Evaluation of an advanced-practice physical therapist in a specialty shoulder clinic: diagnostic agreement and effect on wait times. A single group follow-up study of non-surgical patients seen by physiotherapists working in expanded roles in orthopaedic departments: recall of recommendations, change in exercise and self-efficacy Perceptions of health professionals towards the management of back pain in the context of work: a qualitative study A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of 'PhysioDirect' telephone assessment and advice services for physiotherapy. Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention Evaluation of a primary care musculoskeletal clinical assessment service: a preliminary study. Development and Validation of a Multidisciplinary Mobile Care System for Patients With Advanced Gastrointestinal Cancer: Interventional Observation Study Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Improved early outcome after TKA through an app-based active muscle training programme—a randomized-controlled trial Do physiotherapists' attitudes towards evidence-based practice change as a result of an evidence-based educational programme? The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference Monitoring the change: current trends in outcome measure usage in physiotherapy. A randomized trial of physicians and physical therapists as instructors of the musculoskeletal examination. Does Teaching Physical Therapists to Deliver a Biopsychosocial Treatment Program Result in Better Patient Outcomes? A Randomized Controlled Trial Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units.
PURPOSE To examine the role of an advanced- practice physiotherapist ( APP ) with respect to ( 1 ) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems ; ( 2 ) wait times ; and ( 3 ) satisfaction with care . METHODS This prospect i ve study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre . Agreement was examined on seven major diagnostic categories , need for further examination and surgery , and type of surgical procedure . Wait times were compared between the APP- and surgeon-led clinics from referral date to date of initial consultation , date of final diagnostic test , and date of confirmed diagnosis and planned treatment . A modified and vali date d version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains . Kappa ( κ ) coefficients and bias- and prevalence-adjusted kappa ( PABAK ) values were calculated , and strength of agreement was categorized . Wait time and satisfaction data were examined using non-parametric statistics . RESULTS Agreement on major diagnostic categories varied from 0.68 ( good ) to 0.96 ( excellent ) . Agreement with respect to indication for surgery was κ=0.75 , p<0.001 ; 95 % CI , 0.62 - 0.88 ( good ) . Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points ( p<0.001 ) ; the surgeon 's wait time was significantly reduced over 3 years . High satisfaction was reported in all components of care received from both health care providers . CONCLUSIONS Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction Background Specially trained physiotherapists ( advanced practice physiotherapists ( APP ) ) are working in orthopaedic clinics to improve access to orthopaedic services and support chronic disease management . Little attention has been paid to the impact APPs may have on non-surgical patients . In non-surgical patients with hip or knee arthritis consulting an APP in an orthopaedic clinic , the objectives were to : 1 ) describe patients ’ recall of APP recommendations , use of self-management strategies , and barriers to management six weeks following consultation ; and , 2 ) compare exercise behaviour and self-efficacy at baseline and six weeks . Findings This was a single group pre- and post-intervention study of patients who saw an APP when consulting the orthopaedic departments of two hospitals . At baseline and six weeks participants completed the adapted Stanford Exercise Behaviour Scale ( response options : none , < 60 minutes/week , 1–3 hours/week or > 3 hours/week ) , and the Chronic Disease Self-efficacy Scale ( range 1–10 ; higher scores indicate higher self-efficacy ) . At follow-up participants completed questions on recall of APP recommendations , use of self-management strategies and barriers to management . Seventy three non-surgical patients with hip or knee arthritis participated , a response rate of 89 % at follow-up . Seventy one percent of patients reported that the APP recommended exercise , of whom 83 % reported exercising to manage their arthritis since the visit . Almost 50 % reported an increase in time spent stretching ; over 40 % reported an increase in time spent walking or doing strengthening exercises at follow-up . Common barriers to arthritis management were time , cost and other health problems . Mean chronic disease self-efficacy scores significantly improved from 6.3 to 7.2 ( p < 0.001 ) . The mean difference was 0.95 ( 95 % CI 0.43 , 1.62 ) ; the effect size was 0.51 . Conclusions This pilot study of an APP intervention for non-surgical patients referred for orthopaedic consultation showed promising results , particularly for enhancing use of conservative management strategies such as exercise Background Musculoskeletal complaints have a significant impact on work in terms of reduced productivity , sickness absence and long term incapacity for work . This study sought to explore GPs ’ and physiotherapists ’ perceptions of  sickness certification in patients with musculoskeletal problems . Methods Eleven ( 11 ) GPs were sample d from an existing general practice survey , and six ( 6 ) physiotherapists were selected r and omly using ‘ snowball ’ sampling techniques , through established contacts in local physiotherapy departments .  Semi-structured qualitative interviews were conducted with respondents lasting up to 30 minutes . The interviews were audio recorded and transcribed verbatim , following which they were coded using N-Vivo qualitative software and analysed thematically using the constant comparative methodology , where themes were identified and contrasted between and within both groups of respondents . Results Three themes were identified from the analysis : 1 ) Approaches to evaluating patients ’ work problems 2 ) Perceived ability to manage ‘ work and pain ’ , and 3 ) Policies and penalties in the work-place . First , physiotherapists routinely asked patients about their job and work difficulties using a structured ( protocol -driven ) approach , whilst GPs rarely used such structured measures and were less likely to enquire about patients ’ work situation . Second , return to work assessment s revealed a tension between GPs ’ gatekeeper and patient advocacy roles , often resolved in favour of patients ’ concerns and needs . Some physiotherapists perceived that GPs ’ decisions could be influenced by patients ’ dem and for a sick certificate and their close relationship with patients made them vulnerable to manipulation . Third , the workplace was considered to be a specific source of strain for patients acting as a barrier to work resumption , and over which GPs and physiotherapists could exercise only limited control . Conclusion We conclude that healthcare professionals need to take account of patients ’ work difficulties , their own perceived ability to offer effective guidance , and consider the ‘ receptivity ’ of employment context s to patients ’ work problems , in order to ensure a smooth transition back to work BACKGROUND As a result of long delays for physiotherapy for musculoskeletal problems , several areas in the UK have introduced PhysioDirect services in which patients telephone a physiotherapist for initial assessment and treatment advice . However , there is no robust evidence about the effectiveness , cost-effectiveness or acceptability to patients of PhysioDirect .  OBJECTIVE To investigate whether or not PhysioDirect is equally as clinical ly effective as and more cost-effective than usual care for patients with musculoskeletal ( MSK ) problems in primary care . DESIGN Pragmatic r and omised controlled trial to assess equivalence , incorporating economic evaluation and nested qualitative research . Patients were r and omised in 2 : 1 ratio to PhysioDirect or usual care using a remote automated allocation system at the level of the individual , stratifying by physiotherapy site and minimising by sex , age group and site of MSK problem . For the economic analysis , cost consequences included NHS and patient costs , and the cost of lost production . Cost-effectiveness analysis was carried out from the perspective of the NHS . Interviews were conducted with patients , physiotherapists and their managers . SETTING Four community physiotherapy services in Engl and . PARTICIPANTS Adults referred by general practitioners or self-referred for physiotherapy for a MSK problem . INTERVENTIONS Patients allocated to PhysioDirect  were invited to telephone a senior physiotherapist for initial assessment and advice using a computerised template , followed by face-to-face care when necessary . Patients allocated to usual care were put on to a waiting list for face-to-face care . MAIN OUTCOME MEASURES Primary outcome was the Short Form question naire-36 items , version 2 ( SF-36v2 ) Physical Component Score ( PCS ) at 6 months after r and omisation . Secondary outcomes included other measures of health outcome [ Measure Yourself Medical Outcomes Profile , European Quality of Life-5 Dimensions ( EuroQol health utility measure , EQ-5D ) , global improvement , response to treatment ] , wait for treatment , time lost from work and usual activities , patient satisfaction . Data were collected by postal question naires at baseline , 6 weeks and 6 months , and from routine records by research ers blind to allocation . RESULTS A total of 1506 patients were allocated to PhysioDirect and 743 to usual care .  Patients allocated to PhysioDirect had a shorter wait for treatment than those allocated to usual care [ median 7 days vs 34 days ; arm-time ratio 0.32 , 95 % confidence interval ( CI ) 0.29 to 0.35 ] and had fewer non-attended face-to-face appointments [ incidence rate ratio 0.55 ( 95 % CI 0.41 to 0.73 ) ] . The primary outcome at 6 months ' follow-up was equivalent between PhysioDirect and usual care [ mean PCS 43.50 vs 44.18 , adjusted difference in means -0.01 ( 95 % CI -0.80 to 0.79 ) ] . The secondary measures of health outcome all demonstrated equivalence at 6 months , with slightly greater improvement in the PhysioDirect arm at 6 weeks ' follow-up . Patients were equally satisfied with access to care but slightly less satisfied overall with PhysioDirect compared with usual care . NHS costs ( physiotherapy plus other relevant NHS costs ) per patient were similar in the two arms [ PhysioDirect £ 198.98 vs usual care £ 179.68 , difference in means £ 19.30 ( 95 % CI -£ 37.60 to £ 76.19 ) ] , while QALYs gained were also similar [ difference in means 0.007 ( 95 % CI -0.003 to 0.016 ) ] . Incremental cost per QALY gained was £ 2889 . The probability that PhysioDirect was cost-effective at a £ 20,000 willingness-to-pay threshold was 88 % . These conclusions about cost-effectiveness were robust to sensitivity analyses . There was no evidence of difference between trial arms in cost to patients or value of lost production . No adverse events were detected . CONCLUSIONS Providing physiotherapy via PhysioDirect is equally clinical ly effective compared with usual waiting list-based care , provides faster access to treatment , appears to be safe , and is broadly acceptable to patients . PhysioDirect is probably cost-effective compared with usual care Background If eHealth interventions are not used ( properly ) , their potential benefits can not be fulfilled . User perceptions of eHealth are an important determinant of its successful implementation . This study examined how patients with chronic obstructive pulmonary disease ( COPD ) and their physiotherapists ( PHTs ) value an eHealth self-management intervention following a period of use . Objective The study aim ed to evaluate the perceptions of COPD patients and their PHTs as eHealth users . Methods In this study , an eHealth self-management intervention ( website and mobile phone app ) aim ed at stimulating physical activity ( PA ) in COPD patients was evaluated by its users ( patients and PHTs ) . As participants in a r and omized controlled trial ( RCT ) , they were asked how they valued the eHealth intervention after 6 months ’ use . Interview requests were made to 33 PHTs from 26 participating practice s , and a question naire was sent to 76 patients . The question naire was analyzed in Excel ( Microsoft ) . The interviews with the PHTs and text messages ( short message service , SMS ) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows ( VERBI GmbH ) . Results A total of 60 patients with COPD filled out the question naire , and 24 PHTs were interviewed . The mobile phone app was used 89.0 % ( 160.2/180 days ) ( st and ard deviation [ SD ] 18.5 ) of the time by patients ; 53 % ( 13/24 ) of PHTs reported low or no use . Patients scored the ease of use of the app 5.09 ( SD 1.14 ) ( on a 7-point scale ) . They found the presentation of the PA information in the app to be clear , insightful , and stimulating . All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients . Patients mostly sent informative , neutral messages concerning the PA goal , and PHTs sent mostly motivating , positive messages concerning the PA goal . Messages were not perceived as supportive in reaching the PA goal according to the patients . Perceived usefulness of the intervention for the PHTs was the objective measurement of PA , the ability to see PA patterns over time , and the ability to use the intervention as a tool to give their patients insight into their PA . For patients , it was that the intervention supported them in increasing their PA and that it made them feel fitter . Barriers to use of the intervention according to the PHTs were time constraints and financial reasons . Seventy-nine percent ( 19/24 ) of the PHTs and 58 % ( 35/60 ) of the patients mentioned they would be interested in using the intervention in the future . Conclusions PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention . This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future OBJECTIVES To evaluate the clinical effectiveness of a primary care musculoskeletal clinical assessment service ( MCAS ) . The MCAS is a triage and treatment service for the management of patients with musculoskeletal conditions . DESIGN Prospect i ve observational cohort study . PARTICIPANTS Consecutive patients with musculoskeletal disorders referred to the MCAS from primary care over a 6-month period . INTERVENTIONS Patients were managed within the service in accordance with usual MCAS management/treatment pathways . MAIN OUTCOME MEASURES Previously vali date d self-administered question naires were selected as outcome measures in order to facilitate the use of postal responses . These comprised two generic health status question naires ( Short Form 36 , EuroQol EQ-5D ) , a pain assessment using a visual analogue scale and two measures of patient satisfaction ( Perceived Improvement Evaluation , Deyo and Diehl satisfaction question naire ) . Outcome measures were taken at baseline , and 3 and 12 months after recruitment . RESULTS In total , 217 patients were recruited into the study . Significant improvement was demonstrated with EuroQol at 3 and 12 months ( P=0.043 and 0.035 , respectively ) and the pain visual analogue scale at 3 and 12 months ( P=0.001 and 0.002 , respectively ) . No significant differences were demonstrated with Short Form 36 ( P=0.73 and 0.87 ) . The mean patient-perceived improvement was 33 % at 3 months and 46 % at 12 months . Results showed high levels of patient satisfaction , with 72 % of patients indicating total satisfaction with all aspects of the MCAS . CONCLUSIONS Nationally , models similar to the MCAS have been developed to help improve care for patients and achieve the 18-week access target . This preliminary study shows the possible benefits of adopting this model of care , and identifies the need for further research Background Mobile health apps have emerged as supportive tools in the management of advanced cancers . However , only a few apps have self-monitoring features , and they are not st and ardized and vali date d. Objective This study aim ed to develop and vali date a multidisciplinary mobile care system with self-monitoring features that can be useful for patients with advanced gastrointestinal cancer . Methods The development of the multidisciplinary mobile health management system was divided into 3 steps . First , the service scope was set up , and the measurement tools were st and ardized . Second , the service flow of the mobile care system was organized . Third , the mobile app ( Life Manager ) was developed . The app was developed to achieve 3 major clinical goals : support for quality of life , nutrition , and rehabilitation . Three main functional themes were developed to achieve clinical goals : a to-do list , health education , and in-app chat . Thirteen clinical ly oriented measures were included : the modified Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events question naire , Scored Patient-Generated Subjective Global Assessment ( PG-SGA ) , distress , European Organization for Research and Treatment of Cancer Quality of Life Question naire , International Physical Activity Question naire – Short Form , Low anterior resection syndrome score , satisfaction rate , etc . To vali date the system , a prospect i ve observational study was conducted . Patients with gastric cancer or colon cancer undergoing chemotherapy were recruited . We followed the subjects for 12 weeks , and selected clinical measures were taken online and offline . Results After the development process , a multidisciplinary app , the Life Manager , was launched . For evaluation , 203 patients were recruited for the study , of whom 101 ( 49.8 % ) had gastric cancer , and 102 ( 50.2 % ) were receiving palliative care . Most patients were in their fifties ( 35.5 % ) , and 128 ( 63.1 % ) were male . Overall , 176 subjects ( 86.7 % ) completed the study . Among subjects who dropped out , the most common reason was the change of patient ’s clinical condition ( 51.9 % ) . During the study period , subjects received multiple health education sessions . For the gastric cancer group , the “ general gastric cancer education ” was most frequently viewed ( 322 times ) , and for the colon cancer group , the “ warming-up exercise  ” was most viewed ( 340 times ) . Of 13 measurements taken from subjects , 9 were taken offline ( response rate : 52.0 % to 90.1 % ) , and 3 were taken online ( response rate : 17.6 % to 57.4 % ) . The overall satisfaction rate among subjects was favorable and ranged from 3.93 ( SD 0.88 ) to 4.01 ( SD 0.87 ) on the 5-point Likert scale . Conclusions A multidisciplinary mobile care system for patients with advanced gastrointestinal cancer was developed with clinical ly oriented measures . A prospect i ve study was performed for its evaluation , which showed favorable satisfaction OBJECTIVES To evaluate primary physiotherapist assessment and management of patients with musculoskeletal disorders in primary care , and to compare patient satisfaction with primary assessment by a physiotherapist or a general practitioner ( GP ) . DESIGN An observational , retrospective cohort study review ing medical records , and a separate consecutive non-r and omised study of patient satisfaction . SETTING Primary healthcare centre . PARTICIPANTS Four hundred and thirty-two patients with musculoskeletal disorders , primarily assessed by a physiotherapist . Fifty-one of these patients primarily assessed by a physiotherapist and 42 patients assessed by a GP answered a patient satisfaction question naire . INTERVENTIONS Primary assessment and management of patients with musculoskeletal disorders . MAIN OUTCOME MEASURES Data from medical records within 3-month after the visit , and patient satisfaction question naire . RESULTS Eighty-five percent ( 367/432 ) of patients did not need to see a GP . Serious pathologies were found among the 6 % ( 26/432 ) of patients who were referred to a GP by a physiotherapist , but no serious pathologies were found among the 9 % ( 39/432 ) of patients who subsequently returned for a GP appointment for the same disorder . Patients assessed by a physiotherapist were more satisfied with the information received about their disorder and self-care than patients assessed by a GP . Patients also had higher confidence in the ability of physiotherapists to assess their disorder ( P<0.002 ) . CONCLUSION Physiotherapists can be considered primary assessors of patients with musculoskeletal disorders in primary care as few patients needed additional assessment by a GP , patients with confirmed serious pathologies were identified by the physiotherapists , and patients were satisfied with assessment by a physiotherapist Purpose The purpose of this prospect i ve r and omized-controlled trial ( RCT ) was to evaluate if an app-based feedback-controlled active muscle training programme can be used to improve the outcome in the immediate postoperative period after total knee arthroplasty ( TKA ) . Methods Sixty patients , with a median age of 65.9 years ( range 45–84 ) , awaiting primary TKA were r and omized into a control and training group . Both groups followed an identical postoperative protocol . In addition , the training group postoperatively performed an app-based feedback-controlled active muscle training programme multiple times daily . Outcome measures were active and passive range of motion ( ROM ) , pain at rest and in motion , knee extension strength , the timed “ Up and Go ” , 10-m Walk Test , 30-s Chair St and Test , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , Knee Society Score ( KSS ) , and clinical data . Results The training group performed an average of 18.4 training sessions , which led to significantly higher ROM , less pain at rest and in motion , higher strength , and significantly higher functional scores . More training correlated with a better outcome . Conclusions The use of an app-based feedback-controlled active muscle training programme can improve the clinical outcome after TKA , especially ROM and reduce pain . Clinical ly relevant is that the training programme could be considered an alternative to continuous passive motion after total knee arthroplasty . Level of evidence II RATIONALE The concept of evidence -based practice ( EBP ) encourages health care professionals to provide the most effective health care , and to be accountable for the interventions they provide . Little work has been undertaken to examine how practically allied health professionals ' encompass EBP and how they perceptive and underst and the concept of EBP . The use of opinion leaders to disseminate new evidence into practice , and thereby encourage the behaviour of health care professionals has been proposed . AIMS The aims of this study were to investigate physiotherapists ' attitudes towards EBP and to examine change in their attitudes following an education package , which utilized local opinion leaders . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work to two groups . The intervention group received an evidence -based programme on aspects of EBP including literature search ing and critical appraisal . The attention control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' attitudes towards EBP were measured at baseline ( before r and omization ) and at 3 and 6 months follow-up . RESULTS Physiotherapists reported that they primarily relied on ' courses ' and ' in-service training ' for informing their clinical practice . Most agreed that clinical practice should be based on the best available evidence and that they would change their clinical practice if evidence suggested they should do so . However , many of the physiotherapists reported difficulty in reading journals and could not identify opinion leaders in key areas . In terms of clinical practice , literature , journals and research were ascribed low priority throughout . Differences in attitudes between the intervention and control groups were observed in relation to management support for EBP at 3 and 6 months follow-up . CONCLUSIONS In this study , physiotherapists appeared to be in favour of the idea of EBP , yet they remained reluctant to change their practice . Opinion leaders were not easily identifiable by physiotherapists , suggesting that this method alone may not be an effective method of changing attitudes in clinical practice . The process of changing attitudes in the clinical environment is a complex issue worthy of further research Background Patients who undergo primary Total Knee Replacement surgery ( TKR ) are often discharged within 1 - 3 days after surgery . With this relatively short length of hospital stay , a patient ’s self-management is a crucial factor in optimizing the outcome of their treatment . In the case of TKR , self-management primarily involves adequate pain management , followed by physiotherapy exercises and daily self-care activities . Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity , complexity , and the passive mode of communication used to convey it . Objective This study primarily aims to determine whether actively educating TKR patients with timely , day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive st and ard information about their recovery through the app . In addition , physical functioning , quality of life , ability to perform physiotherapy exercises and daily self-care activities , satisfaction with information , perceived involvement by the hospital , and health care consumption were also assessed . Methods A multicenter r and omized controlled trial was performed in five Dutch hospitals . In total , 213 patients who had undergone elective , primary , unilateral TKR participated . All patients had access to an app for their smartphone and tablet to guide them after discharge . The intervention group could unlock day-to-day information by entering a personal code . The control group only received weekly , basic information . Primary ( level of pain ) and secondary outcomes ( physical functioning , quality of life , ability to perform physiotherapy exercises and activities of daily self-care , satisfaction with information , perceived involvement by the hospital , and health care consumption ) were measured using self-reported online question naires . All outcomes were measured weekly in the four weeks after discharge , except for physical functioning and quality of life , which were measured at baseline and at four weeks after discharge . Data was analyzed using Student t tests , chi-square tests , and linear mixed models for repeated measures . Results In total , 114 patients were enrolled in the intervention group ( IG ) and 99 in the control group ( CG ) . Four weeks after discharge , patients in the IG performed significantly better than patients in the CG on all dimensions of pain : pain at rest ( mean 3.45 vs mean 4.59 ; P=.001 ) , pain during activity ( mean 3.99 vs mean 5.08 ; P<.001 ) and pain at night ( mean 4.18 vs mean 5.21 ; P=.003 ) . Additionally , significant differences were demonstrated in favor of the intervention group for all secondary outcomes . Conclusions In the four weeks following TKR , the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning , quality of life , ability to perform physiotherapy exercises and activities of daily self-care , satisfaction with information , perceived involvement by the hospital , and health care consumption compared to st and ard patient education . Given the rising number of TKR patients and the increased emphasis on self-management , we suggest using an app with timely postoperative care education as a st and ard part of care . Trial Registration Netherl and s Trial Register NTR7182 ; Background The application of rehabilitation robots has grown during the last decade . While meta-analyses have shown beneficial effects of robotic interventions for some patient groups , the evidence is less in others . We established the Advanced Robotic Therapy Integrated Centers ( ARTIC ) network with the goal of advancing the science and clinical practice of rehabilitation robotics . The investigators hope to exploit variations in practice to learn about current clinical application and outcomes . The aim of this paper is to introduce the ARTIC network to the clinical and research community , present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies . Methods ARTIC is a pragmatic observational study of clinical care . The data base includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat ® as part of their treatment . Patient characteristics , diagnosis-specific information , and indicators of impairment severity are collected . Core clinical assessment s include the 10-Meter Walk Test and the Goal Attainment Scaling . Data from each Lokomat ® training session are automatically collected . Results At time of analysis , the data base contained data collected from 595 patients ( cerebral palsy : n = 208 ; stroke : n = 129 ; spinal cord injury : n = 93 ; traumatic brain injury : n = 39 ; and various other diagnoses : n = 126 ) . At onset , average walking speeds were slow . The training intensity increased from the first to the final therapy session and most patients achieved their goals . Conclusions The characteristics of the patients matched epidemiological data for the target population s. When patient characteristics differed from epidemiological data , this was mainly due to the selection criteria used to assess eligibility for Lokomat ® training . While patients included in r and omized controlled interventional trials have to fulfill many inclusion and exclusion criteria , the only selection criteria applying to patients in the ARTIC data base are those required for use of the Lokomat ® . We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses . Due to the st and ardization of assessment s and the use of a common technology , this network could serve as a basis for research ers interested in specific interventional studies exp and ing beyond the Lokomat ® Abstract Objectives Firstly , to compare the effectiveness of a brief physiotherapy intervention with “ usual ” physiotherapy for patients with neck pain . Secondly , to evaluate the effect of patients ' preferences on outcome . Design Non-inferiority r and omised controlled trial eliciting preferences independently of r and omisation . Setting Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire . Participants 268 patients ( mean age 48 years ) with subacute and chronic neck pain , who were referred by their general practitioner and r and omly assigned to a brief physiotherapy intervention ( one to three sessions ) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy , at the discretion of the physiotherapist concerned . Main outcome measures The Northwick Park neck pain question naire ( NPQ ) , a specific measure of functional disability result ing from neck pain . Also , the short form 36 ( SF-36 ) question naire , a generic , health related , quality of life measure ; and the Tampa scale for kinesophobia , a measure of fear and avoidance of movement . Results At 12 months , patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group ( mean difference 1.99 , 95 % confidence interval 0.45 to 3.52 ; P = 0.01 ) . Although the result shows a significant inferiority of the intervention , the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention ( below 1.2 points of NPQ score ) . Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy . Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain . Patients with a preference for the brief intervention may do at least as well with this approach . Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further Physiotherapists have traditionally relied on impairment measures such as range of motion and muscle strength to monitor patient progress . The impact of treatment on patients ' daily activities can be assessed with valid and reliable question naires , but the use of st and ardized question naires by physiotherapists appeared to be limited . A range of strategies were implemented that aim ed to increase physiotherapists ' use of st and ardized measures of functional activities . A simple r and om sample of 300 was drawn from a data base of physiotherapy providers to a transport accident scheme , and was surveyed in March and September 2003 , with response rates of 51 % and 55 % , respectively . There was a statistically significant ( P<.05 ) increase in reported use of seven question naires and a significant reduction in the perception of barriers that were targeted by the interventions The most frequently utilized tests were a pain rating scale and question naires for lumbar and cervical problems . Physiotherapists ' attitudes to outcome measurement were generally positive although there was a small but statistically significant ( P=.02 ) reduction in mean attitude score over the re-test period . Physiotherapists in the population sample d significantly increased their reported use of a range of st and ardized outcome measures over the re-test period . The trend towards greater objectivity in measuring the progress of rehabilitation can enable physiotherapists to develop improved treatment plans with the patients ' needs at the centre of the equation OBJECTIVE To evaluate the effectiveness of physicians vs physical therapists as instructors of the musculoskeletal examination to second year medical students . METHODS A r and omized trial conducted over 3 consecutive years in a physical diagnosis course at The University of North Carolina . During the first ( baseline ) year , medical students received education about the musculoskeletal examination from a lecture and supervision by clinical preceptors . This increased in the second and third ( intervention ) years where r and om halves of each class received supplementary clinical instruction which included a structured manual , a videotape , and supervised practice with either general internal medicine physicians or physical therapists . Outcomes were measured from student performance on a practical test of clinical skills , and by written student evaluations of the supplementary instruction . RESULTS As measured on the clinical examination , performance during the intervention years improved over that during the baseline year in both intervention groups . Measures of medical students ' clinical skills did not correlate with measures of academic aptitude . CONCLUSIONS Clinical education about the musculoskeletal examination should be structured and systematic . Medical students prefer clinical education that is active , provides clear directions , and gives them performance feedback Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability . However , patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course OBJECTIVES To compare the physiotherapy service provided when therapists ' decisions are guided by an evidence -based protocol with usual care ( i.e. patient management based on therapists ' clinical decisions ) . DESIGN Exploratory , controlled , pragmatic sequential time block clinical trial . SETTING Level 3 surgical unit in a tertiary hospital in South Africa . PARTICIPANTS All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission . INTERVENTIONS Usual care was provided by clinicians from the hospital department , and non-specialised physiotherapists were appointed as locum tenens to provide evidence -based protocol care . MAIN OUTCOME MEASURES Patient waiting time , frequency of treatment sessions , tasks performed and adverse events . RESULTS During protocol -care periods , treatment sessions were provided more frequently ( P<0.001 ) and with a shorter waiting period ( P<0.001 ) . It was more likely for a rehabilitation management option to be included in a treatment session during protocol -care periods ( odds ratio 2.34 , 95 % confidence interval 1.66 to 3.43 ; P<0.001 ) . No difference in the risk of an adverse event was found between protocol -care and usual-care periods ( P=0.34 ) . CONCLUSIONS Physiotherapy services provided in intensive care units ( ICUs ) when the decisions of non-specialised therapists are guided by an evidence -based protocol are safe , differ from usual care , and reflect international consensus on current best evidence for physiotherapy in ICUs . Non-specialised therapists can use this protocol to provide evidence -based physiotherapy services to their patients . Future trials are needed to establish whether or not this will improve patient outcome
The quality of the PROMs varied greatly , with Satisfaction most commonly measured utilizing non-st and ardized locally-devised tools ; the EuroQol five-dimensions question naire ( EuroQoL-5D ) and 36-Item Short-Form ( SF-36 ) cited most frequently to capture QoL ; and the Visual Analogue Scale ( VAS ) to capture Pain .
APPs utilized a multiplicity of PROMs across a range of MSK disorders .
OBJECTIVE Advanced practice physiotherapists ( APPs ) , also known as extended scope physiotherapists , provide a new model of service delivery for musculoskeletal ( MSK ) disorders .
Research to date has largely focused on health service efficiencies , with less emphasis on patient outcomes .
The present systematic review aim ed to identify the  patient-reported outcome measures ( PROMs ) being utilized by APPs .