Hong Kong Physiotherapy Journal - Articles in Press

Patellofemoral pain during step descents with and without fatigue-induced hip internal rotation - Corrected Proof

Roy T.H. Cheung — 2012-02-20

Abstract: Weakness of hip external rotator muscles may cause excessive hip internal rotation during functional activity and it is associated with the development of patellofemoral pain (PFP). The aetiology of PFP is multifactorial in nature. Therefore, routine enrolment of patients into a hip-strengthening programme may not be effective and cost-effective. The present study examined the effect of fatigue-induced hip internal rotation during functional activity. Twenty subjects with PFP were asked to descend a step in barefoot before and after an isokinetic exercise protocol to induce muscle fatigue of hip external rotators. The hip motion was captured by eight high-speed cameras and analysed by a three-dimensional motion analysis system. The level of PFP during step descent and their usual PFP level were measured by validated instruments. Patients with PFP presented with more pronounced hip pathomechanics (p<0.001) and greater level of PFP (p=0.001) after muscle fatigue. The pain score after muscle fatigue during step descent better reflects the usual functional disturbance associated with PFP (rs=−0.655, p=0.002). Physical examination with induced muscle fatigue may be helpful in clinical decisions on the management programme for patients with PFP, which are related to altered hip mechanics.

Prevention of osteoporosis: From infancy through older adulthood - Corrected Proof

Donna Cech — 2012-02-20

Abstract: Osteoporosis is a worldwide health concern for individuals of all ethnic and racial groups. The number of individuals diagnosed with osteoporosis and the rate of osteoporotic fractures increases significantly with age. Some variation in the development of osteoporosis can also be related to gender and race, with both genetic and lifestyle factors influencing bone development. Both non-modifiable and modifiable risk factors have been identified as contributing to the development of osteoporosis. Modifiable risk factors are related to diet, smoking, alcohol use and activity level. By understanding the development of the skeletal system and the lifestyle choices that maximize bone development, the risk of development of osteoporosis can be minimized. Physical activity contributes to development of the skeletal system in all age and ethnic groups. Maintaining high levels of physical activity is important across the life span to increase the peak bone mass developed and optimize bone mass during the bone remodelling phases of older adulthood. Bone development and remodelling are influenced by the mechanical strain placed upon the bone during physical activity. By understanding how mechanical forces influence bone development, exercise programmes can be developed that will most effectively stimulate bone growth. The focus of this review will be to discuss factors influencing the life span development of the skeletal system, theoretical frameworks related to bone growth in response to mechanical forces, and the development of osteoporosis prevention programmes for individuals of all ages.

An evaluation of the knowledge level of Nigerian physiotherapists on topical pharmacotherapy - Corrected Proof

Ayodele Teslim Onigbinde, Matthew O.B. Olaogun, Kennedy Iroghue — 2012-02-06

Abstract: Conventional treatment for some diseases involves a combination of pharmacotherapy and physiotherapy. Most of Nigeria’s training schools have introduced the course of pharmacology in their training curriculum but its effect is still unknown. There appears to be inadequate research on physiotherapists’ knowledge of medications in Nigeria. The primary objectives of this study were to determine the knowledge of Nigerian physiotherapists regarding topical pharmacotherapy and to determine the association between knowledge of active ingredients and age, clinical experience, qualification, and work setting. A total of 135 practising physiotherapists participated in the cross-sectional survey study. A self-administered questionnaire was used for this study. Descriptive statistics and Pearson chi-square were used to analyse the data obtained. Only 55 respondents (40.7%) reported that they recently updated their knowledge on topical medications; however, this contradicted the finding that only one participant (0.7%) had very good knowledge while 57 respondents (42.2%) have poor knowledge of the active ingredients in the topical medications listed in this study. Also, 105 respondents (77.8%) indicated their awareness that physiotherapists can recommend topical drugs. The results of this study revealed that some of the sampled physiotherapists have poor knowledge about adverse reactions, contraindications, risks, and mechanisms of action of the listed drugs, and how non-steroidal anti-inflammatory drugs relieve pain. However, results also showed that the respondents had good knowledge (mean score of 2.46±1.03 out of the maximum of score of 3 allotted) of the conditions in which topical medications are indicated, although they have a poor knowledge of the common adverse reactions of topical medications applicable in physiotherapy (mean score of 1.44±1.16 out of the maximum score of 4). A total of 111 respondents (80.7%) could not explain how topical non-steroidal anti-inflammatory drugs relieve pain. The results also showed that there was a significant association between years of clinical experience and scores obtained for knowledge about active ingredients (χ2=347.903, p<0.03). The study concluded that most Nigerian physiotherapists have poor knowledge of topical pharmacotherapy they commonly use in clinical practice. This study suggests the need to organise continuing professional development programmes/seminars on pharmacotherapy as applicable to physiotherapy practice to improve the knowledge base of physiotherapists.

Effect of Acu-TENS on post exercise airway resistance in healthy individuals - Corrected Proof

2012-01-25

Abstract: Transcutaneous electrical nerve stimulation on acupoints (Acu-TENS) is associated with increased exercise duration in healthy individuals and improves forced expiratory volume in 1second (FEV1) in those with respiratory illness. Whether a decrease in airway resistance (AR) is responsible for these respiratory system effects has not been investigated. This pilot study investigated the effect of a single session of Acu-TENS on AR in healthy people. Twenty individuals were invited to the laboratory twice, 1 week apart, to receive in random order either Acu-TENS or placebo-TENS (no electrical output from the TENS unit) over bilateral Lièquē (LU 7) and Dìnchuăn (EX-B1), for 45 minutes before and during a submaximal treadmill exercise test following the Bruce protocol. AR, FEV1, forced vital capacity, rate of perceived exertion and heart rate variability were recorded before, immediately after and 15minutes after exercise. Immediately after exercise the percentage decrease in AR from baseline was greater in the Acu-TENS group (−20.10±4.00%) compared to the placebo-TENS group (−7.99±3.43%) (p=0.029). We conclude that the decrease in AR seen with Acu-TENS in healthy individuals could account for the immediate improvement in FEV1. Acu-TENS may have a role in decreasing AR in patients with airflow limitation.

Clinical implications for the effect of glucosamine sulfate iontophoresis on fasting plasma glucose levels - Corrected Proof

Vikram Mohan, Leonard Joseph — 2012-01-18

We enjoyed reading the recently published paper “Acute effects of combination of glucosamine sulfate iontophoresis with exercise on fasting plasma glucose of participants with knee osteoarthritis” by Onigbinde et al . Glucosamine sulfate is one of the most common drugs prescribed to strengthen cartilage in patients with osteoarthritis. Due to speculation that glucosamine sulfate might increase blood glucose levels, the study by Onigbinde et al generated appreciable clinical interest among readers. However, there are certain points and suggestions that we would like to share with readers before the study’s findings are applied clinically.

Relationship between the duration of taekwondo training and lower limb muscle strength in adolescents - Corrected Proof

Shirley S.M. Fong, William W.N. Tsang — 2012-01-18

Abstract: Previous studies have suggested that different durations of taekwondo (TKD) training may result in different lower limb muscle strengths. The objective of this study was to explore the relationship between the duration of TKD training (i.e., number of hours spent training per week) and lower limb muscle strength (at both fast and slow testing speeds) in adolescents. Isokinetic concentric knee and ankle muscle strengths were measured in 20 TKD practitioners (mean age: 15.8 years) at two different speeds (60°/second and 240°/second). Pearson’s correlation coefficient (two-tailed) showed that the number of TKD training hours per week was positively correlated with the peak torque of the knee extensors (r=0.639, p=0.002) and knee flexors (r=0.472, p=0.036) at 240°/second. This study did not show any significant correlation between TKD training duration and the peak torque of the knee flexors and extensors at slower speeds (60°/second) or the ankle plantar flexors at any speed. Our results support the notion that the more time one spends in TKD training the greater the muscle strength one could gain and that any subsequent improvements in knee muscle strength is velocity specific. Further study is needed to confirm the optimal amount of training and training parameters required to develop knee muscle strength in TKD athletes.

Musculoskeletal pain and its impact on motor performance among stroke survivors - Corrected Proof

Talhatu K. Hamzat, Oladunni C. Osundiya — 2011-03-23

Abstract: Pain is an important clinical factor that can limit movement at a joint and inhibit the functional use of a limb after stroke. Incidence of musculoskeletal pain (MSP) and its impact on motor performance among community-dwelling stroke survivors were investigated in this descriptive study. The study sample comprised 102 (51 men and 51 women) freely consenting stroke survivors (mean age, 52.92±10.24 years) receiving physiotherapy on outpatient basis as part of their rehabilitation programme. They were interviewed and physically assessed for pain, and for those who had MSP, the intensity of their pain and motor performance were assessed using Numerical Box-21 Scale and Stroke Rehabilitation Assessment of Movement, respectively. Data were analysed using Spearman correlation coefficient at alpha value of 0.05. Results showed that 81 (42 men and 39 women) or 79.4% of the sample had pain symptoms, with 23.5% of these having the pain pre-dating stroke onset. Pain distribution by type revealed that MSP and central post-stroke pain was equally distributed (30.9%), whereas the remaining 38.3% presented with mixed type of pain. Among those with MSP, 25.9% had pain at shoulder only, 12.0% at the elbow only, and 2.5% at the ankle joints only. A statistically significant negative correlation (rho=−0.29, p=0.009) was observed between the Numerical Box-21 Scale and Stroke Rehabilitation Assessment of Movement scores. MSP after stroke is as common as central post-stroke pain, and presence of MSP is associated with lower motor performance. There is a need for physiotherapists treating post-stroke individuals to take care of this type of pain to enhance the recovery of motor function.

Clinical diagnosis of soft tissue injuries to the knee by physiotherapists and orthopaedic surgeons: Is there a difference between the two professions? - Corrected Proof

Alex Trompeter, Naveed Shaikh, Chris Bateup, Simon Palmer — 2011-03-23

Abstract: The aim of this study was to compare the accuracy of clinical diagnosis made by trained physiotherapists and orthopaedic surgeons when seeing elective patients in the outpatient clinic. The method involved a retrospective analysis of 100 case notes of patients who had been seen in the orthopaedic outpatient department and consecutively scheduled for knee arthroscopies. Fifty patients were seen by a physiotherapist and 50 by the orthopaedic surgical team. The physiotherapist was able to make a 66% clinically accurate diagnosis compared with 82% by the doctors (p=0.07). Sensitivity was 90.7% for surgeons and 68.1% for physiotherapists, whereas specificity was shown to be 71.4% for surgeons and 66.6% for physiotherapists. The accuracy of clinical diagnosis by trained surgeons is better than that of physiotherapists, although not statistically significant. It is, therefore, justifiable to place patients on theatre lists based only on clinical examination by either physiotherapists or surgeons.

Professional sexual boundaries—Asian and Western perception: An observational study - Corrected Proof

Ian Cooper, Alice Jones, Sue Jenkins — 2011-03-23

Abstract: Question: Do Hong Kong (HK) physiotherapists recognise professional sexual boundaries, and are there differences (1) between genders and (2) when compared with physiotherapists in Western Australia (WA)?Design: Observational study using a postal questionnaire.Participants: One thousand eight hundred and fifteen physiotherapists registered with the HK Physiotherapists’ Registration Board.Outcome Measures: Respondents were asked to state (1) their opinions about the actions of a physiotherapist in six vignettes highlighting professional sexual boundaries; (2) the incidence of sexual attraction and dating of their patients; and (3) their course(s) of action when confronted by an allegation of sexual misconduct against a colleague.Results: Two hundred and fifty-five responses were received (16% response rate). HK physiotherapists were similar to their peers in WA in finding four of the six vignettes unacceptable. Overall, HK physiotherapists were significantly (p<0.01) less conservative than their WA peers. Eighty percent of respondents thought it acceptable for a physiotherapist working for a sports team to date a player and 51% thought it acceptable to date a work colleague to whom they had provided professional ergonomics advice. Although the incidence of sexual attraction was less than that reported from WA, HK physiotherapists were more likely to have dated a current or ex-patient and especially if they worked in the private sector (p<0.01). Seventy percent of respondents stated that they would advise a patient to make a complaint against their colleague to the appropriate authority. Less than 20% stated that they would complain directly to the HK Physiotherapists’ Registration Board or Physiotherapy Association (16% and 7%, respectively).Conclusion: Similarities and differences exist between HK and WA physiotherapists with regard to professional sexual boundaries. Education on this topic is urged within the HK physiotherapy population.

The effects of mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis - Corrected Proof

2011-03-23

Abstract: This experimental design study investigated the effect of a combination of Mulligan techniques and traditional treatment compared with that of traditional treatment alone in patients with lateral epicondylitis. The applied Mulligan techniques included mobilisation with movement and taping, and were aimed to reduce pain, increase grip strength, and improve activities of daily living. A total of 34 patients aged between 16 and 69 years underwent 11 sessions of a combination of Mulligan techniques and traditional treatment (experimental group, n=17) or traditional treatment only (control group, n=17). They were evaluated before the treatment, and after 4 weeks, using visual analogue scale, maximum grip strength, and Patient-Rated Tennis Elbow Evaluation. Analysis showed statistically significant improvement in all outcomes in both the experimental and the control groups. In addition, the mean improvement in visual analogue scale and maximum grip strength was significantly greater in the experimental group than that in the control group. This study showed that the combination of Mulligan techniques with traditional treatment leads to better outcomes in treatment of lateral epicondylitis than traditional treatment alone.

A new beginning - Corrected Proof

Marco Y.C. Pang — 2011-03-23

I am sure you have noticed the new look of the journal. This is done to signify a new beginning, as the Editorial Board will be implementing a series of new plans to raise the standing of the journal. First, we are going to invite more internationally renowned researchers to serve in our Editorial Review Board. It is hoped that, through their expertise in different sub-specialties, the quality of the manuscripts published in our journal can be further enhanced. Second, it is important that our journal be included in the Science Citation Index, so that an impact factor can be assigned to our journal in the future. The journal impact factor is a commonly used index to indicate the standing of scientific journals. Obtaining a decent impact factor is instrumental in attracting more good-quality manuscripts. Rest assured that the Editorial Board will be working very hard towards achieving this goal. Third, to improve the “visibility” of our journal, it is important that our journal appears on major databases, such as MEDLINE or PubMed. Again, the Editorial Board will look into this and take appropriate actions to make this happen.