bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical reasoning processes in physiotherapists' assessment of unilateral neglect: Part one
Authors: Plummer Prudence , Morris Meg E , Denisenko Sonia , Dunai Judith 
Published: May 2014

Although unilateral neglect (ULN) is a complex neurological syndrome comprising several behavioural patterns, physiotherapists do not always differentiate between the different types of neglect when performing neurological assessments. This study explored the clinical decision-making processes used by physiotherapists when assessing ULN after stroke. In total, 14 neurological physiotherapists in Victoria, Australia, participated in the study. They observed a 27-min videotape of an experienced therapist assessing a stroke patient with left ULN. At predetermined intervals, the videotape was paused and participants recorded their thoughts pertaining to the patient at that time. At the completion of the videotape, physiotherapists were asked questions in relation to their clinical decisions. They were also instructed to classify the behaviour of the patient using a glossary of diagnoses.This article provides background to the study and details the methods used. Results and discussion will be presented in part two, in the following issue.
Special seating considerations for the child with a spinal cord injury
Authors: Krey Christin H 
Published: May 2014

Although wheelchair and seating set-up for the paediatric population is a specialty itself, the child who has sustained a spinal cord injury has several distinct orthopaedic needs that must be addressed; specifically, the issues of neuromuscular scoliosis and hip subluxation. These two factors, as well as the biomechanics and kinematics of wheelchair propulsion, will be discussed. This article reviews current published research regarding orthopaedic needs in paediatric spinal cord injury, wheelchair pushrim biomechanics in adults with spinal cord injury and clinical experience. It concludes that preventative measures such as proper seating, positioning and wheelchair set-up should be taken early on to decrease the chance of, or at least slow the rate of development of a scoliotic curve, hip subluxation or an upper extremity over-use injury.
Assessment of the RPE as a measure of cardiovascular fitness in patients with low back pain
Authors: Finucane Laura , Fiddler Helen , Lindfield Helen 
Published: May 2014

Improving cardiovascular fitness is recognized as an important aspect in the rehabilitation of patients with chronic low back pain. The improvement of cardiovascular fitness relies on an individual exercising at a certain intensity. The Rating of Perceived Exertion (RPE) has been widely accepted as a way to monitor exercise intensity.This study aimed to determine the criterion validity and the test–retest reliability of the RPE in patients with chronic low back pain. In total, 30 subjects with chronic low back pain performed two identical submaximal graded cycle ergometer tests. Heart rate and oxygen consumption were recorded continuously using the Metamax oxygen analyser. Subjects reported RPE scores every minute.Strong correlations were found between the RPE and heart rate and RPE and oxygen consumption. The reliability of the RPE was examined using the Bland and Altman 95% limits of agreement statistical test. There were wide limits of agreement, with subjects' scores varying as much as four points between tests. The findings demonstrated that the RPE is a valid measure to monitor exercise intensity in those patients with chronic low back pain. However, its repeatability is questionable.
Physiotherapists' and podiatrists' views on the effectiveness of treatments for plantar fasciitis
Authors: Brown Joan 
Published: May 2014

Little is known about the effectiveness of numerous conservative treatments given for plantar fasciitis. Randomized controlled trials are needed, but researchers need guidance in choosing treatments most likely to be found effective. This study aimed to develop such guidance by analysing physiotherapists' and podiatrists' views on the effectiveness of treatments commonly given by them for plantar fasciitis. A postal self-completed questionnaire survey of Kent, Surrey and Sussex NHS physiotherapists (n=104) and podiatrists (n=62) was undertaken to guide research in future randomized controlled trials. Treatments were rated for recommendation by using four tools: treatments used, treatments not used, total treatment effectiveness scores and total outcome opinion scores. The author concludes that taping is the only treatment recommended for randomized controlled trials.
A pictorial scale of pain intensity (SPIN) for patients with communication impairments
Authors: Turner-Stokes Lynne , Jackson Diana , Horn Sandra , Kersten Paula 
Published: May 2014

Patients with impaired communication often have difficulty describing symptoms such as pain, which hinders both clinical treatment and research. The objective of this study was to develop and characterize a step-by-step process for introducing a new pictorial scale of pain intensity (SPIN) to stroke patients with communication deficits undergoing rehabilitation. To exemplify the process, this article describes a single patient with profound aphasia and right-sided hemiplegia, who was thought to have severe pain in his affected shoulder, probably associated with neuropathic pain. A method of presenting the SPIN, based on a total communication approach, was established and serial pain ratings made by the patient were found to be consistent with independent clinical records. The SPIN appears to have potential as a method for quantifying pain severity in people with limited communication. Further evaluation is needed in a larger sample of patients.
An exploration of walking activity among older psychiatric inpatients
Authors: Stubbs Brendon , Cooper-Evans Mia-Samantha , Durran Marianne , Montenegro Jose Miguel 
Published: May 2014

Physical activity can lead to a longer life expectancy and is associated with preserved independence and quality of life (QOL). The health consequences of being physically inactive for older adults include depression, decreased mobility and decreased QOL. Despite this, recent observational studies of older adults' activity levels have highlighted that older adults in care are remaining sedentary. The aim of the study was to audit the walking activity levels of 53 older adult psychiatric in-patients before and after a health promotion activity which advocated the benefits of walking. Each patient wore a pedometer for three consecutive days. At baseline, only 21% (11/53) were walking the daily amount recommended for older adults. After the intervention this increased to 32%, (15/47) although a total of 33 (70%) patients increased the amount of daily walking (P = 0.002). This study identified that most older adults in the sample did not walk enough to gain the health benefi ts associated with walking. However, there was an encouraging increase in the amount of walking older adults did following some health promotion activity, which warrants further investigation.
Cardiorespiratory physiotherapy in clinical placement: Students' perceptions
Authors: Bennett Rosalie , Hartberg Olaf 
Published: May 2014

This study aimed to explore possible links between clinical experience in cardiorespiratory physiotherapy and the potential for career choice within that specialty. The perceptions of a purposive sample of physiotherapy students were explored using a self-administered questionnaire, which was constructed to produce in-depth data. Analysis showed that students' perceptions of cardiorespiratory physiotherapy correlated significantly to the degree of experience gained. However, experience was gained both within and outside specialty-specific areas and students were using cardiorespiratory skills in a number of clinical areas and settings. Students with the greatest level of experience within cardiorespiratory patient management were more likely to consider future employment within this specialty. Among the influencing factors was the attitude of clinical educators to the specialty. These findings may have implications for future practice and the recruitment of physiotherapists in to this specialty.
The Canadian Occupational Performance Measure: Use in an independent living centre
Authors: Chatfield Jean , Beckett Dawn 
Published: May 2014

This audit explores the use of the Canadian Occupational Performance Measure (COPM) in an independent living centre (ILC) in the UK. Although the COPM is widely used in a variety of situations, the audit setting is currently the only ILC in the UK using this outcome measure. It is used in this setting to prove the effectiveness of occupational therapy in order to secure ongoing funding for the ILC. The audit took place over two years and examined results obtained with the COPM during this period. The findings of the audit were then compared to the findings and analyses of a pilot study carried out by Law et al (1994), which tested the use of the COPM as an outcome measure. The audits highlights the effective use of COPM within this setting, recognizing its challenges and limitations, particularly when used by students and junior staff. It is suggested that this measure can be adopted by other organizations for the purpose of securing funding as well as to prove the value of occupational therapy in similar settings.
Establishing an effective quantity of physiotherapy after stroke: A discussion
Authors: Purton Judy , Golledge Janet 
Published: May 2014

Physiotherapy is a well-established part of stroke rehabilitation and the UK National Clinical Guidelines for Stroke recommend that patients should have as much therapy as is appropriate to their needs. However there is no conclusive evidence of a definitive amount of treatment that is effective. This discussion paper seeks to explore four trends that appear to be emerging from current research on intensity of physiotherapy treatment, namely quantity of treatment, type of interventions used, influence of levels of impairment and lastly, responsiveness of different body parts for recovery. The authors suggest that further research is needed to investigate some key issues. First of all, research should investigate whether the amount of traditional physiotherapy alone should be increased or if additional treatment should be focused on functional tasks and repetition, as advocated within neuroplasticity literature. Further investigation could also explore whether more intensive treatment is beneficial to all patients or only those with specific types of impairment and activity limitation. To reflect this concept, the possibility of establishing more careful matching of patients to treatments should be explored. Finally, it should be determined whether particular contributions to recovery, e.g. lower limb function, are more responsive to intensive treatment than others, e.g hand function.
Family therapy and neuro-rehabilitation: Forging a link
Authors: Bowen Ceri 
Published: May 2014

Family therapy—otherwise known as systemic therapy—is based on a holistic understanding of the impact of illness or injury on the family. The overall aim of family therapy is to draw on family strengths and highlight examples of positive coping in the face of adversity. Family therapy is often delivered in a high-tech ‘open’ clinic setting, in contrast to the majority of rehabilitation efforts which take place behind closed doors, either in acute medical settings, rehabilitation establishments or in the family home. In neuro-rehabilitation there are further difficulties relating to the actual injuries themselves; particularly the impact of reduced mobility, and poor memory and concentration. Together, this can make family therapy a challenging approach. Yet in spite of its challenging nature, there is a growing exploration of links between rehabilitation and family therapy services, particularly in the UK. This new development is based on a belief that rehabilitation should involve a model for supporting families that is flexibly applied, with extra support for the injured party to allow their full participation. This paper outlines the issues and makes the claim for special interest groups to develop the initiative further.
Physical interventions for managing aggression in mental health: Should physiotherapists be involved?
Authors: Stubbs Brendon , Knight Caroline , Yorston Graeme 
Published: May 2014

Dealing with challenging and aggressive patients has been an accepted routine part of psychiatric practice throughout its history. There has been growing concern about the level of violence on psychiatric wards in recent years. Physical intervention is a technique employed by staff to manage an aggressor, the use of which is highly emotive. There is a paucity of evidence to support its effectiveness. Up to 29% of able bodied staff are injured when applying the techniques in training, which is a passive process. Physical intervention is employed throughout psychiatric services, including those where patients may have physical disability such as in older adults and traumatic brain injury. Clearly a blanket approach employing techniques for able-bodied individuals is not acceptable in such populations. This article reviews the relevant literature on physical intervention in mental health, and discusses a new potential role of the physiotherapist in assessing aggressive individuals with physical impairments suitability for restraint techniques. This is based on practice at a leading independent psychiatric hospital in the United Kingdom.
Measuring occupational performance and client priorities in the community: The COPM
Authors: Roberts AEK , James A , Drew J , Moreton S , Thompson R , Dickson M 
Published: May 2014

The primary aim of this study was to examine changes in clients' occupational performance and satisfaction with their performance within a community trust setting, using the Canadian Occupational Performance Measure (COPM). Given the rapid throughput of clients and the pressure of limited resources, the authors postulated that occupational therapy interventions were focusing on clients' self-care needs as a matter of priority for clients to be independent at home. Therefore, at a time when services are seeking to be increasingly client-focused, the authors' secondary aim was to explore whether self-care needs were also the clients' highest priorities. Fourteen occupational therapists and 62 clients took part in the study. The therapists used the COPM to assess the client; the clients completed the COPM at initial interview and at the end of the intervention. Inferential statistics were then used to ascertain any change over the intervention period. The findings showed a statistically significant change in clients' occupational performance and satisfaction with their performance, in all settings, following occupational therapy. There were notable differences in occupational performance goals between men and women, in that a higher percentage of self-care goals were identified by the men. Self-care goals were the most frequently cited goals in all of the settings.
An occupational therapy income-generation group for HIV-positive women in Uganda: Part 2
Authors: Kamba Moses , Rugg Sue 
Published: May 2014

Little is known of the occupational therapy interventions available to occupational therapy clients living with the human immunodeficiency virus (HIV) in the developing world. Part 1 of this article outlined the background literature in this area. Part 2 details a small, interview-based study of ten HIV-positive Ugandan women taking part in such an intervention; an occupational therapy incomegeneration group. The study sought to identify reasons for falling attendance at the group. The study findings reflect both the challenges of being HIV-positive, and the factors influencing women's participation in the group. The women attributed a range of social, emotional and practical benefits to group attendance, relating these to social support and empowerment, as well as opportunities to go beyond the home environment, learn new skills and earn money. The negative aspects of group attendance cited were all interpersonal in nature, relating to conflict with participants' peers and group leaders. This study discusses these findings, and their implications for occupational therapy, concluding that the profession has much to offer clients and that this should be explored further.
Sternal instability during arm elevation observed as dynamic, multiplanar separation
Authors: El-Ansary Doa , Adams Roger , Waddington Gordon 
Published: May 2014

AimsThe purpose of this study was to describe and measure the motion of the sternal edges in a single case with sternal instability, a complication that can follow a sternotomy for cardiac surgery.MethodsUsing proprietary ultrasonography system software, and with a modification whereby the ultrasound unit head was attached to a microphone stand in order to maintain optimal contact with the chest of the seated subject, imaging was performed in the transverse plane during a series of three repeated unilateral arm elevation movements.FindingsUltrasonography showed that the sternal separation was in both the transverse (10–17.5 mm) and sagittal (3.5–18.2 mm) planes during arm elevation.ConclusionsSuch multiplanar separation of the sternal edges in inoperable sternal instability may explain the degree of discomfort experienced by patients with sternal non-union. Future research on sternal closure methods and the effects of activity and exercise on the healing sternum could lead to new clinical guidelines, which might reduce this discomfort.
Investigating physiotherapy and occupational therapy students' outcome effectiveness
Authors: Rone-Adams Shari , Nof Leah , Hart Dennis L , Sandro Colleen R , Wang Ying-Chih 
Published: May 2014

Aims Research has looked at the differences between outcomes of patients treated by novice vs expert therapists, but to date research has not looked at differences in outcomes of patients treated by students and therapists. The purpose of this pilot study was to determine if there was a difference in functional status, treatment visits or treatment duration of patients treated by student therapists compared to patients treated by occupational therapists and physiotherapists. Methods This retrospective study used secondary analysis of the Focus on Therapeutic Outcomes (FOTO), Inc. database, which is used within one outpatient rehabilitation hospital in Ohio, USA. The database contains patient data on functional status measures, number of visits and treatment duration, and comparisons were made in these three areas between patients treated by therapists and therapy students. Findings Data suggested patients treated by therapists tended to have fewer visits (10.8 visits for students, 9.1 visits for therapists), shorter treatment duration (37.6 days for students, 27.2 days for therapists), and greater improvement of functional status compared to patients treated by students. Conclusion The trends in the data suggesting that students used more visits and treated with less improvement in functional status warrants further discussion and investigation. Findings contribute to the ongoing discussion about the need to be efficient and effective, which is consistent within the healthcare industry, while at the same time making sure that students have quality educational experiences.
Causes of delayed discharge following joint replacement surgery
Authors: Williams Geraint 
Published: May 2014

Aims After developing an increased awareness of the issues which delay timely discharge, the author conducted a retrospective case note analysis to establish causes and discuss potential solutions for delays at the elective primary arthroplasty unit at Wirral University Teaching Hospital NHS Trust. Methods A total of 189 patients who underwent total hip or total knee replacements during 2007 were identifi ed. Case notes were scrutinized for causes of failure to achieve target inpatient stay of 5 days or fewer. Findings Rehabilitation factors were the primary cause of delayed discharge in 66 of the 110 patients who failed to achieve target inpatient stay. Post-operative complications were the second most common reason for extended stay, resulting in 21 delays. Organizational, administrative and occupational therapy factors were the source of the remaining 23 delays. Conclusions The arthroplasty unit at Wirral University Teaching Hospital NHS Trust provides a comprehensive postoperative rehabilitation service. Factors which affect the speed of rehabilitation are comprehensive and the process by which it takes place cannot be addressed in isolation. Physiotherapy services are functioning at a premium, and further reductions in stay may only be possible by shifting the emphasis away from quality and redefining the functional rehabilitation requirements for safe discharge. Reducing inpatient times in this situation may not be desirable and could compromise the basic principles of what joint replacement aims to achieve.
Handy skills – partnership working in practice
Authors: Cannon Ben , Williams Sally , Woolcomb Rachel 
Published: May 2014

BackgroundDisabled Adults' Resource Team (DART) was established in 1999 to meet the ongoing health and therapy needs of adults of working age who have an ongoing physical impairment. DART works to a person centred social model, on goal focused episodes of intervention taking into account each service user's individual circumstances. DART therapists work together in an interdisciplinary manner to enable service users to achieve their goals.ContentThis article details how partnership working between a service user with cerebral palsy and his therapists has enabled him to gain the use of his right arm. It identifies the range of treatment modalities that were used and explores how important it is for therapy to remain functionally relevant to the individual.ConclusionsBy interspersing the service user's own report of the experience of therapy with the therapists' perspective, a person centred approach is demonstrated.
Research – a tool to empower or disrupt? The effects of research on those involved
Authors: White Margaret , Smith Judy 
Published: May 2014

Background Research in clinical practice without attachment to a major academic institution can be fraught with difficulties. This article aims to explore some of the difficulties that can be encountered when carrying out research, using the example of a project aiming to use clinical practice to develop more relevant and realistic multidisciplinary outcome measures for the rehabilitation population. In this example, with patient and staff involvement, the reliability study successfully developed the Care Dependency Scale into such a tool. Contents This article does not present the results of the research, which will be presented separately; rather it describes the story of the research project, outlining both the challenges and benefits that transpired as a consequence of staff being involved in research in a small multidisciplinary rehabilitation centre. Conclusions While such research can present many challenges, endeavouring to overcome these can have positive outcomes for both staff and patients. In this case, participating in research proved to be a tool to empower both staff and patients and promoted changes in the Centre. Potential researchers should not be put off their investigations simply because they are not affiliated with an academic institution.