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Physio findings - physiotherapy journal

In our regular research round-up, Physiotherapy Journal editor Michele Harms summarises some papers published online by the journal in the last three months. Janet Wright reports on other research news.

Does deep breathing reduce post-operative complications?

Silva, Li and Rickard investigate whether the inclusion of deep breathing exercises in physiotherapy-directed early mobilisation gives any additional benefit in reducing postoperative pulmonary complications when patients have undergone open upper abdominal surgery.

The authors studied the outcomes of 86 surgical patients who were randomised to: early mobilisation; early mobilisation with breathing exercises; or delayed mobilisation with breathing exercises.

Their results suggest that the mobilisation component may have the greatest effect. However, where mobilisation is delayed, it may be important to continue breathing exercises until patients are able to mobilise.

Silva YR et al. Does the addition of deep breathing exercises to physiotherapy directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery?Physiotherapy 2013;99(3):187-193.www.physiotherapyjournal.com/article/S0031-9406(12)00132-0/abstract

Is deconditioning related to sub-acute, non-specific low back pain?

A study of a cohort of sedentary office workers in Spain suggests that physical deconditioning plays a role in sub-acute, non-specific low back pain.  

The researchers found that when subjects with low back pain were compared with age-matched, healthy sedentary office workers, important differences were found in hand grip strength and extensor trunk endurance in both men and women.

Health-related quality of life was also reduced in subjects with low back pain. While the design of the study did not allow the authors to draw conclusions about causation, they did nevertheless find a relationship between musculoskeletal fitness, particularly in the endurance of the trunk muscles, and low back pain.
del Pozo-Cruz B et al. Musculoskeletal fitness and health-related quality of life characteristics among sedentary office workers affected by sub-acute, non-specific low back pain: A cross-sectional study. Physiotherapy 2013;99(3):194-200.www.physiotherapyjournal.com/article/S0031-9406(12)00085-5/abstract

Incontinence and pelvic floor measurement in sports students

This study looked at pelvic floor strength in a group not usually associated with incontinence.

Forty three female sport students who had never given birth and who performed high levels of physical activity participated.

The researchers looked at whether measurements of pelvic floor muscle strength obtained using the modified Oxford Grading Scale were comparable with those measured using the Peritron manometer.

They also compared the scores obtained from continent and incontinent subjects.

Of the 43 subjects, surprisingly 16 were classified as ‘incontinent’ based on self-report. Five reported urge incontinence, nine reported stress incontinence and two reported mixed urinary incontinence.

They state that this incidence is not uncommon. However, the two measurement procedures found no significant differences in muscle strength between the continent and incontinent subjects.

This study also found only moderate correlation between digital evaluation of pelvic floor muscle contraction strength and Peritron manometer measurements.
Da Roza T et al. Oxford Grading Scale vs manometer for assessment of pelvic floor strength in nulliparous sports students. Physiotherapy 2013:99(3);207-211. www.physiotherapyjournal.com/article/S0031-9406(12)00084-3/abstract

A new activity pacing questionnaire for chronic pain and fatigue

A group of researchers is developing a tool to help in the management of patients with chronic low back pain, chronic widespread pain and chronic fatigue syndrome or myalgic encephalomyelitis.

They used a three-round Delphi Technique in the first stage of the development of the comprehensive tool to assess the multi-faceted nature of pacing among patients with chronic conditions.

The authors argue that there is little consensus on the interpretation of ‘pacing’ and that common strategies advocate both increasing and decreasing activities to relieve the condition.

They found certain elements, including breaking down tasks, not over-doing activities, and gradually increasing activities, were important.

Patients will help to explore the questionnaire’s validity and reliability.
Antcliff  D et al. The development of an activity pacing questionnaire for chronic pain and/or fatigue: a Delphi technique. Physiotherapy 2013:99(3); 241-246. www.physiotherapyjournal.com/article/S0031-9406(12)00138-1/abstract

The CSP’s Physiotherapy Journal, published by Elsevier, has fully switched to digital. Content is available online only for CSP members, who have free access to it as part of their membership, providing they sign up via the CSP website. See: www.csp.org.uk/journal

Neurology

Video athletes tackle disability
Many children with cerebral palsy are physically unfit, putting them at risk of health complications. Playing active video games could improve their range of motion and cardiorespiratory capacity, a small Canadian study has found.

‘Video games already represent an important component of leisure time in younger people, and such games can lead to a high level of exercise intensity in people who are healthy,’ researchers from CHU St-Justine research center in Montreal noted.

To see how children with disabilities could benefit, they studied 20 children, half of them with spastic diplegic cerebral palsy, in a movement analysis laboratory.

The children, aged seven to 12, had their heart rates monitored while they played four different active video games. In the final minute of each game, their leg motion was also analysed.

All the participants had similar results, suggesting that those with cerebral palsy could benefit from active games as much as other children.

They spent much of the time exercising at a level – above 40 per cent of heart rate reserve – that is recommended for improving fitness. A cycling game proved the most effective.
Robert M et al. Exercise Intensity Levels in Children With Cerebral Palsy While Playing With an Active Video Game Console. Physical Therapy 2013; 93: 1084-1091, doi:10.2522/ptj.20120204

Comments & Conclusions

Getting active for two-and-a-half hours at the weekend, or any other time, is as healthy as five regular half-hour bouts of exercise a week, according to a Canadian study of 2,324 adults.

Comparing those who got that much exercise against those who didn’t, they found it was the total amount of weekly exercise rather than regularity that counted against metabolic syndrome and the risk of heart disease, stroke and diabetes.
Clarke J, Janssen I Applied Physiology, Nutrition and Metabolism 2013; 38: 773-778, doi:10.1139/apnm-2013-0049. Thanks to CSP member Helen Skehan for sending in this study.

Researchers have developed a simple scoring system that accurately predicts the risk of dementia in people over 60 with type 2 diabetes.

They analysed nearly 30,000 health records to come up with the system – based on age, health and education – which will help healthcare professionals monitor those most at risk.
Exalto LG et al. Lancet Diabetes & Endocrinology 2013; doi:10.1016/S2213-8587(13)70048-2

People who smoke, avoid exercise or eat little fruit or veg have an increased risk of developing a disability, say researchers who studied data on nearly 4,000 French adults.
The more unhealthy habits, the greater the risk – but drinking alcohol doesn’t seem to add to it.
Artaud F BMJ 2013; 347, doi:10.1136/bmj.f4240

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