Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands

In many countries, the need for physical therapists to use standardised measures has been recognised and is recommended in clinical practice guidelines. Research has shown a lack of clinimetric knowledge and clinical application of measurement instruments in daily practice may hamper implementation of these guidelines. The aims of this study are 1) to investigate the current use of measurement instruments by Dutch physical therapists; 2) to investigate the facilitators and barriers in using measurement instruments

Effects of visual feedback therapy on postural control in bilateral standing after stroke: A systematic review

Objective: To establish whether bilateral standing with visual feedback therapy after stroke improves postural control compared with conventional therapy and to evaluate the generalization of the effects of visual feedback therapy on gait and gait-related activities. Design: A systematic review. Methods: A computer-aided literature search was performed. Randomized controlled trials and controlled clinical trials, comparing visual feedback therapy with conventional balance treatments were included up to April 2005. The methodological quality of each study was assessed with the the Physiotherapy Evidence Database scale. Depending on existing heterogeneity, studies with a common variable of outcome were pooled by calculating the summary effect-sizes using fixed or random effects models. Results: Eight out of 78 studies, presenting 214 subjects, were included for qualitative and quantitative analysis. The methodological quality ranged from 3 to 6 points. The meta-analysis demonstrated non-significant summary effect-sizes in favour of visual feedback therapy for weight distribution and postural sway, as well as balance and gait performance, and gait speed. Conclusion: The additional value of visual feedback therapy in bilateral standing compared with conventional therapy shows no statistically significant effects on symmetry of weight distribution between paretic and non-paretic leg, postural sway in bilateral standing, gait and gait-related activities. Visual feedback therapy should not be favoured over conventional therapy. The question remains as to exactly how asymmetry in weight distribution while standing is related to balance control in patients with stroke

Assessment measures in clinical practice in the Netherlands

Until the first part of the 20th century, health was defined as the absence of disease and was measured in terms of morbidity and mortality. This simple definition of health was rejected in 1948 with the expansion of the concept of health by the World Health Organization (WHO), defining it as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization 1948)

Paratonia:a Delphi procedure for consensus definition

BACKGROUND AND PURPOSE: Paratonia is a motor problem that develops during the course of dementia. Definitions of paratonia used in the literature differ considerably, which has clinical implications and may lead to an undesirable heterogeneity in study populations. For this reason, we initiated a Delphi procedure with known experts in the field to establish an operational consensus definition of paratonia. METHODS: The Delphi procedure involved an anonymous and multistage approach presented as a questionnaire, with each stage building on the results of the previous one in order to reach consensus on the definition of paratonia. RESULTS: Eight of 17 experts agreed to participate in the study. After 4 rounds, the participants reached consensus on the following definition: paratonia is a form of hypertonia with an involuntary variable resistance during passive movement. The nature of paratonia may change with progression of dementia (eg, from active assistance (aka Mitgehen) to active resistance). The degree of resistance depends on the speed of movement (eg, slow > low resistance, fast > high resistance). The degree of paratonia is proportional to the amount of force applied and increases with progression of dementia. The resistance to passive movement is in any direction and there is no clasp-knife phenomenon. CONCLUSION: The Delphi procedure resulted in a comprehensive, operational definition of paratonia. Future research should focus on the reliability and validity of this definition

Search strategy PubMed.

<p>Search strategy PubMed.</p

Summary effect sizes for physical therapy interventions – intensity of practice.

<p>Legend: ADL, Activities of daily living; C, Control group; CI, Confidence interval; E, Experimental group.</p

Summary effect sizes for physical therapy interventions – gait and mobility-related functions and activities.

<p>Legend: A green colored diamond indicates that the summary effect size is significant, while a blue colored diamond indicates that the summary effect size is nonsignificant; CI, Confidence interval; EMG-BF, Electromyographic biofeedback; EMG-NMS, Electromyography-triggered neuromuscular stimulation; FES, Functional electrostimulation; GT, Gait training; NA, Not applicable; NMS, Neuromuscular stimulation; TENS, Transcutaneous electrical nerve stimulation; TT, Treadmill training.</p

Summary effect sizes for physical therapy interventions – other: inspiratory muscle training.

<p>Legend: C, Control group; CI, Confidence interval; E, Experimental group.</p