COVID-19 pandemic and physiotherapy practice: the efficacy of a telephone-based therapeutic program for people with knee osteoarthritis.

BACKGROUND: Knee osteoarthritis (OA) is one of the leading causes of pain and disability among adults worldwide. For many individuals with knee OA, accessing proper physiotherapy services is difficult, especially with the current COVID-19 pandemic. OBJECTIVE: The purpose of the current study is to investigate the feasibility and efficacy of a telephone-based physiotherapy (PT) care program for people with knee OA. METHODS: This was a pilot feasibility study, with a cross-over design and repeated measures. Two groups with knee OA were recruited, an immediate therapy group (IG) and a delayed therapy group (DG). The therapeutic program involved a telephone call from a physiotherapist to the participants 3/week for 8 weeks. Physiotherapist delivered to participants educational information on knee OA, followed-up on adhering to daily therapeutic exercises and coached participants regarding exercises while using a behavioral-change framework to ensure proper therapy. Following the 8-weeks program, the IG group were advised to continue exercises and the DG group were provided with the same telephone-based PT program. RESULTS: Forty participants were enrolled in the study (IG = 20; DG = 20). There were no significant differences between groups at baseline. The results of our study showed that the telephone-based PT program led to improvements across all outcome measures. Participants reported that they had less pain, less stiffness, and an overall improvement in physical function. CONCLUSIONS: A telephone-based PT program appears to be feasible and effective in yielding significant benefits among individuals with knee OA.

Knowledge translation theories in fall prevention and balance control: A scoping review.

Falls are a major problem all over the world. Falls may result in bone fractures, fear of falling, and reduced participation in activities of daily living and in social activities, thus, an increased cost of health care to the individual and the society. Falls occur as a result of compounding factors that combine and overwhelm an individual's ability to maintain or regain his or her balance. However, fall rates are often reported as high, suggesting the presence of a gap between clinical practices related to fall prevention and the knowledge of the best available evidence related to fall prevention. The science of knowledge translation (KT) offers a variety of theories that can facilitate the implementation of up-to-date knowledge among clinicians. Therefore, the aim of this study was to identify and review the use of knowledge translation theories, namely the Knowledge to Action Framework (KTA), Promoting Action on Research Implementation in Health Services framework (PARIHS), Consolidated Framework for Implementation Research (CFIR), and the Theoretical Domains Framework (TDF), in studies related to fall prevention and balance control. A scoping review was conducted to identify studies related to fall prevention and balance control that used one of these four KT theories. An extensive literature search was performed up to January 2021. Two independent reviewers conducted a study selection process followed by data extraction of the search results. Our results identified 16 studies that were related to the scope of our review, with three studies utilizing KTA, two studies using PARIHS, four studies using CFIR, and seven studies using the TDF. Overall, it appears that the use of KT theories is helpful to guide interventions for fall prevention and improve balance control. Future efforts are needed to facilitate the use of KT theories for guiding clinical practices related to fall prevention and balance control.

Waterloo Handedness Questionnaire: Cross-Cultural Adaptation and Psychometric Properties of the Arabic Version.

Handedness is one of the most studied behavioural predictors of cerebral lateralization. Assessing handedness is often essential in neuropsychology and motor behaviour research. Thus, it is important that self-reported assessment tools for determining handedness are available in multiple languages for different cultures. The purpose of the present study was to conduct a translation and cross-cultural adaptation of the Waterloo Handedness Questionnaire into the Arabic language and to assess its psychometric properties. Two independent forward translations were performed by two native Arabic speakers and then synthesized into one version. The synthesized version was backtranslated into English by two independent bilingual translators. An expert committee was formed to review the translation and adaptation process. A final Arabic version of the WHQ was obtained, the WHQ-Ar. Two hundred and ninety adult Arabic speakers were recruited to participate in the study and investigate the properties of the WHQ-Ar. Results showed that the WHQ-Ar had no floor or ceiling effect. For construct validity, results of factor analysis revealed that the WHQ-Ar had two dimensions. Further, the WHQ-Ar had excellent internal consistency with Cronbach's alpha = 0.93. For test-retest reliability, intraclass correlation coefficient score was 0.94. The Bland-Altman plot showed acceptable agreement between test and retest scores. Therefore, the WHQ-Ar is a valid, reliable tool and ready for use among the Arabic-speaking population for determining handedness.

Spasticity Measurement Tools and Their Psychometric Properties Among Children and Adolescents With Cerebral Palsy: A Systematic Review.

PURPOSE: To identify and appraise the literature on the psychometric properties of spasticity measures that have been used among children and adolescents with cerebral palsy (CP). METHODS: A comprehensive literature search was conducted in 5 databases. Two independent reviewers screened the literature search results for relevant studies. Reviewers extracted the data using a standardized form and study quality was assessed using a critical appraisal tool. RESULTS: A total of 44 studies met the selection criteria and were included. We identified 22 different spasticity assessment tools, with different levels of evidence regarding their psychometric properties. CONCLUSION: The findings of the current review indicate that there is limited evidence to recommend 1 spasticity assessment method for children and adolescents with CP. Spasticity assessment in its current state lacks a method that possesses the necessary psychometric properties and is easily used in the clinical setting.

Effects of constraint-induced movement therapy for the lower extremity among individuals post-stroke: A randomized controlled clinical trial.

BACKGROUND: Stroke often leads to lower extremity impairments that significantly hinders functional recovery. OBJECTIVE: To investigate the effectiveness of constraint-induced movement therapy for the lower extremity (CIMT-LE) for improving balance and ambulation among people post-stroke. METHODS: A randomized controlled, single-blinded clinical trial was conducted. Participants were recruited and randomized into one of two groups: CIMT-LE group and control. Outcome measures were the Fugl-Meyer assessment of lower extremity, Berg balance scale, ten-meter walk test and six-minute walk test. Outcome measures were collected at baseline, following the conclusion of the therapeutic programs and after three months. RESULTS: 38 participants were enrolled in the study (19 in each group). No significant differences were found between groups at baseline. At the conclusion of therapeutic programs, both groups showed significant changes compared to baseline. However, changes seen in the CIMT-LE were clinically significant. Further, at three months following the conclusion of the program, the recorded improvements were retained by participants. CONCLUSION: A CIMT-LE program compared to an intensity-matched conventional program yielded significant clinical improvements among people post-stroke. These improvements were seen in lower extremity motor recovery, postural balance and gait speed. Furthermore, these improvements were retained three months following the conclusion of the therapeutic program.

Exploring Saudi Physical Therapists' Perceptions and Opinions on Their Profession: A Mixed-Method Study.

Methods: A cross-sectional, mixed-method study was employed. Practicing PTs and PT students were recruited to fill out a self-administered questionnaire to rank nine different professions (including PT) across different dimensions. Further, participants reported on their job satisfaction and participated in a semistructured interview regarding their responses. Results: A total of 175 individuals participated in this study. The physical therapy profession was rated 6th on level of education, last (9th) on level of income and level of social standing, 5th on level of responsibility, and 3rd on level of usefulness. In the overall occupational prestige, the physical therapy profession was ranked the lowest compared to the other professions. Lastly, the data from the semistructured interviews corroborated the findings identified from the quantitative aspect of our study. Discussion. The overall results of the study indicate that the current perceived level of occupational prestige among Saudi PTs and PT students is somewhat disappointing. Participants generally viewed their profession in a low occupational prestige status, which is in contrast to previous studies conducted in other countries. While some of these results can be explained by the nature and history of the profession in Saudi Arabia, Academic institutions and policy makers should make an effort to promote the occupational prestige of the physical therapy profession.

An external focus of attention compared to an internal focus of attention improves anticipatory postural adjustments among people post-stroke.

BACKGROUND: People after stroke often have postural impairments that can increase their risk of falling. Anticipatory postural adjustments (APAs) are changes in the activity of postural muscles prior to a voluntary movement in order to maintain vertical equilibrium. Previous research suggests that improving APAs leads to better postural control and reduces the risk of falls. Despite the importance of APAs and their impairment among people post-stroke, studies that aim to investigate methods for improving APAs are limited. Consistent evidence supports that an external focus of attention compared to an internal focus of attention, yields superior performance of motor skills that include postural control. RESEARCH QUESTION: What are the effects of adopting different foci of attention on measures of APAs and movement parameters when performing a lower extremity Fitts' task among people post-stroke? METHODS: Twelve individuals post-stroke performed a lower extremity stepping movement (Fitts' task) while adopting an external focus or an internal focus of attention in a within-subject design. A motion capture system was used to record participants' movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at endpoint (SDT). Electromyography was used to measure muscle activity and determine APAs onset and magnitude. For all dependent variables separate repeated measures ANOVAs were conducted to compare performance between foci of attention. RESULTS: The results showed that an external focus of attention yielded significantly better performance on all outcome measures. The improvement in performance was seen in shorter MT, higher PV, shorter ttPV, smaller SDT, earlier APAs onset and more efficient APAs magnitude. SIGNIFICANCE: The changes in outcome measures suggest that adopting an external focus of attention during postural tasks could be an effective strategy for improving balance control among people post-stroke.

Motor Behavior Concepts in the Study of Balance: A Scoping Review.

Previous research suggests that using Fitts' law; attentional focus or challenge point framework (CPF) is beneficial in balance control studies. A scoping review was conducted to examine studies that utilized these motor behavior concepts during balance control tasks. An extensive literature search was performed up to January 2018. Two independent reviewers conducted a study selection process followed by data extraction of the search results. Forty-six studies were identified, with 2 studies related to CPF, 12 studies related to Fitts' law and 32 studies related to focus of attention. The CPF appears to be a useful method for designing a progressive therapeutic program. Fitts' law can be used as a tool for controlling the difficulty of motor tasks. Focus of attention studies indicate that adopting an external focus of attention improves task performance. Overall, studies included in this review report benefit when using the selected motor behavior concepts. However, the majority (>80%) of studies included in the review involved healthy populations, with only three clinical trials. In order to ascertain the benefits of the selected motor behavior concepts in clinical settings, future research should focus on using these concepts for clinical trials to examine balance control among people with balance impairments.

Impact of Spinal Manipulation on Lower Extremity Motor Control in Lumbar Spinal Stenosis Patients: A Small-Scale Assessor-Blind Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to quantify the impact of a single lumbar spinal manipulation (SM) intervention on the leg movement performance of degenerative lumbar spinal stenosis (LSS) patients in a small-scale registered randomized clinical trial. METHODS: Participants with LSS (n = 14) were tested at baseline for pain, lumbar range of motion, and behavioral or kinematic motor performance (using an established Fitts' Law foot-pointing task), then underwent covariate adaptive randomization to receive SM or no intervention. Postintervention all dependent measures were repeated. Experimenters were blinded to patient group allocation. University ethics board approval was attained. RESULTS: For the primary outcome movement time, there was no significant difference between groups. As predicted by Fitts' Law, all participants had longer movement times as task difficulty increased. Secondary kinematic outcomes yielded no significant between-group differences. Consistent with Fitts' Law, kinematic measures changed significantly with task difficulty. Pairwise comparisons revealed the kinematic variables were more adversely affected by greater movement amplitudes than target size changes. No exploratory differences in pain or lumbar range of motion were observed. CONCLUSION: Changes in motor performance were not observed in this chronic pain population after a single SM intervention compared with a control group. Given the sample size, the study may have been underpowered to detect meaningful differences. Fitts' Law was observed for the lower extremity-pointing task for an LSS population and may provide an objective measure of motor performance.

Anticipatory postural adjustments during a Fitts' task: Comparing young versus older adults and the effects of different foci of attention.

Anticipatory postural adjustments (APAs) are an integral part of standing balance. Previous research with balance control has shown that adopting an external focus of attention, compared to an internal focus of attention, yields better performance during motor skills. Despite the importance of APAs, especially among older adults, and the potential benefits of adopting an external focus of attention, studies investigating methods for improving APAs are limited. The aim of this study was to compare behavioral, kinematic and APAs measures while adopting different foci of attention among young and older adults when performing a lower extremity Fitts' task. Ten young adults (mean age 24 years ±â€¯4.37) and ten older adults (mean age 75 years ±â€¯5.85) performed a lower-extremity reaching task (Fitts' task) while adopting an external focus (focus on target) and an internal focus (focus on limb) in a within-subject design. A motion capture system was used to record participants' movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at target (SDT). Electromyography (EMG) was used to determine APAs onset and magnitude. The findings showed that an external focus of attention led to significantly shorter MT, higher PV, shorter ttPV and more accuracy when reaching the target (SDT) for both age groups. Also, EMG results showed that, with an external focus, APAs onset occurred earlier and APAs magnitude was more efficient. As predicted by Fitts' Law, participants spent more time executing movements to targets with higher indices of difficulty. Older adults compared to young adults were more adversely affected by the increase of difficulty of the Fitts' task, specifically, on measures of APAs. In conclusion, adopting an external focus of attention led to better overall movement performance when performing a lower extremity Fitts' task. The task used in the present study can distinguish between APAs for older and young adults. We recommend that future studies expand on our findings in order to establish a performance-based objective measure of APAs to assess clinical interventions for postural control impairment.

Assessment of spasticity after stroke using clinical measures: a systematic review.

PURPOSE: To identify and appraise the literature on clinical measures of spasticity that has been investigated in people after stroke. METHODS: The literature search involved four databases (PubMed, CINAHL, Embase and The Cochrane Library) up to February 2014. The selected studies included those that aimed to measure spasticity using a clinical assessment tool among adult patients post-stroke. Two independent raters reviewed the included articles using a critical appraisal scale and a structured data extraction form. RESULTS: A total of 40 studies examining 15 spasticity assessment tools in patients post-stroke were reviewed. None of the reviewed measurement tools demonstrated satisfactory results for all psychometric properties evaluated, and the majority lacked evidence concerning validity and absolute reliability. CONCLUSION: This systematic review found limited evidence to support the use of most of clinical measures of spasticity for people post-stroke. Future research examining the application and psychometric properties of these measures is warranted. Implications for Rehabilitation There is a need for objective clinical tools for measuring spasticity that are clinically feasible and easily interpreted by clinicians. This review identified various clinical measures of spasticity that have been investigated in people after stroke. Insufficient evidence of psychometric properties precludes recommending one tool over the others. Future research should focus on investigating the psychometric properties of clinical measures of spasticity.