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Physio findings - Research

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

CSP joins campaign to bring findings into the open

The CSP is backing a new initiative to have all research published. Members can help individually by signing a petition in support.

Evidence-based practice relies on the fullest possible research into a subject. Studies published in peer-reviewed journals are considered the most reliable, as they have been evaluated by experts in the same field.

Yet there’s an astonishing gap in our knowledge of what has been discovered. Only about half of all completed clinical trials are ever published, Dr Fujian Song of the University of East Anglia and colleagues reported in 2010.

Now the AllTrials campaign, set up by health and science groups including the BMJ and the Centre for Evidence-based Medicine, is calling for all trials to be registered and all results reported.

‘We need all the evidence about a treatment to understand its risks and benefits,’ say the AllTrials organisers.

Campaigners note that the information gap isn’t neutral. Studies with positive results – finding in favour of whatever they have been investigating – are twice as likely to be published as others.

‘If you tossed a coin 50 times, but only shared the outcome when it came up heads and you didn’t tell people how many times you had tossed it, you could make it look as if your coin always came up heads,’ says AllTrials.

‘This is very similar to the absurd situation that we permit in medicine.’

The CSP signed up to the campaign in April.

‘The CSP strongly advocate evidence-based practice development to achieve advances in health care and public health, so we were pleased to join with medical professionals and patient organisations to back this call for all clinical trials to be published,’ says CSP public affairs and policy officer Rachel Newton.

Song F et al. Dissemination and publication of research findings: an updated review of related biases. Health Technology Assessment 2010; 14: 8, doi:10.3310/hta14080

Please sign the petition for all trials to be registered and all results reported, at
See In perspective, page 22


Could antibiotics ease back pain?
Antibiotics may be able to reduce the chronic pain of spinal-disc herniation, according to new research.

Commonly (though inaccurately) known as a ‘slipped disc’, herniation occurs when the outer part of a spinal disc tears, allowing the soft centre to push through.

Physiotherapist Hanne B. Albert and colleagues at two Danish hospitals report that resulting long-term pain may be caused, in some cases, by bacterial infection.

That wouldn’t affect all herniated discs. The 162 people they studied had a specific condition, in which the neighbouring vertebrae showed signs of swelling that might be caused by infection. The swelling, called Modic type 1 changes or bone oedema, was detected by MRI scans.

The patients were given either antibiotics or a placebo for 100 days, without knowing which they were taking.

Those on antibiotics had significant and lasting improvements in pain, disability and the condition of their joints as revealed by MRI scans.

The placebo group made only very small gains. Dr Albert’s team believes the treatment could help a large minority of back-pain sufferers. Albert HB et al. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. European Spine Journal 2013; 22: 697-707, doi:10.1007/s00586-013-2675-y


Steroid shot plus exercise has cost-effective edge
For patients with moderate to severe shoulder pain, exercise and a steroid injection given by a physiotherapist may be more cost-effective than exercise alone, say researchers.

A team from Birmingham, Leeds and Keele studied 232 middle-aged volunteers with subacromial impingement syndrome, the commonest cause of shoulder pain. This part of the trial looked at cost-effectiveness of treatments.

Physios gave a steroid shot and exercises to one group, while the other group received exercises alone.

Though the differences were small, the steroid-and-exercise group had less time off work, took fewer anti-inflammatory painkillers and cost the NHS less than the exercise-only group.

They also spent less on private healthcare and over-the-counter products, say the authors.

Jowett S et al. Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis. Rheumatology 2013; doi:10.1093/rheumatology/ket149

Comments & Conclusions

Intense Pulsed Light treatment did not significantly reduce the pain and swelling at the back of the ankle caused by chronic mid-body Achilles tendinopathy, say Swansea researchers. They carried out a 12-week double-blind randomised placebo-controlled trial on 47 patients. Hutchison AM et al.Bone & Joint Journal 2103; 95-B: 504-509, doi:10.1302/0301-620X.95B4.30558

People taking the antidepressants mirtazapine and fluoxetine are at double the risk of catching the hospital-acquired infection Clostridium difficile, say US researchers. People with major depression are 36 per cent more likely than average to catch C difficile, and older widowed people are at 54 per cent more risk than those who are married. Depression has previously been linked with changes in the gastrointestinal system. Rogers MA et al. BMC Medicine 2013; 11: 121, doi:10.1186/1741-7015-11-121

Cosmetic breast implants may increase a woman’s risk of death if she develops breast cancer, probably by hiding the cancerous tissue from mammograms during the more treatable early stages, say Canadian researchers. Lavigne E et al. BMJ 2013; 346 doi:10.1136/bmj.f2399

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