Expanding on the research
Mark Elkins outlines what is on offer in the April issue of Journal of Physiotherapy.
Tablet-based exercises improve function after carpal tunnel surgery In carpal tunnel syndrome, raised pressure in the carpal tunnel causes compression and impaired perfusion of the median nerve, resulting in discomfort and paraesthaesia in the hand. Conservative treatments are recommended as initial management, whereas surgical decompression of the carpal tunnel is generally recommended in refractory cases. International guidelines recommend that exercises should be considered in the postoperative period, but there is insufficient evidence to say what the exercise program should be.
A new piece of evidence that we can add to this puzzle is the study by Jesús Blanquero Villar and colleagues from Spain. They conducted a randomised trial involving 50 people who had undergone surgical carpal tunnel release within the previous 10 days. Half were allocated to a control group, who were provided with a four-week exercise program. Prescribed on paper, these exercises included active range of motion exercise for all upper limb joints, with a greater focus on the wrist and hand. In contrast, the experimental group were prescribed their exercise program via an app downloaded to their tablet device.
These active exercises, which emphasised control, dexterity and range, were performed on the screen of the tablet device by following the movement of on-screen targets with the fingertips. The app calibrates to the size of each participant’s hand and monitors their progress to ensure appropriate targets. At the end of the four-week intervention period, the experimental group had improved significantly more than the control group, with an average of 21 points greater improvement on the 100-point functional ability score. For details of the app, see the open-access full-text version of the paper.
Aquatic exercise is particularly beneficial for some outcomes in Parkinson’s disease
Various forms of land-based exercise have been shown to be beneficial for people with Parkinson’s disease. Water-based exercise has also become a popular alternative format for exercise, and several trials have compared the relative efficacy of aquatic exercise and land-based exercise. A new systematic review by Lucia Cugusi and colleagues from Italy has summarised this evidence.
Aquatic exercise gave additional benefit over land-based exercise on three outcomes: balance capacity, fear of falling, and health-related quality of life. However, the magnitude of each extra benefit may be small. For other outcomes, aquatic exercise had effects that were very similar to the effects of land-based exercise. The authors concluded that, if people with Parkinson’s disease prefer the aquatic setting and have the possibility to carry out a rehabilitation program in a hydrotherapy pool, then they can accept that format knowing that it is not inferior to land-based exercise. When there is a choice of a land-based program or an aquatic program, choosing the latter may be justifiable based on the anticipated extra benefits listed above. However, patients should be advised that the additional benefits may be small, so this should be weighed against any potential extra costs, inconvenience or complexity of the aquatic format.
Massage after habitual exercise reduces pain but may not affect fatigue, mood, or muscular performance
In sports, massage is often used to reduce pain and promote physical recovery. Massage can reduce pain and fatigue after very intense, prolonged exercise. However, the effects of massage after a habitual exercise session have had less investigation.
A new randomised trial by Paula Urio Bender and colleagues from Brazil studied massage in 78 recreational runners. After a habitual 10-kilometre run, massage therapy applied to the quadriceps muscle reduced the intensity of pain, but the effect was mild and may not be considered clinically worthwhile by many people.
Massage did not substantially affect fatigue, mood, quadriceps muscle flexibility, knee extension strength or vertical jump performance. Therefore, recreational athletes could be advised that, while massage can be expected to reduce their pain intensity, it is likely that the effect will be mild and physical performance will not be improved. Some may enjoy the massage as a ‘reward’ after exercise, and not be concerned about the magnitude of the pain reduction. Such people may choose to receive massage and certainly the confidence intervals on all outcomes in the study indicated that no substantial detriment would be anticipated.
However, recreational athletes who seek to use massage after habitual exercise as a means to hastening recovery and restoration of muscular function should be advised that such effects would not be anticipated.
Go to journalofphysiotherapy.com to access these and all previously published papers.
Clinical Associate Professor Mark Elkins, APAM, is the scientific editor of Journal of Physiotherapy.
Follow him on Twitter @JOP_Editor.
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