Clear answers to clinical questions

window covered with soap being cleaned by squeegee

Clear answers to clinical questions

window covered with soap being cleaned by squeegee

JOURNAL OF PHYSIOTHERAPY The April issue of the Journal answers some important questions about clinical physiotherapy practice, writes the scientific editor, Mark Elkins.

Is remotely delivered physiotherapy as good as face-to-face physiotherapy for musculoskeletal conditions?

A trial in Sydney randomised 210 musculoskeletal outpatients to either face-to-face physiotherapy for six weeks or one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at two and four weeks and an individualised home exercise program delivered through an app. 

The trial showed that the two formats for delivering physiotherapy had very similar effects on functional limitations. 

The results also showed no clinically important differences in the two formats’ effects on kinesiophobia, pain, global impression of change and quality of life. 

The authors conclude that moving people with musculoskeletal conditions away from a heavy reliance on regular face-to-face physiotherapy can help reduce waiting lists and benefit individuals who have difficulty travelling to physiotherapy appointments, such as those in rural locations or with limited mobility.

Does a regimen of abdominal and pelvic floor muscle exercises during pregnancy worsen diastasis recti abdominis? 

Pregnancy-related diastasis recti abdominis is caused by the growing foetus stretching both the connective tissue and adjacent abdominal muscles, which occurs during the second and third trimesters. 

Although the diastasis naturally resolves in many women, one-third still have persistent diastasis recti abdominis a year later and incur a greater risk of experiencing urinary incontinence, pelvic girdle pain and low back pain

To date, pregnant women are advised against strengthening exercises involving the recti abdominis muscles, as it is thought that these exercises may increase the diastasis; however, the evidence is unclear. 

A new clinical trial from Norway randomised 96 pregnant women with diastasis recti abdominis to a 12-week abdominal and pelvic floor muscle exercise program during pregnancy or to no intervention. 

The exercises had a negligible effect on the diastasis—not improving it but also not making it worse—at the end of the exercise program and also at six weeks postpartum. 

Therefore, the authors conclude that it is safe for pregnant women with diastasis recti abdominis to perform both abdominal and pelvic floor exercises during pregnancy.

Which types of exercise best improve fitness, quality of life and mortality in people with coronary heart disease?

Physiotherapists in Brazil and Australia collaborated on a systematic review to address this question, entering all exercise types in a network meta-analysis to judge the most effective type. 

Most exercise types had some benefit. 

Peak oxygen consumption was best improved by high-intensity interval training, water-based exercise combined with moderate-intensity continuous training, combined aerobic and resistance exercise, and moderate-intensity continuous training. 

Health-related quality of life was best improved by yoga and combined aerobic and resistance exercise

Survival was increased the most by continuous aerobic exercise and combined aerobic and resistance exercise.

Is health coaching effective for chronic pain?

People with chronic pain who engage in regular physical activity have better outcomes than those who live a sedentary lifestyle; however, people with chronic pain engage in less physical activity than those without chronic pain. 

Providing general advice to keep active is insufficient to motivate people with chronic pain to engage in physical activity. 

Health coaching draws on evidence- based behaviour-change techniques from lifestyle medicine, health psychology and athletic performance coaching; it has been assessed for its ability to promote physical activity in the chronic pain population. 

A systematic review pooled published evidence to estimate the effect of health coaching in adults with chronic non-cancer pain.

Health coaching provided small improvements in physical activity, disability and pain in this clinical population. 

Despite the pooling of quality of life data on about 1000 participants, the effect of health coaching on quality of life remained uncertain.

What can physiotherapists do to treat the sequelae of breast cancer?

Clinical Associate Professor Mark Elkins APAM

Breast cancer treatments often lead to long-term physical sequelae including pain, upper limb dysfunction, axillary web syndrome, local sensory changes and fatigue. 

An Invited Topical Review from the Netherlands highlights many physiotherapy interventions that are effective for managing these issues. 

Effective interventions for pain include specific exercise therapy, Pilates and mobilisations. 

Upper limb dysfunction can be reduced with general and specific exercise therapy, Pilates and tai chi. 

It is cancer-related fatigue, though, that has the greatest number of effective interventions: education, supervised general exercise, unsupervised general exercise, massage and mind–body exercise such as yoga and tai chi.

The April issue also contains a diverse range of appraisal items, including critically appraised papers, summaries of the clinimetric properties of measurement tools and appraisals of clinical practice guidelines.

Head to to read the research.

>>Clinical Associate Professor Mark Elkins APAM is the scientific editor of Journal of Physiotherapy

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