In our regular column on research that's relevant to physiotherapists, Janet Wright looks at the latest clinical findings.
The evidence base for physiotherapy is rapidly expanding, but not all studies are carried out well enough to make their conclusions reliable.
The researchers’ work can be undermined by simple mistakes in the way they set the trial up, or even in how they write up their results.
Two new reports by researchers in Australia pinpoint where researchers go wrong, and what they can do to make their research more valuable.
Anne Moseley and colleagues used the Physiotherapy Evidence Database (PEDro) scale to look at nearly 15,000 studies and see what kind of study scored the highest points.
‘Total PEDro scores are higher when trial reports are more recent; are published in English; investigate electrotherapy; and are in the sub-disciplines of musculoskeletal, neurology, cardiopulmonary, gerontology, continence and women’s health, orthopaedics or paediatrics,’ they conclude. Their study offers specific advice to researchers in each sub-discipline.
Sports physiotherapy – along with ergonomics, occupational health and oncology – scored lower on the research scale.
Focusing on sports physio research, Steven Kamper and colleagues note that most of the problems could be solved by careful planning and clear reporting of the trial. But in some cases, researchers simply didn’t have the resources to carry out what they had intended.
A study is less useful if a lot of the participants drop out during the follow-up period, for example.
Researchers can reduce the dropout rate by keeping requirements quite simple and providing plenty of data-collection options – such as in person or by post, email or phone.
But they should also make sure they have enough researchers to collect all the data.
‘An excellent study may therefore require extra time, personnel or money, which can be easily underestimated by researchers,’ the authors comment.Moseley AM et al. The Quality of Reports of Randomized Controlled Trials Varies between Subdisciplines of Physiotherapy. Physiotherapy Canada 2014; 66: 36-43, http://dx.doi.org/10.3138/ptc.2012-68 Kamper SJ et al. Clinical trials in sports physiotherapy. Building on five decades of research to produce even better trials: a critical review and tips for improvements.British Journal of Sports Medicine 2014; 48: 346-348,http://dx.doi.org/10.1136/bjsports-2013-092968
Practice -Therapeutic alliance can ease back pain
A therapist’s attitude and working relationship with a patient can affect the physical outcome of treatments, research has shown in the past. Now a Canadian study reveals how the therapeutic alliance (TA) can affect pain intensity and muscle sensitivity.
Physiotherapist Jorge Fuentes and colleagues at the University of Alberta recruited 117 people with long-term pain in the lower back.
They used interferential current therapy, a form of electrotherapy aimed at easing chronic pain by penetrating deep into the tissue.
One group of therapists had little interaction with the patients they were treating (the ‘limited TA’ group). The others created a supportive and encouraging relationship with their patients (the ‘enhanced TA’ group).
Patients were randomly allocated to one of four groups, receiving either genuine or sham interferential current therapy, with either limited or enhanced TA. Each had one session and the results were then measured.
Those who received the genuine therapy with enhanced TA had ‘clinically meaningful improvements’, the team discovered.
‘The context in which physical therapy interventions are offered has the potential to dramatically improve therapeutic effects,’ the team concluded.Fuentes J et al. Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study. Physical Therapy 2014; http://dx.doi.org/10.2522/ptj.20130118
Comments & Conclusions
- Sixteen-year-olds who ate unhealthy breakfasts were more likely than others to have metabolic syndrome – the group of risk factors putting them at risk of conditions such as diabetes and heart disease – when they reached their forties, according to a study of 889 participants. Wennberg M et al. Public Health Nutrition 2014; http://dx.doi.org/10.1017/S1368980013003509
- Giving up smoking can be as effective as antidepressants in relieving mood disorder, say researchers who analysed 26 studies following smokers and quitters for up to nine years. The ex-smokers enjoyed more positive feelings, along with a significant reduction in stress, anxiety, and anxiety mixed with depression. The effects held for people with and without mental illness. ‘The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders,’ the team concludes. Taylor G et al. BMJ 2014; http://dx.doi.org/10.1136/bmj.g1151
- Scotland has cut waiting times for hip operations and reduced the ‘postcode lottery’ effect, aided by the Scottish government’s purchase of the private Golden Jubilee National Hospital for the NHS, says a new report. It contrasts this successful approach with England’s use of private-sector contracts. Kirkwood G et al. Journal of the Royal Society of Medicine 2014; http://dx.doi.org/10.1177/01410 76814523950
- Men of South Asian origin may need to exercise more than European men – 250 minutes a week instead of the 150 currently recommended – and keep to a lower weight, to achieve a similar reduction in the risk of heart disease and diabetes.Celis-Morales CA et al. PLOS ONE 2013; http://dx.doi.org/10.1371/journal.pone.0082568
Number of subscribers: 0