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Complementary Therapy

Research that’s relevant to physiotherapists: Janet Wright reports on the latest clinical findings

Acupuncture can ease chronic pain

Acupuncture is a reasonable referral option as it can relieve chronic pain, a new study says.

The effects were small but more than could be explained by the placebo effect, say the authors of a systematic review of 29 high-quality randomised controlled trials covering 17,922 patients.

CSP member Nadine Foster and colleagues in the Acupuncture Triallists’ Collaboration looked at the Chinese therapy’s effects on back and neck pain, osteoarthritis, chronic headache and shoulder pain.

Their results showed that genuine acupuncture worked better than either sham treatment or a non-acupuncture intervention on all four conditions.

The National Institute for Health and Clinical Excellence only recommends it for lower back-pain.

The team found that acupuncture’s benefits were less noticeable in patients who received ancillary care, such as physiotherapy.    

The review also identified two components in acupuncture’s effectiveness.

The main one includes factors such as the placebo effect and the patient’s belief in it.

The smaller component includes factors specific to acupuncture, such as depth or location of needling.

‘Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo,’ says the team.

‘However, these  differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors.’
Vickers AJ et al. Acupuncture for Chronic Pain: individual patient data meta-analysis. Archives of Internal Medicine 2012; doi:10.1001archinternmed.2012.3654

Harm is unlikely, but possible

Serious adverse effects from NHS acupuncture treatments are rare, say researchers who studied 325 incidents recorded in the National Reporting and Learning System database over three years.

‘However, miscategorisation and under-reporting may distort the overall picture,’ they say, warning acupuncture practitioners to be prepared in case things go wrong.
Wheway J et al. International Journal of Risk and Safety in Medicine 2012; 24: 163-169

Falls

Everyday exercise helps to keep ol der people on their feet
Making the right kind of exercise part of everyday life can significantly reduce older people’s risk of falling, say Australian researchers, after studying the Lifestyle integrated Functional Exercise (LiFE) approach.

Balance exercise and lower-limb resistance training were already known to reduce the risk, say Lindy Clemson and colleagues from the University of Sydney. However, fewer than 10 per cent of older people regularly do strength training.

The LiFE study team recruited 317 people over 70 who were considered at high risk of falling.

All had had two or more falls (or one fall causing an injury) in the past year, but could walk independently and take exercise.

They were divided into three groups and taught exercises to do at home.

The LiFE group learned principles of balance and strength training and integrated specific activities into everyday life. The second group did a structured programme for balance and lower limb strength, three times a week.

The third group did gentle exercise.

After 12 months, the incidence of falls in the LiFE group was 1.66 per person year, compared with 1.9 in the structured programme and 2.28 among those who just did gentle exercise.  The LiFE group showed more improvements than the others in measures including balance and strength.

‘The LiFE programme provides an alternative to traditional exercise to consider for fall prevention,’ the authors conclude.

‘Functional-based exercise should be a focus for interventions to protect older high-risk people from falling and to improve and maintain functional capacity.’
Clemson L et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ 2012; 345 doi: 10.1136/bmj.e4547
And see new CSP guidelines on preventing falls, including use of exercise: www.csp.org.uk/category/networks/older-people-0

Comments & conclusions

  • Research is starting to show the benefits of early mobility in critically ill patients, says a report on physiotherapy in intensive care units (ICUs), where neuromuscular complications are common. Studies have shown that intensive rehabilitation helps patients on long-term mechanical ventilation, the report adds.  It calls for more research into the benefits of and barriers to early mobility, especially in long-term patients in ICUs.  Fan, E. Respiratory Care 2012; 57, 933-946, www.ncbi.nlm.nih.gov/pubmed/22663968
  • Professional American football players are four times more likely than other people to die of Alzheimer’s or amyotrophic lateral sclerosis, and are three times more likely to die of any neurodegenerative disease, according to the US Centers for Disease Control. However, players’ overall life expectancy is slightly above average. US National Football League involves more contact than soccer or rugby and concussion is common.   Lehmann EJ et al. Neurology 2012; doi:10.1212/WNL.0b013e31826daf50
  • A study of choir members has found that singing improved their well-being regardless of age, gender, nationality or how happy they were to start with. It concludes that choral singing could be used to promote mental health and treat mental illness. Livesey L et al. Journal of Public Mental Health 2012; 11: 10 – 26, doi:10.1108/17465721211207275

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