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Physio findings - Orthopaedic, exercise and older people's issues examined

Janet Wright looks at the latest physio research and clinical findings.

Hip surgery is safer than ever

Death rates after hip replacement surgery practically halved between 2003 and 2011 in England and Wales, a new report reveals. The number of deaths in the first three months after the operation has dropped from 0.56 per cent – already low – to 0.29 per cent.

Researchers analysed data from 409,096 primary hip replacements, using the UK’s National Joint Registry, the largest database on the subject in the world.

Certain medical conditions increased the mortality rate, they found. The risk was doubled by diabetes or renal disease, trebled by a previous heart attack, and increased tenfold by severe liver disease.

Surprisingly, overweight (but not obese) patients – with a body mass index (BMI) between 25 and 30 – fared better than people with a normal BMI of 20-25.

Use of drugs or compression devices to prevent blood clots played an important role, the team found. Spinal anaesthesia proved safer than a general anaesthetic, as did approaching the joint from behind. But the type of implant used did not make any difference to the risk.

‘Widespread adoption of four simple clinical management strategies (posterior surgical approach, mechanical and chemical prophylaxis, and spinal anaesthesia) could, if causally related, reduce mortality further,’ they conclude.  Hunt LP et al. Ninety-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet 2013; 382: 1097-1104, doi:10.1016/S0140-6736(13)61749-3

Sports

Athletes don’t need to stretch a point
Exercise can help to prevent injuries among people leading an inactive modern life. But what about athletes, whose injuries stem from their activity?

To find out what could help, researchers in Copenhagen analysed 25 studies covering 26,610 participants playing a range of sports.

In each study, some players were assigned to do exercises aimed at preventing injury: either strength training, proprioception, stretching or a combination of these.

A control group practised their sport without the preventive exercises. The injuries in each group were counted after a set period of months –3464 injuries in all.

‘Consistently favourable estimates were obtained for all injury prevention measures except for stretching,’ the authors report.

The three studies that focused on stretching found it made no difference to the risk of injury.

Four studies found that muscle-building exercises reduced the risk of injury by 68 per cent. Six studies investigated balance exercises.

Exercise training proved effective against both overuse injuries and acute injuries such as sprains. Combinations of exercises were also found helpful. However, there was not enough evidence to show if any kind of exercise protected against specific injuries. Lauersen JB et al. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials British Journal of Sports Medicine 2013; doi:10.1136/bjsports-2013-092538

Age care

Older people are shaping up
Worried about the health and social costs of an ageing population? No need, says the latest evidence.

‘The extent, speed and effect of population ageing have been exaggerated,’ say researchers at the University of Edinburgh and the centre for demographic studies in Barcelona.

It has usually been measured by a method called “the old age dependency ratio”, the authors explain.

But this doesn’t actually measure dependency – just the number of people over state pension age divided by the number of those who are working age, 16 to 64. In fact, there are more non-working people aged 16-64 than over that age. So older people aren’t straining the budget.

Today’s older people are fitter and healthier than ever, say the team. Some forms of disability are being postponed to later ages, and ‘most acute medical care costs occur in the final months of life, with the age at which these months occur having little effect’.

And as health and education levels tend to rise together, increases in higher education since the 1960s may see further health improvements.

‘Old age dependency turns out to have fallen substantially in the UK and elsewhere over recent decades and is likely to stabilise in the UK close to its current level,’ the authors conclude.Spijker J, MacInnes J. Population ageing: the timebomb that isn’t? BMJ 2013; 347: doi:10.1136/bmj.f6598

  • Today’s over-nineties are mentally and physically fitter than nonagenarians tested a decade earlier, say researchers in Denmark. ‘Increasing longevity associated with improved living conditions and healthcare may result in not just longer lives, but also in elderly functioning better for longer than in earlier generations,’ Professor Kaare Christensen comments. Christensen K et al. Lancet 2013; 382: 1507-1513, doi:10.1016/S0140-6736(13)60777-1

Comments & Conclusions

  • A six-week group-based programme called FACETS can reduce fatigue in people with multiple sclerosis, researchers have found. Participants benefited from learning cognitive behavioural and energy effectiveness techniques, in weekly 90-minute classes. Thomas S et al. Journal of Neurology, Neurosurgery and Psychiatry 2013; 84: 1092-1099, doi:10.1136/jnnp-2012-303816
  • People who eat at least three 28g servings of nuts a week are less likely to die of cancer or heart disease, shows a study of 7,000 people over the age of 55. Nut-eaters were more active, less likely to smoke and had a healthier diet. Guasch-Ferré M BMC Medicine 2013;11: 164 doi:10.1186/1741-7015-11-164

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