Author: Eugene Barsky

In a study, published in the J Am Geriatr Soc. 2004 July; 52(7): 1114–1120, which became available for free @ PubMed Central on May 1, 2006, researchers wanted to examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture.

In a prospective, multisite observational study (please note that this was not a randomized controlled trial, and therefore its results have less validity!), they worked with four hundred forty-three (443) hospitalized older patients discharged after surgery for hip fracture in 1997–98.

Measurements included patient demographics, fracture type, comorbidities, dementia, number of new impairments at discharge, amount of PT between day of surgery and postoperative day (POD) 3, amount of therapy between POD 4 and 8 weeks later, and prefracture, 2-, and 6-month mobility measured using the Functional Independence Measure.

Some of the interesting results included the following: “More PT immediately after hip fracture surgery was associated with significantly better locomotion 2 months later. Each additional session from the day of surgery through POD3 was associated with an increase of 0.4 points (P = .032) on the 14-point locomotion scale, but the positive relationship between early PT and mobility was attenuated by 6 months postfracture. There was no association between later therapy and 2- or 6-month mobility.”

The authors concluded that PT immediately after hip fracture surgery is beneficial.

BTW, if you want to see some live-recorded hip replacement surgeries, check out my post from a month ago, where I pointed to full video recording of the different procedures

As always, you can read the full-text of the article here – http://tinyurl.com/lay3j or the PDF version of the article here – http://tinyurl.com/oketv (95 KB)

In a recent study, published in the Altern Ther Health Med. 2006; 12(1): 40–47., researchers from Oregon wanted to determine the effect of yoga on cognitive function, fatigue, mood, and quality of life in seniors.

They ran a randomized, controlled trial comparing yoga, exercise, and wait-list control groups with one hundred thirty-five generally healthy men and women aged 65–85 years.

Participants were randomized to 6 months of Hatha yoga class, walking exercise class, or wait-list control. Subjects assigned to classes also were asked to practice at home (may be this is the reason for the differences later on…)

There were no effects from either of the active interventions on any of the cognitive and alertness outcome measures. The yoga intervention produced improvements in physical measures (eg, timed 1-legged standing, forward flexibility) as well as a number of quality-of-life measures related to sense of well-being and energy and fatigue compared to controls.

The authors concluded that there were no relative improvements of cognitive function among healthy seniors in the yoga or exercise group compared to the wait-list control group. Those in the yoga group showed significant improvement in quality-of-life and physical measures compared to exercise and wait-list control groups.

You can read the free full text of the study here – http://tinyurl.com/o6hqt or the full text PDF here – http://tinyurl.com/o2tfx

In their recent study, C M McClellan, R Greenwood, and J R Benger from Bristol, UK, published in the very recent issue of the Emergency Medicine Journal 2006;23:384-387, worked to evaluate the effect of introducing an extended scope physiotherapy (ESP) service on patient satisfaction, and to measure the functional outcome of patients with soft tissue injuries attending an adult emergency department (ED), comparing management by ESPs, emergency nurse practitioners (ENPs), and all grades of ED doctor.

During this study, the ESP service operated on four days out of every seven in a week in an urban adult ED. A satisfaction questionnaire was sent to all patients with a peripheral soft tissue injury and fractures (not related to the ankle) within one week of attending the ED. Patients with a unilateral soft tissue ankle injury were sent the acute Short Form 36 (SF-36) functional outcome questionnaire, with additional visual analogue scales for pain, at 4 and 16 weeks after their ED attendance. Waiting times and time spent with individual practitioners was also measured.

The ESP service achieved patient satisfaction that was superior to either ENPs or doctors. Overall 55% of patients seen by the ESP service strongly agreed that they were satisfied with the treatment they received, compared with 39% for ENPs and 36% for doctors (p = 0.048). Assessment of long-term outcome from ankle injury was undermined by poor questionnaire return rates. There was a trend towards improved outcomes at four weeks in those patients treated by an ESP, but this did not achieve statistical significance.

The authors concluded that an ESP achieves higher levels of patient satisfaction than either doctors or emergency nurse practitioners in the management of soft tissue injuries and associated fractures. Much of this may be attributable to reduced waiting time and increased clinician contact for patients seeing an ESP, as well as the specialist skills of this professional group.

While this is not a gold standard RCT (randomized control trial) and while authors failed to demonstrate any significant difference in the outcome of unilateral ankle soft tissue injuries, I found this study quite interesting to share with you working in Public Practice to show that adding an extended scope physiotherapy service to the ER interdisciplinary team may achieve higher levels of patient satisfaction.

You can find FREE full-text of this study here – http://tinyurl.com/ztxbw or full text PDF here – http://tinyurl.com/khnp5