Experiences and needs of physiotherapists and exercise therapists regarding the management of working people with complaints of the arm, neck and shoulder (CANS): A focus group study.

BACKGROUND: Non-traumatic complaints of the arm, neck and/or shoulder (CANS) are difficult-to-treat musculoskeletal conditions. CANS treatment has varying degrees of success, particularly in the working population. OBJECTIVES: To evaluate the experiences and needs of physiotherapists (PTs) and exercise therapists (ETs) regarding the treatment of working patients with CANS. DESIGN: An exploratory qualitative focus group study was conducted. METHOD: Qualitative data were collected from 27 therapists who were purposefully recruited for their broad range of experience and qualifications. The data was analysed using thematic analysis. RESULTS: Both PTs and ETs assess CANS extensively by exploring their patients' psychosocial factors, work-related factors, illness beliefs, and working conditions. Therapists apply hands-off treatment interventions, such as coaching the patient to make behavioural changes and providing self-management support. However, therapists experience many difficulties in these areas, resulting in a need to learn more about coaching techniques for behavioural change, engaging in meaningful conversations about the patient's perspective, supporting patients in building a strong social network in the workplace, and creating a professional network for collaboration. CONCLUSIONS: The treatment of working people with CANS is difficult for PTs and ETs. Therapists express a need to learn more about supporting self-management, applying coaching techniques and engaging in meaningful conversations. Moreover, therapists indicate a need to establish a professional multidisciplinary network to support collaborations with other disciplines to treat working patients with CANS.

Assessing physical therapist students' self-efficacy: measurement properties of the Physiotherapist Self-Efficacy (PSE) questionnaire.

BACKGROUND: Apart from skills, and knowledge, self-efficacy is an important factor in the students' preparation for clinical work. The Physiotherapist Self-Efficacy (PSE) questionnaire was developed to measure physical therapy (TP) students' self-efficacy in the cardiorespiratory, musculoskeletal, and neurological clinical areas. The aim of this study was to establish the measurement properties of the Dutch PSE questionnaire, and to explore whether self-efficacy beliefs in students are clinical area specific. METHODS: Methodological quality of the PSE was studied using COSMIN guidelines. Item analysis, structural validity, and internal consistency of the PSE were determined in 207 students. Test-retest reliability was established in another sample of 60 students completing the PSE twice. Responsiveness of the scales was determined in 80 students completing the PSE at the start and the end of the second year. Hypothesis testing was used to determine construct validity of the PSE. RESULTS: Exploratory factor analysis resulted in three meaningful components explaining similar proportions of variance (25%, 21%, and 20%), reflecting the three clinical areas. Internal consistency of each of the three subscales was excellent (Cronbach's alpha > .90). Intra Class Correlation Coefficient was good (.80). Hypothesis testing confirmed construct validity of the PSE. CONCLUSION: The PSE shows excellent measurement properties. The component structure of the PSE suggests that self-efficacy about physiotherapy in PT students is not generic, but specific for a clinical area. As self-efficacy is considered a predictor of performance in clinical settings, enhancing self-efficacy is an explicit goal of educational interventions. Further research is needed to determine if the scale is specific enough to assess the effect of educational interventions on student self-efficacy.

Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?

PURPOSE: Heterotopic ossification is a common complication after total hip arthroplasty. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to prevent heterotopic ossifications effectively, however gastrointestinal complaints are reported frequently. In this study, we investigated whether etoricoxib, a selective cyclo-oxygenase-2 (COX-2) inhibitor that produces fewer gastrointestinal side effects, is an effective alternative for the prevention of heterotopic ossification. METHODS: We investigated the effectiveness of oral etoricoxib 90 mg for seven days in a prospective two-stage study design for phase-2 clinical trials in a small sample of patients (n = 42). A cemented primary total hip arthroplasty was implanted for osteoarthritis. Six months after surgery, heterotopic ossification was determined on anteroposterior pelvic radiographs using the Brooker classification. RESULTS: No heterotopic ossification was found in 62 % of the patients that took etoricoxib; 31 % of the patients had Brooker grade 1 and 7 % Brooker grade 2 ossification. CONCLUSIONS: Etoricoxib seems effective in preventing heterotopic ossification after total hip arthroplasty. This finding further supports the use of COX-2 inhibitors for the prevention of heterotopic ossification following total hip arthroplasty.

Bilateral changes in forearm oxygen consumption at rest and after exercise in patients with unilateral repetitive strain injury: a case-control study.

STUDY DESIGN: Case-control study. OBJECTIVES: To investigate whether oxygen consumption and blood flow at rest and after exercise are lower in the affected arm of patients with repetitive strain injury (RSI) compared to controls, and lower in the healthy nonaffected forearm within patients with unilateral RSI. BACKGROUND: RSI is considered an upper extremity overuse injury. Despite the local presentation of complaints, RSI may be represented by systemic adaptations. Insight into the pathophysiology of RSI is important to better understand the development of RSI complaints and to develop effective treatment and prevention strategies. METHODS: Twenty patients with unilateral RSI and 20 gender-matched control subjects participated in this study. Forearm muscle blood flow and oxygen consumption were measured using near-infrared spectroscopy at baseline and immediately after isometric handgrip exercises at 10%, 20%, and 40% of the individual maximal voluntary contraction. RESULTS: Unilateral RSI resulted in a lower oxygen consumption and blood flow in the affected forearm at baseline and lower oxygen consumption after incremental handgrip exercises compared to controls (P<.05). In addition, exercise-induced blood flow and oxygen consumption in the nonaffected forearm in patients with RSI were similarly reduced. CONCLUSION: Blood flow and oxygen consumption after exercise are similarly attenuated in the affected and nonaffected arms of patients with unilateral RSI. Our findings suggest that, despite the unilateral character in clinical symptoms, RSI demonstrates systemic adaptations in forearm blood flow and oxygen consumption at rest and after exercise.

Total hip arthroplasty: what information do we offer patients on websites of hospitals?

BACKGROUND: Physicians face a new challenge; the self-educated patient. The internet is an important source that patients use to become self-educated. However, the individual choice for best treatment is difficult. The aim of this study was to investigate what kind of information is offered to total hip arthroplasty patients by internet and what information is appreciated by them. METHODS: Websites of orthopedic departments of all hospitals in the Netherlands were evaluated. In addition, a cohort of 102 patients, diagnosed with arthritic joint disorders, filled in an online survey and gave their opinion concerning the importance of this information. RESULTS: Eighty different orthopedic websites of hospitals were identified. Websites presented information regarding the orthopedic staff surgeon (76%) and the postoperative rehabilitation process (66%). They also offered referral to other orthopedic websites (61%), the opportunity to make an outpatient appointment (21%), and the opportunity to submit an online question (15%). Patients rated the presence of information regarding prosthesis survival as very important (>70%). However, the information on the type of prosthesis used by the hospital, and survival data of the prosthesis, were only present in ~9% and 5% respectively, of the websites. CONCLUSIONS: The content of health information on websites of hospitals is highly variable for total hip arthroplasty. Information regarding the hip implant and prosthesis survival is highly appreciated by patients, however, mostly absent on orthopedic websites in the Netherlands. The internet provides an enormous potential for orthopedic surgeons to inform the self-educated patient.

No impaired hemoglobin oxygenation in forearm muscles of patients with chronic CRPS-1.

OBJECTIVES: Physiotherapy is considered an important treatment option in patients with upper limb complex regional pain syndrome type-1 (CRPS-1). In case of chronic CRPS-1, exercise therapy of the affected limb forms an important part of the physiotherapeutic program. We investigated whether muscle loading in chronic CRPS-1 patients is associated with impairments in muscle circulation of the forearm of the affected limb. METHODS: Thirty patients with chronic CRPS-1 unilaterally affecting their upper limbs, and 30 age-matched and sex-matched control participants were included in this study. Local muscle blood flow and hemoglobin oxygenation were measured by near infrared spectroscopy within the muscles of the forearm at rest, after 1-minute isometric handgrip exercises, and after arterial occlusion. Main outcome parameters were: local muscle blood flow, O2 consumption (mVO2), and postischemic reoxygenation (ReOx). RESULTS: We found no differences in baseline muscle blood flow, mVO2, and ReOx between the affected CRPS-1, unaffected CRPS-1, and control arms. After exercise, mVO2 of the affected CRPS-1 arms was not different from the clinically unaffected CRPS-1 arms. Furthermore, in comparison with the control arms, unaffected CRPS-1 arms showed no difference in mVO2 or ReOx. CONCLUSIONS: Muscle loading does not seems to be related to impairments in muscle oxygen uptake in forearm muscles of upper limbs affected by chronic CRPS-1. Our results suggest that exercise therapy can be safely used in physiotherapeutic training programs for chronic CRPS-1 of the upper limb.

Forearm blood flow and oxygen consumption in patients with bilateral repetitive strain injury measured by near-infrared spectroscopy.

Despite the social impact of repetitive strain injury (RSI), little is known about its pathophysiological mechanism. The main objective of this study was to assess the local muscle oxygenation (mVO2) and blood flow (mBF) of the forearm in individuals with RSI during isometric contractions of the forearm. We employed the non-invasive optical technique near-infrared spectroscopy to assess forearm VO2 and BF. These variables were assessed at 10%, 20%, and 40% of their individual maximal voluntary strength. Twenty-two patients with RSI symptoms in both arms (bilateral RSI) and 30 healthy age-matched subjects participated in this cross-sectional study. The results showed lower mVO2 during exercise and a reduced mBF after exercise. The results suggest that mVO2 and mVO2 are lower in the forearms of individuals with RSI compared with their controls at similar working intensities. This finding indicates that the underlying vasculature may be impaired. Although these findings contribute to the understanding of RSI, future research is necessary to further unravel the mechanisms of this area.

Reliability of videotaped observational gait analysis in patients with orthopedic impairments.

BACKGROUND: In clinical practice, visual gait observation is often used to determine gait disorders and to evaluate treatment. Several reliability studies on observational gait analysis have been described in the literature and generally showed moderate reliability. However, patients with orthopedic disorders have received little attention. The objective of this study is to determine the reliability levels of visual observation of gait in patients with orthopedic disorders. METHODS: The gait of thirty patients referred to a physical therapist for gait treatment was videotaped. Ten raters, 4 experienced, 4 inexperienced and 2 experts, individually evaluated these videotaped gait patterns of the patients twice, by using a structured gait analysis form. Reliability levels were established by calculating the Intraclass Correlation Coefficient (ICC), using a two-way random design and based on absolute agreement. RESULTS: The inter-rater reliability among experienced raters (ICC = 0.42; 95%CI: 0.38-0.46) was comparable to that of the inexperienced raters (ICC = 0.40; 95%CI: 0.36-0.44). The expert raters reached a higher inter-rater reliability level (ICC = 0.54; 95%CI: 0.48-0.60). The average intra-rater reliability of the experienced raters was 0.63 (ICCs ranging from 0.57 to 0.70). The inexperienced raters reached an average intra-rater reliability of 0.57 (ICCs ranging from 0.52 to 0.62). The two expert raters attained ICC values of 0.70 and 0.74 respectively. CONCLUSION: Structured visual gait observation by use of a gait analysis form as described in this study was found to be moderately reliable. Clinical experience appears to increase the reliability of visual gait analysis.