Lung ultrasound offers physiotherapists greater diagnostic accuracy than auscultation or chest radiograph in ventilated patients

Physiotherapists in intensive care need to diagnose lung problems (such as pleural effusion, consolidation, and atelctasis or lung collapse) in order to apply appropriate interventions.

Traditionally, physiotherapists have relied  heavily on lung auscultation via a stethoscope or portable chest radiography. Both of these traditional diagnostic tools have questionable accuracy.

A new systematic review by Louise Hansell and colleagues from Sydney has examined the diagnostic accuracy of a new tool—point-of-care lung ultrasound.

These authors identified seven relevant diagnostic accuracy studies, which provided data on 466 participants.

By statistically pooling the results of these studies where possible, the authors were able to show that lung ultrasound has superior diagnostic accuracy to chest radiograph in assessing lung consolidation and pleural effusion in intubated and mechanically ventilated patients.

This is good news for physiotherapists and patients.

Lung ultrasound is readily available and does not expose patients to radiation.

The review also identified a lack of evidence in support of the diagnostic accuracy of auscultation for these pathologies.

Based on this evidence, the authors recommend that lung ultrasound should be considered as an adjunct to  usual bedside respiratory assessment tools used by physiotherapists in the differential diagnosis of common lung complications in intubated and mechanically ventilated patients.

The authors foresee further research into implementing lung ultrasound as standard clinical practice for physiotherapists in the intensive care unit.

Physiotherapy students achieve comparable performance on clinical placements in public and private sectors

Over 70 per cent of Australian physiotherapists now work within the private sector, yet only a minority of physiotherapy students undertake a clinical placement in the private sector during their training.

Macquarie University has sought to better align clinical education with the current and future physiotherapy workforce requirements by deliberately ensuring that roughly half of their clinical placements occur in the private sector.

In a recent analysis of the outcomes of these clinical placements, Vidya Lawton and colleagues from Macquarie University examined whether student performance differs depending on whether a clinical placement occurs in the private or public sector.

There were negligible differences between private and public sector placements in overall performance, employability skills and clinical skills.

There were also no important differences in clinical performance between the Macquarie University students and graduate-entry students at other Australian universities, many of which appear to provide substantially fewer clinical placements in the private sector.

Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes

Survival rates for cancer are increasing. With this improved survivorship, there is a need to provide interventions to mitigate negative cancer treatment effects and prevent future disease and cancer recurrence.

Among the most commonly reported issues for cancer survivors are physical problems such as pain and fatigue, and psychosocial problems such as fear of recurrence.

Cancer survivors also have an increased risk of developing secondary comorbidities such as cardiovascular disease.

Exercise-based rehabilitation is intended to intervene in this situation to maintain or restore function, reduce symptom burden, maximise independence and improve quality of life.

This form of rehabilitation can be supplemented by contributions from other healthcare professionals such as dietitians and nurses.

Amy Dennett and collagues from Melbourne reviewed the evidence about the multidisciplinary rehabiltiation programs. They identified 17 relevant trials with data on 1962 cancer survivors.

Multidisciplinary, exercise-based rehabilitation increased muscle strength, improved performance on functional strength tests, and reduced depression.

Adherence was typically high. However, there was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on health service outcomes.

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Clinical Associate Professor Mark Elkins, APAM, is the scientific editor of Journal of Physiotherapy. Follow him on Twitter @ JOP_Editor and follow Journal of Physiotherapy @ JPhysiother.