Stretch Exercises Increase Tolerance to Stretch in Patients With Chronic Musculoskeletal Pain: A Randomized Controlled Trial

Background: Stretch is commonly prescribed as part of physical rehabilitation in pain management programs, yet little is known about its effectiveness.

Objective: A randomized controlled trial was conducted to investigate the effects of a 3-week stretch program on muscle extensibility and stretch tolerance in patients with chronic musculoskeletal pain.

Motor Control Exercise for Chronic Low Back Pain: A Randomized Placebo-Controlled Trial

[Background] The evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled.

[Objective] The purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain.

Effects of Mastectomy on Shoulder and Spinal Kinematics During Bilateral Upper-Limb Movement.

[Background ] Shoulder movement impairment is a commonly reported consequence of surgery for breast cancer.

[Objective] The aim of this study was to determine whether shoulder girdle kinematics, including those of the scapula, spine, and upper limb, in women who have undergone a unilateral mastectomy for breast cancer are different from those demonstrated by an age-matched control group.

Muscle Activation and Perceived Loading During Rehabilitation Exercises: Comparison of Dumbbells and Elastic Resistance

[Background]
High-intensity resistance training plays an essential role in the prevention and rehabilitation of musculoskeletal injuries and disorders. Although resistance exercises with heavy weights yield high levels of muscle activation, the efficacy of more user-friendly forms of exercise needs to be examined.

[Objective]
The aim of this study was to investigate muscle activation and perceived loading during upper-extremity resistance exercises with dumbbells compared with elastic tubing.

Progressive Resistance Training Improves Overall Physical Activity Levels in Patients With Early Osteoarthritis of the Knee: A Randomized Controlled Trial

Prescription of resistance training (RT) exercises is an essential aspect of management for knee osteoarthritis (OA). However, whether patients with knee OA who are randomly assigned to receive RT simply substitute RT for other modes of physical activity remains unclear.

The aim of this study was to determine the effect of a structured RT intervention on overall levels of moderate- and vigorous-intensity physical activity (MVPA) in patients with early-onset knee OA. The study compared patients with early-onset OA who participated in an RT program, those who participated in a self-management (SM) program, and those who participated in both RT and SM. Because participants randomly assigned to receive the RT intervention may simply switch activity modes, resulting in little net effect, we assessed total MVPA in addition to tracking changes in strength (force-generating capacity).

A single session of Acu-TENS increases FEV1 and reduces dyspnoea in patients with chronic obstructive pulmonary disease: a randomised, placebo-control

Questions: What is the immediate effect of a single 45-minute session of transcutaneous electrical nerve stimulation over acupoints (Acu-TENS) on lung function and dyspnoea in patients with chronic obstructive pulmonary disease?
Design:
Randomised, placebo-controlled trial with concealed allocation, participant blinding, assessor blinding, and intention-to-treat analysis.
Participants: Forty-six ambulatory patients with a mean age of 75 years, with stage I or II chronic obstructive pulmonary disease, and with no previous experience of TENS or acupuncture.
Intervention: The experimental group received 45 minutes of Acu-TENS over acupoint Ex-B1 bilaterally (0.5 ‘cun’ lateral to the spinous process of the 7th cervical vertebra) while the control group received placebo-TENS with identical electrode placement but no electrical output despite a flashing light indicating stimulus delivery.

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Outcome measures: Lung function was measured as FEV1 and FVC while dyspnoea was
measured using a shortness of breath 100-mm visual analogue scale.
Results: After 45 minutes of Acu-TENS, the experimental group had increased FEV1 by 0.12 litres (95% CI 0.07 to 0.15) and decreased dyspnoea by 10.7 mm (95% CI –13.9 to –7.6) more
than the control group. The effect on FVC was only small (mean difference 0.05 litres, 95% CI –0.01 to 0.10).
Conclusion: Acu-TENS may be a useful non-invasive adjunctive intervention in the management of dyspnoea in patients with chronic obstructive
pulmonary disease. This study suggests that the effect of long-term Acu-TENS warrants further investigation. [Lau KSL, Jones AYM (2008) A single session of Acu-TENS increases FEV1 and reduces dyspnoea in patients with chronic obstructive pulmonary disease: a randomised, placebo-controlled trial. Australian Journal of Physiotherapy 54: 179–184]

Key words: Acupuncture points, Acupressure, TENS, Chronic obstructive pulmonary disease,
Forced expiratory volume, Dyspnoea

author: Ken SL Lau and Alice YM Jones

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Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review

Question: Do clinical tests accurately diagnose rotator cuff pathology? Design: A systematic review of investigations into the diagnostic accuracy of clinical tests for rotator cuff pathology. Participants: People with shoulder pain who underwent clinical testing in order to diagnose rotator cuff pathology.
Outcome measures: The diagnostic accuracy of clinical tests was determined using likelihood ratios.
Results: Thirteen studies met the inclusion criteria. The 13 studies evaluated 14 clinical tests in 89 separate evaluations of diagnostic accuracy. Only one evaluation, palpation for supraspinatus ruptures, resulted in significant positive and negative likelihood ratios. Eight of the 89 evaluations resulted in either significant positive or negative likelihood ratios. However, none of these eight positive or negative likelihood ratios were found in other studies. Of the 89 evaluations of clinical tests 71 (80%) did not result in either significant positive or negative likelihood ratio evaluations across different studies.

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Conclusion: Overall, most tests for rotator cuff pathology were inaccurate and cannot be recommended for clinical use. At best, suspicion of a rotator cuff tear may be heightened by a positive palpation, combined Hawkins/painful arc/infraspinatus test, Napoleon test, lift-off test, belly-press test, or drop-arm test, and it may be reduced by a negative palpation,empty can test or Hawkins-Kennedy test. [Hughes PC, Taylor NF, Green RA (2008) Most clinical tests cannot accuratelydiagnose rotator cuff pathology: a systematic review. Australian Journal of Physiotherapy 54: 159–170]

Key words: Rotator cuff; Diagnosis, differential, Review

Aurhor: Phillip C Hughes, Nicholas F Taylor and Rod A Green

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Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial

Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial
Natalie A de Morton1,2, Jennifer L Keating1, David J Berlowitz2, Bruce Jackson3 and Wen K im2 1Monash University 2Northern Health, Victoria 3Dandenong Hospital Australia

Question: What are the effects of additional exercise on hospital and patient outcomes for acutely-hospitalised older medical patients?

Design: Controlled clinical trial. Participants: 236 patients aged 65 or older admitted to an acute care hospital with a medical illness between October 2002 and July 2003.

Intervention: The experimental group received usual care plus an individually tailored exercise program administered twice daily from hospital admission to discharge. The control group received usual care only.

Outcome measures: The primary outcome was discharge destination. Secondary outcomes were measures of activity limitation (Barthel Index, Timed Up and Go, Functional Ambulation Classification), length of stay, and adverse events.

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Results: There was no significant effect of the additional exercise program on any outcome. There were no significant differences between groups for the proportion of the patients discharged to home (RR 0.99, 95% CI 0.86 to 1.14) or inpatient rehabilitation (RR 0.76, 95% CI 0.30 to 1.51) or for measures of activity limitation at hospital discharge. A one day difference in length of stay was identified between groups but this difference was not significant (p = 0.45). There were no significant differences between groups for adverse events: 28-day readmission (RR 1.10, 95% CI 0.65 to 1.86), patient mortality (RR 1.15, 95% CI 0.16 to 8.0), intensive care admission (RR 0.16, 95% CI 0.01 to 3.13) and falls (RR 0.69, 95% CI 0.17 to 2.81).

Conclusion: Additional physiotherapy intervention during hospitalisation did not significantly improve hospital or patient outcomes. [de Morton NA, Keating JL, Berlowitz DJ, Jackson B, Lim WK (2007) Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial. Australian Journal of Physiotherapy 53: 105–111]

Key words: Hospitalization, Exercise, Physiotherapy, Physical Fitness, Aged

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A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised controlled trial

A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised controlled trial
Natasha K Brusco1,2, Nora Shields1, Nicholas F Taylor1,2 and Jennifer Paratz3 1La Trobe University 2Eastern Health 3The University of Queensland Australia

Question: Is additional Saturday physiotherapy intervention beneficial for inpatients undergoing rehabilitation?

Design: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

Participants: Two hundred and sixty-two inpatients undergoing rehabilitation in an Australian metropolitan hospital.

Intervention: The experimental group received physiotherapy intervention from Monday to Saturday and the control group from Monday to Friday.

Outcome measures: Primary outcomes were hospital and physiotherapy length of stay. Secondary measures were collected to reflect patient outcomes (health state, independence, activity, flexibility and strength) and burden of care (discharge destination, adverse events, and follow-up physiotherapy intervention).

Results: There was a 3.2 day reduction for the experimental group (95% CI –0.5 to 6.9) in hospital length of stay and a 2.5 day reduction (95% CI –0.9 to 5.9) in physiotherapy length of stay.
There was no significant between-group difference in change from admission to discharge for most of the secondary patient
outcomes (health state, independence, activity, flexibility). The risk of the experimental group being categorised as strong relative to the control group was 1.2 (95% CI 0.99 to 1.50). The risk of not being discharged home, of having an adverse event, or requiring follow-up physiotherapy intervention was no greater for the experimental group than the control group.

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Conclusion: The provision of additional Saturday physiotherapy intervention resulted in a trend to shorter hospital and physiotherapy length of stay without affecting patient outcome unfavourably or increasing burden of care, suggesting that a larger multicentre trial is warranted. [Brusco NK, Shields N, Taylor NF, Paratz J (2007) A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised controlled trial. Australian Journal of Physiotherapy
53: 75–81]

Key words: Physiotherapy, Length of Stay, Treatment Outcome, Patient Outcome Assessment, Outcomes Research, Exercise Therapy, Rehabilitation, Randomized Controlled Trial, Cost Analysis


source: Australian Journal of Physiotherapy

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Warm-up reduces delayed-onset muscle soreness but cool-down does not: a randomised controlled trial

Warm-up reduces delayed-onset muscle soreness but cool-down does not: a randomised controlled trial

Roberta YW Law and Robert D Herbert
The University of Sydney, Australia

Question: Does warm-up or cool-down (also called warm-down) reduce delayed-onset muscle soreness?

Design: Randomised controlled trial of factorial design with concealed allocation and intention-to-treat analysis. Participants: Fifty-two healthy adults (23 men and 29 women aged 17 to 40 years).

Intervention: Four equally-sized groups received either warm-up and cool-down, warm-up only, cool-down only, or neither warm-up nor cool-down. All participants performed exercise to induce delayed-onset muscle soreness, which involved walking backwards downhill on an inclined treadmill for 30 minutes. The warm-up and cooldown exercise involved walking forwards uphill on an inclined treadmill for 10 minutes. Outcome measure: Muscle soreness, measured on a 100-mm visual analogue scale. Results: Warm-up reduced perceived muscle soreness 48 hours after exercise on the visual analogue scale (mean effect of 13 mm, 95% CI 2 to 24 mm). However cool-down had no apparent effect (mean effect of 0 mm, 95% CI –11 to 11 mm).

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Conclusion: Warm-up performed immediately prior to unaccustomed eccentric exercise produces small reductions in delayed-onset muscle soreness but cool-down performed after exercise does not. [Law RYW, Herbert RD (2007) Warm-up reduces delayed-onset muscle soreness but cool-down does not: a randomised controlled trial. Australian Journal of Physiotherapy 53: 91–95]

Key words: Exercise, Physical Activity, Sports, Prevention and Control, Muscles, Pain

source: Australian Journal of Physiotherapy

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No model of clinical education for physiotherapy students is superior to another: a systematic review

No model of clinical education for physiotherapy students is superior to another: a systematic review

Peter Lekkas1, Thomas Larsen1, Saravana Kumar1, Karen Grimmer1, Leah Nyland1, Lucy Chipchase1, Gwendolen Jull2, Peter Buttrum3, Libby Carr4 and Jenny Finch4
1University of South Australia 2The University of Queensland 3QEII Jubilee Hospital, Brisbane 4Queensland Health Australia

Question: Which models of undergraduate/entry-level clinical education are being used internationally in allied health disciplines? What is the effect and, from the perspective of stakeholders, what are the advantages, disadvantages, and recommendations for successful implementation of different models of undergraduate/entry-level clinical education?

Design: Systematic review with data from quantitative and qualitative studies synthesised in a narrative format. Participants: Undergraduates/entry-level students from five allied health disciplines undergoing clinical education.

Intervention: Six broad models of clinical education: one-educator-to-one-student (1:1); one-educator-to-multiple-students (1:2); multiple-educators-to-one-student (2:1); multipleeducators- to-multiple-students (2:2); non-discipline-specific-educator and student-as-educator.

Outcome measures: Models were examined for productivity; student assessment; and advantages, disadvantages, and recommendations for implementation.

Results: The review found few experimental studies, and a large amount of descriptive research and opinion pieces. The rigour of quantitative evidence was low, however qualitative was higher. Evidence supporting one model over another was largely deficient with few comparative studies available for analysis. Each model proffered strengths and weaknesses, which were unique to the model.


Conclusion: There is currently no ‘gold standard’ model of clinical education. The perception that one model is superior to any other is based on anecdotes and historical precedents, rather than on meaningful, robust, comparative studies. [Lekkas P, Larsen T, Kumar S, Karen K, Nyland L, Chipchase L, Jull G, Buttrum P, Carr L, Finch J (2007) No model of clinical education for physiotherapy students is superior to another: a systematic review. Australian Journal of Physiotherapy 52: 19–28]

Key words: Models, Educational; Physical Therapy (Specialty); Students, Health Occupations; Teaching; Review Literature

source: Australian Journal of Physiotherapy

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