Patellofemoral pain: challenging current practice – a case report

Patellofemoral pain (PFP) is a common problem in young people, with 1 in 6 suffering at any one time. It is unclear which management approach is the optimal method for treating PFP in the long term, with traditional physiotherapy examination focusing on assessing for specific structural dysfunction. A rationale for a different assessment and treatment approach, one that moves the focus away from a biomedical/tissue pathology model towards one directed at the neurophysiology of pain, has been suggested. The patient was a 21 year old male with a 6 year history of PFP with previous failed physiotherapeutic treatment. He reported previous multiple healthcare practitioners' advice to avoid activities that were painful as reasons for being unable to participate in sporting activities. No specific structural testing was performed, such as specific muscle strength, length, foot position, patella movement and position, or movement patterns. Descriptions of tissue based pathology models of pain, e.g. patella mal-tracking, were actively discouraged and challenged. The patient was taught to perform one uncomfortable/painful exercise as part of his rehabilitation programme twice a day. The patient achieved 80% improvement in his symptoms over 7 appointments and a return to physical activity following a 5 month rehabilitation programme purposively designed to elicit pain by means of gradually exercising and loading the tissues. This case report highlights the need for further research into exercise protocols for patients suffering with PFP based upon neurophysiology models of pain

Measurement of confidence: the development and psychometric evaluation of a stroke specific, measure of confidence

Objective: To design, develop and psychometrically evaluate a stroke specific measure of confidence, the Confidence after Stroke Measure (CaSM) Design: Cross-sectional Setting: Adults in the community Participants: Stroke survivors and healthy elderly participants Methods: Questionnaire items were generated based on the literature and qualitative interviews and piloted with expert groups to establish face validity. A 53-item CaSM was administered to stroke survivors and healthy elderly participants in the community. A second copy was posted four weeks later. Completed questionnaires were analysed for extreme responses, missing values, construct validity (factor analysis), convergent validity, divergent validity and reliability (internal consistency and temporal stability) and comparing responses according to age and gender. Results: Stroke (n =101) and healthy elderly participants (n=101) returned questionnaires. Eight items were removed that had extreme responses and large numbers of missing values. Six items had Item total correlations <0.3 and were removed. A further item was removed demonstrating gender difference. An exploratory factor analysis was conducted on the remaining 38-items. A 27-item three factor solution was derived assessing Self-Confidence, Positive Attitude and Social Confidence, which explained 52% of variance. Cronbach’s Alpha coefficient demonstrated good internal consistency (α=.94). A test re-test on the 27 items indicated good temporal stability (r=0.85 p=0.001). Conclusion: The 27 item CaSM was a valid and reliable measure for assessing confidence in stroke survivors

Falls prevention interventions in older adults with cognitive impairment: a systematic review of reviews

Aim: This critical review explores the review material on falls prevention interventions in older adults with a cognitive impairment such as dementia. Method: A critical, systematic, review of review method was used. Five large electronic databases, MEDLINE, EMBASE, AMED, CINAHL, and the Cochrane electronic library, were searched. The search terms ‘falls’, ‘rehabilitation’, ‘falls prevention’, ‘interventions’, ‘cognitive impairment’, ‘dementia’, and ‘Alzheimer’s disease’, were used. All available reviews were marked against predetermined inclusion and exclusion criteria. Results: There were seven reviews which met the inclusion criteria. Only one of the included reviews had a homogenous population of adults with a cognitive impairment. Exercise was the most commonly reported intervention, included in 91 studies and all seven reviews. Multifactorial and multicomponent falls prevention programmes were also frequently reported. Reports of efficacy were inconsistent for all interventions. Conclusion: Evidence for falls prevention interventions for adults with cognitive impairment is varied and inconclusive. When compared to literature for falls interventions in healthy older adults, both primary and synthesis studies in older adults with cognitive impairment are lacking in quality, number and homogeneity of sample population and interventions. Promising results are emerging but clinical recommendations cannot be made at this time

Keeping adults physically active after Falls Management Exercise (FaME) programmes end: development of a physical activity maintenance intervention

BACKGROUND: Falls prevention exercise programmes help to improve muscle strength, balance and physical function, and reduce falling rates in older adults. Improvements in muscle strength, balance and physical function are reversed if older adults do not continue to be physically active after falls prevention exercise programmes end. This paper describes the design process of an intervention that aimed to maintain physical activity in older adults exiting falls prevention exercise programmes. METHODS: The development of the Keeping Adults Physically Active (KAPA) intervention and its implementation plan was guided by Bartholomew's Intervention Mapping approach. The intervention mapping approach involved (1) performing a needs assessment and developing intervention objectives using previous literature; (2) identifying theory-based intervention strategies from a systematic review and the National Institute of Clinical Excellence guidelines; and (3) designing the KAPA intervention and its implementation plan with the guidance from an expert steering group. RESULTS: The KAPA intervention comprised of six group sessions of motivational interviewing, delivered monthly by trained and mentor-supported falls prevention practitioners. Intervention sessions lasted up to 90 min and were delivered in community settings over a 6-month duration. Participant manuals, illustrated exercise books, physical activity diaries and pedometers supported the KAPA intervention. CONCLUSIONS: The intervention development process, consisting of Bartholomew's Intervention Mapping approach and the input from an expert steering group, was successful in creating the evidence-based KAPA intervention ready to be evaluated in a feasibility trial

Pre- and post-operative voice therapy (PaPOV): Development of an intervention for patients with benign vocal fold lesions

Background: Pre- and post-operative voice therapy may improve voice and quality-of-life outcomes for patients undergoing phonosurgery to remove benign vocal fold lesions (BVFLs). However, what constitutes voice therapy in this population is poorly described, resulting in a poor evidence base, lack of clinical guidelines and unwarranted variation in management. In order to develop the evidence base, a robust, iterative process of intervention development work should precede feasibility testing and effectiveness studies. Methods & procedures: Guidance for developing complex interventions, drawing on evidence, theory and modelling, was used to inform the development of a pre- and post-operative voice therapy intervention entitled 'PaPOV'. Data from four sources of evidence were synthesized using a published triangulation protocol. Data from a systematic review, national survey of current practice, expert interview study, and patient and public involvement conversations were used to populate a triangulation matrix, outlining components of a PaPOV. Data were coded to reflect areas of agreement, dissonance and silence with each component of the intervention. Based on this evidence, an assessment of convergence for each intervention component could be made. Outcomes & results: In total, 61 components of the PaPOV intervention were explored. Of these, 27 were categorized as having stability of consensus according to a priori criteria. A total of 34 failed to meet the criteria. This was more frequently due to silence (27) rather than dissonance (seven) in the data. By evidencing areas of agreement and stability of consensus across data sources, the validity of individual findings has been enhanced. Furthermore, the study has exposed specific areas of the intervention that lack consensus and require exploration through further intervention development studies. Conclusions & implications: This systematic triangulation process has contributed to the development of a PaPOV intervention for patients with BVFLs. Exploration of specific components relating to the intervention will allow outstanding questions to be answered in preparation for feasibility testing

Exploring the benefits and barriers to Nordic walking in people with Parkinson's disease: a feasibility study

Background - Nordic Walking (NW) has shown promising outcomes for people with Parkinson’s Disease (PwPD). Aim - To explore implementation of NW in the National Health Service. Method - Literature review and feasibility study. PwPD joined an eight week NW programme. Attendance and measures of mobility (Timed Up and Go (TUG), ten metre walk test) and quality of life (QoL) (PD non-motor questionnaire) were recorded pre and post intervention. Barriers and facilitators and cost were recorded.Findings - Eight studies indicated that NW is superior to walking and flexibility/ relaxation exercise, with improvements in postural stability and gait. Nine of ten participants completed the intervention with improvements in mobility (0.16 seconds faster (TUG), 1.27 seconds faster (ten metre walk test), and QoL (better sleep, pain management, constipation, mood, exercising outside) after the intervention. Cost £6.50 per participant per session with no adverse events. Conclusion - NW programmes can be safely delivered in the NHS, in partnership with British Nordic walking

Keeping adults physically active after falls management exercise (FaME) programmes end: Development of a physical activity maintenance intervention

Background: Falls prevention exercise programmes help to improve muscle strength, balance, physical function and reduce falling rates in older adults. Improvements in muscle strength, balance and physical function are reversed if older adults do not continue to be physically active after falls prevention exercise programmes end. This paper describes the design process of an intervention that aimed to maintain physical activity in older adults exiting falls prevention exercise programmes.Methods: The development of the Keeping Adults Physically Active (KAPA) intervention and its implementation plan was guided by Bartholomew’s Intervention Mapping approach. The intervention mapping approach involved 1) performing a needs assessment and developing intervention objectives using previous literature; 2) identifying theory-based intervention strategies from a systematic review and the National Institute of Clinical Excellence guidelines; 3) designing the KAPA intervention and its implementation plan with the guidance from an expert steering group.Results: The KAPA intervention comprised of six group sessions of motivational interviewing, delivered monthly by trained and mentor-supported falls prevention practitioners. Intervention sessions lasted up to 90 minutes and were delivered in community settings over a 6-month duration. Participant manuals, illustrated exercise books, physical activity diaries and pedometers supported the KAPA intervention.Conclusions: The intervention development process, consisting 35 of Bartholomew’s Intervention Mapping approach and the input from an expert steering group, was successful in creating the evidence-based KAPA intervention ready to be evaluated in a feasibility trial

The co‐design of an exercise‐based, lifestyle intervention for people with venous leg ulcers; a self‐care, expert‐supported strategy for a chronic condition

Exercise is recommended as an adjunct treatment, alongside compression therapy to increase venous leg ulcer (VLU) wound healing times, however, there are no published programmes available that support patients to exercise at home on their own. To develop an exercise-based lifestyle intervention that is feasible and acceptable to people with VLUs, a participatory approach was utilised. Clinicians, researchers, and people living with VLUs collaborated in the design of “FISCU Home”. Two focus groups and nine interviews were conducted with people living with a VLU. Tissue viability nurses provided clinical expertise. Data was analysed through thematic analysis. Ten key themes were identified and incorporated into FISCU Home: (I) a condition-specific flexible programme, (II) personal assessment and tailored exercises, (III) tapered individualised support, (IV) short lower-intensity sessions, (V) chair-based options, (VI) falls prevention, (VII) accessible resources, (VIII) functional, compact, self-managed exercises, (IX) a behaviour change strategy, and (X) education. FISCU Home has integrated patients' needs and preferences with evidence-based principles and theory to create an exercise-based lifestyle intervention for people with VLUs. FISCU Home could provide a mainstream adjunct therapy in wound care and support the movement towards self-management

Segmentation of Exercise Repetitions Enabling Real-Time Patient Analysis and Feedback Using a Single Exemplar

We present a segmentation algorithm capable of segmenting exercise repetitions in real-time. This approach uses subsequence dynamic time warping and requires only a single exemplar repetition of an exercise to correctly segment repetitions from other subjects, including those with limited mobility. This approach is invariant to low range of motion, instability in movements and sensor noise while remaining selective to different exercises. This algorithm enables responsive feedback for technology-assisted physical rehabilitation systems. We evaluated the algorithm against a publicly available dataset (CMU) and against a healthy population and stroke patient population performing rehabilitation exercises captured on a consumer-level depth sensor. We show the algorithm can consistently achieve correct segmentation in real-time