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Sionnadh McLean

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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 [...]

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.

Quality appraisal as part of the systematic review: a review of current methods


Systematic reviews frequently underpin national and international practice guidelines. Different approaches to the systematic review process, in particular quality appraisal, have been advocated. This paper discusses these approaches and highlights possible limitations which might impact upon the validity of the conclusions drawn. Practical alternatives are offered upon which systematic reviews may be appraised and conducted.

Indian physiotherapists’ perceptions of factors that influence the adherence of Indian patients to physiotherapy treatment recommendations.


Background: Non-adherence to treatment is common and costly. Outside western culture little is known about the reasons for non-adherence with physiotherapy. This qualitative, grounded theory, focus group study investigated physiotherapists’ perception of the factors affecting non-adherence of patients to physiotherapy treatment in India.

Method: Six practising physiotherapists from New Delhi, India, formed a focus group and were invited to discuss their views regarding factors influencing patient non-adherence and their strategies to cope with these factors. The dialogue was transcribed and analysed. Significant statements/ words describing non-adherence were identified and clusters of meaning developed and used to write a composite, thematic description presenting the essence of the discussion.

Results: The major factors identified were: poor awareness of physiotherapy and poor infrastructure, time, economic factors, social and cultural factors and poor communication. Patient and family education formed the basis for many of the strategies identified by physiotherapist to help them manage non-adherence.

Conclusion: Physiotherapists in India recognise some barriers to adherence and have strategies that they perceive as helpful in encouraging motivation that are unique to the Indian social context. Other barriers to adherence and strategies recognised as key to improving adherence in western countries were not recognised by this group.

Foot type and tibialis anterior muscle activity during the stance phase of gait: A pilot study


Background – Normal functioning of the lower limb depends on correct functioning of the foot. It is hypothesized that abnormal foot biomechanics associated with different foot types, may lead to abnormal stresses on proximal muscular structures. These abnormal stresses may eventually result in musculoskeletal injuries.

Method – This experimental pilot study investigated tibialis anterior (TA) muscle electromyography (EMG) activity during stance phase of gait in healthy participants with supinated (n=8), normal (n=10) and pronated (n=10) feet. Subjects walked on a gait analysis treadmill and EMG activity of TA was recorded simultaneously. The total activity of TA during four phases of stance was compared between the three groups.

Results – No statistically significant differences were found in the EMG activity of TA during any of the stance phases of gait for subjects classified in supinated, normal and pronated groups (p>0.05).

Implications – There is no evidence to support the view that foot type will lead to lower limb injury as a consequence of altered TA muscle activity.

Conclusion – It seems that foot type may not be a factor in the development of TA related overuse injuries. However investigation of more severe groups of pronated and supinated subjects may be more revealing.

Measuring upper limb disability in non-specific neck pain: A clinical performance measure


Clinically it is common for patients with non-specific neck pain to report problems with upper limb function. Yet the extent of upper limb deficits in patients with neck pain is not well known and there are few measures available to clinicians to help quantify upper limb capacity in patients with neck pain. This paper synthesises and presents the findings of several studies which attempt to quantify the extent of upper limb disability in patients with non-specific neck pain and describes the development, validation and limitations of the Single Arm Military Press (SAMP) test.

The SAMP test is an easy to conduct, brief, economical, performance based measure of upper limb disability which may prove beneficial for use in clinical practice in different cultural or socioeconomic communities, though further validation is required to confirm this.

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