Effectiveness of physiotherapy rehabilitation approaches for Parkinson's disease: A Durrës case study.

BACKGROUND AND PURPOSE: The article's significance lies in the substantial rise in the risk of developing Parkinson's disease (PD), necessitating the exploration of various approaches to rehabilitation and medical treatment. The purpose of the article is to detect the direct effect of physiotherapy for patients with PD and to identify how it helps in slowing down cardio-pulmonary failure, improving the posture, balance, bradykinesia and tremor. METHODS: The research utilised clinical data from 407 PD patients aged 30-100 years at the Central Polyclinic of Durrës, spanning 2011-2022, and included a systematic literature review and statistical analysis comparing physiotherapy outcomes with European Union standards. RESULTS: The research demonstrates the efficiency of physiotherapy in the short and long term in the treatment of PD for patients and medical personnel. All information can be used to increase the functional abilities of patients and minimise complications after physiotherapy and to estimate the effectiveness of different exercises in delaying PD. Older adults, particularly those aged 71-80, are most affected by PD, with males more likely to be diagnosed. Physiotherapy rehabilitation improves motor symptoms, posture, and balance in 30-80-year-olds, but its effectiveness declines with age. Advanced rehabilitation methods in Italy lead to better outcomes, suggesting the potential for improvement in Durres disease. CONCLUSIONS: The study emphasises the need for improved rehabilitation strategies for older patients by recommending tailored programs, advanced methods, standardisation, training, and long-term monitoring. Further research should concentrate on the long-term sustainability of physiotherapy benefits, the development of targeted interventions for older patients, and the integration of innovative therapeutic approaches.

The impact of the pandemic on physical and functional disabilities in children and adolescents with spina bifida.

STUDY DESIGN: Retrospective and cross-sectional study. OBJECTIVES: The study aimed to carry out telemonitoring to identify the impact of the pandemic on physical and functional disabilities in children and adolescents with SB, as reported by their caregivers, and to investigate adherence to a teleservice. SETTING: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). METHODS: Retrospective and cross-sectional study. Fifty-three patients with SB (mean age 12.0 (4.0) years; 23 males) participated in the telemonitoring. A questionnaire - 'Health management, health conditions, rehabilitation, interest in teleservice, and the well-being of the main caregiver' - investigated the clinical impact of the coronavirus pandemic. Only three caregivers participated in the teleservice (video call). RESULTS: According to telemonitoring, 62% of the patients discontinued physiotherapy sessions, and 69% reported needing adjustments in locomotion devices. The main complaints were muscle weakness and pain. CONCLUSION: We monitored general health and identified demands related to physical rehabilitation using telemonitoring in 42.4% of children and adolescents with SB monitored at the HCFMRP-USP. Telemonitoring and teleservice may be methods used for monitoring health conditions in patients with SB.

Trans-spinal magnetic stimulation combined with kinesiotherapy as a new method for enhancing functional recovery in patients with spinal cord injury due to neuromyelitis optica: a case report.

BACKGROUND: Experimental studies have shown that repetitive trans-spinal magnetic stimulation (TsMS) decreases demyelination and enables recovery after spinal cord injury (SCI). However, the usefulness of TsMS in humans with SCI remains unclear. Therefore, the main objective of this study is to evaluate the effects of TsMS combined with kinesiotherapy on SCI symptoms. We describe a protocol treatment with TsMS and kinesiotherapy in a patient with SCI due to neuromyelitis optica (NMO)-associated transverse myelitis. CASE PRESENTATION: A 23-year-old white male with NMO spectrum disorders started symptoms in 2014 and included lumbar pain evolving into a mild loss of strength and sensitivity in both lower limbs. Five months later, the symptoms improved spontaneously, and there were no sensorimotor deficits. Two years later, in 2016, the symptoms recurred with a total loss of strength and sensitivity in both lower limbs. Initially, physiotherapy was provided in 15 sessions with goals of motor-sensory recovery and improving balance and functional mobility. Subsequently, TsMS (10 Hz, 600 pulses, 20-seconds inter-trains interval, at 90% of resting motor threshold of the paravertebral muscle) was applied at the 10th thoracic vertebral spinous process before physiotherapy in 12 sessions. Outcomes were assessed at three time points: prior to physiotherapy alone (T-1), before the first session of TsMS combined with kinesiotherapy (T0), and after 12 sessions of TsMS combined with kinesiotherapy (T1). The patient showed a 25% improvement in walking independence, a 125% improvement in balance, and an 18.8% improvement in functional mobility. The Patient Global Impression of Change Scale assessed the patient's global impression of change as 'much improved'. CONCLUSION: TsMS combined with kinesiotherapy may safely and effectively improve balance, walking independence, and functional mobility of patients with SCI due to NMO-associated transverse myelitis.

Development of air therapy as a novel therapeutic branch in the field of rehabilitation.

BACKGROUND AND PURPOSE: Developing technology in the field of rehabilitation is vital to accelerate recovery and decrease the side effects of current modalities. Rehabilitation is a challenging science in which the main challenge is not just treating the patient but also to shorten the rehabilitation time and avoid harmful effects. Thus, this review demonstrates the possible design and effects of air therapy as a novel treatment branch besides hydrotherapy, electrotherapy, and manual therapy in the field of rehabilitation. METHODS: The search was conducted over clinical trials, literature reviews, and systematic reviews on the possible effects of treatments that may have similar effects to the newly developed air therapy. This search was conducted in the Web of Science, Scopus, EBSCO, and Medline databases. RESULTS: Air therapy could be used to improve the function of mechanoreceptors, improve circulation and microcirculation, decrease pain, the release of trigger points, regain the elasticity of soft tissues, treat acute and chronic inflammations, decrease muscle cramps and spasticity, strengthen muscle, and decrease muscle fatigue and Decreasing muscle fatigue and delayed muscle soreness. CONCLUSION: Air therapy is a novel treatment modality that can be used effectively in the field of rehabilitation. Air therapy could be a valuable and safe treatment in rehabilitation.

[Evaluation of efficacy of denture occlusal plate combined with comprehensive physical therapy for temporomandibular joint disc displacement without reduction].

PURPOSE: To explore the efficacy of denture occlusal plate combined with comprehensive physical therapy for temporomandibular joint disc displacement without reduction(ADDwoR). METHODS: Sixty patients of ADDwoR and dentition defect or severely worn teeth who visited the Department of Orthodontics and Prosthodontics of Hengshui People's Hospital from January 2019 to December 2020 were selected and randomly divided into denture occlusal plate group (group A) and denture occlusal plate + comprehensive physical therapy group (group B) according to the treatment methods. Maximum mouth opening (MMO) and visual analog pain score(VAS) among all patients were recorded before treatment and every three weeks during three months of treatment. Cone-beam CT(CBCT) was taken before and 3 months after treatment. The changes in clinical efficacy indicators before and after treatment and CBCT data between the two groups were analyzed. Statistical analysis was performed with SPSS 26.0 software package. RESULTS: The differences of VAS of group A and B were statistically significant from before treatment to three weeks after treatment(P＜0.05), and group B decreases more. From 3 weeks after treatment, there was a significant difference of group B for MMO and VAS before treatment (P＜0.05). From 9 weeks after treatment, there was a significant difference of group A for MMO before treatment (P＜0.05), but there was no significant difference in MMO and VAS between group A and B(P＞0.05). CBCT showed narrowed anterior joint space, widened posterior joint space, enlarged superior joint space, decreased horizontal angle of the condyle and increased slope of joint nodules (P＜0.05). The difference between joint depth, anteroposterior diameter of the condyle, internal and external diameter was not significant (P＞0.05). There was significant differences in anterior, superior, and posterior joint space, condylar level angle, and slope of joint nodules of group B compared with group A(P＜0.05). CONCLUSIONS: Denture occlusal plate can effectively improve symptoms of ADDwoR, and denture occlusal plate combined with comprehensive physical therapy can quickly improve mouth opening and reduce pain in the joint area.

Parents' satisfaction with physiotherapy services for neuropediatric outpatients in government and private hospitals in the United Arab Emirates: a cross-sectional study.

Background: Healthcare, like other industries, emphasizes performance, quality, and consumer experience while also attempting to reduce costs. However, high-quality healthcare remains paramount for vulnerable and ill patients. This study aimed to investigate parents' and caregivers' level of satisfaction with physiotherapy services provided to neuropediatric outpatients on the United Arab Emirates (UAE). Methods: This descriptive cross-sectional study included 103 parents/caregivers of children with neurological disabilities that were randomly selected from different Emirates Health Services Hospitals in the UAE. Data was collected using the long-form Patient Satisfaction Questionnaire (PSQ-III). Results: The overall mean satisfaction was 159±7.73 (out of 250 points). Communication (20.36/25), interpersonal factors (20.17/35), and doctor-patient time (20.17/35) had the highest mean satisfaction scores (8.06/10). The lowest mean satisfaction scores were for access/availability/convenience (34.60/60), technical quality (33.17/50), and economic elements (23.83/40). Conclusion: Despite participants' overall satisfaction scores being positive, some service domains require improvement to improve satisfaction, specifically the access/availability/convenience, technical quality, and economic elements. These areas should be prioritized by service providers and managers to improve patients' experiences and clinical outcomes.

Effectiveness of a physiotherapy self-management programme for adult patients with chronic non-specific low back pain in low- and middle-income countries: protocol for a systematic review and meta-analysis.

INTRODUCTION: Chronic non-specific low back pain (CNLBP) is among the most common musculoskeletal system conditions reported worldwide; however, few studies are available from low- and middle-income countries (LMICs). Self-management is a set of tasks performed by the patient aiming at managing their symptoms and interference in activities, mood and relationships due to pain. A physiotherapy-guided self-management programme (SMP) following a biopsychosocial approach has been reported as effective and affordable in the management of CNLBP in high-income countries. The objective of this systematic review is to determine the overall effectiveness of SMPs for adults with CNLBP in LMICs. METHODS AND ANALYSIS: In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocol (PRISMA-P) guidelines will be followed. A three-step search strategy will be used to search the electronic databases (PubMed, MEDLINE, SPORTDiscus, Scopus and CINAHL, Academic Search Complete and PEDro) for randomised controlled trials assessing the effectiveness of physiotherapy-guided self-management for CNLBP among adult participants in LMICs. The processes of screening search results for eligible studies, extracting data from included studies and appraising will be done independently by at least two review authors. Random effects meta-analysis will be used to synthesise results and heterogeneity will be assessed using the I2 test statistic and χ2 test. ETHICS AND DISSEMINATION: Ethics clearance was obtained for the broader PhD study on the development of a physiotherapy-guided SMP for adult people with CNLBP in Limpopo Province, South Africa. The results of the manuscript for this protocol will be published in peer-reviewed journals and also presented at conferences, symposia, and congresses. PROSPERO REGISTRATION NUMBER: CRD42023399572.

The effectiveness of physical therapy in the rehabilitation of patients after arthroscopy of the knee joint.

OBJECTIVE: Aim: To determine the effectiveness of physical therapy on the functional state of law enforcement officers' knee joints after surgical intervention. PATIENTS AND METHODS: Materials and Methods: The research involved law enforcement officers from different units of the National Police of Ukraine (n = 56) who had suffered knee joint injuries in the line of duty, and underwent surgical intervention and rehabilitation procedures. RESULTS: Results: It was found that 78.2 % of respondents had suffered knee joint ligament injuries as a result of falls during rapid movement, while 43.9 % were in full gear (armored protection, helmet, etc.). It was determined that after surgical intervention, the functional state of the knee joint of law enforcement officers who followed the recommendations of physical therapy specialists and systematically performed special sets of physical exercises was significantly different (p < 0.001). Worse results were noted in people who partially followed the recommendations of rehabilitation therapists and performed part of the prescribed procedures and physical exercises. CONCLUSION: Conclusions: The effectiveness of the complex use of physical rehabilitation means for restoring the functioning of the knee joint after surgical intervention, which included arthroscopy, partial menisectomy of the damaged areas, debridement, vaporization of damaged cartilage, etc. was revealed. The positive effect of physical exercises on the functional state of the knee joint was proven. The sets of exercises that are advisable to use to restore the functioning of the knee joint were determined.

The effects of single education session on physiotherapy students' knowledge levels and thoughts on accreditation.

BACKGROUND: and Purpose: In the global landscape, quality assurance is paramount for educational institutions to adapt and thrive. The accreditation process involves evaluating an institution's quality according to standards established by experts and officially documenting its level of quality. This study aimed to assess the impact of a single educational session on physiotherapy and rehabilitation students' awareness and understanding of accreditation processes, recognizing their vital role in quality assurance. METHODS: A pretest-posttest design was employed with 211 students from a physiotherapy and rehabilitation department. Data were collected using a questionnaire assessing demographic information, knowledge about accreditation, and thoughts regarding accreditation. The educational session focused on accreditation criteria and processes, involving presentations and interactive discussions. McNemar's analysis was used to compare the response rates given by the students pre-and post-session. RESULTS: Analysis after the education session revealed a significant increase in students' knowledge of accreditation concepts (p < 0.05). Positive attitudes towards accreditation were reinforced, with students recognizing its importance in education quality. Despite pre-existing positive attitudes, the educational intervention enhanced students' understanding and engagement in accreditation processes with a significant increase in three of the eight questions on thoughts about accreditation (p < 0.05). DISCUSSION: This study underscores the efficacy of educational interventions in fostering student engagement and awareness of accreditation. Findings suggest the need for integrating accreditation education into curricula and advocating its significance through seminars and literature support, ultimately enhancing student participation in quality assurance processes.

Pediatric rehabilitation delivery: discussion is an antidote to disconnection and discontent.

Pediatric rehabilitation is fundamentally different from that of adults. Child physiology differs significantly from that of adults, necessitating specialized rehabilitation approaches. Unique injuries and varying metabolic rates underscore the need for tailored care, which changes over the years as the child grows and develops. Waiserberg's paper, "When Everyone is Responsible, No One Takes Responsibility": Exploring Pediatric Physiotherapy Services in Israel," sheds light on a critical issue. While senior practitioners oversee policy implementation and service delivery, practical physiotherapy treatment lacks continuous monitoring. This is a critical issue. Ideally, every child who requires long-term clinical therapeutic interventions to keep up with peers in mobility, communication and cognitive skills should be assessed by specialists several times throughout the school years, and their personalized rehabilitation plan discussed, reviewed, and adjusted according to their progress. The absence of a standardized protocol for overseeing and directing comprehensive rehabilitation plans leaves therapists feeling alone and adrift, whether working in schools or medical settings. Such an assessment would be an opportunity to create a registry, which is currently nonexistent. The collected data would be a priceless resource in policy decision-making and service planning.

EFisioTrack System for Monitoring Therapeutic Exercises in Patients with Shoulder Orthopedic Injuries in a Hospital Setting: A Pilot Feasibility Study.

To assess the effects of the eFisioTrack monitoring system on clinical variables in patients with prescribed physiotherapy for shoulder injuries, twenty-four adult patients with shoulder orthopaedic injuries who underwent physical therapy treatment in a hospital setting participated in the study (twelve in the experimental group and twelve as controls). Clinical outcome measures were shoulder function and pain (Constant-Murley Score and Disabilities of the Arm, Shoulder, and Hand or DASH score). Each variable was measured by a blinded physiotherapist at baseline and at one month follow-up. Patients performed the prescribed exercises either supervised by the physiotherapist (control group) or in a separate room without therapist supervision (experimental group). There were no statistically significant differences between groups before treatment or at follow-up for any outcomes (p ≥ 0.05). There was a statistically significant decrease (p ≤ 0.05) of at least 10 points in both groups for the DASH score at follow-up. Differences in the total score and subjective components of the Constant-Murley were also evidenced within groups. The use of the eFisioTrack system showed similar results in clinical measures compared to those performed under the direct supervision of the physiotherapist. This approach might be suitable for providing an effective shoulder exercise program at home.

Physical therapy enhances physical and functional abilities in a female patient with gliomatosis cerebri.

Gliomatosis cerebri is a low incidence diffuse glial tumor that affects three or more brain lobes. The survival rate is < 5 years in 20% of the patients. Although chemotherapy seems to improve life expectancy, to date no interventions have been described that help improve the quality of life of these patients. The aim of this study was to assess if physical therapy may contribute to do this. We present the case of a female patient with gliomatosis cerebri of nine years of evolution showing dependence on technical supports and supervision during walking, reduced speed and balance, tremor and dystonia in lower limbs. The patient underwent physiotherapy treatment: trunk control exercises, limb strength, and gait ability. Improvement in functionality was observed. Further studies with a larger sample size are needed to confirm these results .

Operationalisation of health equity principles in physiotherapy hospital triage policies.

BACKGROUND: Healthcare triage policies are vital for allocating limited resources fairly and equitably. Despite extensive studies of healthcare equity, consensus on the applied definition of equity in triage remains elusive. This study aimed to investigate how the principles of equity are operationalised in Australian hospital physiotherapy triage tools to guide resource distribution. METHODS: A retrospective, qualitative content analysis of 13 triage policies from 10 hospitals across Australia was conducted. Triage policies from both inpatient and outpatient settings were sourced. Data were coded deductively using the five discrete domains of the multi-faceted operational definition of health equity posited by Lane et al. (2017): 1) point of equalisation in the health service supply/access/outcome chain, 2) need or potential to benefit, 3) groupings of equalisation, 4) caveats to equalisation, 5) close enough is good enough. Descriptive summative statistics were used to analyse and present the frequency of reported equity domains. RESULTS: Within the included triage tools, four out of five domains of equity were evident in the included documents to guide decision making. Allocation based on perceived patient need and overall health outcomes were the central guiding principles across both inpatient and outpatient settings. Equal provision of service relative to patient need and reducing wait times were also prioritised. However, explicit inclusion of certain equity domains such as discrimination, ensuring equal capability to be healthy and other patient factors was limited. CONCLUSIONS: Physiotherapy triage policies consider various domains of equity to guide resource allocation decisions. Policymakers and service providers can use the insights gained from this study to review the application and operationalisation of equity principles within their healthcare systems through mechanisms such as patient triage tools.

Recurrent patellar dislocation: personalised therapy or operative treatment? The REPPORT randomised trial protocol.

INTRODUCTION: Recurrent patellar dislocation is a debilitating musculoskeletal condition, affecting mainly adolescents and adults under the age of 30. It can persist for many decades, causing pain and cartilage and soft-tissue damage, potentially leading to osteoarthritis. Recurrent patellar dislocation can be managed with physiotherapy or surgery. However, it is not known which treatment is most effective. METHODS AND ANALYSIS: Recurrent Patellar Dislocation: Personalised Therapy or Operative Treatment (REPPORT) is a pragmatic, multicentre, two-arm, superiority, randomised controlled trial. It will compare the clinical and cost-effectiveness of an initial management strategy of personalised, phased and progressive rehabilitation, termed personalised knee therapy versus surgery for recurrent patellar dislocation.The trial's target sample size is 276 participants who will be recruited from approximately 20 sites across the UK. Participants will be randomly allocated to the two treatment groups via a central computer-based minimisation system. Treatment allocation will be in a 1:1 ratio, stratified by age, presence of patella alta and recruitment site.The primary outcome is participant-reported function using the Knee injury and Osteoarthritis Outcome 4-domain score at 18 months post randomisation. Health economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data including patellar instability, health utility, work/education status, satisfaction with social roles and treatment, health resource use and adverse events will be collected at 6, 12, 18 and 24 months. Analysis will be on an intention-to-treat basis and reported in-line with the Consolidated Standards of Reporting Trials statement. ETHICS AND DISSEMINATION: The trial was approved by the East Midlands-Nottingham 2 Research Ethics Committee on 30 March 2023.Results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries, and using the REPPORT website and social media channels. TRIAL REGISTRATION NUMBER: ISRCTN17972668.

Effectiveness of digital Cognitive-Behavioural Therapy for Insomnia in patients with musculoskeletal complaints and insomnia in primary care physiotherapy: study protocol for a randomised controlled trial.

INTRODUCTION: Insomnia is prevalent among patients visiting physiotherapists due to musculoskeletal complaints and associated with poorer pain prognosis. Cognitive-Behavioural Therapy for Insomnia (CBT-I) may be effective for improving sleep quality and pain-related outcomes in these patients, but its availability and utility are limited in daily physiotherapy practice. The aim of this randomised controlled trial (RCT) is to evaluate the effectiveness of digital CBT-I in addition to usual treatment in patients with chronic musculoskeletal complaints and insomnia, compared with usual treatment only. METHODS AND ANALYSIS: In this RCT, eligible and consenting participants will be randomised (1:1 ratio) to one of two interventions: (1) digital CBT-I adjunct to physiotherapy treatment or (2) usual physiotherapy treatment. Patients with musculoskeletal complaints and insomnia visiting a physiotherapist in Norway will be invited to participate in the study. We aim to include 188 participants to detect a difference in the primary outcome. Outcome variables will be assessed at baseline (prior to randomisation) and at 6-week, 3-month, 6-month and 12-month follow-up. The primary outcome is between-group difference in insomnia severity, assessed with the Insomnia Severity Index (0-28 points) at 3 months. Secondary outcomes include between-group differences in pain intensity, physical function, work ability, health-related quality of life, mental distress, and self-reported use of sleep and pain medication. Exploratory analyses will identify patient characteristics influencing the effect of the digital intervention. ETHICS AND DISSEMINATION: This trial is approved by the Regional Committee for Medical and Health Research Ethics in Central Norway (Ref. 2023/533381). The results of the trial will be published in peer-review journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER: ISRCTN91221906.

Physiotherapy practices in the clinical assessment of lateral elbow tendinopathy: An international survey.

BACKGROUND AND PURPOSE: Understanding physiotherapy practices is important to identify variations from empirical evidence and highlight requirements for training. This survey explored international physiotherapy practices for assessment of lateral elbow tendinopathy (LET). METHODS: Two hundred ninety-nine surveyed physiotherapists from eight member countries of the International Federation of Manual and Orthopaedic Physical Therapists completed the survey. Respondents rated their frequency of use (never, rarely, sometimes, often, and always) for items related to: patient history; diagnostic tests; grip and upper limb strength; cervical and neurological assessment; and medical imaging. To establish practices, the five response categories were dichotomised into routine practice (often, always) and not-routine practice (sometimes, rarely, never). A response rate of ≥70% for each dichotomy was used to determine whether an assessment item was deemed routine practice or not, with items not meeting either criterion considered neither routine nor not-routine practice. RESULTS: Most respondents were from United States (63%). The 'chair pick up test', 'cervical special tests', and 'plain radiograph' met our criteria for not routine practice (i.e., 70%, 72%, and 71%, respectively). All other assessment items did not meet the criteria to be considered routine or not-routine practice. CONCLUSION: The chair pick-up test, cervical spine special tests (e.g., Spurling's test), and plain radiography appear to not be routinely used in the assessment of LET. The finding that no assessment technique met the criteria for routine use may imply that physiotherapists adopt a nuanced approach to selecting clinical assessment items as opposed to routinely applying tests.

Lumbar Spine and Neural Tissue Mobilizations Improve Outcomes in Runners Presenting With Foot/Ankle Pathology: A Case Series.

CONTEXT: Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. CASE PRESENTATIONS: Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. MANAGEMENT AND OUTCOMES: All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. CONCLUSIONS: This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures.

A functional intervention within a cognitive approach to chronic cervical radiculopathy : Description of the non-surgical treatment arm in a randomised controlled trial evaluating the effectiveness of surgery.

BACKGROUND: Most patients with cervical radiculopathy improve within the first months without treatment or with non-surgical treatment. A systematic review concluded that these patients improve, regardless of their intervention. Still, many patients are offered surgery, despite limited evidence regarding the indications for surgical treatments. The aim of this article is to describe the intervention that is going to be followed in the non-surgical treatment arm of a randomised controlled trial (RCT) comparing the effectiveness of surgical and non-surgical treatment for patients with cervical radiculopathy. METHODS: The non-surgical intervention is a functional intervention within a cognitive approach founded on previous experiences, and current recommendations for best practice care of musculoskeletal pain and cervical radiculopathy. It is based on the biopsychosocial rather than a biomedical perspective, comprises an interdisciplinary approach (physicians, physiotherapy specialists), and includes brief intervention and graded activities. The intervention consists of 6 sessions over 12 weeks. The primary goals are first, to validate the patients´ symptoms and build a therapeutic alliance, second, to explore the understanding and promote alternatives, and third, to explore problems and opportunities based on patients´ symptoms and function. Motivational factors toward self-management are challenging. We will attempt shared decision-making in planning progress for the individual patient and emphasise learning of practical self-help strategies and encouragement to stay active (reinforcing the positive natural course). General physical activities such as walking will be promoted along with simple functional exercises for the neck- and shoulder region. We will also explore social activity, comorbidities, pain location, sleep, and work-related factors. The health providers will set individualised goals together with each patient. DISCUSSION: The aim of the intervention is to describe a functional intervention within a cognitive approach for patients with chronic cervical radiculopathy. The effectiveness of the present program will be compared to surgery in a randomised controlled trial.