Peter Larmer

Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review

Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a “pattern of evidence” approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single-dimensional or multi-dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence-based guidelines applicable to a number of industrial sectors.

Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire

The aim of this study was to determine the responsiveness, Minimal Important Difference (MID) and Minimal Detectable Change (MDC) scores of the shortened Disability Arm Shoulder Hand (QuickDASH) questionnaire. Participants (n = 35) were recruited from private physiotherapy practices. Participants completed the QuickDASH questionnaire on two occasions; the first prior to treatment and the second at discharge or at six weeks post baseline, whichever event occurred first. The participants also completed a Global Change in Status Questionnaire (GSCQ). Responsiveness across treatment to discharge or at six weeks post initial visit was analysed by calculating the Effect Size (ES) and Standardised Response Mean (SRM). The MID was calculated using an anchor based approach and the MDC score was based upon calculations of the standard error of measurement (SEM). The results indicated that responsiveness was high (ES = 1.02, SRM = 1.1). The MID was 19 points while the MDC was 11 points. These results provide evidence that the QuickDASH is a responsive instrument when utilised in patients seen in private practice over a typical treatment interval.

Ankle sprains: patient perceptions of function and performance of physical tasks. A mixed methods approach.

Purpose. To investigate patients perceptions of function and performance of physical tasks after discharge from treatment for an ankle sprain. Methods. Using a mixed methods approach, 40 participants who presented with an acute sprained ankle and their treating clinicians completed two questionnaires related to function at the start and end of a rehabilitation programme. Additionally, participants completed the questionnaires at 6 weeks following discharge at which time they also performed physical tasks that were still perceived as difficult. Ten participants also completed a semi-structured interview. Results. There were no significant differences (p  >  0.05) in the participants and clinicians initial assessment of function. However, at discharge participants scored their function significantly (p  <  0.05) lower than clinicians. This difference was not apparent 6 weeks later (p  >  0.05). However, there was a significant difference (p   <  0.05) following actual performance of tasks with an effect size of 1.58. Participant interviews confirmed that patients had a fear of re-injury until they actually performed tasks that were perceived as difficult. Conclusions. Clinicians and participants do not have a similar perception of the recovery of an ankle sprain at discharge. Performing tasks which were perceived as difficult were valuable in assisting participants gain an improved appreciation of their function.

Insights from a physiotherapist's lived experience of osteoarthritis

Osteoarthritis (OA) of a hip joint, with subsequent total hip joint replacement surgery, is portrayed in the literature in terms of quantitative research studies, where the person living with the hip disappears in objective statistical analyses, or in qualitative studies where one persons story is fragmented within thematic findings. This phenomenological study of a physiotherapists (Peter) lived experience of OA offers insights relevant to practice. In the initial stages of the disease, Peter was too close to ‘see’ the possibility of OA as a diagnosis. As the pain limited what he could do, he needed to reinvent ways of retaining his sense of ‘self’. The pain worsened; there was nothing that relieved it. The experience became one of endurance, leading to a moment when he decided the time had come to have surgery. Post-surgery, the journey of recovery was one of the feelings vulnerable. He wanted guidance and re-assurance. Paradoxically, recovery showed itself as ‘forgetting’ the body. The insights call for therapists to listen to the experience of clients and be alongside side them as they struggle with vulnerability. Sharing an understanding of the nature of the experience can bring confidence to clients.

Western acupuncture education for New Zealand physiotherapists

Abstract Early acupuncture training programmes in New Zealand were vocationally directed with a focus on the acquisition of clinical skills. Contemporary education has seen the move to postgraduate university-based programmes. Postgraduate Certificate in Acupuncture programmes are available to physiotherapists at two New Zealand universities, Auckland University of Technology and the University of Otago. The rationale for university-based education and the educational philosophies of the two programmes are presented. Tensions with respect to New Zealand acupuncture guidelines and short-course education practices are discussed. The necessity and advantages of university-led acupuncture education programmes are argued. The importance of evidence-based practice in today’s health environment requires practitioners to have a thorough knowledge and understanding of current research. This will ensure that acupuncture remains a ‘tool in the toolbox’ for physiotherapists.

Use of a functional mobility measure to predict discharge destinations for patients admitted to an older adult rehabilitation ward: A feasibility study

To investigate whether the discharge destination for older adults can be predicted using functional mobility as measured by the Modified Elderly Mobility Scale (MEMS), associated with demographic and primary reason for admission variables.

Loneliness in Men 60 Years and Over: The Association With Purpose in Life:

Loneliness as a consequence of getting older negatively impacts on the health and well-being of men as they age. Having a purpose in life may mitigate loneliness and therefore positively impact on health and well-being. Limited research into loneliness and purpose in life has been undertaken in older men. This study seeks to understand the relationship between loneliness and purpose in life in a group of older men. Using data from a cross-sectional survey of 614 men aged 60 years and over living in New Zealand, bivariate and multivariate analyses were undertaken to examine the relationship between loneliness and purpose in life using a range of demographic, health, and social connection variables. Bivariate analysis revealed that being unpartnered and having low socioeconomic status, limited social networks, low levels of participation, and mental health issues were associated with loneliness. Multivariate analysis showed that having poor mental health and lower purpose in life were indicators of loneliness. Consequently, improving mental health and purpose in life are likely to reduce loneliness in at-risk older men. As older men are a heterogeneous group from a variety of sociocultural and ethnic backgrounds, a multidimensional approach to any intervention initiatives needs to occur.

Learning to Think in the Corporate University: Developing a Doctorate for Practice

Over the past few decades, health professional education in disciplines such as our own (midwifery, nursing, and physiotherapy) has shifted from an apprenticeship-based, learning-on-the-job experience to become fully integrated in the university. This has impacted not only on students who find themselves having to write theoretical assignments to rigorous academic standards, but also on those who teach them, for whom the measures of success (and in some cases, the criteria for remaining in employment) now focus largely on research outcomes rather than the quality of their educational practice. At the same time, universities have implemented the corporate business model in response to a variety of internal and external pressures to make money and to meet the demands of students who attend universities primarily as an investment in a future career. Indeed, it could be argued that university education is becoming a financial transaction in which money (course fees) is exchanged for a degree certificate, which is then redeemed in the workplace for a graduate-level salary (Rolfe, 2013).