Hong Kong Physiotherapy Journal

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.

Background: Catastrophizing is an important psychological construct in mediating the behavioral response toward pain.

Objective: The purpose of this study is to examine the psychometric properties of the Pain Catastrophizing Scale (PCS) in Greek clinical population.

Methods: The scale was administered in 376 patients with chronic cervical and lumbar pain. Test–retest reliability, internal consistency (Cronbach $\alpha$) and concurrent validity were assessed. Exploratory (EFA) and Confirmatory Factor Analysis (CFA) were used to test the factorial validity of the hypothesized three factor structure.

Results: The PCS factors suggested high levels of test–retest reliability, whereas Cronbachs’ $\alpha$ values were acceptable. The EFA yielded a three-factor solution and indicated a marginal fit to the data. CFA procedures indicated a rather acceptable fit to the data. The concurrent validity of the instrument was confirmed.

Conclusion: PCS seems to be a reliable and valid instrument in Greek patients with chronic cervical and lumbar pain.

Objective: The aim of this study was to compare the role of a chest physiotherapy (CP) intervention to no intervention on the respiratory status of children under two years of age, with mild-to-moderate bronchiolitis.

Methods: Out of 80 eligible children observed in the Emergency Room, 45 children completed the study with 28 randomized to the intervention group and 17 to the control group. The intervention protocol, applied in an ambulatory setting, consisted of combined techniques of passive prolonged slow expiration, rhinopharyngeal clearance and provoked cough. The control group was assessed with no chest physiotherapy intervention. The efficacy of chest physiotherapy was assessed using the Kristjansson Respiratory Score at the admission and discharge of the visit to the Emergency Room and during clinical visits at day 7 and day 15.

Results: There was a significant improvement in the Kristjansson Respiratory Score in the intervention group compared to the control group at day 15 [1.2 (1.5) versus 0.3 (0.5); $p$-value$=0.005$, in the control and intervention groups, respectively], with a mean difference (95% CI) of $-0.9$ ($-1.6$ to $-0.3$).

Conclusion: Chest physiotherapy had a positive impact on the respiratory status of children with mild-to-moderate bronchiolitis.

Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04260919.

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: Since the outbreak of the SARS-CoV-2 virus in December 2019, the COVID-19 pandemic continues to threaten global stability. Transmission of SARS-CoV-2 is mostly by respiratory droplets and direct contact but viral RNA fragments have also been detected in the faecal waste of patients with COVID-19. Cleanliness and effective sanitation of public toilets is a concern, as flushing the toilet is potentially an aerosol generating procedure. When the toilets are of the squatting type and without a cover, there exists a risk of viral contamination through the splashing of toilet water and aerosol generation.

Objective: This study aims to determine whether the cleanliness of public toilets was a concern to the general population during the COVID-19 pandemic, and whether a squatting toilet was preferred to a seated design.

Methods: A questionnaire was designed and posted on “WeChat” contact groups of the investigators.

Results: The survey showed that 91% of participants preferred squatting toilets, but that 72% were apprehensive of personal contamination when using public toilets. Over 63% of the respondents had encountered an incidence of water splash and would prefer public toilets to be covered during flushing and 83% of these respondents preferred a foot-controlled device.

Conclusion: This survey suggests that consideration should be given to the installation of a simple foot-controlled device to cover public squatting toilets to help restrict potential COVID-19 contamination and to meet hygienic expectations of the public.

Background: Various factors, inherited and acquired, are associated with habitual spinal postures.

Objective: The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants.

Methods: In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2–22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected.

Results: LC and SS angles correlated significantly ($r=0.80$, $p<0.001$). Statistically significant differences for both LC ($p=0.023$) and SS ($p=0.013$) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC ($r=-0.27$, $p=0.004$); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant ($r=-0.17$, $p=0.08$). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC–SS) in standing and the participants’ body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day.

Conclusion: The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.

Background: The Shoulder Pain and Disability Index (SPADI) is the most commonly used self-administered questionnaire which is a valid and reliable instrument to assess the proportion of pain and disability in shoulder disorders. There is no evidence of SPADI questionnaire being translated into regional Indian language (Marathi).

Objective: This study aims to translate and culturally adapt and validate the Marathi version of the SPADI questionnaire. This was done as per the AAOS outcomes committee guidelines.

Methods: Cross-cultural adaptation and psychometric testing of SPADI was done in the Outpatient Physiotherapy Department of Tertiary Care Hospital, Ahmednagar, India.

Results: The internal consistency was assessed by calculating Cronbach alpha value for the pain score (0.908), disability score (0.959), and total SPADI (0.969) which were all high. The Test–retest reliability was assessed using the intraclass correlation coefficient (ICC) values for the pain score (0.993), disability score (0.997), and total SPADI (0.997) which showed excellent reliability. The criterion validity was assessed using Pearson correlation coefficient. In Males, weak to strong negative correlation was observed except for shoulder extension and in females, moderate negative correlation was observed between baseline shoulder range of motion and initial total SPADI scores and individual pain and disability except for shoulder internal rotation. The internal consistency of the Marathi SPADI (Cronbach’s alpha $>$0.99) was higher than the original English version. The reliability of the total Marathi SPADI and its subscale (Intraclass correlation coefficient $>$0.90) were found to be higher than that of the English SPADI and were consistent with the German, Brazilian, Slovene and Greek versions.

Conclusion: The translated and culturally adapted Marathi version of the SPADI questionnaire is a reliable and valid tool for the assessment of pain and disability in Marathi population.