New Zealand Journal of Physiotherapy

Perceptions of people with Parkinson’s on non-motor symptoms and functional ability

Cherie Leung — 2024-07-26

Parkinson’s is the fastest-growing neurological disorder worldwide, exhibiting motor and non-motor symptoms. The condition impacts individuals at multiple levels with both motor and non-motor symptoms (NMS). This study qualitatively explored perceptions of people with Parkinson’s (PwP), NMS, and functional ability. Ten PwP took part in semi-structured phone or Zoom interviews. Data were analysed using the General Inductive Approach. Four major themes were identified: (a) diagnosis as a turning point; (b) nonmotor symptoms and functional ability; (c) self-management; and (d) significant others. The themes were further classified into 13 subthemes and 10 categories. Interaction between the four themes also emerged from the data. A complex nuanced impact was found on the relationships between the individual and their significant others. People with Parkinson’s experienced either a “vicious cycle” or a “virtuous cycle” of symptoms, which were dependent on a multitude of factors, for example, whether it is a “good” or “bad” day and the corresponding actions taken on these days. The findings provide key insights into tailoring advice and support into self-management of Parkinson’s, particularly of actions that can be taken for better outcomes.

Patient expectations of benefit from physiotherapy and relationship to self-reported outcomes: A pilot study

Dustin Barrett — 2024-07-26

Research demonstrates that patient expectations have an influence on physiotherapy outcomes, but little is known regarding expectation changes over time. The primary objective of this pragmatic prospective cohort pilot study was to correlate patient expectations at baseline and after 2 weeks of physiotherapy to self-reported patient outcomes at discharge from physiotherapy treatment. Eligible adult patients with a variety of musculoskeletal disorders reported recovery expectations at initial evaluation and after 2 weeks of treatment. Correlations between expectations and self-reported outcome measures were calculated. Seventeen participants completed this study, and made clinically important improvements over the course of care. Expectations at baseline and 2-week time points generally indicated that participants expect to have a positive outcome from physiotherapy treatment. Participants’ baseline expectations were not significantly correlated to outcome measures or clinically important changes. Yet 2-week expectations were significantly correlated with outcomes and the likelihood of achieving clinically important changes in outcome measures. This relationship may be stronger at 2 weeks compared to baseline. Clinicians might consider repeated measuring of patient recovery expectations across the plan of care to best meet patient needs.

How do novice physiotherapists describe their experiences of workplace support?

Christine Cummins — 2024-07-26

This study aimed to explore how the experiences of workplace support contributed to the developing professional confidence, competence, and workplace experience of the novice physiotherapist working in Aotearoa New Zealand. Using a qualitative descriptive methodology, 12 registered physiotherapists who had graduated within the last 5 years and were employed in various settings across Aotearoa New Zealand were recruited. They participated in semi structured interviews, which were analysed using reflexive thematic analysis. Three themes described participants’ experiences of support: (a) navigating the transition; (b) building capabilities to achieve professional growth; and (c) fostering relationships in the workplace. The participants valued professional support that helped them navigate the early challenges they encountered as well as various forms of support that assisted them in their career development. Provision of support was hugely varied across settings and employers. Findings from this study may assist novice physiotherapists to gain awareness while navigating their own transition, accessing developmental opportunities, and building connections and competencies as a new practitioner. Additionally, this research could encourage employers to consider how best to support their novice employees.

Aotearoa New Zealand physiotherapists’ perspectives of potential expanded roles for sports-related concussion management: A qualitative study

Mya Dalton — 2024-07-26

Concussions (mild traumatic head injury) have received increasing attention in clinical practice, research, and the public press. A range of healthcare providers engage with patients presenting with concussion, and physiotherapists are often at the front line of these consultations, especially on the sports field. We explored physiotherapists’ perspectives of their scope of practice and actual clinical practice within the sports-related concussion diagnosis and return-to-sport context. A qualitative approach with interviews and focus groups was used, including 18 physiotherapists. Three themes were derived: (a) delayed access to concussiontrained general practitioners; (b) navigating concussion care in a strained healthcare system; and (c) proposed expanded role for physiotherapists. Delayed patient access to medical doctors often delayed a formal concussion diagnosis, initiation of specific concussion care, or medical sports clearance. Yet the participants were regularly identifying and managing concussions, and most felt confident to do so. Some participants, particularly those working with high-performance athletes or in multidisciplinary teams, suggested that concussion diagnosis and clearance for return to work or play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.

Physiotherapy management of adults with asthma: A survey of New Zealand practice

Sarah Mooney — 2024-07-26

The role of physiotherapy in adult asthma management in New Zealand is unknown. Contemporary guidelines, including NZ Adolescent and Adult Asthma Guidelines (NZA & AAG), make little reference to physiotherapy. An electronic survey was undertaken to explore the role of physiotherapy in New Zealand in the management of adults with asthma, including what assessment and management techniques were used, self-reported confidence in these techniques, and guiding documents that informed practice. Findings from 59 respondents indicated that New Zealand physiotherapists were not only undertaking generic assessment and management techniques but provided a unique physiotherapy-specific role including breathing retraining and airway clearance techniques. Areas of reduced confidence were identified to guide future training and advanced practice. Physiotherapists were also well placed to influence social determinants at a policy level. While the response rate was limited, this study provides a useful insight into physiotherapy practice in New Zealand in the management of adults with asthma and identifies areas for more holistic practice, as well as future professional advancement.

Whiplash-associated disorders: A case report

Grace Battal — 2024-07-26

Approximately 50% of people who suffer from whiplash enter the chronic phase of this condition and develop persistent symptoms known as chronic whiplash-associated disorders (WAD). This case study aims to contribute to the understanding of rehabilitation programmes combining cervical exercises and proprioceptive training for managing such conditions, as the literature supporting their significance is inconclusive. A 29-year-old female with chronic WAD was evaluated using goniometry, the visual analog scale (VAS), and the neck disability index (NDI). She displayed reduced neck mobility, local neck pain associated with cervicogenic headache, and neck-related disability. The intervention lasted 6 weeks, involving two 40 min weekly sessions. The exercise programme incorporated cervical spine-specific exercises, including range of motion, postural endurance, and muscle strengthening, as well as sensorimotor exercises targeting kinaesthetic sense, eye movement control, and eye-head coordination. The outcome measures reflected the resolution of symptoms and physical impairments. The patient experienced significant improvements in cervical mobility, as she regained a full range of movement in all planes. The patient also demonstrated amelioration in both pain and cervical function states. The VAS score dropped from 6/10 to 2/10; likewise, the NDI score decreased from 58% to 22% at the end of the treatment. Our observations suggest that a rehabilitation programme retraining both the cervical musculature and sensorimotor control may be effective in reducing pain and disability in people with chronic WAD. Further research is required to determine the optimal exercise programme for managing symptoms chronicity in people with WAD.

The efficacy of anterior cruciate ligament reconstruction and rehabilitation compared to conservative management for reducing the incidence of post-traumatic osteoarthritis following anterior cruciate ligament injury: A systematic review

Catherine McIntosh — 2024-07-26

Anterior cruciate ligament (ACL) injury is a risk factor for developing post-traumatic osteoarthritis (PTOA). The burden of ACL injuries and PTOA is considerable and predicted to increase if there is no change in their management. The efficacy of different ACL rehabilitation interventions in reducing the incidence of PTOA is unknown. This systematic review aimed to identify, synthesise, and critique research findings that evaluated the effectiveness of anterior cruciate ligament reconstruction (ACLR) plus rehabilitation compared to rehabilitation alone on the incidence of PTOA following ACL injury. A quality critique of the selected studies was undertaken using a modified Downs and Black appraisal tool. Data were extracted and analysed to answer the research question: What is the effect of ACL reconstruction and rehabilitation compared to conservative management on the incidence of PTOA after ACL injury? Six good-quality articles were retained for final review. Five studies compared the effect of surgical and non-surgical management of ACL injuries on developing PTOA. One study investigated the impact of different ACL rehabilitation protocols on the development of PTOA. The incidence of PTOA following ACL injury was comparable regardless of the surgical or non-surgical intervention and rehabilitation compared in each study. Further high-quality studies are needed to inform ACL injury management to reduce the impact of PTOA following ACL injury.

Health navigation for people experiencing newly acquired long-term physical disability: A realist-informed integrative review

Emily Timothy — 2024-07-26

Navigating healthcare complexities can be challenging for disabled people, leading to challenges accessing services when required, and contributing to inequitable outcomes for disabled people and their families. Physiotherapists may be key health providers for people with newly acquired physical disabilities and may experience these navigational complexities themselves. Health navigators have been postulated as one solution and are well established in services for other health conditions such as cancer and mental health. However, navigation services for disabled people are less well developed and implemented. This realist-informed integrative review aimed to articulate and clarify underlying causal processes of health navigation programmes for people with newly acquired long-term physical disability, particularly within the New Zealand context. A two-phase literature search was conducted using integrative review methods. Two primary foci emerged for navigation programmes – a targeted health focus, directed towards reducing secondary complications and better service use and flow, or holistic health focus, directed towards more aspirational outcomes. Nine mechanisms of effect were identified across the spectrum of navigational programmes, with empowerment and self-determination overarching. Our findings are important for synthesising knowledge about existing navigation programmes and clarifying the aims and outcomes of future programmes addressing the navigational needs of disabled people.

The relevance of research in clinical practice

Kirsten Davie — 2024-07-26