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Proximal rectus femoris avulsion is an uncommon injury that is usually seen in athletes, particularly in the Western population. While the existing literature largely focuses on surgical treatment as the main approach, growing evidence suggests that conservative management for these injuries can also be effective. Such injuries are rarely associated with non-sport activities and have not been documented in the Indian population to date. In this report, we present a case of partial proximal avulsion of the rectus femoris that was managed conservatively with a structured rehabilitation programme, leading to good functional outcome.

Background: Recovery of walking ability is important for stroke patients because it increases the likelihood of discharge and is the essential basis for achieving functional independence. Walking training intensity, measured in meters (m), provides a tangible measure of progress that is obvious and directly relates to a patient’s ability to walk in real-world scenarios. Objectives: To determine the relationship between walking training distance, m and discharge walking ability of sub-acute stroke patients using modified functional ambulation classification (MFAC), and to compare the achieved walking training distance between two distinct groups; non-assisted and assisted walkers of sub-acute stroke patients and their between-group differences in discharge functional outcomes including modified Rivermead mobility index (MRMI) and Berg’s balance scale (BBS). Method: The design was a retrospective study conducted in an inpatient rehabilitation center. A total of 87 patients were assigned to the Non-Assisted Walker group and Assisted Walker group according to their discharge MFAC. The correlation between walking training distance and discharge functional outcomes, and the between-group differences in walking training distance, functional outcomes of MFAC, MRMI and BBS were analyzed. Results: The achieved walking training distance in the Non-Assisted Walker group was significantly ($p<0.001$) higher than that of the Assisted Walker group. The achieved walking training distance in Non-Assisted Walker group and the Assisted Walker group were $3190$$\mathrm{\text{m}}\pm 2636$ and $1178$$\mathrm{\text{m}}\pm 1145$, respectively. There were significant between-group differences ($p<0.001$) in discharge MRMI and BBS indicating that the Non-Assisted Walker group achieved better functional outcomes at discharge compared to the Assisted Walker group. The achieved walking training distance had moderate correlations with discharge MFAC ($r=0.53,p<0.001$), discharge MRMI ($r=0.54,p<0.001$) and discharge BBS ($r=0.47,p<0.001$), respectively. Conclusion: The results suggested that higher walking training intensity, as reflected by greater achieved walking training distance, is associated with higher levels of walking ability at discharge and better functional outcomes.

Background: Stroke rehabilitation in inpatient setting requires high intensity of manpower and resources. Early stratification of patients with stroke could facilitate early discharge plan and reduce avoidable length of stay (LOS) in hospital. Stratification of patients with stroke in clinical setting is usually based on functional scores which are quite time-consuming and require a special training to complete the full score.

Objective: The objective of the study was to explore whether Modified Functional Ambulation Category (MFAC) can serve as a stratification tool of patients with stroke in inpatient rehabilitation.

Methods: This was a retrospective, descriptive study of the demographic, functional outcomes of patients with stroke in an inpatient rehabilitation center. A total of 2,722 patients completed a stroke rehabilitation program from 2011 to 2015 were recruited. The patients were divided into seven groups according to their admission MFAC. The between-group difference in LOS, functional outcomes at admission and discharge including Modified Rivermead Mobility Index (MRMI) and Modified Barthel Index (MBI) as well as MRMI gain, MRMI efficiency, MBI gain, and MBI efficiency were analyzed.

Results: Subjects with admission categories of MFAC 2 and 3 had a highly significant ($p<0.001$) MRMI gain (6.2 and 6.6, respectively) and subjects with admission categories of MFAC 3 to 5 had highly significant ($P<0.001$) MRMI efficiency (0.34, 0.40, and 0.39, respectively). The subjects with admission categories of MFAC 2 to 5 had a highly significant ($p<0.001$) MBI gain (9.7, 10.2, 9.3, and 7.0, respectively) and the subjects with admission categories of MFAC 4 to 5 had a highly significant ($p<0.001$) MBI efficiency (0.70 and 0.72, respectively). The subjects with admission categories of MFAC 1 and 2 had a highly significant ($p<0.001$) LOS (27.7 and 26.6, respectively). MFAC profile was also established to represent the distribution of discharge MFAC of subjects according to their admission MFAC. The chance of subjects with admission categories of MFAC 1 and MFAC 2 progress to any kind of walker (MFAC $>$ 2) is 12.7% and 58.2%, respectively. The chance of subjects with admission MFAC 3, MFAC 4 and MFAC 5 progress to independent walker (MFAC $>$ 5) is 6.7%, 14.8%, and 50.3%, respectively. Both admission MFAC and admission MBI had strong correlations with discharge MFAC ($r=0.84$, $P<0.0001$ and $r=0.78$, $P<0.0001$, respectively), discharge MRMI ($r=0.82$, $P<0.0001$ and $r=0.78$, $P<0.0001$, respectively) and discharge MBI ($r=0.78$, $P<0.0001$ and $r=0.94$, $P<0.0001$, respectively).

Conclusion: This study showed that patients on admission with moderate disability in term of MFAC had the greatest mobility gain and basic activities of daily living (ADL) gain from inpatient stroke rehabilitation. Admission MFAC could be a stratification tool of patients with stroke in inpatient rehabilitation.

Background: Physiotherapists play a key role in sports injury rehabilitation within the sports healthcare team. A strong athlete–physiotherapist relationship is necessary for effective treatment and shaping of athletes’ expectations of injury rehabilitation. Hence, it is necessary to factor the injured athletes’ expectations in structuring a rehabilitation program.

Objective: The aim of this study was to determine athletes’ expectations about physiotherapy in sports injury rehabilitation.

Methods: We performed a cross-sectional survey in which data was collected using the expectation about athletic training (EAAT) questionnaire from 120 recruited athletes of different sporting disciplines. Percentages, means and standard deviations of the expectation scores were computed. Associations between socio-demographic characteristics and athletes’ expectations of physiotherapy in sports injury rehabilitation were analyzed with the chi-square test. Differences between the athletes’ expectations of physiotherapy and demographic characteristics were also analyzed with Kruskal–Wallis and Mann–Whitney tests.

Results: The study revealed that there was no significant difference ($p>0.05$) between gender, injury type, physiotherapy experience and mental skills experience and the athletes’ expectations. There was a significant difference ($p<0.05$) between competition level and athletes’ expectations.

Conclusion: It was concluded that athletes in the Greater Accra Region have high expectations of physiotherapy in injury rehabilitation; thus sports physiotherapists would need to enhance their communication with athletes which may also help them better understand the risks, benefits, timeline and rehabilitation approach.

Background: Occupational health physiotherapy has been practiced in the UK over several decades. In the past decade, the role of occupational health physiotherapy has gained recognition as a profession that can be embedded within occupational health departments; however, limited information is known about the role of physiotherapists from professional groups outside the allied health domain in this context.

Objective: The aim of this study is to explore the experiences of occupational health doctors and nurses about the role of physiotherapy in occupational health rehabilitation.

Methods: This study is a qualitative investigation underpinned by an interpretative construct. Thirteen semi-structured interviews were conducted. Two occupational health doctors and 12 nurses were purposively recruited from two National Health Service (NHS) hospitals. Data were analyzed using thematic content analysis, coded manually and verified by member checking.

Results: The benefits of occupational health physiotherapists were rapid access intervention, advanced knowledge and clinical reasoning, evidence-based practice, and providing an additional perspective. The emerging themes of the challenges that occupational health physiotherapists may face include dealing with occupational health challenges, managing role conflicts, personal qualities and attributes, and role substitution.

Conclusion: Participants described numerous roles of occupational health physiotherapists ranging from clinical to organizational components. On-going research is needed to support the role development of physiotherapists providing occupational health rehabilitation and to further advocate for its relevance in this setting.

Objective: To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program.

Methods: Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals.

Results: A total of 56 participants were allocated to the experimental group $(n=27)$ and control group $(n=29)$. There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain.

Conclusion: The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.

Background: Musculoskeletal pain (MSP) conditions are common in the educational leaning environment and are often associated with poor ergonomic conditions.

Objective: This study investigated the prevalence, pattern and possible risk factors of MSP among undergraduate students of occupational therapy and physiotherapy in a South African university.

Methods: A cross-sectional survey using an internet-based self-designed electronic questionnaire was used to obtain information about participants’ socio-demography, ergonomic hazards, MSP, and relevant personal information. Descriptive statistics, chi-square, and logistic regression were used in analyzing the data.

Results: There were 145 participants (females 115 (79.3%); physiotherapy (74) 51.03%), making 36.7% of the present undergraduate student population in the two departments. The most prevalent ergonomic work hazards were prolonged sitting (71.7%) and repetitive movements (53.8%). The 12 months prevalence of MSP among the students was 89.7%. The pattern of MSP revealed that pain on the neck region was most prevalent (66.2%) followed by pain in the low back region (64.4%). Duration of daily travels and participation in regular exercise activities were significantly associated with the prevalence of MSP. Logistic model explained 23.6% of the variance in prevalence of MSP and correctly classified 94.1% of cases (${\chi }^2=13.73$, $p=0.03$). The right-handed students were 0.13 times more likely to present with MSP than left-handed students. Also, students who exercised regularly were 9.47 times less likely to present with MSP.

Conclusion: MSP is highly prevalent among health science undergraduates and is significantly associated with sedentary postures and inadequacy in structured physical activity participation.

Objectives: (1) To assess the effects of a conventional, delayed physiotherapy protocol used by Ischemic Stroke (IS) and Hemorrhagic Stroke (HS) post-stroke patients, in their electromyographic activation patterns during hemiparetic gait; and (2) to study whether this protocol may improve the functional abilities in this population.

Methods: This is an observational, descriptive, and analytical quasi-experimental trial. Forty patients with unilateral IS ($n=25$) and HS ($n=15$) stroke were recruited; the stroke involved the motor cortex or sub-cortical areas, and the patients were able to walk independently. Interventions with standard protocols of physiotherapy were carried out. Evaluations (clinical and gait assessment) were performed at the time of admission and at the end of the protocol. Outcome measures include Stroke Impact Scale, Timed Up and Go Test, and gait electromyographic evaluation.

Results: Only IS patients (with an average of $124.4\pm 45.4$ months delayed access to physiotherapy rehabilitation) had improvements in Timed Up and Go Test (change in $\mathrm{\text{speed}}=-8.0$seg $p<0.05$) and presented an anticipation of the onset in Upper leg muscles after the intervention. BF ($p=0.05$), ST ($p=0.001$), and RF ($p=0.024$), started their recruitment (onset) earlier at the swing phase of the gait cycle, which is more similar to the normal pattern (grey shadow). IS and HS ($120.4\pm 28.4$ months since last stroke) patients presented higher electromyographic activation, after physiotherapy, of the posterior leg muscles (gastrocnemius, semitendinosus and biceps femoris) during stance phase ($p<0.05$).

Conclusion: IS patients had improvements after delayed conventional physiotherapy. For HS limited response to intervention was observed.

Objective: To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training.

Methods: A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals.

Results: With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II ($p=0.015$) and significant higher MBI scores ($\mathrm{\text{mean}}\pm \mathrm{\text{standard}}$ deviation, median; Study group: $47.4\pm 19.6$ points, 51 points; Control group: $43.0\pm 20.0$ points, 43 points; $p=0.042$) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: $8.2\pm 5.5$ points, 7 points; Control group: $8.4\pm 6.1$ points, 6 points; $p=0.998$) and MBI scores (Study group: $63.0\pm 23.4$ points, 68 points; Control group: $61.2\pm 26.1$ points, 64 points; $p=0.743$) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: $7.7\pm 3.9$ days, 7 days; Control group: $7.4\pm 5.0$ days, 6 days; $p=0.192$). The average LOS in rehabilitation hospital (Study group: $20.0\pm 5.5$ days, 20 days; Control group: $24.3\pm 9.9$ days, 23 days; $p<0.001$) and total in-patient LOS (Study group: $26.7\pm 6.4$ days, 26 days; Control group: $30.7\pm 11.2$ days, 28 days; $p<0.001$) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, $p<0.001$).

Conclusion: Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.

Background: Pneumonia is a frequent diagnosis for patients admitted to Australian intensive care units (ICUs) for invasive ventilation. Physiotherapists in ICU provide interventions to enhance respiratory function and physical recovery.

Objective: This retrospective cohort study aimed to describe physiotherapy management of adults with pneumonia who require invasive mechanical ventilation in a single Level 3 ICU in a quaternary teaching hospital.

Methods: All adults admitted with a medical diagnosis of pneumonia requiring invasive mechanical ventilation over a two-year period were included. Demographic and clinical data, including APACHE II score, ventilator-free days (VFDs) to day 28, ICU length of stay (LOS), and type and frequency of physiotherapy episodes of care delivered in ICU, were collected from electronic medical records. Correlations between VFDs to day 28 and the frequency of physiotherapy interventions delivered per subject were examined using Spearman’s rho analysis.

Results: From 208 records screened, 66 subjects with an ICU admission diagnosis of pneumonia, who required invasive mechanical ventilation, were included. Median (IQR) ICU LOS was 10 (5–17) days, and mortality rate was 15.2% ($n=10$). The cohort had a median of 20.5 (IQR 2–25) VFDs to day 28. Community-acquired pneumonia (66.7%, $n=44$) was the most frequent type of pneumonia diagnosis. There were 1110 episodes of physiotherapy care, with patients receiving a median of 13.5 (IQR 6.8–21.3) episodes during their ICU stay, with a median rate of 1.2 (IQR 1.0–1.6) episodes per day. Over 96.7% of patients with pneumonia received physiotherapy treatment during their ICU stay. Overall, physiotherapy treatments consisting only of respiratory techniques were most commonly provided (55.1%, $n=612$). Airway suctioning (92.4%, $n=61$), patient positioning (72.7%, $n=48$) or positioning advice to nurses (77.3%, $n=51$), and hyperinflation techniques (63.6%, $n=42$) were among the respiratory techniques most delivered.

Conclusion: This study described the current intensive care physiotherapy management in a single center for adults with pneumonia who required invasive mechanical ventilation, demonstrating that respiratory physiotherapy interventions are often provided for this ICU patient cohort. Further research is warranted to determine the efficacy of respiratory physiotherapy interventions to justify their use for ICU patients with pneumonia receiving invasive mechanical ventilation.

Background: A clinical quality improvement programme named Accelerated Stroke Ambulation Programme (ASAP) was piloted in Physiotherapy Department of Tai Po Hospital from 1st October 2019 to 30th September 2020 and executed as a standard practice afterwards. The goal of ASAP was to facilitate early maximal walking ability of stroke patients in early rehabilitation phase. ASAP featured (1) proactive outcome monitoring and standardised process compliance monitoring by a patient database — Stroke Registry; (2) standardised mobility prediction by Reference Modified Rivermead Mobility Index (MRMI) Gain and (3) standardised intervention database — Stroke Treatment Library. Objective: To investigate the effectiveness of ASAP in an inpatient rehabilitation setting for stroke patients in terms of functional outcomes. Methods: The design was a retrospective comparative study to analyse the difference in functional outcomes of Pre-ASAP Group (1st October 2018 - 30th September 2019) and Post-ASAP Group (1st October 2020–30th September 2021). The primary outcome measures were MRMI, Berg’s Balance Scale (BBS), Modified Barthel Index (MBI), MRMI Gain, BBS Gain, MBI Gain, MRMI Efficiency, BBS Efficiency and MBI Efficiency. Results: There 348 subjects in Pre-ASAP Group and 281 subjects in Post-ASAP Group. Both groups had highly significant within-group improvement in MRMI, BBS and MBI ($p<0.001$). The MRMI Gain of Pre-ASAP Group and Post-ASAP Group was 6.32 and 7.42, respectively; and the difference was significant ($p<0.05$). The BBS Gain of Pre-ASAP Group and Post-ASAP Group was 8.17 and 9.70, respectively; and the difference was in margin of significance ($p=0.069$). The MBI Gain of Pre-ASAP Group and Post-ASAP Group was 10.69 and 11.96, respectively; but the difference was non-significant ($p=0.280$). The MRMI Efficiency, BBS Efficiency and MBI Efficiency of Post-ASAP Group were higher than Pre-ASAP Group but the difference was non-significant. The results of this study reflected that stroke rehabilitation programme with proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database was practical in real clinical practice with better functional outcomes than traditional physiotherapy practice which were dominated by personal preference and experience of therapists. Conclusion: Proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database may enhance the effectiveness in terms of functional outcomes of stroke rehabilitation programme.

Background: Mobile health (M-health) has emerged as a promising solution for enhancing the management of low back pain. However, the feasibility of M-health among the Chinese population and its influencing factors remain unclear.

Objective: This study aimed to assess the acceptance of M-health among people with chronic low back pain (CLBP) and physiotherapists in Shanghai, China, and to explore the influencing factors of its utility in the treatment of CLBP.

Methods: Semi-structured interviews and focus groups were conducted with 25 participants with CLBP and 20 physiotherapists, utilising a combination of group discussion and individual interview. Thematic analysis, supported by NVivo software, was employed to identify and examine the themes regarding the facilitators and barriers to the utility of M-health in Shanghai, China.

Results: The focus group discussions revealed a broad spectrum of factors that drive or hinder participants’ acceptance of M-health. Three main themes related to the feasibility of M-health were identified from the interviews: (1) Reasons for embracing M-health; (2) Reasons for resisting M-health; (3) Recommendations to enhance the feasibility of M-health. In general, participants exhibited enthusiasm towards the prospect of offering M-health as a viable treatment.

Conclusions: The findings of this study indicate that the feasibility of M-health depends on many factors in Shanghai, China. Efforts to promote the establishment of M-health policy or laws, rational integration of M-health and face-to-face model and improvement of the functions of M-health applications may increase its feasibility in Shanghai, China.

Ataxia telangiectasia (AT) is a rare neurodegenerative condition with a prevalence of 1 in 40,000 to 1 in 300,000 worldwide. It involves a genetic mutation of chromosome 11q.26. The condition is inherited in an autosomal recessive manner causing atrophy of the cerebellum due to loss of Purkinje fibres. AT presents early in childhood and the clinical features depend on the type of mutation. The study is a case report of a rare genetic disorder of a 9-year-old female who came to the physiotherapy clinic with a diagnosis of AT. The patient was presented with progressively worsening gait problems with frequent falls, with complete dependence on assistance and impaired balance and coordination. The treatment program was 12 months divided into an intense physiotherapy program for two months followed by 10 months of two times per week of physiotherapy sessions. The program was divided into four elements which are: (1) Lifestyle changes, (2) Strengthening exercises, (3) Coordination exercises, and (4) Balance training exercises. The result showed a positive outcome in increasing the patient’s independence, increased muscle strength, reduced ataxia symptoms intensity, and the patient can carry out complex activities with the help of accessory orthosis devices.