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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.

Are optimists and pessimists both right about pain?

Patients’ expectations influence the results of treatments for neck pain, physiotherapy researchers have reported. And this could allow physios to help the pessimists.

The team, from three US universities, worked with data from a study in which 140 patients were treated for neck pain.

They found that more than three quarters of the patients expected massage or manipulation to relieve their pain. More than half thought strengthening and range-of-motion exercises would help. Under 1 per cent put their trust in surgery.

The patients, with an average age of 39, were randomly allocated into two groups, to receive five sessions of either exercises and manipulation or exercises only.

After six months, the patients with highest expectations of pain relief had better outcomes than those who hadn’t expected the treatment to do much good.

‘An interaction with the physical therapist, during which education is provided to reduce pain-related fear, may result in a more optimistic expectation for improvement, with the potential for improved clinical outcomes,’ say the researchers.
Bishop MD et al. Patient Expectations of Benefit From Interventions for Neck Pain and Resulting Influence on Outcomes Journal of Orthopaedic & Sports Physical Therapy 2013; 43: doi:10.2519/jospt.2013.4492

Women’s health

Baby, don’t go breaking my back.
Women often run the risk of a musculoskeletal injury when picking up their children, say researchers in New Zealand.

Physiotherapist Renee Vincent and occupational therapist Clare Hocking gave a questionnaire to 25 women, aged 28 to 40, nearly two thirds of whom reported having low back pain.

The researchers observed the women at home in Auckland with their children, weighing 9-14 kilos.

They noticed at least one risk factor each time a woman lifted her child, with moderate to high risk most often related to the child’s weight or the mother’s grip.

Other common sources of risk were space constraints, reaching (up, down or out) and use of equipment.

The move women said they found most stressful was bending while carrying a child.

The researchers found that trunk rotation of more than 45 degrees, or combining rotation and side bending, caused moderate to high risk in 72.4% of the lifts they observed.

‘Risk factors for musculoskeletal disorders are present to a significant degree, and further research in this area is warranted,’ say the researchers, who have developed a structured checklist for observing women’s risk when lifting a child.
Vincent R, Hocking C. Factors that might give rise to musculoskeletal disorders when mothers lift children in the home Physiotherapy Research International 2013; 81–90, doi:10.1002/pri.1530

Older people

Exercise can help with or without supervision
Exercise programmes may help to reduce falls among educationally and economically disadvantaged older people, researchers have found.

A team from São Paulo University Medical School in Brazil and the University of Michigan in the USA recruited 119 volunteers, average age 79. All lived in their own homes and had previously had falls.

They were randomly allocated into three groups, one of which did fully supervised exercise at a centre, while the second group did minimally supervised exercise at home and the third did no exercise.

After four months, the two exercise groups both showed improvements in relevant measures such as getting up from a chair and tandem-walk speed -- walking heel-to-toe. The non-exercising control group made no improvement.

Both exercise programmes ‘may be equally effective in improving fall-relevant functional mobility’, say the researchers.
Almeida TL et al. Minimally Supervised Multimodal Exercise to Reduce Falls Risk in Economically and Educationally Disadvantaged Older Adults Journal of Aging and Physical Activity 2013; 21: 241–259, www.ncbi.nlm.nih.gov/pubmed/22952201

Comments & Conclusions

Men with high levels of omega-3 fatty acids in their blood are more likely to get prostate cancer, especially the most aggressive kind, say US researchers.

Though the team didn’t ask whether the men took supplements or simply ate a lot of fatty fish (which are rich in omega-3), some experts have commented that such high levels are more likely to come from supplements.

The same study linked high blood levels of linoleic oil, from vegetable sources, with a lower-than-average risk of prostate cancer. Brasky TM et al. Journal of the National Cancer Institute 2013; doi:10.1093/jnci/djt174

People with severe hip or knee arthritis symptoms are up to three times less likely to do paid work, and up to four times less likely to do unpaid work, than patients with an arthritis diagnosis but no symptoms, say Australian researchers. Ackerman IN et al. Physical Therapy 2013; 93: 889-899, doi:10.2522/ptj.20120423

The only factors predicting who would stick with a treatment programme for congenital torticollis (twisted neck) were the mother’s perceptions of the effect of torticollis on her baby’s activities and the programme’s importance for the baby’s future function – not her level of trust in the therapist, attitude towards healthcare styles or belief in the treatment’s effectiveness. Rabino SR et al. Pediatric Physical Therapy 2013; 25: 298-303, doi: 10.1097/PEP.0b013e318298eb92

For young wheelchair-users with cerebral palsy, the 10-m shuttle ride test is a valid way to measure cardiorespiratory fitness, say Netherlands researchers who tested 23 children and teenagers. Verschuren O et al. Physical Therapy 2013; 93: 967-974, doi: 10.2522/ptj.20120513

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