Helen McBurney

Knee joint kinematics from familiarised treadmill walking can be generalised to overground walking in young unimpaired subjects

We studied the familiarisation time required for reliable sagittal-plane knee kinematics and temporal-distance gait measurements to be obtained from treadmill walking. We also studied whether knee kinematics and temporal-distance gait measurements obtained from familiarised treadmill walking can be generalised to overground walking. Sixteen subjects without pathology walked on a level overground walkway and on a treadmill. A motion measurement system was used to measure sagittal plane knee movements and temporal-distance gait parameters during overground and treadmill walking. Highly reliable knee kinematics and temporal-distance gait measurements [intraclass correlation coefficient (ICC)(2,1)>/=0.93] were found after 6 min of treadmill walking. These measurements, obtained after 6 min of treadmill walking, were highly correlated with and not significantly different to those of overground walking. Reliable measurements that can be generalised to overground walking, can be obtained from the treadmill within a familiarisation time of 6 min.

Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty

This study developed and validated an easily administered method of predicting a patients risk of needing extended inpatient rehabilitation after hip or knee arthroplasty. Seven factors generated by experts and from the literature were shown to be statistically significantly related to discharge destination (P</=.001). Factor weightings derived from a logistic regression equation and tested on the first 520 cases were used to devise a scoring method. This method was validated using a further 130 cases and the Risk Assessment and Predictor Tool (RAPT) was formulated. The RAPT identified 3 levels of risk of needing extended inpatient rehabilitation after hip or knee arthroplasty, with an accuracy rate of 89% for those most at risk.

Reliability of performance‐based measures in people awaiting joint replacement surgery of the hip or knee

BACKGROUND AND PURPOSE Understanding the reliability of selected measurement tools is a prerequisite to understanding the effects of clinical interventions. The aim of this investigation was to determine the reliability of the 50-Foot Timed Walk (50 FTW) and 30-second Chair Stand Test (30 CST) in subjects awaiting joint replacement surgery of the hip or knee. METHODS Eighty-two subjects participating in a 6-week exercise programme were assessed at baseline, 7 weeks and 15 weeks. Four trials of the 50 FTW and two trials of the 30 CST were completed at each assessment. Eleven trained assessors completed the assessments. RESULTS Intra-class correlations were consistently high for the 50 FTW and 30 CST at all assessments. At the baseline assessment, trial 1 was found to be significantly different from subsequent trials for both the 50 FTW and 30 CST. This effect was not evident at the 7-week and 15-week assessments. At the baseline assessment, scores for the 50 FTW became stable after the first trial. Estimates of minimum detectable change indicated that participants needed to change by more than 3.08 seconds and 1.64 stands to be 90% confident that a real change had occurred for the 50 FTW and 30 CST, respectively. CONCLUSION The 50 FTW and 30 CST can be reliable measures of physical performance. However, because we found a practice effect at the baseline assessment, a practice trial should be allowed before data collection begins. Because only two trials of the 30 CST were completed, further research is required to confirm whether scores at the initial assessment become stable on repeated testing.

Hospital stay and discharge outcomes after knee arthroplasty: implications for physiotherapy practice.

Patient outcomes at discharge from acute care after knee arthroplasty were investigated in a prospective observational outcome study at three Melbourne public acute care hospitals during a five-month period from November 1999 to March 2000. The participants were 105 consecutive patients (35 at each hospital), with a mean age of 71 years. Outcome measures were length of stay, destination (home or rehabilitation), knee range of movement, and functional mobility at discharge from the acute care facility. During the study period, mean hospital length of stay across the three hospitals was 6.5 days, more than 30% less than the Victorian average for the preceding year. In that time, 56% of patients had achieved functional independence sufficient for discharge directly home, however only 36% were actually discharged home. The reasons identified for discharge to rehabilitation despite the achievement of sufficient functional independence included pressure on clinicians to decrease length of stay and the need to make decisions regarding discharge early in the post-operative recovery when the eventual patient outcome may still be unclear. Unnecessary discharges to rehabilitation increase the overall length of stay in the health care system and costs per patient. This finding suggests a method of risk screening is required to assist clinical decision making with regard to discharge.

Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial

OBJECTIVE To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee. DESIGN Randomized, single-blind, before-after trial. SETTING Physiotherapy gymnasium and hydrotherapy pool. PARTICIPANTS Patients awaiting elective hip or knee joint replacement surgery. INTERVENTIONS Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment. MAIN OUTCOME MEASURES Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale. RESULTS Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes. CONCLUSIONS While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.

Workplace stressors experienced by physiotherapists working in regional public hospitals

OBJECTIVE To identify and measure the effects of workplace stressors experienced by Victorian regional physiotherapists. DESIGN Survey questionnaire. SETTING AND PARTICIPANTS A questionnaire was distributed to three Victorian regional public physiotherapy departments and data were collected from 80 physiotherapists. MAIN OUTCOME MEASURES The type and frequency of workplace stressors, the nature and frequency of common signs and symptoms of stress and the amount of leave taken as a result of stress were measured. RESULTS Caseload quantity, complexity of patients, constant excessive workload, covering staff on leave and staff shortages, were reported as key workplace stressors. Physiotherapists aged between 20 and 29 years were significantly more likely to report a higher number of workplace stressors (F = 4.173, n = 80, P = 0.009). Inpatient rehabilitation physiotherapists were significantly more likely to report stress at a higher frequency than physiotherapists working in other areas (chi(2) = 14.359, n = 73, P = 0.002). Eleven per cent of all respondents reported taking leave from work as a result of stress with no significant difference identified between those who took leave and those who did not. There was, however, a trend identified with senior staff (Z = 1.792, n = 80, P = 0.073) and those who work in inpatient rehabilitation (chi(2) = 6.926, n = 80, P = 0.074) being more likely to take leave as a result of stress. Many of these physiotherapists did not make their employers aware of the reasons for the leave (77%, n = 9). CONCLUSIONS High caseloads, periods of increased activity and staff shortages are some of the factors that contribute to stress in regional physiotherapists. Younger therapists were more likely to identify stressors with greater frequency. Strategies to monitor, prevent and manage stress should be implemented to minimise burnout in regional physiotherapists.

Community ambulation: Environmental impacts and assessment inadequacies

Background. Community ambulation is an important goal for both clients and health professionals yet it is an outcome only variously achieved by clients discharged from rehabilitation settings back into their community. Objective. To review the available literature about the assessment tools that are currently used to determine community ambulation status and to determine from an evaluation of these tools the effectiveness of the evaluation when compared to known environmental dimensions that impact on ambulation in the community. Method. A review of published papers from English language literature using CINAHL, ProQuest, Medline and other databases was conducted. Results. Only eight papers were found in the literature to inform health professionals about the impact of the environment on community ambulation. No current mobility assessment tools were identified that assess all the environmental demands that can impact on the activity of community ambulation. From the tools reviewed the most frequently evaluated environmental mobility dimensions were walking distance and time constraints. Conclusions. Health professionals need assessment tools that evaluate the impact of the environment on an individuals mobility in order to determine community ambulation status. The literature to date provides little guidance about the impact of the environment and current evaluation tools are limited in clinical usefulness with respect to the depth and breadth of information gained.

Community ambulation: Influences on therapists and clients reasoning and decision making

Background. Community ambulation is an important element of a rehabilitation training programme and its achievement is a goal shared by rehabilitation professionals and clients. The factors that influence a physiotherapists or health professionals decision making around the preparation of a client for community ambulation and the factors that influence a clients decision to return to walking in their community are unclear. Objective. To review the available literature about the factors that have influenced the reasoning and decision making of rehabilitation therapists and clients around the topic of ambulation in the community. Method. Three separate searches of the available literature were undertaken using Ovid, Cinahl, ProQuest, Medline and Ebscohost databases. Databases were searched from 1966 to October 2006.The first search explored the literature for factors that influence the clinical reasoning of rehabilitation therapists. The second search explored the literature for factors that influence clients decision to ambulate in the community. A third search was undertaken to explore the literature for the demands of community ambulation in rural communities. Results. Very few studies were found that explored community ambulation in the context of clinical reasoning and decision making, the facilitators and barriers to a clients return to ambulation in their community or the demands of ambulation in a rural community. Conclusion. Consideration of the environment is key to the successful return to walking in the community of clients with mobility problems yet little literature has been found to guide physiotherapists decision making about preparing a clients to return to walking in the community. An individuals participation in their society is also a result of the interaction between their personal characteristics and his or her environment. The influence of these characteristics may vary from one individual to another yet the factors that influence a persons decision to return to walking in their community after stroke remain unclear.