Anne M. Moseley

Evidence for physiotherapy practice: A survey of the Physiotherapy Evidence Database (PEDro)

Evidence-based practice involves the use of evidence from systematic reviews and randomised controlled trials, but the extent of this evidence in physiotherapy has not previously been surveyed. The aim of this survey is to describe the quantity and quality of randomised controlled trials and the quantity of systematic reviews relevant to physiotherapy. The Physiotherapy Evidence Database (PEDro) was searched. The quality of trials was assessed with the PEDro scale. The search identified a total of 2,376 randomised controlled trials and 332 systematic reviews. The first trial was published in 1955 and the first review was published in 1982. Since that time, the number of trials and reviews has grown exponentially. The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999. There is a substantial body of evidence about the effects of physiotherapy. However, there remains scope for improvements in the quality of the conduct and reporting of clinical trials.

A Randomized, Controlled Trial of Quadriceps Resistance Exercise and Vitamin D in Frail Older People: The Frailty Interventions Trial in Elderly Subjects (FITNESS)

OBJECTIVES:  To determine the effectiveness of vitamin D and home‐based quadriceps resistance exercise on reducing falls and improving the physical health of frail older people after hospital discharge.

Change in length of relaxed muscle fascicles and tendons with knee and ankle movement in humans

Ultrasonography was used to measure changes in length of muscle fascicles in relaxed human tibialis anterior and gastrocnemius during passively imposed changes in joint angle. Changes in the length of muscle fascicles were compared to changes in the length of the whole muscle‐tendon units calculated from joint angles and anthropometric data. Relaxed muscle fascicles underwent much smaller changes in length than their muscle‐tendon units. On average, muscle fascicles in tibialis anterior [saw] 55 ± 13 % (mean ±s.d.) of the total change in muscle‐tendon length. This indicates nearly half of the total change in muscle‐tendon length was taken up by stretch of tendon. In gastrocnemius, which has relatively long tendons, only 27 ± 9 % of the total change in muscle‐tendon length was transmitted to muscle fascicles. Thus, the tendency for passive movement to be taken up by the tendon was greater for gastrocnemius than tibialis anterior (P = 0.002). For these muscles, the relatively large changes in tendon length across much of the physiological range of muscle‐tendon lengths could not wholly be explained by tendon slackness, changes in fibre pennation, or stretch or contraction history of the muscle. Our data confirm that when joints are moved passively, length changes [seen] by muscle fascicles can be much less than changes in the distance between muscle origin and insertion. This occurs because tendons undergo significant changes in length, even at very low forces.

There was evidence of convergent and construct validity of Physiotherapy Evidence Database quality scale for physiotherapy trials

OBJECTIVE To evaluate the convergent and construct validity of the Physiotherapy Evidence Database (PEDro) scale used to rate the methodological quality of randomized trials in physiotherapy. STUDY DESIGN AND SETTING PEDro total scores and individual-item scores were extracted from 9,456 physiotherapy trials indexed on PEDro. Convergent validity was tested by comparing PEDro total scores with three other quality scales. Construct validity was tested by regressing the PEDro score and individual-item scores with the Institute for Scientific Information Web of Knowledge impact factors (IF) and SCImago journal rankings (SJR) for the journals in which the trials were published. RESULTS Testing of convergent validity revealed correlations with the other quality scales ranging from 0.31 to 0.69. The PEDro total score was weakly but significantly associated with IF and SJR (P < 0.0001). Eight of the 10 individual scale items that contribute to the PEDro total score were significantly associated with IF. CONCLUSION This study provides preliminary evidence of the convergent and construct validity of the PEDro total score and the construct validity of eight individual scale items.

Cochrane reviews used more rigorous methods than non-Cochrane reviews: survey of systematic reviews in physiotherapy.

OBJECTIVE To describe the quality and methods of systematic reviews of physiotherapy interventions, compare Cochrane and non-Cochrane reviews, and establish the interrater reliability of the Overview Quality Assessment Questionnaire (OQAQ) quality assessment tool. STUDY DESIGN AND SETTING A survey of 200 published systematic reviews was done. Two independent raters assessed the search strategy, assessment of trial quality, outcomes, pooling, conclusions, and overall quality (OQAQ). The study was carried out in the University research center. RESULTS In these reviews, the five most common databases searched were MEDLINE, EMBASE, Cochrane Library, CINAHL, and Cochrane Review Group Registers. The Cochrane allocation concealment system and Jadad Scale were most frequently used to assess trial quality. Cochrane reviews searched more databases and were more likely to assess trial quality, report dichotomous outcomes for individual trials, and conduct a meta-analysis than non-Cochrane reviews. Non-Cochrane reviews were more likely to conclude that there was a beneficial effect of treatment. Cochrane reviews were of higher quality than non-Cochrane reviews. There has been an increase in the quality of systematic reviews over time. The OQAQ has fair to good interrater reliability. CONCLUSION The quality of systematic reviews in physiotherapy is improving, and the use of Cochrane Collaboration procedures appears to improve the methods and quality.

A Description of the Trials, Reviews, and Practice Guidelines Indexed in the PEDro Database

This perspective provides an overview of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy. Data from the Physiotherapy Evidence Database (PEDro) are used to describe key events in the history of physical therapy research and the growth of evidence of effects of interventions used in the various subdisciplines of physical therapy. The 11,494 records that were identified reveal a rich history of physical therapy research dating back to the first trial in 1929. Most of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy have been published since the year 2000. This rapid growth presents a challenge for physical therapists who want to keep up to date in clinical practice.

Normative data for passive ankle plantarflexion–dorsiflexion flexibility

OBJECTIVE To describe the normal distribution parameters for measures of passive ankle plantarflexion-dorsiflexion flexibility obtained from a large sample of able-bodied young adult subjects. DESIGN Seven variables were assessed and descriptive analyses were conducted. BACKGROUND While assessment of plantarflexion-dorsiflexion flexibility is an important component of a clinical examination of plantarflexion contracture, there is limited normative data available that can be used as a reference for clinical decision-making. METHODS Data were collected from 300 able-bodied male and female subjects aged between 15 and 34 years. Both ankles were measured. Load-displacement curves were collected using a manually controlled instrumented footplate. Six variables were extracted from these curves: passive torque at zero and 10 deg, passive stiffness at zero and 10 deg, and two coefficients from an equation fitted to the curve (i.e., k and b). The seventh variable, passive dorsiflexion range of motion, was quantified using a clinical procedure. RESULTS Flexibility variables did not differ between the left and right ankles, nor between the dominant and non-dominant legs. All variables were normally distributed. These distributions can, therefore, be adequately described using their mean and standard deviation values. CONCLUSIONS This study has substantially increased the available database on plantarflexion-dorsiflexion flexibility and forms the basis of norm-referenced clinical tests.

Test–re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study

Primary objective: Assess the test–re-test reliability of walking speed, step length and step width measurement in people with traumatic brain injury (TBI). Research design: Repeated measures (two test occasions). Methods: Thirteen people with TBI completed four comfortable and four fast-paced walking trials of the 10 m walk test and two trials of the 6-minute walk test (6MWT). Walking speed, step length and step width were measured during the 10 m walk test and walking distance and average speed were measured during the 6MWT. The tests were repeated 1-week later. Main results: Walking speed and distance showed excellent test–re-test reliability, with an intra-class correlation coefficient (ICC) of 0.95–0.96. Reliability was also high for step length and width measurement (ICC 0.91–0.98). Conclusions: This test–re-test reliability means that walking speed and distance and step length and width can be used by physiotherapists to monitor improvements in walking after TBI.

Impact of Ankle-foot Orthoses on Gait and Leg Muscle Activity in Adults with Hemiplegia

Summary Objectives To evaluate the effects of ankle-foot orthoses on adult hemiplegic gait and to investigate the impact of ankle-foot orthoses on the muscle activity of the paretic lower limb in adults with hemiplegia. Design A database search was conducted (Medline 1966-2000, Cinahl 1982-2000 and Embase 1982-2000) during the period of June 2000 to February 2001. Citation tracking was also carried out to locate any other relevant references. Articles were included and excluded according to criteria determined by the author. Results Thirteen articles met the inclusion criteria for effects of ankle-foot orthoses on gait. The studies involved hemiplegic subjects at various stages of recovery, and encompassed a broad range of orthoses and gait parameters. The overall results suggested that ankle-foot orthoses might improve velocity, stride length, gait pattern and walking efficiency in people with hemiplegia who could walk without an ankle-foot orthosis and had dynamic or spastic foot drop. Only four studies of the effects of ankle-foot orthoses on muscle activity in paretic lower limbs were identified in this review. Overall evidence of impact of ankle-foot orthoses on muscle activity of paretic legs in adults with hemiplegia was weak, and no conclusion can be drawn from these trials due to large individual differences, conflicting findings and poor generalisability of the studies. Conclusion This systematic literature review suggests that ankle-foot orthoses may lead to immediate kinematic and temporal improvements in gait in selected hemiplegic patients but their effect on the paretic lower limb muscle activity is inconclusive. The review highlights a lack of well designed and adequately powered randomised controlled trials on the use of ankle-foot orthoses by adults with hemiplegia.

Measurement of passive ankle dorsiflexion: Procedure and reliability

The purpose of this study was to develop a reliable procedure to measure passive ankle dorsiflexion in the clinical setting. A known torque was applied to produce ankle dorsiflexion in a standardised testing position. Ankle angle was measured using skin surface markers and polaroid photography. The interrater reliability of this procedure was evaluated by having five testers each measure 15 subjects. It was found that the procedure was highly reliable; the Intraclass Correlation Coefficient for the combined group data was 0.97 and the percentage intertester agreement was 77 per cent. These results demonstrate that the measurement procedure has the potential to be a clinically useful means of evaluating the effect of physiotherapeutic intervention aimed at altering passive ankle dorsiflexion movement.