Initial Development and Validation of Physical Therapy-Patient Education Questionnaire (PT-PEQ).

BACKGROUND: Patient education can increase patient engagement and positive outcomes with physical therapy treatment. This study aimed to develop and evaluate the psychometric properties of a physical therapy patient education questionnaire. METHODS: Candidate items were developed and evaluated by an expert panel for content validity. The resulting items were administered to 350 patients in physical therapy treatment, and the reliability and validity of the scale's subscales were evaluated. RESULTS: The final version of the questionnaire consists of 36 items that assess six education domains for patients receiving physical therapy: 1) assessment and information provision (10 items), 2) hygiene and safety (9 items), 3) patient empowerment (8 items), 4) emergency and infection control (3 items), 5) adverse event prevention (4 items), and 6) identity confirmation (2 items). The internal consistency of the subscales ranged from 0.69 to 0.92, and support for the six-domain structure of the items was supported via factor analysis. CONCLUSIONS: The questionnaire was successfully developed and evidenced good psychometric properties for the assessment of the perceived importance of six physical therapy education domains. Research is needed to evaluate potential gaps between patients' perceived education needs and therapist education activities during physical therapy treatment.

The clinical and biomechanical effects of customized foot orthoses in individuals with plantar heel pain: A pre-post intervention study.

BACKGROUND: Customized foot orthoses (CFOs) are often recommended for the management of plantar heel pain. However, there is a lack of information regarding lower limb and multi-segment foot motion during gait. RESEARCH QUESTION: This study aimed to determine the effects of heat moulded CFOs on foot and lower limb kinematics when compared with prefabricated foot orthoses (PFOs) and wearing no orthoses (shod condition), and to determine the short-term effects of CFOs on pain intensity and foot function. METHODS: The immediate effects of CFOs on the lower limb and multi-segment foot motion were assessed. Participants were then asked to use the CFOs for one month and foot pain, function, and temporal-spatial parameters were assessed at baseline and at one month follow up. RESULTS: Thirty-five participants (22 females), aged 40.1 (10.5) years, with a mean duration of symptoms of 12.59 months were recruited. The symptomatic limbs showed a higher forefoot varus angle and greater rearfoot and forefoot corrections were required compared to the non-symptomatic limbs. When compared with PFOs and shod conditions, CFOs provided the least forefoot and knee motion in the transverse plane during contact phase (P < 0.05, d=0.844-1.720), least rearfoot motion in the coronal plane during midstance (P < 0.05, d=0.652), and least forefoot motion in the frontal plane, knee motion in the transverse plane, and hallux motion during the propulsive phase (P < 0.05, d=0.921-1.513). Significant improvements were seen for foot pain and function (P < 0.05, d=1.390-2.231) with significant increases in cadence and walking velocity after one month of CFO use (P < 0.05, d=0.315-0.353), and those most likely to respond had greater pain and less ankle eversion (P < 0.05, d=0.855-1.115). SIGNIFICANCE: CFOs appear to improve pathological biomechanics associated with plantar heel pain. After one month follow up, the CFOs decreased pain intensity and increased foot function, and showed significant improvements in temporal and spatial parameters of gait.

Can orthotic wedges change the lower-extremity and multi-segment foot kinematics during gait in people with plantar fasciitis?

BACKGROUND: Orthotic wedges with medial posting of the forefoot and rearfoot have been shown to be effective in controlling excessive foot pronation in people with plantar fasciitis (PF), however the best prescription remains unclear. RESEARCH QUESTION: The aim of this study was to determine the biomechanical effects of two designs of orthotic wedges within a shoe on the hip, knee, rearfoot, and forefoot kinematics in individuals with PF. METHODS: Thirty-five participants with PF were recruited. They were asked to walk under three randomized conditions; shod, shod with orthotic wedges with foot assessment technique 1 (W1), and shod with orthotic wedges from a new assessment technique (W2). Biomechanical outcomes included lower limb and multi-segment foot kinematics in each subphase of the stance gait, including contact phase, midstance phase, and propulsive phase. RESULTS: Compared with shod, the W1 significantly increased rearfoot dorsiflexion, decreased peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W1 increased rearfoot inversion, decreased hallux dorsiflexion, and peak hallux dorsiflexion during the propulsive phase. For W2, the wedge significantly decreased peak knee internal rotation, decreased forefoot abduction, peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W2 increased rearfoot inversion, decreased hallux dorsiflexion, and decreased peak hallux dorsiflexion during the propulsive phase. When comparing W1 and W2, W1 showed greater rearfoot dorsiflexion during the contact phase. SIGNIFICANCE: These findings suggest that the use of forefoot varus wedges, and the combination of forefoot and rearfoot varus wedges, can change the lower limb kinematics, the multi-segment foot kinematics estimated using markers fixed to the shoe, and the relative length of the plantar fascia which can be associated with a reduction in pain and symptoms during walking.