PTSci: News for Physiotherapists

2005-05-11T20:03:00.000-04:00

EDMONTON - For many people, lower back pain is a part of life. Now a new Canadian study suggests the best treatment may be exercise.

Lying around while suffering is probably the worst thing to do for a sore back, according to an exhaustive review on the benefits of exercise for chronic back pain that persists for months.
Individually-tailored, supervised exercise therapy works best to reduce chronic low back pain.

The inactivity is more likely to prolong the suffering compared to stretching and strengthening exercises, which reduce pain and help to get people moving faster.

The benefits of exercise may kick in faster for those taking painkillers, getting massages or other treatments, the researchers concluded.

For acute back pain, which flares up for a few weeks, exercise and doing nothing are about equal in value. The pain should go away on its own.

In a second study, Dr. Jill Hayden of Toronto's Institute for Work & Health and her colleagues looked at how to maximize the benefits of the activities by analysing the results of 61 trials on nearly 6,400 adults with different types of lower back pain.

Hayden's advice is to toss the handouts given out at a doctor's office because they aren't effective.

Rather, her research suggests the number 1 approach is an individually tailored program that emphasizes stretching. Strengthening exercises, such as lifting weights, or static exercises common in yoga can also be helpful.

Physiotherapists or trainers are best able to teach the right kinds of exercises for each case. Videos are also available to walk people through how to do them, rather than trying to follow a handout from a general practitioner.

The meta-analysis on the benefits of exercise therapy and the review of what makes an exercise program successful both appear in the May 3 issue of the Annals of Internal Medicine.

2005-03-02T19:36:00.000-05:00

It seems as if my posts are a little infrequent lately. I don't anticipate a significant change in this, so if you're craving more research articles, I'll let you in on my secret: the MDLinx network. They have a tonne of topical newsletters for many areas related to physio.

I asked them to create a therapylinx.com, but it was denied. It would be so neat to be connected to the network, with sub-topic newsletters for Physio, OT, SLP, RT, etc. Maybe if enough people ask, they'll give in.

In the meantime, check out: Family Medicine's Sport Medicine, Neurology's Spine, Ortho's Hip, Knee, Foot & Ankle, Shoulder, etc., or Pulmonology's CF, COPD, or Restrictive Lung Disease newsletters. I see also that you can create a custom newsletter - enter your search words and newsletter frequency and they'll send you all articles that match. You can also subscribe to a number of the journals directly for their latest issue's table of contents and abstracts.

It takes mere seconds to scan the articles, and you're bound to come up with at least a couple of abstracts and even a couple of full-text articles. Then, when you're having so much fun, you too can post your finds to PTSci. I'll take 2-3 volunteers who want to help share the physio research with the 265+ subscribers who receive the daily updates, and also those who access the website directly. Email me and we can discuss what is involved and how you can help.

2005-02-25T19:20:00.000-05:00

Changing Paradigm for the Treatment of Clubfeet

Clubfoot is one of the most common pediatric orthopaedic conditions. Until recently, surgical management was the treatment of choice. Nonoperative treatment techniques, including the Ponseti casting and French physical therapy methods, have peeked interest of orthopaedists eager to find a less aggressive treatment method that can assure a lasting, good result. Both methods have proven successful in reducing the number of patients requiring extensive surgical release and, as a result, have become an integral part of pediatric orthopaedic practice. A clear understanding of both treatment methods is important for the orthopaedic nurse to allow quality nursing care and help assure a successful outcome for young patients.

[full-text article]

2005-02-25T19:17:00.000-05:00

Dual-Task-Related Gait Changes

Walking time and number of steps increased significantly under both dual-task conditions compared to walking alone (p < 0.001) without reaching a significant difference between the two dual-task conditions (respectively, p = 0.131 and p = 0.407), whereas lateral gait instability (frequency of lateral line stepping-over) increased significantly in association with counting backward (p = 0.006) but not with the verbal fluency task (p = 1). Conclusion: Among the studied sample of transitional older adults, a walking- associated arithmetic task significantly interfered with lateral gait stability, whereas no lateral gait deviations were seen in association with a verbal fluency task. We, therefore, suggest that the choice of the attention-splitting task in dual-task gait assessment among older adults must be made carefully.

2005-02-25T19:08:00.000-05:00

A pilot investigation of the efficacy of falls risk assessment tools and prevention strategies in an elderly hip fracture population [full-text article, including assessment tools/measures]

2005-02-25T19:01:00.000-05:00

Hip Muscle Weakness and Overuse Injuries in Recreational Runners.

Results comparing the injured and noninjured groups showed that leg dominance did not influence the leg of injury ([chi]2(1) = 0.134; P = 0.71). Correlations for internal reliability of muscle measurements between trials 1 and 2 with the hand-held dynamometer ranged from 0.80 to 0.90 for the 6 muscle groups measured, and all P values were less than 0.0001. No significant side-to-side differences in hip group muscle strength were found in the noninjured runners (P = 0.62-0.93). Among the injured runners, the injured side hip abductor (P = 0.0003) and flexor muscle groups (P = 0.026) were significantly weaker than the noninjured side. In addition, the injured side hip adductor muscle group was significantly stronger (P = 0.010) than the noninjured side. Duration of symptoms was not a contributing factor to the extent of injury as measured by muscle strength imbalance between injured and uninjured sides.

Conclusions: Although no cause-and-effect relationship has been established, this is the first study to show an association between hip abductor, adductor, and flexor muscle group strength imbalance and lower extremity overuse injuries in runners. Because most running injuries are multifaceted in nature, areas secondary to the site of pain, such as hip muscle groups exhibiting strength imbalances, must also be considered to gain favorable outcomes for injured runners. The addition of strengthening exercises to specifically identified weak hip muscles may offer better treatment results in patients with running injuries.

2005-02-25T18:55:00.000-05:00

Correlation of radiographic and MRI parameters to morphological and biochemical assessment of intervertebral disc degeneration

2005-02-19T07:21:00.000-05:00

Consider systemic causes of heel pain. Not all heel pain is caused by plantar fasciitis, and not all heel pain is mechanical in nature.

How often has a patient presented with a chief complaint of heel pain, still limping around after having been to numerous physicians? On entering the treatment room, you find the patient has brought along numerous orthoses from previous practitioners and well-meaning friends and family, along with multiple pairs of shoes of all styles and colors.

After examining the patient and the shoes you find no overt signs of plantar fasciitis. It is worth considering that the heel pain might be from another source: the local manifestation of a systemic disease. Remember that not all causes of heel pain are plantar fasciitis, and not all heel pain is mechanical in nature. Approximately 5% to 10% cases are nonmechanical in origin.

2005-02-13T17:13:00.000-05:00

Evaluation of Effects of Cervical...tures by Computerized Tomography:

The aim of this study was to evaluate the biomechanical efficacy of cervical spinal traction on spinal structures in cervical disc herniation patients. Thirteen patients diagnosed with acute cervical disc herniation by computerized tomography (CT) and clinical findings were treated by a special traction system consisting of a traction device placed on a traction board fitted on the CT table. Spinal structures were evaluated before and after 20 min of traction. The herniated disc level was C5-C6 in eight of the patients. Changes following traction were: regression of herniated disc area, increase in spinal canal area (11.21 mm2), spinal column elongation between C2 and C7 (l.39 mm) and intervertebral discal space widening at the C5-C6 level. Cervical traction has a significant biomechanical effect on spinal structures, which can be demonstrated by CT evaluation before and after traction.

2005-02-13T15:19:00.000-05:00

IngentaConnect What is Collaborative Reasoning?

Most physiotherapists would agree on the need to establish effective working relationships with their patients in order to achieve successful outcomes in therapy. Collaboration, as an entity in clinical practice, has continued to increase in importance due to a changing climate of healthcare. Traditional models of physiotherapy treatment based on the medical model and delivered in acute settings are giving way to newer models of practice, such as health promotion, that are patient or client centred and increasingly located in community settings. At the same time, the notion of patient compliance with physiotherapy advice and exercises, deriving from a medical model of practice, is being superseded by the notion of collaborative decision making (or reasoning) in physiotherapy. Recent physiotherapy literature suggests that collaborative decision making is an advanced clinical skill, while also casting doubt on just how well or consistently physiotherapists are able to set goals with their patients and nurture a collaborative approach in working towards those goals. The purpose of this article is to demonstrate how clinical reasoning is an ideal vehicle by which physiotherapy practitioners can reflect on the process of collaboration with their patients in clinical practice. Three particular forms of collaboration are identified which can be traced to different assumptions about knowledge and how this knowledge is both generated and used by practitioners in clinical practice. In this paper, we argue that these different forms of collaboration each have an important role in clinical practice as they address both the diversity and underlying nature of those treatment goals that may be seen as desirable from the perspective of either practitioner or patient. In turn, these forms of collaboration assist in the development of a variety of knowledge and skills for both practitioners and patients alike.

2005-02-13T15:15:00.000-05:00

Active Patient Involvement in the Establishment of Physical Therapy Goals: Effects on Treatment Outcome and Quality of Care

Background: Little research has been carried out on the effects of involving patients in goal setting. The purpose of this study was to investigate the effects of active patient involvement in the establishment of physical therapy treatment goals. Outcome measures included both physical treatment results and patient ratings of the quality of care. Subjects and Methods: All patients (n=77) at the rehabilitation unit of the department of rheumatology at a Swedish university hospital were included in a randomized controlled trial. Control-group patients received physical therapy treatment according to traditional methods. Intervention-group patients were involved in a goal-forum intervention, where therapist and patient together established goals for treatment. All patients completed questionnaire surveys at discharge. Results: Stepwise logistic regression analysis revealed that patients in the intervention group were more likely to achieve better physical treatment results for range of motion, strength and balance, compared to controls. Goal-forum patients also gave higher ratings than the control group on quality of care scales. Discussion and Conclusion: Active patient involvement in establishing physical therapy goals may have beneficial effects on both treatment outcomes and patient ratings of the quality of care. Further studies involving more physical therapists and longer follow-up periods are warranted.

2005-02-07T21:08:00.000-05:00

Relationship of Physical Examination Findings and Self-Reported Symptom Severity and Physical Function in Patients With Degenerative Lumbar Conditions

The most frequent physical examination findings were a positive quadrant test (70%), followed by lower-extremity muscle weakness (64%), abnormal reflexes (62%), and active lumbar extension (61%). Patients who were symptomatic during the quadrant test, patients who had pain with lateral flexion, and patients who had lower-extremity weakness had higher self-reported LSS symptom severity (t=-3.06, P=.003; t=-2.96, P=.004; and t=-3.2, P=.002, respectively). Pain with lumbar extension was moderately correlated with LSS symptom severity (Spearman rho=.31, P=.007). No lumbar PE procedure was associated with decreased condition-specific function. The quadrant test was the strongest predictor of symptom severity (beta=.54, r2=.21, P=.0009). Discussion and Conclusion. The association between PE findings and self-reported symptom severity in this sample is consistent with the pathoanatomy of degenerative spinal conditions and indicates that movement that narrows the foraminal space contributes to symptom severity. The quadrant test distinguished those subjects with clinically meaningful low back symptom severity but was not predictive of impaired function.

2005-01-27T20:59:00.000-05:00

Boing Boing: Funhaler

"The Funhaler is an asthma medicine delivery device for kids. Traditional asthma inhalers scare kids into misuse (or non-use), but the Funhaler apparently 'overcomes these difficulties by motivating the child to inhale willingly and effectively by the use of breath-driven incentive toys attached to the device, such as whistles and spinning discs.'"

This could be good for any pediatric patients... or heck, even some adults!

Complete Muscle Tables for the Human Body

2005-01-11T21:15:00.000-05:00

Where would I have been without The Hosford Muscle Tables:
Skeletal Muscles of the Human Body in university? And now they've got additional features, including Bony Anatomy & Radiology.

Journal of Rehabilitation Research and Development: Index of Online Issues

2005-01-11T20:51:00.000-05:00

A number of full-text articles on various rehabilitation issues from 1998-2004

The Running Shoe Prescription

2005-01-11T20:46:00.000-05:00

The Running Shoe Prescription [full-text; note: article's link will likely expire with the next journal edition]

Are patients more at ease when you use familiar words?

2005-01-10T20:40:00.000-05:00

Are patients more at ease when you use familiar words?

"Physicians are the experts in the science, and patients are the experts in themselves. If we can come toward a middle, and speak the same language, then we'd both be happier,"... 'When you get to diagnosis, you probably do want the medical language,' Dr. Ogden said. 'But when you're exploring the problem, you probably want the lay language.'

Gait & Posture: January 2005

2005-01-10T20:13:00.000-05:00

Gait & Posture has a complimentary issue with several full-text articles:

Synthesis of standing-up trajectories using dynamic optimization

Kinetics of compensatory gait in persons with myelomeningocele

Ground reaction forces on stairs: effects of stair inclination and age

Direct visualisation of gaze and hypometric saccades in cerebellar patients during visually guided stepping

The assessment of body sway and the choice of the stability parameter(s)

Does head extension and flexion increase postural instability in elderly subjects when visual information is kept constant?

The effects of blurred vision on the mechanics of landing during stepping down by the elderly

Familiarisation to treadmill walking in unimpaired older people

Within- and between-day stability of treadmill walking VO2 in children with hemiplegic cerebral palsy: Stability of walking VO2 in children with CP

Review of motor control mechanisms underlying impact absorption from falls

The natural history of human gait and posture: Part 1. Spine and pelvis

The natural history of human gait and posture: Part 2. Hip and thigh

Gait analysis system for assessment of dynamic loading axis of the knee

A 46-year-old woman with rigidity and frequent falls

2005-01-10T19:50:00.000-05:00

A 46-year-old woman with rigidity and frequent falls

A 46-year-old woman presents to the movement disorders clinic for a reevaluation after three neurologists said she probably had Parkinson disease. Her symptoms started 3 years ago with stiffness in both hands and the gradual onset of an intermittent resting tremor in her right (dominant) hand. Soon after, she started to fall forwards frequently without losing consciousness.

[full-text pdf case study]

CNN.com - Going downhill has health benefits - Jan 7, 2005

2005-01-10T18:24:00.000-05:00

Going downhill has health benefits

A novel study of hikers in the Alps made the intriguing discovery that different types of exercise had different effects on fats and sugars in the blood.

Going uphill cleared fats from the blood faster, going downhill reduced blood sugar more, and hiking either way lowered bad cholesterol. The Austrian researchers tested both forms of exercise on 45 healthy people who normally exercised very little. For the study, the participants took three to five hourlong hikes each week. For two months they hiked uphill and rode the ski lift down. The next two months they took the lift up and hiked down.

Their blood sugar and cholesterol levels were checked before the study started and after each two-month exercise segment. They also were given tests to see how quickly and well their blood removed fats and sugar after each exercise phase. The hikers made no changes in their diets, so that the effects of the exercise could be isolated.

The researchers were surprised to find that hiking downhill removed blood sugars and improved glucose tolerance, while uphill hiking mostly improved levels of fats called triglycerides. This could be good news for diabetics, who often have trouble with concentric and many types of aerobic exercise, Drexel said. They may be better able to tolerate downhill hiking, and may get more out of it, too. It also might be a good way for people who do not exercise now to get started, Drexel suggested.

One problem with going downhill a lot is pressure on the knees. Fletcher said more gyms need exercise machines that work downhill muscles without stressing knees.

2005-01-02T10:16:00.000-05:00

The Honda ASIMO project, once converting findings from human to robot and back to human may offer some interesting insights into gait analysis. The videos are pretty neat.

2004-12-21T08:22:00.000-05:00

Characteristic Gait Patterns in Neuromuscular Pathologies

This article reviews the characteristic gait patterns of six specific patient populations: muscular dystrophy, polio and flaccid paralysis, cerebrovascular accident and hemiplegia, cerebral palsy and diplegia, spina bifida, and spinal cord injury. Overviews of the epidemiology, natural history, characteristic gait patterns, gait impedance factors and orthopedic management are presented.

Just for Fun: Homunculi

2004-12-19T20:35:00.000-05:00

Remember the homunculus in anatomy textbooks? Not nearly as aesthetically appealing as these:
Homunculus: what a man's body would look like if each part grew in proportion to the area of the cortex of the brain concerned with its sensation/movement, respectively.

Sensory:

Motor:

[Source]

2004-12-12T17:37:00.000-05:00

Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference

At 12 months, patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group (mean difference 1.99, 95% confidence interval 0.45 to 3.52; P=0.01). Although the result shows a significant inferiority of the intervention, the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention (below 1.2 points of NPQ score). Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy.

Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain. Patients with a preference for the brief intervention may do at least as well with this approach. Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further.

I wonder what percentage preferred the short treatment, and how this was determined (how can you prefer something if you haven't tried the alternative?).

2004-12-12T17:34:00.000-05:00

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care

Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than 'best care.' For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.

Conclusions Relative to 'best care' in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

2004-12-12T07:30:00.000-05:00

Breathing Exercises from a website for singers. Excerpts and links may be useful for some patients.

3 Dimensional body images

2004-12-11T08:59:00.000-05:00

Does it Matter Which Exercise?: A Randomized Control Trial of Exercise for Low Back Pain.

A total of 312 acute, subacute, and chronic patients, including LBP-only and sciatica, underwent a standardized mechanical assessment classifying them by their pain response, specifically eliciting either a 'directional preference' (DP) (i.e., an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or sideglide/rotation tests), or no DP. Only DP subjects were randomized to: 1) directional exercises 'matching' their preferred direction (DP), 2) exercises directionally 'opposite' their DP, or 3) 'nondirectional' exercises. Outcome measures included pain intensity, location, disability, medication use, degree of recovery, depression, and work interference.

Results. A DP was elicited in 74% (230) of subjects. One third of both the opposite and non-directionally treated subjects withdrew within 2 weeks because of no improvement or worsening (no matched subject withdrew). Significantly greater improvements occurred in matched subjects compared with both other treatment groups in every outcome (P values <0.001), including a threefold decrease in medication use.

Conclusions. Consistent with prior evidence, a standardized mechanical assessment identified a large subgroup of LBP patients with a DP. Regardless of subjects' direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects' DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management.

The authors are Audrey Long and Ron Donelson - strong advocates of McKenzie methods, if it wasn't apparent by their methods and conclusion.

2004-12-11T08:55:00.000-05:00

Lumbar Disc Degeneration: Epidemiology and Genetic Influences

There are extreme variations in the reported prevalence of specific degenerative findings of the lumbar spine among studies, which cannot be explained entirely by age or other identifiable risk factors (e.g., prevalence figures for disc narrowing varied from 3% to 56%). It is likely that these variations are due, in great part, to inconsistencies in case definitions and measurements, which are impeding epidemiologic research on disc degeneration. Research conducted over the past decade has led to a dramatic shift in the understanding of disc degeneration and its etiology. Previously, heavy physical loading was the main suspected risk factor for disc degeneration. However, results of exposure-discordant monozygotic and classic twin studies suggest that physical loading specific to occupation and sport has a relatively minor role in disc degeneration, beyond that of upright postures and routine activities of daily living. Recent research indicates that heredity has a dominant role in disc degeneration, explaining 74% of the variance in adult populations studied to date. Since 1998, genetic influences have been confirmed by the identification of several gene forms associated with disc degeneration.

I had a patient say this to me just the other day - that her DDD was genetic, and I thought she was attempting to convince herself that it was just something she had no control over. Now I'm realizing that maybe I was wrong.

2004-12-11T08:48:00.000-05:00

Electromyographic activity in the immobilized shoulder girdle musculature during contralateral upper limb movements

EMG activity in all muscles was low during quiet immobilized standing (<1.5% maximal voluntary contraction [MVC]). During slow contralateral upper limb motions, activity ranged from 0.7% to 51.6% MVC (highest in trapezii) and was less than 15% MVC in the supraspinatus, infraspinatus, and anterior deltoid. Bimanual jar opening increased biceps activity from 7.8% to 16.1% MVC. During fast contralateral upper limb motions, peak infraspinatus activity increased to 56.7% during a fast straightforward reach. Supraspinatus activity was relatively high during all resisted backward-pulling motions (25.2%-32.1% MVC), whereas resisted forward reaching produced relatively little activity in the anterior deltoid, supraspinatus, infraspinatus, or biceps. Several slow and fast motions produced high trapezius activity (>45% MVC) with low supraspinatus, biceps, and anterior deltoid activities (<10% MVC). Our findings suggest that (1) immobilized shoulder girdle muscle EMG activity during quiet standing is negligible in asymptomatic individuals; (2) contralateral upper limb motions at self-selected speeds are not likely to be harmful to healing tissues; (3) during early healing periods, patients with biceps-labral injury should minimize bimanual activities, those with supraspinatus injury should avoid backward-pulling motions, and those with infraspinatus injury should avoid fast straightforward reaches; and (4) cross-body, straightforward, or downward reaches at either a slow or fast speed may be appropriately prescribed as rehabilitative exercises that can be initiated while the shoulder remains immobilized.

2004-12-11T08:46:00.000-05:00

The effect of limb support on muscle activation during shoulder exercises

The purpose of this study was to determine the difference in demands on glenohumeral musculature during unsupported and supported active range-of-motion (AROM) shoulder exercises. Twenty healthy subjects volunteered for this study. Surface or fine-wire bipolar electrodes were applied to the infraspinatus, posterior deltoid, anterior deltoid, pectoralis major, and supraspinatus muscles. Subjects performed vertical wall slides and diagonal wall slides (45 deg angle) with their hand in contact with the wall (supported) and not in contact with the wall (unsupported). Significantly greater supraspinatus activity was found in the unsupported exercises versus the supported exercises (F4,76 = 4.38, P = .003). Exercises performed in the 45 deg diagonal position were more demanding on shoulder musculature than vertical exercises (F1,19 = 19.3, P < .001). Although our results were obtained in healthy subjects and the implications in a pathological population are not clear, we suggest that when designing a progression of exercises for increasing shoulder muscular activity, supported short lever arm AROM exercises should precede unsupported long lever arm AROM exercises.

The Bell Curve in Medicine

2004-12-03T19:11:00.000-05:00

The Bell Curve in Medicine and how it relates to Cystic Fibrosis.

Google Scholar

2004-11-19T17:33:00.000-05:00

Google Scholar

Google Scholar enables you to search specifically for scholarly literature, including peer-reviewed papers, theses, books, preprints, abstracts and technical reports from all broad areas of research. Use Google Scholar to find articles from a wide variety of academic publishers, professional societies, preprint repositories and universities, as well as scholarly articles available across the web.

We've already got Pedro and Pubmed, but sometimes, this might elicit different results, and I wonder if a higher likelihood of full-text articles.

2004-11-19T17:31:00.000-05:00

Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial.

At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 92% (57) compared with 47% (30) for physiotherapy and 32% (19) for wait-and-see policy. However, recurrence rate in the injection group was high. Long-term differences between injections and physiotherapy were significantly in favour of physiotherapy. Success rates at 52 weeks were 69% (43) for injections, 91% (58) for physiotherapy, and 83% (49) for a wait-and-see policy. Physiotherapy had better results than a wait-and-see policy, but differences were not significant. INTERPRETATION: Patients should be properly informed about the advantages and disadvantages of the treatment options for lateral epicondylitis. The decision to treat with physiotherapy or to adopt a wait-and-see policy might depend on available resources, since the relative gain of physiotherapy is small.

Developing Ethiopian Physiotherapy

2004-11-04T20:36:00.000-05:00

I have a physio friend (Jen) who has gone to Ethiopia for a year with her husband who's teaching for VSO. She's been sending updates of what life is like as she works as an instructor in the country's only physio school:

Work for me is going really well, I think! It definitely took me a few days (or more) to adjust to some of the realities of the hospital and the university. The wards are terribly crowded and definitely smelly, people are very, very ill (often with HIV/AIDS), patients wait outside for hours, sometimes days, for treatment. Because there are no CT scans here, people with neurological problems are often diagnosed with “intra-cranial space occupying lesion (ICSOL)”, for which there doesn’t seem to be any treatment. I have been given all of the paediatric cases and there are some pretty sad ones… an awful lot of kids with burns, paralysis from spinal tuberculosis, and we even think we have a new polio case, which isn’t supposed to happen anymore with the vaccine so widely available.

The way the education system works here is that university students are generally assigned to their programs according to their marks, so considering that only about one third of my class actually chose physiotherapy, I think they are doing really well! It must be incredibly difficult for them, learning in English, which is a second language for all of them, and after having first gotten used to their Dutch teachers they now have to adjust to our Canadian accents! On top of the language difficulties, there is a huge shortage of textbooks. The students cannot afford to buy their own books, and the library only has a few copies of each text, so I am not sure how they manage. It is also very difficult for them to access the internet for current articles and information.

I am currently responsible for teaching two classes, and also supervising about 10 students on clinical placement two days a week. This week I introduced my students to “play therapy” and we spent a fantastic hour outside with some of the kids in the chronic paediatric unit playing parachute games, volleyball and football (soccer). One great success was Fanta, a 12 year old girl with severe burns, whom we finally managed to coax outside and who was happily chasing balloons all over the grounds by the end of the morning.

She recently sent a request, which I thought I'd pass on to all PTSci'ers:

Hello again physio folk,
Just writing with some requests regarding ways that you guys could help out with our project over here. Now that we have started teaching I realize how much these students still need to learn, and how much work the curriculum needs. People were very kind to offer help, so following are a couple of ideas I have had.

If anyone wants to send books (even older ones) it would be appreciated. The students cannot afford to buy books and we only have a few copies in the library. It is also near impossible to photocopy. So, books would be appreciated. Apparently it is much cheaper to send them through the US as they have a book rate. The address would be: Physiotherapy Department, Gondar Hospital, GCMS, PO box 196, Gondar, Ethiopia.

If anyone has any fairly simple assessment forms for various conditions (burns, arthritis, paeds, ortho, etc…) and could send these on line, that would be great too. [NOTE: email me and I'll forward them on, or email me and I'll give you her email address]

Do you think anyone in the physio world would be interested in setting up sort of a “big brother/sister” relationship with these students?? I guess what I was thinking was that it would be a purely professional mentoring relationship, by email or snail mail. You see, when these guys graduate they will be the first and only physios in the country, so who will they have to ask advice from??? I also thought it would be a way for them to do some continued learning after they graduate, if articles could be sent over from Canada, or continued ed course notes, or whatever. Obviously, it will be a while before professional courses will be offered over here, I think!! [NOTE: email me and I'll give you her email address if you're interested]
Anyway, let me know what you think about this, or if you have any other ideas!

We all probably have a textbook or two which we never use but would be immensely useful for them. Emailing an assessment form is probably no big deal, either. And think of what they (and we) could learn from mentoring. Thanks for your help in this.

Oh, and one other thing - I was almost able to cover her leave of absence but then things kinda fell through. Unfortunately, there's still no one to cover her job working for Ongwanada - a Kingston, Ontario organization providing multi-disciplinary services for adults with developmental disabilities. If anyone is interested, email me and I'll put you in touch with Ongwanada. Oh yeah, the vacant position is almost certain to turn into a permanent position when she returns!

2004-10-31T20:00:00.000-05:00

Is it really myositis? A consideration of the differential diagnosis.

A thorough clinical assessment, including a detailed family history, complemented by electromyography and creatine kinase measurements, should be undertaken in any patient with presumed idiopathic inflammatory myopathy. In addition, a muscle biopsy remains essential in all cases. A precise tissue diagnosis confirming features of an active inflammatory process should be achieved before immunosuppressive treatment is commenced. An increasing array of immunocytochemical and histioenzymatic stains now allows a full analysis and will help to confirm or exclude virtually all the differential diagnostic possibilities considered in this review. Electron microscopy may also be valuable in selected cases. Close collaboration between clinicians and muscle pathologists is essential in allowing the most accurate interpretation of myopathologic findings in the clinical context.

2004-10-31T19:59:00.000-05:00

Early Intervention for the Management of Acute Low Back Pain: A Single-Blind Randomized Controlled Trial of Biopsychosocial Education, Manual Therapy, and Exercise.

At 6 weeks, the assess/advise/treat group demonstrated greater improvements in disability, mood, general health, and quality of life than patients in the assess/advise/wait group (P < 0.05). Disability and pain were not significantly different between the groups at long-term follow up (P > 0.05). However, mood, general health, and quality of life remained significantly better in the assess/advise/treat group (P < 0.05).

Conclusions. At short-term, intervention is more effective than advice on staying active, leading to more rapid improvement in function, mood, quality of life, and general health. The timing of intervention affects the development of psychosocial features. If treatment is provided later, the same psychosocial benefits are not achieved. Therefore, an assess/advise/treat model of care seems to offer better outcomes than an assess/advise/wait model of care.

2004-10-31T19:55:00.000-05:00

Does This Patient Have an Instability of the Shoulder or a Labrum Lesion?

Shoulder complaints are frequently recurrent. Instability might cause some of these complaints. Best evidence supports the value of the relocation and anterior release tests. Symptoms related to IAP (labral tears) remain unclear. Most promising for establishing labral tears are currently the biceps load I and II, pain provocation of Mimori, and the internal rotation resistance strength tests.

2004-10-31T19:53:00.000-05:00

Kinesiophobia in chronic fatigue syndrome: Assessment and associations with disability

Kinesiophobia appears to be associated with activity limitations/participation restrictions but not with exercise capacity in patients with CFS.

2004-10-16T19:25:00.000-04:00

Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: A randomized clinical trial

Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. No major differences were found on baseline characteristics between groups. Success rates (primary outcome) after 5 weeks were 81% in the manual therapy group and 50% in the exercise group (odds ratio 1.92, 95% confidence interval 1.30, 2.60). Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks.

Conclusion: The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip.

2004-10-09T08:38:00.000-04:00

Joint range of motion limitations in children and young adults with spinal muscular atrophy

Eighty-nine percent of the participants with SMA type II experienced knee extension limitation. Approximately 50% of the participants with both types of SMA had ankle dorsiflexion limitation. The motions of knee and hip extension and ankle dorsiflexion also had a relatively high contracture index. The number of motions with limited range positively correlated (P<.001) with age and upper-extremity functional grade (the higher the functional grade, the poorer the functional ability) for SMA type II.

2004-10-09T08:25:00.000-04:00

Indications for Magnetic Resonance Imaging in Presumed Adolescent Idiopathic Scoliosis

The most valuable single indicator of an abnormal finding on magnetic resonance imaging was absence of thoracic apical segment lordosis: eight of thirty-nine patients with that indicator had an abnormal finding on magnetic resonance imaging. The optimal diagnostic yield for a single category of indicators occurred when an atypical curve pattern was the only indicator: six of fifty-eight patients in whom this was the case had an abnormal finding on magnetic resonance imaging. None of the twenty children in whom pain was the only indicator category had an abnormal imaging study. The optimal diagnostic yield occurred when both an atypical curve pattern and neurological indicators were present: thirteen (25%) of fifty-three patients in whom this was the case had an abnormal finding on magnetic resonance imaging. Thirteen of the twenty-seven patients received surgical treatment for the abnormality of the central nervous system revealed by the imaging.

Conclusions: The correct use of diagnostic tests is an important component of effective medical practice. An abnormality of the central nervous system is present in approximately 10% of patients with presumed adolescent idiopathic scoliosis in whom only subtle abnormalities are identified on the basis of the clinical history, physical examination, or radiographic examination. Knowledge of the diagnostic value of the specific clinical indicators, considered individually and in combination, can help the clinician to determine more effectively when advanced imaging of the central nervous system should be performed.

2004-10-09T08:23:00.000-04:00

Rotator Cuff Repair in Patients Fifty Years of Age and Younger

Results: There were three small, fifteen medium, six large, and five massive tears. Rotator cuff repair was associated with significant long-term pain relief (p = 0.0001). However, there was no significant long-term improvement in active abduction or external rotation. Postoperative pain, active abduction, and external rotation did not vary significantly according to gender, tear size, repair type, or whether a distal clavicular excision had been performed. There were eleven excellent, five satisfactory, and thirteen unsatisfactory results. Seven shoulders had additional surgery for the treatment of a recurrent tear (five), instability (one), or osteoarthritis (one). Three of the five repairs that were done for the treatment of a recurrent tear were performed ten years or more after the time of the index procedure.

Conclusions: Rotator cuff repair in young patients is associated with long-term pain relief. However, this procedure is not associated with significant long-term improvement in motion, and a large proportion of patients have an unsatisfactory long-term result. The results of rotator cuff repair in young patients appear to be less favorable than those in a mixed-age population.

2004-10-09T08:19:00.000-04:00

Congenital dislocation of the hip

Congenital dislocation of the hip (CDH) remains a significant problem in terms of diagnosis and treatment. Clinically screening has not eradicated late presenting cases although ultrasound examination is promising particularly in early management. The imperative is early diagnosis since most hips will respond to simple abduction splintage. A later diagnosis is synonymous with surgical intervention either in the form of open or closed reduction. Both procedures often necessitate later surgery common in the form of a pelvic osteotomy to address residual acetabular dysplasia. The later the primary surgery the more complex it becomes and the long term prognosis in terms of early onset osteoarthritis is compromised.

2004-10-02T20:31:00.000-04:00

Predictive Factors for Neck and Shoulder Pain: A Longitudinal Study in Young Adults.

A random sample of 826 high school students was investigated when they were 15 to 18 years old and again at 22 to 25 years of age. Altogether, 394 (48%) patients participated in both surveys. The outcome variable was weekly neck and shoulder pain during the past 6 months in adulthood, and the explanatory variables included some sociodemographic factors, leisure time activities, self-assessed physical condition, psychosomatic stress symptoms, and symptoms of fatigue and sleep difficulties.

Results. In 7 years, the prevalence of weekly neck and shoulder pain increased from 17% to 28%. Among those who were asymptomatic at baseline, 6-month incidence of occasional or weekly neck and shoulder pain was 59% 7 years later. In an adjusted model, psychosomatic symptoms remained an associated factor for prevalent neck and shoulder pain 7 years later for both females and males. In females, neck and shoulder pain in adolescence was associated with prevalent neck and shoulder pain in adulthood, and sports loading dynamically in the upper extremities was an associated factor for a low prevalence of neck and shoulder pain 7 years later. In separate analyses of incident neck and shoulder pain, psychosomatic stress symptoms predicted neck and shoulder pain in adulthood.

"The Good News Is: I Just Saved a Bunch of Money Switching to Willis"

2004-09-28T18:16:00.000-04:00

Canadian physiotherapists may wish to be aware that an alternative exists to purchasing liability insurance through the Canadian Physiotherapy Association. The identical packages can be purchased directly through Willis.

Through the CPA (in addition to membership), you pay $750 for coverage. Going directly through Willis, if you are:

Newly Licensed, you pay $450.00 (saving $300)

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Complete and fax the Professional Liability Application (and a copy of your resume and certificate of license) to Willis and they will process the application and mail you an invoice. If you have any questions, call 1-800-268-8532 (or locally at: 416-869-1320).

2004-09-27T07:00:00.000-04:00

Randomised controlled trial of physiotherapy compared with advice for low back pain

Patients in the therapy group reported enhanced perceptions of benefit, but there was no evidence of a long term effect of physiotherapy in either disease specific or generic outcome measures (mean difference in change in Oswestry disability index scores at 12 months -1.0%, 95% confidence interval -3.7% to 1.6%). The most common treatments were low velocity spinal joint mobilisation techniques (72%, 104 of 144 patients) and lumbar spine mobility and abdominal strengthening exercises (94%, 136 patients).

Conclusions: Routine physiotherapy seemed to be no more effective than one session of assessment and advice from a physiotherapist.

There are also some interesting comments to this article. I strongly encourage all readers to comment on ptsci.blogspot.com on any/all of the abstracts which are posted, to promote a similarly beneficial discussion amongst the community of physiotherapists.

2004-09-23T07:08:00.000-04:00

Predictive Factors for Neck and Shoulder Pain: A Longitudinal Study in Young Adults.

In 7 years, the prevalence of weekly neck and shoulder pain increased from 17% to 28%. Among those who were asymptomatic at baseline, 6-month incidence of occasional or weekly neck and shoulder pain was 59% 7 years later. In an adjusted model, psychosomatic symptoms remained an associated factor for prevalent neck and shoulder pain 7 years later for both females and males. In females, neck and shoulder pain in adolescence was associated with prevalent neck and shoulder pain in adulthood, and sports loading dynamically in the upper extremities was an associated factor for a low prevalence of neck and shoulder pain 7 years later. In separate analyses of incident neck and shoulder pain, psychosomatic stress symptoms predicted neck and shoulder pain in adulthood.

2004-09-21T21:17:00.000-04:00

Does Stretching Improve Performance?: A Systematic and Critical Review of the Literature.

Of the 23 articles examining the effects of an acute bout of stretching, 22 articles suggested that there was no benefit for the outcomes isometric force, isokinetic torque, or jumping height. There was 1 article that suggested improved running economy. Of 4 articles examining running speed, 1 suggested that stretching was beneficial, 1 suggested that it was detrimental, and 2 had equivocal results. Of the 9 studies examining the effects of regular stretching, 7 suggested that it was beneficial, and the 2 showing no effect examined only the performance test of running economy. There were none that suggested that it was detrimental.

Conclusions: An acute bout of stretching does not improve force or jump height, and the results for running speed are contradictory. Regular stretching improves force, jump height, and speed, although there is no evidence that it improves running economy.

2004-09-10T17:55:00.000-04:00

Diagnosis and Management of Scaphoid Fractures [full-text article]

2004-09-10T17:53:00.000-04:00

Exercise and bracing in the osteoporotic and osteopenic individual.

Exercise programs, such as resistance training and tai chi, confer beneficial effects on the osteopenic and osteoporotic individual and complement medical management, with larger gains in bone mineral density noted in combination than those achieved by medical treatment alone. Braces may achieve similar effects in the lumbar spine, and hip protectors appear to offer protection to the individual at risk for hip fracture.

Summary: Exercise programs and bracing should be offered to the osteopenic and osteoporotic individual in a manner similar to medical treatment. Emphasis on these important nonmedical management approaches is essential to maximize the potential benefits to this patient population.

2004-09-05T20:04:00.000-04:00

Physical activity and risk of coronary heart disease in India

In age- and sex-adjusted analyses, people in the highest level of leisure-time exercise (>145 metabolic equivalents [MET]-minutes per day, equivalent to 36 minutes of brisk walking per day) had a relative risk of 0.45 (95% CI: 0.31, 0.66) compared with non-exercisers. Multivariate adjustment for other risk factors did not substantially alter the association. We observed a positive association between non-work sedentary activity and CHD risk; people with >3.6 hours per day of sedentary activity (for example, television viewing) had an elevated risk of 1.88 (95% CI: 1.09, 3.20) compared with <70 minutes per day in multivariate analysis.

Conclusion: Leisure-time exercise, including as much as 35-40 minutes per day of brisk walking, was protective for CHD risk and sedentary lifestyles were positively associated with risk of CHD. Given limited resources for care of CHD in India and the important role of physical exercise in disease risk in urban India, improvements in physical activity should be promoted.

2004-09-05T20:02:00.000-04:00

Physical activity and stroke. A meta-analysis of observational data

Moderately intense physical activity compared with inactivity, showed a protective effect on total stroke for both occupational (RR = 0.64, 95% CI: 0.48-0.87) and leisure time physical activity (RR = 0.85, 95% CI: 0.78-0.93). High level occupational physical activity protected against ischaemic stroke compared with both moderate (RR = 0.77, 95% CI: 0.60-0.98) and inactive occupational levels (RR = 0.57, 95% CI: 0.43-0.77). High level compared with low level leisure time physical activity protected against total stroke (RR = 0.78, 95% CI: 0.71-0.85), haemorrhagic stroke (RR = 0.74, 95% CI: 0.57-0.96) as well as ischaemic stroke (RR = 0.79, 95% CI: 0.69-0.91). Studies conducted in Europe showed a stronger protective effect (RR = 0.47, 95% CI: 0.33-0.66) than studies conducted in the US (RR = 0.82, 95% CI: 0.75-0.90).

Conclusions: Lack of physical activity is a modifiable risk factor for both total stroke and stroke subtypes. Moderately intense physical activity is sufficient to achieve risk reduction.

2004-09-05T19:57:00.000-04:00

How to manage musculoskeletal conditions: when is (Multidisciplinary) Rehabilitation appropriate?

Multidisciplinary rehabilitation has established efficacy in few musculoskeletal conditions. It is likely to be effective in the context of chronic back pain and possibly other types of chronic pain, and in frail older people with hip fractures. The principles of multidisciplinary rehabilitation, which include time-limited and goal-directed interventions, can be used in other musculoskeletal interventions but there have not yet been sufficient randomized trials to determine its effectiveness. Multidisciplinary rehabilitation is relatively costly and therefore is not likely to be cost effective unless it achieves return to work in people in the working-age group, or averts the need for residential care in frail older people.

2004-09-04T11:11:00.000-04:00

Musculoskeletal Rehabilitation in Osteoporosis: A Review

Fractures caused by osteoporotic fragility may be prevented with multidisciplinary intervention programs, including education, environmental modifications, aids, and implementation of individually tailored exercise programs, which are proved to reduce falls and fall-related injuries. In addition, strengthening of the paraspinal muscles may not only maintain BMD but also reduce the risk of vertebral fractures. Given the strong interaction between osteoporosis and falls, selection of patients for prevention of fracture should be based on bone-related factors and on risk factors for falls. Rehabilitation after vertebral fracture includes proprioceptive dynamic posture training, which decreases kyphotic posturing through recruitment of back extensors and thus reduces pain, improves mobility, and leads to a better quality of life. A newly developed orthosis increases back extensor strength and decreases body sway as a risk factor for falls and fall-related fractures. Hip fractures may be prevented by hip protectors, and exercise programs can improve strength and mobility in patients with hip fracture. So far, there is no conclusive evidence that coordinated multidisciplinary inpatient rehabilitation is more effective than conventional hospital care with no rehabilitation professionals involved for older patients with hip fracture. Further studies are needed to evaluate the effect of combined bone- and fall-directed strategies in patients with osteoporosis and an increased propensity to falls.

2004-09-04T11:10:00.000-04:00

Acetaminophen as symptomatic treatment of pain from osteoarthritis

Acetaminophen has a good risk/benefit ratio that has prompted international consensus panels to recommend its use as first-line therapy in dosages of up to 4 g/day.

2004-09-03T22:32:00.000-04:00

Effective pain management for patients with arthritis

The aim of this article is to provide an overview of pain management for patients with osteoarthritis(OA) and rheumatoid arthritis (RA). After reading this article you should be able to: (1) Understand the needs of a patient experiencing pain from OA or RA. (2) Recognise an appropriate framework for the assessment and monitoring of pain control. (3) Identify therapeutic and non-therapeutic options for pain management. (4) Discuss the risks and benefits of the therapeutic options used in pain management.

[pdf full-text article]

2004-09-03T22:30:00.000-04:00

Acromio-Humeral Distance Variation Measured by Ultrasonography and Its Association With the Outcome of Rehabilitation for Shoulder Impingement Syndrome.

A significant reduction of the AHD was found within groups between rest and active abduction (P < 0.05). Comparison of AHD between groups was not statistically different (P = 0.06; [beta]< 0.80). In pre-post rehabilitation analysis, improvement of the Western Ontario Rotator Cuff Index score was positively correlated to the reduction of the AHD narrowing as the arm was abducted (r = 0.86; P = 0.01).

Conclusions: The ultrasound measure of AHD is reliable and sensitive. Although a distinct pattern of AHD variation in SIS patients could not be confirmed, a strong positive relationship was found between the reduction of AHD narrowing and functional improvement following rehabilitation. Ultrasound measurement of AHD might help identify SIS patients who will benefit from rehabilitation.

2004-09-03T22:25:00.000-04:00

Nonsurgical treatment effective for carpal tunnel syndrome
Compares placebo, local, and oral steroids. Comments on the limited data on effectiveness of therapeutic interventions. [pdf abstract]

2004-08-17T21:01:00.000-04:00

Long-Term Results of Total Joint Arthroplasty in Elderly Patients Who Are Frail.

One hundred arthroplasties (70 hips, 30 knees) were done. On a subjective grading scale, 95% of the patients were very satisfied, 5% reported satisfactory outcomes and no patients considered their results poor. After surgery, 90% of the patients became community walkers without assistance. The level of independent living was maintained in 97% of patients at long-term followup. Causes of morbidity included two infections, one dislocation, and one leg-length discrepancy.

2004-08-17T20:56:00.000-04:00

Measurement of Spinal Mobility in Ankylosing Spondylitis: Comparison of Occiput-to-Wall (OWD) and Tragus-to-Wall (TWD) Distance

OWD and TWD are equally reliable in assessing thoracic spine extension. Although the TWD is in general easier to perform in AS patients compared to OWD, we recommend the OWD measurement over TWD: in OWD measurement a value of zero easily distinguishes patients with normal thoracic spine extension from kyphosed patients.

2004-08-17T20:53:00.000-04:00

Tai chi for treating rheumatoid arthritis (Cochrane Review)

Tai Chi-based exercise programs had no clinically important or statistically significant effect on most outcomes of disease activity, which included activities of daily living, tender and swollen joints and patient global overall rating. For range of motion, Tai Chi participants had statistically significant and clinically important improvements in ankle plantar flexion. No detrimental effects were found. One study found that compared to people who participated in traditional ROM exercise/rest programs those in a Tai Chi dance program reported a significantly higher level of participation in and enjoyment of exercise both immediately and four months after completion of the Tai Chi program.

Reviewers' conclusions: The results suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis. In addition, Tai Chi has statistically significant benefits on lower extremity range of motion, in particular ankle range of motion, for people with RA. The included studies did not assess the effects on patient-reported pain.

2004-08-17T20:50:00.000-04:00

Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia

Because of insufficient or conflicting evidence, no recommendations were made about systematically searching for maxillary sinusitis, chest physiotherapy, the timing of tracheostomy, prone positioning, prophylactic intravenous antibiotics, or intravenous plus topical antibiotics.

2004-08-10T22:02:00.000-04:00

The supine hip extensor manual muscle test: A reliability and validity study

Reliability testing showed excellent agreement (82%). Subjects with pathology had significant differences in mean torque (P<.01) for the assigned grade 5 (176Nm), grade 4 (103Nm), grade 3 (67Nm), and grade 2 (19Nm). Healthy adults showed significant differences between grade 5 (212Nm) and grade 4 (120Nm) in mean torque (P<.05).

Conclusions The supine MMT is a reliable and valid method with which to assess hip extension strength.

2004-08-10T20:36:00.000-04:00

Ipsilateral motor pathway confirmed by combined brain mapping of a patient with hemiparetic stroke: A case report

This study investigated the motor control pathway using both functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) in a patient with left hemiparesis with an infarction on the posterior limb of the right internal capsule. fMRI was performed using the blood oxygen level-dependent technique at 1.5T with a standard head coil. The motor activation task consisted of hand grasp-release movements in 1-Hz cycles. TMS was performed using a butterfly coil; the intersection of the wings (center of the coil) was applied tangentially to the scalp 1.0cm apart. Stimulation was performed at 100% of maximal output. Motor evoked potentials (MEPs) from both abductor pollicis brevis (APB) muscles were obtained simultaneously. fMRI showed that the unaffected (left) primary sensorimotor cortex (SM1) was activated by movements of the unaffected (right) hand. Conversely, the bilateral SM1 were activated by movements of the affected (left) hand. Brain mapping using TMS showed that ipsilateral MEPs were obtained at the affected (left) APB muscle when the unaffected (left) motor cortex was stimulated. We concluded that the ipsilateral motor pathway from the unaffected motor cortex to the affected hand was present in this patient.

2004-08-10T20:32:00.000-04:00

Right and left knee laxity measurements: a prospective study of patients with anterior cruciate ligament injuries and normal control subjects

The KT-1000 arthrometer revealed a significant increase in laxity measurements in right knees compared with left knees. This difference was found both preoperatively and postoperatively in patients undergoing ACL reconstruction. The same thing was found in a group of persons without any known knee problems.

2004-08-07T07:26:00.000-04:00

Clinical Factors Predicting Fractures Associated with an Anterior Shoulder Dislocation

Chi-square, logistic regression, and recursive partitioning analysis showed three significant factors for the presence of fracture-dislocation: 1) age 40 years or older, 2) a first episode of dislocation, and 3) mechanism of injury (i.e., a fall greater than one flight of stairs, a fight/assault episode, or a motor vehicle crash). A multiple logistic regression model estimated the significant adjusted odds ratios (and their 95% confidence intervals [95% CIs]) for each of the three factors: 5.18 (95% CI = 2.74 to 9.78), 4.23 (95% CI = 1.82 to 9.87), and 4.06 (95% CI = 1.95 to 8.48), respectively. A predictive model using any one of the three factors reached a sensitivity of 97.7% (95% CI = 91.8% to 99.4%), a specificity of 22.9% (95% CI = 18.1% to 28.5%), and a negative predictive value of 96.6% (95% CI = 88.3% to 99.6%).

2004-08-07T07:16:00.000-04:00

Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively), mostly for back pain (45% and 24%, respectively). Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23%) than users of other therapies (5–16%). Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale) and meditation least helpful (median of 3) in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option.

2004-08-06T21:53:00.001-04:00

Diagnosing Heel Pain in Adults
[full-text html article]

2004-08-06T21:53:00.000-04:00

Operative Treatment for Hip Fractures in Patients 100 Years of Age and Older: Is It Justified?

Twenty-three patients (17 females and 6 males) were identified with ages ranging from 100 to 107 (mean: 101.8). The group had 4 subcapital and 19 pertrochanteric fractures and between 1 and 4 major background diseases. Four patients were treated nonoperatively (1 due to major pneumonia and 3 refused the operative procedure). Three of those 4 patients died in the same month of admission, and 1 patient died during the second month. Among the 19 patients who underwent operation, 17 patients have died, living between 0 and 78 months (mean: 13.8) postoperatively. Two are still alive (21 and 45 months) after the operation. Eight patients died prior to 6 months, and 11 lived more than a year after the operation. A comparison between these 2 groups showed greater major background disease in the patients who died prior to 6 months (P < 0.05).

Conclusions: Most hip fractures in patients over100 years of age are pertrochanteric. Patients with 2 or more major background diseases have an increased risk for dying in the first 6 months after the operation. Most patients having operations in this age group had a postoperative reduction in mobility status and in performing basic activities of daily living.

2004-08-06T21:51:00.000-04:00

Repetitive strain injuries: fact or fiction.

Nontraumatic soft tissue musculoskeletal disorders such as carpal tunnel syndrome, lateral epicondylitis, and shoulder pain continue to dominate the workplace with total health care costs for all conditions over $1.25 trillion. Causation is the result of many factors: individual (intrinsic) and workplace (extrinsic) risk factors. Although epidemiologic studies have improved definition, they cannot prove a theory; they can only disprove a theory. Evidence-based medicine studies have improved the understanding of trends, patterns, and relevancies while continuing to emphasize the importance of psychosocial issues. Individual coping skills affect reporting of musculoskeletal pain. Early return to work remains a cornerstone of medical management while improving outcomes and reducing disability.

Summary: The current knowledge base does not allow a physician to apply specific causation for an individual experiencing work-related nontraumatic soft tissue musculoskeletal disorders. Because epidemiologic data are statistical, there is no way to know how it might apply to a particular case. This fundamental incompatibility between the epidemiologic perspective and the clinician's perspective, even with very compelling epidemiologic data, is of only limited use to the clinician. Furthermore, because "work-related" is legally determined on the basis of jurisdictional requirements, it is possible for a physician to opine that specific work activities have a strong epidemiologic association and therefore may have contributed to the onset of symptoms. The physician should understand that this opinion implies compensability and with it responsibility for payment. This nonmedical requirement puts stress on the traditional patient-physician relation and may lead to a patient's unhappiness with the outcomes of treatment.

2004-08-06T21:42:00.000-04:00

Osteomyelitis

Bone and joint infections are painful for patients and frustrating for both them and their doctors. The high success rates of antimicrobial therapy in most infectious diseases have not yet been achieved in bone and joint infections owing to the physiological and anatomical characteristics of bone. The key to successful management is early diagnosis, including bone sampling for microbiological and pathological examination to allow targeted and long-lasting antimicrobial therapy. The various types of osteomyelitis require differing medical and surgical therapeutic strategies. These types include, in order of decreasing frequency: osteomyelitis secondary to a contiguous focus of infection (after trauma, surgery, or insertion of a joint prosthesis); that secondary to vascular insufficiency (in diabetic foot infections); or that of haematogenous origin. Chronic osteomyelitis is associated with avascular necrosis of bone and formation of sequestrum (dead bone), and surgical debridement is necessary for cure in addition to antibiotic therapy. By contrast, acute osteomyelitis can respond to antibiotics alone. Generally, a multidisciplinary approach is required for success, involving expertise in orthopaedic surgery, infectious diseases, and plastic surgery, as well as vascular surgery, particularly for complex cases with soft-tissue loss.

2004-08-06T21:38:00.000-04:00

Identifying Athletes At Risk of Hamstring Strains and How to Protect Them

1. One common soft-tissue injury in sports involving sprinting and kicking a ball is the hamstring strain. Strain injuries often occur while the contracting muscle is lengthened, an eccentric contraction. We have proposed that the microscopic damage to muscle fibres that routinely occurs after a period of unaccustomed eccentric exercise can lead to a more severe strain injury.
2. An indicator of susceptibility for the damage from eccentric exercise is the optimum angle for torque. When this is at a short muscle length, the muscle is more prone to eccentric damage. It is known that subjects most at risk of a hamstring strain have a previous history of hamstring strains. By means of isokinetic dynamometry, we have measured the optimum angle for torque for nine athletes with a history of unilateral hamstring strains. We also measured optimum angles for 18 athletes with no previous history of strain injuries. It was found that mean optimum angle in the previously injured muscles was at a significantly shorter length than for the uninjured muscles of the other leg and for muscles of both legs in the uninjured group. This result suggests that previously injured muscles are more prone to eccentric damage and, therefore, according to our hypothesis, more prone to strain injuries than uninjured muscles.
3. After a period of unaccustomed eccentric exercise, if the exercise is repeated 1 week later, there is much less evidence of damage because the muscle has undergone an adaptation process that protects it against further damage. We propose that for athletes considered at risk of a hamstring strain, as indicated by the optimum angle for torque, a regular programme of mild eccentric exercise should be undertaken. This approach seems to work because evidence from a group of athletes who have implemented such a programme shows a significant reduction in the incidence of hamstring strains.

2004-08-06T21:37:00.000-04:00

Popping Sarcomere Hypothesis Explains Stretch-Induced Muscle Damage

1. Exercise that involves stretching a muscle while active cause microscopic areas of damage, delayed onset muscle soreness and adaptation to withstand subsequent similar exercise.
2. Longer muscle lengths are associated with greater damage and recent animal experiments show that it is the length relative to optimum that determines the damage.
3. In humans, walking down stairs, taking two at a time, increases the length of the muscle during the lengthening and increases the delayed onset muscle soreness.
4. The observed pattern of damage is consistent with explanations based on sarcomere length instabilities.
5. The pattern of adaptation is consistent with the number of sarcomeres in series in a muscle being modulated by exercise, especially the range of muscle lengths over which eccentric exercise regularly occurs.

2004-08-06T21:35:00.000-04:00

Clinical practice guideline for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure
Note: abstract offers no content. Obtain article for guidelines.

2004-08-06T21:32:00.001-04:00

Encouraging reflection and critical thinking in practice

For reflection to become a transferable skill that is used in practice, practitioners need to learn how to combine this skill with critical thinking. This article provides practical guidance to mentors, clinical supervisors and preceptors on how this might be encouraged.

[full-text pdf]

2004-08-06T21:32:00.000-04:00

Low level laser therapy (Classes I, II and III) for treating osteoarthritis (Cochrane Review)

The pooled estimate (random effects) of three trials showed no effect on pain measured using a scale (SMD: -0.2, 95% CI: -1.0, +0.6), but there was statistically significant heterogeneity (p>0,05). Three of the trials showed no effect and two demonstrated very beneficial effects with laser. In another trial, with no scale-based pain outcome, significantly more patients reported pain relief (yes/no) with laser with an odds ratio of 0.05, (95% CI: 0.0 to 1.56). Only one study found significant results for increased knee range of motion (WMD: -10.62 degrees, 95% CI: -14.07,-7.17). Other outcomes of joint tenderness and strength were not significant. Lower dosage of LLLT was found as effective than higher dosage for reducing pain and improving knee range of motion.

2004-08-06T21:22:00.000-04:00

Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials

Topical NSAIDs were superior to placebo in the first two weeks of treatment but not the following two weeks. Topical NSAIDs were less effective than oral NSAIDs numerically at any week and statistically in the first week.

The effect size for improvement in function also showed superiority of topical NSAIDs over placebo in the first two weeks but not in weeks 3 and 4. A statistically significant effect size for improvement in stiffness was seen at one week but not at two weeks.

The clinical response rate ratio was statistically significant in the first but not fourth week. No difference was found between topical NSAIDs and oral NSAIDs.

Topical NSAIDs had no more side effects than placebo. Compared with oral NSAIDs, fewer patients taking topical NSAIDs had any adverse events, withdrawals due to side effects, and gastrointestinal side effects, but significantly more patients had local side effects such as rash, itch, and burning.

Sensitivity analyses showed that although baseline pain score influenced the statistical inference only, the type of topical NSAID produced significantly different effect sizes. Other factors did not affect the results.

[full-text]

2004-08-01T07:12:00.000-04:00

Placebo interventions for all clinical conditions (Cochrane Review)

Placebo interventions are often claimed to improve patient-reported and observer-reported outcomes, but this belief is not based on evidence from randomised trials that compare placebo with no treatment.

We found no statistically significant pooled effect of placebo in 38 studies with binary outcomes (4284 patients), relative risk 0.95 (95% confidence interval (CI) 0.89 to 1.01). The pooled relative risk for patient-reported outcomes was 0.95 (95% CI 0.88 to 1.03) and for observer-reported outcomes 0.91 (95% CI 0.81 to 1.03).

There was an apparent effect of placebo interventions on pain (SMD -0.25 (95% CI -0.35 to-0.16)), and phobia (SMD -0.63 (95% CI -1.17 to -0.08)); but also a substantial risk of bias.

There was no statistically significant effect of placebo interventions in eight other clinical conditions investigated in three trials or more: nausea, smoking, depression, overweight, asthma, hypertension, insomnia and anxiety, but confidence intervals were wide.

2004-08-01T07:09:00.000-04:00

Shoulder posture and median nerve sliding

Neither moving the head forward or trunk flexion caused significant movement of the median nerve. In contrast, 4.3 mm of movement, adding 0.7% strain, occurred in the forearm during shoulder protraction. A delay in movement at the start of protraction and straightening of the nerve trunk provided evidence of unloading with the shoulder flexed and elbow extended and the scapulothoracic joint in neutral. There was a 60% reduction in nerve movement in the arm during contralateral neck side flexion when the shoulder was protracted compared to scapulothoracic neutral.

Conclusion: Slumped sitting is unlikely to increase nerve strain sufficient to cause changes to nerve function. However, shoulder protraction may place the median nerve at risk of injury, since nerve movement is reduced through the shoulder region when the shoulder is protracted and other joints are moved. Both altered nerve dynamics in response to moving other joints and local changes to blood supply may adversely affect nerve function and increase the risk of developing upper quadrant pain.

2004-07-28T21:45:00.000-04:00

Elastic compression stockings reduce risk of post-thrombotic syndrome after DVT

After bringing together this research, the reviewers concluded that the evidence in favour of wearing compression stockings after DVT is strong. In the three trials with the most reliable data, the risk of experiencing PTS and severe PTS was halved. One in five of the people people (20%) who wore the compression stockings got PTS, compared with more than two in five people (43%) in the groups who did not wear stockings.

There were no adverse effects from wearing stockings reported in the trials, but the reviewers warned that compression stockings could worsen the condition of people who have a weakened arterial blood supply. It is not known how long people who have had a DVT can benefit from wearing stockings.

2004-07-26T21:04:00.000-04:00

Effects of cardiac rehabilitation on exercise capacity in Type 2 diabetic patients with coronary artery disease

The baseline exercise capacity parameters were not different between diabetic and non-diabetic subjects. After cardiac rehabilitation, improvement of exercise capacity was significantly less in patients with diabetes compared with those without diabetes: peak workload (19% vs. 29%, P = 0.022), peak VO2 (13% vs. 30%, P = 0.002), anaerobic threshold (12% vs. 31%, P = 0.017). In the diabetic patients, a significant inverse relation between fasting blood glucose and change in peak VO2 was observed on both univariate (r = -0.40, P = 0.002) and multivariate (P = 0.001) analyses.

Conclusions: The benefit of cardiac rehabilitation, after an acute ischaemic heart event, in exercise capacity is significantly lower in Type 2 diabetic patients. The response to cardiac rehabilitation in those with diabetes appears to be influenced by blood glucose levels.

2004-07-26T21:00:00.000-04:00

Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial

An 8-week, hip-exercise intervention, during which the control group received basic isometric and active range of motion exercises; the experimental group received strength and postural stability exercises.

Results: There was a statistically significant improvement in all measures of self-perceived function, muscle strength (hip flexors, 24.4%; hip extensors, 47.8%; hip abductors, 41.2%; knee extensors, 23.4%), and postural stability (36.8%) in the experimental group and no significant change in the control group. Neither group had statistically significant changes in fear of falling measures.

Conclusions: An exercise program emphasizing weight bearing and postural stability significantly improved muscle strength, postural stability, and self-perceived function in patients 4 to 12 months after THA.

2004-07-26T20:58:00.000-04:00

An Analysis of the Relationship Between Activity and Pain in Chronic and Acute Low Back Pain

We found that during the first 7 days of acute low back pain, there was a significant (P < 0.01) degree of cross-correlation between activity and pain. On average, pain followed activity by approximately 30 min. As these patients improved and reported less pain, the relationship between activity and pain disappeared. There was no such relationship at any point among the patients with chronic low back pain.

2004-07-26T19:45:00.000-04:00

Ohio physical therapists getting direct patient access

Ohio is the 48th state to give patients direct access to physical therapists, but its law has a few caveats. After the initial evaluation, the physical therapist must inform the patient's physician of his or her findings within five days. And if there is no substantial progress in the patient's condition after 30 days, the physical therapist must consult with or refer the patient to a doctor.

I think the Canadian public health care system would benefit greatly from such rules - applicable to hospitals and private clinics. Insurance companies would also likely benefit such rules. These rules seem quite realistic to me.

Molly A. Katz, MD, president-elect of the Ohio State Medical Assn., said the new law is a disservice to the public. "We believe patients need a medical diagnosis before any physical therapy is begun," Dr. Katz said. "Physical therapy is very important, and it should be done in collaboration with a physician. That's the bottom line."

99% of the referrals we receive from doctors state "shoulder pain" or "sciatica" or "knee replacement" or some such ambiguous "diagnosis" - more a "chief complaint" or "surgical history", which physios (and even patients) are quite capable of identifying, or, the diagnoses that are included are more often wrong. Physios are capable of developing their own treatment plan based on their clinical findings (there's nothing more annoying that a referral for "ultrasound for back pain"!) I agree that a diagnosis often cannot be made without consulting the physician, but the corollary is also true (the physician will often not make an accurate diagnosis without consulting the physio). We are a team of compatible cooperative professionals - we each work best when we work together. Direct access should never be seen as excluding the other, but rather allowing access to either side of the team to improve service provision for each.

2004-07-25T19:51:00.000-04:00

Patients With Chronic Neck Pain Demonstrate Altered Patterns of Muscle Activation During Performance of a Functional Upper Limb Task.

A general trend was evident to suggest greatest electromyograph amplitude in the sternocleidomastoid, anterior scalenes, and left upper trapezius muscles for the whiplash-associated disorders group, followed by the idiopathic group, with lowest electromyographic amplitude recorded for the control group. A reverse effect was apparent for the right upper trapezius muscle. The level of perceived disability (Neck Disability Index score) had a significant effect on the electromyographic amplitude recorded between neck pain patients.

Conclusions. Patients with neck pain demonstrated greater activation of accessory neck muscles during a repetitive upper limb task compared to asymptomatic controls. Greater activation of the cervical muscles in patients with neck pain may represent an altered pattern of motor control to compensate for reduced activation of painful muscles. Greater perceived disability among patients with neck pain accounted for the greater electromyographic amplitude of the superficial cervical muscles during performance of the functional task.

2004-07-25T19:36:00.000-04:00

Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching

CRPNF (contract-relax proprioceptive neuromuscular facilitation) stretching using submaximal contractions is just as beneficial at improving hamstring flexibility as maximal contractions, and may reduce the risk of injury associated with PNF stretching.

2004-07-22T19:16:00.000-04:00

Surgical reconstruction for chronic lateral instability of the ankle

2004-07-22T19:13:00.000-04:00

The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: Results of a prospective, randomized study

This prospective, randomized trial was performed to compare the results of treating subacromial impingement syndrome of the shoulder by a guided self-training program with the treatment by conventional physiotherapy or a functional brace. Sixty patients with the diagnosis of an outlet impingement syndrome of the shoulder (Neer I and II) were treated either by strengthening the depressors of the humeral head with a guided self-training program, by conventional physiotherapy, or by wearing a functional brace. The Constant-Murley score was assessed after 6 and 12 weeks. Shoulder pain was monitored with a visual analog scale. All three groups showed a significant improvement in shoulder function as well as a significant reduction in pain. There were no statistically significant differences among the groups. Guided self-training can lead to results similar to those of conventional physiotherapy. The comparable effect of the functional brace remains unclear and might be explained by an influence on proprioception.

What the heck is "conventional physiotherapy"? Modalities? I should hope that's not the perception. Personally, my physiotherapy includes the aforementioned program of strengthening the depressors of the humeral head (and I'd imagine that a instructed and reviewed program would be superior to a self-training program).

2004-07-22T19:11:00.000-04:00

Cost-Effectiveness of Low-Level Heat Wrap Therapy for Low Back Pain

Economic evaluation of this study suggests that the NHS cost of introducing heat wrap therapy in place of oral analgesics would be modest and heat wrap therapy might potentially reduce the total cost of managing episodes of lower back pain.

2004-07-22T19:08:00.000-04:00

Are changes in fear-avoidance beliefs, catastrophizing, and appraisals of control, predictive of changes in chronic low back pain and disability?

Interventions for chronic low back pain (CLBP) often attempt to modify patients' levels of catastrophizing, their fear-avoidance beliefs, and their appraisals of control. Presumably, these interventions are based on the notion that changes in these cognitive factors are related to changes in measures of adjustment. The aim of the present study was to explore whether changes on these cognitive factors were related to changes in CLBP and disability. Fifty-four CLBP patients completed a series of self-report measures prior to beginning a cognitive-behavioral based intervention and again upon discharge. Change scores (post-treatment score minus pre-treatment score) were calculated for each of the self-report measures. The study found that changes in the cognitive factors were not significantly associated with changes in pain intensity. In contrast, reductions in fear-avoidance beliefs about work and physical activity, as well as increased perceptions of control over pain were uniquely related to reductions in disability, even after controlling for reductions in pain intensity, age and sex. The final model explained 71% of the variance in reductions in disability.

2004-07-22T19:06:00.000-04:00

Interventions for treating mallet finger injuries (Cochrane Review)

There was insufficient evidence from comparisons tested within randomised trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury. There was a useful reminder that splints used for prolonged immobilisation should be robust enough for everyday use, and of the central importance of patient adherence to instructions for splint use. There was insufficient evidence to determine when surgery is indicated.

Sometimes insufficient evidence is as (or more) important to be aware of as significant results.

2004-07-22T19:04:00.000-04:00

The Effect of Bracing on Patella Alignment and Patellofemoral Joint Contact Area.

Large changes in pain and contact area occurred without sizable changes in patellar alignment. The results of this study suggest that changes in patellar alignment by itself may not be responsible for pain alleviation after patellar bracing.

2004-07-12T21:41:00.000-04:00

Disability, Arthritis, and Body Weight among Adults 45 Years and Older

Class 3 obesity (BMI 40) was significantly associated with disability among participants both with and without self-reported arthritis. The adjusted odds ratio (AOR) for disability in participants with class 3 obesity was 2.75 [95% confidence interval (CI) = 2.22 to 3.40] among those with self-reported arthritis and 1.77 (95% CI = 1.20 to 2.62) among those without self-reported arthritis compared with those of normal weight (BMI 18.5 to <25). Persons with self-reported arthritis who were obese, class 2 (BMI 35 to <40) and obese, class 1 (BMI 30 to <35) and women with self-reported arthritis who were overweight (BMI 25 to <30) also had higher odds of disability compared with those of normal weight [AOR = 1.72 (95% CI = 1.47 to 2.00), AOR = 1.30 (95% CI = 1.17 to 1.44), and AOR = 1.18 (95% CI = 1.06 to 1.32), respectively].

Discussion: Our findings reveal that obesity is associated with disability. Preventing and controlling obesity may improve the quality of life for persons with and without self-reported arthritis.

2004-07-10T09:15:00.000-04:00

The Painful Scapulothoracic Articulation: Surgical Management.

To clarify the indications and effectiveness of surgical decompression for scapulothoracic bursitis, 16 patients were evaluated, who during a 5-year period, had surgical treatment of refractory pain and snapping in the scapulothoracic region. Twelve women and four men with a mean age of 41 years had one of five methods of surgical decompression of the scapulothoracic articulation. Six patients had an open resection of the scapulothoracic bursa with excision of the superomedial portion of the scapula, two had this procedure using an arthroscopic method, and six had a combined approach with arthroscopic scapulothoracic bursectomy and open resection of the superomedial scapula through a small incision. One patient had an arthroscopic and one an open scapulothoracic bursectomy only. At final followup of an average of 36 months (range, 24-69 months), 81% of patients reported satisfaction with the procedure and indicated they would have it again based on the relief they obtained from pain. The Simple Shoulder Test was 9.8 (range, 2-12). Although there was no statistical difference in the success using any given technique, we thought that the combined open and arthroscopic approach was the most effective, and surgical treatment is an acceptable method for treatment of refractory painful scapulothoracic bursitis.

2004-07-10T09:13:00.000-04:00

Osteoarthritis in the Carpometacarpal Joint of the Thumb: Prevalence and Associations with Disability and Mortality

The age-adjusted prevalence of thumb carpometacarpal osteoarthritis of Kellgren grade 2, 3, or 4 was 7% for men and 15% for women. After adjustment for age, sex, and other alleged risk factors, body mass index was found to be directly proportional to the prevalence of thumb carpometacarpal osteoarthritis in both sexes. The adjusted odds ratio was 1.29 (95% confidence interval, 1.15 to 1.43) per 5-kg/m2 increment in body mass index. No significant association was found between the physical workload history and thumb carpometacarpal osteoarthritis. Restricted mobility of the thumb and local tenderness and swelling were frequently found in conjunction with radiographic evidence of thumb carpometacarpal osteoarthritis. Advanced (grade-3 or 4) thumb carpometacarpal osteoarthritis predicted the total mortality rate in men (adjusted relative risk, 1.32; 95% confidence interval, 1.03 to 1.69). Radiographic signs of thumb carpometacarpal osteoarthritis did not predict work disability.

Conclusions and Clinical Relevance: Obesity is a strong determinant of thumb carpometacarpal osteoarthritis in both sexes. The effect of thumb carpometacarpal osteoarthritis on disability and mortality in the general population is modest. Because of the rarity of ensuing disability, carpometacarpal osteoarthritis of the thumb is likely to be underdiagnosed in clinical practice.

2004-07-10T08:57:00.000-04:00

Does a pre-operative exercise programme improve mobility and function post-total knee replacement: a mini-review

Both studies found that there was no significant impact on function or mobility. However, both had a number of methodological weaknesses which meant that the findings must be viewed with extreme caution. It was concluded that it was not possible to answer the question posed based on this review. Implications of this for practice are considered.

2004-07-10T08:55:00.000-04:00

A cohort study of 7 day a week physiotherapy on an acute orthopaedic ward

For the total patient cohort, no statistically significant differences were detected between groups for average length of stay (ALOS) or time to achieve independent transfers and mobility. However, intervention patients with a fractured ankle had a significantly shorter ALOS (p=0.05) and achieved independent mobility sooner than the control group (p=0.03). Intervention patients admitted for a total knee replacement achieved independent transfers significantly sooner that control patients (p=0.04). Clinically significant improvements were demonstrated in a number of other diagnostic subgroups. A large number of patients in both groups experienced a delayed discharge for organisational reasons, but the proportion was significantly higher in the intervention group (p<0.001). This study provides some evidence of the effectiveness of 7 day a week physiotherapy in reducing average length of stay and attaining functional goals sooner for certain diagnostic subgroups. With a larger study, benefits may be demonstrated for a wider range of patients. To maximise the benefits of 7 day a week physiotherapy, organisational delays to discharge need to be minimised.

2004-07-09T20:43:00.000-04:00

The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: A longitudinal analysis

Radiologic progression is not linear in individual patients. Fluctuations in disease activity are directly related to changes in radiologic progression, which supports the hypothesis that disease activity causes radiologic damage. This relationship might only exist in RF-positive patients.

2004-07-09T20:41:00.000-04:00

Preoperative Factors Associated with Improvements in Shoulder Function After Humeral Hemiarthroplasty

The preoperative absence of erosion of the glenoid was associated with greater improvement in shoulder function and level of comfort after hemiarthroplasty (p < 0.001). Shoulders that had not had previous surgery had greater functional improvement than did those that had previous surgery (p = 0.012). Shoulders with an intact rotator cuff showed significantly (p < 0.5) greater improvement in the ability to lift weight above shoulder level after hemiarthroplasty (p <0.5). With regard to diagnoses, shoulders with rheumatoid arthritis, capsulorrhaphy arthropathy, and cuff tear arthropathy had the least functional improvement, whereas those with osteonecrosis (p = 0.0004) and with primary (p = 0.02) and secondary degenerative joint disease (p = 0.03) had the greatest improvement. Patient age and gender did not significantly affect the outcome.

Conclusions: These results suggest that the functional improvement following humeral hemiarthroplasty is related to factors that are identifiable before surgery. These data may be of benefit in preoperative discussions with patients who have a shoulder disorder and are considering treatment with hemiarthroplasty.

2004-07-09T20:40:00.000-04:00

Varus-valgus alignment in the progression of patellofemoral osteoarthritis

Lateral PF OA progression, which occurred in 120 (30%) of 397 knees, was more common than was medial PF OA progression, which occurred in 60 knees (15%). Varus (versus nonvarus) alignment increased the odds of PF OA progression isolated to the medial PF compartment (adjusted OR 1.85, 95% confidence interval [95% CI] 1.00-3.44). Valgus alignment increased the odds of PF OA progression isolated to the lateral compartment (adjusted OR 1.64, 95% CI 1.01-2.66).

Conclusion: Lateral PF OA progression was more common than medial progression, and varus-valgus alignment influenced the likelihood of PF OA progression in a compartment-specific manner. Interventions that address the stress imposed by alignment on the PF compartments may delay PF OA progression and should be developed.