The effect of alternating and biphasic currents on humans' wound healing: a literature review

[Abstract] Although different types of currents, including bidirectional currents, have been used to promote healing, there is neither a summary about their effects nor consensus on best parameters to be used. The aim of this article is to provide an overview of current evidence on the effectiveness of bidirectional electrical stimulation on wound healing in accordance with the parameters used. Relevant articles were selected following a search of Medline, Cochrane, Embase, CINAHL, and PEDro for English, Spanish, Portuguese, Italian, or French articles published between 1980 and 2011. Ten trials and four case-series were found that deal with pressure ulcers, diabetic ulcers, venous ulcers, skin flaps, and amputation. Eight trials were of low-quality. Five of ten controlled trials found a statistically significant difference on wound healing, and another four trials found positive trends. Both of the two skin flap trials, one of two diabetic trials, and two of five pressure ulcer trials found a significant difference in bidirectional stimulated groups. Both TENS and NMES types of currents were used, but many parameters were not specified. In general, bidirectional currents appear to increase wound healing rates and reduce size of wounds, above all in skin flaps. However, there is a lack of well-designed studies on biphasic and alternating stimulation, and there is a need for improvement in description of parameters and in uniformity of nomenclature

The Motivations and Aspirations of Indian Physiotherapists Who Migrate Overseas to Study and Work: A Grounded Theory Study

Objective: To explore why Indian physiotherapists seek to migrate overseas for study and work. Design: Qualitative research using Constructivist Grounded Theory (CGT) methodology. Setting: Individual interviews and focus groups were conducted in the UK and India, at university, clinic or hotel locations convenient to the participants. Participants: Nineteen physiotherapists from across India. Thirteen had studied or worked in the UK, Australia or Kuwait, and six had no overseas experience. Findings: The participants desired a ‘better life’ due to factors perceived as less favourable in India: pay levels, professional respect and professional development. These elements were inter-dependent and their importance varied between participants and according to gender. Indian societal values amplified the importance of pay for male physiotherapists, whereas females prioritised professional development. Migrant physiotherapists aspired to professional autonomy through the development of knowledge, skills and experience. Respect was important, but there were different perspectives on its achievement and the relevance of titles. For those studying overseas, work was sought to recoup the cost of that study, and, importantly to consolidate learning and experience of autonomous physiotherapy practice. They all planned to return to India and wished to transfer their knowledge and skills back into practice in India. Conclusion: Pay, respect and professional development are all motivators for Indian physiotherapists to study and work overseas. An ability to practise physiotherapy autonomously is a key factor underpinning the achievement of each of these elements and thus the ultimate aspiration to have a ‘better life’

A description of physical therapists' knowledge in managing musculoskeletal conditions

BACKGROUND: Physical therapists increasingly provide direct access services to patients with musculoskeletal conditions, and growing evidence supports the cost-effectiveness of this mode of healthcare delivery. However, further evidence is needed to determine if physical therapists have the requisite knowledge necessary to manage musculoskeletal conditions. Therefore, the purpose of this study was to describe physical therapists' knowledge in managing musculoskeletal conditions. METHODS: This study utilized a cross-sectional design in which 174 physical therapist students from randomly selected educational programs and 182 experienced physical therapists completed a standardized examination assessing knowledge in managing musculoskeletal conditions. This same examination has been previously been used to assess knowledge in musculoskeletal medicine among medical students, physician interns and residents, and across a variety of physician specialties. RESULTS: Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists. Physical therapist students enrolled in doctoral degree educational programs achieved significantly higher scores than their peers enrolled in master's degree programs. Furthermore, experienced physical therapists who were board-certified in orthopaedic or sports physical therapy achieved significantly higher scores and passing rates than their non board-certified colleagues. CONCLUSION: The results of this study may have implications for health and public policy decisions regarding the suitability of utilizing physical therapists to provide direct access care for patients with musculoskeletal conditions

The propensity to adopt evidence-based practice among physical therapists

<p>Abstract</p> <p>Background</p> <p>Many authors, as well as the American Physical Therapy Association, advocate that physical therapists adopt practice patterns based on research evidence, known as evidence-based practice (EBP). At the same time, physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy. The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP.</p> <p>Methods</p> <p>The study used a 69 item mailed self-completion questionnaire. The questionnaire had four major sections. The first three sections were each drawn from a different theoretical framework and from different authors' work. The instrument was developed to capture the propensity of physical therapists to adopt EBP, characteristics of the social system in the workplace of physical therapists, personal characteristics of physical therapists, and selected demographic variables of physical therapists. The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America. A random sample of 1320 potential participants was drawn.</p> <p>Results</p> <p>939 questionnaires were returned for a response rate of 73%. 831 of the participants' questionnaires were useable and became the basis for the study. There was a moderate association between desire for learning (<it>r </it>= .36, <it>r</it>²= .13), highest degree held (<it>r </it>= .29, <it>r</it>²= .08), practicality (<it>r </it>= .27, <it>r</it>²= .07) and nonconformity (<it>r </it>= .24, <it>r</it>²= .06) and the propensity to adopt EBP. A negative correlation was found between age, years licensed and percentage of time in direct patient care. The findings demonstrated that the best three variables for predicting the propensity to adopt EBP in physical therapy were: desire for learning, highest degree held, and practicality.</p> <p>Conclusion</p> <p>The study confirms there is no single factor to facilitate research evidence into day-to-day practice. Multiple practice change strategies will be needed to facilitate change in practice.</p

Using knowledge brokers to facilitate the uptake of pediatric measurement tools into clinical practice: a before-after intervention study

<p>Abstract</p> <p>Background</p> <p>The use of measurement tools is an essential part of good evidence-based practice; however, physiotherapists (PTs) are not always confident when selecting, administering, and interpreting these tools. The purpose of this study was to evaluate the impact of a multifaceted knowledge translation intervention, using PTs as knowledge brokers (KBs) to facilitate the use in clinical practice of four evidence-based measurement tools designed to evaluate and understand motor function in children with cerebral palsy (CP). The KB model evaluated in this study was designed to overcome many of the barriers to research transfer identified in the literature.</p> <p>Methods</p> <p>A mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months), ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months), and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored.</p> <p>Results</p> <p>PTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools.</p> <p>Conclusions</p> <p>KBs positively influenced PTs' self-reported knowledge and self-reported use of the targeted measurement tools. Further research is warranted to investigate whether this is a feasible, cost-effective model that could be used more broadly in a rehabilitation setting to facilitate the uptake of other measurement tools or evidence-based intervention approaches.</p

Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults (Review)

Background: Fibromyalgia is a long-term medical condition that is characterised by long-lasting widespread pain throughout the body. TENS is a treatment that involves putting pulsed electrical currents across the surface of the skin using two or four electrodes. It is used to manage painful conditions. TENS is inexpensive, can be self-administered by people with fibromyalgia, and is not associated with any particular side effects. TENS reduces pain during movement so it may be useful in addition to other treatments to help people carry on their normal lives. Study characteristics: In January 2017, we found eight clinical studies that examined 315 people. We included TENS administered to produce a non-painful 'tingling' sensation at the site of pain either as a treatment alone or combined with exercise treatment. All studies used TENS in comparison with 'fake' (called placebo or sham) TENS, no treatment, or other treatments such as medicine or hydrotherapy (treatment in water). Key results: We did not find enough high-quality studies to allow us to come to any conclusions about the effectiveness of TENS for fibromyalgia pain. Even though seven studies concluded that TENS relieved pain associated with fibromyalgia, the studies were low quality and the findings for measures of pain were inconsistently reported. Studies did not measure most of our outcomes and it was not always clear what aspects of pain were being reported (e.g. present pain, remembered pain, pain severity, etc.). Only one small pilot study found that one 30-minute treatment of TENS reduced pain on movement during and immediately after treatment; however, there were too few participants observed and it is unknown whether this effect would be maintained over a longer course of TENS treatments. Overall, it is not possible to judge whether TENS reduces pain associated with fibromyalgia. There were no serious side events reported in any of the studies. Quality of the evidence: We rated the quality of the evidence from studies using four levels: very low, low, moderate, or high. Very low-quality evidence means that we are very uncertain about the results. High-quality evidence means that we are very confident in the results. The quality of the evidence was very low overall because of a lack of data

Transcutaneous Electrical Nerve Stimulation (TENS) for fibromyalgia in adults

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the analgesic efficacy and adverse events of TENS for fibromyalgia in adults. We will assess TENS on its own or added to usual care in comparisons with placebo (sham) TENS, usual care, or no treatment