Ann Moore

A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder.

Study Design. Randomized, single blind, controlled trial. Objective. To determine the efficacy of 2 components of musculoskeletal physiotherapy on chronic low back disorder. Summary of Background Data. Musculoskeletal physiotherapy encompasses many treatment methods, however, manual therapy and exercises to rehabilitate spinal stabilization are the most frequently used. Despite their popularity, scant evidence supports their use on subjects with chronic low back disorder. Methods. A total of 346 subjects were randomized to manual therapy, a 10-week spinal stabilization rehabilitation program, or a minimal intervention control group. Data were collected at baseline, and 3, 6, 12, and 24 months after intervention. Outcome measures recorded intensity of low back pain, disability, handicap, medication, and quality of life. There were 4 main variables combined in a primary component analysis to form a single outcome measure (i.e., a measure of dysfunction). Results. The results indicated statistically significant improvements in favor of the spinal stabilization group at the 6-month stage in pain (65.9% reduction in symptoms) and dysfunction (combined mean reduction of 134, standard error 23.84), and at the 1-year stage in medication (34.3% reduction in medication), dysfunction (combined mean reduction of 134, standard error 18.2), and disability (mean difference in change 15.71 Oswestry Disability Index, 95% confidence interval 19.3–10.01). Conclusions. As a component of musculoskeletal physiotherapy, the spinal stabilization program is more effective than manually applied therapy or an education booklet in treating chronic low back disorder over time. Both manual therapy and the spinal stabilization program are significantly effective in pain reduction in comparison to an active control. To our knowledge and up until now, this result has not been shown in patients with chronic low back disorder.

M-mode ultrasound: a reliable measure of transversus abdominis thickness?

OBJECTIVE The purpose of this study was to establish a reliable method for measuring transversus abdominis thickness in asymptomatic human subjects in supine lying, standing and walking. DESIGN AND METHODS This was a single operator reliability study using ultrasound imaging to measure 22 subjects on three separate occasions. A purpose built high-density foam reinforced belt was used to house and position the transducer over the mid-point of the transversus abdominis. Each subject was imaged in supine, standing, and treadmill walking at 3 kph. Intraclass correlation coefficients and standard error of measurement analysis were used to measure the data. RESULTS The correlation coefficient data analysis resulted in intraclass correlation coefficients of 0.94 (standard error of measurement 0.35) in supine lying, 0.88 (0.66) in standing and 0.88 (0.56) in walking. CONCLUSION The method described is a reliable tool for measuring changes in thickness of transversus abdominis in supine lying, standing and walking. RELEVANCE This procedure has the potential to detect dysfunctional changes in abdominal muscle activity for patients with low back pain in a functional setting.

Measurement of abdominal muscle thickness using M-mode ultrasound imaging during functional activities

Ultrasound imaging has been previously utilized in the measurement of muscle thickness and cross-sectional area in research studies, and advocated as a clinical biofeedback tool in the rehabilitation of transversus abdominis function following episodes of low back pain. This paper describes how the thickness of the abdominal muscles can be quantified with a new measurement technique using M-mode ultrasound. The technique uses a custom-made transducer holder that facilitates measurement of muscle thickness changes during functional activity. Limitations of the technique and potential future applications are discussed. The M-mode ultrasound technique may provide an effective method for the non-invasive measurement of abdominal muscle thickness during functional activities.

A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain

Study Design. A multicenter assessor-blinded randomized clinical trial was conducted. Objectives. To investigate the difference in effectiveness of manipulative therapy and interferential therapy for patients with acute low back pain when used as sole treatments and in combination. Summary of Background Data. Both manipulative therapy and interferential therapy are commonly used treatments for low back pain. Evidence for the effectiveness of manipulative therapy is available only for the short-term. There is limited evidence for interferential therapy, and no study has investigated the effectiveness of manipulative therapy combined with interferential therapy. Methods. Consenting subjects (n = 240) recruited following referral by physicians to physiotherapy departments in the (government-funded) National Health Service in Northern Ireland were randomly assigned to receive a copy of the Back Book and either manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), or a combination of manipulative therapy and interferential therapy (CT; n = 80). The primary outcome was a change in functional disability on the Roland Morris Disability Questionnaire. Follow-up questionnaires were posted at discharge and at 6 and 12 months. Results. The groups were balanced at baseline for low back pain and demographic characteristics. At discharge all interventions significantly reduced functional disability (Roland Morris scale, MT: −4.53; 95% CI, −5.7 to −3.3 vs. IFT: −3.56; 95% CI, −4.8 to −2.4 vs. CT: −4.65; 95% CI, −5.8 to −3.5; P = 0.38) and pain (McGill questionnaire, MT: −5.12; 95% CI, −7.7 to −2.5 vs. IFT: −5.87; 95% CI, −8.5 to −3.3 vs. CT: −6.64; 95% CI, −9.2 to −4.1; P = 0.72) and increased quality of life (SF-36 Role-Physical, MT: 28.6; 95% CI, 18.3 to 38.9 vs. IFT: 31.4; 95% CI, 21.2 to 41.5 vs. CT: 30; 95% CI, 19.9 to 40; P = 0.93) to the same degree and maintained these improvements at 6 and 12 months. No significant differences were found between groups for reported LBP recurrence, work absenteeism, medication consumption, exercise participation, or healthcare use at 12 months (P > 0.05). Conclusions. For acute low back pain, there was no difference between the effects of a combined manipulative therapy and interferential therapy package and either manipulative therapy or interferential therapy alone.

Evaluating Practice Education Models in Occupational Therapy: Comparing 1:1, 2:1 and 3:1 Placements

Practice education is an essential part of the education of health professionals, yet in spite of this there is an acknowledged shortage of placements. At the same time, educational research indicates that peer learning, and in particular problem-based learning, has advantages for students. Studies that have investigated models of placements where more than one student at a time share an educator have shown that this may bring benefits for both educators and students. This study was carried out with the aim of determining the impact of different models of practice placement (1:1, 2:1 and 3:1) on the quality of education for students and on the quality of the experience for educators, in both occupational therapy and physiotherapy courses at a university in the South of England. This article focuses on the occupational therapy component of the study. Six occupational therapy educators and 11 students took part, providing examples of all three models of placement. The findings indicated that while all three models provided both advantages and disadvantages for educators and students, the 2:1 model offered more opportunities for peer support and enhanced the quality of the educational experience through peer learning. In some settings, however, it is probably the case that only the 1:1 model is possible. The findings also suggest that the success of any placement model depends heavily on how well the placement has been planned.

Evaluation of Physiotherapy Clinical Educational Models: Comparing 1:1, 2:1 and 3:1 placements

Summary Nationally there is an increasing problem of clinical placement shortages for physiotherapy which is likely to become worse with the implementation of Government National Health Service plans. The purpose of this study was to compare experiences of clinical educators and students using three different clinical placement models. Method Eight clinical educators volunteered to experience 1:1, 2:1 and 3:1 placement models; 48 third-year physiotherapy students volunteered to attend these placements. Data were collected by face-to-face interviews with educators and students at the end of each placement. Department managers and visiting tutors were also interviewed when all the placements were completed. All interviews were recorded on audiotape, transcribed verbatim and assessed for accuracy. The data were analysed thematically using NVIVO software and assessed for reliability and validity. Results Themes emerged that had an effect on the success of a placement. These included the time the educator spent with individual students, size of department, number of patients and availability of accommodation. The experiences of the interviewees suggest that each of the models has advantages and disadvantages, but they all provide valuable learning opportunities. The results indicate that the success of any placement model depends heavily on how the placement is planned. Conclusion It is evident from the findings that all three models investigated have a place in physiotherapy clinical education. The 2:1 and 3:1 models provide different learning opportunities from the 1:1, but are no less important; they can now be promoted in the clinical setting with more evidence to support their use. If implemented these models will contribute to increasing placement numbers while still maintaining high quality learning environments for the students and rewarding experiences for the educators.

Peripheral Nerve Motion Measurement with Spectral Doppler Sonography: A Reliability Study

This study evaluates single operator test-retest reliability of spectral Doppler ultrasound measurement of median nerve excursion during wrist extension. Longitudinal motion of the median nerve was measured at the elbow on three occasions in both upper limbs of 16 healthy subjects using a standard colour Doppler ultrasound system. The mean of the three maximum velocity time integrals was calculated from the spectral Doppler sonogram of each test. Analysis of data with intraclass correlation coeffcient indicated a high degree of repeatability (0.92). Spectral Doppler ultrasound may provide a valuable method for measurement of peripheral nerve motion and may have a role in the clinical assessment of entrapment syndromes.

A new, comprehensive normative database of lumbar spine ranges of motion

Aims and objectives: To generate gender-specific and broadly based agerelated indices for normative lumbar ranges of motion for all planes of movement. Design: This was a repeated measures prospective study of spinal range of motion in a sample of volunteer subjects utilizing a portable modified CA6000 Spine Motion Analyzer (Orthopedic Systems Inc., Union City, CA, USA). Setting: Data collection was carried out in a variety of community locations including fire, police and ambulance stations, offices and community centres. Subjects: A total of 405 asymptomatic subjects (196 female, 209 male) were recruited, aged 16–90 years, from sedentary, mixed and physically demanding occupations. Methodology: Indices of lumbar spine ranges of motion were measured in standing following a standardized protocol for sagittal flexion/extension, coronal lateral flexion and horizontal axial rotation movements. Results: Male and female normative flexion ranges declined by approximately 40% (72–40 degrees) across the age spectrum. Extension declined the greatest, by approximately 76% (29–6 degrees) overall. In lateral flexion male and female ranges declined approximately 43% (29–15 degrees) in each direction (total 58–30 degrees). In axial rotation no age-related decline was observed and ranges of motion remained at approximately 7 degrees in each direction (total 14 degrees) across all the ages of the subject group. Conclusions: Data have been generated that provide comprehensive, gender-specific, broadly based and age-related indices for normative lumbar ranges of motion in all planes of movement. These are applicable to individuals throughout adult life, from adolescence through to old age.

Measurement of lumbar spine range of movement and coupled motion using inertial sensors – A protocol validity study

Measurement of spinal lumbar range of movement is useful in clinical examination of the spine and for monitoring changes in spinal movement characteristics of individuals over time, particularly in the research context. As the spine exhibits six degrees of movement, three dimensional measurements provide additional information that could benefit the study of spinal conditions. Inertial measurement systems present an innovative method of spinal motion measurement. These systems are small and portable, and of low cost compared to laboratory based three dimensional measurement systems such as electromagnetic and opto-electronic systems. The present study aimed to validate the use of inertial measurement systems in three dimensional spinal range of movement measurement using an electromagnetic tracking system as a reference. Twenty-six healthy participants had their lumbar spine range of movement measured using both an inertial measurement system and an electromagnetic tracking system. Measurements taken by the inertial measurement system were found to be highly correlated with the electromagnetic tracking system (overall regression R(2) 0.999, p < 0.005). Measurements showed strong agreement (mean differences between -0.81° and 1.26°) and produced no significant difference from the electromagnetic tracking system (paired t-test p > 0.05). The ranges of movement measured were also highly comparable to those reported in the literature. Inertial measurement systems that consist of triaxial gyroscopes, accelerometers and magnetometers are concluded to be valid tools for three dimensional spinal range of movement measurement within or outside of the laboratory settings due to their cost, size and portability.

Chartered Society of Physiotherapy's identification of national research priorities for physiotherapy using a modified Delphi technique

OBJECTIVE To define research priorities to strategically inform the evidence base for physiotherapy practice. DESIGN A modified Delphi method using SurveyMonkey software identified priorities for physiotherapy research through national consensus. An iterative process of three rounds provided feedback. Round 1 requested five priorities using pre-defined prioritisation criteria. Content analysis identified research themes and topics. Round 2 requested rating of the importance of the research topics using a 1-5 Likert scale. Round 3 requested a further process of rating. Quantitative and qualitative data informed decision-making. Level of consensus was established as mean rating ≥ 3.5, coefficient of variation ≤ 30%, and ≥ 55% agreement. Consensus across participants was evaluated using Kendalls W. PARTICIPANTS Four expert panels (n=40-61) encompassing a range of stakeholders and reflecting four core areas of physiotherapy practice were established by steering groups (n=204 participants overall). FINDINGS Response rates of 53-78% across three rounds were good. The identification of 24/185 topics for musculoskeletal, 43/174 for neurology, 30/120 for cardiorespiratory and medical rehabilitation, and 30/113 for mental and physical health and wellbeing as priorities demonstrated discrimination of the process. Consensus between participants was good for most topics. Measurement validity of the research topics was good. The involvement of multiple stakeholders as participants ensured the current context of the intended use of the priorities. CONCLUSIONS From a process of national consensus involving key stakeholders, including service users, physiotherapy research topics have been identified and prioritised. Setting priorities provides a vision of how research can contribute to the developing research base in physiotherapy to maximise focus.