Aim : The objective of this study was to investigate Nigerian physiotherapy teachers' self-assessment on the attributes of effective clinical teaching and the importance attached to these attributes. Methodology: The McGill Clinical Teacher Evaluation including self-assessment and importance of the attributes of clinical teaching was used to survey 46 clinicians and academicians who teach physiotherapy in fi ve of the seven physiotherapy programs in Nigeria. Descriptive and nonparametric statistics were used to analyze and interpret data. Results : Overall, the Nigerian teachers' self-and importance rating on McGill clinical teachers ' attributes was high. The teachers rated themselves least on attributes related to challenging content from text and journals and encouraging student to take responsibility for their learning, while customizing clinical teaching to suit the students ' level and occasionally challenging content from texts and journals were the least important attributes. Academic faculty gave higher importance ratings for displaying good judgment in decision making than clinical faculty, while a modest link was found between years of post-professional experience and self-perception as effective teacher. Conclusion : The attributes with lowest self-assessment and importance may indicate areas for future concentration particularly in the Nigerian academic community, including curriculum content and design of physiotherapy teachers training.
Aims: To investigate whether there are associations between the professional assessment of a patient's main clinical problem and the patient's self-reported health among patients with musculoskeletal disorders and/or mental disorders. To investigate differences in self-reported health and work-related measures in patients who were recommended clinical versus work-related interventions. Method: A cross-sectional study, including a convenience sample of 210 patients, visiting occupational health service. Patients answered a questionnaire on demographic variables, dimensions of health, functioning, work ability and working conditions. Patients’ main clinical problem and type of intervention was classified by physiotherapists. Activity limitations were identified using the Patient-Specific Functional Scale. Findings: The main clinical problems were: medical/organic problems (39%), psychosocial problems (46%) and physical work-related problems (15%). The psychosocial group reported more problems in mental functioning and the medical/organic group had worse physical functioning. There were significant differences for the main clinical problem, educational level, work ability, social interaction skills and mobility in patients who were recommended clinical versus work-related interventions. Conclusions: There are associations between the professional biopsychosocial classification and the patient's self-reported health and functioning. Clinical reasoning may be improved by including systematic biopsychosocial assessment of specific health and working conditions, and activity limitations according to Patient-Specific Functional Scale.
In this issue of Advances in Physiotherapy, four papers focus on clinical implications in physiotherapy practice and one on student learning in a physiotherapy program.In order to reduce the risk o...
emphasize that further studies are needed to establish the relationship between EMG muscle rest and the subject ’ s perceived muscle tension. A comparison of HR measured by Polar RS400 and ECG, validity and repeatability is reported by Engstr ö m and co-workers from Lund, Sweden. Healthy subjects performed a cycle ergometer test for 5 min on loads of 50, 100 and 150 W. HR was measured with both EEG and Polar RS400 simultaneously. The results showed a high and signifi cant correlation, ranging from 0.97 to 1.00 between the two measurement tools. In repeated tests, the mean difference in HR between tests and between measurement equipment was low and non-signifi cant. The authors conclude that the Polar RS400 is well suited for recording HR during physical activity and exercise. Bembalgi and Naik from India studied galvanic skin resistance (GSR) biofeedback in a tension-type headache – a comparison between auditory, visual and combined feedback GSR – in a randomized controlled trial. They recruited 143 patients to the three above-mentioned biofeedback treatment groups and to a control group. Pain variables, consumption of analgesics and quality of life scores were evaluated at baseline and at 6 months follow-up. All three forms of bio-feedback were effective in treatment of tension-type headache. Combined GSR biofeedback seemed to be slightly more effective compared with auditory or visual feedback. A case report is presented by Dal é n and co-workers from Karolinska Institutet, Sweden, on the effects on BMC in children with severe cerebral palsy (CP) by use of a standing shell, mounted on a vibrating platform. Four children with CP participated; two used the platform for 8 – 9 months, while two were controls. A switch was done after 1 year. Dual-energy X-ray absorptiometry was performed and a change in BMC values was seen at the lumbar spine after standing on the vibrating platform. The children reacted positively to the vibrating platform, which may be an enjoyable method to increase BMC in children with severe CP. EDITORIAL
Purpose: To study the association between muscle rest of vocational electromyographic (EMG) recordings and perceived muscle tension, and whether this association is modifi ed by limiting the EMG measure to pauses from active work.Methods: A muscle rest measure was calculated in a whole workday EMG recording of the upper trapezius muscles, as well as during pauses from active work in 19 males and 23 females (mean age 22 years, range 20-25). Self-reports on muscle tension habits and the covariates neck and shoulder pain, perceived stress level, and leisure time physical activity were collected in a questionnaire.Results: The muscle rest measure showed a moderate negative correlation with the subjects ' perceived muscle tension. This association became somewhat stronger and statistically signifi cant when the EMG measure was restricted to the pauses from active work.Conclusions: Perceived muscle tension is associated to trapezius EMG muscle rest during pauses from active work.
Background and aims: Assessment of respiration is important in medicine and physical therapy. As respiration is multifaceted, we need several specific examination methods. The purpose of this study was to develop a method for examination of visible respiratory movements, by extracting from two examinations the items with best ability to discriminate among healthy controls, patients with pain disorders and patients with psychotic disorders. Methods: Two physiotherapists independently examined 132 individuals (34 healthy persons, 32 with localized pain, 32 with widespread pain and 34 with psychoses). Items were assigned to subscales by explorative factor analysis. Internal consistency of subscales was examined with Cronbach's alpha. To examine validity, one-way analysis of variance and the area under the curve (AUC) were used. Results: We identified four subscales: Tension, Position of Thorax, Basal respiration and Thoracic movements. Cronbach's alpha ranged from 0.75 to 0.86. The subscales' discriminating ability was excellent between healthy controls and patients, and fair between patients with localized pain and the two other patient groups. Conclusions: The respiration domain of the new Global Body Examination has 21 items, which comprise four subscales with high internal consistency and good ability to discriminate between healthy persons and patients with pain disorders or psychosis.
The aim was to evaluate effects on bone mineral content (BMC) in children with severe cerebral palsy (CP) standing on a self-controlled dynamic platform (vibrations, jumps and rotation), assess reactions expressed and record negative effects. An experimental design was used. Four children with severe CP participated. Two children used the platform for 8-9 months while two children were controls (period I). After 1 year, the former users were controls (period II). Dual-energy X-ray absorptiometry was performed. Children in period I (Child 1/Child 2) were exposed to whole body vibration for 330/394 min on 28/25 occasions and showed a percentage change in BMC values at the lumbar spine of + 35/+ 23% (versus controls, Child 3/Child 4, -9/+ 7%), left legs-9/-12% (vs. -2/-12%) and right legs + 61/+ 34% (vs.-18/+ 10%). Children in period II (Child 3/Child 4) were exposed for 524/635 min on 57/64 occasions. The corresponding percentage change in BMC values at the lumbar spine was + 10/+ 10% (+ 21/+ 5%), left legs +26/+ 22% (0/+5%) and right legs +26/+17% (+15/-1%). The children's reactions were perceived positive. No negative effects were recorded. Standing on a self-controlled dynamic platform may be an enjoyable method to increase BMC in children with severe CP.
The aim of the paper is to describe the introduction of a portfolio method of teaching and learning, and to describe students’ perceptions of the method as well as a peer-review system in a course, in the physiotherapy programme, at the Karolinska Institutet. A further aim was to describe the level of grades over time. A modified form of a showcase portfolio method together with a three-graded assessment criteria was introduced into the course. Students, over five semesters, were included in the project (n = 287) of which 91% answered questions and statements regarding their perception of the assessment method and the peer-review system. All portfolios were graded in a scale of three: fail, pass and pass with distinction. The majority of students were satisfied and reported positive learning effects with the assessment method and review system. However, the students asked for more guidance in how to give feedback. During these five semesters, the percentage of students that passed with distinction increased and the percentage of students that failed decreased. Three years after implementing the portfolio, our impression is that the method encourages students to take a more active part in learning and leads to a deeper approach to knowledge.
Although palpation is frequently used in physiotherapy examinations, a limited amount of research has been done to clarify this concept. The aim of this study was to describe physiotherapists’ experiences of shoulder palpation with the intention of obtaining detailed descriptions of the concept of palpation. Three focus group interviews were conducted, including a total of seven physiotherapists who had experience of patients with shoulder disability built up over a long period. A qualitative content analysis of the interviews was carried out. The findings showed how palpation can be perceived as a skill that could be described from two different perspectives: Manual and technical palpation and Palpation being dependent on the relationship between the physiotherapist and the patient. Palpation requires time, and the knowledge and experience of palpating built up over time. We also found how the two “perspectives” of palpation were inseparable from each other. The ability to perform manual and technical palpation and the relationship between the physiotherapist and the patient can be considered an interactive learning situation where the physiotherapist and the patient develop mutual knowledge of the body.
Aims: This study determined what activities are associated with total hip replacement (THR) dislocation to better inform patients about “at risk” activities. Methodology: All patients who attended our institution from December 2007 to May 2011 with a first-time dislocation following primary THR were retrospectively reviewed. This consisted of 100 patients, 31 males and 69 females, with a mean age at dislocation of 75 years. Major findings: Activities including getting into or out of bed, twisting or turning in bed, getting onto or up from a toilet and putting shoes, socks or stockings on were most frequently associated with THR dislocation. There was no difference in the activities associated with THR dislocation between the different age groups, surgical approach (anterolateral vs. posterior) or duration since primary THR. There was no difference in activities associated with dislocation between males and females except for putting socks/shoes/stockings on from a sitting position, where females reported a higher incidence of dislocation (14%) compared to males (0%). Principal conclusions: This study identified that patients should be specifically counselled to avoid picking objects up off the floor, to be vigilant when getting in or out of bed, and when getting off the toilet.
Abstract In a heterogeneous group of patients with long-term musculoskeletal pain (LMP), there is a need for a short test to assess physical ability. The Test Instrument for Profile of Physical Ability (TIPPA) includes observed physical ability and pain behaviour as well as the individual's self-assessment of his or her ability and experience of exertion. The relation between these four dimensions of the individual is made visible in a profile. The aim of this study was to investigate the inter-rater reliability of pain behaviour, to reconstruct the limits for the grades in the nine physical activities and to investigate the test–retest reliability of these reconstructed grades. The results showed that the percentual agreement between the two physiotherapists who observed LMP patients (n = 7) was 100% for seven of the activities and 86% for the two remaining activities. The reconstruction of the grading system was based on the results of healthy persons (n = 48) and LMP patients (n = 658) performing the nine physical activities. For test–retest of the reconstructed grading system in a patient group (n = 13), no disagreement was found between occasions but a systematic disagreement was found in one activity. This study confirms that the TIPPA instrument is reliable and the grading system discriminates between healthy persons and LMP patients.
Our objective was to assess the loading during a resistance-training task at a given training intensity in subjects with stroke and in healthy subjects. Subjects with stroke (n = 11) and two control groups (n = 11 in each) underwent strength measurements and a resistance-training task for elbow flexors. Torque and muscular activity obtained during the resistance-training task was related to values obtained during strength measurements. Even if relative loading throughout the concentric phase of the resistance-training task, expressed as percent of concentric isokinetic torque, was found to be similar among groups, we found indications of insufficient loading for the stroke group. Relative loading during the eccentric contraction phase, expressed as percent of eccentric isokinetic torque, was significantly lower for the stroke group. Also, when related to isometric maximum voluntary contraction, the loading was significantly lower for the stroke group, compared with the control groups, during the concentric and eccentric contraction phases. Furthermore, muscle activation during, as well as muscular fatigue after, the resistance-training task was somewhat lower for the stroke group. Hence, for subjects with stroke, the relative loading during resistance training, performed at a training intensity considered adequate for able-bodied, appears to be too low compared with the healthy controls.
Human movement and function are central concepts in physiotherapy. The sociologist Pierre Bourdieu's theory including the concept of habitus, capital and field, provides an analytical tool for understanding how social structures are incorporated. The aim of this study was to describe female body movements in a non-western society and to suggest how physiotherapists may study movements in a broader perspective. Method: A one-year qualitative fieldwork was carried out in a mountainous village in Nepal. A group of women were followed through their daily living activities. Rudolph Laban's model was used for movement analyses. Findings: Generally, the movements of women in the fertile age were expressed by a direct and bounded flow with little use of personal space and rotation of the body. When men were present, the young women's bodies appeared concave with more restricted movements. Postmenopausal women's movements were flexible with a much freer flow compared with the young ones. The free flow was also observed in the youngest girls before the age of menarche. Conclusion: The findings from this study illustrate how structures, relationships, norms and values in the social field are incorporated and expressed in movements influencing human function in ways that should be considered within physiotherapy.
Aims: The purpose of this study was to investigate criterion-related validity and test-retest repeatability of the heart rate monitor Polar RS400 versus electrocardiogram (ECG). Methodology: Ten healthy subjects, 19-34 years, performed a cycle ergometer test 5 min on each load (50, 100 and 150 W). Heart rate (HR) was measured with ECG and Polar RS400 and recorded digitally. After at least one hour resting the test was repeated. Major findings: The results showed a significant correlation between HR measured by ECG and by Polar RS400 with correlation coefficients ranging from 0.97 to 1.00. In test 1 the mean difference +/- 2SD between HR Polar and HR ECG was 0.7 +/- 4.3 bpm and in test 2, 0.2 +/- 3.2 bpm. In the repeated tests, the mean difference of HR between test 2 and test 1 +/- 2SD was 3.2 +/- 11.9 bpm with ECG and 2.6 +/- 14.3 bpm with Polar RS400 and these differences were not statistically significant. Conclusion: This study indicates good criterion- related validity and test-retest repeatability of Polar RS400. Differences observed at individual levels should be noticed, but are not considered to be clinically important. Polar RS400 is thus well suited for recording HR during physical activity and exercise training.
Finding ways of supporting healthy ageing for the ever-increasing numbers of older persons is an important task for physiotherapy. There is evidence that physical activity such as dance has salutogenic effects, but knowledge of how participation in such a bodily activity is experienced is limited. The aim of this study was to develop knowledge on elderly persons' experiences of participating in a dance workshop. Seventeen persons aged 61-89 were included in the study. Data was collected through qualitative open interviews and DVD recordings. Data was analysed with an interpretative narrative qualitative method. The analysis resulted in two themes: "A surprising awareness about the connection between body and mind" and "Participation leads to personal growth". The results of this study support the concept that physical activity in the form of dance is experienced as beneficial by older persons. Furthermore, the results encourage further inquiry regarding dance as physiotherapeutic intervention promoting health in elderly persons.
The aim of the present study was to analyse and describe muscle function, quality of life and functional capacity before and after shoulder instability surgery. Twenty-six women aged 34 (+/- 14) years and 95 men aged 32 (+/- 10) years participated in this study. All patients were on the waiting list or had undergone shoulder instability surgery. The study was performed with a cross-sectional design and patients were examined pre-operatively, 6-month post-operatively or 7-year post-operatively. Handgrip strength measurement, active range of motion (AROM), isometric shoulder muscle strength measurement, health-related quality of life measured by Western Ontario Shoulder Instability Index (WOSI (c)) and shoulder function using the Constant Score were evaluated. The mean AROM in flexion for women in all groups ranged from 162 degrees (+/- 16) to 169 degrees (+/- 12), and for men from 157 degrees (+/- 19) to 162 degrees (+/- 12). The mean AROM in abduction ranged from 170 degrees (+/- 25) to 177 degrees (+/- 5) for women and from 177 degrees (+/- 8) to 179 degrees (+/- 24) for men. The mean AROM in external rotation ranged from 89 degrees (+/- 14) to 95 degrees (+/- 14) for women and from 83 degrees (+/- 21) to 85 degrees (+/- 12) for men. Men were significantly stronger and had a larger AROM on the non-injured side compared with the injured side, whereas differences were found between non-injured and injured side for women only in AROM. The scores from the WOSI (c) for all the patients were far from normative values suggesting that the patient's subjective experience does not fully reflect the physical examination. The results from the present study can guide the physiotherapist to give patients realistic expectations of shoulder function concerning AROM and muscle strength.
Objective: Continuous positive airway pressure (CPAP) is the fi rst treatment of choice for obstructive sleep apnea syndrome (OSAS). However, adherence rates are low with no clear consensus on causes. Behavioral support strategies are needed, which is an evolving arena for physiotherapists within sleep medicine. The purpose of this study was to describe patients' experiences of CPAP treatment in obese individuals with moderate to severe OSAS. Methods: A qualitative content analysis was employed. Fifteen participants were consecutively selected. Data were collected by semi-structured interviews. Results: Experiences were described and structured according to three themes: (1) coming to terms with wearing CPAP; (2) getting a new life; and (3) being restricted in everyday life. Conclusion: A focus on incentives for regular CPAP use is important when supporting the use of a device that has almost as many disadvantages as advantages. Positive and negative reinforcers may receive greater attention when tailoring behavioral support for initiation and maintenance of CPAP. The potential of involving spouses and signifi cant others to reinforce self-management behaviors needs further studies.
The aim of this study was to evaluate the efficacy of myofascial trigger point massage in the muscles of the head, neck and shoulders regarding pain in the treatment of females with chronic tension-type headache. They were randomized into either a treatment group (n = 20) (one session of trigger point massage per week for 10 weeks) or a control group receiving no treatment (n = 19). The patients kept a diary to record their pain on a visual analogue scale (VAS), and the daily intake of drugs (mg) during the 4 weeks before and after the treatment period. The McGill Pain Questionnaire and the Short Form (SF-36) Questionnaire 1.1 were completed immediately before and after each treatment period. Morning pain measured on VAS was chosen as the primary outcome. A significant improvement in morning pain was recorded in the treatment group compared with the control group (difference of the change: 8.8 (95% CI 0.11–17.4), p = 0.047). Furthermore, a significant decrease in the number of trigger points was observed in the treatment group compared with the control group. Myofascial trigger point massage has a beneficial effect on pain in female patients with chronic tension-type headache.
Purpose: This study describes caregivers ' experiences of person transfer situations involving people with dementia. Method: Qualitative focus group interviews were conducted with a total of 10 caregivers; two groups with fi ve persons each, including two men and eight women. The resulting data were extracted and condensed into meaning units and codes using content analysis. Findings: One main theme was formulated that represents the caregivers ' experiences of person transfer situations involving people with dementia: "Reciprocal struggle in person transfer tasks". Five categories were formulated: "Becoming familiar and making contact", "Risking one ' s own body to protect the resident from injury", "Focused yet aware of the surroundings", "Identifying needs to facilitate the person transfer "and "Struggling to be understood ". Conclusion: Person transfer situations involving people with dementia are subject to sudden changes. The ongoing challenge is to ensure a dynamic approach that can be adapted to the needs of the person with dementia at any given time. There is a need for more studies within the fi eld about care and rehabilitation among people with dementia. We suggest that assessment of person transfer situations involving people with dementia and their caregivers is an important issue for further investigation and physiotherapeutic interventions.
