Michele Harms, editor of the CSP’s Physiotherapy journal, sums up the latest research findings from the issue out this month 98(4) December 2012. Janet Wright looks at other papers
Clinical trial registration important for good and bad results
From January 2013, protocols of clinical trials need to be registered with a free, publicly available and fully searchable register.
In an editorial, the editors of the major international physiotherapy journals present a united view on the importance of registration.
Physiotherapy already advocates this practice, which helps to reduce selective reporting and publication bias.
Registration is important when, for example, studies which find few differences or results contrary to their expectations may choose to report only favourable outcomes which can give a misleading impression.
Similarly, trials showing negative or non-significant results can be put in the ‘bottom drawer’ and never find a place in the literature.
Clinical trials registries can be searched and protocols can be compared to the published papers to determine whether the report is true to the original protocol. Trials need to be registered before recruitment of the first subject.
Clinical trial registration in physiotherapy journals: recommendations from the International Society of Physiotherapy Journal Editors. Physiotherapy 2012;98 (4):273-6.
Who will blow the whistle on bad practice?
This is an interesting study by Mansbach, Melzer and Bachner which investigates the willingness of students and qualified physiotherapists to whistle blow in situations where patients may need protection.
They pose three questions:
- Are physiotherapists and physiotherapy students willing to take action to prevent misconduct in order to protect a patient’s interests?
- Are they willing to report the misconduct to authorities within an organisation and/or outside it?
- Are they willing to report a colleague’s wrongdoing as well as that of a manager?
While perceiving misconduct to be serious, physiotherapists perceived a colleague’s misconduct as being more serious than that of the student.
Physiotherapists were more likely to intervene internally, where students were more prepared than the physiotherapists to take action externally. Mansbach A, Melzer I and Bachner YG. Blowing the whistle to protect a patient: a comparison between physiotherapy students and physiotherapists.Physiotherapy 2012;98(4):307-12.
Six-minute walk test aids cardiac rehab
A group of researchers in Australia undertook a systematic review to look at the validity, reliability and responsiveness of using the six-minute walk test (6MWT) in patients attending cardiac rehabilitation.
They found 16 studies met the review criteria and concluded there is strong evidence to suggest that the 6MWT is responsive to change in this population.
Further research is required to define the measure’s reliability and validity in this setting.Bellet RN, Adams L and Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness – a systematic review. Physiotherapy 2012;98(4):277-86.
Seating design in schools affects back pain
Authors from Cardiff University, the University of East Anglia and the University of Plymouth jointly report a study which looked at self-reported back pain in adolescents.
Candy and the team recruited a large sample of 14 to 16-year-old students to determine whether providing them with a foam seating wedge improved their posture and reduced the intensity of their back pain.
They researchers found that the use of a forward tilting seat wedge reduced back pain, particularly in the evenings.Candy EA, Farewell D, Jerosch-Herold C. Shepstone L, Watts RA and Stephenson RC. Effect of a high-density foam seating wedge on back pain intensity when used by 14 to 16-year-old school students: a randomised controlled trial. Physiotherapy 2012;98(4):300-06.
Knee rehabilitation comes under spotlight
A group of researchers from Cardiff performed a systematic review to examine the evidence for clinical effectiveness of knee rehabilitation techniques.
They found it difficult to make conclusions about the effect of exercise due to variation in the exercise programmes reported.
They also report a dearth of high quality research to support the use of manual therapy, electrotherapy or taping in isolation.
The reserachers suggest that multimodality physiotherapy programmes are beneficial. Button K, Iqbal AS, Letchford RH and van Deursen RWM. Clinical effectiveness of knee rehabilitation techniques and implications for a self-care treatment model.Physiotherapy 2012; 98(4):287-300.
From January 2013 Physiotherapy Journal subscriptions will switch to a purely electronic format. To find out more about the switch, visit www.csp.org.uk/journal
Exercise eases heart disease and cancer fatigue
Serious health problems shouldn’t automatically scare people off taking aerobic exercise. Researchers found it helps to relieve fatigue in people with cancer both during and after treatment. They updated a Cochrane report after analysing 56 studies involving 4,068 people.
Long periods of inactivity can weaken muscles and increase fatigue, say the authors. They recommend balancing rest with aerobic exercise.
Another team put 63 patients with stable congestive heart failure into a group exercising at 60 per cent of peak oxygen consumption twice a week.
Sixty others followed no formal exercise regime.
After 10 years, the exercisers could still work at the same rate. More of the non-exercisers had died or been readmitted to hospital.
Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews 2012; 11: CD006145, doi: 10.1002/14651858.CD006145.pub3. Belardinelli R et al. 10-year exercise training in chronic heart failure: a randomized controlled trial. Journal of the American College of Cardiology 2012; 60:1521-8, doi: 10.1016/j.jacc.2012.06.036
Physios fix soft-tissue injuries with fewer drugs
Extended-scope physios (ESPs) treat soft-tissue injuries as effectively as doctors and emergency nurse practitioners, say researchers.
They recruited 372 patients at a Bristol accident and emergency department, with straightforward peripheral soft-tissue injuries and no special circumstances such as other injuries or disease. The patients were randomly divided into three groups for treatment.
The physios gave medicine to fewer patients (3.6 per cent) than the nurses (23.2 per cent) or the doctors (42.2 per cent), and spent more time with each patient.
After eight weeks, outcomes for those treated by physios or nurses were as good as for those receiving routine care from a doctor, says the team.
‘This result ... demonstrates that the ESP should be considered as part of the clinical skill mix without detriment to outcomes,’ say the authors.
McClellan CM et al. A randomised trial comparing the clinical effectiveness of different emergency department healthcare professionals in soft tissue injury management. BMJ Open 2012; 2: e001092, doi:10.1136/bmjopen-2012-001092
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