Physio findings: A&E delays & top tips for researchers

In our regular round-up of research that's relevant to physiotherapy staff, Janet Wright looks at the latest research news.

Emergency physio service cuts  A&E delays

Can physiotherapists successfully manage an A&E caseload by themselves? 
Physiotherapist Matthew Sutton, of Flinders University in Adelaide, and colleagues asked this when they studied a physiotherapy service in the emergency department of a busy city hospital. 
After A&E patients had seen a triage nurse, about one in eight was considered suitable for the physio service – a total of 1,320 during a 12-month period. Diagnoses included soft-tissue injuries such as sprains and strains, limb fractures in which the skin wasn’t broken and non-traumatic back pain.  
The team set out to see if the physios’ patients had any more misdiagnoses or adverse effects, or longer stays, than a group with similar diagnoses who had gone through the usual medical route. 
They also compared the use of diagnostic imaging procedures such as ultrasound, X-rays and computerised tomography (CT) scans. Less use would be preferable (as long as that didn’t lead to misdiagnoses), not only to save on time and costs, but because X-rays and CT scans could expose patients to a slight risk from radiation.
The open-access study found no adverse effects among the physios’ 1,320 patients. Although 33 of the patients returned to the emergency department within four weeks, none of these were found to have had an incorrect diagnosis or a missed fracture.
The physios’ patients were treated in little more than half the time it took the medics: 103 minutes, on average, compared with 185 minutes for those seen by medical staff. This was partly because the physios sent fewer patients for diagnostic ultrasound, X-rays or CT scans.
‘Importantly, these reductions in the use of imaging were not at the compromise of patient safety,’ say the authors.
They note that, as physios were only on duty during the day, they weren’t dealing with more complicated after-hours cases, for example with patients who were drunk. 
Even so, as one patient in eight was potentially suitable for the physiotherapy service, this could cut waiting times significantly. 
‘The main finding of this study was that the physiotherapy service was able to identify appropriate patients and provide safe management without any identified adverse events or misdiagnoses,’ the authors conclude. Sutton M et al. Primary-contact physiotherapists manage a minor trauma caseload in the emergency department without misdiagnoses or adverse events: an observational study, Journal of Physiotherapy 2015.

Lung cancer patients slow down after surgery

People with lung cancer need a certain level of exercise capacity to be eligible for surgery. Yet they often have a history of smoking and other lung conditions that reduce their ability to exercise. 
Physiotherapists Elizabeth Schofield and Corrine Ward and colleagues, at Imperial College NHS Trust in London, compared patients having surgery with others who had chemotherapy or radiotherapy, to see if the surgical patients were more active. 
As the team expected, the surgery patients reported being more active than the others before the operation.
However, among the 39 patients who responded to a survey, only 19 per cent of those who had had an operation were willing to exercise during the next three months, compared with 60 per cent of those who had not had surgery. 
‘It is surprising that, post-surgery, survivors appeared to think they were less able to participate in exercise than non-surgical survivors and did not want to,’ say the authors.
‘As part of service delivery improvement we will look at preparing survivors for their treatment, and educate them on the importance of remaining active throughout and after treatment, ideally with individualised exercise prescriptions.’  Schofield E et al. Physical activity levels of lung cancer survivors, Cancer Nursing Practice 2014

Top tips for researchers

The council for allied health professions research (CAHPR) has launched a range of ‘top tips’ leaflets for budding researchers. The first three explain how to prepare a scientific poster, how to run a journal club, and how to get your research published. Each one has a set of clear and concise instructions along with practical suggestions. 
From the leaflet on getting published, for example: ‘Set yourself short-term goals – “I will write 500 words in the next three hours” rather than “I plan to have this written by the end of next month”.’  Find out more here

Comments and conclusions

Exercise can relieve depression in adults with neurological disorders, particularly if they do enough to meet current activity guidelines, say researchers who reviewed 26 studies covering 1324 participants with seven different conditions. Adamson BC et al. Archives of Physical Medicine and Rehabilitation 2015.
Hormone replacement therapy (HRT) does not reduce women’s risk of heart disease after menopause, and may increase the risk of stroke, say Cochrane researchers who analysed studies covering 40,000 women worldwide. HRT is also linked with a ‘significant’ increase in the risk of the two most common kinds of ovarian cancer, according to a meta-analysis of 52 studies covering 21,488 women.  Boardman HMP et al. Cochrane Database of Systematic Reviews 2015Collaborative Group on Epidemiological Studies of Ovarian Cancer, Lancet 2015
A ‘worryingly high’ number of children with diabetes are showing signs of potentially serious complications such as high blood pressure, says the National Paediatric Diabetes Audit in its 2013-14 report, published in March 2015. Nearly a quarter of children with diabetes over 12 are obese
Janet Wright

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