Background and Purpose. With Continuing Professional Development activity, a requirement of Allied Health Professional registration in the UK and said to be most effectively supported by practitioners who adopt a deep approach to learning, a UK university has been exploring how its pre-registration curriculum influences learner development. This paper investigates the possible influences of the clinical placement component of the curriculum that is structured as four 4-week blocks during both Years 2 and 3 of the 3-year BSc (Hons) programme. A range of placement models are used within this structure including the traditional 1:1 educator : student ratio and those that have a higher ratio of student(s) : educator(s). Methods. This phase of the larger project used a case study design framed about students from two academic year groups on one UK undergraduate, pre-registration physiotherapy programme. Three questionnaires comprising a learning approaches inventory, a demographic questionnaire and a placement self-assessment form were posted to Year 2 and 3 students during one clinical placement. The students were invited to complete the questionnaires halfway through their placement, but in advance of the first, formal placement education feedback meeting. The need for students’ self-assessment prevented follow-up data collection. Results. Analysis of the data from the learning approaches inventory against the demographic variables and placement assessment scores suggest that students’ learning strategies depend upon the number of students, educators and assessors involved in their placement. The paper explores the possible links between placement experience, learning strategy and academic outcome. The authors question assumptions about the perceived benefits of some placement education models. Conclusion. Increasing the ratio of student : educator or educator : student may have a detrimental effect on students’ learning development when placements are of 4-week duration. If such placement models are adopted, then students and placement educators must be adequately prepared and supported so that students’ learning development towards the deep-learning autonomous professionals of tomorrow can continue through placement education. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke. Method. Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function. Results. All patients showed decreased scores in the TAS and RVGA after Watsu application. Conclusions. Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. The remediation of postural control problems is a common feature of many physiotherapy interventions. Provision of augmented visual feedback through use of mirror-reflected body image is one means by which therapists can purportedly facilitate patients’ postural correction abilities. Despite the historic place of this treatment modality within the physiotherapist’s armamentarium, the strategy has however received very limited investigation. The aim of this study was to evaluate the extent to which availability of reflected body image influences the normal subjects’ postural control abilities when in a sitting position. Method. A pilot investigation was undertaken, utilizing a sample of convenience comprising 18 healthy female subjects (mean age 20.8 years). All subjects underwent testing of their sitting postural control abilities in two separate conditions: with and without mirror feedback. A full length therapy mirror, as typically found in many rehabilitation departments, was used where appropriate to provide the reflected body image. Testing was carried out three times for each condition (six tests in total), obtaining average performance across three tests for each condition. Test order for each subject for the six tests was varied using a Latin square procedure to control for learning effect. Measurement of the subjects’ postural control abilities was achieved by Balance Performance Monitor using a seat plate monitor and evaluating body sway path (mm). Postural control was challenged during testing by asking the subjects to maintain a standardized complex sitting position. Results. Group mean sway path with mirror feedback was lower than without: means 165.72 mm (standard deviation [SD] = 40.52 mm) versus 244.74 mm (SD = 68.48 mm). This suggested improved postural control ability when the subjects were able to view their reflected body image during testing. A related t test (t = 4.873, n = 18) showed differences between the two conditions to be statistically significant (p < 0.001), 95% confidence interval = 44.80 mm-113.23 mm. Conclusion. This relatively unsophisticated evaluation of mirror feedback nonetheless suggested a potential intervention effect. The precise mechanism(s) by which this strategy might effect changes in postural control ability, as well as the likely carryover of the effect and its replication in individuals with movement control problems, are all issues requiring further investigation. Nonetheless, these results provide provisional support for the notion that mirror feedback is a potentially useful strategy in the training of postural control. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Monitoring range of movement is a key aspect of managing hip problems in children with cerebral palsy. The aim of this study was to assess the clinical utility, reliability and responsiveness of a new measurement tool, the Proximat, for hip range of movement. Method. Passive hip abduction, adduction, medial and lateral rotation were measured by using the Proximat on 26 children with cerebral palsy attending three special schools: 16 of whom are boys, mean age = 7 years and 6 months (standard deviation = 4.2 years), range 2-15 years. Testing was undertaken by two physiotherapists to assess interrater reliability and repeated the following day to assess test-retest reliability. Total, random and systematic errors were calculated for interrater and test-retest. Results. The Proximat was quick and easy to use and acceptable to the children. High reliability was found for all movements (intraclass correlation coefficient = 0.83-0.93) with reasonable responsiveness; total error was 2.5-12 degrees. Most of the error was random with little evidence of systematic bias. Conclusions. The Proximat is a reliable, responsive and acceptable method of measuring passive hip movements in children with cerebral palsy in day-to-day clinical practice. A change of 8-12 degrees is needed to overcome measurement error and to indicate that a ‘true’ change in range of movement has occurred. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background. Fatigue is one of the most common symptoms of multiple sclerosis (MS) (Mathiowetz et al., 2005). Although education about energy conservation is widely used in the clinical setting, research to ensure evidence-based practice is still limited (MSC, 1998; Brañas et al., 2000; The National Collaborating Centre for Chronic Conditions, 2004). Aim. To test the methodology for a further randomized controlled trial. To evaluate the impact of an energy conservation programme (ECP). Design. Pilot randomized controlled trial. Method. A convenience sample of 13 people with MS was randomly allocated to two groups. The experimental intervention was an ECP and the control intervention a peer support group which received information about MS and its treatment. Both interventions were delivered in group format once a week for six weeks in two-hour sessions. Outcome Measures. The Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), MS Impact Scale-29 (MSIS-29) and MS Self-efficacy Scale (MSSS). Statistics. Repeated-measures analysis of variance (ANOVA). Statistical analysis was conducted on an intention to treat (ITT) and compliers only basis. Results. There were significant reductions over time in the FIS for both groups (p = 0.004). Although the experimental group showed larger reductions in the FIS, the difference between groups was not significant (p = 0.12). Similarly, both groups showed a strong trend towards significant differences over time for the FSS and MSSS (p = 0.05), but differences between the groups were not significant (p = 0.58). Differences for the MSIS-29 were neither significant over time (p = 0.58) nor between the groups (p = 0.66). Conclusion. This pilot study shows that an ECP may be beneficial and supports further evaluation of the effect of an ECP in the management of MS-related fatigue. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Understanding the reliability of selected measurement tools is a prerequisite to understanding the effects of clinical interventions. The aim of this investigation was to determine the reliability of the 50-Foot Timed Walk (50 FTW) and 30-second Chair Stand Test (30 CST) in subjects awaiting joint replacement surgery of the hip or knee. Methods. Eighty-two subjects participating in a 6-week exercise programme were assessed at baseline, 7 weeks and 15 weeks. Four trials of the 50 FTW and two trials of the 30 CST were completed at each assessment. Eleven trained assessors completed the assessments. Results. Intra-class correlations were consistently high for the 50 FTW and 30 CST at all assessments. At the baseline assessment, trial 1 was found to be significantly different from subsequent trials for both the 50 FTW and 30 CST. This effect was not evident at the 7-week and 15-week assessments. At the baseline assessment, scores for the 50 FTW became stable after the first trial. Estimates of minimum detectable change indicated that participants needed to change by more than 3.08 seconds and 1.64 stands to be 90% confident that a real change had occurred for the 50 FTW and 30 CST, respectively. Conclusion. The 50 FTW and 30 CST can be reliable measures of physical performance. However, because we found a practice effect at the baseline assessment, a practice trial should be allowed before data collection begins. Because only two trials of the 30 CST were completed, further research is required to confirm whether scores at the initial assessment become stable on repeated testing. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Purpose. To report contemporary data on the daily frequency of the sit-to-stand (STS) movement in a healthy, independently living, adult population. Relevance. As a key determinant of functional independence, which has a high mechanical load, the STS movement is a common feature of rehabilitation. Knowledge of STS frequency during daily activities could inform rehabilitation goals and content, but has rarely been examined. To date, only McLeod et al. (1975) have investigated this, reporting an average of 92 daily STS transitions in healthy young participants. Methods. Fifteen healthy, free-living, ambulant adults (three males; mean age 40 years) were recruited from the general population. An activity monitor (activPALTM, PALtechnologies, Glasgow, UK) reported free-living activity for each subject for seven consecutive days. Analysis. The average number of STS transitions per day was calculated from the whole period. Data were separated into working and non-working days, and compared using a paired t-test. Results. On average, participants performed 64 (±19) STS movements each day, with large individual differences [range 35-105]. Participants performed significantly (p = 0.047) more STS movements on a working day [68 (±24)] than on a non-working day [55 (±17)]. Discussion. Fewer STS movements were recorded than previously reported (McLeod et al., 1975). This may reflect general changes in lifestyle; however, comparisons should consider the small samples involved and methodological differences. Conclusion. This study provides contemporary data for STS frequency and demonstrates a significant difference between working and non-working days. This information could guide rehabilitation and future research. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Data on performance times for the ‘timed up and go’ (TUG) test with analyses of factors, that eventually could affect the result in patients with hip fracture, have not been published to date. The aims of the present study, therefore, were to assess normative reference values of TUG performances and determine the influence of individual and clinical factors on TUG-test scores in patients with hip fracture. Method. In this prospective, descriptive study, a total of 196 consecutive patients over the age of 60, and able to perform the TUG when discharged directly to their own homes from a specialized orthopaedic hip fracture unit, were evaluated. The association between TUG scores and categorical variables were examined, and linear regression was used to investigate the factors influencing performance times. Results. Univariate analysis showed significant differences between all categorical variables, except gender, but multivariate linear regression analyses showed that only a high pre-fracture function level, evaluated by the New Mobility Score (B = -11), was independently associated with having a good TUG score, while older age (B = 0.49), having an intertrochanteric fracture (B = 7), performing TUG with a walker (B = 15), and performing TUG in the later postoperative period (B = 0.39) were independently associated with having a poorer TUG score. Conclusions. These preliminary normative reference values of TUG performances in patients with hip fracture can be used as references, to which individuals can expect to perform. Multivariate testing suggests that clinicians should use age, pre-fracture function, fracture type and walking-aid specific data when interpreting the TUG test results. Physiotherapists should be aware of this if TUG scores are to be used predictively or as an outcome measure in patients with hip fracture, especially in research. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Adequate knowledge, positive attitude, and willingness to provide services are important factors in rendering competent and compassionate care to patients living with Acquired Immunodeficiency Syndrome (AIDS). Inadequate knowledge and poor attitude could exclude the application of the principles of logic and scientific methods to the practice of physiotherapy, and could result in fragmented care, with a potentially negative impact on treatment outcome and patient satisfaction. The purpose of this study was (1) to investigate the Nigerian physiotherapists’ global knowledge, attitude and willingness to provide care for patients living with AIDS (PLWA), and to (2) determine the relationship between socio-demographic variables and previous encounter with PLWA, and physiotherapists’ knowledge, attitude and willingness to care for AIDS survivors. Methods. Using a 90-item two-part questionnaire that elicited sociodemographic and previous AIDS encounter information, and also assessed knowledge, attitude and willingness to provide care to PLWA, physiotherapists (N = 131) practicing in Nigeria were surveyed. Results. Overall, the physiotherapists showed unsatisfactory knowledge about AIDS, harbored negative attitude towards PLWA, and some were unwilling to provide care for PLWA. Previous experience caring for PLWA influenced their attitude, and modest but positive relationships were found between knowledge and attitude and between attitude and willingness. Conclusion. The study underscores the need to address Nigerian physiotherapists’ working knowledge deficits and negative attitudes to PLWA. A comprehensive AIDS education that would assist clinicians in exploring their attitude, stereotype and bias against PLWA is warranted. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. The vast majority of health services within Canada’s single payer universal health care system are publicly funded. Despite the highly political and controversial emphasis placed on public funding, the structure of delivery within this health care system does not require public ownership. In this research, we developed a conceptual framework for analysing the public and private mix of physical therapy (PT) delivery in the province of Ontario. We then applied this framework to examine the shifts in employment structure of physical therapists (PTs) in Ontario. Methods. A two-phased health policy case study methodology was used. In the first phase, we reviewed publicly available documents and conducted a series of 30 key informant interviews in order to develop our framework. In the second phase, we applied the framework and performed secondary analysis of the provincial PT registration database to assess change in practice setting between 1996 and 2002. Results. We identified nine models of delivery that fall into three categories of ownership structure: (a) public; (b) private not-for-profit; and (c) private for-profit. During the six-year period between 1996 and 2002, the relative proportion of PTs employed in the not-for-profit sector decreased (from 59.6% to 54.8%) whereas the share in the for-profit sector grew (from 40.4% to 45.2%). Conclusions. The shifting balance in the structure of delivery may be transforming how PT services are provided in the province. Private for-profit providers appear to be increasing their market share; however, the outcomes relative to this shift has yet to be fully explored. Further policy and health services research is warranted to more fully understand the consequences of this shift on variables such as professional autonomy, access, cost and quality of services across Canada, but also within similar and dissimilar international jurisdictions. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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