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risk primary ankle sprains pose, the
development of a UK evidence-based
guideline for this common problem may
be appropriate. Stratification of care may
also aid in identification of patients at
higher risk of recurrence and chronicity.
This in turn may facilitate selection of the
most appropriate treatment methods.
The Norwich Patellar Instability
score: Validity, internal consistency
and responsiveness
Smith TO, Chester R, Hunt N, Cross JL,
Clark A, Donell ST
Background/Aims: This study assessed
the validity, internal consistency,
responsiveness and floor-ceiling effects
of the Norwich Patellar Instability (NPI)
score for a cohort of conservatively
managed people following first-time
patellar dislocation (FTPD).
Methods: Fifty patients were recruited,
providing 130 completed datasets over
12 months. Patient NPI score, Lysholm
Knee score, Tegner Level of Activity
score and isometric knee extension
strength were assessed at baseline,
6 weeks, 6 and 12 months post-injury.
Results: There was high convergent
validity with a statistically significant
correlation between NPI and Lysholm
Knee score (p<0.001), Tegner Level of
Activity score (p<0.001) and isometric
knee extension strength (p<0.002).
Principal component analysis revealed
the NPI demonstrated good concurrent
validity, with four components accounting
for 70.4% of the variability. While the
NPI demonstrated a floor effect for
13 of the 19 items, no ceiling effect
was reported. There was high internal
consistency, with a Cronbach a value of
0.93 (95% CI 0.91–0.93). NPI score was
responsive to change over the 12-month
period, with an effect size of 1.04 from
baseline to 12 months post-injury.
Conclusions: The NPI can be considered
a valid and responsive outcome measure
to assess patellar instability symptoms
for people conservatively managed
following FTPD. The high floor effects
reported in this study need further
exploration to improve the ability of
the NPI to detect people with lower
perceived instability symptoms.
Clinicians’ perceptions and
experiences of using dynamic
elastomeric fibre orthoses with
patients with neurological disorders
Hassan A, Snowdon N
Background/Aims: Dynamic elastomeric
fibre orthoses (DEFOs) or Lycra garments
are used to help control movement and
posture in people with neurological
conditions. The effectiveness of these
garments has been investigated previously
in small, low-quality studies. No previous
qualitative research has been conducted on
user experiences or clinicians’ reasoning.
The objective of this study was to
understand clinical reasoning behind the
prescription of Lycra garments for adults
with neurological disorders.
Methods: Qualitative, semi-structured
interviews were conducted with therapists
(n=7) who had used DEFOs with at least
five adults with neurological pathologies.
Data were analysed using thematic analysis.
Results: Four themes were identified:
i) what DEFOs might work for; ii) how to
assess its potential; iii) how to fund the
garments, and iv) practicalities around
their use. DEFOs were felt to be helpful
for conditions such as ataxia, low tone and
spasticity, and improving posture, balance
and upper limb function. The concept of
dynamic control was important, in that
the garments can provide support without
restricting movement and proprioception.
The impact of DEFOs was assessed using
standardised outcome measures, patient
feedback and quality of movement.
Conclusions: There appears to be
potential use for DEFOs, however, a
key challenge lies in determining which
patients are likely to benefit. This study
suggests a protocol for prescribing Lycra
garments. It is recommended that this be
applied and evaluated in clinical practice.
Identifying and evaluating
evidence of adverse events and
contraindications of manual
therapy for low back pain
Shipley J
Background: Sign up to Safety, an
NHS initiative, encourages the reporting
of incidences within health care and
reduction of all avoidable harms. Manual
therapy is offered as a treatment choice
for low back pain by physiotherapists;
however, there appears no definitive
answer of who this option is safe for.
Methods: A systematic search and
review of the literature was carried out to
explore the classification and frequency
of adverse events from manual therapy
for low back pain. Six databases were
searched using a range of synonyms for
the population, intervention and outcome,
using controlled terms and MeSH indexing.
Results: Twenty studies were selected
through a priori inclusion and exclusion
criteria. These represented a variety of
study designs and a narrative synthesis
was conducted. Using the best current
classification system for adverse events
of manual therapy revealed the majority
of adverse events reported should be
classified as ‘not adverse’. Moderate
events were less frequent and major
events were rare.
The quality of the selected studies
was assessed according to relevance
and rigour. Relevance of the studies was
not demonstrated and confidence in the
studies’ rigour was low. A quarter of the
studies listed contraindications to manual
therapy but these were poorly referenced
and were of expert opinion without
explicit critical appraisal at best.
Conclusions: There is no clear message
from the literature identifying which
subgroups should be excluded from
manual therapy. There is a lack of
consensus as to what constitutes an
adverse event, how these should be
graded and difficulty attributing adverse
events to specific manual therapy
technique due to mixed methods of
manipulation and mobilisation.
Implications: Future studies are
needed to develop reliable and validated
standardised outcome measures of
adverse events from manual therapy. A
standardised national reporting system
for adverse events from manual therapy
is needed. Formulation of a consensus
group to consider relative risk ratio
alongside defined adverse events and
current understanding of mechanism of
effect of manual therapy would assist in
establishing the safety of manual therapy
for different low back pain subgroups.
© 2015 MA Healthcare Ltd
PRS Conference abstracts
International Journal of Therapy and Rehabilitation, August 2015, Vol 22, No 8
© MA Healthcare Ltd. Downloaded from by on October 25, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.
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