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Scapular muscle performance in patients with lateral epicondylalgia
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Abandonment rates of prosthesis are 8.5% for TTA, 10.5% for TFA and 8.4% for bilateral amputees. Conclusion(s): The use of the SPARG national database allows evaluation of service provision at a local and National level with targeted research projects to adapt the services provided. Implications: The ability to record the numbers of amputations, demographics of the population, outcomes regarding fitting with a prosthesis and trends in early walking aid and compression therapy provision is vital for benchmarking services. Keywords: SPARG; Trans-Tibial; Trans-Femoral Funding acknowledgements: The Scottish Physiotherapy Amputee Research Group. Ethics approval: Not applicable. http://dx.doi.org/10.1016/j.physio.2015.03.496 Research Report Poster Presentation Number: RR-PO-05-10-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 EXERCISE ADHERENCE IN AN UNDERSERVED POPULATION J.M. Day 1 , J. Irion 1 , F. Bindele 2 1 University
USA; USA
of South Alabama, Physical Therapy, Mobile, of South Alabama, Statistics, Mobile,
2 University
Background: Physical therapy service learning projects and volunteer experiences in foreign countries are becoming more frequent. Patients in underserved regions unlikely receive therapy services regularly; therefore, adherence to a home exercise program (HEP) is critical. Purpose: The primary purpose of this study was to observe home exercise adherence rates between the 1st and 2nd visits in an underserved population. The secondary purpose of this study was to determine specific factors that affect HEP adherence in this population. Methods: Consecutive patients seen in Santo Domingo, Ecuador were considered for participation in this observational study. All patients were recruited from one clinic or during home visits in the surrounding community over a 5 month period by one physical therapist. To be included in the study, patients were required to display sufficient cognitive ability by stating their name, the date, their location, and their reason for being at that location, were at least 19 years of age, and had an impairment or functional limitation that is included in the physical therapy scope of practice. Patient demographics, medical history, and answers to questionnaires were collected on the initial visit. Immediately after the initial evaluation, patients were issued 5 home exercises. On the subsequent follow up visit, adherence was measured and was defined as a score of 80% on the Medical Outcomes Study
eS301
General Adherence Questionnaire (MOS). Those scoring less than 80%, were asked an open ended question as to why they did not perform their exercises. Separate Kruskal-Wallis tests were performed on the categorical variables (gender, marital status, education, employment, duration of symptoms, comorbidities) and separate Spearman correlation tests were performed on the continuous data (age, pain level, Sport Injury Rehabilitation Adherence Questionnaire score). Alpha was set at p ≤ .05 a priori. Results: Thirty- six patients (mean age 57, SD 17) satisfied the eligibility criteria and agreed to participate. Twenty-eight of the recruited 36 patients were seen for a second visit. Fifteen of the 28 subjects with follow up were considered adherent (54%). With a significance level of p = 0.05, age was negatively correlated with adherence (p = 0.048, r = −0.543). The most frequent reasons given for non-adherence were pain during the exercise or that the exercises were too difficult to perform. Conclusion(s): Exercise adherence in this population is similar to previously reported data, but in areas where access to health care is limited, it may be necessary to improve adherence. It is possible that both age and the level of difficulty of the exercises influence adherence. Future studies are needed to determine if adherence rates are improved when age and the difficulty of the exercises are more carefully considered. Implications: Physical therapists may want to consider the age of a patient as well as the level of difficulty of the exercise when prescribing an HEP to underserved patients in a foreign country. Keywords: Service learning; Volunteer; Physical therapy Funding acknowledgements: This project was not funded. Ethics approval: The study protocol was approved by the University of South Alabama’s Institutional Review Board. Subjects’ rights were protected. http://dx.doi.org/10.1016/j.physio.2015.03.497 Research Report Platform Presentation Number: RR-PL-637 Sunday 3 May 2015 08:30 Hall 405 SCAPULAR MUSCLE PERFORMANCE IN PATIENTS WITH LATERAL EPICONDYLALGIA J.M. Day 1 , A. Nitz 2 , T. Uhl 2 1 University
of South Alabama, Physical Therapy, Mobile, USA; 2 University of Kentucky, Physical Therapy, Lexington, USA Background: Empirical evidence suggests that addressing scapular muscle deficits may be an important component of rehabilitation in patients with lateral epicondylalgia (LE).
eS302
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
However, there is limited descriptive data directly assessing scapular muscle performance in patients with LE. Purpose: The primary purpose of this study was to describe scapular strength, endurance, and muscle thickness (measured by rehabilitative ultrasound imaging (RUSI)) in patients with LE compared to a control group. Our secondary purpose was to examine the same measures of muscle performance in a comparison of the patients involved and uninvolved limbs. Methods: Consecutive patients referred to 4 outpatient clinics were considered for participation in this cross sectional study. For the control group, healthy subjects were recruited and matched to patients by age and gender. To be included in the study, patients had to test positive on 2/5 clinical tests for LE and scored greater than 10% on a selfreport disability scale (QDASH). Healthy subjects had to be between the ages of 30 and 65 and score less than 10% on the QDASH. Strength of the lower trapezius (LT), middle trapezius (MT), and serratus anterior (SA) was assessed with a hand held dynamometer. Static posterior scapular muscle endurance was assessed at 135◦ horizontal abduction with the subject in prone. Percent change in muscle thickness of the LT and SA was assessed in sitting using RUSI. The differences between groups for all dependent variables were evaluated with separate repeated measures analysis of covariance (ANCOVA). Alpha was set at p ≤ .05 a priori. Results: Twenty- eight patients (mean age 47 SD 9) and 28 controls (mean age 46 SD 9), satisfied the eligibility criteria and agreed to participate. When comparing the experimental group to the control group, there was significantly less LT strength (p = .002), SA strength (p < .001), scapular muscle endurance (p = .002), and percent change in SA thickness (p = .016). When comparing the involved limb to the uninvolved limb in LE patients, only the SA was found to be weaker by 2 kg compared to the non-involved side (p = .02). Conclusion(s): Scapular muscle performance is diminished in only the serratus when comparing side to side differences in patients with LE. However, when compared to matched control multiple muscular parameters are found to be deficient. Interpretation of these differences should be cautioned as only 2 measures exceeded MDC. Implications: Assessment of scapular strength and endurance in patients with LE should be screened and the results should be compared to normative data, yet to be established. Future studies should develop normative databases and investigate the efficacy of treating scapular muscle performance deficits as part of a comprehensive treatment program. Keywords: Strength; Endurance; Rehabilitative ultrasound imaging Funding acknowledgements: This project was not funded. Ethics approval: The study protocol was approved by the University of Kentucky’s Institutional Review Board. Subjects’ rights were protected. http://dx.doi.org/10.1016/j.physio.2015.03.498
Research Report Poster Presentation Number: RR-PO-20-21-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 PHYSIOTHERAPISTS PRESCRIBING NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND ANALGESICS E. Daynes, T. Horgan Coventry University, Health and Life Sciences, Coventry, United Kingdom Background: Since August 2013, physiotherapists are able to become an independent prescriber in the UK. This legislation was based on the Allied Health Professionals Prescribing and Medicines Supply Mechanisms Scoping Project Report (2009) which recommended that physiotherapists should gain limited prescribing rights. The Department of Health (DOH) identified the benefits for patients, but there has been little research exploring the views of physiotherapists. This study sought to investigate student physiotherapists’ views to give a unique insight into their beliefs about the legislation and the impact that it may have on the physiotherapy profession. Purpose: This study aimed to explore physiotherapy student’s opinions about the new legislation allowing physiotherapists to independently prescribe non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. Methods: Within the framework of qualitative research, two focus groups of nine participants were used to collect context rich information. The groups comprised of physiotherapy students with clinical experience. Convenience sampling with an element of snowball sampling was used. Participants were excluded from the study if: they were not final year physiotherapy students, did not speak fluent English or found social situations distressing. Information sheets explaining the legislation prior to the focus group were used to prime the group interviews. The interviews were facilitated by the researcher and independent observer. Final transcripts were analysed using thematic analysis and methods of peer review and member checking were used to ensure truthful and honest accounts from the participants. Results: The three emerging themes were: patient success and expectations, development of the profession and multidisciplinary (MDT) development. Within patient success and expectations, participants highlighted patient benefits, issues with safety; such as drug interactions, and the effect on compliance. Development of the profession suggested that the reputation and trust of the physiotherapist may be jeopardized. The theme MDT development raised issues that may arise from independent prescribing such as role conflict and communication breakdown. An underlying theme of how patient and professionals perceptions could impact the extension of this scope was identified.
Abandonment rates of prosthesis are 8.5% for TTA, 10.5% for TFA and 8.4% for bilateral amputees. Conclusion(s): The use of the SPARG national database allows evaluation of service provision at a local and National level with targeted research projects to adapt the services provided. Implications: The ability to record the numbers of amputations, demographics of the population, outcomes regarding fitting with a prosthesis and trends in early walking aid and compression therapy provision is vital for benchmarking services. Keywords: SPARG; Trans-Tibial; Trans-Femoral Funding acknowledgements: The Scottish Physiotherapy Amputee Research Group. Ethics approval: Not applicable. http://dx.doi.org/10.1016/j.physio.2015.03.496 Research Report Poster Presentation Number: RR-PO-05-10-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 EXERCISE ADHERENCE IN AN UNDERSERVED POPULATION J.M. Day 1 , J. Irion 1 , F. Bindele 2 1 University
USA; USA
of South Alabama, Physical Therapy, Mobile, of South Alabama, Statistics, Mobile,
2 University
Background: Physical therapy service learning projects and volunteer experiences in foreign countries are becoming more frequent. Patients in underserved regions unlikely receive therapy services regularly; therefore, adherence to a home exercise program (HEP) is critical. Purpose: The primary purpose of this study was to observe home exercise adherence rates between the 1st and 2nd visits in an underserved population. The secondary purpose of this study was to determine specific factors that affect HEP adherence in this population. Methods: Consecutive patients seen in Santo Domingo, Ecuador were considered for participation in this observational study. All patients were recruited from one clinic or during home visits in the surrounding community over a 5 month period by one physical therapist. To be included in the study, patients were required to display sufficient cognitive ability by stating their name, the date, their location, and their reason for being at that location, were at least 19 years of age, and had an impairment or functional limitation that is included in the physical therapy scope of practice. Patient demographics, medical history, and answers to questionnaires were collected on the initial visit. Immediately after the initial evaluation, patients were issued 5 home exercises. On the subsequent follow up visit, adherence was measured and was defined as a score of 80% on the Medical Outcomes Study
eS301
General Adherence Questionnaire (MOS). Those scoring less than 80%, were asked an open ended question as to why they did not perform their exercises. Separate Kruskal-Wallis tests were performed on the categorical variables (gender, marital status, education, employment, duration of symptoms, comorbidities) and separate Spearman correlation tests were performed on the continuous data (age, pain level, Sport Injury Rehabilitation Adherence Questionnaire score). Alpha was set at p ≤ .05 a priori. Results: Thirty- six patients (mean age 57, SD 17) satisfied the eligibility criteria and agreed to participate. Twenty-eight of the recruited 36 patients were seen for a second visit. Fifteen of the 28 subjects with follow up were considered adherent (54%). With a significance level of p = 0.05, age was negatively correlated with adherence (p = 0.048, r = −0.543). The most frequent reasons given for non-adherence were pain during the exercise or that the exercises were too difficult to perform. Conclusion(s): Exercise adherence in this population is similar to previously reported data, but in areas where access to health care is limited, it may be necessary to improve adherence. It is possible that both age and the level of difficulty of the exercises influence adherence. Future studies are needed to determine if adherence rates are improved when age and the difficulty of the exercises are more carefully considered. Implications: Physical therapists may want to consider the age of a patient as well as the level of difficulty of the exercise when prescribing an HEP to underserved patients in a foreign country. Keywords: Service learning; Volunteer; Physical therapy Funding acknowledgements: This project was not funded. Ethics approval: The study protocol was approved by the University of South Alabama’s Institutional Review Board. Subjects’ rights were protected. http://dx.doi.org/10.1016/j.physio.2015.03.497 Research Report Platform Presentation Number: RR-PL-637 Sunday 3 May 2015 08:30 Hall 405 SCAPULAR MUSCLE PERFORMANCE IN PATIENTS WITH LATERAL EPICONDYLALGIA J.M. Day 1 , A. Nitz 2 , T. Uhl 2 1 University
of South Alabama, Physical Therapy, Mobile, USA; 2 University of Kentucky, Physical Therapy, Lexington, USA Background: Empirical evidence suggests that addressing scapular muscle deficits may be an important component of rehabilitation in patients with lateral epicondylalgia (LE).
eS302
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
However, there is limited descriptive data directly assessing scapular muscle performance in patients with LE. Purpose: The primary purpose of this study was to describe scapular strength, endurance, and muscle thickness (measured by rehabilitative ultrasound imaging (RUSI)) in patients with LE compared to a control group. Our secondary purpose was to examine the same measures of muscle performance in a comparison of the patients involved and uninvolved limbs. Methods: Consecutive patients referred to 4 outpatient clinics were considered for participation in this cross sectional study. For the control group, healthy subjects were recruited and matched to patients by age and gender. To be included in the study, patients had to test positive on 2/5 clinical tests for LE and scored greater than 10% on a selfreport disability scale (QDASH). Healthy subjects had to be between the ages of 30 and 65 and score less than 10% on the QDASH. Strength of the lower trapezius (LT), middle trapezius (MT), and serratus anterior (SA) was assessed with a hand held dynamometer. Static posterior scapular muscle endurance was assessed at 135◦ horizontal abduction with the subject in prone. Percent change in muscle thickness of the LT and SA was assessed in sitting using RUSI. The differences between groups for all dependent variables were evaluated with separate repeated measures analysis of covariance (ANCOVA). Alpha was set at p ≤ .05 a priori. Results: Twenty- eight patients (mean age 47 SD 9) and 28 controls (mean age 46 SD 9), satisfied the eligibility criteria and agreed to participate. When comparing the experimental group to the control group, there was significantly less LT strength (p = .002), SA strength (p < .001), scapular muscle endurance (p = .002), and percent change in SA thickness (p = .016). When comparing the involved limb to the uninvolved limb in LE patients, only the SA was found to be weaker by 2 kg compared to the non-involved side (p = .02). Conclusion(s): Scapular muscle performance is diminished in only the serratus when comparing side to side differences in patients with LE. However, when compared to matched control multiple muscular parameters are found to be deficient. Interpretation of these differences should be cautioned as only 2 measures exceeded MDC. Implications: Assessment of scapular strength and endurance in patients with LE should be screened and the results should be compared to normative data, yet to be established. Future studies should develop normative databases and investigate the efficacy of treating scapular muscle performance deficits as part of a comprehensive treatment program. Keywords: Strength; Endurance; Rehabilitative ultrasound imaging Funding acknowledgements: This project was not funded. Ethics approval: The study protocol was approved by the University of Kentucky’s Institutional Review Board. Subjects’ rights were protected. http://dx.doi.org/10.1016/j.physio.2015.03.498
Research Report Poster Presentation Number: RR-PO-20-21-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 PHYSIOTHERAPISTS PRESCRIBING NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND ANALGESICS E. Daynes, T. Horgan Coventry University, Health and Life Sciences, Coventry, United Kingdom Background: Since August 2013, physiotherapists are able to become an independent prescriber in the UK. This legislation was based on the Allied Health Professionals Prescribing and Medicines Supply Mechanisms Scoping Project Report (2009) which recommended that physiotherapists should gain limited prescribing rights. The Department of Health (DOH) identified the benefits for patients, but there has been little research exploring the views of physiotherapists. This study sought to investigate student physiotherapists’ views to give a unique insight into their beliefs about the legislation and the impact that it may have on the physiotherapy profession. Purpose: This study aimed to explore physiotherapy student’s opinions about the new legislation allowing physiotherapists to independently prescribe non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. Methods: Within the framework of qualitative research, two focus groups of nine participants were used to collect context rich information. The groups comprised of physiotherapy students with clinical experience. Convenience sampling with an element of snowball sampling was used. Participants were excluded from the study if: they were not final year physiotherapy students, did not speak fluent English or found social situations distressing. Information sheets explaining the legislation prior to the focus group were used to prime the group interviews. The interviews were facilitated by the researcher and independent observer. Final transcripts were analysed using thematic analysis and methods of peer review and member checking were used to ensure truthful and honest accounts from the participants. Results: The three emerging themes were: patient success and expectations, development of the profession and multidisciplinary (MDT) development. Within patient success and expectations, participants highlighted patient benefits, issues with safety; such as drug interactions, and the effect on compliance. Development of the profession suggested that the reputation and trust of the physiotherapist may be jeopardized. The theme MDT development raised issues that may arise from independent prescribing such as role conflict and communication breakdown. An underlying theme of how patient and professionals perceptions could impact the extension of this scope was identified.