School of Clinical Sciences - Te Kura Mātai Haumanu

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https://hdl.handle.net/10292/1241

The School of Clinical Sciences plays an important role in specialist teaching and research conducted by its academic staff and postgraduate students. This places AUT students at the forefront of much of the ground-breaking research undertaken in New Zealand, especially in the fields of Midwifery, Nursing, Occupational Therapy, Oral Health, Paramedicine, Physiotherapy, Podiatry.

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The frequency and incidence of low-back-pain/sciatica in an urban-population
(New Zealand Medical Association, 1991-10-09) Laslett, M; Crothers, C; Beattie, P; Cregten, L; Moses, A
The frequency, incidence and severity of low back pain was assessed by a random telephone survey of 314 urban New Zealanders. Relationships between the severity and frequency of low back pain and referred lower extremity pain and other variables such as occupation, recreation, age, sex and predominant working posture was analysed.Point incidence was 17.5%, weekly incidence 33.4%, yearly incidence 63.7% and total incidence 79%. Some 28.3% get frequent minor episodes and 6.4% get frequent severe episodes of low back pain. Nearly 50% suffer the initial episode before the age of 30 years.Of those suffering low back pain within the last seven days, 14.3% experience reference below the knee and the total incidence of below knee pain was 13.7%. Over half (51.6%) have pain that has lasted seven days or less, but a third have had pain for longer than seven weeks. No correlation between the incidence of low back pain and referred pain and occupational posture was found.In conclusion, this telephone survey established that the incidence of low back pain in New Zealand is similar to that reported in overseas studies. The survey could not establish differences in low back pain characteristics across different social groupings, nor could a relationship between occupational posture and low back pain be established.
The use of evidence-based practice in the physiotherapy management of the uncomplicated coronary artery bypass graft patient in the United Kingdom
(Australian Physiotherapy Association, 2001) Reeve, JC; Ewan, S,
A survey of physiotherapy on-call and emergency duty services in New Zealand
(New Zealand Society of Physiotherapists, 2003) Reeve, JC
Physiotherapists working in hospitals are commonly required to undertake emergency on-call duties. Concerns from within the profession about the quality of on-call services have been expressed. The aims of this study were to audit oncall practice in New Zealand, identify variations in service provision and ascertain physiotherapists’ concerns in providing these services. A postal questionnaire was distributed to senior physiotherapists in all New Zealand hospitals expected to provide physiotherapy emergency on-call duties (n = 38). A response rate of 97.4% (n=37) was obtained of which 33 respondents provided on-call physiotherapy. Assessment of competency to undertake on-call duties, agreed standards of practice, the use of protocols, training and support provided were ascertained. Respondents were asked to highlight their most important concerns in the provision of their on-call service. These were found to be maintenance of competency, service provision, training and resource issues. This study demonstrates wide variations in the practice and provision of on-call duties by physiotherapists and highlights common concerns in the provision of these services. Strategies to diminish these concerns require further consideration at both national and local levels.
Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests
(Australian Physiotherapy Association, 2003) Laslett, M; Young, SB; Aprill, CN; McDonald, B
Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference standards. The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference standard. In a blinded concurrent criterion-related validity design study, 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections. The centralisation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process. Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection. Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain. In the primary subset analysis of 34 patients, sensitivity, specificity and positive likelihood ratio (95% confidence intervals) of the clinical evaluation were 91% (62 to 98), 83% (68 to 96) and 6.97 (2.70 to 20.27) respectively. The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone. A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac joints.
Inter-tester reliability of a new diagnostic classification system for patients with non-specific low back pain
(Australian Physiotherapy Association, 2004) Petersen, T; Olsen, S; Laslett, M; Thorsen, H; Manniche, C; Ekdahl, C; Jacobsen, S
Most patients referred to physiotherapy with low back pain are without a precise medical diagnosis. Identification of subgroups of non-specific low back pain patients may improve clinical outcomes and research efficiency. A pathoanatomic classification system has been developed, classifying patients with non-specific low back pain into 12 different syndromes and three subcategories based on history and physical examination. The purpose of this study was to estimate the inter-tester reliability of clinical tests used as criteria for classifying patients. Ninety patients with chronic low back pain were each examined by two physiotherapists. A total of four physiotherapists conducted the assessments, Examination findings were recorded independently by the two examiners. Percentage of agreement and kappa coefficients were calculated for each category. The overall rate of agreement was 72% and the kappa coefficient was 0.62 for the mutually exclusive syndromes in the classification system. Agreement rates for each of the syndromes ranged from 74% to 100% and kappa coefficients ranged from 0.44 to 1.00. The findings suggest the inter-tester reliability of the system is acceptable. The relatively modest level of total agreement (39%) for the system as a whole might indicate that the utility of the system for general screening purposes is limited, compared with the utility in identification of particular syndromes. Due to low prevalence of positive findings in some of the syndromes, future work should focus on testing reliability on a larger sample of patients, and testing of validity and feasibility of the system.
Zygapophysial joint blocks in chronic low back pain: a test of Revel's model as a screening test
(BioMed Central Ltd, 2004-11-16) Laslett, M; Oberg, B; Aprill, CN; McDonald, B
Background: Only controlled blocks are capable of confirming the zygapophysial joints (ZJ) as the pain generator in LBP patients. However, previous workers have found that a cluster of clinical signs ("Revel's criteria"), may be valuable in predicting the results of an initial screening ZJ block. It was suggested that these clinical findings are unsuitable for diagnosis, but may be of value in selecting patients for diagnostic blocks of the lumbar ZJ's. To constitute evidence in favour of a clinical management strategy, these results need confirmation. This study evaluates the utility of 'Revel's criteria' as a screening tool for selection of chronic low back pain patients for controlled ZJ diagnostic blocks.Methods: This study utilized a prospective blinded concurrent reference standard related validity design. Consecutive chronic LBP patients completed pain drawings, psychosocial distress and disability questionnaires, received a clinical examination and lumbar zygapophysial blocks. Two reference standards were evaluated simultaneously: 1.75% reduction of pain on a visual analogue scale (replication of previous work), and 2. abolition of the dominant or primary pain. Using "Revel's criteria" as predictors, logistic regression analyses were used to test the model. Estimates of sensitivity, specificity, predictive values and likelihood ratios for selected variables were calculated for the two proposed clinical strategies.Results: Earlier results were not replicated. Sensitivity of "Revel's criteria" was low sensitivity (<17%), and specificity high (approximately 90%). Absence of pain with cough or sneeze just reached significance (p=0.05) within one model.Conclusions: "Revel's criteria" are unsuitable as a clinical screening test to select chronic LBP patients for initial ZJ blocks. However, the criteria may have use in identifying a small subset (11%) of patients likely to respond to the initial block (specificity 93%).
The physiotherapy management of the coronary artery bypass graft patient
(Association of charted physiotherapists in respiratory care, 2005) Reeve, JC; Ewan, S
This study investigated the current physiotherapy management of the patient undergoing routine coronary artery bypass graft. A postal questionnaire was sent to the senior physiotherapists in all (n=52) cardiothoracic units in the United Kingdom. Respondents were asked to identify assessment and treatment programmes in both the preoperative and postoperative management of these patients and the basis on which these programmes were implemented. An indication of current research awareness was also ascertained. A response rate of 80% (n = 40) was obtained.
Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain
(Biomed Central Ltd, 2005-06-09) Laslett, M; McDonald, B; Tropp, H; Aprill, CN; Oberg, B
Background: The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards.Methods: We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC) statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses.Results: In a sample of chronic LBP patients (n=216) with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC) was estimated at 13%. "Exact" agreement between clinical and reference standard diagnoses was 32% and "clinical agreement" 51%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis), PCC was 33% with actual agreement 56%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatomic categories produced a kappa of 0.31.Conclusion: Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified.
Critically Appraised Papers. Adherence to rehabilitation after anterior cruciate ligament reconstructive surgery - Commentary
(New Zealand Society of Physiotherapists, 2006) Bassett, SF
The physiotherapy management of patients undergoing thoracic surgery. A survey of current practice in Australia and New Zealand [Abstract]
(Australian Physiotherapy Association, 2006) Reeve, JC; Denehy, L; Stiller, K
Physiotherapy is considered an essential component of the management of patients following thoracotomy, yet the type of interventions utilised and evidence of their efficacy has not been clearly established. This study aimed to ascertain the current physiotherapy management of patients undergoing thoracotomy. A purpose-designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n = 57). A response rate of 81% was obtained (n = 46). Preoperatively, 35% (n = 16) of respondents assessed all patients presenting for thoracotomy, 41% (n = 19) assessed only some patients (usually based on risk assessment) with 24% (n = 11) undertaking no preoperative physiotherapy assessment or treatment. The majority of respondents (96%, n = 44) attended all patients following surgery, with 63% (n = 29) performing prophylactic physiotherapy interventions to prevent postoperative pulmonary complications. Others assessed all patients postoperatively but treated only when appropriate (33%, n = 15). Physiotherapy usually commenced on day one postoperatively (80%, n = 37) with the most commonly used treatment interventions being deep breathing exercises, active cycle of breathing techniques, cough, forced expiratory techniques and sustained maximal inspirations. Most respondents reported patients sat out of bed on day one postoperatively (89%, n = 41) and commenced walking on day one (70%, n = 32). Shoulder range of movement exercises also normally commenced on day one (50%, n = 23). The majority of respondents offered no postoperative pulmonary rehabilitation (54%, n = 25), outpatient follow up (94%, n = 43) or post-thoracotomy pain management (87%, n = 40). While most patients after thoracotomy receive physiotherapy assessment and/or treatment postoperatively, relatively few are reviewed following discharge from hospital.
Mixed Methods Research: Positivism Dressed in Drag?
(AUT University; SAGE, 2006) Giddings, L
The claim that mixed methods is the third methodological movement of the twentieth century could have unexpected consequences for the future of research in the social sciences and health disciplines. Implied is a belief that the mixing of qualitative and quantitative methods will produce the ‘best of both worlds’. This assumption, combined with inherent promises of inclusiveness, takes on a reality and certainty in research findings that serves well the powerful nexus of economic restraint and evidence-based practice. I argue that the use of the terms ‘qualitative’ and ‘quantitative’ as normative descriptors reinforces their binary positioning, effectively marginalising the methodological diversity within them. Ideologically, mixed methods covers for the continuing hegemony of positivism, albeit in its more moderate, post positivist form. If naively interpreted, mixed methods could become the preferred approach in the teaching and doing of research. Rather than the promotion of more co-operative and complex designs for increasingly complex social and health issues, economic and administrative pressures may lead to demands for the ‘quick fix’ that mixed methods appears to offer.
Can Internationally Comparative Methods Enrich Understandings of Occupation? Food Preparation in Elderly Kentucky, New Zealand, and Thailand Women
(AUT University, 2006) Pierce, D; Bunrayong, W; Hocking, C; Rattakorn, P; Shordike, A; Vittayakorn, S; Wright-St Clair, V
Going Online to Learn Health Sciences Research Methods: The Student Experience
(AUT University; Australasian Society for Computers in Learning in Tertiary Education (ascilite), 2006) Giddings, LS; Campbell, S; Maclaren, P
Health professionals are attracted to the flexibility of the virtual classroom for their on-going education. Recent studies have documented the differences in pedagogy between Internet based learning online and the traditional classroom setting, but few have investigated student health professionals' transitional process while engaged in online learning. The purpose of this mixed methods evaluation study was to document students' experience of a six month online research methods paper (unit). Specifically it explores factors that influenced student transition to online pedagogy and successful completion of the paper. Descriptive qualitative and quantitative analyses were applied to 230 student evaluations and 1720 emails collected over a four year period. The findings supported those of previous studies; the main reasons students study online is the flexibility it offers (87%) and the ability to study without taking time off work (72%). The student experiences were captured in the overarching theme 'from enduring to enjoying'. A teacher who works within a collaborative team, engages students early with interactive skill acquisition learning activities, and is responsive to online students' unique needs, can successfully facilitate students through the virtual classroom transitional phases: from 'virtual paralysis' to 'engagement' to 'getting into it' to 'surprised enjoyment'. Without strategies in place, however, teachers risk being overwhelmed by the onslaught of student emails, with the allotted teacher-student contact time slip sliding away.
Aging Well in New Zealand: Messages for Practice
(The New Zealand Association of Occupational Therapists (http://www.nzaot.com/), 2006) Wright-St Clair, V
No abstract.
Mixed Methods Research for the Novice Researcher
(AUT University; eContent Management Pty Ltd, 2006) Giddings, L; Grant, B
Mixed methods research is becoming increasingly popular in the health and social science disciplines. The aim of this article is to give an overview of the varieties of mixed methods designs. We begin by situating mixed methods research in the context of a paradigmatic framework which assists a researcher in making decisions concerning the design of their study. Although the most commonly used mixed methods designs are underpinned by positivist/postpositivist assumptions, the combination of qualitative and quantitative methods can be used within any research paradigm.
Development of the RoBE self-efficacy scale for people with breathing pattern disorders
(New Zealand Society of Physiotherapists, 2006) Rowley, J; Nicholls, DA
This pilot study developed the Rowley Breathing Self-Efficacy scale (RoBE scale) to assess people’s self-efficacy regarding their ability to control symptoms of their Breathing Pattern Disorders (BPD). The participants were 16 patients attending physiotherapy clinics for treatment of BPD, and 10 control participants. Participants completed a Nijmegen questionnaire, Hospital Anxiety and Depression (HAD) Scale, and the RoBE scale, and repeated this four days later. Reliability of the RoBE scale was supported in the intraclass correlation value of 0.69 for the BPD population, and Cronbach’s alpha values of 0.84 and 0.80 for the two data completions. The Mann-Whitney U analysis supported a statistically significant difference between the scores of the BPD and control populations, which was also seen in the median scores in first and second completions (BPD population 54/90 and 53/90, control population 89/90 and 90/90 respectively). When a cut-off score of 75/90 was applied, based on the distribution of the scores of the control group, this discriminated between the control and the BPD groups in 15/16 cases. The Spearman’s analysis did not show statistical significance comparing RoBE scores with the other questionnaires. The raw data showed a clear differentiation, however, therefore the lack of statistical significance may be due to the study being underpowered for such analysis. This study indicates the RoBE scale shows potential for assessing self-efficacy in the population of people with BPD, and further research is required to confirm this.
Physiotherapy and the shadow of prostitution: the Society of Trained Masseuses and the massage scandals of 1894
(AUT University, 2006-05-01) Nicholls, DA; Cheek, J
In 1894 the Society of Trained Masseuses (STM) formed in response to massage scandals published by the British Medical Journal (BMJ). The Society's founders acted to legitimise massage, which had become sullied by its association with prostitution. This study analyses the discourses that influenced the founders of the Society and reflects upon the social and political conditions that enabled the STM to emerge and prosper. The founders established a clear practice model for massage which effectively regulated the sensual elements of contact between therapist and patient. Massage practices were regulated through clearly defined curricula, examinations and the surveillance of the Society's members. A biomechanical model of physical rehabilitation was adopted to enable masseuses to view the body as a machine rather than as a sensual being. Medical patronage of the Society was courted enabling the Society to prosper amongst competing organisations. Using Foucault's work on power we explore the contingent nature of these events, seeing the massage scandals in context with broader questions of sexual morality, professionalisation and expertise in the late nineteenth century society. We argue that many of the technologies developed by the founders resonate with physiotherapy practice today and enable us to critically analyse the continued relevance of the profession to contemporary healthcare.
Older Adult's Participation in Everyday Occupations and the Consequences for Positive Aging in New Zealand
(World Federation of Occupational Therapists, 2006-07-23) Wright-St Clair, VA
Invited commentary: does stretching increase ankle dorsiflexion range of motion: a systematic review [by Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C]
(BMJ Publishing Group, 2006-08-01) Rome, K
Background: Many lower limb disorders are related to calf muscle tightness and reduced dorsiflexion of the ankle. To treat such disorders, stretches of the calf muscles are commonly prescribed to increase available dorsiflexion of the ankle joint. Hypothesis: To determine the effect of static calf muscle stretching on ankle joint dorsiflexion range of motion. Study design: A systematic review with meta-analyses. Methods: A systematic review of randomised trials examining static calf muscle stretches compared with no stretching. Trials were identified by searching Cinahl, Embase, Medline, SportDiscus, and Central and by recursive checking of bibliographies. Data were extracted from trial publications, and meta-analyses performed that calculated a weighted mean difference (WMD) for the continuous outcome of ankle dorsiflexion. Sensitivity analyses excluded poorer quality trials. Statistical heterogeneity was assessed using the quantity I2. Results: Five trials met inclusion criteria and reported sufficient data on ankle dorsiflexion to be included in the meta-analyses. The meta-analyses showed that calf muscle stretching increases ankle dorsiflexion after stretching for ≤15 minutes (WMD 2.07°; 95% confidence interval 0.86 to 3.27), >15–30 minutes (WMD 3.03°; 95% confidence interval 0.31 to 5.75), and >30 minutes (WMD 2.49°; 95% confidence interval 0.16 to 4.82). There was a very low to moderate statistical heterogeneity between trials. The meta-analysis results for ≤15 minutes and >15–30 minutes of stretching were considered robust when compared with sensitivity analyses that excluded lower quality trials. Conclusions: Calf muscle stretching provides a small and statistically significant increase in ankle dorsiflexion. However, it is unclear whether the change is clinically important.
The lived experience of occupational performance during recovery from mental illness
(AUT University, 2006-10-10) Sutton, D

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