Anorexia nervosa and exercise
The authors describe the dilemma faced by physical therapists treating people with anorexia nervosa.
As a condition often preceded by excessive physical activity, should the management of these patients include exercise training?
The authors Ng, Ng and Wong, based at Singapore General Hospital, conducted a systematic review and meta-analysis.
They identified a number of studies with mixed results and limitations which meant that they were unable to exclude publication bias.
However they tentatively conclude that the inclusion of supervised exercise training in the management of patients with anorexia nervosa appears to be safe.
They report no detrimental effect on the anthropometry and some improvement in strength and cardiovascular fitness. Ng LWC, Ng DP, Wong WP. Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis. Physiotherapy 2013:99(1); 1-11
Surgery or conservative care for spinal stenosis?
May and Cromer from Sheffield Hallam and Leeds Universities conducted a systematic review to examine whether surgical management was more effective than non-surgical treatment for spinal stenosis.
Having included 18 studies in the review, four out of five studies suggested that decompression surgery was more effective than conservative care, but only one study was considered to be of high quality.
In six high-quality studies, there was strong evidence that steroid epidural injections were not effective; in four out of five studies (two of which were of high quality), there was moderate evidence that calcitonin was not effective.
They found no evidence for the effectiveness of other conservative interventions.
This lack of evidence for the effectiveness of conservative care leads them to conclude that there is an urgent need for further work in this area. May S, Comer C. Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review Physiotherapy 2013:99(1); 12-21
The six-minute walk test
Walking tests are in everyday use in physiotherapy departments.
A group of researchers from Hong Kong Polytechnic University looked at the effect of varying some of the parameters used in the six-minute walk test (6MWT).
This included the effect of walkway length and turning direction on the distance covered during the test.
They included participants more than 50 years of age, who completed the test over walkways of various lengths and different directions of turning, towards dominant or non-dominant sides.
The authors found that the length of the walkway had a significant effect on the six-minute walk distance, with the greatest distance and lowest number of turns found for the 30-m walkway.
Their results suggest that the turning direction had no effect.
They conclude that subjects can turn in either direction without significantly affecting the results when using a standard walkway for the 6MWT. Ng SS, Yu PC, To FP, Chung JS and Cheung TH. Effect of walkway length and turning direction on the distance covered in the 6-minute walk test among adults over 50 years of age: a cross-sectional study. Physiotherapy 2013:99(1); 63 -71
Aerobic dance during pregnancy
Kari Bø and a group of researchers from the Norwegian School of Sport Sciences in Oslo conducted a randomised controlled trial to look at the effect of aerobic dance on cardio-respiratory fitness in pregnant women.
Sixty-two women were randomised to either two aerobic dance classes and 30 minutes of daily physical activity for 12 weeks or a control group.
They used a submaximal treadmill test to measure cardio-respiratory fitness and found that the aerobic dance programme had no effect on cardio-respiratory fitness in pregnant women.
Halvorsen S, Haakstad LAH, Edvardsen E and Bø K. Effect of aerobic dance on cardiorespiratory fitness in pregnant women: A randomised controlled trial Physiotherapy 2013:99(1); 42-49
The papers mentioned above are gathered in Volume 99 Number 1 of the print journal, published on 1 March 2013. Members wishing to see the individual papers can do so online and as PDFs via the CSP website.
Full details of how to access Physiotherapy online are available on the CSP website at: www.csp.org.uk/publications/journal.
A guide to viewing Physiotherapy online was distributed with the last issue of Frontline.
Physios help patients back to work sooner
A study of treatments for whiplash injury found that a course of physiotherapy gave no better results, over the long term, than a single advice session with a physio (see Frontline News, 23 February).
However, the package of up to six sessions did help in the short term, the researchers report in the Lancet.
‘Our trial confirms physiotherapy packages that include exercise and manual therapy are effective in accelerating recovery of function, reducing pain in the short term and reducing work absence,’ say Sarah E Lamb of Warwick Clinical Trials Unit and colleagues.
The sessions could include manual therapy, exercise, pain-management advice, tips for dealing with travel anxiety and a screen for post-traumatic stress.
Patients receiving this package took about 40 per cent less time off work than those who just had one advice session, cutting sick-leave by an average of four days.
The authors recommend usual consultations in emergency departments and a single physiotherapy advice session for persistent symptoms.
This was the second step in a trial that had previously trained A&E staff to provide patients with an active-management consultation. The active-management step was not found to provide any additional benefit.
The smaller number of patients who volunteered for the physiotherapy step tended to have worse than average symptoms.
Patients were more likely to comply with a single session than with a package that meant repeated visits to a practitioner.
‘Modest improvements in disability could mean that people can return to work more quickly,’ say the authors.
Sarah E Lamb et al. on behalf of the Managing Injuries of the Neck Trial (MINT) Study Team. Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomized controlled trial. Lancet 2013; 381: 546–556, doi:10.1016/S0140-6736(12)61304-X
People with dementia are twice as likely to fall as someone without dementia, says physiotherapist Julie Whitney. But no one has yet come up with a proven effective strategy to tackle this.
Ms Whitney, a research fellow at the Clinical Age Research Unit, Kings College Hospital London, is principal investigator in a study of a pilot scheme tackling the problem. The intervention is being carried out among older people with dementia living in care homes.
It includes a review by a geriatrician, balance training exercise and management of dementia-related behaviour.
The randomised controlled trial, Prevention of falls in cognitively impaired older adults living in residential care, is being funded by the NHS National Institute for Health Research.
Ms Whitney can be contacted at firstname.lastname@example.org or 020 3299 3420.