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.

Successful physical therapy treatment using high-velocity low-amplitude thrust manipulation of a patient with neck pain scoring sub-optimally on cervical and thoracic clinical prediction rules for manipulative therapy


This case report describes successful outpatient physical therapy intervention (including High Velocity Low Amplitude Thrust (HVLAT) spinal manipulation) of a 43 year-old female patient with neck pain who did not fit ideal clinical prediction rule criteria for thoracic or cervical manipulation following an initial unsuccessful course of physical therapy. Following patient report of “0% improvement” in a physical therapy clinic that did not include HVLAT, patient care was transferred to a different clinic and the patient received physical therapy care that included HVLAT for 10 sessions. During that time, neck disability index scores decreased from 76% to 18%, meeting previously established criteria for minimally detectable change as well as clinically meaningful change. Cranio-cervical flexion test abilities improved from 18mmHg to 28mmHg, active cervical rotation improved from 45 degrees bilaterally to 85 degrees bilaterally, and neck pain had decreased from 7/10 to 0/10 on a Numeric Pain Rating Scale. Functionally, the patient re-acquired the ability to work an 8 hour shift of manual labor, to turn her head and back out of the driveway with her car, and to sleep through the night without waking in pain. The potential relative importance of non-clinical psychosocial factors in the prediction of outcome in patients who do not ideally fit clinical prediction rules is discussed.

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.


I wish to congratulate Marwaha et al (2010) for bringing out a valid exposition on a novel direction of thought, with special consideration on Indian physiotherapy practice scenario. The study is the first of its kind in relation to the geographical pattern of patient-related barrier adherence and the therapists’ views using a qualitative approach. What [...]

Effects of 4 weeks whole body vibration on electromechanical delay, rate of force development, and presynaptic inhibition.


Long-term functional changes after whole-body vibration (WBV) training have been attributed to adaptations in the neuromuscular system. The present study examined the effect of four weeks of WBV training on muscle function outcome variables [rate of force development (RFD), electromechanical delay (EMD)], and spinal control mechanisms (pre-synaptic inhibition). Forty young individuals with no history of lower leg injuries were randomly assigned to an experimental or control group. The experimental group received WBV training (three bouts of two minutes, three times a week) for four weeks. During each of the training sessions, the subjects stood on the vibration platform with the knees slightly flexed. The control group performed periods of standing in the same position as the experimental subjects. After four weeks of WBV training, the experimental (WBV) group demonstrated a significant improvement in electromechanical delay (EMD). The results also showed a significant group × test interaction for RFD and intrinsic pre-synaptic inhibition (IPI) over the course of the study. Enhanced neuromuscular activation (EMD and RFD) and increased spinal reflex gain followed by 4 weeks of WBV training indicate that WBV training might be used not only for athletes engaged in sports that require explosive type of muscular activation, but also for the elderly individual who need to exert a rapid rise in muscle force in injury related situations.

A case of long thoracic nerve palsy


A 31 year old male developed unilateral neck pain associated with increased kyphotic posture 24 hours after having general anaesthesia for ankle surgery. The pain and postural adaptation resolved, but a painless shoulder dysfunction developed. Following assessment a provisional diagnosis of long thoracic nerve palsy was made, and a ‘wait and see’ approach to management was taken. The dysfunction gradually resolved over a 12 month period without further investigation or intervention. The case study is discussed in light of possible neurophysiological mechanisms involved and of published literature on the management of long thoracic nerve palsy.

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.

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