Background: Knee osteoarthritis (OA) is associated with changes in walking biomechanics such as altered excursion or change in joint load. Manual therapy (MT) may modulate pain via the enhancement of descending pain mechanisms which could influence neuromuscular activity and subsequently lead to changes in the mechanical behavior of the joint such as modification of joint load. There is limited research, and an opportunity exists to further explore whether MT can influence biomechanics during walking.

Objective: The 1° aim of this study is to explore whether MT intervention influences the biomechanical outcomes of gait in people with knee OA. The 2° aim is to explore the relationship between biomechanical outcomes of gait and clinical outcomes (pain and function), following MT intervention.

Methods: Prospective registration no. ACTRN12624000157572p. Study design: single-arm pretest-posttest design. The participants will be included as per defined inclusion and exclusion criteria. Primary outcome: Peak knee adduction moment (KAM) measured by biomechanical gait analysis. Secondary outcomes: knee range of motion, pain while walking, fear and avoidance, recommended core set of patient-reported outcomes, and 2° biomechanical outcome measures of gait. Time-points: Baseline I, baseline II at 4-week, post-intervention at 8-week, and follow-up at 6-month. Knee-focused tailored MT will be provided with the frequency of 2 sessions/week x 45-60 mins x 3 consecutive weeks.

Results: We will report descriptive statistics of each outcome measure. To evaluate our 1° aim, we will use repeated measures ANOVA and a Tukey HSD post hoc test. We will perform repeated measure correlation tests to assess our 2° aim.

Conclusion: It is an exploratory study that will provide preliminary evidence on whether MT could influence biomechanical outcomes of gait.

Implications: This study will advance the knowledge of MT mechanisms. It may provide further support for the role of MT in the management of people with knee OA.

Background
My research explores physiotherapists’ understanding of falls risk in people with osteoarthritis. The number of people diagnosed with osteoarthritis is increasing, as is Aotearoa’s aging population. There is a well-researched link between osteoarthritis and falls, with an increased risk of falls in this population. Physiotherapists have an important role in assessing and treating people with osteoarthritis, and in preventing falls and managing people after falling. It is therefore important to find out how physiotherapists consider falls in their treatment of people with osteoarthritis.

Purpose
Little is known about how physiotherapists perceive the connection between falls and osteoarthritis, and evidence from Australia shows the link may not be considered. This study's purpose was to explore if physiotherapists in Aotearoa New Zealand consider falls risk in people with osteoarthritis. This research is an important step to gain insight into current clinical practice.

Methods
I used a Qualitative Descriptive method for this study and semi-structured interviews to collect data from 10 physiotherapists; data were then analysed by qualitative content analysis.

Results
Three themes were conceptualized from the data: (1) What’s the risk? (2) Making assumptions, and (3) The gatekeeper of treatment. We found factors such as age, co-morbidities, system restraints, roles and assessment forms influenced participants’ clinical decision making, and that physiotherapists do not appear to be routinely screening for falls risk in people with osteoarthritis.

Conclusions
The findings of this study suggest a benefit to patients with osteoarthritis of physiotherapists questioning about falls, regardless of other presenting clinical features.

Implications
The finding supports our understanding of how physiotherapists might effectively manage falls risk in the OA population, to shape future guidelines and recommendations. These findings, if acted upon could result in reducing fall-related injuries, fatalities, and healthcare costs, benefitting people with OA and healthcare systems.

Background: There is no national framework to identify and chart an individual’s post COVID symptoms in New Zealand (NZ). The Long Covid Symptom Map (LCSM) was developed in March 2022. Cardiorespiratory physiotherapists treating patients at that time felt an increasing need to have something that made sense of overwhelming complex narratives and they were unable to gain access to overseas tools.
Purpose: The LCSM streamlines the patient experience, identifying key symptoms and directing care to the right professional.
Method: Developed by the author (July 2022) and tested for red flag identification. The LCSM was presented to the Cardiorespiratory Special Interest Group in a webinar, and they agreed to pilot and support its use. The LCSM was presented at The Otago Forum ‘Journey through the Fog’ and at National conference in 2023. The LCSM has continued to be used by a growing number of practitioners as well as patients who chart their own symptoms. Newly revised and adopted into the Ministry of Health National Clinical Guidelines; it has been taken up by Queensland Health Australia. Future research is planned, commencing with evaluation of the LCSM.
Results: The LCSM is easy to use, completion can be supported or independently managed. As predicted, it saves time, assessing and providing direction to the most appropriate Allied Health Professional when presented with a complex cluster of symptoms.
Conclusion: The LCSM Identifies primary symptoms and functional disabilities.
It provides a body chart and narrative space to capture all symptoms and it supports red flag recognition.
It offers timely patient reporting of multiple symptoms and continues to evolve.
Implications: The LCSM has merit for all staff working with Long Covid patients, reducing the time needed to determine symptoms and offering a meaningful platform for the patient from which they can receive treatment, feel heard and demonstrate change.

Background
Achilles tendon rupture is a traumatic injury and ongoing deficits in plantar flexor endurance and strength are seen 12 months post injury. There is poor consensus regarding the optimal acute conservative management strategy to date.

Purpose
To assess the effects of immediate weight bearing vs delayed weight bearing standard care post Achilles tendon rupture on perceived function, Achilles tendon length and plantar flexor muscle performance at 12 months post injury.

Method
This study was a cross-sectional design assessing participants 12 months post conservatively managed Achilles tendon rupture in an immediate weight bearing (VACOped) group compared to a standard care group. 34 participants were recruited (VACOped group: 20; Standard Care group: 14). Perceived function was measured using the Achilles Tendon Rupture Score (ATRS) and the Injury-Psychological Readiness to Return to Sport (I-PRRS). Functional outcomes were measured using the total heel raise work test, maximum voluntary contraction of the plantar flexors (MVC), single leg hop for distance and height and a lateral continuous hop test. Achilles tendon length was measured using the resting angle method.

Results
There was no significant difference between groups for all outcome measures (p.>0.05). Across groups the mean score for the ATRS and I-PRRS was 76 and 42 respectively. A significant difference between limbs was seen in the total heel raise work test (33%), MVC (18%), hop for distance (12%) and hop for height (19%). Hanging angle was increased by a mean of 32% across groups.

Conclusion
The main findings of this study demonstrate that there are still ongoing deficits in self-perceived function, plantar flexor muscle performance and tendon elongation across limbs post rupture, irrespective of initial weight bearing capacity.

Implications
These findings should provide patients and clinicians with confidence around loading the Achilles tendon early post rupture but raises questions regarding the expectations of recovery.

Physiotherapy has the potential to benefit people with voice and throat problems, in conjunction with existing services. Yet as a niche area of practice, little is known about the impact or role of physiotherapy in voice and throat care. This study aims to explore the impact and role of physiotherapy in voice and throat care, from the perspective of people who have accessed such care. Gaining a better understanding of how physiotherapy contributes to care has the potential to improve services. An interpretive description design was used to explore participants perspectives of the impact and role of physiotherapy through individual semi-structured interviews with people who had accessed physiotherapy for voice or throat care through a single private practise. Transcripts were analysed with a general inductive approach suitable for qualitative evaluation data. Data were analysed from six interviews and four main themes emerged, with each theme further characterised by categories. Two themes related to the impact of physiotherapy in voice and throat care: Offers a deeper understanding of issues affecting their voice/throat; and facilitates individualised specific management. Two themes related to the role of physiotherapy in voice and throat care: Complements existing services; and Valuable service. This study indicates that physiotherapy for voice and throat problems can complement existing services while adding value, providing people with a deeper understanding of their problem, and facilitating specific management. These findings help inform how physiotherapy can contribute to voice and throat care services.

Background
Voice physiotherapy has the potential to benefit a wide range of people with voice and throat problems, in conjunction with existing services. Yet as a niche and novel area, little was known about the characteristics of individuals presenting for physiotherapy care with voice and throat problems.
Purpose
This study aimed to describe the demographic and clinical characteristics of individuals presenting to physiotherapy for voice and throat-related problems and to use this information to clarify the role of physiotherapy in the established voice care team
Methods
A retrospective clinical case notes review was conducted of all clients who accessed physiotherapy for voice and throat problems at a private practice based in Christchurch, New Zealand within a 12-month period from 1st October 2020 to 1st October 2021.
Results
Data were analyzed from 53 patient charts. The typical profile of an individual accessing the service were female (n=37) NZ European (n=26), singer (n=43), with chronic problems (n=20), of a non-traumatic origin (n=45). The mean age was 35 (SD 17.79, range 19-80) and five (10%) of client’s issues had a relevant ACC claim. Voice problems were present in n=39 and muscle-related problems were present in N=42 of cases. Treatment primarily included laryngeal manual therapy and various modes of exercise therapy.
Conclusions
The clinical characteristics described offer insight into the demographic and clinical characteristics, such as age, ethnicity, origin, and chronicity of problems of individuals accessing physiotherapy services for voice and throat problems. A high prevalence of muscle-related problems and wider issues were identified, consistent with the physiotherapy skill set.
Implications
By identifying and managing muscle-related voice problems and addressing wider factors contributing to voice and throat problems, physiotherapy appears to complement existing ENT or SLT services, which tend to focus on other factors affecting the voice and throat.

Background: The world faces considerable challenges to health and wellbeing. Globally distributed determinants have a powerful influence on health outcomes with inequitable drivers of ill health distributed within and across population groups.
Purpose: To provide a summary of recent peer-reviewed and published literature in the field of Global Health and Physiotherapy from the past 10 years.
Methods: Literature review
Results: Physiotherapists can and should play an active role in forming healthy policy for all. There are several identified global and local movements that physiotherapists can contribute to to ensure equitable access to the determinants of health, including the global drivers of health inequities, education and clinical practice.
Conclusion(s): Healthcare workers can play an important role in providing equitable, accessible healthcare for all. The Sustainable Development Goals and the Environmental Physiotherapy Association are examples in which physiotherapists can contribute to global advocacy movements.
Implications: Physiotherapists can play a pivotal role within the field of Global Health to advocate for equitable, healthier environments, particularly for those who face inequities to the determinants of health.

Background and purpose: Strabismus is an ophthalmic disorder that affects balance, function, and psychosocial aspects. The research stream on strabismus and balance in children started as a ‘coffee conversation’ between research physiotherapists and ophthalmologist/s in 2014. Further discussions on collaborative research led to a series of investigations in children with strabismus.
Collectively, these research findings suggest that children with strabismus rely on their visual input even when they are inaccurate. The findings also imply that children with strabismus have issues with their sensory integration that affect their balance control as well as their physical function (Detailed scientific information on these can be found elsewhere). However, the question of “What do these research findings mean to children with strabismus, their whānau, or healthcare practitioners?” was the primary driving purpose of this innovative research practice.

Methods: Drawing upon the importance of co-design for meaningful research impact, we set out to think differently about a way of communicating findings that is meaningful. The team included Science Communication and Physiotherapy students working together with the research team and physiotherapists which brought perspectives of science communication, research impact, and physiotherapy research and practice. A strategy was developed to communicate a ‘statistically significant finding’ to a wider audience that is meaningful.

Output/outcome: The activity generated a set of animation resources, infographics, activities, and events targeted at better communicating how balance systems worked in individuals and how the current research contributed new knowledge to the existing body of knowledge.

Conclusion & implications: The co-designing activity supported the development of resources for communicating specialist knowledge to a wider audience in a meaningful way. Researchers can explore alternative ways to communicate the findings for better research impact. The resources themselves will be useful in clinical practice to support people living with long-term conditions that require sensory-motor reorganisation.

Background:
Myotonic Dystrophy Type 1 (DM1) is a genetic disorder affecting multiple organ systems causing progressive disability and shortened life expectancy. It is characterised by myotonia and progressive muscle weakness, primarily affecting the distal leg and arm muscles, craniofacial muscles, and neck flexors before impacting more proximal musculature. Falls are 10 times more common in DM1 than in aged-matched healthy volunteers. This has been attributed to muscle weakness, but more recently other facets of balance have been considered.

Purpose:
To assess the extent of balance issues in patients with DM1 and determine which components of balance may be impaired and to what extent.

Methods:
We aim to recruit 20 adult participants with DM1 who can walk 10 m independently without a walking aid.

Physiotherapy assessment will include visual acuity, pinprick, light touch, vibration, proprioception, 2-point discrimination, Scale for Assessment and Rating of Ataxia (SARA) and postural sway in standing and walking using the Gait and Balance App (G&B App). Strength data for these participants is being collected in a concurrently running study.

An Audiologist will conduct the vestibular assessment which includes 3D video Head Impulse Test (high velocity vestibulo-ocular reflex function) and Vestibular-Evoked Myogenic Potentials (function of the otolithic organs of the inner ear and their neural pathways). Oculomotor function (ability to accurately fixate and track a visual target) and Caloric testing (low velocity horizontal vestibulo-ocular reflex function).

Descriptive statistics will determine the rates of abnormalities for each assessment.

Results:
The two participants recruited so far have both shown abnormalities in their vestibulo-ocular reflexes, impaired standing balance on a compliant surface with eyes open and closed and impaired sensation and joint position sense.

Conclusion:
Conclusions will be drawn upon study completion.

Implications:
Understanding the impaired systems of patients with DM1 will guide future physiotherapy practice and research.

Background
Physiotherapy is a mainstay treatment for paediatric musculoskeletal concerns, however many serious paediatric medical conditions present with musculoskeletal symptoms. Historically, children living in Taranaki with musculoskeletal concerns were seen by physiotherapists, with limited paediatric experience, in private practice clinics. In 2022 Active Plus Taranaki started providing paediatric specific services from an experienced Paediatric physiotherapist.

Purpose
This study reviews the patterns of onward referral from paediatric physiotherapy to paediatrics and ultimately the number of children diagnosed with red flags/requiring medical treatment since opening the Paediatric physiotherapy services at Active Plus.

Methods
A retrospective audit of medical records between February 2022 to July 2022 and August 2023 to January 2024 (this was due to maternity leave) was completed on all patients referred to Active Plus Taranaki for paediatric assessment.

Results
A total of 34 patients were seen by the paediatric physiotherapist. 15 of these were referred with diagnosis from orthopaedic surgeons. 19 were self-referred or from general practitioners, of these 19, 6 (31.5%) were referred by the paediatric physiotherapist for further investigations (either to paediatricians, Paediatric Neurologists, or orthopaedic surgeons). All 6 of these children received medical diagnosis.
Mild cerebral palsy (GFCS1) was the most common diagnosis with 2 patients, the remainder of patients were diagnosed with Chronic recurrent multifocal osteomyelitis, Perthes disease, infantile scoliosis, thoracic spine syrinx and structural brain abnormality.

Conclusion
Although we acknowledge the small sample size of this study, this indicates a high percentage of children presenting at physiotherapy may have underlying conditions or red flags.

Implications
Children who present at paediatric clinics via self-referral or GP referral should be assessed with the knowledge that paediatric red flags can and will present in children and these are different to adults. An understanding of local paediatric networks and referral criteria is essential to all physiotherapists working with children.

Background – The term ‘Long Covid’ describes those with ongoing symptomatic COVID-19 (< 12 weeks) and those with Post‑COVID-19 syndrome (PACS) (>12 weeks post infection.)
New Zealand’s unique experience of COVID-19 presents challenges in defining an accurate incidence of ‘Long Covid’ locally. Observational research suggests approximately 4-4.5% incidence in a triple vaccinated, Omicron focused cohort.
Purpose - PACS presents with a range of symptoms with fatigue, brain fog, breathlessness and impaired exercise tolerance being some of the most common. Allied health input has been shown to be effective internationally in treating PACS. However few individuals with PACS fit existing criteria for Allied Health services in Canterbury.
Methods – Funding was identified to run a 6-month MDT pilot service to support individuals with PACS. A broad range of allied health professions were involved. Input was through clinics, home visits, telehealth and education sessions.
Results – The service opened for referrals from May 1st -June 9th only due to volume of referrals and indications that funding would cease at the end of the 6-month term. Despite limited interventions for the over 100 referrals received, 60% had improved Post Covid Functional Scale scores, 58% improved Long Covid Symptom severity scores and 81% improved in Breathing pattern assessment scale scores. Participant feedback was overwhelmingly positive.
Conclusions – MDT intervention for those with PACS can be effective at improving functional, symptom severity and breathing pattern scores. The service was well received by participants. The incidence of PACS in the Canterbury population remains unclear due to the brief period during which referrals were able to be accepted.
Implications – Individuals experiencing PACS are likely to benefit from an individualised MDT approach to managing their symptoms. With the closure of the service, many people with PACS continue to struggle to get support with managing their symptoms.

Background: The use of diagnostic imaging in low back pain management is often inappropriate despite recommendations from clinical practice guidelines. There is limited understanding of factors that influence the imaging clinical decision-making process.

Purpose: The aim of this scoping review was to explore literature on factors that influence clinicians’ decision to refer people with LBP for imaging. How these factors could be addressed to influence imaging referral behaviour was also considered.

Method: A scoping review was conducted following the PRISMA-ScR guidelines using the following databases: Medline, CINAHL, EBSCO, Scopus, and Cochrane Reviews. Full text English language peer-reviewed articles published between 2010 and February 2023 were included. Data were analysed through an inductive process to categorise the factors that influence clinical decision-making.

Results: Thirty-five studies were included in the review. A variety of clinical and non-clinical factors were found that influence imaging clinical decision-making. Three categories were developed: clinical features, non-modifiable and modifiable factors. The focus was on modifiable factors, which were further divided into patient beliefs and clinician beliefs.

Conclusion: This is the first scoping review of factors that influence imaging clinical decision-making in LBP management. There are patient and clinician beliefs which could be targeted to effect a change in clinical practice.

Implications: Few studies have investigated how patient beliefs affect the decision to refer for imaging. The decision to use imaging is often perceived to be based on objective findings, this research suggests that the beliefs of both clinician and patients, play a role in decision-making. These beliefs are not always acknowledged and may result in inequitable and harmful overuse of imaging. Supporting clinicians to confront their beliefs and co-design strategies to improve public knowledge and clinical practice, would reduce wasteful expenditure and potential clinical harm.

Background
Low back pain (LBP) is the leading cause of disability worldwide. For most people, episodes of acute LBP will resolve quickly; however, recurrence is common, and for some, the pain will become chronic. Low back pain research traditionally reports direct and indirect monetary costs and focuses less on the intangible costs on a person’s life. The effects of LBP on activity and quality of life have been widely reported, however, the specifics of these effects remain unclear.

Purpose
Health-related low back pain costs can be direct, indirect, or intangible. The purpose of this review was to identify the intangible, non-monetary costs of LBP from the perspective of the individual.

Methods
A scoping review of literature was undertaken. Four databases were searched up to 6th March 2023. Data from the included studies were coded and analysed using directed content analysis.

Results
Forty-five studies met the inclusion criteria. Six categories were derived from the data, all of which express the experience of the person with LBP: Perceptions of Pain, Patient Experience of Healthcare, Becoming Defined by Low Back Pain, Life on Hold, My Social Self, and Disrupted Work Life.

Conclusions
This review highlights the profound effect of LBP on people’s lives and their sense of self. The findings illustrate the perceptions of pain, experiences with health services, interference in daily living and work, and psychological and social disruptions.

Implications
There is a need for healthcare practitioners to recognise and validate the lived experience of people with LBP. Patients should be reassured that invisible pain does not suggest that their pain is imagined; they should experience empathy for its impact on their lives. Acknowledging the effect of pain can help to ease suffering and give their experience the legitimacy it deserves.

Background: Wearable technologies may offer additional benefits over current rehabilitation strategies for orthopaedic care, including remote monitoring. Best practice following knee injuries involves objective assessment to determine rehabilitation progress and functional ability. Despite the potential, no inertial sensor devices have been successfully integrated for assessing knee movement and gait in- and out of clinical settings. A custom-built inertial sensor was developed and embedded into a commercially available knee brace paired with a mobile application.
Purpose: To investigate usability of the instrumented knee brace for individuals with anterior cruciate ligament reconstruction (ACLR) or meniscal injury.
Methods: In this cross-sectional study 16 participants (age 28.44 SD:9.2) were fitted with the brace on their affected limb and 34 healthy participants (age 26.2 SD:6.8) were fitted with the device on their dominant limb. User experience and device usability was assessed using the System Usability Scale (SUS). Participants completed a 10m walk test and 6-minute walk test while wearing the brace.
Results: The average overall SUS score was 79.46 which is deemed as “good”, and individual items were scored as relatively positive (average=2.90). Significantly higher SUS scores were observed in participants with a knee condition (81.13) compared to healthy participants (77.38; F = 4.23, p=0.02).
Conclusions: Overall, good usability was reported among participants. Participants did find the instrumented knee brace to be cumbersome and complex, but most also reported they would use the device frequently. The device was rated higher by those with a knee condition, suggesting individuals affected by health conditions may view wearables more positively than healthy individuals.
Implications: The findings highlight the opportunity of using wearable technologies as a rehabilitation tool to collect patient reported outcome measures and functional assessments away from the constraints of the clinic. We have yet to establish all potential end-user requirements in real-world settings, including healthcare providers.

SMA refers to a group of autosomal recessive neuromuscular diseases characterised by progressive degeneration of alpha motor neurons in the spinal cord and brainstem. There are 44 adults with SMA throughout Aotearoa, with an additional 5 residing overseas where they have access to disease modifying therapies (DMTs) that aren’t accessible in Aotearoa. Importantly, many of these patients are not engaged with healthcare services.

Purpose:
To describe what is already known about motor function characteristics of adults with SMA in Aotearoa and our intention to assess and support these patients prospectively.

Methods:
Current data being presented is available from Pūnaha Io –New Zealand’s NeuroGenetic Registry and Biobank.

We have established a multi-disciplinary SMA clinic at the University of Auckland Centre for Brain Research Neurogenetics Clinic. Patients throughout Aotearoa will be supported to travel to Auckland for the clinic where they will be reviewed by a neurologist and a physiotherapist who will complete a variety of functional measures relevant to their type of SMA. The combined information will be reported back to the patient and their GP with recommendations for management and referrals for local allied health and support services.

We have developed ambulatory and non-ambulatory assessment protocols for these patients; including motor, respiratory, timed function and patient reported outcomes.

Results:
Of the adults with SMA residing in Aotearoa 15 have type2, 12 have type3A, 11 have type 3B, 4 have adult onset.
20 are ambulatory and 24 are full time wheelchair users.

Conclusions:
Data from the clinic will inform Pharmac of the need for reimbursement of DMTs in Aotearoa. Additionally, participants will be supported to access healthcare services.

Implications:
This clinic will assist in ensuring that Aotearoa meets best practice standards of care for SMA and benefiting our participants to live well across the lifespan.