Impressive effects identified in the latest research
Editor Clinical Associate Professor Mark Elkins summarises the research in the latest issue of the Journal of Physiotherapy.
The April issue of the Journal of Physiotherapy contains research into the physiotherapy management of sciatica, assessment of physiotherapy students on clinical placements, and early mobilisation in the intensive care unit.
Some of the other studies in this issue are highlighted in more detail below.
Physiotherapy intervention gets people off the waiting list for carpal tunnel surgery
Carpal tunnel syndrome can cause pain, sensory disturbance and sometimes weakness, typically in the median nerve distribution.
Surgical decompression of carpal tunnel syndrome brings long-term improvement but waiting times for the procedure in the public healthcare system are typically long. Many developed countries have large waiting lists for the surgery.
To intervene in this situation, a group of researchers from Australia, the Netherlands and the UK collaborated on a trial to determine whether physiotherapy could improve the symptoms of people awaiting carpal tunnel surgery.
The intervention they tested was a combination of education, night splinting and home exercises provided at a single group appointment and continued as a home-based program. The education included a presentation and booklet regarding carpal tunnel syndrome pathophysiology, treatment options (conservative management and surgery), posture and activity-modification principles.
The presentation and booklet are available in the published paper.
This combined intervention reduced progression to surgery. At 24 weeks, conversion to surgery was 59 per cent in the experimental group and 80 per cent in the control group. More patients in the experimental group identified as improved at six weeks: 20 versus four per cent. No serious adverse effects were reported.
Electrical muscle stimulation during haemodialysis improves functional capacity and strength
Haemodialysis is being used to manage the growing number of people with end-stage renal disease. The level of daily physical activity of people who require haemodialysis is generally lower than that of their healthy peers, especially on dialysis days, so they typically develop a marked deterioration of functional capacity. Voluntary exercise is not always feasible for these patients.
A group of researchers in Spain conducted a systematic review of trials of electrical neuromuscular stimulation during dialysis. Intradialytic muscle stimulation improved functional capacity (31 metres on 6-minute walk test), peak workload, and muscle strength. It also appears to improve some aspects of quality of life. No clear effects on cardiovascular or biochemical outcomes were identified, but it can be delivered without adverse effects.
Although the results supported the efficacy of electrical stimulation, the authors reinforce that voluntary physical exercise should be performed whenever possible.
They also discuss that the application of neuromuscular electrical stimulation superimposed onto voluntary physical exercise could provide greater benefits than the latter alone in this population, and this could be the topic of further investigation.
Mobilisation with movement improves outcomes after distal radius fracture
Distal radius fracture is the most common fracture in the elderly and it increases in incidence and costs are predicted for the coming decades.
Systematic reviews conclude there is insufficient evidence to determine the best rehabilitation following a distal radius fracture. There is some evidence that exercise or joint mobilisations might improve outcomes after cast removal for a distal radius fracture.
Physiotherapists in Australia and Denmark collaborated on a multicentre trial to see if outcomes after distal radius fracture could be improved.
The control group in their trial used upper limb range of motion exercises twice daily and were provided advice about swelling control, skin care, gradually increasing use of the upper limb during activities of daily living. The experimental group received the same exercises and advice, plus ‘mobilisation with movement’ to improve range in supination and wrist extension.
At four weeks, adding the mobilisation with movement caused supination to improve by 12 degrees more, wrist extension by 14 degrees more, wrist flexion by nine degrees more, and patient-reported measures of their symptoms, function and improvement. Benefits were still evident at 12 weeks for supination, extension and flexion. When patient-reported measures were reassessed at six and 12 months, the control had ‘caught up’ to achieve similar ratings.
Nevertheless, the greater improvement in the experimental group in the short term indicates months with greater range and function and less severe symptoms.
The April issue also contains a diverse range of appraisal items, including critically appraised papers, clinimetric summaries, and appraisals of clinical practice guidelines. Go to journal.physio to read the research.
About the author
Clinical Associate Professor Mark Elkins, APAM, is the scientific editor of Journal of Physiotherapy. Follow him on Twitter @JOP_Editor and follow the Journal of Physiotherapy @JPhysiotherapy.
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