Delving into the research


Mark Elkins outlines what is on offer in the October issue of the Journal of Physiotherapy.

The October issue of the Journal of Physiotherapy contains two editorials: one examines how musculoskeletal pain care might be improved for Aboriginal and Torres Strait Islander populations, and the other takes an international perspective on integrating physiotherapists in oncology care. Each editorial has some novel ideas for how clinical physiotherapists might advance their practice in these different clinical areas. The original research papers address a wide variety of research topics to answer some important clinical questions, as summarised below.

Is a home-based exercise program effective in people with Parkinson’s disease?

This high-quality systematic review reports some good news. Based on the results of 16 trials, it provides clear evidence that home-based prescribed exercise improves balance-related activities and gait speed in people with Parkinson’s disease. The review also shows that these improvements are similar to the improvements achieved with equivalent centre-based exercise.

Can motor imagery improve balance and mobility in older adults?

Targeted balance, strength and functional training is effective in older people. Such training can be impaired or precluded in some older people, such as those with prescribed mobility restrictions after recent surgery, or with anxiety about exercising without supervision. Motor imagery training involves repetitive mental rehearsal of an action without executing that action formally. This systematic review examined trials of motor imagery training in older people without a neurological condition. The included study populations were either healthy older people or those recovering from orthopaedic surgery. Multiple sessions of mental imagery training clearly improves measures of balance and mobility. However, due to limitations in the amount and quality of the available data, it is not yet possible to confirm whether these benefits are large enough to be considered worthwhile.

Can advice from a physiotherapist increase physical activity in older hospital inpatients?

Older inpatients spend long periods resting in bed, regardless of their reason for hospitalisation. Low physical activity during hospitalisation  is associated with loss of muscle strength and function. These losses are associated with important outcomes after hospital discharge, including disability and mortality. A new randomised trial has shown that verbal and written advice to remain active during hospitalisation improves physical activity levels among older inpatients. While the size of these benefits is uncertain, they appear to be large enough to carry over into the prevention of loss of mobility.

Is short-term cryotherapy helpful for people with knee osteoarthritis?

Cryotherapy is sometimes used to treat the pain and disability of knee osteoarthritis. Clinical guidelines for osteoarthritis differ in their recommendations about cryotherapy. Recent systematic reviews conclude that further evidence about cryotherapy for knee osteoarthritis is needed. A new trial enrolled 60 people. The experimental group received cryotherapy, delivered as packs of crushed ice applied to the knee with mild compression. The control group received the same regimen but with sham packs filled with sand. The interventions were applied once a day for four consecutive days. Short-term cryotherapy was not superior to a sham intervention in terms of relieving pain or improving function and quality of life in people with knee osteoarthritis. Although cryotherapy is considered a widely used resource in clinical practice, this study does not suggest that it has an important short-term effect, when compared to a sham control.

What do physiotherapists think about managing the physical health of people with severe mental illness?

People with severe and persistent mental illness typically have poor physical health and comorbid conditions such as obesity, diabetes, and cardiovascular and respiratory disease. Physiotherapists are well trained in delivering interventions that can assist with these comorbidities and reduce the risk of future health problems. Despite this, physiotherapy has limited presence within the multidisciplinary mental health team. Physiotherapists may fail to engage with this population because of insufficient education, low confidence, health system structure, and stigmatisation of people with mental illness. Physiotherapists should seek existing training opportunities in mental health, increase their education in mental health, and address health system barriers.

Do Australian adults expect physiotherapists to provide advice about physical activity and general health?

Many adults do not achieve recommended physical activity levels. Physiotherapists can advise them about physical activity and other health behaviours to prevent and treat several conditions. Past research suggested that patients expect physical interventions more than advice about physical activity and health behaviours, and that physiotherapists perceive these expectations in their patients. A new survey, however, shows that Australian adults think that it is likely and important that a physiotherapist would provide advice about physical activity and general health behaviours. Physiotherapists should anticipate this and not hesitate to raise the topics of physical activity and general health behaviours.

Click here to access these and all previously published papers.

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

© Copyright 2018 by Australian Physiotherapy Association. All rights reserved.