Physiotherapists’ knowledge of and adherence to evidence-based practice guidelines and recommendations for ankle sprains management: a cross-sectional study

BackgroundLateral ankle sprain (LAS) is a common and burdensome injury. However, the quality of its management is scant. Nowadays, physiotherapy management of musculoskeletal diseases seems to be generally not based on research evidence. Studies that investigated the knowledge-to-practice gap in LAS management are yet to be carried out. Therefore, this research investigated physiotherapists’ knowledge of and adherence to LAS Clinical Practice Guidelines (CPGs) and recommendations.MethodsA cross-sectional study based on an online survey structured in three sections. The first section collected demographic data. The second section showed two clinical cases (with positive and negative Ottawa Ankle Rules (OAR), respectively). The participants indicated which treatments they would adopt to manage them. Participants were classified as ‘following’, ‘partially following’, ‘partially not following’ and ‘not following’ the CPGs and recommendations. In the third section, participants expressed their agreement with different CPG and recommendation statements through a 1-5 Likert scale.ResultsIn total, 483 physiotherapists (age: 34 ± 10; female 38%, male 61.5%, other 0.5%) answered the survey: 85% completed the first two sections, 76% completed all three sections. In a case of acute LAS with negative OAR, 4% of the participants were considered as ‘following’ recommended treatments, 68% as ‘partially following’, 23% as ‘partially not following’, and 5% as ‘not following’. In a case of acute LAS with positive OAR, 37% were considered ‘following’ recommended treatments, 35% as ‘partially following’, and 28% as ‘not following’. In the third section, the consensus was achieved for 73% of the statements.ConclusionThis study showed that although there is a good knowledge about first-line recommended treatments, a better use of CPGs and recommendations should be fostered among physiotherapists. Our results identify an evidence-to-practice gap in LAS management, which may lead to non-evidence-based practice behaviors

A study of the observation of pain by spinal cord injured people reveals the topographic mapping of the sensorimotor qualities of empathic reactivity.

The experience of empathy for pain is underpinned by sensorimotor and affective dimensions which are behaviourally and neurally distinct. Spinal cord injuries (SCI) induce a massive, below-lesion level, sensorimotor body-brain disconnection. This condition may make it possible to test whether sensorimotor deprivation alters specific dimensions of empathic reactivity to observed pain. To explore this issue, we asked SCI people with paraplegia and healthy controls to observe videos of painful or neutral stimuli administered to a hand (intact) or a foot (deafferented). The stimuli were displayed by means of a virtual reality set-up and seen from a first person (1PP) or third person (3PP) visual perspective. A number of measures were recorded: behaviour measures (from explicit verbal reports on the videos) and implicit measures of muscular activity (from an EMG from the corrugator and zygomatic muscles) representing a proxy of sensorimotor dimensions and of autonomic reactivity (the electrodermal response and Respiratory Sinus Arrhythmia) representing a proxy of affective dimensions. While no across group differences in the explicit verbal reports on the stimuli depicting pain were found, the SCI people exhibited reduced facial muscle reactivity for the stimuli applied to the foot (but not the hand) seen from the 1PP. Tellingly, the corrugator activity (an index of sensorimotor empathic reactivity) correlated with SCI participants’ neuropathic pain. There were no across group differences in autonomic reactivity suggesting that SCI lesions may affect sensorimotor more than the affective dimensions connected to empathy for pain