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Rich in research

CSPpreviews a packed Congress programme from the Association of Orthopaedic Chartered Physiotherapists (AOCP)

The orthopaedic programme at this year's CSP Congress offers physiotherapists the opportunity to bone up on new research in the field.

One of the highlights will be a session explaining how understanding the role of inappropriate muscle activity can greatly improve the outcome of rehabilitation for patients with unstable shoulders.

The treatment concept of abnormal muscle patterning is the first agenda item on day two of the AOCP programme for the Society's flagship scientific conference, which takes place in Birmingham from October 8 to 10.

Delegates will hear results from a retrospective review of almost 900 shoulder cases, which showed abnormal muscle patterning in as many as 45 per cent of cases. Physiotherapist Anju Jaggi, one of the presenters on the topic, told Frontline that muscle reprogramming of these patients has been highly successful - symptoms were improved in 87 per cent of cases and complete stability achieved in 34 per cent of patients.

A clinical specialist at the Royal National Orthopaedic Hospital in Stanmore, Anju is a key member of the shoulder and elbow unit team, which has developed a classification for shoulder instability. She has been sharing the results of this work during the past two years, lecturing both nationally and internationally on the management of atraumatic and muscle patterning shoulder instability.

'Two pathologies can coexist to create the instability and it is our experience that abnormal muscle activation may contribute to both traumatic and atraumatic structural causes of unstable shoulders,' Anju explained. 'Physiotherapy treatment at our unit focuses on regaining normal movement patterns - the use of biofeedback and postural retraining being the mainstay of treatment.'

Rehabilitation is the focus of another programme highlight, exploring a multi-centre randomised controlled trial which compared two popular strategies for treating chronic back pain.

Physio Helen Frost, a research fellow at the University of Warwick, will present a paper on the study, which looked at surgical stabilisation of the lumbar spine versus intensive rehabilitation. She said although patients in both groups reported significant reductions in disability during the two-year follow-up period, there was no clear evidence that surgery was any more beneficial for patients with low back pain.

The double-sided presentation will present outcomes to both the clinical trial itself and the practical and ethical problems of recruiting to such trials. Karen Barker, head of physiotherapy services at the Nuffield Orthopaedic Centre in Oxford, will talk about influential factors around recruiting surgeons, therapists and eligible patients.

'Few large trials exist of surgical treatment and it is conceptually difficult for patients and surgeons to accept the equivalence of operative and non-operative treatments,' she explained.

The spine stabilisation trial's own target of 1,000 participants was lower than expected, yielding only 349 patients. Karen will talk about this and other related issues from the perspectives of both professionals and patients.

The group's final session for Congress 2004 will look at the treatment of patients with massive rotator cuff tears - where the leading edge of the tear has retracted past the glenoid margin. Given the UK's ageing population, it is an increasing problem, and one which presents a 'particular challenge' to physiotherapy, believes the paper's presenter, Bobby Ainsworth.

Bobby is a consultant physiotherapist in musculoskeletal medicine at Torbay Hospital, Devon, where a rehab programme has been developed for these patients and a pilot study carried out to evaluate its effectiveness.

The programme has since been rolled out to many parts of the UK and work is now being done to refine it further.

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