Physiospot - Physiotherapy and Physical Therapy in the Spotlight » Research

Do you have patients that battle chronic pain?

Brooke McVeigh — Wed, 23 May 2012 14:23:06 +0000

If you answered yes to this question, I urge you to check out the May issue of Evidence In Motion’s online Journal Club: How to Explain CENTRAL SENSITIZATION to Patients with ‘Unexplained’ Chronic Musculoskeletal Pain

In this issue, Dr. Jo Nijs, PT, PhD provides the evidence-based explanations and treatment options for many cases of chronic musculoskeletal pain. The May issue also includes a BONUS article that will help you recognize Central Sensitization. Click here to purchase this issue and learn how you can help your patients win the battle against chronic pain!

Mirror therapy for improving motor function after stroke: Cochrane Review

Rachael Lowe — Mon, 14 May 2012 09:09:26 +0000

Paralysis of the arm or leg is common after stroke and frequently causes problems with activities of daily living such as walking, dressing or eating. Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the patient’s midsagittal plane, thus reflecting movements of the non-paretic side as if it were the affected side. The objective of this Cochrane reviw was to summarise the effectiveness of mirror therapy for improving motor function, activities of daily living, pain and visuospatial neglect in patients after stroke. 14 studies with a total of 567 participants that compared mirror therapy with other interventions were compared.

At the end of treatment, mirror therapy improved movement of the affected limb and the ability to carry out daily activities. Mirror therapy reduced pain after stroke, but only in patients with a complex regional pain syndrome. The beneficial effects on movement were maintained for six months, but not in all study groups. No adverse side effects were reported. Further research is needed with larger studies in natural clinical settings, and with a comparison of mirror therapy with more routine treatments.

Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. The Cochrane Library, 14 March 2012.

No related posts.

Efficacy of Directional Preference Management for Low Back Pain: A Systematic Review

Rachael Lowe — Tue, 01 May 2012 15:58:52 +0000

Providing specific treatment based on symptom response for people with low back pain (LBP) and a directional preference (DP) is a widely used treatment approach. The efficacy of treatment using the principles of directional preference management (DPM) for LBP is unclear. The purpose of this systematic review was to determine the efficacy of treatment using the principles of DPM for people with LBP and a DP. Only RCTs investigating DPM for people with LBP and a DP were included. Outcomes for pain, back specific function, and work participation were extracted. Six RCTs were included in this review. Five were considered high quality. Clinical heterogeneity of the included trials prevented meta-analysis. GRADE quality assessment revealed mixed results; however, moderate evidence was identified that DPM was significantly more effective than a number of comparison treatments for pain, function, and work participation at short-term, intermediate-term, and long-term follow-ups. No trials found that DPM was significantly less effective than comparison treatments.

Although this systematic review showed mixed results, some evidence was found supporting the effectiveness of DPM when applied to participants with a DP, particularly at short-term and intermediate-term follow-ups. Further high-quality RCTs are warranted to evaluate the effect of DPM applied to people with LBP and a DP.

Surkitt, L. D., Ford, J. J., Hahne, A. J., Pizzari, T., McMeeken, J. M.. Efficacy of Directional Preference Management for Low Back Pain: A Systematic Review. Physical Therapy, May 2012 vol. 92 no. 5 652-665

No related posts.

Anxiety and Depression Should be Adressed in Individuals with Arthritis.

Rachael Lowe — Tue, 01 May 2012 15:54:55 +0000

Are you doing enough to alleviate the fears of your patients with arthritis? A recent study published in Arthritis Care and Research found that anxiety is more common than depression among US adults with arthritis. The study sample comprised US adults aged ≥ 45 years with doctor-diagnosed arthritis (n=1,793) from Arthritis Condition and Health Effects Survey (a cross-sectional, population based, random digit dialed telephone interview survey). Anxiety and depression were measured using separate and validated subscales of the Arthritis Impact Measurement Scales. The results showed that anxiety was more common than depression (31% and 18% respectively); overall, a third of respondents reported at least one of the two conditions and most (84%) of those with depression also had anxiety.

Despite the clinical focus on depression among people with arthritis, anxiety was found to be almost twice as common as depression. Given their high prevalence, profound impact on quality of life, and range of effective treatments available, health care providers should be encouraged to screen all people with arthritis for both anxiety and depression.

No related posts.

New low back pain guidelines from the APTA.

Rachael Lowe — Thu, 05 Apr 2012 15:39:06 +0000

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.

Anthony Delitto, Steven Z. George, Linda R. Van Dillen, Julie M. Whitman, Gwendolyn Sowa, Paul Shekelle, Thomas R. Denninger, Joseph J. Godges. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. 2011J Orthop Sports Phys Ther. 2012;42(4):A1-A57.

We’ve added these to our Clinical Guidelines Resource in Physiopedia where you can see all the clinical guidelines that are available internationally for a variety of conditions. Do you know of any more that we can add to this list?

No related posts.

Falls prevention exercise classes benefit older people.

Rachael Lowe — Fri, 30 Mar 2012 11:30:28 +0000

Falls prevention exercise classes are beneficial for older people, according to a report published last month by the Royal College of Physicians(RCP) in the UK. The RCP report is based on feedback from more than 1,700 older people who attended NHS-run exercise programmes that aimed to reduce falls. The results showed that 96 per cent of older people felt the exercises were beneficial, while 95 per cent were either satisfied or very satisfied with their exercise programme. The report summarises that the delivery of evidence-based exercise classes varies widely between healthcare providers, and many patients need to be made more aware that therapeutic exercise can help to prevent falls.

Physiotherapists should be striving to raise awareness of how strength and balance exercises can promote healthy ageing, as well as ensuring that they adhere to the evidence base for exercise. There is still work to be done in raising awareness of the evidence base for exercise in this population and the fact that exercise is more cost effective than any other intervention for falls prevention.

See the full research report here…

No related posts.

Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries

Rachael Lowe — Mon, 12 Mar 2012 08:38:57 +0000

This excellent clinical commentary provides a thorough scientific basis for anterior cruciate ligament rehabilitation based on graft selection, patient population, and concomitant injuries. Rehabilitation following anterior cruciate ligament surgery continues to change, with the current emphasis being on immediate weight bearing and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills. The rehabilitation program should be based on scientific and clinical research and focus on specific drills and exercises designed to return the patient to the desired functional goals. The goal is to return the patient’s knee to homeostasis and the patient to his or her sport or activity as safely as possible. Unique rehabilitation techniques and special considerations for the female athlete are also discussed.

Kevin E. Wilk, Leonard C. Macrina, E. Lyle Cain, Jeffrey R. Dugas, James R. Andrews. Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries. J Orthop Sports Phys Ther 2012;42(3):153-171.

No related posts.

The neurophysiological effects of a single session of spinal joint mobilization: does the effect last?

Rachael Lowe — Sat, 10 Mar 2012 07:30:28 +0000

Studies detailing the neurophysiological effects of spinal manual therapy have fueled a paradigm shift away from a strict biomechanical model. However, a recent systematic review of the temporal nature of a single session of spinal thrust manipulation found that the neurophysiological effects were only temporary. The objective of this review was to examine the temporal nature of neurophysiological effects after one session of spinal mobilization. Studies eligible for this review had to report on the temporal component of the neurophysiological effects of a single session of joint mobilization of the spine in human subjects. In order to be sure that the temporal nature of these effects was captured, the studies had to monitor neurophysiological effects for a time beyond the immediate post-treatment period. This systematic review followed the methodology for preferred reporting items for systematic reviews and meta-analyses. In order to assess the quality, strength, and importance of the included studies, the grading of recommendations assessment, development and evaluation system was used. Results of this review showed that the neurophysiological effects of a single session of spinal mobilization are mostly 5 minutes or less. An exception to these findings is hypoalgesia which may last up to 24 hours, based on one study. Continued research on small samples of healthy subjects with irrelevant immediate outcomes like salivary rate, skin conductance, and skin temperature should give way to randomized controlled trials on subjects with pain and decreased function.

Hegedus, Eric J; Goode, Adam; Butler, Robert J; Slaven, Emily. The neurophysiological effects of a single session of spinal joint mobilization: does the effect last? Journal of Manual & Manipulative Therapy, Volume 19, Number 3, 2011, pp. 143-151(9)

No related posts.

Evidence In Motion Announces a Business Track for Manipalooza 2012

Brooke McVeigh — Tue, 28 Feb 2012 16:48:29 +0000

Evidence In Motion (EIM) is excited to announce that they will be adding a business track to the Manipalooza 2012 curriculum. The business track will consist of a full day of lecture and discussion about private physical therapy practice management and will be held in San Antonio, Texas on May 19, 2012.

Manipalooza 2012 is an annual four day boot camp of hands-on learning in manipulation, soft tissue techniques and pain management strategies for physical therapists. The event, to be held May 19-22 in San Antonio, Texas, will showcase many of the national and international thought leaders in the physical therapy profession, as well as respected faculty from across the country. The topics addressed at Manipalooza serve to improve patient outcomes and energize physical therapists through facilitating collaborations with peers.

“We decided to add the business track to Manipalooza this year to provide a forum for private practice physical therapists to learn more about what makes a practice tick,” states EIM principle Larry Benz, DPT, MBA. “We will be using case studies and real world examples to show owners and managers what works and what doesn’t. It’s going to be a fantastic place to brainstorm and interact with private practice PTs from all over.”

Benz will be leading the business track along with David Browder, PT, DPT, OCS. The charge for the business track alone is $100. EIM Executive Program in Private Practice Management students and graduates will be charged a discounted fee of $75. The business track fee will be included for participants who sign up for the full 4 days of Manipalooza. Topics for the business track include the following:

Patient’s Revenge: What do you do when patients tell everybody about their horrific experience in your clinic via social media and the internet?
How to Design a Winning Physical Therapy Business Model
Practice Exchange Forum: An open discussion of the recent issues and challenges in private practice physical therapy
Happy Hour to Conclude the Day!

Click here for more information on Manipalooza’s Business Track.

Click here to register for Manipalooza’s Business Track (you must login to your MyEIM account to register.)

Click here for more information about Manipalooza.

Manchester-Oxford foot questionnaire (MOXFQ) reported as responsive compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery

Rachael Lowe — Thu, 09 Feb 2012 10:42:00 +0000

Dawson et al have recently reported the responsiveness of the Manchester–Oxford Foot Questionnaire (MOXFQ) compared with foot/ankle-specific and generic outcome measures used to assess all surgery of the foot and ankle. They recruited 671 consecutive adult patients awaiting foot or ankle surgery, of whom 427 (63.6%) were female, with a mean age of 52.8 years (18 to 89). patients independently completed the MOXFQ, Short-Form 36 (SF-36) and EuroQol (EQ-5D) questionnaires pre-operatively and at a mean of nine months (3.8 to 14.4) post-operatively. Foot/ankle surgeons assessed American Orthopaedic Foot and Ankle Society (AOFAS) scores corresponding to four foot/ankle regions. A transition item measured perceived changes in foot/ankle problems post-surgery. Of 628 eligible patients proceeding to surgery, 491 (78%) completed questionnaires and 262 (42%) received clinical assessments both pre- and post-operatively. The regions receiving surgery were: multiple/whole foot in eight (1.3%), ankle/hindfoot in 292 (46.5%), mid-foot in 21 (3.3%), hallux in 196 (31.2%), and lesser toes in 111 (17.7%). Foot/ankle-specific MOXFQ, AOFAS and EQ-5D domains produced larger effect sizes (> 0.8) than any SF-36 domains, suggesting superior responsiveness. In analyses that anchored change in scores and effect sizes to patients’ responses to a transition item about their foot/ankle problems, the MOXFQ performed well. The SF-36 and EQ-5D performed poorly. Similar analyses, conducted within foot-region based sub-groups of patients, found that the responsiveness of the MOXFQ was good compared with the AOFAS.

This evidence supports the MOXFQ’s suitability for assessing all foot and ankle surgery.

Dawson, J., Boller, I., Doll, H., Lavis, G., Sharp, R., Cooke, P., Jenkinson, C. Responsiveness of the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery. 2011, Journal of Bone and Joint Surgery,February 2012, vol. 94-B no. 2:205-209

Read more about the Manchester–Oxford Foot Questionnaire (MOXFQ)

No related posts.