This book summarizes the effectiveness of several therapeutic modalities in the treatment of neurologic and musculoskeletal disabilities and.
Table of contents
- Current Evidence Based Protocols on the Use of Therapeutic Modalities
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- Background:
It was emphasized to the participants that they should report what is actually used in their practice and not what ideally should be done.
The questionnaire underwent a pilot test with 10 therapists with adequate representation from different specialization fields and levels of experience. In this test phase, the participants were asked to give feedback concerning time taken, content, understandability, clarity, order, interest, and appropriateness. The changes suggested by the reviewers and later incorporated in the survey included adding questions regarding assessment of scapular motion in females and males separately and excluding a few open-ended questions.
Data from pilot testing were not included in the final analyses. The final questionnaire included 33 questions, only four of which were open-ended questions related to certain demographic details of the respondents. Not all questions were compulsory. A link to the survey was sent by email and to Indian physical therapy-based social media groups.
The link remained active between February 18 th and May 5 th Reminder emails were sent every 3 rd week to non-responders. In the cover letter, respondents were informed that they were participating voluntarily and were free to withdraw at any time. They provided informed consent by clicking on the 'next' link in the survey.
There were no financial benefits to the respondents of the survey. The current evidence for the effectiveness of physical therapy interventions was collected using an electronic literature search performed in PubMed and Cochrane Database of Systematic Reviews. The search was limited to literature published in the previous fifteen years in English. Only systematic reviews and meta-analyses were considered. References of the articles were also searched for further relevant material.
Based on the assessments of the review authors, the strength of evidence for the various interventions used for SIS was obtained. The current evidence regarding changes in kinematics and muscle activity associated with SIS was also searched to identify the correct strategies for exercise intervention for SIS patients.
Current Evidence Based Protocols on the Use of Therapeutic Modalities
The proportions of physical therapists using different techniques were estimated and comparisons across gender, experience level, and training were made using chi square statistics. Furthermore, data were analyzed to see if the respondents' choice of therapy compared with their responses for etiology. We received a total of responses.
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Amongst these, 30 respondents were therapists practicing outside India and 82 were incomplete and hence excluded. The results were analyzed from the remaining responses. The median time required to fill the survey was 19 minutes. More than half Many also had training in manipulation therapy Demographics of the respondents of the survey.
Regarding etiology, the respondents ranked the three most significant causes of SIS as shown in Figure 1. In the subgroup that chose abnormal motion as the most significant cause,. Relative percentages of respondents declaring their top three causes for SIS. Comparing the intervention choices made by physical therapists, The reported use of taping techniques was relatively lower Relative percentage of respondents using different intervention techniques for the management of SIS.
The number who responded for each technique is included in parenthesis in column 1. The 'Yes' column depicts the percentage who claim confidence in the effectiveness of the use of the technique; 'Maybe' depicts the percentage who claim to use the technique with low or no confidence in its effectiveness; and 'No' depicts the percentage of those who either reported no knowledge of the technique or did not use the technique. Of all the respondents using exercise therapy, However, no systematic patterns were identified. Over a fifth Two-thirds reported strengthening of pectoral muscles and biceps brachii.
Almost all respondents The percentage of respondents who suggested that they avoided exercises beyond 90 degrees early in rehabilitation was The number of respondents Though most respondents Therapists usually reported targeting reduction of activity of upper trapezius, supraspinatus, or pectoralis minor.
The most preferred electrotherapeutic modalities were ultrasound and interferential therapy Table 2. There was relatively no difference in the choice of superficial heat or cold. The results of the study indicate that Indian physical therapists partially follow the evidence for assessment and management of SIS.
The choices of intervention were mostly appropriate to their reported beliefs for the etiology of the condition. Some of the potential reasons that may cause or aggravate the pathology are modifiable by physical therapeutic interventions. The study attempted to evaluate Indian physical therapists' level of awareness of current evidence-based practices.
Music Therapy: Research and Evidence-Based Practice | ScienceDirect
A modifiable and often explored phenomenon associated with SIS is the change in kinematics and muscle function 23 , A physical therapeutic evaluation should therefore include assessment of muscle tightness, strength, and function beyond the special tests for SIS. Symptom alteration tests, such as scapular assistance 12 and reposition tests 25 , are also recommended. In our study, we found that Indian physical therapists refrained from scapular examination, especially in females. This may be due to socio-cultural reasons.
The authors believe that most women patients in India are not asked to undress adequately to correctly assess scapular dyskinesis. Therefore, therapists may fail to identify movement impairments to devise a targeted treatment approach.
Background:
A dependence on special tests may help in a diagnosis, but does not guide exercise prescription The survey result indicates that physical therapists claim to design individually tailored exercise regimes; however, they seem to prescribe generic and indiscriminate shoulder muscle strengthening and stretching exercises. However, the literature suggests that the upper trapezius causes scapular anterior tilt 23 , which reduces subacromial space, and therefore therapists should focus on reducing its activity by prescribing relaxation instead of strengthening exercises.
Reduced scapular upward rotation is seen in some patients with SIS 27 , As terminal arm elevation requires upper trunk extension and glenohumeral external rotation, tightness in the pectoralis major and latissimus dorsi should not be overlooked. Stretching the pectoralis minor is especially important as it is attached to the coracoid process and its tightness is associated with decreased scapular posterior tilt There is evidence that dyskinesis becomes evident after repetitive movement suggesting reduced fatigue resistance in scapular muscles Induced fatigue protocols also change scapular kinematics 33 , These findings suggest that an exercise program should incorporate targeted endurance exercises for shoulder muscles.
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In accordance with the current literature 14 , 16 , 19 , more Indian physical therapists reported using exercises than glenohumeral mobilization techniques to manage the condition. Subjects with SIS usually have no limitation of movement, except internal rotation deficits in some posterior internal impingement patients 14 , There were a higher percentage of physical therapists who reported using mobilization techniques if they had special training for it.
It is important to note that shoulder instability may lead to secondary SIS and hence capsular stretches and joint mobilization techniques should not be used indiscriminately Regarding the use of thoracic and acromioclavicular joint mobilization, there is inconclusive evidence for its effectiveness in the management of SIS Similarly, there is lack of evidence supporting the use of certain electrotherapeutic modalities for the management of SIS. The role of high voltage electrical stimulation in the rehabilitation of patellofemoral pain.
American Physical Therapy Association; Effectiveness of electromyographic biofeedback in the treatment of musculoskeletal pain.
Physical therapy treatment of knee extensor mechanism disorders: J Orthop Sports Phys Ther. The efficacy of treatment of different intervention programs for patellofemoral pain syndrome: Evaluation of the scope and quality of systematic reviews on nonpharmacological conservative treatment for patellofemoral pain syndrome.
Training program and additional electric muscle stimulation for patellofemoral pain syndrome: Arch Phys Med Rehabil. Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome. The effect of electrical stimulation to the vastus medialis muscle in a patient with chronically dislocating patella.
Nonoperative treatment for patellofemoral pain. Electric muscle stimulation of the quadriceps in the treatment of patellofemoral pain. A comparison of two types of electrical Stimulation of the quadriceps in the treatment of patellofemoral pain syndrome: Rehabilitation of patellofemoral pain syndrome: TENS versus diadynamic current therapy for pain relief.
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- Effect of Therapeutic Modalities on Patients With Patellofemoral Pain Syndrome.
Cosca DD, Navazio F. Common problems in endurance athletes. Athletes attending a sports injury clinic: Br J Sports Med. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med. A randomized controlled trial of physical therapy treatment programs in patellofemoral pain syndrome. Scoring of patellofemoral problems. A nonsurgical approach to examination and treatment of the patellofemoral joint: Pathology and nonsurgical management of the patellofemoral joint.
Crit Rev Phys Rehabil Med. Biofeedback exercise improved the EMG activity ratio of the medial and lateral vasti muscles in subjects with patellofemoral pain syndrome. Philadelphia Panel The Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for knee pain.
Rehabilitation of patellofemoral joint disorders: Low level laser treatment of chondromalacia patellae. A comprehensive treatment approach for patellofemoral pain syndrome in young women. A multicenter, single-masked study of medial, neutral, and lateral patellar taping in individuals with patellofemoral pain syndrome.
Intrinsic risk factors for the development of anterior knee pain in an athletic population: The efficacy of laser therapy in wound repair: Biofeedback supplementation to physiotherapy exercise programme for rehabilitation of patellofemoral pain syndrome: Support Center Support Center. Please review our privacy policy. Akarcali et al 1: Antich et al 4: All received 4 exercises and 1 modality, 4 treatments over 7 to 8 days Phonophoresis: However, specific recommendations are lacking concerning which adjunct modalities to employ.
This book will discuss current evidence-based clinical practice guidelines have been developed in the treatment of neurologic and musculoskeletal conditions. Clinicians use a variety of modalities to reduce pain improve mobility and treat neuromusculoskeletal injuries and disabilities. Examples of therapeutic modalities include: Specific recommendations are lacking concerning which adjunct modalities to use.
This review will summarize the effectiveness of several therapeutic modalities in the treatment of neurologic and musculoskeletal disabilities and the challenges faced by the health practitioner in selecting the most appropriate treatment. Campbell Biology by Peter V. Urry and Steven A. Wasserman , Hardcover 8.