Aged care as a bellwether of future physiotherapy.

Aged care is becoming an increasingly significant feature of health care, but it is not an area physiotherapists have traditionally favored. Aging populations of increasingly chronically ill people represent the most important community of need in health care however, and so physiotherapists risk being marginalized if they do not adapt their practices to meet this growing need. Aged care may therefore represent a testing ground for a new physiotherapy, and the lessons learned in reforming physiotherapy for older adults may extend to all aspects of practice. In this paper, I explore how our current approach to aged care came about, and make the case for change. Having critiqued biomedicine, I also argue that the newer holistic models of health care are equally inadequate, because they attempt to dissolve important philosophical differences between physical, experiential, and social paradigms into an amorphous whole. I argue that these 'embodied' models of health make a holistic approach to aged care impossible and, instead, suggest new materialism and object-oriented ontologies as alternative physiotherapy paradigms.

Evaluación de competencias en prácticas cinésicas preprofesionales. Aportaciones del Mini Clinical Evaluation Exercise (mini-CEX) / Skills assessment in practice prekinesiology professionals. Contributions of the Mini Clinical Evaluation Exercise (mini-CEX)

Introducción. Hasta el momento, la evaluación en las carreras de licenciatura en cinesiología contempla contenidos conceptuales, además de que el estudiante desarrolle en el proceso de enseñanza-aprendizaje contenidos procedimentales y actitudinales. Las competencias necesarias para el ejercicio de la cinesiología afectan los dominios procedimentales y actitudinales, más allá de los conceptuales, lo que pone de manifiesto la insuficiencia de las evaluaciones tradicionales. Por tal motivo se analizó la aplicación y las aportaciones de un instrumento de evaluación holística, el mini-CEX. Sujetos y métodos. Se aplicó una planilla del mini-CEX adaptada a 125 estudiantes de cuarto y quinto año de la carrera de licenciatura en cinesiología que cursan asignaturas específicas de práctica profesional. Resultados. Participaron 125 estudiantes en 20 evaluaciones (cinco en cada asignatura), con una media de 1,3 a 4,6, que fue mejorando en cada evaluación. El tiempo de cada una fue de 20 minutos. Conclusión. El instrumento constituye un aportación a la evaluación de competencias en estudiantes de cinesiología (AU)

Introduction. So far, the evaluation Degree Careers in Kinesiology, provide conceptual, regardless students develop in the teaching-learning process in the field, procedural and attitudinal. The skills required for the exercise of kinesiology undertake procedural and attitudinal domains, beyond the conceptual, which highlights the inadequacy of traditional assessments. Therefore the applicability and reliability of an instrument of holistic assessment, the mini-CEX analyzed. Subjects and methods. A form of mini-CEX 125 adapted to fourth and fifth year of the Bachelor in Kinesiology specific subjects enrolled in professional practice applies. Results. 125 students participated in 20 evaluations (five in each subject) with an average of 1.3 to 4.6, which was improving with every evaluation. Each time was 20 minutes. Conclusion. It is concluded that the reliability and feasibility study indicated when applied kinesiology students (AU)

Força muscular respiratória e pico de fluxo expiratório de pacientes com bronquiectasia submetidos à reabilitação respiratória / Respiratory muscle strength and peak expiratory flow in patients with bronchiectasis underwent pulmonary rehabilitation / La fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria

Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo ®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia(AU)

Objetivo. Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia

Objective. This research aimed to evaluate the respiratory muscle strength and peak expiratory flow in patients with bronchiectasis undergoing respiratory rehabilitation. Method. Clinical trial where, after scrutiny of inclusion and exclusion criteria, the sample was divided randomly into experimental group (EG, n = 13, age = 60 ± 14.86 years) - who underwent treatment with respiratory rehabilitation twice week, lasting 40 minutes per session, at 12 weeks and control group (CG, n = 13, age = 58 ± 13.90 years) - patients with conservative clinical follow-up without therapy during the period of research because they were part of a waiting list for care. The dependent variables of the study were respiratory muscle strength (maximal inspiratory pressure - MIP- expiratory pressure - MEP) and peak expiratory flow (PEF), measured by the manometer and the peak flow®, respectively. The level of significance was set at p < 0.05. Results. In within groups comparison, there was a significant increase only in the EG variables, namely: MIP (Δ = 18.08 cm H2O, p < 0.001) and MEP (cmH2O Δ = 12.31, p < 0.001) and PEF (Δ = 26.77 l / min, p = 0.016). In the between groups comparison, increased satisfactory post-test, GE, compared to GC in MIP and MEP (p = 0.005). Conclusion. it appears that physical therapy influences the proposed increase in respiratory muscle strength and peak expiratory flow in patients with bronchiectasis(AU)

The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners (chiropractors, osteopaths, and musculoskeletal physiotherapists) across the United Kingdom. SUMMARY OF BACKGROUND DATA: A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations. METHODS: In total, 1758 practitioners were randomly allocated to either of the 2 study arms. One arm was posted a printed information package containing guideline recommendations for the management of LBP (n = 876) and the other received no intervention (n = 882). The primary outcome measure consisted of 3 "quality indicators" (activity, work, and bed-rest) relating to a vignette of a patient with LBP, in which responses were dichotomized into either "guideline-inconsistent" or "guideline-consistent." The secondary outcome was the practitioners' LBP-related beliefs, measured using the Health Care Providers Pain and Impairment Relationship Scale. Outcomes were measured at baseline and at 6 months. RESULTS: Follow-up at 6 months was 89%. The changes in reported behavior on the quality indicators were as follows: activity, odds ratio (OR) 1.29 (95% confidence interval, 1.03-1.61) and number needed to be treated (NNT), 19 (15-28); work, OR 1.35 (1.07-1.70) and NNT 19 (14-29); and bed-rest, OR 1.31 (0.97-1.76) and NNT 47 (33-103). The composite NNT for a change from guideline-inconsistent to guideline-consistent behavior on at least 1 of the 3 quality indicators was 10 (9-14). LBP-related beliefs were significantly improved in those who were sent the information package (P = 0.002), but only to a small degree (mean difference, 0.884 scale points; 95% confidence interval, 0.319-1.448). CONCLUSION: Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners, toward practice that is more in line with guideline recommendations.

Physical therapy in the 21st century (Part II): evidence-based practice within the context of evidence-informed practice.

Part II of this two-part introduction to this Special Issue on physical therapy practice in the 21st century outlines a health-focused strategy for physical therapists to lead in the assault on lifestyle conditions, global health care priorities, described in Part I. Consistent with contemporary definitions of physical therapy, its practice, professional education, and research, physical therapy needs to reflect 21st-century health priorities and be aligned with global and regional public health strategies. A proposed focus on health emphasizes clinical competencies, including assessments of health, lifestyle health behaviors, and lifestyle risk factors; and the prescription of interventions to promote health and well-being in every client or patient. Such an approach is aimed to increase the threshold for chronic conditions over the life cycle and reduce their rate of progression, thereby preventing, delaying, or minimizing the severity of illness and disability. The 21st-century physical therapist needs to be able to practice such competencies within the context of a culturally diverse society to effect positive health behavior change. The physical therapist is uniquely positioned to lead in health promotion and prevention of the lifestyle conditions, address many of their causes, as well as manage these conditions. Physical therapists need to impact health globally through public and social health policy as well as one-on-one care. This role is consistent with contemporary definitions of physical therapy as the quintessential noninvasive health care practitioner, and the established efficacy and often superiority of lifestyle and lifestyle change on health outcomes compared with invasive interventions, namely, drugs and surgery. A concerted commitment by physical therapists to health and well-being and reduced health risk is consistent with minimizing the substantial social and economic burdens of lifestyle conditions globally.

Physical therapy management of low back pain has changed.

BACKGROUND: Since the 1990s, new insights in the physical therapy management of low back pain have been described in guidelines. Furthermore, insurance companies introduced a volume policy to control the costs for physical therapy. OBJECTIVE: This study aims to establish if developments in knowledge and health policy since the 1990s have resulted in changes in the physical therapy management of patients with low back pain (LBP) in the Netherlands. METHODS: Data from 3148 patients, referred because of LBP, were selected from the databases of two registration studies (1989-1992 and 2002-2003) of patients treated by physical therapists. Descriptive statistics were used to compare patient characteristics. A multi-level regression analysis was carried out to determine a change in the number of treatment sessions adjusting for patient and disease characteristics, and to control for different levels (patient and physical therapist). RESULTS: A small decline in the number of treatment sessions was observed. In 2002, exercise therapy was the most frequently applied intervention, while massage and physical modalities were the interventions of first choice in the early 1990s. CONCLUSION: Our results suggest that since 1990 the management of patients with LBP by physical therapists in the Netherlands has changed. Both quality management by the profession and volume policy by government and insurance companies seem to have been instrumental in bringing about a decline in the number of treatment visits and an increase in the use of evidence-based interventions.

La Fisioterapia Respiratoria en España: una aproximación a su realidad / Respiratory Physiotherapy in Spain: an approach to its reality

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La Fisioterapia en los balnearios / Physiotherapy in the spas

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El papel del fisioterapeuta en el balneario / Physiotherapists role on spa

La presencia de los fisioterapeutas en los balnearios es reciente y escasa. En este artículo se hace una aproximación conceptual al papel que debe desarrollar el fisioterapeuta en un balneario, basándose, por una parte, en la definiciones de Fisioterapia y sus actuaciones realizadas por la Asociación Española de Fisioterapeutas, y, por otra, que los balnearios utilizan fundamentalmente agentes físicos propios de la Fisioterapia y con los mismos fines que ésta (AU)

Physiotherapists presence in a spa is recent and scarce. On this article a conceptual approach is made to the physiotherapists role on spa; it is based on one side on the definition of physiotherapists and their role made by the Spanish Association of Physiotherapists; on the other side spa use basically physical agents characteristic of Physiotherapy and with the same purposes (AU)

Situación actual de la Fisioterapia en los balnearios de España / The current situtation of Physiotherapy in Spanish spa resorts

Objetivo. Describir el número de fisioterapeutas que en la actualidad trabajan en los balnearios españoles y recabar información de los directores médicos acerca de si la presencia de un fisioterapeuta en el equipo mejora o mejoraría la calidad asistencial. Material y método. Estudio observacional descriptivo en el que se ha recogido la información de forma prospectiva. El ámbito de estudio han sido los balnearios de todas las comunidades autónomas españolas. Resultados. Se han identificado un total de 88 balnearios en nuestro país. La Rioja es la Comunidad Autónoma con un mayor número de fisioterapeutas por balneario: 12/1, mientras que Cataluña es la que cuenta con un mayor número de médicos: 14 (20%), y masajistas-auxiliares de baño: 42 (33,1%). La opinión de los directores médicos y/o gerentes en cuanto a si la presencia de un fisioterapeuta mejora o mejoraría la calidad asistencial resultó ser manifiestamente positiva tanto en la Comunidad Autónoma Gallega como en el resto del país. Conclusiones. De los resultados de nuestro estudio se puede concluir que únicamente un reducido número de fisioterapeutas desempeña su labor profesional en los balnearios españoles, muy especialmente cuando se le compara con otros colectivos (masajistas-auxiliares de baño) (AU)

Objective. Description of number of physiotherapists actually working in Spanish spa centers and obtain by entraty information through medical directors about knowing if the presence of a physiotherpist in the team increases or could increase the welfare quality. Materials and method. Observance descriptive study in which the information in a prospective form has been picked up. The field of study have been the spa centers in all the Spanish autonomus communities Outcome. A total of 88 spa centers have been identified in our country. La Rioja is the Autonomous Community with a largest number of physiotherapist by spa center: 12/1, while Cataluña is the one having a largest number of doctors with: 14 (20%) and bath masseur-assistants: 42 (33,1%). The opinion of the medical directors and/or managers about if the presence of a physiotherapist increases or could increase the welfare quality has been clearly positive as well in the Galician Autonomous Community as in the other parts of the country.C Conclusions. From the outcome of our study we can infer that only a small number of physiotherapists perform his professional work in Spanish spa centers, especially when you compare with the other groups (bath masseur-assistants) (AU)

Impacto en kinesiología: necesidad de definir y evaluar / Impact in physical therapy: needs to define and assess

Los cada vez más exigentes estándares de atención en salud han conducido al desarrollo de metodologías para la evaluación del impacto del tratamiento kinesiológico en el proceso de la rehabilitación del paciente. Para ello se ha adoptado, entre otros, como herramienta la clasificación propuesta por la Organización Mundial de la Salud, en la cual se reconocen tres esferas durante el proceso de recuperación: deterioro, discapacidad y handicap. El adoptarlas posibilita priorizar la atención y esclarecer los objetivos del tratamiento. Si bien la literatura al respecto es escasa, y con resultados muchas veces poco favorables, cada día aumenta el interés por investigar. Por esta razón se propone continuar buscando escalas de evaluación de manera de abrir un nuevo camino de discusión para el quehacer kinésico

O papel da fisioterapia no preparo para o parto de cócoras / The paper of phisiothrapy in the preparation of the squat delivery

O parto de cócoras tem assumido, nos dias atuais, posiçäo de destaque dentro do campo da obstetrícia, pela evidência dos benefícios da relaçäo materno-fetal, das condiçöes pós-natais imediatas da mäe e do próprio recém-nascido, em relaçäo a outros tipos de parto. Neste contexto, a fisioterapia contribui significativamente para oferecer uma preparaçäo física adequada às mulheres que se submeteräo ao parto de cócoras, proporcionando um desenvolvimento harmonioso dos períodos de gestaçäo, parto e puerpério