Physiotherapy Practice and Research

Proximal humeral fractures (PHFs) are common fractures in older adults and their prevalence is on the rise. Recovery following this fracture can be complex and disabling. Treatment varies from non-surgical management such as immobilisation to surgical procedures, with choice dependent on type and severity of fracture and patient health.

Several systematic reviews have considered the evidence for non-surgical versus surgical management of PHF in older adults. This commentary considers these findings for clinical practice and further research.

Three systematic reviews exploring non-surgical versus surgical management were selected based on the quality of their included evidence, and individually critically appraised. Findings from the reviews were reported for each outcome, and the implications considered for clinical practice and future research.

Findings from the three reviews suggest that surgical management of PHF in older adults does not result in better functional outcomes or quality of life and non-surgical management should achieve acceptable upper limb function while decreasing the risks of surgery. More complex three-part fractures may also be managed non-surgically with fair to good functional results relative to fracture severity.

The findings align with current guidance to offer non-surgical management to uncomplicated cases of PHF in adults and older adults. More complex three-part PHFs may also be managed well non-surgically. There is however a lack of evidence and guidance on the specifics of rehabilitation for this type of management and further research is needed to evaluate the factors that contribute to the effectiveness of non-surgical interventions.

Chronic low back pain (CLBP) significantly impairs function and productivity, emphasizing the need for effective solutions, with virtual reality (VR) emerging as a novel alternative for management.

The aim of this systematic review and meta-analysis was to examine the effects of VR interventions on pain, disability and kinesiophobia, compared with other therapeutic interventions in CLBP patients.

In July 2023, we searched PubMed and PEDro databases for studies that examined the effects of VR interventions on pain, disability or kinesiophobia in adults with CLBP. Using a meta-analysis with a random-effects model, we derived the standardized mean difference as the pooled effect.

We found 33 studies, 22 of which were eligible for meta-analysis. Most studies were of good quality, with 12/22 reaching a score between 6 and 8 points on the PEDro scale. VR demonstrated superior results compared to placebo (SMD = –1.90; 95% CI = –3.60 to –0.20; p = 0.03), no intervention (SMD = –1.66; 95% CI = –2.49 to –0.83; p < 0.001), exercise (SMD = –0.61; 95% CI = –1.06 to –0.16; p = 0.008), and VR combined with physical therapy showed greater efficacy than exercise combined with physical therapy (SMD = –1.42; 95% CI = –2.33 to –0.52; p = 0.002) in pain intensity outcome. However, no significant differences were found for disability outcome.

VR interventions are superior to non-VR interventions in terms of improving pain intensity in CLBP patients, but not also for disability outcomes. Further research is needed for conclusive insights into VR’s efficacy.

Lung volume reduction (LVR) procedures can improve quality of life and survival in appropriately selected individuals with emphysema. LVR is recommended in national and international guidelines for the management of chronic obstructive pulmonary disease. Between 2016 and May 2023, less than 300 procedures were completed in the Republic of Ireland (ROI). Therefore, this survey of Irish Thoracic Society (ITS) members aimed to explore respiratory healthcare professionals’ knowledge of the LVR referral pathway and criteria. It also aimed to identify and understand any obstacles which currently limit referral and assessment for LVR procedures as well as any training needs which may exist.

An online survey was developed and distributed to ITS members in April 2023. The survey focused on respondents’ knowledge of the LVR service, perceptions of LVR procedures and understanding of the referral pathway and criteria.

There were 84 responses from 423 potential respondents, with a response rate of 20%. Most respondents are aware of the LVR service in the Mater Misericordiae University Hospital, with 30% reporting good knowledge of the eligibility criteria and 18% reporting a good understanding of the referral pathway. Appropriate patient selection and surgical complications are the main concerns cited by respondents.

Work is needed to develop the knowledge and understanding of LVR procedures and referral process in ROI, particularly the eligibility criteria and referral pathway. Survey responses highlight the need for educational resources around LVR and this research will help to give focus to the development of these resources.

In March 2020, on the recommendation of the Chief Medical Officer, routine elective hospital medical activity was suspended and a national ‘stay at home order’ was implemented for a period of 16 weeks in response to the global COVID-19 pandemic. Most hospitals suspended their Cardiac Rehabilitation services. Many older adults did not receive the medical help they needed. This will have an impact on their health-related quality of life (HRQoL) now and thereafter.

Explore the effect of Virtual Cardiac Rehabilitation VCR delivered during Covid-19 Pandemics on the overall health-related quality of life (HRQoL) of older adults with cardiac problems.

A retrospective study design was used. Rand-36 scores in a population of older adults aged 60+ who participated in VCR between March 2020 and September 2021 were compared pre- and post-program. Convenience sampling method was used and only those who gave informed written consent for data use were included. SPSS version 27 was used to analyze data using descriptive statistics.

Significant increases in median post-VCR scores, compared to pre-VCR scores (p < 0.001) were shown in the Physical domain from (95% CI 307.5–342.5). Mental health domain from (95% CI 301.5–340.5). There was statistically highly significant difference in scores in Chester Step Test METs pre- post VCR 16% (p < 0.001). There were no significant differences found in patients’ perception of Physical Function, Role Limit (Emotional) and Energy/Fatigue (p > 0.05).

VCR delivered during Covid-19 Pandemic, had positive effect on the overall HRQoL of older adults with cardiac problems. VCR offered as an option in CR may potentially improve completion rate and facilitate behavioral modifications.

Various types of canes are frequently utilised in stroke rehabilitation to support walking ability by compensating for hemiplegic gait. However, Randomised Controlled Trial (RCT) design varies considerably in the area of cane use following stroke and there is no scoping review published to date on this topic. Thus, it is crucial for better evidence informed clinical care and future research that RCT evidence regarding specific assistive walking devices is examined.

Identify and map the types of canes that currently exist and review their impact on the rehabilitation of functional mobility post-stroke.

The following databases were searched: PubMed/MEDLINE, Web of Science, and CINAHL in Ebsco. Two authors independently screened 425 titles, identifying 16 RCT studies for inclusion in the review.

16 studies were selected for review. Five different cane designs were identified, including one-point cane, three-point cane, quad cane, weight-supported feedback cane, and rolling cane. Twelve studies were crossover RCT and four were parallel RCT. Stroke phase varied widely among subjects included in the studies and outcome measures utilised and resultant findings are heterogeneous.

More evidence is required to clearly indicate the effect of canes on people who have had a stroke and parallel long-term RCTs with follow-up assessment are lacking. Furthermore, there is a lack of research examining variations in new cane designs that specifically target motor function in people who have had a stroke at specific stages. Future research should aim to address the identified inconsistencies and knowledge gaps to facilitate novel and evidence-informed clinical care regarding assistive walking devices for post stroke rehabilitation.

It remains unclear whether balance is influenced by biological sex, anthropometrics, wearing footwear, or dual tasking. Such information is important to aid clinical reasoning pertaining to assessment and rehabilitation.

To investigate the influence of biological sex, anthropometrics, footwear, physical activity and dual tasking (DT) on balance performance.

An observational study was performed on eighty-six healthy participants. Anthropometric assessment and static balance performance was evaluated, during double leg stance with eyes open (DLSEO) and eyes closed (DLSEC) and during single-leg-stance (SLS). All tasks were assessed with and without footwear and a cognitive task was introduced to assess the effect of DT on static balance performance.

Generally, the static balance performance of females was better than males, across all balance tasks, with some large effect sizes (ES). In both sexes, without footwear tasks resulted in better balance during the DLSEC task but with footwear, static balance performance was better during SLS in males only. Overall minimal differences were observed between single and dual task with a large ES for SLS and DLSEO for females. Upper body size was moderately negatively correlated to static balance performance.

Females outperformed males, footwear and DT had some, but minimal influence on static balance. Anthropometrics were moderately correlated with balance. Balance performance should be compared to unisex normative data sets and performed as a single task, with or without footwear.

Clinical education (CE) is an integral part of physiotherapy degree programmes. CE presents a unique learning opportunity for students to implement classroom-based teaching directly with patients and clients. Despite patients being central to CE, limited research exists around patients’ opinions of CE and the impact of student involvement in patient care. To our knowledge, there has been no study exploring patient perceptions of being treated by student physiotherapists in Ireland.

The aim of this study was to explore the perceptions and experiences of patients who have been assessed and treated by pre-registration MSc Physiotherapy students.

This was a cross-sectional survey study, involving both quantitative and qualitative content analysis.

A total of 42 inpatient participants male n = 24 (57%) female n = 18 (43%) with 30 participants (71%) aged ≥70 were included in this study. All participants reported satisfaction with the treatment received by a student physiotherapist and reported they would avail of further treatments in the future. The benefits identified from interaction of participants with physiotherapy students included patient education and interpersonal skills. No disadvantages of being assessed and treated by a student physiotherapist were identified. Considerations for improvements identified included timing of physiotherapy sessions, frequency of sessions and the consideration of use of technology with patients.

This study identified that all participants were very satisfied from receiving treatment interventions led by a student physiotherapist. Increased patient education and interpersonal skills were highlighted as key advantages from participants being assessed and treated by a student physiotherapist in clinical practice.

High pressure in diabetic foot plantar areas causes ulcer formation, leading to disability and amputations. Around 25% of diabetics experience foot ulcers, with prevalence rates varying among Africans, Asians, and Europeans. Egypt has the highest rates, ranging from 6.1% to 29.3%.

To investigate the impact of functional ankle taping correction on plantar foot ulcer healing in diabetic patients.

A double-blinded randomized controlled trial design. A total of 70 patients with plantar foot ulcers PFUs were randomly divided into two groups: group A, which received ankle taping in addition to usual medical therapy and debridement, and group B, which received ankle taping without routine medical treatment and debridement. Over two months, all patients underwent evaluation using a Walkway pressure monitoring system, goniometer, wound workstation, and saline injection. This evaluation aimed to determine maximal peak plantar pressure, active ankle dorsiflexion, wound area, and volume sequentially.

Initially, there was no meaningful difference between the two groups. However, after eight weeks of treatment, there was a substantial impact, as indicated by a p-value of 0.001 and an f-value of 87.49 for treatment effect at 95% CI.Furthermore, a statistically significant interaction was found between treatment and time in the ankle-taping group between pre-and post-treatment. However, no difference was identified in the control group.

The correction of ankle taping has a significant impact on various factors, including peak plantar pressure, ankle dorsiflexion, wound area, and wound volume. This correction leads to a reduction in peak plantar pressure, wound area, and volume while also enhancing active ankle dorsiflexion.