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Physio findings - Respiratory

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

Training aids lung function before surgery on oesophagus

Cancer patients having surgery on their oesophagus are at high risk of developing respiratory problems such as pneumonia after the operation.

During the past decade, physiotherapists have moved towards teaching patients techniques such as inspiratory muscle training (IMT) – strengthening the muscles involved in inhalation – before rather than after an operation.

Studies have shown that learning IMT in advance can reduce complications after operations on the chest or abdomen, such as coronary bypass or repair of an abdominal aortic aneurysm.

Daniela Dettling and colleagues, of the University of Amsterdam’s Academic Medical Centre, set out to discover whether IMT would work equally well before oesophageal surgery.

They divided 83 patients into two groups. The 44 patients in the IMT group were taught the exercises and asked to practise for 20 minutes a day for at least two weeks before the operation.

They were asked to keep a diary of their daily sessions, including complaints and any adverse reactions. Once a week they came into the hospital to do their exercises under supervision by a physiotherapist, who measured their muscle strength and endurance.

The day before surgery and afterwards, both the IMT and the control group received normal physiotherapy care: deep-breathing manoeuvres, coughing techniques and early mobilisation.

The researchers found that patients in the IMT group had improved their respiratory function and reported no ill effects.

However, the IMT group did not have significantly fewer chest infections after their operations than the control group.

The researchers considered this might be because removal of the oesophagus had a more drastic effect on diaphragm function than other operations that had been studied.

Another possibility was that the cancer patients had better lung function to start with than, say, coronary-bypass patients, so the exercises would not make so much difference.

‘Despite the fact that this pilot study showed no significant differences in the incidence of pneumonia in patients undergoing oesophagectomy, the results show a beneficial effect on respiratory function,’ say the authors.

‘Further research of pre-operative risk factors is needed to determine which patients are at highest risk to develop post-operative pneumonia. IMT may be of value in these high-risk patients.’
Dettling DS et al. Feasibility and Effectiveness of Pre-operative Inspiratory Muscle Training in Patients Undergoing Oesophagectomy: A Pilot Study. Physiotherapy Research International 2013; 18: 16-26, doi:10.1002/pri.1524

Women’s health

Back pain linked with stress incontinence
Women with chronic back pain are more likely to develop urinary incontinence (UI) too, say researchers who analysed data from more than 2300 women.

Those with a long-lasting back problem had a 44 per cent higher risk of having stress UI, in which a sudden movement such a cough or laugh can cause leakage.

‘There are numerous factors associated with the development of back pain, yet little consideration has been given to the pelvic floor musculature and dysfunction of this musculature, which may also cause UI,’ say the authors.

They call on practitioners to keep this link in mind when treating women who have chronic back pain and/or UI.

‘Clinicians must consider this association and the relationship of relevant trunk muscles, including pelvic floor musculature,’ say the authors.
Bush HM et al. The Association of Chronic Back Pain and Stress Urinary Incontinence: A Cross-sectional Study. Journal of Women’s Health Physical Therapy 2013; 37: 11-18.

 A survey of 327 young women aged 18 to 30 years revealed that almost 15 per cent experienced urinary incontinence.

But more than two-thirds of these (and most of the women surveyed) said they would not seek professional help for the condition.
Tremback-Ball A et al. Journal of Women’s Health Physical Therapy 2013: 37: 29–34.Both studies can be found at: http://journals.lww.com/jwhpt

Comments & Conclusions

  • A large trial comparing mobile and fixed bearings in total knee replacement has found no significant difference between the two after five years in terms of patient outcomes, need for further surgery or cost to the NHS.Breeman S et al. Bone & Joint Journal 2013; doi:10.1302/0301-620X.95B4.29454
  • Gait speed, five-times sit-to-stand and hand grip strength are reliable measures of performance for patients in cardiac rehabilitation, say researchers, and are worth using in clinical practice.Puthoff ML, Saskowski D. Cardiopulmonary Physical Therapy Journal 2013; pptjournal.org/current/march_2013/popup_mar13_abstract_a4.php
  • Intense pulsed light treatment of Achilles tendinopathy – a condition causing ankle pain and stiffness – resulted in no measurable benefit compared with a placebo.  Hutchison AM et al. Bone & Joint Journal 2013; doi:10.1302/0301-620X.95B4.30558
  • A telehealth scheme in which patients with long-term conditions were monitored by phone or online did not prove effective compared with usual care, say researchers.Patients with chronic obstructive pulmonary disease, heart failure or diabetes showed no improvement in quality of life, anxiety or depression during a year-long study. However, telehealth monitoring caused no harmful effects for most patients either.Cartwright M et al. BMJ 2013; doi:10.1136/bmj.f653
  • Moderate exercise is as good as vigorous exercise for reducing the risk of high blood pressure, raised cholesterol, diabetes and possibly even heart disease. Researchers analysed data covering more than 33,000 runners and 15,000 walkers, and found that – if they used up the same amount of energy (meaning that the walkers had to keep going for longer than the runners) – they made roughly the same health gains.Williams PT et al. Arteriosclerosis, Thrombosis and Vascular Biology 2013; doi:10.1161/atvbaha.112.300878

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