Physical therapists' evidence-based practice profile and perspectives of entry-level EBP education: a mixed methods study in the Philippines.

BACKGROUND AND PURPOSE: Inclusion of evidence-based practice (EBP) in entry-level physical therapy (PT) curricula is meant to develop the necessary competencies for better EBP uptake in clinical practice. This study aimed to: 1) determine the practice, knowledge, and values for EBP of the graduates of an entry-level PT curriculum with EBP education; 2) compare graduates' EBP practice profile to their EBP knowledge and values; and 3) explore their views on their EBP education and how EBP education influenced their practice. METHODS: A convergent parallel design was used to gather quantitative and qualitative data. The Evidence-based Practice Profile - 2 (EBP2) questionnaire was used for quantitative data. Focus group discussions and open-ended questions in the EBP2 were sources for qualitative data. RESULTS: Seventy-seven completed the questionnaire and eight participated in focus group discussions. Participants scored highest for Relevance domain (standardized mean = 75.3) and lowest for Practice (standardized mean = 45.5). Three themes, 'Positive impact of EBP education,' 'Realities of PT clinical practice, and 'Strategies to improve EBP education' were derived. Data integration confirmed findings that graduates have good knowledge, value for, and confidence in doing EBP. DISCUSSION AND CONCLUSION: Findings suggest that early EBP education led to adequate knowledge, confidence, and positive attitudes, but practice barriers hinder EBP uptake. The medical model of service delivery was identified as a factor that influences EBP use. There is a need to revisit the EBP education program to complement real-world demands.

Proprioceptive neuromuscular facilitation to improve motor outcomes in older adults with chronic stroke.

This case series described changes in motor outcomes across 4 cases of older adults (mean age - 64.75) with chronic stroke (more than 6 months) after implementation of a 6-week proprioceptive neuromuscular facilitation-based program. Findings of this study were compared with a previously reported case. At baseline, all cases presented with motor impairments that increased their fall risk such as impaired balance, lower extremity strength, and mobility. Outcomes were measured using the Mini-BESTest, posturography, 5 times sit-to-stand test, upright motor control test, and 10-meter walk test. All cases completed 1 hour of therapy 3 times a week for 6 consecutive weeks at a university-based outpatient rehabilitation clinic. Positive outcomes in balance, strength, and mobility were seen in all cases. Proprioceptive neuromuscular facilitation can modify motor outcomes to decrease fall risk in older people with chronic stroke. Chronicity of stroke, age, and co-morbidities may influence the degree of improvements expected in these motor outcomes.

Hold-relax and contract-relax stretching for hamstrings flexibility: A systematic review with meta-analysis.

OBJECTIVE: To synthesize evidence on the effects of hold-relax and contract-relax stretching (HR and CR) on hamstrings flexibility compared with no intervention and other stretching techniques. DESIGN: Electronic databases (PubMed, PEDro, Cochrane CENTRAL, Scopus, LILACS) were searched from inception until March 31, 2014 and updated until May 31, 2017. Randomized controlled trials involving HR and CR to improve hamstrings flexibility in adults (aged ≥18 years old) with or without a pathological condition were included. Two reviewers independently searched literature, assessed risk of bias, and extracted data, while a third reviewer settled disagreements. RESULTS: Thirty-nine trials (n = 1770 healthy adults; median PEDro score = 4/10) were included. Meta-analysis showed large effects compared to control immediately after 1 session (6 trials, SMD = 1.02, 95% CI = 0.69 to 1.35, I2 = 2%) and multiple sessions (4 trials, SMD = 1.02, 95% CI = 0.64 to 1.40, I2 = 0%). Meta-analysis showed conflicting results compared to static stretching, while individual trials demonstrated conflicting results compared to other techniques. CONCLUSIONS: The immediate effects of HR and CR on hamstrings flexibility in adults are better against control. The long-term effects against other stretching types, and optimal exercise prescription parameters require further research.

Effects of proprioceptive neuromuscular facilitation on balance, strength, and mobility of an older adult with chronic stroke: A case report.

This study described the effects of a proprioceptive neuromuscular facilitation (PNF) program on balance, strength, and mobility in an older adult with chronic stroke. The patient was male, aged 69 years, with right hemiplegia for 17 years, and had diminished balance, balance confidence, lower extremity (LE) strength, and gait velocity. He received 1 h of PNF-based therapy thrice a week for six weeks. Outcome measures were: Mini-BESTest, limits of stability (LOS), Activities-Specific Balance Confidence Scale (ABC), Five Time Sit-to-Stand Test (FTSST), Upright Motor Control Test (UMCT), and 10 Meter Walk Test (10 MWT). The patient improved on the Mini-BESTest (25/28, from 21/28), FTSST (27.47 s, from 30.27 s), UMCT knee extension (moderate, from weak), and 10 MWT (0.82 m/s, from 0.67 m/s); and positive changes in LOS dimensions. PNF was effective in enhancing balance, strength, and mobility in an older adult with chronic stroke and may mitigate falls risk in this population. More research is needed to determine its impact in a larger sample of older people with chronic stroke.