In our regular column on research that's relevant to physiotherapists, Janet Wright looks at the latest clinical findings.
Did you know that, as a member of the CSP, you have free online access to the society’s journal, Physiotherapy, published by Elsevier? The contents of the current issue of Physiotherapy journal are now available online.
Here, editor Michele Harms looks at a new study on evidence-based practice
Physiotherapists know the importance of evidence-based practice (EBP).
However, the authors of this article argue that its uptake within physiotherapy has been inconsistent. They systematically review 32 studies that focus on therapists’ implementation, understanding and attitudes towards EBP.
One particularly interesting finding is the mistaken belief that EBP disregards clinical expertise.
The authors found evidence that physiotherapists felt they had to apologise for using it in their practice. Perhaps more understandably, some were concerned about applying the results of research to individual patients. The authors suggest that this is best addressed through education.
They found that physiotherapists lack skills in searching for appropriate literature and report a lack of dedicated time in which to undertake this activity.
Fundamental problems, like understanding what constitutes evidence and what is the ‘best’ evidence on which to base practice, are compounded by a lack of high-quality research available.
They recognise that education and CPD are key factors in implementation, and recommend further work to identify effective strategies for clinicians to engage with research evidence. Scurlock-Evans L et al. Evidence-Based Practice in Physiotherapy: a systematic review of barriers, enablers and interventions. Physiotherapy 2014; in press, http://dx.doi.org/10.1016/j.physio.2014.03.001
Athletes braced to protect their ankles. The commonest form of sports injury is a sprained ankle, in which a ligament is stretched or torn – sometimes more than one. Once this happens the weakened joint sprains more easily in the future.
Researchers trying to reduce the risk of further sprains have been looking at two different approaches: ankle braces and neuromuscular training programmes. Both have proved useful in some studies, so researchers have now tested them against each other.
Kasper Janssen and colleagues in the Netherlands recruited 384 athletes who had each recovered from an ankle sprain, and split them into three groups.
One group wore a semi-rigid ankle brace during all sports activities for a year.
The second group followed a home-based neuromuscular training programme for eight weeks. The programme, shown in an earlier study to reduce the risk of another sprain by 35 per cent, involved three sessions a week of exercises, including use of a balance board.
The third group did the training programme and also wore the brace, but only for eight weeks.
At the end of a year’s follow-up, 15 per cent of the brace group had had another sprain, compared with 27 per cent of those who had only done the training, and 19 per cent of the combination group.
Bracing proved no better than training in reducing the severity of further sprains. Janssen K et al. Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British Journal of Sports Medicine 2014; http://dx.doi.org/10.1136/bjsports-2013-092947
Physios fine tune group programmes for individuals. Group exercise programmes are widely used and cost-effective in treating lower back pain. But they could be made more effective for individuals, says Alex Daulat of the community musculoskeletal team at Ealing Hospital NHS Trust.
Mr Daulat, an extended scope physiotherapist doing postgraduate research at Middlesex University London, sent 154 questionnaires to physiotherapy departments.
Almost all those who responded used group exercise programmes. Only 47 per cent of respondents were able to refer non-English speaking patients to the group programmes. And none of the group programmes offered manual therapy.
‘Group exercise programmes lack individualised exercise and education specific to the patient,’ says Mr Daulat in a study published in International Musculoskeletal Medicine. ‘Those patients for whom English is not their first language may be excluded from attending,’ he adds.
He recommends an alternative group programme with individual education sessions and manual therapy where appropriate, plus interpreters for patients who need them.
This alternative – the Spinal Rehabilitation Programme, which he developed – will be compared with a standard group exercise programme in the next stage of the research.
‘It is hoped that this study may also change the way physiotherapists prescribe and deliver exercise for chronic lower-back pain in clinical practice,’ says Mr Daulat.Daulat A.
A physiotherapy survey to investigate the use of exercise therapy and group exercise programmes for the management of non-specific chronic low back pain. International Musculoskeletal Medicine 2013;http://dx.doi.org/10.1179/1753615413Y.0000000022
Comments & conclusions
- New research questions the long-held belief that saturated fats, largely from animal products, harm the heart and that polyunsaturated fatty acids can protect the heart. Chowdhury R et al. Annals of Internal Medicine 2014; http://dx.doi.org/10.7326/M13-1788. DiNicolantonio JJ Open Heart 2014; http://openheart.bmj.com/content/1/1/e000032.full
- Being married to someone with diabetes increases your own chance of developing diabetes by 26 per cent. That’s probably because partners tend to have similar lifestyle risks, for example from unhealthy eating and lack of activity. Leong A et al. BMC Medicine 2014; http://dx.doi.org/10.1186/1741-7015-12-12
- The rapid assessment disuse index, a tool designed to identify patients with high levels of sitting and low daily physical activity, shows ‘good reliability and moderate validity’. Shuval K et al. British Journal of Sports Medicine 2014; http://dx.doi.org/10.1136/bjsports-2013-092901
- The vitamins in fruit juice may not be health-enhancing enough to outweigh the high calorie count of its natural sugars, say specialists. They advise against counting it as one of the recommended ‘five fruit and veg’ daily, and recommend drinking no more than 150 mls a day. Sattar N and Gill JMR Lancet Diabetes & Endocrinology 2014; http://dx.doi.org/10.1016/S2213-8587(14)70013-0
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