Papers by Annette Swinkels
Archives of Physical Medicine and Rehabilitation, 2011
The primary aim of this study was to assess the intrarater reliability of ultrasonographic measur... more The primary aim of this study was to assess the intrarater reliability of ultrasonographic measurements of acromion-greater tuberosity (AGT) distance in patients with stroke using portable ultrasound. A secondary aim was to determine the discriminant validity of the ultrasonographic technique by comparison of AGT distance measurements of stroke-affected and unaffected shoulders. Test-retest design. Two local National Health Service hospitals in the South West of England. Patients with first-time stroke (N=26; 16 men, 10 women; mean age ± SD, 71±10y) with 1-sided weakness who gave informed consent were recruited. Not applicable. Portable diagnostic ultrasound was used to record measurements on day 1 and again within a fortnight. Bedside measurements were undertaken by a single physical therapist with patients seated upright in a standard hospital chair. Intraclass correlation coefficients (ICCs) and standard errors of measurement were used to assess reliability. Minimum detectable change (MDC90) scores were used to estimate the magnitude of change that is likely to exceed measurement error. Repeated-measures analysis of variance (ANOVA) was used to assess discriminant validity. Mean ± SD AGT distances on the stroke-affected side and unaffected side were 2.3±0.6cm and 1.9±0.3cm, respectively. ICC for within-day reliability was .98 for the affected shoulder and .95 for the unaffected shoulder. Corresponding values for between-day reliability were .94 and .76. The standard error of measurement for both affected and unaffected shoulders was less than 0.2cm. Within-day MDC90 for the affected shoulder and the unaffected shoulder was ±0.2cm and ±0.1cm, respectively. Repeated-measures ANOVA showed a significant difference between mean AGT distance for the affected and unaffected shoulders. Ultrasonographic measurement of AGT distance demonstrates both intrarater reliability and discriminant validity and has the potential to assess shoulder subluxation in patients with stroke. Research into interrater reliability and concurrent validity of ultrasonographic measurements of AGT distance in patients with stroke is required.
Journal of Neurology Neurosurgery and Psychiatry, 1994
Physiotherapy, 2015
Please cite this article as: Stenner R, Swinkels A, Mitchell T, Palmer S, Exercise prescription f... more Please cite this article as: Stenner R, Swinkels A, Mitchell T, Palmer S, Exercise prescription for patients with non-specific chronic low back pain: a qualitative exploration of decision making in physiotherapy practice., Physiotherapy (2015), http://dx.Abstract 32 33 Title: Exercise prescription for patients with non-specific chronic low back 34 pain: a qualitative exploration of decision making in physiotherapy practice. 35 36 Background: Providing an effective exercise prescription process for patients with 37 non-specific chronic low back pain (NSCLBP) is a challenging task. Emerging 38 research has indicated that partnership in care and shared decision making are 39 important for people with NSCLBP and calls for further investigation into the 40 approaches used to prescribe exercise. 41 42 Objective: To explore how shared decision making and patient partnership are 43 addressed by physiotherapists in the process of exercise prescription for patients 44 with NSCLBP. 45 46
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
The pelvic floor muscles are active in normal erectile function. Therefore, it was hypothesised t... more The pelvic floor muscles are active in normal erectile function. Therefore, it was hypothesised that weak pelvic floor muscles could be a cause of erectile dysfunction. To compare the efficacy of pelvic floor muscle exercises and manometric biofeedback with lifestyle changes for men with erectile dysfunction. Randomised controlled trial. The Somerset Nuffield Hospital, Taunton, United Kingdom. Fifty-five men with erectile dysfunction (median age 59.2 years; range 22-78 years) were enrolled from a local urology clinic. Of these, 28 participants were randomised to an intervention group and engaged in pelvic floor exercises, as well as receiving biofeedback and suggestions for lifestyle changes. Twenty-seven controls were solely advised on lifestyle changes. Baseline, 3- and 6-month assessments were: erectile function domain of International Index of Erectile Function (IIEF), Partner's International Index of Erectile Function (PIIEF), Erectile Dysfunction-Effect on Quality of Life ...
Rheumatology, 2010
Background: The aim of this systematic review was to assess the effectiveness of nurse-led care (... more Background: The aim of this systematic review was to assess the effectiveness of nurse-led care (NLC) by comparing its outcomes with those of physician-led care or multidisciplinary care in rheumatology. Methods: MEDLINE, EMBASE, CINAHL and EBM reviews (Jan 1988-Sept 2009) were searched using the terms:(nurse led OR nurse practitioner OR nurse specialist) and (effectiveness OR treatment outcome). The inclusion criteria were: 1) Primary studies with reported patient outcome data 2) RCTs with at least 2 concurrent intervention ...
Physiotherapy Theory and Practice, 2010
Shoulder subluxation is subjectively assessed by a palpable increase in the distance between the ... more Shoulder subluxation is subjectively assessed by a palpable increase in the distance between the acromion and the humerus. Diagnostic ultrasound has potential for objective assessment of this distance. We used portable ultrasound to measure the distance between the acromion and greater tuberosity (acromion-greater tuberosity [AGT] distance) and tested the intrarater reliability in healthy individuals prior to testing on stroke patients. Thirty-two healthy participants aged 51-85 years (mean 64.2+/-10.5) were recruited. Seated participants were scanned by a physiotherapist trained in shoulder ultrasound. Measurements were recorded on day 1 and again within 2 weeks. Reliability was assessed by intraclass correlation coefficients. The mean AGT distance was 1.68+/-0.41 cm for the left and 1.78+/-0.40 cm for the right shoulder. Within-day intrarater reliability coefficients were 0.99 and 0.98 for the left and right shoulders, respectively. Corresponding values for day-to-day reliability were 0.96 and 0.97. Portable diagnostic ultrasound is a quick and reliable method of assessing AGT distance in healthy individuals when measured by the same examiner.
Physiotherapy, 1995
Ropbceplbn.lolee.bed-reslplaslerdPariscyhdenr sMnr)r Roprkceptionrrsstes(edinttk3kwresofeigM~on ~... more Ropbceplbn.lolee.bed-reslplaslerdPariscyhdenr sMnr)r Roprkceptionrrsstes(edinttk3kwresofeigM~on ~b & i e s t m d t e n p a W n b~~~d~ legcylindm. Repeat measurements were taken at WeeMy tbnebon*n~asmeyQaduelyresunedfulrve$M beerhg.RsarBmM,mnparedrrinr)conbdaNoeiqJRcant dUbmce8 were found. Functional &elicits foikming these orulopescmc-donotappearpDbeduetoedepthre Chalphlmeepoprioeepabn R l ? d h 3 s c l r p o r t a n e n t~ ries on the importance of input from muscle afferent8 in pwidng--. poplllar ccnceptsm~ pbMcilydpropriocep(ive mechanisms in non-neurokoical p e a e n r s m a y n e e d t o b e b e . mptkm in norm81, arteo-arthr#ic and repraced knees', Jounn?/ Baftby, H S (1982). 'The second CMwloOd ofproprioceptian' , Wels. J, KurM. M a n d R m . S (1994).-dacognitive demand on knee position matching', Physio-WMer. J E (1912). 'The ofeone~&MsurgerY,730,1,53MI. Iherepy. OO,ll, m-761. d -. PemjmAand M o p w~5 5 . 2 . 4 4 6 . l?svkw, lo. 3 7 -.
Physiotherapy, 2003
Introduction By recognising predisposing factors for the development of complex regional pain syn... more Introduction By recognising predisposing factors for the development of complex regional pain syndrome, physiotherapists could have an opportunity to prevent the onset of a downward spiral of pathology, pain, and dysfunction, and the resultant healthcare and work-loss costs.
Physical Therapy Reviews, 2009
... backache 34. search 8. pilates 26. back pain 35. data extraction ... First author Hayden et a... more ... backache 34. search 8. pilates 26. back pain 35. data extraction ... First author Hayden et al. (2005)33 Primary aim To assess the effectiveness of exercise therapy for reducing pain and disability in adults with non-specific acute, sub-acute and chronic low back pain compared to ...
BJU International, 2005
To examine the role of pelvic floor exercises as a way of restoring erectile function in men with... more To examine the role of pelvic floor exercises as a way of restoring erectile function in men with erectile dysfunction.
Archives of Physical Medicine and Rehabilitation, 2011
The primary aim of this study was to assess the intrarater reliability of ultrasonographic measur... more The primary aim of this study was to assess the intrarater reliability of ultrasonographic measurements of acromion-greater tuberosity (AGT) distance in patients with stroke using portable ultrasound. A secondary aim was to determine the discriminant validity of the ultrasonographic technique by comparison of AGT distance measurements of stroke-affected and unaffected shoulders. Test-retest design. Two local National Health Service hospitals in the South West of England. Patients with first-time stroke (N=26; 16 men, 10 women; mean age ± SD, 71±10y) with 1-sided weakness who gave informed consent were recruited. Not applicable. Portable diagnostic ultrasound was used to record measurements on day 1 and again within a fortnight. Bedside measurements were undertaken by a single physical therapist with patients seated upright in a standard hospital chair. Intraclass correlation coefficients (ICCs) and standard errors of measurement were used to assess reliability. Minimum detectable change (MDC90) scores were used to estimate the magnitude of change that is likely to exceed measurement error. Repeated-measures analysis of variance (ANOVA) was used to assess discriminant validity. Mean ± SD AGT distances on the stroke-affected side and unaffected side were 2.3±0.6cm and 1.9±0.3cm, respectively. ICC for within-day reliability was .98 for the affected shoulder and .95 for the unaffected shoulder. Corresponding values for between-day reliability were .94 and .76. The standard error of measurement for both affected and unaffected shoulders was less than 0.2cm. Within-day MDC90 for the affected shoulder and the unaffected shoulder was ±0.2cm and ±0.1cm, respectively. Repeated-measures ANOVA showed a significant difference between mean AGT distance for the affected and unaffected shoulders. Ultrasonographic measurement of AGT distance demonstrates both intrarater reliability and discriminant validity and has the potential to assess shoulder subluxation in patients with stroke. Research into interrater reliability and concurrent validity of ultrasonographic measurements of AGT distance in patients with stroke is required.
Annals of the Rheumatic Diseases, 2011
Objectives To investigate the effect of group cognitive behavioural therapy (CBT) for fatigue sel... more Objectives To investigate the effect of group cognitive behavioural therapy (CBT) for fatigue self-management, compared with groups receiving fatigue information alone, on fatigue impact among people with rheumatoid arthritis (RA). Methods Two-arm, parallel randomised controlled trial in adults with RA, fatigue ≥6/10 (Visual Analogue Scale (VAS) 0-10, high bad) and no recent change in RA medication. Group CBT for fatigue self-management comprised six (weekly) 2 h sessions, and consolidation session (week 14). Control participants received fatigue self-management information in a 1 h didactic group session. Primary outcome at 18 weeks was the impact of fatigue measured using two methods (Multi-dimensional Assessment of Fatigue (MAF) 0-50; VAS 0-10), analysed using intention-to-treat analysis of covariance with multivariable regression models. Results Of 168 participants randomised, 41 withdrew before entry and 127 participated. There were no major baseline differences between the 65 CBT and 62 control participants. At 18 weeks CBT participants reported better scores than control participants for fatigue impact: MAF 28.99 versus 23.99 (adjusted difference −5.48, 95% CI −9.50 to −1.46, p=0.008); VAS 5.99 versus 4.26 (adjusted difference −1.95, 95% CI −2.99 to −0.90, p<0.001). Standardised effect sizes for fatigue impact were MAF 0.59 (95% CI 0.15 to 1.03) and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of CBT. Secondary outcomes of perceived fatigue severity, coping, disability, depression, helplessness, self-effi cacy and sleep were also better in CBT participants. Conclusions Group CBT for fatigue self-management in RA improves fatigue impact, coping and perceived severity, and well-being.
Age and Ageing, 2008
knee arthritis is a risk factor for falling. Increasing numbers of people are receiving total kne... more knee arthritis is a risk factor for falling. Increasing numbers of people are receiving total knee arthroplasty (TKA) but the natural history of falling before and after TKA is unknown. to prospectively monitor falls in pre- and post-operative TKA patients and to identify independent risk factors for post-operative falling. a prospective observational study with a 1-year follow-up. community-dwelling older people recruited from a regional orthopaedic centre. consecutive patients added to the TKA waiting list who completed monthly falls diaries, pre-operatively and 1 year post-operatively. Data on knee status (WOMAC: pain, stiffness and function), balance confidence (the Activities Balance Confidence Scale-UK-ABC-UK) and mood (Geriatric Depression Scale-GDS) were collected at quarterly intervals. ninety-nine patients received a primary TKA. 24.2% fell in the last pre-operative quarter (24 patients reported 44 falls) and this decreased to 11.7-11.8% in the first four post-operative quarters. 45.8% of people who fell pre-operatively fell again in the first post-operative year. Higher pre-operative GDS scores and a history of falling were significant independent predictors of post-operative falling. a recent history of falling is common in people undergoing TKA and approximately 45% of patients fall again in the year following surgery. Patients being considered for TKA should be asked about falls history and undergo falls risk assessment and intervention.
Physical therapy, 2014
Glenohumeral subluxation (GHS) is a common poststroke complication. Treatment of GHS is hampered ... more Glenohumeral subluxation (GHS) is a common poststroke complication. Treatment of GHS is hampered by the lack of objective, real-time clinical measurements. The aims of this study were: (1) to compare an ultrasound method of GHS measurement with the fingerbreadth palpation method using a receiver operating characteristic curve (ROC) and (2) to report the sensitivity and specificity of this method. A prospective study was conducted. The study was conducted in local hospitals and day centers in the southwest of England. One hundred five patients who had one-sided weakness following a first-time stroke (51 men, 54 women; mean age=71 years, SD=11) and who gave informed consent were enrolled in the study. Ultrasound measurements of acromion-greater tuberosity (AGT) distance were used for the assessment of GHS. Measurements were undertaken on both shoulders by a research physical therapist trained in shoulder ultrasound with the patient seated in a standardized position. Fingerbreadth palp...
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Papers by Annette Swinkels