Background: COVID-19, caused by the SARS-CoV-2 virus, is a novel coronavirus that has led to a global pandemic. Physiotherapy is among the beneficial treatments for this disease. This study ...investigated the impact of the priority and delay of prone positioning and chest physiotherapy (CPT) on patients with COVID-19. Methods: A randomized clinical trial was conducted involving 26 COVID-19 patients who were randomly assigned to two groups: one group prioritizing prone positioning over chest physiotherapy (comprising seven men and six women, with an average age of 67.46 ± 5.91) and the other group prioritizing CPT over prone positioning (comprising eight men and five women, with an average age of 68.38 ± 5.85). Respiratory outcomes, including SpO2, PaO2, FiO2, FEV1, and FVC, were measured using pulse oximetry, arterial blood gas analysis (ABG), and spirometry). FEV1/FVC and SpO2/FiO2 ratios were evaluated both before and after the intervention Results: The demographic characteristics of the patients and the baseline respiratory outcomes between the two groups did not exhibit significant differences (P > 0.05). A significant difference was observed in respiratory outcomes within each group before and after the intervention (P < 0.05). However, after the intervention, there were no significant differences between the two groups in terms of respiratory outcomes (P > 0.05) Conclusion: Both prioritizing prone positioning over CPT and prioritizing CPT over prone positioning appeared to improve each respiratory outcome. Nevertheless, it was not observed that prioritizing or delaying prone positioning and CPT improved respiratory outcomes in patients with COVID-19.
Basic human needs besides clothing, food and housing that are no less important are health. Along with current demands and needs, health is sometimes neglected either intentionally or ...unintentionally. Health awareness is sometimes not a priority when individuals feel healthy, but it becomes very important and expensive when an individual has experienced illness and has disrupted daily activities, suffered material, and material losses. Students, who are part of a social society, have a moral responsibility in promoting healthy lifestyles and healthy living behaviours. Society considers that physiotherapist as a profession has the ability and skills about healthy lifestyles and has positive health attitudes and behaviours. This study aims to determine the description of the healthy behaviour of students. . This study used a descriptive research design, with a sample of 108 students covering semesters one, three and six who attended and filled out the questionnaire at a predetermined time (accidental sampling). Data were taken using a HPLP-II questionnaire that measures healthy behaviour. Data analysis using SPSS program by finding the average value of six healthy behaviours of students. The results of the study: from the average score of six behaviours measured, the highest score on the spiritual behaviour of students was 2,966 and the lowest score was on the physical activity behaviour of the students. The conclusion of this study is that Physiotherapy students have unhealthy behaviours including physical activity behaviour, nutritional, stress management and health responsibilities and healthy behaviour of students including interpersonal and spiritual relationships
To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief ...training in Cognitive Functional Therapy (CFT).
As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions.
The analysis revealed four descriptive categories: "hung out to dry," "stuck," "making sense and taking control," and "holistic approach to care and living," that varied based on six themes.
Although the participants accepted this approach to care well, there was significant variation in patients' conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes.
Implications for rehabilitation
The participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives.
This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don't feel abandoned by the system.
Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.
Chest physiotherapy is widely used in people with cystic fibrosis in order to clear mucus from the airways. This is an updated version of previously published reviews.
To determine the effectiveness ...and acceptability of chest physiotherapy compared to no treatment or spontaneous cough alone to improve mucus clearance in 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 of the Group's Cystic Fibrosis Trials Register: 02 June 2015.
Randomised or quasi-randomised clinical studies in which a form of chest physiotherapy (airway clearance technique) were taken for consideration in people with cystic fibrosis compared with either no physiotherapy treatment or spontaneous cough alone.
Both authors independently assessed study eligibility, extracted data and assessed the risk of bias in the included studies. There was heterogeneity in the published outcomes, with variable reporting which meant pooling of the data for meta-analysis was not possible.
The searches identified 157 studies, of which eight cross-over studies (data from 96 participants) met the inclusion criteria. There were differences between studies in the way that interventions were delivered, with several of the intervention groups combining more than one treatment modality. One included study looked at autogenic drainage, six considered conventional chest physiotherapy, three considered oscillating positive expiratory pressure, seven considered positive expiratory pressure and one considered high pressure positive expiratory pressure. Of the eight studies, six were single-treatment studies and in two, the treatment intervention was performed over two consecutive days (once daily in one, twice daily in the other). This enormous heterogeneity in the treatment interventions prevented any meta-analyses from being performed. Blinding of participants, caregivers or clinicians in airway clearance studies is impossible; therefore this was not considered as a high risk of bias in the included studies. Lack of protocol data made assessment of risk of bias unclear for the majority of other criteria.Four studies, involving 28 participants, reported a higher amount of expectorated secretions during chest physiotherapy as compared to a control. One study, involving 18 participants, reported no significant differences in sputum weight. In five studies radioactive tracer clearance was used as an outcome variable. In three of these (28 participants) it was reported that chest physiotherapy, including coughing, increased radioactive tracer clearance as compared to the control period. One study (12 participants) reported increased radioactive tracer clearance associated with all interventions compared to control, although this was only reported to have reached significance for postural drainage with percussion and vibrations; and the remaining study (eight participants) reported no significant difference in radioactive tracer clearance between chest physiotherapy, without coughing, compared to the control period. Three studies, involving 42 participants reported no significant effect on pulmonary function variables following intervention; but one further study did report significant improvement in pulmonary function following the intervention in some of the treatment groups.
The results of this review show that airway clearance techniques have short-term effects in the terms of increasing mucus transport. No evidence was found on which to draw conclusions concerning the long-term effects.
Chest physiotherapy is widely prescribed to assist the clearance of airway secretions in people with cystic fibrosis. Oscillating devices generate intra- or extra-thoracic oscillations orally or ...external to the chest wall. Internally they create variable resistances within the airways, generating controlled oscillating positive pressure which mobilises mucus. Extra-thoracic oscillations are generated by forces outside the respiratory system, e.g. high frequency chest wall oscillation. This is an update of a previously published review.
To identify whether oscillatory devices, oral or chest wall, are effective for mucociliary clearance and whether they are equivalent or superior to other forms of airway clearance in the successful management of secretions in people with cystic fibrosis.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conference proceedings. Latest search of the Cystic Fibrosis Trials Register: 29 July 2019. In addition we searched the trials databases ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Latest search of trials databases: 15 August 2019.
Randomised controlled studies and controlled clinical studies of oscillating devices compared with any other form of physiotherapy in people with cystic fibrosis. Single-treatment interventions (therapy technique used only once in the comparison) were excluded.
Two authors independently applied the inclusion criteria to publications, assessed the quality of the included studies and assessed the evidence using GRADE.
The searches identified 82 studies (330 references); 39 studies (total of 1114 participants) met the inclusion criteria. Studies varied in duration from up to one week to one year; 20 of the studies were cross-over in design. The studies also varied in type of intervention and the outcomes measured, data were not published in sufficient detail in most of these studies, so meta-analysis was limited. Few studies were considered to have a low risk of bias in any domain. It is not possible to blind participants and clinicians to physiotherapy interventions, but 13 studies did blind the outcome assessors. The quality of the evidence across all comparisons ranged from low to very low. Forced expiratory volume in one second was the most frequently measured outcome and while many of the studies reported an improvement in those people using a vibrating device compared to before the study, there were few differences when comparing the different devices to each other or to other airway clearance techniques. One study identified an increase in frequency of exacerbations requiring antibiotics whilst using high frequency chest wall oscillation when compared to positive expiratory pressure (low-quality evidence). There were some small but significant changes in secondary outcome variables such as sputum volume or weight, but not wholly in favour of oscillating devices and due to the low- or very low-quality evidence, it is not clear whether these were due to the particular intervention. Participant satisfaction was reported in 13 studies but again with low- or very low-quality evidence and not consistently in favour of an oscillating device, as some participants preferred breathing techniques or techniques used prior to the study interventions. The results for the remaining outcome measures were not examined or reported in sufficient detail to provide any high-level evidence.
There was no clear evidence that oscillation was a more or less effective intervention overall than other forms of physiotherapy; furthermore there was no evidence that one device is superior to another. The findings from one study showing an increase in frequency of exacerbations requiring antibiotics whilst using an oscillating device compared to positive expiratory pressure may have significant resource implications. More adequately-powered long-term randomised controlled trials are necessary and outcomes measured should include frequency of exacerbations, individual preference, adherence to therapy and general satisfaction with treatment. Increased adherence to therapy may then lead to improvements in other parameters, such as exercise tolerance and respiratory function. Additional evidence is needed to evaluate whether oscillating devices combined with other forms of airway clearance is efficacious in people with cystic fibrosis.There may also be a requirement to consider the cost implication of devices over other forms of equally advantageous airway clearance techniques. Using the GRADE method to assess the quality of the evidence, we judged this to be low or very low quality, which suggests that further research is very likely to have an impact on confidence in any estimate of effect generated by future interventions.
Abstract Background Physiotherapy is a routine component of post-operative management following total knee arthroplasty (TKA). As the demand for surgery increases it is vital that post-operative ...physiotherapy interventions are effective and efficient. Objectives Determine the most beneficial active physiotherapy interventions in acute hospital and inpatient rehabilitation for improving pain, activity, range of motion and reducing length of stay for adults who have undergone TKA. Data sources Electronic databases MEDLINE, CINAHL, PUBMED and EMBASE. Study eligibility criteria Randomised controlled trials investigating the effect of active physiotherapy interventions in the acute hospital or inpatient rehabilitation setting for adults who have undergone TKA. Study appraisal and synthesis methods Risk of bias for individual studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Standardised Mean Differences (SMD) or Mean Differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses. Quality of meta-analyses was assessed using the Grades of Research, Assessment, Development and Evaluation approach. Results Accelerated physiotherapy regimens were effective for reducing acute hospital length of stay (MD −3.5 days, 95% CI −5.7 to −1.3). Technology-assisted physiotherapy did not show any difference for activity (SMD −0.34, 95% CI −0.82 to 0.13). From high quality individual studies pain, activity and range of motion improved with accelerated physiotherapy regimens and activity improved with hydrotherapy. Limitations Lack of blinding and small sample sizes across the included trials. Conclusion After TKA, there is low level evidence that accelerated physiotherapy regimens can reduce acute hospital length of stay. Systematic review registration number PROSPERO (Registration number CRD42014013414) http://www.crd.york.ac.uk/PROSPERO.
Background Context
Assessment of posture and lumbo-pelvic alignment is often a main focus in the classification and treatment of patients with low back pain. However, little is known regarding the ...effects of motor control interventions on objective measures of lumbo-pelvic alignment.
Purpose
The primary aim of this study was to describe the variation of sagittal lumbo-pelvic alignment in patients with nociceptive mechanical low back pain. The secondary aim was to compare the effects of a high-load lifting exercise (HLL) and low-load motor control exercises (LMC) on change in lumbo-pelvic alignment with a special emphasis on patients with high and low degrees of lumbar lordosis (lu) and sacral angle (sa).
Study Design
This study is a secondary analysis of a randomized controlled trial evaluating the effects of HLL and LMC.
Patient Sample
Patients from the primary study, i.e. patients categorized with nociceptive mechanical low back pain, who agreed to participate in the radiographic examination were included (n=66).
Outcome measures
Lateral plain radiographic images were used to evaluate lumbo-pelvic alignment regarding lumbar lordosis and sacral angle as outcomes with posterior bend as an explanatory variable.
Methods
The participants were recruited to the study from two occupational health care facilities. They were randomized to either the HLL or LMC intervention group and offered 12 supervised exercise sessions. Outcome measures were collected at baseline and at the end of intervention period 2 months after baseline.
Between and within group analyses of intervention groups and sub-groups based on the distribution of the baseline values for lumbar lordosis and sacral angle respectively, (LOW, MID, HIGH), were performed using both parametric and non-parametric statistics.
This study was supported by two grants from Visare Norr (12000 US dollars) and Norrbotten County Council (13000 US dollars). The supporting organizations were not involved in the collection of data, analysis, interpretation or drafting of the manuscript.
Results
The ranges of values for the present sample for lumbar lordosis were 26.9-91.6° (M=59.0°, SD=11.5°) and for sacral angle were 18.2-72.1° (M=42.0°, SD=9.6°). There were no significant differences between the intervention groups in the percent change of either outcome measure. Neither did any outcome change significantly over time within the intervention groups. In the sub-groups, based on the distribution of respective baseline values, LOW lu showed significantly increased lumbar lordosis, whereas HIGH sa , showed significantly decreased sacral angle following intervention.
Conclusions
This study describes the wide distribution of values for lumbo-pelvic alignment for patients with nociceptive mechanical low back pain. Further research is needed to investigate sub-groups of other types of low back pain and contrast findings to those presented in this study. Our results also suggest that re-training of lumbo-pelvic alignment could be possible for patients with low back pain.
In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected ...the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicinecontent and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.
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