (iv) curriculum design and development. The evaluation in its entirety is explored in this paper under these four main headings. Results are summarised and followed by a discussion of the implications of findings for professional entry-level physiotherapy education. Both the findings and their implications are drawn together in this way to provide a coherent picture of the new knowledge generated by this work and its potential impact on physiotherapy education. Based on this newly generated knowledge, recommendations for future physiotherapy education in terms of physical activity and exercise promotion and prescription are provided. These recommendations are accompanied by an illustrated sample curriculum for contemporary education. Methodological limitations are addressed and discussed and avenues for future research are highlighted.