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Concept: Physical therapy


In September 2010, the first International Scientific Tendinopathy Symposium (ISTS) was held in Umeå, Sweden, to establish a forum for original scientific and clinical insights in this growing field of clinical research and practice. The second ISTS was organised by the same group and held in Vancouver, Canada, in September 2012. This symposium was preceded by a round-table meeting in which the participants engaged in focused discussions, resulting in the following overview of tendinopathy clinical and research issues. This paper is a narrative review and summary developed during and after the second ISTS. The document is designed to highlight some key issues raised at ISTS 2012, and to integrate them into a shared conceptual framework. It should be considered an update and a signposting document rather than a comprehensive review. The document is developed for use by physiotherapists, physicians, athletic trainers, massage therapists and other health professionals as well as team coaches and strength/conditioning managers involved in care of sportspeople or workers with tendinopathy.

Concepts: Medicine, Clinical trial, Research, Management, Clinical research, Physical therapy, Canada, Massage


BACKGROUND: People with idiopathic Parkinson’s disease (PD) frequently have low activity levels, poor mobility and reduced quality of life. Although increased physical activity may improve mobility, balance and wellbeing, adherence to exercises and activity programs over the longer term can be challenging, particularly for older people with progressive neurological conditions such as PD. Physical activities that are engaging and enjoyable, such as dancing, might enhance adherence over the long term. The objective of this study was to evaluate the feasibility of a randomized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD. METHODS: Twenty-four people with idiopathic PD referred for movement rehabilitation were randomized to receive standard physiotherapy exercises or Irish set dancing classes once per week plus a weekly home program for 6 months (12 in each group). The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation. The primary outcome was motor disability measured by the motor component of the UPDRS, which was assessed prior to and after therapy by trained assessors blinded to group assignment. The Timed Up and Go, the Berg Balance Scale and the modified Freezing of Gait Questionnaire were secondary measures. Quality of life of the people with PD was evaluated using the PDQ-39. RESULTS: Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe. There were no differences between groups in the rate of adverse events such as falls, serious injuries, death or rates of admission to hospital. The physiotherapists who provided usual care remained blind to group allocation, with no change in their standard clinical practice. Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy. Although improvements were made in both groups, the dance group showed superior results to standard physiotherapy in relation to freezing of gait, balance and motor disability. CONCLUSIONS: Irish dancing and physiotherapy were both safe and feasible in this sample from Venice, with good adherence over a comparatively long time period of 6 months. A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility, balance and quality of life in people living with idiopathic PD.Trial registration: EudraCT number 2012-005769-11.

Concepts: Clinical trial, Randomized controlled trial, Physical exercise, Exercise, Parkinson's disease, Physical therapy, Irish dance


The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study’s aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients.

Concepts: Alzheimer's disease, Therapy, Physical therapy


The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness?

Concepts: Therapy, Physical therapy, Rehabilitation medicine, Healthcare occupations


To compare 2 different treatment approaches, physical therapy modalities, and joint mobilization versus whole-body cryotherapy (WBC) combined with physical therapy modalities and joint mobilization, for symptoms of adhesive capsulitis (AC) of the shoulder.

Concepts: Therapy, Physical therapy, Shoulder, Joint manipulation, Adhesive capsulitis of shoulder, Manual therapy, Manipulative therapy


The aim of this theoretical article is to elaborate on the underpinning of Norwegian psychomotor physiotherapy (NPMP). With a narrative and hermeneutic point of departure, we explore the unfolding of a 10-year-long treatment by analysing a particular narrative from this treatment context in relation to some foundational perspectives on movement, sensation and time. A woman in her late thirties suffering from muscular tensions and pain, depression, anxiety and anorexia, came for NPMP. The investigation of her treatment experience is based on the journal written by her physiotherapist and first author of this article. We suggest that new experiences in movement and sensation as well as changes in movement patterns can contribute to retuning in sensation and restructuring of narrative time. Feeding the fictional space and narrative fantasy with new experiences in movement and sensation can help counteracting delusional ideas and assist changes, supporting embodied narrative identity. Ingrid’s experience is discussed in the light of Trygve Braatøy’s understanding of muscular functions, Knud E Løgstrup’s phenomenology of sensation and Paul Ricouer’s narrative time.

Concepts: Psychology, Concepts in metaphysics, Physical therapy, Knowledge, Perspective, Narrative, Edmund Husserl, Paul Ricœur


OBJECTIVES: The purpose of this study was to discover the frequency and type of use of online resources for continuing professional development displayed by physiotherapists in the UK. Therapists' skills, needs and frustrations using these resources were explored. With the relatively recent release and saturated use of the internet the potential presence of a skills gap between therapists at different stages of their career was also investigated. DESIGN: National online survey study. SETTING: The online survey was carried out using the international online service ‘Survey Monkey’. PARTICIPANTS: 774 physiotherapists from students to band 8c completed the survey. INTERVENTIONS: The online survey was advertised through Frontline, the Interactive Chartered Society of Physiotherapy, Journal of Physiotherapy Pain Association and cascade email through research and other networks. RESULTS: Most physiotherapists reported using the internet for professional purposes daily (40%) or 2 to 4 times a week (37%), with only 8% of respondents using it less than once a week. Overall the results suggest band 6 and 7 physiotherapists had the least skills and most frustrations when using online search engines. CONCLUSIONS: History and the nature of rapid technological advancement, specifically of the internet, appears to have created a generational skills gap within the largest group of the physiotherapy workforce band 6 and 7 therapists. Students, band 5 and band 8a therapists appear to most successfully use online resources and the reasons for this are explored.

Concepts: Therapy, United Kingdom, Physical therapy, Web search engine, World Wide Web, Internet, History of the Internet, Personal development


Objective: The aim of this study is to investigate whether the curricula for physiotherapy education in Germany conform to standards recommended in the World Confederation for Physical Therapy (WCPT) guideline for physical therapist professional entry-level education, published by the WCPT. This Guideline specifies education standards for physical therapists that are able to act as independent practitioners, without referral from another health care professional. Methods: To assess the German curricula of physical therapist education, a list of assessment dimensions was derived from the WCPT-Guideline by means of content analysis. The content validity of this list was estimated by nine experts using Lawshe’s method. The German Training and Examination Regulations for Physiotherapists (PhysTh-AprV) and all available regional curricula were studied. All documents were evaluated by 2 independent coders who rated the conformity of the documents with the assessment dimensions. Results: Based on the Lawshe procedure, the whole test content validity index of the 61 out of 67 examined assessment dimensions was 0,84. Cohen’s kappa coefficient for intercoder reliability was 0,71-0,97. The German curricula showed high correlation with the WCPT Guideline on many theoretical basic subjects. Fulfillment of some of the requirements showed heterogeneous results. Autonomous practitioners largely lacked special competencies. Conclusions: None of the German educational standards meets the expectations of the WCPT Guideline in terms of direct access. Considering the deficits of the German educational standards and the release date of some of them, a continuous development of the German education does not appear to be adequate. This issue needs to be addressed in the current debate on health policy.

Concepts: Therapy, Physical therapy, Massage, Joint manipulation, American Physical Therapy Association, Physical therapist


The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term ‘femoroacetabular impingement syndrome’ was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).

Concepts: Exercise, Therapy, Physician, Orthopedic surgery, Physical therapy, Massage, Joint manipulation, American Physical Therapy Association


Quadrilateral space syndrome (QSS) is a rare disorder characterized by axillary nerve and posterior humeral circumflex artery (PHCA) compression within the quadrilateral space. Impingement is most frequently due to trauma, fibrous bands, or hypertrophy of one of the muscular borders. Diagnosis can be complicated by the presence of concurrent traumatic injuries, particularly in athletes. Since many other conditions can mimic QSS, it is often a diagnosis of exclusion. Conservative treatment is often first trialed, including physical exercise modification, physical therapy, and therapeutic massage. In patients unrelieved by conservative measures, surgical decompression of the quadrilateral space may be indicated.

Concepts: Muscle, Exercise, Physical therapy, Exercise physiology, Massage, Axillary nerve, Posterior humeral circumflex artery, Quadrangular space