Purpose: Urinary incontinence (UI) is prevalent among people with chronic respiratory diseases. The experience of UI increases social isolation and may compromise participation in pulmonary rehabilitation programmes (PRPs). Therefore, among physiotherapists who deliver PRPs, we sought to describe (1) whether they enquire about UI in those referred to these programmes and (2) the way in which they approach this condition in those who disclose it. Method: This cross-sectional, observational study recruited physiotherapists employed by tertiary hospitals in Australia who were experienced in delivering PRPs. Participants completed an online survey that sought information regarding the way they approach UI in people referred to a PRP. Results: Of the 39 participants who were emailed the survey, data were available on 35 (89%). Enquiring about UI was undertaken “Always” or “Frequently” by 80% of participants. However most (69%) felt they lacked the skills to manage UI, and few (23%) could identify appropriate online resources to provide to people experiencing UI. The most common management strategy was to refer people who reported UI to a colleague with expertise in this area. Conclusion: Although physiotherapists who offer PRPs appear to ask about UI, they have limited strategies to manage this condition.
Abstract Research Question: Does a concomitant neck injury affect concussion outcomes in adults? Method: This study was conducted at the Hull-Ellis Concussion and Research Clinic (Toronto Rehabilitation Institute, Canada). The authors analyzed records of prospectively collected data from individuals between July 2019 and March 2020, followed for care until 8 weeks post-injury. Participant characteristics and outcomes were analyzed according to the presence or absence of a neck injury. Statistical analyses included comparisons of symptom severity and recovery rates. Results: Eighty-two medical files were reviewed; 19 participants were excluded due to missing data; and 63 were included in the study. Of participants included, 25 (40%) were diagnosed with a concurrent neck injury. In week 1, the neck injury group presented with higher symptom severity, mean 59 out of 132 (SD 32) versus 39 out of 132 (SD 26) for the no neck injury group. By the end of the follow-up period, fewer individuals with a neck injury had recovered from their concussion (44% with neck injury vs. 66% without). Conclusion: Our findings demonstrate that the combination of both concussion and neck injury can result in a greater number and intensity of initial symptoms and a longer duration for recovery of injury-related symptoms.
Abstract Purpose: To address the demands of an aging patient population, hospitals must embark on service model redesign. This study tests the hypothesis that an aging population requires increased physiotherapy (PT) and describes evolving patient demographics and PT workload to inform recommendations on resource adjustments to meet the needs of older adults admitted to medicine in-patient units. Methods: This was a mixed-methods study including a retrospective review of Medical Records and Workload Measurement System to compare patient characteristics and PT workload in 2018 and 2022, with focus groups to contexualize data. Results: The number of in-patients receiving PT services in 2018 and 2022 did not change. Significant increases were seen in average PT service hours provided per day (17.1 vs. 25.0 hours) and per patient (3.43 vs. 4.76 hours). The average number of PT interactions per patient increased (7.16 vs. 9.15), as did the number of patients requiring multiple PT interactions per day (51% of patients in 2018 vs. 58% in 2022). Statistically significant increases were seen in mean patient age (77 vs. 78 years) and median length of stay (7.8 vs. 9.7 days). Conclusion: This study provides metrics demonstrating that despite stable patient volumes, in-patient care needs increased.
Abstract Purpose: To determine the gaps, barriers, and opportunities in applying mobile health (mHealth) to physiotherapy. Method: Twelve semi-structured interviews were conducted with adults who had undergone anterior cruciate ligament reconstruction (ACLR) and had utilized a mobile app as part of their post-surgical rehabilitation. Qualitative data were analyzed using Braun and Clarke’s Thematic Analysis and a socio-ecological model. Participants also completed a System Usability Scale (SUS) and a digital literacy questionnaire. Results: The app scored an average of 85 and a letter grade of A on the SUS. The app supported rehabilitation at the intrapersonal level. Average session duration was 30 minutes; app use lasted an average of 6 months; and adherence was increased. At the interpersonal level, the app facilitated relationships with physiotherapists. The app provided indirect support at institutional and policy levels. Conclusions: Utilizing a socio-ecological model, this study identified how an app can facilitate ACLR rehabilitation and indicated barriers that cannot be addressed through an app. Overall, rehabilitation at the intrapersonal level and interpersonal levels is supported. However, barriers at higher levels were not addressed.
Purpose: Sex- and gender-based factors can act as barriers to stroke recovery. The primary objective of this study was to describe and explore potential sex- and gender-based characteristics that may be associated with the clinical responses of six participants to a 4-week telerehabilitation programme. Method: Using a multiple case study design and purposeful sampling (age and stroke severity), we contrasted and compared responses of three male and three female participants. Participants completed four assessments: pre- and post-intervention, 3- and 6-month follow-ups. Outcome measures were the Stroke Impact Scale-3 (SIS-3), 30-second sit-to-stand (30sSTS) test, and Activity-Specific Balance Confidence Scale. Sex- and gender-based characteristics were reported, and individual trajectories were described. Results: Female participants had more favourable trajectories in emotion, memory and thinking, mobility, participation domains of the SIS-3, and activity-specific balance confidence. Female participants also had sustained improvements in 30sSTS. Stroke type and marital status are among the personal characteristics of female participants that may explain the responses observed. Conclusion: The more favourable trajectories in many domains demonstrated by women could be explained by sex- and gender-based characteristics. Men possessed personal characteristics often associated with poorer functional recovery, contradicting sex- and gender-based disparities generalized to women with stroke. Objectif : des facteurs li & eacute;s au sexe et au genre peuvent compromettre le r & eacute;tablissement apr & egrave;s un accident vasculaire c & eacute;r & eacute;bral (AVC). Cette & eacute;tude avait comme objectif primaire de d & eacute;crire et d'explorer les caract & eacute;ristiques relatives au sexe et au genre susceptibles d'& ecirc;tre associ & eacute;es aux r & eacute;ponses cliniques de six participants & agrave; un programme de t & eacute;l & eacute;r & eacute;adaptation de quatre semaines. M & eacute;thodologie : & agrave; partir d'une m & eacute;thodologie de multiples & eacute;tudes de cas et d'un & eacute;chantillonnage raisonn & eacute; (& acirc;ge et gravit & eacute; des AVC), les auteurs ont contrast & eacute; et compar & eacute; les r & eacute;ponses de trois hommes et de trois femmes. Les participants ont effectu & eacute; quatre & eacute;valuations : avant et apr & egrave;s l'intervention, suivi au bout de trois mois, puis suivi au bout de six mois. Les mesures de r & eacute;sultats suivantes ont & eacute;t & eacute; privil & eacute;gi & eacute;es : la Stroke Impact Scale-3 (SIS-3 ou & eacute;chelle d'impact des AVC-3), le test du lever de chaise en 30 secondes (TLC30) et l'& eacute;chelle de confiance en l'& eacute;quilibre pendant l'activit & eacute;. Les caract & eacute;ristiques propres au sexe et au genre ont & eacute;t & eacute; d & eacute;clar & eacute;es, et les trajectoires individuelles, d & eacute;crites. R & eacute;sultats : les participantes avaient des trajectoires plus favorables sur le plan de l'& eacute;motion, de la m & eacute;moire et de la r & eacute;flexion, des domaines de participation de la SIS-3 et de la confiance en l'& eacute;quilibre pendant l'activit & eacute;. Elles ont & eacute;galement obtenu de meilleurs r & eacute;sultats au TLC30. Le type d'AVC et la situation familiale faisaient partie des caract & eacute;ristiques des participantes susceptibles d'expliquer les r & eacute;ponses observ & eacute;es. Conclusion : les trajectoires plus favorables des femmes dans bien des domaines pourraient s'expliquer par des caract & eacute;ristiques propres au sexe et au genre. Les hommes poss & eacute;daient des caract & eacute;ristiques personnelles souvent associ & eacute;es & agrave; un moins bon r & eacute;tablissement fonctionnel, qui contredisent les disparit & eacute;s li & eacute;es au sexe et au genre g & eacute;n & eacute;ralis & eacute;es chez les femmes qui ont v & eacute;cu un AVC.
