Physiotherapy students\u27 perceptions and experiences of clinical prediction rules

Objectives: Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. Design: Cross-sectional survey using a paper-based questionnaire. Participants: Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. Results: Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). Conclusions: The large majority of students in this sample knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them

Age-related differences in foot mobility in individuals with patellofemoral pain

Background Age-related changes in midfoot mobility have the potential to influence success with foot orthoses intervention in people with patellofemoral pain (PFP). The aim of this study was to determine whether older people with PFP demonstrate less foot mobility than younger adults with PFP. Methods One hundred ninety four participants (113 (58%) women, age 32 ± 7 years, BMI 25 ± 4.9 kg/m2) with PFP (≥ 6 weeks duration) were included, with foot mobility quantified using reliable and valid methods. K-means cluster analysis classified participants into three homogenous groups based on age. After cluster formation, univariate analyses of co-variance (covariates: sex, weight) were used to compare midfoot height mobility, midfoot width mobility, and foot mobility magnitude between age groups (significance level 0.05). Results Cluster analysis revealed three distinct age groups: 18–29 years (n = 70); 30–39 years (n = 101); and 40–50 years (n = 23). There was a significant main effect for age for midfoot height mobility (p  0.05). Conclusion Individuals with PFP aged 40–50 years have less foot mobility than younger adults with PFP. These findings may have implications for evaluation and treatment of older individuals with PFP

Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability - implications for central nervous system involvement: a systematic review with meta-analysis

Introduction Tendinopathy manifests as activity-related tendon pain with associated motor and sensory impairments. Tendon tissue changes in animals present in injured as well as contralateral non-injured tendon. This review investigated evidence for bilateral sensory and motor system involvement in unilateral tendinopathy in humans

An integrative model of lateral epicondylalgia

Tennis elbow or lateral epicondylalgia is a diagnosis familiar to many within the general community and presents with an uncomplicated clinical picture in most cases. However, the underlying pathophysiology presents a more complex state and its management has not been conclusively determined. Research on this topic extends across anatomical, biomechanical and clinical literature; however, integration of findings is lacking. We propose that the current understanding of the underlying pathophysiology of lateral epicondylalgia can be conceptualised as encompassing three interrelated components: (i) the local tendon pathology, (ii) changes in the pain system, and (iii) motor system impairments. This paper presents a model that integrates these components on the basis of a literature review with the express aim of assisting in the targeting of specific treatments or combinations thereof to individual patients

CHANGE IN FOOTSTRIKE POSITION IS RELATED TO ALTERATIONS IN RUNNING ECONOMY IN TRIATHLETES

Biomechanical factors are likely related to the impairment in running economy frequently observed in triathletes when running after cycling (Millet et al., 2000). Cycling has been shown to interfere with muscle recruitment during subsequent running in some highly-trained triathletes (Chapman et al., 2008), but the implications of this on run performance are unknown. Links between muscle recruitment and running economy have been established during isolated running (Paavolainen et al., 1999), which compel the proposition that any change in muscle recruitment following cycling might be associated with running economy. Stride frequency, stride length and hip and knee angles have been reported to be unchanged after cycling (Quigley & Richards, 1996; Hue et al., 1997), however, muscle recruitment and limb movement have not been simultaneously measured in previous studies that have investigated the relationship between biomechanical factors and running economy after cycling. The purpose of the current investigation was to evaluate changes in neuromuscular control (muscle and movement control) during running after a 45 min high-intensity cycle and their relationships to alterations in running economy

SHORT-TERM PLYOMETRIC TRAINING IMPROVES ALTERED NEUROMOTOR CONTROL DURING RUNNING AFTER CYCLING IN TRIATHLETES

Cycling has a direct negative effect on some highly-trained triathletes’ ability to execute optimal neuromotor strategies specific to running (Chapman et al., 2008). The presence of altered neuromotor control when running off-the-bike has been associated with exercise-related leg pain (Chapman et al., 2010). Accordingly, identification of training interventions that could minimise this interference may aid in prevention of injury and augmentation of performance during running following cycling. Plyometric training is a specific form of strength training that has been reported to improve running economy by enhancing neuromuscular function (Paavolainen et al., 1999). The primary aim of this study was to examine the effect of plyometric training on triathletes neuromotor control and running economy in those in which neuromotor control is aberrant during running after cycling

Elephant in the room: how much pain is ok? If physiotherapy exercise RCTs do not report it, we will never answer the question.

Pain experience and response associated with exercise is likely important and may for some conditions be an essential part of recovery, but we lack data. The patient's pain experience is currently absent from the reporting guideline for exercise RCTs (CERT) and is frequently omitted from papers (figure 1). We respectfully recommend researchers explicitly state at what level pain during and after exercise was permitted and experienced (box 1)

Dry needling and exercise for chronic whiplash - a randomised controlled trial

Chronic whiplash is a common and costly problem. Sensory hypersensitivity is a feature of chronic whiplash that is associated with poor responsiveness to physical treatments such as exercise. Modalities such as dry-needling have shown some capacity to modulate sensory hypersensitivity, suggesting that when combined with advice and exercise, such an approach may be more effective in the management of chronic whiplash. The primary aim of this project is to investigate the effectiveness of dry-needling, advice and exercise for chronic whiplash

Optimising physiotherapy for people with lateral elbow tendinopathy - Results of a mixed-methods pilot and feasibility randomised controlled trial (OPTimisE)

The OPTimisE intervention was developed to address uncertainty regarding the most effective physiotherapy treatment strategy for people with Lateral Elbow Tendinopathy (LET). To assess the feasibility of conducting a fully-powered randomised controlled trial (RCT) evaluating whether the OPTimisE intervention is superior to usual physiotherapy treatment for adults with LET. A mixed-methods multi-centred, parallel pilot and feasibility RCT, conducted in three outpatient physiotherapy departments in the UK. Patients were independently randomised 1:1 in mixed blocks, stratified by site, to the OPTimisE intervention or usual care. Outcomes were assessed using pre-defined feasibility progression criteria. 50 patients were randomised (22 Female, 28 Male), mean age 48 years (range 27-75). Consent rate was 71% (50/70), fidelity to intervention 89% (16/18), attendance rate in the OPTimisE group 82% (55/67) vs 85% (56/66) in usual care, outcome measure completion 81% (39/48) at six-month follow-up. There were no related adverse events. Patients and physiotherapists reported that the OPTimisE intervention was acceptable but suggested improvements to the trial design. 49 patients were recruited from physiotherapy referrals vs one from primary care records. Outcome measure return rates were higher when completed online (74%) compared to postal questionnaire (50%). Exploratory analysis showed improvements in both groups over time. It is methodologically feasible to conduct a fully powered RCT comparing the clinical and cost-effectiveness of the OPTimisE intervention versus usual physiotherapy treatment. Considering the similar improvements observed in both groups, careful consideration is needed regarding the priority research question to be addressed in future research. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.