- Email: [email protected]
Patients experiences of participating in an exercise group after anterior cruciate ligament reconstruction (ACLR)
Abstracts / Manual Therapy 25 (2016) e57ee169
pain score during isometric contraction also improved following intervention (p¼0.001) with pain reducing from on average 5+/-1.3cm to 1.1+/-1.1cm. Conclusion: A single intervention of patella mobilisation had a significant effect on subjects with patellofemoral pain, and caused knee extensor strength and pain during quadriceps contraction to be significantly improved. This may have been caused by the significant change in patella position also reported within this study Implications: As patellofemoral pain is often characterised by patients having quadriceps weakness and pain an intervention which is able to ameliorate these is obviously of significance in the management of this condition Funding acknowledgements: Work was unfunded Ethics approval: Ethical approval was granted by the University of Salford research ethics committee
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in identification of PFS for both targeted treatment clinically, and to aid recruitment in future research. References (1) McPoil TG et al. Heel pain-plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the Orthopaedic section of the APTA. J Orthop Sports Phys Ther. 2008; 38(4):A1-a18. Funding acknowledgements: This research was funded by a Health Research Board (HRB), Ireland Undergraduate Summer Student Research grant. Ethics approval: Ethics approval was obtained from Beaumont Hospital Medical Research Ethics Committee. Disclosure of interest: None Declared
Disclosure of interest: None Declared Keywords: Diagnostic accuracy, Plantar fasciitis, Ultrasound Imaging Keywords: Mobilisation, Patella, Strength Intergrating Research into practice PO2-LL-051 VALIDITY OF CLINICAL ASSESSMENT COMPARED WITH PLANTAR FASCIA THICKNESS ON ULTRASOUND FOR PLANTAR FASCIITIS: A CROSS-SECTIONAL STUDY 1
2
2
2
1, *
Intergrating Research into practice PO2-LL-054 PATIENTS EXPERIENCES OF PARTICIPATING IN AN EXERCISE GROUP AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION (ACLR) F. Poget.
1
R. Fagan , V. Cuddy , J. Ashton , M. Clarke , H. French . School of Physiotherapy, Royal College of Surgeons in Ireland, Ireland; 2 Physiotherapy Department, Beaumont Hospital, Dublin, Ireland * Corresponding author.
Background: Plantar fasciitis (PFS) is a degeneration of the plantar aponeurosis in the foot. Ultrasound (US) can be used as a diagnostic imaging technique for this condition, with similar diagnostic accuracy to Magnetic Resonance Imaging (MRI). Common factors associated with plantar fasciitis include increased Body Mass Index (BMI), reduced ankle dorsiflexion and increased foot pronation. Purpose: This study aimed firstly to determine the diagnostic utility of the clinical diagnosis of PFS compared with US examination, and secondly, to determine the relationship between a range of symptom-related and physical examination items and US-diagnosed PFS. Methods: This cross-sectional study was approved by the Ethics (Medical Research) Committee Beaumont Hospital (REC 14/54). Patients referred from orthopaedic and rheumatology clinics were screened for eligibility and informed consent was obtained. Clinical criteria were based on presence of medial heel pain for a minimum of six weeks, aggravated by rising or initial weight bearing after inactivity (1). Study participants underwent clinical and US examination by two independent blinded assessors. PFS was determined on US by measuring plantar fascia thickness. The following characteristics were recorded: BMI, foot type (pronated, supinated, neutral) and ankle dorsiflexion range (prssence of equinus). Diagnostic accuracy was determined by estimating sensitivity and specificity of clinical criteria against US measurement (gold standard). Mann-Whitney U tests and Chi-squared analyses were used to compare differences in symptom-based and physical examination variables between those with and without PFS. All statistical analyses were undertaken in SPSS v22 (IBM corp). Results: Fourteen participants (28 feet) were recruited. Sensitivity and specificity of clinical diagnosis compared to US was 62.50% (95% Confidence Interval (CI):35.43-84.80%) and 58.33% (95% CI:27.67-84.23%), respectively. Increased body weight was significantly associated with PFS (p¼0.04). 75% of those with US-diagnosed PFS had altered biomechanics compared to 92% of those negative for PFS by US. Equinus was present in 87.5% of US-diagnosed PFS patients, and 83.3% of participants with a negative diagnosis of PFS (p¼0.27). Conclusion: Clinical diagnosis demonstrated only moderate diagnostic accuracy for PFS compared with PF thickness as measured with US. Weight was significantly associated with PFS. Foot type and reduced dorsiflexion may have an association with foot pain, but not PFS alone. The small sample size may partially explain the results Implications: Clinical assessment alone may not be sufficient in ruling in or ruling out PFS. Further clinical criteria may have to be investigated to aid
Background: Anterior cruciate ligament reconstruction (ACLR) has a high incidence and results in significant costs for healthcare. Despite reported successful physical outcomes, such as knee range of motion, strength and stability, only half of patients are able to return to their preinjury level of sport participation. While suboptimal physical outcomes may partially explain these less than satisfactory results, there is growing evidence that social and contextual factors contribute to patients achieving their preinjury level of activity (Lee et al, 2008). Motivation, adherence to rehabilitation, social support, fear of re-injury and self-efficacy seem to be essential to attain successful recovery following ACLR. Group therapy has been suggested to provide physical and these psychosocial benefits to individuals affected by other pathologies such as osteoarthritis and peripheral neuropathy (McCarthy et al., 2004; Powell-Cope et al., 2014). This project explores how physiotherapists can address these factors in an ACLR group setting. Purpose: The aim of this study was to explore the patients’ perceptions and experiences of participating in a weekly exercise group following ACLR and to investigate the impact on their rehabilitation. The research was carried out as a Master degree’s dissertation and as part of the service development of the clinic where the ACLR group took place. Methods: Hermeneutic phenomenology was used to explore the experience of nine participants, recruited from the clinic where the ACLR exercise group took place. Two focus groups, following a semi-structured outline and facilitated by a moderator and an independent observer occurred in summer 2015. Data was transcribed and analysed using thematic analysis. Results: Three males and six females aged 21 to 57 years old (median: 30) engaged in the study. Four considered themselves as sedentary, the other six reported participating in sports, such as handball or running, at a preinjury rate of two to five trainings per week. Three major themes emerged from the data: psychosocial factors, identity of the ACLR group and physical outcomes. The group influenced the participants’ motivation, enjoyment and commitment to exercise during the rehabilitation. Social support and reassurance were mostly gained. The participants taking part in sport experienced the ACLR group as a substitute for sport trainings. The group was further suggested to enhance speed of recovery and facilitate the return to normal life, especially for participants with lower reported motivation and adherence to home-exercises. The challenging role of the physiotherapist was highlighted as well as the promotion of shared accountability between patients and the group’s therapist. Moreover, the ACLR group’s identity was questioned within the rehabilitation process, and the need for more transparency about roles was suggested for all stakeholders, including patients, physiotherapists, surgeons and health insurers in order to promote group therapy in the Swiss healthcare context. Conclusion: Participating in an exercise group therapy is perceived as increasing motivation, self-confidence, social support and helps enhance a faster successful recovery and return to normal life following ACLR. Our
e142
Abstracts / Manual Therapy 25 (2016) e57ee169
findings indicate that participants with a lower reported adherence to home-exercises especially benefit from it. For future research, a quantitative or mixed methods approach would be appropriate to assess the cost-effectiveness and the benefits of an exercise group therapy. Implications: The ACLR exercise group can help participants to overcome difficulties with regard to motivation and exercise adherence encountered during their ACLR rehabilitation. Better transparency of roles and information should be provided to all stakeholders to facilitate its implementation. Funding acknowledgements: No funding was involved in this study. Ethics approval: The research proposal was approved by the ethics and governance committee of the University of Brighton and by the relevant organisation in Switzerland. Disclosure of interest: None Declared Keywords: Anterior cruciate ligament reconstruction (ACLR), Group therapy, Hermeneutic phenomenology Intergrating Research into practice PO2-LL-055 VALIDATION OF THE LATERAL ANTERIOR DRAWER TEST FOR EXAMINING POSTERIOR CRUCIATE LIGAMENT INTEGRITY IN CADAVERIC KNEES G. Seeber 1, M. Wilhelm 2, O. Matthijs 2, G. Windisch 3, P. Sizer 2, B. Reichert 4, *. 1 Orthopedics, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; 2 Texas Tech University Health Science Center, Lubbock, Texas, United States; 3 Praxis f. Manuelle Medizin, Graz, Austria; 4 Carl von Ossietzky University, Oldenburg, Germany * Corresponding author.
Background: Clinicians are often unable to identify posterior cruciate ligament (PCL) ruptures through common clinical tests. This leads to undetected tears and potential degenerative changes within the knee joint (e.g. irreversible cartilage damage). The lateral-anterior drawer (LAD) test is distinguished from the more common clinical tests by its lateral-anterior testing force direction and has been proposed for the diagnosis of PCLruptures. However, it has not yet been validated. Purpose: To assess the construct and concurrent validity of the LAD test. Methods: Eighteen cadaveric knees (36-94 years old; mean ¼ 79 years), embalmed according to the method of Thiel, were sectioned from pelvis to foot. With skin and subcutaneous tissue removed, threaded markers were inserted into the distal femur and proximal tibia. Each femur was stabilized and the tibia was translated in lateral-anterior direction for the LAD, versus straight posterior for the posterior sag sign (PSS). Each test was repeated three times with the PCL both intact and cut in that order. Digital images were captured at start and finish positions during each trial. Tibial marker translation during each trial was digitized using the MATLAB Program. Means and standard deviations were established for each condition. The PSS values were used as a reference standard for establishing LAD concurrent validity. Results: Tibial translation was significantly greater with the PCL cut versus intact during the LAD (u¼-3.680; p<0.002) and PSS (u¼-3.724; p<0.002) tests. There was no significant difference between the changes in tibial translation after the PCL was cut during the LAD versus PSS tests (t¼2.029; p¼0.07). Conclusion: The LAD test detected changes in tibial translation corresponding with changes in PCL integrity, supporting test construct validity. The LAD test was at least as effective for assessing PCL integrity as the PSS test, supporting test concurrent validity. The use of the LAD test may be best suited when: (1) joint end-feel is important to the diagnosis; (2) increased muscle tone accompanies the knee injury and hinders an accurate PSS test use; and (3) the tester is rather inexperienced. Furthermore, positive LAD and PSS tests could be clustered to strengthen PCL tear diagnostic suspicions. Further studies are needed to determine intra- and inter-tester-reliability of the LAD test. Implications: Adding the LAD test to the diagnostic algorithm in PCL tear diagnostic suspicions may be conducive to detect PCL tears more precisely and hence preserve patients from subsequently developing irreversible cartilage damage due to knee laxity.
Funding acknowledgements: This project was unfunded. Ethics approval: Medical ethical approval has not been necessary to conduct this trial. Disclosure of interest: None Declared Keywords: Clinical Diagnostic, Drawer Test, Posterior Cruciate Ligament Intergrating Research into practice PO2-MT-060 THORACIC MANIPULATION AND ADJUVANT EXERCISE AS A COMPONENT OF POSTOPERATIVE ROTATOR CUFF REPAIR REHABILITATION: A CASE REPORT E. Chaconas 1,*, B. Mcintosh 2. 1 Doctor of Physical Therapy, University of St. Augustine, St. Augustine, United States; 2 Active Life and Sports Physical Therapy, Towson, United States * Corresponding author.
Background: Compromised movement of the scapulae and thoracic spine are considered to be impairments associated with rotator cuff pathology. Outcomes following rotator cuff repair vary with up to 90% of surgical repairs subsequently failing. Interventions targeting potential causative impairments such as decreased thoracic spine mobility and poor periscapular motor control can be beneficial. Purpose: The purpose of this case report is to describe the physical therapists management of a patient after rotator cuff repair, utilizing thoracic spine manipulation and periscapular motor control, to restore function of the shoulder complex. Methods: A 62-year-old female presented to the physical therapist with a complete tear to the supraspinatus tendon that was surgically repaired. The patient’s limitations included inability to perform overhead reaching, limited shoulder function as measured by a score of 35% on the shoulder pain disability index (SPADI) and 8/10 pain measured with the numeric pain rating scale (NPRS). Thoracic spine manipulation and periscapular motor control exercises were initiated during post-operative week 3 and progressed over the course of eight weeks. Results: Results indicated improved mobility, strength, and motor control of the shoulder complex. The SPADI improvement to 35% and NPRS improvement to 2/10 pain both exceed reported values of minimal clinical important difference. Conclusion: Integrating thoracic manipulation and periscapular motor control exercise aided in the restoration of function and reduced pain during post-operative rotator cuff repair rehabilitation. Further research is needed to establish the cause and effect relationship for interventions targeting the thoracic spine and scapulae in cases of post-operative rotator cuff repair rehabilitation. Implications: The benefit of thoracic manipulation for subacromial pain syndrome has been established and clinicians should consider investigating the use of these techniques for patients recovering from rotator cuff repair surgery. Funding acknowledgements: No funding support was provided for this project. Ethics approval: Ethics approval was not required for this retrospective case report but the patient did provide consent for the use of clinical data. Disclosure of Interest: None Declared Keywords: Manipulation, Rotator cuff, Shoulder pain Intergrating Research into practice PO2-PA-063 “I KNOW WHAT I WANT BUT I’M NOT SURE HOW TO GET IT” e EXPECTATIONS OF PHYSIOTHERAPY TREATMENT OF PERSONS WITH PERSISTENT PAIN T. Calner*, G. Isaksson, P. Michaelson. Division of Health and Rehabilitation, Department of Health Science, Lulea University of Technology, Lulea, Sweden * Corresponding author.
pain score during isometric contraction also improved following intervention (p¼0.001) with pain reducing from on average 5+/-1.3cm to 1.1+/-1.1cm. Conclusion: A single intervention of patella mobilisation had a significant effect on subjects with patellofemoral pain, and caused knee extensor strength and pain during quadriceps contraction to be significantly improved. This may have been caused by the significant change in patella position also reported within this study Implications: As patellofemoral pain is often characterised by patients having quadriceps weakness and pain an intervention which is able to ameliorate these is obviously of significance in the management of this condition Funding acknowledgements: Work was unfunded Ethics approval: Ethical approval was granted by the University of Salford research ethics committee
e141
in identification of PFS for both targeted treatment clinically, and to aid recruitment in future research. References (1) McPoil TG et al. Heel pain-plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the Orthopaedic section of the APTA. J Orthop Sports Phys Ther. 2008; 38(4):A1-a18. Funding acknowledgements: This research was funded by a Health Research Board (HRB), Ireland Undergraduate Summer Student Research grant. Ethics approval: Ethics approval was obtained from Beaumont Hospital Medical Research Ethics Committee. Disclosure of interest: None Declared
Disclosure of interest: None Declared Keywords: Diagnostic accuracy, Plantar fasciitis, Ultrasound Imaging Keywords: Mobilisation, Patella, Strength Intergrating Research into practice PO2-LL-051 VALIDITY OF CLINICAL ASSESSMENT COMPARED WITH PLANTAR FASCIA THICKNESS ON ULTRASOUND FOR PLANTAR FASCIITIS: A CROSS-SECTIONAL STUDY 1
2
2
2
1, *
Intergrating Research into practice PO2-LL-054 PATIENTS EXPERIENCES OF PARTICIPATING IN AN EXERCISE GROUP AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION (ACLR) F. Poget.
1
R. Fagan , V. Cuddy , J. Ashton , M. Clarke , H. French . School of Physiotherapy, Royal College of Surgeons in Ireland, Ireland; 2 Physiotherapy Department, Beaumont Hospital, Dublin, Ireland * Corresponding author.
Background: Plantar fasciitis (PFS) is a degeneration of the plantar aponeurosis in the foot. Ultrasound (US) can be used as a diagnostic imaging technique for this condition, with similar diagnostic accuracy to Magnetic Resonance Imaging (MRI). Common factors associated with plantar fasciitis include increased Body Mass Index (BMI), reduced ankle dorsiflexion and increased foot pronation. Purpose: This study aimed firstly to determine the diagnostic utility of the clinical diagnosis of PFS compared with US examination, and secondly, to determine the relationship between a range of symptom-related and physical examination items and US-diagnosed PFS. Methods: This cross-sectional study was approved by the Ethics (Medical Research) Committee Beaumont Hospital (REC 14/54). Patients referred from orthopaedic and rheumatology clinics were screened for eligibility and informed consent was obtained. Clinical criteria were based on presence of medial heel pain for a minimum of six weeks, aggravated by rising or initial weight bearing after inactivity (1). Study participants underwent clinical and US examination by two independent blinded assessors. PFS was determined on US by measuring plantar fascia thickness. The following characteristics were recorded: BMI, foot type (pronated, supinated, neutral) and ankle dorsiflexion range (prssence of equinus). Diagnostic accuracy was determined by estimating sensitivity and specificity of clinical criteria against US measurement (gold standard). Mann-Whitney U tests and Chi-squared analyses were used to compare differences in symptom-based and physical examination variables between those with and without PFS. All statistical analyses were undertaken in SPSS v22 (IBM corp). Results: Fourteen participants (28 feet) were recruited. Sensitivity and specificity of clinical diagnosis compared to US was 62.50% (95% Confidence Interval (CI):35.43-84.80%) and 58.33% (95% CI:27.67-84.23%), respectively. Increased body weight was significantly associated with PFS (p¼0.04). 75% of those with US-diagnosed PFS had altered biomechanics compared to 92% of those negative for PFS by US. Equinus was present in 87.5% of US-diagnosed PFS patients, and 83.3% of participants with a negative diagnosis of PFS (p¼0.27). Conclusion: Clinical diagnosis demonstrated only moderate diagnostic accuracy for PFS compared with PF thickness as measured with US. Weight was significantly associated with PFS. Foot type and reduced dorsiflexion may have an association with foot pain, but not PFS alone. The small sample size may partially explain the results Implications: Clinical assessment alone may not be sufficient in ruling in or ruling out PFS. Further clinical criteria may have to be investigated to aid
Background: Anterior cruciate ligament reconstruction (ACLR) has a high incidence and results in significant costs for healthcare. Despite reported successful physical outcomes, such as knee range of motion, strength and stability, only half of patients are able to return to their preinjury level of sport participation. While suboptimal physical outcomes may partially explain these less than satisfactory results, there is growing evidence that social and contextual factors contribute to patients achieving their preinjury level of activity (Lee et al, 2008). Motivation, adherence to rehabilitation, social support, fear of re-injury and self-efficacy seem to be essential to attain successful recovery following ACLR. Group therapy has been suggested to provide physical and these psychosocial benefits to individuals affected by other pathologies such as osteoarthritis and peripheral neuropathy (McCarthy et al., 2004; Powell-Cope et al., 2014). This project explores how physiotherapists can address these factors in an ACLR group setting. Purpose: The aim of this study was to explore the patients’ perceptions and experiences of participating in a weekly exercise group following ACLR and to investigate the impact on their rehabilitation. The research was carried out as a Master degree’s dissertation and as part of the service development of the clinic where the ACLR group took place. Methods: Hermeneutic phenomenology was used to explore the experience of nine participants, recruited from the clinic where the ACLR exercise group took place. Two focus groups, following a semi-structured outline and facilitated by a moderator and an independent observer occurred in summer 2015. Data was transcribed and analysed using thematic analysis. Results: Three males and six females aged 21 to 57 years old (median: 30) engaged in the study. Four considered themselves as sedentary, the other six reported participating in sports, such as handball or running, at a preinjury rate of two to five trainings per week. Three major themes emerged from the data: psychosocial factors, identity of the ACLR group and physical outcomes. The group influenced the participants’ motivation, enjoyment and commitment to exercise during the rehabilitation. Social support and reassurance were mostly gained. The participants taking part in sport experienced the ACLR group as a substitute for sport trainings. The group was further suggested to enhance speed of recovery and facilitate the return to normal life, especially for participants with lower reported motivation and adherence to home-exercises. The challenging role of the physiotherapist was highlighted as well as the promotion of shared accountability between patients and the group’s therapist. Moreover, the ACLR group’s identity was questioned within the rehabilitation process, and the need for more transparency about roles was suggested for all stakeholders, including patients, physiotherapists, surgeons and health insurers in order to promote group therapy in the Swiss healthcare context. Conclusion: Participating in an exercise group therapy is perceived as increasing motivation, self-confidence, social support and helps enhance a faster successful recovery and return to normal life following ACLR. Our
e142
Abstracts / Manual Therapy 25 (2016) e57ee169
findings indicate that participants with a lower reported adherence to home-exercises especially benefit from it. For future research, a quantitative or mixed methods approach would be appropriate to assess the cost-effectiveness and the benefits of an exercise group therapy. Implications: The ACLR exercise group can help participants to overcome difficulties with regard to motivation and exercise adherence encountered during their ACLR rehabilitation. Better transparency of roles and information should be provided to all stakeholders to facilitate its implementation. Funding acknowledgements: No funding was involved in this study. Ethics approval: The research proposal was approved by the ethics and governance committee of the University of Brighton and by the relevant organisation in Switzerland. Disclosure of interest: None Declared Keywords: Anterior cruciate ligament reconstruction (ACLR), Group therapy, Hermeneutic phenomenology Intergrating Research into practice PO2-LL-055 VALIDATION OF THE LATERAL ANTERIOR DRAWER TEST FOR EXAMINING POSTERIOR CRUCIATE LIGAMENT INTEGRITY IN CADAVERIC KNEES G. Seeber 1, M. Wilhelm 2, O. Matthijs 2, G. Windisch 3, P. Sizer 2, B. Reichert 4, *. 1 Orthopedics, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; 2 Texas Tech University Health Science Center, Lubbock, Texas, United States; 3 Praxis f. Manuelle Medizin, Graz, Austria; 4 Carl von Ossietzky University, Oldenburg, Germany * Corresponding author.
Background: Clinicians are often unable to identify posterior cruciate ligament (PCL) ruptures through common clinical tests. This leads to undetected tears and potential degenerative changes within the knee joint (e.g. irreversible cartilage damage). The lateral-anterior drawer (LAD) test is distinguished from the more common clinical tests by its lateral-anterior testing force direction and has been proposed for the diagnosis of PCLruptures. However, it has not yet been validated. Purpose: To assess the construct and concurrent validity of the LAD test. Methods: Eighteen cadaveric knees (36-94 years old; mean ¼ 79 years), embalmed according to the method of Thiel, were sectioned from pelvis to foot. With skin and subcutaneous tissue removed, threaded markers were inserted into the distal femur and proximal tibia. Each femur was stabilized and the tibia was translated in lateral-anterior direction for the LAD, versus straight posterior for the posterior sag sign (PSS). Each test was repeated three times with the PCL both intact and cut in that order. Digital images were captured at start and finish positions during each trial. Tibial marker translation during each trial was digitized using the MATLAB Program. Means and standard deviations were established for each condition. The PSS values were used as a reference standard for establishing LAD concurrent validity. Results: Tibial translation was significantly greater with the PCL cut versus intact during the LAD (u¼-3.680; p<0.002) and PSS (u¼-3.724; p<0.002) tests. There was no significant difference between the changes in tibial translation after the PCL was cut during the LAD versus PSS tests (t¼2.029; p¼0.07). Conclusion: The LAD test detected changes in tibial translation corresponding with changes in PCL integrity, supporting test construct validity. The LAD test was at least as effective for assessing PCL integrity as the PSS test, supporting test concurrent validity. The use of the LAD test may be best suited when: (1) joint end-feel is important to the diagnosis; (2) increased muscle tone accompanies the knee injury and hinders an accurate PSS test use; and (3) the tester is rather inexperienced. Furthermore, positive LAD and PSS tests could be clustered to strengthen PCL tear diagnostic suspicions. Further studies are needed to determine intra- and inter-tester-reliability of the LAD test. Implications: Adding the LAD test to the diagnostic algorithm in PCL tear diagnostic suspicions may be conducive to detect PCL tears more precisely and hence preserve patients from subsequently developing irreversible cartilage damage due to knee laxity.
Funding acknowledgements: This project was unfunded. Ethics approval: Medical ethical approval has not been necessary to conduct this trial. Disclosure of interest: None Declared Keywords: Clinical Diagnostic, Drawer Test, Posterior Cruciate Ligament Intergrating Research into practice PO2-MT-060 THORACIC MANIPULATION AND ADJUVANT EXERCISE AS A COMPONENT OF POSTOPERATIVE ROTATOR CUFF REPAIR REHABILITATION: A CASE REPORT E. Chaconas 1,*, B. Mcintosh 2. 1 Doctor of Physical Therapy, University of St. Augustine, St. Augustine, United States; 2 Active Life and Sports Physical Therapy, Towson, United States * Corresponding author.
Background: Compromised movement of the scapulae and thoracic spine are considered to be impairments associated with rotator cuff pathology. Outcomes following rotator cuff repair vary with up to 90% of surgical repairs subsequently failing. Interventions targeting potential causative impairments such as decreased thoracic spine mobility and poor periscapular motor control can be beneficial. Purpose: The purpose of this case report is to describe the physical therapists management of a patient after rotator cuff repair, utilizing thoracic spine manipulation and periscapular motor control, to restore function of the shoulder complex. Methods: A 62-year-old female presented to the physical therapist with a complete tear to the supraspinatus tendon that was surgically repaired. The patient’s limitations included inability to perform overhead reaching, limited shoulder function as measured by a score of 35% on the shoulder pain disability index (SPADI) and 8/10 pain measured with the numeric pain rating scale (NPRS). Thoracic spine manipulation and periscapular motor control exercises were initiated during post-operative week 3 and progressed over the course of eight weeks. Results: Results indicated improved mobility, strength, and motor control of the shoulder complex. The SPADI improvement to 35% and NPRS improvement to 2/10 pain both exceed reported values of minimal clinical important difference. Conclusion: Integrating thoracic manipulation and periscapular motor control exercise aided in the restoration of function and reduced pain during post-operative rotator cuff repair rehabilitation. Further research is needed to establish the cause and effect relationship for interventions targeting the thoracic spine and scapulae in cases of post-operative rotator cuff repair rehabilitation. Implications: The benefit of thoracic manipulation for subacromial pain syndrome has been established and clinicians should consider investigating the use of these techniques for patients recovering from rotator cuff repair surgery. Funding acknowledgements: No funding support was provided for this project. Ethics approval: Ethics approval was not required for this retrospective case report but the patient did provide consent for the use of clinical data. Disclosure of Interest: None Declared Keywords: Manipulation, Rotator cuff, Shoulder pain Intergrating Research into practice PO2-PA-063 “I KNOW WHAT I WANT BUT I’M NOT SURE HOW TO GET IT” e EXPECTATIONS OF PHYSIOTHERAPY TREATMENT OF PERSONS WITH PERSISTENT PAIN T. Calner*, G. Isaksson, P. Michaelson. Division of Health and Rehabilitation, Department of Health Science, Lulea University of Technology, Lulea, Sweden * Corresponding author.