In our regular column on research that's relevant to physiotherapists, Janet Wright looks at the latest clinical findings.
Arthritis - Symptom relief is in patients’ hands
Exercises are routinely recommended for osteoarthritis in the hands, though evidence for them has been conflicting.
Now a randomised controlled trial has shown that a combination of two kinds of exercise has significant effects.
A team from two Norwegian hospitals recruited 80 women and randomised them into two groups. Both groups received a leaflet of information and lifestyle advice on dealing with their condition.
One group also received an exercise programme to be carried out three times a week, along with a rubber ball for the strengthening exercises and rubber bands to provide resistance for range-of-motion exercises.
By the end of the three-month trial, the non-exercisers’ symptoms had deteriorated.
But the exercisers were found to have significantly improved their grip strength and activity performance, and reduced their pain and fatigue.
The range-of-motion exercises helped maintain joint mobility and thumb web space (so the thumb could move freely), while strengthening exercises maintained joint stability as well as increasing grip strength.
Hennig T et al. Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial. Annals of the Rheumatic Diseases 2014;
Respiratory - Supervised exercise keeps patients happier
People with chronic obstructive pulmonary disease (COPD) gained more benefit from an exercise programme including one supervised session a week than from exercising at home, they reported to researchers.
A group of 48 patients who had previously completed a pulmonary rehabilitation programme took part in the year-long study.
One group attended an exercise session once a week, supervised by a physiotherapist in a hospital outpatients department.
They were also expected to do four weekly sessions at home. The others just exercised at home. All were asked to keep an exercise diary.
Three and six months into the programme, each group had assessments from their physio.
Their exercises were reviewed and they had a chance to discuss their progress.
At the end of a year, 75 per cent of the patients answered a survey.
The group that exercised alone reported some improvements in fitness and wellbeing. But those who attended the weekly session at outpatients enjoyed the programme more than the home-alone exercisers.
They also did more exercise, gained more fitness and had greater improvements in wellbeing.
‘The positive attitudes reported by both groups combined with the maintenance of exercise capacity and quality of life at 12 months, suggest that continuing to exercise (supervised or unsupervised) with regular reassessment can maintain the benefits achieved during a pulmonary rehabilitation programme, at least for 12 months,’ say the authors.
Spencer LM et al. A Survey of Opinions and Attitudes Toward Exercise Following a 12-month Maintenance Exercise Program for People with COPD. Cardiopulmonary Physical Therapy Journal 2013;
Hip replacement Walking without aids speeds up recovery
Encouraging patients get back on their feet after hip replacement can significantly improve their recovery, new research shows.
Italian researchers worked with 60 women and 40 men, starting while they were still in hospital after having a hip replaced.
The volunteers, who also had other health problems, were divided randomly into two groups.
Both groups carried out five 90-minute exercise sessions a week.
The intervention group did task-oriented exercises and were encouraged not to use any walking aids after they left hospital.
The control group did standard exercises and were advised to use walking aids for three months after surgery.
All were tested before and at the end of the three-week trial, and again after 12 months.
Those who had been encouraged to get quickly back to full weight-bearing were significantly better than the others, even after a year.
‘Task-oriented exercises associated with early full weight-bearing improve disability, pain, activities of daily living, and quality of life after total hip replacement,’ the authors conclude. Monticone M et al. Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial. Clinical Rehabilitation 2014
- A coordinated care programme for people with dementia has shown positive effects for patients and their family carers. The Partners in Dementia Care programme coordinates medical and community services, mainly via phone and computer. In a study of more than 500 patients, the US programme reduced patients’ psychosocial problems such as relationship strain, depression and unmet needs. Bass DM et al. Alzheimer’s Research & Therapy 2014;
- Pregnant women who smoke increase their risk of having a baby with facial deformities such as cleft palate, or losing the baby and endangering their own life in an ectopic pregnancy, says a report by the US surgeon-general. These add to a list of tobacco’s already-known adverse effects on pregnancy.
- Aerobic exercise is known to reduce the risk of diabetes. Now research shows that women who also do muscle-conditioning (such as yoga) or muscle-strengthening exercise reduce the risk a lot more. Doing at least 150 minutes of aerobic activity and an hour of muscle strengthening and conditioning a week could reduce the risk by a third compared with that of inactive women.Anders G et al. PLOS Medicine 2014;
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