Martin Mackey

Patient Satisfaction With Musculoskeletal Physical Therapy Care: A Systematic Review

Background Patient satisfaction is an important patient-centered health outcome. To date, no systematic review of the literature on patient satisfaction with musculoskeletal physical therapy care has been conducted. Purpose The purpose of this study was to systematically and critically review the literature to determine the degree of patient satisfaction with musculoskeletal physical therapy care and factors associated with satisfaction. Data Sources The databases CINAHL, MEDLINE, and EBM Reviews were searched from inception to September 2009. Study Selection Articles were included if the design was a clinical trial, observational study, survey, or qualitative study; patient satisfaction was evaluated; and the study related to the delivery of musculoskeletal physical therapy services conducted in an outpatient setting. The search located 3,790 citations. Fifteen studies met the inclusion criteria. Data Extraction Two authors extracted patient satisfaction data and details of each study. Data Synthesis A meta-analysis of patient satisfaction data from 7 studies was conducted. The pooled estimate of patient satisfaction was 4.44 (95% confidence interval=4.41–4.46) on a scale of 1 to 5, where 5 indicates high satisfaction and 1 indicates high dissatisfaction. Additional data were summarized in tables and critically appraised. Limitations Nonrespondent bias from individual studies may affect the accuracy and representativeness of these data. Conclusion Patients are highly satisfied with musculoskeletal physical therapy care delivered across outpatient settings in northern Europe, North America, the United Kingdom, and Ireland. The interpersonal attributes of the therapist and the process of care are key determinants of patient satisfaction. An unexpected finding was that treatment outcome was infrequently and inconsistently associated with patient satisfaction. Physical therapists can enhance the quality of patient-centered care by understanding and optimizing these determinants of patient satisfaction.

Relationship between field walking tests and incremental cycle ergometry in COPD

Background and objective:  Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD. However, incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians. The aims of the study were to (i) investigate the physiological and psychophysical responses to the 6‐min walk test (6MWT), incremental shuttle walk test (ISWT) and cycle ergometer test (CET); and (ii) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer.

Seeking the optimal posture of the seated lumbar spine

Prolonged sitting with poor posture is associated with the development of lower back pain. Ergonomic texts for physiotherapists contain diverging and confusing views on recommended postures for the lumbar spine when seated that will promote postural health and optimal functioning of the lumbar spine. A review of the literature reveals that proponents of both the lordosed and kyphosed lumbar seated position use similar arguments with contradictory conclusions. The arguments of those advocating the kyphosed lumbar seated posture are, however, often anecdotal and unsubstantiated by research. This paper evaluates the confl icting views and concludes that the lordosed seated posture, regularly interspersed with movement, is the optimal sitting posture and assists in maintaining lumbar postural health and preventing low back pain.

The Impact of a Computerized Work Environment on Professional Occupational Groups and Behavioural and Physiological Risk Factors for Musculoskeletal Symptoms: A Literature Review

Introduction Computers have become an essential tool for many office based professional occupations, but their use is also accompanied by change to work demands and psychosocial work environment. Whilst considerable research exists relating to the potential health risks associated with computer work amongst semi-skilled occupations, there is a paucity of knowledge regarding the impact of an increasingly computerized workplace on the physical and psychological wellbeing of professional occupations. Methods A literature search was conducted using OVID Medline, PsycINFO and Cinahl databases. Papers published between 1980 and 2007 were selected for review. These included epidemiological and experimental studies that explored the relationships among occupational demands and stressors, work behaviours and musculoskeletal health in workers operating in a computerized work environment. Results In response to workload, deadline and performance monitoring pressures, many professional workers are often encouraged to perform long hours of computer work with high mental demands; work at a hectic workpace resulting in heightened muscle tension and forces, and with inadequate work breaks. These factors were identified in this review as risk factors for work related musculoskeletal symptoms. Conclusion As new technology continues to computerise the way professionals do their work, it is important for organizations to identify and measure the risks to health and wellbeing associated with these changes. Further research with professional groups is needed to support effective risk management decisions.

Kyphosed Seated Postures: Extending Concepts of Postural Health Beyond the Office

Introduction The harmful effects of sustained sitting and the health of the spine are well documented. The focus of much of this investigation has been sedentary occupations. However, how people sit during leisure hours can impact on the health of the spine both in and out of working hours. Methods A literature search was conducted using Amed, Cinahl and OVID Medline databases. Papers published between 1985 and 2007 were selected for review. These included epidemiological and experimental studies that explored the relationships between seated postures and health of the lumbar spine. Until recently there was confusion in the scientific literature as to which seated postures were least harmful: lordosed or kyphosed. This article reviews and analyses these conflicts in relation to leisure sitting. Results Analysis of the literature demonstrates that kyphosed seated postures when sustained are more harmful to the health of the lumbar spine than lordosed seated postures. There is a misconception amongst designers and users of leisure seating that kyphosed relaxed postures are comfortable and that comfort equates with health. It is argued that sustained kyphosed postures are insidiously harmful to the spine in that they may contribute to disc degeneration in the absence of pain. Sustained kyphosed postures also adversely affect spinal ligaments, muscles and joints and lead to neuromuscular and cumulative trauma disorders and loss of spinal stability. Conclusion Recent research demonstrates that postures popularly assumed in recreational or leisure seating lead to cumulative damage to soft tissues of the spine. These effects may still be present at the commencement of the following work day. In the prevention of work disability caused by sustained sitting, health professionals must consider the impact of leisure seating design and recreational sitting behaviour.

Hip and knee pain: Role of occupational factors

Many people rely economically on occupations involving high loading of the hip or knee joints for lengthy periods, possibly placing them at increased risk of developing chronic pain in these joints. There is a growing body of evidence from large longitudinal cohort studies, case-control studies and population-based surveys that certain occupations, or having work involving considerable heavy lifting, kneeling or squatting, may be associated with increased risk of symptomatic hip or knee osteoarthritis and joint replacement surgery. Only a few studies have evaluated the effectiveness of specific workplace strategies to reduce this risk. Identifying modifiable workplace risk factors and implementing feasible and accessible preventative strategies will be of great public health significance in the next decade.

Prevalence and risk factors for musculoskeletal symptoms with computer based work across occupations.

OBJECTIVES The purpose of this study was to compare the 12-month prevalence of musculoskeletal symptoms and risk factors associated with computer based work between occupations in a sample of Australian public sector employees. METHOD A cross-sectional study was completed with employees of 6 government departments. An online survey was electronically distributed to over 8,000 employees characterised by a range of occupational groups and levels of employment. Data collected included individual and employment characteristics, estimation of hours worked with a computer per day and self-reported musculoskeletal symptoms in the upper extremity and spinal areas using the Nordic Musculoskeletal Questionnaire. RESULTS Responses from 934 completed surveys could be used. There was no significant difference in the prevalence of reported musculoskeletal symptoms between occupational groups except for the wrist/hand and elbow areas. Estimated duration of computer work per day was significantly associated with increased musculoskeletal symptoms in the neck (OR 1.41, 95%CI: 1.09 to 1.83), wrist/hand/s (OR 1.46, 95%CI: 1.17 to 1.83) and elbow/s (OR 1.41, 95%CI: 1.07 to 1.85) areas, with the finding of a linear relationship between hours worked and prevalence of symptoms. A greater proportion of employees in higher level management and professional occupational groups were found to be working with a computer in excess of 6 to 8 hours per day compared with those in non-professional (administration and secretarial) groups. CONCLUSION Hours worked with a computer per day was a significant risk factor for reported musculoskeletal symptoms amongst all occupational groups working in Australian public sector offices. No significant difference in the level of risk was found between occupations.

Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2.

OBJECTIVE Knee range of motion (ROM) at discharge from acute care is used as a clinical indicator following total knee replacement (TKR) surgery. This study aimed to assess the clinical relevance of this indicator by determining whether discharge knee ROM predicts longer-term knee ROM and patient-reported knee pain and function. METHODS A total of 176 TKR recipients were prospectively followed after discharge from acute care. Outcomes assessed included knee ROM and Oxford knee score post rehabilitation and 1 year post surgery. Discharge ROM and other patient factors were identified a priori as potential predictors in multiple linear regression modelling. RESULTS A total of 133 (76%) and 141 (80%) patients were available for follow-up post rehabilitation [mean postoperative week 8.1 (SD 2.7)] and at 1 year [mean postoperative month 12.1 (SD 1.4)], respectively. Greater discharge knee flexion was a significant (P < 0.001) predictor of greater post-rehabilitation flexion but not 1-year knee flexion (P < 0.083). Better discharge knee extension was a significant predictor of better post-rehabilitation (P = 0.001) and 1-year knee extension (P = 0.013). Preoperative Oxford score and post-rehabilitation knee flexion independently predicted post-rehabilitation Oxford score, and gender predicted 1-year Oxford score. Discharge ROM did not significantly predict Oxford score in either model. CONCLUSION The finding that early knee range predicts longer-term range provides clinical evidence favouring the relevance of discharge knee ROM as a clinical indicator. Although longer-term patient-reported knee pain and function were not directly associated with discharge knee ROM, they were associated with ROM when measured concurrently in the sub-acute phase. No causal effect has been demonstrated, but the findings suggest it may be important for physiotherapists to maximize range in the early and sub-acute periods.

Prescription of walking exercise intensity from the incremental shuttle walk test in people with chronic obstructive pulmonary disease.

ObjectiveThis study determined the intensity of walking exercise prescribed from 70% of peak speed achieved during the incremental shuttle walk test (ISWT) in people with chronic obstructive pulmonary disease and whether a steady-state response was achieved when exercising at this intensity. DesignEach participant performed lung function tests, an incremental cycle test, two ISWTs, and a 10-min continuous walking exercise at 70% peak ISWT speed. Oxygen consumption (V˙O2) was collected using a portable system (Cosmed K4b2, Rome, Italy). The V˙O2 from the 10-min walking exercise was compared with V˙O2peak from the better ISWT as a measure of walking exercise intensity. ResultsThirty-four participants completed the study. The mean intensity achieved during the 10-min walking exercise was 76% (11%) V˙O2peak. Steady-state V˙O2 was achieved by minute 5 in the 10-min walking exercise. ConclusionsPrescription of walking exercise at 70% of the peak ISWT speed provided an intensity appropriate for achieving physiologic training responses.

Study protocol: the effects of work-site exercise on the physical fitness and work-ability of older workers

BackgroundOlder workers have a higher rate and cost of injury than younger workers and with a rapidly ageing work force there is a need to identify strategies to address this problem. Older workers are less physically active and fit than younger workers and so have reduced work ability. The reduced work ability means they are more likely to be fatigued at work and so at greater risk of injury. Exercise could potentially assist this problem. Exercise training has been previously shown to improve fitness in older people however there has been no evaluation of workplace exercise program for older workers. We do not know if the programs are feasible and can improve the fitness and work ability of older workers. We have designed a randomised controlled trial to evaluate whether exercise improves fitness and perceived work-ability of older workers.Methods/DesignThis paper describes the protocol for a trial examining the effects of a 12-week physical training program in workers over the age of 45. Participants will be randomized to an exercise or no-intervention control group. The primary outcomes are cardiorespiratory endurance, lifting capacity, upper and lower limb strength and perceived work-ability.DiscussionThis trial will test the feasibility of implementing a worksite-based exercise program as a means of improving the physical fitness and work-ability of older workers performing physically demanding work. If we demonstrate the feasibility of the program we will conduct a larger trial that additionally measures injury outcomes.