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Physio-findings - Orthopaedic

In our regular column on research that’s relevant to physiotherapists, Janet Wright looks at the latest clinical findings

Come on in, the water’s lovely

Early mobilisation aids recovery after an operation, and aquatic physiotherapy offers a gentle way into regaining mobility.

But is it as safe as land-based therapy, or could immersion in water impede wound recovery?

Australian researchers trawled databases for suitable studies of aquatic physiotherapy being used within the first three months after orthopaedic surgery.

Out of 5069 potentially relevant articles, they identified eight suitable studies covering 287 patients.

These studies revealed that aquatic physiotherapy was both helpful and safe, the authors report.

It allowed patients to increase the amount of weight they put on an injured limb gradually and with control.

During those early weeks after surgery, it was as effective as land-based therapy in reducing pain and swelling and increasing patients’ strength and range of motion.

Patients could safely start as early as four days after an operation, the researchers found, as long as the wound was covered by an appropriate waterproof dressing.

This needed to fit well, allow the full range of movement and be changed afterwards.

Aquatic physiotherapy proved particularly helpful after rotator cuff repair, reconstruction of the anterior cruciate ligament, and replacement of knee or hip joints.

‘After orthopaedic surgery, aquatic physical therapy improves function and does not increase the risk of wound-related adverse events,’ the authors conclude.

The studies used in this systematic review covered various kinds of aquatic therapy including stretching, strengthening, range-of-motion and aerobic exercise.

All the studies were controlled trials comparing water-based with land-based physiotherapy among adults over the age of 18.

Studies were excluded if no data could be obtained on adverse effects.
Villalta EM, Peiris CL. Early aquatic physical therapy improves function and does not increase risk of wound-related adverse events for adults after orthopaedic surgery: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation 2012; doi:10.1016/j.apmr.2012.07.020


Golf and dancing could be the answer
Few older people do the amount of exercise required to reduce their risk of falling, say Australian researchers.

They carried out a telephone survey of more than 5,600 older people.

Only 12 per cent did strength training, six per cent did balance training and 21.8 per cent took part in balance-challenging activities such as tai chi, dancing, golf, bowls or team sports twice a week.

Those least likely to do enough exercise lived in poor neighbourhoods, were obese, had little education, had walking difficulties or had fallen in the past year.

‘Population-based approaches and targeted strategies for high-risk groups are needed,’ the team concluded.
Merom D et al. Prevalence and correlates of participation in fall prevention exercise/physical activity by older adults Preventive Medicine 2012; 55: 613–617, doi:10.1016/j.ypmed.2012.10.001


Neck problems may not last
How well do the immediate effects of a whiplash injury predict the long-term results?

A team from the University of Antwerp in Belgium carried out a systematic review of the literature, to see if the likelihood of developing long-term whiplash-associated disorder (WAD) could be predicted among people who already showed cervical motor dysfunctions – common symptoms of WAD -- during the first six weeks after their injury.

Although about half of all patients in the studies recovered within three months, many of the others went on to suffer WAD.

Its symptoms often include cervical motor dysfunctions such as reduced ability to move the neck or to reposition the head accurately in relation to the body, and a change in the patterns of muscle activation (probably to minimise use of painful muscles).

However, said the researchers, people who had cervical motor dysfunctions in the earlier stage weren’t necessarily the ones who had most pain and disability or who went on to develop a long-term disorder.

So their predictive value turned out to be doubtful.

The team called for further studies ‘to investigate the complex nature of all underlying mechanisms within a biopsychosocial framework’.
Daenen L et al. Cervical motor dysfunction and its predictive value for long-term recovery in patients with acute whiplash-associated disorders: A systematic review Journal of Rehabilitation Medicine 2013; 45: 113-122, doi:10.2340/16501977-1091

A new study updates the 2007 meta-analysis of 12 significant risk factors for whiplash injury after a road accident, Walton DM et al. Journal of Orthopaedic and Sports Physical Therapy, doi: 10.2519/jospt.2013.4507

Sports injuries

How do we know what’s
There is very little evidence to back most physiotherapy techniques aimed at helping hamstring injuries heal, an updated Cochrane review shows.

A wide search of databases for randomised controlled trials found only two suitable studies, with a total of 104 participants.

These revealed limited evidence that stretching exercises may help elite athletes recover faster from hamstring injuries, and some preliminary evidence that exercise to correct movement dysfunction may speed athletes’ recovery and reduce the risk of a further injury.

They did not consider pain or patient satisfaction.

But, say the authors, until further evidence on treatments for hamstring injuries is available, ‘current practice and widely published rehabilitation protocols cannot either be supported or refuted’.
Mason DL et al. Rehabilitation for hamstring injuries. Cochrane Database of Systematic Reviews 2012; doi: 10.1002/14651858.CD004575.pub3

Comments & Conclusions

A six-week exercise programme for children with Down’s syndrome significantly improved their agility and their strength, especially in the knee muscles, compared with a control group.

The children, aged 10 and 11, did five minutes on a treadmill and 20 minutes of virtual-reality activity three times a week. Lin HS, Wuang YP. Research in Developmental Disabilities 2012; 33:2236-2244, doi: 10.1016/j.ridd.2012.06.017

A weight-loss programme based on a low-energy liquid diet and provided by the NHS helped 91 severely obese people to reduce their weight by an average of nearly 17kg, University of Glasgow researchers report.

A third of those who took part had kept at least 15kg off when followed up a year later.
Lean M et al. British Journal of General Practice 2013; 63: e115-e124, oi:10.3399/bjgp13X663073

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