Your comments: 6 September 2017

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The life aquatic

The National Institute for Health and Care Excellence (NICE) spondyloarthritis guideline recognises the value of aquatic physiotherapy. This was highlighted in Frontline’s two-part clinical update on spondyloarthritis (5 July and 2 August)
AStretch, a group of physiotherapists with a specialist interest and expertise in spondyloarthritis, are launching a National Survey in partnership with the National Ankylosing Spondylitis Society and funded by the society’s research fund. AStretch recognises there is a ‘postcode’ impact on the access, provision and mode of delivery of aquatic services for spondyloarthritis in the UK. The survey will map hydrotherapy resources across the UK to assist those affected by spondyloarthritis to find a local aquatic service. 
The worrying trend of pool closures was raised at the AStretch conference in December. As the project lead, my recommendation is ‘use it or lose it’ by developing specialist aquatic services for spondyloarthritis. Our survey aims to empower physiotherapists to develop their own aquatic services for spondyloarthritis in order to widen participation, in line with NICE recommendations. 
AStretch is keen to hear from physiotherapists involved in aquatic services to support this vital piece of research. The national survey will be emailed to all physiotherapy departments in the UK this month and closes in October.   To get involved, email
  • Melanie Martin, advanced physiotherapy practitioner @MelRheum 

Relieving pressure

I have recently been impressed by an innovative integral air-filled mattress and sleep system that some of my complex needs clients have used on a trial basis.
They have all benefited from improved sleep quality, sleeping for longer periods and more restful sleep. The most impressive thing from a therapeutic angle is the drastic impact it has had is on altering their abnormal postural tone, thus improving trunk symmetry and active functional movements.
It has also had a marked impact on reducing pressure areas caused by contractures and deformities.
The mattress is controlled by a handset to inflate or deflate specific tubes, but for people who are unable to use their hands it can be used with eye gaze technology, allowing them to manage their own position and pressure relief in bed.
I urge physiotherapists who work with clients with complex neurological needs, whether paediatric or adult, to consider the use of these products to manage sleep, posture in bed, abnormal postural tone and skin integrity.
For more information, email me at
  • Penny Townsend, paediatric physiotherapist, Holmfirth, West Yorkshire 

Chronic fatigue

I write in response to your report on guided graded exercise self-help programmes (page 20, 2 August). Graded activity and cognitive behavioural therapy have been the management strategy for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) since 2011 and the PACE (Pacing, graded Activity and Cognitive behaviour therapy; a randomised Evaluation) trial.   The recent controversy over the validity of the patient data collected in the PACE trial was reported in the Journal of Health Psychology. 
This may direct more interest towards the growing body of research into the physical changes in patients with CFS/ME. 
Foremost is the work, begun in 2004, by Øystein Fluge and Olaf Mella in Norway into the effects of the chemotherapy drug rituximab on the B-cells of the immune system.
More recently, work by Stanford University School of Medicine, led by Mark Davis, professor of immunology, were discussed by Sarah Knapton.
Her article in the Daily Telegraph states that CFS is an inflammatory disease that ‘could soon be diagnosed by a blood test’. Summarising some of the key points in an article published in Proceedings of the National Academy of Sciences, Ms Knapton said: ‘People suffering the symptoms of CFS show spikes in 17 proteins [known as cytokines] produced by the immune system. The bigger the rises, the more severe the condition.’ 
A total of 192 patients and 392 healthy controls took part in the study. 
  • Merryn Fergusson, private practitioner, Dalry, Dumfries and Galloway   
Frontline and various

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