Physiotherapy goal setting in anterior cruciate ligament rehabilitation : an exploration of training, practice and beliefs

Despite the growing interest into the role of physiotherapists providing psychological interventions within anterior cruciate ligament (ACL), literature surrounding goal setting practices within this field is minimal. The main purpose of this research was to explore physiotherapists’ approaches, training and beliefs into goal setting practices used within ACL rehabilitation. The thesis consisted of seven chapters, two of which were empirical studies. The empirical chapters aimed to gain further insight into physiotherapists understanding on the psychological aspects of patients following ACL surgery, theoretical knowledge of goal setting, experiences of implementing goals, training received on goal setting and future training needs. Study four involved a UK cross sectional online survey of one hundred and twenty four physiotherapists (N=124). The survey provided an insight of perceptions and goal setting approaches used within ACL rehabilitation. These findings were further explored in study five which involved a UK semi-structured interview study including twenty four physiotherapists (N=24), using an inductive approach. Study five provided a much deeper understanding in to physiotherapist’s goal setting practices, training and experiences within ACL rehabilitation and also revealed issues surrounding the initial consultation process. The research findings were conceptualised into a theoretical, innovative goal setting model. The goal of this model is to outline a multi-phase conceptual model of an appropriate ACL rehabilitation goal setting strategy for physiotherapists in an attempt to guide both practice, teaching and research

The Clinical Effectiveness of Using Kinesio Tape Following Wisdom Teeth Extraction

Surgical removal of third molars (3M) is a routine, low risk procedure. Common post-surgical symptoms are typically swelling, pain and trismus. Kinesiology Taping (KT) is a relatively new treatment option in musculoskeletal pathologies and some of the hypotheses of KT is that it reduces pain, oedema and increases blood flow; however current evidence does not support its use. Patient A underwent a routine removal of 3 third molars via general anaesthetic. A post-surgical lymphatic drainage KT application was applied to the patient’s lower mandible and masseter region. Results showed a significant reduction in pain, swelling and trismus was also reduced. The post op recovery time was decreased from the post op material of 10 days to 5 days; therefore suggesting that KT is potentially an effective treatment following surgical removal of wisdom teeth

Comparison of the Thesslay Test and McMurray Test: A Systematic Review of Comparative Diagnostic Studies

The Thessaly test is a relatively recently developed meniscal test; therefore research compared to other meniscal tests is somewhat limited. In addition, a systematic review comparing the Thessaly’s test with a long standing test such as the McMurray test has not been previously conducted. Objectives: To systematically identify and appraise all empirical studies comparing the diagnostic accuracy of the Thessaly test and McMurray test. Procedure: Eligible studies were identified through a rigorous search of ScienceDirect, CINAHL Plus, Pubmed, PEDro, EMBASE and Cochrane Library from January 2004 until August 2014. Full English reports of studies investigating the accuracy of the Thessaly test and McMurray test. Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) scores were completed on each selected article. Results: The Thessaly test reported to have higher diagnostic accuracy values (61-96%) compared to the McMurray test (56- 84%). Although McMurray test showed to have higher sensitivity in the detection of lateral meniscal tears, the Thessaly reported to more sensitive for medial and higher specificity values for both medial and lateral tears. Limitations: All the included studies have considerable limitations related to inclusion and exclusion criteria and recording of test outcomes. Conclusion: Higher strength of evidence studies are warranted to ensure a more robust data collection of information in addition to further investigate the diagnostic accuracy of such tests

The Effects of Wetted Ice on Dynamic Stability over a Rewarming Period

BACKGROUND During half time or breaks in play cryotherapy is often applied for analgesia for minor musculoskeletal sport injury, however the effect of cryotherapy on dynamic stability is debated. A risk factor for further lower limb injury may be heightened due to a reduction in dynamic postural stability. OBJECTIVES The purpose of the current study was to investigate the effects of wetted-ice applied for 20-minutes at the ankle on dynamic stability using the star excursion balance test, immediately-post exposure and over a rewarming period of 30-minutes. MATERIALS AND METHODS Twenty-two healthy male athletes that regular took part in land-based sport were assessed on reach directions of Anterior (Ant), Posteromedial (PM), and Posterolateral (PL) using the modified star excursion balance test (mSEBT) on the non-dominant limb. Thermal imaging quantified skin surface temperature (Tsk) over lateral and medial regions. Participants were tested pre-intervention, exposed to 15-minutes wetted-ice cryotherapy application, immediately-post and up to 30-minutes post intervention at 10-minute intervals. RESULTS Significant decreases in Tsk over the medial and lateral regions of the ankle (p < 0.05) not returning to pre-cooling temperatures at 30-minutes post. Significant decrease in reach -distance scores (ANT, PL and PM) pre-immediately post and at 10, 20 and 30-minutes post cryotherapy exposure. CONCLUSION Following wetted ice application to the non-dominant ankle, dynamic postural stability was adversely affected for up to 30-minutes post exposure demonstrated through a decrease in reach scores for ANT, PL and PM directions. Functional performance which requires stabilising mechanisms may be negatively affected and contribute to a heightened risk of injury or further injury in consideration of the findings

Physiotherapy Student's Perceptions of the Ideal Clinical Educator

Background The skills and qualities of the clinical educator are clearly embedded within the literature. The interactions between the educator and student throughout the placement journey are an important component of the student’s experience. Although clinical educator roles and interactions with students have been studied in physiotherapy, determining the perceived ideal clinical educator through the lens of the student remained under analysed. The aim of this study was to explore physiotherapy student’s perceptions of the ideal clinical educator. Method The study involved 16 physiotherapy final year students using two focus groups. An inductive approach using thematic analysis was employed to gain data rich cases. Results The results revealed 3 main themes, which were educator role, placement experiences and ideal clinical educator. The importance of communication skills, knowledge and being approachable were central to the students perceived ideal clinical educator. Paradoxically, it is not a mandatory requirement for physiotherapists to undertake practice education training, therefore the study revealed that pedagogical practices were not being employed consistently such as structured feedback and methods of assessment. Discussion This study highlighted the importance of providing clinical educators with the relevant pedagogical theory to ensure that the approach in which students are mentored through their placements are more consistent. Equipping clinical educators with the underlying principles of teaching and learning strategies may improve student self-efficacy, rapport and the learning experience. Conclusion Future research examining the link universities have with their local placement providers may help bridge the knowledge gaps of physiotherapists who are not formally trained in practice education as opposed to having to attend out of work conventional practice educator courses. In addition curriculum consideration in relation to how students are prepared for placements e.g. resilience strategies may help reduce negative learning experience

Musculoskeletal physiotherapists’ use of psychological interventions::A systematic review of therapists’ perceptions and practice

Background Research has demonstrated that incorporating psychological interventions within physiotherapy practice has numerous potential benefits. Despite this physiotherapists have reported feeling inadequately trained to confidently use such interventions in their day-to-day practice. Objective To systematically review musculoskeletal physiotherapists’ perceptions regarding the use of psychological interventions within physiotherapy practice.Data sources Eligible studies were identified through a rigorous search of AMED, CINAHL, EMBASE, MEDLINE and PsychINFO from January 2002 until August 2013.Study eligibility criteria Full text qualitative, quantitative and mixed methodology studies published in English language investigating musculoskeletal physiotherapists’ perceptions regarding their use of psychological interventions within physiotherapy practice.Study synthesis and appraisal Included studies were appraised for risk of bias using the Critical Appraisal Skills Programme qualitative checklist. Meta-analysis was not possible due to study heterogeneity.Results Six studies, all with a low risk of bias, met the inclusion criteria. These studies highlighted that physiotherapists appreciate the importance of using psychological interventions within their practice, but report inadequate understanding and consequent under utilisation of these interventions.Limitations These results should be noted with some degree of caution due to various limitations associated with the included studies and with this review, including the use of a qualitative appraisal tool for mixed methodology/quantitative studies.Conclusion These findings suggest that musculoskeletal physiotherapists are aware of the potential benefits of incorporating psychological interventions within their practice but feel insufficiently trained to optimise their use of such interventions; hence highlighting a need for further research in this area and a review of physiotherapist training