Aim: This pilot study compared the efficacy of superficial dry needling (SDN), deep dry needling (DDN), placebo dry needling (PDN) and a common physiotherapy control group (CON) when used in the treatment of myofascial trigger points (MTrPs) in rotator cuff syndrome (RCS) patients. Methodology: A randomised, single-blind, placebo-controlled pilot study (n=20) was conducted comparing the three needling groups to each other and to a common physiotherapy protocol. Participants were selected patients presenting for treatment in a private practice. The objectives of the study were to compare the groups on three levels: Pre trial-Post trial, within individual treatment session (Intra-treatment), and between treatment sessions (Inter-treatment). All groups were treated with the same basic common protocol but three of them had the addition of one each of the needling interventions. A modified Constant-Murley scale, range of motion and power were used as outcomes measures. Ethical permission was obtained from the University of the Witwatersrand. Results: Results were analysed for the four groups using an ANCOVA. DDN had significant improvement over CON over the trial period (p≤0.05) and SDN (p≤0.02). This was particularly due to highly significant intra-treatment effect on internal range of motion at session 3 (p≤0.01) and the highly significant inter-treament effect between session 3 and 4 (p≤0.03). DDN was significantly less effective than the other groups at session 3 (p≤0.01) and session 4 (p≤0.03). External rotation power was also significantly greater for DDN between sessions 2 and 3 (inter-treatment) (p≤0.05). 49% of the MTrPs identified were found within the infraspinatus muscles. Discussion: Twitch-obtaining dry needling (DDN) appears to show greater clinical benefit on the effects of myofascial trigger points than SDN, CON or PDN. The effect appears to correlate with the greater incidence of MTrPs in the infrapinatus muscles whose functions directly relate to the improved parameters. The clinical effect may be related to the effects of the bleeding elicited by intramuscular needling (humoral effects). This is evidenced by the transiently poor effect of DDN immediate following treatment becoming significanly better by the following treatment. Conclusion: The pilot study showed that DDN may be an effective treatment for RCS when used in conjunction with a conventional physiotherapy programme. The elicitation of a local twitch response and associated bleeding may be significant. In future studies, particular attention should be paid to both the infraspinatus muscle and the timing of the intervention and observation intervals.

The physical body is the one thing we have with us from the day we enter life to the day we depart. Most of us take for granted the fact that our bodies and all the systems therein do what we expect them to without pain or discomfort. It is important to keep this vessel as functional as possible. In this society where independence and mobility are highly valued, it is often thought that the body needs to be in working order to take full advantage of the world around us. It is easier to live when the body is in complete working order since our society is one designed for those with independent mobility. Although it may be difficult to see directly after an injury, quality of life is enhanced when mobility is regained. Reduced functionality leads to physical and emotional debilitation. Reduced functionality may occur from an accident, disease, injury or genetic abnormalities. According to The Disability Statistics Rehabilitation Research and Training Center, the fourth most common condition (4.6% of all conditions) which causes individuals to limit activities, is the impairment of lower extremities, greatly effecting quality of life (Persoon, 2004 and Rikli, 2005) Among the lower extremities, impairments, knee joint injuries and chronic pain are common. A 2003 interview from ABC television quotes Scott Lephart, Ph.D. as saying, knee injuries are occurring in epidemic proportions. Knee injuries constitute only about 15% of all sports injuries but are 50% of visits to sports doctors, indicating that when they happen, they are usually significant. (McLaughlin) This project will focus on lower extremity injuries since it is the largest orthopedically limiting condition. Physical Therapy is one of the medical options used to regain normal functionality of an injured body part or to reduce chronic pain from a musculoskeletal condition. Patients are referred to PTs by a physician, orthopedist or surgeon after an injury. The referrals come after a physician has confirmed that a patient needs to regain functionality and reduce pain after surgery or the incident of chronic pain. Patients may be seen at a variety of locations including the hospital (both in-patient and out-patient), a private PT office, at home, in a nursing home, or in an athletic center. The profile of patients who see PTs is changing and growing. The population of the United States shows a breakdown of 49.1% and 50.1% males to females. (Hicks et al., 2004) In therapeutic settings, the genders are unequally represented with 44.2% of patients being male and 55.8% being female. It has been hypothesized that more women are participating in sports and suffering subsequent injuries (Brisette, 2004 and abclocal.go.com). Compared to their representation in the U.S. general population, middle aged (50-74) and older (74+) adults were overrepresented in the demographics of those seen by a physical therapist. Most frequently seen patients were middle-aged adults (50-74) and young adults (20-49). The population is living longer and, through modern medicine, are able to live with chronic and disabling conditions. These conditions require treatment possibly resulting in the rise of patient statistics weighted towards the older population (Brisette, 2004). A patient participating in a course of physical therapy has not only to contend with the physical ramifications of an injury, but also the psychological issues (Uppal, 2003). While bones, ligaments and cartilage are healing, patients are required to participate in a series of exercises both at home and in a therapists office. While rehabilitating at home, patients may find it difficult to remember, make time or feel motivated to do these exercises. These issues are a large obstacle on the path to wellness. The design solution presented in this thesis looks at the factors which influence motivation including community, positive and negative feedback, tracking and goals. The proposed solution will incorporate information from the fields of psychology, wearable technology and physical therapy. Pain and injury do not necessarily motivate individuals to participate in a course of a HEP (home exercise program) which can eventually lead to better health. Knowing a product will make you feel better does not make you use it. A goal is not enough. To further motivate individuals, aspects of fun, community, autonomy and competence can greatly improve a persons desire to heal (Uppal, 2003 and Deci-Ryan and Coleman, 1998). A customizable, networked solution is proposed where individuals may use one, two or all three parts of an integrated system to track daily and overall progress, work with a buddy and communicate with a therapist. It is hypothesized that with this system, patients will be more motivated to participate in at home physical therapy to regain full functionality. The research and design process took part in various stages. Processes moved from the general to the specific as research and interviews informed the work.

Abstract Physical therapy (PT) referral model is the major entrance for public to receive professional PT services. In additional to the traditional ¡§restricted referral model¡¨, the new ¡§independent referral model¡¨ is introduced in some regional teaching healthcare institutions. Searching for the appropriate referral model of PT may be the first step for patients to get high quality PT services, and should be concerned and emphasized. The study aims to investigate the perceptions of relevant medical professionals (physicians specialized in orthopedic, neurology, neurosurgery, plastic surgery, family practice, and pediatrics, and physical therapists) and outpatient patients to the current PT referral model in the studied hospitals. Primary findings are as following: 1. Physical therapists are in favor of ¡§independent referral model¡¨ compared to physicians in the surveyed groups. 2. Based on the characteristics of physicians, ¡§field of specialty¡¨ and ¡§confirm with the National Insurance Reimbursement Regulation¡¨ are significant related to their perceptions of the ideal referral model. 3. Based on the characteristics of physical therapists, ¡§age¡¨, ¡§professional education¡¨, and ¡§clinical experience¡¨ are significant related to their perceptions of the ideal referral model. 4. Outpatients in the studied hospitals perceive that physical therapists are more aware of the treated conditions than physicians. 5. Outpatients in the studied hospitals perceive that physical therapists are in a better position for developing rehabilitative plan than physicians.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2002. / Includes bibliographical references.

Thesis (Ed. D.)--West Virginia University, 2002. / Title from document title page. Document formatted into pages; contains xi, 178 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 151-160).

Thesis (Ed. D.)--West Virginia University, 2003. / Title from document title page. Document formatted into pages; contains vi, 79 p. : ill. Vita. Includes abstract. Includes bibliographical references (p. 54-58).

This study investigated the prevalence of thumb problems in Australian physiotherapists and the association between these thumb problems and various potential risk factors. Information concerning the nature and type of thumb problems experienced by physiotherapists was also sought. The study sample consisted of a random selection of physiotherapists identified from the registration lists held by the Physiotherapy Registration Boards of each Australian state and the Northern Territory. The measurement tool used in this study was a self-administered questionnaire that was sent to participating physiotherapists by mail. The questionnaire was purpose designed for this study and was based partly on previously used questionnaires that had investigated work related musculoskeletal disorders. In addition, the questionnaire was based on information obtained from informal discussions with colleagues and formal focus groups. As part of its development, the questionnaire underwent a number of pilot studies and a limited study investigating test-retest reliability. / Questionnaires were mailed to 1562 registered Australian physiotherapists, with a return rate of 70.6 per cent and a completion rate of 67.6 per cent. The sample of 961 respondents included in the study appeared representative of the population of Australian physiotherapists from which it was drawn, in terms of demographic data. The current prevalence of thumb problems was found to be 65.3 per cent (394 respondents) and the lifetime prevalence of thumb problems was 55.3 per cent (628 respondents). The factors that were found to be significantly associated with thumb problems included working in the area of orthopaedic outpatients (odds ratios 2.3-3.4), trigger point therapy (odds ratio 2.3) and massage (odds ratio 2.1); the presence of thumb joint hypermobility (odds ratio 2.2-2.6); or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques (odds ratio 5.0). Other factors such as the hours worked per week, years worked in an area of physiotherapy practice and the presence of general joint pathology did not increase the risk of thumb problems in this sample of Australian physiotherapists. / The symptoms most often reported by the 628 respondents with thumb problems were pain (90.1%) and instability (22.0%). The majority of the thumbs (57.0%) of respondents with thumb problems had been symptomatic for more than one year, but only 9.0 per cent of thumbs had caused symptoms on a daily basis over the last 12 months. The majority of respondents with thumb problems reported an insidious onset to their thumb problems that was related to their work as a physiotherapist (79.6%), with the onset occurring most frequently during the first five years after graduation. The metacarpophalangeal (MCP) joint was most commonly identified by respondents as being the source of their thumb problems (33.5%). While thumb symptoms did not affect activities to a marked degree, aching, pain and instability (of the MCP joint) were the symptoms that most often stopped activity. / Approximately half of the respondents (52.2%) with thumb problems in this sample had sought treatment for these problems, with taping the most commonly utilised treatment modality. For those physiotherapists with thumb problems, the thumb problems were found to have had a major effect on their career, with 19.1 per cent of those with thumb problems changing their field of physiotherapy practice and 4.0 per cent leaving the physiotherapy profession as a result of their thumb problems. / In conclusion, the prevalence of thumb problems in Australian physiotherapists appears to be high, and can be of sufficient intensity to impact on physiotherapists careers. Working in the area of manual therapy, having hypermobile thumb joints and being able unable to stabilise the joints of the thumbs whilst performing physiotherapy techniques appear to be particular risk factors for the development of thumb problems in physiotherapists. / Thesis (MApSc(Physiotherapy))--University of South Australia, 2005.

Thesis (MAppSc in Physiotherapy) -- University of South Australia, 1993

Thesis (M.S.)--Indiana University, Dept. of Kinesiology, 2006. / Includes bibliographical references.

Dissertation (MHSc--Health Science) -- AUT University, 2007. / Primary supervisor: Duncan Reid. Includes bibliographical references. Also held in print (ix, 60 leaves ; 30 cm.) in North Shore Campus Theses Collection (T 615.82 POL)