Physio findings: knee exercises, latest articles from Physiotherapy journal

In our regular round-up on research Janet Wright looks at how knee exercises build elders’ confidence. Physiotherapy journal editor Michele Harms highlights the latest articles.


Knee exercises build elders’ confidence

Older people sometimes describe a fall as having been caused by their knee buckling, or giving way. New research shows that knee-buckling is linked with an increased risk of falls, especially among people who have knee pain or osteoarthritis.
Because knee buckling can be caused by muscle weakness and poor balance, researchers recommend a programme of targeted exercises to increase the joint’s stability and reduce its likelihood of giving way. Building knee stability also improves patients’ quality of life as they regain confidence in their balance, say the authors.
Michael Nevitt and colleagues analysed data covering 1,842 people in the US Multicenter Osteoarthritis Study. The patients, aged 54 to 84 (average age 67) when the study started, were followed up five years later.
Those who, before the trial started, had already experienced a fall when their knee buckled were 4.5 times more likely than others to have had further falls in the next five years. They were twice as likely to have been significantly injured in a fall, three times as likely to have had their movement limited by a fall injury, and four times as likely to lack confidence in their balance. 
‘Interventions that reduce knee buckling may help prevent falls, fall-related injuries and adverse psychological consequences of falls in persons with knee osteoarthritis,’ the authors conclude. They warn that, as the main symptom of knee arthritis is pain, professionals may miss signs of instability. 
  • Janet Wright 

Journal Findings

Physiotherapy editor Michele Harms highlights the latest articles online and in print

The March issue of Physiotherapy (Volume 102, Issue 1) includes summaries of three focused symposia from the World Confederation for Physical Therapy held in Singapore last year.

Two are featured here:

  • Evidence-based app An international authorship including experts from America, the Netherlands, the UK, Canada and Australia have developed a simple app based on an algorithm to guide the clinician in decision making in the treatment of upper extremity impairments following stroke.
    Best practice for arm recovery post stroke: an international application Wolf SL et al for the Upper Extremity Stroke Algorithm Working Group.
  • Strength training This symposium summarised the emerging scope of practice in strength training in the field of physical therapy. It gave an overview of the importance and effects of evidence-based strength exercise protocols. It focused on ageing adults, obese and metabolically unhealthy subjects, patients with type 2 diabetes and frail patients with coronary artery disease. The authors considered the benefits of an active lifestyle for health in these patients.
    Strength training in physical therapy Hautala  AJ et al.

Plantar fasciitis

Available online, as an article in press, Grieve and Palmer report on a survey which sought information on how physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. A total of 257 physiotherapists completed the survey and their responses suggest that advice and education, with an emphasis on self-management, and including calf and hamstring stretching was the most commonly reported treatment approach. From a manual therapy perspective, massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy were popular.  

Managing low back pain in pregnancy

Pregnancy-related low back pain is very common, and 629 physiotherapists responded to a survey conducted by the EASE back study team. The team found that most respondents treated patients in three to four, one-to-one treatment sessions over three to six weeks. They found multimodal management to be common; with various exercise programmes, manual therapy, massage and acupuncture being used to varying degrees.
Current management of pregnancy-related low back pain: a national cross-sectional survey of UK physiotherapists Bishop A et al

Treatment after rotator cuff repair

Thomson, Jukes and Lewis report a systematic review to compare exercise therapies, continuous passive movement (CPM) and the duration of postsurgical immobilisation following surgical repair of the rotator cuff. 
Their aim was to determine the most effective rehabilitation protocol. Although they found no difference between the rehabilitation methods studied, the results suggested that patients could expect to see an improvement in pain levels, range of the shoulder joint and related function.

1000 norms project

Physiotherapists and researchers need access to robust patient-centred outcome measures and databases holding appropriate reference values. This group of Australian researchers are currently undertaking a study with the aim of generating a freely accessible database of musculoskeletal and neurological reference values representative of the healthy population aged from three years to 100 years. They will include dexterity, balance, ambulation, joint range of motion, strength and power, endurance and motor planning. This database will be invaluable for those conducting research in related areas and for clinicians who want to compare patient data with ‘normal’ values.  

Comments and conclusions

  • Patients who receive psychological therapies at a time and place of their choice are more likely to find the treatment successful, say researchers who studied data on 14,587 patients in England and Wales. Williams R et al. BMC Psychiatry 2016; - open access
  • Children aged two to five years with a particular type of cystic fibrosis could be treated safely with the drug ivacaftor, a small study has found. The drug, already licensed for use by older children, was found safe and effective in children with a CFTR gating mutation.  Davies JC et al. Lancet Respiratory Medicine 2016; 
  • T’ai chi can help people gain fitness even if they have chronic health conditions, say researchers who reviewed 33 studies of patients with cancer, osteoarthritis, heart failure or chronic obstructive pulmonary disease. The meditative exercise also relieved pain and stiffness in arthritis.  Chen YW et al. British Journal of Sports Medicine 2015; 
Janet Wright and Michele Harms

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