Author: Eugene Barsky

This short article was published a couple of days ago in Australian family physician, 2006 Aug;35(8):599-600. The author, Jan Smith – an APA sports and musculoskeletal physiotherapist, states something we all know – that “there are many patients who can’t achieve the recommended 30 minutes of moderate walking most days in order to control their weight.” She believes that these people need an individual program designed to meet their particular needs, their body, and their environment. General practitioners can refer patients to a physiotherapist for a therapeutic exercise regimen that is evidence based and realistic.

This short opinion article is an interesting reading about working with overweight patients. You can read the free full-text of it here.

This is a study that concludes that: “study indicated that early access to physical therapy resulted in greater improvement in perceived pain at 6 months compared to later access.”

This Swedish research published in the recent issue of The Clinical journal of pain 2006 Jul-Aug;22(6):505-11, worked to evaluate the effects of early access (EA) to physical therapy treatment for patients with subacute low back pain compared to access with a 4-week waiting list.

This prospective, randomized clinical trial have had 60 patients that were randomized either to EA within 2 days for physical examination and individualized physical therapy treatment (n=32) or a control group with a 4-week waiting list (n=28).

Self-administrated questionnaires were used for assessment at inclusion, at discharge, and at 6 months. Primary outcome measure was pain intensity assessed by Borg category scale for ratings of perceived pain. Secondary outcomes included the Orebro musculoskeletal pain screening questionnaire, the Roland and Morris disability questionnaire, sick-leave, visits to health care, and physical therapy.

Interestingly, the results showed no significant differences in pain between the groups at discharge. However, at 6 months, the reduction of pain was significantly greater in the EA group compared to the control group (P=0.025).

Thanks a lot to Susan Harris who has brought this study for our attention!

Those of you interested in the history of the profession may find this recent (2005) article by Beth Linker from UPenn’s History and Sociology of Science Department to be of interest. It explores the development of post–World War I allied medical professions in the United States, and more specifically the rise of physiotherapy as it was used to rehabilitate maimed soldiers.

I only wish that more research could be done in our Canadian context about the history of the profession in this country!

To read the full PDF version of the article, please click here. Many thanks to Beth Linker for sharing the full text!

This article, published in the recent issue of Physiotherapy Research – 2006 Mar;11(1):35-47, says that “Owing to a scarcity of clinical research, evidence-based clinical guidelines are not available to guide physiotherapy rehabilitation after total knee replacement surgery. This is despite the fact that, annually, over 20 000 patients in Australia, over 300 000 patients in North America and 36 000 patients in the UK potentially require rehabilitation at this time to regain functional independence and to resume recreational and work-related physical activities”

The authors conducted a nationwide postal survey involving public and privately funded hospital physiotherapy departments survey of clinicians aimed to describe standard (usual) care after total knee replacement in Australia and to provide possible explanations for practice variance, if such variation exists.

A response rate of 65% (65/100) was obtained – an excellent result! Elements of consistency and diversity across the acute and post-acute phases were evident. Consistent findings included the provision of gait retraining and exercise prescription in the acute period, the requirement for independent ambulation as a criterion for discharge from acute care and the routine referral to ongoing outpatient or community-based physiotherapy. Less consistency was reported for the use of continuous passive motion and cryotherapy in the acute phase, the modes of ongoing rehabilitation, discharge from rehabilitation criteria and the tools for measuring outcomes. Both institutional and non-institutional factors appeared to explain the demonstrated practice variation.

The authors concluded that: “In order to propagate evidence-based practice guidelines and uniformity in care, well-designed clinical trials are required to identify cost-effective rehabilitation programmes after total knee replacement.”