Physio findings - Neurology

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

Group physiotherapy reduces MS falls

A 10-week course of group physiotherapy reduced the number of falls among people with multiple sclerosis (MS) who use walking aids, researchers in Ireland report.

MS patients have a high risk of falling, especially those who use walking aids. And as they tend to have poor bone density, they are more likely to break a bone.

About half of the 111 volunteers in the study had had a fall within the previous three months, say Susan Coote and colleagues, at the University of Limerick’s Department of Clinical Therapies and Centre for Physical Activity and Health Research.

The 48 who took part in group physiotherapy carried out a programme of six exercises targeting both balance and strength, in one-hour sessions once a week.

Dr Coote’s team found that patients who felt the greatest fatigue were the most likely to fall, along with those feeling most impact from the physical or psychological symptoms of MS.

‘This new finding suggests that fatigue management strategies may be an important element of falls prevention programmes for people with MS who use walking aids,’ the paper states.

It also calls for more research into the cause or effect relationship between fatigue and falls. Does the effect of fatigue on muscles hinder the normal balance response that would prevent a fall?

Does falling, and fear of falling, make people with MS become less active, increasing their feelings of fatigue as they lose fitness?  ‘These complex relationships require further investigation,’ say the authors.
Coote S et al. Falls in People With Multiple Sclerosis Who Use a Walking Aid: Prevalence, Factors, and Effect of Strength and Balance Interventions. Archives of Physical Medicine and Rehabilitation 2013; 94: 616-621, doi:10.1016/j.apmr.2012.10.020


Advice helps patients back to work
Employees with back pain returned to work sooner after a single consultation with a physiotherapist and a rehabilitation doctor than after treatment by a multidisciplinary team, a Danish team has found.

They divided 351 employees, who were on sick-leave because of lower-back pain, into two groups. Of these, 175 received a physical examination and reassuring advice during their single appointment.

The other patients saw the physio and doctor as part of a team of specialists including a case manager, who compiled a rehabilitation plan for each one.

Although the single consultation cost €1,377 less per patient, it got people back to work faster.

The only ones to benefit more from the multidisciplinary approach were those in a sub-group who felt they had little control over their work situation or were worried about losing jobs.
Jensen C et al. Cost-effectiveness and cost-benefit of a multidisciplinary intervention compared to a brief intervention to facilitate return to work in sick-listed low-back pain patients. Spine 2013; doi:10.1097/BRS.0b013e31828ca0af


Tai chi in chronic conditions
Recent studies have shown the value of the Chinese exercise routine tai chi in a number of conditions. In one, researchers analysed studies of the effects of these meditative exercises 253 depressed people, most of them aged over 55.

‘Tai chi appeared to have a significant impact on reducing depressive symptoms compared with the waiting list control groups,’ the team concluded.

‘It appears that at a minimum, tai chi has no harmful effects and is economical for older adults who are largely inactive or have a chronic disease, such as osteoarthritis,’ they said. (Chi I et al. Geriatrics & Gerontology International 2013; doi:10.1111/j.1447-0594.2012.00882.x).

Other findings show that tai chi might help balance, mental health and quality of life for people who have had a stroke was published at doi:10.1097/PHM.0b013e31826edd21

Tai chi could also ease pain and improve mobility in fibromyalgia (doi:10.1007/s10067-012-1996-2). It slowed the deterioration in movement coordination suffered by people with schizophrenia (doi:10.1155/2012/923925).

People with chronic obstructive pulmonary disease found tai chi helpful in reaching their recommended exercise levels (doi:10.1183/09031936.00036912). And it could help slow the loss of cognitive functions in older people (doi:10.1016/j.jamda.2012.03.008)

Thanks to Ros Smith, a physio who teaches modified tai chi exercises, for alerting Physio Findings to these studies.

Readers are welcome to send in references to published research that may interest other CSP members.

Comments & Conclusions

Young adults are in worse shape than older generations were at the same age and are at increasing risk of obesity-related conditions in old age, say Netherlands researchers.

They studied data from the Doetinchem Cohort Study, which began in 1987 and regularly measured the weight, blood pressure and cholesterol levels of more than 6,000 adults aged 20 and upwards.
Hulsegge G et al. European Journal of Preventive Cardiology 2013;doi: 10.1177/2047487313485512

People with knee arthritis are less active in cold weather, especially older patients, say researchers, who advise practitioners to take this into account when devising exercise regimes. Robbins SM et al. Physiotherapy Canada 2013; doi:10.3138/ptc.2012-39

A weekly treadmill session as part of their physiotherapy helped children with cerebral palsy, aged from eight to 15, to make significant progress with their rehabilitation after leg surgery. Grecco L et al. Pediatric Physical Therapy 2013; doi:10.1097/PEP.0b013e3182888495

Social isolation has been linked with a higher risk of death in old people –whether or not they feel lonely.

Using details of 6,500 adults over 50 from the English Longitudinal Study of Ageing, University College London researchers found that a lack of friends and family around had more effect on death rates than the feeling of loneliness, though both reduced quality of life. Steptoe A. et al. PNAS 2013; doi: 10.1073/pnas.1219686110
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Janet Wright

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