Clinical implications from research in your Journal
Mark Elkins, APAM, summarises the content of the latest issue.
The July issue of Journal of Physiotherapy contains research into progressive heavy-slow resistance training for plantar fasciopathy, sit-to-stand training after stroke, and hip abductor strengthening exercises after total knee arthroplasty. Some of the other studies in this issue are highlighted in more detail below. The rest of the issue contains appraisal of research related to clinical conditions as diverse as asthma, shoulder pain, paediatric cancer, spinal stenosis, and chronic stroke. There are also two editorials. The first editorial is related to shifting societal beliefs to facilitate a truly biopsychosocial approach to pain management. The second editorial introduces DiTA, which is a new database of research into diagnostic test accuracy. All in all, a bumper issue.
What information do people with low back pain want? Although education is recommended in most clinical practice guidelines for low back pain, most guidelines do not specify what content should be included in patient education. Yuan Lim and colleagues from Melbourne and Perth reviewed the results of over 40 studies to summarise what information people with low back pain say they need. Two major areas of perceived health information needs for low back pain emerged. The first major area was needs related to information content: general information related to low back pain, its cause and underlying pathology; strong desire for diagnosis and imaging; prognosis, future disability and effect on work capacity; precipitants and management of flares; general management approaches; self-management strategies; prevention; and support services. The second major area of needs related to how the information was delivered. People with low back pain wanted clear, consistent information delivered in a suitable tone and understandable language.
What is the risk of recurrence of low back pain?
Given the evidence from the above study that people with low back pain often want to know about their prognosis, physiotherapists need to know how commonly and how quickly low back pain reoccurs and what prognostic factors there are for a recurrence of low back pain. Tatiane da Silva and colleagues from Sydney examined this in an inception cohort study with 250 participants who had recovered from an episode of low back pain within the last month. Within 12 months after recovery, about 70 per cent of participants had a recurrence of an episode of low back pain, while about 40 per cent had a recurrence of activity-limiting low back pain and about 40 per cent had a recurrence of low back pain for which healthcare was sought. The median time to recurrence of an episode of low back pain was 139 days. Frequent exposure to awkward postures, longer time sitting (more than five hours per day), and more than two previous episodes were predictive of recurrence of an episode of low back pain within 12 months. Physiotherapists can use these findings to inform people with a current or recent episode of low back pain about the likelihood of recurrence.
What do people in Transition Care and their families think about family-assisted therapy?
Transition Care provides older people who have been in hospital with low-intensity rehabilitation and other interventions to assist their return-to-community participation. Involving the family to assist in providing greater opportunities for rehabilitation (family- assisted therapy) is favourably viewed by younger people in Transition Care and their families. Recently, a trial by Katherine Lawler and colleagues from Melbourne showed that involving family members in therapy helped older people in Transition Care to improve some rehabilitation outcomes such as daily steps and the Modified Barthel Index score. However, there were important findings from the concurrent qualitative analysis of the experiences of the patients and family members who participated in the trial. People in Transition Care and their family members believed that family-assisted therapy empowered them to increase opportunities for physical activity, and that it provided physical and psychosocial benefits. Simplicity, boundaries, training and support were considered important elements of family-assisted therapy. Therefore, although the trial was designed to improve physical outcomes for patients, the most important finding was about empowerment of patients and families in an otherwise disempowering setting—reducing stress rather than increasing caregiver burden.
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