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PHYSIOTHERAPY OUTCOME MEASURES

AND REHABILITATION

Priit Eelmäe, PT, MScUniversity of TartuInstitute of Exercise Biology and Physiotherapy

31 October 2007, Tartu

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Physiotherapy in Estonia -present situation and perspectives

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Professional standard

• Was elaborated and accepted at 2002 spring• 2004 – Estonian Physiotherapist’s

Association organizes first time licence examinations

• Professional standard enables 3 different categories

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Number of physiotherapists in Estonia

• ~400 but …• Regional problems • PT’s working mostly in hospitals• Private practice and community based

services practically doesn’t exist• FUTURE – as based to the Estonian

rehabilitation development strategy 2015 – we must have 900 PT on 2015 and 200 of them must work community based settings

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Number of physiotherapists and students entering PT education as compared

Europe to Estonia

Number of PTs per 100 000

Number of PT students entering PT education per year (per 100 000)

Europe (mean) 105,4 7,5

ESTONIA 20 1,3

1. SLCP, 19982. EPA, 2003

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Where in Estonia physiotherapists are educated?

1996 – 2000

1. Physiotherapists were educated in University of Tartu. Governmental order was every year 15 students.

Since 2001/02

1. University of Tartu

2. Tartu Medical School

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New model of Physiotherapy education in Estonia

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1Bachelor studies180 ECTS

Master studies120 ECTS

PhD studies240 ECTS

Continuing education

Post-graduate education

Under graduate education

years

Post basic education

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Structure of new curriculum of physiotherapy in University of Tartu

BACHELOR LEVEL (180 ECTS)

• 1 year – general + preclinical studies

• 2 year – preclinical + professional studies

• 3 year – professional studies

MASTER LEVEL (120 ECTS)

• 2 years – specialisation1. Children's physiotherapy

2. Adults physiotherapy

3. Geriatric physiotherapy

4. Sports physiotherapy

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The assessment of functioning and health – the bases of effective

physiotherapy

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Why we need

outcome measures

in physiotherapy?

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Outcome measures help us to change from opinionbased

to evidence based

Opinion-based• Based on opinions and consensus among

experts• Implicit• Individual preferences and interpretations• Authority based (static and non-critically

accepted)

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• What is evidence-based physiotherapy?– High quality clinical research

– Patient preferences

– Practice knowledge

• Why is evidence based physiotherapy important?– For patient

– For physiotherapists and profession

– For funders of physiotherapy services

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Evidence based practice

Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best of best research evidence and patient values

(Sackett 1996).

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Clinical guidelines

• Who should develop clinical guidelines?• International collaboration

– WCPT-Europe has agreed common position on guideline development methodology in physiotherapy (J. Mead & P. van der Wees, 2004)

• Uniprofessional or multiprofessional guidelines?

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PICO

The Questions about the effects of intervention are breaked into four parts (Sackett et al 2000)

• Patient or problem

• Intervention or management strategy

• Comparative intervention

• Outcome

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Example

Patient Intervention Comparison intervention

Outcome

Adult with acute low back pain

Bed rest Advice to stay active

Pain and disability

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Some examples

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First example

• The use of Woodway

tredmill training or ….

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Gait assessment

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Walking test in lab

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Testing of knee extensors strength with Cybex II type isokinetic dynamometer

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• Berg Balance Scale• Elderly Mobility Scale• Trendelenburg test

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Second example

Low Back Pain

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• VAS ?• Oswestry Back Pain Disability Index ?

• Opened or closed questions?

Pain Assessment

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Lassegue test

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The assessment of spinal and abdominal muscles maximal strength (Häkkinen et. al., 2003)

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Assessment and training of deep spinal muscles with Bio-Feedback System

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Dynamic endurance test for abdominals (Friedrich jt. 1998) (Häkkinen jt. 2003)

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Only after assessment physiotherapist can recommend exercises

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Only after assessment physiotherapist can recommend exercises

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For the measurement range of motion of cervical spineis used KENO Cervical

Measurement System

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For muscle strength measurements is possible to use digital Manual Muscle

Tester

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Assessment of wrist flexors and extensors maximal voluntary contraction

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Assessment of arm flexors and extensors maximal voluntary contraction

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Thank you for attention!