Physio findings - Physiotherapy Journal

With the September 2014 issue of Physiotherapy Journal out now, editor Michelle Harms highlights the main papers and Janet Wright looks at other findings.

Did you know that, as a member of the CSP, you have free online access to the society’s journal, Physiotherapy, published by Elsevier? The contents of the current issue of Physiotherapy journal are available here.

Editor Michele Harms looks at a new study on evidence-based practice.

ACL Injury affects proprioception

Anterior cruciate ligament (ACL) injuries are commonly seen by physiotherapists and can have a major impact on knee function, particularly in sportsmen and women.The authors of this current systematic review and meta-analysis examine the significant role that the anterior cruciate ligament plays in knee proprioception.

Six studies were considered sufficiently robust to be included in the meta-analysis. Their main findings suggest, albeit with caution, that injury has a detrimental effect on proprioception and additionally that people who have had an ACL repair demonstrate better proprioception that those whose ligament has been left unrepaired. However, the authors’ discussion raises questions about the clinical significance of these differences and the reliability with which the outcomes have been measured. Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy Volume 100, Issue 3, September 2014, Pages 187–195.

Do Physiotherapists pay lip service to evidence-based practice?

Why, despite clear benefits of basing practice on well-founded evidence, is the uptake within physiotherapy so inconsistent? The authors pose this poignant and important question. They argue that an evidence-based practice (EBP) approach is essential to ensure quality and consistency of care. Thirty-two studies were included in their systematic review. Although many physiotherapists were found to hold positive attitudes towards EBP, this did not necessarily translate into consistent, high-quality implementation.

The authors argue the view that there is a moral and economic obligation to base decision-making on research findings. Surely there is also a legal obligation here too? In examining the barriers to EBP implementation, which include a lack of time and skills, and misperceptions of EBP, the authors raise the question of what can be modified to facilitate the translation of evidence into practice. Modifications to organisational cultures and facilities as well as to individual attitudes, education and support are required.
Laura Scurlock-Evans, Penney Upton et al, Evidence-based Practice in physiotherapy: a systematic review of barriers, enablers and interventions. Physiotherapy Volume 100, Issue 3, September 2014, Pages 208–219.

Randomised controlled trial on adhesive capsulitis

A group of researchers based predominantly in the USA conducted a double-blind, randomised, controlled trial to explore non-surgical restoration of shoulder range of motion for patients with adhesive capsulitis.

Sixty participants with adhesive capsulitis were randomised to two groups who both received three traditional therapy sessions per week for four weeks. In addition, the experimental group used a static progressive stretch device for four weeks.

Participants who used the device were found to have less pain and greater selective active and passive range. Importantly this improvement was maintained at 12 month follow-up. They were also found to have better upper limb function, measured using the disabilities of the arm, shoulder and hand (DASH) questionnaire. M. Ibrahima, R. Donatelli et al, Efficacy of a static progressive stretch device as an adjunct to physical therapy in treating adhesive capsulitis of the shoulder: a prospective, randomised studyPhysiotherapy Volume 100, Issue 3, September 2014, Pages 228–234.

Jenet Wright


Shoulders benefit from hands-on physiotherapy
Steroid injections and manual therapy are equally effective in relieving shoulder pain, say researchers who compared these two common treatments.

But patients who had an injection went back to their doctor more often than those who had had physiotherapy.

Daniel I. Rhon, of Brooke Army Medical Center in Texas, and colleagues studied 104 adults of working age. All had been diagnosed with shoulder impingement syndrome, which covers a number of common injuries causing shoulder pain.

The volunteers were randomly selected to receive either a single steroid injection or a course of manual physiotherapy.All were also given exercises to do at home. The injection group had the option of up to two further injections during the following year, if necessary. The physiotherapy group received six half-hour sessions over a period of three weeks.

Both groups enjoyed a significant improvement in their pain and disability, both after treatment and during the following year.   But by the end of the year, 60 per cent of the injection group had gone back for more treatment, compared with 37 per cent of those who had manual physiotherapy. Rhon DI et al. One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome:A Pragmatic Randomized Trial. Annals of Internal Medicine 2014.

Janet Wright

Comments & conclusions

  • Being overweight increases children’s risk of developing asthma, say researchers, whose findings suggest that increasing weight may have contributed to the rising incidence of asthma in the late twentieth century. Granell R et al. PLOS Medicine 2014
  • An increase in everyday physical activity may reduce the risk of developing knee osteoarthritis, or slow its progress if you already have arthritis. Researchers have found it’s the time spent in activities that counts, more than the amount of effort put in. Dunlop D et al. BMJ 2014.
  • Giving deprived areas bigger increases in NHS funding than wealthier areas saved the lives of 35 men and 16 women per 100,000 of each sex, say researchers. ‘Dropping this policy may widen inequalities,’ they warn. Barr B et al. BMJ 2014.

Janet Wright

Janet Wright and Michelle Harms

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