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Physiotherapy Journal

Michele Harms, editor of the CSP’s Physiotherapy Journal, reviews the new issue, Physiotherapy 98 (3) 2012. Janet Wright looks at other papers

New technology aids rehabilitation

How can physiotherapists draw on technological expertise and advances aligned to the goals of rehabilitation?
One way is through developing and adapting gaming technology for use in the rehabilitation setting. The September issue of Physiotherapy draws together 12 papers in areas where advancing technology has been applied to clinical practice, six of which are papers based on research presented at the World Confederation for Physical Therapy event in Amsterdam last June.

A team of researchers from Toronto report on a preliminary randomised controlled trial that asked whether the Nintendo Wii Fit has a place in the physiotherapy management of outpatients following total knee replacement.

In a study of 50 patients, the study group received a physiotherapy session followed by 15 minutes of Wii Fit gaming activities. The control group received a physiotherapy session followed by lower extremity exercises. Fung and colleagues report no difference between groups for their primary outcomes.

They conclude that the Wii Fit is an acceptable form of rehabilitation but more work is needed to look at its effect on patient motivation and adherence to a programme.

In a study looking at the feasibility and effectiveness of a low-cost gaming system for young children with developmental delay, Salem and colleagues randomised 40 children to an experimental (Wii) group and a control group. Their results supported the use of the Wii as a feasible, safe and potentially effective therapeutic tool when used as part of the rehabilitation programme of children with developmental delay. Their main findings were a change in single leg stance and improved grip strength.

Researchers from Ireland present the results of two studies. The first looked at active video games as a form of exercise and the effect of gaming experience; and the second; compared the energy expended playing Xbox Kinect with the  Wii and the difference between single and multiplayer modes.

O’Donovan and colleagues report that experience of gaming may affect the exercise intensity of games requiring controller skill and that playing against others may have a small effect on energy expenditure.

Larin, Dennis and Stansfield, from New York, combine the expertise of a physical therapist, occupational therapist and computer scientist and report on the development of a Pioneer 3-DX mobile robot.

By utilising a Nintendo Wii Balance Board to control directional movement of the WeeBot, infants without disabilities, aged five to 10 months, demonstrated significant improvement in driving performance and goal-directed movement when compared with infants who used a joystick.
Fung V, Ho A, Shaffer J, Chung E, Gomez M. Use of Nintendo Wii Fit™ in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial. Physiotherapy 2012; 98(3):183-8.
Salem S, Gropack SJ, Coffin D, Godwin EM. Effectiveness of a low-cost virtual reality system for children with developmental delay: a preliminary randomised single-blind controlled trial. Physiotherapy 2012; 98(3):189-195.
O’Donovan C, Hussey J. Active video games as a form of exercise and the effect of gaming experience: a preliminary study in healthy young adults. Physiotherapy 2012; 98(3):205-210.
O’Donovan C, Hirsch E, Holohan E, McBride I, McManus R, Hussey J. Energy expended playing Xbox
Kinect™ and Wii™ games: a preliminary study comparing single and multiplayer modes. Physiotherapy 2012; 98(3):224-229.
Larin HM, Dennis CW, Stansfield S. Development of robotic mobility for infants: rationale and outcomes. Physiotherapy 2012; 98(3):230-237.

National research priorities

Also in the September issue, the journal reports on the Chartered Society of Physiotherapy’s work on identifying the national research priorities for physiotherapy.

The report, authored by Gabrielle Rankin and three others used a process of national consensus involving key stakeholders, and included service users.

They report on research topics which were identified by the participants as important, of which are prioritised. It is hoped to use these priorities to identify topics appropriate for national funding programmes.
Rankin G, Rushton A, Oliver P and Moore A. Chartered Society of Physiotherapy’s identification of national research priorities for physiotherapy using a modified Delphi technique. Physiotherapy 2012; 98(3):260-271.


Evidence-based practice

Physio and philosopher tackle hard truths about evidence
Evidence-based practice is the cornerstone of modern healthcare, and the weight of published evidence is mounting. But how reliable are even the ‘gold standard’ methods of research, such as randomised controlled trials?  

CSP member Roger Kerry and colleagues from Nottingham University – including philosopher Stephen Mumford – tackle this contentious issue in the Journal of Evaluation in Clinical Practice.

Systematic reviews, meta-analyses and clinical guidelines can be thought of as ‘scientific truthmakers’, says the team. They are becoming increasingly rigorous, as researchers try to filter out bias and to reveal definite cause-and-effect relationships. And yet, the team found, they did not necessarily predict what would happen in practice.

One element is that rigorous study conditions don’t reflect the complexity of the real world, where healthcare professionals make daily decisions.

‘The findings are at odds with what is considered gold-standard research methods, but in line with previous reports,’ the researchers conclude. ‘Further work should focus on scientific dynamics within healthcare research and evidence-based practice constructs.’

Mr Kerry’s blog discusses the findings at http://rogerkerry.posterous.com/scientific-error-and-the-real-world
Kerry R et al. Analysis of scientific truth status in controlled rehabilitation trials. Journal of Evaluation in Clinical Practice 2012; doi: 10.1111/j.1365-2753.2012.01855.x


Funding questions  

Follow the money
When you’re doing some research, a useful thing to know about any non-NHS site is who funds it. Patient.co.uk  provides information for professionals as well as for patients. It is written by medics and funded by EMIS, a company that makes computing systems for GPs.

It receives no funding from external sources, such as drug companies. Advertisements on the site bring in extra income but aren’t endorsed by patient.co.uk

Comments & conclusions

Regular exercise can reverse some of the damage caused by a heart attack, say Chinese researchers. A meta-analysis of 15 randomised controlled trials on left ventricular remodelling (changes in the heart’s structure and physiology) in 813 patients with stable heart failure, showed aerobic exercise was effective, especially if continued for six months or more. Strength training had no effect.
Chen YM et al. International Journal of Clinical Practice 2012; 66: 782-791, doi: 10.1111/j.1742-1241.2012.02942.x

Middle-aged people who do two and a half hours of physical activity a week tend to have lower-than-average levels of inflammation, say University College London researchers who studied 4,289 adults for 10 years. Inflammation is linked with ageing conditions, including cardiovascular disease.
Hamer M et al. Circulation 2012; doi: 10.1161/ CIRCULATIONAHA.112.103879

There is strong evidence for offering supervised exercise programmes to everyone with intermittent claudication – a symptom of peripheral artery disease that causes pain on walking – according to a new clinical review and a summary of NICE guidance.
Peach G. et al. BMJ 2012; 345 doi: 10.1136/bmj.e5208. Layden J et al. BMJ 2012; 345 doi: 10.1136/bmj.e4947

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