Physiotherapy

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A comparison of treadmill walking and overground walking in independently ambulant stroke patients: A pilot study
(Taylor & Francis, 2009-02) Puh, Urska; Baer, Gill
Purpose. The purpose of the study was to compare the spatio-temporal and joint kinematic gait parameters of stroke patients walking on a treadmill and overground, to examine the assumption that patients walking on a treadmill will approximate the requirements of walking overground. Methods. Ten independently ambulant chronic stroke patients were included in the study. Vicon™ was used to collect spatio-temporal and joint kinematic data during overground walking at comfortable speed and at matched speed on the treadmill. Results. Walking on the treadmill demonstrated statistically significantly lower cadence, and longer step times of the non-hemiplegic and hemiplegic limbs. Absolute stance times of both limbs, absolute double support time, relative stance time and relative double support time were significantly longer during treadmill walking. Compared to overground walking, the inter-limb symmetries of step time, stance time, and stance/swing time ratio were significantly greater on the treadmill. During treadmill walking, joint kinematic data showed statistically significant changes with greater flexion of the nonhemiplegic knee and hip at initial contact, and less hip extension of the hemiplegic limb. Maximal ankle plantarflexion and knee extension of the hemiplegic limb occurred later in the gait cycle on the treadmill. Conclusion. These differences suggest it may be useful to use treadmill in conjunction with overground walking to focus on improving specific walking deficits in patients with stroke
A new system for the measurement of displacements of the human body with widespread applications in human movement studies
(1999) Rowe, P.; Durward, B.; Crosbie, J.; Fowler, V.; Baer, Gill
This paper reports the development, construction and use of a new system for the measurement of linear kinematics in one, two or three dimensions. The system uses a series of rotary shaft encoders and inelastic tensioned strings to measure the linear displacement of key anatomical points in space. The system is simple, inexpensive, portable, accurate and flexible. It is therefore suitable for inclusion in a variety of motion analysis studies. Details of the construction, calibration and interfacing of the device to an IBM PC computer are given as is a full mathematical description of the appropriate measurement theory for one, two and three dimensions. Examples of the results obtained from the device during gait, running, rising to stand, sitting down and pointing with the upper limb are given. Finally it is proposed that, provided the constraints of the system are considered, this method has the potential to measure a variety of functional human movements simply and inexpensively and may therefore be a valuable addition to the methods available to the motion scientist.
A study of sit to stand in normal subjects and hemiplegic subjects
(1993) Baer, Gill
A systematic review and meta-analysis of selected motor learning principles in physiotherapy and medical education
(BioMed Central, 2016-01-15) Sattelmayer, K. M.; Hilfiker, R.; Elsig, S.; Baer, Gill
Background Learning of procedural skills is an essential component in the education of future health professionals. There is little evidence on how procedural skills are best learnt and practiced in education. There is a need for educators to know what specific interventions could be used to increase learning of these skills. However, there is growing evidence from rehabilitation science, sport science and psychology that learning can be promoted with the application of motor learning principles. The aim of this review was to systematically evaluate the evidence for selected motor learning principles in physiotherapy and medical education. The selected principles were: whole or part practice, random or blocked practice, mental or no additional mental practice and terminal or concurrent feedback. Methods CINAHL, Cochrane Central, Embase, Eric and Medline were systematically searched for eligible studies using pre-defined keywords. Included studies were evaluated on their risk of bias with the Cochrane Collaboration's risk of bias tool. Results The search resulted in 740 records, following screening for relevance 15 randomised controlled trials including 695 participants were included in this systematic review. Most procedural skills in this review related to surgical procedures. Mental practice significantly improved performance on a post-acquisition test (SMD: 0.43, 95 % CI 0.01 to 0.85). Terminal feedback significantly improved learning on a transfer test (SMD: 0.94, 95 % CI 0.18 to 1.70). There were indications that whole practice had some advantages over part practice and random practice was superior to blocked practice on post-acquisition tests. All studies were evaluated as having a high risk of bias. Next to a possible performance bias in all included studies the method of sequence generation was often poorly reported. Conclusions There is some evidence to recommend the use of mental practice for procedural learning in medical education. There is limited evidence to conclude that terminal feedback is more effective than concurrent feedback on a transfer test. For the remaining parameters that were reviewed there was insufficient evidence to make definitive recommendations.
A systematic review of assessments for procedural skills in physiotherapy education
(De Gruyter, 2017-06-30) Sattelmayer, Martin; Hilfiker, Roger; Baer, Gill
Introduction: Learning of procedural skills is important in the education of physiotherapists. It is the aim of physiotherapy degree programmes that graduates are able to practice selected procedures safely and efficiently. Procedural competency is threatened by an increasing and diverse amount of procedures that are incorporated in university curricula. As a consequence, less time is available for the learning of each specific procedure. Incorrectly performed procedures in physiotherapy might be ineffective and may result in injuries to patients and physiotherapists. The aim of this review was to synthesise relevant literature systematically to appraise current knowledge relating to assessments for procedural skills in physiotherapy education. Method: A systematic search strategy was developed to screen five relevant databases (CINAHL, Cochrane Central, SportDISCUS, ERIC and MEDLINE) for eligible studies. The included assessments were evaluated for evidence of their reliability and validity. Results: The search of electronic databases identified 560 potential records. Seven studies were included into this systematic review. The studies reported eight assessments of procedural skills. Six of the assessments were designed for a specific procedure and two assessments were considered for the evaluation of more than one procedure. Evidence to support the measurement properties of the assessment was not available for all categories. Discussion: It was not possible to recommend a single assessment of procedural skills in physiotherapy education following this systematic review. There is a need for further development of new assessments to allow valid and reliable assessments of the broad spectrum of physiotherapeutic practice.
Achievement of simple mobility milestones after stroke
(Elsevier, 1999-04) Smith, M.; Baer, Gill
Abstract Objectives: To observe the mobility outcomes of an inpatient population of stroke patients grouped according to the Oxfordshire Community Stroke Project classification. Study Design: Mobility milestones-, standardized measures of functional movement, were used to examine mobility recovery. Participants: Two hundred thirty-eight stroke patients admitted to the Western General Hospital, Edinburgh. Main Outcome Measures: Times taken to achieve four mobility milestones: 1-minute sitting balance, 10-second standing balance, a 10-step walk, and a 10-meter walk. Results: For all subjects the median times to achieve the milestones were as follows: 1-minute sitting balance, day of stroke; 10-second standing balance, 3 days; 10-step walk, 6 days; and a 10-meter walk, 9 days. Subjects sustaining a partial anterior circulation infarct, lacunar infarct, or posterior circulation infarct achieved the mobility milestones most rapidly and generally had a shorter hospital stay. Conclusions: A hierarchical pattern of recovery of mobility reflecting variation between subgroups was observed. Predicted timescales for recovery of mobility are suggested.
Acquisition of procedural skills in pre-registration physiotherapy education comparing mental practice against no mental practice: The Learning of Procedures in Physiotherapy Education Trial - a development of concept study
(SAGE, 2020-09-10) Sattelmayer, Karl; Jagadamma, Kavi; Hilfiker, Roger; Baer, Gill
Introduction: Procedural skills are a central element in the education of physiotherapists. Procedural skills relate to the execution of a practical task. An educational intervention, which can be used to support skill acquisition of procedural skills, is mental practice (MP). Several studies have investigated the use of MP or imaging in medical education. This pilot study evaluated the application of MP on the acquisition of procedural skills in physiotherapy education.
An exploration of physical activity experiences in people with Parkinson's disease
(Elsevier Science B.V. Amsterdam, 2015-05) Hislop, Jane; Gray, Stephanie; Melling, Simon; Paraskevopoulos, L.; Baer, Gill
The assessment of procedural skills in physiotherapy education: A measurement study using the Rasch model
(BMC, 2020-05-25) Sattelmayer, Martin; Jagadamma, Kavi; Sattelmayer, Franziska; Hilfiker, Roger; Baer, Gill
Background: Procedural skills are a key element in the training of future physiotherapists. Procedural skills relate to the acquisition of appropriate motor skills, which allow the safe application of clinical procedures to patients. In order to evaluate procedural skills in physiotherapy education validated assessment instruments are required. Recently the assessment of procedural skills in physiotherapy education (APSPT) tool was developed. The overall aim of this study was to establish the structural validity of the APSPT. In order to do this the following objectives were examined: i) the fit of the items of APSPT to the Rasch-model, ii) the fit of the overall score to the Rasch model, iii) the difficulty of each test item and iv) whether the difficulty levels of the individual test items cover the whole capacity spectrum of students in pre-registration physiotherapy education.
Challenges in integrating international evidence relating to stroke rehabilitation: experiences from a Cochrane systematic review
(Wiley, 2014-12) Pollock, A.; Campbell, P.; Baer, Gill; Choo, P-L; Forster, A.; Morris, J.; Pomeroy, V. M.; Langhorne, P.
There are many randomized controlled trials relating to stroke rehabilitation being carried out in China, which are often published in Chinese-language journals. A recent update to our Cochrane systematic review of physical rehabilitation to improve function and mobility after stroke included 96 trials; over half (51) were conducted in China; 37 of these included studies were published in Chinese. Analyses within this Cochrane review support the conclusion that physical rehabilitation, using a mix of components from different approaches, is effective for the recovery of function and mobility after stroke. The inclusion of the Chinese studies had a substantial impact on the volume of evidence and, consequently, the conclusions. In this paper, we explore whether it is appropriate to draw implications for clinical practice throughout the world from evidence relating to a complex rehabilitation intervention delivered within one particular geographical healthcare setting. We explore the unique challenges associated with incorporating the body of evidence from China, particularly the Chinese-language publications, and identify the ongoing debate about the quality of Chinese research publications. We conclude that the growing body of evidence from China has important implications for future systematic reviews and evidence-based stroke care, but analysis and interpretation raise challenges, and improved reporting is critical.
Content of physical Rehabilitation interventions: Can we generalise from Chinese trials to other geographical regions?
(Wiley, 2014-11) Pollock, A.; Baer, Gill; Campbell, P.; Choo, P-L; Langhorne, P.; Morris, J.; Pomeroy, V. M.; Forster, A.
Does treadmill training improve walking after stroke - the long-term follow-up from a phase II randomised controlled trial.
(Wiley, 2009) Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa; Smith, M.
Introduction: A recent Cochrane review has indicated that current evidence for the effectiveness of Treadmill Training (TT) following stroke is inconclusive. This paper reports the 6 month follow up of mobility outcomes from a phase II feasibility randomised-controlled trial investigating an eight week TT programme with ambulant and non-ambulant people with sub-acute stroke. Method: Sub-acute stroke patients within 3 months of stroke onset were recruited from four stroke rehabilitation units. Randomisation based on side of lesion and initial independence or dependence in walking allocated participants to receive either an eight week programme of ''usual physiotherapy'' (control) or physiotherapy including TT (experimental). Mobility outcomes taken at baseline and 6 months after randomisation included: the Modified Rivermead Mobility Index (RMI); Functional Ambulation Classification (FAC); Timed Up and Go (TUG); 10 min walk test (10 mwt); and the 6 min walk test (6 mwt). Results: Seventy-seven participants were recruited, 39 were randomised to control, and 38 to experimental. At 6 months post randomisation, while both groups had improved their mobility scores, Mann-Whitney U-tests showed no significant differences between the groups for RMI (U=481.5; p=0.421); FAC (U=488; p=0.457); TUG (U=204; p=0.678); 10 mwt (U=262; p=0.956) or 6 mwt (U=194.5; p=0.892). Conclusion: The results indicated that while both groups improved their mobility scores from baseline measures, there were no statistically significant differences between the groups at 6 months. The amount and content of ''usual physiotherapy'' and TT is being analysed to determine whether this may be one of the influencing factors.
Effectiveness of commercially available gaming devices in upper limb stroke rehabilitation
(Maney, 2014-02) Casserly, D.; Baer, Gill
Background: Hemiparesis of the upper extremity is estimated to affect 50-75% of individuals who experience a stroke. Recently the use of commercially available off-the-shelf (COTS) gaming technology has shown promise for providing interactive rehabilitation. The existing evidence however, has not yet been reviewed systematically to determine the effectiveness of such gaming devices in upper limb (UL) rehabilitation post-stroke. Objectives: To determine the effectiveness of COTS gaming technology for UL rehabilitation in post-stroke patients and to assess the feasibility, and effect on quality of life (QoL). Methods: A systematic search of the databases CINAHL, MEDLINE, PsycINFO, Pubmed, SPORTDiscus, and SCOPUS was conducted. Quality scoring of the included articles was based on the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Results: In total, eight studies were included for review. The commercial gaming devices were found to be feasible for use among post-stroke individuals. The devices were found to be effective as an adjunct to conventional stroke rehabilitation, and were feasible in relation to time taken, cost-effectiveness, safety, and the positive effect on the QoL of the stroke population. Conclusions: As the findings of the current review are primarily based on lower levels of research, it is not possible to make recommendations regarding the use of these devices in clinical practice. However, findings of the included studies did indicate that rehabilitation including gaming technology had a positive effect on the UL rehabilitation of stroke patients
Establishing the reliability of mobility milestones as an outcome measure for stroke ,
(2003) Baer, Gill
Objective: To establish intrarater, interrater, and test-retest reliability of a standardized measure of mobility, mobility milestones,- incorporating sitting balance, standing balance, and walking ability. Design: Repeated-measures reliability study by using video data of patients with stroke. Setting: Physiotherapy and rehabilitation departments in Scotland. Participants: Forty physiotherapists recruited from within the Lothian region: 20 senior physiotherapists with at least 3 years of experience working with neurologic patients and 20 staff grade physiotherapists with less than 12 months of experience working with neurologic patients. Intervention: Videotape comprising 40 clips (36 original clips, 4 repeated clips) of stroke patients of differing levels of ability attempting the mobility milestones was produced. After a short training session in the interpretation and application of the mobility milestones, each physiotherapist viewed the tape separately and scored whether the milestone had been achieved or not. This was repeated at a separate test session 2 weeks later. Main Outcome Measure: Score for each mobility milestone. Results: Kappa statistics were used to determine interrater reliability and showed good (.61-.80) to very good (.81-1.0) reliability for 3 of 4 milestones. Intraclass correlation coefficients (ICCs) were used to determine intrarater reliability of the 4 repeated clips and showed 75% of all subjects had high (ICC2,1=.91-1.0) reliability. The ICC2,1 for test-retest reliability showed a similar pattern, with 70% of subjects showing good (.81-.90) or high (.91-1.0) reliability. Conclusions: The mobility milestones showed favorable levels of reliability when used by experienced or novice physiotherapists. The milestones can be adopted as a simple clinical outcome measure for use with stroke. Further research is required to establish reliability levels when the measure is used by different rehabilitation professionals.
Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: A qualitative study
(Elsevier, 2017-03-16) Lehmann, Isabelle; Baer, Gill; Schuster-Amft, Corina
Objectives The YouGrabber (YG) is a new virtual reality training system that focuses on unilateral and bimanual activities. This nested study was part of a larger multicentre randomised controlled trial and explored experiences of people with chronic stroke during a 4 week intensive upper limb training with YG. Design: A qualitative design using semi-structured, face-to-face interviews. A phenomenological descriptive approach was used, with data coded, categorized and summarized using a thematic analysis. Topics investigated included: the experience of YG training, perceived impact of YG training on arm function, and the role of the treating therapist. Results: Five people were interviewed (1 female, age range 55-75yrs, 1-6yrs poststroke). Seven main themes were identified: (1) general experience, (2) expectations, (3) feedback, (4) arm function, (5) physiotherapist's role, (6) fatigue, (7) motivation. Key experiences reported included feelings of motivation and satisfaction, with positive factors identified as challenge, competition, fun and effort. The YG training appeared to trigger greater effort, however fatigue was experienced at the end of the training. Overall, patients described positive changes in upper limb motor function and activity level, e.g. automatic arm use. While the opportunity for self-practice was appreciated, input from the therapist at the start of the intervention was deemed important for safety and confidence. Conclusions: Reported experiences were mostly positive and the participants were motivated to practice intensively. They enjoyed the challenging component of the games.
Exploring the concept of feedback provision during motor skill training for people living with a long – term neurological impairment: a scoping review
(Elsevier, 2024-12-13) Papakonstantinou, Konstantinos N.; van der Linden, Marietta; Baer, Gill
Background Feedback plays a fundamental role in motor skill training. A significant challenge that physiotherapists face during daily clinical practice is to structure, formulate and deliver feedback in an efficient manner, incorporating a standardized approach that will facilitate motor skill acquisition for people with neurological disorders. Objectives The objective of this scoping review was to identify and describe feedback provided by physiotherapists during the rehabilitation process of people living with long-term neurological impairments. Data sources A comprehensive search across the following databases was undertaken: PubMed, Cochrane Library, Medline, PsycINFO, CINAHL, Sport Discus, Web of Science and Pedro Study selection Articles were included if they reported on studies involving feedback applied by the therapist during rehabilitation for people living with long-term neurological impairments. Synthesis methods A narrative synthesis was undertaken to describe and appraise the current state of the literature Results Eighteen articles were included and analysed in this scoping review. Most of the articles involved stroke patients, apart from one study that involved cerebral palsy children and another one including patients with Parkinson disease. Verbal feedback was the most described type of feedback. Verbal feedback and other types of feedback identified have not been reported with consistency and clarity. It was also found that the feedback provided was often not described in sufficient detail. Conclusion Feedback protocols used in the rehabilitation of people living with long-term conditions have been poorly described and structured in the articles included in this review.
How feasible is the delivery of treadmill training early after stroke within the NHS: Findings of a Phase II randomised controlled trial
(Wiley, 2009) Smith, M.; Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa
Introduction: RCP Stroke Guidelines advocate treadmill training (TT) for gait rehabilitation post-stroke. The protocols described in previous studies were intensive, short-term and may not be feasible to deliver within a UK clinical setting. One aim of this Phase II study was to explore key elements of delivering TT in a clinical setting within the NHS. Method: As part of a randomised controlled trial over 8 weeks, participants with stroke were allocated to a control or experimental group. The protocol demanded that all participants received a minimum of three therapy sessions per week of which at least two were on the treadmill for experimental participants. A treadmill system with unweighing harness was used. The content of treadmill sessions was decided by the treating therapists and all parameters were recorded. Results: Seventy-seven participants were recruited with 39 randomised to the experimental group. Experimental participants received a median of two treadmill sessions per week, with an average total walking time on the treadmill of between 8 and 16 min/week, at a median speed of 0.6m/s. Use of a support harness by participants reduced from 49% in week 1 to 23% in week 8. Conclusion: Only the minimum number of treadmill interventions were delivered. Clinical staff cited staffing levels, number of staff required for safety and time required for harness application as some of the reasons for the limited TT. These findings suggest that it may not be feasible to deliver sufficient doses of TT within the current NHS clinical environment.
Inter-and intra-rater reliability of the Infant Motor Profile in 3 to 18 months old infants
(Wolters Kluwer, 2016) Hecker, E.; Baer, Gill; Stark, C.; Mueller, B.; Supik, H.; Herkenrath, P.; Hadders-Algra, M.
Level of diagnostic agreement in musculoskeletal shoulder diagnosis between remote and face‐to‐face consultations: A retrospective service evaluation
(2024-04-21) Cockburn, Louise; Baer, Gill; Rhodes, Jenna
Background and Aims: To determine the level of diagnostic agreement between remote and face‐to‐face consultation in assessing shoulder complaints. Methods: A retrospective service evaluation with three groups of patient data; those assessed only face‐to‐face (group 1), remotely then face‐to‐face (group 2), remotely only (group 3). Patient data were extracted from 6 secondary care shoulder Advanced Physiotherapy Practitioner's (APPs) records, covering six sites. Three‐hundred‐and‐fifty‐nine sets of patient data were included in the final evaluation. The main outcome measure was the percentage of agreement between diagnosis at initial and follow‐up consultation, when assessed by APPs across the three groups. A Pearson χ2 test was used to assess the relationship between the method of consultation and the level of diagnostic agreement. Diagnoses were categorized as either the same, similar, or different by an independent APP. Secondary outcome measures investigated whether age or the length of time between appointments had any effect in determining the level of diagnostic concordance. Results: There was exact agreement of 77.05% and 85.52% for groups 1 and 3, respectively, compared with 34.93% for patient data in group 2. Similar clinical impressions across both initial and follow‐up were seen 16.39% of the time in group 1, 7.24% of the time in group 3, and 36.99% in group 2. Lastly, the percentage of times a diagnosis was changed between initial and review appointments occurred in only 6.56% of group 1 contacts, 7.24% of group 3 contacts, but 28.08% of the time in group 2. Conclusion: There was a large mismatch in the diagnosis of musculoskeletal shoulder complaints, when patients are initially assessed remotely and then followed‐up in‐person. This has implications for the future provision of shoulder assessment in physiotherapy.
mHealth Applications: Developing the collaborative infrastructure to enable SMARTer solutions to prehabilitation for patients with oesophago-gastric cancer
(Lothian Health and Care Professions Conference, 2023) Kelly, Alison Elizabeth; Salisbury, Lisa; Baer, Gill; Couper, G; Arnott, R