Conference Proceedings 5-6 April 2013

St. David’s Lecture Theatre, University of Otago

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Contents

Letter of Welcome ................................................................................................................................... 2

Sponsorship ............................................................................................................................................ 3

Acknowledgements ................................................................................................................................. 4

Programme.............................................................................................................................................. 5

General Information ................................................................................................................................ 9

Social Functions .................................................................................................................................... 11

Keynote Speakers ................................................................................................................................. 12

Invited Speakers ................................................................................................................................... 15

Concurrent sessions ............................................................................................................................. 18

Conference Opening ..................................................................................................................... 19

Prevention Session ....................................................................................................................... 20

Prevention Stream 1 ..................................................................................................................... 21

Prevention Steam 2 ....................................................................................................................... 26

Education Session ........................................................................................................................ 31

Intervention Session ...................................................................................................................... 33

Intervention Stream 1 .................................................................................................................... 34

Intervention Steam 2 ..................................................................................................................... 39

Acupuncture Session .................................................................................................................... 44

Participation Session ..................................................................................................................... 46

Participation Stream 1 ................................................................................................................... 47

Participation Steam 2 .................................................................................................................... 52

Physiotherapy Profession ............................................................................................................. 57

Evaluation Session ........................................................................................................................ 59

Evaulation Stream 1 ...................................................................................................................... 61

Evaluation Stream 2 ...................................................................................................................... 65

Education ...................................................................................................................................... 70

Poster .................................................................................................................................................... 72

Notes: .................................................................................................................................................... 78

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Letter of Welcome

I would like to welcome you to the School of Physiotherapy Centennial Scientific Conference – PhysioForward 2013. Our School is the oldest School of Physiotherapy in the country. To celebrate 100 years of physiotherapy education in New Zealand we are hosting a conference that not only reflects on the past, but more importantly, looks to the future.

This conference will showcase innovative and thought-provoking research in the areas of physiotherapy and rehabilitation from across the world and New Zealand. The fundamental theme of the conference is the future of physiotherapy practice in a changing health delivery climate. The conference will be divided into four presentation themes key to the physiotherapy and rehabilitation professions both clinically and at a research and policy level. These themes are: prevention, intervention, participation and evaluation. We hope you will take this opportunity to connect with the physiotherapy profession and its partners and look forward to meeting with you over the days of the conference.

Associate Professor Leigh Hale CHAIR – CONFERENCE ORGANISING COMMITTEE

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Sponsorship

The School of Physiotherapy are very pleased to acknowledge the support of the following sponsors. All conference sponsors will be hosting exhibitions in the St David Theatre. Premiere Sponsorship: Physiotherapy New Zealand

Keynote Sponsor: Canon

The School of Physiotherapy also acknowledges the financial support of the following: Maurice and Phyllis Paykel Trust Otago/Southland Branch Trust

PNZ Otago

Exhibition supporters: Back in Motion, Australia Physio Pac Trifour Technics Ltd.

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Acknowledgements

Scientific Committee Associate Professor Leigh Hale (Chair) Dr. Cath Smith Dr. Gisela Sole Dr. Steve Tumilty Donna Keen Scientific Conference Advisory Group Dr Cathy Chapple, Assoc. Prof Stephan Milosavljevic Nathan Wharerimu Dr Stephanie Woodley Janet Copeland Centenary Planning Group Prof. David Baxter (Chair) Dr. Margot Skinner Donnella Aitken-Ferguson Trish Didham Dr Gill Johnson Sinéad Kearney Elisabeth Lukeman Judith McCracken Student Volunteers Aleksandra Macznik Daniela Aldabe Hemakumar Devan Divya Adhia Susan Baxter Poonam Mehta The Academic and Administrative Staff of the School of Physiotherapy The Scientific Conference committee would also like to acknowledge the participation of all our Keynotes, Invited speakers, Platform and Poster presenters, and Conference Delegates.

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Programme

Thursday 4th April

4:00pm Registration Open

5:30-6:30pm

Conference Welcome drinks Venue: St. David’s Lecture Theatre

Friday 5th April

8.45am Conference Welcome and housekeeping Mihi Whakatau

9.10am Prof. Jeff Basford, (St. David’s Lecture Theatre)

9.50am Hon. Tariana Turia Minister of Disability Issues & Assoc. Minister of Health (St. David’s Lecture Theatre)

10.00am Prevention session: Prof. Elizabeth Dean St. David’s Lecture Theatre

10.40am Morning Tea

Prevention - Stream 1 (St. David Lecture Theatre)

Prevention - Stream 2 (RM 1)

Education (RM 3)

11.00am Invited speaker: Prof. Keith Hill Venue: St. David’s Lecture Theatre

Invited speaker: Dr Margot Skinner

11.30am Hale, L. ‘Facilitating long-term physical activity for people with Multiple Sclerosis’

Clay, L. ‘Quad bike accidents on NZ farms – “she’ll be ‘right’, it won’t happen to me”!’

Dissanayaka , T. ‘A comparison of male and female Physiotherapy students’ perception from problem based learning in Musculoskeletal Physiotherapy’

11.50am Wurzer, B. ‘Community-based peer-led group exercise programme for older adults at-risk of falling: types of injuries sustained at 12-month follow-up’

Tantisuwat, A. ‘Effects of smoking on respiratory function in youth people’

O’Brien, D. ‘Students self-evaluation of their interprofessional skills following a placement at AUT’s Akaoranga Integrated Health Clinic’

12.10pm Sole, G. ‘Compensatory changes and influence of footwear during stair

Behrmann, J. ‘An end to the primacy of cost-efficacy: a relational approach to

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ascent and decent following knee injury: a knee osteoarthritis perspective’

triage for physiotherapy services’

12.30pm Arumugam, A. ‘Effects of application of a pelvic compression belt on isokinetic strength of the thigh muscles in healthy sportsmen’

Mandic, S. ‘Exercise capacity and cardiovascular function in healthy individuals and coronary artery disease: Effects of regular physical activity’

12.50pm Lunch and Poster Session

2pm Intervention session: Prof. Bill Vicenzino

Intervention - Stream 1 (St. David Lecture Theatre)

Intervention - Stream 2 (RM 1)

2.40pm Caldwell, K. ‘Does low level laser therapy reduce pain from cracked or grazed nipples in breastfeeding Western Australian women?’

Kanagasabai, P. ‘Effect of multisensory stimulation on neuromotor development in preterm infants’

3.00pm Aldabe, D. ‘Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis?’

Phillips, R. ‘Does use of the cough assist machine reduce hospitalisation time for children with neuromuscular weakness?’

3.20pm Afternoon Tea

Intervention - Stream 1 continued (St. David Lecture Theatre)

Intervention - Stream 2 continued (RM 1)

Acupuncture (RM 3)

3.40pm Invited speaker: Prof. Julie Hides 'Effect of Motor Control Training on muscle size and football games missed due to injury'

Invited speaker: Dr Andrea Cheville

4.10pm Woodley, S. ‘Proximal hamstring anatomy and its potential relevance to acute strains’

Kannan, P. ‘Systematic review and meta-analysis of randomized controlled trials of physiotherapy interventions for primary dysmenorrhea’

Schneiders, T. ‘The homeostatic effect of acupressure on systolic and diastolic blood pressure’

4.30pm Sole, C. ‘Patterns of mediolateral footwear asymmetry found in commonly used footwear’

Beatti, A. ‘A double-blind placebo-controlled investigation into the effects of interferential therapy on experimentally induced pain using a cross-over design’

Macznik, A. ‘A review of the evidence for the use of acupuncture for sports injury management’

4.50pm Panel discussion/Q&A session (keynotes and invited speakers – 6 people)

6.30pm Conference dinner

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Saturday 6th April

9.00am Participation session: Prof. Steve Wolf (St. David Lecture Theatre)

Participation - Stream 1 (St. David Lecture Theatre)

Participation - Stream 2 (RM 1)

Physiotherapy profession (RM 3)

9.50am Baxter, S. ‘Rheumatoid Arthritis and its management by Physical Activity: What people with RA want’

Mulligan, H. ‘Participatory Action Research to develop a programme for self-management of fatigue in multiple sclerosis’

McMeeken, J. ‘A shared past, a shared future….’

10.10am Ward, L. ‘Yoga for musculoskeletal conditions: A Delphi survey to establish international consensus of core intervention components’

Snowdon, J. ‘Self-management of fatigue for people with Multiple Sclerosis: an innovate programme developed with people with MS’

Graham, J. ‘Working outside the box’

10.30am Morning Tea

Participation - Stream 1 continued (St. David Lecture Theatre)

Participation - Stream 2 continued (RM 1)

11.00am Invited speaker: Prof John Sullivan

Invited speaker: Prof. Aimee Stewart

11.30pm Darlow, B. ‘The attitudes and beliefs of New Zealanders about low back pain’

Hamilton, J. ‘Communicating rehabilitation messages through story, with reference to cerebral palsy in Papua New Guinea’

11.50pm Smith, C. ‘Effects of the Canterbury earthquakes on physiotherapists and physiotherapy service provision: A qualitative study’

Bryant, K. ‘Using Kaupapa Maori Research principles to guide the development of the Haua Maori project’

12.10pm Lunch

12.30pm PNZ AGM

2.00pm Evaluation session: Prof. Maurits Van Tulder (St. David Lecture Theatre)

Evaluation - Stream 1 (St. David Lecture Theatre)

Evaluation - Stream 2 (RM 1)

Education (RM 3)

2.40pm Mehta, P. ‘Outcome measures in randomized controlled trials of neuropathic pain conditions: a systematic review of systematic reviews’

Ribeiro, D. ‘Dose-response relationship between work-related cumulative postural exposure and low back pain: A systematic review’

Caswell, P ‘Participation in education to achieve better outcomes – learners and their physiotherapists share the same goals’

3.00pm Devan, H. ‘Physical activity and low back

Mani, R. ‘Adherence to low back pain

Robinson, P. ‘Assessment of

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pain in persons with traumatic transfemoral amputation: a national cross-sectional survey’

guidelines and its perceived clinical utility among physiotherapists in New Zealand: A national survey’

student clinical competence; do clinical educator student assessments vary and does moderation reduce variance?’

3.20pm Afternoon Tea

Evaluation - Stream 1 continued (St. David Lecture Theatre)

Evaluation - Stream 2 continued (RM 1)

3.40pm Invited speaker: Prof David Baxter

Invited speaker: Assoc. Prof. Louise Ada

4.10pm Higgs, C. ‘Evaluation of clinical outcomes form a pilot education and exercise programme for people with chronic health conditions’

Winser, S. ‘Psychometric properties of clinical outcome measures for balance in cerebellar ataxia: A systematic review’

4.30pm Kwan, J. ‘ASRU Live well: evaluation of a weight management and wellness programme for people with a spinal cord injury’

Adhia, D. ‘Palpation-digitization of pelvic landmarks for non-invasive innominate kinematic assessment: An inter-tester reliability..’

4.50pm Closing address

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General Information

Information and Registration Desk Hours The registration desk will be open on Thursday 4 April from 4.00pm until 6.30pm. It will re-open at 8.00am until 5.30pm on Friday 5 April and 8.00am until 5.30pm on Saturday 6 April. Contact Details: During the day and after hours 021 2099304 Daily Notices All information or changes to the programme and other items of interest will be posted daily on the notice board. Housekeeping announcements will be made during the plenary sessions as and when required. Transport

Airport Transfers Registrants are advised to make their own arrangements and to speak to their accommodation venues about their airport transfers. Please have your flight number and departure time available for them.

Airport Shuttles Airport Shuttles are an affordable way to get to Dunedin Airport, especially for the solo traveller. Each way will cost approximately $20-$25 and we strongly recommend that you book your shuttle in advance. Walk-ups are welcome but are dependent upon availability. Dunedin Taxis Phone 03 477 6611 www.dunedintaxis.co.nz/services#shuttles Super Shuttle 0800-SHUTTLE (748885) www.supershuttle.co.nz Kiwi Shuttles Phone 03 487 9790 Mobile 027 277 3852 www.kiwishuttles.co.nz

Taxi Services Dunedin Taxis 03 477 7777 United Taxis Phone 03 455 5555 www.unitedtaxis.co.nz City Taxis Phone 03 477 1771 or 0800 771 771 www.citytaxis.co.nz Internet Access Free wireless access is available at the venue. See the Information desk for access codes and instructions Emergencies, Medical Needs and Illnesses

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Housekeeping notices at the beginning of each day note health and safety precautions for the venue. If you have any medical needs please see the Information desk. Outside medical emergency: please contact Dunedin Urgent Doctors on 03 479 2900

http://www.dunedinurgentdoctors.com/

Conference Meetings

PNZ AGM 12.30 -2.00 pm. St David Lecture Theatre Meeting Room: Book at Registration Room 4 at St. David is available to be used as a meeting room. Please see the Information desk to make a room booking. Conference Prizes PNZ Otago are proud to support the Centennial Conference 2013. In keeping with the Southern Physiotherapy Symposium theme, we would like to award a prize for the presentation with the most significant clinical relevance. The $500 prize will be awarded by a group of PNZ Otago members. The winner of the prize will be announced at the conclusion of the conference proceedings on Saturday afternoon.

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Social Functions

Thursday 4th

April Welcome Drinks The School of Physiotherapy welcomes you to join them for an informal conference opening from 5.30-6.30pm at St. David Lecture Theatre Evening meal is by own arrangements Friday 5

th April Gala Dinner

A Gala dinner will be held to celebrate the School of Physiotherapy 100 year Alumni Celebrations and the Physio Forward Conference Venue: The University Link Time: 6.30 Dress: Semi Formal Saturday 6

th April Farewell and Thank You Drinks

Time: 5.00pm following the end of the conference Light refreshments

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Keynote Speakers

Dr. Jeff Basford Mayo Clinic

Jeffrey Basford, M.D., Ph.D. has a diverse background that includes a PhD in physics, teaching in the Middle East, service as an Army officer and a period of scientific consulting which culminated in completing residency training in Physical Medicine and Rehabilitation in 1980. Doctor Basford has been a member of the Department of Physical Medicine and Rehabilitation at the Mayo Clinic since 1982 where his clinical responsibilities have emphasized neurological rehabilitation. Doctor Basford's research has focused on central nervous system rehabilitation and the effects of physical agents on the body. Dr. Basford is currently Professor of Physical Medicine and Rehabilitation at Mayo, director of its Research Training Program and past chair of its research committee. He has served on numerous editorial boards, thesis committees and advisory panels. He is currently Chair of the NIH Function, Integration and Rehabilitation Subcommittee and editor in chief of the Archives of Physical Medicine

Prof. Elizabeth Dean University of British Columbia Professor Elizabeth Dean is on faculty in the Department of Physical Therapy, University of British Columbia, Canada, and Adjunct Professor, Department of Physical Therapy, Iceland. Her academic and clinical career and experiences have spanned 30 countries. Because lifestyle-related conditions are pandemic not only in high-income countries, her research and publications have increasingly focused on integrating and translating knowledge of cultural relativism and diversity in promoting health and wellness worldwide. She is especially interested in exploiting evidence-based non-invasive physical therapy interventions (healthy lifestyles including health education and exercise) to prevent, in some cases reverse, as well as manage these conditions that are associated with enormous human suffering and societal cost. Along with an international team, Dr. Dean convened two physical therapy summits on global health at the World Confederation of Physical Therapy Congress 2007 and 2011. She is co-editor (with Donna Frownfelter) and co-author of Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice (5th edition) (Elsevier: PA, 2013). She served as Special Issue editor for Physical Therapy in the 21st Century: a New Evidence-informed Practice Paradigm and Implications (Physiotherapy Theory and Practice, 2009). Her work through private practice and the UBC Post Polio Clinic has taken her to Pakistan on an Asia Pacific University Scholar’s Award. She practiced for over a year as Senior of the Cardiovascular/ Cardiorespiratory Team with the Kuwait Dalhousie Project in Kuwait, and spent a year as a resident Visiting Professor at the Hong Kong Polytechnic University.

Hon. Tariana Turia

Minister, New Zealand Government

Hon Tariana Turia, Member for Te Tai Hauauru, Māori Party Current Parliamentary Roles o Co-Leader o Minister for Whānau Ora o Minister for Disability Issues o Associate Minister of Health o Associate Minister of Housing o Associate Minister for Social Development o Associate Minister for Tertiary Education, Skills and Employment o Member, Officers of Parliament Committee o Member, Privileges Committee

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Career o Former Southern Regional Co-ordinator, Māori Access training programmes o Worked in Māori Affairs Head Office o Former Chief Executive, Te Oranganui Iwi Health Authority o Manager, Whanganui Regional Development Board Trust 1989-1989 o Manager, Whaioranga Iwi Social Services Unit 1991-1991 o Service broker, Te Puni Kokiri (Whanganui Office) 1993-1995

Community activities o Former member, Evaluation team, first pilot cervical screening project for Māori women o Former member, Kura Kaupapa Māori establishment task forces o Founding team member, Te Awa Youth Trust 1980-1980

Prof. Maurits van Tulder VU University Professor van Tulder is head of the Health Economics and Health Technology Assessment section, and Vice-dean, Faculty of Earth and Life Sciences at the VU University and the VU University Medical Centre in Amsterdam, the Netherlands. He is director of the Musculoskeletal Health Research program of the EMGO+ Institute for Health and Care Research, and director of the Research Master Program Lifestyle & Chronic Disorders. He is a highly experienced epidemiologist and his main research interests are musculoskeletal disorders, with a methodological focus on systematic reviews and economic evaluation. Professor van Tulder is co-editor of the Cochrane Back Review Group, Deputy Editor of the European Spine Journal and has been chairman or committee member for at least 5 low back pain and several other clinical guidelines. As such he has led the field in summarising the latest evidence for the management of low back pain. He is a frequent invited speaker at scientific conferences. Professor van Tulder has ample expertise in designing and analysing trials incorporating economic evaluations and systematic reviews. He has published more than 250 scientific papers in international peer reviewed journals; his h-index is 43.

Prof. Bill Vicenzino

University of Queensland

Bill's scholarship is focused on musculoskeletal health, pain and injury with an emphasis on sport and physical activity, where there is a need for evidence based approaches to rehabilitation and prevention. Since graduating as a physiotherapist in 1980, Bill has worked in musculoskeletal and sports physiotherapy, mainly in private practice. During his time in practice and spurred on through his postgraduate coursework studies in Sports and Musculoskeletal Physiotherapy (1984, 1990) he developed a particular interest in the underpinning evidence for physical therapies – which ones work, why and how? His PhD (2000) focused on mechanisms of spinal manipulative therapy and resulted in publication of an evidenced based theoretical model for this physical treatment. His recent book 'Mobilisation with Movement: The art and the science', which evolved from those early studies, was in the top 10 best sellers at Elsevier Health [Health Professionals Category] in its first year of publication. Lately his clinical research has focused on treatments for overuse injuries (e.g., tennis elbow and patellofemoral pain), with a number of randomized clinical trials attracting NHMRC funding and being published in high impact medical journals (BMJ, Lancet). This research has questioned the common use of steroid injections for tendinopathy and showed how physical treatments provide effective early resolution of the condition. Bill led a recently completed ARC linkage project with the Australian Institute of Sport that improved our understanding of exercise (cross training) and physical therapies such as tape and orthoses on neuromuscular control of the leg and foot. This involved a team of 4 PhD scholars and a post-doctoral industry fellow, with a number of publications in high impact exercise science journals (e.g., Medicine and Science in Sport and Exercise). One of the interesting findings from this work was that cycling prior to running in triathlon leads to impaired muscle control in

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some athletes and that these are associated with stress injuries of the leg. A specific exercise approach was then shown to mitigate the poor neuromotor control. Bill is currently collaborating as a chief investigator on a NHMRC program grant pursuing further the issues pertaining to musculoskeletal pain and injury, which in part is invigorating his drive to understand better the underlying problems in painful tendons. Bill has communicated his findings from his research in 125 peer reviewed journal publications, a book and 26 book chapters and over 300 invited workshops, seminars and conference presentations. He has been supervisor for 21 PhD candidates, 11 of which have graduated. Bill is the co-ordinator for the coursework Master of Sports Physiotherapy program at the University of Queensland and teaches across undergraduate and postgraduate programs in musculoskeletal healthcare, focusing on lower limb and sports physiotherapy. He contributes to the publication of knowledge through service as an Associate Editor for the Journal of Orthopaedic and Sports Physical Therapy and the British Journal of Sports Medicine, Editorial Board member of Physiotherapy Practice and Research, as a member of the International Editorial Panel for Manual Therapy as well as an ad hoc reviewer to a number of medical, sport and rehabilitation journals. He also serves as the UQ Chair of the Medical Research Ethics Committee.

Prof. Steve Wolf Emory University Steve received his AB in Biology from Clark University, his physical therapy certificate from Columbia University, MS in physical therapy from Boston University and his Ph.D. in neurophysiology from Emory University. He has defined the selection criteria for the application of EMG biofeedback to restore upper extremity function among chronic patients with stroke. These findings became the inclusion criteria for most constraint induced movement therapy stroke studies. He recently completed his role as Principal Investigator for the NIH nationally funded EXCITE Trial, the first multi-center Phase III non–surgical, non-pharmacological, upper extremity stroke rehabilitation study ever funded by the NIH. Steve’s interests in feedback also led to the comparison of center of pressure biofeedback with Tai Chi for falls reduction in older adults. He has over 200 publications and 700 national and international presentations on these topics. He has served in multiple administrative and leadership capacities for the American Physical Therapy Association and for groups associated with the promotion of research and clinical service within neurorehabilitation. He is the recipient of the Marian Williams Award for Research Golden Pen Award, Georgia Merit Award, Physical Therapy Association of Georgia; Catherine Worthingham Fellowship; Robert C. Bartlett Recognition Award, Foundation for Physical Therapy; Distinguished Service Award, Section on Clinical Electrophysiology; Helen J. Hislop Award for Excellence in Contributions to Professional Literature; Lucy Blair Service Award; Section on Geriatrics outstanding published paper award; Neurology Section, Outstanding Researcher Award; Mary McMillan Lecturer. He has been a keynote speaker for many organizations and as a commencement speaker for several institutions and has served on several study sections and advisory boards for the NIH.

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Invited Speakers

Prof. Louise Ada University of Sydney Prof Ada has an academic position with teaching, administrative and research responsibilities, in the Discipline of Physiotherapy, Clinical and Rehabilitation Sciences Faculty Research Group, Faculty of Health Sciences, University of Sydney. Prof Louise Ada's research career has focused on rehabilitation after stroke. In particular, she has completed high-impact studies examining the contribution of motor impairments to physical disability which have strongly influenced stroke rehabilitation. In addition, her increasing number of randomised controlled trials into rehabilitation of stroke patients have all been included in the NHMRC-approved guidelines Recovery and Rehabilitation after Stroke. Louise has delivered plenary presentations at international and national conferences, at both physiotherapy and multidisciplinary forums on stroke and neurological rehabilitation. Prof Ada has over 90 peer-reviewed articles in both international and national journals. She has published her theoretical work in international journals with high impact such as Brain and Journal of Neurology, Neurosurgery, and Psychiatry, her rehabilitation studies in the leading rehabilitation journals such as Archives of Physical Medicine and Rehabilitation, and her work of relevance to a physiotherapy audience in the Australian Journal of Physiotherapy, now the leading international physiotherapy research journal. She has also the Editor of edited 2 books and authored of three contributing 14 book chapters. Prof Louise Ada has recently been awarded the Australasian Association of Consultants in Rehabilitation Medicine Prize by The Royal Australasian College of Physicians (2011), The Vice-Chancellor’s Award for Support of the Student Experience Teaching, The University of Sydney (2011) and the Support of the Student Experience Teaching Award, Faculty of Health Sciences, The University of Sydney (2010). Prof Louise Ada also received the JO Miller Award for Excellence in Teaching, Faculty of Health Sciences, the University of Sydney (2005).

Prof. David Baxter University of Otago David Baxter’s research interests are varied, and his approach to researching clinical problems pragmatic: He is currently involved with analysis of results from a large survey of use of complementary and alternative medicine in the general population (part of the Northern Ireland Life and Times Survey), and a developing multinational network project which is focussed on the use of activity monitors in rehabilitation. Current project include: Activity monitoring in low back pain; laser therapy: effectiveness in tendinopathies; complementary and alternative medicine for the relief of pain; use of complementary and alternative medicine in the general population; auricular acupuncture personalised exercise programme (APEP) trial.

Dr. Andrea Cheville Mayo Clinic Andrea’s research focuses on the delivery of supportive care services to optimize the functionality and quality-of-life for patients with cancer in all disease stages.

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Her research goals are: o Identifying novel strategies to protect critical elements of the lymphatic system during primary

cancer treatments; and facilitating lymphatic healing in order to reduce risk of developing secondary lymphedema.

o Developing novel models for the delivery of supportive cancer care that overcome traditional logistic, geographic and cost barriers.

o Clarifying the physiologic mechanisms by which symptom burden, physical functioning and stress reciprocally interact in order to develop improved treatment approaches.

Prof. Julie Hides Australian Catholic University Areas of Research o Motor control training for those with low back pain o The use of ultrasound imaging in rehabilitation o The effectiveness of motor control training for elite athletes o Muscle imbalance in elite athletes

Interests o Innovative use of imaging techniques in physiotherapy teaching o Prevention of low back pain and musculoskeletal disorders

Prof. Keith Hill Curtin University Keith Hill graduated from Lincoln Institute of Health Sciences in 1980. He has worked primarily in gerontological and neurological physiotherapy clinical roles. Since completing his PhD at The University of Melbourne in 1998, investigation balance dysfunction in older people, he has transitioned to a primarily research role at the National Ageing Research Institute, and La trobe University (2007-2012). In January 2012, he commenced as Head of the School of Physiotherapy at Curtin University .

Dr. Margot Skinner University of Otago Margot graduated from the New Zealand School of Physiotherapy and obtained both her post graduate degrees from the University of Otago. Her PhD, undertaken in the Dunedin School of Medicine was titled 'Conservative therapies for the management of obstructive sleep apnoea'. Before moving into the academic field Margot's practice was mainly hospital based in acute medicine and surgery including intensive care units. Margot's role in the School of Physiotherapy has included various administrative and curriculum development roles whilst still continuing to teach and undertake research in the cardiopulmonary area. Margot also has an international profile as a member of the WCPT Executive Committee.

Prof. Aimee Stewart University of the Witwatersrand Prof Aimée Stewart is an Associate Professor responsible for the development of post-graduate research in the Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa. She is a National Research Foundation (NRF) rated researcher and leads the NRF Research Niche Area on the management of chronic disease and

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disability, including HIV/AIDS. Much of her research has focussed on the role of the family in supporting life style changes in chronically ill patients, and she was awarded her PhD in 2003 for work in this area. She is internationally recognised having served as the Africa representative on the International Scientific Congress Committee of the World Confederation of Physical Therapy for the WCPT congress in 2011 , and as a regular adviser and examiner to the Kigali Health Institute of Rwanda. Much of her work in Kigali has been focussed on the development, establishment and review of their four-year physiotherapy degree programme. She has over 80 publications in local and international journals, and has presented her work at many local and international conferences. Her mentorship and successful supervision of 13 PhD and 40 MSc students to completion from South Africa, a number of African countries and India has led to the emergence of a vibrant research culture within the department. The production of these graduates is an important contribution of resources focussed on the management of chronic disease and disability within public health care. She regularly examines both local and international post-graduate theses and has served on many committees at the university and in the profession. She was awarded an exceptional service medal by the Faculty of Health Sciences in 2007. She was the winner of the South African Department of Science and Technology “Distinguished Women in Science” award in the Social Sciences and Humanities category in 2011 and received a WCPT Africa Service Award in 2012 for her work in Rwanda.

Prof. John Sullivan University of Otago John Sullivan is a Professor in the Centre for Physiotherapy Research at the University of Otago. He received his Diploma in Physical Education from the University of Otago and a Master’s and PhD in Kinesiology from the University of Waterloo (Canada). John joined the staff of the School of Physiotherapy in 1996 following working at Concordia University and the Montreal Rehabilitation Institute in Montreal, Canada. He has published research in the following areas: the measurement of neurological deficits; the use of therapeutic massage; the role of physical activity in the rehabilitation process following a traumatic brain injury; the development of tools for the assessment of a sports concussion and, the knowledge and awareness of concussive brain injury information and best practice management guidelines. His current research is focused on the understanding of the role of social media in concussion awareness and management.

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Concurrent sessions

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Friday 5th

April

Conference Opening

8.45am St David Lecture Theatre Chair: Leigh Hale Conference Welcome and Housekeeping Mihi Whakatau 9.10 am.

Keynote: Prof. Jeff Basford Chair: Leigh Hale

Rehabilitation Research Trends: Challenges and Opportunities

The goal of rehabilitation is the improvement of the lives and function of people. In the past our care has tended to improve empirically with its ties to a firm research basis often questionable. Today economics and societal expectations dictate a more organized and prioritized approach. The changes required are not trivial as they require a balancing of values, knowledge and, at times, sacrifice of our own interests. Much, however, has already been accomplished with a number of national and international bodies identifying a several common priorities. Among these are the need to 1) improve our research infrastructure and the quality of its output; 2) precisely measure functional change; 3) effectively translate meaningful findings into practice and 4) deliver health care delivery cost-effectively. Translation of these priorities into specific initiatives is underway and funding agencies are increasingly requiring proof of comparative effectiveness and functional endpoints. This presentation will briefly outline the above issues and then review their impact on the researcher. Here the picture is overall positive but mixed. Research quality is improving. Enhanced infrastructure and training have increased the number of researchers and the volume of their output. Conversely, academic promotion and retention remain tied to external funding while the level of competition for support has skyrocketed. Larger, more sophisticated studies have become the norm with papers publishable a decade ago now being rejected. Our field is clearly improving, but we must adapt to survive. Life in an isolated area of research is more difficult, but if we are willing to change, the value of our work will benefit.

9.50am

Keynote: Hon. Tariana Turia Chair: Leigh Hale

Minister of Disability Issues and Assoc. Minister of Health

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Prevention Session

10.00am St David Theatre Chair: Leigh Hale

Keynote: Prof. Elizabeth Dean

PhysioForward in the 21st Century: Interprofessionalism and Implications for Health-focused Practice This key note takes a serious look at physiotherapy's role in health care this century and on the health care team. Interprofessional health care is a much used term in health care today, but what does it mean, how does it differ from conventional multiprofessional health care, and are outcomes better. What are the implications for physiotherapy practice, entry-level education, and research? This address tackles these forward-looking questions and concludes that if health care outcomes are to be maximal this century, offering the best cost: effective benefit, the physiotherapy profession needs to ensure it has a clear position for the 21st century and that it can articulate its role in specific terms. The evidence supports that physiotherapy like other health professions needs to reconfigure to align itself with 21st century trends and public expectations. Interprofessional care may be a central vehicle in this process.

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Prevention Stream 1

11.00am St. David Lecture Theatre Chair: Dr. Cath Smith

Invited Speaker: Prof. Keith Hill

Balance impairment in older people with Alzheimer's Disease: Is it a problem, and can a home based exercise program improve performance? Hill K

1,2, Suttanon P

2,3,4, Dodd K

4, Said C

5, Williams S

2, Byrne N

2, LoGiudice D

6, Lautenschlager N

7.

1Curtin University (Australia),

2National Ageing Research Institute (Australia),

3Thammasat University

(Thailand), 4La Trobe University (Australia),

5Austin Health (Australia),

6Royal Melbourne Hospital

(Australia), 7The University of Melbourne (Australia).

Falls are common in people with Alzheimer’s disease (AD), and become more frequent with disease progression. Two studies are reported: Study 1 comparing balance performance in people with mild-moderate AD and age and gender matched controls; Study 2 investigated the feasibility, safety, and preliminary evidence of the effectiveness of a home-based exercise program in improving balance and mobility and reducing falls risk of for people with AD. Method: Study 1- 25 community-dwelling people with mild to moderate Alzheimer disease (mean age=81.0, 64% female) and 25 cognitively intact age- and gender-matched people completed a comprehensive balance and mobility assessment. Study 2-Forty community dwelling people with mild-moderate AD (mean age=81.9, SD=5.72; 62.5% female) were recruited, and randomised to a 6 month home-based individually tailored balance, strengthening and walking exercise program, or a 6 month home-based education program (control). Carers were actively involved in supervising the exercise program. Participants were assessed at baseline and 6 months on validated measures of balance, mobility, falls risk and falls. Intention-to-treat analysis using a generalized linear model with group allocation as a predictor variable was used to evaluate program effectiveness. Feasibility and adverse events were systematically recorded at each contact. Results: Study 1- Standing balance in people with AD was significantly impaired across a range of static and dynamic balance conditions, activity level, gait, and mobility measures (p<0.05). Study 2-No adverse events were reported by participants in the exercise program. 58% the 19 exercise participants finished the program, with 83% adherence for these participants. Significant improvements were achieved for the exercise group relative to the control group on Functional Reach (p=0.002) and the Falls Risk for Older People-Community score (p=0.008). Trends for improvement were also evident for several other balance, mobility, falls and falls risk measures in the exercise group relative to the control group. Balance is impaired in people with mild to moderate severity AD. A home based exercise program targeting balance appears feasible and safe, and may improve balance performance and reduce falls risk in this group.

22

11.30am Facilitating long-term physical activity for people with Multiple Sclerosis Hale LA

1, Smith C

1, Mulligan H

1 and Treharne GJ

2

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand 2Department of Psychology, University of Otago, Dunedin, New

Zealand Participation in physical activity (PA) is important for health but long term engagement is challenging for people with multiple sclerosis (MS). We developed an approach called “Blue Prescription” (BP). to enhance PA adherence based on three evidence-based factors: 1) choice of activity, (2) control over level of engagement, and (3) support in choice of activity with advice and encouragement over time from a physiotherapist. The physiotherapist uses motivational interviewing techniques to assist the person to set goals around PA levels, to choose the desired PA and to problem-solve how the desired PA programme can be achieved, and then supports the person using e-mail, telephone or text messaging. Later volitional help sheets assist the person with maintaining their level of engagement long term. Our exploratory study investigated the benefits and acceptability of BP for 26 people with MS using a non-controlled before-after design. The primary outcome at baseline and three months later was the MS Impact Scale (MSIS-29). Data were analysed with Wilcoxon signed ranks test. In-depth interviews explored acceptability. The General Inductive Approach was used to analyse these data. The physical component of the MSIS-29 significantly improved by a median change of 6.5 (95% CI -10.5 to -2.0; p=0.007). Qualitative analysis identified ‘support’ as a key theme with the sub-themes signifying the importance of ‘The relationship’, ‘The approach’, and ‘Supporting myself’. BP had a favourable impact on the lives of our participants; they felt supported and motivated to engage in physical activity, and enhanced self-efficacy enabled them to support themselves.

23

11.50am

Community-based peer-led group exercise programme for older adults at-risk of falling: types of injuries sustained at 12-month follow-up

Wurzer BM1, Hale LA

1, and Waters DL

2

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand 2Department of Preventive and Social Medicine

University of Otago, Dunedin The Steady-As-You Go (SAYGO) programme is a peer-led fall prevention programme for older adults, and has shown to improve measures of strength and balance, thus reducing falls risk. However, details about falls and related injuries have not been investigated. This paper presents the number of falls and fall-related injuries during a 12-month follow-up of older adults attending the SAYGO programme. All Otago region class attendees of existing groups were invited to participate. Consent and baseline data were obtained from 210 people. Falls were monitored on a monthly basis via self-reported falls calendars and fall event questionnaires. Injurious falls that required medical attention were followed up by phone to obtain detailed information about the fall using a structured questionnaire. Three participants were excluded and at 12-month follow-up, three participants passed away and 30 withdrew. Data were completed for 14 males and 159 females (a total of 174 attendees, average age 77.5 years, SD 6.5, range 61-99). More than a third (n=55) out of a total of 148 falls that occurred did not result in any injuries. Reported injuries were primarily sprains and bruises that did not require medical attention. Twenty-six people sought medical attention, of which six people sustained a fracture. None were hip fractures. This study showed that the majority of injuries reported were minor sprains and bruises, with no hip fractures. Further research is needed to determine if older adults at-risk of falling who attend community-based peer-led exercise classes sustain less severe injuries after a fall.

24

12.10pm

Compensatory changes and influence of footwear during stair ascent and decent following knee injury: a knee osteoarthritis perspective Sole G

1, Carman A

1 and Mündermann A

2

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand 2Department of Orthopaedics, University Hospital Basel, Switzerland

Individuals with anterior cruciate ligament (ACL) or meniscus injuries are at increased risk for early-onset knee osteoarthritis. Changes in knee loading, evident by changes in kinematics and kinetics, potentially contribute towards osteoarthritis. The aims were to compare knee kinematics and kinetics during stair ascent and descent of the injured to uninjured sides for individuals with ACL and/or meniscus injuries, and explore the effect of footwear on these variables. Twenty participants (5 females) with such injury within the past 36 months underwent three-dimensional gait analysis during stair ascent and descent. Stance phase sagittal and frontal plane knee kinematics and kinetics were obtained using inverse dynamics for the conditions of barefoot, own shoes and lateral heel wedges placed inside the shoes. Repeated measures ANOVAs were used to test main effects between injured and uninjured sides and footwear conditions. Resultant external knee flexion moments during stair ascent were 20% and 29% for the shoes and wedged conditions, respectively, than in the barefoot condition. During stair descent the resultant knee adduction moments were significantly lower for injured compared to uninjured sides (first peak: -42%, p=0.004; second peak:-45%, p=0.008), increasing for the uninjured sides when wearing shoes compared to barefoot. During stair decent maximum knee flexion angles were higher for the shoe than the barefoot condition, and knee flexion moments increased with lateral wedging compared to barefoot. The findings suggest persisting compensatory gait mechanisms following knee injuries to lower joint loading that are counteracted by footwear.

25

12.30pm

Effects of application of a pelvic compression belt on isokinetic strength of the thigh muscles in healthy sportsmen Arumugam A

1, Milosavljevic S

1, Woodley S

2 and Sole G

1

1 School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand.2Department of Anatomy, University of Otago, Dunedin 9054

Functional stability of the pelvic girdle has been explored as a contributing factor for hamstring injuries. Pelvic compression belts (PCB) can be used to improve pelvic stability; however, it is unknown whether these have an influence on hamstring function. The purpose of this study was to investigate whether application of a PCB affects isokinetic strength of the thigh muscles. Twenty nine healthy sportsmen underwent isokinetic testing of one knee (the choice of leg selection was randomised) in a seated position on a Biodex

TM system 3 pro Isokinetic dynamometer. One set of five

reciprocal concentric-extensor and concentric-flexor contractions was performed followed by a set of five eccentric-flexor contractions, at an angular velocity of 60°/second, with or without a PCB (randomised). Percentage of mean torque normalised to body weight for each of four time-based movement-quartiles was determined. A two-by-four (belt conditions by movement quartiles) repeated-measures analyses of variance (p < 0.05) was used to compare average torque-body weight percentage obtained from each movement quartile between conditions. There was an overall main effect for belt conditions for eccentric-flexor contraction (p = 0.02) but not for other contraction types. Post-hoc comparisons using Bonferroni correction revealed a significant increase in middle and outer quartiles for eccentric-flexor torque with the application of PCB (p < 0.05). This study gives an insight into the role of external pelvic compression using a PCB in altering neuromotor control of the hamstring muscles and provides baseline data for comparing sportsmen with injured hamstring muscles.

26

Prevention Steam 2

11.00am Rm. 1 Chair: Dr. Steve Tumilty

Invited Speaker: Dr. Margot Skinner

Physiotherapy: do we have the infrastructure to build global capacity? School of Physiotherapy, Centre for Heath, Activity and Rehabilitation Research, University of Otago, Dunedin, New Zealand The World Confederation for Physical therapy (WCPT) is one of the five health professions that comprise the World Health Professions Alliance, a group that speaks for more than 26 million health professionals in 130 countries. The Alliance works to improve global health, health services and facilities as well as enhancing collaboration with other stakeholders. A major challenge for the Alliance is to facilitate building the capacity of the workforce to meet population needs and also to ensure that health services are accessible, for example to those living in rural communities, following natural disasters and where disparities mean health is unaffordable. In the present era where non-communicable diseases are the greatest burden on global health services, survival rates from natural disasters are improving and there is a burgeoning population of the “over 80’s”, the demand for preventive education and rehabilitation services by physiotherapists is high. However in many countries there is an imbalance between supply of health professionals and demand on and sustainability of services. The presentation will draw on examples to illustrate WCPT’s commitment to building global capacity through support for the development of physiotherapy education programmes that meet WCPT’s guidelines for professional practice at the entry level; facilitating opportunities for all physiotherapists to be able to work as autonomous practitioners; innovations in health that improve access to physiotherapy services and support for the promotion of inter-professional collaborative practice.

27

11.30am Quad bike accidents on NZ farms – “she’ll be ‘right, it won’t happen to me”! Clay L

1, Treharne GJ

2, Hay-Smith EJC

3 and Milosavljevic S

1

1 School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand, 2Department of Psychology, University of Otago,

3RTRU, University of

Otago Quad bikes are used extensively on NZ farms but are involved in approximately 28% of work-related deaths. This study explored whether farmers with a ‘cavalier’ attitude and a propensity for risk taking are more susceptible to quad bike loss of control events (LCE). Farmers (n=216) from Otago and Southland participated in the study. Initial random sampling from public databases was supplemented using a variety of strategies. A face to face structured survey investigated for LCEs and psychological constructs along with information on how often participants used the colloquialism “she’ll be ‘right”. Data were analysed descriptively and using generalised linear mixed models for count data with random effects. Fifty two farmers (24%) reported never having had an LCE, 81 (38%) reported having had 1-2 events whilst 80 (38%) reported having had between 3-50 events. Factors significantly associated with LCEs included unrealistic optimism, an impulsive sensation seeking personality, age and sex. Generally, farmers did not have risk-taking personalities or fatalistic beliefs but did appear to have an “it won’t happen to me” attitude towards their risk of quad bike accidents, however, the stronger this attitude, the less likely farmers where to report LCEs. Further exploration into the factors that contribute to individual farmer’s perception of LCE risk is required and may allow for more targeted quad bike safety interventions.

28

11.50am Effects of smoking on respiratory function in youth people Tantisuwat A

1 and Thaveeratitham P

1Department of Physical Therapy, Faculty of Allied Health Sciences,Chulalongkorn University,

Thailand Smoking has a direct effect on the respiratory system. The rates of cigarette smoking in young people continue to increase steadily. The purpose of this study was to quantify and compare the respiratory function between smoking and non-smoking youth people in Bangkok. This study had a cross-sectional design. Smoking and non-smoking male participants, aged between 15 to 18 years were recruited (N=34 per group). Participants were asked to complete information about smoking and the Fagerstorm test for nicotine dependence questionnaire, and their respiratory function was tested (measurement of chest expansion, lung function testing with a spirometer, and assessment of respiratory muscle strength). All respiratory function tests demonstrated significantly differences between the smoking and non-smoking groups (p<0.05). Smokers started cigarette smoking at the age 15 to 18 years. The most common duration of cigarette smoking was 1 – 3 years and the largest level of nicotine dependence in youth people was in low. These study findings show that short-term cigarette smoking can lead to problems of the respiratory system. Such information can be used to show the harm of smoking and should be used to encourage young people to quit smoking or avoid starting cigarette smoking.

29

12.10pm

An end to the primacy of cost-efficacy and urgency: a relational approach to triage for physiotherapy services Behrmann J

1 and Laliberté M

2

1McGill University, Montréal, Canada;

2Université de Montréal, Montréal, Canada

Structured upon values of cost-efficacy and urgency, the ‘patient-centred model’ guiding triage for physiotherapy services is problematic in terms of social justice. Structuring triage exclusively on these values results in the designation of less ‘cost-effective and urgent’ patients—being typically members of vulnerable populations with chronic physical disabilities—to the lowest priority for services. This results in further concentration of disability amongst these populations. In agreement with the growing call for physiotherapy practice to reorient towards a ‘relational’, primary healthcare model of practice, this theoretical research presents a reformed triage structure that upholds a more just provision of services. Moving beyond the clinical needs of individual patients, relational perspectives in health and social justice reorient policy analysis towards the needs of communities, where disadvantaged and socially excluded community groups receive greater priority for targeted health improvement. By using relational frameworks in health and social justice as analytical guides for reform, a resultant ‘relational triage model’ offers a more balanced approach to prioritise patients based on both cost-efficacy and urgency considerations and the health needs of vulnerable populations. Thus, in addition to clinical factors, relational factors allot priority according to the degree a disability results in the social exclusion of patients and contributes to the unjust concentration of morbidity and disadvantage amongst particular community groups. By incorporating relational approaches into physiotherapy practice, a relational triage model will contribute towards a more just provision of healthcare that breaks cycles of vulnerability and disability amongst communities that are often overlooked.

30

12.30pm

Exercise capacity and cardiovascular function in healthy individuals and coronary artery disease: Effects of regular physical activity Mandic S

1, Stevens E

1, Brown C

1, Hodge C

1, Horwood H

1, Nye ER

2, Body D

3, Barclay L

3, Walker R

2

and Williams MJA 2.

1 School of Physical Education, University of Otago, Dunedin

2 Dunedin School of Medicine, University

of Otago, Dunedin 3 Dunedin Hospital, Dunedin

Despite significant exercise benefits, many elderly individuals are physically inactive. This study compared exercise capacity and cardiovascular function in 4 groups of age- and gender-matched elderly individuals: active (CA) and inactive (CI) coronary artery disease patients, healthy active (HA), and healthy inactive (HI) individuals. Sixty-four participants (n=16 (63% men) per group; age: 72.6 SD6.5 years) completed a symptom-limited graded exercise test with expired gas analysis on a cycle ergometer. Exercise capacity was measured as peak oxygen consumption (VO2peak). Cardiovascular function during exercise was assessed using bioimpedence-based technology. Physical activity status was determined by 12-month physical activity recall (active: ≥2000 kcal/week; inactive: <2000 kcal/week). HA had significantly higher VO2peak compared to CI and HI (both p<0.05) but not CA (CA: 20.6 SD5.4; CI: 18.0 SD4.5; HA: 24.5 SD 4.2; HI: 19.7 SD 5.3 ml/kg/min). Predicted VO2peak (CA: 102SD 24; CI: 91 SD16; HA: 121SD 19; HI: 95SD 17%; all p<0.05 vs HA) and peak heart rate (CA: 121 SD 20; CI: 118 SD20; HA:149 SD14; HI: 127SD 23 bpm; all p<0.05 vs HA) were significantly higher in HA compared to other three groups. Peak cardiac output was significantly higher in HA compared to CA and CI (both p<0.05) but not HI group (p=0.062) (CA: 11.9 SD2.0; CI: 12.3 SD 2.6; HA:15.2 SD 3.1; HI: 12.7 SD3.3 L/min). Peak stroke volume was not different between the groups. No differences in exercise capacity and cardiovascular responses were observed between CA, CI and HI groups. While healthy active elderly individuals have favourable exercise capacity and cardiovascular function, healthy inactive elderly individuals have similar exercise capacity and cardiovascular response to exercise to individuals with coronary artery disease.

31

Education Session

11.30am. Rm. 3 Chair: Mr. Ramakrishnan Mani

A comparison of male and female Physiotherapy students’ perception of problem based learning in Musculoskeletal Physiotherapy T. D. Dissanayaka

1, K. N. Marambe

2, E. Liyanage

1

1Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka

2Medical Education Unit, Faculty of Medicine, University of Peradeniya, Sri Lanka

The most commonly used teaching in schools, universities and institutes in Sri Lanka is the traditional or conventional lecture method. Problem based learning (PBL) introduced by the McMaster Medical School in the mid-1960s, has become a popular teaching learning method and is used in many educational programs of health care professionals such as in medical, dentistry, physiotherapy, occupational therapy, speech pathology, and Allied health curricula all over the world. The most commonly used teaching method in the Department of Physiotherapy; Faculty of Allied Health Sciences is the conventional lecture. Few studies have assessed the perception of PBL to musculoskeletal physiotherapy education, and even fewer have examined whether women and men evaluate PBL differently. Thus this study was undertaken to compare perceptions of the male and female students in relation to learning musculoskeletal physiotherapy. The study population comprised of third year physiotherapy students of the Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka. Teaching of selected musculoskeletal conditions related to upper and lower limb was carried out in four PBL sessions. A 15 item, self-administered questionnaire with a 5 point Likert scale was used to assess students’ perception on PBL. 24 females and 8 males responded (comprising 75% of the total cohort). Majority of both male (83%) and female (83%) students agreed that it promotes critical thinking. However, men expressed rather more (83%) trust in fulfilling learning objectives and confirmed greater enjoyment. Most of women (66%) felt that it has helped them to learn more when working in a group. Both genders equally perceived time-consuming as the main disadvantage. The gender differences were not substantial. Thus it can be concluded that third year physiotherapy students’ in both genders have a positive attitude towards PBL as a teaching learning strategy.

32

11.50am

Student’s self-evaluation of their interprofessional skills following a placement at AUT's Akaoranga Integrated Health Clinic O’Brien D

1, McCallum A

1, and Bassett S

1,

1AUT University, Auckland Evidence suggests when different health professionals work collaboratively they become more patient centred and efficient. Internationally, some institutions offering health professional education now include inter-professional learning opportunities. AUT University provides one such experience for students who complete a placement at the University's clinic. We don’t know if students benefit from this experience. This study aims to explore both the utility of the Inter-Professional Education (IPE) questionnaire and the students’ post placement beliefs. Student beliefs were measured by the IPE questionnaire, which comprises of three sections. The Interprofessional Socialization and Valuing Scale (ISVS), with 24 items measuring three subscales (self-perceived ability to work with others, value of working with others, and comfort in working with others) which are rated from zero to six (most valuable). A short answer section with two closed- and eight open-ended questions about their perceptions of the placement, and a short demographic questionnaire. Descriptive data were analysed using descriptive statistics. Open-ended responses were analysed using content analysis. Thirty-seven students completed the questionnaire. The Cronbach alpha for ISVS subscales were acceptable (.77, .85, .74). The students scored high for each of the three ISVS subscales (4.92, 4.70, 4.47). Short answer question results found eighty three percent of students described the overall experience as good, 91% stated it changed how they related to other health professions and 78% indicated they better understood what other health professions did. The results suggest the IPE student questionnaire is an effective tool for measuring students beliefs and the students’ view inter-professional experiences as valuable and beneficial.

33

Intervention Session

2.00pm St. David Lecture Theatre Chair: Dr. Gisela Sole

Keynote: Prof. Bill Vicenzino

Physiotherapy or injections for lateral epicondylalgia: a PHYSIOFORWARD example of forward thinking and movement. Patients with lateral epicondylalgia, a common overuse disorder of the upper limb, presenting to general medical practice are likely to be treated with a corticosteroid injection. There is level 1 evidence that these injections are very effective (>80% success rate), but only in the short term with several randomized clinical trials reporting protracted recovery, poorer outcomes and higher recurrences (~60% compared to if adopted a wait and see approach) after 6 weeks. Physiotherapy in addition to the corticosteroid injections is frequently advocated in order to avoid protracted recovery and recurrences. This presentation will provide a lab-to-clinic research and development of a physiotherapy approach to addressing the problem of protracted recovery and higher recurrence rates following steroid injections as an example of how ‘making it happen’ can occur with forward thinking and moving.

34

Intervention Stream 1

2.40pm Rm. St. David Lecture Theatre Chair: Dr. Steve Tumilty

Does low level laser therapy reduce pain from cracked or grazed nipples in breastfeeding Western Australian women?

Caldwell K

1, Kabikwa O

1, Snowball L

1, Thompson J

1, Andrews A

1 and Briffa NK

1

1School of Physiotherapy, Curtin University of Technology, Perth, Western Australia

Nipple pain and trauma are often cited as reasons for breastfeeding cessation. It was investigated whether the addition of laser therapy to standard care was more effective than placebo at reducing the pain associated with breastfeeding related nipple trauma. In this randomised placebo controlled trial 22 subjects were recruited from women referred to physiotherapy at King Edward Memorial Hospital (KEMH) Western Australia. Ten received active treatment and 12 placebo. A class 3B single GaAIAs laser diode or identical placebo applicator were used to provide treatment at 3Jcm2, 100% per point in a grid pattern. The primary outcome measure was pain using numerical rating scale (NRS). Follow up calls were made at two and eight weeks to assess breastfeeding continuance. After one treatment median (IQR) pain reduced from 3.00(4.5) to 0.50(1.00) (p=0.003) in the placebo group compared to 4.00 (3.25) to 2.50 (2.25) (p=0.006) in the active group. Though the change was significantly greater for the placebo group (p=0.025) there was a trend towards continued breastfeeding in the active group at 8 week follow up (p=0.09). Outliers, placebo effect and therapist bias may have influenced results. The power of this study was low but it has provided good quality pilot data for power calculations for a definitive RCT. Although laser was not significantly better than placebo in this study the potential for Type I and II error suggest it would be premature to cease using laser until more definitive research is available.

35

3.00pm

Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? Aldabe D

1,2, Milosavljevic, S

2 and Bussey MD

1

1School of Physical Education, University of Otago, School of Physiotherapy - University of Otago,

School of Physiotherapy, 2Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand Studies suggest that pregnancy related pelvic girdle pain (PPGP) is caused by a combination of mechanical and hormonal factors. However, a recent systematic review showed that the levels of the hormone Relaxin are not associated with PPGP during pregnancy. Validated biomechanical models of the pelvis shows that muscle activity and pelvic joint mobility are key elements in pelvic stability. The aim of this SR was to determine the level of evidence for altered mechanic and motor control of the pelvis being associated with PPGP during pregnancy. This systematic review was undertaken by following PRISMA guidelines. Six databases were used in the electronic search. Observational cohorts, cross sectional or case-control studies focused on the association between altered kinematic/kinetic and motor control of the pelvis and PPGP during pregnancy were included. Study selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. The Newcastle-Ottawa scale and the guidelines proposed by the Cochrane Back Review Group was used to assess risk of bias and quality of evidence respectively. Three hundred and fifty four references were identified and after excluding unwanted articles, ten studies met the final inclusion criteria. Seven studies were case-control and three were prospective cohort studies. Six high quality studies found association between PPGP and altered motor control and mobility of the pelvis. Conclusion: the level of evidence for an association between PPGP and altered motor control and kinematic or kinetic of the pelvis was found to be moderate.

36

3.40pm Rm. St David Lecture Theatre Chair: Mr. Daniel Ribeiro

Invited Speaker: Prof. Julie Hides

Can motor control training reduce the risk of injury among elite football players? Hides JA

1 and Stanton WR

1,

1School of Physiotherapy, Australian Catholic University, Brisbane Campus, Australia

Lower limb injuries have the highest incidence and prevalence rates in Australian Football League (AFL). Deficits in the muscles of the lumbo-pelvic region, such as a smaller size of multifidus (MF) muscle, have been related to occurrence of lower limb injuries in AFL players. Motor control training programs (MCT) have been effective in restoring the size and control of the MF muscle. This trial was a panel design with 3 groups. The MCT involved training while receiving feedback from ultrasound imaging, progressed into a functional rehabilitation program. Assessments of muscle size and function were performed using magnetic resonance imaging (MRI), and included measurement of cross-sectional areas (CSAs) of MF, psoas (PS), and quadratus lumborum (QL) muscles, and assessments of abdominal muscles. Injury data were obtained from club records. Results showed that a smaller size of the MF muscle or QL muscle was predictive of injury in the playing season. The risk of sustaining a severe injury was lower for those players who received the MCT. While there are many factors associated with injuries in AFL, MCT may provide a useful addition to strategies aimed at reducing lower limb injuries.

37

4.10pm

Proximal hamstring anatomy and its potential relevance to acute strains Woodley SJ

1, Storey RN, and Stringer MD

1Department of Anatomy, University of Otago, PO Box 913, Dunedin 9054, New Zealand

Acute hamstring strains often occur near the proximal musculotendinous junction (MTJ), and the muscle affected appears to be related to the type of activity. The aim of this study was to examine the detailed morphology of the proximal MTJs of the hamstrings to elucidate anatomical differences between muscles that could be relevant to acute strains. The hamstrings were (i) dissected and serially sectioned bilaterally in five male cadavers (aged 64-85 years); and (ii) scanned using magnetic resonance imaging in 11 young active men (aged 18-30 years). Length, volume and cross-sectional area of the proximal tendon and muscle were measured, the muscle-tendon interface area of the proximal MTJs calculated (cadavers only), and the MTJs reconstructed three-dimensionally using Amira 4 software. The relative force of muscle contraction at the proximal MTJ was estimated by calculating muscle belly volume: MTJ interface area ratio. Semimembranosus had the longest proximal tendon and MTJ, and the greatest muscle-tendon interface area (84.6 ±31.5 cm2). Muscle belly volume: MTJ interface area ratios suggested that biceps femoris long head is exposed to the greatest force at its proximal MTJ (ratio 1.68 compared to 1.65 [semitendinosus] and 1.24 [semimembranosus]). The anatomy of the proximal MTJ in biceps femoris long head and semitendinosus may render them particularly vulnerable to acute strains during powerful muscle contraction. In contrast, the larger muscle-tendon interface of semimembranosus suggests less force concentration at its MTJ whilst its longer proximal free tendon may explain its vulnerability to slow speed stretching injuries.

38

4.30pm

Patterns of mediolateral footwear asymmetry found in commonly used footwear Sole CC

1, Milosavljevic S, Sole G, Sullivan SJ

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand. The cutting edge in current footwear research revolves around decreasing medial knee loading equivalent to barefoot. This has led to the development of laterally biased designs. This conflicts with designs to decrease foot pronation. These preventive diverging mediolateral interventions are non-holistic, incomplete and lack an evolutionary perspective. One area missing from the debate is the current footwear asymmetric status of individuals and the type of degradation that occurs. The aim was to determine the frequency and magnitude of mediolateral asymmetry in commonly worn footwear. It was hypothesised that lateral asymmetry was more prevalent. Sports and street shoes of participants from two studies was assessed for type, age, purpose and frequency of use, heel height, outersole wear, mid- and innersole stiffness Assessment of 506 shoes from 144 participants (29.1 ± 11.0 years) showed that 39.1% had neutral or symmetrical wear, 3.2% had 1 mm medial biased, while 57.7% had between 1 mm and 8 mm of lateral biased heel wear and/or compression. Lateral asymmetry was thus common in worn shoes and consideration should be given to neutralise, repair or replace footwear before degradation occurs. This may be an important factor linked to ankle inversion injuries, falls in the elderly and the development of medial knee osteoarthritis. Ideally all footwear used by individuals needs to be assessed as similar designs may have unique and even opposite patterns of wear.

39

Intervention Steam 2

2.40 pm. Rm. 1 Chair: Dr. Hilda Mulligan

Effect of multisensory stimulation on neuromotor development in preterm infants. Kanagasabai P S

1, Rao B K

2, Mohan D

3, Lewis L

4 and Kamath A

5

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand., 2Department of Physiotherapy, Manipal University, Karnataka, India

3Assist Prof, Department of Physiotherapy, Manipal University, Karnataka, India,

4Department of

Paediatrics, Manipal University, India, 5Department of Community Medicine, Manipal University.

Neonatal physical therapy in the form of multisensory stimulation has been found to improve the alertness and weight gain in preterm infants. We investigated the effect of multisensory Auditory, Tactile, Visual and Vestibular stimulus (ATVV) on neuromotor development in preterm infants. Fifty preterms born at 28-36 weeks and birth weight of 1000-2000 grams were recruited for the study using convenience sampling. They were randomized into control group (n=25) and study group (n=25). New Ballard score used for the baseline measurement of neuromaturity was comparable in both groups. In the NICU, study group received ATVV for 12 minutes, 5 sessions per week along with routine NICU care from 33 weeks gestational age for infants born at 28-32 weeks and from 48 hours of birth for infants born at 33-36 weeks until discharge from the hospital. The control group received routine NICU care. At term age the preterm infants were assessed using Infant Neurological International Battery (INFANIB) and the groups were compared using independent t test. Compared to the control group, the multisensory stimulated infants showed higher neuromotor score (p=0.001) including french angle components heel to ear (p=0.016) and popliteal angle (p=0.001). This indicates improved flexor tone in caudal segment which is necessary for normal development of milestones and prevention of postural deformities. We conclude that multisensory stimulation may have a beneficial effect on the tonal maturation in preterm infants. However, further studies are warranted with long term follow up to determine the effect of ATVV on neurodevelopmental outcome in preterm infants.

40

3.00pm

Does use of the cough assist machine reduce hospitalisation time for children with neuromuscular disease? – A preliminary investigation. Phillips RE ¹, Reed PW ², McNamara D ³, Edwards EA ³. Allied Health¹, Starship Research Office² & Paediatric Respiratory Dept³, Starship Children’s Hospital, Auckland 1001 The Cough Assist Machine (CAM) has been shown to provide short term improvements in cough peak flows (CPF) in children with neuromuscular weakness (NMW). Longer term impacts are less clear. We hypothesised that regular domiciliary use of the CAM would be safe, reduce respiratory admissions, improve lung function tests (LFT) and quality of life (QOL). Children with NMW were recruited from the Starship Children’s Hospital Respiratory Service with sufficiently impaired cough that they suffered prolonged frequent admissions or protracted symptoms. The sample size was further limited by machine availability. Six children (all wheelchair bound; N=5 Spinal Muscular Atrophy type 2; N=1 congenital muscular dystrophy; N=5 on nocturnal Non-Invasive Ventilation; mean age 9.3 years (range 2-14)) were enrolled in a 2 year observational study using the CAM daily. The primary outcome measure was number of inpatient days for respiratory infections. Secondary outcomes were changes in LFT (FEV1; CPF), QOL (PEDS QOL) and qualitative feedback. Admission data was compared to 2 years prior to CAM initiation by retrospective review of hospital records. The results showed that all participants had fewer days hospitalised for respiratory infections. No adverse events occurred. LFT and QOL data showed no significant change. Qualitative feedback was positive. This study suggests that prophylactic domiciliary use of the CAM is safe for children with underlying NMW and reduces hospitalisation time for respiratory infections. Further research is required with larger groups, less heterogeneous causes of NMW and from an earlier age to determine the full potential of the CAM.

41

3.40pm Rm. 1 Chair: Dr. Gill Johnson

Invited Speaker: Dr. Andrea Cheville

Integrating rehabilitation services into chronic disease management: Cancer, a case in point Mayo Clinic The global burden of disability due to chronic diseases is growing as the population age and disease modifying therapies improve. Yet, clinical efforts to mitigate disablement among chronically diseased patients have been limited and are not expanding to address the growing need. Research examining disablement – its sources, detection, and treatment – has been most extensive in cancer and has revealed a disturbing pattern of severe under-diagnosis and -treatment that has persisted for over four decades. Limited epidemiological data hampers an accurate estimation of the magnitude or fiscal consequences of under-treatment. However the fact that, despite skyrocketing pharmaceutical costs, hospitalizations and institutionalizations account for a majority of cancer-related expenditures in the last year of life argues that patient disablement contributes significantly to health care utilization. A small body of research suggests that improved disability detection and treatment rates are constrained by diverse factors including: 1) a belief that anti-cancer treatments adequately address cancer-related disablement, 2) a failure to integrate functional assessment and related dialogue into cancer care delivery, 3) a lack of clear causal linkage between discrete impairments and disability, 4) an absence of simple referral pathways for time-challenged clinicians, 5) a reluctance among cancer patients to engage in the rehabilitation process, and 6) limited interest and expertise among the rehabilitation community in caring for patients with cancer. This presentation will discuss the evidence implicating these factors, and explore the likelihood that they contribute to an under-treatment of disablement in other chronic disease states, e.g. solid organ failure, congestive heart failure, etc. Strategies to address them will be outlined including non-physician based screening for functional decline, use of telemedicine, and the development of referral algorithms based on radiographic and other clinical data sources.

42

4.10pm

Systematic review and meta-analysis of randomized controlled trials of physiotherapy interventions for primary dysmenorrhea Kannan P

1, and Claydon L

2,

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, 2New Zealand, Anglia Ruskin University, Cambridge, UK

Primary dysmenorrhea (PD) is defined as cramping pain in the lower abdomen that occurs during menstruation without identifiable pelvic pathology. We aimed at determining the efficacy of physiotherapeutic interventions compared to placebo and control in the management of PD. Databases CINAHL, PEDro, Embase, Web of Science and Ovid Medline were searched using related terms for dysmenorrhea and physiotherapy intervention. The search yielded 223 citations; eleven trials with 393 subjects were included for review. Two independent reviewers assessed the methodological quality of trials using PEDro and GRADE assessment tool. The meta-analysis revealed that acupuncture (WMD -2.25: 95% CI -2.89, -1.62: P<0.00001) and acupressure (WMD -1.19: 95% CI -1.84, -0.54: P=0.0003) were more efficacious than control for pain intensity immediately after treatment. Meta-analysis of studies comparing acupuncture and placebo showed no significant difference between the two groups (WMD- 1.78: 95% CI -3.64, 0.08: P=0.06). Data from RCTs using manipulation, heat, yoga and TENS showed these modalities were efficacious compared to placebo (WMD -1.40: 95% CI -2.54, -0.26: P=0.02), (WMD -1.80: 95% CI -2.67, -0.93: P<0.0001), (WMD -0.95: 95% CI -1.25, -0.65: P<0.00001), (WMD -2.30: 95% CI -4.17, -0.03: P=0.05) respectively, for treating PD. This systematic review with meta-analysis identified promising evidence for the use of acupuncture and acupressure compared to control in the management of PD. However, the analysis on the efficacy of both acupuncture and acupressure compared to placebo was not statistically significant. Further high quality research comparing the effect of acupuncture and acupressure to recommended placebo controls is required.

43

4.30pm

A double-blind placebo-controlled investigation into the effects of interferential therapy on experimentally induced pain using a cross-over design Beatti, A

1, Tucker K

2 and Chipchase L

2

1Health Rehabilitation Centre for Armed Forces, Taif, Saudi Arabia,

2The University of Queensland,

Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane QLD 4072, Australia The objectives of the study was to investigate the analgesic effect of interferential therapy (IFT) on experimentally-induced pain. Subjects: Ten healthy subjects. Design and methods: A double-blind placebo-controlled investigation. Anterior knee pain was induced via an (0.2 ml) injection of hypertonic saline into the medial infrapatellar fat pad, on four separate days. Immediately following the injection, subjects received 20 minutes of control, placebo IFT, 4 Hz IFT or 100 Hz IFT at sensory level stimulation, in random order. Subjects reported on the pain severity and the size of the painful region every 30 seconds until pain ceased. The location of the pain was reported (on a standardised figure of the knee divided into 9 segments), 2, 7 and 12 minutes after the painful injection. Results: There was no effect of condition on pain severity, size of painful area, maximum reported pain severity, maximum size of painful area, duration of pain, total pain severity (sum of pain scores at each time point) nor on the total size of the painful area (sum of pain size at each time point) (all p >0.09). There was no interaction between time and condition on pain severity and size of painful area (p=0.21 and 0.48, respectively). The location of pain was more dispersed at 7 minutes in the control condition (8/9 segments) compared to the placebo, 4Hz and 100 Hz conditions (2/9, 1/9 and 3/9 segments, respectively). Conclusion: IFT is not effective at reducing acute experimentally induced pain severity or size of the painful area. However, it may limit pain spreading from its source.

44

Acupuncture Session

4.10pm Rm. 3 Chair: Karen Keith

The homeostatic effect of acupressure on systolic and diastolic blood pressure Schneiders AG

1, Burrough RN, Cooper SL, Gifford EL, King LM, Robinson MJ, Keith KG, Macznik

AK and Sullivan SJ 1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand. Hypertension affects nearly one billion people worldwide and is a significant risk factor for cardiovascular disease and stroke. Acupressure is becoming increasingly popular as an alternative form of health treatment in western populations and may be useful in controlling blood pressure, particularly as it has been shown to have a homeostatic effect through the autonomic nervous system. The aim of this study was to assess the effect of acupressure on blood pressure in a normal to prehypertensive/prehypotensive population. Sixty five subjects who reported normal blood pressure parameters participated in this study and were allocated into either an intervention or control group. The intervention group was instructed to apply daily self-acupressure on three homeostatic acupuncture points (LI4, LI11, & LR3), for a seven day period. On completion of the study, the overall analysis demonstrated no statistically significant change in blood pressure in the control group or the intervention group immediately after the first application of acupressure (p=.42), nor after the week of self applied acupressure (p=.22). However, when the blood pressure in the intervention group was analysed in blood pressure subgroups, a statistically significant 7.3mmHg systolic (p=.003) and 4.1mmHg diastolic (p=.001) decrease in the high-normal subgroup was demonstrated at day-seven. No statistically significant changes were noted in the normal group, but a trend appeared within the low-normal group of increasing systolic pressure. This preliminary study demonstrates that acupressure has a homeostatic effect on blood pressure in individuals who identify within a normal range.

45

4.30pm

A review of the level of evidence for the use of acupuncture for sports injury management Macznik AM

1, Schneiders AG

1, Sullivan SJ

1 and Athens J

2

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand. 2Department of Preventive and Social Medicine, University of Otago,

Dunedin, 18 Frederick Street The use of acupuncture for the management of musculoskeletal conditions is becoming increasingly popular in Sports Medicine practice; however, it is unclear if current scientific evidence supports its use. The aim of this study was to perform a systematic review of the literature and examine the level of evidence for the use of acupuncture for the treatment of sports injuries. Seven databases were searched (Medline, EMBASE, AMED, SPORTDiscus, CINAHL, Scopus, and Web of Science) with no language restrictions using appropriate MeSH terms combined with Boolean operators. From the total of 1015 articles retrieved, 38 met the inclusion criteria and were eligible for review, including eight clinical trials (5 RCTs), with the highest level of evidence being 1B (Oxford Centre for Evidence-Based Medicine scale). The majority of clinical trials used pain as the primary outcome measure and included the following musculoskeletal conditions; plantar fascitis, tibial stress syndrome, hamstring injury, patellar tendon terminal disease, knee ligament injury, rotator cuff syndrome and various overload microtraumas. Due to the heterogeneity of the studies, meta-analysis was not feasible. Five of the eight clinical trials reported some benefit from acupuncture treatment. However, due to limitations in study design, follow-up periods and mode of acupuncture application, caution is advised regarding the interpretation of these results. The findings of this systematic review suggest that acupuncture has the potential to be efficacious in the treatment of sports injuries, particularly for pain relief. However more high quality research conducted in accordance with the CONSORT statement guidelines is required.

46

Saturday 6th April

Participation Session

9.00am St David Lecture Theatre Chair: Assoc. Dr. Cath Smith

Keynote: Prof. Steve Wolf

The Mobile “World” of Stroke Rehabilitation: From Clinic to Community Wolf S

1 and Smith E

2

1Emory University

2 Department of Arts, Media and Engineering,Arizona State University

Over the past decade the evidence suggesting that task oriented retraining can improve functional capacity amongst stroke survivors has become quite compelling. Moreover, within the context of task practice, the impetus to challenge the patient seems to be intimately linked to favorable plasticity within the central nervous system. At the same time, and somewhat antithetically, there is a global diminution in availability and support for intensive and persistent rehabilitation services for survivors of stroke. Such an unfortunate reality coupled with advances in technologies demands that we consider alternative ways in which services can be provided outside the confines of a clinical environment while assessing the impact that novel delivery systems has upon individual participatory activities. Accordingly, this presentation reviews some of the activities in which the speaker has been engaged and is currently undertaking to foster better outcomes using upper extremity post-stroke rehabilitation as a model. Data from the EXCITE Trial, our present robotic ARM study, and our mixed reality work will be presented to indicate that indeed advances in telerehabilitation and bioengineering can serve as viable and necessary options to promote neurorehabilitation. Last, the 3-year activities of an international “think tank” toward developing consistent algorithms for post stroke upper extremity rehabilitation will be explored and thoughts regarding future directions for global continuity will be offered.

47

Participation Stream 1

9.50am Rm. St. David Lecture Theatre Chair: Dr. Cathy Chapple

Rheumatoid Arthritis and its management by Physical Activity: What people with RA want. Baxter S V

1; Treharne GJ

2; Stebbings S

3,Smith C

1; Hale L

1

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand University of Otago, 2 Department of Psychology, University of Otago

3Dunedin School of Medicine, University of Otago

RA is a chronic, systemic auto-immune inflammatory disease which has high economic costs and patient impact. Disease management, secondary conditions and symptom severity could potentially be assisted by regular participation in exercise; however the uptake of exercise is no greater than those in the general population. This research investigated perceived facilitators and barriers to exercise through a semi structured telephone interview with 8 participants with RA, recruited from the Department of Rheumatology. Prospective sampling required that the participants had to be able to walk for 1 km unassisted in order to sample those who could potentially participate in an exercise intervention. Thematic analysis using the General Inductive approach began immediately, and interviews were ceased once perceived saturation of information occurred. Five themes emerged from the data (verified by two independent reviewers). These themes included: fear, unpredictability of disease course, social connection, safety and overwhelming information. Participants were asked to problem solve for the barriers identified, and asked for their opinions on type, frequency and duration of exercise. These themes and their incorporation into a framework for use in the subsequent walking intervention will attempt to overcome the perceived barriers to participation in exercise for people with RA.

48

10.10am

Yoga for musculoskeletal conditions: A Delphi survey to establish international consensus of core intervention components Ward L

1, Stebbings S

3 Sherman K

3, Cherkin D

3, and Baxter D

1.

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand University of Otago, 2 Dunedin School of Medicine, University of Otago

3Group Health Research Institute, Seattle

A Delphi survey was conducted to develop a reference list for the design and reporting of yoga interventions for musculoskeletal conditions. Researchers and yoga consultants identified from a systematic review of yoga for musculoskeletal conditions were invited to participate in the Delphi. Forty one participants from 6 countries were recruited. The 3-round Delphi was conducted via electronic surveys. Round 1 consisted of an open-ended question, designed to generate items considered as core yoga intervention components. These items were rated for importance for inclusion in the Delphi list on a 5-point Likert scale in Round 2, and any items not reaching consensus were forwarded to Round 3 for re-rating. Thirty six participants (88%) completed the survey. Round 1 generated 348 comments, which were grouped into 49 items for rating in Round 2, and 31 items for re-rating in Round 3. Consensus among participants was reached on 33 items, grouped under 5 themes: 1) defining the yoga intervention (parameters of the intervention, minimum parameter values, and appropriateness of the intervention); 2) content of the yoga protocol; 3) delivery of the yoga protocol (yoga instructors, best practice, and resources); 4) outcome measure domains; and 5) reporting of the intervention. The 33-item Delphi list provides a reference tool for standardisation of best practice in the development of future yoga interventions for musculoskeletal conditions. The use of this list will increase homogeneity of yoga research design, enhancing the ability to compare research outcomes across studies, and to reproduce safe and effective therapeutic yoga protocols.

49

11.00am Rm. St. David Lecture Theatre Chair: Prof. David Baxter Invited Speaker: Prof. John Sullivan

A new way of doing things: Exploring the potential uses of social media in disseminating physiotherapy knowledge to a worldwide audience. 1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand University of Otago With a large sector of the world’s population actively involved in using the internet on a regular basis to search information, purchase products and share life stories, it is not unexpected that health information will be an important part of these activities. With the advent of social networking sites such as Facebook, Twitter and YouTube, the platform for information dissemination and exchange within an everyday context is even simpler and friendlier. An incredible amount of health information is readily available; however, the consumer may not be in the position to know whether this information is sound or appropriate for their condition. While healthcare researchers and clinicians spend considerable time and energy generating an evidence-based approach to treatment interventions, best practice management scenarios and prevention programmes, this is generally targeted to other professionals via traditional literature sources. However, less energy is devoted to providing this information in an appropriate form for use by the general public. This presentation will use examples from our on-going research investigating what the consumer is likely to find about topics such as sports concussion and low back pain on social media sites (including Twitter and YouTube), and whether this information is in keeping with classic best practice information. These findings suggest the need for information to be packaged in ways that facilitate dissemination to the public and how social media may be able to accomplish this.

50

11.30pm

The attitudes and beliefs of New Zealanders about low back pain Darlow B

1,2, Baxter GD

2, Mathieson F

3 Perry M

2, and Dean S

4, Dowell A

1

1Department of Primary Health Care and General Practice, University of Otago, Wellington

2School of

Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand University of Otago, Dunedin

3Department of Psychological Medicine, University of

Otago, Wellington4University of Exeter Medical School, Exeter, United Kingdom

Psychosocial factors are more important than most biomedical or biomechanical factors in the development of low back pain (LBP) and disability. An understanding of the attitudes and beliefs held by New Zealanders with LBP will help physiotherapists to identify and address these factors. Twelve people with acute LBP and eleven people with chronic LBP were purposefully sampled to participate in semi-structured qualitative interviews. Interviews were conducted face to face with the aid of a topic guide. The interviews were analysed with a framework of Interpretive Description to produce themes which could inform clinical understanding. Key themes to emerge were that: i) the back is viewed as a vulnerable structure which needs to be protected, especially when it is painful; ii) LBP is very threatening because of its complexity, the impact it has upon life and function, societal stigma, and because it is associated with significant uncertainty; and iii) activity is approached from a risk-benefit framework, with psychological benefits often being more important than physical. These findings suggest that physiotherapists may positively influence their patients’ approach to movement and activity with explanations which mitigate the perceived risks, and focus upon the psychological as well as physical benefits. Care should be exercised when choosing explanatory models and management approaches to ensure that they do not reinforce the perception that the back needs to be protected. An understanding of the views of people with LBP will help physiotherapists to more effectively meet the information needs of their patients.

51

11.50pm

Effects of the Canterbury earthquakes on physiotherapists and physiotherapy service provision: A qualitative study Smith, C.M, Mulligan HF and Ferdinand S 1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand University of Otago Physiotherapists frequently volunteer their services following natural disasters in developing countries. Following a period of service, volunteers are able to return home to a safe and stable environment. The circumstances that physiotherapists found themselves in the Canterbury earthquakes offered an unprecedented opportunity to examine the effects on physiotherapists of living through a disaster themselves. We interviewed 33 physiotherapists (six male, 27 female) representing a range of physiotherapy services in the Canterbury region. We asked how the Canterbury earthquakes had affected physiotherapists and their services. Audio-taped interviews were transcribed, then analysed inductively for themes. We found that physiotherapists faced three distinct challenges. Firstly, in the immediacy of the most damaging earthquake (February 22nd 2011), physiotherapists felt that they were under-utilized with regards to disaster planning implementation, leaving some feeling frustrated at their perceived lack of usefulness. Secondly, in the months following these events physiotherapists described an inter-related process of ‘uncertainty’ and the giving and receiving of ‘support’ and, how this process influenced their personal and professional ‘resilience’. Thirdly, physiotherapists encountered a new genre of injuries including ’shovel shoulder’, ‘pothole neck’ and severe muscle spasms triggered by emotional trauma. This study highlighted key roles that physiotherapists are well equipped for following a natural disaster: the provision of psychological support, and the versatility of practice which enables innovative environmental and mobility solutions for patients to better cope with the challenging environment encountered in such disasters. We recommend that these skills are recognised and incorporated into future disaster management.

52

Participation Steam 2

9.50am Rm. 1 Chair: Associate Prof. Leigh Hale

Participatory Action Research to develop a programme for self-management of fatigue in multiple sclerosis Mulligan H

1, Snowdon J and Tapper L

2

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand University of Otago 2The Multiple Sclerosis and Parkinson’s Society of

Canterbury Self-management of a long-term condition such as Multiple Sclerosis (MS) is an important and growing area in healthcare. Fatigue is the most common and disabling symptom of MS. Despite the high incidence of MS in New Zealand, there is no formal or cohesive approach to supporting people to manage disabling fatigue. This study describes how we used Participatory Action Research to develop a programme for self-management of MS fatigue. Participatory Action Research (PAR) consists of cycles of decision-making, action and reflection by a group of people towards an identified goal. Individuals with MS and health professionals met together for a series of cycles to develop the focus, content and format of a programme for self-management of fatigue in MS. Meetings were audio-taped, transcribed, and then analysed inductively for themes relating to the PAR process. The PAR group (6 individuals with MS, 2 physiotherapists, and one occupational therapist) met for up to 2.5 hours on four occasions over three months. Three themes about the PAR process became evident: 1) Becoming and staying involved 2) Taking control and 3) Action! These themes captured participants’ excitement of being able to ‘give to others’ via a meaningful project, the collective energy provided by working as a group, and steps taken along the way to develop the programme. Using PAR proved to be an innovative, satisfying and meaningful way to develop a valid resource for the New Zealand population who live with MS related fatigue.

53

10.10am

Self-management of fatigue for people with Multiple Sclerosis: an innovative programme developed with people with MS. Snowdon J

1, Mulligan H

2 and Tapper L

1

1The Multiple Sclerosis and Parkinson’s Society of Canterbury Inc., Christchurch

2School of

Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand University of Otago Fatigue is the most common and debilitating symptom of multiple sclerosis (MS), and is often described as overwhelming and disabling. It affects a person’s ability to cope with everyday life. Self-management can be described as having self-reliance and confidence in the day to day management of a long-term condition. New Zealand has no formal approach to supporting people with MS to self-manage fatigue. This report details the focus, content and format of an innovative self-management program for people with MS related fatigue, developed for the MS and Parkinson’s Society of Canterbury. For its development, we used Participatory Action Research with three health professionals and seven individuals with MS who had previously participated in a fatigue management course as participants. The programme, is a 6 week group based course with an accompanying workbook. The course aims to increase attendee’s knowledge of MS related fatigue, help them gain an understanding of their own experience of fatigue and thereby develop individual strategies to manage fatigue in their daily lives. A training program and manual sits alongside the program, so that health professionals can be trained to run the program in other sites. The program is intended for use as a resource for the New Zealand population who live with MS related fatigue.

54

11.00am Rm. 1 Chair: Assoc. Prof. Leigh Hale

Invited Speaker: Prof Aimee Stewart

Community participation: an important part of the rehabilitation process. Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, South Africa. Our claim as rehabilitation personnel is that we contribute to the quality of life of our patients with our interventions. However evidence shows that most rehabilitation efforts are focussed on managing impairment and improving various activities. These dimensions although important have minimal bearing on quality of life. Good quality of life is dependent on peoples’ ability to actively participate in their communities and engage in self- fulfilling activities. If after experiencing a disabling event people are not able to live a meaningful life within their limitations we need to question whether we have fulfilled our role as rehabilitation professionals. For a sense of positive self- worth which is fundamental to good quality of life people need to have a sense of continuity in their lives; a need to belong and contribute to their families, friends and communities; a need to experience meaning and purpose and to be able to have choices and control over their lives. These attributes have different manifestations in different cultures. To achieve a good quality of life for our patients rehabilitation personnel have to have an understanding of what the above means to people who live in different communities that have specific cultural norms and expectations, that guide what is meant by full participation within a family and community. This is particularly true of the many traditional communities found in the developing world. So to provide holistic rehabilitation we need to include the participation needs and aspirations of our patients. The cultural norms of the communities in which rehabilitation personnel are engaged need to be understood, integrated and measured in our rehabilitation programmes so that maximum family and community participation can be achieved by our patients.

55

11.30am.

Communicating rehabilitation messages through story, with reference to cerebral palsy data from Papua New Guinea. Hamilton, J. Many children in Papua New Guinea have cerebral palsy. They have limited rehabilitation opportunities. An illustrated children’s story was created as one way to address this need. Between 1983-1990 data was collected regarding 191 children, 13 years and under, with cerebral palsy, living in East New Britain villages. Data included numbers of rehabilitation sessions and project staff levels. Questionnaires were completed by health network staff. The data highlighted very low numbers of rehabilitation sessions per child due to problems of distance, lack of compliance and low staff levels. The data was then used alongside cultural interviews and questionnaires and studies of children’s literature and communication methods to produce an illustrated children’s story about a child with cerebral palsy. The story teaches ways to assist a child who has cerebral palsy and shows the value of physiotherapy, and was distributed to some Papua New Guinean schools. The story was well received by teachers and children, and inspired the writing of five more disability awareness stories, relating to leprosy, quadriplegia, HIV/AIDS, and hearing and speech impairment. Story writing is an effective communication tool to help prevent disability and to increase awareness regarding the value of rehabilitation services.

56

11.50pm

Using Kaupapa Māori Research principles to guide the development of the Haua Mana Māori Project Bryant KP

1, Tikao K

2, Mirfin-Veitch B

2, Milosavljevic S

1, Hale L

1

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin,

New Zealand University of Otago 2 Donald Beasley Institute

Little research has been undertaken to determine why or resolve the poor utilization of physiotherapy services by Māori in New Zealand. Ideally, using research directions which consider a Māori world view and value systems, or Kaupapa Māori Research principles, should facilitate improved utilization of physiotherapy services by Māori. Kaupapa Māori research is centred on elevating mana for Māori. According to this model, researchers should endeavor to identify and respect Māori aspirations for research, and outcomes should benefit all the research participants. Being directed by these principles provides an avenue to plan, conduct, evaluate and disseminate research in a culturally responsive manner. This paper presents identified principles used to frame the Haua Mana Māori Project, a collaborative study, which addresses Southern Māori perspectives of health, disability and accessibility of disability services. It also introduces processes and outcomes of using Kaupapa Māori principles in the consultation and development of this research. The Haua Mana Māori research project process has led to an innovative research tool which continues to be trialed on a larger population. The process was lengthy and involved, with many hui, much time spent in communication, establishing and maintaining healthy relationships, establishing Roopu Kaiarahi (a research advisory group of members of the Disabled Māori population and their whanau), who have informed the research process. Discussion on this process and outcomes of using this model is important as it demonstrates effective research techniques used for this Māori population, leading to positive outcomes within this community.

57

Physiotherapy Profession

9.50am Rm. 3 Chair: Dr. Margot Skinner

A shared past, a shared future… McMeeken J

1

1The University of Melbourne

The objective of this paper is to trace the links between New Zealand and Australia with particular reference to education. Why was a university important to physiotherapy education? What are the shared aspects of education? What can we learn for the future? There were two particularly significant periods in the shared educational history of physiotherapy in New Zealand and Australia. This historiographical paper traces the decisions that formulated the educational beginnings through the decisions of the new Australasian Massage Association in 1906, the educational revolutions of the 1980s and 90s and the formation of the Heads of Schools Australia and New Zealand in 1992. Primary research sources include early reports of the Australasian Massage Association; government and newspaper documents; a personal manuscript collection; physiotherapy school and university documents; oral history interviews; and articles from journals. The outcome of the research shows the early enthusiasm for proposals for education and practice of the Australasian Massage Association resulted in the establishment of educational programs with the universities of Melbourne in 1906 and Otago in 1913. The Association branches in New Zealand and Australia soon went their own way. However strong educational programs in Dunedin and Melbourne developed. By the 1980s these were closely integrated with tertiary colleges as well as the universities. Protracted political action by physiotherapists resulted in a new program at the University of Melbourne in 1991 and a review of the program in Dunedin 1994, facilitating strong educational ties across the Tasman. The research supports the conclusion that many aspects of our shared history and growing relationships have been beneficial to education and physiotherapy practice in both countries.

58

10.10am

Working outside the box Graham ,J

1

1Professional Advisor, Enable New Zealand

As physiotherapists our Scope of Practice has often defined how we work and the boundaries that have been set for us to work within. Some of the traditional areas that physiotherapists have worked are being whittled away by other professions, personal trainers, massage therapists and Occupational Therapists. Are we as Physiotherapists in danger of losing our identities? A change of workplace to a different type of role resulted in a struggle to find my own identity as a physiotherapist and whether I was working within the definitions of this practice. I therefore took some time to reconsider. Using an autoethnographical approach a retrospective analysis of my life and career was conducted. Emphasis was given to particular points of change and their influence on me and my practise. Current literature was also included to support the reflection and determine the influence the change had and whether this was supported for me personally and for the physiotherapy profession a as a whole. The skills that we have learnt as undergraduates and developed as therapists, our clinical reasoning and practical approach allows us to expand into less traditional areas. Evidence to support this viewpoint is available. My personal experiences have given some insight into how to maintain professional identity in an ever changing health environment. To grow as physiotherapists we must break down the traditional boundaries and learn to work outside the box.

59

Evaluation Session

2.00pm St David Lecture Theatre Chair: Dr. Gisela Sole

Keynote: Prof. Maurits van Tulder

Evidence-based practice: what we know and don’t know about management of low back pain Department of Health Sciences & EMGO Institute for Health and Care Research, VU University Amsterdam, the Netherlands Evidence-based practice seems to be the paradigm within modern health care. Within evidence-based practice systematic reviews of randomised controlled trials provide the best scientific basis for treatment recommendations. Many randomised controlled trials have been conducted and published on physiotherapy for low back pain. The results of these trials have been summarised in systematic reviews. Evidence from these systematic reviews shows that some interventions that are commonly used in clinical practice are and others are not supported by scientific evidence. Evidence-based practice is not simply providing treatments that are supported by randomised trials. Clinical expertise and preferences of patients and physicians also play an important role in evidence-based practice. Clinical guidelines are important tools in evidence-based medicine. They take evidence but also other aspects into account, such as adverse events, costs, feasibility, availability. In the field of low back pain, clinical guidelines for the management of low back pain exist in many countries and the recommendations in these guidelines seem quite consistent. There seems to be consensus about the optimal management of low back pain in primary care. However, effects are still small and some challenges remain to further improve the management of low back pain and consequently improve patient outcomes. These challenges will be presented and discussed.

60

Evaluation Steam 1

2.40pm Rm. St. David Lecture Theatre Chair: Mr. Chris Higgs

Outcome measures in randomized controlled trials of neuropathic pain conditions: a systematic review of systematic reviews Mehta P

1, Clayton L

2, Hendrick P

3 and Baxter GD

1

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, 2New Zealand, Anglia Ruskin University, Cambridge, UK

Neuropathic pain (NeP) is a prevalent, disabling, multi-dimensional condition with significant morbidity; however there appears to be a variable approach in the use of outcome measures in NeP trials. A search of systematic reviews of interventional randomized controlled trials for NeP was undertaken to investigate the range and types of outcome measures employed to determine treatment effects. Keywords and MESH searches were conducted in five electronic databases from inception to 31st January 2012. Full text English language reviews based on various acute and chronic NeP conditions were included. Two independent reviewers screened papers for inclusion, extracted data, and assessed the quality of reviews. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to critically appraise the reviews. A total of 47 studies were identified: the majority of reviews (n = 29/ 47, 62%) scored well on the PRISMA (PRISMA scores of 20-27/ 27). Change in levels or intensity of pain were used by the majority of studies as the primary outcome measure in intervention studies (n = 41/47 studies, 87%). Few studies employed a functional outcome measure (FOM) as either a primary or secondary outcome measure (n = 7/47, 15% of studies). These results demonstrate that measures of pain are predominantly used in trials of NeP conditions and highlight the scant usage of FOMs. The lack of standardization for the diagnostic criteria in NeP trials is also an issue which needs to be considered for future research and guidelines development.

61

3.00pm

Physical activity and low back pain in persons with traumatic transfemoral amputation: a national cross-sectional survey Devan, H

1, Tumilty S

1, and Smith C

1

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin

Low back pain (LBP) is a common secondary condition following lower limb amputation. The purpose of this study was to investigate LBP prevalence and the relationship between LBP and physical activity (PA) levels in a national sample of persons with traumatic transfemoral amputation (TFA). A random sample of persons (N=322) with uni-lateral traumatic TFA and a minimum prosthesis usage period of six months was chosen from the New Zealand Artificial Limb Board national database. Mail-based surveys were administered with questions investigating LBP prevalence and characteristics, current physical activity, demographics and history of amputation. Of the participants who completed the survey (55% response rate), 64.1% reported LBP and 39.1% of this group reported restricted activity due to their LBP. There was no relationship between the PA levels of persons with and without LBP (χ2= 2.11, p >.05). There was an equal distribution of persons with LBP in low, medium, and high PA sub-groups. However, persons who reported restricted activity due to LBP had lower PA scores compared to persons with ‘no’ restricted activity (χ2= 11.56, p <.05). Based on the results our study, LBP is prevalent in the traumatic TFA population. PA levels are not influenced by the presence or absence of LBP. However, future studies investigating LBP coping strategies and using objective PA outcome measures might further elucidate the relationship between PA and LBP in this population.

62

3.40pm Rm. St. David Lecture Theatre Chair: Prof. John Sullivan Invited Speaker: Prof. David Baxter

Electrophysical Agents: Current Evidence and Future Trends Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago Electrophysical agents (EPAs) have been a core element of physiotherapy practice since the formation of the profession. Initially comprising modalities such as galvanic and faradic currents, ultraviolet, and hot and cold packs, subsequent advances in technology have led to the development of sophisticated devices capable of delivering multimodal treatments, incorporating clinical decision support systems. Usage of EPAs had declined markedly over the last two decades, reflecting changes in practice patterns in some countries (e.g. wound care), an increasing focus on orthopaedic and manipulative therapy to the exclusion of EPAs as part of musculoskeletal treatment, and the adoption of evidence-based practice as the foundation of physiotherapy clinical management. Lack of evidence in particular is commonly advanced as a rationale for the reduction in routine use of EPAs. Although the evidence for some EPAs is limited or contradictory,there is a developing body of evidence of clinical effectiveness from high quality systematic reviews, particularly for laser therapy and laser acupuncture. Furthermore, there is an increasing recognition of the critical relevance of treatment parameters (and particularly dosage) to clinical effectiveness. For the future, while usage of EPAs in routine clinical practice may have declined in some countries, increasing evidence of clinical effectiveness and integration of the best evidence concerning parameter selection will provide a compelling case for the selective use of some EPAs as a core element of physiotherapy practice.

63

4.10pm

Evaluation of clinical outcomes from a pilot education and exercise programme for people with chronic health conditions. Higgs, C

1

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand New Zealand’s ageing population has increased the prevalence of chronic health conditions. Although health education and exercise have known benefits in the management of chronic health conditions, limited studies have investigated this form of intervention in a New Zealand context. This non-controlled clinical study evaluated the health outcomes of an inter-professional 12-week education and exercise programme for people with chronic health conditions (obesity, diabetes type II, kidney failure, osteoarthritis, cardiovascular disease and chronic obstructive pulmonary disease) at completion and 6 months follow-up. The programme comprised of a twice weekly class facilitated by a physiotherapist, a registered nurse and a physiotherapy student. Each class involved self-management education sessions from invited health professionals (goal setting, the benefits of exercise, heart health, diabetes control, medication use and healthy eating options) (45 minutes) followed by supervised circuit exercises including aerobic and resistance training (45 minutes). Waist circumference, weight, resting blood pressure, the six minute walk test (6MWT), the Stanford self-efficacy questionnaire and the Stanford exercise behaviour questionnaire were measured for each participant pre, post and 6-month post intervention Thirty six participants (mean age 60, SD 16, range 41-81yrs old) were recruited; 30% identified as either of Māori or Pacific ethnicity and 15 were male. Preliminary analysis indicated clinically significant improvements in the 6MWT (mean increase of 77 metres) and minutes spent exercising per week (mean increase of 90 minutes) post-intervention. An inter-professional 12-week education and exercise programme may help people to better manage their chronic health conditions and a randomised controlled trial is warranted to investigate efficacy.

64

4.30pm

Live well: evaluation of a weight management and wellness programme for people with a spinal cord injury Kwan J

1

1Auckland Spinal Rehabilitation Unit (ASRU), Counties Manukau District Health Board (CMDHB),

Auckland, New Zealand With increasing longevity, obesity and associated co-morbidities are a growing problem among people with a spinal cord injury (SCI). Minimal research exists on weight management interventions for this population. This was an exploratory study evaluating the effects of a weight management and wellness programme for community dwelling individuals with a SCI. Nine adults (aged 25-76 years) with paraplegia and obesity participated in the prospective study. The 12 week group programme, led by a Dietician and Physiotherapist, consisted of three sessions a week, incorporating physical activity and dietary education. Weight, fitness, dietary behaviour, and subjective wellbeing outcomes were measured at baseline, week 12 and week 24. Average weight at baseline was 103.2±28.5 kg (BMI 37.0±5.8 kg/m²) and average weight change was -0.4±3.5 kg at week 12 and -6.0±8.6 kg at week 24. Improved fitness was seen in 12 minute wheelchair aerobic push test, with a median percentage distance change of 10.5% at week 12 and 11.6% at week 24. At week 12 all participants’ scores on a modified Dobson’s short fat questionnaire showed an improvement in dietary behaviour. Scores from the personal wellbeing index revealed improved subjective wellbeing at week 12 and week 24. Results indicate that group programmes have the potential to assist with weight management and aspects of wellbeing for people with SCI. There was a trend towards positive outcomes; a controlled trial involving multiple groups should be undertaken to further assess the significance of the outcomes.

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Evaluation Stream 2

2.40pm Rm. 1 Chair: Dr. Tony Schneider

Dose-response relationship between work-related cumulative postural exposure and low back pain: A systematic review Ribeiro D

1, Aldabe D

2, Sole G

1, Abbott JB

3, PhD, and Milosavljevic S.

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand , School of Physical Education, University of Otago, 3 Dunedin School

of Medicine, University of Otago Exposure to repetitive trunk flexion is considered a risk factor for low back pain (LBP). Due to its cumulative nature, the interaction between range of motion, duration of sustained posture and frequency of trunk flexion is complex and contributes to a non-linear relationship between tissue load tolerances with time. This systematic review aimed to assess the evidence for a dose-response relationship between range of motion, duration, and frequency of trunk flexion, and risk of occupational LBP. Methods: An electronic systematic search was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and Scopus databases focusing on cohort and case-control studies. Studies were included if they focused on non-specific LBP and postural exposure, considering range of motion, duration or frequency of trunk flexion as independent variables. No language restriction was imposed. Included studies were assessed for risk of bias using the Newcastle-Ottawa Scale for observational studies and a summary of evidence is presented. Results: Eight studies were included and all were methodologically rated as high quality. The included studies yielded a total of 7023 subjects who were considered for risk analysis. Different outcome measures for postural exposure were adopted making meta-analysis difficult to perform. Conclusions: We could not find a clear dose-response relationship for work posture exposures and low back pain. Limited evidence was found for range of motion and duration of sustained flexed posture as risk factor for LBP. We found no studies assessing frequency of trunk flexion as a risk factor for LBP.

66

3.00pm

Adherence to low back pain guidelines and its perceived clinical utility among physiotherapists in New Zealand- A national survey Hendrick P

1, Mani R

2, Schneiders A

2, Milosavljevic S

2 and Bishop A

3

1University of Nottingham, England

2 School of Physiotherapy, Centre for Health, Activity, and

Rehabilitation Research, University of Otago, Dunedin, New Zealand Adherence to low back pain (LBP) guidelines by physiotherapists is important for facilitating best practice management of non-specific LBP (NSLBP). Few studies exist on adherence to LBP guidelines; however, those that have studied UK, Dutch, and Norwegian physiotherapists demonstrate varied compliance to national recommendations. Although New Zealand (NZ) is considered one of the pioneers in the provision of LBP guidelines, no studies to date have investigated the extent of adherence to LBP guidelines by NZ physiotherapists. Therefore, a cross-sectional online survey of NZ physiotherapists (n=1039) was conducted which included questions on guideline adherence measures (advice for work, activity and bed rest for nonspecific low back pain), and the perceived clinical utility of guidelines in management decisions for NSLBP. The overall survey response rate was 17% (n=170/1029). Results demonstrate that the advice given by physiotherapists was either ‘strictly’ (work-35.3%, activity-5.3%, bedrest-24.1%) or ‘broadly in line with guideline recommendations (work-60%, activity-87.6%, bed rest-63%). Although the majority of the participants (82%) were aware of LBP guidelines, only 52% of participants reported that guidelines were helpful in clinical decision making for patients with NSLBP. This study demonstrates that physiotherapists in NZ inadvertently adhere to LBP guidelines when providing routine advice (work, activity, and bedrest) for patients with NSLBP. The observed inequity regarding the guidelines perceived clinical utility demonstrates that further research is required on factors which influence physiotherapist’s perceptions towards LBP guidelines usage.

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3.40pm Rm. 1 Chair: Dr. Hilda Mulligan

Invited Speaker: Prof. Louise Ada

Community ambulation after Stroke University of Sydney Following stroke, most survivors learn to walk again but few manage this easily in the community. Walking speed of community dwelling people after stroke has been reported to be as low as 0.3 m/s and walking distance being reported as around 250 m. Improving walking is important because walking ability has been directly linked to amount of physical activity undertaken in the community after stroke. In order to optimise the outcome of walking, practice is critical because skill in performance improves as a function of practice. Walking on a treadmill is one way of encouraging practice in that it may be viewed as a form of forced use. Furthermore, there is now evidence that not only is it beneficial, but that even walking at the fastest speeds possible does not result in any deterioration of the walking pattern. Of course, the ability to improve walking depends upon the underlying strength of the lower limb muscles. Finally, in order to encourage participation, walking outside in the community needs to be undertaken as part of rehabilitation.

68

4.10pm

Psychometric properties of clinical outcome measures for balance in cerebellar ataxia: A systematic review. Winser SJ

1, Smith C

1, Hale L

1, Claydon LS

2, Whitney S

3 and Mehta P

1.

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand 2Faculty of Health Social Care and Education, Anglia Ruskin

University, Cambridgeshire, UK.3School of Health and Rehabilitation Sciences, University of

Pittsburgh, Pennsylvania, US. In a previous narrative review we identified 45 outcome measures that are used for the assessment of balance and postural control. Of these, 35 are clinic-based balance assessment tools (7 health condition specific, 4 assessing at body structure and function level, 24 at activity level and none at participatory level). This review identified a need to determine the psychometric properties of these outcome measures in people with cerebellar ataxia, in order to make recommendations for the selection and clinical utility of the most appropriate measures for this population. We searched Medline, Amed, CINAHL, Web of science and Embase from database inception till April 2012. Articles focussing on psychometric property testing of clinical outcome measures for balance were included and search was restricted to English language. Search identified 21 full text articles for this review. Quality of the full text articles was assessed using the COSMIN instrument. Psychometric properties had been tested for 16 outcome measures in people with cerebellar ataxia (10 were generic scales and 6 were ataxia grading scales having balance assessment as a sub-component). Based on the COSMIN grading, the quality of the studies investigating psychometric properties of most of the generic scales were rated poor and those of the ataxia grading scales ranged from poor to excellent. The Activities-specific Balance Confidence (ABC) Scale and Berg Balance scale (BBS) appear to have most of psychometric properties estimated with favourable results for clinical utility. Among the ataxia rating scales the International Co-operative Ataxia Rating Scale (ICARS) is psychometrically robust and results are favourable for clinical utility. A firm recommendation is not made and future trials are warranted of high methodological quality possibly guided by the COSMIN tool. Key words: Psychometric property, validity, reliability, balance, cerebellar ataxia.

69

4.30pm Palpation-digitization of pelvic landmarks for non-invasive innominate kinematic assessment- An inter-tester reliability study Adhia DB

1, Bussey MD

2, Mani R

2, Jayakaran P, Aldabe D

1 and Milosavljevic S.

1Department of Physical Education,

2School of Physiotherapy, Centre for Health, Activity, and

Rehabilitation Research, University of Otago, Dunedin, New Zealand Movement anomalies of innominate bone have been difficult to diagnose owing to lack of reliable and valid techniques available for non-invasive quantification of innominate movement. Although complex position and orientation of innominate movement renders its kinematic evaluation difficult, recent techniques of palpation-digitization of pelvic landmarks using electromagnetic tracking devices have been able to accurately and non-invasively quantify innominate kinematics. While this technique has demonstrated radiographic validity and test-retest reliability, its inter-tester reliability is yet to be tested. Further the measurement errors in palpation-digitization of pelvic landmarks could influence the calculations of innominate angular displacements. A single group repeated measure design was thus conducted, to primarily investigate the inter-tester reliability of palpation-digitization technique for innominate vector length measurements, and secondarily determine the impact of palpation-digitization errors on innominate angle calculation. Four trained musculoskeletal physiotherapists palpated and digitized the pelvic landmarks in fourteen young (18-40 years) healthy adults. The tester order was randomized and each tester was blinded to measurements taken by other testers. The innominate vector length was calculated from 3D coordinates of palpated and digitized pelvic landmarks in two test positions of hip. Reliability indexes of Intraclass correlation coefficient (≥0.97) and Standard error of measurement (≤2.02mm) demonstrated very high inter-tester reliability and accuracy of palpation-digitization technique for innominate vector length measurements, irrespective of the test positions. The sensitivity analysis demonstrated negligible influence of palpation-digitization errors on innominate angle measurements. The results thus support the clinical and research utility of this technique for non-invasive kinematic evaluation of innominate motion for this population.

70

Education

2.40pm Rm. 3 Chair: Dr. Gill Johnson Participation in education to achieve better outcomes - learners and their physiotherapists share the same goals Caswell P

1

1New Zealand Ministry of Education

Physiotherapists work in school settings in New Zealand to ensure that children and young people with disabilities are able to participate in, and gain maximum benefit from, their schooling experience. This presentation presents the findings of these studies undertaken to examine the role and contribution of the physiotherapist in New Zealand special education between 1996 and 2008. In particular information gathered from therapists regarding their professional learning and development needs will be discussed. Physiotherapists were first employed by hospitals to work in school based clinics 60 years ago. Today the employers are the ministry of education and school boards of trustees. Therapists are members of collaborative educational teams working to design individualised approaches to assessment and intervention - the stepping stones to the achievement of priority learning goals for each student. A physiotherapist contributes a particular range of knowledge and skills to the team but must learn to use them in new ways to ensure maximum benefit for the learner. The research identified therapists’ need and desire for a comprehensive, ongoing programme of professional development and support that would better equip them for their role in schools. Today a physiotherapist in search of such training requires determination and the willingness to explore outside the square. The suggestion is made that the ministry of education, schools of physiotherapy and occupational therapy and college of education should form a collaborative team in order to develop and offer an appropriate post graduate qualification.

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3.00pm

Assessment of student clinical competence; do clinical educator student assessments vary and does moderation reduce variance? Robinson P

1, Bozikovic A

1 and Vardi I.

1

1School of Physiotherapy, Faculty of Health Sciences, Curtin University, Perth, Australia

Entry-level Physiotherapy courses in Australia and New Zealand have adopted the Assessment of Physiotherapy Practice (APP) to assess students’ competence during clinical placements. Inconsistencies exist amongst clinical educators in assessing these entry-level practice capabilities. The use of a consensus moderation methodology to address these inconsistencies was undertaken. Participants viewed a DVD of a student/patient interaction, and independently assessed the student using the APP. Following consensus moderation, participants re-rated the student performance. Workshops facilitated by trained moderators were undertaken in the core physiotherapy areas: cardiopulmonary (n = 11), neurology (n = 21) and musculoskeletal (n = 18). Large variance amongst educators existed in all groups pre-moderation (cardiopulmonary, SD = 12.15; neurology, SD = 12.62; musculoskeletal, SD = 11.8). Post-moderation, variance decreased in all groups, (cardiopulmonary, SD = 5.43, p < 0.001; neurology, SD = 4.67, p < 0.001; musculoskeletal, SD = 8.5, p = 0.09). Seventy-four percent either agreed or strongly agreed that they had increased confidence in rating consistently with their peers following consensus moderation. Moderation reduces inter-rater variability when using the APP to assess video vignettes of student clinical performance. Moderation discussions are viewed as a positive method of improving consistency of APP scoring by participants. Universities should consider a consensus moderation process for training new educators to ensure consistency and fairness in fieldwork assessment, and to create an agreed benchmark to which existing educators can assess. The extent to which this learning is transferred back into clinically situated student assessments warrants further investigation.

72

Poster

73

Body position preferences of women in the later stages of pregnancy with respect to manual therapy for lumbo-pelvic pain Ashby JF

1 and Johnson GM

1

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand Lumbo-pelvic pain is a common problem experienced by pregnant women but there is little information regarding how to best tailor manual therapy approaches suitable for pregnant women. The purpose of this longitudinal observational study was to identify the preferred treatment position for women applicable to physiotherapy intervention at different stages of pregnancy. Thirteen pregnant women, all experiencing a normal pregnancy irrespective of lumbo-pelvic pain entered the study at 20 weeks gestation. Subjects were assessed in a face-to-face session at 20-22 weeks gestation where anthropometric data were gathered. Subjects were placed in three physiotherapy treatment positions (side lying, quarter turn from prone and forward leaning sitting) in random order and asked to rank their least preferred to most preferred position. Reasons for their choice were also obtained. Subjects were then contacted by telephone at 26, 32 and 38 weeks and again asked to rank their favoured physiotherapy treatment positions on each occasion. The results showed that at all four stages of pregnancy, side lying was the preferred therapeutic position of the three options. Sitting was the second choice for most women and this position was increasingly favoured as pregnancy progressed. On the basis of these results, the side lying and sitting positions are recommended as the treatment positions for manual therapy techniques and the quarter turn from prone position should be only used as a last resort. In each case, it is also recommended that physiotherapists seek feedback from pregnant women regarding individual positional preference prior to undertaking manual therapy interventions.

74

The contribution of selected lifestyle factors to the reporting of postconcussion-like symptoms in a student population. Balasundaram AP

1, Schneiders AG

1, Athens J

2 and Sullivan SJ

1

1 School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of

Otago, Dunedin, New Zealand 2Department of Preventive and Social Medicine, Dunedin School of

Medicine, University of Otago, Dunedin.

The self-report of symptoms (e.g. headache, fatigue) is an integral component of the assessment of concussion in athletes by Sports Physiotherapists and other health professionals. However, many of these same symptoms are also present in the general population and are assumed to be influenced by a range of lifestyle factors. This study documented the contribution of lifestyle factors to the postconcussion-like symptom scores in a non-concussed cohort. Six hundred and three (154 males and 449 females) aged 18 -30 years from the University of Otago student population participated in this study. Web-based survey was used to acquire data using the Sport Concussion Assessment Tool 2 – postconcussion symptom scale (22 symptoms) as the outcome measure. Multiple linear regression modelling was conducted on various lifestyle variables as predictors to determine their contribution to the symptom scores. Females (M =11.98, SD=6.03) reported higher (p < .05) symptom scores than males (M =13.06, SD =5.88). Stress, anxiety, depression, mental fatigue, physical activity were positively correlated (p<0.05) with symptom scores; while, energy/fatigue, sleep health, alcohol consumption and life satisfaction were negatively correlated (p<0.05). The overall model explained 47.3% variance in the symptom scores. Mental fatigue (β= 0.27; p< 0.001) and depression (β=0.23; p<0.001) were the strongest predictors of symptom scores. These results provide definitive information on how lifestyle factors contribute to the reporting of postconcussion-like symptoms. Conclusion: Sports Physiotherapists need to exercise caution when making informed decisions about management of the player and their safe return-to-play.

75

Effectiveness of home self-care programs on pain and walking ability among older people with knee osteoarthritis in community: a pilot study Harnmontree P

1, Sermcheep P

1, Peungsuwan P

1, Eungpinithpong S

1 and Srisaenpang W

2

1Department of Physical Therapy, Khon Kaen University, Thailand

2Head of Department of

Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand The purpose of this study was to investigate the effectiveness of home self -care programs with physical therapy (PT) and traditional Thai form of PT (TPT) on pain and walking ability. The study design was a community-based trial. Thirty participants with knee osteoarthritis, aged 50-85 years, were recruited from two villages around the urban Khon Kaen province, Thailand. Two villages were randomly to given a difference program. The PT included Swedish massage and resistance exercise, and the TPT included Thai massage and exercise with wand, additionally superficial heat or cold were also recommended. All participants received a booster session once a month for 3 months, including education and home visit. They were asked to continue their program for 6 months overall. After 3 months the TPT group demonstrated significantly greater improvement in pain (p=0.046) and walking ability with six-minute walk test (p=0.01), and most participants had good adherence. However, at the 6

th month, no differences were found. Even though adherence in the PT group was

poorer than in the TPT group, the beneficial effects were the same. In conclusion, no differences between groups were found in the long-term. However, the short-term results suggest a home self-care program with TPT can be effective in improving pain and walking ability for older people with osteoarthritis knee in community. Future research should focus on how to improve or maintain program adherence to achieve the maximum program benefit.

76

The effect of qualitative and quantitative feedback on the performance of cervical mobilisations Minnoch P

1, Naylor G

2, Golby J

2 and Olsen P

2.

1University of Otago, Christchurch.

2University of Teesside, Middlesbrough, England.

Purpose and relevance: Researchers have found feedback substantially improves the performance of mobilisations. This study investigated the effect of qualitative and quantitative feedback on the performance of cervical mobilisations. Subjects: Year 3 students (n=24) who were novices in cervical mobilisations were randomly assigned to a Flexiforce (quantitative) or tutor (qualitative) feedback group in a four-week crossover study. Design and Methods: A Flexiforce system measured mass (g) during Grade One Posterior-Anterior C6 mobilisations (three trials of 30s). Subjects performed the mobilisations (Pre-test), and then participated in two feedback sessions with qualitative feedback from a tutor (10y experience) or quantitative feedback produced by a Flexiforce system (Phase One). After a retention test, subjects crossed to the other condition (Phase Two). Results: On average, subjects

produced 155g (1.5N) in the Pre-test. Average and peak mass were significantly (p<0.05) lower

after Phase One compared to the Pre-test (50g (0.5N) and 180g (1.8N)) in both conditions. There were minimal differences after Phase Two compared to Phase One. Discussion: The enhanced performance of the mobilisations was probably due to subjects gaining knowledge through internal and external feedback. Further changes in performance were small, which is synonymous with motor learning research where gains in performance reduce as a practitioner becomes more skilful. Conclusion: Feedback enhanced mobilisation performance and the Flexiforce system produced similar outcomes as an experienced tutor. The system could be a useful teaching tool to help novice therapists learn mobilisations but may lack the precision to quantify smaller changes as therapists become more skilful.

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Outcome measures to identify and evaluate the influence of cerebellar lesions on balance and postural control. Winser SJ

1, HaleL

1, Claydon LS

2 and Smith C

1,

1School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University

of Otago, Dunedin, New Zealand 2Faculty of Health Social Care and Education, Anglia Ruskin

University, UK.

A wide range of outcome measures are used for the assessment of balance and postural control among people with cerebellar ataxia. There is a need to explore the spectrum of tools used in order to determine their utility. Thus this narrative review aimed to 1) Identify, categorise and discuss outcome measures used for the evaluation of balance and postural control in cerebellar assessment and intervention. 2) Identify outcome measures which might relate to the localisation of cerebellar lesion. An electronic search of Google Scholar, Index New Zealand, Ovid Medline, ProQuest Central, ScienceDirect, Scopus and Web of Knowledge was done from database inception till Dec 2011. Articles related to evaluation of clinical interventions for cerebellar signs, identification or illustration of clinical presentation of problems with balance and postural control relating to cerebellar lesions, of any cause were selected for review. Trials involving animals, studies on cerebellar lesions which did not involve postural control and balance and articles published in languages other than English were excluded. The International Classification of Functioning (ICF) was used to categorize the outcome measures as: health condition specific (n=7), body structure and function level (n=13), activity level (n=25), and none at a participatory level. Accessibility, time required to perform and psychometric property testing determined the utility of outcome measures. Frequency and amplitude of postural sway, measures obtained from force plate testing, were used to localise the cerebellar lesion. None of the clinical tools appeared to localize cerebellar lesion. Health condition specific outcome measures were used for cerebellar intervention trials and psychometric properties of outcome measures at an activity level were not tested among pure cerebellar lesions. Further investigation is warranted to streamline the utility and selection of outcome measures for clinical practice.

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Notes:

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