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Physio findings: Physio help for vegetative states, exercise reduces the risk of falls

In our regular round-up of research that's relevant to physiotherapy staff, Janet Wright looks at how physios help families cope with vegetative states and how exercise helps to reduce the risk of falls.

How physios help families cope with vegetative states

Physiotherapy for patients in vegetative or minimally conscious states aims to prevent or treat chest infections, keep joints and muscles working or even help to increase the patient’s level of awareness. 
 
But the relatives of these patients – often young people who had accidents in their teens or twenties – may interpret what they see very differently.
 
‘Understanding family perspective is important because research highlights that families face profound challenges in dealing with, and making sense of what is happening to their relative,’ say CSP member Julie Latchem, of Cardiff University, and colleagues. 
 
‘Good communication with families is an important part of establishing positive care relationships and delivering appropriate care treatment.’ 
 
Analysing in-depth interviews with 65 relatives showed the team that many held physios in high regard for the care and respect they showed to patients, as well as for their practical interventions. 
 
‘Physiotherapists were often singled out for their ability to offer individualised, person-centred care in a context where the vegetative or minimally conscious state patient risks being treated as "just a body",’ the team report, in a paper that can be read in full online.
 
Although the relatives valued physiotherapy, some were distressed by treatments such as suctioning, splinting and use of the tilt table, which looked to them like a form of torture. On the other hand, withdrawal of physiotherapy could send a frightening message about the patient’s prognosis.
 
‘Physiotherapists can make an important contribution to supporting this patient group and their families, but it is vital to recognise that family understandings of physiotherapy may differ significantly from those of physiotherapists,’ the team conclude.
 
‘Physiotherapists need to identify how families view interventions and modify their explanations accordingly.’Latchem J et al. Physiotherapy for vegetative and minimally conscious state patients: family perceptions and experiences. Disability & Rehabilitation 2015.

Exercise proves to reduce the risk of falls

Evidence on how to prevent falls is of crucial importance to clinicians working with older people. So physiotherapist Brendon Stubbs, of the University of Greenwich, and colleagues set out to find the best possible information.
 
Randomised controlled trials (RCTs) provide very clear evidence about a treatment, by dividing similar people randomly into two or more groups and giving the treatment to one group while the others receive a different one, or a placebo (fake treatment) or none at all. 
 
However, any RCT may contain some shortcomings and none can provide the whole story. 
 
Researchers get a higher level of evidence by doing a meta-analysis – finding all suitable RCTs and using statistical techniques to analyse all their results – and a higher level again by reviewing all suitable meta-analyses.
 
‘There is increasing recognition that even a perfect meta-analysis with perfect data can only provide a partial overview of the interventions available to clinicians,’ say Mr Stubbs and colleagues. 
 
‘This is particularly true in complex interventions such as falls prevention where many different options are available to clinicians.’ 
 
The team carried out an umbrella review of meta-analyses covering thousands of older people living in the community (rather than in care homes) and without extra risk factors such as Parkinson’s or stroke. The studies included all kinds of falls, and any intervention that aimed at preventing falls.
 
The team found consistent evidence that both exercise and multifactorial interventions could prevent falls. 
 
Some studies looked at the effects of vitamin D supplementation, and came up with conflicting results. The supplement seems most effective when combined with calcium, but calcium supplementation may increase the risk of heart problems. 
 
‘The results of this review support the notion that exercise should be provided to community older adults to prevent falls,’ say the authors. ‘A balanced programme including both endurance, balance and strength exercises could be recommended.’ Stubbs B et al. What Works to Prevent Falls in Community-Dwelling Older Adults? An Umbrella Review of Meta-analyses of RCTs. Physical Therapy 2015.

Comments and conclusions

The Scottish stroke allied health professionals forum has produced a consensus statement on the use of electrical stimulation after a stroke. The unfunded team surveyed clinicians across Scotland, carried out an extensive literature search, did two audits and had a shortlist of home devices reviewed by biomedical specialists. 
 
The full statement can be viewed here; or see the quick reference guide here.
 
After surgery to reconstruct an anterior cruciate ligament, athletes may be at greater risk of further injury and joint degeneration than was previously thought, say researchers who found the athletes had a wider range of certain movements in the injured joint during games-specific tasks. Clarke S et al. Medicine & Science in Sports & Exercise 2015
 
Video games need further development to provide care-home residents with a reliable source of activity and mental stimulation, as current games often require too much support to be used independently, researchers told a conference on human-computer interaction. Gerling K et al. CHI 2015.  
 
Researchers who studied 2,715 Barcelona children say those attending school in areas of high traffic pollution had poorer cognitive development, even allowing for possible effects of social class and educational quality. Sunyer J et al. PLoS Medicine 2015.
 

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