ACQUISITION OF COMPLEX THERAPEUTIC PROCEDURES IN PRE-REGISTRATION PHYSIOTHERAPY EDUCATION USING MOTOR LEARNING PRINCIPLES

This thesis focuses on the acquisition of complex procedures in physiotherapy education using two motor learning principles and reports on five separate key studies: Chapter II: A study about the definition of procedural skills in physiotherapy education using a systematic review design and a text mining approach. Chapter III: A systematic review about the effectiveness of different attentional foci on the acquisition of complex motor skills. Chapter IV: A critical analysis of mental practice interventions in health professions education: A condensed review. Chapter V: The development and validation of a mental practice script for a transfer procedure for people with hemiparesis after stroke. Chapter VI: A randomised controlled trial evaluating the effectiveness and feasibility of two motor learning principles on the acquisition of complex procedures in physiotherapy education Chapter II: Randomised controlled trials and systematic review reporting about procedural skills were systematically searched. A qualitative analysis identified several relevant sub-concepts of procedural skills such as “execution of a motor task” or “decision-making”. A quantitative analysis was performed to identify term occurrences and to create a network of associations between the used terms. Based on both analyses a novel definition of “procedural skills in physiotherapy education” was proposed and operationalised. Chapter III: Studies comparing the effectiveness of an external focus of attention versus an internal focus of attention on the acquisition of complex motor skills were systematically searched in Medline, Embase, ERIC and SPORTDiscus. Findings of a meta-analysis were in favour of external focus of attention (SMD: -0.54; 95% CI between -0.86 and -0.22). Meta-regression identified “task complexity” as potential relevant predictor variable. Chapter IV: This study analysed how mental practice interventions designed for health professions were defined, structured and adhered to proposed best practice variables of mental practice. Chapter V: A mental practice script for a transfer procedure for people with hemiparesis was developed and validated in this study. Experienced physiotherapists were interviewed how they perform the procedure. Analysis of the interviews resulted in the development of a preliminary script, which was piloted to validate the manuscript. Chapter VI: The effectiveness and feasibility of two motor learning principles (mental practice and focus of attention) was evaluated on two different task procedures in pre-registration physiotherapy education. The difference between mental practice and no mental practice was not statistically significant. Findings of the comparison of the attentional focus differed between task procedures. An internal focus of attention was more effective for the acquisition of a transfer task procedure. For the second task procedure in vestibular rehabilitation the performance between the internal and external focus of attention groups was similar. Conclusions: This was the first study, to the authors knowledge, that investigated the acquisition of complex motor task skills in pre-registration physiotherapy students. The results presented in this thesis will help inform educators and researchers regarding the use of mental practice and different attentional foci to support the teaching approach for acquisition of complex skills in physiotherapy education

Is power training or conventional resistance training better for function in elderly persons? A meta-analysis

Objective: to determine the effects of power training with high movement velocity compared with conventional resistance training with low movement velocity for older community-dwelling people. Design: systematic review of randomised controlled trials. Data sources: the Cochrane Central Register of Controlled Trials, PubMed (Medline), EMBASE, CINAHL, PEDro and Scholar-Google. Trials: all randomised or quasi-randomised trials investigating power training with high movement velocity versus conventional resistance training with low movement velocity in elderly persons over the age of 60 years. The primary outcomes were measures of functional outcomes; secondary outcomes were balance, gait, strength, power, muscle volume and adverse effects. Results: eleven trials were identified involving 377 subjects. The pooled effect size for the follow-up values of the functional outcomes was 0.32 in favour of the power training (95% CI 0.06 to 0.57) and 0.38 (95% CI −0.51 to 1.28) for the change value. The pooled effect from three studies for self-reported function was 0.16 in favour of power training (95% CI −0.17 to 0.49). Conclusion: power training is feasible for elderly persons and has a small advantage over strength training for functional outcomes. No firm conclusion can be made for safet

Over-ground walking or robot-assisted gait training in people with multiple sclerosis ::does the effect depend on baseline walking speed and disease related disabilities? A systematic review and meta-regression

Background : It was suggested that robot-assisted gait training (RAGT) should not be routinely provided to disabled patients in place of conventional over-ground walking training (CGT). There exist several randomised controlled trials reporting on RAGT for people with multiple sclerosis. However, the effectiveness of RAGT varies between studies with the effectiveness pointing in different directions. It might be possible that the effectiveness of RAGT and CGT depends on the disease related disabilities of the people included in the clinical studies. We aimed to systematically search RCTs and to perform a meta-regression to compare the effects of robot-assisted gait training in people with less and higher disease related disabilities. The Expanded Disability Status Scale (EDSS) scores were used to classify level of disability. Methods : A systematic search was developed to search four electronic databases (MEDLINE, CENTRAL, EMBASE and CINAHL) for eligible articles. A random effects model was applied to meta-analyse the effects of the interventions. Meta-regression was performed with an uni-variable random effects model using baseline walking speed and EDSS to predict the between group effect. Results : The search on databases resulted in 596 records and finally nine studies were included into the review. The pooled estimates of the effects for performance over short and long distance tests were small and non-significant: -0.08 SMD (95% CI: -0.51 to 0.35) and − 0.24 SMD (95% CI: -0.67 to 0.19). Neither baseline walking speed or disease related disability were related to the mean effect size. Discussion : Future studies are needed to help clinicians to decide, which intervention should be allocated to the individual patient

Assessment tools and incidence of hospital-associated disability in older adults: a rapid systematic review

Background During hospitalization older adults have a high risk of developing functional impairments unrelated to the reasons for their admission. This is termed hospital-associated disability (HAD). This systematic review aimed to assess the incidence of HAD in older adults admitted to acute care with two outcomes: firstly in at least one activity of daily living from a set of functional tasks (e.g., Katz Index) and secondly the incidence of functional decline in an individual functional task (e.g., bathing), and to identify any tools or functional tasks used to assess activities of daily living (ADL) in hospitalized older patients. Methods A rapid systematic review was performed according to the recommendations of the Cochrane Rapid Reviews Methods Group and reported the data according the PRISMA statement. A literature search was performed in Medline (via Ovid), EMBASE, and Cochrane Central Register of Controlled Trials databases on 26 August 2021. Inclusion criteria: older adults (≥65 years), assessment of individual items of activities of daily living at baseline and discharge. Exclusion criterion: studies investigating a specific condition that could affect functional decline and studies that primarily examined a population with cognitive impairment. The protocol was registered on OSF registries (https://osf.io/9jez4/) identifier: DOI 10.17605/OSF.IO/9JEZ4. Results Ten studies were included in the final review. Incidence of HAD (overall score) was 37% (95% CI 0.30–0.43). Insufficient data prevented meta-analysis of the individual items. One study provided sufficient data to calculate incidence, with the following values for patients’ self-reported dependencies: 32% for bathing, 27% for dressing, 27% for toileting, 30% for eating and 27% for transferring. The proxy reported the following values for patients’ dependencies: 70% for bathing, 66% for dressing, 70% for toileting, 61% for eating and 59% for transferring. The review identified four assessment tools, two sets of tasks, and individual items assessing activities of daily living in such patients. Conclusions Incidence of hospital-associated disability in older patients might be overestimated, due to the combination of disease-related disability and hospital-associated disability. The tools used to assess these patients presented some limitations. These results should be interpreted with caution as only one study reported adequate information to assess the HAD incidence. At the item level, the latter was higher when disability was reported by the proxies than when it was reported by patients. This review highlights the lack of systematic reporting of data used to calculate HAD incidence. The methodological quality and the risk of bias in the included studies raised some concerns

L'influence de la physiothérapie sur les chutes, la peur de chutes et les pertes d'équilibre chez les patients parkinsoniens: une revue systématique

Introduction : La maladie de Parkinson est une atteinte neurodégénérative se manifestant par un syndrome hypokinétique-hypertone avec un tremblement de repos, une rigidité, une akinésie ou une instabilité posturale. Cette maladie neurologique cause de nombreuses chutes s’élevant entre 37% et 68% chez les patients parkinsoniens provoquant une peur de chutes ainsi qu’une diminution de la qualité de vie. Objectifs : L’objectif primaire est de connaître l'influence de la physiothérapie sur les risques et la peur de chutes ainsi que sur les pertes d’équilibre. Méthode: Nous avons cherché dans les bases de données : Pubmed, MEDLINE via Ovid, PEDro, Web of Science, CINAHL et The Cochrane Library. La recherche et la sélection s’est réalisée individuellement. Résultat : Huit études randomisées contrôlées avec 471 patients parkinsoniens ont été incluses. Les tests évaluant les chutes ainsi que l’équilibre, soit le Berg Balance Scale, le Time Up and Go, l’UPDRS subscale 3 et le Sensory Organization Test, ont montré que les traitements en physiothérapie pouvaient influencer positivement, mais aucun résultat n’est significatif. Dans le Fall Diary, le Fall Efficacy Scale et le Functional Reach Test, les résultats se contredisent sur les effets de l’intervention. Enfin, la qualité de vie est améliorée par les traitements en physiothérapie de manière non significative. Conclusion : La physiothérapie semble avoir des effets positifs envers les chutes et les pertes d’équilibre chez les patients parkinsoniens. Cependant, il existe des évidences insuffisantes quant à la réelle efficacité de la physiothérapie. Par conséquent, d’autres études avec une bonne homogénéité des interventions sont nécessaires afin d’obtenir une meilleure évidenc

The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education ::a systematic review and meta-analysis with integrated meta-regression

Background : Acquisition of procedures is an important element in health professions education. Traditionally procedures are taught using a “see one - do one” approach. That is a teacher demonstrates and describes a procedure and afterwards the students practice the procedure. A more recent teaching approach for the acquisition of procedural skills was presented by Walker and Peyton. Peyton’s teaching approach is a stepwise teaching approach and consists of the following four steps: demonstration, deconstruction, comprehension and performance. The aims of this study were (i) to systematically evaluate the effectiveness of Peyton’s 4–step teaching approach on the acquisition of procedural skills in health professions education and (ii) to evaluate whether studies with fewer students per teacher showed a larger between group difference than studies with more students per teacher. Methods : We searched in Medline, PsycInfo, Embase and ERIC for eligible studies. Records were screened by two independent reviewers. A random effects meta-analysis was performed to evaluate skill acquisition and time needed to perform the procedures at post-acquisition and retention tests. A meta-regression was used to explore the effect of the number of students per teacher on the estimated effect of the educational interventions. Results : An effect size of 0.45 SMD (95% CI [0.15; 0.75]) at post-acquisition and 0.7 SMD (95% CI [−0.09; 1.49]) at retention testing were in favour of Peyton’s teaching approach for skill acquisition. The groups using Peyton’s teaching approach needed considerably less time to perform the procedure at post-acquisition (SMD: −0.8; 95% [CI −2.13 to 1.62]) and retention (SMD: −2.65; 95% CI [−7.77 to 2.47]) testing. The effectiveness of Peyton’s teaching approach was less clear in subgroup analyses using peer teachers. Meta-regression showed that the number of students per teacher was an important moderator variable. Conclusion : Peyton’s teaching approach is an effective teaching approach for skill acquisition of procedural skills in health professions education. When peer students or student tutors are used as teachers the effectiveness of Peyton’s teaching approach is less clear. Peyton’s teaching approach is more effective when small groups with few students per teacher are used

Identification des tests et des approches physiothérapeutiques pour un patient post-AVC qui présente un syndrome Pusher ::une étude de portée

Introduction : Le contraversive pushing est un symptôme neurologique qui peut apparaître après une lésion cérébrale. Il est caractérisé par une poussée active du patient vers son côté hémiplégique. On constate un réel manque de consensus concernant différents aspects de cette pathologie. But : Cette étude avait pour but de réunir les connaissances actuelles et de relever les concepts clés existants pour parler des définitions, tests et traitements du contraversive pushing, afin de souligner les lacunes de la littérature à ce sujet. Méthode : Il s’agit d’une étude de portée. Les publications ont été cherchées sur CINAHL, Embase, Cochrane et MEDLINE/Ovid. Les données ont été extraites et mises sous forme de tableaux de concepts. Résultats : Cinquante-deux études ont été incluses. Les concepts les plus abordés pour la définition sont la « poussée active » et la « résistance à la correction passive ». Pour les tests, les concepts ont été décrits pour la Scale of Contraversive Pushing, la Modified Scale of Contraversive Pushing, la Burke Lateropulsion Scale et Four Point Pusher Scale. Les concepts les plus cités dans les traitements sont l’entraînement d’activités et le feed-back visuel. Discussion : En 1985, la définition de Davies était déjà complète par rapport aux concepts importants relevés. La Scale of Contraversive Pushing semble l’échelle la plus exhaustive en lien avec les concepts. L’intervention qui utilise le plus de concepts est la physiothérapie conventionnelle avec contrôle postural et feed-back visuel. Conclusion : Les concepts des tests correspondent bien à ceux des définitions. Pour lestraitements, en revanche, ils sont relativement indépendants de ceux des définitions

Determining the optimal virtual reality exergame approach for balance therapy in persons with neurological disorders using a rasch analysis ::longitudinal observational study

Background: Virtual reality (VR) exergames have gained popularity in the rehabilitation of persons with neurological disorders as an add-on therapy to increase intensity of training. Intensity is strongly dependent on the motivation of the patient. Motivation can be increased by delivering variation within training and challenging exercises. However, patients are often underchallenged, as exergame difficulty often does not match the patient’s ability. A Rasch analysis can establish hierarchy of exergame items in order to assist the delivery of patient-centered therapy. Objective: The aim of this study was to apply the Rasch model to create a hierarchical order of existing VR balance exergames and to relate these exergames to the abilities of persons with neurological disorders, in order to deliver challenge and variation. Methods: A total of 30 persons with stroke and 51 persons with multiple sclerosis (MS) were included in the study. All participants performed a training program, lasting 3 weeks for persons with MS and 4 weeks for persons with stroke, in which they performed VR balance exergames with a movement recognition–based system (MindMotion GO; MindMaze SA). VR exercise scores, Berg Balance Scale scores, and clinical descriptive data were collected. Berg Balance Scale and device scores were analyzed with the Rasch model using a repeated-measures approach to examine whether the distribution of exercise scores fitted the Rasch model. Secondly, a person-item map was created to show the hierarchy of exercise difficulty and person ability. Results: Participants completed a selection of 56 balance exercises (ie, items), which consisted of a combination of various balance tasks and levels (ie, exercises). Using repeated measures, this resulted in a count of 785 observations. Analysis showed strong evidence for unidimensionality of the data. A total of 47 exercises (ie, items) had a sufficiently good fit to the Rasch model. Six items showed underfit, with outfit mean square values above 1.5. One item showed underfit but was kept in the analysis. Three items had negative point-biserial correlations. The final model consisted of 47 exercises, which were provided for persons with low to moderate balance ability. Conclusions: The VR exercises sufficiently fitted the Rasch model and resulted in a hierarchical order of VR balance exercises for persons with stroke and MS with low to moderate balance ability. In combination with the Berg Balance Scale, the results can guide clinical decision-making in the selection of patient-focused VR balance exercises

Effects of physical activity and dietary supplement on fat free mass and bone mass density during weight loss ::a systematic review and meta-analysis

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed

First steps towards a risk of bias corpus of randomized controlled trials

Risk of bias (RoB) assessment of randomized clinical trials (RCTs) is vital to conducting systematic reviews. Manual RoB assessment for hundreds of RCTs is a cognitively demanding, lengthy process and is prone to subjective judgment. Supervised machine learning (ML) can help to accelerate this process but requires a hand-labelled corpus. There are currently no RoB annotation guidelines for randomized clinical trials or annotated corpora. In this pilot project, we test the practicality of directly using the revised Cochrane RoB 2.0 guidelines for developing an RoB annotated corpus using a novel multi-level annotation scheme.We report interannotator agreement among four annotators who used Cochrane RoB 2.0 guidelines. The agreement ranges between 0% for some bias classes and 76% for others. Finally, we discuss the shortcomings of this direct translation ofannotation guidelines and scheme and suggest approaches to improve them to obtain an RoB annotated corpus suitable for ML