QUESTION: What is the effect of early physiotherapy intervention on pain and patient satisfaction in acute low back pain? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat anal...QUESTION: What is the effect of early physiotherapy intervention on pain and patient satisfaction in acute low back pain? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 110 patients attending the Accident and Emergency Department of a local acute hospital. INTERVENTION: The experimental group received early physiotherapy intervention which consisted of education, reassurance, pain management, mobility training, interferential therapy, walking training, and walking aids as indicated. The control group received only walking training and walking aids as indicated. All participants received conventional medical intervention and outpatient physiotherapy intervention. OUTCOME MEASURES: Pain was measured using the Numeric Pain Rating Scale and satisfaction was measured using the Numeric Global Rating of Change Scale at baseline, discharge from the Accident and Emergency Department, admission to the Physiotherapy Outpatient Department, 1 month, 3 months, and 6 months. RESULTS: Participants in the experimental group had 1.6 out of 10 points (97.5% CI 0.8 to 2.3) less pain than the control group on discharge from the Accident and Emergency Department and still had 0.9 points (97.5% CI 0.1 to 1.6) less pain on admission to the Physiotherapy Outpatient Department. Participants in the experimental group were 2.1 out of 20 points (97.5% CI 1.2 to 2.9) more satisfied than the control group on discharge from the Accident and Emergency Department. CONCLUSION: Early physiotherapy intervention was effective in reducing pain and increasing satisfaction for patients with acute low back pain in an Accident and Emergency Department but the effect tailed off.
QUESTION: What is the effectiveness of strategies to increase the implementation of physiotherapy clinical guidelines? DESIGN: Systematic review. PARTICIPANTS: Physiotherapists treating any type of patients. INTERVENTION...QUESTION: What is the effectiveness of strategies to increase the implementation of physiotherapy clinical guidelines? DESIGN: Systematic review. PARTICIPANTS: Physiotherapists treating any type of patients. INTERVENTION: Single or multiple strategies to increase the implementation of physiotherapy clinical guidelines. OUTCOME MEASURES: Professional practice, patient health, and cost of care. RESULTS: Five papers reporting three cluster-randomised trials evaluated whether multifaceted strategies based on educational meetings increased the implementation of low back pain guidelines (2 trials) or whiplash guidelines (1 trial). Educational meetings were effective in increasing adherence to the following recommendations of low back pain guidelines: limiting the number of sessions (RD 0.13, 95% CI 0.03 to 0.23), using active intervention (RD 0.13, 95% CI 0.05 to 0.21), giving adequate information (RD 0.05, 95% CI 0.00 to 0.11), increasing activity level (RD 0.16, 95% CI 0.02 to 0.30), changing attitudes/beliefs about pain (RD 0.13, 95% CI 0.01 to 0.24). Educational meetings were effective in increasing adherence to the following recommendations of whiplash guidelines: reassuring the patient (RD 0.40, 95% CI 0.07 to 0.74), advising the patient to act as usual (RD 0.48, 95% CI 0.15 to 0.80), using functional outcome measures (RD 0.62, 95% CI 0.32 to 0.92). There was no evidence that patient health was improved or that the cost of care was reduced. CONCLUSION: This review shows that multifaceted interventions based on educational meetings to increase implementation of clinical guidelines may improve some outcomes of professional practice but do not improve patient health or reduce cost of care. These findings are comparable with results among other health professions.
QUESTION: Are there differences in physical activity between older adults undergoing inpatient rehabilitation and those living in the community? Are there differences in physical activity within and between these two gro...QUESTION: Are there differences in physical activity between older adults undergoing inpatient rehabilitation and those living in the community? Are there differences in physical activity within and between these two groups on weekdays compared to weekends? Are there differences in physical activity within and between these two groups over the day? DESIGN: An observational study. PARTICIPANTS: Twenty-five elderly patients (aged 81 years) undergoing rehabilitation and 25 age- and gender-matched community-dwelling people (aged 80 years). OUTCOME MEASURES: The Positional Activity Logger was used to measure the frequency and duration of time spent upright (uptime), over three consecutive days, including a weekend day. RESULTS: The inpatient group achieved a median daily uptime of 1.3 hours which was significantly less than the community group's median of 5.5 hours (p < 0.001). Uptime for inpatients was significantly greater on weekdays (1.6 hours) when therapy was available than on weekend days (1.1 hours) when therapy was generally not available (p < 0.001), whereas uptime for community participants was no different on weekdays (5.9 hours) than on weekend days (4.8 hours) (p = 0.05). Median uptime was significantly less for the inpatient group than for the community group at all times of day (p < 0.001). CONCLUSION: Elderly patients undergoing rehabilitation spend much of the day less physically active than their community peers.
QUESTION: What are the costs and utilisation of healthcare resources, their determinants, and quality of life for people attending outpatient physiotherapy after ankle fracture? DESIGN: Longitudinal observational study....QUESTION: What are the costs and utilisation of healthcare resources, their determinants, and quality of life for people attending outpatient physiotherapy after ankle fracture? DESIGN: Longitudinal observational study. PARTICIPANTS: Ninety-four adults (2 dropouts) following cast removal after isolated ankle fracture attending outpatient physiotherapy at three hospitals in Sydney, Australia. OUTCOME MEASURES: Costs incurred (direct healthcare costs and out-of-pocket costs) and utilisation of healthcare system resources were measured at 4, 8, 12, 16, 20, and 24 weeks. Quality of life was measured shortly after cast removal and at 4, 12, and 24 weeks. Factors known to influence costs and utilisation in other conditions (private health insurance, income level, gender, and pain) were also measured. RESULTS: The total cost per person was AUD 735 (SD 876) over 24 weeks. Outpatient physiotherapy accounted for the highest costs in both direct healthcare (39%) and out-of-pocket (42%) costs. Less than 20% of participants sought private non-medical care in addition to receiving outpatient physiotherapy. None of the factors investigated had a significant influence on costs and utilisation. Quality of life score improved over the 24 weeks by a mean of 6.1 points out of 45 (95% CI 5.2 to 6.9), with most of the improvement occurring in the domain of independent living. CONCLUSION: Information on costs and utilisation of healthcare resources can be used to plan health services, eg, the number of physiotherapy sessions required after ankle fracture. Private health insurance, income level, gender, or pain did not influence the costs or the decision behind seeking care over and above publicly-provided physiotherapy.
QUESTION: Are use and perceived load of school bags and the prevalence of spinal pain different between male and female adolescents? Is use of school bags related to perceived load of school bags? Are use and perceived l...QUESTION: Are use and perceived load of school bags and the prevalence of spinal pain different between male and female adolescents? Is use of school bags related to perceived load of school bags? Are use and perceived load of school bags related to spinal pain? DESIGN: Cross-sectional observational study. PARTICIPANTS: 1202 adolescents recruited from the 'Raine' Cohort Study. OUTCOME MEASURES: Use and perceived load of school bags as well as spinal pain were measured by questionnaire. RESULTS: The prevalence of back and neck pain was approximately 50%; 53% of females reported neck pain compared with 44% of males (p < 0.01). Almost half of participants carried their school bag for more than 30 minutes per day with 85% carrying their bag over both shoulders. School bags were felt to be heavy by 54% and to cause fatigue by 51%. Carrying a school bag for more than 30 minutes daily and taking an inactive form of transport to school (car or bus) increased the odds of having both back (OR 1.40, 95% CI 1.08 to 1.82) and neck pain (OR 1.47, 95% CI 1.13 to 1.91). CONCLUSION: Neck pain is as common as back pain amongst adolescents. Perceived school bag load, duration of carriage and method of transport to school are associated with back and neck pain. Physical activity in the form of walking or riding to school may offset the potentially provocative effects of prolonged bag carriage and warrants further investigation.
QUESTION: Does electrical stimulation in addition to passive stretching reduce spasticity and contracture more than passive stretching alone in children with cerebral palsy? DESIGN: Randomised within-participant controll...QUESTION: Does electrical stimulation in addition to passive stretching reduce spasticity and contracture more than passive stretching alone in children with cerebral palsy? DESIGN: Randomised within-participant controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Eleven (one dropout) children with cerebral palsy and bilateral knee flexor spasticity aged 13 years (SD 1). INTERVENTION: One leg in each participant received the experimental intervention for four weeks which consisted of 30 min of electrical stimulation of the quadriceps 3 times per week and passive stretching of the hamstrings 5 times per week. The other leg received the control intervention for four weeks which consisted of passive stretching of the hamstrings 5 times per week. OUTCOME MEASURES: Spasticity of the hamstrings was measured using the modified Ashworth scale. Contracture was measured as maximum passive knee extension using goniometry. RESULTS: The mean difference in decrease in the modified Ashworth score due to the addition of electrical stimulation to the stretching regimen was 0.8 points (95% CI 0.1 to 1.5). The mean difference in increase in passive knee extension due to the addition of electrical stimulation to the stretching regimen was 4 degrees (95% CI 0 to 7). CONCLUSION: Electrical stimulation combined with passive stretching is marginally more effective than passive stretching alone for spastic limbs of children with cerebral palsy.
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...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 7(th) cervical vertebra) while the control group received placebo-TENS with identical electrode placement but no electrical output despite a flashing light indicating stimulus delivery. 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.
QUESTION: Are oxygenation and static compliance improved immediately after manual hyperinflation following myocardial revascularisation? Does this lead to earlier extubation and shorter hospital stay? Does it reduce post...QUESTION: Are oxygenation and static compliance improved immediately after manual hyperinflation following myocardial revascularisation? Does this lead to earlier extubation and shorter hospital stay? Does it reduce postoperative pulmonary complications? DESIGN: Randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis. PARTICIPANTS: Fifty-five patients who underwent myocardial revascularisation. INTERVENTION: After an hour in recovery, the experimental group received manual hyperinflation with positive end expiratory pressure followed by suction while the control group received suction only. OUTCOME MEASURES: Oxygenation (PaO(2) in mmHg) and static lung compliance (in ml/cmH(2)O) were measured immediately after suction. Time to extubation (in minutes) and length of hospital stay (in days) were collected and postoperative pulmonary complications were confirmed by X-ray. RESULTS: PaO(2) was 11.7 mmHg (95% CI 9.4 to 14.0) greater in the experimental group while static compliance was 8.5 ml/cmH(2)0 (95% CI 6.4 to 10.6) greater than in the control group. The experimental group was extubated 76 minutes (95% CI 24 to 128) earlier than the control group but did not have a shorter length of stay (mean difference 0.5 days, 95% CI -0.2 to 1.2). The relative risk of postoperative pulmonary complications was no greater (RR 0.57, 95% Cl 0.20 to 1.60) in the experimental group than in the control group. CONCLUSION: The group that received early manual hyperinflation had markedly better oxygenation and static compliance as well as shorter mechanical ventilation times than the control group. The length of hospital stay and incidence of postoperative pulmonary complications were similar in the two groups.
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 s...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. 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.