Lucy Chipchase

Do early quadriceps exercises affect the outcome of ACL reconstruction? A randomised controlled trial

A prospective, blinded, randomised controlled trial investigated the effectiveness of quadriceps exercises following anterior cruciate ligament reconstruction. A treatment group (Quadriceps exercise group) performed straight leg raises and isometric quadriceps contractions throughout the first two postoperative weeks, and a second group (No quadriceps exercise group) did not. A battery of outcome measures assessed subjects postoperatively at day one, two weeks, and one, three and six months. A total of 103 patients (Quadriceps exercise n = 48, No quadriceps exercise n = 55) commenced the study with 91 subjects available at final follow up (Quadriceps exercise n = 47, No quadriceps exercise n = 44). Performance of quadriceps exercises significantly improved a number of knee flexion and extension range of motion measurements (p = 0.01 to 0.04). No significant differences were found between the two groups at any postoperative period for quadriceps lag (p = 0.36), functional hop testing (p = 0.49 to 0.51), isokinetic quadriceps strength (p = 0.70 to 0.72), the majority of numerical analogue scores (p = 0.1 to 0.94) and Cincinnati scores (p = 0.10 to 0.84). Subjects performing quadriceps exercises reported significantly higher pain scores with exercise on the first postoperative day (p = 0.02). At six months postoperatively, the Quadriceps exercise subjects reported significantly more favourable Cincinnati scores for symptoms (p = 0.005) and problems with sport (p = 0.05). While average knee laxity was not significantly different between treatment groups over time (p = 0.27 to 0.94), quadriceps exercise performance was associated with a significantly lower incidence of abnormal knee laxity. Isometric quadriceps exercises and straight leg raises can be safely prescribed during the first two postoperative weeks and confer advantages for faster recovery of knee range of motion and stability. It remains to be proven whether the magnitude of differences between groups is clinically significant.

The effect of low-Dye taping on peak plantar pressures of normal feet during gait

This study investigated whether low-Dye anti-pronation taping altered peak plantar pressures of normal feet during gait. The Emed-AT-2 platform system was used to measure peak plantar pressures. Forty subjects performed two sets of six walks over the Emed-AT-2 forceplate. One set of walks was performed barefoot whilst the other set was performed with the low-Dye tape applied to the right foot. Computer software divided the heel, midfoot and forefoot into six areas (masks) for analysis. The mean for the peak plantar pressures (N/cm(2)) of each of these masks was determined for both sets of walks. Paired t-tests found a significant difference between the barefoot and taped peak plantar pressures in each of the six masks. Overall low-Dye anti-pronation taping significantly altered the peak plantar pressures of normal feet during gait. Of particular interest was that a significant reduction in mean peak plantar pressure was observed in the medial midfoot (1.4 N/cm(2)) whilst a significant increase occurred in the lateral midfoot (2.6 N/cm(2)).

Looking back at 100 years of physiotherapy education in Australia

The authors provide a brief overview of the major landmarks in physiotherapy education and celebrate some of the visionary physiotherapy leaders who have made a significant contribution to physiotherapy education in Australia. (non-author abstract)

Is education immune from evidence-based scrutiny?

Evidence-based practice appears to be well established in our profession. However, the main focus of evidence-based practice has been in the clinical and research realms; with clinicians and researchers often bearing the brunt of criticism concerning the lack of evidence supporting physiotherapy management practices. In the move towards global evidence-based practice, very little attention has been given to the practices of physiotherapy education programs in Australia. If universities and physiotherapy educators are put under the same evidence-based practice spotlight, how well do their educational programs and curricula rate? How defensible are their teaching and learning practices?

Therapeutic Ultrasound: Clinician Usage and Perception of Efficacy

A mailed questionnaire, employing both open- and closed-ended questions, was distributed to all members of the Australian Physiotherapy Association (South Australian branch) registering an interest in the musculoskeletal field. Questions were asked regarding the usage and perception of the effectiveness of therapeutic ultrasound. A response rate of 55% was achieved, with a total of 210 questionnaires available for statistical analysis. The results demonstrated that ultrasound is frequently used as an electrotherapy modality by South Australian musculoskeletal physiotherapists. Most physiotherapists perceived ultrasound to be effective in treating localized, superficial conditions, especially when used in conjunction with other treatment techniques and at suitable dosages. However, ultrasound was thought to be most effective in producing a placebo effect. These findings suggest that ultrasound is perceived as an effective treatment tool when applied appropriately. Its placebo quality may contribute to its effectiveness. Further scientific research is warranted to confirm the results. Randomized controlled trials investigating ultrasounds usefulness for muscle strains, scar tissue, bursitis and tendinitis are indicated. The results of this study will be useful for educators and researchers, and suggest that more research into ultrasound applied as part of a treatment package is needed.

The analgesic effect of interferential therapy on clinical and experimentally induced pain

Abstract Background: Interferential therapy (IFT) is one of the most popular modalities used by physiotherapists for the management and control of pain. Despite its widespread use, there remains debate surrounding its effectiveness. Objectives: The aim of this systematic review was to evaluate the published literature on the effectiveness of IFT in reducing pain. Method: A literature search of Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and Physiotherapy Evidence Based (PEDro) was performed. This review adhered only to randomised controlled trials (RCTs) that investigated IFT in the presence of a control group. PEDro scale was used to assess the methodological quality of the included studies. Results: Nine RCTs met the inclusion criteria of this review. One study evaluated the effect of IFT on clinical pain while remaining studies examined induced pain including thermal (cold and hot), ischemic, mechanical, and delayed onset of muscle soreness. No clear conclusion was withdrawn regarding the effectiveness of IFT on pain management due to the high variability in study design and deficiencies in methodological quality. The data were limited and contradicting and therefore, of equivocal support to the pain reduction effect of IFT. Conclusion: There is inadequate evidence to support the effectiveness of IFT in pain management. Clearly, there is a need for RCTs with high methodological quality to establish IFT efficacy.

A framework for determining curricular content of entry level physiotherapy programmes: electrophysical agents as a case study

Abstract Electrophysical agents have been a core part of physiotherapy practice since the establishment of the profession. However, significant changes in the health arena over the last 20 years have challenged the place of electrophysical agents as a core aspect of physiotherapy practice. The development of manual techniques and a greater focus on exercise therapies and evidence based practice have led to a shift in the way physiotherapists view and use electrophysical agents. At the same time, the types and complexity of electrophysical equipment has increased considerably. These changes create difficulties in determining which electrophysical agents should be included in entry level physiotherapy curricula. Using electrophysical agents as an example, this paper presents the challenges facing the profession in terms of what and how decisions concerning entry-level physiotherapy curricula may be made. A framework for integrating both clinical practice trends and research evidence is presented as a means for determining entry level physiotherapy curricula in the next ten years.

Physiotherapy education in a digital era: blending and flipping

The face of university education is changing. Access to the Internet and the rapid development of communication and mobile technologies mean academics are now able to design curricula that have the potential to dramatically alter the way physiotherapy education is provided. In particular, there is the potential that a large portion of entry-level physiotherapy education could be provided remotely with students’ no longer require to attend campus. A number of learning innovations make this a distinct possibility. Blended learning is the combination of online (synchronous and asynchronous) and face-to-face engagement to support and enhance learning through active approaches and interaction between students, teachers and resources. In the simplest form, blended learning uses web-based university learning management systems (e.g. Blackboard) to provide course materials. However, a growing proportion of faceto-face activities can now be enhanced with mobile and video technologies. For example, complementary blended learning programs, using web-based videos and on-line resources, have been shown to be effective for the acquisition of palpation skills and neurological observational and analytical skills. The use of educational and mobile technologies is also an important feature of, what has been termed, the ‘flipped classroom’. The flipped classroom is an inversion of traditional teaching where students attend didactic lectures or practical sessions and then are required to complete assignments tasks following the lectures. In the flipped classroom, students gain exposure to material outside the class, usually by reading prepared material or watching short pre-recorded lecture videos, with class time used to assimilate knowledge through strategies such as problem solving, discussion or debate. Anecdotally, the flipped classroom is being used increasingly for the teaching of practical physiotherapeutic skills. For example, highresolution videos of practical skills with instructions can be made available to students prior to a practical class. This allows practical class time to be reserved for feedback on the skill rather than a proportion of the class being taken up by demonstration. Thus, in the flipped practical class, physiotherapy educators spend less time demonstrating, more time interacting with students, and more time supporting rather than driving learning. While research into blended learning and the flipped classroom in physiotherapy and other health professionals is in its infancy, there are implications of these pedagogical approaches. First, there may be a tendency to believe that if material is provided online then, much like a didactic lecture, students have gained ‘knowledge’. Blended learning and flipped classrooms are more than a simple alteration of the method by which information is imparted. To ensure that students gain the most from these approaches, students require authentic learning spaces where they can work collaboratively with teaching staff to achieve deeper understanding. The value of a flipped class is in the repurposing of class time where students can inquire about lecture content, test their skills in applying the knowledge or clinical skills, and interact with one another in hands-on activities. This will require that physiotherapy educators reconceptualise their teaching approaches to function more as a coach or facilitator, encouraging students in individual inquiry and collaborative effort. Second, these new approaches and the available technology create numerous opportunities for sharing of educational resources. This is evidenced by one of the early proponents of the flipped classroom. Salman Khan, a hedge funds manager with degrees in Maths and Science, created a free stock of over 4,000 videos covering everything from basic algebra to chemistry. These videos, originally posted on YouTube for his cousins, grew in popularity with school students such that he created the Kahn Academy (https://www.khanacademy.org/). The Kahn Academy is a substantial not for profit online resource, available to teachers and students alike. This story raises the possibility that physiotherapy entry-level teaching material could be shared across state and national borders. There is no doubt that physiotherapy academics are designing and developing videos of clinical

The effectiveness of real time ultrasound as a biofeedback tool for muscle retraining

Abstract Background: Real time ultrasound (RTUS) is being used by physiotherapists as a tool for enhancing biofeedback. Aim: The aim of this systematic review was to summarise and evaluate the available literature on the effectiveness of RTUS as a biofeedback tool for muscle retraining. Method: A systematic review of the literature was performed to identify primary research examining the effect of RTUS muscle retraining. Studies were ranked according to the National Health and Medical Research Council hierarchy of evidence. The methodological quality of the randomised controlled trials was systematically assessed using the PEDro rating scale while a modified tool for case series studies was used. Results: Three RCTs, one case series and one case study were included. The methodological quality of the five studies was average to good, ranging from 55 to 82%. The studies used abdominal, multifidus and pelvic floor muscles to demonstrate the effects of RTUS biofeedback. The results varied depending on the purpose of the tool and the muscles re-trained. The effectiveness of RTUS as a teaching tool is moderate for multifidus, modest for abdominal muscles and weak for pelvic floor muscles. There was a paucity of available literature on the long term retention of muscle control following use of RTUS as a biofeedback tool. Conclusion: While research in this field is limited in quantity at the current time, the results warrant further investigation. However, future researchers must make an effort to ensure that their study design is of the highest quality and also demonstrate the long term effects of using RTUS to enhance muscle retraining.

Teaching Filipino physiotherapists on-shore: an Australian-Filipino collaborative postgraduate health education initiative.

INTRODUCTION This paper outlines a collaborative, cross-national educational initiative, commenced in 2001, in which an Australian university provided clinical and research education assistance to a Filipino University. The aim was to establish the first Filipino Master of Science in Physical Therapy program that would train physiotherapists in their home country using best available content and teaching expertise. PROCESS Principles of quality transnational education underpinned the program design and contractual agreements. Australian educational input was tailored to local constraints to ensure efficient and effective delivery of high quality, relevant material. Approximately 60% of the inaugural program was delivered by Australian educators in one-week intensive courses on-shore in the Philippines, using local facilities and case-scenarios. Follow-up support and evaluation were provided by video, email, written workbooks and assignments once these educators returned to Australia. Filipino graduates, who were competent with course content, taught the remaining subjects. In line with an aim of empowering Filipino graduates to assume responsibility for teaching all aspects of the program by 2006, the Australian educators are now teaching less than 25% of the course content to subsequent student cohorts. After 2006, they will provide mentorship only to the program. RESULTS In 2003, 12 students in the first cohort graduated with Master of Science in Physical Therapy from the University of Santo Tomas (UST). Twenty-four students subsequently enrolled in the second cohort (commenced 2003) and 21 students into the third cohort (commenced 2004). Six of the inaugural graduate cohort are currently acting as tutors for the Australian educators and will assume full teaching roles in 2006. Comparison of feedback from student evaluations at UST indicates significant improvements in teaching quality for the graduates from the inaugural program. Research activity and publications have also increased as a result of completion of the program. DISCUSSION Such a cross-institutional, cross-national program has not been described previously for physiotherapy, and no other similar health program (for nursing) evaluated the educational processes in the manner used in this program. The program met its aims and has produced sustainable educational outcomes and outputs. CONCLUSION Future scholarly activities between the two institutions include extension of postgraduate training to other health disciplines, cross-institutional PhD student enrollments and collaborative research.