Physio findings - Physiotherapy Journal

Bullying, COPD, MSK telephone assessment, unpublished drug trials

Do student physiotherapists experience bullying?

Stubbs and Soundy have undertaken a number of studies in this and related areas.

In their current paper they consider the incidence and type of bullying behaviours experienced by 52 final year undergraduates while on clinical placement.

They found that 25 per cent of their cohort reported at least one incidence of bullying including belittling remarks, intimidation and persistent criticism but that the majority did not report this to the university.

They highlight the negative effects of this type of behaviour on the well-being of students.
Physiotherapy students’ experiences of bullying on clinical internships: an exploratory study B. Stubbs and A. Soundy Physiotherapy 2013:99(2);178-80

Airway clearance techniques in acute exacerbations of chronic obstructive pulmonary disease (COPD)

A group of researchers based in Australia report on a national survey of airway clearance techniques in acute exacerbations of COPD.

They surveyed 189 physiotherapists from 89 Australian public hospitals.

They were particularly interested in airway clearance technique prescription, indications for use, aims, importance and effectiveness and the factors which influenced their respondent’s choice of technique and their underlying knowledge of the evidence.

They found that the most frequently prescribed techniques were physical exercise, the forced expiratory technique and the active cycle of breathing technique.Airway clearance techniques in acute exacerbations of COPD: a survey of Australian physiotherapy practice CR. Osadnik, CF. McDonald, AE. Holland Physiotherapy 2013:99(2);101 – 106

Telephone assessment and advice for patients with musculoskeletal problems

Following The PhysioDirect trial, which looked at a telephone assessment and advice service, this paper describes the system used in the trial and how physiotherapists were trained and supported to use the system and deliver the PhysioDirect service.

The system now serves a population of 350,000 people. In the study, funded by the Medical Research Council (MRC) and managed by the National Institute for Health Research (NIHR), the authors highlight the need for training and the enhanced skill set required for telephone assessment and advice particularly in listening and communication.

The authors suggest that physiotherapists conducting telephone assessments should be clinically experienced in the diagnosis of musculoskeletal conditions, but that even experienced physiotherapists would benefit from training to develop proficiency and confidence in delivering care over the telephone.

In the study, the physiotherapists were supported by a computerised system which used a number of algorithms and management pathways which facilitated standardisation of the intervention.
PhysioDirect: Supporting physiotherapists to deliver telephone assessment and advice services within the context of a randomised trial A Bishop, J Gamlin, J Hall, C. Hopper and N.E. Foster Physiotherapy 2013:99(2); 113 – 118

Patellofemoral pain and exercise dose–response

Researchers in Norway and Sweden conducted a multicentre, randomised controlled clinical trial to compare two different therapeutic exercise regimens in patients with patellofemoral pain syndrome.

Participants were treated three times each week for 12 weeks.

One group received high-dose, high-repetition medical exercise therapy, and the control group received low-dose, low-repetition exercise therapy.

The programmes differed in number of exercises, repetition, sets and time spent performing aerobic/global exercises.

The results demonstrated a dose–response effect on pain and functional outcomes; high-dose, high-repetition medical exercise therapy was found to be more efficacious than low-dose, low-repetition exercise therapy for this patient group.

Dose-response effects of medical exercise therapy in patients with patellofemoral pain syndrome: a randomised controlled clinical trial B. Østerås, H. Østerås, T.A. Torstensen and O. Vasseljen . Physiotherapy 2013:99(2);126-131 Papers

The papers here are available free on line to CSP members. Physiotherapy articles are published online first and gathered for the quarterly print journal.  

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Unpublished findings make drugs look better than they are

A new study confirms that unpublished research obstructs our understanding of treatments.

‘The incomplete or total lack of reporting of drug trials is so common that our perceptions of the true benefits and harms of drugs are generally much too positive,’ say Nicole Wolfe and colleagues, of the University of California-San Francisco and the Nordic Cochrane Centre in Denmark.

For various reasons, trials on the same subject may come up with differing results, even if all are well-conducted. (Latest studies with interesting results don’t necessarily disprove previous research, though media reports sometimes give this misleading impression.)

But overall conclusions are needed, to inform evidence-based practice and provide the most accurate advice.

That’s where the sheer number of published studies is useful, in helping to reveal a pattern.

So researchers sometimes carry out ‘systematic reviews’ of all relevant trials on a particular topic.

However, only about half of all studies carried out are ever published, which leaves reviewers working with patchy evidence.

‘Authors of systematic reviews have difficulty obtaining unpublished data,’ say Dr Wolfe and colleagues.

The CSP is backing a campaign for all research to be registered and reported (see Physio Findings, 5 June).

Meanwhile, Dr Wolfe and colleagues are calling for unpublished findings to be made available to other researchers.

‘Given the competitive climate in research, publication, and fundraising, researchers who voluntarily share their data when such sharing is not required for everyone may be at a disadvantage.

Therefore, standards for data sharing should be uniform and universally applied,’ say the authors.

‘Our findings suggest that the burden of responsibility for making clinical drug trial data available to researchers should not lie with individual study authors or with sponsoring companies, but with government authorities.’
Wolfe N et al. Strategies for obtaining unpublished drug trial data: a qualitative interview study. Systematic Reviews 2013; 2: 31, doi:10.1186/2046-4053-2-31

Sign the petition for all research to be registered and reported:

Michelle Harms

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