Background and Purpose
Range-of-motion (ROM) exercises may contribute to hemiparetic shoulder pain, but the underlying mechanisms are unknown. This study examined scapular and humeral movement patterns in people with hemiparesis post stroke as they performed commonly prescribed ROM exercises.
Methods
Using kinematic techniques, we studied 13 people with hemiparesis, both with and without pain, as they performed three commonly prescribed ROM exercises: person-assisted ROM, self-assisted ROM, and cane-assisted ROM. Their data were compared to a group of 12 matched control subjects performing scapular plane shoulder elevation using mixed model ANOVAs. Correlation analyses were used to examine the relationship between participants’ ratings of pain and kinematic data.
Results
The hemiparetic group had mild pain at rest that increased during the performance of the exercises. During shoulder elevation, humeral external rotation in the hemiparetic group was decreased in all three ROM exercises compared to the control group. Scapular upward rotation in the hemiparetic group was decreased for the person-assisted ROM exercise only. No differences in scapular tilt were found between groups. The extent of movement abnormalities was not related to pain severity.
Discussion and Conclusions
People with hemiparesis had altered scapular and humeral movement patterns and increased shoulder pain when performing the ROM exercises. These data can assist clinicians in making decisions regarding which exercises to prescribe to preserve shoulder motion and prevent contractures in this population.
Objective: No peer-reviewed research has explored professional and ethical issues encountered by physical therapists in treating patients with COVID-19. The purpose of this study was to explore the experiences of physical therapists regarding the professional and ethical issues they encountered during the COVID-19 pandemic.
Methods: The current study used reflexive thematic analysis, a qualitative research design developed by Braun and Clarke, to analyze individual interviews.
Results: Analysis of the coded interviews produced 6 primary themes (uncertainty, physical therapist’s role, ethical dilemmas and moral distress, emotions, providing care and working conditions, and management and leadership influence) and associated subthemes.
Conclusions: Physical therapists reported numerous professional and ethical issues across the individual, organizational, and societal realms during the COVID-19 pandemic. This study highlights the need for education and resources to prepare physical therapists for professional and ethical issues encountered during pandemics. Specifically, there is a need to define the physical therapist’s role in pandemics and prepare the physical therapy personnel for dealing with ethical issues, stress, uncertainty, and organizational changes associated with pandemics. Ethical guidelines would support organizations in delineating fair processes for triage and allocation of scarce resources for acute care physical therapy during healthcare emergencies.
Impact: The COVID-19 pandemic has produced significant changes in healthcare and physical therapist practice. This study reports results of the first research study focusing on professional and ethical issues experienced by physical therapists in acute care during the COVID-19 pandemic. As the US faces an unprecedented spike in COVID-19 cases and deaths, results of this study may contribute to physical therapists’ preparation for and response to professional and ethical issues encountered in acute care during the pandemic.
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