ORCID Profile
0000-0003-2968-6950
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Publisher: Informa UK Limited
Date: 02-11-2019
Publisher: Informa UK Limited
Date: 02-01-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-1999
DOI: 10.1097/00007632-199907010-00011
Abstract: A descriptive questionnaire of chartered physiotherapists. To investigate current physiotherapeutic management of low back pain throughout Britain and Ireland. Physiotherapists play a key role in low back pain management. Although clinical guidelines for best practice have been developed recently, there has been no large-scale attempt to describe current physiotherapeutic treatment approaches within Britain or Ireland. After semi-structured interviews (n = 6) and two pilot studies (n = 77) were done, postal questionnaires were distributed to four regional cluster s les of the membership of two physiotherapy professional organizations (n = 2654). After two mailings, a random s le of 90 nonresponders were followed up. Data were analyzed using the Statistical Package for the Social Sciences (SPSS Ltd., Woking, Surrey, UK), and precision of the survey estimates was assessed by calculation of s ling errors and intraclass correlation coefficients for cluster s ling. Results were received from 1548 therapists (total response rate, 58.3%) of these, 813 reported that they were practicing in settings in which they treated patients with low back pain. Analysis of the results indicated the overall popularity of the Maitland mobilization and McKenzie approaches among physiotherapists. Although exercise per se was mentioned frequently by respondents, a marked difference in opinion among therapists regarding the optimal type of exercise for low back pain was obvious. Little evidence was demonstrated of the use of manipulation, fitness programs, or multidisciplinary efforts involving behavioral and physical aspects of treatment. Commonly used methods of electrotherapy were interferential therapy, ultrasound, pulsed short-wave diathermy, and transcutaneous electrical nerve stimulation. The results of this study emphasize the need to evaluate further and improve the dissemination of findings regarding the effectiveness of specific physiotherapy approaches for low back pain management.
Publisher: Wiley
Date: 10-04-2015
DOI: 10.1111/PAPR.12293
Abstract: A range of outcome measures across various domains are used to evaluate change following an intervention in clinical trials on chronic neuropathic pain (NeP). However, to capture a real change in the variable of interest, the psychometric properties of a particular measure should demonstrate appropriate methodological quality. Various outcome measures in the domains of pain and physical functioning have been used in the literature for NeP, for which in idual properties (eg, reliability/validity) have been reported. To date, there is no definitive synthesis of evidence on the psychometric properties of those outcome measures thus, the aim of this systematic review was to evaluate the methodological quality [COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines] of studies that evaluated psychometric properties of pain and physical functioning outcome measures used for NeP. Specific MeSH/keywords related to 3 areas (pain and/or physical functioning, psychometric properties, and NeP) were used to retrieve relevant studies (English language) in key electronic databases (MEDLINE (Ovid), CINAHL (EBSCO), Scopus, AMED, and Web of Science) from database inception-July 2012. Articles retrieval/screening and quality analysis (COSMIN) were carried out by 2 independent reviewers. Twenty-four pain and thirty-seven physical functioning outcome measures were identified, varying in methodological quality from poor-excellent. Although a variety of pain and physical functioning outcome measures have been reported in the literature, few have demonstrate methodologically strong psychometric properties. Thus, future research is required to further investigate the psychometric properties of existing pain and physical functioning outcome measures used for clinical and research purposes.
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.IJNURSTU.2009.09.012
Abstract: The aim was to investigate peoples' experiences of the impact of chronic low back pain. Chronic low back pain is a complex disorder with wide-ranging adverse consequences that can impact on people's lifestyles and self-image. It is also a condition that can sometimes be treated with some scepticism by health care providers and other people in the person's life. It has been suggested that further research into the subjective experience of chronic blow back pain is needed to develop a better understanding of its impact. This study is a qualitative analysis of semi-structured interviews with 64 participants identified as having chronic low back pain who were interviewed about the impact of the condition on their lives. The data were analysed using a method of inductive thematic analysis. Four main themes were identified: the unpredictability of the pain, the need for vigilance, the externalization/objectification of the body and the alteration to sense of self. Nurses have an important role to play in working with patients experiencing chronic low back pain to identify any patterns associated with exacerbations of the condition, validating their experiences of chronic low back pain and facilitating the accommodation of chronic low back pain into a more satisfying sense of self.
Publisher: BMJ
Date: 05-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-1995
Publisher: Elsevier BV
Date: 11-2002
Abstract: Manual therapy is the most commonly used approach in the management of low back pain (LBP) and encompasses a wide range of techniques. The aims of this study were to investigate the current use of mobilizations with movement (MWM) for LBP management in Britain and to inform future clinical research exploring their effects.A postal survey of a random s le of 3295 practising physiotherapists in Britain was conducted. A response rate of 72.1% (n=2357) was obtained. Of these, 48.2% (n=1136) reported treating LBP, of whom 41.1% (n=467) reported using MWMs in LBP management. Therefore, the s le applicable for analysis consisted of these 467 therapists currently treating LBP and using MWMs. Most respondents (51.4%) worked in a national health service setting. Over half of the respondents used MWMs on at least a weekly basis, with 61.9% using MWMs primarily for mechanical LBP. The most commonly reported changes seen immediately after the application of MWMs were increases in range of movement (ROM) (54.4%) and pain relief (27.5%). This was also reflected in the outcomes chosen to evaluate improvement. On average, two spinal levels were mobilized using 2-3 sets of 4-5 repetitions. The lower lumbar levels were treated more often. Most therapists indicated using a combination of other treatment approaches together with MWMs when treating LBP patients. In conclusion, this study is the first to describe the current practice of MWMs by physiotherapists in Britain, and the results will be used to inform the design of a clinical trial exploring the effects of MWMs for LBP.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Publisher: Springer Science and Business Media LLC
Date: 08-02-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2000
Publisher: Springer Science and Business Media LLC
Date: 06-11-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2000
DOI: 10.1097/00002508-200009000-00012
Abstract: To investigate the hypoalgesic effect of true and sham acupuncture upon experimentally induced ischemic pain. Human volunteers (n = 60) were required to attend two sessions for pain induction using a submaximal effort tourniquet technique on the first occasion, baseline pain scores were recorded and on the second, 48 hours later, subjects were randomly allocated to one of five groups: Control, Treatment Groups 1 or 2, or Placebo Groups 1 or 2. Healthy human volunteers. In all the Treatment and Placebo Groups, subjects received some form of needle acupuncture 15 minutes before, and 5 minutes during, the pain induction procedure on the second day. Treatment Group 1 received acupuncture on acupuncture points situated distal to the tourniquet, whereas Treatment Group 2 received acupuncture on acupuncture points situated proximal to the tourniquet. In Placebo Groups 1 and 2, subjects received 'sham' acupuncture either on nonacupuncture points (Placebo Group 1) or on acupuncture points (Placebo Group 2) using (standardized) minimal levels of stimulation. A licensed acupuncturist who was not involved in data collection and analyses carried out all treatments. Pain was assessed using a computerized visual analog scale (VAS) and a McGill Pain Questionnaire (MPQ). Analysis of VAS scores using ANOVA revealed no significant differences between groups (e.g., VAS sum of differences data (mean +/- SEM): Treatment Group 1: 90+/-47, Treatment Group 2: 187+/-56, Placebo Group 1: 152+/-40, Placebo Group 2: 121+/-42, CONTROLS: 46+/-24, p>0.05). Analysis of MPQ percentage difference scores using one-way ANOVA revealed some isolated effects in the subjective descriptors and the Pain Rating Index, both for Treatment Group 2 and Placebo Group 2, proving them superior to any of the other groups. The results of the study provide no convincing evidence for a superior hypoalgesic effect of acupuncture compared with "sham" procedures on this model of experimental pain.
Publisher: Wiley
Date: 13-05-2010
DOI: 10.1111/J.1365-2648.2010.05316.X
Abstract: This paper is a report of a study of the self-management strategies of people with chronic low back pain and how their healthcare professionals perceived their role in facilitating self-management. Chronic low back pain is a complex disorder, challenging to treat, and associated with wide-ranging adverse consequences including physical disability, psychosocial disruption, and increased use of healthcare resources. Most clinical guidelines suggest that self-management strategies are the best treatment option. A qualitative analysis was conducted of semi-structured interviews with 64 people identified as having chronic low back pain and 22 healthcare professionals nominated by that person. The interviews were conducted in 2008. The people with chronic low back pain were asked about their self-management strategies healthcare professionals were asked about how they perceived their role in the person's self-management. Data were analysed using a content analysis. The most common strategies used by participants to manage their chronic low back pain were medication, exercise and application of heat. The nominated healthcare professionals were predominantly physiotherapists and general practitioners. Physiotherapists described exercises, particularly those aimed at improving core strength, as the main strategy that they encouraged people to use. General practitioners regarded themselves as primarily having three roles: prescription of pain medication, dispensing of sickness certificates, and referral to specialists. People with chronic low back pain use self-management strategies that they have discovered to provide relief and to prevent exacerbation. The strategies reflect an active process of decision-making that combines personal experience with professional recommendations.
Publisher: Informa UK Limited
Date: 02-11-2018
Publisher: Informa UK Limited
Date: 2001
DOI: 10.1080/096382801750110892
Abstract: The Bobath concept is one of the most widely used approaches in stroke rehabilitation within Europe. This survey aimed to provide an expert consensus view of the theoretical beliefs underlying current Bobath practise in the UK. Questionnaires (with sections related to: therapist background, physiotherapy management, theoretical beliefs and gait re-education strategies used) were posted to all senior level physiotherapists working in stroke care (n = 1,022). The majority of respondents had more than 10 year's experience overall and at least 5 years experience in stroke care. The Bobath concept was the preferred approach (n = 67%) followed by an 'eclectic' approach (n = 31%). Despite a high level of consensus between groups, there were 13 significant differences highlighted between Bobath and 'eclectic' groups related to recovery, control of tone, the analysis and facilitation of normal movement and function. In summary. Bobath therapists considered that patients needed to have normal tone and use normal movement patterns in order to perform functional tasks. They would delay patients from performing tasks independently if abnormal tone and movement would be reinforced by task practice. They were not opposed to the use of walking aids and orthotics. This survey has raised several issues for debate within physiotherapy such as the automatic translation of movement into function, carry over outside therapy, and the way in which tasks should be practiced. The dominance of the Bobath concept needs to be justified by establishing that it is both effective and efficient at achieving its treatment aims of: normalizing tone, improving intrinsic recovery of the affected side and function within everyday tasks.
Publisher: Elsevier BV
Date: 06-2001
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2003
DOI: 10.1016/S0304-3959(03)00292-6
Abstract: This study evaluated the effects of varying frequency, intensity and stimulation site, of transcutaneous electrical nerve stimulation (TENS) in an experimental model of pain. In a double-blind design 240 volunteers were randomised to one of six experimental TENS groups, a sham TENS or control (n=30 per group gender balanced). Two TENS frequencies (110 or 4 Hz) and two intensities (strong but comfortable or highest tolerable) at a fixed pulse duration (200 micros) were applied at three sites relative to the measurement site (segmentally, extrasegmentally or a combination of these), for 30 min. Pressure pain thresholds (PPT) were measured using a pressure algometer, in the first dorsal interosseous muscle, every 10 min, during stimulation and for a further 30 min. The high frequency, high intensity segmental, and combined stimulation groups, showed rapid onset and significant hypoalgesic effects. This effect was sustained for 20 min post-stimulation in the high frequency segmental group. All other TENS intervention groups showed hypoalgesic responses similar to the sham TENS group, and none of these groups reached a clinically significant hypoalgesic level. The role of TENS frequency, intensity and site are pivotal to achieving optimal hypoalgesic effects, during and after stimulation. Clinical applications of these parameter combinations require further investigations.
Publisher: Elsevier BV
Date: 07-2000
Abstract: To investigate the efficacy of commonly available analgesics in the management of delayed-onset muscle soreness over an 11-day period. Double-blind, placebo-controlled randomized trial. University laboratory. Sixty healthy volunteers (30 men, 30 women) with no current arm pain or pathology completed the experimental procedure. Subjects were randomly allocated to one of five experimental groups: control placebo aspirin (900 mg) codeine (60 mg) and paracetamol (1000 mg) (n = 12 in all groups). Delayed soreness was induced in the nondominant elbow flexors using a standardized exercise protocol of repeated eccentric contractions. Pain (visual analogue scale McGill pain questionnaire [MPQ]), range of extension, flexion and resting angle (universal goniometer), and mechanical pain threshold (pressure algometer). Measurements were taken before and after drug administration each day, except for the MPQ, which was completed on the first and third days of the experiment. Analysis of results using repeated-measures analysis of variance and relevant post hoc tests provided no evidence of the effectiveness of any of the preparations. There is no beneficial effect from the medications, at least at the doses stated, in the management of delayed-onset muscle soreness.
Publisher: Wiley
Date: 12-2005
DOI: 10.1002/PRI.16
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-1996
DOI: 10.1097/00002508-199612000-00009
Abstract: Two separate studies investigated the hypoalgesic effect of manipulation of Transcutaneous Electrical Nerve Stimulation (TENS) parameters on two models of experimental pain: the Submaximal Effort Tourniquet Technique and cold-pressor pain. For the first study, 32 healthy subjects (16 male and 16 female) attended once for the purpose of cold-pressor pain induction that involved immersion of the nondominant hand in a water bath at 0 degree C. Subjects were allocated to Control, Placebo, or 1 of 2 treatment groups (110 or 4-Hz TENS). Pain threshold measurements (time to withdrawal of hand in seconds) were obtained over six standardised cold pain cycles (i.e., two before stimulation onset, three during stimulation, and one cycle after stimulation). In the second study, 48 healthy volunteers (24 male and 24 female) attended on two occasions, 48 h apart, for the purposes of ischaemic pain induction. On the first attendance, baseline data were obtained and on the second, subjects were randomly allocated to Control, Placebo, or one of four treatment groups with different combinations of stimulation frequencies and pulse durations (4 or 110 Hz and 50 or 200 microseconds). Measurements of "current pain intensity" and "worst pain experienced" were obtained via the Visual Analogue Scale (VAS) and the McGill Pain Questionnaire (MPQ), respectively. Analysis of variance performed on both sets of collected data revealed no significant differences between any of the groups, thus indicating no apparent relevance of manipulation of TENS parameters using these models of pain. Several hypotheses are suggested to explain these findings.
Publisher: Elsevier BV
Date: 03-2007
DOI: 10.1016/J.JMPT.2007.01.015
Abstract: This study investigates the immediate effects of flexion mobilizations with movement techniques (MWMs) on spinal range of movement in in iduals with low back pain and also their impact on pain. A preliminary attempt has been made to describe the clinical profiles of subjects who were thought to benefit from MWMs. A small-scale explanatory study was conducted using a crossover design, placebo-controlled, with subjects and assessors blinded. After assessment by physiotherapists, 26 subjects with low back pain with pain on lumbar flexion, thought to be appropriate for treatment with MWMs, participated. Subjects received an MWM intervention and a placebo intervention in a randomized order. Lumbar spinal flexion and extension and pain during flexion were recorded immediately before and after each intervention, using double inclinometry and visual analogue scales. Mean spinal range of movement increased significantly with the MWM intervention, as compared with the placebo (true flexion: MWMs 49.2 degrees [SD 16.4], placebo 45.3 degrees [SD 14.1], P = .005 total flexion: MWMs 76.7 degrees [SD 22.4], placebo 69.7 degrees [SD 21.5], P = .005). Mean pain scores did not change. The MWMs produced statistically significant, but small, immediate spinal mobility increases but no pain reduction when compared with placebo. By introducing clinical judgment into the subject selection process for the trial, 19 (73%) of 26 subjects benefited from MWMs techniques in terms of range of movement and/or pain intensity, whereas 9 (35%) subjects showed such changes with the placebo intervention.
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/09638280500535132
Abstract: The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept. Nine patients, at least 6 weeks post stroke and recently discharged from a stroke unit, were measured before and after a period of outpatient physiotherapy (mean duration = 17.4 weeks). Therapy was documented using a treatment checklist for each patient. The primary outcome measures were a number of gait variables related to the therapists' treatment hypothesis, recorded during the gait cycle using the CODA motion analysis system. Other secondary outcome measures were the Motor Assessment Scale, Modified Ashworth Scale, subtests of the Sodring Motor Evaluation Scale, the Step test, a 10-m walk test, the Barthel Index and the London Handicap Score. Recovery of more normal gait patterns in the gait cycle (using motion analysis) did not occur. Significant changes in temporal parameters (loading response, single support time) for both legs, in one kinematic (dorsiflexion during stance) and one kinetic variable on the unaffected side (hip flexor moment), and most of the clinical measures of impairment, activity and participation (with the exception of the Modified Ashworth Scale and the 10-m walk) were noted. Study findings did not support the hypothesis that the Bobath approach restored more normal movement patterns to the gait cycle. Further research is required to investigate the treatment techniques that are effective at improving walking ability in people after stroke.
Publisher: Informa UK Limited
Date: 22-12-2011
DOI: 10.3109/09638288.2011.631683
Abstract: This study explored processes that influenced involvement in recreational exercise for in iduals with neurological disability, to identify strategies to promote physical activity for health and well-being in this population. Nineteen participants (11 males and eight females), aged 20-71 years, with a range of neurological conditions and functional limitations, were recruited in one large metropolitan area in New Zealand. In idual semi-structured interviews explored participants' views, perceptions, and experiences of undertaking recreational exercise. Data were analysed for themes. For some in iduals, recreational exercise is undertaken for its physical, psychological, or social benefits, despite the physical activity itself feeling relatively unsatisfactory. In contrast, in iduals who are able to undertake their preferred choice of recreational exercise experience intense satisfaction. This motivates self-maintenance of physical activity, even for those in iduals who require carer support or assistance to do so. This study has identified that there can be two forms of involvement in recreational exercise that allows in iduals with neurological disability to become more physically active. The information could be further developed and tested in intervention studies to provide strategies for health professionals to facilitate engagement in physical activity for people with neurological disability.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2002
DOI: 10.1016/S0304-3959(02)00118-5
Abstract: Transcutaneous electrical nerve stimulation (TENS) is a popular form of electrostimulation. Despite an extensive research base, there remains no consensus regarding the parameter selection required to achieve maximal hypoalgesic effects. The aim of this double blind, sham-controlled study was to investigate the relative hypoalgesic effects of different TENS parameters (frequency, intensity and stimulation site) upon experimentally induced mechanical pain. Two hundred and forty participants were recruited in order to provide statistical analysis with 80% power at alpha = 0.05. Subjects were randomised to one of the six TENS groups, a control, and a sham TENS group (n = 30, 15 males, 15 females, per group). TENS groups differed in their combinations of stimulation frequency (4 or 110 Hz), intensity ('to tolerance' or 'strong but comfortable') and stimulation site (segmental--over the distribution of the radial nerve or, extrasegmental--over acupuncture point 'gall bladder 34', or a combination of both segmental and extrasegmental). Pulse duration was fixed at 200 micros. Stimulation was delivered for 30 min and subjects were then monitored for a further 30 min. Mechanical pain threshold (MPT) was measured using a pressure algometer and taken from the first dorsal interosseous muscle of the dominant hand, ipsilateral to the stimulation site. MPT measures were taken, at baseline, and at 10-min intervals for 60 min. Difference scores were analysed using repeated measures and one-way ANOVA and relevant post hoc tests. Low frequency, high intensity, extrasegmental stimulation produced a rapid onset hypoalgesic effect, which increased during the stimulation period (P < 0.0005 control and sham) and was sustained for 30 min post-stimulation (P < 0.0005(control), P = 0.024(sham)). Whilst high frequency, 'strong but comfortable' intensity, segmental stimulation produced comparable hypoalgesic levels during stimulation, this effect was not sustained post-stimulation. Stimulation at a combination of the two sites did not produce any greater hypoalgesic effects. These results may have implications for the clinical use of sensory stimulation.
Location: No location found
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for David Baxter.