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Empathy is a multifaceted phenomenon that is difficult to measure. Self-report questionnaires are the most common and well-validated measures while currently no validated protein biomarkers associated with the empathic reaction have been established. Trigger films have been previously used in psychological research to evoke emotions. Thus, in the present randomized cross-over study we investigated the responses of nine salivary biomarkers that have been related to emotions and stress following an empathy triggering and a control film sequence. Additionally, questionnaires for empathy (Saarbrucken Personality Questionnaire (SPQ)) and current mental stress were applied and participants were asked to assess the film protagonists’ emotions using the Positive and Negative Affect Schedule. Data from 46 participants were included in the analysis. α-Amylase, IgA, IL-1β and estradiol showed a significantly different response between the empathy and control intervention. Moreover, normalized levels of these biomarkers significantly correlated with single scales of the SPQ (control film sequence: α-amylase and IgA with personal distress; estradiol with empathic concern; IL-1β with fantasy; empathy triggering film sequence: IgA with empathic concern, fantasy and the total empathy score). These findings indicated that the observed changes in salivary biomarker levels were reflective of a physiological response to the empathy triggering film sequence. Future studies using different triggers and settings will show if the identified biomarkers can be considered as surrogate markers for empathic reactions in general.

This study showed that the EFS was able to evoke an emotional response in young women, which was correlated to empathy. Verification of these results is needed with a larger, more representative sample. The film could be used to evaluate the effectiveness of empathy training in health professions.

Background/Aims An ongoing discussion about direct access to physiotherapy for patients with musculoskeletal pain disorders in Austria requires the development of a curriculum that educates physiotherapy students to make autonomous decisions to treat the patient without the need for medical referral (keep), to treat the patient with additional medical check-up (keep and refer) or to send the patient for medical evaluation without physiotherapeutic management (refer), and to recognise the presence of serious pathologies. The aim of this study was to examine the feasibility, acceptability and potential effectiveness of an educational intervention that was provided to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree. Methods An educational intervention was given to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree, which consisted of a single, 1-hour face-to-face case-based lecture on the principles of differential diagnosis, screening for possible red flag pathologies and review of the body systems. A control group did not receive the intervention, but both groups completed 11 validated vignettes. Results Half of Austrian universities (n=6/12) and 116 final year Austrian undergraduate physiotherapy students took part in the study. All students from the intervention group were satisfied with the intervention and 77.6% found the intervention beneficial for making keep/refer decisions based on clinical vignettes. Overall, 89.7% did not find the intervention too time consuming. A potential effectiveness of the intervention could not be demonstrated. Conclusions Future similar studies need to investigate if more teaching hours and/or if different educational methods are capable of improving the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students.

Background\ud The Targeted Interventions for Patellofemoral Pain studies (TIPPs) have identified three subgroups exist in UK and Turkish patellofemoral pain (PFP) populations: Strong; Weak and Tight; and Weak and Pronated, based on six clinical assessments. The thresholds used to develop the subgrouping algorithms were based on normative values sourced from various populations and countries.\ud \ud Objectives\ud Explore normative scores from the clinical assessments in a singular non-PFP population whilst considering potential differences between ethnicities and sex (primary aim). Revisit inter-rater reliability of each assessment (secondary aim).\ud \ud Design\ud Cross-sectional and test-retest.\ud \ud Method\ud The six assessments; rectus femoris length, gastrocnemius length, patellar mobility, hip abductor strength, quadriceps strength, and Foot Posture index (FPI) were measured in 89 New Zealanders (34% Māori, 45% female). Two raters independently assessed 17 participants to examine inter-rater reliability.\ud \ud Results\ud Significant interactions between ethnic group and sex were noted for rectus femoris length and patella mobility. Māori versus European males exhibited greater rectus femoris tightness (p = 0.001). Māori versus European females demonstrated greater patellar mobility (p = 0.002). Females were significantly weaker than males in normalised strength measures (p < 0.001), and had lower FPIs. Mean differences between testers for all measures were small and not significant, except for FPI which had a 2.0 point median difference (p = 0.021).\ud \ud Conclusions\ud Our results indicate that sex is an important factor worth considering within the TIPPs subgrouping approach, more than ethnicity, especially for the normalised strength measures. The sub-optimal reliability of FPI warrant reconsideration of its inclusion within TIPPs.

Due to current measurement, sizing and fitting approaches, poor bra fit is prevalent amongst larger breasted women. The impact of improving bra fit hasn’t yet been explored. This pre-clinical study aimed to explore immediate and short-term biomechanical responses to changing breast support garment. Asymptomatic participants (n=24) performed a static standing task, drop jumps and seated typing whilst kinematic data from the breasts and spine were recorded. Three breast support conditions were assessed: Usual, professionally fitted bra in the immediate term (PFB), and the same professionally fitted bra after four weeks wear (PFB28). Bra fit assessments were included for both bras. All participants failed the bra fit assessment when wearing the Usual bra and 67% (n=16) failed when wearing the PFB. Less bra fit issues were present in the PFB, resulting in immediate biomechanical changes relating to breast support and spinal posture, yet nothing in the short term (PFB28). This research sets the foundations for future work to investigate whether the implementation of better fitting breast support garments can influence musculoskeletal pain amongst larger breasted women, whilst attributing potential improvement of symptoms, objective measures of breast support and spinal posture.

Background Despite increasing evidence regarding the benefit of intensive task-specific practice and aerobic exercise in stroke rehabilitation, implementation remains difficult. The factors influencing implementation have been explored from therapists’ perspectives; however, despite an increased emphasis on patient involvement in research, patients’ perceptions have not yet been investigated. Objective The study aimed to investigate factors influencing implementation of higher intensity activity in people with stroke and to compare this with therapists’ perspectives. Design The design was a cross-sectional qualitative study. Methods The study used semistructured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from interviews with people with stroke were compared and contrasted with factors perceived by rehabilitation therapists. Results Ten people with stroke were interviewed before data saturation was reached. Participants had a positive attitude regarding working hard and were satisfied with the graded exercise test, high intensity intervention, and the feedback-monitoring devices. Therapists and patients had contrasting perceptions about their beliefs regarding intensive exercise and the content of the intervention, with therapists more focused on the methods and patients more focused on the personal interactions stemming from the therapeutic relationship. Conclusions People with stroke perceived no barriers regarding the implementation of higher intensity rehabilitation in practice and were positive towards working at more intense levels. Contrastingly, from the therapists’ perspective, therapists’ beliefs about quality of movement and issues around staffing and resources were perceived to be barriers. In addition, therapists and people with stroke perceived the contents of the intervention differently, highlighting the importance of involving patients and clinicians in the development and evaluation of rehabilitation interventions.

Background\ud New and innovative approaches are needed to overcome the barriers to engaging people in physical and leisure activity after stroke. Outdoor cycling, including the use of adapted or electric bicycles, may be one approach. However, perceptions of stroke survivors on this topic have not yet been explored. \ud Purpose \ud To explore a sample of stroke survivors’ perspectives, who expressed an interest in cycling, about cycling and the use of electric bicycles. \ud Methods \ud A convenience sample of stroke survivors were identified through focus groups at a ‘Cycling after Stroke’ event, local stroke support groups, and structured interviews at a national conference for stroke survivors. Quantitative data were analysed descriptively and qualitative data analysed thematically.\ud Results \ud Data were collected from 21 stroke survivors, seven of whom were current cyclists. All participants were independently mobile with, or without, the use of a walking aid. Themes oriented around the value of cycling (e.g. getting out of the house, doing something for yourself, and feeling part of a community); concerns and challenges (safety and negotiating adaptations); and how they could be overcome (starting slowly and identifying sources of assistance). \ud Conclusion \ud Outdoor cycling may be a worthwhile approach to increasing physical and leisure activity after stroke. However, barriers still exist and need to be addressed to provide inclusive opportunities for adapted and electric cycling for stroke survivors. Due to the small sample size and bias population, further research is needed to explore stroke survivors’ perspectives on cycling to provide solutions to overcome the barriers identified. \ud 181

Variations in access to health care are known to contribute to differences in life expectancy, morbidity and health-related quality-of-life across population subgroups. We undertook a scoping review to identify what is known about in-country variations in access to services for adults with multiple sclerosis and to identify gaps in the literature to inform future research and national policies. We searched MEDLINE, CINAHL, EMBASE, PSYCHINFO, SocINDEX and Social Science Abstracts from inception to end of December 2016 for quantitative studies which had investigated differences in access to prevention services, healthcare services, treatments and social care between inequality groups, defined using the PROGRESS-PLUS framework. A total of 4959 unique abstracts yielded 36 papers which met our eligibility criteria. Only 3 studies were cohort studies and only 4 were population-based; most were from the United States (n = 27). There were 6 studies on access to MS focused care and 6 on access to Disease Modifying drugs. There were 3 studies on access to prevention/lifestyle programmes and none on access to welfare services or information support. There were no papers examining inequalities in access for 'vulnerable' groups, such as, those with learning disability. In the available studies, there was evidence of inequalities in access to services with a trend for worse access among men, older age groups, those from lower socio-economic groups or the least educated, non-caucasians, those with mental health problems and those from rural areas. In the studies on access to disease modifying treatments, older age and lower socioeconomic status were consistently associated with a lower rate of uptake, while race and gender were not. Inequalities or disparities in access to all levels of services and treatments will need to be addressed through a strategic research agenda with an emphasis on population-based studies and development and evaluation of interventions to reduce inequality. [Abstract copyright: Copyright © 2019 Elsevier B.V. All rights reserved.]

© 2019 - IOS Press and the authors. All rights reserved. INTRODUCTION: Patellar mobility is often routinely assessed in people with patellofemoral pain (PFP) in clinical practice. This study assessed the stability of the data when measuring patellar mobility using the total medial-lateral patellar glide test across multiple repetitions. It also compared patellar mobility of people with healthy knees to people with PFP and within subgroups of PFP. METHODS: Twenty-two people without knee problems underwent five repetitions of the total medial-lateral patellar glide test. Differences in mean value for each repetition and the intra-class correlations (ICC) between the first assessment and the average values of additional repetitions were calculated. Mean patellar mobility was compared with 127 participants with PFP who took part in a previously published subgrouping study. Differences between the healthy knee group and PFP subgroups were also explored using a one-way ANOVA with pairwise comparisons. RESULTS: The mean patellar mobility in healthy individuals was 16.4mm (SD 5.3), difference in mean patellar mobility across repetitions was minimal and the ICC ranged between 0.93 and 0.95. People with PFP had significantly lower patellar mobility than the healthy knee group. Two of three PFP subgroups had statistically significantly lower mean patellar mobility (difference in mean -5.6mm and -6.5mm; P

Background The evidence base for stroke rehabilitation recommends intensive and repetitive task-specific practice, as well as aerobic exercise. However, translating these -evidence-based interventions from research into clinical practice remains a major -challenge. Objective The objective of this study was to investigate factors influencing implementation of higher-intensity activity in stroke rehabilitation settings. Design This qualitative study used a cross-sectional design. Methods Semi-structured interviews were conducted with rehabilitation therapists from 4 sites across 2 Canadian provinces who had experience in delivering a higher-intensity intervention as part of a clinical trial (Determining Optimal post-Stroke Exercise [DOSE]). An interview guide was developed, and data were analyzed using implementation frameworks. Results Fifteen therapists were interviewed before data saturation was reached. Therapists and patients generally had positive experiences regarding high-intensity interventions. However, therapists felt they would adapt the protocol to accommodate their beliefs about ensuring movement quality. The requirement for all patients to have a graded exercise test and the use of sensors (eg, heart rate monitors) gave therapists confidence to push patients harder than they normally would. Paradoxically, a system that enables routine graded exercise testing and the availability of staff and equipment contribute challenges for implementation in everyday practice. Conclusions Even therapists involved in delivering a high-intensity intervention as part of a trial wanted to adapt it for clinical practice; therefore, it is imperative that researchers are explicit regarding key intervention components and what can be adapted to help ensure implementation fidelity. Changes in therapists’ beliefs and system-level changes (staffing and resources) are likely necessary to facilitate higher-intensity rehabilitation in practice.

© 2018 - IOS Press and the authors. All rights reserved. Background: Despite clinical intervention, people with chronic inflammatory demyelinating polyneuropathy (CIDP) experience difficulties in gait and balance on a daily basis. However, the effects on these variables of a tailored home based exercise programme for this population have not been investigated. Purpose: This case series aims to investigate the effects of a home based tailored exercise programme on gait and balance in people with CIDP. Methods: Case series of seven people with CIDP from a neurology department of a local hospital. Participants took part in a 6 week Otago exercise programme, which include walking, strengthening and balance tasks. Participants were assessed 10 times; 3 times prior, 3 times during an exercise intervention, 3 times post intervention and once at three months follow up. The outcome measures were Berg Balance scale, 10 meter walk test, fatigue severity scale and EQ-5D-5L. Results: Participants showed an increase in walking speed and balance after the exercise intervention and most kept these improvements at 3 months follow up. Conclusion: This study shows that exercise can be beneficial for gait and balance in people with CIDP. These findings are in line with literature from related diseases such as Guillain-Barre Syndrome. However studies with a larger sample size are needed to confirm these findings in the population.

© 2017 Informa UK Limited, trading as Taylor & Francis Group Purpose: The recognition of pathological processes, which are not appropriate for physiotherapy, is a crucial part of the clinical reasoning process. Over recent years, there have been several research efforts investigating qualified physiotherapists and doctoral students’ capability in making precise clinical decisions on whether a patient’s condition is suitable for physiotherapy intervention (keep), or rather requires medical check-up (refer). No study so far has examined the keep/refer decision making abilities of final year undergraduate physiotherapy students within Europe. Materials and methods: A survey containing 12 validated vignettes was distributed among 2238 final year undergraduate physiotherapy students from 15 different member countries of the European Network of Physiotherapy in Higher Education (ENPHE). Results: Seventy-three respondents were included in the final analysis. Only slightly more than half (mean: 53%; median: 67%) of the medical critical vignettes were answered correctly. Just eight respondents (11%) correctly identified all three medical critical vignettes. Conclusion: European final year undergraduate physiotherapy students are not sufficiently equipped with enough knowledge and skills to make very precise keep/refer decisions (based on clinical vignettes) and, most importantly, seem insufficiently trained to accurately identify more critical medical conditions which need a timely referral to another health care professional.

BackgroundThis 2-year study explored the experiences of clinical physical therapists who used a participatory action research (PAR) approach to learn about the practice of clinical research.ObjectivesThe aim of this study was to explore the experiences of physical therapists who were conducting clinical research, facilitated by a PAR approach.DesignA mixed-methods research design was used.MethodsPhysical therapists completed questionnaires, were interviewed, and participated in focus groups prior to and after the 1-year intervention and 1 year later. The research facilitator took field notes. Questionnaire data were analyzed descriptively, and themes were developed from the qualitative data. Twenty-five therapists took part in 4 self-selected groups.ResultsThree groups actively participated in the PAR research projects (n=14). The remaining 11 therapists decided not to be involved in clinical research projects but took part in the study as participants. After 1 year, one group completed the data collection phase of their research project, and a second group completed their ethics application. The third group ceased their research project but hosted a journal club session. At completion of the study, the experiences of the physical therapists were positive, and their confidence in conducting research and orientation toward research had increased. The perceptions of physical therapists toward research, relationships among individuals, and how the clinical projects were structured influenced the success of the projects.LimitationsOnly physical therapists of one hospital and no other health care practitioners were included in this study.ConclusionsFourteen physical therapists divided among 3 PAR groups were overall positive about their experiences when they conducted a research project together. This finding shows that a PAR approach can be used as a novel tool to stimulate research participation in clinics.

Background\ud \ud Keep/refer decision as the ability to independently determine whether a patient’s condition is suitable for physiotherapy management (keep) or not (refer), is regarded as an core element in the World Confederation of Physical Therapists‘ (WCPT) Guideline for Standards of Physical Therapy Practice. However, it is currently unknown how individual European countries have implemented this in their national guidelines.\ud \ud Objectives\ud \ud To determine if keep/refer decision making abilities are an integral part of national guidelines for the physiotherapy profession of member countries of the European Network of Physiotherapy in Higher Education (ENPHE).\ud \ud Data Sources\ud \ud A review was performed including medical databases, the grey literature and personal correspondence with professional ENPHE member associations. To gain the information of interest, all eligible documents were reviewed.\ud \ud Results\ud \ud 11 national guidelines for the physiotherapy profession could be obtained. Two additional member associations use European guidelines as their national ones. Despite the fact that in the WCPT guidelines keep/refer decision making abilities are clearly described as a core element, there exists huge inconsistency as to how various European (with direct and non direct access systems) countries have included them in their national guidelines.\ud \ud Conclusion\ud \ud Despite the fact that most ENPHE member countries deem a close collaboration between health care professionals important and that physiotherapists should know the limitation of their expertise, keep/refer decision making abilities as explicitly stated in the WCPT guidelines were not included in the majority of guidelines that were reviewed.

BackgroundCurrent multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible.MethodThe exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests.ResultsOne hundred and thirty participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean BMI 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7-60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (i) ‘strong’, (ii) ‘weak and tighter’, and (iii) ‘weak and pronated foot’.ConclusionsWe conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other datasets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes.

Janssen JC, Le-Ngoc L. Intratester reliability and validity of concentric measurements using a new hand-held dynamometer. Objective To assess the reliability of a new hand-held dynamometer (HHD) to perform concentric measurements, and to determine the agreement between the HHD and the criterion standard isokinetic dynamometer. Design Elbow flexion concentric measurements were performed on a mechanical arm using the HHD and the isokinetic dynamometer. Setting Engineering laboratory and university strength-testing facility. Participants Three patient profiles, differing in range of motion (ROM) and strength, were simulated by a mechanical arm. Interventions Not applicable. Main Outcome Measures Peak torque and ROM obtained from concentric elbow flexion profiles. Results Intratester reliabilities, measured with the intraclass correlation coefficient (ICC 1,1 ), of the peak torque and start and end ROM are excellent for both the HHD (.99, .98, and .99, respectively) and the isokinetic dynamometer (.99 for all 3 variables). The angle of peak torque was rated fair to good in intrareliability for both devices, at .64 (HHD) and .69 (isokinetic dynamometer). Validity, measured within the limits of agreement (LOA) between the 2 devices, was clinically acceptable for peak torque and start ROM, although not for end ROM and angle of peak torque. Conclusions It is possible to use the new HHD to obtain dynamic measurements of joint motion. Intratester reliability of the HHD is excellent and is in clinical acceptable agreement with the isokinetic dynamometer for peak torque and start ROM. End ROM was, however, not in agreement because of a systematic error in the isokinetic dynamometer measurement for 1 of the 3 tested profiles. Intratester reliabilities of the angle of peak torque were fair to good for both the HHD and isokinetic dynamometer, but the LOA were not clinically acceptable. Stability of the arm and speed of measurement might be confounding factors in this study.

Background\ud Patellofemoral Pain (PFP) is a musculoskeletal disorder causing significant pain and dysfunction around the knee, commonly leading to long term limitations. People with PFP are commonly referred for physiotherapy, although current multimodal physiotherapy approaches tend to be rather ad-hoc and are failing in the long term. Identification of patient strata (or subgroups) who may respond differentially to interventions has been recognised as an international priority. It has been proposed that there are PFP patient strata, classified based on clinical tests, who would respond to modes of interventions targeted at the individual's stratum.\ud \ud Methods\ud Participants with PFP underwent clinical assessment of muscle weakness, muscle length, patellar mobility and foot posture. The presence of strata was explored using two classification techniques: hierarchical cluster analysis and latent profile analysis (LPA); for LPA, the Bayesian Information Criterion was used to guide model selection.\ud \ud Results\ud One hundred and twenty seven (of 130) recruited participants had complete assessment data. A three strata solution appeared optimal from modelling and clinical perspectives. The three suggested strata were characterised as: stronger; weaker and tighter; weaker with pronated feet. However, although membership of the stronger stratum was consistent, there were substantial differences in the other composition of the other two strata between the two classification approaches.\ud \ud Conclusion\ud PFP patients can be classified into clinical strata, although further investigation is needed to identify thresholds upon which stratification should be performed. Interventions are currently being mapped onto the strata and feasibility and evaluation trials of these interventions should then be performed.

A desire to have every student attending our University be aware of, and reflect on, disability in their studies and future careers, initiated our project to explore how to enhance disability awareness within all our University’s papers. In this project we systematically reviewed pertinent literature and ran an action research workshop for staff. Strategies to enhance disability awareness identified in the literature and workshop were presented and verified at an interactive conference presentation. Embedding disability awareness into curricula is challenging; staff considered themselves powerless to bring about change in their departments, but thought that one way to do so would be by modelling inclusive behaviour and by introducing subtle inclusive practices into papers taught. The identified strategies may be of use to others contemplating similar curricular modifications.

The purpose of this study is to evaluate the clinical and radiological results and the survival of the SAL II mobile bearing knee prosthesis at 5-year follow up. Between February 1995 and March 1998 a total of 246 SAL II total knee arthroplasties were performed in 232 patients. The mean follow up was 5.0 years. Thirteen revisions had been carried out (5%). The mean total Knee Society Score increased from 88 preoperatively to 153 and 155 at 1 and 5 years follow up, respectively. The mean flexion angles were 106 degrees and 107 degrees pre- and postoperatively. None of the prostheses showed radiological loosening. No dislocations or subluxations of inserts were seen. The Kaplan-Meier cumulative survival is 95% for revision for any reason at 5.0 years, with a worst case scenario of 91%. The survival for aseptic loosening is 99%. The results of SAL II after a minimum follow up of 5 years are favourable and comparable with fixed bearing and other mobile bearing designs in terms of Knee Society Score and survival. Noteworthy are the good radiological results of this device which showed a good fixation of the prosthesis at 5 years.