Institut Régional de Formation aux
Métiers de Rééducation et de Réadaptation des Pays de la Loire.
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Mention de date : June 2018
Paru le : 01/06/2018
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[article] How Do Physical Therapists in the United Kingdom Manage Patients With Hip Osteoarthritis? Results of a Cross-Sectional Survey [texte imprimé] / Melanie A. Holden, Auteur ; Kim L. Bennell, Auteur ; Rebecca Whittle, Auteur . - 2018 . - p. 461-470. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 461-470
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PATHOLOGIE Ostéoporose PROFESSION SANITAIRE & SOCIALE Masseur kinésithérapeute MOTS OUTILS Enquête GÉOGRAPHIE POLITIQUE Royaume Uni Thesaurus Santé Publique Hanche
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Résumé : |
Background: Hip osteoarthritis (OA) is common, painful, and disabling. Physical therapists have an important role in managing patients with hip OA; however, little is known about their current management approach and whether it aligns with clinical guideline recommendations.
Objective: The objective of this study is to describe United Kingdom (UK) physical therapists’ current management of patients with hip OA and to determine whether it aligns with clinical guidelines.
Design: The design is a cross-section questionnaire.
Methods: A questionnaire was mailed to 3126 physical therapists in the UK that explored physical therapists’ self-reported management of a patient with hip OA using a case vignette and clinical management questions.
Results: The response rate was 52.7% (n = 1646). In total, 1148 (69.7%) physical therapists had treated a patient with hip OA in the last 6 months and were included in the analyses. A treatment package was commonly provided incorporating advice, exercise (strength training 95.9%; general physical activity 85.4%), and other nonpharmacological modalities, predominantly manual therapy (69.6%), and gait retraining (66.4%). There were some differences in reported management between physical therapists based in the National Health Service (NHS) and non–NHS-based physical therapists, including fewer treatment sessions being provided by NHS-based therapists.
Limitations: Limitations include the potential for nonresponder bias and, in clinical practice, physical therapists may manage patients with hip OA differently.
Conclusion: UK-based physical therapists commonly provide a package of care for patients with hip OA that is broadly in line with current clinical guidelines, including advice, exercise, and other nonpharmacological treatments. There were some differences in clinical practice between NHS and non–NHS-based physical therapists, but whether these differences impact on clinical outcomes remains unknown. |
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15913 |
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[article] Physical Therapists’ Ability to Identify Psychological Factors and Their Self-Reported Competence to Manage Chronic Low Back Pain [texte imprimé] / Emanuel Brunner, Auteur ; Wim Dankaerts, Auteur ; André Meichtry, Auteur . - 2018 . - p. 471-479. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 471-479
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PATHOLOGIE Lombalgie PSYCHOLOGIE Psychologie PROFESSION SANITAIRE & SOCIALE Masseur kinésithérapeute
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Résumé : |
Background: In the management of chronic low back pain (LBP), identifying and managing more patients who are at high risk and who have psychological barriers to recovery is important yet difficult.
Objective: The objective of this study was to test physical therapists’ ability to allocate patients into risk stratification groups, test correlations between therapists’ assessments of psychological factors and patient questionnaires, and explore relationships between psychological factors and therapists’ self-reported competence to manage patients with chronic LBP.
Design: This was a pragmatic, observational study.
Methods: Patients completed the STarT Back Tool (SBT, for risk stratification), the Four-Dimensional Symptom Questionnaire (distress, depression, anxiety), and the Tampa Scale of Kinesiophobia (kinesiophobia) prior to the intake session. After this session, physical therapists estimated patient prognostic risk using the 3 SBT categories and rated patient psychological factors using a 0-to-10 scale. Finally, therapists reported their self-reported competence to manage the patient. Intraclass and Spearman rank correlations tested correlations between therapists’ intuitive assessments and patient questionnaires. A linear-mixed model explored relationships between psychological factors and therapists’ self-reported competence.
Results: Forty-nine patients were managed by 20 therapists. Therapists accurately estimated SBT risk allocation in only 41% of patients. Correlations between therapist perceptions and patient questionnaires were moderate for distress (r = 0.602) and fair for depression (r = 0.304) and anxiety (r = 0.327). There was no correlation for kinesiophobia (r = −0.007). Patient distress was identified as a negative predictor of therapists’ self–reported competence.
Limitations: This was a cross-sectional study, conducted in only 1 center.
Conclusions: Physical therapists were not very accurate at allocating patients into risk stratification groups or identifying psychological factors. Therapists’ self-reported competence in managing patients was lowest when patients reported higher distress. |
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15914 |
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[article] Caregiver-Provided Physical Therapy Home Programs for Children with Motor Delay: A Scoping Review [texte imprimé] / Edward James R. Gorgon, Auteur . - 2018 . - p. 480-493. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 480-493
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SOCIOLOGIE Handicap SOINS Soins DÉMOGRAPHIE Enfant
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Résumé : |
Background: Caregiver-provided physical therapy home programs (PTHP) play an important role in enhancing motor outcomes in pediatric patient populations.
Purpose: This scoping review systematically mapped clinical trials of caregiver–provided PTHP that were aimed at enhancing motor outcomes in children who have or who are at risk for motor delay, with the purpose of (1) describing trial characteristics; (2) assessing methodologic quality; and (3) examining the reporting of caregiver-related components.
Data Sources: Physiotherapy Evidence Database (PEDro), Cochrane CENTRAL, PubMed, Scopus, ScienceDirect, ProQuest Central, CINAHL, LILACS, and OTseeker were searched up to July 31, 2017.
Study Selection: Two reviewers independently assessed study eligibility. Randomized or quasi-randomized controlled trials on PTHP administered by parents, other family members, friends, or informal caregivers to children who had or who were at risk for motor delay were included.
Data Extraction: Two reviewers independently appraised trial quality on the PEDro scale and extracted data.
Data Synthesis: Twenty-four articles representing 17 individual trials were identified. Populations and interventions investigated were heterogeneous. Most of the trials had important research design limitations and methodological issues that could limit usefulness in ascertaining the effectiveness of caregiver-provided PTHP. Few (4 of 17) trials indicated involvement of caregivers in the PTHP planning, assessed how the caregivers learned from the training or instructions provided, or carried out both.
Limitations: Included studies were heterogeneous, and unpublished data were excluded.
Conclusions: Although caregiver-provided PTHP are important in addressing motor outcomes in this population, there is a lack of evidence at the level of clinical trials to guide practice. More research is urgently needed to determine the effectiveness of care-giver-provided PTHP. Future studies should address the many important issues identified in this scoping review to improve the usefulness of the trial results. |
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15915 |
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[article] Sitting Together And Reaching To Play (START-Play): Protocol for a Multisite Randomized Controlled Efficacy Trial on Intervention for Infants With Neuromotor Disorders [texte imprimé] / Regina T. Harbourne, Auteur ; Stacey C. Dusing, Auteur ; Michele A. Lobo, Auteur . - 2018 . - p. 494-502. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 494-502
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THÉRAPEUTIQUE Protocole thérapeutique DÉMOGRAPHIE Enfant MOTS OUTILS RandomisationUtilisation du hasard dans la constitution d'un échantillon pour une étude ou une enquête.
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Résumé : |
Background: There is limited research examining the efficacy of early physical therapy on infants with neuromotor dysfunction. In addition, most early motor interventions have not been directly linked to learning, despite the clear association between motor activity and cognition during infancy.
Objective: The aim of this project is to evaluate the efficacy of Sitting Together And Reaching To Play (START-Play), an intervention designed to target sitting, reaching, and motor-based problem solving to advance global development in infants with motor delays or neuromotor dysfunction.
Design: This study is a longitudinal multisite randomized controlled trial. Infants in the START-Play group are compared to infants receiving usual care in early intervention (EI).
Setting: The research takes place in homes in Pennsylvania, Delaware, Washington, and Virginia.
Participants: There will be 140 infants with neuromotor dysfunction participating, beginning between 7 to 16 months of age. Infants will have motor delays and emerging sitting skill.
Intervention: START-Play provides individualized twice-weekly home intervention for 12 weeks with families to enhance cognition through sitting, reaching, and problem-solving activities for infants. Ten interventionists provide the intervention, with each child assigned 1 therapist.
Measurements: The primary outcome measure is the Bayley III Scales of Infant Development. Secondary measures include change in the Early Problem Solving Indicator, change in the Gross Motor Function Measure, and change in the type and duration of toy contacts during reaching. Additional measures include sitting posture control and parent-child interaction.
Limitations: Limitations include variability in usual EI care and the lack of blinding for interventionists and families.
Conclusions: This study describes usual care in EI across 4 US regions and compares outcomes of the START-Play intervention to usual care.
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15916 |
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[article] Non–Small Cell Lung Carcinoma: Clinical Reasoning in the Management of a Patient Referred to Physical Therapy for Costochondritis [texte imprimé] / Craig P. Hensley, Auteur ; Alicia J. Emerson, Auteur . - 2018 . - p. 503-509. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 503-509
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PATHOLOGIE Cancer SYMPTÔME Douleur , Inflammation PROFESSION SANITAIRE & SOCIALE Masseur kinésithérapeute Thesaurus Santé Publique Poumon , Thorax
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Résumé : |
Background and Purpose: Chest pain, a frequent complaint for seeking medical care, is often attributed to musculoskeletal pathology. Costochondritis is a common disorder presenting as chest pain. Initial physical therapist examination emphasizes red flag screening. Reexamination throughout the episode of care is critical, particularly when patients are not progressing and/or in the presence of complex pain presentations. The purpose of this case report is to describe the clinical reasoning process in the management of a patient referred to physical therapy with a medical diagnosis of costochondritis.
Case Description: A 59-year-old woman presented with a 5-month history of left–sided chest pain that had progressed to include the cervical and shoulder regions. She reported multiple psychosocial stressors; a depression screen was positive. She reported a history of asthma and smoking and improvement in recent fatigue, coughing, dyspnea, and sweating. At the initial visit, shoulder, cervical, and thoracic active and passive range of motion and joint mobility testing reproduced her pain. Allodynia was present throughout the painful areas in the left upper quarter.
Outcomes: The patient demonstrated improvement over 30 days (4 visits). On her fifth visit (day 35), she reported an exacerbation of her chest and upper extremity pain and noted increased fatigue, sweating, dyspnea, and loss of appetite. Even though her pain was again reproduced with musculoskeletal testing, the physical therapist contacted the patient's physician regarding the change in presentation. A subsequent chest computed tomography scan revealed a non–small cell lung adenocarcinoma.
Discussion: Cancer can masquerade as a musculoskeletal condition. This case highlights the importance of screening, clinical reasoning, and communication throughout the episode of care, particularly in the presence of chronic pain and psychosocial stressors. |
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15917 |
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[article] Hand Edema in Patients at Risk of Breast Cancer–Related Lymphedema: Health Professionals Should Take Notice [texte imprimé] . - 2018 . - p. 510-517. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 510-517
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PATHOLOGIE Cancer , Glande mammaire [pathologie] SYMPTÔME Oedème Thesaurus Santé Publique Main
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Résumé : |
Background: There is little research on hand edema in the population at risk for breast cancer–related lymphedema (BCRL).
Objectives: Study aims included reporting potential importance of hand edema (HE) as a risk factor for progression of edema in patients treated for breast cancer at risk for BCRL, reporting risk factors for BCRL, and reporting treatment of HE.
Design/Methods: This was a retrospective analysis of 9 patients treated for breast cancer in Massachusetts General Hospital's lymphedema screening program who presented with isolated HE. Limb volumes via perometry, BCRL risk factors, and HE treatment are reported.
Results: Edema was mostly isolated to the hand. Three patients had arm edema >5% on perometry; and 2 of these had edema outside the hand on clinical examination. Patients were at high risk of BCRL with an average of 2.9/5 known risk factors. Arm edema progressed to >10% in 2 high-risk patients. Treatment resulted in an average hand volume reduction of 10.2% via perometry and improvement upon clinical examination.
Limitations: The small sample size and lack of validated measures of subjective data were limitations.
Conclusions: In this cohort, patients with HE carried significant risk factors for BCRL. Two out of 9 (22%), both carrying ≥4/5 risk factors, progressed to edema >10%. Isolated HE may be a prognostic factor for edema progression in patients treated for breast cancer at risk for BCRL. Further research is warranted. |
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15918 |
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[article] Function, Shoulder Motion, Pain, and Lymphedema in Breast Cancer With and Without Axillary Web Syndrome: An 18-Month Follow-Up [texte imprimé] / Linda A. Koehler, Auteur ; David W. Hunter, Auteur ; Anne H. Blaes, Auteur . - 2018 . - p. 518-527. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 518-527
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PATHOLOGIE Cancer SYMPTÔME Douleur Thesaurus Santé Publique Épaule
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Résumé : |
Background: Axillary web syndrome (AWS) can develop following breast cancer surgery and presents as a tight band of tissue in the axilla with shoulder abduction.
Objective: The objectives were to determine the prevalence and natural history of AWS and the association between AWS and function, range of motion, pain, lymphedema, and body mass index (BMI).
Design: This study was a longitudinal prospective cohort study utilizing a repeated measures design.
Methods: Axillary web syndrome, function, shoulder range of motion, pain, and lymphedema (using circumference, bioimpedance spectroscopy, tissue dielectric constant) were assessed in women at 2, 4, and 12 weeks and 18 months following breast cancer surgery. Prevalence of AWS and the association with the measured outcomes were analyzed.
Results: Thirty-six women agreed to participate in the study. The cumulative prevalence of AWS was 50% (18/36) at 18 months following breast cancer surgery. AWS was identified as a risk factor for reduced function. Women with AWS had statistically reduced range of motion, lower BMI, and higher number of lymph nodes removed compared to the non-AWS group. Forty-one percent (13/32) of women had AWS at 18 months. AWS reoccurred in 6 women following resolution, and a new case developed beyond the early postoperative period. The overall prevalence of physical impairments ranged from 66% to 97% within the first 18 months following surgery regardless of AWS.
Limitations: Limitations include a small sample size and potential treatment effect.
Conclusion: AWS occurs in approximately 50% of women following breast cancer surgery. It can persist for 18 months and potentially longer, develop beyond the early postoperative time period, and reoccur after resolution. Clinicians need to be aware of the chronicity of AWS and its association with reduced range of motion and function. |
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15919 |
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[article] Breaking Down Barriers to the Utilization of Standardized Tests and Outcome Measures in Acute Care Physical Therapist Practice: An Observational Longitudinal Study [texte imprimé] / Brian McDonnell, Auteur ; Shannon Stillwell, Auteur ; Shelby Hart, Auteur . - 2018 . - p. 528-535. Langues : Français ( fre) in Physical Therapy > Vol. 98 n° 6 (June 2018) . - p. 528-535
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PROFESSION SANITAIRE & SOCIALE Masseur kinésithérapeute MOTS OUTILS Échelle , Évaluation INFORMATION & COMMUNICATION Étude prospective
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Résumé : |
Background: Standardized tests and outcome measures (STOM) have not been consistently implemented as part of most physical therapists’ practice. Incidence of STOM use among physical therapists at Beth Israel Deaconess Medical Center was similar to low levels cited nationally among acute care physical therapists. Targeted knowledge translation (KT) strategies have been suggested to promote the application of research evidence into clinical decision making.
Purpose: The purpose of this quality improvement (QI) effort was to implement a series of interventions aimed at increasing both use and interpretation of STOM by physical therapists practicing in acute care.
Design: This study used an observational longitudinal design.
Methods: A literature review identified current barriers and facilitators to the use of STOM by physical therapists. KT strategies were tailored to the practice setting in order to target barriers and promote facilitators to the use of STOM. Data were collected through retrospective chart review at baseline and then subsequently at 4 periods following the implementation of the QI project.
Results: A statistically significant increase in both the use (primary outcome) and interpretation (secondary outcome) of STOM was observed following the implementation of KT strategies. The increase was sustained at all subsequent measurement periods.
Limitations: Limitations include the lack of a control group and the small number of setting- and diagnosis-specific STOM available for use by physical therapists practicing in acute care.
Conclusions: Implementation of KT strategies was associated with an increase in the frequency of use and interpretation of STOM. Similar QI efforts are feasible in any acute care physical therapy department and potentially other settings.
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https://academic.oup.com/ptj |
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https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=15920 |
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