In our regular column on research that's relevant to physiotherapists, Janet Wright looks at the latest clinical findings.
Skilled hands ease the pain of pregnancy
Physiotherapy can relieve some of the most common pains women experience during pregnancy, a Cochrane review has shown.
More than two thirds of pregnant women have lower back pain, and nearly a fifth feel pain in the pelvic area.
Victoria Pennick and Sarah D Liddle, of the Cochrane Pregnancy and Childbirth Group, reviewed 26 trials in which women received a treatment in addition to usual care, and were compared with those who received only the usual care.
More than 4000 women took part. Physiotherapy was found to relieve both back and pelvic pain more than usual care alone.
A multimodal intervention including manual therapy, exercise and education also helped, as did osteopathy, acupuncture or use of a rigid pelvic belt.
Although all the studies were randomised controlled trials, not all were equally well conducted, so the evidence was of varying quality, the authors point out.
Moderate-quality evidence suggested that evening pain in the pelvis and back could be significantly reduced by either acupuncture or exercise, tailored to the stage of pregnancy, with acupuncture proving better for the pelvic pain.
‘Further research is very likely to have an important impact on our confidence in the estimates of effect and is likely to change the estimates,’ say the authors. Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy Cochrane Database of Systematic Reviews 2013; www.ncbi.nlm.nih.gov/pubmed/23904227
Musculoskeletal - Exercise proves worth the effort
Patients with arthritis are sometimes reluctant to exercise the painful area. A new study arms physios with the latest evidence to prove it really is worth persevering.
Researchers investigated whether exercise is more effective than not exercising for patients with lower-limb osteoarthritis.
They also compared the effects of different exercise interventions on pain and function.
After combing through nine databases for research that was relevant and well conducted, they found 60 suitable studies – 44 on knee arthritis, two on hip arthritis and the rest covering both. In all, 8218 patients took part.
The results showed ‘significant benefits’ from exercising.
‘For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control,’ the authors say.
For function, a combination of strengthening, flexibility and aerobic exercise significantly reduced volunteers’ limitations.
‘An approach combining exercises to increase strength, flexibility and aerobic capacity is likely to be most effective in the management of lower-limb osteoarthritis,’ they conclude. Uthman OA et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis BMJ 2013; 347, doi:10.1136/bmj.f5555
Exercise - Exercise better than drugs in stroke patients
Physical interventions are more effective than drug treatment for patients with stroke, according to findings of a review of 16 meta-analyses of trials involving a total of more than 300,000 patients.
The study, by researchers at the London School of Economics and Stanford University, USA, set out to look at the effectiveness of exercise on death rates compared to drug interventions.
They looked at four conditions – secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure and prevention of diabetes.
Exercise was significantly more effective than anticoagulant or antiplatelet drugs for patients with stroke and as good as drugs in preventing coronary heart disease and diabetes.
‘Exercise interventions should be considered as a viable alternative to, or alongside, drug therapy,’ the authors suggest. Naci H et al. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study BMJ 2013;347: doi, 10.1136/bmj.f5577
Comments & Conclusions
- The saline injection used as a placebo in trials assessing the effects of a steroid shot may in some cases ease back pain, researchers have found.But, they warn, the few relevant trials they found were short-term and low-quality.Bicket MC et al. Anesthesiology 2013; 119: 907–931, doi:10.1097/ALN.0b013e31829c2ddd
- Lifestyle changes that support emotional and physical health may help increase lifespan by lengthening telomeres, the part of a chromosome that controls cell ageing, say researchers.They recommend intimacy, social support and stress management as well as exercise and a plant-based wholefood diet. Ornish D et al. Lancet Oncology 2013; doi:10.1016/S1470-2045(13)70366-8
- Patients’ walking speed improved after a course of physiotherapy in three different hospital settings, researchers found. Best results were among patients in skilled nursing or inpatient rehabilitation. Those in acute care improved to a lesser extent. Braden HJ et al. JACPT 2013; 4: 20, www.acutept.org/displaycommon.cfm?an=1&subarticlenbr=46
- Boys under six years old need about 70 minutes a day of at least moderate exercise, increasing to 85 minutes for those aged six to nine, according to new guidelines on reducing children’s risk of cardiovascular disease. Girls need the 60 minutes recommended by earlier guidelines.Both sexes should include 20 minutes of vigorous exercise.Jiménez-Pavón D et al. BMC Medicine 2013; 11: 172, doi:10.1186/1741-7015-11-172
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