Physio findings - Neurological

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

Physios help exercisers keep with the programme

An innovative scheme combining physiotherapy and self-help can motivate people with disabilities to stick with an exercise programme, New Zealand researchers have found.

The University of Otago team – three physios and a psychologist – aimed to help people create a sustainable programme of activities.

The team had already found healthcare professionals could help by acknowledging people’s individual wishes and abilities, so that patients felt in control of what they were doing.

The team’s ‘Blue Prescription’ scheme (physios in New Zealand often wear a blue uniform) recruited 27 people with multiple sclerosis.

Some had been put off by earlier programmes giving them exercises that hurt or didn’t fit in with their circumstances. Each had up to three appointments with a physio, to discuss the patient’s goals and interests and set up an activity programme.

The physio also helped each patient get started, for example by going with them to a swimming pool or gym and ensuring they could use their chosen equipment effectively.

Physio and patient then kept in touch for three months, helping the patient modify or fine-tune their own programme. In a final meeting, they looked at strategies the patient had found successful and planned them into a continuing programme.

The teams’ interviews and assessments showed a sustained increase in physical activity among the patients.

‘A core concept of the approach is the recognition that people are different, with diverse needs, likes and dislikes,’ say the authors, ‘and that sustained participation … requires autonomy coupled with meaningful support from a healthcare professional such as a physical therapist’.

They now plan to extend their research into areas such as other health conditions and cost-effectiveness.
Mulligan H et al. Combining Self-help and Professional Help to Minimize Barriers to Physical Activity in Persons With Multiple Sclerosis: A Trial of the ‘Blue Prescription’ Approach in New Zealand. Journal of Neurologic Physical Therapy 2013; 37: 51-57, doi:10.1097/NPT.0b013e318292799e, full text: JNPT


Depression slows recovery after a fracture
Health professionals may help patients make a better recovery from a hip fracture by looking out for signs of depression.

Depressed patients made less progress and had weaker immune systems than others, a team of researchers at the University of Birmingham found.

They studied 101 fracture patients, who hadn’t previously been diagnosed with depression and weren’t taking any medication that might affect their immune systems.

They found that 38 had become depressed by six weeks after their accident. Compared with the non-depressed patients and a control group of healthy people aged over 60, they had poorer balance, increasing their risk of a fall.

Blood tests showed measurable differences in their immune systems, reducing the ability of white blood cells called neutrophils to help fight off infection.

Six months after the injury, most of the 38 were still depressed. They were walking more slowly than those without depression and were less able to carry out everyday activities.

‘We went in to this study assuming that the stress of a hip fracture would be the major factor resulting in poor immune function in these patients, and that depression might make things a little worse,’ says Janet Lord, who led the study.

‘Instead the data revealed that the depression was the major factor influencing how well a patient recovered,’ says Professor Lord.

The team also discovered differences in the ratio between two hormones in the depressed patients. They had lower levels of dehydroepiandrosterone sulphate, which has been reported to combat depression and improve the immune system, and had more of the stress hormone cortisol.

‘Despite reports regarding the high prevalence of depression and depressive symptoms in hip fracture patients, it still remains undetected in the majority of patients,’ say the authors.

‘Our findings support the need for preventing and treating depression and depressive symptoms to improve outcomes.’
Duggal NA et al. Depressive symptoms are associated with reduced neutrophil function in hip fracture patients. Brain, Behavior and Immunity 2013; doi:10.1016/j.bbi.2013.07.004

Comments & Conclusions

Healthcare Improvement Scotland has produced a scoping report on Lycra splinting for children with cerebral palsy.

The best available evidence showed that splinting may improve functional abilities in some of those with the condition.

But evidence on clinical effectiveness was limited and there was none available on cost-effectiveness. ‘I feel there is a need for more research in this area,’ says author Julie Calvert.

‘What is the clinical and cost effectiveness of dynamic elastomeric fabric orthoses for cerebral palsy?’ can be downloaded from Healtcare Improvement Scotland.
Green leafy vegetables caused 22 per cent of food poisoning cases in a large US study, probably through contamination with easy-to-remove bacteria.

Experts warn consumers to wash all fruit and veg – and to wash their own hands before eating or preparing food – in case anyone along the supply line failed to wash their hands with soap after using the loo. Painter JA et al. Emerging Infectious Diseases 2013; 19: 407-415, doi:10.3201/eid1903.111866
An extensive trial of telephone health coaching has found no evidence of reductions in hospital treatment or secondary healthcare costs over a year, and some possibility that these increased.

The Birmingham OwnHealth trial gave a personalised healthcare plan and monthly phone calls to 2,698 patients with chronic conditions, recruited from GP practices.

But over the next year, these patients had more emergency admissions and more outpatient sessions than a well-matched control group. Steventon A et al. BMJ 2013; 347, doi:10.1136/bmj.f4585

Janet Wright

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