Physiotherapy

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239 Functional activities during which the community-dwelling ageing population in the UK may experience near-falls: a modified Delphi consensus development study [Abstract]
(Elsevier, 2025-03-27) Qashwa, Yazeed; Tan, C.-W.; Long, Joanna; Lane, Judith
25. Upper limb morbidity after treatment for breast cancer: A cross-sectional study of lymphedema and function
(2012-11) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Tan, Chee-Wee; Barber, Matthew; Breast Cancer Institute
Introduction: This study explored the prevalence of impaired upper limb function (ULF) and lymphoedema (LO) after breast cancer treatment, their relationships with each other, quality of life, and with patient/treatment characteristics.
366 Opening the black box of cognitive functional therapy: a review using the Template for Intervention Description and Replication (TIDieR) checklist [Abstract]
(Elsevier, 2025-03-27) Qashwa, Yazeed; Gray, H.
60 - Physical Activity, Function, and Exercise-Based Rehabilitation for People on Dialysis
(Elsevier, 2022-07-29) Mayes, Juliet; Koufaki, Pelagia; Greenwood, Sharlene Anuska
The focus on increasing physical activity (PA) for those people with a high burden of cardiometabolic conditions and complications (i.e., kidney failure, diabetes, cardiovascular comorbidities), for managing symptoms and maintaining physical well-being, is at an all-time high. Rehabilitation, meaning recovering or restoring what is necessary to get on with living, has been a low priority in most dialysis facilities, and the inclusion of integrated rehabilitation programs for dialysis patients is not routinely offered as part of patient care. A published British Association of Sport and Exercise Science (BASES) expert statement in 2015 on exercise for people with chronic kidney disease (CKD) suggests that every stable patient with CKD, irrespective of age, gender, comorbidities, or prior exercise experience, should be provided with specific written advice on how to safely and effectively increase PA to (i) enhance confidence and self-efficacy in performing physical activities; (ii) attenuate deterioration of physical function and associated limitations in activities of daily living; (iii) increase physiological reserve; (iv) reduce comorbid events; and (v) enhance quality of life. The focus of this chapter is on the core principle of exercise for reversing the effects of physical deconditioning and optimizing physical functioning and quality of life in patients on dialysis.
A clinical audit of the Emergency Department: Doctors' opinions on the diagnosis and management of cervical spine radiculopathy
(2024-03-29) McDonnell, Patricia; Jagadamma, Kavi; Rangra, Prateek
Objective: A clinical audit was carried out on the opinions of doctors working in the Emergency Department (ED) of a large urban hospital regarding the diagnosis and management of cervical spine radiculopathy (CSR). Using international guidelines and current research, it aimed to determine if patients attending this ED were diagnosed and managed in line with best practice, and to identify any discrepancies or areas for improvement in relation to this. Method: Doctors working in this ED were sent an online questionnaire and descriptive analysis was performed on the results to ascertain how they diagnose and manage patients who present with symptoms of CSR. It covered; presentation and definitions of CSR, identification of red flags, clinical tests used, diagnostic test criteria, appropriate management, education and advice given, and the criteria for further management. Additionally, it looked at their opinion on the services' needs. Results: Most agreed that CSR will improve within 4 weeks with non‐operative management; however, there was a lack of consensus regarding the most affected nerve root, differential diagnosis and appropriate diagnostic tests. Opinions aligned regarding the identification of red flags and early management, especially with widespread neurological deficits. However, the management of ongoing pain or new neurological signs, differed between clinicians. Most participants strongly agreed that access to MRIs affected referrals within an ED episode. Conclusion: Overall, the opinions matched recommended guidelines; however, some gaps in knowledge and differing management approaches were identified, indicating the need for ongoing education and standardisation of management.
A Comparison of Bilateral and Unilateral Upper-Limb Task Training in Early Poststroke Rehabilitation: A Randomized Controlled Trial
(2008-07) Morris, J.; van Wijck, Frederike; Joice, S.; Ogston, S. A.; Cole, I.; MacWalter, R. S.
Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. Objective: To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation. Design: A single-blinded randomized controlled trial, with outcome assessments at baseline, postintervention (6wk), and follow-up (18wk). Setting: Inpatient acute and rehabilitation hospitals. Participants: Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset. Intervention: Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program. Main Outcome Measures: Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor. Results: No significant differences were found in short-term improvement (0-6wk) on any measure (P>.05). For overall improvement (0-18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0-0.1; P=.05) and ARAT pinch section (95% CI, 0.3-5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P<.05), but this was irrespective of the treatment group. Conclusions: Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation. 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.
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 constructivist grounded theory of staff experiences relating to early mobilisation of mechanically ventilated patients in intensive care
(SAGE, 2022-02-23) Clarissa, Catherine; Salisbury, Lisa; Rodgers, Sheila; Kean, Susanne
Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive care units were collected to understand healthcare staff experiences relating to early mobilisation in mechanical ventilation. Data included observations of mobilisation activities, individual staff interviews and two focus groups with multidisciplinary staff. Managing Risks emerged as the core category and was theorised using the concept of risk. The middle-range theory developed in this study suggests that the process of early mobilisation starts by staff defining patient status and includes a process of negotiating patient safety, which in turn enables performing accountable mobilisation within the dynamic context of an intensive care unit setting.
A critical review of the validity of measuring stages of change in relation to exercise and moderate physical activity
(2007) Bulley, Catherine; Donaghy, Marie; Payne, A.; Mutrie, N.
Many professionals are integrally involved in the promotion of exercise and physical activity, for specific therapeutic purposes, and with the aim of improving population health and quality of life. Design and evaluation of intervention strategies are frequently underpinned by the Transtheoretical Model, a process-oriented approach to behaviour change. One component of this model is the stage of change structure, which describes a person's behaviour in the context of a change process. It is frequently used to assess current levels of exercise or physical activity participation, and as a measure of change in behaviour following intervention. This paper discusses the importance of validity in the assessment of stages of change for exercise and physical activity. Various different scales exist and have been investigated for validity using comparisons with self-reported outcome measures and physiological markers of activity. Generally, comparative data provide evidence of stage hierarchies relating to both exercise and physical activity. However, this does not establish actual levels of activity represented by stage allocation, limiting its applicability. Further appropriately designed comparisons with objective measures are required if the stage of change structure is to be applied as a meaningful, accurate and sensitive tool for the measurement of physical activity and exercise.
A mixed methods service evaluation of a pilot functional electrical stimulation clinic for the correction of dropped foot in patients with chronic stroke
(Cambridge University Press, 2011-07-29) Shiels, J.; Wilkie, K.; Bulley, Catherine; Smith, Stephen; Salisbury, Lisa
Aim To undertake a service evaluation of the pilot Lothian functional electrical stimulation (FES) clinic using both quantitative and qualitative methods and clinical practice reflection. Background Clinical guidelines recommend that FES, for the management of dropped foot after stroke, is delivered by a specialist team. However, little detail is provided about the structure and composition of the specialist team or model of service delivery. A pilot Lothian FES clinic was developed to explore the clinical value of providing such a service to stroke patients with dropped foot and identify any service modifications. Methods Mixed methods were used to evaluate the service and included quantitative, qualitative and reflective components. Phase 1: Before and after service evaluation of patients attending the FES clinic between 2003 and 2007. Outcomes of gait velocity and cadence were recorded at initial clinic appointment and 6 months after application of FES. Phase 2: Qualitative research exploring patients with stroke and carers' experiences of the FES clinic. Data were collected via semi-structured interviews. Phase 3: A reflection on the service delivery model. Participants: Phase 1: 40 consecutive out-patients with stroke; Phase 2: 13 out-patients with stroke and 9 carers; Phase 3: Three specialist physiotherapists engaged in running the FES clinic. Findings Statistically significant improvements (p < 0.001) were demonstrated in gait velocity and cadence. Qualitatively, one super-ordinate theme 'The FES clinic met my needs' emerged. Within this were four sub-themes, namely 1. 'Getting to grips with FES wasn't difficult'; 2. 'It's great to know they're there'; 3. 'Meeting up with others really helps' and 4. 'The service is great but could be better'. On reflection, minor modifications were made to the service delivery model but overall the service met user needs. This dedicated FES clinic produced positive physical outcomes and met the needs of this chronic stroke population.
A Morbidity Screening Tool for identifying fatigue, pain, upper limb dysfunction and lymphedema after breast cancer treatment: A validity study
(Elsevier, 2013-11-15) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Barber, Matthew; Tan, Chee-Wee
Purpose: This study aimed to investigate validity of a newly developed Morbidity Screening Tool (MST) to screen for fatigue, pain, swelling (lymphedema) and arm function after breast cancer treatment. Methods: A cross-sectional study included women attending reviews after completing treatment (surgery, chemotherapy and radiotherapy), without recurrence, who could read English. They completed the MST and comparator questionnaires: Disability of the Arm, Shoulder and Hand questionnaire (DASH), Chronic Pain Grade Questionnaire (CPGQ), Lymphedema and Breast Cancer Questionnaire (LBCQ) and Functional Assessment of Cancer Therapy questionnaire with subscales for fatigue (FACT F) and breast cancer (FACT B + 4). Bilateral combined shoulder ranges of motion were compared (upward reach; hand behind back) and percentage upper limb volume difference (%LVD =/>10% diagnosed as lymphedema) measured with the vertical perometer (400T). Results: 613 of 617 participants completed questionnaires (mean age 62.3 years, SD 10.0; mean time since treatment 63.0 months, SD 46.6) and 417 completed objective testing. Morbidity prevalence was estimated as 35.8%, 21.9%, 19.8% and 34.4% for fatigue, impaired upper limb function, lymphedema and pain respectively. Comparing those self-reporting the presence or absence of each type of morbidity, statistically significant differences in comparator variables supported validity of the MST. Statistically significant correlations resulted between MST scores focussing on impact of morbidity, and comparator variables that reflect function and quality of life. Conclusion: Analysis supports the validity of all four short-forms of the MST as providing indications of both presence of morbidity and impacts on participants' lives. This may facilitate early and appropriate referral for intervention. 2013 Elsevier Ltd. All rights reserved.
A needs assessment of lymphoedema services in Fife and resulting recommendations
(Wounds UK, 2007) Bulley, Catherine
Lymphoedema is a chronic condition that leads to reduced quality of life through its negative impacts on physical, psychological, and social aspects of health. Limb swelling leads to discomfort and pain, reduced movement and function, and acute inflammatory episodes. Individuals experience altered body image and self-esteem impacting on social interaction. There is evidence that specialist management of the condition leads to improved quality of life. Concern regarding the adequacy of lymphoedema services led to the commissioning of a needs assessment by the Core Cancer Review Group in Fife, Scotland. The needs assessment used a variety of methods. Current services were located through consultation of known providers and databases. Existing databases were analysed to find out the number of people requiring the service: hospital admissions and diagnoses were analysed alongside a survey of primary practices in Fife. Access to existing services was explored through a telephone survey of referrers (n _ 44), and qualitative interviews with five service providers and five clients. At the time of the study, non-palliative National Health Service (NHS) provision consisted of one part-time clinician; the service provided was under pressure from rapidly increasing referrals.However, consensus from referrers, providers, and clients indicated that there were obstacles to achieving diagnosis and referral, especially for those with non-cancer-related lymphoedema. This was primarily due to poor referrer awareness of the condition, its management, and existing services, for example, only seven per cent of those surveyed would refer to existing specialist services. Delayed referral is a significant issue, as prompt intervention leads to more positive treatment outcomes. As a result of the needs assessment, recommendations were made to increase staffing levels, promote awareness of the condition and related services, and improve geographical and multidisciplinary coordination of the service.
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 phase II pilot study comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy in the management of chronic low back pain
(2014-07) Daulat, Alexander; Goodlad, Emily
Objectives: To conduct a phase II pilot randomized controlled trial (RCT) comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy for the management of non-specific chronic low back pain (CLBP) and determine the feasibility for a larger RCT. Introduction: There is moderate evidence for exercise combined with manual therapy in the treatment of CLBP. Patients with CLBP have decreased muscle power and cardiac capacity due to their low activity levels that leads to a de-conditioning syndrome and pain. This de-conditioning syndrome may be best addressed by total body strengthening. Methods: Thirteen patients with CLBP were allocated to two groups by block randomization. Group Awas the home total body strengthening programme plus manual therapy and group B was the standard physiotherapy exercise regimen plus manual therapy. Both groups received a course of manual therapy and a specific home exercise programme for 3 months. Three outcome measures pre-and post-treatment were used measuring function, pain, and quality of life. Results: The treatment programmes in this pilot study were implemented successfully with a dropout rate of 19%. All the outcome measures used in this pilot study were responsive to change. Both groups showed a clinically important difference to function following treatment as well as improvements to pain and health related quality of life. Conclusion: The small sample size was one of the weaknesses of this pilot study. The findings from this pilot study suggest a future RCT is feasible to determine whether a home total body strengthening programme plus manual therapy is an effective management strategy for CLBP.
A Pilot Study to Explore the Predictive Validity of 4 Measures of Falls Risk in Frail Elderly Patients
(Elsevier, 2005-08) Thomas, Janet I.; Lane, Judith
Objectives To test the hypothesis that scores on 4 falls risk measures will differ significantly in patients reporting recurrent falls compared with those who do not; and to explore the validity of each measure to predict such falls status. Design A convenience sample was tested to establish the sensitivity and specificity of the Functional Reach Test, Timed Up & Go test, one-leg stance test (OLST), and balance subsection of the Performance Oriented Mobility Assessment (B-POMA). A 12-month retrospective falls history was used to identify recurrent fallers. Setting A day hospital for the elderly. Participants Convenience sample of 30 day hospital patients. The inclusion criteria were: ability to rise from a chair and walk 6m; no severe cognitive impairment or blindness; age 65 years or older. Interventions Not applicable. Main Outcome Measures Scores on the 4 tests and retrospective falls histories. Results Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers (P<.05). An OLST time of 1.02 seconds or less (odds ratio [OR]=15.2; 95% confidence interval [CI], 1.72–133.95) and B-POMA score of 11 or less (OR=18.5; 95% CI, 2.05–167.79) were predictive of day hospital patients having a history of recurrent falls. Conclusions OLST and B-POMA both have potential as screening tools for risk of falls, but this observation requires confirmation in a prospective study.
A project to qualitatively evaluate an exercise programme for wheelchair users with MS: an opportunity for clinically-based student research?
(2008-09-27) Galante, Claudia; Bulley, Catherine; Hooper, Julie
This presentation will describe a clinical/academic research collaboration via each team member's project 'journey'. A programme of monthly exercise classes, intended to facilitate maintenance of physical function of wheelchair-dependent people with MS, was developed and piloted by Julie Hooper at an out-patients physiotherapy gym. The MS Society Edinburgh branch part-funded the classes. Formal independent evaluation of the pilot programme was required. A focus group study to explore the six participants' experiences was proposed and registered with NHS Lothian R&D by Julie Hooper. Discussion between her and Cathy Bulley highlighted the possibility of the study being carried out as a supervised student project, both to provide necessary evaluation rigour and offer the opportunity for a student to gain qualititative research skills in a clinical environment. Claudia Galante conducted the focus group and wrote up the results for her dissertation. Key findings demonstrated the strong desire of the group to be more physically active, and multiple benefits to their quality-of-life. Dissemination of the findings is underway to help inform future service provision for this population. This project represented a very successful pilot of clinically-based dissertations that benefitted all parties; more such collaborations are now being planned.
A prospective qualitative exploration of views about attending pulmonary rehabilitation
(Wiley, 2009-02-04) Bulley, Catherine; Donaghy, Marie; Howden, Stella; Salisbury, Lisa; Whiteford, Suzanne; Mackay, Elaine
Background and Purpose. Pulmonary rehabilitation has been found to be an effective strategy for managing chronic obstructive pulmonary disease (COPD). However, attendance at such programmes is not optimal, therefore, this study aimed to develop an in-depth understanding of views regarding attendance at pulmonary rehabilitation and experiences which may have shaped these views. Methods. An inductive qualitative study was carried out within the framework of Interpretative Phenomenological Analysis. Five female and four male individuals with COPD who had been referred for pulmonary rehabilitation participated in semi-structured interviews. Interviews were conducted prior to participation in pulmonary rehabilitation. Results. Three main themes were identified that related to views about attending pulmonary rehabilitation. The first is entitled Desired benefits of attending pulmonary rehabilitation, which described realistic hopes about impact on daily life. The second theme was called Evaluating the threat of exercise, and it encompassed both positive and negative evaluations; some interviewees described fear and avoidance of exercise, while others were determined to overcome symptoms. These attitudes extended to views about pulmonary rehabilitation. The third theme was called Attributing value to pulmonary rehabilitation. Contrasting opinions about the value of attending pulmonary rehabilitation appeared to be influenced by the nature of prior interactions with health personnel and systems as well as information about the programme provided at referral. The referrer's attitude towards pulmonary rehabilitation appeared to be particularly influential. Conclusion. In summary, when considering rehabilitation attendance, potential participants are able to identify possible benefits, but previous experiences of symptoms and attitudes towards their condition can influence views both positively and negatively. Information and enthusiasm conveyed by the referring clinician, as well as previous interactions with health professionals can have powerful impact on views about attending. Referral practices should be informative and enthusiastic to increase the likelihood of uptake. Copyright 2009 John Wiley & Sons, Ltd.
A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components
(British Editorial Society of Bone and Joint Surgery, 2008-01) Nutton, R. W.; van der Linden, Marietta; Rowe, P. J.; Gaston, P.; Wade, F. A.
Modifications in the design of knee replacements have been proposed in order to maximise flexion. We performed a prospective double-blind randomised controlled trial to compare the functional outcome, including maximum knee flexion, in patients receiving either a standard or a high flexion version of the NexGen legacy posterior stabilised total knee replacement. A total of 56 patients, half of whom received each design, were assessed pre-operatively and at one year after operation using knee scores and analysis of range of movement using electrogoniometry. For both implant designs there was a significant improvement in the function component of the knee scores (p < 0.001) and the maximum range of flexion when walking on the level, ascending and descending a slope or stairs (all p < 0.001), squatting (p = 0.020) and stepping into a bath (p = 0.024). There was no significant difference in outcome, including the maximum knee flexion, between patients receiving the standard and high flexion designs of this implant.
A protocol for the development of professional competencies: the SPA Project
(2005) Bulley, Catherine; Donaghy, Marie
A qualitative theory guided analysis of stroke survivors' perceived barriers and facilitators to physical activity
(2014-10) Nicholson, Sarah L.; Donaghy, Marie; Johnston, Marie; Sniehotta, Falko F.; van Wijck, Frederike; Johnston, Derek; Greig, Carolyn; McMurdo, Marion E. T.; Mead, Gillian
Purpose: After stroke, physical activity and physical fitness levels are low, impacting on health, activity and participation. It is unclear how best to support stroke survivors to increase physical activity. Little is known about the barriers and facilitators to physical activity after stroke. Thus, our aim was to explore stroke survivors' perceived barriers and facilitators to physical activity. Methods: Semi-structured interviews with 13 ambulatory stroke survivors exploring perceived barriers and facilitators to physical activity post stroke were conducted in participants' homes, audio-recorded and transcribed verbatim. The Theoretical Domains Framework (TDF) informed content analysis of the interview transcripts. Results: Data saturation was reached after interviews with 13 participants (median age of 76 years (inter-quartile range (IQR) = 69-83 years). The median time since stroke was 345 d (IQR = 316-366 d). The most commonly reported TDF domains were "beliefs about capabilities", "environmental context and resources" and "social influence". The most commonly reported perceived motivators were: social interaction, beliefs of benefits of exercise, high self-efficacy and the necessity of routine behaviours. The most commonly reported perceived barriers were: lack of professional support on discharge from hospital and follow-up, transport issues to structured classes/interventions, lack of control and negative affect. Conclusions: Stroke survivors perceive several different barriers and facilitators to physical activity. Stroke services need to address barriers to physical activity and to build on facilitators to promote physical activity after stroke.