QUESTION: Is there a difference in the level and pattern of free-living physical activity between individuals with chronic low back pain and matched controls? DESIGN: Observational, cross-sectional study. PARTICIPANTS: F...QUESTION: Is there a difference in the level and pattern of free-living physical activity between individuals with chronic low back pain and matched controls? DESIGN: Observational, cross-sectional study. PARTICIPANTS: Fifteen individuals with chronic low back pain and fifteen healthy controls matched for age, gender, and occupation. OUTCOME MEASURES: Participants wore an activity monitor for seven days. Level of physical activity was measured as time standing and walking, and number of steps averaged over a 24-hour day (midnight to midnight), day time (9.00 am - 4.00 pm), and evening time (6.00 pm - 10.00 pm), and work days versus non-work days. Pattern of physical activity was measured as number of steps and cadence during short (< 20 continuous steps), moderate (20-100 continuous steps), long (> 100-499 continuous steps), and extra long walks (>or= 500 continuous steps). RESULTS: Over an average 24-hour day, the chronic low back pain group spent 0.7 fewer hours (95% CI 0.3 to 1.1) walking, and took 3480 fewer steps (95% CI 1754 to 5207) than the healthy controls. They took 793 fewer steps/day (95% CI -4 to 1591) during moderate walks, and 1214 fewer steps/day (95% CI 425 to 2003) during long walks, and 11 fewer steps/min (95% CI 4 to 17) during extra long walks than the healthy controls. CONCLUSION: Individuals with chronic low back pain have a lower level, and an altered pattern, of physical activity compared with matched controls.
QUESTION: Do the self-reported aggravating activities of people with chronic non-specific low back pain move the spine in a consistent direction? DESIGN: Cross-sectional observational study. PARTICIPANTS: 240 people with...QUESTION: Do the self-reported aggravating activities of people with chronic non-specific low back pain move the spine in a consistent direction? DESIGN: Cross-sectional observational study. PARTICIPANTS: 240 people with chronic non-specific low back pain. OUTCOME MEASURE: The self-reported aggravating activities from the Patient Specific Functional Scale were classified as flexion, extension or unilateral according to the direction of lumbar spine movement. PARTICIPANTS were described as demonstrating a directional pattern if all three self-reported aggravating activities moved the spine in the same direction. RESULTS: Of the 148 participants with three classifiable aggravating activities, 47 (32%) demonstrated a directional pattern with 46 (98%) demonstrating a flexion pattern and 1 (2%) an extension pattern. The observed incidence of a directional pattern in the three self-reported aggravating activities of the 148 participants (32%) was no different from what would have been expected by chance. There were no clinical or demographic differences between those who demonstrated a directional pattern and those who did not. CONCLUSION: There is no evidence for the existence of a consistent direction of spinal movement during the self-reported aggravating activities of people with chronic non-specific low back pain.
QUESTIONS: What is the physical ability of very old people? Is physical ability affected by age or sex? Is it affected by type of housing, level of independence in activities of daily living, cognition, or nutrition? DES...QUESTIONS: What is the physical ability of very old people? Is physical ability affected by age or sex? Is it affected by type of housing, level of independence in activities of daily living, cognition, or nutrition? DESIGN: A population-based cross-sectional observational study. PARTICIPANTS: Half the 85-year-old population, and the total population aged 90 and = 95 (range 95-103) in Umea, Sweden who were measured in the Umea 85+ Study (n = 238). OUTCOME MEASURES: Usual and fastest gait speed (m/s) over 2.4 metres, three consecutive chair stands (s), the Berg Balance Scale, and ability to perform the measures (yes/no). RESULTS: The median (10th to 90th percentile) usual gait speed was 0.49 m/s (0.23-0.75), time to perform the chair stands test was 12.6 seconds (8.5-20.2), and the Berg Balance Scale score was 45 (0-54). Men had greater physical ability than women. An age-related decline in physical ability was seen in women, but not in men. The Berg Balance Scale showed no floor or ceiling effects, but gait speed and chair stands resulted in a floor effect, especially for women. CONCLUSION: There were large variations in physical ability in these very old people. These data provide valuable reference values of physical ability in the oldest age groups for commonly-used clinical measures.
QUESTION: Is four weeks of home-based balance training more effective than four weeks of home-based strength training at decreasing pain in patients with knee osteoarthritis? DESIGN: Randomised trial with concealed alloc...QUESTION: Is four weeks of home-based balance training more effective than four weeks of home-based strength training at decreasing pain in patients with knee osteoarthritis? DESIGN: Randomised trial with concealed allocation and assessor blinding. PARTICIPANTS: 48 community volunteers with knee osteoarthritis. INTERVENTION: Two groups undertook home-based exercise programs: one group performed balance training and the other performed strength training. Participants performed 30 repetitions/leg/day, 5 days/week for four weeks. OUTCOME MEASURES: The Knee injury and Osteoarthritis Outcome Score was used to evaluate pain, which was the primary outcome. Secondary outcomes were the other subscales of the Knee injury and Osteoarthritis Outcome Score (other symptoms, function in daily living, function in sport and recreation, knee-related quality of life), strength, and mobility. RESULTS: There was no significant difference between groups for pain (mean difference -3 points out of 100, 95% CI -10 to 5). The only between-group difference in the Knee injury and Osteoarthritis Outcome Score was in knee-related quality of life, where the strength group improved 17 points out of 100 (95% CI 5 to 28) more than the balance group. There was no significant difference between groups for strength. The only between-group difference in mobility was in the time taken to walk downstairs, where the strength group improved by 2 s (95% CI 0 to 3) more than the balance group. CONCLUSION: There was no difference in pain between home-based strength training and home-based balance training in patients with knee osteoarthritis. TRIAL REGISTRATION: NCT 00687726.
QUESTION: Is the addition of passive mobilisation of shoulder region joints to advice and exercise for patients with shoulder pain and stiffness more effective than advice and exercise alone? DESIGN: Randomised trial wit...QUESTION: Is the addition of passive mobilisation of shoulder region joints to advice and exercise for patients with shoulder pain and stiffness more effective than advice and exercise alone? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 90 people who had shoulder pain and stiffness for more than one month. INTERVENTION: All participants received advice and exercise. The experimental group also received passive joint mobilisation of shoulder region joints. OUTCOME MEASURES: Primary outcome measures included pain and disability measured with the 13-point Shoulder Pain and Disability Index. Secondary outcome measures were self-perceived global improvement measured on a 6-point scale and active ranges of motion. Subjects received a maximum of 10 sessions of therapy. Outcome measurements were taken at baseline, one month, and six months. RESULTS: The experimental group had 3% (95% CI -5 to 11) less pain and disability than the control group at one month and 1% (95% CI -13 to 16) less pain at six months, which are statistically nonsignificant. Their global perceived effect was 0.1 out of 5 (95% CI -0.2 to 0.4) worse than the control group at one month and 0.1 (95% CI -0.5 to 0.7) better at 6 months, which are also statistically non-significant. Differences between groups in all range of motion measures were small and statistically non-significant. CONCLUSION: The addition of passive joint mobilisation of shoulder region joints is not more effective than advice and exercise alone for shoulder pain and stiffness. TRIAL REGISTRATION: ACTRN 12605000080628.
QUESTION: Do females with patellofemoral pain syndrome have decreased hip muscle strength compared with the unaffected side and with healthy controls? DESIGN: A systematic review of observational studies published up to...QUESTION: Do females with patellofemoral pain syndrome have decreased hip muscle strength compared with the unaffected side and with healthy controls? DESIGN: A systematic review of observational studies published up to January 2008. PARTICIPANTS: Females with patellofemoral pain syndrome and healthy controls. OUTCOME MEASURES: Strength for at least one hip muscle group had to be included in the study. Hip muscle strength was recorded as force or torque. RESULTS: Five cross-sectional studies with a mean Newcastle-Ottawa Assessment Scale score of 6 out of 9 met the inclusion criteria. Strong evidence was found for a deficit in hip external rotation, abduction and extension strength, moderate evidence for a deficit in hip flexion and internal rotation strength, and no evidence for a deficit in hip adduction strength compared with healthy controls. Moderate evidence was found for a decrease in hip external rotation and abduction strength but no evidence for a decrease in hip extension, flexion, adduction and internal rotation strength compared with the unaffected side. CONCLUSION: Females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy controls.
QUESTION: What are the sexual boundaries between physiotherapists and their patients? and do they differ between males and females? DESIGN: Observational study using a postal questionnaire. PARTICIPANTS: 2248 physiothera...QUESTION: What are the sexual boundaries between physiotherapists and their patients? and do they differ between males and females? DESIGN: Observational study using a postal questionnaire. PARTICIPANTS: 2248 physiotherapists registered with the Physiotherapist's Registration Board of Western Australia. OUTCOME MEASURES: Respondents were asked to state: i) their perception of the behaviour of a hypothetical physiotherapist in six vignettes highlighting professional sexual boundaries; ii) the incidence of sexual attraction between themselves and their patients, and iii) the course(s) of action they would take in a situation of alleged sexual misconduct between a physiotherapist colleague and a patient. RESULTS: A response rate of 42% (939 responses, 706 females) was achieved. The majority of respondents (= 80%) thought the physiotherapist's behaviour to be wrong in four of the six vignettes; 65% of respondents thought it acceptable for a physiotherapist who provides physiotherapy services to a rugby team to go on a date with a team member; 74% of males and 41% females (p > 0.001) reported having felt sexually attracted to a patient; respondents were aware of a colleague who had dated a patient (33%) or ex-patient (60%). When presented with a vignette describing alleged sexual misconduct, 83% of respondents stated they would advise the patient to make a written complaint to the appropriate disciplinary body. Less than 20% stated that they would personally report their colleague to the Physiotherapists' Registration Board (19%) or the Australian Physiotherapy Association National Professional Standards Panel (15%). CONCLUSION: The variation in responses to the vignettes, the reported incidence of sexual attraction and dating of patients, and apparent confusion with regard to the complaints process identifies the need for education of the physiotherapy profession in Australia.
QUESTION: Is there an association between Caesarean section and back pain over the longer term? DESIGN: Secondary analysis of data from the Australian Longitudinal Study on Women's Health. PARTICIPANTS: The mid-aged coho...QUESTION: Is there an association between Caesarean section and back pain over the longer term? DESIGN: Secondary analysis of data from the Australian Longitudinal Study on Women's Health. PARTICIPANTS: The mid-aged cohort of women within the Australian Longitudinal Study on Women's Health aged 54 to 59 years (n = 9146). OUTCOME MEASURES: Data were included from women who answered the question regarding back pain. Data were extracted on whether they had given birth and, if so, whether it was by Caesarean section. Then, data on confounding variables (such as arthritis, asthma, osteoporosis, hysterectomy, ovaries removed, and repair of prolapsed vagina, bladder or bowel, menopause, smoking) were also extracted. RESULTS: After adjusting for confounding factors, women who delivered by Caesarean section had the same odds (OR 1.03, 95% CI 0.81 to 1.31) of having back pain as women who had not had a birth. CONCLUSION: Previous delivery by Caesarean section is not associated with increased back pain in mid-aged Australian women.
QUESTION: What are the key items in the clinical reasoning process which expert clinicians identify as being relevant to the assessment and management of patients with shoulder pain? DESIGN: Qualitative study using a thr...QUESTION: What are the key items in the clinical reasoning process which expert clinicians identify as being relevant to the assessment and management of patients with shoulder pain? DESIGN: Qualitative study using a three-round Delphi procedure. PARTICIPANTS: Twenty-six experts in the UK consented to be involved and were contactable, of whom 20 contributed, with 12, 15, and 15 contributing to the different rounds. RESULTS: Clinical reasoning was mostly about diagnostic reasoning, but also involved narrative reasoning. Diagnostic reasoning involved both pattern recognition and hypothetico-deductive reasoning. Diagnostic reasoning emphasised general history items, a constellation of signs and symptoms to identify specific diagnostic categories, and standard physical examination procedures. Narrative reasoning was highlighted by the communication involved in expert history taking, seeing patients in their functional and psychological context, and collaborative reasoning with the patient regarding management. CONCLUSIONS: These expert clinicians demonstrated the use of diagnostic pattern recognition, and hypothetico-deductive and narrative clinical reasoning processes. The emphasis was on the history and basic physical examination procedures to make clinical decisions.
QUESTION: Does an advice and exercise program improve outcome for adults following distal radius fracture? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPA...QUESTION: Does an advice and exercise program improve outcome for adults following distal radius fracture? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Fifty-six patients whose fracture had been managed with pins and/or cast. INTERVENTION: The experimental group received a physiotherapist-directed program of advice and exercises. The control group did not receive any physiotherapy intervention. OUTCOME MEASURES: The primary outcome was wrist extension (measured with a goniometer). Secondary outcomes were the other wrist ranges of motion (measured with a goniometer), grip strength (measured with a dynamometer), pain, and activity limitations (measured with questionnaires). These outcomes were measured initially, then three and six weeks later. Participants also rated their satisfaction with physiotherapy intervention at Week 6. RESULTS: No difference was found between groups for the primary outcome of wrist extension (mean difference 6 deg, 95% CI -3 to 14), nor for the secondary outcomes of other range of motion data and grip strength. The difference between groups for pain was -16 points out of 100 (95% CI -27 to -5) at Week 3, and -14 points (95% CI -25 to -3) points at Week 6, and for activity was -13 points out of 100 (95% CI -24 to -2) at Week 3; in favour of the experimental group. The experimental group was also more satisfied with the amount of physiotherapy intervention. CONCLUSION: An advice and exercise program provided some additional benefits over no intervention for adults following distal radius fracture.