In our regular column on research that's relevant to physiotherapists, Janet Wright looks at the latest clinical findings.
Children with spina bifida may need more help from professionals to cope with school and social life than other children with disabilities.
Researchers studied 83 children, average age around 10, who had had a spinal-cord injury before the age of three.
They compared them with 54 others, average age around 11, who had spina bifida.
The children with spinal-cord injuries were happier at school and reported less anxiety than those with spina bifida.
Those whose injuries had left them paraplegic were happier than those with spina bifida, both at school and overall, and took part in more activities.
‘Children and adolescents with spina bifida would benefit from increased support at school and in social participation,’ the authors conclude.Flanagan A et al. Psychosocial Outcomes of Children and Adolescents With Early-Onset Spinal Cord Injury and Those With Spina Bifida. Pediatric Physical Therapy 2013; 25: 452-459, http://dx.doi.org/10.1097/PEP.0b013e3182a5d35c
Extended-scope physios put patients on the right track
Triage by an extended-scope physio (ESP) is proving successful in reducing waiting lists without lowering standards of treatment.
Physio-led musculoskeletal clinics have been set up in Ireland to reduce both costs and waiting-list times by avoiding unnecessary referrals to a consultant.
To evaluate activity and outcomes, Kyla Ashmore of University College Dublin and colleagues carried out a clinical audit.
The audit covered all 140 patients referred to an ESP-led knee screening clinic from November 2010 to December 2011.
The ESP managed 59.3 per cent of patients, and referred the others to the orthopaedic surgeon.
Of those who were referred, 84 per cent went on to have an operation – showing that the physio was making accurate assessments of patients’ needs. The ESP’s diagnostic accuracy was found to be ‘substantial’.Ashmore K et al. Triage of knee pain by an extended-scope physiotherapist in an orthopaedic clinic: a clinical audit. Physiotherapy Practice and Research 2014; 35: 25-32, http://dx.doi.org/10.3233/PPR-130034
Supervised programmes enhance patients’ recovery after surgery
A programme of supervised exercise can help patients make a better recovery after back-decompression surgery, according to a Cochrane review.
The operation is carried out to relieve spinal stenosis, in which narrowing of the canal that the spinal nerves pass through causes pain in the back and legs.
But though surgery usually eases leg pain, it is less effective against pain in the back and patients may still have difficulty carrying out everyday tasks.
Alison McGregor of Imperial College London and colleagues looked at studies comparing patients who did supervised rehabilitation after the operation with others who were simply advised to stay active.
The rehabilitation sessions started six to 12 weeks after the operation and lasted 30 to 90 minutes, once or twice a week.
Those who took part improved their ability to carry out everyday activities, as well as reducing their pain. And they were still reaping the benefits when they were tested a year later.
‘Evidence suggests that active rehabilitation is more effective than usual care in improving both short- and long-term (back-related) functional status,’ say the authors.
‘Similar findings were noted for secondary outcomes, including short-term improvement in low back pain and long-term improvement in both low back pain and leg pain.’
However, they note that little research has yet been done in the area: they found only three relevant randomised controlled trials, covering a total of 373 patients. They call for more research to be carried out. McGregor AH et al. Rehabilitation following surgery for lumbar spinal stenosis. Cochrane Database of Systematic Reviews 2013; http://dx.doi.org/10.1002/14651858.CD009644.pub2
Meditation may help to ease pain
Clinicians should be prepared to discuss meditation with patients, say researchers.
After reviewing 47 relevant trials of meditation, they suggest that meditation didn’t show stronger effects than exercise, drugs or other behavioural therapies.
But Madhav Goyal and colleagues found moderate evidenc that this self-help technique could ease anxiety, depression and even pain.
‘Meditation programmes can result in small to moderate reductions of multiple negative dimensions of psychological stress,’ they conclude.Goyal M et al. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. JAMA Internal Medicine 2014; http://dx.doi.org/10.1001/jamainternmed.2013.13018
Comments & Conclusions
- Some obese people seem immune to the health risks usually associated with their weight, suggesting that other factors may be at least as important as body mass index. Further investigation could help create more tailored treatments, according to a Personal View in the medical journal BMJ. Stefan N et al. BMJ 2013; http://dx.doi.org/10.1016/S2213-8587(13)70062-7
- More than a third of patients with spinal-cord injury who could walk had at least one fall during six months of study, researchers in Thailand report. Of the 89 participants, those with more serious injuries had a greater risk of falling, as did those who were frightened of falling or had poor functional abilities. Phonthee S et al. Physical Therapy 2013; 93: 1061-1072, http://dx.doi.org/10.2522/ptj.20120467
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