Gillian Brydson

Walking ability as a measure of treatment effect in early rheumatoid arthritis

Objective: To assess the clinical usefulness of a prototype walkmat system in patients with early rheumatoid arthritis (RA). Subjects: Twenty-four subjects with early RA and symptomatic forefoot disease requiring therapy with second-line drugs were recruited. Design: Each subject underwent clinical assessment together with gait analysis on the contact sensitive walkmat system and Kistler forceplate before and after six months of treatment with second-line drugs. Two subjects were lost to follow-up. Results: There was the expected improvement in disease activity in response to therapy. Significant differences were also demonstrated in defined gait parameters that indicated improved weight-bearing and enhanced forefoot propulsion. Conclusion: Medical therapy improved walking ability in patients with RA and the walkmat system provided a useful adjunct to existing outcome measures in the assessment of lower limb function.

A Preliminary Validation of the 10-metre Incremental Shuttle Walk Test as a Measure of Aerobic Capacity in Women with Rheumatoid Arthritis

Summary With the increasing importance of evidence-based practice and demonstrable clinical effectiveness, the need for valid outcome measures for all physiotherapy interventions is greater than ever. The VO 2max remains the definitive measurement of aerobic capacity. However, there are serious practical and ethical concerns involved with applying such a demanding test to patients. As a consequence field tests are often applied with aerobic capacity inferred from performance. The most widely accepted and researched of these is the 10-metre incremental shuttle walk test (SWT) ( Singh et al., 1992 , Singh et al., 1994 ). In the present study the validity of a symptom-limited SWT as a measure of aerobic and functional capacity was examined with concurrent respiratory gas analysis. A VO 2max value (aerobic capacity) established with linear extrapolation and observed VO 2peak (functional capacity) were regressed against the number of shuttles completed. An earlier study ( MacSween, 2001 ) established acceptable levels of reliability and validity of linear extrapolation. No statistically significant linear relationship was found between aerobic capacity and number of shuttles completed (R 2 9.7%). Despite this finding, the advantages of developing an alternative to costly laboratory testing warrants further study of the SWT in patient groups. A statistically significant linear relationship was found between functional capacity and the number of shuttles completed ( R 2 61.4%). On the basis of the present results the SWT is a valid field test of functional capacity but not of aerobic capacity.

Physiotherapy for Homeless People

Summary Background Literature suggests that homeless people, owing to their chaotic lifestyles, do not always access healthcare services. Studies have described healthcare services dedicated to homeless people but, so far as the authors could establish, physiotherapy was not offered to this population in the United Kingdom. It is widely recognised that traumatic injuries and respiratory, musculoskeletal and mobility problems are common among homeless people. Purpose The purpose of this article was to describe the development of a dedicated physiotherapy service for homeless people from its initial pilot period through to securing funding for a permanent service. The challenges involved in setting up such a unique service were addressed. Conclusions This article provided a model for healthcare provision that facilitates access to physiotherapy for homeless people in Glasgow. It is a model that could be considered in other urban areas with an acknowledged homeless population.

Physiotherapy for Homeless People: Implementation and service evaluation

Methods During the initial nine-month period a pilot service was established and evaluated using a combination of audit and qualitative methodologies. A unique needs-led physiotherapy service was developed, which involved clinics within drop-in centres and a domiciliary service for hostel dwellers. To answer key questions about service use, patients’ records over a two-year period were analysed. Findings Two hundred and one patients self-referred over the pilot period. 84% of a stratified random sample of patients expressed satisfaction with the service. Emerging themes from the qualitative analysis suggested the easy access nature and positive attitudes of the physiotherapists contributed to the high level of satisfaction. To evaluate the established service, descriptive statistics were collated from two years of service provision, with patterns of attendance and presenting problems discussed.