Physical Therapy
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/642
2024-01-16T08:21:11ZLong COVID rehabilitation: A collaborative approach to managing a new phenomenon
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/1071
Long COVID rehabilitation: A collaborative approach to managing a new phenomenon
Tucker, E; Pick, A; Rogers, R; Salt, Heather; Masey, V
Purpose: Post COVID Syndrome (Long COVID) is the continuation of symptoms related to a COVID-like-illness after 12 weeks post onset (NICE Guidelines December 2020). Most recent ONS prevalence data (April 2021) predicts that as many as 1 in 7 people, 13.7% of 20,000, have symptoms lasting more than 12 weeks, with a significant impact on daily function, employment and quality of life. The aim of this project was to evaluate a new collaborative service, designed to meet the needs of this complex patient group.
Methods: In Oxfordshire, there were no specific services available to support and rehabilitate patients with Long COVID, despite the growing number of patients experiencing a multitude of complex symptoms including breathlessness, fatigue, and anxiety. Given the range of primary symptoms, a holistic and multidisciplinary approach to managing the cohort was paramount. Medical and Allied Health Professionals from already established and existing services joined forces to develop a rehabilitation strategy that would put patients at its centre.
With the additional funding released by NHSE for Post COVID Assessment Clinics, a full collaboration began to evolve with the local CCG, acute and community trusts, named the Oxfordshire Post COVID Service. It was anticipated that this collaborative approach would enable us to provide a seamless approach to care.
Results: At time of writing, 434 patients had been referred to the Rehabilitation pathway of the Oxfordshire Post COVID Service, of whom 250 assessed and established on rehabilitation strategies. Patients referred are triaged by both leading Acute Trust Consultant and Community Trust AHP to identify the best place of care based on symptoms and functionality, utilising the Post COVID Functional Scale. At assessment, patients share their ‘story’, establish goals and identify most appropriate rehabilitative strategy. Clinicians involved in these processes include Respiratory and Rehabilitation Medicine Consultants, Psychiatrists, Psychologists, CBT Therapists, Physiotherapists and Occupational Therapists.
Processes are in place to offer patients an individualised approach to rehabilitation through the use of web based platform, symptom tracking application, development of virtual groups and encouraging use of external resources including ENO Breathe, Your COVID Recovery, NHS Yoga Platforms and we have linked locally with Age UK and Generation Games initiatives.
Patient feedback has been actively sought from the outset, ensuring that the patient voice is always heard and listened to. So far, it has been overwhelmingly positive.
Conclusion(s): Close collaboration between multiple professions, Trusts and Organisations resulted in seamless care, patient satisfaction and an excellent model of service delivery. Further work is required to support the recognition of health inequalities, with specific focus on BAME communities. We are in the process of collaborating with local GP's, inequality leads and local centres to develop focus groups ensuring that these voices are heard, and plans established to ensure equitable services are accessible to all.
Impact: COVID has enabled us to break down barriers, both real and perceived, to establish a successful and recognised service that can be used as a model of service delivery to demonstrate how other conditions could be, and potentially should be, managed in the future.
2022-02-01T00:00:00ZDo sagittal spinal curvature and back extensor endurance correlate with gait and balance measures in people with degenerative spinal conditions?
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/1068
Do sagittal spinal curvature and back extensor endurance correlate with gait and balance measures in people with degenerative spinal conditions?
Dawes, Helen
The aim was to investigate the relationship between sagittal spinal curvature and endurance with dynamic balance and gait in people with symptomatic degenerative spinal conditions.
Methods: In this cohort study, participants were enrolled if they had symptomatic osteoporosis (OP) or lumbar spinal stenosis (LSS). Outcomes measured were thoracic kyphosis, lumbar lordosis, kyphosis percentage, Timed Loaded Standing (TLS), Four Square Step Test (FSST), Two minute walk test (2MWT), gait speed, Activities of Balance Confidence (ABC) scale, and Modified Gait Efficacy Score (mGES). Descriptive statistics and correlation analyses were performed. Parametric and non-parametric correlation analyses of spinal curvature and endurance outcomes with balance and gait outcomes were conducted in the group as a whole and in subgroups based on the primary spinal condition.
Results: Of 41 participants, 19 had a primary spinal condition of osteoporosis and 22 had lumbar spinal stenosis. The mean (SD) age was 74.0 (7.4) years, BMI was 27.44 (5.30) kg/m2, 27 participants were female, and 44% of participants reported one or more falls in the previous year. There were weak to null correlations between spinal curvature characteristics and all gait and balance measures, and there were moderate correlations between higher back extensor endurance (TLS) and faster gait speed (rs = 0.527), higher 2MWT (rs = 0.560), better FSST (rs = −0.327), higher ABC (rs = 0.316) and higher mGES (rs = 0.317) scores. When separating the group by primary spinal condition, the same relationships with TLS remained, but moderate correlations involving spinal curvature were shown within the OP subgroup, where better dynamic balance (FSST) correlated with increased thoracic kyphosis (rs = -0.416) and lumbar lordosis (rs = −0.424), and increased kyphosis percentage correlated with lower mGES scores (r = −0.429).
Conclusion(s): The results suggest that back extensor endurance has a stronger correlational relationship with both performance-based and self-reported gait and balance outcomes compared to sagittal spine curvature, regardless of the spinal condition. However, when anlaysed separately, a correlative relationship between spinal curvature and dynamic balance did emerge in the OP subgroup where the same was not seen in the LSS subgroup. These subgroup findings suggest either the limited impact of spinal curvature in people with LSS or the dominance of other LSS symptoms masking a relationship between spinal curvature and gait and balance measures. Future research should be conducted on a larger sample to explore these correlations and expand to causal relationships.
Impact: The findings from this study are foundational for further research to magnify the specific relationships between spinal characteristics and physical function in people with specific symptomatic spinal conditions. A more in-depth clinical description could help inform targeted physiotherapy rehabilitation and interventions in these patient groups.
2022-02-01T00:00:00ZThe importance of prototype similarity for physical activity: Cross-sectional and longitudinal associations in a large sample of young adolescents
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/1033
The importance of prototype similarity for physical activity: Cross-sectional and longitudinal associations in a large sample of young adolescents
Dawes, Helen
Objectives. Physical activity declines during adolescence. The Theory of Planned
Behaviour (TPB) is a useful framework for investigating activity but leaves variance
unexplained. We explored the utility of a dual-process approach using the TPB and the
Prototype Willingness Model (PWM) to investigate correlates of physical activity, and 1-
year change in physical activity, among a large sample of adolescents.
Design. A cross-sectional and longitudinal analysis of baseline and follow-up data from
the Fit to Study cluster-randomized trial.
Methods. A total of 9,699 secondary school pupils at baseline and 4,632 at follow-up
(mean age = 12.5 years) completed measures of past week physical activity and
constructs from both behaviour-change models, at time-points 1 year apart. Crosssectional analyses used multilevel, stepwise regression models to measure the strength of
associations between model constructs and physical activity, and variance in behaviour
explained by PWM over and above TPB. In longitudinal analyses, change scores were
calculated by subtracting follow-up from baseline scores. Models controlling for trial
treatment status measured the strength of associations between change scores, and
variance explained.
Results. At baseline, after controlling for past behaviour, physically active prototype
similarity had the strongest relationship with activity after the intention to be active.
Change in prototype similarity had the strongest relationship with change in activity after
the change in intention and attitudes. Prototype perceptions and willingness explained
additional variance in behaviour.
Conclusion. A dual-process model incorporating prototype perceptions could more
usefully predict physical activity than models based on rational expectations alone.
Behaviour-change interventions promoting an active self-image could be tested for effects
on physical activity
Open Access
2022-02-01T00:00:00ZNeuroergonomic Assessment of Developmental Coordination Disorder
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/956
Neuroergonomic Assessment of Developmental Coordination Disorder
Dawes, Helen
Until recently, neural assessments of gross motor coordination could not reliably handle active tasks, particularly in realistic environments, and offered a
narrow understanding of motor-cognition. By applying a comprehensive neuroergonomic approach using optical mobile neuroimaging, we demonstrated the
broader capability for ecologically relevant neural evaluations for the “difficult-to-diagnose” Developmental Coordination Disorder (DCD), a motor-learning
deficit affecting 5-6% of children with lifelong complications.
We confirmed that DCD is not an intellectual, but a motor-cognitive disability, as gross motor /complex tasks revealed neuro-hemodynamic deficits and
dysfunction within the right middle and superior frontal gyri of the Prefrontal Cortex. Furthermore, by incorporating behavioral performance, aberrant patterns
of neural efficiency in these regions were revealed in DCD children, specifically during motor tasks. Lastly, we provide a framework, evaluating disorder impact
in real-world contexts to identify those for whom interventional approaches are most needed and open the door for precision therapies.
This work is licensed under a Creative Commons Attribution 4.0 International License
2021-09-01T00:00:00Z