Service guidelines, models, and protocols for integrating rehabilitation services in primary healthcare in Brazil, Russia, India, China, and South Africa: a scoping review.

PURPOSE: The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa). METHODS: A scoping review guided by Arksey and O'Malley's framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data. RESULTS: The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services. CONCLUSION: This review discusses BRICS countries' rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives.

The integration of rehabilitation services in low-resourced and remote settings can be improved by involving community health workers and community rehabilitation workers in transdisciplinary teams.Peer support workers and community health workers can improve rehabilitation outcomes, particularly through shared care models that emphasize peer-to-peer learning, mentoring, and coaching.Self-management interventions can have a positive impact on functional outcomes.Integrated rehabilitation services in primary healthcare can be supported through community-based rehabilitation, which emphasises community involvement and engagement.

Physiotherapy management of children with cerebral palsy in low- and middle-income countries: a scoping review protocol.

INTRODUCTION: Cerebral Palsy (CP) is the most common childhood physical disability worldwide. Approximately 1.5 to 4 children per live births live with CP, globally. There have been no specific treatments that can reverse the brain damage responsible for the complex clinical dysfunctions of CP. There are, however, several interventions that are currently being used by physiotherapists, most of which are deemed to be ineffective and unnecessary. We will conduct a scoping review aimed at mapping evidence on the physiotherapy management of children living with CP in low- and middle-income countries (LMICs). METHODS: The scoping review will be guided by the Arksey and O'Malley and Levac et al. frameworks. The databases that will be used to search for literature include PubMed, MEDLINE, CINAHL, EBSCOhost, Web of Science, and ProQuest One Academic and Scopus. Gray literature articles will also be included in this review, provided they meet our inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews (PRIMSA-ScR) guideline will be used to report the results of the scoping review. The screened results will be reported using the PRISMA flow diagram guidelines, and the results will be charted using an electronic data charting form and analyzed using thematic analysis. DISCUSSION: Understanding how physiotherapists manage children with CP in LMICs is essential for the development of internationally sound, yet locally relevant, intervention strategy for physiotherapists. It is anticipated that the results of the scoping review will inform the thinking geared towards the development of a contextualised evidence-based framework for physiotherapists to effectively manage CP in children. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework. https://doi.org/10.17605/OSF.IO/VTJ84.

Altered sagittal plane mechanics is associated with Functional Movement Screen deep squat score.

Background: The Functional Movement Screen (FMS) assesses the quality of movements, including the deep squat (DS), which is used in sports settings. The validity of the individual item scores has yet to be established. Objectives: To investigate the validity of the FMS DS by comparing the sagittal plane kinematics of participants who achieve different observer scores. Method: Seventeen injury-free, adolescent male cricket bowlers were assessed. The movement was captured using the Optitrack® motion capture system. Simultaneously, observers scored participants' execution of the DS according to the standard FMS scoring criteria. Participants were grouped into Group 1 (lowest score), Group 2 (altered movement mechanics) or Group 3 (perfect score) according to observer scores. Specific joint angles of each group were compared using the Kruskal-Wallis and Mann-Whitney U tests. Results: There were significant differences in the degree to which the femur passed the horizontal between Group 3 and Group 1 (p = 0.04, r = 0.61) and Group 2 and Group 1 (p = 0.03, r = 0.66) and the difference in the degree to which the torso was kept vertical between Group 3 and Group 1 (p = 0.02, r = 0.66) and Group 2 and Group 1 (p = 0.02; r = 0.72). Conclusion: Kinematic differences exist between participants who achieve different observer scores for the FMS DS. Clinical implications: While differences in sagittal plane kinematics have been observed in participants scoring high on the FMS DS and participants scoring low, further investigation into the validity of the frontal plane kinematics is warranted, as well as the concurrent validity of the individual scoring criteria.

Corticosteroid therapy versus physiotherapy on pain, mobility and function in shoulder impingement: A short note.

Background: The global estimate of shoulder pain is 67% and is often associated with subacromial impingement syndrome. Interventions include corticosteroid injection (CSI) therapy and physiotherapy. Further information is needed to compare the effect of these interventions on pain, joint range of motion (ROM) and shoulder function. Objectives: To summarise the best evidence comparing the effect of CSI versus physiotherapy on pain, shoulder ROM and shoulder function in patients with subacromial impingement syndrome. Method: This evidence statement is based on a systematic review and meta-analysis of three randomised controlled trials (RCTs), namely, Rhon et al. (2014) (n = 136), Hay et al. (2003) (n = 207) and Van der Windt et al. (1998) (n = 109), with a total of 452 participants. A total of 14 studies were reviewed and only 3 studies met the inclusion criteria. Results: An improvement in shoulder function was found in favour of CSI at 6- to 7-week follow-up (p < 0.0001), but no evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM over 4-12 weeks. In 24 and 48 weeks, no evidence was found for the superiority of CSI compared to physiotherapy for shoulder function, pain or ROM. Conclusion: No evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM in the short term besides an improvement in shoulder function in favour of CSI at 6-7 weeks. There was a weak recommendation with moderate quality of evidence based on three RCTs (2B). Clinical implications: This evidence statement may inform clinical practice when determining which intervention is best suited to manage patients with shoulder pain.

The association between physical fitness parameters and in-season injury among adult male rugby players: a systematic review.

INTRODUCTION: The high prevalence of injury among rugby players emphasizes the need for research related to injury risk factors. Physical fitness-related risk factors are likely culprits contributing to both contact and non-contact injuries. Establishing associations between preseason measured physical fitness aspects and injury risk, not only provide players' baseline fitness parameters but could also identify injury prone players, thereby contributing to injury prevention strategies. Therefore, the objective of this review was to assess and summarize scientific literature related to the association between preseason measured physical fitness tests and in-season injury among male rugby players. EVIDENCE ACQUISITION: A systematic review was performed in compliance with the PRISMA 2020 Guidelines. This review considered observational, prospective cohort study designs. Studies that included male rugby (rugby union, rugby league, Australian football rules and rugby sevens) players aged 18 years or above from all levels of participation, evaluating the association between physical fitness test outcome and injury, were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies in any language. Searched databases included Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), the Cochrane Controlled Trials Register in the Cochrane Library, ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, SPORTDiscus with Full Text, SCOPUS and Science Direct. Key words used were "rugby," "injury," "physical fitness," and "risk factors." Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal tool for cohort studies from the Joanna Briggs Institute (JBI SUMARI). EVIDENCE SYNTHESIS: A total of 16 studies were eligible for inclusion in this review. The mean critical appraisal score was 82.63% (SD=17.86). Forty-meter sprint speed was associated with injury in all three (100%) studies that included the test. Inconsistencies in the statistical analysis, however, make comparison difficult. None of the studies that investigated upper (N.=1) and/or lower body power (N.=3) identified power as a risk factor. Conflicting results were found for the association between strength, flexibility, cardiorespiratory fitness, and injury. CONCLUSIONS: Identifying factors associated with injury risk is an important step in the injury prevention paradigm. Once identified, players can be screened for risk factors prior to participation in sport. Interventions, based on screening results, which not only improve performance but also decrease players' risk of sustaining injuries (i.e., physical fitness related risk factors), provide additional incentive for compliance. Overall, this review highlights the inconsistency in testing methods used to gauge specific physical fitness constructs among rugby players, limiting the extent to which comparison of results and pooling of data is possible.

Sport Science Lab® Screening Protocol: The association between physical fitness Parameters and injury among elite rugby players.

CONTEXT AND OBJECTIVES: The Sport Science Lab® (SSL®) screening protocol includes novel methods of assessing flexibility, strength, plyometric ability and rugby specific fitness. The objective of this study was to investigate the association between these tests and injury among professional rugby players. DESIGN: Prospective cohort study. SETTING: Fitness facilities of participating teams. PARTICIPANTS: Thirty-nine injury-free, elite, adult (>18 years), male rugby players. MAIN OUTCOME MEASURES: The test battery consisted of eleven flexibility-, nine strength- and six plyometric tests and a rugby specific fitness test (RSFT). Injuries were recorded weekly during the 2019 rugby season. Associations between test results and injuries were analysed utilising suitable tests of association i.e., sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value and odds ratios (OR) (with confidence intervals (CI)). Bivariate correlations and logistic regression were performed to assess the relationship of the predictor variables to the outcome. RESULTS: Players who achieved the set standard for the RSFT (OR = 3.17; 95% CI = 0.79-12.75), triple horizontal broad jump (OR = 2.40; 95% CI = 0.86-19.61) and lateral depth jumps (OR = 2.40-3.44; 95% CI = 0.53-18.84) were two to three times less likely to sustain an injury during the season. CONCLUSION: Players with superior rugby specific fitness and cyclic linear- and lateral plyometric ability, may have a decreased risk of sustaining injuries.

The interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® screening protocol amongst professional rugby players.

BACKGROUND: Considering the injury incidence rate (IR) associated with elite-level rugby, measures to reduce players' injury risk are important. Establishing scientifically sound, pre-season musculoskeletal screening protocols forms part of injury prevention strategies. OBJECTIVE: To determine the interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® (SSL) screening protocol. METHODS: We determine the interrater and intrarater reliability of 11 flexibility and nine strength tests. Twenty-four injury-free, elite, adult (> 18 years), male rugby players were screened by two raters on two occasions. To establish intrarater and interrater reliability, Gwet's AC1, AC2 and intraclass correlation coefficients (ICC) were used for the analysis of binary, ordinal and continuous variables, respectively. Statistical significance was set at 95%. RESULTS: Flexibility tests which require lineal measurement had at least substantial interrater (ICC = 0.70-0.96) and intrarater reliability (ICC = 0.89-0.97). Most of the flexibility tests with binary outcomes attained almost perfect interrater and intrarater reliability (Gwet's AC1 = 0.8-0.97). All strength tests attained at least substantial interrater (Gwet's AC2 = 0.73-0.96) and intrarater (Gwet's AC2 = 0.67-0.97) reliability. CONCLUSION: The level of interrater and intrarater reliability of most of the flexibility and strength tests investigated supports their use to quantify various aspects of neuromusculoskeletal qualities and possible intrinsic risk factors amongst elite rugby players. CLINICAL IMPLICATIONS: Establishing the reliability of tests, is one step to support the inclusion thereof in official screening protocols. Results of our study, verify the reliability of the simple, clinically friendly strength and flexibility tests included and therefore support their use as preparticipation screening tools for rugby players. Further investigation as to the association thereof to athletes' injury risk and performance is warranted.