Physio findings - orthopaedic

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

Tests predict who may need help with walking

Knowing if a patient is likely to need a walking aid after hip replacement could help physios tailor their rehabilitation programmes.

Japanese researchers set out to see if patients’ walking ability could be predicted, and have reported their findings in the journal Physiotherapy.

They assessed 88 patients, 51 of whom could walk unaided six months after their hip replacement while 37 walked with the help of a stick.

The patients ranged in age from 35 to 80 years old, with an average of about 60.

Six months after surgery, the team found that older patients were more likely to need a walking aid. But a bigger factor turned out to be lack of strength in the leg muscles, as measured by tests showing specific cut-off points.

‘This information may allow patients to set appropriate goals for their rehabilitation,’ say the authors, who suggest that a programme of gradual loading training could be helpful.

They noted that other factors may also play a role, such as use of walking aids before the operation, other health conditions, postural stability and strength in the patient’s other side.

More research is needed, they conclude. Nankaku M et al. Factors associated with ambulatory status 6 months after total hip arthroplasty Physiotherapy 2013; doi:10.1016/

CSP members can access Physiotherapy free at Physiothery journal and services


What makes shoulder pain go or return?
Looking at the different factors associated with shoulder pain that clears up or comes back could reduce patients’ risk of long-term pain, say Australian researchers.

The team used data from 2,337 participants in the North West Adelaide Health Study, who took part in telephone interviews, had clinical assessments and filled in questionnaires.

The 14.6 per cent who had experienced shoulder pain in the past few years were likely to do more heavy work than average, and to have pain in other joints.

Pain in other joints was also associated with recurrent shoulder pain, reported by 8.8 per cent of participants.

This group was also was more likely to smoke, and to have decreased movement and depressive symptoms.

The 8.7 per cent of respondents who said their shoulder pain had cleared up also had decreased shoulder movement and pain in other joints.

They were also more likely to be female and have a stronger grip.

‘Consideration of all of these factors may assist in the prevention and management of shoulder pain and the possible identification of those at risk of long-term shoulder problems,’ say the authors. Gill TK et al. Shoulder pain in the community. An examination of associative factors using a longitudinal cohort study Arthritis Care & Research 2013; doi:10.1002/acr.22082


High intensity helps
Incomplete spinal-cord injury, in which the spine is damaged but not broken, leaves people with varying levels of feeling and mobility.

Carrying out muscle-contracting exercises at maximum intensity can lead to temporary increases in patients’ strength.  

A research team led by physiotherapist Arun Jayaraman focused on five people who had been living with incomplete spinal-cord injury for at least a year.  

The volunteers each completed two four-week programmes: one of progressive and one of maximal-intensity resistance training.

Tests taken after the high-intensity programme showed that the volunteers had gained in leg strength, balance and walking ability.

No such improvements were seen after the progressive resistance training, however.

The Chicago-based research team concluded that a simple short-term maximal-intensity training programme could help patients make rapid progress. Jayaraman A et al. Short-term maximal-intensity resistance training increases volitional function and strength in chronic incomplete spinal cord injury: A pilot study Journal of Neurologic Physical Therapy 2013; 37: 112-117, doi:10.1097/NPT.0b013e31828390a1

Comments & Conclusions

  • New guidelines for controlling blood pressure include a greater emphasis on healthy lifestyle and increasing use of home monitoring, along with advice for doctors. Mancia G et al. European Heart Journal 2013; 34: 2159-2219, doi: 10.1093/eurheartj/eht151
  • Smokers are less likely than average, and obese patients are more likely, to have hip or knee replacement surgery, analysis of 54,288 Australians’ records has shown.Mnatzaganian G et al. BMC Musculoskeletal Disorders 2013; 14: 262, doi:10.1186/1471-2474-14-262
  • Ethnic differences in healthy heart shape mean that 10 times more black than white athletes are likely to be misdiagnosed with a heart condition and may be mistakenly warned to give up sport, say researchers.Zaidi A et al. Circulation 2013; 127: 1783-1792, doi:10.1161/CIRCULATIONAHA.112.000270
  • Sitting for four hours a day increases the risk of cardiovascular disease and diabetes among men and women of all races. The effects are especially clear among poorer people and those taking no exercise, say researchers who studied the health records of 4,560 adults.Staiano AE et al. British Journal of Sports Medicine 2013; doi:10.1136/bjsports-2012-091896


Janet Wright

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