The physiotherapy profession has many effective interventions to assist people with rib fractures, making a unique contribution as part of a multidisciplinary team. 

In the Invited Topical Review, the evidence is summarised for the following interventions: transcutaneous electrical nerve stimulation; education; cryotherapy; adhesive, localised chest wall splint; incentive spirometry; non- invasive ventilation; active cycle of breathing techniques; continuous positive airway pressure; pulsed ultrasound; and triage guidelines.

Each intervention comes with a concise summary paragraph to highlight the implications for clinical practice.

Diagnosis (including point-of-care ultrasound), aetiology, prognosis and medical management are also reviewed.

This is followed by a review of the evidence on whether advanced practice physiotherapists and physicians make similar diagnoses and surgical triage decisions when assessing patients with musculoskeletal disorders. 

The review also compared the clinical efficacy of advanced practice physiotherapy care to usual medical care.

The diagnostic concordance and surgical triage concordance between the physiotherapists and physicians was good to very good.

These results suggest that advanced practice physiotherapists can effectively diagnose and triage musculoskeletal disorders in a manner that aligns well with medical specialists. 

Furthermore, the physiotherapy care led to reductions in pain and disability that were comparable or greater than usual medical care at medium-term follow-up.

Periodisation is a training methodology used to optimise individual outcomes; it involves planned variation in program variables (eg, mode, intensity, repetitions, sets, order and rest) to maximise gains. 

For example, the construction of a periodisation model could involve a period of recuperative exercises after weeks of stress, gradually increasing the intensity with respective volume settings. 

Mark Elkins.

In a randomised trial with 100 people with knee osteoarthritis, periodised circuit training gave comparable improvements regardless of whether it was administered via telehealth or in a face-to-face format.

The smallest worthwhile effect, determined with benefit–harm trade-off, represents the minimum between-group difference in an outcome that a patient considers worth the costs, risks and inconveniences of an intervention. 

It is the most appropriate index of clinical importance to inform treatment decision-making and interpret the findings of clinical trials and meta-analyses.

In a benefit–harm trade-off study with 116 people with acute low back pain and 230 people with chronic low back pain, the smallest worthwhile effect on pain severity for non-steroidal anti-inflammatory drugs was a 30 per cent and 27.5 per cent reduction respectively. 

The smallest worthwhile effect for an individualised exercise program for people with chronic low back pain was a 20 per cent reduction in pain, additional to no treatment.

Constraint-induced movement therapy improves upper limb function in eligible patients after stroke. 

Despite the demonstrated efficacy, several barriers to providing the therapy have been reported and it is not routinely provided to eligible stroke survivors. 

A literature review pooling data from qualitative and quantitative studies found that constraint-induced movement therapy is challenging but support at all levels helps. 

Therapists need the know-how, resources and staffing to implement the therapy.

It is different from other interventions and there are positives and negatives to this. 

Functional outcomes do not always meet the high expectations.

Patients with cervical arterial dissection can present with musculoskeletal neck pain and/or headache as one of the first symptoms and sometimes the only symptom. 

Physiotherapists must be able to distinguish between vascular and musculoskeletal neck pain and headache. 

To assist with this, the International Federation of Orthopaedic Manipulative Physical Therapists developed a clinical reasoning framework for the cervical spine.

However, in a new study with 150 patients, the framework was found to have poor diagnostic accuracy. 

The sensitivity was low and the specificity was moderate. 

The positive and negative likelihood ratios were weak. 

The area under the curve was poor. This paper comes with an invited commentary to help clinicians interpret these findings appropriately.

Appraisal items consider chronic knee pain after total knee replacement, overweight and obesity in knee osteoarthritis, neck pain, fatigue in chronic illness, multiple sclerosis, venous thromboembolism and pregnancy.

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>> Clinical Associate Professor Mark Elkins APAM is the scientific editor of Journal of Physiotherapy. Follow him on X (formerly Twitter) @JOP_Editor and follow Journal of Physiotherapy @JPhysiother.