PhysioForum.net : News

Invitation for Physio-Jobs.Net

Rob — Tue, 04 Aug 2009 07:56:01 +0200

We recently started Physio-Jobs.Net and we are inviting you to join us.
Physio-Jobs.Net is an international career website for physiotherapists looking for a (better) job.

Physio-Jobs.Net is free of charge for job seekers and employers.

Job seekers

Searching for jobs is quick and easy. We have two types of job searches: quick and advanced. Quick search requires you to fill out just a few fields to get results. Advanced searchÂ is used when you want to get more specific, such as specifying a geographic area, minimum salary, experience level, etc.
Register at Physio-Jobs.net and post your resume on Physio-Jobs.Net and employers will contact you.
Members can also also activate our Job Agent. This agent automatically emails you the relevant jobs.

Employers

Each job you post gets its own separate page. Your, name, job location, and other job information is listed on this page. A detailed job description is entered, which can be used to make specific requirements or provide more information about the job. After a job is posted, job seekers can save or apply the jobs they want!
Employers can find resumes of job seekers that match their criteria. A powerful resume search allows employers to search by industry, experience level, geographic location, and more!
Your jobs will be syndicated by our RSS, PhysioForum.Net, Twitter, Indeed, SimplyHired, Oodle, Google base and Oodle.

CQ-index breast care

Rob — Sat, 04 Jul 2009 14:25:19 +0200

The CQ-index breast care is a useful instrument to assess patientsâ€™ experiences with breast care. The CQ-index corresponds to an international trend, as NIVEL researchers show in their publication in the European Journal of Cancer.
Patient-centeredness has become central in many healthcare systems worldwide. Transparency is an important requirement: hospitals must be informed about their patientsâ€™ experiences to be able to improve aspects of low satisfaction. Consequently, patient satisfaction measurement has become routine in many countries. In this context, it is innovative to measure patientsâ€™ experiences (in stead of their satisfaction) and to compare these experiences with the importance patients attach to quality aspects. The Consumer Quality-index (CQ-index) is a new Dutch instrument by which patientsâ€™ experiences and their priorities can be measured. In the Netherlands, the CQ-index has become the national standard to measure patient experiences.

Quality improvement
Using the new CQ-index breast care, hospitals can assess specific quality aspects that need improvement. For example, breast cancer patients thought that information about a second opinion is very important, and they reported relatively negative experiences on that aspect. A quick appointment following referral or quickly available test results were also important to patients, but patients reported quite positive experiences in most hospitals. There is not much improvement potential on these aspects. The CQ-index informs about the relation between the importance that patients attaches to an issue and how often this aspect leads to a negative experience.

The CQ-index survey
The NIVEL regularly updates the CQ-index surveys. Hospitals that want to use the survey can download it from the website of the Centre for Consumer Experience in Healthcare. In addition to hospitals, other parties such as health Insurance companies and patient organisations can use the survey.

Source: NIVEL

The Effectiveness of the Bobath Concept in Stroke Rehabilitation

Rob — Thu, 21 May 2009 11:41:04 +0200

In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation.
Method
A systematic literature search was conducted in the bibliographic databases MEDLINE and CENTRAL (March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lower limb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database (PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches.

Results
The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studies involving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath on sensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidence available, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness.

Conclusions
This systematic review confirms that overall the Bobath Concept is not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach. This review has highlighted many methodological shortcomings in the studies reviewed; further high-quality trials need to be published. Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment.

Source: ahajournals.org

Reliability and agreement in gait measurements among patients with brain injury

Rob — Thu, 21 May 2009 09:40:22 +0200

The aim of this study was to evaluate the agreement and test-retest reliability in two walking tests. A consecutive sample of 20 voluntary subjects with brain injury was recruited. Velocity, cadence, right- and left-step length were measured using the GAITrite electronic walkway system and the Ten Meter Walking (TMWT) paper and pencil test. The gait evaluation methods (GAITrite and TMWT) were placed on top of each other. The subjects performed three comfortably paced walking trials approximately 30 min apart. Cronbach's alpha, typical error, change in the mean and Bland-Altman plots, 95% limits of agreement (LOA) were used as statistics of reliability for the agreement between the tests.

The intra-class correlation coefficient (ICC), LOA and coefficient of variation (CV) were used as statistics for test-retest reliability. In addition, the objective was to ascertain inter- and intra-rater reliability of these tests. Overall, Cronbach's alpha (0.99) values showed excellent results in both tests.

Test-retest and inter-rater ICC values were good (0.95-0.99) in both tests and measured parameters. The absolute reliability results were good in all tests. This study showed acceptable agreement, test-retest and inter-rater reliability of gait measured in both GAITrite and TMW tests in brain-injured patients.

Source: Informaworld

Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life

Rob — Thu, 21 May 2009 00:01:47 +0200

Recent evidences show that education and rehabilitation while waiting for knee replacement have positive effects on the patients' health status. Identification of factors associated with worse pain, function and health-related quality of life (HRQoL) while waiting for surgery could help develop pre-surgery rehabilitation interventions that target specifically these factors and prioritize patients that may benefit the most from them. The objectives of this study were to measure pain, stiffness, function and HRQoL in patients at enrolment on waiting lists for knee replacement and to identify demographic, clinical, socioeconomic and psychosocial characteristics associated with these outcomes.
Methods
This study is part of a broader study measuring the effects of pre-surgery wait in patients scheduled for knee replacement. From 02/2006 to 09/2007, 197 patients newly scheduled for total knee replacement were recruited from the waiting lists of three university hospitals in Quebec City, Canada. Pain, stiffness and function were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores.

Results
The scores of all eight HRQoL physical and mental domains of the SF-36 were significantly lower than aged matched Canadian normative data (p<0.05). Contralateral knee pain, higher psychological distress, higher body mass index (BMI) and the use of a walking aid were significantly associated with worse function (p<0.05) and contributed to 22% of the variance of the WOMAC function score (multiple r=0.47). A higher BMI, the use of a walking aid, contralateral knee pain and advanced age were significantly associated with worse physical function (p<0.05) and contributed to 17% of the variance of the SF-36 HRQoL physical functioning score (multiple r=0.41).

Conclusions
Patients waiting for knee replacement have poor function and HRQoL. Characteristics that were found to be associated with these outcomes could help develop pre-surgery rehabilitation program and prioritize patients that may benefit the most from them. Such programs could include interventions to reduce psychological distress, therapeutic exercises targeting both knees and weight loss management.

Source: BMC

Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation

Rob — Thu, 14 May 2009 00:16:00 +0200

The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD). This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness of PLDD versus standard surgical procedure has been performed. We present the design of a randomized controlled trial, studying the cost-effectiveness of PLDD versus conventional open discectomy in patients with sciatica from lumbar disc herniation.
Methods
The study is a randomized prospective multi-center trial, in which two treatment strategies are compared in a parallel group design. Patients (age 18-70 years) visiting the neurosurgery department of the participating hospitals, are considered for inclusion in the trial when sciatica due to lumbar disc herniation has lasted more than 8 weeks. Patients with disc herniation smaller than 1/3 of the spinal canal diameter, without concomitant lateral recess stenosis or sequestration, are eligible for participation, and are randomized into one of two treatment arms; either Percutaneous Laser Disc Decompression or conventional discectomy. The functional outcome of the patient, as assessed by the Roland Disability Questionnaire for Sciatica at 8 weeks and 1 year after treatment, is the primary outcome measure. The secondary outcome parameters are recovery as perceived by the patient, leg and back pain, incidence of re-intervention, complications, quality of life, medical consumption, absence of work and secondary costs.

Discussion
Open discectomy is still considered to be the golden standard in the surgical treatment of lumbar disc herniation. Whether Percutaneous Laser Disc Decompression has at least as much efficacy as the standard surgical procedure, and is more cost-effective, will be determined by this trial.

Source: BMC Musculoskeletal Disorders

Cumulative occupational lumbar load and lumbar disc disease - results of a German multi-center case-control study (EPILIFT)

Rob — Fri, 08 May 2009 19:02:45 +0200

The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study.
Methods
In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg), patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females) or symptomatic lumbar disc narrowing (145 males, 206 females) were prospectively recruited. Population control subjects (453 males and 448 females) were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR) and 95% confidence intervals (CI) were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males) or psychosocial strain at work (in females), respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag-time analyses.

Results
We found a positive dose-response relationship between cumulative occupational lumbar load and lumbar disc herniation as well as lumbar disc narrowing among men and women. Even past lumbar load seems to contribute to the risk of lumbar disc disease.

Conclusions
According to our study, cumulative physical workload is related to lumbar disc diseases among men and women.

Source: BMC Musculoskeletal Disorders

Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT

Rob — Thu, 30 Apr 2009 11:09:15 +0200

The purpose of this study was to determine whether the intensity of PT (once versus twice daily) following TKA affects short-term recovery.Â A randomised controlled trial compared an exercise regimen of two sessions per day with a similar programme administered once daily. Primary outcome measure was ROM.Â The results showed that at the time of hospital discharge, there was no difference between the experimental andÂ control groups in range of motion.Â The authors conclude that in their setting twice daily PT sessions do not produce different results as daily PT sessions. It may be questioned whether multiple daily therapy sessions are needed as an in-hospital PT regimen in OA total knee patients.

BMC Musculoskeletal Disorder 2006, 7:71, online

View Abstract

View full free article (pdf)

Injection Therapy for Subacute and Chronic Low Back Pain: An Updated Cochrane Review

Rob — Thu, 30 Apr 2009 11:03:25 +0200

The objective of this review was to determine if injection therapy is more effective than placebo or other treatments for patients with subacute or chronic low back pain. Eighteen trials (1179 participants) were included in this review. The injection sites varied from epidural sites and facet joints (i.e. intra-articular injections, peri-articular injections and nerve blocks) to local sites (i.e. tender-and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics, and a variety of other drugs. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy.

There is insufficient evidence to support the use of injection therapy in subacute and chronic lowback pain. However, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy.
Spine, 2009, 34(1), 9-59

Link to Abstract