"This patient is not appropriate": Perspectives of physiotherapy students and clinical educators on exposing students to patients with complex needs during clinical practice placements.

BACKGROUND: Clinical practice placements play an important role in preparing students for challenging areas of clinical practice. Little is known about student learning needs for working with patients with complex needs during clinical practice placements, and clinical educator decision-making that underpins this exposure. PURPOSE: To explore the perspectives of physiotherapy students and clinical educators on exposing students to working with and learning from patients with complex needs during clinical practice placements across Queensland and New South Wales, Australia. METHODS: Six semi-structured focus groups with pre-registration physiotherapy students undertaking clinical practice placements (n = 19) and semi-structured one-on-one interviews with clinical educators (n = 20). Data were analyzed using reflexive thematic analysis. RESULTS: Four overarching themes were generated following analysis: 1) Complexity is challenging; 2) Tension between student exposure and patient care; 3) Variance in expectations; and 4) Readiness for complexity. CONCLUSION: Physiotherapy students and clinical educators recognize the challenges and importance of exposure to patients with complex needs. Student learning experiences are influenced by clinical educator decision-making, which is often unclear, leading to varying opportunities. This study highlights the need for enhanced support from clinical educators to prepare students for working with patients with complex needs.

Exploring strengths and weaknesses in health services research culture and capacity.

Objective Fostering a research culture and enhancing research capacity within the workforce is essential for any health service aiming to provide evidence-based care. This study aims to explore the research culture and capacity in a community health service setting and provide a comparison to previous published research in other health service settings. Methods Participants were invited to complete a survey consisting of demographics and the Research Capacity and Culture (RCC) tool. Median and interquartile ranges were calculated for each RCC item and compared to three Australian and one international comparison. Results A total of 73 staff members from Metro North Community and Oral Health service participated. The team-level scores for the RCC were overall the lowest. Comparison to previously published research using the RCC indicated marginally higher scores for individual-level items in our study across all domains. Individual-level items were very weak to weakly correlated with the team and organisation-level RCC items. Strong to very strong correlations were found between a majority of the team and organisation-level items. Conclusions Team-level scores were substantially lower when compared to individual and organisational levels. The item 'team leaders that support research' was positively correlated with various organisation-level items, indicating that if the respondent perceived the team leader as a low supporter of research the respondent perceived several organisation items also poorly. As an important stakeholder in enabling research in a health service, organisations should investigate the challenges experienced by team leaders in facilitating research and the support or training they may need.

Theories, Models, Frameworks, Guidelines, and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review.

BACKGROUND: Traumatic life experiences (TLE) are common and can affect a person's physical being and health-related behaviors, including those related to oral health. This scoping review aimed to identify evidence exploring the implementation and provision of trauma-informed care (TIC) in oral health services delivery. METHODS: Arksey and O'Malley's framework with enhancements proposed by Levac et al. and Peters et al. was used. Studies were selected based on a preset inclusion and exclusion criteria and the population/concept/context framework. Primary charting of descriptive data was conducted, followed by thematic analysis to identify ideas common within the included literature. Searches were conducted in Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases. Google Scholar and ProQuest were used to identify grey literature. RESULTS: The search identified 251 records, with fifteen records meeting the inclusion criteria. Limited models, frameworks, and recommendations for trauma-informed practices in oral health services were identified. Recommendations for TIC practices were identified, and clinical practice adjustments for dental practitioners were described to improve service delivery for patients who may have experienced trauma. Avenues for future research were identified. CONCLUSIONS: Limited evidence exists to guide trauma-informed practice in oral health service delivery. This scoping review highlights the need for further research into approaches and practices of TIC for oral health services delivery to assess their efficacy and the need to develop evidence-based TIC frameworks to meet the unique needs of oral health service providers and populations.

Prioritising enhancements across allied health telehealth services in a metropolitan hospital: Using a concept mapping approach.

INTRODUCTION: A prior study examining perceptions of Allied Health Professions (AHP) telehealth services at a metropolitan hospital highlighted multiple issues impacting service uptake, operationalisation, and delivery. Concept mapping methodology was utilised to address these issues and prioritise actionable telehealth service improvements. METHODS: Representatives (n = 22) from seven AHP departments and consumers generated statements addressing the question: 'What do we need to do to enhance and sustain telehealth services?' Statements were synthesised and then clinicians and managers sorted them into similar groups and assigned each statement a ranking of perceived (a) importance and (b) changeability. Multivariate and multidimensional scaling was undertaken to develop a final prioritised set of goals for change. RESULTS: Ninety-six unique statements were generated as actionable goals for change. Statements were grouped into 13 clusters relating to improvements in staff support, infrastructure, consumer support and organisational processes. All clusters were rated >50% for importance (range 3.3-2.4 out of 4) and changeability (range 2.6-2.1 out of 4). Twenty-six statements were ranked highest for importance and changeability. Key prioritised areas were staff training, consumer advocacy and engagement, telehealth operations and workflow. CONCLUSION: Concept mapping was an effective process for generating a prioritised list of actions to enhance AHP telehealth services.

The Effectiveness of Aquatic Plyometric Training in Improving Strength, Jumping, and Sprinting: A Systematic Review.

CONTEXT: Aquatic plyometric training may provide benefits due to reduced joint loading compared with land plyometric training; however, the reduced loading may also limit performance gains. OBJECTIVE: To systematically review the effect of aquatic plyometric training on strength, performance outcomes, soreness, and adverse events in healthy individuals. EVIDENCE ACQUISITION: Five databases were searched from inception to June 2020. Quality assessment and data extraction were independently completed by 2 investigators. When similar outcome measures were used, standardized mean differences were calculated. EVIDENCE SYNTHESIS: A total of 19 randomized controlled trials with 633 participants (mean age, range 14-30 y) were included. Aquatic plyometric training was most commonly performed in waist to chest deep water (12/19 studies), 2 to 3 times per week for 6 to 12 weeks (18/19 studies), with final program foot contacts ranging from 120 to 550. Meta-analyses were not completed due to the clinical and statistical heterogeneity between studies. Compared with land plyometric training, aquatic plyometric training exercises and dosage were replicated (15/16 studies) and showed typically similar performance gains (3/4 knee extensor strength measures, 2/4 leg extensor strength measures, 3/4 knee flexor strength measures, 7/10 vertical jump measures, 3/3 sprint measures). In total, 2 of 3 studies monitoring muscle soreness reported significantly less soreness following training in water compared with on land. Compared with no active training (no exercise control group or passive stretching), most effect sizes demonstrated a mean improvement favoring aquatic plyometric training (23/32 measures). However, these were not significant for the majority of studies measuring isokinetic knee strength, vertical jump, and sprinting. The effect sizes for both studies assessing leg press strength indicated that aquatic plyometric training is significantly more effective than no training. CONCLUSION: Aquatic plyometric training appears similarly effective to land plyometric exercise for improving strength, jumping, and sprinting and may be indicated when joint impact loading needs to be minimized. However, the low quality of studies limits the strength of the conclusions.

Sensorimotor system changes in adolescent rugby players post-concussion: A prospective investigation from the subacute period through to return-to-sport.

BACKGROUND: The pathophysiology of concussion is complex. Altered sensorimotor function post-concussion may contribute to the wide range of symptoms and impairments reported. There is currently limited evidence documenting changes in sensorimotor function during the recovery period. The aim of this study was to investigate the effect of concussion on the sensorimotor system in adolescents post-concussion using a multifaceted approach. STUDY DESIGN: Prospective nested case-control study. METHODS: A total of 285 male adolescent rugby players underwent assessment of sensorimotor function during preseason. Players who sustained a concussion during the season and control players, matched for age and playing position, were assessed in the subacute period (3-5 days) and after return-to-sport (3 weeks). Tests of sensorimotor function included balance, cervical spine and vestibulo-ocular function, and measurement of the size and contraction of lumbopelvic muscles (ultrasound imaging). RESULTS: Twenty-three players (8%) sustained a concussion. Of these, 20 players were assessed during the subacute period and 17 players following return-to-sport. The prevalence of vestibulo-ocular dysfunction increased from 38.9% to 72.2% during the subacute period and dysfunction was present in 83.3% of players after return-to-sport (p = 0.01). Changes in lumbar multifidus muscle size (p = 0.002) and thickness (p = 0.05) at the L5 vertebral level were observed. No statistically significant changes in balance, cervical spine proprioception, or contraction of lumbopelvic muscles were found (p > 0.05). CONCLUSION: Changes in sensorimotor function were observed in the subacute period post-concussion, with some persisting after return-to-sport. Using symptom-based criteria for return-to-sport may not adequately reflect the sequelae of concussion on the sensorimotor system.

Sustaining allied health telehealth services beyond the rapid response to COVID-19: Learning from patient and staff experiences at a large quaternary hospital.

The patient, clinician and administration staff perspectives of telehealth (specifically videoconferencing) services provided by Allied Health Professions (AHP) at a large quaternary hospital were explored. The purpose was to understand stakeholders' perceptions of the service during initial COVID-19 restrictions and examine factors that influenced the implementation and sustained use of telehealth. A sequential mixed-methods approach was undertaken. Stage 1 involved surveys completed by patients (n = 109) and clinicians (n = 66) who received and provided care via telehealth, respectively, across six AHP departments. Stage 2 involved focus groups with clinicians (n = 24) and administrative staff (n = 13) to further examine implementation and sustainability factors.All participant groups confirmed that telehealth was a valid service model and valued the benefits it afforded, particularly during COVID-19 restrictions. Both patients and clinicians reported that not all AHP services could be delivered via telehealth and preferred a blended model of telehealth and in-person care. Increased administrative staff assistance was needed to support growing telehealth demand. Main factors to address are the need to expand AHP telehealth models and workforce/patient training, improve workflow processes and enhance technical support.Despite rapid implementation, telehealth experiences were overall positive. Study findings are being used to generate solutions to enhance and sustain AHP telehealth services.

Vestibulo-ocular dysfunction in adolescent rugby union players with and without a history of concussion.

OBJECTIVES: Sport-related concussions are common in adolescent contact sports. Vestibulo-ocular dysfunction has been reported in athletes post-concussion. There is a lack of research on vestibulo-ocular function in sporting adolescents, and the influence of previous concussions on the vestibular system in this population. The aim of this study was to investigate vestibulo-ocular function in a cohort of adolescent rugby players with and without a history of concussion during pre-season assessment. DESIGN: Cross-sectional cohort. METHODS: 213 male adolescent (13-18 years old) rugby players were recruited from six schools in Queensland, Australia. Vestibulo-ocular assessments were conducted during the preseason and included clinical assessment of oculomotor function and the vestibulo-ocular reflex (VOR) using the clinical and video-Head Impulse Test (HIT). Players were allocated into two groups: no history of concussion in the last 12 months (n = 165); and concussion in the last 12 months (n = 48). RESULTS: There were no between group differences in vestibulo-ocular function for players with and without a history of concussion (p = 0.65). However, vestibulo-ocular dysfunction was reported in 69 (32.7%) of the players tested, who had either abnormal oculomotor control or VOR function. CONCLUSIONS: The high prevalence of vestibulo-ocular dysfunction in adolescent rugby players suggests that positive clinical findings post-concussion need to be interpreted carefully in the absence of baseline or pre-concussion assessments.

Force during functional exercises on land and in water in older adults with and without knee osteoarthritis: Implications for rehabilitation.

BACKGROUND: Closed kinetic chain and plyometric exercises are commonly used in aquatic rehabilitation because they are believed to reduce joint loading whilst replicating functional tasks. However, the forces and relationship to land-based functional movement is unknown. This study aims to compare vertical ground reaction force during squats, calf raises and jumping in older adults with and without knee osteoarthritis on land and in water. METHODS: Forty one participants (Healthy n = 21; Knee osteoarthritis n = 20; Age 68.5 (4.4) years) completed squats and calf raises at slow, medium and maximal speeds and jumping at maximal speed on land and in waist and chest depth water. Vertical ground reaction force and pain rating was measured in each environment. RESULTS: Force in all exercises was significantly greater on land than in chest depth water (p < 0.005). Peak force was significantly greater at maximal speed compared to slow speed (p < 0.001). The pattern of force in squats at slow speed in water was different to on land, with force highest at the start and end of the exercise and decreasing in the central phase. Pain ratings were significantly lower (p < 0.001) in water compared to on land in squats. CONCLUSIONS: Closed kinetic chain exercises offer inherently different loading in an aquatic environment. Body weight squats and calf raises in water could be defined as either neuromotor or low load, high velocity training. Maximal speed exercise in water produces higher relative load compared to slow speed and minimal pain providing an opportunity for clinicians to use greater speed to address power deficits.

A Systematic Review of the Reported Proportions of Diagnoses for Dizziness and Vertigo.

OBJECTIVES: To determine the typical proportions of diagnoses for patients presenting with dizziness or vertigo based on clinical speciality and to assess the change in proportions of diagnoses over time. DATA SOURCES: Following PRISMA guidelines, systematic searches of PubMed and CINAHL databases and follow-up reference searches were performed for articles published in English up to October 2016. STUDY SELECTION: Analysis of searches yielded 42 studies meeting the criteria of case series of adult patients with dizziness and/or vertigo presenting to general practice, emergency departments or specialist outpatient clinics. DATA EXTRACTION: Data comprising demographics, diagnostic cases, and the total number of cases were recorded and independently tested, followed by a risk of bias analysis. DATA SYNTHESIS: Sample size weighted proportions expressed as percentages with confidence intervals were calculated and compared using χ analysis and a reference proportion formed by the combination of Ear Nose and Throat and Neurotology case series published between 2010 and 2016. Analysis of diagnostic trends over time used Poisson regression with consideration for overdispersion. CONCLUSIONS: This systematic review of case series demonstrated significant differences in the proportions of diagnoses for patients presenting with dizziness or vertigo, depending on the specialty making the diagnosis. ENT proportions were dominated by BPPV, Psychogenic and Menière's disease diagnostic categories, whereas emergency proportions were dominated by Other, Cardiac, and Neurological categories. Analysis of case series proportions over time revealed increases in diagnoses such as Benign Paroxysmal Positional Vertigo and Vestibular Migraine, and a corresponding decrease in the diagnoses of Menière's disease.

Low-cost electromyography - Validation against a commercial system using both manual and automated activation timing thresholds.

Widespread use of electromyography (EMG) as an assessment and biofeedback method may be limited by costly commercial systems. Low-cost devices are available; however their validity is unknown. This study determined the concurrent validity of a low-cost EMG on a microchip compared with a commercially available system during isometric and dynamic muscle contractions. Inter-tester, intra-session reliability of manual data extraction during data processing compared to a simple, automatic thresholding method using the Teager-Kaiser energy operator (TKEO) was also evaluated. 10 healthy women (age 28.1 ±â€¯6.8 yrs, height 162.1 ±â€¯6.8 cm, mass 60.3 ±â€¯10.2 kg) were assessed simultaneously with a commercially available EMG system (Telemyo DTS) and a custom low-cost EMG system (Myoware Muscle Sensor) during voluntary isometric contractions, knee extension, squatting, stepping and jumping. Two surface electrode sets (connected to the low-cost and the commercial system) were placed end to end along the same Vastus Lateralis muscle fibre line. Peak and mean contraction intensity, and contraction duration were analysed. Overall the relative agreement between systems was excellent for peak muscle activation (ICC 0.77-0.96) and modest to excellent for mean muscle activation (ICC 0.68-0.95) and contraction duration (ICC 0.65-0.99). Inter-tester, intra-session reliability was excellent for peak contraction intensity (ICC > 0.99) and modest to excellent for mean contraction intensity, with the TKEO method primarily recording stronger agreement than the manual method. Poor to excellent inter-tester reliability occurred for contraction duration. Our findings indicate that a low-cost EMG system is comparable to a commercial system for assessing muscle activation, and that using the TKEO improved the reliability of timing related variables.

Epidemiology of injuries in Australian school level rugby union.

OBJECTIVES: There is a high incidence of injuries in rugby union due to the physical nature of the game. There is a lack of large-scale injury surveillance data reported for school level rugby players of different ages. Our study aimed to investigate the frequency and nature of injuries being sustained during an Australian school level rugby union season. DESIGN: Prospective observational study. METHODS: Injury surveillance was conducted on 3585 rugby players from all 8 schools participating in an interschool rugby competition in Queensland, Australia. Match injury data were collected using paper-based injury recording forms during the season using a 'medical-attention' injury definition for each age group from opens (17 and 18year olds) through to year 5 teams (9-10year olds). RESULTS: There were 332 injuries recorded over 14,029 player hours during the season. The overall rate of injury was 23.7/1000 player hours (95% CI, 21.2-26.3). The incidence of upper and lower limb injuries were 6.3 and 5.6 injuries/1000 player hours respectively (95% CI, 5.1-7.8 and 4.5-7.0). The incidence of suspected concussion injuries was 4.3/1000 player hours (95% CI, 3.6-5.5). Injuries differed across age groups and tackling was the most common mechanism of injury. CONCLUSIONS: The injury patterns observed in this large sample of players could be used to guide injury prevention programs in school level rugby union. Injury prevention programs should include age appropriate interventions and focus on improving the techniques used during the contact phase of rugby.

Effectiveness of Aquatic Exercise in Improving Lower Limb Strength in Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the effectiveness of aquatic exercise in improving lower limb strength in people with musculoskeletal conditions. DATA SOURCES: A systematic search used 5 databases, including MEDLINE, CINAHL, Embase, SPORTDiscus, and The Cochrane Library. STUDY SELECTION: Randomized controlled trials evaluating aquatic exercise with a resistance training component for adults with musculoskeletal conditions compared with no intervention or land-based exercise were identified. Fifteen studies from the initial yield of 1214 met these criteria. DATA EXTRACTION: Data related to participant demographics, study design, and methods, interventions, and outcomes, including numerical means and SDs, were extracted independently by 2 reviewers. DATA SYNTHESIS: Nine of the 15 studies were of high quality, scoring at least 6 on the Physiotherapy Evidence Database Scale. Limited consideration of the prescription of resistance in the aquatic exercise and application of resistance training principles existed. Low- or very low-quality evidence indicates there was no difference in average effect between aquatic exercise and no exercise in improving hip abductor strength (standardized mean difference [SMD], .28; 95% confidence interval [CI], -.04 to .59), knee extensor strength (SMD, .18; 95% CI, -.03 to .40), knee flexor strength (SMD, .13; 95% CI, -.20 to .45), or lower limb endurance (SMD, .35; 95% CI, -.06 to .77). Low-quality evidence indicates no difference in average effect between aquatic and land exercise for knee extensor (SMD, -.24; 95% CI, -.49 to .02) or flexor strength (SMD, -.15; 95% CI, -.53 to .22). CONCLUSIONS: It is likely that the inadequate application of resistance in water is a significant contributor to the limited effectiveness of aquatic exercise interventions in improving hip and knee muscle strength in people with musculoskeletal conditions. Future research is needed to quantify resistance with aquatic exercises and to determine if using opportunities for greater resistance in aquatic rehabilitation and appropriate resistance training principles can be more effective in improving muscle strength.

Spatiotemporal, kinematic, force and muscle activation outcomes during gait and functional exercise in water compared to on land: A systematic review.

BACKGROUND: Exercises replicating functional activities are commonly used in aquatic rehabilitation although it is not clear how the movement characteristics differ between the two environments. A systematic review was completed in order to compare the biomechanics of gait, closed kinetic chain and plyometric exercise when performed in water and on land. METHODS: Databases including MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane library were searched. Studies were included where a functional lower limb activity was performed in water and on land with the same instructions. Standardized mean differences (SMD) and 95% confidence intervals were calculated for spatiotemporal, kinematic, force and muscle activation outcomes. FINDINGS: 28 studies included walking or running (19 studies), stationary running (three), closed kinetic chain exercise (two), plyometric exercise (three) and timed-up and go (one). Very large effect sizes showed self-selected speed of walking (SMD >4.66) and vertical ground reaction forces (VGRF) (SMD >1.91) in water were less than on land, however, lower limb range of movement and muscle activity were similar. VGRF in plyometric exercise was lower in water when landing but more similar between the two environments in propulsion. Maximal speed of movement for walking and stationary running was lower in water compared to on land (SMD>3.05), however was similar in propulsion in plyometric exercise. INTERPRETATION: Drag forces may contribute to lower self-selected speed of walking. Monitoring speed of movement in water assists in determining the potential advantages or limitations of aquatic exercise and the task specificity to land-based function.

Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis.

OBJECTIVE: To investigate the effectiveness of aquatic exercise in the management of musculoskeletal conditions. DATA SOURCES: A systematic review was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and The Cochrane Central Register of Controlled Trials from earliest record to May 2013. STUDY SELECTION: We searched for randomized controlled trials (RCTs) and quasi-RCTs evaluating aquatic exercise for adults with musculoskeletal conditions compared with no exercise or land-based exercise. Outcomes of interest were pain, physical function, and quality of life. The electronic search identified 1199 potential studies. Of these, 1136 studies were excluded based on title and abstract. A further 36 studies were excluded after full text review, and the remaining 26 studies were included in this review. DATA EXTRACTION: Two reviewers independently extracted demographic data and intervention characteristics from included trials. Outcome data, including mean scores and SDs, were also extracted. DATA SYNTHESIS: The Physiotherapy Evidence Database (PEDro) Scale identified 20 studies with high methodologic quality (PEDro score ≥6). Compared with no exercise, aquatic exercise achieved moderate improvements in pain (standardized mean difference [SMD]=-.37; 95% confidence interval [CI], -.56 to -.18), physical function (SMD=.32; 95% CI, .13-.51), and quality of life (SMD=.39; 95% CI, .06-.73). No significant differences were observed between the effects of aquatic and land-based exercise on pain (SMD=-.11; 95% CI, -.27 to .04), physical function (SMD=-.03; 95% CI, -.19 to .12), or quality of life (SMD=-.10; 95% CI, -.29 to .09). CONCLUSIONS: The evidence suggests that aquatic exercise has moderate beneficial effects on pain, physical function, and quality of life in adults with musculoskeletal conditions. These benefits appear comparable across conditions and with those achieved with land-based exercise. Further research is needed to understand the characteristics of aquatic exercise programs that provide the most benefit.

Predictors of discharge destination in a geriatric population after undergoing rehabilitation.

BACKGROUND AND PURPOSE: Patients undertaking inpatient rehabilitation comprise a diverse group, including patients with stroke and other neurological conditions, patients who have fallen with or without a resulting fracture, and patients with joint replacements, general debility, or various cardiopulmonary conditions. It is not clear whether diagnosis has an impact on discharge destination in a heterogeneous patient group. The purpose of this study was to determine whether diagnostic category matters or whether it is rehabilitation length of stay (LOS), ability on the 10-Meter Walk Test (10MWT), or Balance Outcome Measure for Elder Rehabilitation (BOOMER) at discharge that predicts discharge destination in elderly patients undergoing rehabilitation who had previously lived at home. METHODS: A retrospective audit was undertaken at a single rehabilitation facility in South East Queensland, Australia, that serviced 4 local short-term care hospitals. Participants were admitted consecutively to the facility between June 2010 and March 2012 who met inclusion criteria. These included a primary diagnosis category of orthopedic conditions, debility, stroke, and other neurological conditions according to the Australasian Rehabilitation Outcomes Centre and older than 60 years (n = 248). Interventions while being a rehabilitation inpatient comprised usual care physiotherapy individually tailored and incorporating elements of balance, strengthening, and functional exercise. Main outcome measures were discharge to residential aged care facility (RACF) versus home, differences between diagnostic categories in terms of discharge destination, LOS, and performance on outcome measures. Prediction of discharge destination by LOS, 10MWT, and BOOMER performance at discharge was explored. RESULTS: A total of 28 patients (12.3%) were discharged to RACF. Diagnosis was not correlated with discharge destination (Pearson χ2 = 1.26, P = .74). The variables rehabilitation LOS, an inability to perform the 10MWT at discharge, and discharge BOOMER score of less than 4 can predict discharge destination with 86.4% accuracy (P = .002). This model had a sensitivity of 71.4% (discharge to RACF) and specificity of 93.3% (discharge home). DISCUSSION: To return home after rehabilitation, patients need to be able to walk at least 10 m and undertake tasks such as moving from sitting to standing, turning around, as well as managing steps. The study revealed that a standardized suite of measures of functional ability and balance may not be appropriate for patients in all diagnostic categories undergoing rehabilitation. Therefore, just as intervention needs to be tailored for the individual patient, the measure of their progress also should be unique.

Exercise for people with hip or knee osteoarthritis: a comparison of land-based and aquatic interventions.

Expert opinion considers the referral of people with osteoarthritis (OA) for physiotherapy to be a core component of managing the functional disability and pain of the disease. Clinical guidelines for the physiotherapy management of people with OA focus on three main areas: exercise, pain relief, and specific manual therapy techniques. Land-based group and individual physiotherapy exercise programs, as well as manual therapy, have demonstrated a distinct benefit in favor of physiotherapy intervention. Similarly, both general and specific aquatic physiotherapy exercise programs have shown positive outcomes for people with OA. This review will focus primarily on therapeutic exercise to improve strength and fitness and reduce pain in people with hip or knee OA. An overview of the principles of hydrodynamics relevant to aquatic exercise is also included to facilitate an understanding of effective aquatic exercise programs. The issue of compliance with exercise programs will also be discussed. Clinicians will, therefore, gain an understanding of the benefits of land-based and aquatic exercise for people with OA.

A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of inpatient aquatic physiotherapy in addition to usual ward physiotherapy on the recovery of strength, function, and gait speed after total hip or knee replacement surgery. DESIGN: Pragmatic randomized controlled trial with blinded 6-month follow-up. SETTING: Acute-care private hospital. PARTICIPANTS: People (n=65) undergoing primary hip or knee arthroplasty (average age, 69.6+/-8.2y; 30 men). INTERVENTIONS: Participants were randomly assigned to receive supplementary inpatient physiotherapy, beginning on day 4: aquatic physiotherapy, nonspecific water exercise, or additional ward physiotherapy. MAIN OUTCOME MEASURES: Strength, gait speed, and functional ability at day 14. RESULTS: At day 14, hip abductor strength was significantly greater after aquatic physiotherapy intervention than additional ward treatment (P=.001) or water exercise (P=.011). No other outcome measures were significantly different at any time point in the trial, but relative differences favored the aquatic physiotherapy intervention at day 14. No adverse events occurred with early aquatic intervention. CONCLUSIONS: A specific inpatient aquatic physiotherapy program has a positive effect on early recovery of hip strength after joint replacement surgery. Further studies are required to confirm these findings. Our research indicates that aquatic physiotherapy can be safely considered in this early postoperative phase.