Non-surgical treatment of pes planovalgus associated pain—a systematic review

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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426

Ethics approval: None, because single case studies do not need an Ethic approval in Switzerland. http://dx.doi.org/10.1016/j.physio.2015.03.271 Research Report Poster Presentation Number: RR-PO-07-02-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 RELIABILITY OF HAMSTRING REFLEX RESPONSES AFTER TIBIA PERTURBATION H. Baur 1 , T. Hanke 1 , U. Bamert 1 , S. Bruhn 2 , P. Henle 3 1 Bern

University of Applied Sciences, Health, Physiotherapy, Bern, Switzerland; 2 University of Rostock, Institute of Sports Science, Rostock, Germany; 3 Sonnenhofspital, Orthopaedic Surgery, Knee Surgery and Sports Injuries, Bern, Switzerland Background: The anterior cruciate ligament (ACL) is prone to severe injury during various forms of physical activity. ACL rupture is therefore one of the most common injury in sports resulting in long rehabilitation and high health costs. Knowledge about injury genesis and possible protective mechanisms may help to enhance prevention strategies as well as rehabilitation schemes. Especially active stability mechanisms play an important role in maintaining knee joint stability. A fast posterior–anterior translation of the tibia is counteracted by a stretch induced activation of the hamstrings. The magnitude of neuromuscular reflex responses is related to active knee stability mechanisms influencing knee joint stiffness. A sound application of perturbation is necessary in order to investigate hamstring reflex responses. Purpose: The aim of this pilot work was therefore to analyze reliability of hamstring reflex responses during a sudden artificially induced tibia perturbation. Methods: Fourteen healthy subjects (7 female, 7 male) with intact ACLs (passive tibia translation: left: 5.5 ± 1.6 mm, right: 5.2 ± 1.5 mm) and a mean age of 30 ± 5 years (height: 1.75 ± 7 m, weight: 68 ± 11 kg, BMI: 22.3 ± 2.3 kg m−2 , physical activity: 3.9 ± 1.3 h/week) were recruited. After warm-up (10 min on a cycle ergometer at 80 W), subjects underwent ten bilateral tibia perturbations with an established apparatus (Bruhn 2011). Surface electromyography signals of the M. biceps femoris and M. semitendinosus were measured. After rectification of EMG signals an average out of 10 single trials was calculated for each session. RMS values in distinct time windows in relation to tibia translation onset (−50–0 ms (preactivation), 20–40 ms, 40–60 ms, 60–95 ms) were computed. Measures of absolute (Bland Altman analysis with bias/limits of agreement in % of group means) and relative reliability (Intraclass-Correlation Coefficient (ICC) were calculated.

Results: The values for M. bicpes femoris revealed ICCs between 0.88 and 0.96 for the defined time intervals. The bias and limit of agreement ranged between 2 ± 10% and 8 ± 41%. M. semitendinosus time intervals exhibited ICCs between 0.87 and 0.95. The bias and limits of agreement were between 3 ± 6% and 11 ± 42%. Conclusion(s): This pilot study shows that hamstring reflex responses following sudden posterior–anterior tibia translation can be obtained with adequate reliability. Results suggest general feasibility of stretch reflex application but further optimization of measurement setup (tibia perturbation apparatus, measurement procedure) is warranted before the setup can be implemented in intervention studies. Implications: Reliabel reflex response measurements offer the possibility for further research. The next step is the analysis of functional differences between athletes with intact ACL compared to athletes with ACL ruptures. This analysis may provide selective parameters (differing healthy and injured) that can also be used in intervention studies and quality control of rehabilitation. Keywords: Anterior cruciate ligament (ACL); Knee injury; Sensorimotor control Funding acknowledgements: No external funding was received for this project. Ethics approval: The study was approved by the Ethics Committee of the Canton Bern (KEK-Nr. Z049/13) and was classified as “low risk”. http://dx.doi.org/10.1016/j.physio.2015.03.272 Research Report Poster Presentation Number: RR-PO-09-21-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 NON-SURGICAL TREATMENT OF PES PLANOVALGUS ASSOCIATED PAIN—A SYSTEMATIC REVIEW A. Blasimann, A. Nötzli, L. Schaffner, H. Baur Bern University of Applied Sciences, Health, Physiotherapy, Bern, Switzerland Background: Pes planovalgus or flatfoot-associated complaints are frequent symptoms, which are thought to be caused by the foot deformity itself. The chronic degeneration of the posterior tibialis tendon is widespread with a prevalence of approximately 10%. Affected patients suffer from functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment. There is only limited evidence concerning the numerous therapy approaches since high quality studies are missing. Nonetheless, foot orthoses are considered to be the first line therapy approach.

WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426

Purpose: The objectives of this systematic review were to evaluate useful non-operative therapy regimens for patients with posterior tibialis tendon dysfunction (PTTD) and to test for their practicability. Methods: In January 2013, a systematic literature search was done in the databases Pubmed/MEDLINE, Cinahl, PEDro, Web of Science and Google Scholar concerning nonoperative treatments for PTTD (stage I and II after Johnson & Strom). Pain was defined as primary outcome. Exclusion criteria were as follows: PTTD stage III or IV, surgery, published before January 2001, other language than English, German, French or Italian. Key words were flatfoot, PTTD, conservative, usual care, orthoses, pain, functional and further more. All authors read the seven found articles and decided on inor exclusion of the respective study. If not all authors agreed on in- or exclusion of the article, discussion took place until consensus was achieved. Results: In total, seven studies with 214 patients could be analyzed. Pain reduction was achieved through wearing orthoses only but also in combination with other conservative interventions such as strength training, stretching, electrotherapy, application of ice, joint mobilization, taping and sensorymotor training. Three studies reported significant improvements of pain assessed with the Visual Analogue Scale (VAS). Five studies described significant improvements of the patient-reported questionnaire Foot Function Index (FFI). In four studies, the pain level decreased during Single Leg Heel Rise (SLHR) movements. Conclusion(s): Positive effects could be found either with foot orthoses only or with combined interventions. Unfortunately no single intervention could be found to be responsible for improvements in function and/or pain reduction. In more than one study there was no control group, only a small number of patients or different assessments were used for the evaluation of functional impairment or pain. Therefore a direct comparison of all included studies was not possible. Implications: Further prospective, randomizedcontrolled studies of high quality will be needed in the future to get evidence about the efficacy of single therapy applications. Keywords: Flatfoot; Pain; Foot orthoses Funding acknowledgements: This scientific work was not funded. Ethics approval: Ethics approval was not necessary to do a systematic review. http://dx.doi.org/10.1016/j.physio.2015.03.273

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Special Interest Report Poster Presentation Number: SI-PO-17-01-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 IMPROVING QUALITY OF LIFE OF CHILDREN WITH DISABILITY IN NORTH GONDAR ZONE, ETHIOPIA 2014: AN INNOVATIVE PROJECT M. Bayisa 1 , S. Demeke 1 , S. Fasika 1 , F. Ruiter 2 , E. Abebe 3 , A. Overvelde 4 1 University of Gondar, College of Medicine and Health Sciences, Physiotherapy, Gondar, Ethiopia; 2 Totohealth, Nairobi, Kenya; 3 University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia; 4 Radboudumc, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands

Background: According to the 2011 World Health Organization report an estimated 650 million people with disability live in the world, of which 80% is from the developing countries where rehabilitation services are poor. In the same year, an estimated 17.6% population (15 million people) lives with disability in Ethiopia, of which 3–4 million are children. Though, the community based rehabilitation and the health extension workers are the primary contact workforces in the community, these fieldworkers do not have specific skill training on screening children with disability which resulted in less number of referral of children with disability for rehabilitation in North Gondar zone. The zone has a total of 22 districts inhabiting nearly 3 million population. The number of children referred for rehabilitation in the past year was only 152 with mean age of 13.6 years. Hence, skill training and linking health extension workers with community based rehabilitation workers is beneficial in screening of children with disabilities and improving the referral system. Purpose: The purpose of this project is to improve the quality of life of children with disability in North Gondar zone by early detection, referral and intervention through capacity building of community based rehabilitation and health extension workers. Methods: This project was implemented in collaboration with Dutch pediatric physiotherapists, University of Gondar, and North Gondar zone health bureau. This project covers 11 districts. SWOT analyses were done on screening skills and referral of deviant development and disabilities in children among community based rehabilitation and health extension workers. Training of trainers was conducted for the Ethiopian physiotherapists by the Dutch physiotherapists. Then training on normal and abnormal child development along with screening skills and early intervention was delivered for 78 trainees for five days at the University of Gondar in September 2014. At the end of the training, the trainees were deployed to the community with basic assessment tools such as screening tools for developmental delay, the Pediatric