Physiotherapy Practice and Research

INTRODUCTION: Gluteal muscle control plays a vital role in the entire lower extremity kinematics and their weakness is observed in individuals with an ankle sprain. However, the relationship between gluteal muscle strength and balance in individuals with chronic ankle instability is not known.

METHODS: Thirty-two individuals with chronic ankle instability (CAI) participated in the study (mean age = 24±2 years, height = 154.1±6.3 cms). Maximal isometric strength (lbs) of gluteal medius and gluteus maximus was measured using hand-held dynamometer. Balance was measured using the Star Excursion Balance Test (SEBT) and the reach distances were calculated normalizing to limb length. Pearson’s Product-Moment Correlation was used to examine the relationship between gluteal muscle strength and balance.

RESULTS: Mean composite SEBT test scores were (Mean/SD = 96.13/7.32) and were positively correlated with isometric gluteal muscle strength scores (G med Mean/SD = 25.6/8.4 lbs, G max Mean/SD = 31.4 /6.3 lbs). There was a good relationship between gluteus medius strength and balance scores and a weak relationship between gluteus maximus strength and SEBT scores in individuals with CAI.

CONCLUSION: The present study found that there is moderate to a good relationship between isometric gluteal muscle strength and balance in participants with chronic ankle stability.

BACKGROUND: Advanced practice physiotherapist (APP) triage posts were set up as a waiting list initiative in orthopaedics and rheumatology in the public healthcare setting.

PURPOSE: The purpose of this study was to perform an analysis of embedded physiotherapists’ opinions on a new national initiative, across multiple centres in the Irish public healthcare setting.

METHODS: This was a multi-stage project, involving semi structured interviews and self-reported questionnaire. Data were analysed using inductive qualitative methodology, with descriptive statistics, chi squared tests and odds ratios for quantitative data.

RESULTS: Seventy nine percent (n = 19/24) of respondents felt that they had a good relationship with their consultant(s); while 48% (n = 12/25) were satisfied with the triage setup. By comparison to services where APP clinics operated independently from routine orthopaedic clinics, APPs were 5.4 times more likely to be satisfied if their clinic was located within the consultant clinic ‘greater than 75% of the time’ (99% CI, 1.22–23.96), decreasing to 2.71 times if in consultant clinics ‘50–75% of the time’ (99% CI, 1.26–5.84). Respondents also expressed higher satisfaction if greater than 50% of their educational opportunities (formal and informal) were within the consultant-led team setting (OR 1.64, CI 95% 1.00–2.68). Themes emergent from qualitative analysis were importance of the relationship with consultant and team; lack of formal educational opportunity; and concerns regarding access for patients to further investigations (e.g. radiology), consultant review and physiotherapy treatment.

CONCLUSIONS: Specific triage models, team interaction and educational opportunities vary, influencing therapist satisfaction. Recommendations are made regarding future service provision and policy.

INTRODUCTION: This study aimed to compare the immediate effects of Posterior Anterior (PA) L4 and L5 mobilisations on range of motion and muscle activity measures in the lumbar and hamstring regions of asymptomatic individuals.

METHODS: Thirty-eight participants were randomly allocated to a mobilisation (n = 20) or control (n = 18) group. The mobilisation group received central PA mobilisations to the L4 and L5 vertebrae, three times for two minutes. The control group received no mobilisation. Pre- and post-test measures included lumbar range of motion, measured by the modified Schober test and hamstring extensibility by the active knee extension test. Local Erector Spinae and Biceps Femoris muscle activation were also measured by surface Electromyography. Data were analysed using magnitude-based inferences.

RESULTS: Lumbar mobilisations had a most likely beneficial effect on active lumbar flexion 18.6% (90% CL 11.8 ± 25.8%) and active knee extension range 22.8% (–29.6 ± 15.2%). Mobilisations had a possible beneficial effect in sEMG activation reduction of the Erector Spinae –4.7% (–10.5 ± 1.4%) and Bicep Femoris –6.1% (–13.1% ± 1.6%) during lumbar flexion. Likely beneficial effects of reduced sEMG were found following mobilisations during the active knee extension test for the Erector Spinae –18.3% (–27.7–7.6%) and Biceps Femoris muscle activity –20.8% (–30.9 ± 9.2%).

DISCUSSION: L4 and L5 mobilisations increase lumbar and hamstring range of motion in the immediate term. Our unique finding was that, in this sample population, muscle activity in both local Erector Spinae and Biceps Femoris reduced, most likely due to the mobilisations applied.

AIMS: Pulmonary rehabilitation is of proven benefit in improving function and health-related quality of life in patients with COPD; however long-term maintenance is poor. Though reasons for this are not fully understood, psychological concepts such as Health Locus of Control (HLOC) may be of interest. This exploratory study aimed to investigate whether HLOC can be altered through pulmonary rehabilitation.

METHODS: A non-randomised uncontrolled before/after design was used. Eligible participants with a diagnosis of COPD and attending their first pulmonary rehabilitation programme were invited to participate. The intervention consisted of standard pulmonary rehabilitation care – a six-week course comprising twice-weekly group-based exercise and education sessions. Participants completed the Multidimensional Health Locus of Control Form-C (MHLC-C) and standard assessments pre (baseline) and post the six-week programme.

RESULTS: Ninety-six patients were invited to participate, 46 consented and 20 completed both pre-and-post study outcomes. Significant improvement between pre-and-post tests were found for two MHLC-C dimensions (Internal: mean increase 5.4, p = 0.012 and Doctors: mean increase 2.1, p = 0.016).

CONCLUSIONS: Though limited by methodological issues, the results tentatively suggest that HLOC can be significantly altered through group-based pulmonary rehabilitation, potentially through enhanced self-management and education strategies empowering patients. Further investigation of these findings and the relationship with long-term maintenance is warranted.

BACKGROUND: This study investigated the clinical effectiveness of a newly developed primary care group exercise programme for people with Parkinson’s disease (PD) in terms of balance, functional mobility and self reported outcomes. A secondary aim was to explore participant’s perceptions of the programme and barriers to participation.

METHODS: A cohort study with measures pre/post/three month post intervention was carried out. Outcomes included the Six Minute Walk Test (6MWT), Timed Up and Go test (TUG), Lindop Scale, Functional Reach Test (FRT), Berg Balance Scale (BBS) and Parkinson Disease Questionnaire-39 (PDQ-39). The intervention was a once weekly, hour long circuit-based exercise class, with an educational component. Two focus groups were conducted.

ANALYSIS: Changes from pre to post and pre to three months were tested using paired sample ‘t’ tests, Wilcoxon signed ranks tests and chi square tests. Bonferroni corrected statistical significance was set at p < 0.025. Qualitative data were subject to thematic content analysis.

RESULTS: Fifteen participants, 11 male, 4 female of mean age 72 years and mean Hoehn and Yahr rating 2.5, were included. Clinically and statistically significant changes (p < 0.025) in BBS, FR and PDQ-39 were found after exercise participation and these were sustained after three months. There was a trend for declining proportion of patients falling at follow up (40% in 3 months prior to programme v 10%). Emerging qualitative themes included enjoyment and perceived functional improvements.

CONCLUSION: This research reveals the effectiveness of this programme in improving balance, functional mobility and QoL. Participants perceived numerous benefits and suggested areas for improvement. Developing similar programmes around Ireland could optimise future healthcare management for the PD population.

STUDY DESIGN: Longitudinal test re-test.

OBJECTIVES: To investigate the reliability of isokinetic dynamometry at measuring concentric and eccentric plantarflexion torque in knee flexion and extension.

BACKGROUND: Plantarflexor muscle deficits are associated with Achilles tendon disorders. Isokinetic testing is often completed in knee extension to assess force production from both Gastrocnemius and Soleus but testing can also be completed in higher degrees of knee flexion to inhibit Gastrocnemius biasing testing to Soleus in relative isolation. The reliability of these methods of testing has not been robustly determined.

METHODS: Thirty-seven physically active healthy volunteers underwent bilateral testing using concentric speeds of 90°/s and 225°/s, and an eccentric speed of 90°/s, in knee extension and 80° knee flexion. A test re-test methodology was employed. Peak Torque, Work and Average Power were assessed using best repetition data. Intra-class correlation coefficients (ICC), absolute standard error of measurements (SEM) and minimal detectable change (MDC) where calculated for all variables.

RESULTS: ICC data for peak torque values were 0.73–0.87, work per repetition values 0.73–0.86 and average power per rep values of 0.72–0.85, whilst ICC values for peak torque data represented as a percentage of body weight (% BW) were 0.61–0.83, 0.62–0.84 and 0.59–0.82 respectively. MDC ranged from 2.1–35.9. These results suggest a relatively low to moderate change is required to be confident of an actual change in force output. Five parameters fell below 0.7 ICC threshold, all were measures of the left leg in a flexed knee position.

CONCLUSION: Isokinetic dynamometry was reliable for testing plantarflexor torque in knee extension and flexion. Expressing data as a % BW is slightly less reliable when testing the non-dominant leg. The reported MDC is around the observed change reported in intervention studies.

BACKGROUND: Torticollis in infancy is frequently managed by physiotherapists working in paediatrics. However, the assessment and physiotherapy treatment of torticollis in infancy has not been reported adequately in the literature.

OBJECTIVES: To explore the assessment and management of infants with torticollis by physiotherapists in Ireland.

METHODS: An online survey was conducted among members of the Irish Society of Chartered Physiotherapists’ clinical interest/employment groups, specifically: Chartered Physiotherapists in Community Care; Chartered Physiotherapists in Paediatrics; Chartered Physiotherapists in Private Practice; and Chartered Physiotherapists in Women’s Health and Continence.

RESULTS: Sixty-seven physiotherapists completed the survey. There was a high level of agreement amongst physiotherapists regarding what subjective information is sought at initial assessment. However, there was less agreement on the nature of the objective assessment. There was a high level of agreement in the use of assessment techniques for both cervical spine range of motion and posture, with the vast majority of respondents using visual estimation for both. The most common treatment techniques used are positioning, handling and neurodevelopmental facilitation.

CONCLUSIONS: This study explored the physiotherapy assessment and management of torticollis in infancy in Ireland. This survey identified that there was a lack of consensus on the objective examination used with infants. It is recommended that physiotherapists include screening for fine motor and hip asymmetries in their assessments and that a pathway of care is developed including access to further specialists and investigations.