Hong Kong Physiotherapy Journal

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.

Background: Clinical outcomes are very important in clinical assessment, and responsiveness is a component inside the outcome measures that needs to be investigated, particularly in chronic nonspecific low back pain (CNSLBP).

Objective: This study aimed to investigate the responsiveness of pain, functional capacity tests, and disability in individuals with CNSLBP.

Methods: Twenty subjects were assessed in pain using the following methods: visual analog scale (VAS) and numeric pain rating scale (NPRS), functional capacity tests: functional reach test (FRT), five-time sit-to-stand test (5 TSST), and two-minute step test (2 MST), and disability level: modified Oswestry Disability Questionnaire (MODQ), Thai version before and after 2-week intervention session. For interventions, the subjects received education, spinal manipulative therapy, and individual therapeutic exercise twice a week, for a total of two weeks. The statistics analyzed were change scores, effect size (ES), and standardized response mean (SRM).

Results: The most responsive parameter for individuals with CNSLBP was pain as measured by numeric pain rating scale (NPRS) (ES $-$0.986, SRM $-$0.928) and five-time sit-to-stand test (5 TSST) (SRM $-$0.846).

Conclusion: This study found that NPRS pain and 5 TSST were responsive in individuals with CNSLBP at two weeks after the beginning of interventions.

Background: With dramatic increase in the number of older individuals, special efforts have been made to promote the levels of independence and reduce fall rates among these individuals.

Objective: To investigate the effects of Thai dance exercises over 6 weeks on functional mobility and fall rates in community-dwelling older individuals.

Methods: Sixty-one community-dwelling older adults were interviewed and assessed for their demographics and fall data during 6 months prior to participation in the study. Then they completed the quasi-experimental Thai dance exercise program for 50 minutes$/$day, 3 days$/$week over 6 weeks. Their functional mobility relating to levels of independence and safety were assessed prior to training, at 3-week and 6-week training. After completing the program at 6 weeks, participants were prospectively monitored for fall data over 6 months.

Results: Participants improved their functional mobility significantly after 3- and 6-week training $(p<0.01)$. The number of faller individuals obviously decreased from 35% $(n=21)$ prior to training to only 8% $(n=5)$ after training $(p<0.01)$.

Conclusion: The current findings further extend benefits of Thai dance as an alternative musical exercise program to promote levels of independence and safety among community-dwelling older adults.

Background: Evidence suggests patients with non-specific low back pain (NSLBP) have altered lumbar and pelvic movement patterns. These changes could be associated with altered patterns of muscle activation.

Objective: The study aimed to determine: (1) differences in the relative contributions and velocity of lumbar and pelvic movements between people with and without NSLBP, (2) the differences in lumbopelvic muscle activation patterns between people with and without NSLBP, and (3) the association between lumbar and pelvic movements and lumbopelvic muscle activation patterns.

Methods: Subjects (8 healthy individuals and 8 patients with NSLBP) performed 2 sets of 3 repetitions of active forward bending, while motion and muscle activity data were collected simultaneously. Data derived were lumbar and pelvic ranges of motion and velocity, and ipsilateral and contralateral lumbopelvic muscle activities (internal oblique$/$transverse abdominis (IO$/$TA), lumbar multifidus (LM), erector spinae (ES) and gluteus maximus (GM) muscles).

Results: Lumbar and pelvic motions showed trends, but exceeded 95% confidence minimal detectable difference (MDD${}_{95}$), for greater pelvic motion $(p=0.06)$, less lumbar motion $(p=0.23)$ among patients with NSLBP. Significantly less activity was observed in the GM muscles bilaterally $(p<0.05)$ in the NSLBP group. A significant association $(r=-0.8$, $p=0.02)$ was found between ipsilateral ES muscle activity and lumbar motion, while moderate, but statistically non-significant associations, were found between GM muscle activity bilaterally and lumbar velocity $($ipsilateral: $r=-0.6$, $p=0.14$; contralateral: $r=-0.6$, $p=0.16)$ in the NSLBP group.

Conclusion: Findings indicated patients had greater pelvic contribution, but less lumbar contribution which was associated with less activation of the GM bilaterally.

Background: Individuals with Parkinson’s disease (PD) invariably experience functional decline in a number of motor and non-motor domains affecting posture, balance and gait. Numerous clinical studies have examined effects of various types of exercise on motor and non-motor problems. But still much gap remains in our understanding of various therapies and their effect on delaying or slowing the dopamine neuron degeneration. Recently, Tai Chi and Yoga both have gained popularity as complementary therapies, since both have components for mind and body control.

Objective: The aim of this study was to determine whether eight weeks of home-based Tai Chi or Yoga was more effective than regular balance exercises on functional balance and mobility.

Methods: Twenty-seven individuals with Idiopathic PD (Modified Hoehn and Yahr stages 2.5–3) were randomly assigned to either Tai Chi, Yoga or Conventional exercise group. All the participants were evaluated for Functional Balance and Mobility using Berg Balance Scale, Timed 10m Walk test and Timed Up and Go test before and after eight weeks of training.

Results: The results were analyzed using two-way mixed ANOVA which showed that there was a significant main effect for time as F (1, 24) $=74.18$, $p=0.000$, $\eta p^2=0.76$ for overall balance in Berg Balance Scale. There was also significant main effect of time on mobility overall as F(1, 24) $=77.78$, $p=0.000$, $\eta p^2=0.76$ in Timed up and Go test and F(1, 24) $=48.24$, $p=0.000$, $\eta p^2=0.67$ for 10m Walk test. There was a significant interaction effect for $\mathrm{\text{time}}\times \mathrm{\text{group}}$ with F(2, 24) $=8.67$, $p=0.001$, $\eta p^2=0.420$ for balance. With respect to mobility, the values F(2, 24) $=5.92$, $p=0.008$, $\eta p^2=0.330$ in Timed Up and Go test and F(2, 24) $=10.40$, $p=0.001$, $\eta p^2=0.464$ in 10m Walk test showed a significant interaction. But there was no significant main effect between the groups for both balance and mobility.

Conclusion: The findings of this study suggest that Tai Chi as well as Yoga are well adhered and are attractive options for a home-based setting. As any form of physical activity is considered beneficial for individuals with PD either Tai Chi, Yoga or conventional balance exercises could be used as therapeutic intervention to optimize balance and mobility. Further studies are necessary to understand the mind–body benefits of Tai Chi and Yoga either as multicomponent physical activities or as individual therapies in various stages of PD.

Background: Other than pathoanatomical diagnosis, physical therapy managements need the diagnosis of movement-related impairments for guiding treatment interventions. The classification system of the Movement System Impairment (MSI) has been adopted to label the musculoskeletal disorders in physical therapy practice. However, reliability study of this classification system in individuals with shoulder pain has not been reported in the literature.

Objective: This paper investigated the intertester reliability of the diagnosis based on the MSI classification system in individuals with shoulder pain.

Methods: The patients with shoulder pain, between the ages 18–60 years, were recruited if he or she had pain between 30 and 70 on the 100mm visual analog scale for at least three months. The examiners who were two physical therapists with different clinical experiences received a standardized training program. They independently examined 45 patients in random order. Each patient was examined by both therapists on the same day. The standardized examination scheme based on the MSI approach was used. Patients were identified to subgroup syndromes according to scapular and humeral syndromes and also determining their subcategory syndromes. Six scapular subcategory syndromes included downward rotated, depressed, abducted, wing, internal rotated$/$anterior tilted, and elevated. Three humeral subcategory syndromes were anterior glide, superior glide, and medial rotated. More than one subgroup and subcategory of syndromes could be identified in each patient. The test results of each session were blinded to another therapist. The percentages of agreement and kappa statistic were determined.

Results: The results showed that agreement levels in identifying subgroup syndromes was fair $($71.11% agreement, kappa coefficient $=$ 0.34$)$ and classifying subcategories syndromes were poor to substantial $($73.33$–$91.11% agreement, kappa coefficient $=$ 0.20$–$0.66$)$. The overall agreement and kappa value of the MSI classification of subcategory syndromes was poor (kappa coefficient $=$ 0.11; 95% CI 0.05–0.18$)$. The agreement level of subcategories for scapular depression and humeral superior glide syndromes was substantial. The scapular winging, depression, and downward rotation were the three syndromes that were most frequently identified by both the examiners.

Conclusion: The intertester reliability between therapists with different experience according to the MSI approach for shoulder pain classification was generally acceptable to poor due to the nature of the classification system. The standardized procedure and intensive training can be used for inculcating novice therapists with adequate level of intertester reliability of examination.

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.