Physiotherapy

COACH: Challenging osteoarthritis and changing health (2021)

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Type of publication:Conference abstract

Author(s):*Haines-Eynon A.

Citation:Physiotherapy, 2021. Conference: Virtual Physiotherapy UK 2020 Conference. Virtual, Online. 113(Supplement 1) (pp e52-e53)

Abstract:Purpose: To develop, implement and evaluate an integrated rehabilitation programme for patients with hip and knee osteoarthritis (OA). To encourage behavioural changes by using social prescribing to facilitate longer-term management. Method(s): Patients with OA of the hip and/or knee were eligible for the class. An attempt was made to include as many patients as possible even with comorbidities. Any patients with any cardiac or respiratory conditions were still eligible provided they were able to manage any acute changes to their condition. Patients were assessed by a physiotherapist following a referral from a GP, ESP or consultant who completed an induction including 4 outcome measures; MSK-HQ, numeric rating scale (NRS), 30-s sit to stand and 4 x 10 m walk test. Patients took part in a 6-week programme consisting of 6 weekly 1 h sessions. Each session included a targeted strengthening circuit and a changing education presentation designed to help people improve their understanding of the condition. The final session which focused around longer term self management was attended by the Healthy Lifestyles Team to educate patients on available services within the local community. At the end of the final session all outcome measures were repeated and patients were given a patient satisfaction questionnaire. On completion of the class patients were given the opportunity to continue with their exercise programme in the hospital gym for a further period of time or encouraged to continue with their exercises in their local gym. They were referred back to their physiotherapist if they were still not able to manage their symptoms. Result(s): One hundred and twenty-three patients started the class, three of these were referred back to their physiotherapist as they were unable to engage in the class environment and a further 17 did not complete the course after the initial session. At least 75% of patients had repeat scores greater than or equal to their initial results on all outcome measures. The minimal clinically important improvement (MCII) value was achieved in 50.6% of patients in the MSK-HQ, 31.6% in the 4 x 10 m walk test, 36.7% in the NRS and 46.5% in the 30 s sit to stand test. Conclusion(s): The results demonstrate an important improvement to patient's pain and function following six exercise class and educational sessions. A wide inclusion criterion with patients who had multiple comorbidities meant these outcomes are more representative of the population and are more generalizable. Giving patients a starting point and a seamless approach from a hospital environment to self-management makes it more likely that patients will continue with a healthy lifestyle reducing the need for recurring visits to healthcare providers. Impact: The class had capacity for up to 12 patients allowing patients more treatment time compared to a routine 20 min follow up appointment. Also by avoiding 1:1 physiotherapy appointments the strain on acute services and its associated costs were reduced. This programme Identifies a further effective treatment option for patients with hip and knee OA. Funding acknowledgements: No funding was required for this study.

An evaluation of the current assessment methods used within a district general NHS trust spasticity service (2021)

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Type of publication:Journal article

Author(s):*Fitzgerald, A. ; Pandyan, P.A.

Citation:Physiotherapy, December 2021. Vol 113, Supplement 1, p. E21-E22

Abstract:The management of spasticity in specialist clinic has not been evaluated objectively. One of the barriers to conducting an audit is the lack of a robust patient-centred assessment framework. The aim of this study was to audit the existing patient notes and from this develop a patient-centred assessment framework that provides objective data that can be used to audit the service.

Transcutaneous electrical acupoint stimulation for people with chronic musculoskeletal pain: an exploratory review (2019)

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Type of publication:
Journal article

Author(s):
Ely, S. ; Barlas, P.

Citation:
Physical Therapy Reviews, Dec 2019 Vol. 24(6) p.377-388

Abstract:
Background: Transcutaneous electrical acupoint stimulation (TEAS) is a form of stimulation-induced analgesia with potential as a non-invasive alternative to acupuncture, suitable for self-application. The clinical evidence for TEAS for people with chronic musculoskeletal pain is limited.
Objectives: This exploratory review aimed to evaluate the potential of TEAS as a pain relief option for people with chronic musculoskeletal pain and explore the evidence relating to dose parameters.
Methods: A literature search was conducted using Medline, EMBASE, CINAHL, AMED and the Cochrane Database for studies that used TEAS or specified the use of Transcutaneous electrical nerve stimulation (TENS) over acupuncture points for people with chronic pain. Data relating to the treatment dose parameters was extracted including frequency, intensity, treatment duration and stimulation location, to identify themes and trends with a narrative analysis and review.
Results: The review included 20 studies consisting of 13 randomised controlled trials, four comparative trials and three cross-over studies. Most RCTs indicated some beneficial effect on pain scores, but the overall quality of evidence was low. Most studies applied a TENS device for 20–40 minutes, several times a week similar to an acupuncture treatment protocol. There was no clear evidence that the electrical parameters of frequency and intensity or the choice of acupuncture points had an effect on the outcomes.
Conclusions: People with chronic musculoskeletal pain may achieve pain relief using TEAS but the existing evidence is limited and high quality clinical evidence is required to establish efficacy. Effects appear to be achieved with short applications, several times a week in a protocol similar to those used with acupuncture. It is not clear whether the choice of acupuncture point, stimulation frequency or intensity has an impact on the results. Further investigation of the effect of stimulation duration for both TEAS and TENS is recommended.

Pitfalls in the study of neovascularisation in achilles and patellar tendinopathy: a review of important factors for clinicians to consider and the need for greater standardisation (2019)

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Type of publication:
Journal article

Author(s):
Fallows, R. and *Lumsden, G.

Citation:
Physical Therapy Reviews; Dec 2019 Vol. 24(6) p.346-357

Abstract:
Background: The search for new vessels in pathological tendons is a relatively new field. In spite of a rapid growth in research and clinical experience, there is still poor agreement in the musculoskeletal community regarding the significance and measurement of so called “neovascularisation”. Any relationship between vascularity, tendon healing, degeneration and pain is not yet clear, as it has been considered as a normal physiological adaptation to loading yet also seen in chronic painful Achilles tendons. An expression of the degree of “neovascularisation” could potentially have significance if the amount of neovascularisation could be related to the degree of symptoms or dysfunction caused by the pathology in the tendon.
Objectives: This review examines the potential variables that can affect the quantification of the Doppler signal in Achilles and patellar tendinopathy under three perspectives. Firstly, the variables that arise from the actual technology that allows the capturing of the Doppler signal from intra-tendinous microvasculature flow, secondly by an awareness of known and highly likely physiological factors that may alter the rate of flow and thirdly by an exploration describing the actual methods and qualities of acquiring quantitative data of the microvascular flow with Doppler.
Methods: A literature search was conducted across AMED, CINAHL, Google Scholar, SPORTDiscus, MEDLINE and NCBI (PubMed) for studies related to the qualitative or quantitative measure of the Doppler signal in relation to a clinical outcome of Achilles or patellar tendinopathy. Parameters regarding machine settings and examination conditions were extracted to identify the utilisation of important factors and consistency with a narrative analysis.
Discussion: Many of these influential factors have never been controlled for in previous studies and the methods have been unreliable and poorly reported. There is a need for international agreement on a standardised protocol in the assessment of the microvascularity of tendons, which could then help determine if the quantification of “neovascularisation” is a reliable and clinically relevant finding.

 

Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem? (2018)

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Type of publication:
Journal article

Author(s):
*Lumsden, Gordon; *Lucas-Garner, Kerry; *Sutherland, Sarah; *Dodenhoff, Ron

Citation:
Musculoskeletal care; Mar 2018; vol. 16 (no. 1); p. 209-213

Abstract:
AIMSPhysiotherapists are beginning to utilize diagnostic ultrasound imaging in upper limb/shoulder clinics. The aim of the present study was to receive feedback on the views of the patients concerning the usefulness of the information obtained immediately from the scan in the management of their problem.METHODS A questionnaire was offered to all patients attending a physiotherapist-led upper limb/shoulder clinic who underwent ultrasound imaging as part of a shoulder assessment over a 6-month period. A total of 103 patients completed a questionnaire for analysis.RESULTSPatients rated the ultrasound scan to be of benefit in all aspects. Regarding the ability to understand their shoulder problem better and in feeling reassured about their problem, 97% of patients either strongly agreed or agreed that this was the case. Concerning the capability of managing their problem, 89% of patients strongly agreed or agreed that they felt more able to do this. In total, 96% of patients evaluated the ultrasound scan to be of very high/high value to them.CONCLUSION Patients highly rate the information gained from ultrasound imaging in a physiotherapy-led upper limb/shoulder clinic and felt that it assisted them in the understanding, reassurance and management of their problem.

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