Physiotherapy

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Airway clearance techniques for patients experiencing acute exacerbations of chronic obstructive pulmonary disease in the Republic of Ireland
(IOS Press, 2021-12-10) Hanrahan, Ciara; Pedlow, Katy; Osadnik, Christian
Background and Objectives: Airway clearance techniques (ACTs) are used by physiotherapists with the purpose of clearing sputum from bronchial airways. They are commonly prescribed for patients experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPD), however large variability in practice is commonly observed. This study aimed to explore current physiotherapy practice regarding ACTs for people with AECOPD in the Republic of Ireland. Method: An online survey was distributed to physiotherapy clinicians via direct email and the Irish Society of Chartered Physiotherapists. Main survey themes, identified from previous studies using the same survey tool, included current practice in relation to use of ACTs, perception of their effectiveness, clinical reasoning and awareness of the literature and guidelines. For the purpose of this study, ACTs were defined as techniques used by a physiotherapist for the purpose of clearing sputum from patients’ airways. Results: 202 surveys were distributed and seventy responses (35%) were received. The majority of respondents (n = 56, 80%) reported prescribing ACTs for more than 60% of patients with AECOPD, the most common techniques being physical activity (n = 65, 93%) and active cycle of breathing techniques (n = 53, 90%). Sputum management (n = 66, 94%) was the most commonly reported indicator for use of ACTs. The majority of physiotherapists (n = 42, 60%) reported being unsure of the literature regarding ACTs in AECOPD. Conclusion: The response rate to this survey was low, however results show that physiotherapists in the Republic of Ireland regularly prescribe ACTs for patients with AECOPD. Physical activity and active cycle of breathing techniques were the most commonly used ACTs and perceived to be the most effective techniques in AECOPD, with sputum management the most commonly reported indicator for use. Further research is required to explore not only physiotherapists clinical reasoning in relation to the use of ACTs for AECOPD and the perceptions of their effectiveness, but also the lack of awareness of the literature and guidelines.
Behaviour change interventions for physical activity in adults with chronic obstructive pulmonary disease; a systematic review and meta-analysis
(Elsevier B.V., 2023-11-14) Hanrahan, Ciara; Broderick, Julie; O'Connor, Terence M.; McVeigh, Joseph G.; University College Cork
Background: Physical activity in adults with COPD is poor, but behaviour change interventions could help improve activity. This systematic review aims to examine behaviour change interventions to promote physical activity and health outcomes for adults with COPD. Methods: Eight databases were searched from inception until February 2022: Web of Science, CENTRAL, MEDLINE, EMBASE, APA PsychINFO, CINAHL, PROSPERO, Cochrane Airways Trials Register. Relevant studies were appraised to determine the impact of behaviour change interventions on physical activity outcomes. Interventions were mapped to Michie's Theoretical Domains Framework (TDF) and a meta-analysis and narrative synthesis conducted. The Cochrane risk of bias tool and the GRADE criteria evaluated bias and the quality and certainty of the evidence. Results: Twelve randomized controlled trials (RCTs) were included in the review (n= 1211). The most frequently utilized behaviour change interventions included counselling, stepcount monitoring, social support and goal setting. The most commonly measured outcomes across studies were steps-per-day, physical activity levels, exercise capacity and quality of life. A meta-analysis of comparable studies demonstrated there was no difference in stepcount in favour of behaviour change interventions with respect to steps-per-day (SMD 0.16, 95% CI -0.03, 0.36; p=0.10). There was some evidence of short-term improvement in physical activity and quality of life, with behaviour change interventions related to goals, behaviour regulation and social influences. Conclusions: People with COPD may benefit from behaviour change interventions to increase physical activity and quality of life in the short-term. The overall certainty and quality of the evidence is low however.
Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol
(HRB OPen Research, 2023-08-10) Kelly, Marie; Fullen, Brona; Martin, Denis; Bradley, Colin; O'Mahony, Billy; McVeigh, Joseph G.; Health Research Board
Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the “eHealth: It’s TIME prototype”. The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 – 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 – 5) and musculoskeletal physiotherapists (n = 3 – 5). Conclusion: The eHealth: It’s TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
Design of a physiologically based feedback loop using biosensors for interactive XR and spatial computing environments
(IEEE, 2024) Ó Riain, Eoghan; McVeigh, Joseph G.; Fullen, Brona M.; Martin, Denis; Murphy, David
This work investigates the signal characteristics of a physiological response (acute stress) and determines the viability of developing a Virtual Reality (VR) integrated physiologically based real-time feedback loop. This work has possible applications in physiotherapy and patient rehabilitation for long-term conditions including long COVID, persistent pain, and chronic fatigue. Using real-time physiological data, this approach can offer an individualised and immersive therapeutic experience. By synchronizing VR experiences with physiological responses, clinicians can optimise treatment efficacy and facilitate targeted rehabilitation efforts. A design and early prototype were developed to include a feedback loop driven by an ensemble of biosignal signatures, correlating with stress responses, that adjusts dynamic components in the environment. The prototype shows the feasibility of developing a physiologically based XR environment suitable for virtual physiotherapy interventions.
Dual tasking interferes with dynamic balance in young and old healthy adults
(IOS Press, 2021-01-11) Sulaiman, Amal Al-Shaikh; Kelly, Marie; O’Connor, Mairead; Bamiou, Doris-Eva; Pavlou, Marousa; Ménière’s Society, UK
BACKGROUND: Functional mobility requires an ability to adapt to environmental factors together with an ability to execute a secondary task simultaneously while walking. A complex dual-tasking gait test may provide an indication of functional ability and falls risk among community-dwelling older adults. PURPOSE: The aim of this cross-sectional study is to investigate age-related differences in dual-tasking ability and to evaluate whether dual-tasking ability is related to executive function. METHODS: Forty-one community-dwelling healthy older and forty-one younger adults completed a dual-tasking assessment in which concurrent tasks were incorporated into the Functional Gait Assessment (FGA). The manual dual-task involved carrying a glass of water (FGA-M) while the cognitive dual-tasks involved numeracy (FGA-N) and literacy (FGA-L) related tasks. FGA scores under single (FGA-S) and dual-task conditions together with associated dual-task costs and response accuracy were determined. Executive function was assessed using The Behavioural Assessment of the Dysexecutive Syndrome (BADS). RESULTS: FGA-N and FGA-L scores were adversely affected in both groups compared to FGA-S (p≤0.001). However, score reductions and dual-task costs were significantly greater for older adults compared to younger adults on FGA-N (p≤0.05) and FGA-L (p≤0.001), with older adult performance on FGA-N associated with falls risk (p≤0.05). Executive function did not appear to be related to dual-tasking ability. CONCLUSION: Findings suggest that cognitively demanding tasks while walking, have a deleterious effect on dynamic balance and could place older adults at a greater risk of falls.
Education and training interventions for physiotherapists working in dementia care: a scoping review
(Elsevier Inc., 2022-11-10) O'Sullivan, Trish; McVeigh, Joseph G.; Timmons, Suzanne; Foley, Tony
Objectives: Physiotherapy plays a key role in many aspects of dementia care, most notably in maintaining mobility. However, there is a lack of dementia care training at undergraduate and postgraduate level, and more importantly, a paucity of evidence as to what constitutes effective dementia education and training for physiotherapists. The aim of this scoping review was to explore and map the evidence, both quantitative and qualitative, relating to education and training for physiotherapists. Design: This scoping review followed the Joanna Briggs Institute methodology for scoping reviews. A chronological narrative synthesis of the data outlined how the results relate to the objectives of this study. Setting: All studies, both quantitative and qualitative on dementia education and training conducted in any setting, including acute, community care, residential or any educational setting in any geographical area were included. Participants: Studies that included dementia education and training for both qualified and student physiotherapists were considered. Results: A total of 11 papers were included in this review. The principal learning outcomes evaluated were knowledge, confidence, and attitudes. Immediate post- intervention scores showed an improvement in all three outcomes. The Kirkpatrick four level model was used to evaluate the level of outcome achieved. Most educational interventions reached Kirkpatrick level 2, which evaluates learning. A multi-modal approach, with active participation and direct patient involvement seems to enhance learning. Conclusions: Allowing for the heterogeneity of intervention design and evaluation, some common components of educational interventions were identified that led to positive outcomes. This review highlights the need for more robust studies in this area. Further research is needed to develop bespoke dementia curricula specific to physiotherapy.
Effectiveness of exercise on fatigue and sleep quality in fibromyalgia: a systematic review and meta-analysis of randomized trials
(Elsevier, 2020-07-05) Estévez-López, Fernando; Maestre-Cascales, Cristina; Russell, Deborrah; Álvarez-Gallardo, Inmaculada C.; Rodriguez-Ayllon, María; Hughes, Ciara M.; Davison, Gareth W.; Sañudo, Borja; McVeigh, Joseph G.; Horizon 2020; Health and Social Care Northern Ireland
Objectives: To determine the effects of exercise on fatigue and sleep quality in fibromyalgia (primary aim) and to identify which type of exercise is the most effective in achieving these outcomes (secondary aim). Data Sources: PubMed and Web of Science were searched from inception until October 18, 2018. Study Selection: Eligible studies contained information on population (fibromyalgia), intervention (exercise), and outcomes (fatigue or sleep). Randomized controlled trials (RCT) testing the effectiveness of exercise compared with usual care and randomized trials (RT) comparing the effectiveness of 2 different exercise interventions were included for the primary and secondary aims of the present review, respectively. Two independent researchers performed the search, screening, and final eligibility of the articles. Of 696 studies identified, 17 RCTs (n=1003) were included for fatigue and 12 RCTs (n=731) for sleep. Furthermore, 21 RTs compared the effectiveness of different exercise interventions (n=1254). Data Extraction: Two independent researchers extracted the key information from each eligible study. Data Synthesis: Separate random-effect meta-analyses were performed to examine the effects from RCTs and from RTs (primary and secondary aims). Standardized mean differences (SMD) effect sizes were calculated using Hedges’ adjusted g. Effect sizes of 0.2, 0.4, and 0.8 were considered small, moderate, and large. Compared with usual care, exercise had moderate effects on fatigue and a small effect on sleep quality (SMD, –0.47; 95% confidence interval [CI], –0.67 to –0.27; P<.001 and SMD, –0.17; 95% CI, –0.32 to –0.01; P=.04). RTs in which fatigue was the primary outcome were the most beneficial for lowering fatigue. Additionally, meditative exercise programs were the most effective for improving sleep quality. Conclusions: Exercise is moderately effective for lowering fatigue and has small effects on enhancing sleep quality in fibromyalgia. Meditative exercise programs may be considered for improving sleep quality in fibromyalgia.
The effectiveness of social prescribing in the management of long-term conditions in community-based adults: a systematic review and meta-analysis
(SAGE Publications, 11-06-2024) O’Sullivan, Declan J.; Bearne, Lindsay M.; Harrington, Janas M.; Cardoso, Jefferson Rosa; McVeigh, Joseph G.
Objective: The objective of this systematic review and meta-analysis was to evaluate the effectiveness of social prescribing interventions in the management of long-term conditions in adults. Data Sources: Eleven electronic databases were searched for randomized and quasi-randomized controlled trials. Review Methods: Outcomes of interest were quality of life, physical activity, psychological well-being and disease-specific measures. Bias was assessed with the Cochrane Risk of Bias 2 tool. A narrative synthesis and meta-analysis were performed. Results: Twelve studies (n=3566) were included in this review. Social prescribing interventions were heterogeneous and the most common risks of bias were poor blinding and high attrition. Social prescribing interventions designed to target specific long-term conditions i.e. cancer and diabetes demonstrated significant improvements in quality of life (n=2 studies) and disease specific psychological outcomes respectively (n=3 studies). There was some evidence for improvement in physical activity (n=2 studies) but most changes were within group only (n=4 studies). Social prescribing interventions did not demonstrate any significant changes in general psychological well-being. Conclusion: Social prescribing interventions demonstrated some improvements across a range of outcomes although the quality of evidence remains poor.
The effectiveness of working wrist splints in adults with rheumatoid arthritis: A mixed methods systematic review
(Medical Journals Sweden, 2014-04-01) Ramsey, Lucia; Winder, Robert John; McVeigh, Joseph G.
OBJECTIVE: To evaluate the effectiveness of working wrist splints in people with rheumatoid arthritis. DATA SOURCES AND STUDY SELECTION: This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Ten databases were searched from inception until September 2012 for quantitative and qualitative studies on the effectiveness of working wrist splints in rheumatoid arthritis. DATA EXTRACTION: Data was extracted on participants, interventions, outcome measures and results. Experimental studies were evaluated using the van Tulder scale and the Cochrane Risk of Bias tool. Data was extracted by a single reviewer and all studies were reviewed by two blind reviewers. DATA SYNTHESIS: Twenty-three studies were included in the review (n = 1,492), 13 experimental studies including 9 randomized controlled trials (RCTs) and 2 qualitative studies. Data was summarized using best evidence synthesis and a meta-ethnographical approach guided qualitative evidence synthesis. There is strong quantitative evidence (including 9 RCTs), supported by conclusions from qualitative literature, that working wrist splints reduce pain (d = 0.7-0.8), moderate evidence that grip strength is improved (d = 0.3-0.4) and dexterity impaired and insufficient evidence of their effect on function. CONCLUSIONS: Working wrist splints reduce pain and improve grip in rheumatoid arthritis. The effect of splints on function is not yet clear.
eHealth interventions to support self-management in people with musculoskeletal disorders, “eHealth: It’s TIME”—A scoping review
(Oxford University Press, 2022-01-13) Kelly, Marie; Fullen, Brona; Martin, Denis; McMahon, Sinéad; McVeigh, Joseph G.; Irish Society of Chartered Physiotherapists
Objective: eHealth-mediated interventions have been proposed as one option to support self-management in those with musculoskeletal disorders (MSDs). This scoping review aimed to chart the evidence regarding eHealth modalities, musculoskeletal diagnosis, and outcomes of eHealth-mediated self-management support interventions in persons with MSDs and identify any gaps within the literature. Methods: Six electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Database of Systematic Reviews), 7 grey literature sources (eg, OpenGrey), and reference and citation lists of included studies were searched from database inception to July 2020. Published studies of adult participants with a MSD utilizing an eHealth intervention to support self-management were included. Studies were limited to those published in English. Two reviewers independently screened all studies. Data were extracted by 1 reviewer and reviewed by another reviewer. Results: After screening 3377 titles and abstracts followed by 176 full texts, 87 studies fulfilled the eligibility criteria. The majority were published in the last 5 years (n = 48; 55%), with almost one-third originating in the United States (n = 28; 32%). The most common eHealth modality type was internet based (n = 22; 35%), with almost one-half (n = 41; 47%) of the included studies involving participants with widespread musculoskeletal symptoms. The most commonly reported outcomes were related to body functions (ie, pain intensity) (n = 67; 45%), closely followed by activities and participation (ie, function) (n = 65; 44%), with environmental factors (ie, health care utilization) the least commonly reported (n = 17; 20%). Conclusions: There is considerable variation within the eHealth-mediated self-management support intervention literature. Research is needed on the role of eHealth-mediated self-management support interventions across a broad range of MSDs to guide clinical practice. Impact: This scoping review has identified gaps in the literature relating to specific eHealth modalities, musculoskeletal diagnoses, and health care utilization data, which should guide future research.
eHealth interventions to support self-management: Perceptions and experiences of people with musculoskeletal disorders and physiotherapists - ‘eHealth: It’s TIME’: A qualitative study
(Taylor & Francis, 2022-11-25) Kelly, Marie; Fullen, Brona M.; Martin, Denis; Bradley, Colin; McVeigh, Joseph G.; Irish Society of Chartered Physiotherapists
Background: There is increasing interest in the potential role of eHealth interventions to support self-management in people with musculoskeletal disorders (MSDs). The COVID-19 pandemic appears to have been a significant catalyst for the implementation of eHealth modalities into routine practice, providing a unique opportunity for real-world evaluation of this underutilized method of delivering physiotherapy. Objective: To explore the perceptions of eHealth-mediated supported self-management from the perspective of people with MSDs and physiotherapists who work in this clinical area. Methods: A qualitative interpretive descriptive approach was used. Semi-structured telephone interviews with 13 musculoskeletal physiotherapists and 13 people with musculoskeletal disorders were undertaken. Transcripts were analyzed using reflexive thematic analysis. Results: Three main themes were identified: 1) Flexibility within a blended care model; 2) eHealth as a facilitator of self-management support; and 3) Technology: Getting it right. Participants expressed concerns about assessment and diagnosis, establishing a therapeutic relationship and felt eHealth should be reserved for follow-up purposes. There was a consistent view expressed that eHealth could facilitate aspects of self-management support. A lack of resources and suboptimal user experience remains a challenge. Conclusions: eHealth-mediated self-management support interventions were broadly acceptably, predominately as a follow-up option.
Emotional intelligence impairments in women with fibromyalgia: Associations with widespread pain
(Sage Publications, 2019-12-09) Luque-Reca, Octavio; Pulido-Martos, Manuel; Gavilán-Carrera, Blanca; Inmaculada C García-Rodríguez; McVeigh, Joseph G.; Aparicio, Virginia A.; Estévez-López, Fernando; Ministerio de Economía y Competitividad; Ministerio de Educación y Formación Profesional; Universidad de Granada; Universidad de Jaén; Horizon 2020; H2020 Marie Skłodowska-Curie Actions
This study aimed at testing the differences in emotional intelligence ability between women with fibromyalgia (cases) and their age-matched counterparts not with fibromyalgia from the general population (controls) and analysing the association between emotional intelligence ability and widespread pain in women with fibromyalgia. A total of 133 cases and 77 controls participated in this cross-sectional study. Controls performed better than cases on emotion understanding. Higher emotion perception and management were significantly associated with lower widespread pain. Therefore, women with fibromyalgia may experience difficulties in understanding emotional information. In fibromyalgia, higher emotion perception and management abilities are independently related to lower widespread pain.
Fibromyalgia syndrome – a risk factor for poor outcomes following orthopaedic surgery: A systematic review
(Elsevier, 2021-06-09) D'Onghia, Martina; Ciaffi, Jacopo; McVeigh, Joseph G.; Di Martino, Alberto; Faldini, Cesare; Ablin, Jacob N.; Meliconi, Riccardo; Ursini, Francesco
Background: Fibromyalgia (FM) is a complex syndrome incorporating many features associated with poor outcome in orthopaedic surgery. Aim of the present review was to comprehensively characterize the available evidence on the consequences of pre-existent FM on the outcomes of orthopaedic surgery. Methods: We performed a systematic search in MedLine and Web of Science (WOS) to identify studies evaluating the effect of FM on patient-centred outcomes, opioids consumption and postoperative complications. Results: The search strategy identified 519 records in PubMed and 507 in WOS. A total of 27 articles were deemed eligible for inclusion in qualitative synthesis. Based on quality assessment, 10 studies were rated as good quality, 10 as fair quality and 7 as poor quality. Studies reporting the prevalence of FM in consecutive patients undergoing orthopaedic surgery (n = 19) were included in quantitative synthesis. The pooled prevalence of FM in patients undergoing orthopaedic surgery was 4.1% (95% CI: 2.4–6.8) in those receiving hip or knee surgery, 10.1% (95% CI: 5.7–17.2) in those receiving shoulder or elbow surgery and 21.0% (95% CI: 18.5–23.7) in those receiving spinal surgery. The results of our systematic review consistently report FM as a significant risk factor for less satisfaction, higher pain, worse functional outcome, increased risk for postoperative opioids prescription and higher rate of medical and surgical complications following orthopaedic surgery. Conclusion: Identifying pre-existing FM in patients scheduled for elective orthopaedic surgery may help to better assess the benefit/risk ratio, improve patients’ awareness and minimize any discrepancy between expectancy and results.
Improved muscle strength, muscle power, and physical function after flywheel resistance training in healthy older adults: A randomized controlled trial
(Lippincott, Williams & Wilkins, 2022-01) Sañudo, Borja; de Hoyo, Moisés; McVeigh, Joseph G.
This study aimed to examine whether flywheel resistance exercise training improved muscle strength, muscle power, and physical function in older adults. Thirty-six older adults (64 ± 5 years) were randomly allocated to either a flywheel resistance exercise training group (ETG; n = 18) or a control (CON) group (n = 18). Subjects in the ETG underwent 6 weeks of resistance training on a flywheel squat device (4 sets of 9 maximal repetitions). Isokinetic concentric (60 and 240°·s−1) and eccentric (120°·s−1) knee extension and flexion peak torques and mean power were measured. Physical function was assessed by the 30-second Chair Sit-Stand Test (CST) and walking speed. After the intervention, within-group analyses showed significantly greater flexion torques and mean power with the dominant leg (concentric at 60°·s−1 and 240°·s−1 and eccentric at 120°·s−1; all d > 0.7, p < 0.05) and improvements in CST (d > 0.8) in the ETG, while no substantial differences were found in the CON group. Significant between-group differences in knee flexion torque both concentric (at 60°·s−1: η2 = 0.168 and 240°·s−1: η2 = 0.112) and eccentric (at 120°·s−1: η2 = 0.103) with the dominant leg were also found in favor of the ETG. There was also significantly better performance in the CST for the ETG (η2 = 0.207). There was a significant association between changes in strength and changes in mean power in the ETG. Changes in physical function outcomes were also observed. In conclusion, flywheel resistance exercise training is an appropriate form of activity for improving strength and functional capacity of older adults.
Patients’ and carers’ experience and perceptions of the pilot Integrated Care Programme for Older Persons in Cork City (ICPOP): a qualitative evaluation
(University College Cork, 2020-07-23) Shinkwin, Claire; McCullagh, Ruth; McVeigh, Joseph
Introduction: The older adult population is increasing dramatically. Older adults experience prolonged hospital admissions and are at a higher risk of experiencing hospital-associated decline, with frail older adults being even more vulnerable. This increases their risk of mortality, readmission, and care-dependency. The Integrated Care Programme for Older Persons (ICPOP) was introduced in Ireland in response to these demanding demographic changes, with an aim of improving quality of life for older adults by supporting them to live well in their homes. The framework for the ICPOP places an emphasis on the importance of evaluating the structural, process and patient outcomes in order to achieve the service objectives. This thesis addresses patient outcomes, with an overall aim of exploring patients’ and carers’ experiences and perceptions of the ICPOP in Cork city. The participants’ feedback will be used to further refine the service. Method: In order to approach this research question, it was necessary for the researcher to gain a more in-depth knowledge on the characteristics of similar models of care worldwide, and their effectiveness compared to usual inpatient care. Therefore, this project was divided into two phases. Phase 1 consisted of a systematic review. The main objective of this review was to determine whether hospital at home is an effective model of care for acutely unwell older adults, compared to usual inpatient care. A secondary aim was to further explore the optimal parameters (i.e. frequency, intensity, duration, and type of care provided) in the delivery of care, to improve patient outcomes. The findings of this review were also used to inform the interview schedule which was used in Phase 2. In Phase 2, the researcher addressed the main research question using qualitative research methods. Semi-structured interviews were carried out with patients and carers in their own homes. The interview guide was developed with guidance from the themes, as listed by Proctor et al (2011), exploring implementation, service, and client outcomes. Data was analysed using thematic analysis. The resulting categories were then organised using the constructs of the conceptual framework for implementation outcomes. Results: In phase 1, a total of 917 studies were screened. Among these, 23 studies were identified as highly relevant, with 16 studies ultimately fulfilling the inclusion and exclusion criteria and being included for review. The systematic review was limited by a lack of newly published randomised controlled trials and a high risk of bias across many studies. In the context of these limitations, there was evidence to support hospital at home in the areas of patient and carer satisfaction and carer burden, compared to usual inpatient care. It was not possible to determine optimal parameters in the delivery of care due to the under-reporting of interventions across many of the studies. The qualitative study revealed service users’ overwhelming satisfaction with the ICPOP. Key elements contributing to this included the accelerated discharge from hospital and home-based rehabilitation, caring personnel, the positive, therapeutic relationships developed with staff, reassurance for patients and carers and the patient’s functional recovery. Some uncertainties regarding the duration of care, end of care and rehabilitative element of the service were also highlighted. Conclusion: This study has made an important contribution to the topic of hospital at home models of care for the older adult. This study demonstrated that the patients’ and carers’ satisfaction with this service is largely due to receiving care in the home environment, the social aspect of care, reassurance for both the patient and carer, and the patients’ functional recovery. The importance of continuity of care and social relationships was also highlighted. Further high quality RCTs are necessary in order to determine the effectiveness of hospital at home care compared to usual inpatient care for the older adult, with accurate reporting of interventions in order to explore the optimal characteristics for the delivery of this model of care to improve patient outcomes.
Patients’ perceptions and experience of hospital-based, student-led physiotherapy treatment interventions: A survey
(IOS Press, 2024-12-06) Cole, Aaron; Lombard, Eileen; Brennan, Roisin; O’Sullivan, Trish; O’Shea, Aidan; McVeigh, Joseph G.
BACKGROUND: Clinical education (CE) is an integral part of physiotherapy degree programmes. CE presents a unique learning opportunity for students to implement classroom-based teaching directly with patients and clients. Despite patients being central to CE, limited research exists around patients’ opinions of CE and the impact of student involvement in patient care. To our knowledge, there has been no study exploring patient perceptions of being treated by student physiotherapists in Ireland. OBJECTIVE: The aim of this study was to explore the perceptions and experiences of patients who have been assessed and treated by pre-registration MSc Physiotherapy students. METHODS: This was a cross-sectional survey study, involving both quantitative and qualitative content analysis. RESULTS: A total of 42 inpatient participants male n = 24 (57%) female n = 18 (43%) with 30 participants (71%) aged ≥70 were included in this study. All participants reported satisfaction with the treatment received by a student physiotherapist and reported they would avail of further treatments in the future. The benefits identified from interaction of participants with physiotherapy students included patient education and interpersonal skills. No disadvantages of being assessed and treated by a student physiotherapist were identified. Considerations for improvements identified included timing of physiotherapy sessions, frequency of sessions and the consideration of use of technology with patients. CONCLUSIONS: This study identified that all participants were very satisfied from receiving treatment interventions led by a student physiotherapist. Increased patient education and interpersonal skills were highlighted as key advantages from participants being assessed and treated by a student physiotherapist in clinical practice.
Physiotherapy management of fibromyalgia syndrome: a survey of practice in Northern Ireland
(MA Healthcare, 2013-09-29) McVeigh, Joseph G.; Baxter, G. D.; Archer, Susan; Hurley, Deirdre; Basford, Jeffrey R.
The aim of this study was to identify the physiotherapeutic management of patients with fibromyalgia syndrome (FMS) in Northern Ireland. A postal questionnaire was distributed to physiotherapists working in outpatient settings in this region (n = 106). A response rate of 71% (n = 75) was achieved. Patients with FMS featured in the caseloads of all respondents. The most important reported goal of treatment was to ‘increase daily function’ (n = 24; 32%). Exercise (n = 44; 58.7%) and hydrotherapy (n = 12; 16.0%) were the most common treatment approaches. A total of 45.3% (n = 34) of respondents stated that they did not believe they could adequately assess patients with FMS and 41.3% (n = 31) reported that they had no training in the management of FMS. Private practitioners were significantly (P = 0.05) more likely to believe that physiotherapy was beneficial for patients with FMS than their NHS counterparts. In conclusion, physiotherapy treatments for patients with FMS in Northern Ireland are consistent with current evidence. However, practice varies and physiotherapists are uncomfortable with their level of training in FMS
Proof of concept of prehabilitation: A combination of education and behavioural change, to promote physical activity in people with fibromyalgia
(BMJ Publishing, 2023-07-14) Courel-Ibáñez, Javier; Estévez-López, Fernando; Hughes, Ciara; Adams, Nicola; Fullen, Brona M.; Davison, Gareth; Montgomery, Ashley; Cramp, Fiona; Maestre, Cristina; Martin, Denis; McVeigh, Joseph G.; Ministerio de Ciencia e Innovación; Health and Social Care Northern Ireland
Objectives To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM). Settings Open-label, feasibility clinical trial. Participants Eleven people with FM (10 women). Interventions The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support). Primary and secondary outcome measures Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention. Results One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%–38% but resulted in 5%–26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals’ priorities and to offer a variety of physical activity programmes to improve motivation. Conclusions This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support.
A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study
(AboutScience Srl, 2021) Kelly, Marie; Higgins, Anna; Murphy, Adrian; McCreesh, Karen
Background: In response to issues with timely access and high non-attendance rates for Emergency Department(ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvementproject. This telehealth option requires minimal resources, with the added benefit of allowing the healthcareprofessional streamline care. A primary aim was to investigate whether this service model can reduce wait timesand non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability.Methods: This was a single-site quality improvement cohort study that compares data on wait time to firstphysiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a servicebased on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients werereferred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercyUniversity Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected ondischarge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data,Chi-Square tests were performed. A level of significance ofp≤0.05 was set for this study.Results: Those that contacted the telephone assessment and advice service had a significantly reduced wait time(median 6 days; 3–8 days) compared to those that opted for usual care (median 35 days; 19–39 days) (p≤0.05).There was no significant between-group differences for non-attendance rates or satisfaction.Conclusion: A telephone assessment and advice service may be useful in minimising delays for advice for thosereferred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadlyacceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-faceconsultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial iswarranted to confirm these findings.
Tender point count and total myalgic score in fibromyalgia: Changes over a 28-day period
(Springer, 2007-07-20) McVeigh, Joseph G.; Finch, M. B.; Hurley, D. A.; Basford, J. R.; Sim, J.; Baxter, G. D.; Physiotherapy Research Foundation
Tender point count (TPC) is central to fibromyalgia syndrome (FMS), and with total myalgic score (TMS) is often used to monitor the patient’s condition. This study aimed to determine the stability of TPC and TMS over time, and to examine how well these measures reflected patients’ perceptions of their condition. Twenty-four patients with FMS completed the Fibromyalgia Impact Questionnaire (FIQ) and a visual analogue scale (VAS) measuring well-being, at entrance into the study, and 7 and 28 days later. There was no significant change in TPC (P = 0.074), FIQ score (P = 0.291) or VAS (P = 0.079) of well-being with time. However, mean TMS score did change over time (P = 0.021). There was no correlation between total FIQ score and the other measures (all P-values > 0.05). The significant change in TMS over time may reflect the natural fluctuation in the clinical presentation of FMS.

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