Clinical Studies

Abstract

Introduction Children with cerebral palsy (CP) and other neurodevelopmental disabilities often receive a home programme of exercises to assist in reaching their therapy goals. Adherence to exercise programmes is necessary to attain the level of practice required to achieve goals; however, adherence can be difficult to accomplish. In this paper, we describe the protocol for a randomised controlled trial to evaluate the effectiveness of delivering a home exercise programme to school-age children with disabilities using Physitrack, an online exercise prescription tool with a website or app interface.

Methods and analysis

Participants aged 6–17 years, with CP or other neurodevelopmental disabilities, receiving community physiotherapy services in Western Australia, will be recruited. Participants will be stratified by age and functional mobility and randomised to either the intervention group, who will complete an 8-week home exercise programme using Physitrack, or the control group, who will complete an 8-week exercise programme without Physitrack. Researcher blinding to group allocation, and participant blinding to outcome, will be maintained. The primary outcome measures are adherence to the home exercise programme with weekly collection of home exercise logs; achievement of individualised goals by phone interview before and after intervention; and correctness of exercise performance by collection and analysis of videos of participants performing home exercises. Secondary outcome measures include enjoyment of physical activity, confidence to complete exercise programme, preferred method of delivery of programme and usability of Physitrack. A sample size of 58 participants will be necessary to see an effect on home programme adherence. Data will be analysed using the intention-to-treat principle.

Ethics and dissemination

Ethical approval was obtained from Curtin University Human Research Ethics Committee in July 2016 (10391).

Outcomes will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences.Trial registration number ACTRN12616000743460; Pre-results.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ and http://dx.doi.org/10.1136/bmjopen-2017-018316

The research study was developed with input from clinicians, telehealth experts, business owners and funding bodies to evaluate the effectiveness and value of physiotherapy treatment delivered via telehealth during the COVID-19 pandemic.

The project measured the following objectives:
• the characteristics of physiotherapists who implemented telehealth services
• the nature of the services
• the types of patients who utilised telehealth physiotherapy services
• the types of conditions that were treated and their management
• patient outcomes and experiences
• consultation features

This information will be used to advocate for ongoing
funding of telehealth services by physiotherapists. It
is a cross-sectional online survey with ethics approval
obtained through the University of Melbourne.

Bay State Physical Therapy, leading Physical Therapy care provider in the US North East, used Physitrack Telehealth (PTT) and patient engagement systems to stay connected to their patients during the Covid-19 global pandemic – with great success.

Within a matter of a few days, Physitrack was able to get all BSPT practitioners set-up, and trained on using Telehealth. By mid-March BSPT was 100% virtual – using Physitrack’s award-winning technology and patient apps.

You can read more about the research that was done in this published study, which highlights the objective success BSPT has had with PTT and virtual care.

Background: Over the last few years, telerehabilitation services have developed rapidly, and patients value benefits such as reduced travelling barriers, flexible exercise hours, and the possibility to better integrate skills into daily life. However, the effects of physiotherapy with telerehabilitation on postoperative functional outcomes compared with usual care in surgical populations are still inconclusive.

Objectives: To study the effectiveness of physiotherapy with telerehabilitation on postoperative functional outcomes and quality of life in surgical patients.

Data sources: Relevant studies were obtained from MEDLINE, EMBASE, CINAHL, the Cochrane Library, PEDro, Google Scholar and the World Health Organization International Clinical Trials Registry Platform.

Study selection: Randomised controlled trials, controlled clinical trials, quasi-randomised studies and quasi-experimental studies with comparative controls were included with no restrictions in terms of language or date of publication.

Data extraction and synthesis: Methodological quality was assessed using the Cochrane risk of bias tool. Twenty-three records were included for qualitative synthesis. Seven studies were eligible for quantitative synthesis on quality of life, and the overall pooled standardised mean difference was 1.01 (95% confidence interval 0.18 to 1.84), indicating an increase in favour of telerehabilitation in surgical patients.

Limitations: The variety in contents of intervention and outcome measures restricted the performance of a meta-analysis on all clinical outcome measures.

Conclusions: Physiotherapy with telerehabilitation has the potential to increase quality of life, is feasible, and is at least equally effective as usual care in surgical populations. This may be sufficient reason to choose physiotherapy with telerehabilitation for surgical populations, although the overall effectiveness on physical outcomes remains unclear. PROSPERO registration number: CRD42015017744.

Keywords: Exercise; Functional status; Physiotherapy; Surgery; Telehealth; Telemedicine; Telerehabilitation.

Copyright © 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Background

A comparative observational study was conducted using data collected from routine care provided by qualified Ascenti physiotherapy practitioners. Patients involved in the study were referred to Ascenti for a range of needs.

The study involved exporting anonymised data that mapped the treatment journeys of 27,096 patients who had accessed virtual physiotherapy support before and during the Covid-19 crisis - running up until 10 June 2020. Of this population, 9,506 had received virtual-only treatment, while 17,590 had received a mix of virtual and face-to-face care.

A control group was then built using the data of 6,226 patients who had been treated with in-person physiotherapy only.

Results

Measured on a 10-point pain Numerical Rating Scale (NRS) all patient groups saw significant reductions in their levels of pain following treatment, regardless of what type of treatment they accessed and regardless of the severity of their injury or condition.

In the population-level analysis, patients that combined face-to-face treatment with virtual sessions delivered through the app saw the biggest improvements, moving from a 5.4 NRS score at initial assessment to 1.8 at discharge - an improvement of 3.6 points on average. Patients who only accessed face-to-face treatment reduced their pain by 3.4 points on average, while people who were treated virtually and didn’t see a physio in-person improved by an average of 3.1 points.

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Objectives:

To evaluate the feasibility of a 12-week progressive resistance training program for people with patellofemoral pain (PFP) targeting proximal muscle strength and power; and resulting clinical and muscle capacity outcomes.

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Main outcome measures:

Feasibility outcomes included eligibility, recruitment rate, intervention adherence, and drop-outs. Secondary outcomes included perceived recovery, physical function (AKPS and KOOS-PF), worst pain (VAS-cm), kinesiophobia (Tampa), physical activity (IPAQ), and hip strength (isometric and 10 repetition maximum) and power.

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Results:

Eleven people, from 36 who responded to advertisements, commenced the program. One participant withdrew. Ten participants who completed the program reported improvement (3 completely recovered; 6 marked; and 1 moderate). Higher AKPS (effect size [ES] = 1.81), improved KOOS-PF (ES = 1.37), and reduced pain (ES = 3.36) occurred alongside increased hip abduction and extension dynamic strength (ES = 2.22 and 1.92, respectively) and power (ES = 0.78 and 0.77, respectively). Isometric strength improved for hip abduction (ES = 0.99), but not hip extension.

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Conclusion

A 12-week progressive resistance training program targeting proximal muscle strength and power is feasible and associated with moderate-large improvements in pain, function, and hip muscle capacity in people with PFP. Further research evaluating the efficacy of progressive resistance training is warranted.

Background

Physiotherapy is a proven effective treatment strategy after total knee and hip arthroplasty (TKA/THA), however there is considerable practice variation regarding its timing, content and duration. This study aims to compare the (cost-) effectiveness of a standardized, treat-to-target postoperative physiotherapy strategy with usual postoperative care.

Methods

Using a cluster randomized study design, consecutive patients scheduled for a primary TKA/THA in 18 hospitals in the Netherlands will be assigned to the treat-to-target physio therapy strategy or usual postoperative care. With the treat-to-target strategy a standardized, individually tailored, exercise program is aimed at the attainment of specific functional milestones. Assessments are done at baseline, 6 weeks and 3, 6, 9 and 12 months follow up. The primary outcome will be the Knee injury / Hip disability and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS / HOOS-PS) at 3 months follow up. Secondary outcomes are the numeric rating scale for pain, the Oxford Knee and Hip Scores, performance-based test and the EuroQol 5D-5L for quality of life. Healthcare use, productivity and satisfaction with postoperative care are measured by means of questionnaires. In total, 624 patients will be needed of which 312 TKA and 312 THA patients.

Discussion

The study will provide evidence concerning the (cost-) effectiveness of the treat-to-target postoperative physiotherapy treatment compared to usual postoperative care. The results of this study will address an important evidence gap and will have a significant impact in daily practice of the physio therapist.

Trial registration

Registered in the Dutch Trial Registry on April 15, 2018. Registration number: NTR7129.

Exercise is an integral component of the conservative management of most musculoskeletal conditions. However adherence to exercises is often low and this impacts on treatment effectiveness. The aim of this randomised controlled trial is to evaluate whether the addition of a web-based system, Physitrack, to usual physiotherapy treatment improves patient adherence levels to exercises compared to the usual non web-based methods physiotherapists use to deliver exercise programs to people with musculoskeletal conditions.

PANTHER was a a 2-year study run by the University of Melbourne, comparing exercise prescription via Physitrack to paper handouts and the effect that has on patient adherence and other outcomes.

Conclusions: A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established.

With over 2 million patient contacts each year, GSTT is one of the busiest NHS trusts in the UK. The Fracture Clinic set out to establish patient exercise adherence and staff satisfaction with the use of Physitrack in treating Achilles tendon ruptures, anterior glenohumeral joint dislocations, Weber A ankle fractures and distal radius fractures.

Implementation of a web and smartphone based exercise prescription program in MSK Physiotherapy.

St George’s serves a population of 1.3 million patients in southwest London. To help the team to manage an ever growing caseload, St George’s embarked on a study to look at the engagement with a digital exercise prescription tool versus paper based programmes.

Adherence to exercise was better for patients using the digital platforms compared to a paper version.

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You can see the poster presented here: https://www.dropbox.com/s/lztj7mzl9hughqm/Physiouk%20poster%202017%203.pdf?dl=0

FAST @ HOME wants to enable rehab at home after getting a stroke through a composite program of digital, already existing interventions. Based on the wishes of professionals, stroke patients and informal caregivers, multiple existing and evaluated interventions are combined in a digital environment.

In an effect study with 150 rehabilitants, the effectiveness of this platform will be tested: "To what extent is the quality of care improved as a result of digital support for home rehabilitation for stroke patients?" This question is answered from the perspective of the patient and from the healthcare providers.

Objective: The aim of this study was to evaluate the feasibility and preliminary effects of a multicomponentintervention to decrease sedentary time during and shortly after hospitalization.

Design: This is a quasi-experimental pilot study comparing outcomes in patients admitted before andafter the implementation of the intervention.

Setting: The study was conducted in a university hospital.

Subjects: Participants were adult patients undergoing elective organ transplantation or vascular surgery.

Interventions: In the control phase, patients received usual care, whereas in the intervention phase,patients also received a multicomponent intervention to decrease sedentary time. The interventioncomprised eight elements: paper and digital information, an exercise movie, an activity planner, apedometer and Fitbit Flex™, a personal activity coach and an individualized digital training program.

Measures: Measures of feasiblity were the self-reported use of the intervention components (yes/no) and satisfaction (low–high = 0–10). Main outcome measure was the median % of sedentary timemeasured by an accelerometer worn during hospitalization and 7–14days thereafter.

Results: A total of 42 controls (mean age = 59 years, 62% male) and 52 intervention patients (58years,52%) were included. The exercise movie, paper information and Fitbit Flex were the three most frequentlyused components, with highest satisfaction scores for the fitbit, paper information, exercise movie anddigital training. Median sedentary time decreased from 99.6% to 95.7% and 99.3% to 91.0% between Days 1 and 6 in patients admitted in the control and intervention phases, respectively. The difference a Day 6 reached statistical significance (difference = 41min/day, P=0.01). No differences were seen afterdischarge.

Conclusion: Implementing a multicomponent intervention to reduce sedentary time appeared feasibleand may be effective during but not directly after hospitalization.

The project VEERKRACHT aims to develop physiotherapeutically supported interventions for women with metastatic breast cancer. The aim is to promote fitness and well-being in order to maintain or improve the quality of life.

For the Fysio Future Lab, a group of innovative physiotherapists test technological applications in daily practice. By means of short questionnaires and interviews, the user-friendliness, applicability and physiotherapeutic added value are mapped out for each application. These pilot studies focus on the perspective of the therapist and the patient. In addition, it is possible for both patients and therapists to complete a short questionnaire for technological applications that are already used. Physitrack was subject of the first study.

A study in partnership with NSW Ambulance to investigate the effects of different types of exercise training on a range of cardio-metabolic and musculoskeletal health outcomes in regional and rural paramedics.

A randomised controlled trial to evaluate the effectiveness of delivering a home exercise programme to school-age children with disabilities (cerebral palsy) using Physitrack.

This study focuses on the delivery of physiotherapy and dietitian interventions remotely to measure cost-effectiveness and outcomes of remote health interventions for patients with chronic conditions. Physitrack is used to deliver the exercise interventions and educational content to participants, track adherence to the exercise interventions and have video calls with patients.

PhysioFIRST is an assessor and participant blinded randomised controlled trial comparing the effectiveness of two physiotherapy interventions for hip pain (FAI) in adults aged 18-50 years. The physitrack app is being used to deliver the exercise interventions to participants in both groups, and to track adherence to the exercise interventions.

Through a global collaboration, HIPARTI aims to determine the efficacy of hip arthroscopic surgery compared to a sham surgery (diagnostic arthroscopy only) for patients with symptomatic and radiological findings related to impingement (FAI) and/or labral tears using a randomized controlled design. Physitrack is used to deliver standardised exercise programs and collect outcomes data for analysis.

INTRODUCTION: Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).

METHODS AND ANALYSIS: Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation.

ETHICS AND DISSEMINATION: Validation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation.

TRIAL REGISTRATION NUMBER: NCT02730338.