Brazilian classification of physical therapy diagnosis

BACKGROUND

The Brazilian Classification of Physical Therapy Diagnosis, developed by the Federal Council of Physiotherapy and Occupational Therapy (COFFITO), has the constitutional objectives of standardizing ethical, scientific and social aspects of the Physical Therapy profession.

OBJECTIVE

To describe the work process, rationale and proposal for standardization of a physical therapy diagnosis classification system in Brazil.

METHODS

A working group was created to propose a standardized classification for the description and codification of physical therapy diagnoses. Some terminologies common to the International Classification of Functioning (ICF) were used to make the nomenclature of diagnoses compatible with the outcomes inherent in the field of physical therapy.

RESULTS

The Brazilian Classification of Physical Therapy Diagnosis project culminated in a physical therapy diagnosis model consisting of terms grouped by organic systems and identifying codes. In addition, an application was developed to allow professionals to use the standardized diagnostic classification in an online system.

CONCLUSION

The diagnostic classification system is expected to advance the Physical Therapy profession allowing the identification of structural and/or functional alterations in a simplified and standardised manner. From a physical therapy perspective, this classification may help to consolidate the autonomy of the Brazilian physical therapists by establishing a clearer pathway between the diagnosis and interventions.

The Ability of Austrian Qualified Physiotherapists to Make Accurate Keep-Refer Decisions and to Detect Serious Pathologies Based on Clinical Vignettes: Protocol for a Cross-sectional Web-Based Survey

BACKGROUND

The recognition of serious pathologies affecting the musculoskeletal (MSK) system, especially in the early stage of a disease, is an important but challenging task. The prevalence of such serious pathologies is currently low. However, in our progressing aging population, it is anticipated that serious pathologies affecting the MSK system will be on the rise. Physiotherapists, as part of a wider health care team, can play a valuable role in the recognition of serious pathologies. It is at present unknown how accurately Austrian qualified physiotherapists can detect the presence of serious pathologies affecting the MSK system and therefore determine whether physiotherapy management is indicated (keep patients) or not (refer patients to a medical doctor).

OBJECTIVE

We will explore the current ability of Austrian qualified physiotherapists to recognize serious pathologies by using validated clinical vignettes.

METHODS

As part of an electronic web-based survey, these vignettes will be distributed among a convenience sample of qualified Austrian physiotherapists working in a hospital or private setting. The survey will consist of four sections: (1) demographics and general information, (2) the clinical vignettes, (3) questions concerning the clinical vignettes, and (4) self-perceived knowledge gaps and learning preferences from the perspective of study participants. Results will further be used for (1) international comparison with similar studies from the existing literature and (2) gaining insight into the participants' self-perceived knowledge gaps and learning preferences for increasing their knowledge level about keep-refer decision-making and detecting serious pathologies.

RESULTS

Data collection took place between May 2022 and June 2022. As of June 2022, a total of 479 Austrian physiotherapists completed the survey. Data analysis has started, and we aim to publish the results in 2023.

CONCLUSIONS

The results of this survey will provide insights into the ability of Austrian physiotherapists to make accurate keep-refer decisions and to recognize the presence of serious pathologies using clinical vignettes. The results of this survey are expected to serve as a basis for future training in this area.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43028.

Movement System Theory and Anatomical Competence: Threshold Concepts for Physical Therapist Anatomy Education

This viewpoint proposes eight anatomy threshold concepts related to physical therapist education, considering both movement system theory and anatomical competence. Movement system theory provides classifications and terminology that succinctly identifies and describes physical therapy practice from a theoretical and philosophical framework. The cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal systems are all included within this schema as the movement system theory encompasses all body systems interacting to create movement across the lifespan. Implementing movement system theory requires an ability to use human anatomy in physical therapist education and practice. Understanding the human body is a mandatory prerequisite for effective diagnosis, assessment, treatment, and patient evaluation. Anatomical competence refers to the ability to apply anatomic knowledge within the appropriate professional and clinical contexts. Exploring the required anatomical concepts for competent entry-level physical therapist education and clinical practice is warranted. The recommended threshold concepts (fluency, dimensionality, adaptability, connectivity, complexity, stability or homeostasis, progression or development, and humanity) could serve as an integral and long-awaited tool for guiding anatomy educators in physical therapy education.

Using the diagnostic thinking inventory in musculoskeletal physiotherapy: a validity and reliability study

BACKGROUND

Development of clinical reasoning is an essential aspect in musculoskeletal physiotherapy practice that is linked to better outcomes. The measurement of clinical reasoning has placed an emphasis on diagnostic reasoning using different types of examinations. The Diagnostic Thinking Inventory (DTI) is a self-assessment tool developed to measure two aspects of diagnostic reasoning: flexibility in thinking (FT) and structure in memory (SM). DTI is valid and reliable that has been used extensively in medical field.

OBJECTIVE

To investigate the validity and reliability of DTI in musculoskeletal physiotherapy practice.

METHODS

Two groups of musculoskeletal physiotherapists completed DTI. Expert musculoskeletal physiotherapists assessed face and content validity. Data from the second group of musculoskeletal physiotherapists were used to assess test-retest reliability. Internal consistency was calculated using Cronbach's alpha. Construct validity was assessed by comparing both groups. Data were analyzed using the IBM SPSS statistics 25.0 version.

RESULTS

The experts agreed that DTI measures diagnostic reasoning. For test-retest reliability, average intraclass correlation coefficient was 0.91, 0.92 and 0.90 (p < 0.001) for DTI, FT and SM scores, respectively. Cronbach's alpha was 0.909, 0.919 and 0.897 (p < 0.001) for DTI, FT and SM, respectively. The independent samples t-test demonstrated that the experts group achieved higher and statistically significant score (p < 0.001).

CONCLUSION

DTI is valid and reliable in measuring diagnostic reasoning in the context of musculoskeletal physiotherapy practice. It can be used to assess the impact of continuing education on musculoskeletal physiotherapists' diagnostic reasoning.

[Physiotherapeutic assessment of chronic pelvic pain syndrome : Development of a standardized physiotherapeutic assessment instrument for interprofessional cooperation in patients with chronic pelvic pain syndrome]

BACKGROUND

The chronic pelvic pain syndrome (CPPS) can be associated with physiotherapeutic findings. An interprofessional approach is recommended for patients with CPPS; however, no standardized physiotherapeutic assessment and documentation instrument for specific physiotherapeutic assessments exist, which is not only the foundation for physiotherapy but also for interprofessional communication.

OBJECTIVE

The aim was the development of a physiotherapeutic assessment instrument for patients with CPPS and therefore, to create a tool for clinical use, research and interprofessional communication.

MATERIAL AND METHODS

Based on an explorative literature search and an expert consensus, the first version of the instrument was developed as part of a specialized outpatient clinic. This version was applied clinically for 13 months, edited and finalized after another expert consensus.

RESULTS

The developed instrument Physical Therapy Assessment for Chronic Pelvic Pain Syndrome (PTA-CPPS) lists external and internal groups of muscles for a systematic assessment of myofascial findings. Functional capacity, breathing movements as well as scars and regions of pain are recorded. A manual for the assessment protocol was developed as accompanying material.

CONCLUSION

The developed instrument provides for the first time a physiotherapeutic assessment tool for patients with CPPS for interprofessional clinical and scientific use.

Pain-related fear of (re-)injury in patients with low back pain: Estimation or measurement in manual therapy primary care practice? A pilot study

BACKGROUND

Manual physical therapists (MPTs) working in primary care get limited information about patient's courses of (chronic) low back pain (LBP). Identification of kinesiophobia is mostly based on clinical perception.

OBJECTIVE

The aim of this study was to evaluate the association between the scores with which manual physical therapists in a primary care setting identify kinesiophobia in patients with low back pain, and the patients' self-reported measures of kinesiophobia.

METHODS

The cross-sectional study comprised 104 patients with LBP and 17 MPTs. Patients first independently completed the Tampa Scale for Kinesiophobia (TSK-17). The therapists, blinded to the TSK-scores, rated their perception of a patient's kinesiophobia using the Visual Analogue Scale-Estimation (VAS-est) and the accuracy of their ratings using the Visual Analogue Scale-Accuracy (VAS-ac). Kendall's tau b was used to determine the level of correlation between scores on the TSK-17 and the VAS-est.

A preliminary case series evaluating the safety and immediate to short-term clinical benefits of joint mobilization in hemophilic arthritis of the lower limb

OBJECTIVES

Arthritis resulting from recurrent intra-articular bleeding in individuals with hemophilia can be severely debilitating due to joint pain and stiffness with subsequent loss of mobility and function. Very limited studies have investigated the potential benefits of joint mobilization for this condition. This case series is a preliminary investigation of safety, as well as immediate and short-term clinical benefits, associated with gentle knee and ankle joint mobilization in people with hemophilic arthropathy.

METHODS

A single intervention of joint mobilization was applied to the affected knees and/or ankles of 16 individuals with severe or moderate hemophilia within a public hospital setting. Adverse events, as well as immediate (pain-free passive joint range, Timed Up and Go Test with maximum pain numerical rating scale) and short-term (Lower Extremity Functional Scale) effects of the intervention were evaluated with a repeated measures ANOVA.

RESULTS

There were no adverse events. An immediate significant increase was observed in pain-free passive ankle joint range of motion (p < 0.05) following the joint mobilization intervention.

DISCUSSION

The findings of this case series suggest that gentle joint mobilization techniques may be safely considered as part of a multimodal management approach for hemophilic arthropathy.

Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update

Introduction and hypothesis

Stress urinary incontinence (SUI) is the most common form of incontinence impacting on quality of life (QOL) and is associated with high financial, social, and emotional costs. The purpose of this study was to provide an update existing Dutch evidence-based clinical practice guidelines (CPGs) for physiotherapy management of patients with stress urinary incontinence (SUI) in order to support physiotherapists in decision making and improving efficacy and uniformity of care.

Materials and methods

A computerized literature search of relevant databases was performed to search for information regarding etiology, prognosis, and physiotherapy assessment and management in patients with SUI. Where no evidence was available, recommendations were based on consensus. Clinical application of CPGs and feasibility were reviewed. The diagnostic process consists of systematic history taking and physical examination supported by reliable and valid assessment tools to determine physiological potential for recovery. Therapy is related to different problem categories. SUI treatment is generally based on pelvic floor muscle exercises combined with patient education and counseling. An important strategy is to reduce prevalent SUI by reducing influencing risk factors.

Results

Scientific evidence supporting assessment and management of SUI is strong.

Conclusions

The CPGs reflect the current state of knowledge of effective and tailor-made intervention in SUI patients.

Clinical practice guideline for the physiotherapy of patients with whiplash-associated disorders

STUDY DESIGN

A clinical practice guideline.

OBJECTIVES

To assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with whiplash-associated disorders Grades I and II.

SUMMARY OF BACKGROUND DATA

Whiplash constitutes a considerable problem in health care. Many interventions are used in physiotherapy practice, despite increasing evidence for the use of active interventions. There is still no clinical practice guideline for the management of patients with whiplash-associated disorders. METHOD OF DEVELOPMENT: A computerized literature search of Medline, Cinahl, Cochrane Controlled Trial Register, Cochrane Database of Systematic Reviews, and the Database of the Dutch National Institute of Allied Health Professions was performed to search for information about the diagnostic process and the therapeutic process in whiplash patients. When no evidence was available, consensus between experts was achieved to develop the guideline. Practicing physiotherapists reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it.

RECOMMENDATIONS

The diagnostic process consists of systematic history taking and a physical examination supported by reliable and valid assessment tools to document symptoms and functional disabilities. The primary goals of treatment are a quick return to normal activities and the prevention of chronicity. Active interventions such as education, exercise therapy, training of functions, and activities are recommended according to the length of time since the accident and the rate of recovery. The biopsychosocial model is used to address the consequences of whiplash trauma.

CONCLUSIONS

Scientific evidence for the diagnosis and physiotherapeutic management of whiplash is sparse; therefore, consensus is used in different parts of the guideline. The guideline reflects the current state of knowledge of the effective and appropriate physiotherapy in whiplash patients. More and better research is necessary to validate this guideline in the future.