People with cystic fibrosis (CF) experience chronic airway infections as a result of mucus buildup within the lungs. Repeated infections often cause lung damage and disease. Airway clearance ...therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. This is an update of a previously published review.
To compare the clinical effectiveness of ACBT with other airway clearance therapies in CF.
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched clinical trials registries and the reference lists of relevant articles and reviews. Date of last search: 29 March 2021.
We included randomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing ACBT with other airway clearance therapies in CF.
Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study. We used GRADE to assess our confidence in the evidence assessing quality of life, participant preference, adverse events, forced expiratory volume in one second (FEV
) % predicted, forced vital capacity (FVC) % predicted, sputum weight, and number of pulmonary exacerbations.
Our search identified 99 studies, of which 22 (559 participants) met the inclusion criteria. Eight randomised controlled studies (259 participants) were included in the analysis; five were of cross-over design. The 14 remaining studies were cross-over studies with inadequate reports for complete assessment. The study size ranged from seven to 65 participants. The age of the participants ranged from six to 63 years (mean age 18.7 years). In 13 studies follow up lasted a single day. However, there were two long-term randomised controlled studies with follow up of one to three years. Most of the studies did not report on key quality items, and therefore, have an unclear risk of bias in terms of random sequence generation, allocation concealment, and outcome assessor blinding. Due to the nature of the intervention, none of the studies blinded participants or the personnel applying the interventions. However, most of the studies reported on all planned outcomes, had adequate follow up, assessed compliance, and used an intention-to-treat analysis. Included studies compared ACBT with autogenic drainage, airway oscillating devices (AOD), high-frequency chest compression devices, conventional chest physiotherapy (CCPT), positive expiratory pressure (PEP), and exercise. We found no difference in quality of life between ACBT and PEP mask therapy, AOD, other breathing techniques, or exercise (very low-certainty evidence). There was no difference in individual preference between ACBT and other breathing techniques (very low-certainty evidence). One study comparing ACBT with ACBT plus postural exercise reported no deaths and no adverse events (very low-certainty evidence). We found no differences in lung function (forced expiratory volume in one second (FEV
) % predicted and forced vital capacity (FVC) % predicted), oxygen saturation or expectorated sputum between ACBT and any other technique (very low-certainty evidence). There were no differences in the number of pulmonary exacerbations between people using ACBT and people using CCPT (low-certainty evidence) or ACBT with exercise (very low-certainty evidence), the only comparisons to report this outcome.
There is little evidence to support or reject the use of the ACBT over any other airway clearance therapy and ACBT is comparable with other therapies in outcomes such as participant preference, quality of life, exercise tolerance, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of ACBT on outcomes important for people with cystic fibrosis such as quality of life and preference.
The relevance of ecosystems to physiotherapy has traditionally been overlooked, despite its potential for health impacts relevant to conditions often managed by physiotherapists.
The purpose of this ...article is to introduce the concept of ecosystem services to physiotherapists, and to discuss how understanding ecosystem services may improve patient care, and population and planetary health.
Physiotherapists with an understanding of ecosystem services may improve patient care by value-adding to management through patient education, empathy, advocacy, and broader population health approaches. Physiotherapists are also well placed to promote the conservation and restoration of ecosystem through participation, advocacy, and the development of public health measures, to the benefit of global sustainability and population health. Further research is required into how physiotherapists currently use nature-based interventions, and the barriers and enablers to their use. To be adequately prepared to meet the challenges that climate change and environmental degradation pose to patient care, population health and health systems, both current and future physiotherapists need to take a broader view of their practice. By including consideration of the potential role of the environment and green space exposure in particular on their patient's health, physiotherapists can ultimately contribute more to population and planetary health.
Physical exercise training may form an important part of regular care for people with cystic fibrosis. This is an update of a previously published review.
To assess the effects of physical exercise ...training on exercise capacity by peak oxygen consumption, pulmonary function by forced expiratory volume in one second, health-related quality of life and further important patient-relevant outcomes in people with cystic fibrosis.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search: 04 May 2017.We searched ongoing trials registers (clinicaltrials.gov and the WHO ICTRP). Date of most recent search: 10 August 2017.
All randomised and quasi-randomised controlled clinical trials comparing exercise training of any type and a minimum duration of two weeks with conventional care (no training) in people with cystic fibrosis.
Two authors independently selected studies for inclusion, assessed methodological quality and extracted data. The quality of the evidence was assessed using the GRADE system.
Of the 83 studies identified, 15 studies which included 487 participants, met the inclusion criteria. The numbers in each study ranged from nine up to 72 participants; two studies were in adults, seven were in children and adolescents and six studies included all age ranges. Four studies of hospitalised participants lasted less than one month and 11 studies were outpatient-based, lasting between two months and three years. The studies included participants with a wide range of disease severity and employed differing levels of supervision with a mixture of types of training. There was also wide variation in the quality of the included studies.This systematic review shows very low- to low-quality evidence from both short- and long-term studies that in people with cystic fibrosis aerobic or anaerobic physical exercise training (or a combination of both) has a positive effect on aerobic exercise capacity, pulmonary function and health-related quality of life. No study reported on mortality; two studies reported on adverse events (moderate-quality evidence); one of each study reported on pulmonary exacerbations (low-quality evidence) and diabetic control (very low-quality evidence). Although improvements were not consistent between studies and ranged from no effects to clearly positive effects, the most consistent effects of the heterogeneous exercise training modalities and durations were found for maximal aerobic exercise capacity (in four out of seven studies) with unclear effects on forced expiratory volume in one second (in two out of 11 studies) and health-related quality of life (in two out of seven studies).
Evidence about the efficacy of physical exercise training in cystic fibrosis from 15 small studies with low to moderate methodological quality is limited. Exercise training is already part of regular outpatient care offered to most people with cystic fibrosis, and since there is some evidence for beneficial effects on aerobic fitness and no negative side effects exist, there is no reason to actively discourage this. The benefits from including physical exercise training in an individual's regular care may be influenced by the type and duration of the training programme. High-quality randomised controlled trials are needed to comprehensively assess the benefits of exercise programmes in people with cystic fibrosis and the relative benefits of the addition of aerobic versus anaerobic versus a combination of both types of physical exercise training to the care of people with cystic fibrosis.
In addition to patient care, physiotherapy is increasingly important in research at university hospitals. Genuine physiotherapy research plays a decisive role in this. This position statement ...describes the opportunities, benefits, framework conditions, challenges, and research priorities of genuine physiotherapy research at German university hospitals.
Gender matters in physiotherapy Stenberg, Gunilla; Fjellman-Wiklund, Anncristine; Strömbäck, Maria ...
Physiotherapy theory and practice,
11/2022, Letnik:
38, Številka:
13
Journal Article
Recenzirano
Odprti dostop
The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. ...In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
Rhizarthrosis is the second most common degenerative disease of the hand, associated with pain, function disability, and impaired quality of life. The literature describes various operative ...techniques for the treatment of rhizarthrosis, but the outcomes of the effectiveness of RegJoint™ implant are still scarce. Purpose: The aim of this study is to determine the effectiveness of using the RegJoint™ implant in the operative treatment of rhizarthrosis and the subsequent recovery. Material and methods: In the period 2019-2023, a total of 48 patients diagnosed with rhizarthrosis (46 women and 2 men) of average age 61.4 (±3.2) years went for treatment through the clinical bases of UМHAT "Kaneff" - Ruse and UMHAT "SOFIAMED"- Sofia. All of them were operated with the bioabsorbable implant - RegJoint™, after which the thumb was immobilized using a fixation splint for 6 weeks. Their average hospital stay was 3.2 (±1.3) days, after which they underwent rehabilitation procedures for 6 months. Results: Functional capacity was assessed using the DASH test, and thumb movements were tested using the Kapanji score three times - preoperatively and at the end of the 6th and 12th postoperative months. The results at the end of 6 months and 1 year period show a significant improvement in terms of pain, swelling and functional status of the operated hand. Conclusion: The combined surgical intervention for the treatment of rhizarthrosis with a RegJoint™ implant, combined with adequate and timely physiotherapy, ensures a high-quality, fast and painless functional restoration of the thumb and the overall function of the hand.
In order to effectively examine, test, and treat patients with exercise, physical therapists need to understand how physiology from the cellular to the systems level provides the basis for normal ...responses to exercise. But that is not enough.
The study aimed to explore new United Kingdom (UK) graduate physiotherapists' perceived preparedness for clinical practice to provide valuable information to support curriculum development.
An ...online, mixed method cross-sectional questionnaire was used. Newly qualified UK physiotherapists completed a survey, capturing how physiotherapy degrees prepared them for practice against (1) UK proficiency standards and (2) cross-discipline physiotherapy related clinical skills. Respondents were asked for reflections of their degree course including teaching and effectiveness. Data were converted into proportions with a 95% confidence interval. Likert-scale questions were treated as numeric variables with the mean and standard deviation (SD) calculated for combined responses. Thematic analysis reported patterns of data extracted from open-ended questions.
Of a total of 376 respondents, 365 were included in data analysis. Overall respondents perceived that courses prepared them 'well' against 12 of the 15 standards, on a Likert scale of 1-5. Respondents reported that perceived competence was 'indifferent' for manual therapy skills (mean 3.14 ± SD 1.13), red flag (3.45 ± 1.11) and clinical flag management (2.92 ± 1.16). Exercise prescription (2.42 ± 1.35), psychosocial skills (2.27 ± 1.23) and patient management (2.41 ± 1.12) were areas identified for further teaching focus. Placements were the preferred teaching method most applicable to practice followed by practical seminars.
Respondents felt sufficiently prepared for practice against UK proficiency standards but not physiotherapy related clinical skills. Areas for curricula development included exercise prescription, psychology and pain management.
Concussion is a common injury in sport. Most individuals recover in 7-10 days but some have persistent symptoms. The objective of this study was to determine if a combination of vestibular ...rehabilitation and cervical spine physiotherapy decreased the time until medical clearance in individuals with prolonged postconcussion symptoms.
This study was a randomised controlled trial. Consecutive patients with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion (12-30 years, 18 male and 13 female) were randomised to the control or intervention group. Both groups received weekly sessions with a physiotherapist for 8 weeks or until the time of medical clearance. Both groups received postural education, range of motion exercises and cognitive and physical rest until asymptomatic followed by a protocol of graded exertion. The intervention group also received cervical spine and vestibular rehabilitation. The primary outcome of interest was medical clearance to return to sport, which was evaluated by a study sport medicine physician who was blinded to the treatment group.
In the treatment group, 73% (11/15) of the participants were medically cleared within 8 weeks of initiation of treatment, compared with 7% (1/14) in the control group. Using an intention to treat analysis, individuals in the treatment group were 3.91 (95% CI 1.34 to 11.34) times more likely to be medically cleared by 8 weeks.
A combination of cervical and vestibular physiotherapy decreased time to medical clearance to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion.
NCT01860755.
Work-related burnout is a significant concern amongst healthcare professionals, including physiotherapists. It can negatively impact on both staff well-being and the quality of care delivered to ...patients.
To estimate the prevalence of burnout among physiotherapists.
PubMed, CINAHL, Web of Science, Embase, Scopus and PsycINFO, from inception to February 1st, 2022.
Studies reporting burnout prevalence among physiotherapists.
Prevalence of burnout. Sub-analyses were performed grouping studies based on countries where surveys were conducted, classified as developed or developing countries. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale.
32 studies were included in the systematic review and 31 in the meta-analysis, enrolling a total of 5984 physiotherapists from 17 countries. Pooled prevalence (95% confidence interval) of burnout was 8% (4−15). Prevalence figures for Maslach Burnout Inventory dimensions were: (i) emotional exhaustion, 27% (21−34) (ii) depersonalization, 23% (15−32) (iii) low personal accomplishment, 25% (15−40). Both overall and single components prevalence was higher, although not significantly, in studies from developing than in developed countries.
Tools used to assess burnout and cut-off scores chosen to identify the burnout prevalence differed across studies.
Prevalence of burnout reported by physiotherapists appears high worldwide, in particular in developing countries, and compares with that reported by nurses and physicians. Substantial heterogeneity in the prevalence of burnout, in its definition and assessment methods across studies, and limited quality of most studies precludes drawing definitive conclusions.
PROSPERO CRD42022307876
•This is the first systematic review on prevalence of burnout among physiotherapists worldwide. The pooled prevalence of burnout was 8%.•Both overall and single components prevalence tended to be higher in developing than in developed countries.•Substantial heterogeneity in the prevalence of burnout, in its definition and assessment methods across studies, and limited quality in most studies precludes drawing definitive conclusions.
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