Physio findings: back care, pilates, stability exercises, balance and falls

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

Back care - Reviewers question use of core stability exercises

Stabilisation exercises are widely taught to treat non-specific lower back pain, but are they any more helpful than other forms of active exercise? 
Benjamin Smith, a senior physiotherapist at London Road Community Hospital in Derby, and colleagues set out to see how effective the use of stabilisation, or ‘core stability’ exercises has proved to be.
‘Despite it being the most commonly used form of physiotherapy treatment within the UK, there is a lack of positive evidence to support its use,’ say the team.
In 2008, a systematic review found that specific stabilisation exercises might be more helpful than no treatment, but were unlikely to produce a better outcome than any other form of exercise. 
Many more studies have been published since then, so Mr Smith’s team updated the 2008 review by searching five databases. Unlike the 2008 team, they restricted their search to studies in which a core stability programme was used alone. 
‘In the 2008 review the majority of studies favouring stabilisation exercises combined the exercises with some other form of treatment, implying that it was the package of care that was effective rather than stabilisation exercises alone,’ say the authors. 
Mr Smith’s team found that a core stability programme could give patients slightly more short-term relief than other exercise. But when followed up for a year or more, the differences became insignificant.
‘There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term,’ the authors conclude.
‘This review cannot recommend stabilisation exercises for low back pain in preference to other forms of general exercise, and further research is unlikely to considerably alter this conclusion.’ Smith B et al. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis, BMC Musculoskeletal Disorders 2014.  May S & Johnson R. Stabilisation exercises for low back pain: a systematic review, Physiotherapy 2008.

Pilates - Quality of research clouds findings on balance and falls

Pilates exercise can improve older people’s balance, according to researchers in Australia who reviewed existing studies. 
But, although poor balance increases the risk of falling, there isn’t clear evidence on whether learning Pilates actually reduces the number of falls. 
Anna Lucia Barker, of Monash University in Melbourne, and colleagues found six suitable published studies. But only three gave enough detail to show whether the exercises they used provided ‘a moderate or high challenge to balance’ – as recommended for best practice.
‘The evidence suggests Pilates can improve balance, an important risk factor for falls in older adults,’ say the team.
‘However, there is limited data on the impact on falls. Effects may have been over-estimated due to the low methodological quality of studies. Best-practice recommendations were rarely applied in prior studies.’

Comments & Conclusions

  • Playing a musical keyboard can help people with multiple sclerosis to improve control of their hands, say researchers, who used a special keyboard with hospital patients. The half-hour exercise sessions, carried out daily for 15 days, also improved patients’ hand strength and dexterity. Gatti R et al. Physiotherapy Research International 2014.
  • The quality of articles published in physiotherapy journals has improved and the proportion of original studies and review articles has increased, say researchers who studied work published in 2000-2002 and 2010-2012. Snell K et al. Physiotherapy Canada 2014. 
  • Overweight children taking part in a trial had poorer balance than those of a healthy weight, perhaps partly because they also had weaker legs, researchers say. Martino SA et al. Archives of Physical Medicine and Rehabilitation 2014.
  • In tests of memory and mental speed, 1484 former or current shift workers scored less than 1685 other people. The effects lasted at least five years after they stopped working shifts. Meanwhile, the government’s Health survey for England has found that shift workers are more likely to be unwell and overweight, even though they tend to be younger than the general workforce. Marquié JC et al. Occupational & Environmental Medicine 
Janet Wright

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