Physiotherapy Rehabilitation of Scapholunate Ligament Instability Following Ganglion Cyst in a Recreational Basketball Player: A Case Report.

Ganglion cysts are prevalent benign soft tissue tumors, commonly occurring on the dorsal wrist and often associated with underlying joint structures like the scapholunate ligament (SLL), a critical stabilizer of the wrist. SLL instability, frequently resulting from acute trauma or repetitive stress, can significantly impair wrist function, causing pain, reduced range of motion, and decreased grip strength. This case report details the conservative management of a 25-year-old recreational basketball player who presented with SLL instability and a dorsal ganglion cyst following two separate wrist injuries. Despite initial conservative management, the patient continued to experience persistent pain and functional limitations. Diagnostic imaging confirmed the presence of a ganglion cyst arising from the SLL, which necessitated a targeted physiotherapy regimen. The rehabilitation protocol focused on pain relief, wrist stability, muscle strengthening, and functional performance, employing phonophoresis, K-taping, laser therapy, and progressive strengthening exercises. Throughout treatment, the patient exhibited marked improvements in wrist range of motion, muscle strength, and pain reduction, ultimately returning to basketball activities without recurrence of symptoms. This case underscores the potential effectiveness of conservative physiotherapy in managing SLL instability with associated ganglion cysts, emphasizing the importance of a comprehensive, multifaceted approach to rehabilitation in restoring wrist function and enabling a return to sports.

[Highlights 57th SEPAR Congress]. / Highlights del 57.° Congreso de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR).

The Spanish Society of Pneumology and Thoracic Surgery (SEPAR) has held its 57th Congress in Valencia from 6 to 8 of June 2024. The SEPAR Congress is the leading meeting for the entire respiratory scientific community, which allows learning about the main scientific advances in this area and provides the ideal situation to create and strengthen ties. This year, under the title "Respiratory Health for everybody", the SEPAR Congress stressed the importance of raising awareness about the importance of caring for and protecting our respiratory system. In this review, we offer a summary of some notable issues addressed in six selected areas of interest: chronic obstructive pulmonary disease (COPD), asthma, interstitial lung diseases (ILDs), pulmonary vascular diseases, sleep and breathing disorders and respiratory physiotherapy.

Comparison of the Efficacy of Ultrasound-Guided Suprascapular Nerve Blocks and Intraarticular Corticosteroid Injections for Frozen Shoulder: A Randomized Controlled Trial.

BACKGROUND: The current mainstream treatment for frozen shoulder is a combination of physiotherapy and intraarticular corticosteroid injections (IACIs). Recently, the ultrasound-guided suprascapular nerve block (SSNB) has developed as a notable alternative option to the mainstream treatment. OBJECTIVE: We aimed to compare ultrasound-guided SSNBs' effectiveness to IACIs' as treatments for frozen shoulder. STUDY DESIGN: This study was conducted as a prospective single-blind, randomized controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, a medical center in Taipei, Taiwan. METHODS: Patients with frozen shoulder (n = 76) were enrolled as participants and allocated to either an SSNB group (n = 38) or an IACI group (n = 38). Both groups received 2 injections of 20 mg of triamcinolone and 3 mL of 1% lidocaine at 2-week intervals and underwent the same physiotherapy protocol for 3 months. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). The secondary outcome measures were the Shoulder Disability Questionnaire (SDQ), the active and passive range of motion (ROM) of each patient's affected shoulder, and the 36-item Short Form Health Survey (SF-36). Evaluations were performed at baseline and at 4 and 12 weeks after starting treatment. RESULTS: Both groups achieved significant improvements in all outcome measures, except the general health subscale of the SF-36 at 4 and 12 weeks after starting treatment. For time and group interaction, the results for the SDQ (P = .047) and SF-36 (bodily pain, P = .025) indicated significant differences that favored IACIs. Additionally, the IACI group achieved more favorable outcomes than did the SSNB group on the SPADI (P = .094) and in ROM (i.e., abduction [P = .190] and external rotation [P = .081]) as well as on 2 subscales of the SF-36: bodily pain (P = .059) and role-emotional (P = .072). LIMITATIONS: Our study is limited by the lack of participant stratification based on the stages of frozen shoulder and the 12-week follow-up period. CONCLUSIONS: A combination of ultrasound-guided IACIs and physiotherapy should be attempted first as a frozen shoulder treatment.

Design of a Health Education Program to Manage Chronic Neck Pain: Protocol for a Development Study.

BACKGROUND: Chronic neck pain (CNP) needs attention to its physical, cognitive, and social dimensions. OBJECTIVE: We aimed to design a health education program (HEP) with a biopsychosocial approach for patients with CNP. METHODS: A literature search on CNP, health education, and biopsychosocial models was carried out. Seven physiotherapists with expertise in HEPs and chronic pain participated in three teams that evaluated the literature and prepared a synthesis document in relation to the three target topics. Experts compiled the information obtained and prepared a proposal for an HEP with a biopsychosocial approach aimed at patients with CNP. This proposal was tested in the physiotherapy units of primary care health centers belonging to the East Assistance Directorate of Madrid, and suggestions were included in the final program. RESULTS: The HEP for CNP with a biopsychosocial approach consists of 5 educational sessions lasting between 90 and 120 minutes, carried out every other day. Cognitive, emotional, and physical dimensions were addressed in all sessions, with particular attention to the psychosocial factors associated with people who have CNP. CONCLUSIONS: The proposed HEP with a biopsychosocial approach emphasizes emotional management, especially stress, without neglecting the importance of physical and recreational exercises for the individual's return to social activities. The objective of this program was to achieve a clinically relevant reduction in perceived pain intensity and functional disability as well as an improvement in quality of life in the short and medium term. TRIAL REGISTRATION: ClinicalTrials.gov NCT02703506; https://clinicaltrials.gov/study/NCT02703506. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56632.

Exploring the Impact of Personalized Physical Therapy on a Patient With Motor Neuron Disorder: A Case Study.

This case study examines the effect of a tailor-made physiotherapy regimen on an 85-year-old male patient who was suffering from bulbar motor neuron disease (MND) and had a history of stroke and COVID-19. The physiotherapy plan was designed to strategically address the patient's respiratory issues, generalized weakness affecting limb muscles, and speech and swallowing difficulties. Frequent evaluations made it possible to adjust the treatment plan, emphasizing a holistic strategy to improve the patient's overall quality of life. Improvements in scores on multiple functional scales and manual muscle testing were shown by outcome measures and follow-up evaluations. This case emphasizes how important customized physiotherapy is for maximizing functional outcomes and enhancing the quality of life for patients dealing with the complicated conditions of bulbar MND.

The effects of balance training in patients with total hip arthroplasty : A randomized controlled pilot study.

BACKGROUND: Total hip arthroplasty (THA) causes damage to hip joint mechanoceptors, which in turn leads to decrease in proprioception and increase in balance disorders. Few research has focused on balance training in patients with arthroplasty and none investigated the long-term effect of balance training using objective balance assessment methods in THA patients. The purpose of our study was to investigate the effects of balance training in patients with THA until 26 weeks postoperatively. METHOD: For this study 24 patients with hip osteoarthritis, who were candidates for THA were recruited. Of the patients with THA 16 completed the study protocol and the patients were randomized to 2 groups: conventional rehabilitation (CR, n = 8) or conventional rehabilitation plus balance training (CR + BT, n = 8). The CR group completed typical surgery-specific exercise programs, while the CR + BT group completed the CR plus balance exercises. The patients were evaluated by a hand-held dynamometer, single leg stance test (SLST), Tetrax balance system, Harris hip score, lower extremity function scale, 5 times sit to stand test and 50-foot timed walk test preoperatively and 8, 14 and 26 weeks postoperatively. RESULTS: While the CR + BT group showed significant improvement for the right extremity eyes closed SLST score (p < 0.05), there was no significant difference for other assessment parameters between the CR and CR + BT groups (p > 0.05). There were significant improvements in both groups until 26 weeks following THA (p < 0.05). CONCLUSION: The results of our study indicate that there were similar improvements in the balance and functional parameters in the CR and CR + BT groups. There was no additional benefit after 26 weeks of controlled balance exercises following THA.

Effectiveness of monopolar diathermy by radiofrequency combined with exercise in patients with chronic low back pain: A randomized clinical trial.

BACKGROUND: Chronic low back pain can severely affect quality of life. While several treatments are available, the combination of therapies often results in better outcomes. OBJECTIVE: This study delves into the comparative effectiveness of combining monopolar dielectric diathermy radiofrequency (MDR) with supervised therapeutic exercise against the latter treatment alone. METHODS: A randomized single-blind controlled trial was conducted. The intervention group (n= 30) received MDR with supervised therapeutic exercises for eight weekly sessions for four weeks. The control group (n= 30) received only the same exercise protocol. The following self-report measures were assessed before the first treatment session, at four, and 12 weeks: disability, pain, kinesiophobia, quality of life, sleep quality, emotional distress, isometric trunk strength, and trunk flexion range. RESULTS: Repeated ANOVA measures revealed significant time*group interactions for the McQuade test (p= 0.003), the physical role (p= 0.011), vitality (p= 0.023), social function (p= 0.006), and mental health subscales (p= 0.042). Between-group analyses showed significant differences for all outcomes at each follow-up: RMDQ (post-treatment, p= 0.040), ODI (post-treatment and 12-week, p= 0.040), VAS (p< 0.001), TSK (p< 0.001), and McQuade Test (p< 0.020). CONCLUSION: The combination of diathermy radiofrequency with supervised therapeutic exercise significantly surpasses the efficacy of supervised therapeutic exercise alone, showcasing improvements in pain, disability, kinesiophobia, lumbar mobility in flexion, and overall quality of life in patients with chronic low back pain.

Home-based cardiac rehabilitation in older adults: expert-recommendations for physiotherapist-led care to improve daily physical functioning and reduce comorbidity-related barriers.

Background: Cardiac rehabilitation (CR) can reduce mortality and improve physical functioning in older patients, but current programs do not support the needs of older patients with comorbidities or frailty, for example due to transport problems and physical limitations. Home-exercise-based cardiac rehabilitation (HEBCR) programs may better meet these needs, but physiotherapy guidelines for personalising HEBCR for older, frail patients with cardiovascular disease are lacking. Purpose: To provide expert recommendations for physiotherapists on how to administer HEBCR to older adults with comorbidities or frailty. Methods: This Delphi study involved a panel of Dutch experts in physiotherapy, exercise physiology, and cardiology. Three Delphi rounds were conducted between December 2020 and February 2022. In the first round panellists provided expertise on applicability and adaptability of existing CR-guidelines. In the second round panellists ranked the importance of statements about HEBCR for older adults. In the third round panellists re-ranked statements when individual scores were outside the semi-interquartile range. Consensus was defined as a semi-interquartile range of ≤ 1.0. Results: Of 20 invited panellists, 11 (55%) participated. Panellists were clinical experts with a median (interquartile range) work experience of 20 (10.5) years. The panel reached a consensus on 89% of statements, identifying key topics such as implementing the patient perspective, assessing comorbidity and frailty barriers to exercise, and focusing on personal goals and preferences. Conclusion: This Delphi study provides recommendations for personalised HEBCR for older, frail patients with cardiovascular disease, which can improve the effectiveness of CR-programs and address the needs of this patient population. Prioritising interventions aimed at enhancing balance, lower extremity strength, and daily activities over interventions targeting exercise capacity may contribute to a more holistic and effective approach, particularly for older adults.

A 7-item Tampa Scale for Kinesiophobia in people with femoroacetabular impingement syndrome: evaluation of structural validity, hypothesis testing, internal consistency and minimally important change.

BACKGROUND: The 17-item Tampa Scale for Kinesiophobia (TSK) is a commonly used patient-reported outcome measure (PROM) to assess kinesiophobia, but the measurement properties of the TSK in people with femoroacetabular impingement syndrome (FAIS) are unknown. OBJECTIVES: 1) Revise the existing TSK by removing items, as needed, with inadequate functioning to optimise the TSK for people with FAIS, and 2) evaluate construct validity (both structural validity and hypothesis testing), internal consistency, and minimal important change. METHODS: Cross-sectional cohort study including 153 young adults with FAIS. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate structural validity and the TSK was revised to remove items with poor function, improving CFA model fit. Hypothesis testing, internal consistency (Cronbach's α) and minimal important change (distribution-based method) were also evaluated. RESULTS: A 7-item version of the TSK provided the best CFA model fit with 10-items functioning poorly and needing to be removed. The 7-item TSK was uni-dimensional (single factor in EFA) and had adequate structural validity (Standardised Root Measure Square = 0.0771). The 7-item TSK had insufficient hypothesis testing with moderate correlations to 8/14 PROMs measuring different constructs. The 7-item TSK had adequate internal consistency (α = 0.783). The minimal important change of the 7-item TSK was 6.00 points (0-100 point scale). CONCLUSION: We found that the '7-item TSK for FAIS', had superior structural validity to the original 17-item scale, suggesting that it may be more appropriate for use in this population. Further studies should evaluate other measurement properties of the 7-item scale.

Perceptions of using exoskeleton technology among physiotherapists and stroke survivors in Malaysia: a mixed methods study.

Exoskeleton technology has the potential to enhance the functional abilities of individuals with upper or lower limb dysfunction, including stroke survivors. However, its adoption in Malaysia has been limited due to its restricted availability in rehabilitation centres and hospitals. In this study, we aim to explore the perceptions and opinions of physiotherapists and stroke survivors regarding exoskeleton technology, focusing on identifying desired design features and investigating their views on its use in rehabilitation. An online survey was conducted to assess the preferred features of exoskeleton technology among physiotherapists and stroke survivors. Subsequently, one-to-one online in-depth interviews were carried out with physiotherapists who had experience using exoskeleton technology. Data were analysed using descriptive, thematic, and triangulation analysis methods. The analysis included 81 survey questionnaires from physiotherapists and 122 from stroke survivors. Both groups highlighted cost-effectiveness, safety, comfort, and ease of use as key features of exoskeletons. Additional insights from in-depth interviews with five physiotherapists emphasized the importance of a user-friendly interface, adjustability, and a lightweight design. Physiotherapists also expressed that exoskeleton technology could reduce their workload, minimize musculoskeletal-related disorders, and enhance their confidence. The main desired features identified by both physiotherapists and stroke survivors for exoskeleton technology include cost-effectiveness, safety, comfort, and ease of use. Physiotherapists further viewed it as a valuable tool to alleviate their workload and reduce musculoskeletal-related disorders while boosting confidence. These findings offer valuable guidance to developers, engineers, and manufacturers in the country, aiding in the development of client-centred exoskeleton features.

Insights from users of exoskeleton technology can improve its design and usability, particularly in rehabilitation settings.Addressing specific functionalities and user needs will help enhance rehabilitation outcomes for stroke survivors and physiotherapists. However, challenges, such as accessibility and affordability need to be addressed to fully integrate exoskeleton technology into clinical practice.This study offers valuable guidance for developers and manufacturers to create user-friendly, cost-effective designs that are adaptable to the unique requirements of local healthcare systems and users.

Perturbation Training in Anterior Cruciate Ligament Graft Tear and Posterolateral Corner Injury: A Case Report of a Combined Injury.

This case study illustrates how rehabilitation for combination injuries necessitates a thorough, customized strategy that includes perturbation training to address complicated biomechanical impairments because of the complex relationship between the anterior cruciate ligament (ACL) and the posterolateral corner (PCL). An 18-year-old female basketball player visited the Sports Rehab Outpatient Department with a complaint of pain in the posterior aspect of her knee, difficulty fully flexing her right knee joint, and intermittent instability one month after an injury. Her grade 2 ACL tear was accompanied by thinning of the lateral collateral ligament and strain of the popliteofibular ligament as per the MRI findings before the ACL reconstruction surgery. She underwent a knee graft sprain and ACL re-injury. The decision was made to manage the injury conservatively by implementing a rehabilitation program focused on perturbations to improve neuromuscular control and functional stability of the knee. This case report highlights the significance of a multidisciplinary approach, evidence-based interventions (such as the Lysholm score, International Knee Documentation Committee-Subjective Knee Form, and Tempa Scale of Kinesiophobia as outcome measures), and patient-centered care. This study intends to make a significant contribution to sports medicine and orthopedic rehabilitation by clarifying the complexities of rehabilitation in such complicated circumstances.

Integrated Rehabilitation of Longitudinal Extensive Transverse Myelitis: Study of a Complex Case.

Longitudinal extensive transverse myelitis (LETM) is a rare neurological disorder portrayed by inflammation of the spinal cord spanning three or more vertebral segments. It can lead to severe symptoms such as weakness, sensory abnormalities, and dysfunction in various parts of the body. LETM can be idiopathic or associated with autoimmune conditions like Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO). Diagnosis of LETM requires MRI imaging of the spine, and treatment often involves corticosteroids, intravenous immunoglobulins (IVIG), and plasma exchange. Physical therapy plays a crucial role in managing LETM, focusing on improving functional abilities, mobility, and quality of life. This study outlines a 62-year-old male who was admitted with a complaint of bilateral weakness of both upper and lower limbs, predominantly on the left side, seizures, falls, and stiffness of the left limbs. He also complained of a cough with sputum, cluster headache, bowels and bladder dysfunction, and impaired vision. Neurologic examination showed hypotonia and reduced muscle strength in all four limbs with impairment of the optic nerve. The following investigations were conducted: MRI, Chest X-ray, and ultrasound. He was advised for physiotherapy, after which he showed improvement in functional independence and a general recovery following the treatment.

Rehabilitation Strategies for Post-fasciotomy Recovery in Acute Spreading Cellulitis: A Case Report.

Cellulitis is a skin condition that affects both the dermis and the subcutaneous fat. Acute compartment syndrome has been associated with streptococcal infection. The present case highlights the role of physiotherapy in rehabilitating a patient suffering from compartment syndrome due to cellulitis. A 45-year-old female complained of swelling over the left forearm for five days. After being referred to the surgery department, she underwent clinical examinations, indicating cellulitis. As part of the surgical procedure, she had a fasciotomy and split skin grafting. Her pain was assessed using the numerical pain rating scale (NPRS), gradual in onset and progressive in nature, and aggravated on movement. The patient's case demonstrates the importance of following a planned physical therapy treatment regimen to restore functional activity, range of motion (ROM), and muscle strength.

The Effectiveness of Conservative Interventions on Pain, Function, and Quality of Life in Adults with Hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorders and Shoulder Symptoms: A Systematic Review.

Objective: To synthesize the evidence on conservative interventions for shoulder symptoms in hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD). Data Sources: A literature search was conducted using data sources Medline, PEDro, CINAHL, AMED, Elsevier Scopus, and the Cochrane Library from January 1998 to June 2023. Study Selection: The review included primary empirical research on adults diagnosed with hEDS or HSD who experienced pain and/or mechanical shoulder symptoms and underwent conservative interventions. Initially, 17,565 studies were identified, which decreased to 9668 after duplicate removal. After title and abstract screening by 2 independent authors, 9630 studies were excluded. The full texts of the remaining 38 were assessed and 34 were excluded, leaving 4 articles for examination. Data Extraction: Two authors independently extracted data using a predefined extraction table. Quality assessment used the Joanna Briggs Institute checklists and the Template for Intervention Description and Replication. Data Synthesis: The review covered 4 studies with a total of 7 conservative interventions, including exercise programs, kinesiology taping, and elasticized compression orthoses. Standardized mean differences were calculated to determine intervention effects over time. The duration of interventions ranged from 48 hours to 24 weeks, showing positive effect sizes over time in the Western Ontario Shoulder Instability Index, pain levels, improved function in activities of daily living, and isometric and isokinetic strength. Small to negligible effect sizes were found for kinesiophobia during completion of exercise programs. Conclusions: Shoulder symptoms in hEDS/HSD are common, yet significant gaps in knowledge remain regarding conservative interventions, preventing optimal evidence-based application for clinicians. Further research is necessary to explore the most effective intervention types, frequencies, dosages, and delivery methods tailored to the specific requirements of this patient population.

Is There Room for Improvement? Stroke Rehabilitation Environments May Not Reflect Home Environments in Terms of Chair, Toilet, and Bed Heights.

The present study aims to describe the chair, bed, and toilet heights in rehabilitation hospitals and home environments to challenge rehabilitation clinicians to better prepare stroke survivors for discharge home. This study uses analysis of secondary outcomes from a multicentre, phase II randomized controlled trial (HOME Rehab trial) and additional observation of hospital environment. Data were collected from six rehabilitation hospitals and the homes of two hundred first-time stroke survivors who were aged >45 years. Chair, bed and toilet heights were measured; we measured 936 chairs and beds in hospital (17%) and home (83%) environments. Mean chair height at home was 47 cm (SD 6), which was 2 cm (95% CI, 0-4) lower than in the hospital ward and 5 cm (95% CI, 3-7) lower than in the hospital gym. Mean toilet height at home was 42 cm (SD 3), which was 3 cm (95% CI, 2-4) lower than in the hospital. Study findings suggest a disparity in heights between hospitals and home. Although clinicians may be aware of this disparity, they need to ensure that chair and bed heights within the hospital environment are progressively made lower to better prepare stroke survivors for discharge home.

Translating acceptability to sustained delivery: Clinician and manager perspectives on implementing modified constraint-induced movement therapy in an early-supported discharge rehabilitation service.

BACKGROUND: Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) function after stroke. Despite up to one-third of stroke survivors being eligible, clinical uptake remains poor. To address this, a multi-modal behaviour change intervention was implemented across a large seven-site early-supported discharge (ESD) rehabilitation service. This study investigated the acceptability of mCIMT implementation within this ESD service and identified adaptations required for sustained delivery. METHODS: This qualitative study was nested within a mixed-methods process evaluation of mCIMT implementation. Four focus groups (n = 24) comprising therapists (two groups), therapy assistants (one group), and allied health managers (one group) were conducted. Data were analysed using reflexive thematic analysis and mapped to the Theoretical Domains Framework (TDF). CONSUMER AND COMMUNITY INVOLVEMENT: Consumers were not directly involved in this study; however, lived experience research partners have helped shape the larger mixed-methods implementation study. FINDINGS: Four themes were generated and mapped to the TDF. Factors related to acceptability included interdisciplinary practice in sharing workloads (belief about capabilities), practice opportunities across a range of UL presentations (skills), clinician attitudes influencing patient engagement (optimism), time constraints (belief about consequences), and cognitive overload from multiple systems and processes (memory, attention, and decision-making processes). Factors facilitating sustained delivery included improving stroke survivor education (knowledge), sharing success stories across teams (reinforcement), manager facilitation (social/professional role and identity), and the perception that the ESD setting was optimal for mCIMT delivery (social influences). CONCLUSION: mCIMT was acceptable in the ESD service, with clinicians feeling a responsibility to provide it. Key adaptations for sustained delivery included ongoing training, resource adaptation, and enhanced patient and carer engagement. Successful implementation and sustained delivery of mCIMT in the ESD service could enhance UL function and reduce the burden of care for potentially hundreds of stroke survivors and their carers. PLAIN LANGUAGE SUMMARY: Modified constraint-induced movement therapy (mCIMT) helps improve arm movement after a stroke. However, many stroke survivors do not get this therapy. To fix this, we started a program in a large home-based rehabilitation service. This study looked at how well mCIMT could fit into this service. We also wanted to know what changes were needed to make sure it was regularly provided. We held four group discussions with therapists, therapy assistants, and health managers. A total of 24 people took part. From these discussions, we found several important points. Therapists needed to work together as a team. They also needed to practice mCIMT to get better at delivering it. Therapists having a positive attitude would encourage more stroke survivors to take part. For long-term success, stroke survivors need better education about mCIMT. Managers need to encourage therapists to provide mCIMT. The rehabilitation service should also share their success stories about this therapy to encourage therapists to deliver it and stroke survivors to ask for it. Therapists enjoyed delivering mCIMT in the rehabilitation service. It worked better than other therapies to improve a stroke survivor's arm function. Because of this, they also felt it was their duty to offer mCIMT. Having ongoing training and better resources would help keep mCIMT going. If mCIMT can be provided regularly in this service, it could lead to better arm function and less care needed for many stroke survivors and their carers.

Utilising Xsens Gait Analysis to Improve Functional Outcomes in Chronic Ankle Instability: A Multifaceted Physiotherapy Approach.

Chronic ankle instability (CAI) is a common consequence of lateral ankle sprains, resulting in persistent pain, instability, and functional limitations. This case report investigates the effectiveness of a physiotherapy intervention for a 25-year-old female patient with CAI, marked by recurrent ankle sprains and persistent symptoms despite prior conservative treatments. The patient exhibited swelling, pain, and instability, with clinical assessment revealing significant ligament laxity and a high longitudinal arch in both feet. A comprehensive physiotherapy regimen focused on core, hip, and ankle muscle strength, dynamic balance, and proprioception was implemented, incorporating ankle stretches, joint mobilization, core strengthening, hip strengthening, and dynamic balance exercises on unstable surfaces. Pre-rehabilitation outcome measures included a numeric pain rating of 7/10, a Cumberland ankle instability tool (CAIT) score of 15/30, and a foot and ankle outcome score (FAOS) of 63%. Gait analysis revealed a speed of 0.79 m/s, a cadence of 99.24 steps/min, and a distance of 14.23 meters. Post-intervention, significant improvements were observed: pain reduced to 1/10, the CAIT score increased to 28/30, and the FAOS rose to 89%. Gait parameters also improved, with speed increasing to 0.90 m/s and distance to 15 meters. This case underscores the effectiveness of a targeted physiotherapy approach in managing CAI, highlighting the importance of a multi-dimensional rehabilitation strategy to enhance functional outcomes and reduce associated symptoms of CAI.

Physiotherapy students' and officers' knowledge, attitudes, and perceptions of mental health.

Background: Physiotherapy in mental health is not very popular among physiotherapists, students, healthcare professionals, and people living with mental illness (PLWMI), although many PLWMI are managed by physiotherapy students and physiotherapists. Aim: This study aimed to determine the knowledge, attitudes, and perceptions of physiotherapy students and physiotherapy community service officers (PCSOs) towards mental health. Setting: The study was conducted in KwaZulu-Natal (KZN). Methods: A concurrent mixed-method was employed using the Attitudes Toward Psychiatry (ATP-30) questionnaire and focus group discussions. The questionnaire was distributed to 100 PCSOs and 191 physiotherapy students. Focus groups were conducted to assess the knowledge gained through the undergraduate programme, comprising three groups of students from second to fourth year and two groups of PCSOs. An interview was also conducted with one PCSO. Results: A total of 146 students and 72 community service officers completed the questionnaire. Participants had an overall positive attitude, with a mean ATP-30 score of 108.02 (standard deviation [s.d.] = 10.86). Those with a family member or friend with a mental illness scored higher. Focus groups revealed limited knowledge about mental health and reluctance to work in the field. Conclusion: Physiotherapy students and PCSOs in KZN had positive attitudes towards mental health despite limited knowledge. They expressed a desire for more information about mental health. Contribution: The curriculum needs to include adequate mental health content to prepare students to manage PLWMI after graduation, reducing stigma, and negative perceptions, and ensuring confidence.

'Their role has a lot of purpose beyond being just being about exercises': a qualitative study of patients' experiences of physiotherapy following a mild traumatic brain injury.

Following a mild traumatic brain injury (mTBI; also known as concussion), physiotherapists may be involved in injury identification, assessment and rehabilitation. However, how people perceive and experience the physiotherapist's role is not well understood. Semistructured interviews were undertaken with patients who saw a physiotherapist individually or as part of a multidisciplinary team following mTBI in New Zealand. Interviews were recorded, transcribed verbatim and analysed using the interpretive descriptive approach. A total of 12 interviews were held with participants aged 19-67 (50% female; mean age 37 (SD=14.8) years) who had a mTBI on average 9 (SD=8) months ago. Thematic coding of interviews generated four themes, each supported by three to five categories representing their experiences: (1) 'How physiotherapy could help me'-representing how the interventions were delivered; (2) 'Empower me to manage my mTBI'-representing participants learnings to self-manage; (3) 'Set me up to get the most out of treatment'-representing considerations needed before, during and after practice to maximise engagement and (4) 'Get to know me and what's important to me'-representing the importance of considering the person as a whole, and preferences for assessment, intervention, communication and culture throughout service delivery. Overall, participants reported variable mTBI care experiences yet perceived the physiotherapist as having a key role in supporting self-management and treating headaches, neck pain and balance issues. mTBI physiotherapy care needs to be more attuned to patients' preferences and circumstances and delivered in a way that maximises rehabilitation outcomes. Building effective therapeutic connections with patients may be key to addressing these concerns simultaneously in practice.