Physio Findings - Physiotherapy journal Patellofemoral pain

Research that’s relevant to physios: Physiotherapy editor michele harms presents the latest issue

Diagnosing patellofemoral pain syndrome

What are the best tests and clinical findings to help the physiotherapist screen patients and diagnose patellofemoral pain syndrome (PFPS)?

The latest issue of Physiotherapy includes a systematic review that summarises the research on the accuracy of various diagnositic tests.

The authors suggest that, because of the difficulties in diagnosing this condition, PFPS may be a ‘diagnosis of exclusion and may be best ruled in after ruling out other contending diagnoses’.

Although the results of the review are inconclusive, the authors provide a useful summary of the tests used to assess this condition.

Cook C et al. Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review. Physiotherapy 2012: 98(2); 93–100.

Rotator cuff tendinopathy exercise

In a review, the authors consider the effectiveness of exercises for rotator cuff tendinopathy, which incorporate exercise against gravity or resistance, by reviewing randomised control trials in this area.

As in many fields of research on techniques used by physiotherapists, the authors report a number of limitations associated with the studies they review.

However, they conclude (albeit with caveats) that the available literature supports the use of exercise.

Littlewood C et al. Exercise for rotator cuff tendinopathy: a systematic review Physiotherapy 2012: 98(2); 101-109.

The STarT Back trial

The authors describe one of the interventions used in the STarT Back trial. They consider, among other issues, the management of low back pain in primary care.

The interventions in this trial targeted patients identified as ‘low’, ‘medium’ or ‘high’ risk based mainly on the presence of psychosocial risk factors.

The paper describes the development and content of the programme designed for the ‘high risk’ patient group.

The researchers use two scores to assess patients, one of which (the ‘distress subscale score’) assesses fear, anxiety, catastrophising, depression and bothersomeness.

Details of the tool can be found as an appendix to the paper.

The authors describe the rationale and development of the learning objectives and suggest methods of delivery of the training programme for physiotherapists involved in the treatment of ‘high risk’ patients.

They describe an approach they call ‘psychologically informed practice’, as distinct from cognitive behavioural therapy, and draw together the management of psychological risk factors and an evidence-based pain management approach.

Main CJ et al. Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial’s ‘high-risk’ intervention (StarT Back; ISRCTN 37113406). Physiotherapy 2012: 98(2); 110-117.

Hand exercise trials in rheumatoid arthritis

A team of researchers from Warwick, Southampton and Keele universities describes an intervention for strengthening and stretching the hand for the patient with rheumatoid arthritis, known as the SARAH trial.

This intervention is being used in a large multi-centred randomised control trial in a UK NHS setting.

The paper summarises hand exercise trials in rheumatoid arthritis and provides useful illustrations of the hand exercises included in the SARAH trial.

Heine PJ et al. Development and delivery of an exercise intervention for rheumatoid arthritis: Strengthening and stretching for rheumatoid arthritis of the hand (SARAH) trial. Physiotherapy 2012: 98(2); 122-130.

Managing frozen shoulder

The authors describe key points in the diagnosis and assessment of contracted (frozen) shoulder and provide a summary of clinical questions and tentative recommendations.

While some evidence was initially judged to be ‘high quality’, much was later downgraded due to imprecision or inconsistency.

Hanchard NCA et al. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder: quick reference summary, Physiotherapy 2012: 98(2): 118-121.

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