Transcript Pealkiri - Tartu Vaimse Tervise Hooldekeskus

PHYSIOTHERAPY
OUTCOME MEASURES
AND REHABILITATION
Priit Eelmäe, PT, MSc
University of Tartu
Institute of Exercise Biology
and Physiotherapy
31 October 2007, Tartu
1
Physiotherapy in Estonia present situation and
perspectives
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Professional standard
• Was elaborated and accepted at 2002 spring
• 2004 – Estonian Physiotherapist’s
Association organizes first time licence
examinations
• Professional standard enables 3 different
categories
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Number of physiotherapists
in Estonia
•
•
•
•
~400 but …
Regional problems
PT’s working mostly in hospitals
Private practice and community based
services practically doesn’t exist
• FUTURE – as based to the Estonian
rehabilitation development strategy 2015 – we
must have 900 PT on 2015 and 200 of them
must work community based settings
4
Number of physiotherapists and students
entering PT education as compared
Europe to Estonia
Europe (mean)
ESTONIA
Number of PTs
per 100 000
Number of PT students
entering PT education
per year (per 100 000)
105,4
7,5
20
1,3
1. SLCP, 1998
2. EPA, 2003
5
Where in Estonia
physiotherapists are educated?
1996 – 2000
1. Physiotherapists were educated in University
of Tartu. Governmental order was every year
15 students.
Since 2001/02
1. University of Tartu
2. Tartu Medical School
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New model of
Physiotherapy education in Estonia
years
PhD studies
240 ECTS
Master studies
120 ECTS
Bachelor studies
180 ECTS
Postgraduate
education
Continuing education
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8
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6
5
4
3
2
1
Post basic
education
Under graduate
education
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Structure of new curriculum of
physiotherapy in University of Tartu
BACHELOR LEVEL (180 ECTS)
• 1 year – general + preclinical studies
• 2 year – preclinical + professional studies
• 3 year – professional studies
MASTER LEVEL (120 ECTS)
• 2 years – specialisation
1. Children's physiotherapy
2. Adults physiotherapy
3. Geriatric physiotherapy
4. Sports physiotherapy
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The assessment of functioning and
health – the bases of effective
physiotherapy
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Why we need
outcome measures
in physiotherapy?
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Outcome measures help us to
change from opinionbased
to evidence based
•
•
•
•
Opinion-based
Based on opinions and consensus among
experts
Implicit
Individual preferences and interpretations
Authority based (static and non-critically
accepted)
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• What is evidence-based physiotherapy?
– High quality clinical research
– Patient preferences
– Practice knowledge
• Why is evidence based physiotherapy
important?
– For patient
– For physiotherapists and profession
– For funders of physiotherapy services
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Evidence based practice
Evidence-based medicine (EBM) is the
conscientious, explicit and judicious use of
current best evidence in making decisions about
the care of individual patients. The practice of
evidence based medicine means integrating
individual clinical expertise with the best of best
research evidence and patient values
(Sackett 1996).
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Clinical guidelines
• Who should develop clinical guidelines?
• International collaboration
– WCPT-Europe has agreed common position on
guideline development methodology in
physiotherapy (J. Mead & P. van der Wees, 2004)
• Uniprofessional or multiprofessional
guidelines?
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PICO
The Questions about the effects of intervention are
breaked into four parts (Sackett et al 2000)
•
•
•
•
Patient or problem
Intervention or management strategy
Comparative intervention
Outcome
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Example
Patient
Intervention
Comparison
intervention
Outcome
Adult with
acute low
back pain
Bed rest
Advice to stay
active
Pain and
disability
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Some examples
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First example
• The use of Woodway
tredmill training or ….
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Gait assessment
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Walking test in lab
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Testing of knee extensors strength with
Cybex II type isokinetic dynamometer
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• Berg Balance Scale
• Elderly Mobility Scale
• Trendelenburg test
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Second example
Low Back Pain
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Pain Assessment
• VAS ?
• Oswestry Back Pain Disability Index ?
• Opened or closed questions?
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Lassegue test
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The assessment of spinal and abdominal
muscles maximal strength (Häkkinen et. al., 2003)
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Assessment and training of deep spinal
muscles with Bio-Feedback System
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Dynamic endurance test for abdominals
(Friedrich jt. 1998) (Häkkinen jt. 2003)
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Only after assessment physiotherapist
can recommend exercises
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Only after assessment physiotherapist
can recommend exercises
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For the measurement range of motion of
cervical spineis used KENO Cervical
Measurement System
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For muscle strength measurements is
possible to use digital Manual Muscle Tester
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Assessment of wrist flexors and extensors
maximal voluntary contraction
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Assessment of arm flexors and extensors
maximal voluntary contraction
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Thank you for attention!
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