| 1. |
- Crea, Simona, et al.
(författare)
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Time-Discrete Vibrotactile Feedback Contributes to Improved Gait Symmetry in Patients With Lower Limb Amputations : Case Series
- 2017
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Ingår i: Physical Therapy. - : AMER PHYSICAL THERAPY ASSOC. - 0031-9023 .- 1538-6724. ; 97:2, s. 198-207
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Tidskriftsartikel (refereegranskat)abstract
- Background. Reduced sensory feedback from lower leg prostheses results in harmful gait patterns and entails a significant cognitive burden because users have to visually monitor their locomotion. Objectives. The purpose of this study was to validate a sensory feedback device designed to help elderly patients with transfemoral amputation to improve their temporal gait symmetry after a training program aimed at associating the vibrotactile patterns with symmetrical walking. Design. This was a prospective quasi-experimental study including 3 elderly patients walking with lower leg prostheses. Methods. During training sessions, participants walked on a treadmill equipped with feedback device that controlled vibrotactile stimulators based on signals from a sensorized insole while provided with visual feedback about temporal gait symmetry. The vibrotactile stimulators delivered short-lasting, low-intensity vibrations synchronously with certain gait phase transitions. During pretraining and posttraining sessions, participants walked without visual feedback about gait symmetry under 4 conditions: with or without vibrotactile feedback while performing or not performing a secondary cognitive task. The primary outcome measure was temporal gait symmetry. Results. with <= 52 hours of training,the participants improved their temporal gait symmetry from 0.82 to 0.84 during the pretraining evaluation session to 0.98 to 1.02 during the follow-up session across all conditions. Following training, participants were able to maintain good temporal gait synmsetry, without any evidence of an increased cognitive burden. Limitations. The small sample size and short follow-up time do not allow straightforward extrapolations to larger populations or extended time periods. Conclusions. Low-cost, gait phase-specific vibrotactile feedback after training combined with visual feedback may improve the temporal gait synmsetry in patients with transfemoral amputation without representing an additional cognitive burden.
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| 2. |
- Danielsson, Louise, 1979, et al.
(författare)
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“Crawling Out of the Cocoon”: Patients’ Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression.
- 2016
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 96, s. 1241-1250
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Tidskriftsartikel (refereegranskat)abstract
- Background: While the effectiveness of physical exercise for depression has been studied for many years, few studies have described patients’ experiences of what exercise means to them, beyond the biological focus. Moreover, exercise as a treatment for depression is rarely explored in a physical therapy context. Objectives: The purpose was to explore a physical therapy exercise intervention, as experienced by persons suffering from major depression. Design: This study had an inductive approach and employed qualitative content analysis. Methods: Semi-structured interviews were conducted with 13 persons who participated in physical therapist-guided aerobic exercise in a randomized controlled trial. The participants were all diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders. Data were collected and analyzed in an inductive tradition using qualitative content analysis according to Graneheim and Lundman. Results: Four categories emerged: struggling toward a healthy self, challenging the resistance, feeling alive but not euphoric, and needing someone to be there for you. The participants experienced that although the exercise intervention was hard work, it enhanced the feeling of being alive and made them feel that they were doing something good for themselves. These feelings were a welcome contrast to the numbness and stagnation they experienced during depression. Conclusions: Exercise in a physical therapy context can improve the participants’ perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient’s vulnerability and ambiguity in an empathic and perceptive way.
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| 3. |
- Dean, E., et al.
(författare)
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Health Competency Standards in Physical Therapist Practice
- 2019
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Ingår i: Physical Therapy. - : NLM (Medline). - 0031-9023 .- 1538-6724. ; 99:9, s. 1242-1254
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Tidskriftsartikel (refereegranskat)abstract
- Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.
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| 4. |
- Elvén, Maria, 1973-, et al.
(författare)
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Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students
- 2019
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:8, s. 964-976
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Tidskriftsartikel (refereegranskat)abstract
- Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-a-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. This study used an exploratory cross-sectional design. The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R-2=0.04; SBC change in R-2=0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. The limitations of this study are that it was cross-sectional. Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.
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| 5. |
- Hansson, Nils, et al.
(författare)
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Nobel Prize for Physical Therapy? Rise, Fall, and Revival of Medico-Mechanical Institutes
- 2015
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 95:8, s. 1184-1194
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Tidskriftsartikel (refereegranskat)abstract
- This historical vignette explores the considerations of the Nobel Prize Committee for Physiology or Medicine by vetting the Nobel Prize chances of Dr Gustaf Zander (1835–1920). His way to stardom started 150 years ago when he began mechanizing the passive and active movements that physical therapists manually used to treat diseases. A glance at his machines shows that they parallel surprisingly well what can be found in modern fitness studios. By combining files from the Nobel Prize Archive and sources from the first physical therapists, this vignette pieces together why Zander was considered one of the best candidates for the Nobel Prize in 1916. By providing this glimpse of history, questions about the origin of physical therapy concepts and the profession of the physical therapist are raised.
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| 6. |
- Jakobsson, Max, et al.
(författare)
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Level of Evidence for Reliability, Validity, and Responsiveness of Physical Capacity Tasks Designed to Assess Functioning in Patients With Low Back Pain: A Systematic Review Using the COSMIN Standards.
- 2019
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 99:4, s. 457-477
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Physical capacity tasks (ie, observer-administered outcome measures that comprise a standardized activity) are useful for assessing functioning in patients with low back pain. PURPOSE: The purpose of this study was to systematically review the level of evidence for the reliability, validity, and responsiveness of physical capacity tasks. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Scopus, the Cochrane Library, and relevant reference lists were used as data sources. STUDY SELECTION: Two authors independently selected articles addressing the reliability, validity, and responsiveness of physical capacity tasks, and a third author resolved discrepancies. DATA EXTRACTION AND QUALITY ASSESSMENT: One author performed data extraction, and a second author independently checked the data extraction for accuracy. Two authors independently assessed the methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist, and a third author resolved discrepancies. DATA SYNTHESIS AND ANALYSIS: Data synthesis was performed by all authors to determine the level of evidence per measurement property per physical capacity task. The 5-repetition sit-to-stand, 5-minute walk, 50-ft (∼15.3-m) walk, Progressive Isoinertial Lifting Evaluation, and Timed "Up & Go" tasks displayed moderate to strong evidence for positive ratings of both reliability and construct validity. The 1-minute stair-climbing, 5-repetition sit-to-stand, shuttle walking, and Timed "Up & Go" tasks showed limited evidence for positive ratings of responsiveness. LIMITATIONS: The COSMIN 4-point checklist was originally developed for patient-reported outcome measures and not physical capacity tasks. CONCLUSIONS: The 5-repetition sit-to-stand, 50-ft walk, 5-minute walk, Progressive Isoinertial Lifting Evaluation, Timed "Up & Go," and 1-minute stair-climbing tasks are promising tests for the measurement of functioning in patients with chronic low back pain. However, more research on the measurement error and responsiveness of these tasks is needed to be able to fully recommend them as outcome measures in research and clinical practice.
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| 7. |
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| 8. |
- Johansson, Hanna, et al.
(författare)
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Controlling the uncontrollable : Perceptions of balance in people with parkinson disease
- 2019
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:11, s. 1501-1510
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Exercise improves balance in Parkinson disease (PD), yet the majority of people with the diagnosis are physically inactive. Insights gained from understanding how people with PD (PwPD) make sense of their symptoms and their ability to control them may inform the communication strategies and motivational approaches adopted by physical therapists. No previous study has qualitatively explored how PwPD perceive the concept of balance and the beliefs they hold concerning their ability to affect balance.OBJECTIVE: This study aimed to explore the meaning of balance for PwPD and the beliefs they hold regarding their ability to influence their balance in everyday life.DESIGN: The design is a qualitative study with an inductive approach.METHODS: In-depth interviews were conducted with 18 participants with PD (age range 46 to 83 years, Hoehn and Yahr range 1 to 4), and transcripts were analyzed using qualitative content analysis.RESULTS: Five main themes emerged from the analysis: remaining in control over the body; adapting behavior to deal with uncertainty; directing focus to stay one step ahead; resilience as a defense, and exercise beliefs and reservations. Interpretation of the underlying patterns in the main themes yielded the overarching theme of focus and determination to regain control over shifting balance.CONCLUSIONS: The concept of balance was perceived as both bodily equilibrium and mind-body interplay and was described in the context of remaining in control over one's body and everyday life. Cognitive resources were utilized in order to direct focus and attention during balance-challenging situations in a process involving internal dialogue. Even participants who did not express beliefs in their ability to affect balance through exercise used psychological resilience to counter the challenges of impaired balance.
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| 9. |
- Joseph, C, et al.
(författare)
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Client Perspectives on Reclaiming Participation After a Traumatic Spinal Cord Injury in South Africa
- 2016
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Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 96:9, s. 1372-1380
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe development of rehabilitation services promoting participation in people living with a traumatic spinal cord injury (TSCI) is of major concern for physical therapists. What the client sees as effective participation, barriers, and facilitators might be different due to their particular context. This study was conducted to gain insight into the experiences of attaining an important outcome in a developing context.ObjectiveThe aim of this study was to explore the experiences of reclaiming participation in community-dwelling people with TSCI in South Africa.DesignThis was an explorative, qualitative study with inductive content analysis.MethodsIndividual semistructured interviews were conducted with 17 adults living with a TSCI in order to explore their experience of participation. The verbatim transcripts were analyzed, and the end result was an overall theme that included 4 emerging categories.ResultsThe theme “participation possibility” denotes the eventual involvement in life situations. Within this theme, there were 4 categories that emerged as a representation of essential aspects along the continuum of reclaiming participation: (1) dealing with the new self, (2) a journey dominated by obstacles, (3) the catalyst of participation, and (4) becoming an agent. Dealing with and recognizing these intervening conditions seem critical for clients to reconstruct the meaning that is necessary for a broader conception of participation.LimitationsThe transferability of these findings to dissimilar contexts may be limited.ConclusionClient perspectives on reclaiming participation after injury affirm the notion of eventual participation, with each person finding strategies to succeed. In order to help clients reclaim participation, health professionals should develop contextually sensitive programs that include peer mentoring and reduce the influence of hindering factors.
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| 10. |
- Linton, Steven J., 1952-, et al.
(författare)
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Understanding the Etiology of Chronic Pain From a Psychological Perspective
- 2018
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Ingår i: Physical Therapy. - : American Physical Therapy Association. - 0031-9023 .- 1538-6724. ; 98:5, s. 315-324
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Tidskriftsartikel (refereegranskat)abstract
- The etiology of chronic pain-related disability is not fully understood, particularly from a clinical perspective. Investigations to date have identified risk factors and elucidated some important processes driving the development of persistent pain problems. Yet this knowledge and its application are not always accessible to practicing physical therapists or other clinicians. This article aims to summarize the main psychological processes involved in the development of chronic pain disability and to derive some guidelines for treatment and future research. To this end, the focus is on the paradox of why coping strategies that are helpful in the short term continue to be used even when-ironically-they maintain the problem in the long term. To aid in summarizing current knowledge, 4 tenets that elucidate the etiology of chronic pain are described. These tenets emphasize that chronic pain disability is a developmental process over time, contextual factors set the stage for this development, underlying transdiagnostic psychological factors fuel this development, and the principles of learning steer the development of pain behaviors. With these tenets, an explanation of how a chronic problem develops for one person but not another is provided. Finally, hypotheses that can be empirically tested to guide clinical application as well as basic research are generated. In conclusion, understanding the psychological processes underlying the etiology of chronic pain provides testable ideas and a path forward for improving treatment interventions.
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