Research is a central pillar of evidence-based practice, and physiotherapists around the world are adding to the body of knowledge. CSP members are increasingly doing their own studies – asking the questions posed by their own practice and setting out to find the answers.
In the 18 November issue
we highlighted work by award-winners at this year’s Physiotherapy UK. Here we look at more members’ contributions in the fields of neck pain, dementia and Achilles tendon problems.
Painful point wins student award
Neck pain is a common problem, often centred on active ‘trigger points’ in the upper trapezius muscle.
Compression therapy – applying firm and consistent thumb pressure – can reduce the sensitivity of a trigger point after initially causing discomfort. But how does it work?
Previous research has revealed that spinal manipulation could increase activity in the sympathetic nervous system (SNS). Edward Hutton, who won this year’s student poster award at Physiotherapy UK, studied 45 Coventry University physiotherapy students to investigate whether compression therapy had similar effects.
The participants, who all had latent trigger points, were randomly divided into three groups. The intervention group received compression therapy, the placebo group received light touch to the same point and the control group had no treatment.
Skin conductance tests on the participants’ fingers revealed that SNS activity in the intervention group had increased by 92.9 per cent, compared with just 7.8 per cent in the placebo group and 3.2 per cent among the controls.
‘Results contribute to the body of evidence which suggests that manual therapy techniques achieve positive treatment outcomes by activation of the SNS,’ the researchers report.
An investigation into the effects of compression therapy on latent Upper Fibres of Trapezius trigger points on peripheral sympathetic nervous system activity in the upper limb,
Injections could help heels
CSP members are working on an innovative treatment for heel pain, which affects 150,000 people a year and can cause difficulty in walking.
Dr Rebecca Kearney, clinical lecturer at the University of Warwick, is recruiting patients with Achilles tendinopathy for a randomised controlled trial starting in the new year, funded by Arthritis Research UK (ISRCTN: 13254422). At Oxford University, Dr David Keene will study patients with Achilles tendon ruptures (www.path2study.org), funded by the MRC/National Institute for Health Research partnership.
In each trial, patients will receive injections of platelet rich plasma taken from their own blood and containing growth factors that could stimulate tendon repair. A control group will receive placebo injections.
Music moves dementia patients
Persuading patients with moderate-to-severe dementia to take part in routines such as rehabilitation can be difficult. But exercise is important to reduce their high risk of falls and injuries.
‘Maintaining physical fitness in this client group is an uphill task,’ says Omkar Sawant, a mental health physiotherapist with Derbyshire Community Healthcare trust.
However, there’s evidence that music can help people with cognitive issues to focus on physical activities, Mr Sawant told the International Dementia Conference held in Birmingham in November. So he and colleagues devised a routine to get patients moving.
They adapted a standard exercise routine to include more and shorter components, starting with an ice-breaker session to get patients interested. Sessions included a variety of activities, working upper and lower limbs separately and adding chair-based exercises, and ending with a long relaxation session.
The team spent many hours finding music to motivate their patients. Some patients liked well-known songs but were distracted from exercising by joining in with the lyrics. Eventually the group found a winning mix of popular instrumentals, classical music and opera.
Patients enjoyed the sessions, with both relatives and staff noticing improvements in their well-being after exercise sessions. The patients were better able to concentrate, showed less distress or agitation and got on better with other patients and staff.
- For more information about the study, which is not yet published, contact Mr Sawant at firstname.lastname@example.org;
Comments & conclusions
- Low-fat diets are no more effective for long-term weight loss than low-carb or Mediterranean diets, say researchers who analysed 53 studies covering more than 68,000 adults. Tobias DK et al. Lancet Diabetes and Endocrinology 2015.
- Sleep apnea, in which people have breathing difficulties while they’re asleep, may increase the risk of developing gout. Researchers found people with sleep apnea were 60 per cent more likely than others to develop gout, as shortage of oxygen affect the levels of uric acid in the blood. Obesity and smoking increase the risk of sleep apnea. Zhang Y et al. Arthritis & Rheumatology 2015.
- Mindfulness-based cognitive therapy (MBCT) could be as useful as antidepressants for patients with recurrent depression, especially those who had been abused in childhood. Researchers studied 424 patients who were all taking antidepressants. One group were given MBCT and supported in tapering off their antidepressant use, while the other continued their usual medication. After two years, just under half the patients in each group had had a relapse. ‘Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life,’ say researchers. Kuyken W et al. Lancet 2015 - open access.