Physio findings: One-to-one programme for knees and reading keeps you up-to-date

In our regular round-up of research that's relevant to physiotherapy staff, Janet Wright looks at the latest research news.

One-to-one programme works best for knees

An updated Cochrane review confirms that exercise is good for people with arthritis in their knees. And it has the best results when patients are individually treated.
Marlene Fransen of the University of Sydney and colleagues, from the Cochrane Musculoskeletal Group, looked at 54 studies covering 3,913 people, mostly with mild to moderate symptoms. In each study, participants were put on a therapeutic exercise programme – usually including muscle strengthening, functional training and aerobic fitness – and compared with others who didn’t do the exercises.
Looking at the immediate effects, the team found that exercise reduced participants’ pain and improved their physical function. Although these benefits are small to moderate, say the authors, the pain-relief is comparable to the effect of non-steroidal anti-inflammatory drugs.
One-to-one treatment had better effects on patients’ pain and physical function than either exercise classes or a home-based programme, they found.
High-quality evidence from 44 trials covering 3,537 people found that exercise reduced pain by an average of 12 points on a 100-point scale. 
In eight of the studies, some patients found that the exercises caused pain in the knee or lower back. But they reported no injuries or other serious adverse effects.
‘Healthcare professionals and people with OA [osteoarthritis] can be reassured that any type of exercise programme that is done regularly and is closely monitored by healthcare professionals can improve pain and physical function related to knee OA in the short term,’ the authors conclude.
‘This allows a great deal of choice, ranging from individual physiotherapy-led sessions and exercise classes to home-based programmes.’  Fransen M et al. Exercise for osteoarthritis of the knee, Cochrane Library 2015; 14651858CD004376.pub3

Reading keeps you up to date

Research is important, says the CSP. One way for members to take part is by keeping up to date with the latest findings so you can use that knowledge, where relevant, in your work.
Read Physiotherapy journal, for example. CSP members no longer have to wait to receive a printed copy every three months but can now read the full text of everything onlineas it is published, via a link herefrom the website.
There are numerous journals publishing physiotherapy research. Some, including Physiotherapy, cover all aspects. Others specialise in a particular area, such as the Association of Paediatric Chartered Physiotherapists’ publication, the ACPC Journal, or the Journal of Neurologic Physical Therapy.
In addition, general medical journals also publish some studies involving physiotherapy. See for example the BMJ website here.
Look for journals that publish ‘peer-reviewed’ studies. This means each one has been assessed by experts in the field before being accepted for publication. Journal websites may also show their ‘impact factor’, meaning the average number of times its publications are cited by other researchers. You can read more about this here.  
The CSP subscribes to many journals, which you can read online free of charge. The society’s librarians can show you how. They can also help you set up ‘rich site summary’ (RSS) feeds for other journals, which will put regular updates from each journal into your inbox.
An abstract, or brief summary, of each paper is usually provided free of charge on a journal’s website. Most journals charge you to read full papers, though you may be able to access them if your employer or institute – or the CSP – has a subscription.
There’s a movement towards giving readers free access to full peer-reviewed papers. The Directory of open access journals, for example, lists thousands of journals in which papers can be read free of charge see their website for more details. 
And, of course, each issue of Frontline highlights some interesting new published studies on the Physio Findings pages. 

Comments and conclusions

Exercise and other lifestyle changes can prevent diabetes or even reverse it in the early stages, say doctors. A simple questionnaire can reveal your individual risk and suggest what action to take. 
Care home residents are significantly more likely than other older people to be dehydrated and, as a result, to die after being admitted to hospital, say researchers. Wolff A et al. Journal of the Royal Society of Medicine 2015
Reducing patients’ fear that exercise will make them worse is key to relieving chronic fatigue syndrome, say researchers. The PACE trial found in 2011 that many patients benefited from a tailored programme of gradually increasing exercise. A further analysis of trial data suggests that fear of a debilitating relapse is one of the strongest factors holding patients back. Chalder T et al. Lancet Psychiatry 2015
Older people who took part in a fitness programme using Wii balance games not only improved their balance. They enjoyed the sessions enough to continue the exercises and recommend the six-week programme to others. Roopchand-Martin SC et al. Archives of Physical Medicine and Rehabilitation 2014.  
Janet Wright

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