Aims: This service evaluation explored and reported findings from a new multi-disciplinary service where physiotherapists were incorporated into an orofacial team who managed patients with chronic Temporomandibular Dy...Aims: This service evaluation explored and reported findings from a new multi-disciplinary service where physiotherapists were incorporated into an orofacial team who managed patients with chronic Temporomandibular Dysfunction (TMD). Methods: We collected data before the physiotherapists’ involvement and on discharge from physiotherapy management. Outcomes were patient-reported pain (numerical rating scale (NRS 0 to 10)), patient specific functional score (PSFS), health-related quality of life (EQ-5D) and range of mandibular depression (mm). Exploratory analyses compared baseline to follow-up scores on discharge from physiotherapy. Results: 79 patients (mean age 40 (SD 18);female 87%) received physiotherapy. At discharge, there was a mean reduction in pain: 2.8 (95% CI 2.0 to 3.6), improvement in function: ﹣4.0 (95% CI ﹣4.7 to ﹣3.3), improvement in health: ﹣0.139 (95% CI ﹣0.196 to ﹣0.082) and increase in mandible depression: ﹣6.6. (95% CI ﹣9.1 to ﹣4.1). Conclusions: The results provide early, exploratory evidence that patients with chronic temporomandibular dysfunction treated by physiotherapists achieve clinically important changes in pain, function and health in the short term.展开更多
Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with...Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statistically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52;95% CI -14.72 to 7.44) or long-term at one year (p = 0.37;95% CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs.展开更多
Relevance and Method: The purpose of this project was to evaluate the effectiveness of the Emergency Physiotherapy Practitioner (EPP) service against quality care indicators identified as part of the “gold standard”...Relevance and Method: The purpose of this project was to evaluate the effectiveness of the Emergency Physiotherapy Practitioner (EPP) service against quality care indicators identified as part of the “gold standard” for emergency care in England. The study was prospective and evaluated time to initial assessment, total time in the emergency department and un-planned re-attendance rate within a seven-day period for all patients seen by the EPP’s over a period of one year. Outcomes: One thousand and seven patients were seen by EPPs in the emergency department. The median wait time for treatment by an EPP was 34.5 minutes (95th percentile = 122). Regional median wait time was 45 minutes (95th percentile = 138). National median wait time was 55 minutes (95th percentile = 192). Median total time spent in ED for patients seen by EPPs was 99 minutes (95th percentile = 224). Regional median total time in ED was 223 (95th percentile = 239). Nationally median total time in ED was 136 minutes (95th percentile = 336). Three percent of patients seen by an EPP returned to the ED, compared to 6% regionally and 7.5% nationally. Conclusions: EPPs excelled in all three indicators and exceeded regional and national figures. The re-return rate met the current standard of being less than 5%. It could be justified that the addition of the EPPs to the emergency department was an efficient and effective service development.展开更多
文摘Aims: This service evaluation explored and reported findings from a new multi-disciplinary service where physiotherapists were incorporated into an orofacial team who managed patients with chronic Temporomandibular Dysfunction (TMD). Methods: We collected data before the physiotherapists’ involvement and on discharge from physiotherapy management. Outcomes were patient-reported pain (numerical rating scale (NRS 0 to 10)), patient specific functional score (PSFS), health-related quality of life (EQ-5D) and range of mandibular depression (mm). Exploratory analyses compared baseline to follow-up scores on discharge from physiotherapy. Results: 79 patients (mean age 40 (SD 18);female 87%) received physiotherapy. At discharge, there was a mean reduction in pain: 2.8 (95% CI 2.0 to 3.6), improvement in function: ﹣4.0 (95% CI ﹣4.7 to ﹣3.3), improvement in health: ﹣0.139 (95% CI ﹣0.196 to ﹣0.082) and increase in mandible depression: ﹣6.6. (95% CI ﹣9.1 to ﹣4.1). Conclusions: The results provide early, exploratory evidence that patients with chronic temporomandibular dysfunction treated by physiotherapists achieve clinically important changes in pain, function and health in the short term.
文摘Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statistically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52;95% CI -14.72 to 7.44) or long-term at one year (p = 0.37;95% CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs.
文摘Relevance and Method: The purpose of this project was to evaluate the effectiveness of the Emergency Physiotherapy Practitioner (EPP) service against quality care indicators identified as part of the “gold standard” for emergency care in England. The study was prospective and evaluated time to initial assessment, total time in the emergency department and un-planned re-attendance rate within a seven-day period for all patients seen by the EPP’s over a period of one year. Outcomes: One thousand and seven patients were seen by EPPs in the emergency department. The median wait time for treatment by an EPP was 34.5 minutes (95th percentile = 122). Regional median wait time was 45 minutes (95th percentile = 138). National median wait time was 55 minutes (95th percentile = 192). Median total time spent in ED for patients seen by EPPs was 99 minutes (95th percentile = 224). Regional median total time in ED was 223 (95th percentile = 239). Nationally median total time in ED was 136 minutes (95th percentile = 336). Three percent of patients seen by an EPP returned to the ED, compared to 6% regionally and 7.5% nationally. Conclusions: EPPs excelled in all three indicators and exceeded regional and national figures. The re-return rate met the current standard of being less than 5%. It could be justified that the addition of the EPPs to the emergency department was an efficient and effective service development.
