Physio findings: Physiotherapy journal

Physiotherapy journal editor Michele Harms looks at the latest research, including musculoskeletal triage, movement measurements, and grip strength in children.

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 availablehere.

Who should conduct musculoskeletal triage?

Researchers based predominantly in the UK have collaborated on a study to define the optimum features of a triage system for patients with musculoskeletal conditions. They looked at different methods of administering triage including face-to-face consultation, paper referral letter or telephone consultation. Although they included studies involving different professional groups including GPs, nurses, occupational therapists, speech therapists and physiotherapists, patients were more concerned about ease of access to treatment than the profession of the individual conducting the triage.

In the studies included in the review, the most frequent method of delivery was by a physiotherapist performing face-to-face triage of orthopaedic patients. They found this resulted in high patient and GP satisfaction, improved patient function and symptoms, and suggested that this system reduced costs and waiting times. Joseph C et al Musculoskeletal triage: A mixed methods study, integrating systematic review with expert and patient perspectives Physiotherapy 2014;100(4): 277–289.  Full text.

How useful are range of movement measurements in manipulation?

This group of Australian researchers conducted a systematic review on the usefulness and variety of methods used to measure cervical range of motion. They were particularly interested in whether cervical range of motion, measured predominantly by goniometer, inclinometer and a cervical range of motion (CROM) device could contribute to patient diagnosis or prognosis; and whether it was affected by mobilisation and manipulation. The patients included in the 36 studies had cervical spine disorders. The authors found limited evidence for diagnostic value in cervicogenic headache, cervical radiculopathy and cervical spine injury. The prognostic value of cervical range of motion was equivocal, as was whether CROM increases or decreases following mobilisation/manipulation.  Snodgrass SJ et al. The clinical utility of cervical range of motion in diagnosis, prognosis, and evaluating the effects of manipulation: a systematic review; Physiotherapy 2014; 100(4):290–304; Full text.

Grip strength in children

Databases of anthropometric characteristics of different populations are very valuable resources. They provide a database of normative values for population variables like height, weight, levels of fitness or range of movement. This study measured grip strength in 295 healthy children aged between six and 13 years.

As might be predicted, grip strength increased with age, was similar in boys and girls, and the dominant hand was stronger than the non-dominant hand. Grip strength is important information for anyone working or conducting research in the field of paediatrics where grip strength is used as a clinical or outcome measure. de Souza MJ et al. Normative data for hand grip strength in healthy children measured with a bulb dynamometer: a cross-sectional study; Physiotherapy 2014;100(4):313–318; Full text

Neurology Water helps patients improve walking skills

Hydrotherapy can help to slow the progress of neurological conditions that stiffen and weaken patients’ legs, a New Zealand study has found.

Claire Davies, of the University of Auckland, and colleagues studied nine patients with hereditary spastic paraparesis, which makes leg muscles increasingly tense and hard to control.

The volunteers took part in 45-minute sessions twice a week for 10 weeks. They started by walking backwards, forwards and sideways, and followed on with strengthening exercises, using the water for resistance.

Some patients had buoyancy devices – such as water wings or pool noodles – put around their ankles to increase the effort. Those who could swim, using a buoyancy aid if necessary, did a series of swimming exercises.

At the end of 10 weeks, the researchers found ‘significant’ improvements in the patients’ ability to walk, as measured by both the 10-metre and the six-minute walk test. Davies C et al.The Effect of Hydrotherapy Treatment on Functional Outcomes of Patients with Hereditary Spastic Paraparesis, Archives of Physical Medicine and Rehabilitation 2014.

Comments  &  Conclusions

  • Babies born prematurely or at a very low weight are likelier to need a hip (though not a knee) replacement in later age because of arthritis, researchers have found.  They are already known to be at greater risk of heart disease, osteoporosis and diabetes. Hussain SM et al. Arthritis Care and Research 2014
  • Seven-day working can be cost-effective and improve patient outcomes, says an editorial in Australia’s Journal of Physiotherapy. It lets physiotherapists provide care while other health professionals are working and when patients need it. The challenge, say the authors, is to ‘embed the notion that providing additional physiotherapy through a seven-day service can be a routine, beneficial and desirable part of practice’. Taylor NF and Shields N. Journal of Physiotherapy 2014
  • Changes in the way a person with Parkinson’s walks could be an early sign of cognitive deterioration. Subtle changes in gait, such as slowing down or swaying more, are linked with changes that may lead to dementia, even before these are picked up by cognitive tests, say researchers.  Lord S et al. Frontiers in Aging Neuroscience 2014.  
Michele Harms

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