Category: Research

Those of you interested in the history of the profession may find this recent (2005) article by Beth Linker from UPenn’s History and Sociology of Science Department to be of interest. It explores the development of post–World War I allied medical professions in the United States, and more specifically the rise of physiotherapy as it was used to rehabilitate maimed soldiers.

I only wish that more research could be done in our Canadian context about the history of the profession in this country!

To read the full PDF version of the article, please click here. Many thanks to Beth Linker for sharing the full text!

This article, published in the recent issue of Physiotherapy Research – 2006 Mar;11(1):35-47, says that “Owing to a scarcity of clinical research, evidence-based clinical guidelines are not available to guide physiotherapy rehabilitation after total knee replacement surgery. This is despite the fact that, annually, over 20 000 patients in Australia, over 300 000 patients in North America and 36 000 patients in the UK potentially require rehabilitation at this time to regain functional independence and to resume recreational and work-related physical activities”

The authors conducted a nationwide postal survey involving public and privately funded hospital physiotherapy departments survey of clinicians aimed to describe standard (usual) care after total knee replacement in Australia and to provide possible explanations for practice variance, if such variation exists.

A response rate of 65% (65/100) was obtained – an excellent result! Elements of consistency and diversity across the acute and post-acute phases were evident. Consistent findings included the provision of gait retraining and exercise prescription in the acute period, the requirement for independent ambulation as a criterion for discharge from acute care and the routine referral to ongoing outpatient or community-based physiotherapy. Less consistency was reported for the use of continuous passive motion and cryotherapy in the acute phase, the modes of ongoing rehabilitation, discharge from rehabilitation criteria and the tools for measuring outcomes. Both institutional and non-institutional factors appeared to explain the demonstrated practice variation.

The authors concluded that: “In order to propagate evidence-based practice guidelines and uniformity in care, well-designed clinical trials are required to identify cost-effective rehabilitation programmes after total knee replacement.”

Hospital for Special Surgery’s (New York) Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician textbook was formally launched at the American Physical Therapy Association annual conference on Saturday, June 24, 2006, in Orlando.

The item’s description says that: “Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician is the first book of its kind to cover all aspects of evidence-based postsurgical rehabilitation for musculoskeletal disease. The book features easy-to-follow guidelines developed at Hospital for Special Surgery that enable practitioners and students to look up a procedure and quickly see the recommended rehabilitation strategy.”

Incorporating 45 comprehensive guidelines, it is the first textbook of its kind to cover all aspects of evidence-based postsurgical rehabilitation for musculoskeletal disease.

A DVD accompanies the book, featuring more than 60 minutes of rehabilitative demonstrations and instructions. It shows patients receiving treatments for cerebral palsy, sports injuries, pediatric procedures and hand injuries.

To view table-of-contents and an excerpt of Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician, please visit http://www.hss.edu/professionals/specialties/rehabilitation/postsurgical-guidelines/

This text (ISBN – 0323032001) is available to purchase from Elsevier (major health sciences publisher) here .

I will ask UBC Library to purchase this text as well 🙂

This recent article by Janette W. Powell and Peter A. Huijbregts (PABC member from Victoria), published in the last issue of the Journal of Manual & Manipulative Therapy Vol. 14 No. 2 (2006), E19 – E29 , systematically reviews the available research on concurrent criterionrelated validity of physical examination tests for the diagnosis of acromioclavicular joint (ACJ) dysfunction.

The authors say that : “The currently available best research evidence supports the inclusion of a number of tests with a specific interpretation in a physical examination format for the diagnosis of painful ACJ dysfunction.

A negative finding on the cross-body adduction test, tenderness on palpation of the ACJ, and the Paxinos sign may serve to rule out a painful ACJ dysfunction. A positive finding on the active compression test, the cross-body adduction test, and the acromioclavicular resisted extension test may serve to rule in a painful ACJ dysfunction. A positive finding on all three tests for the cross-body adduction, active compression, and resisted acromioclavicular extension may be relevant when the physical therapist is considering a medical-surgical referral and associated higher-risk interventions.

This review indicates that future research is required 1) to evaluate the diagnostic utility of the gold standard tests used in the studies retrieved; 2) to examine the reliability and concurrent criterion-related validity (with validated gold standard tests) of these and other physical tests and history items commonly used in the diagnosis of ACJ lesions, both isolated and in the form of multi-test regimens; and 3) to study predictive validity of findings on tests and multi-test regimens for ACJ dysfunction coupled to outcomes with diagnosis-specific (orthopedic manual) physical therapy, medical, and surgical interventions. “

BTW, Journal of Manual & Manipulative Therapy, an international peer-reviewed journal, working in the field of manual therapy, clinical research, therapeutic practice, and academic training, has recently started making some of its content available for free on their website – very wise step, I believe!

Read full-text of this article in PDF format here

Those of you interested in the history of the profession might be interested in this article by Beth Linker from the Program in the History of Medicine and Science, Yale University, recently published in Journal of the History of Medicine and Allied Sciences 2005 60(3):320-354.

The author discusses the American Physiotherapy Association (APA, now APTA) and its 1935 “Code of Ethics and Discipline,” and demonstrates how through their Code, APA therapists engaged in a dynamic dialogue with physicians of the American Medical Association (AMA) in the name of professional survival.

She concludes that, contrary to historians and philosophers who contend that professional women have historically operated under a gender-specific ethic of care, the physiotherapists avoided rhetoric construed as feminine and instead created a “business-like” creed in which they spoke solely about their relationship with physicians and remained silent on the matter of patient care.

The free full-text of this article in PDF format might be accessed here

In a recent study J. Moffett and S. McLean from the Institute of Rehabilitation, University of Hull, published in the latest Rheumatology 2006 45(4):371-378, provide an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews.

A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits.

Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy.

Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored.

Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.

To read the full text of the article in PDF format, click here

Let’s talk this time about some qualitative research. In this interesting study, published in BMC Med Educ. 2005; 5: 3, researchers wanted to describe the reflections of physiotherapy students from a Middle East culture during their clinical placements and to compare them to reflections of physiotherapy students from a Western culture.

Researchers asked 21 students in the baccalaureate physiotherapy program at a university in the United Arab Emirates (UAE) to write weekly entries in a journal while in their clinical placements. Students described events, their reaction to them, and how it might affect their future behavior. The themes collected were then compared to those derived from a similar study of Canadian physiotherapy students.

The study found that physiotherapy students from a Middle East culture consider many of the same issues as students from a Western culture when asked to reflect on their clinical experience. They reflect on their personal growth, on how they learn in a clinical setting, and on the ethical and professional behaviors of themselves and others.

Issues, such as Awareness of learning, Professional behaviors, Self-development and orientation shift, and Ethics are discussed. Interesting stuff!

Here is the free full text of the article click – http://tinyurl.com/ncl5h . Here is the free PDF version – http://tinyurl.com/l8e7s .