1 PHYSIOTHERAPY OUTCOME MEASURES AND REHABILITATION Priit Eelmäe, PT, MSc University of Tartu Institute of Exercise Biology and Physiotherapy 31 October 2007, Tartu

2 Physiotherapy in Estonia - present situation and perspectives

3 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

4 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

5 Number of physiotherapists and students entering PT education as compared Europe to Estonia Number of PTs per Number of PT students entering PT education per year (per ) Europe (mean)105,47,5 ESTONIA201,3 1.SLCP, EPA, 2003

6 Where in Estonia physiotherapists are educated? 1996 – 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

7 New model of Physiotherapy education in Estonia Bachelor studies 180 ECTS Master studies 120 ECTS PhD studies 240 ECTS Continuing education Post- graduate education Under graduate education years Post basic education

8 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

9 The assessment of functioning and health – the bases of effective physiotherapy

10 Why we need outcome measures in physiotherapy?

11 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)

12 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

13 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).

14 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?

15 PICO The Questions about the effects of intervention are breaked into four parts (Sackett et al 2000) P atient or problem I ntervention or management strategy C omparative intervention O utcome

16 Example PatientInterventionComparison intervention Outcome Adult with acute low back pain Bed restAdvice to stay active Pain and disability

17 Some examples

18 First example The use of Woodway tredmill training or ….

19

20 Gait assessment

21 Walking test in lab

22 Testing of knee extensors strength with Cybex II type isokinetic dynamometer

23 Berg Balance Scale Elderly Mobility Scale Trendelenburg test

24 Second example Low Back Pain

25 VAS ? Oswestry Back Pain Disability Index ? Opened or closed questions? Pain Assessment

26 Lassegue test

27 The assessment of spinal and abdominal muscles maximal strength (Häkkinen et. al., 2003)

28 Assessment and training of deep spinal muscles with Bio-Feedback System

29 Dynamic endurance test for abdominals (Friedrich jt. 1998) (Häkkinen jt. 2003)

30 Only after assessment physiotherapist can recommend exercises

31 Only after assessment physiotherapist can recommend exercises

32 For the measurement range of motion of cervical spineis used KENO Cervical Measurement System

33 For muscle strength measurements is possible to use digital Manual Muscle Tester

34 Assessment of wrist flexors and extensors maximal voluntary contraction

35 Assessment of arm flexors and extensors maximal voluntary contraction

36 Thank you for attention!