Physio-findings - Exercise

In our regular column on research that's relevant to physiotherapists, Janet Wright looks at the latest clinical findings.

Mixed responses give clues about ME programmes

A structured form of exercise is recommended for people with myalgic encephalomyelitis (or chronic fatigue syndrome, CFS/ME), a condition that causes numerous symptoms including exhaustion.  

Yet many patients report that it hasn’t helped them. Now researchers have looked at their concerns and suggested some ways to make progress.

Graded Exercise Therapy (GET) aims to help people with CFS/ME gradually increase their activity. It’s meant to be carried out by specially trained therapists under strict conditions to prevent the exercise causing a relapse.

Randomised controlled trials (RCTs) have shown that GET can be effective. Yet exercise-based rehabilitation schemes remain unpopular with many patients.

‘The repeated discrepancy between the RCT results regarding efficacy and survey reports concerning the effectiveness of these therapies remains unexplained, generating ongoing controversy,’ say Bristol physiotherapist Pete Gladwell and colleagues.

The team set out to explore patients’ experiences of GET and two other rehab approaches – Exercise on Prescription and Graded Activity Therapy – using 76 responses to an online survey carried out by the charity Action for ME.

Positive themes from the survey included supportive communication and the value of goal setting.

Other themes included an increase in patients’ confidence caused by taking exercise and the benefits of a routine linked with baseline setting and pacing.

But some patients reported poor communication, lack of a setback plan, being pushed to exercise too hard or feeling blamed if the programme didn’t work for them.

Responses to the Action for ME survey suggested that some therapists weren’t following guidelines set by the National Institute for Health and Care Excellence, say the researchers.

‘These findings suggest areas for improving therapist training, and for developing quality criteria for rehabilitation in CFS/ME,’ the authors conclude.
Gladwell P et al. Use of an online survey to explore positive and negative outcomes of rehabilitation for people with CFS/ME. Disability and Rehabilitation 2013; doi:10.3109/09638288.2013.797508


Home is where the heart recovers
Home-based rehabilitation could be as effective as inpatient care for patients following cardiac surgery, United States-based researchers have found.

They offered low-to-medium-risk patients a home-based rehab package, supervised by a visiting doctor and checked every day by a physio and a nurse using telemonitoring.  

Other health staff also visited during the four-week programme. Clinical examinations such as blood tests and electrocardiography were taken regularly.

A hundred volunteers chose the home-based option. These were compared with 100 similar patients on the hospital rehab programme. All the participants had their exercise capacity tested using the six-minute walk test before rehabilitation began.

After four weeks, the two groups were examined again. Both had improved their exercise capacity, but otherwise showed no difference from their pre-rehab measurements.

‘The programme was found to be effective and comparable to the standard in-hospital rehabilitative approach, indicating that rehabilitation following cardiac surgery can be implemented effectively at home when coadministered with an integrated telemedicine service,’ say the authors.

However, they noted that patients had chosen home care rather than being randomly selected, which limits the ability to generalise about it.
Scalvini S et al. Home-Based Versus In-Hospital Cardiac Rehabilitation After Cardiac Surgery: A Nonrandomized Controlled Study. Physical Therapy 2013; doi:10.2522/ptj.20120212


Daily standing combats children’s disabilities
Children who can’t stand up unaided are at risk of numerous health problems.

Supported-standing devices can help to combat these risks, which include fractures from loss of bone density.

Supported-standing programmes are in widespread use to help build children’s strength and mobility.

Now researchers have done a systematic review of the published evidence and come up with recommendations for the amount of time needed to achieve useful results.

Physiotherapist Ginny Paleg and colleagues searched seven databases and found 30 suitable studies that met all their criteria.

They concluded that an hour to 90 minutes a day had a positive effect on bone density.

An hour a day standing in 30 to 60 degrees of total bilateral hip abduction improved hip stability.

Half an hour to 45 minutes was enough to help relieve spasticity.

And 45 to 60 minutes improved range of motion in children’s hips, knees and ankles.

They recommend carrying out the standing programmes five days a week.
Paleg GS et al. Systematic Review and Evidence-Based Clinical Recommendations for Dosing of Pediatric Supported Standing Programs. Pediatric Physical Therapy 2013; 25: 232-247, doi: 10.1097/PEP.0b013e318299d5e7

Comments & Conclusions

Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse.

In a recent study, researchers found that use of laxative drugs is associated with a slightly higher risk of falls, though not of fractures, in postmenopausal women.

Writing in BMC Geriatrics, the authors note: ‘Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls, should be considered as first measures to avoid potential negative consequences associated with laxative use.’
Haring B et al. BMC Geriatrics 2013; 13: 38, doi:10.1186/1471-2318-13-38

Anti-embolism stockings can prevent deep-vein thrombosis, but only if they fit the patient correctly. Many stockings do not fit properly, researchers have found.

The three researchers from Herriot-Watt University in Edinburgh call for the implementation of an international survey of patient leg sizes to improve the fit.
Macintyre L et al. International Journal of Nursing Studies 2013: doi: 10.1016/j.ijnurstu.2013.01.005

Janet Wright

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