Physio findings - Ethical dilemmas

Research that’s relevant to physios: Physiotherapy editor Michele Harms presents the new issue and Janet Wright looks at other papers

Physiotherapy journal

Peer physical examination in pelvic floor physiotherapy practice
Two researchers in Australia debate the ethical, moral and practical implications of teaching and learning clinical skills in examination of the pelvic floor.

Recognising the importance of peer physical examination in many fields of physiotherapy practice teaching, the authors raise the issue of how students may feel pressurised to participate despite their own discomfort and embarrassment.

The authors propose a three stage process to address ethical issues, allow informed consent and give participants choice and alternatives to participation.
Delany C, Frawley H. A process of informed consent for student learning through peer physical examination in pelvic floor physiotherapy practice. Physiotherapy 2012; 98(1): 33-39

Chronic low back pain and patterns of exercise
Three researchers based in Limerick, Ireland, report on a systematic review examining whether people with chronic low back pain demonstrate an altered level or pattern of physical activity to their healthy counterparts.

They challenge the assumption that patients with chronic back pain are less active and review the current body of evidence in this area.

They comment on the major methodological limitations of the published studies, particularly the small sample sizes, regrettably all too common in physiotherapy relevant literature. Their main finding is that in the populations studied, the data revealed few differences in the overall activity level of adults or adolescents with chronic low back pain.
Griffin DG, Harmon DC, Kennedy NM. Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature. Physiotherapy 2012; 98(1): 13-23

Achilles tendon rupture and weight bearing
Researchers at the University of Warwick systematically reviewed early rehabilitation methods following rupture of the Achilles tendon.

They consider the effects of such ruptures and the potential for immediate weight bearing rehabilitation programmes.

Their results are based on 424 patients reported in nine studies. They established that the four components of the rehabilitation protocol centred on the degree of maintained plantar flexion, the inclusion of daily range of movement exercises, the type of orthotic and the length of time it was worn.
Kearney R, McGuinness K, Achten J, Costa M.  A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Physiotherapy 2012; 98(1): 24-32

Classifying shoulder syndromes
The shoulder joint presents the clinician with a challenge because of the difficulty of determining a diagnosis based on common clinical markers.

A research team from Canada suggests that an appropriate classification system is a necessary prerequisite to defining and managing this clinical problem.

The authors have drawn up a shoulder classification system following a large reliability study involving 55 physiotherapists and 255 patients with shoulder pain.
Carter T, Hall H, McIntosh G, Murphy J. MacDougall J, Boyle C. Intertester reliability of a classification system for shoulder pain. Physiotherapy 2012; 98(1): 40-46

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Exercise  can improve life after cancer
Researchers have measured the effects of physical activity on health and well-being in people who have survived different cancers.

After treatment, cancer survivors getting back to everyday activities often find they have little energy and tire quickly. Earlier studies have shown that exercise can improve their health and quality of life.

Now researchers from the University of Hong Kong have analysed 34 studies of patients who had been treated for various cancers: breast, prostate, gynaecological, colorectal, gastric or lung.

The studies, lasting 13 weeks on average, assessed the effects of aerobic exercise and strength training on more than 3,000 patients, whose average age was 55.

Breast cancer survivors found that exercise aided control of weight and blood-sugar, improved leg strength and reduced depression and fatigue.

Aerobic and resistance exercise proved significantly more effective than aerobic exercise alone in improving physical fitness and emotional well-being, and in coping with feelings about breast cancer.

Patients treated for other forms of cancer showed improvements in weight control, physical functions such as oxygen consumption and handgrip strength, depression and quality of life.

‘Quality of life was a clear significant benefit of physical activity and, clinically, there were important positive effects on physical functions and quality of life,’ the authors said. They call for more research to be carried out, for example into intensity of exercise and effects on cancers other than of the breast.
Fong DYT et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials.
BMJ 2012: 344; d7998


Drugs triple dementia patients’ risk of falling

Older people with dementia are three times more likely to be injured in a fall if they are taking selective serotonin reuptake inhibitor (SSRI) antidepressants, a study from the Netherlands has found.

Earlier antidepressants, which can have side effects including dizziness, have long been linked with an increased risk of falls. SSRIs were originally thought to be safer.

Researchers at the Erasmus University Medical Centre in Rotterdam recorded drug use and falls among 248 nursing home residents, with an average age of 82. Carolyn Sterke and colleagues found that, over two years, 152 of the residents had a total of 683 falls, of which 220 caused injuries including broken bones.

Residents on SSRIs were three times more likely to be injured in a fall than their neighbours who weren’t taking the drugs. The risk was even higher among SSRI-users who were also given sedatives.

‘Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses,’ said Dr Sterke.

A study published in January showed that adults aged 25-60 were 2.5 times more likely to be injured in a fall if they routinely took two or more medicines (see Physio findings, page 18, 1 February 2012).
Sterke CS et al. Dose-response relationship between selective serotonin reuptake inhibitors and injurious falls: A study in nursing home residents with dementia. British Journal of Clinical Pharmacology 2012, doi: 10.1111/j.1365-2125.2012.04124.x


Why can joints get worse when they feel better?
Most treatments for knee arthritis aim to reduce the pain. Yet researchers have found that people quite often lose some mobility after pain has been relieved.

Daniel K White from the Department of Physical Therapy and Athletic Training at Sargent College, Boston University, US, and colleagues studied 465 people whose knee pain had been eased and discovered that about 20 per cent were walking measurably more slowly than before.

The team found that people with new health problems were 1.8 times more likely than the others to have slowed down, and those with widespread pain were 1.7 times more likely. Relief of knee pain alone was not enough to outweigh these factors.
White DK et al. Reasons for functional decline despite reductions in knee pain: The Multicenter Osteoarthritis Study. Physical Therapy 2011: 91; doi: 10.2522/ptj.20100385


Michael Harms & Janet Wright

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