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Physio findings - research that’s relevant to physiotherapists

Janet Wright reports on the latest clinical findings.

Psychotherapy aids physical recovery from whiplash

Whiplash injuries can have lasting psychological effects. Some patients develop post-traumatic stress disorder (PTSD), and this may hinder their response to physiotherapy, slowing physical as well as psychological recovery.

Trauma-focused cognitive behavioural therapy has proved moderately effective against PTSD in chronic pain conditions.

So researchers tested it on patients diagnosed with both chronic whiplash-associated disorders and PTSD.

They recruited 26 volunteers and randomly assigned half of them to receive psychotherapy. All 26 were tested at the end of treatment time and again six months later.

Compared with the control group, those who received trauma-focused cognitive behavioural therapy showed significant reductions in stress-disorder symptoms at the end of treatment, with further improvements six months later.

But their neck disability also improved significantly, along with physical, emotional and social functioning.

Limited changes were found in their sensory pain thresholds.

‘The finding that treatment of PTSD resulted in improvements in neck disability and quality of life, and changes in cold pain thresholds, highlights the complex and interrelating mechanisms that underlie both whiplash-associated disorders and PTSD,’ said the authors.
Dunne RL et al. A randomized controlled trial of cognitive-behavioral therapy for the treatment of PTSD in the context of chronic whiplash. Clinical Journal of Pain 2012; 28: 755-765, doi: 10.1097/AJP.0b013e318243e16b.

DOI

Read all about it
To fit as much information as possible into Physio findings, we leave out the titles of papers in the Comments & Conclusions column, as a full title can double the length of a short item.

But all studies summarised in Physio findings should be easily found on the Internet by using the Digital Object Identifier (DOI) system, which gives documents a permanent address.

Just go to http://dx.doi.org and type into the box the DOI number shown at the end of the reference.

As with web addresses (URLs), this has to be exactly accurate, so be careful not to include any spaces or any punctuation marks, such as colon at the beginning or a full stop at the end.

Physio findings stories without a DOI include a web address wherever possible.

Stroke

Home-based upper-limb therapy needs further research
Interest in home-based stroke therapies is increasing.

But there is little evidence, as yet, to assess the value of such programmes for people left with arm problems after a stroke.

Researchers pored through Cochrane trials registers and nine databases, but found only four appropriate randomised controlled trials, including 166 participants.

The studies revealed no significant differences in results, either in arm movement or ability to carry out everyday activities.

‘There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care,’ they concluded.
Coupar F et al. Home-based therapy programmes for upper limb functional recovery following stroke. Cochrane Database Systematic Review 2012; 5, doi: 10.1002/14651858.CD006755.pub2

Arthritis

Stationary cycling can help painful knees
Exercise can reduce the pain of osteoarthritis and improve mobility. But it has to be the right kind to avoid making matters worse.

Researchers recruited 37 volunteers with knee arthritis to a trial using stationary bicycles. The 27 women and 10 men were randomly assigned to either regular cycling sessions or a control group.

After 12 weeks, the cyclists showed significant improvements in walking speed, pain and stiffness.

‘Stationary group cycling may be an effective exercise option for individuals with mild to moderate knee osteoarthritis and may improve pain felt with walking,’ said the authors.
Salacinski AJ et al. The effects of group cycling on gait and pain-related disability in individuals with mild to moderate knee osteoarthritis: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy 2012; doi:10.2519/jospt.2012.3813

Comments & conclusions

  • Overweight children have a significantly increased risk of cardiovascular disease, and the extra risk for children who are obese may be higher than previously thought, say researchers.Friedemann C et al. BMJ 2012; 345 doi:10.1136/bmj.e4759
  • Fear of falling stops many older people going out, especially in winter, according to a survey by the Women’s Royal Voluntary Service.As a result, one in 20 people aged over 75 never go out alone, the charity found. More than a fifth of respondents had lost confidence after a fall – but fewer than a quarter had been visited since their accident by a falls-prevention team.WRVS ‘Falls: measuring the impact on older people’, www.wrvs.org.uk/news-and-events
  • Eating oily fish such as mackerel and fresh tuna may slightly reduce your risk of a stroke, say researchers.But it’s not known whether the health benefits stem from the omega-3 oils or from other nutrients in fish. And fish-oil supplements don’t affect the risk of stroke. Chowdhury R et al.BMJ 2012; doi:10.1136/bmj.e6698
  • Exercise improves walking speed, balance and ability to carry out everyday activities in frail older people, a meta-analysis of randomised controlled trials has shown.But it doesn’t necessarily improve quality of life or ability to get up from a chair and walk. Chou CH et al.Archives of Physical Medicine and Rehabilitation 2012; 93: 237-244, doi:10.1016/j.apmr.2011.08.042

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