The development of a stakeholder-endorsed national strategic plan for advancing pain education across Canadian physiotherapy programs.

Background: The Canadian Pain Task Force recently advanced an action plan calling for improved entry-level health professional pain education. However, there is little research to inform the collaboration and coordination across stakeholders that is needed for its implementation. Aims: This article reports on the development of a stakeholder-generated strategic plan to improve pain education across all Canadian physiotherapy (PT) programs. Methods: Participants included representatives from the following stakeholder groups: people living with pain (n = 1), PT students and recent graduates (n = 2), educators and directors from every Canadian PT program (n = 24), and leaders of Canada's national PT professional association (n = 2). Strategic priorities were developed through three steps: (1) stakeholder-generated data were collected and analyzed, (2) a draft strategic plan was developed and refined, and (3) stakeholder endorsement of the final plan was assessed. The project was primarily implemented online between 2016 and 2018. Results: The plan was developed through five iterative versions. Stakeholders unanimously endorsed a plan that included five priorities focusing on uptake of best evidence across (1) national PT governance groups and (2) within individual PT programs; (3) partnering with people living with pain in pain education; (4) advocacy for the PT role in pain management; and (5) advancing pain education research. Conclusion: This plan is expected to help Canadian stakeholders work toward national improvements in PT pain education and to serve as a useful template for informing collaboration on entry-level pain education within other professions and across different geographic regions.

Contexte: Le Groupe d'étude canadien sur la douleur a récemment présenté un plan d'action appelant à améliorer la formation initiale des professionnels de la santé sur la douleur. Cependant, il y a peu de recherche pouvant alimenter la collaboration et la coordination entre les parties prenantes nécessaires à sa mise en œuvre.Objectifs: Cet article rend compte de l'élaboration d'un plan stratégique généré par les parties prenantes pour améliorer la formation sur la douleur dans tous les programmes canadiens de physiothérapie.Méthodes: Les participants comprenaient des représentants des groupes de parties prenantes suivants : les personnes vivant avec la douleur (n = 1), les étudiants en physiothérapie et nouveaux diplômés (n = 2), les enseignants et les directeurs de chaque programme canadien de physiothérapie (n = 24) et les dirigeants de l'association professionnelle nationale des physiothérapeutes du Canada (n = 2). Les priorités stratégiques ont été élaborées en trois étapes : (1) les données générées par les parties prenantes ont été collectées et analysées, (2) un projet de plan stratégique a été élaboré et affiné, et (3) l'approbation du plan final par les parties prenantes a été évaluée. Le projet a été principalement mis en œuvre en ligne entre 2016 et 2018.Résultats: Le plan a été élaboré en cinq versions itératives. Les parties prenantes ont approuvé à l'unanimité un plan qui comprenait cinq priorités axées sur l'adoption des meilleures données probantes (1) dans les groupes de gouvernance nationaux en physiothérapie et (2) au sein des programmes individuels de physiothérapie ; (3) l'établissement de partenariats avec les personnes vivant avec la douleur dans le cadre de la formation sur la douleur ; (4) le plaidoyer pour le rôle de la physiothérapie dans la prise en charge de la douleur; et (5) l'avancement de la recherche en matiére de formation sur la douleur.Conclusion: Ce plan devrait aider les parties prenantes canadiennes à améliorer la situation à lé'chelle nationale en ce qui concerne la formation sur la douleur en physiothérapie et servir de modéle pour alimenter la collaboration dans le cadre de la formation initiale sur la douleur dans d'autres professions et dans différentes régions géographiques.

Development of a national pain management competency profile to guide entry-level physiotherapy education in Canada.

BACKGROUND: National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across Canada. AIMS: This study aimed to create a consensus-based competency profile for pain management, specific to the Canadian PT context. METHODS: A modified Delphi design was used to achieve consensus across Canadian university-based and clinical pain educators. RESULTS: Representatives from 14 entry-level PT programs (93% of Canadian programs) and six clinical educators were recruited. After two rounds, a total of 15 competencies reached the predetermined endorsement threshold (75%). Most participants (85%) reported being "very satisfied" with the process. CONCLUSIONS: This process achieved consensus on a novel pain management competency profile specific to the Canadian PT context. The resulting profile delineates the necessary abilities required by physiotherapists to manage pain upon entry to practice. Participants were very satisfied with the process. This study also contributes to the emerging literature on integrated research in pain management by profiling research methodology that can be used to inform related work in other health professions and regions.

Contexte: Contexte: Les stratégies nationales nord-américaines préconisent des améliorations sensibles à la formation de base en matiére de prise en charge de la douleur afin de contribuer à la réduction du fardeau de la douleur chronique. Des travaux antérieurs ont généré un ensemble de compétences interprofessionnelles utile en matiére de prise en charge de la douleur afin de guider la formation des futurs professionnels de la santé. Cependant, trés peu de travaux ont porté sur l'acquisition de telles compétences pour des professions individuelles dans différentes régions. L'uisition de compétences spécifiques à une profession adaptées au contexte local est une première étape nécessaire pour leur intégration dans les systèmes réglementaires locaux. Notre groupe travaille à cet objectif dans le cadre de programmes de formation de base en physiothèrapie partout au Canada.Objectifs: Cette étude visait à créer un profil de compétences consensuel pour la prise en charge de la douleur, propre au contexte canadien de la physiothérapie.Méthodes: Un devis Delphi modifié a étè utilisé pour parvenir à un consensus parmi des formateurs en milieu universitaire et clinique en matière de douleur en milieu universitaire et clinique.Résultats: Des représentants de 14 programmes de formation de base en physiothérapie (93 % des programmes canadiens) et de six formateurs en milieu clinique ont été recrutés. Après deux tours, 15 compétences ont atteint le seuil d'approbation prédéterminé (75 %). La plupart des participants (85 %) ont déclaré être « très satisfaits ¼du processus.Conclusions: Ce processus a permis de dégager un consensus sur un nouveau profil de compétences en matiére de prise en charge de la douleur propre au contexte canadien de la physiothérapie. Ce profil délimite les habiletés requises des physiothérapeutes pour prendre en charge la douleur en début de pratique. Les participants ont été très satisfaits du processus. Cette étude contribue également à la littérature émergente sur la recherche intégrée en matière de prise en charge de la douleur en définissant une méthodologie de recherche qui peut être utilisée pour éclairer des travaux similaires dans d'autres professions de la santé et dans d'autres régions.

The ability of heart rate or perceived exertion to predict oxygen uptake varies across exercise modes in persons with tetraplegia.

STUDY DESIGN: Descriptive study. OBJECTIVES: To examine grouped and intra-individual relationships between 1) exercise intensity and heart rate (EI-HR); 2) EI and oxygen uptake (EI-VO2); 3) VO2 and HR (VO2-HR); and 4) perceived exertion and VO2 (PE-VO2) in persons with tetraplegia (C4/5-C8) during different modes of exercise. SETTING: Community in Winnipeg, Canada. METHODS: Participants exercised at 3 graded intensities during arm ergometry (ERG), wheeling indoors on cement (MWC), or hand-cycling outdoors (HC). EI (Watts, km/hr) and VO2, HR and PE were recorded. RESULTS: 22 persons completed ERG, 14/22 also completed MWC and 5/22 completed ERG, MWC and HC. Regression analysis of grouped data showed a significant relationship between EI-VO2 but not for EI-HR or HR-VO2. Intra-individual analyses showed a strong correlation (r or ρ > 0.7) for VO2-HR for 16/22 during ERG. In the participants completing multiple exercise modes, a strong VO2-HR relationship was present in 12/14 in ERG, but in only 6/14 in MWC. The 5 persons exercising with all 3 modes had a strong HR-VO2 relationship in 5/5 for ERG, 2/5 in MWC and 1/5 in HC. A strong relationship for PE-VO2 was observed in a higher proportion of participants (versus HR-VO2) during MWC (9/14) and HC (2/4). CONCLUSION: Within the same individual, the HR-VO2 relationship varies across modes, despite exercising over similar ranges of steady-state VO2. HR appears less able to predict VO2 compared to PE. Based on these new findings, systematic investigation of the HR-VO2 relationship across modes of exercise in tetraplegia is warranted.

An Exploratory Randomized Trial of Physical Therapy for the Treatment of Chemotherapy-Induced Peripheral Neuropathy.

Background. Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of taxane treatment and cannot currently be prevented or adequately treated. Physical therapy is often used for neural rehabilitation following injury but has not been evaluated in this patient population. Methods. Single-blind, randomized controlled exploratory study compared standard care to a physical therapy home program (4 visits) throughout adjuvant taxane chemotherapy for stage I-III patients with breast cancer (n = 48). Patient questionnaires and quantitative sensory testing evaluated the treatment effect throughout chemotherapy to 6 months post treatment. Nonrandomized subgroup analysis observed effect of general exercise on sensory preservation comparing those reporting moderate exercise throughout chemotherapy to those that did not exercise regularly. Clinical Trial Registration. clinicaltrials.gov (NCT02239601). Results. The treatment group showed strong trends toward less pain (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17-1.01; P = .053) and pain decreased over time (OR 0.85, 95% CI 0.76-0.94; P = .002). Pain pressure thresholds (P = .034) and grip dynamometry (P < .001) were improved in the treatment group. For the nonrandomized subgroup analysis, participants reporting general exercise had preservation of vibration (Left P = .001, Right P = .001) and normal heat pain thresholds (Left P = .021, Right P = .039) compared with more sedentary participants. Conclusion. Physical therapy home program may improve CIPN pain in the upper extremity for patients with breast cancer, and general exercise throughout chemotherapy treatment was observed to have correlated to preservation of sensory function. Further research is required to confirm the impact of a physical therapy home program on CIPN symptoms.

Neuropathic Pain in Taxane-Induced Peripheral Neuropathy: Evidence for Exercise in Treatment.

One in 2 Canadians is expected to acquire cancer in their lifetime. Many cancers, including breast, ovarian, and lung cancer, are treated using taxane chemotherapy with curative intent. A major adverse effect with the use of taxane chemotherapeutic agents is taxane-induced peripheral neuropathy (TIPN). Both positive (spontaneous pain, heightened sensitivity with light touch, tingling, itching, burning) and negative (loss of touch, loss of hot/cold sensations, and loss of pain) sensory symptoms can be experienced in the hands and feet and worsen with increasing dose and treatment duration. The pathophysiology of TIPN is still unknown but likely involves multiple mechanisms, including microtubule impairment, neuroimmune and inflammatory changes, ion channel remodeling, impaired mitochondrial function, and genetic predisposition. This review highlights current theories on the pathophysiology for TIPN, the cellular responses thought to maintain neuropathic pain, and the growing support for exercise in the treatment and prevention of peripheral neuropathy and neuropathic pain in both animal and human models.

Quantitative sensory profiles of upper extremity chemotherapy induced peripheral neuropathy: Are there differences in sensory profiles for neuropathic versus nociceptive pain?

Aims: The aim of this study was to define the sensory phenotypes of taxane-induced peripheral neuropathy (TIPN) between neuropathic and nonneuropathic symptoms in a breast cancer population to identify future targets for mechanism-based pain management. Methods: Participants (n = 48) with stage I-III breast cancer. Self-report questionnaires and quantitative sensory testing were used to assess sensory symptoms. The self-report version of the Leeds Assessment for Neuropathic Symptoms and Signs (S-LANSS) divided the groups into neuropathic and nonneuropathic sensory phenotypes. In total, five visits over approximately 8 months assessed each participant from pre-chemotherapy to 6 months post-chemotherapy. Results: Out of 191 nerve assessments, 150 had an S-LANSS <12 defined as "nonneuropathic" and 41 scored >12, which was defined as "neuropathic." Numeric Pain Rating Scale (NPRS) was analyzed based on percentages of those experiencing 1+ pain (graded 1/10 or higher) versus no pain. The neuropathic group had 82.9% of 1+ pain vs. 28.7% in the nonneuropathic group (odds ratio = 7.49; 95% confidence interval, 2.76-20.3; P = 0.001). The neuropathic group reported impaired function on the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire (P = 0.002). Heat pain threshold resulted in statistical differences for the left hand but not the right hand in the neuropathic group (P = 0.05). No other quantitative data on warm/cool or cold or vibration demonstrated sensory differences between the groups. Conclusions: Few differences in sensory profiles measured using quantitative sensory testing (QST) were found. Heat pain thresholds were normalized, possibly suggesting that the neuropathic group retained C-fiber and transient potential vanilloid 1 (TRPV1) function. Participants with neuropathic pain demonstrated significant differences with increased pain and decreased function.

Objectif: Déterminer les phénotypes sensoriels associés à la neuropathie périphérique induite par le taxane dans une population de personnes atteintes de cancer du sein, selon qu'elles présentent des symptômes de neuropathie ou non, afin de déterminer les cibles futures pour la prise en charge de la douleur axée sur les mécanismes.Méthodes: Participants (n = 48) atteints d'un cancer du sein de stade I-III. Des questionnaires d'auto-évaluation et des tests sensoriels quantitatifs ont été utilisés pour évaluer les symptômes sensoriels. À l'aide de la version d'auto-évaluation de l'outil d'évaluation des symptômes et des signes de la douleur neuropathique de Leeds (S-LANSS), les groupes ont été divisés en phénotypes sensoriels avec neuropathie et sans neuropathie. Au total, cinq visites échelonnées sur une période d'environ huit mois ont permis d'évaluer chaque participant avant le début de la chimiothérapie jusqu'à six mois après le début de celle-ci.Résultats: 191 évaluations des nerfs, parmi lesquelles 150 participantes ont obtenu une note < 12 pour le S-LANSS, définis comme «sans neuropathie ¼, tandis que 41 participantes ont obtenu une note > 12, définie comme « avec neuropathie ¼. L'échelle numérique d'évaluation de la douleur a été analysée sur la base du pourcentage de participantes éprouvant une douleur égale ou supérieure à 1 (note de 1/10 ou plus) comparativement à aucune douleur. 82,9 % des patientes du groupe avec neuropathie éprouvaient une douleur égale ou supérieure à 1 comparativement à 28,7% pour le groupe sans neuropathie (RR = 7,49, CI 95 % 2,76-20,3, p = 0,001). Le groupe avec neuropathie a fait état d'une altération du fonctionnement selon le questionnaire DASH (p = 0,002). Des différences significatives ont été observées en ce qui concerne le seuil de la douleur thermique pour la main gauche, mais pas pour la main droite dans le groupe avec neuropathie (p = 0,05). Aucune autre donnée quantitative portant sur la sensibilité aux températures chaudes, tièdes ou froides, ou encore à la vibration, n'a révélé de différences sensorielles entre les groupes.Conclusions: On a constaté peu de différences entre les profils sensoriels mesurés par les tests sensoriels qualitatifs. Les seuils de douleur thermique ont été normalisés, ce qui indique probablement le maintien du fonctionnement des fibres de C et du TRPV1 chez le groupe avec neuropathie. Des différences significatives ont été observées chez les personnes souffrant de douleur neuropathique, dont une augmentation de la douleur et une diminution du fonctionnement.

Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines.

The World Health Organization recognizes obesity as a global and increasing problem for the general population. Because of their reduced physical functioning, people with spinal cord injury (SCI) face additional challenges for maintaining an appropriate whole body energy balance, and the majority with SCI are overweight or obese. SCI also reduces exercise capacity, particularly in those with higher-level injury (tetraplegia). Tetraplegia-specific caloric energy expenditure (EE) data is scarce. Therefore, we measured resting and exercise-based energy expenditure in participants with tetraplegia and explored the accuracy of general population-based energy use predictors. Body composition and resting energy expenditure (REE) were measured in 25 adults with tetraplegia (C4/5 to C8) and in a sex-age-height matched group. Oxygen uptake, carbon dioxide production, heart rate, perceived exertion, and exercise intensity were also measured in 125 steady state exercise trials. Those with motor-complete tetraplegia, but not controls, had measured REE lower than predicted (mean = 22% less, p < 0.0001). REE was also lower than controls when expressed per kilogram of lean mass. Nine had REE below 1200 kcal/day. We developed a graphic compendium of steady state EE during arm ergometry, wheeling, and hand-cycling. This compendium is in a format that can be used by persons with tetraplegia for exercise prescription (calories, at known absolute intensities). EE was low (55-450 kcal/h) at the intensities participants with tetraplegia were capable of maintaining. If people with tetraplegia followed SCI-specific activity guidelines (220 min/week) at the median intensities we measured, they would expend 563-1031 kcal/week. Participants with tetraplegia would therefore require significant time (4 to over 20 h) to meet a weekly 2000 kcal exercise target. We estimated total daily EE for a range of activity levels in tetraplegia and compared them to predicted values for the general population. Our analysis indicated that the EE values for sedentary through moderate levels of activity in tetraplegia fall well below predicted sedentary levels of activity for the general population. These findings help explain sub-optimal responses to exercise interventions after tetraplegia, and support the need to develop tetraplegia-specific energy-balance guidelines that reflects their unique EE situation.

Photobiomodulation using high- or low-level laser irradiations in patients with lumbar disc degenerative changes: disappointing outcomes and remarks.

BACKGROUND: Laser therapy seems to be a beneficial physical agent for chronic low back pain (LBP), and it is commonly used in the clinical rehabilitation practice. However, there are still no indisputable and clearly defined protocols and practical guidelines, and further, the methodology of the previous reports leaves many unsatisfied and raises some reservations. OBJECTIVE: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in patients with lumbar disc degenerative changes based on the analysis of the short- and long-term results and in comparison with the placebo effect. DESIGN: This study was a prospective and placebo-controlled clinical trial. MATERIALS AND METHODS: A group of 68 participants were qualified for the therapy and were assigned to four comparative groups in the order they volunteered: HILT of 1,064 nm, 60 J/cm2, 10 minutes (HILT); sham (HILT placebo); LLLT of 785 nm, 8 J/cm2, 8 minutes; and sham (LLLT placebo). The following tests were used to assess the effectiveness of treatment: 1) the visual analogue scale; 2) the Laitinen Questionnaire Indicators of Pain; 3) the Oswestry Disability Index; 4) the Roland-Morris Disability Questionnaire; 5) Lasegue test; and 6) Schober's test. All measurements were carried out before and after irradiations (3 weeks) and in follow-ups (1 and 3 months). RESULTS: After applying verum or placebo laser irradiation, therapeutic progress was observed in all comparative groups; however, no statistically significant differences were observed among the procedures. CONCLUSION: The high- and low-energy laser therapy methods used in the present article are ineffective in relation to patients with lumbar disc degenerative changes in both the short- and long-term perspectives and do not show a significant advantage over the placebo effect.

Effect of laser therapy on expression of angio- and fibrogenic factors, and cytokine concentrations during the healing process of human pressure ulcers.

Objective: To evaluate the effect of laser irradiation at different wavelengths on the expression of selected growth factors and inflammatory mediators at particular stages of the wound healing process. Methods: Sixty-seven patients were recruited, treated, and analyzed (group A - 940 nm: 17 patients; group B - 808 nm: 18 patients; group C - 658 nm: 16 patients; group D - sham therapy: 17 patients). Patients received a basic treatment, including repositioning and mobilization, air pressure mattress and bed support surfaces, wound cleansing and drug therapy. Additionally, patients received laser therapy once a day, 5 times a week for 1 month in use of a semiconductor lasers (GaAlAs) which emitted a continuous radiation emission at separate wavelengths of 940 nm (group A), 808 nm (group B) and 658 nm (group C). In group D (sham therapy), laser therapy was applied in the same manner, but the device was off during each session (only the applicator was switched on to scan pressure ulcers using none coherent red visible light). Results: The positive changes in the measured serum (IL-2, IL-6 and TNF-α) and wound tissue (TNF-α, VEGF and TGFß1) parameters appeared to be connected only with the wavelength of 658 nm. The significant change in pro-inflammatory mediator levels [interleukin 2 (IL-2) with p=0.008 and interleukin 6 (IL-6) with p=0.016] was noticed after two weeks of laser therapy. In the other groups, the inflammation was also reduced, but the process was not as marked as in group C. Similarly, in the case of tumor necrosis factor (TNF-α) concentration, where after two weeks of treatment with irradiation at a wavelength of 658 nm, a rapid suppression was observed (p=0.001), whereas in the other groups, these results were much slower and not as obvious. Interestingly, again in the case of group C, the change in TNF-α concentration in wound tissue was most intensive (≈75% reduction), whereas the changes in other groups were not as obvious (≈50% reduction). After irradiation (658 nm), the VEGF expression increased significantly within the first two weeks, and then it decreased and maintained a stable level. In contrast, the TGFß1 activity remained level, but always higher in comparison to other groups Conclusions: The effective healing of pressure ulcers is connected with laser irradiation at a wavelength of 658 nm. We believe that this effect is related to the inhibition of inflammatory processes in the wound and stimulation of angiogenesis and fibroblast proliferation at this specific radiation (based both on concentration of interleukins and TNF-α serum level and VEGF, TGFß1, TNF-α activities in wound biopsies). Laser therapy at wavelengths of 940 and 808 nm does not significantly affect the above-mentioned repair processes, which explains its low effectiveness in the treatment of pressure ulcers.

Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia.

In this study, 67 participants (95% female) with fibromyalgia (FM) were randomly assigned to an online acceptance and commitment therapy (online ACT) and treatment as usual (TAU; ACT + TAU) protocol or a TAU control condition. Online ACT + TAU participants were asked to complete 7 modules over an 8-week period. Assessments were completed at pre-treatment, post-treatment, and 3-month follow-up periods and included measures of FM impact (primary outcome), depression, pain, sleep, 6-minute walk, sit to stand, pain acceptance (primary process variable), mindfulness, cognitive fusion, valued living, kinesiophobia, and pain catastrophizing. The results indicated that online ACT + TAU participants significantly improved in FM impact, relative to TAU (P <.001), with large between condition effect sizes at post-treatment (1.26) and follow-up (1.59). Increases in pain acceptance significantly mediated these improvements (P = .005). Significant improvements in favor of online ACT + TAU were also found on measures of depression (P = .02), pain (P = .01), and kinesiophobia (P = .001). Although preliminary, this study highlights the potential for online ACT to be an efficacious, accessible, and cost-effective treatment for people with FM and other chronic pain conditions. PERSPECTIVE: Online ACT reduced FM impact relative to a TAU control condition in this randomized controlled trial. Reductions in FM impact were mediated by improvements in pain acceptance. Online ACT appears to be a promising intervention for FM.

Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice.

Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice.

Objectif : en réponse à des demandes de conseils de physiothérapeutes pour optimiser la stimulation musculaire à l'aide de la stimulation électrique neuromusculaire (SENM), une revue, une synthèse et une extraction de données de la littérature ont été entreprises par six formateurs, cliniciens et chercheurs en physiothérapie dans le domaine des agents électrophysiques. L'objectif était de cibler des affections couramment traitées ayant fait l'objet d'une quantité suffisante d'études pour tirer des conclusions concernant l'efficacité de la SENM. Les études devaient porter sur la SENM produisant des contractions musculaires visibles et toniques. Méthodes : quatre bases de données électroniques (CINAHL, Embase, PubMed et Scopus) ont été parcourues à la recherche d'études pertinentes publiées entre la création des bases de données et mai 2015. D'autres articles ont été tirés de bibliographies de revues systématiques et de collections personnelles. Résultats : les données extraites ont été synthétisées par consensus des auteurs en vue de dresser des recommandations sur l'optimisation des paramètres et des techniques d'application de la stimulation dans le traitement de déficits musculaires associés aux affections suivantes: accident vasculaire cérébral (extrémité inférieure ou supérieure; aigu ou chronique), reconstruction du ligament croisé antérieur, syndrome fémoro-rotulien douloureux, arthrose du genou et arthroplastie totale du genou, ainsi que des maladies graves et en stade avancé. Les auteurs fournissent également un résumé des éléments clés de chaque étude incluse dans la revue. Enfin, ils recommandent une nomenclature de l'électrothérapie et présentent des conseils pour l'utilisation sécuritaire et efficace de la SENM. Conclusion : ce document constitue pour les physiothérapeutes une ressource permettant d'appuyer leur utilisation de la SENM sur des données probantes.

The interacting effects of treadmill walking and different types of visuospatial cognitive task: Discriminating dual task and age effects.

OBJECTIVE: The objective of this study is to examine the influence that visuospatial cognitive tasks have on gait function during DT treadmill walking, and as a function of age. Conversely, to examine the influence that walking has on executive functions involving visuospatial processing. METHODS: Twenty-five young (26±6.1years) and 25 older adults (76±3.9) performed different types of computerized visuomotor (VM) tracking and visuospatial cognitive tasks (VCG) while standing and treadmill walking. Spatiotemporal gait variables, average values and co-efficient of variation (COV) were obtained from 40 consecutive steps during single- and dual-task walk trials. Performance-based measures of the VM and VCG task were obtained during standing and walking. RESULTS: VM dual-task walking had a significant effect on gait measures in the young age group (YG), but no DT effect was observed in the old age group (OG). Visuomotor tracking performance, however, was significantly reduced in the OG as compared to the YG when tested in both standing and walking. The opposite was true for VCG; a significant DT effect on gait performance was observed in the OG, but no DT effect was observed in the YG. Success rate of the VCG task decreased during walking, but only for OG. CONCLUSION: Controlling gait speed and objective evaluation of the visuospatial cognitive tasks helps to determine the level of engagement in the DT tasks. This is important in order to determine the strategies used during the DT test protocols, i.e. cross-domain interference.

Treatment of low back pain: First extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group-based rehabilitation program with oral drug treatment alone up to 24 months.

BACKGROUND: This study aimed to examine the effects of the extended follow-up of an original trial (NCT00600197) which has been published in The Clinical Journal of Pain. METHODS: Eighty-three percent (165 of 197) of the original study, including 82 patients in intervention and 83 patients in the control group, provided extended 24-month follow-up data. The intervention was a group-based multidisciplinary rehabilitation program which was continued by monthly motivational consultation. Data on measures of Short Form 36 (SF-36), Quebec Disability Scale (QDS) and Ronald Morris Disability (RDQ) were collected at 12-, 18- and 24-month follow-ups and analyzed through repeated measures analysis of variance. RESULTS: The patients who responded (n = 165) and who did not respond (n = 32) to the questionnaires were the same in terms of all baseline data except for physical function which was better for respondents (P < 0.05). Among the respondents, both intervention and control groups were the same at baseline except for education level and mental health which was better in the intervention group (P < 0.05). As a result, the intervention group had consistently better outcomes regarding all variables except for social function at all follow-up times. Furthermore, in the intervention group only for mental health the interaction between time and group was significant (P = 0.01). DISCUSSION: The designed multidisciplinary program could improve health-related quality of life and disability up to 24 months in chronic low back pain patients.

Correcting waveform bias using principal component analysis: Applications in multicentre motion analysis studies.

Multicentre studies are rare in three dimensional motion analyses due to challenges associated with combining waveform data from different centres. Principal component analysis (PCA) is a statistical technique that can be used to quantify variability in waveform data and identify group differences. A correction technique based on PCA is proposed that can be used in post processing to remove nuisance variation introduced by the differences between centres. Using this technique, the waveform bias that exists between the two datasets is corrected such that the means agree. No information is lost in the individual datasets, but the overall variability in the combined data is reduced. The correction is demonstrated on gait kinematics with synthesized crosstalk and on gait data from knee arthroplasty patients collected in two centres. The induced crosstalk was successfully removed from the knee joint angle data. In the second example, the removal of the nuisance variation due to the multicentre data collection allowed significant differences in implant type to be identified. This PCA-based technique can be used to correct for differences between waveform datasets in post processing and has the potential to enable multicentre motion analysis studies.

Task-Oriented Training with Computer Games for People with Rheumatoid Arthritis or Hand Osteoarthritis: A Feasibility Randomized Controlled Trial.

OBJECTIVES: To examine the feasibility of a clinical trial on a novel, home-based task-oriented training with conventional hand exercises in people with rheumatoid arthritis or hand osteoarthritis. To explore the experiences of participants who completed their respective home exercise programmes. MATERIALS AND METHODS: Thirty volunteer participants aged between 30 and 60 years and diagnosed with rheumatoid arthritis or hand osteoarthritis were proposed for a single-center, assessor-blinded, randomized controlled trial ( ClinicalTrials.gov : NCT01635582). Participants received task-oriented training with interactive computer games and objects of daily life or finger mobility and strengthening exercises. Both programmes were home based and were done four sessions per week with 20 minutes each session for 6 weeks. Major feasibility outcomes were number of volunteers screened, randomized, and retained; completion of blinded assessments, exercise training, and home exercise sessions; equipment and data management; and clinical outcomes of hand function. Reaching the recruitment target in 18 months and achieving exercise compliance >80% were set as success criteria. Concurrent with the trial, focus group interviews explored experiences of those participants who completed their respective programmes. RESULTS: After trial initiation, revisions in inclusion criteria were required to promote recruitment. A total of 17 participants were randomized and 15 were retained. Completion of assessments, exercise training, and home exercise sessions; equipment and data collection and management demonstrated excellent feasibility. Both groups improved in hand function outcomes and exercise compliance was above 85%. Participants perceived both programmes as appropriate and acceptable. Participants who completed task-oriented training also agreed that playing different computer games was enjoyable, engaging, and motivating. CONCLUSIONS: Findings demonstrate initial evidence on recruitment, feasibility of trial procedures, and acceptability of task-oriented training in people with rheumatoid arthritis or hand osteoarthritis. Since the pilot trial was unsuccessful in participant recruitment, a large trial will not follow.

Out-Patient Pulmonary Rehabilitation Improves Medial-Lateral Balance in Subjects With Chronic Respiratory Disease: Proof-of-Concept Study.

BACKGROUND: Recent studies show balance impairment in subjects with chronic respiratory disease. The aim of this proof-of-concept study was to investigate clinical and quantitative measures of balance in people with chronic respiratory disease following participation in an out-patient pulmonary rehabilitation (PR) program to better understand features of balance improvement. A secondary aim was to probe possible mechanisms for balance improvement to provide the foundation for optimal design of future studies. METHODS: Eleven individuals with chronic respiratory disease enrolled in an 8-week out-patient PR program participated. Standing balance, measured with a force plate, in the medial-lateral and anterior-posterior directions with eyes open and closed was assessed with linear (SD and sway path length) and non-linear (diffusion analysis) center-of-pressure measures. Balance was evaluated clinically with the Timed Up and Go and Four Square Step Test. Fear of falling and balance confidence were assessed with questionnaires. RESULTS: After participation in PR, medial-lateral sway path length decreased (P = .031), and center-of-pressure diffusion in the medial-lateral direction was slower (P = .02) and traveled over less distance (P = .03) with eyes closed. This suggests greater control of medial-lateral sway. There was no change in anterior-posterior balance (P > .067). Performance improved on the Timed Up and Go (median [interquartile range] pre-PR = 9.4 [7.9-12.8] vs. post-PR = 8.1 [7.3-12.2] s, P = .003) and Four Square Step Test (median [interquartile range] pre-PR = 9.3 [7.2-14.2] vs. post-PR = 8.7 [7.4-10.2] s, P = .050). There were no changes in balance confidence (P = .72) or fear of falling (P = .57). CONCLUSIONS: Participation in an 8-week out-patient PR program improved balance, as assessed by clinical and laboratory measures. Detailed analysis of force plate measures demonstrated improvements primarily with respect to medial-lateral balance control. These data provide a basis for the development of larger scale studies to investigate the mechanisms for medial-lateral balance improvements following PR and to determine how PR may be refined to enhance balance outcomes in this population. (ClinicalTrials.gov registration NCT00864084.).

Test-retest reliability and convergent validity of a computer based hand function test protocol in people with arthritis.

OBJECTIVES: A computer based hand function assessment tool has been developed to provide a standardized method for quantifying task performance during manipulations of common objects/tools/utensils with diverse physical properties and grip/grasp requirements for handling. The study objectives were to determine test-retest reliability and convergent validity of the test protocol in people with arthritis. METHODS: Three different object manipulation tasks were evaluated twice in forty people with rheumatoid arthritis (RA) or hand osteoarthritis (HOA). Each object was instrumented with a motion sensor and moved in concert with a computer generated visual target. Self-reported joint pain and stiffness levels were recorded before and after each task. Task performance was determined by comparing the object movement with the computer target motion. This was correlated with grip strength, nine hole peg test, Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, and the Health Assessment Questionnaire (HAQ) scores. RESULTS: The test protocol indicated moderate to high test-retest reliability of performance measures for three manipulation tasks, intraclass correlation coefficients (ICCs) ranging between 0.5 to 0.84, p<0.05. Strength of association between task performance measures with self- reported activity/participation composite scores was low to moderate (Spearman rho <0.7). Low correlations (Spearman rho < 0.4) were observed between task performance measures and grip strength; and between three objects' performance measures. Significant reduction in pain and joint stiffness (p<0.05) was observed after performing each task. CONCLUSION: The study presents initial evidence on the test retest reliability and convergent validity of a computer based hand function assessment protocol in people with rheumatoid arthritis or hand osteoarthritis. The novel tool objectively measures overall task performance during a variety of object manipulation tasks done by tracking a computer based visual target. This allows an innovative method of assessing performance than considering the time taken to complete a task or relying on subjective measures of self-reports on a limited range of objects and tasks covered. In addition, joint pain and stiffness levels before and after a manipulation task are tracked, which is lacking in other hand outcome measures. Performance measures during a broad range of object manipulation tasks relate to many activities relevant to life role participation. Therefore, task performance evaluation of common objects, utensils, or tools would be more valuable to gauge the difficulties encountered in daily life by people with arthritis. Future studies should consider a few revisions of the present protocol and evaluate a number of different objects targeting strength, fine, and gross dexterity based tasks for a broader application of the tool in arthritis populations.

Effect of increasing awareness of pelvic floor muscle function on pelvic floor dysfunction: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: This randomized controlled study with blinding allocation evaluated pelvic floor knowledge (PFK) and the presence of pelvic floor dysfunction (PFD) in women office workers. The effects of receiving pelvic floor muscle (PFM) health education on PFK and PFD were also evaluated. METHODS: Of 161 female volunteers, 145 (90.0 %, age range 18-69 years) responded. They were randomly allocated to three groups (group A 48, group B 48, group C 49). Online surveys were completed by all groups on three occasions using validated tools (Prolapse and Incontinence Knowledge Quiz, PFDI-20, PFIQ-7) and PFM exercise items. On completion of the baseline survey, groups A and B received an education intervention (group C was the control). Following this, all participants completed the second survey. Two months later, to allow time for the PFM exercises to have an effect, group A attended a re-education presentation, followed by the final survey administered to all groups. The results were analyzed using analysis of variance and Tukey's test. RESULTS: Participants receiving both PFM exercise education interventions (group A) and those receiving only the first education intervention (group B) showed highly significant improvements in PFK compared with the control group (both p < 0.001). The groups receiving PFM exercise education also showed a highly significant decrease in PFD symptoms (p < 0.001), and a significant increase in quality of life (QoL; p < 0.05). CONCLUSIONS: While the results of this study cannot be generalized to all women, low levels of PFK was associated with high a prevalence of PFD, and an increase in knowledge/awareness following education was significantly associated with an increase in QoL and a decrease in PFD symptoms.

Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis.

BACKGROUND: The utility of acupuncture in managing osteoarthritis symptoms is uncertain. Trial results are conflicting and previous systematic reviews may have overestimated the benefits of acupuncture. METHODS: Two reviewers independently identified randomized controlled trials (up to May 2014) from multiple electronic sources (including PubMed/Medline, EMBASE, and CENTRAL) and reference lists of relevant articles, extracted data and assessed risk of bias (Cochrane's Risk of Bias tool). Pooled data are expressed as mean differences (MD), with 95% confidence intervals (CI) (random-effects model). RESULTS: We included 12 trials (1763 participants) comparing acupuncture to sham acupuncture, no treatment or usual care. We adjudicated most trials to be unclear (64%) or high (9%) risk of bias. Acupuncture use was associated with significant reductions in pain intensity (MD -0.29, 95% CI -0.55 to -0.02, I2 0%, 10 trials, 1699 participants), functional mobility (standardized MD -0.34, 95% CI -0.55 to -0.14, I2 70%, 9 trials, 1543 participants), health-related quality of life (standardized MD -0.36, 95% CI -0.58 to -0.14, I2 50%, 3 trials, 958 participants). Subgroup analysis of pain intensity by intervention duration suggested greater pain intensity reduction with intervention periods greater than 4 weeks (MD -0.38, 95% CI -0.69 to -0.06, I2 0%, 6 trials, 1239 participants). CONCLUSIONS: The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis. SYSTEMATIC REVIEW REGISTRATION: CRD42013005405.

The interacting effect of cognitive and motor task demands on performance of gait, balance and cognition in young adults.

Mobility limitations and cognitive impairments, each common with aging, reduce levels of physical and mental activity, are prognostic of future adverse health events, and are associated with an increased fall risk. The purpose of this study was to examine whether divided attention during walking at a constant speed would decrease locomotor rhythm, stability, and cognitive performance. Young healthy participants (n=20) performed a visuo-spatial cognitive task in sitting and while treadmill walking at 2 speeds (0.7 and 1.0 m/s).Treadmill speed had a significant effect on temporal gait variables and ML-COP excursion. Cognitive load did not have a significant effect on average temporal gait variables or COP excursion, but variation of gait variables increased during dual-task walking. ML and AP trunk motion was found to decrease during dual-task walking. There was a significant decrease in cognitive performance (success rate, response time and movement time) while walking, but no effect due to treadmill speed. In conclusion walking speed is an important variable to be controlled in studies that are designed to examine effects of concurrent cognitive tasks on locomotor rhythm, pacing and stability. Divided attention during walking at a constant speed did result in decreased performance of a visuo-spatial cognitive task and an increased variability in locomotor rhythm.