Gillian Yeowell

What are the perceived needs of Pakistani women in the North west of England in relation to physiotherapy, and to what extent do they feel their needs are being met?

OBJECTIVE To gain an insight into the needs of female Pakistani service users in relation to physiotherapy. DESIGN A qualitative research design was utilised, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed and the data were analysed using thematic analysis. SETTING A venue of the service users own choosing in one geographical area of the North west of England. PARTICIPANTS Six, Pakistani, Muslim female patients who had recently received physiotherapy from a range of specialisms. Five participants came to the UK from Pakistan, and one participant of Pakistani heritage came to the UK from East Africa. An interpreter was used in four of the six interviews. FINDINGS Four main themes emerged from data analysis: issues of gender; language issues including the subthemes of crosscultural communication, time and materials; role of exercise; and acquiescence. CONCLUSIONS It appears that physiotherapy provision for female patients with Pakistani backgrounds may be failing to meet their needs, which may affect compliance. In order to address these issues, culturally competent health care needs to be provided and the following points are worthy of consideration:

The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review

Objective: To evaluate the effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury. Methods: The following databases were searched: PubMed, Ovid, The Cochrane Library and Web of Science. Studies published between the inception of the databases and December 2015 were sought using appropriate keywords in various combinations. This search was supplemented with a manual search of the references of selected studies. Studies were assessed for methodological quality using the Physiotherapy Evidence Database scale. Results: A total of 500 studies were identified, of which eight studies met the inclusion criteria and were included in the present review. The average Physiotherapy Evidence Database score for the studies included was 5.8, which reflects an overall moderate methodological quality. The eight studies investigated a total of 451 subjects of which 71% (n=319) were males. The age of the participants in the eight studies ranged from 15 to 57 years. The duration of the intervention in the studies ranged from 3 to 24 weeks. This review found that pre-operative physiotherapy rehabilitation is effective for improving the outcomes of treatment following anterior cruciate ligament injury, including increasing knee-related function and improving muscle strength. However, whilst there was a significant improvement in quality of life from baseline following intervention, no significant difference in quality of life was found between the control and intervention groups. Conclusions: There is evidence to suggest that pre-operative physiotherapy rehabilitation is beneficial to patients with anterior cruciate ligament injury.

Older adults' perceptions of adherence to community physical activity groups

ABSTRACT Community physical activity (PA) groups have come in to being worldwide to inspire older adults to engage in PA. However, there is limited evidence that older adults adhere to these groups, particularly those of a lower socio-economic status, with health conditions, from black and minority ethnic (BME) groups and men. This study aimed to explore experiences of attending PA groups from the viewpoint of community-living older adults, including those sub-groups of the population highlighted above. The purpose was to gain an understanding of what would influence long-term adherence to community PA groups. Eighteen participants aged 65 and above took part in three focus groups carried out in North West England. Thematic network analysis was used for theme generation and interpretation. Low-cost, universal locations are essential to enable older adults to engage regularly in PA, however, it is the social space that is created within these physical settings that is most influential in fostering their long-term adherence. Facilitating cross-cultural relationships and supporting older adults to have more control in shaping the PA environment will ensure that these settings are more conducive to the long-term adherence of diverse groups of older adults.

Is there an association between back pain and stress incontinence in adults with cystic fibrosis? A retrospective cross-sectional study

BACKGROUND Back pain and stress urinary incontinence (SUI) are common in adults with cystic fibrosis (CF). This study aimed to establish whether there is an association between back pain, lung function and stress urinary incontinence and its relative risk. METHOD This was a cross-sectional, retrospective analysis of the Manchester Musculoskeletal Screening Tool (MMST) data. It includes pain, (Short Form McGill Pain Questionnaire (SF-MPQ and VAS)) and International Consultation on Incontinence Short Form (ICIQ-UI-SF) measures. Associations were tested using Spearmans rank correlation coefficient. Relative risk of developing symptoms was calculated the sig level was p=0.05. RESULTS ICIQ-UI-SF was associated with back pain (SF-MPQ) (Rho=0.32, p<0.001) and pain (VAS) (Rho=0.23, p<0.01). RR of developing SUI with back pain was 2; RR of developing back pain with SUI was 1.3. CONCLUSIONS An association is indicated between back pain (SF-MPQ and VAS), and SUI in adults with CF. This information is important when developing management strategies in the CF population.

Evaluation of a rolling rehabilitation programme for patients with non-specific low back pain in primary care: an observational cohort study.

AIM The Back Rehabilitation Programme (BRP) is a group exercise programme for patients with non-specific low back pain (NSLBP) that combines cognitive behavioural therapy principles and therapeutic exercise to empower patients to self-manage their condition. Poor attendance and high attrition rates resulted in changes to the format of the programme from a standard sequential approach to a continual rolling approach. The aim of this study was to evaluate the effectiveness of this new approach on patient outcomes and its impact on attendance rates. METHOD A service evaluation, using a retrospective, observational cohort design, of all patients with NSLBP who attended the BRP during a 12-month period was undertaken. Outcome measures used were as follows: Bournemouth Questionnaire (BQ); fitness tests: sit to stand test, step test and walk test (taken at baseline and post programme); and attendance (taken post programme). RESULTS Of the patients, 56% had an improved BQ score ≥ 47%, indicating a clinically significant change. Inferential testing showed statistically significant improvements in the BQ and all three fitness tests post programme (P< 0.0001). In total, 62 patients attended the rolling BRP, and 41 patients (66%) completed. Thus, the percentage of patients completing the new programme had doubled compared with the original standard programme. CONCLUSION Patients with NSLBP who attended the continual rolling BRP show clinical and statistical improvements. The rolling format also appeared to enhance patient attendance. As such, the rolling BRP should be considered by practitioners as an effective management strategy when treating patients with NSLBP.

‘Oh my gosh I’m going to have to undress’: potential barriers to greater ethnic diversity in the physiotherapy profession in the United Kingdom

OBJECTIVE To explore the views and experiences of South Asian participants in relation to the potential barriers to increasing ethnic diversity of the physiotherapy profession. DESIGN A qualitative research design was utilised, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed and the data were analysed using thematic analysis. SETTING A venue of the participants own choosing in the North west of England. PARTICIPANTS FINDINGS From analysis of the data generated, three subthemes emerged in relation to the overarching theme; potential barriers: decreased knowledge of physiotherapy; issue of status; tension between cultures. CONCLUSIONS It appears that a lack of knowledge may impact negatively on BME potential students considering physiotherapy as a possible career. The status of the profession was found to be an important factor in career choice. However, a lack of knowledge led many to consider physiotherapy to be less prestigious than other healthcare professions. Finally, a lack of sensitivity with the information given during the selection process caused some participants anxiety and to question physiotherapy as a career choice. Due consideration should be given to these potential barriers to address the underrepresentation of BME groups in physiotherapy.

Systematic Review of Patient Perspectives and Quality of Life Outcomes Associated with Use of Topical Interventions for Treatment of Chronic Wounds

OBJECTIVES: Chronic wounds are wounds that do not heal as expected, or those borne of an underlying aetiology such as venous insufficiency or diabetes. These wounds can last a long time and affect a patient’s quality of life (QoL) over a period of months and years. This review examined the patient perspective and QoL burden of living with and treating a chronic wound using topical interventions. METHODS: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out. Databases searched included: Science Direct, NICE Evidence search, Medline (PubMed), Centre of Reviews and Dissemination (University of York), and the Cochrane Database, additional literature identified through discussion with experts and manufacturers. Data extraction was performed by a team of three researchers and conducted in 2 parts. 1) Qualitative studies examining patient perspectives were addressed using thematic analysis and, 2) Clinical trials that included a QoL endpoint measured with a standard tool were addressed using a narrative synthesis. A critical appraisal was performed using the Hawker tool for assessing qualitative studies. RESULTS: 3422 records identified. After initial screening of titles and abstracts, 817 full text articles were judged versus inclusion and exclusion criteria and 19 studies included (11 qualitative studies and 8 RCTs). Of the 11 qualitative studies, 5 assessed Venous Leg Ulcer (VLU) 2 examined Pressure Ulcers (PUs), 1 Diabetic foot Ulcers, and 3 investigated chronic wounds more broadly. Of the 8 RCTs included for data extraction, 6 assessed VLUs and 2 DFUs. CONCLUSIONS: Patients with chronic wounds incur a substantial QoL burden, presenting with pain, diminished mobility and a sense of ‘loss of self’. In addition to using standard measures, other qualitative methods identify important dimensions such as odour, exudate, pain, and social isolation.

Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management

OBJECTIVE Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. METHOD A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. RESULTS In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. CONCLUSION This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.

Clinical and economic evaluation of a Case Management Service for patients with back pain

AIM To evaluate the clinical-effectiveness and resource use associated with Case Management Services in a UK private sector DESIGN: An observational cohort study based on prospective data collection of patient reported outcome measures and data collection from an existing administrative health database. SETTING A United Kingdom (UK) private healthcare provider PARTICIPANTS: Consecutive referrals into the Case Management Service over a three-month period. INTERVENTIONS Participants were managed within the Case Management Service in accordance with usual pathways. MAIN OUTCOME MEASURES Outcome measures included EQ-5D-5L and PSFS. Measurements were taken at baseline, and repeated at the point at which the clients case was closed. The CARE measure examined patient reported experience. Cost Consequence analysis was completed using existing data for the same period of time in two separate years: 2014, two years after CMS implementation, and 2011, prior Case Management Service development RESULTS: There was a statistically significant improvement in quality of life (EQ-5D-5L p < 0.0001; EQ-VAS p < 0.001) and functional ability (p < 0.001) following the Physiotherapy Case Management. The CARE measure showed high levels of patient satisfaction with 96% of clients rating their individual case manager as good to excellent. The cost consequences analysis showed a cost reduction in therapy resource utilisation by £252 842 (from £10 772 875 to £10 520 034). CONCLUSIONS The Case Management Service showed the provision to be providing significant improvement in quality of life and functional outcomes within efficient use of resources, and service users are highly satisfied with their experience.

Newspaper response to the back pain myth busting advice - bruising but helpful

Following on from recent newspaper articles,1 BJSM podcasts2 and the Chartered Society of Physiotherapys recent Back Pain Myth buster campaign,3 a short article was published in the Daily Mail Online 4 in August of this year. The article summarised the messages of the back pain myth buster campaign and advocated basic evidence-based approaches to exercise and management. The article was accessed over 29 000 times with 125 reader comments being posted in the following 2 weeks. Having reviewed the comments, it became apparent that there were a number of themes within the data and thus a colleague and I undertook a thematic analysis of the comments …