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Greetings from the sunny Vancouver,

Following Neil Pearson’s presentation on Managing Patients in Pain
at the Physiotherapy Association of British Columbia (PABC) AGM last Saturday (full-text presentation and some comments from Neil would be posted sometimes later this week), you might be interested to learn that a group of Canadian physiotherapists have recently established a Canadian Physiotherapy Pain Sciences Group – CPPSG. Neil Pearson is co-chairing this group together with Dave Walton from Ontario

This group is aspired by “promoting excellence in the management of pain by Canadian
Physiotherapists.”

The group also started to produce their own newsletter. For instance, the second newsletter (PDF format, 100KB), published during March 2006, has an interesting book reviews section and some background of the group mission.

You can also contact Diane Jacobs for more information about the group and their plans.

Right after the PABC AGM meeting last Saturday (excellent presentations by Neil Pearson and the WAD group – I will blog on these later this week – including the full presentation texts :), I just wanted to have a bit of your attention to this excellent article, written by Robert D Herbert, Chris G Maher, Anne M Moseley, and Catherine Sherrington from the School of Physiotherapy, University of Sydney, and published in the British Medical Journal (one of the five top medical journals) in 2001 – BMJ, 2001 October 6; 323(7316): 788–790.

The authors say that publication of randomised trials and systematic reviews in physiotherapy has increased spectacularly over the past few years. There were more than 2,700 randomised trials and systematic reviews in physiotherapy, of which more than 800 have been published since 1997 (till 2001). The evidence from the best of these trials confirms the value of some current physiotherapy practices and the ineffectiveness of others. Some little used interventions have been found to be remarkably beneficial.

This article describes some advances in understanding of physiotherapy that have arisen from recent clinical trials: Urinary incontinence, Movement dysfunction resulting from stroke, Acute and chronic respiratory disease, and Prevention of falls in elderly people.

Moreover, this article discusses the Centre for Evidence-Based Physiotherapy’s PEDro (Physiotherapy Evidence Database) – the major (FREE) Evidence Based Physio resource!

I will be discussing and explaining PEDro in details sometimes in the near future, however, please do take a couple of minutes to play around with this resource…you will appreciate the evidence our colleagues in Australia have collected and organized for us all!

Some additional summary points from this article include the following:
• Early provision of reassurance and advice to return to activity can prevent chronic disability associated with back pain
• Massage and electrotherapy are not useful for chronic pain, but exercise programmes can reduce disability
• Women with urinary incontinence can be helped with pelvic floor muscle training
• Multidisciplinary stroke rehabilitation programmes reduce the risk of disability and death and institutionalised care or dependency
• Prophylactic chest physiotherapy reduces postoperative complications in high risk patients
• Pulmonary rehabilitation programmes for people with asthma and chronic obstructive pulmonary disease reduce dyspnoea and increase walking distance
• Tailored exercise programmes reduce the risk of falls in elderly people

Full text of this article is available here – http://tinyurl.com/ldbhc or a PDF copy is available here – http://tinyurl.com/m27ml

I am going to blog about Neil Pearson’s approach to Managing Patients in Pain tomorrow – stay tuned 🙂

MONEY Magazine and Salary.com researched hundreds of jobs, considering their growth, pay, stress-levels and other factors. Here are the results – http://money.cnn.com/magazines/moneymag/bestjobs/top50/index.html

Physiotherapists made it to the 12th place! Huge congrates to you all 🙂 With the Average pay of US$54,883 and 10-year job growth of 36.74%, this is actually one of the best professions in the world!

Unfortunately, librarians didn’t make it even to the first 100 positions 🙁 Well, personally, I believe that this is the best job in the world, well, no comments about the pay though 🙁

To read the physiotherapy profile click here – http://money.cnn.com/magazines/moneymag/bestjobs/snapshots/12.html

Also, please note that physiotherapy is the fifth fastest-growing profession in America, and Physical Therapist Assistants is the third 🙂

Our Australian colleagues (Peter D Brukner, Kay M Crossley, Hayden Morris, Simon J Bartold and Bruce Elliott) from the Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne in their Feb. 2006 review of Recent advances in sports medicine published in The Medical Journal of Australia, have concluded that the McConnell multimodal physiotherapy regimen is effective in treating patellofemoral pain.

Overuse knee injuries are one of the most common musculoskeletal conditions presenting to general and sports medical practices. Overuse knee pain is usually anterior, inferior or retropatellar, and the most common condition responsible for this pain is patellofemoral pain (PFP).

In PFP, the pain may be localised, but is most likely to be generalised around the patella, and non-specific. It may be precipitated by an increase in the frequency or intensity of repetitive loaded activities (eg, running, walking up and down hills or stairs, squatting). Tenderness is usually localised to the retropatellar area and pain reproduced on step-up, step-down or squat.

Patellofemoral pain is not a self-limiting condition, and physiotherapy generally includes several components: retraining the VMO component, stretching, mobilisation, massage, general conditioning, taping/bracing, foot orthoses, balance training, and hip muscle training. This approach, with its emphasis on training the VMO in a weightbearing position in conjunction with taping of the patella and first described by Australian physiotherapist Jenny McConnell, has gained widespread acceptance in Australia and increasingly internationally.

Five systematic reviews of randomised controlled trials, three of which were methodologically sound, have found this multimodal physiotherapy program to be of benefit in relieving anterior knee pain. In another randomised controlled trial, a multimodal intervention resulted in an earlier onset of VMO (relative to the vastus lateralis) and improved knee flexion during stair ambulation.

You can read the FREE full-text of this interesting review here – http://tinyurl.com/ndyxd or alternatively explore the excellent (and FREE) content of The Medical journal of Australia here – http://www.mja.com.au/index.html

Does McKenzie Therapy Improve Outcomes for Back Pain?

Brian Busanich and Susan Verscheure, our neighbours from the south – the University of Oregon, Eugene – asked this clinical question in their article published in the spring 2006 issue of the Journal of Athletic Training: “What is the clinical evidence base for McKenzie therapy in management of back pain?”

The authors used a good EBP methodology, to be included in their review a study had to be: (1) the study was a randomized or quasi-randomized controlled trial, (2) the subjects’ primary complaint was nonspecific low back pain or neck pain with or without radiation to the extremities, (3) the authors investigated the efficacy of the McKenzie method/McKenzie treatment in comparison with no treatment, sham treatment, or another treatment, (4) individualized patient treatment and treatment were specified according to McKenzie principles, and (5) the authors reported at least one of the outcome measures of pain, disability, quality of life, work status, global perceived effect, medication use, medical visits, or recurrence.

The authors used 7 evidence based databases: MEDLINE, EMBASE, DARE, CINAHL, PEDro, the Cochrane Register of Clinical Trials (CENTRAL), and the Cochrane Database of Systematic Reviews – an excellent selection! I would also add SPORTDiscus to their strategy…

McKenzie therapy was compared with the following: nonsteroidal anti-inflammatory drugs, educational booklet, back massage with back care advice, strength training with therapist supervision, spinal mobilization, or general mobility exercises.

Main results included:
– Trends favored McKenzie therapy at intermediate-term (3–12 months) follow-up for pain and disability, as well as work absences.
– The McKenzie treatment group in the cervical spine study had less pain and disability at both short- and intermediate-term follow-up than did the exercise group, although the effect sizes were small. The same McKenzie treatment group tended to have fewer health care contacts in the ensuing 12 months than the comparison exercise group.

The results suggested that McKenzie therapy provides a reduction in short-term pain (mean reduction of 8.6 on a 100-point scale) compared with the therapies mentioned above.

Conclusions: This review provides evidence that McKenzie therapy results in a decrease in short-term (12 months) outcomes or outcomes other than pain and disability (eg, quality of life).

Here is the link to FREE full-text for this article published on PubMed Central – http://tinyurl.com/nzsfu , and here is the link to full-text PDF (18KB) – http://tinyurl.com/pedzc

Share your comments with others in the Comments Section 🙂

Being asked about what my sessions would include, here is what I am going to cover during our tour to Okanagan, Northern BC and Vancouver Island during the next weeks:

1) Mastering General Search Engines – one-hour workshop. During this hour we will learn how to use free general search engines (Google, Yahoo, MSN) to locate reliable health / medical physiotherapy information. We will learn how to master a general search engine of your choice (we will take Google as our example) to search for reliable health information, including grey literature; moreover I would also cover the fun things you can do with your search engine and also future directions in search.

2) Mastering PubMed for Physiotherapists – one-hour workshop. During this hour we will learn to use PubMed (U.S. National Library of Medicine – world largest biomedical database – FREE) to find high-evidence in physiotherapy and other health sciences research. This would be our major research workshop during which we will learn how to use PubMed with most of its power options, including the Medical Subject Headings (MeSH).

3) Staying up-to-date with professional information – using alerts and current awareness services – ½ hour workshop. During this short workshop, we will learn how to create alerts to professional information published in your area of practice (or interest) using three different tools: a) PubMed My NCBI – biomedical professional information; b) Google Alerts – general interest information; and c) PubSub – searching future information, which hasn’t been published yet – very cool!

For members in Lower Mainland we would have these workshops taught in small groups (7-9 people) in computer labs of UBC, Vancouver General Hospital and St. Paul’s Hospital during weekday evenings or weekends (according to your preference). Location and time would be suited to your needs and registration would be required. I intend to start running these workshops in two weeks after polishing some last content… Stay tuned 🙂

As promised earlier this week, today, I am posting some videos of live hip replacement surgeries, which were videotaped for the U.S. National Library of Medicine during the recent two years. The videos last approximately an hour.

You will need RealPlayer to view the programs. If you do not have Real Player, you will be prompted to obtain a free download of the software before you view the presentation. You can also download the RealPlayer media player at www.real.com.

Hip Replacement:

• Computer-Assisted Hip Replacement Surgery – http://tinyurl.com/qcywr (Robert Wood Johnson University Hospital, New Brunswick, NJ, 09/13/2005)

• Dual Incision MIS Hip Replacement with Stryker Navigation – http://tinyurl.com/p4vy5 (St. Cloud Hospital, St. Cloud, MN, 11/16/2004)

• Hip Replacement Surgery – http://tinyurl.com/rxy24 (Vanderbilt University Medical Center, Nashville, TN, 04/13/2005)

• Minimally Invasive Hip Replacement Surgery for Osteonecrosis – http://tinyurl.com/errff (Good Samaritan Hospital, Baltimore, MD, 07/20/2004)

• Minimally Invasive Total Hip Replacement – http://tinyurl.com/hatzo (Morristown Memorial Hospital, Morristown, NJ, 06/18/2004)

• Zimmer MIS Anterolateral Hip Procedure – http://tinyurl.com/ebdsx (Presbyterian Hospital, Albuquerque, NM, 10/06/2005)

• Zimmer Revision Hip Arthroplasty – http://tinyurl.com/eqx9h (Central Dupage Hospital, Winfield, IL, 11/11/2005)

Hope these might be of some interest to some of you 🙂