The second physical therapy summit on global health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n=32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization's non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.info:eu-repo/semantics/acceptedVersio

Quadriceps EMG in open and closed kinetic chain tasks in women with patellofemoral pain

The authors investigated whether the discrepancy noted in the literature regarding delayed and decreased activity in vastus medialis obliquus (VMO) in people with patellofemoral pain (PFP) depends on the nature of the open kinetic chain (OKC) and the closed kinetic chain (CKC) in the experimental task. They hypothesized that activity in VMO would be more delayed and decreased in CKC tasks than in OKC tasks. Women with PFP (n = 17) and healthy controls (n = 17) performed isometric quadriceps contractions in CKC and OKC tasks. The authors manipulated only the application of resistance. Electromyographs (EMGs) showed that participants with PFP reacted later and activated the quadriceps more in the CKC task but had intramuscular quadriceps coordination similar to that of controls. The nature of the OKC task or the CKC task does not seem to explain contradictory findings regarding VMO activation

Relative difference among 27 functional measures in patients with knee osteoarthritis : an exploratory cross-sectional case-control study

Background: To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient's situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures' selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods: We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61years, 64% women) referred by general physicians to a hospital's osteoarthritis-school, and 31 healthy participants (mean age 55years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen's d. For non-parametric data, ds were estimated by p-values and sample sizes according to statistical formulas. Finally, all ds were ranked and interpreted after Hopkins' scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results: Very large differences between patients and controls were found on the Pain numeric rating scale(1), the Knee Injury and Osteoarthritis Scale (KOOS, all subscales)(2), as well as the orebro Musculoskeletal psychosocial scale(3) (P<0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test(4) and Accelerometer registered vigorous-intensity physical activity in daily life(5) (P<0.001). Respectively, these measures clustered on ICF as follows: (1)body function, (2)all three ICF-dimensions, (3)body function and participation, (4)activity, and (5)participation. Limitations: The limited sample excluded elderly patients with severe obesity. Conclusions: Very large differences across all ICF dimensions were indicated for the KOOS and orebro questionnaires together for patients aged 45-70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions

Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive : an exploratory cross-sectional study

Background: To improve the goal-directedness of strength exercises for patients with knee osteoarthritis (KOA), physical rehabilitation specialists need to know which muscle-groups are most substantially weakened across the kinetic chain of both lower extremities. The purpose was to improve the knowledge base for strength exercise therapy. The objective was to explore the relative differences in muscle strength in the main directions bilaterally across the hip, knee, and ankle joints between patients with light-to-moderate symptomatic and radiographic KOA and people without knee complaints. Methods: The design was an exploratory, patient vs. healthy control, and cross-sectional study in primary/secondary care. Twenty-eight patients with mild to moderate KOA (18 females, mean age 61) and 31 matched healthy participants (16 females, mean age 55), participated. Peak strength was tested concentrically or isometrically in all main directions for the hip, knee, and ankle joints bilaterally, and compared between groups. Strength was measured by a Biodex Dynamometer or a Commander II Muscle Tester (Hand-Held Dynamometer). Effect sizes (ES) as Cohen's d were applied to scale and rank the difference in strength measures between the groups. Adjustment for age was performed by analysis of covariance. Results: The most substantial muscle weaknesses were found for ankle eversion and hip external and internal rotation in the involved leg in the KOA-group compared to the control-group (ES [95% CI] -0.73 [-1.26,-0.20], -0.74 [-1.26,-0.21], -0.71 [-1.24,-0.19], respectively; p < 0.01). Additionally, smaller but still significant moderate muscle weaknesses were indicated in four joint-strength directions: the involved leg's ankle inversion, ankle plantar flexion, and knee extension, as well as the uninvolved leg's ankle dorsal flexion (p < 0.05). There was no significant difference for 17 of 24 tests. Conclusions: For patients with KOA between 45 and 70 years old, these explorative findings indicate the most substantial weaknesses of the involved leg to be in ankle and hip muscles with main actions in the frontal and transverse plane in the kinetic chain of importance during gait. Slightly less substantial, they also indicate important weakness of the knee extensor muscles. Confirmatory studies are needed to further validate these exploratory findings

Relative difference among 27 functional measures in patients with knee osteoarthritis : an exploratory cross-sectional case-control study

Background: To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient's situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures' selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods: We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61years, 64% women) referred by general physicians to a hospital's osteoarthritis-school, and 31 healthy participants (mean age 55years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen's d. For non-parametric data, ds were estimated by p-values and sample sizes according to statistical formulas. Finally, all ds were ranked and interpreted after Hopkins' scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results: Very large differences between patients and controls were found on the Pain numeric rating scale(1), the Knee Injury and Osteoarthritis Scale (KOOS, all subscales)(2), as well as the orebro Musculoskeletal psychosocial scale(3) (P<0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test(4) and Accelerometer registered vigorous-intensity physical activity in daily life(5) (P<0.001). Respectively, these measures clustered on ICF as follows: (1)body function, (2)all three ICF-dimensions, (3)body function and participation, (4)activity, and (5)participation. Limitations: The limited sample excluded elderly patients with severe obesity. Conclusions: Very large differences across all ICF dimensions were indicated for the KOOS and orebro questionnaires together for patients aged 45-70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions