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Predictors of self-management in patients with chronic low back pain: a longitudinal cohort study protocol

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Studies on self-management (SM) support programmes in chronic low back pain (CLBP) have failed to show clinically meaningful treatment benefit, which potentially highlights lack of research on predictors of effective SM. The purpose of this multi-centre non-experimental longitudinal cohort study is to identify the predictors of SM and its change over time in community ambulant adults (18-65 years) who are attending or have recently attended outpatient physiotherapy for their CLBP (approx. n=400). Self-reported validated measures for SM, pain intensity, disability, physical activity level, kinesiophobia, catastrophising, depression and global impression of change will be recorded at baseline and six-months. Descriptive statistics, correlation and multiple regression will be employed for the primary data analyses. This study protocol has ethical approval and is registered in ClinicalTrials.gov (ID: NCT02636777). Study results will inform patient selection for SM support in CLBP, and the development of tailored and targeted SM support programmes for this patient group.

The Effect of Mobilising the Lumbar 4/5 Zygapophyseal Joint on Hamstring Extensibility in Elite Soccer Players

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Objectives: The role of the lumbar spine to influence hamstring extensibility remains unclear. This study aimed to compare the immediate effects of L4/5 mobilisations on measures of neural and muscle hamstring extensibility in asymptomatic elite male soccer players.

Subjects: Twenty-five male soccer players from an English Premier League team with no current injury.

Methods: Players were randomly assigned to one of two groups, intervention or control. Neural hamstring extensibility was measured pre- and post-mobilisations by the straight leg raise test. The muscle biased component was measured by the passive knee extension test. Participants in the intervention group received specific lumbar mobilisations to the unilateral L4/5 zygapophyseal joint, 3 times for 1 minute, with each mobilisation separated by a 1-minute recovery, nominated by dominant kicking foot. The control group received no mobilisations between pre- and post-measures. Data were analysed using magnitude-based inferences.

Results: Lumbar mobilisations had a very likely small beneficial effect on the straight leg raise test (6.3%; 90% confidence limits ±2.7%) and a likely small beneficial effect on the passive knee extension test (-23%; ±14%).

Conclusion: Specific lumbar mobilisations have the ability to increase the neural and muscle extensibility of the hamstring muscle group in elite male soccer players in the immediate term.

Effect of neural mobilization and splinting on carpal tunnel syndrome

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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.

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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

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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

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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.

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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.

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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

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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.

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