Effect of neural mobilization and splinting on carpal tunnel syndrome


Study objective: To evaluate the clinical benefit of neural mobilization and splinting compared with splinting alone in carpal tunnel syndrome (CTS).

Methods: Patients were randomized into two groups using Pre/Post-test experimental design. On day 0 and 21st (i.e. pre and post treatment), patients were administered Boston Questionnaire. Grip strength, pain intensity, and sensory testing were completed using validated outcomes measures. Both groups were advised to wear full-time neutral angle wrist splint for three weeks. Neuromobilisation technique for the median nerve was performed, the protocol included treatment of total three weeks, with six days per week management for only one group additionally and they were encouraged by the therapist to complete the self mobilisation home exercise program once a day. Independent t-test was used to compare VAS, sensory testing at three sites name as site 1(tip of the thumb), site 2(proximal index finger), site 3(tip of the index finger) and grip strength between the groups on 0 and the 21st day. Mann-Whitney Test was used to compare the score of Boston Questionnaire Symptom Severity Scale and Functional Status Scale between the groups on 0 and the 21st day.

Results: The data showed that with the use of three weeks protocol there was a significant difference (p<0.05) between post treatment values of VAS score, Boston Questionnaire Symptom Severity Scale , Functional Status Scale taken and Sensory testing at three sites i.e site 1,site 2 and site 3 on 21st day between group A and group B but more improvement was seen in the group B. The data of this study showed that there was non-significant difference between post treatment values of Grip strength on 21st day between group A and group B i.e. there was no improvement in grip strength.

Conclusion: This study demonstrated that patients suffering from CTS can have substantial improvement with the combined treatment of neural mobilisation and splinting.

Ultrasound evaluation of Achilles tendon thickness in asymptomatic’-s: A reliability study.


Background: Achilles tendon disorders are among the most common maladies encountered in sports medicine. Increased tendon thickness is considered to be a risk factor for Achilles tendon disorders. Ultrasonography is currently the modality of choice that best demonstrate the Achilles tendon abnormalities. This study investigated Intra-rater reliability of ultrasound in Achilles tendon thickness measurements among asymptomatic’-s, performed by a qualified physiotherapist with limited ultrasound training.

Method: A test retest reliability design was used. 25 healthy participants were recruited from Sheffield Hallam University. Achilles tendon thickness measurements were performed on two occasions, approximately 30 minutes apart; by the same rater, under same testing conditions.

Results: The Intraclass correlation coefficient (ICC) for intra-rater reliability was found be excellent (ICC =0.935; 95% confidence interval, 0.88-0.96).
Implications: Ultrasound can be used in the field of physiotherapy as a clinical tool for prevention, assessment and monitoring rehabilitation of athletes.

Conclusion: Ultrasound evaluation of Achilles tendon thickness can be reliably performed by a qualified physiotherapist with limited ultrasound training. Further research is required to investigate inter rater reliability and among different patient populations with proper US training.

The steady integration of bioethics in Physiotherapy


As new theories emerge and new exercises, movements and techniques are taken up by the hands and mind of a physiotherapist, our profession is continuously developing. This paper discusses the development of ethical concerns within the profession, specifically in relation to autonomy and welfare of the patients.

Working in social enterprises


There is much debate in the UK about proposed changes to the National Health Service (NHS) which will lead to a much stronger market orientation for aspects of the service. Although the changes are ‘proposed’ in the current Government’s Department of Health bill (2011) and previous white paper (Department of Health 2010), various initiatives to develop services into new forms of social enterprise were already being implemented under the previous administration, and allied health professionals (AHPs) were being encouraged to establish themselves in these forms of organization. This discussion paper will explore some of the issues and the background to this development, particularly with regard to the implications for occupational therapy services.

Re: Marwaha K, Horobin H and McLean SM (2010) Indian physiotherapists’ perceptions of factors that influence the adherence of Indian patients to physiotherapy treatment recommendations.


This letter raises a number of issues which appear to relate to two main areas of concern for Senthil Kumar. Firstly he critiques the paper by Marwaha et al (2010) and secondly he critiques the editorial processes employed by IJPTR. These will be dealt with in order. Critique of Marwaha et al (2010) We would [...]

O’Connell D, O’Connell J, Hinman M (2011) Special tests of the cardiopulmonary, vascular and gastrointestinal systems.


Whilst there has been a plethora of books related to special tests in musculoskeletal examination, a compilation of the evaluation and testing procedures of other physiological systems of the body has been long overdue. O’Connell et al (2011) have recently published a handy volume on the special tests of the cardiopulmonary, vascular and gastrointestinal systems. [...]

Writing for publication for the first time — Try the hunter style


Healthcare practitioners who want to write for publication for the first time can waste time and energy by relying on writing behaviour learned in educational settings, characterised in this article as the gatherer style of writing. The gatherer style is suitable for authors who are preparing literature reviews and similar types of publication.

A hunter style of writing is more appropriate when an author wants to describe work carried out, whether research, a quality improvement study, a clinical audit, a service evaluation or another project. In the hunter style, an author works through a systematic thought process and makes key decisions about the work the author wants to describe, before starting to write. The thought process includes defining what journal readers want to read about, answering key questions about the subject being written about and organising the ideas into a logical structure. Practical points about writing clearly also are provided.

Physiotherapists’ perceptions of patient adherence to home exercises in chronic musculoskeletal rehabilitation.


Background – Rehabilitation of chronic musculoskeletal conditions usually involves long-term home-based exercise programmes. Exercises have been shown to alleviate pain, improve joint mobility and stability, allow faster return to work and prevent progression of chronic conditions. Non-adherence of patients to unsupervised long-term exercise is a major problem that affects treatment outcome. This study explores UK physiotherapists’ perceptions of exercise adherence and their interventions to tackle it in clinical practice.

Method – A convenience sample of five experienced physiotherapists from Sheffield Hallam University were interviewed. Interviews were transcribed and analysed. Interpretative Phenomenological Analysis (IPA) was used to analyse data transcriptions.

Results – The identified themes revolved around issues of patient-therapist collaboration in chronic rehabilitation. The subordinate themes were: negotiating ownership and self management, education and pain, professional power and patient attitudes and communication.

Conclusion – Experienced physiotherapists recognised barriers and often critically viewed their practice. They undertook necessary interventions in their practice but persisting non-adherence made them question the patient’s role in the partnership.

Cross cultural adaptation of the Quebec Back Pain Disability Scale from English into Arabic


Background – Back disability measures are considered important by stake-holders as they offer a means of evaluating the effect of low back pain. The Quebec Back Pain Disability Scale (QDS) is a commonly-used measure of back disability, but it has only been adapted into four languages.

Method – Using a combination of cross-cultural adaptation guidelines for self-reported measures, health professionals, methodologists and Arabic linguists voluntarily participated in cross cultural adaptation of the QDS. At least three different participants were included in each of four stages.

Results – A pre-final version of the Arabic QDS was developed. The equivalence of the adapted measure to the original QDS version was agreed by examining it from four perspectives: idiomatic, experiential, conceptual and semantic.

Implications – The pre-final version is ready to be tested in almost any Arabic speaking population. This will give the opportunity to gather data in the third most widely spoken language worldwide, representing a target population of more than 500 million people.

Conclusion – The QDS can be cross-culturally adapted into Arabic without losing any concepts of the original scale; this adapted scale is ready for further testing.

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