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Physio Findings - Shoulder pain and mind games for older people

Research that’s relevant to physios: Janet Wright reports on the latest clinical news

Simple exercises work for shoulder pain

A review of published research has proved what physios have long observed: that exercises are effective in treating shoulder pain.

CSP member Catherine Hanratty, of the University of Ulster, led a study into management of subacromial impingement syndrome (SAIS), the commonly diagnosed condition causing pain in the shoulder.

The international team – including colleagues from Belfast Health and Social Care Trust, Keele University in England and the Mayo Clinic in Maryland, USA – pored through 10 databases for firm evidence on the use of exercise.

They found 16 randomised controlled trials covering 1162 SAIS patients, and looked at the effects on pain, strength, function, and quality of life.

‘There was strong evidence that exercise decreases pain and improves function at short-term follow-up,’ the team report in the journal Seminars in Arthritis and Rheumatism.

‘There was also moderate evidence that exercise results in short-term improvement in mental well-being and a long-term improvement in function for those with SAIS.’

They also found that exercise had a small positive effect on rotator-cuff strength in the short term and on long-term function.

‘Unsurprisingly, the longer patients performed the exercises, the greater the reduction in their pain,’ says Ms Hanratty, a PhD student in the university’s Health and Rehabilitation Sciences Research Centre.

However, differences in the way the 16 trials were conducted prevented the team discovering what type, intensity, frequency or duration of exercise worked best.

They are now setting up a randomised controlled trial of their own to find out more.

‘I hope that the results of this study combined with the new clinical trial will help physiotherapists and doctors improve the outcomes for people with shoulder pain,’ says Ms Hanratty.

Hanratty C et al. The Effectiveness of Physiotherapy Exercises in Subacromial Impingement Syndrome: A Systematic Review and Meta-Analysis. Seminars in Arthritis and Rheumatism 2012, http://dx.doi.org/10.1016/j.semarthrit.2012.03.015 


Older people

Mind games keep ageing brains in shape
Older people can stay active and live independently for longer with the help of mental and physical exercises, Chinese researchers report.

Yan Cheng of Tongji Hospital in Shanghai and colleagues used two forms of structured cognitive training in a randomised controlled trial, published in the open-access journal BMC Medicine.

The ‘multi-domain’ regime included physical exercise, handicrafts and health education along with exercises for memory, reasoning, problem-solving and map-reading. Single-domain training focused on reasoning only.

Volunteers aged 65 to 75 took hour-long sessions twice a week for 12 weeks, plus homework.

The training improved their reasoning, memory, language and hand eye co-ordination.

Multi-domain training had longer-term effects and, surprisingly, improved reasoning skills more than the exercises that focused on reasoning alone.

That may be because reasoning needs to collaborate with other processes, say the authors, to keep the mind flexible in thinking, making links and reacting to the world.

Cheng Y et al. The effects of multi-domain versus single-domain cognitive training in non-demented older people. BMC Medicine 2012; 10: 30, doi:10.1186/1741-7015-10-30.

Members’ corner

Report underlines unique role of physios in preventing readmissions
Proof of physiotherapy’s ability to reduce hospital readmissions is a valuable tool in cost-conscious times.

CSP member Nicola Clague-Baker has written a paper detailing the evidence for specialist services to reduce the risk of falls among patients leaving hospital.

‘Reducing and maintaining low readmission rates requires the application of specialist physiotherapy skills, which include comprehensive risk assessment skills, detailed treatment techniques and immediate post-discharge support,’ she concludes.

‘The Physiotherapy role in the acute hospital setting – risk assessment and prevention of readmissions’ is available from Nicola Clague-Baker, tel 0116 252 3305, email: njc36@leicester.ac.uk

Comments & Conclusions

Most medical students are taught little or nothing about the benefits of exercise, a University College London survey of the UK’s 31 medical schools reveals. Only four teach this in each undergraduate year, and five offer no instruction about physical activity.
Weiler R et al. British Journal of Sports Medicine 2012; doi:10.1136/bjsports-2012-091380

A systematic review of conservative treatments (not involving drugs or surgery) for secondary lymphoedema finds no evidence to suggest which is the most effective. However, the Canadian researchers say ‘harms are few and unlikely to cause major clinical problems’.
Oremus M et al. BMC Cancer 2012; doi:10.1186/1471-2407-12-6

Walking can have a powerful effect in relieving symptoms of depression, say researchers in Stirling and Edinburgh, who set out to see if it had the same proven benefits as more arduous forms of activity. But more research is needed to see how this could be used in primary care, say the team, who found only eight suitable randomised controlled trials with 341 subjects.
Robertson R et al. Mental Health and Physical Activity 2012; doi: 10.1016/j.mhpa.2012.03.002

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