Engaging patients through education: a modified-Delphi consultation to develop recommendations for patient education interventions in the management of subacromial pain syndrome in physical therapy.

PURPOSE: To develop recommendations to support the range of patient education interventions relevant in the management of patients with subacromial pain syndrome (SAPS) in physical therapy. MATERIALS AND METHODS: A 3-round modified Delphi consultation was used to obtain consensus agreement on the relevance of 12 preliminary recommendations. These were developed from a literature review and an expert consultation on general educational strategies and specific patient education interventions for the management of SAPS. The analysis assessed the rate of consensus on the relevance of these recommendations. Delphi panelists were rehabilitation professionals including physical (n = 21) and occupational therapists (n = 1) with SAPS experience, and patient-partners (n = 2) presenting shoulder pain. RESULTS: The Delphi consultation resulted in 13 revised consensus recommendations. Six consensus recommendations addressed general educational strategies to facilitate patient education, including teaching methods and materials, and seven addressed specific educational interventions, including teaching symptom self-management and tailoring activities and participation. These recommendations were incorporated into a clinical decision-making tool to support the selection of the most relevant patient education interventions. CONCLUSION: The recommendations developed in this study are relevant to guide physical therapist's clinical decisions making regarding interventions using patient education for SAPS. They promote active engagement and empowerment of individuals with SAPS.

Patient education, as a strategy to promote self-management of the condition, can help empower individuals with subacromial pain syndrome.Patient education may be relevant to addressing psychosocial factors that are often not adequately addressed in subacromial pain syndrome.Consensus and comprehensive patient education recommendations are relevant to support physical therapists' decision making in the management of subacromial pain syndrome.Such recommendations and a decision-support tool based on a scoping review of the literature, expert opinion and consensus are now available.

Artificial Intelligence and Digital Divide in Physiotherapy Education.

The potential of artificial intelligence (AI) in health care and education has become increasingly evident, promising to revolutionize how healthcare professionals deliver services and how learners engage with educational content. AI enhances individualized student learning experiences and transforms education delivery by adapting to emerging healthcare advancements. We emphasize the current need for more exploration of AI's applications in day-to-day education in physiotherapy schools. We conducted a PubMed search, revealing a significant gap in research on AI in physiotherapy education compared to medical and dental education. Knowledge gaps and varied perspectives among Canadian healthcare students, including physiotherapy students, highlight the need for targeted educational strategies and ethical considerations. We conclude with a call to bridge the digital divide in physiotherapy education, stressing the importance of integrating AI to empower students and foster innovation in physiotherapy education.

Measuring Health Care Work-Related Contextual Factors: Development of the McGill Context Tool.

INTRODUCTION: Contextual factors can influence healthcare professionals' (HCPs) competencies, yet there is a scarcity of research on how to optimally measure these factors. The aim of this study was to develop and validate a comprehensive tool for HCPs to document the contextual factors likely to influence the maintenance, development, and deployment of professional competencies. METHODS: We used DeVellis' 8-step process for scale development and Messick's unified theory of validity to inform the development and validation of the context tool. Building on results from a scoping review, we generated an item pool of contextual factors articulated around five themes: Leadership and Agency, Values, Policies, Supports, and Demands. A first version of the tool was pilot tested with 127 HCPs and analyzed using the classical test theory. A second version was tested on a larger sample (n = 581) and analyzed using the Rasch rating scale model. RESULTS: First version of the tool: we piloted 117 items that were grouped as per the themes related to contextual factors and rated on a 5-point Likert scale. Cronbach alpha for the set of 12 retained items per scale ranged from 0.75 to 0.94. Second version of the tool included 60 items: Rasch analysis showed that four of the five scales (ie, Leadership and Agency, Values, Policies, Supports) can be used as unidimensional scales, whereas the fifth scale (Demands) had to be split into two unidimensional scales (Demands and Overdemands). DISCUSSION: Validity evidence documented for content and internal structure is encouraging and supports the use of the McGill context tool. Future research will provide additional validity evidence and cross-cultural translation.

Usability and Efficacy of Artificial Intelligence Chatbots (ChatGPT) for Health Sciences Students: Protocol for a Crossover Randomized Controlled Trial.

BACKGROUND: The integration of artificial intelligence (AI) into health sciences students' education holds significant importance. The rapid advancement of AI has opened new horizons in scientific writing and has the potential to reshape human-technology interactions. AI in education may impact critical thinking, leading to unintended consequences that need to be addressed. Understanding the implications of AI adoption in education is essential for ensuring its responsible and effective use, empowering health sciences students to navigate AI-driven technologies' evolving field with essential knowledge and skills. OBJECTIVE: This study aims to provide details on the study protocol and the methods used to investigate the usability and efficacy of ChatGPT, a large language model. The primary focus is on assessing its role as a supplementary learning tool for improving learning processes and outcomes among undergraduate health sciences students, with a specific emphasis on chronic diseases. METHODS: This single-blinded, crossover, randomized, controlled trial is part of a broader mixed methods study, and the primary emphasis of this paper is on the quantitative component of the overall research. A total of 50 students will be recruited for this study. The alternative hypothesis posits that there will be a significant difference in learning outcomes and technology usability between students using ChatGPT (group A) and those using standard web-based tools (group B) to access resources and complete assignments. Participants will be allocated to sequence AB or BA in a 1:1 ratio using computer-generated randomization. Both arms include students' participation in a writing assignment intervention, with a washout period of 21 days between interventions. The primary outcome is the measure of the technology usability and effectiveness of ChatGPT, whereas the secondary outcome is the measure of students' perceptions and experiences with ChatGPT as a learning tool. Outcome data will be collected up to 24 hours after the interventions. RESULTS: This study aims to understand the potential benefits and challenges of incorporating AI as an educational tool, particularly in the context of student learning. The findings are expected to identify critical areas that need attention and help educators develop a deeper understanding of AI's impact on the educational field. By exploring the differences in the usability and efficacy between ChatGPT and conventional web-based tools, this study seeks to inform educators and students on the responsible integration of AI into academic settings, with a specific focus on health sciences education. CONCLUSIONS: By exploring the usability and efficacy of ChatGPT compared with conventional web-based tools, this study seeks to inform educators and students about the responsible integration of AI into academic settings. TRIAL REGISTRATION: ClinicalTrails.gov NCT05963802; https://clinicaltrials.gov/study/NCT05963802. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/51873.

The Black Box of Patient Education: An Expert Consultation on Patient Education Interventions and Strategies for the Management of Subacromial Pain Syndrome.

Purpose: To identify patient education, interventions, and strategies to optimize the management of subacromial pain syndrome (SAPS) in physical therapy, based on the experiential knowledge of patient-partners and caregivers involved in the rehabilitation of this condition. Method: Using a semi-deductive approach building on the evidence extracted from the literature, an expert consultation using focus groups was conducted. The experts were physical therapists (n = 5) and an occupational therapist with extensive clinical experience, as well as a patient-partner. Analysis followed the Framework method. Results: Two main themes emerged: (1) interventions directly related to patient education, consisting of nine sub-themes, including symptom self-management and pain phenomenon, and (2) patient education strategies to broadly frame the interventions, consisting of 10 sub-themes, including educational materials and clinical teaching approaches. Conclusion: The consultation confirmed and expanded the knowledge from the literature by adding knowledge that emerged from the experts' practical experience. It resulted in the development of preliminary statements on structured patient education interventions and management strategies for SAPS. These emerging statements are, to our knowledge, the first to inform patient education specifically as it relates to the management of SAPS taking into account psychosocial and contextual factors.

Objectif: déterminer les mesures d'éducation des patients, les interventions et les stratégies à utiliser pour optimiser la prise en charge du conflit sous-acromial (CSA) en physiothérapie, d'après les connaissances expérientielles de patients-partenaires et de soignants qui participent à la réadaptation de cette affection. Méthodologie: au moyen d'une approche semi-déductive s'appuyant sur les données probantes tirées de publications scientifiques, les chercheurs ont réalisé une consultation d'experts au sein de groupes de travail. Ces experts étaient des physiothérapeutes (n = 5) et un ergothérapeute possédant une vaste expérience clinique, de même qu'un patient-partenaire. L'analyse a fait appel à la méthode du cadre logique. Résultats: deux grands thèmes ont émergé : 1) les interventions directement liées à l'éducation des patients, composées de neuf sous-thèmes, incluant l'autogestion des symptômes et le phénomène de la douleur, et 2) les stratégies d'éducation des patients pour encadrer sommairement les interventions, composées de dix sous-thèmes, y compris le matériel pédagogique et les méthodes d'enseignement clinique. Conclusion: la consultation a confirmé et élargi les connaissances tirées des publications scientifiques, car elle a permis d'ajouter le savoir issu de l'expérience pratique des experts. Elle a entraîné la préparation de déclarations préliminaires sur des interventions structurées d'éducation des patients et sur des stratégies de prise en charge du CSA. À notre connaissance, ces déclarations préliminaires sont les premières à éclairer les mesures d'éducation des patients, plus particulièrement à l'égard de la prise en charge du CSA, en tenant compte des facteurs psychosociaux et contextuels.

Revealing The Unseen: A Review of Wood's Lamp in Dermatology.

In use for over a century, the Wood's lamp is a time-tested tool to aid in the diagnosis of certain superficial infections, pigmentary disorders, and metabolic diseases. To achieve its high utility, the Wood's lamp projects ultraviolet light onto the skin which in turn reflects a visible light that a trained eye can use to diagnose and monitor multiple dermatological ailments. Although new alternatives to Wood's lamp have been considered, it still remains a favored method of diagnosis because it is safe, cost-effective, and reliable. In this review, the authors explore the myriad applications of Wood's lamp in the field of dermatology.

Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: Clinical Practice Guideline Methods.

OBJECTIVES: To present the methods used to develop a clinical practice guideline (CPG) with recommendations endorsed by key stakeholders for assessing, managing, and supporting return to work for adults with rotator cuff disorders. DESIGN: Clinical practice guideline development. METHODS: A steering committee composed of the research team of this project led the development of this CPG in 5 phases, which followed the standards of the NICE and AGREE II collaborations. During the preparation phase (I), a multidisciplinary working committee of experts in managing rotator cuff disorders (n = 20) determined the scope and objectives of the CPG. The recommendations development phase (II) included initial knowledge synthesis, development of preliminary recommendations, systematic consultations with a multidisciplinary panel of key stakeholders (n = 51) using a modified three-round Delphi approach and drafting of the original CPG. In the external evaluation phase (III), an external committee of experts evaluated the original CPG using the AGREE II tool. In the dissemination phase (IV), the strategy for disseminating the CPG was developed and implemented. During the update phase (V), the CPG was revised based on an update of the initial knowledge synthesis. RESULTS: Seventy-three preliminary recommendations were developed from the initial knowledge synthesis. During the Delphi consultation, all of these recommendations were endorsed, and one new recommendation was proposed by panelists. The original CPG received an overall AGREE II score of 83% from the external evaluators. In 2021, an update of the initial 2017 knowledge synthesis was conducted and 13 recommendations were revised. CONCLUSION: The 5-phase consensus methods approach guided the development of a high-quality CPG on assessing, managing, and supporting return to work for adults with rotator cuff disorders. J Orthop Sports Phys Ther 2022;52(10):665-674. Epub: 27 July 2022. doi:10.2519/jospt.2022.11307.

Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline.

OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decisionmaking for diagnosis and treatment, and planning for successful return to work. J Orthop Sports Phys Ther 2022;52(10):647-664. Epub: 27 July 2022. doi:10.2519/jospt.2022.11306.

Tactile stimulation programs in patients with hand dysesthesia after a peripheral nerve injury: A systematic review.

STUDY DESIGN: This is a systematic review performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. INTRODUCTION: Diverse approaches based on tactile stimulation are used in hand rehabilitation settings to treat touch-evoked dysesthesias. However, there is a lack of literature synthesis on the description and the effectiveness of the various approaches based on tactile stimulation that can be used for treating hand dysesthesia after nerve injury. PURPOSE OF THE STUDY: The purpose of the study was to summarize the current evidence on tactile stimulation programs for managing touch-evoked hand dysesthesia due to nerve injury. METHODS: The search was carried out on Medline, Embase, CINAHL, and the Cochrane Library databases. The selected studies had to present patients with touch-evoked dysesthesia after nerve injury who were treated with tactile stimulation approaches to reduce pain. The methodological quality of the included studies was assessed using the methodological index for nonrandomized studies scale, as well as the risk of bias. RESULTS: Eleven studies met the inclusion criteria. These studies present tactile stimulation interventions that are heterogeneous relative to the target populations and the intervention itself (desensitization versus somatosensory rehabilitation method). Painful symptoms appear to diminish in patients with touch-evoked hand dysesthesia, regardless of the tactile stimulation program used. However, the included studies present significant risks of bias that limit the confidence in these results. DISCUSSION: The evidence does not unequivocally support the beneficial effects of tactile stimulation to treat touch-evoked hand dysesthesia. CONCLUSION: Future studies with more rigorous methodological designs, such as randomized controlled trials, are required to verify the potential benefits of these approaches.

Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial.

BACKGROUND: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. OBJECTIVE: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. METHODS: Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 min were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over 3 weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. RESULTS: With no baseline differences between groups (p > 0.075), perturbation training yielded large improvements in most variables in the Perturb (p < 0.05, Effect Size: ES > .46) group (n = 10) and the NonPerturb (p ≤ .089, ES > .45) group (n = 7 post-crossing), except for maximal strength (p > .23) in the NonPerturb group. Walking-only training in the NonPerturb group (n = 8, pre-crossing) mostly had no effect (p > .292, ES < .26), except on balance confidence (p = .063, ES = .46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. CONCLUSION: Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830.

Seasonal movements and tributary-specific fidelity of blue sucker Cycleptus elongatus in a Southern Plains riverscape.

This study used acoustic telemetry and a multistate Cormack-Jolly-Seber model to determine the seasonal movement patterns of blue sucker Cycleptus elongatus from 2015 to 2017. Several hypotheses were ranked using AICc , and it was determined that the movement patterns of blue suckers in a mainstem reach below a hydropower dam (i.e., tailwater) differed from those of blue suckers tagged in the major tributaries (perennial with stream order >3). This study estimated a low probability (≤0.13) blue suckers would leave the tailwater reach at any time during the study. Conversely, blue suckers tagged in the major tributaries had a high probability (≥0.88) of leaving after the spawning season (February-May). Blue suckers tagged in the major tributaries displayed a high probability (0.83) of returning to the tributaries in the spawning season of 2016 when discharges were high. Blue suckers also had a higher probability of fidelity to the tributary where they were tagged (0.65) rather than straying to different tributaries (0.18). The majority of tagged blue suckers that strayed selected the only undammed tributary in the study area. In 2017, spring discharges were low, and the probability of blue suckers returning to any major tributary was low (0.19), with little difference in the probability of displaying site fidelity (0.10) vs. straying (0.09).

Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations.

OBJECTIVES: To perform a systematic review of clinical practice guidelines (CPGs) and semantic analysis of specific clinical recommendations for the management of rotator cuff disorders in adults. DATA SOURCES: A systematic bibliographic search was conducted up until May 2018 in Medline, Embase, and Physiotherapy Evidence Database, or PEDro, databases, in addition to 12 clinical guidelines search engines listed on the Appraisal of Guidelines for Research and Evaluation (AGREE) website. STUDY SELECTION: Nine CPGs on the management of rotator cuff disorders in adults or workers, available in English or French, and published from January 2008 onward, were included and screened by 2 independent reviewers. DATA EXTRACTION: CPG methodology was assessed with the AGREE II checklist. A semantic analysis was performed to compare the strength of similar recommendations based on their formulation. The recommendations were categorized in a standardized manner considering the following 4 levels: "essential," "recommended," "may be recommended," and "not recommended." DATA SYNTHESIS: Methodological quality was considered high for 3 CPGs and low for 6. All CPGs recommended active treatment modalities, such as an exercise program in the management of rotator cuff disorders. Acetaminophen or nonsteroidal anti-inflammatory drug prescriptions and corticosteroid injections were presented as modalities that may be recommended to decrease pain. Recommendations related to medical imagery and surgical opinion varied among the guidelines. The most commonly recommended return-to-work strategies included intervening early, use of a multidisciplinary approach, and adaptation of work organization. CONCLUSIONS: Only 3 CPGs were of high quality. The development of more rigorous CPGs is warranted.

Baropodometric quantification and implications of muscle coactivation in the lower limbs caused by head movement: A prospective study.

BACKGROUND: In healthy young adults, muscle coactivation can sometimes be induced by remote voluntary contractions when the motor task is forceful, maximal, tiring, or cyclic and brief. OBJECTIVES: To show that a change in plantar pressure is an unequivocal response to backward movement of the head, and to contribute to a better understanding of physiotherapy methods that involve remote muscle activation. METHODS: Involuntary coactivation was quantified as a percentage of the anteroposterior plantar pressure distribution, using a baropodometric platform in a population of young adults. The baropodometric data were collected from a 1s recording after 30 s in the reference condition, and from 1s recordings during the first second and then during the 120th second in the test condition. The results were analyzed with Bayesian statistics (Markov chains and Monte Carlo integration techniques). RESULTS: 90 adults participated in the study (age range: 19-26; 38 males and 52 females). The forefoot plantar pressure increased in all cases, by a mean multiplicative factor (on a logit scale) of 1.12 (from 72.24% to 74.45%) when the head was aligned over the trunk. CONCLUSIONS: This 90-participant trial confirmed our initial hypothesis: a increase in forefoot plantar pressure is a systematic response to the motor task (head movement), and suggests greater recruitment of the plantar flexor muscles. A spinal reflex and/or a previously unknown form of motor overflow might be involved in this phenomenon. These results support the development of inductive physiotherapy techniques based on remote muscle activation in the treatment of musculoskeletal disorders. CLINICALSTRIAL. GOV IDENTIFIER: NCT02320097.

Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials.

BACKGROUND: Rotator cuff calcific tendinopathy is characterised by the deposition of hydroxyapatite crystals in one of the rotator cuff tendons and can be managed by ultrasound-guided lavage. However, evidence regarding the efficacy of ultrasound-guided lavage for rotator cuff calcific tendinopathy remains inconclusive. The aim of this systematic review and meta-analysis is to update the available evidence on the efficacy of ultrasound-guided lavage in adults with rotator cuff calcific tendinopathy. METHODS: A literature search was conducted up to April 2018 in four bibliographic databases to identify randomised control trials that compared ultrasound-guided lavage alone with other interventions to treat rotator cuff calcific tendinopathy. Randomised control trials were assessed with the Cochrane Risk of Bias Tool. Meta-analyses and/or qualitative synthesis of the evidence were performed. RESULTS: Three randomised control trials were included. Pooled results for pain (n=226) indicated that ultrasound-guided lavage may significantly decrease pain when compared with shockwave therapy, with a mean difference of -1.98 out of 10 points (95% CI -2.52 to -1.45) in the short term and of -1.84 (95% CI -2.63 to -1.04) in the long term. Based on one trial (n=25), ultrasound-guided lavage significantly improved function when compared with shockwave therapy (p<0.05). Based on another trial (n=48), the addition of ultrasound-guided lavage to a corticosteroid injection significantly improves function in the long term (p<0.05). CONCLUSION: For individuals with rotator cuff calcific tendinopathy, low-quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone. Future trials could modify the present conclusions. TRIAL REGISTRATION NUMBER: CRD42018095858.

Management of long-term complex regional pain syndrome with allodynia: A case report.

STUDY DESIGN: Case report. INTRODUCTION: Conventional rehabilitation alone may not be effective in reducing symptoms in some patients with complex regional pain syndrome. PURPOSE OF THE STUDY: This case report portrays the benefits of a new tailored rehabilitation program for a 39-year-old patient suffering from upper limb complex regional pain syndrome with severe touch-evoked pain (static mechanical allodynia). METHODS: This patient had previously received conventional rehabilitation for a year and a half including physical and nonsurgical medical interventions that did not improve symptoms or function. In the search for an alternative, this patient was referred to occupational therapy to try a tailored rehabilitation program, drawing on multiple strategies used sequentially according to the patient's tolerance and symptom evolution. During this 22-month program, the following methods were added (listed chronologically): somatosensory rehabilitation of pain method, graded motor imagery, pain management modalities, active mobilizations, strengthening exercises, and task simulation. The patient successively showed resolution of mechanical allodynia, decreased pain, reduction of tactile hypesthesia and improvement in active range of motion, strength, and function. These improvements allowed him to return to work. DISCUSSION: This suggests that a tailored rehabilitation program combining somatosensory rehabilitation of pain method, graded motor imagery and more conventional approaches could improve symptoms and functional status in patients with upper limb complex regional pain syndrome, even with persistent refractory symptoms. CONCLUSION: The addition of the somatosensory rehabilitation of pain method and the graded motor imagery approach to conventional therapy could be considered in cases of complex regional pain syndrome that do not respond to conventional rehabilitation alone.

Chronic Skin Fragility of Aging: Current Concepts in the Pathogenesis, Recognition, and Management of Dermatoporosis.

Thin skin and the appearance of bruises, seemingly unprovoked, are frequent complaints of elderly patients. Chronic cutaneous insufficiencies such as these are termed dermatoporosis. Although it is seldom the primary reason for consultation, dermatoporosis is associated with bleeding and healing complications and presents an opportunity for patient education and prevention. In this review, the authors explore the risk factors, pathogenetic mechanisms, clinical expression, and evidence-based therapies reported for chronic skin fragility due to aging.

Fostering clinical reasoning in physiotherapy: comparing the effects of concept map study and concept map completion after example study in novice and advanced learners.

BACKGROUND: Health profession learners can foster clinical reasoning by studying worked examples presenting fully worked out solutions to a clinical problem. It is possible to improve the learning effect of these worked examples by combining them with other learning activities based on concept maps. This study investigated which combinaison of activities, worked examples study with concept map completion or worked examples study with concept map study, fosters more meaningful learning of intervention knowledge in physiotherapy students. Moreover, this study compared the learning effects of these learning activity combinations between novice and advanced learners. METHODS: Sixty-one second-year physiotherapy students participated in the study which included a pre-test phase, a 130-min guided-learning phase and a four-week self-study phase. During the guided and self-study learning sessions, participants had to study three written worked examples presenting the clinical reasoning for selecting electrotherapeutic currents to treat patients with motor deficits. After each example, participants engaged in either concept map completion or concept map study depending on which learning condition they were randomly allocated to. Students participated in an immediate post-test at the end of the guided-learning phase and a delayed post-test at the end of the self-study phase. Post-tests assessed the understanding of principles governing the domain of knowledge to be learned (conceptual knowledge) and the ability to solve new problems that have similar (i.e., near transfer) or different (i.e., far transfer) solution rationales as problems previously studied in the examples. RESULTS: Learners engaged in concept map completion outperformed those engaged in concept map study on near transfer (p = .010) and far transfer (p < .001) performance. There was a significant interaction effect of learners' prior ability and learning condition on conceptual knowledge but not on near and far transfer performance. CONCLUSIONS: Worked examples study combined with concept map completion led to greater transfer performance than worked examples study combined with concept map study for both novice and advanced learners. Concept map completion might give learners better insight into what they have and have not yet learned, allowing them to focus on those aspects during subsequent example study.

Patellar tendon vibration reduces the increased facilitation from quadriceps to soleus in post-stroke hemiparetic individuals.

BACKGROUND: Stimulation of the femoral nerve in healthy people can facilitate soleus H-reflex and electromyography (EMG) activity. In stroke patients, such facilitation of transmission in spinal pathways linking the quadriceps and soleus muscles is enhanced and related to co-activation of knee and ankle extensors while sitting and walking. Soleus H-reflex facilitation can be depressed by vibration of the quadriceps in healthy people, but the effects of such vibration have never been studied on the abnormal soleus facilitation observed in people after stroke. OBJECTIVES: To determine whether vibration of the quadriceps can modify the enhanced heteronymous facilitation of the soleus muscle observed in people with spastic stroke after femoral nerve stimulation and compare post-vibration effects on soleus facilitation in control and stroke individuals. METHODS: Modulation of voluntary soleus EMG activity induced by femoral nerve stimulation (2×motor threshold) was assessed before, during and after vibration of the patellar tendon in 10 healthy controls and 17 stroke participants. RESULTS: Voluntary soleus EMG activity was facilitated by femoral nerve stimulation in 4/10 (40%) controls and 11/17 (65%) stroke participants. The level of facilitation was greater in the stroke than control group. Vibration significantly reduced early heteronymous facilitation in both groups (50% of pre-vibration values). However, the delay in recovery of soleus facilitation after vibration was shorter for the stroke than control group. The control condition with the vibrator turned off had no effect on the modulation. CONCLUSIONS: Patellar tendon vibration can reduce the facilitation between knee and ankle extensors, which suggests effective presynaptic inhibition but decreased post-activation depression in the lower limb of people after chronic hemiparetic stroke. Further studies are warranted to determine whether such vibration could be used to reduce the abnormal extension synergy of knee and ankle extensors in people after hemiparetic stroke.