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1.
Pediatr Phys Ther ; 31(4): 331-336, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568376

RESUMO

PURPOSE: This study is a follow-up to the quantitative survey to examine the perceptions of pediatric physical therapists (PTs) on the application of the 2013 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG). METHOD: Qualitative semi-structured telephone interviews were completed. Interview questions focused on how the guidelines influenced practice, facilitators and barriers to implementation, and knowledge translation activities. RESULTS: Thirteen pediatric PTs from a variety of practice settings participated. Positive perceptions about the CMT CPG included the use of flow charts, synthesized literature in one place, and validation of examination and intervention approaches. Negative perceptions included its length and that approaches without published evidence were not addressed. Three major themes were identified: knowledge and evidence for practice, education of clinicians, and the CPG structure and components that influenced practice. CONCLUSIONS: The CMT CPG provided a number of benefits. Recommendations for future enhancement and development are provided.


Assuntos
Fisioterapeutas/normas , Modalidades de Fisioterapia/normas , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa , Torcicolo/congênito , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Inquéritos e Questionários , Torcicolo/reabilitação , Adulto Jovem
2.
Medicine (Baltimore) ; 98(37): e17099, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517838

RESUMO

BACKGROUND: This is the first systematic review evaluating and statistically synthesis the current studies regarding the effects of Tai Chi on pain and disability in patients with low back pain (LBP). METHODS: Seven electronic databases including PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and VIP information from inception to early March 2019 were searched. The Physiotherapy Evidence Database (PEDro) Scale was used to assess quality of all included randomized controlled trials (RCTs). The pooled effect size (weight mean difference, WMD) and 95% confidence interval (CI) were calculated to determine the effect of Tai Chi on pain and disability among LBP patients based on random effects model. RESULTS: The aggregated results of the meta-analysis suggested that Tai Chi significantly decreased pain (WMD = -1.27, 95%CI -1.50 to -1.04, P < .00001, I = 74%) and improve function disability, Oswestry disability index (ODI) subitems: pain intensity (WMD = -1.70, 95% CI -2.63 to -0.76, P = .0004, I = 89%); personal care (WMD = -1.93, 95% CI -2.86 to -1.00, P < .0001, I = 90%); lifting (WMD = -1.69, 95% CI -2.22 to -1.15, P < .0001, I = 66%); walking (WMD = -2.05, 95% CI -3.05 to -1.06, P < .0001, I = 88%); standing (WMD = -1.70, 95% CI -2.51 to -0.89, P < .0001, I = 84%); sleeping (WMD = -2.98, 95% CI -3.73 to -2.22, P < .00001, I = 80%); social life (WMD = -2.06, 95% CI -2.77 to -1.35, P < 0.00001, I = 80%) and traveling (WMD = -2.20, 95% CI -3.21 to -1.19, P < .0001, I = 90%), Japanese Orthopedic Association (JOA) score (WMD = 7.22, 95% CI 5.59-8.86, P < .00001, I = 0%), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) physical functioning (WMD = 3.30, 95% CI 1.92-4.68, P < .00001), and Roland-Morris Disability Questionnaire (RMDQ) (WMD = -2.19, 95% CI -2.56 to -1.82, P < .00001). CONCLUSION: We drew a cautious conclusion that Tai Chi alone or as additional therapy with routine physical therapy may decrease pain and improve function disability for patients with LBP. Further trials are needed to be conducted with our suggestions mentioned in the systematic review.


Assuntos
Dor Lombar/terapia , Manejo da Dor/normas , Tai Ji/normas , Humanos , Manejo da Dor/métodos , Modalidades de Fisioterapia/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Tai Ji/métodos
3.
Gait Posture ; 74: 83-86, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31491564

RESUMO

BACKGROUND: There is a clinical need to be able to reliably detect meaningful changes (0.1 to 0.2 m/s) in usual gait speed (UGS) considering reduced gait speed is associated with morbidity and mortality. RESEARCH QUESTION: What is the impact of tester on UGS assessment, and the influence of test repetition (trial 1 vs. 2), timing method (manual stopwatch vs. automated timing), and starting condition (stationary vs. dynamic start) on the ability to detect changes in UGS and fast gait speed (FGS)? METHODS: UGS and FGS was assessed in 725 participants on a 8-m course with infrared timing gates positioned at 0, 2, 4 and 6 m. Testing was performed by one of 13 testers trained by a single researcher. Time to walk 4-m from a stationary start (i.e. from 0-m to 4-m) was measured manually using a stopwatch and automatically via the timing gates at 0-m and 4-m. Time taken to walk 4-m with a dynamic start was measured during the same trial by recording the time to walk between the timing gates at 2-m and 6-m (i.e. after 2-m acceleration). RESULTS: Testers differed for UGS measured using manual vs. automated timing (p = 0.02), with five and two testers recording slower and faster UGS using manual timing, respectively. 95% limits of agreement for trial 1 vs. 2, manual vs. automated timing, and dynamic vs. stationary start ranged from ±0.15 m/s to ±0.20 m/s, coinciding with the range for a clinically meaningful change. Limits of agreement for FGS were larger ranging from ±0.26 m/s to ±0.35 m/s. SIGNIFICANCE: Repeat testing of UGS should performed by the same tester or using an automated timing method to control for tester effects. Test protocol should remain constant both between and within participants as protocol deviations may result in detection of an artificial clinically meaningful change.


Assuntos
Análise da Marcha/métodos , Marcha/fisiologia , Modalidades de Fisioterapia , Velocidade de Caminhada/fisiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/normas , Adulto Jovem
4.
Ultrasonics ; 99: 105943, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398497

RESUMO

The evaluation of the performance of nine physiotherapy ultrasound transducers used clinically was performed in the hospital environment using an acoustically absorbing thermocromic tile developed at the National Physical Laboratory (UK). The method consists of exposing an acoustic absorber tile, part of which contains a thermochromic pigment, to the ultrasonic beam, thereby forming an image of the intensity profile of the transducer. Images acquired using thermochromic materials were postprocessed in order to estimate effective radiating area (ERA) and beam nonuniformity ratio (BNR) for ultrasound transducers operating within the frequency range from 1.0 to 3.3 MHz, and nominal applied intensities in the range of 1-2W/cm2. Results of our measurements have shown that thermocromic tile can be used for quality control of ultrasound transducers in the hospital environment. Experimental results show that proposed method can be used to distinguish highly non - uniform ultrasound beams with high value of BNR. Influence of exposure duration on obtained ERA and BNR values was also analysed. Our results show that values for ERA increase with insonation time, while BNR values decrease. In order to compare our results with theory we have estimated temperature rise in thermochromic material experimentally and compare it with theoretical prediction.


Assuntos
Modalidades de Fisioterapia/instrumentação , Modalidades de Fisioterapia/normas , Terapia por Ultrassom/instrumentação , Terapia por Ultrassom/normas , Humanos , Teste de Materiais , Garantia da Qualidade dos Cuidados de Saúde , Transdutores
5.
J Rehabil Med ; 51(9): 683-691, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31448806

RESUMO

OBJECTIVES: To examine the reliability, validity and responsiveness of 3 different short versions of the Balance Evaluation Systems Test (BESTest: S--BESTest, Brief-BESTest and Mini-BESTest) in patients with subacute stroke. DESIGN: A prospective cohort study. PARTICIPANTS: Patients with subacute stroke. METHODS: Patients were assessed using the full BESTest. Scores of 3 short-form BESTests were later extracted. The intra-rater and inter-rater reliability (n = 12) were gathered from 5 raters. Concurrent validity was assessed with the Berg Balance Scale (BBS). Floor/ceiling effect, internal responsiveness and external responsiveness with the BBS (n = 70) were assessed at baseline, 2 weeks and 4 weeks post-rehabilitation. RESULTS AND CONCLUSION: All short-form BESTests demonstrated excellent intra-rater and inter-rater reliability (intraclass correlation coefficient (ICC) = 0.95-0.99) and excellent concurrent validity (r = 0.93-0.96). Unlike the Brief-BESTest and Mini-BESTest, the S-BESTest and BESTest had no significant floor/ceiling effects (< 20%). The standardized response mean of all 4 BESTest versions were large, ranging between 1.19 and 1.57, indicating sufficient internal responsiveness. The area under the curve of the S-BESTest and BESTest were significantly higher than the Brief-BESTest and Mini-BESTest, reflecting better accuracy of the S-BESTest and BESTest in identifying patients with subacute stroke who had balance improvement using the minimal clinically important difference of 6 and 16 points, respectively. These findings suggest that the S-BESTest is a short-form BESTest that is appropriate for assessing balance impairments in patients with subacute stroke.


Assuntos
Avaliação da Deficiência , Modalidades de Fisioterapia/normas , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/patologia
6.
Work ; 63(3): 369-374, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256106

RESUMO

BACKGROUND: Musculoskeletal disorders are not properly managed in office workers because of their busy work life. In-house physical therapy is a good way to manage the musculoskeletal disorders in office workers. Despite the numerous advantages of in-house physical therapy, the establishment and research of in-house physical therapy were insufficient. OBJECTIVE: The purpose this study was to determine the characteristics of musculoskeletal disorders in office workers and to investigate their satisfaction with in-house physical therapy clinics and the associated factors. METHODS: In this study, 664 office workers who used in-house physical therapy clinics were surveyed for characteristics of musculoskeletal disorders and satisfaction with in-house physical therapy clinics. RESULTS: Of these office workers, the most common causes of damage were nontraumatic (36.8%) and the most common lesion sites were the neck (30.3%) and lower back (25.6%). In the empirical characteristics of in-house physical therapy clinics, basic thermoelectric treatments were the most common (46.8%). The satisfaction with in-house physical therapy clinic was generally high. In addition, the cause of damage and treatment contents affected treatment-related and functional return-related satisfaction. CONCLUSION: In-house physical therapy, including therapeutic exercises and self-management education, is a good system to manage musculoskeletal disorders in office workers.


Assuntos
Pessoal Administrativo/psicologia , Instituições de Assistência Ambulatorial/normas , Doenças Musculoesqueléticas/classificação , Satisfação do Paciente , Modalidades de Fisioterapia/normas , Pessoal Administrativo/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/psicologia , República da Coreia , Inquéritos e Questionários
7.
Pediatr Phys Ther ; 31(3): 234-241, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31206504

RESUMO

PURPOSE: To describe the quality improvement (QI) activities used to improve treatment dose documentation for individuals with cerebral palsy (CP) and to discuss insights gained from this project. METHODS: Global and smart aims were established and interventions were tested from January 2017 through February 2018 using Plan-Do-Study-Act cycles. Performance was tracked overtime using run and control charts. RESULTS: The QI initiative resulted in a sustainable increase in percentage of dose elements present in the electronic medical record from 78% to 94%. Key drivers of improvement included (1) knowledge and awareness of dose, (2) clinician buy-in, (3) effective engagement of child and parent, (4) therapist knowledge of evidence-based treatments, (5) transparent and reliable documentation system, and (6) audit and clinician feedback. CONCLUSIONS: QI methods provided the tools to improve workflow and increase dose documentation for individuals with CP.


Assuntos
Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia/normas , Melhoria de Qualidade/organização & administração , Criança , Prática Clínica Baseada em Evidências , Retroalimentação , Feminino , Humanos , Conhecimento , Participação do Paciente , Melhoria de Qualidade/normas
8.
PLoS One ; 14(5): e0216357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120910

RESUMO

BACKGROUND AND OBJECTIVES: Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of people with stroke after BULT and UULT. RESEARCH DESIGN AND METHODS: This systematic review and meta-analysis identified 21 randomized controlled trials (RCTs) met the eligibility criteria from CINAHL, Medline, Embase, Cochrane Library and PubMed. The outcome measures were the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Box and Block Test (BBT), which are validated measures of upper limb function. RESULTS: Twenty-one studies involving 842 subjects with stroke were included. Compared with UULT, BULT yielded a significantly greater mean difference (MD) in the FMA-UE (MD = 2.21, 95% Confidence Interval (CI), 0.12 to 4.30, p = 0.04; I2 = 86%, p<0.001). However, a comparison of BULT and UULT yielded insignificant mean difference (MD) in terms of the time required to complete the WMFT (MD = 0.44; 95%CI, -2.22 to 3.10, p = 0.75; I2 = 55%, p = 0.06) and standard mean difference (SMD) in terms of the functional ability scores on the WMFT, ARAT and BBT (SMD = 0.25; 95%CI, -0.02 to 0.52, p = 0.07; I2 = 54%, p = 0.02). DISCUSSION AND IMPLICATIONS: Compared to UULT, BULT yielded superior improvements in the improving motor impairment of people with stroke, as measured by the FMA-UE. However, these strategies did not yield significant differences in terms of the functional performance of people with stroke, as measured by the WMFT, ARAT and BBT. More comparative studies of the effects of BULT and UULT are needed to increase the reliability of these conclusions.


Assuntos
Modalidades de Fisioterapia/normas , Reabilitação do Acidente Vascular Cerebral/métodos , Extremidade Superior/fisiologia , Humanos , Transtornos Psicomotores/terapia , Recuperação de Função Fisiológica , Ensino
9.
Medicina (Kaunas) ; 55(5)2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31108862

RESUMO

Background and objectives: Manual massage therapy is a therapeutic option for the treatment of several pathological conditions affecting the musculoskeletal system. It has been pointed out that massage might be beneficial for chronic obstructive pulmonary disease (COPD) patients thanks to therapeutic effects primarily related to hyperemia (increased skin temperature and blood flow), and activation of the lymphatic system. The present study reports current evidence on the systemic effects of manual massage in patients with COPD. Materials and Methods: A scoping review was conducted on five major databases. The search went through all databases since their inception until December 2018. Results: Seventy-eight citations were retrieved; after the selection process was completed, seven articles were considered eligible. In patients receiving manual massage, improvements were observed in Forced Expiratory Volume in 1 s, dyspnea perception, and in the 6-min walking test. Conclusions: To date, the use of manual massage in patients with COPD is not supported by substantial evidence in the literature: indeed, it is proposed as a therapeutic option in association with other interventions such as physical exercise.


Assuntos
Massagem/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Humanos , Massagem/métodos , Modalidades de Fisioterapia/psicologia , Modalidades de Fisioterapia/normas , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida/psicologia
10.
Am J Occup Ther ; 73(2): 7302205020p1-7302205020p10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30915963

RESUMO

IMPORTANCE: To develop a practical program in the early phase after nerve repair for more rapid return of function. OBJECTIVE: To investigate the effects of touch-observation and task-based mirror therapy on the sensorimotor outcomes of patients with nerve repair. DESIGN: An assessor-blinded study with a randomized controlled design. SETTING: University hospital. PARTICIPANTS: We recruited 12 patients with median or ulnar nerve repair between the level of midpalm and elbow referred by the plastic surgeons. INTERVENTION: The patients were randomized into touch-observation and task-based mirror therapy or control groups, and both groups received training for 12 wk. OUTCOMES AND MEASURES: The Semmes-Weinstein monofilament (SWM) test, two-point discrimination test, Purdue Pegboard Test (PPT), Minnesota Manual Dexterity Test (MMDT), and pinch-holding-up activity test were assessed at pretreatment, immediately after treatment, and 12 wk after the last treatment. RESULTS: The experimental group showed greater improvements in the results of the pinch-holding-up activity test and the PPT Unilateral Pin Insertion, Bilateral Pin Insertion, and Assembly subtests. However, change on the SWM test revealed no significant difference between the two groups. CONCLUSIONS AND RELEVANCE: Touch-observation and task-based mirror therapy is an effective but low-cost treatment protocol to optimize sensorimotor control and functional capability of the upper limb in patients with peripheral nerve injury.


Assuntos
Mãos/fisiopatologia , Traumatismos dos Nervos Periféricos/reabilitação , Modalidades de Fisioterapia/normas , Tato/fisiologia , Avaliação da Deficiência , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Força de Pinça/fisiologia
11.
Z Evid Fortbild Qual Gesundhwes ; 140: 43-51, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30837124

RESUMO

BACKGROUND: Today we are faced with changes in society and healthcare needs resulting from demographic transition. Among many other developments, the increasing complexity of healthcare creates new requirements for health professionals. To meet these requirements, such as evidence-based practice, professionally experienced therapists need additional training courses to acquire scientific competencies in addition to their professional competence. Certification courses for practitioners in the fields of speech therapy, occupational therapy and physical therapy offer a way to achieve these scientific competencies. AIM: The aim of this study was to gather empirical data that help to develop scientific contents for additional training courses on a higher education level. These contents must fit the learning needs of the target group with regard to evidence-based practice. METHODS: In a multi-method approach a questionnaire was created consisting of four parts. These contained closed questions on self-assessed learning needs for competencies in evidence-based practice with and without links to therapeutic practice, open questions about the design of a certification course as well as socio-demographic questions. The results were shown using frequencies and correlations between learning, work experience and level of education. Contextual correlations were calculated using Kendall's tau correlation of Cramer's V, a contingency coefficient based on Chi square. Answers to the open questions were assigned to subcategories. RESULTS: The answers of 70 therapists (11,5 % speech therapist, 17,1 % occupational therapists, 70 % physical therapists, 1,4 % unspecified) were evaluated. The results demonstrate that there are high learning needs (> 80 %) of the total sample regarding content of assessments and test procedures, evidence-based practice as well as clinical decision-making and interprofessional cooperation. The therapists see a high demand for additional skills combined with scientific knowledge and their own professional experience (92,8 %). Almost 90 % identified high learning requirements for the skill of critically reflecting on the treatments they provided. Depending on prior professional experience, learning needs differed for evidence-based practice with and without links to therapeutic practice. As to the design of certification courses, the participants preferred low costs, a flexible time-structure as well as teaching methods making the input more vivid and comprehensible. DISCUSSION: Scientific qualification of healthcare practitioners must address the learning requirements for evidence-based practice. For this purpose, teaching of scientific work skills such as scientific writing, evidence-based practice and quantitative and qualitative methods is recommended. The fact that the questionnaire has not been validated may limit the validity of the results. Due to the indirect distribution of the questionnaires, the survey may have been liable to non-response bias.


Assuntos
Medicina Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Certificação , Estudos Transversais , Alemanha , Humanos , Terapia Ocupacional/educação , Terapia Ocupacional/normas , Modalidades de Fisioterapia/normas , Fonoterapia/educação , Fonoterapia/normas
12.
NeuroRehabilitation ; 44(1): 67-77, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814369

RESUMO

BACKGROUND: Balance disorders cause disability in stroke and increase risk of falls. The Balance Evaluation Systems Test (BESTest), examines balance, determines parameters causing balance disorders, provides information on risk factors for falls. OBJECTIVE: To investigate the sensitivity and specificity of the BESTest in determining the risk of falls in stroke patients. METHODS: Fifty patients with chronic stroke were included in the study. Balance was assessed using BESTest, Berg Balance Scale (BBS), Activity Specific Balance Confidence scale (ABC) and Biodex-BioSway Balance System. To examine the content validity of BESTest, the relationship between BESTest and other balance assessment methods was examined. The internal consistency reliability of BESTest was evaluated by Cronbach's α coefficient. Analysis of receiver operating characteristics (ROC) was performed to determine cut-off point, sensitivity and specificity. RESULTS: BESTest, BBS, ABC and Biodex-BioSway Balance System results of faller stroke patients were worse than that of non-faller (p <0.05). Internal consistency of BESTest was found to be Cronbach's α = 0.960. The BESTest value of area under curve (AUC) was 0.844, with a cut-off point of 69.44%, a sensitivity of 75% and a specificity of 84.6% (p < 0.01). CONCLUSION: BESTest is reliable and valid with high sensitivity and specificity in determining the risk of fall in stroke patients.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação da Deficiência , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/normas , Psicometria , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade
13.
Value Health ; 22(3): 355-361, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832974

RESUMO

BACKGROUND: The distribution of EQ-5D-3L values (health state profiles, weighted by value sets) often shows two distinct groups, arising from both the distribution of profiles and the characteristics of value sets. To date, there is little evidence about the distribution of EQ-5D-5L values. OBJECTIVES: To explore the distribution of EQ-5D-5L profiles; to compare the distributions of EQ-5D-5L values arising from the English value set (EVS) and a 'mapped' value set (MVS); and to develop further the methods used to investigate clustering within EQ-5D data. METHODS: We obtained data from Cambridgeshire Community Services NHS Trust containing EQ-5D-5L profiles before treatment for three patient groups: community rehabilitation (N=6919); musculoskeletal physiotherapy (N=19999); and specialist nursing services (N=3366). Values were calculated using the EVS and MVS. Clusters were examined using the k-means method and Calinski-Harabasz pseudo-F index stopping rule. RESULTS: We found no evidence for clustering of EQ-5D-5L values arising from the classification system and no strong or consistent evidence of clustering arising from the EVS. There was clearer evidence of clustering using the MVS, with two being the optimal number of clusters. The clusters that were found for the EVS were very different from the MVS clusters. CONCLUSIONS: Unlike the EQ-5D-3L, clustering of EQ-5D-5L values does not seem to be driven by clustering of its profile. This suggests the EQ-5D-5L is superior in that it is less likely to generate artefactual clusters - however, clusters may still result from using value sets such as MVS that have the tendency to generate them.


Assuntos
Serviços de Saúde Comunitária/normas , Doenças Musculoesqueléticas/reabilitação , Enfermeiras Clínicas/normas , Modalidades de Fisioterapia/normas , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Enfermeiras Clínicas/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
14.
Pediatr Phys Ther ; 31(2): 200-207, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30865142

RESUMO

PURPOSE: To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center. DESIGN: This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013. METHODS: The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure. RESULTS: Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test. CONCLUSIONS: This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.


Assuntos
Dor Crônica/fisiopatologia , Avaliação da Deficiência , Extremidade Inferior/fisiopatologia , Modalidades de Fisioterapia/normas , Adolescente , Canadá , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pediatria , Estudos Retrospectivos
15.
BMC Geriatr ; 19(1): 20, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674278

RESUMO

BACKGROUND: Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. METHODS: A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist. The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories. As appropriate, the intraclass correlation coefficient (ICC), Cohen's kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated. RESULTS: Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests. ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test). CONCLUSIONS: The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00005591 ). Registered 2 February 2015.


Assuntos
Disfunção Cognitiva/diagnóstico , Serviços de Saúde para Idosos/normas , Limitação da Mobilidade , Velocidade de Caminhada/fisiologia , Caminhada/fisiologia , Caminhada/normas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/psicologia , Estudos Transversais , Feminino , Serviços de Saúde para Idosos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/normas , Admissão do Paciente/tendências , Modalidades de Fisioterapia/normas , Modalidades de Fisioterapia/tendências , Equilíbrio Postural/fisiologia , Reprodutibilidade dos Testes
16.
Physiother Res Int ; 24(2): e1769, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30657232

RESUMO

OBJECTIVE: The purpose of this study was to determine the interrater reliability and measurement error of the standardized Timed Up and Go (TUG) Test manual using the fastest of the three timed TUG trials in hospitalized and community-dwelling older individuals. METHODS: Thirty participants (19 from a hospital and 11 from an outpatient geriatric centre: 20 women, 10 men), 65 years or older, all of whom had been referred to physiotherapy due to a functional decline, were included. All participants performed the TUG Test across two sessions (three trials in each) on the same day, separated by a minimum of 30 min. The two raters were blinded to each other's ratings until the end of the study, and the rater order was randomized. RESULTS: Participants from the outpatient centre had a higher prereferral functional level when evaluated with the New Mobility Score and performed the TUG Test significantly faster than the hospital group. Accordingly, reliability estimates are reported for each specific group. Interrater reliability was excellent for both groups (intraclass correlation coefficient2.1  ≥ 0.93), and no systematic between-rater difference for obtained TUG times was found. The measurement error was acceptable both at the group (standard error of measurement [SEM] = 1.7 s and SEM% = 8 [hospital] vs. 0.7 s and 6 [outpatient]) and the individual (minimal detectable change [MDC95 ] = 4.6 s and MDC95 % = 23 [hospital] vs. 1.8 s and 17 [outpatient]) level. CONCLUSION: Findings suggest that using the fastest of the three TUG trials is highly reliable between raters and with acceptable measurement error. We, therefore, suggest that the standardized TUG manual with the fastest of the three timed trials be used for the assessment of functional mobility in hospitalized and community-dwelling older individuals.


Assuntos
Avaliação Geriátrica/estatística & dados numéricos , Modalidades de Fisioterapia/normas , Equilíbrio Postural , Análise e Desempenho de Tarefas , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Distribuição Aleatória , Reprodutibilidade dos Testes , Estudos de Tempo e Movimento
17.
Physiother Theory Pract ; 35(1): 94-99, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29393715

RESUMO

Reliable methods of measuring turnout in dancers and comparing active turnout (used in class) with functional (uncompensated) turnout are needed. Authors have suggested measurement techniques but there is no clinically useful, easily reproducible technique with established inter-rater and intra-rater reliability. We adapted a technique based on previous research, which is easily reproducible. We hypothesized excellent inter-rater and intra-rater reliability between experienced physical therapists (PTs) and a briefly trained faculty member from a university's department of dance. Thirty-two participants were recruited from the same dance department. Dancers' active and functional turnout was measured by each rater. We found that our technique for measuring active and functional turnout has excellent inter-rater and intra-rater reliability when performed by two experienced PTs and by one briefly trained university-level dance faculty member. For active turnout, inter-rater reliability was 0.78 among all raters and 0.82 among only the PT raters; intra-rater reliability was 0.82 among all raters and 0.85 among only the PT raters. For functional turnout, inter-rater reliability was 0.86 among all raters and 0.88 among only the PT raters; intra-rater reliability was 0.87 among all raters and 0.88 among only the PT raters. The measurement technique described provides a standardized protocol with excellent inter-rater and intra-rater reliability when performed by experienced PTs or by a briefly trained university-level dance faculty member.


Assuntos
Dança/fisiologia , Modalidades de Fisioterapia/normas , Adolescente , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Adulto Jovem
18.
Intensive Care Med ; 45(1): 1-12, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30506354

RESUMO

PURPOSE: To evaluate the effect of non-pharmacological interventions versus standard care on incidence and duration of delirium in critically ill patients. METHODS: We searched electronic and grey literature for randomised clinical trials up to March 2018. Two reviewers independently screened, selected and extracted data. Meta-analysis was undertaken using random effects modelling. RESULTS: We identified 15 trials (2812 participants). Eleven trials reported incidence of delirium. Pooled data from four trials of bright light therapy showed no significant effect between groups (n = 829 participants, RR 0.45, 99% CI 0.10-2.13, P = 0.19, very low quality evidence). Seven trials of various individual interventions also failed to report any significant effects. A total of eight trials reported duration of delirium. Pooled data from two trials of multicomponent physical therapy showed no significant effect [n = 404 participants, MD (days) - 0.65, 99% CI - 2.73 to 1.44, P = 0.42, low quality of evidence]. Four trials of various individual interventions also reported no significant effects. A trial of family voice reorientation showed a beneficial effect [n = 30, MD (days) - 1.30, 99% CI - 2.41 to - 0.19, P = 0.003, very low quality evidence]. CONCLUSIONS: Current evidence does not support the use of non-pharmacological interventions in reducing incidence and duration of delirium in critically ill patients. Future research should consider well-designed and well-described multicomponent interventions and include adequately defined outcome measures.


Assuntos
Delírio/terapia , Estado Terminal/epidemiologia , Estado Terminal/psicologia , Estado Terminal/terapia , Delírio/epidemiologia , Delírio/psicologia , Humanos , Incidência , Modalidades de Fisioterapia/psicologia , Modalidades de Fisioterapia/normas
19.
Curr Opin Anaesthesiol ; 32(1): 23-28, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30531607

RESUMO

PURPOSE OF REVIEW: Lung resection provides the best outcome for patients with early stage lung cancer. However, lung cancer surgery carries a significant risk of perioperative complications. Patient risk may be reduced by addressing modifiable risk factors in the preoperative period. We review how this can be achieved through preoperative rehabilitation pathways. RECENT FINDINGS: Cardiorespiratory fitness is an independent predictor of survival for nonsmall cell cancer. Preoperative exercise programmes may improve cardiorespiratory reserve and reduce perioperative complications. Additional benefits may be achieved through interventions such as smoking cessation programmes, correction of anaemia, improvement of nutritional status and improved oral hygiene. These interventions may also have the additional benefit of enabling high-risk patients previously deemed unsuitable for surgery to be optimized to such a degree that they can undergo surgery. These interventions will achieve maximal benefit when delivered early in lung cancer pathways; this requires close collaboration amongst multidisciplinary teams. SUMMARY: Lung cancer surgery carries significant risk of postoperative pulmonary complications. Through integrating prehabilitation interventions into lung cancer pathways, there are opportunities to improve long-term outcomes for patients.


Assuntos
Neoplasias Pulmonares/reabilitação , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Aptidão Cardiorrespiratória/fisiologia , Terapia Combinada/métodos , Terapia Combinada/normas , Procedimentos Clínicos/normas , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Equipe de Assistência ao Paciente/normas , Modalidades de Fisioterapia/normas , Pneumonectomia/métodos , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Fatores de Risco
20.
Physiother Res Int ; 24(1): e1745, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30225966

RESUMO

OBJECTIVE: The aim of the study was to determine if evidence-based physiotherapy (EBP) was being applied in the public physiotherapy and physical rehabilitation departments in Ecuador, Zone 3. METHODS: A cross-sectional study was developed applying the "Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists" questionnaire, designed by Jette et al. and validated in Spanish by Guerra et al. to 67 physiotherapists working in the public service in the provinces of Chimborazo, Cotopaxi, Pastaza, and Tungurahua. RESULTS: Of the physiotherapists, 65.67% fully agree in being necessary to implement EBP in their clinical setting; however, 44.78% identified EBP as highly time demanding. Insufficient time (95.52%), lack of information resources (53.73%), and absence of support among co-workers (50.75%) were reported as the main barriers that prevent physiotherapists from practicing EBP. CONCLUSIONS: Physiotherapists showed a positive attitude and interest towards EBP, although there is unawareness on how to accomplish EBP on daily basis in addition to little specific training during preprofessional studies in relation to scientific research.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Fisioterapeutas/normas , Modalidades de Fisioterapia/normas , Estudos Transversais , Equador , Feminino , Humanos , Masculino , Fisioterapeutas/educação , Fisioterapia/normas , Saúde Pública , Inquéritos e Questionários
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