Category: Research

Here is a very recent – Oct. 2006 study published in the highly respected BMJ – BMJ. 2006 Oct 20; [Epub ahead of print]

This study authors from Primary Care Musculoskeletal Research Centre, Keele University, worked to evaluate the effectiveness of two primary care strategies for delivering evidence based care to people aged 55 or over with knee pain: enhanced pharmacy review and community physiotherapy.

The intervention for almost 300 patients was as following: Enhanced pharmacy review (pharmacological management in accordance with an algorithm); community physiotherapy (advice about activity and pacing and an individualised exercise programme); control (advice leaflet reinforced by telephone call).

The outcome measure was : Change in Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months.

Some results: Compared with control, mean differences in change scores for physiotherapy were 1.15 (95% confidence interval 0.2 to 2.1) for pain and 3.99 (1.2 to 6.8) for function; those for pharmacy were 1.18 (0.3 to 2.1) for pain and 1.80 (-0.8 to 4.5) for function. However, these differences were not sustained to six or 12 months.

Moreover, significantly fewer participants in the physiotherapy group reported consulting their general practitioner for knee pain in the follow-up period, and use of non-steroidal anti-inflammatory drugs was lower in the physiotherapy and pharmacy groups than in the control group.

The authors concluded that:” Evidence based care for older adults with knee pain, delivered by primary care physiotherapists and pharmacists, resulted in short term improvements in health outcomes, reduced use of non-steroidal anti-inflammatory drugs, and high patient satisfaction. Physiotherapy seemed to produce a shift in consultation behaviour away from the traditional general practitioner led model of care.”

The free full text for this article is available via BMJ here.

Here is an interesting study published in the venerable BMJ, in the very recent Sep 29; 2006 issue. This study objectives were to investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.

They worked with almost 200 patients and introduced eight sessions of physiotherapy; corticosteroid injections; or wait and see. They measured: global improvement, grip force, and assessor’s rating of severity measured at baseline, six weeks, and 52 weeks.

Results: “Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.”

The Australian authors from the School of Health and Rehabilitation Sciences, University of Queensland, concluded that: “Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.”

You can read the free full text for this article here

The last issue of the Journal of Manual & Manipulative Therapy (Volume 14, Number 3) is online now – http://jmmtonline.com/current/

As usual, there is a lot of free content provided by the journal’s editorial team, including two video files on Upper Thoracic Extension Thrust Manipulation and Supine Cervical Flexion Rotary Thrust Manipulation.

Take a look!

This a new paper published in the recent <Med Teach. 2006 Feb;28(1):e32-9 by Allan Ward and Jackie Gracey from the School of Health Sciences, University of Ulster, Northern Ireland.

The paper authors were interested in reflective practice within physiotherapy education as a method for reducing the ‘theory-practice gap’ and as a means of articulating, exposing and developing knowledge embedded in practice.

Consent for the study was obtained via the professional body (The Chartered Society of Physiotherapists) (CSP) and data was collected via postal questionnaire.

Results indicated a diversity of experience in respondents both in terms of their role as Coordinator and their training in reflective practice. There was also no clear consensus regarding facilitative models or assessment methods even though the majority of coordinators believed that reflective practice should be considered to be a central component of physiotherapy teaching strategies.

The authors concluded that: “The results of this survey provide a focus for further empirical research into reflective practice as part of the physiotherapy curricula, while advancing the understanding of reflective practice from a broader perspective and clarifying the benefits to students, teachers, patients and practitioners.”

If interested, please find the full text of this paper here [PDF, 155KB]

This very recent article by Ross Iles and Megan Davidson from School of Physiotherapy, La Trobe University, Australia, published in the very recent issue of Physiotherapy Research International (PHYSIOTHER RES INT), 2006; 11(2): 93-103, worked to investigate Australian physiotherapists’ self-reported practice, skills and knowledge of evidence-based practice and to examine differences between recent and experienced graduates, physiotherapists with low and high levels of training and physiotherapists working in private practice and hospital settings.

A survey was sent to 230 physiotherapists working in hospitals and in private practice. One hundred and twenty-four were completed and returned.

Despite the findings that approx 70% of respondents said they frequently (at least monthly) read research literature, only 10.6%, 15.3% and 26.6% of respondents, respectively, searched PEDro, Cochrane and Medline or Cinahl databases frequently, and only 25.8% of respondents reported critically appraising research reports.

Does it surprise you? How often do you search these resources to stay up-to-date with your practice. Okay, I know most of you don’t have access to CINAHL, Cochrane or MEDLINE, however, PubMed and PEDro are FREE!

Interestingly, recent graduates rated their evidence-based practice skills more highly than more experienced graduates, but did not perform evidence-based practice tasks more often.

Physiotherapists with higher levels of training rated their evidence-based practice skills more highly, were more likely to search databases and to understand a range of evidence-based practice terminology than those with lower levels of training.

Intriguingly, private practice and hospital physiotherapists rated their evidence-based practice skills equally and performed most evidence-based practice activities with equal frequency.

The authors concluded that: “Respondents had a positive attitude toward evidence-based practice and the main barriers to evidence-based practice were time required to keep up to date, access to easily understandable summaries of evidence, journal access and lack of personal skills in searching and evaluating research evidence. Efforts to advance evidence-based practice in physiotherapy should focus on reducing these barriers.”

Excellent study , really, and it emphasizes once again what we are trying to do here at our partnership between PABC and UBC. My mandate is to help you with your evidence based needs: research, practice, teaching and learning.

We have workshops that cover PubMed from EBP perspective, I do tons of research questions for you and much more. Even this blog is supposed to satisfy some of your EBP needs 🙂 Have you noticed that?

A new study published in the newest issue of Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27 – “The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study” was conducted with the aim of determining the efficacy of 300 mW, 830 nm laser in the management of chronic neck pain.

The primary outcome measure was change in a 10 cm Visual Analogue Scale (VAS) for pain. Secondary outcome measures included Short-Form 36 Quality-of-Life questionnaire (SF-36), Northwick Park Neck Pain Questionnaire (NPNQ), Neck Pain and Disability Scale (NPAD), the McGill Pain Questionnaire (MPQ) and Self-Assessed Improvement (SAI) in pain measured by VAS.

The mean VAS pain scores improved by 2.7 in the treated group and worsened by 0.3 in the control group . Interestingly, significant improvements were seen in the active group compared to placebo for SF-36-Physical Score (SF36 PCS), NPNQ, NPAD, MPQVAS and SAI. The results of the SF-36 – Mental Score (SF36 MCS) and other MPQ component scores (afferent and sensory) did not differ significantly between the two groups.

The authors have concluded that : “Low-level laser therapy (LLLT), at the parameters used in this study, was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.”

Thanks to Marj Belot for suggesting this study from her perspective 🙂

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!