Ruth Grant

Acute lobar atelectasis: A comparison of five physiotherapy regimens

Thirty-five patients with acute lobar atelectasis were allocated to one of five treatment groups (seven patients per group). Intubated patients received manual hyperinflation and suction with or without the addition of postural drainage or modified postural drainage and chest wall vibrations. For the non-intubated patients, deep breathing, coughing and huffing replaced the techniques of manual hyperinflation and suction. Frequency of treatment ranged from hourly for 6 h for four groups, to one treatment only for the fifth group. The results suggest that modified postural drainage is an effective additional component to manual hyperinflation and suction performed hourly for 6 h. The addition of chest wall vibrations to this treatment regimen did not further enhance the response to treatment, nor did the use of traditional postural drainage positions. There was evidence that hourly treatment for 6 h using modified postural drainage, manual hyperinflation and suction was more effective than one treatment only.

Physiotherapy for female stress urinary incontinence: a multicentre observational study

Background: No previous data are available on the effectiveness of physiotherapy management of urinary stress incontinence with relevance to the Australian health system.

Physical Therapy of the Cervical and Thoracic Spine (Clinics in Physical Therapy)

I. Anatomy, Biomechanics, and Innervation Functional and Applied Anatomy of the Cervical Spine. Biomechanics of the Cervical Spine. Biomechanics of the Thorax. Innervation and Pain Patterns of the Cervical Spine. Innervation and Pain Patterns of the Thoracic Spine. II. Examination and Assessment Clinical Reasoning in Orthopedic Manual Therapy. Examination of the Cervical and Thoracic Spine. Premanipulative Testing of the Cervical Spine-Reappraisal and Update. Combined Movements of the Cervical Spine in Examination and Treatment. Muscles and Motor Control in Cervicogenic Disorders. Upper Limb Neurodynamic Test: Clinical Use in a Big Picture Framework. III. Clinical Management Manual Therapy Techniques Applied to the Cervical Spine. Management of Cervical Headache. Management of Selected Cervical Syndromes. The Sympathetic Nervous System and Pain: A Reappraisal. Manual Therapy for the Thorax. Movement Impairment. Syndromes of the Thoracic and Cervical Spine. Mechanical Diagnosis and Therapy for the Cervical and Thoracic Spine. Neck and Upper Extremity Pain in the Workplace. Efficacy of Manual Therapy in the Treatment of Neck Pain. Reflection on the Changing. Nature of Professional Practice. Index.

Australian physiotherapy student intake is increasing and attrition remains lower than the university average: a demographic study

QUESTIONS Have student numbers (ie, intake and attrition) changed since the introduction of graduate entry-level physiotherapy courses in Australian universities? What is the impact of any changes in student numbers on university funding? What is the impact of any changes in student numbers on the workforce? Have student characteristics (ie, gender, country of origin, background) changed? DESIGN Demographic study of 2003 graduates, 2004 student intake, and estimated 2007 student intake. PARTICIPANTS Eleven Schools of Physiotherapy in Australia. RESULTS In 2003, 836 new physiotherapists graduated, and in 2004, 1108 students commenced with the percentage of graduate-entry Masters and international students increasing. Compared to the overall average 25% attrition rate of students from university, the rate for physiotherapy students was less than 5%; the funding formula thus underestimates physiotherapy student numbers across the years of the courses. While it remains the case that in undergraduate and graduate-entry programs most physiotherapy students are female, a greater proportion of males are entering graduate-entry Masters programs than undergraduate courses. International student numbers are increasing in line with trends across the sector, but representation of Aboriginal and Torres Strait Islander students in physiotherapy courses was lower than within universities generally. CONCLUSIONS The marked overall increase in student numbers and greater retention rate in the graduate entry-level courses puts physiotherapy at a disadvantage in relation to Department of Education, Science and Training student funding. While the substantial increase in new physiotherapists may serve to ease workforce demands in the short term, significant pressure on physiotherapy academics and clinical educators was evident.

Are breathing and coughing exercises necessary after coronary artery surgery

To investigate whether the incidence of post-operative pulmonary complications was significantly higher in a control group compared with treatment groups receiving prophylactic chest physiotherapy after coronary artery surgery, 120 patients completed a randomised controlled study. The patients in group 1 (n = 40) received no pre- or post-operative chest physiotherapy. The patients in group 2 (n = 40) were seen pre-operatively for education and instruction in breathing and coughing exercises and post-operatively received supervision and assistance from a physiotherapist in performing these exercises. The frequency of chest physiotherapy was twice per day on the first two post-operative days and once per day on the third and fourth post-operative days. The patients in group 3 (n = 40) received the same chest physiotherapy as those in group 2 except that the frequency was increased to four times per day on the first two post-operative days and twice per day on the third and fourth post-operative days. The pa...

Obsolescence or Lifelong Education: Choices and Challenges

Summary Estimates of the half-life of professional knowledge and competence, and the way in which they have been derived, are explained. It is clear that we may quickly become professionally obsolescent in these repects after graduation. Mandatory continuing education has been recommended as the answer to professional obsolescence but what evidence have we that this is so? Indeed, how successful is continuing education per se in combating professional obsolescence? There is a need to change the emphasis in continuing education, from one where nearly all available energy is spent by professional associations on the evaluation of inputs, to an evaluation of outputs. For example, does a change in professional practice occur as a result of a continuing education programme? Initial professional education and the development of skills which facilitate lifelong learning are considered in an attempt to answer the question: ‘Can we develop active learners for life?’

The Pursuit of Excellence in the Face of Constant Change

Summary Paradigms or patterns of practice which function well in a tranquil period may cease to do so if the world around the professional activity changes. A first step in the pursuit of excellence particularly in changing times, is to know who we are, to agree on collective and individual paradigms. Much physiotherapy research continues to focus upon improvement in impairments, rather than health related quality of life outcomes in evaluating efficacy of physiotherapy interventions.

Continuing education - does it make for a more competent practitioner?

It is more than two decades since mandatory continuing education (MCE) was introduced in the United States and barely a decade since some professional associations adopted MCE in Australia. The value of MCE as a means of maintaining or improving professional competence remains unclear. Despite there being no clear cut evidence of enhanced competence, no profession having adopted MCE has returned to a policy of voluntary continuing education. In Australia there appears to be a drift of health professions into mandatory continuing education. If MCE is adopted by the physiotherapy profession, what will the reasons be? The challenge is to clearly establish the links between continuing education, professional competence and health outcomes.

The costs and benefits of physiotherapy as first-line treatment for female stress urinary incontinence

Objective: To evaluate the costs and benefits of physiotherapy for stress urinary incontinence (SUI) in Australia.

Energy expenditure during physiotherapist-assisted and self-treatment in cystic fibrosis

Cystic fibrosis (CF) results in increased energy requirements at rest. However, the energy expended during physiotherapy management is unknown. The aim of this study, therefore, is to examine the energy expended during two commonly used forms of chest physiotherapy in CF subjects. Twenty-six CF subjects completed a randomised crossover trial with 48 hours between treatments. Two regimens of treatment were conducted: therapist-assisted treatment (active cycle of breathing, ACBT, with percussion, vibration), and independent treatment (ACBT alone, under the supervision of a physiotherapist). Subjects completed pulmonary function tests before and after either treatment. Indirect calorimetry and oximetry parameters were recorded at rest, during, and following treatment. Treatment groups were compared using ANOVA and two-sample crossover t-tests. When compared to resting values, physiotherapy treatment resulted in significant increases in VO2, VCO2 and respiratory exchange ratio. No difference was evident between treatment regimens for the change in VO2 between baseline and treatment. The increase in ventilation (baseline to treatment) was significantly greater for the therapist-assisted treatment. The therapist-assisted ACBT was associated with a significant carryover effect for forced expiratory flow at 50% of vital capacity (FEF50). Oxygen requirements for the two treatments were similar. However, the assisted regimen resulted in greater changes in minute ventilation during treatment and improved 48-hour post-treatment pulmonary function after only one treatment session. These findings suggest that the inclusion of percussion and vibration within the ACBT may influence respiratory muscle activity during treatment and result in improved pulmonary function.