Don’t Miss the New PP+ Features!

We are always working hard to improve your experience, make sure you keep your eyes peeled for other new features.

The list of courses on PP+ is impressive and the quality of our courses is recognised around the world. This means that many of our courses are becoming accredited by organisations such as ProCert, the SASP, TPTA and the WCPT. This list is going to grow and it can already be difficult to keep track of which courses are certified in different countries.

But don’t worry we have a solution!Image showing the accreditation feature

To simplify things we have added a new feature to your PP+ page. It will show you which courses have been accredited and how many points each course is worth. This will enable you to get those certificates and points to meet your yearly CPD requirements in confidence.

Once you’ve completed a course you will receive a certificate with your name and date of completion on. These certificates are essential to prove that you have completed the course, however they are easy to misplace. There is nothing more frustrating than not being able to find them. That’s why we’ve added, a second, new feature. There will also be an area on PP+ where you can find all of your completed course certificates which can be downloaded whenever you need them.

We hope you find these new features helpful, and as always feedback is welcome.

 

Arthroscopic decompression not recommended in the treatment of RC tendinopathy: a RCT at minimum follow-up of 10yrs

shoulder online course

Rotator cuff tendinopathy has a multifactorial origin. Rejecting the mechanistic theory has also led to abandoning operative treatment at initial presentation in the first line. Physiotherapy exercise programmes are the accepted first line treatment. The aim of this study was to assess the long-term additional benefits of subacromial decompression in the treatment of rotator cuff tendinopathy.

This randomised controlled trial of 140 patients (52 men, 88 women, mean age 47.1 years; 18 to 60) with rotator cuff tendinopathy extended previous work up to a maximum of 13 years. The patients were randomised into two treatment groups: arthroscopic acromioplasty and a supervised exercise treatment and a similar supervised exercise treatment alone. Self-reported pain on a visual analogue scale (VAS) was the primary outcome measure. Secondary measures were disability, working ability, pain at night, Shoulder Disability Questionnaire score and the number of painful days during the three months preceding the final assessment.

A total of 90 patients (64%) returned questionnaires at a mean 12 years after randomisation. On an intention-to-treat basis, both treatment groups reached statistically significant improvement compared with the initial VAS for pain, but there was no significant difference between groups. The same was true in the secondary outcome measures. Due to group changes, the results were also analysed per protocol: operated or not. No significant differences between the groups were found.

The natural history of rotator cuff tendinopathy probably plays a significant role in the results in the long-term. Even though the patients who underwent operative treatment had a stronger belief in recovery, which is likely to be surgical and the effect of placebo, the exercise group obtained similar results. In the future, an optimum exercise regime should be searched for, as the most clinically and cost-effective conservative treatment for rotator cuff tendinopathy.

The Hambisela Project

We have some amazing cerebral palsy resources available on Physiopedia with highlights being the “Managing Cerebral Palsy” course available to PP+ members. The quality of this course is cemented by the 20 CCU’s which are up for grabs if you complete the course. If you haven’t had a look, you should, it is available free with the trial PP+ account.

We have a lot of cerebral palsy content on PP and a highlight is the Hambisela Project. The project is free and aims to empower and develop the skills of therapists, parents and caregivers of children with cerebral palsy in low resourced communities. Did I mention that the content was free?

The team behind the Hambisela project want to share this knowledge with as many people as possible and have teamed up us to create Physiopedia Pages based on their content. We are very proud to have their content on our pages and trust me when I say it is a highlight. There are 6 modules covering the following:

If you find the project content helpful and enjoy it as much as we do then please share with your colleagues. Hambisela are keen to spread the message and content within their project, help them change the lives of people with cerebral palsy around the world.Thank you for creating such an amazing resource!

Read about the Project Here

Who Gets the Best Care?

Best Care

Do professional athletes always get the “best care,” they are the “best athletes” so they should right? Well, that might depend on how someone defines “best care.” Many of the therapists that read this blog on a regular basis might question the “best” portion behind some of the “care” delivered to our athletes that so many in our culture hold to such a high degree. This was on full display at the Olympics last year with all the cupping hickie marks left on the athletes.

Unfortunately, many people in our culture believe in a false assumption that the best athletes always get the best healthcare. Which lately seems to be coming into question (see Tiger Woods and Steve Kerr). Do not get me wrong, there are some great therapist delivering excellent care for professional athletes. However, just because someone works with a professional athlete does not mean they are a great therapist and thus delivering the best care. Yet look at how often we hear individuals that work with professional athletes quickly tout this point when they are speaking publicly or on social media (i.e. “Well, in my work with getting professional athletes back into competition…”) Why don’t we hear therapist boast about their work with what our culture would call the more common individual, “Well, in my work with getting the factory worker back to work…”. Interestingly we probably hear the opposite, “Well I just work with factory workers, so I don’t have the expertise of those that work with professional athletes.” Whether it is intentional or not, it may be a bit of an “appeal to authority” regarding their expert opinion when someone name drops that they work with professional athletes. I wish we could all understand that just because someone works with professional athletes that alone does not make them an expert. I would not disagree that getting a high-level athlete back to performing at a high level can require some expertise, but does it require more expertise then getting the factory worker back to work? In some ways, it could be argued that getting the factory worker back to work is, dare I say, more challenging and requires an even higher level of expertise in some areas.

Unfortunately, our culture puts our sporting heroes on a high pedestal and many dream of being like them or providing care for them. Enough so that there was a commercial accompanied by a song bold enough to flat out say “Be like Mike.” When it comes to being like them not only do people want to dress and use the same equipment as them, but they want to get the same health care as them. It must have been the cupping that made Michael Phelps win a few more gold medals, not the fact that he is just a more genetically gifted and harder working individual than others. Doesn’t this speak to so many of our cultural woes? We want a quick and easy magical fix, not the reality of hard work and realistic expectations.

The truth is, sadly, it is not just the patients that fall victim to this, many therapist have a belief that there must be a magical quick and easy treatment technique to fix all their patients. The thought of pro athletes are getting it so it must be great, can easily slip into a therapist’s thinking. In addition, maybe it is when someone reads the testimony about a treatment that got someone better when all other regular treatments failed. This surely must be the magic treatment that needs to be in the toolbox to deliver the best care. Many therapist tend to avoid the more realistic expectation that some patients may not get 100% better, definitely not in one or two treatments, and it will take the hard work of the knowledge of the evidence and motivation of the patient through the hard work of therapy to get a good outcome over a realistic time-period.

I often wonder if pro athletes only got evidence-based care wrapped up with realistic expectations that focused on hard work, if we could redefine what “best care” really might be. Because there are some factory workers out there getting this level of care from their therapist and not realizing they get better care then some professional athletes do.

What Say You?
via Dr. Kory Zimney

edit: My thoughts on this….  
Many PTs express an interest in treating “athletes” but there are too many PTs and not enough “athletes.” What they really mean is, “I want to work with motivated individuals.” I’ve worked with plenty of athletes at all levels;  they can cancel, no-show, have equipment that is falling apart (Olympic hopeful with heel falling off his last), and be just as non-compliant as your “normal” patient. Everyone deserves the best care, and the bell curve normally means athletes often get care that may less than what they need.

Keeping it Eclectic…

Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

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Come Find us at WCPT Congress in South Africa!

WCPT Congress South Africa 2017

We are at #WCPT2017 make sure you come and see us!

It’s not often that we get the chance to meet our readership and we would love for you to come and visit us, at Congress in Cape Town. It’ll be busy for Physiopedia as well as for you, but wouldn’t it be nice to put a little time aside for each other?

We will have a stand in the exhibition hall (next to South Africa House) where we will be showing you the latest and greatest features that Physiopedia, Physiospot and Physiopedia Plus can offer. We would love to hear what you think of the new site. Don’t feel like you need to stay just for a tour of the new features, come for a chat and let’s discuss what is happening with physiotherapy around the world.

Rachael Lowe is flying the Physiopedia flag proudly, with a total of 4 presentations. Rachael is a brilliant speaker; her passion and energy is inspiring and she will certainly be a highlight for everyone at Congress. Make sure you come to at least one of the following:

  1. Sunday 2 July 12:30-13:15 –  Are Physiotherapists Walking the Walk? A Global Survey of Physiotherapists Physical Activity Levels – Poster Area, Exhibition Hall
  2. Sunday 2 July 16:15-17:45 – Lessons Learned from Educating the Global Physiotherapy Profession through Massive Open Online Courses – Room 2.60
  3. Tuesday 4 July 10:15-11:15 – Career development Networking Session (Technology and Entrepreneurship) – Indaba Area Zone 1, Exhibition Hall
  4. Tuesday 4 July 13:00-13:15 – Global learning through MOOCs the Physiopedia experience – Indaba Area Zone 2, Exhibition Hall

It’s not too late to register for Congress, we would love to meet you all.

Supervised or unsupervised rehabilitation after total hip replacement provides similar improvements for patients

The objective of this study was to determine do patients do better with unsupervised home PT or in an outpatient setting Are the outcomes after a supervised (centre-based) and an independent (home-based) physical rehabilitation program delivered in the early post-discharge phase (<8weeks) equivalent in an adult THR population.

The participants included 98 adult post unilateral elective total hip replacement (THR) and they were randomly assigned to supervised/centre-based exercise (n=56) or unsupervised/home exercise (n=42) and followed 6 months post-surgery. The supervised group attended a 4 week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.

The WOMAC, SF-36 mental and physical component scores(MCS and PCS) questionnaires, the UCLA activity rating and the Timed up and Go test (TUG). There were no differences between groups for any measure. Overall differences between the adjusted means were: WOMAC 0.5 [-6.75, 5.73], SF-36 PCS 0.8 [-6.5 – 8.1], SF-36 MCS 1.7 [-4.1 – 7.4], UCLA 0.3 [5.19, 6.10] and TUG 0 secs [-1.4 – 1.3].

Results demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late stage rehabilitation was not tested.

The “Strengthen your ankle” program to prevent recurrent injuries

Recurrent ankle sprains can be reduced by a neuromuscular training program (NMT). The way NMT is delivered may influence the incidence of long term recurrent injuries, residual pain and disability. This RCT with a follow-up of twelve months, evaluated whether the implementation method of a proven effective NMT program delivered by a mobile application or a written instruction booklet, resulted in differences in injury incidence rates, functional ankle disability/pain in the long term, assuming equal compliance – as is shown in previous research – with the 8-week intervention.

220 athletes with a history of ankle sprain were recruited for this RCT. 110 athletes were offered the freely available “Strengthen your ankle App” and the other 110 received a printed Booklet. Primary outcome measure was incidence density of ankle sprains. Secondary outcome measures were residual pain/disability and the individual cumulative number of ankle sprains during follow-up. The incidence densities of self-reported ankle sprain recurrences were not significantly different between both groups (HR 1.06; 95% CI 0.76-1.49). Median FADI (Functional Ankle and Disability Index) scores increased equally over time in both groups, indicating a lower rate of limitation and pain in both groups at follow-up. Neither FADI scores nor cumulative recurrent injuries were significantly different between groups.

This study showed that the implementation method of a NMT program by using an App or a Booklet did neither lead to different injury incidence rates in the long term nor did it influence residual functional disability/pain. Assuming equal compliance during the 8-week intervention, both methods show similar effectiveness in twelve-month follow-up.