Domhnall MacAuley

The Use of Ice in the Treatment of Acute Soft-Tissue Injury A Systematic Review of Randomized Controlled Trials

Background There are wide variations in the clinical use of cryotherapy, and guidelines continue to be made on an empirical basis. Study Design Systematic review assessing the evidence base for cryotherapy in the treatment of acute soft-tissue injuries. Methods A computerized literature search, citation tracking, and hand searching were carried out up to April 2002. Eligible studies were randomized-controlled trials describing human subjects recovering from acute soft-tissue injuries and employing a cryotherapy treatment in isolation or in combination with other therapies. Two reviewers independently assessed the validity of included trials using the Physiotherapy Evidence Database (PEDro) scale. Results Twenty-two trials met the inclusion criteria. There was a mean PEDro score of 3.4 out of of 10. There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment. Conclusion Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries.

Personal significance: the third dimension

1–3 Using this model, clinicians try to turn the patient’s story into a clinical question, and to answer that question by searching for the best relevant evidence, applied in an appropriate manner. We rank that evidence, by convention, according to a hierarchy of study designs and criteria that relate to internal strengths of a study. By definition, such evidence comes from population studies, and the results relate to what happens in groups of people, rather than in an individual. Decisions are based on interpretation of the evidence by objective criteria, distant from the patient and the consultation. Subjective evidence is anathema. In this context, evidence-based medicine is almost always doctor centred; it focuses on the doctor’s objective interpretation of the evidence, and diminishes the importance of human relationships and the role of the other partner in the

Evidence-based sports medicine

Evidence-based sports medicine / , Evidence-based sports medicine / , کتابخانه دیجیتال جندی شاپور اهواز

Physical activity, physical fitness, blood pressure, and fibrinogen in the Northern Ireland health and activity survey.

STUDY OBJECTIVE: To investigate the relationship between physical activity, physical fitness, blood pressure, and fibrinogen. DESIGN: This was a cross sectional population study using a two stage probability sample. SETTING: Northern Ireland. PARTICIPANTS: A sample of 1600 subjects aged 16-74 years from the population of Northern Ireland. MAIN OUTCOME MEASURES: Physical activity profile from computer assisted interview using the Allied Dunbar national fitness survey scales. Physical fitness using estimation of VO2 max by extrapolation from submaximal oxygen uptake while walking on a motor driven treadmill. Systolic and diastolic blood pressure measured with a Hawksley random zero sphygmomanometer. Measurement of fibrinogen using the Clauss method. MAIN RESULTS: There were significant relationships between both current and past activity and blood pressure. These were of a magnitude that would have been clinically significant, but for the fact that, with the exception of the relationship between habitual activity and diastolic pressure (p = 0.03) and past activity and systolic pressure (p = 0.03) in men, they were not sustained after adjustment for the effect of age using analysis of variance. After adjustment for other potentially confounding factors using multiple regression, there was an inverse relationship between systolic blood pressure and past activity in men, so that those with a life-time of participation compared with a life-time of inactivity had a lower systolic blood pressure of 6 mmHg (p < 0.05). There was a highly significant (p < 0.001) inverse association between both systolic and diastolic blood pressure and physical fitness (VO2 max) which was not sustained after adjustment for possible confounding factors. There were relationships between fibrinogen and highest recorded activity (p < 0.001), habitual activity (p < 0.01), and past activity (p < 0.01) in men but no significant relationship in women. The relationship between fibrinogen and activity was no longer sustained after adjustment for possible confounding factors. There was a highly significant (p < 0.001) inverse relationship with physical fitness using VO2 max. This relationship was sustained after adjustment for possible confounding factors in both men (p < 0.05) and women (p < 0.001). CONCLUSIONS: There was a relationship between physical activity, physical fitness, and blood pressure but the relationship was greatly influenced by age. A reduction of 6 mmHg in systolic blood pressure associated with past activity is of clinical significance and supports the hypothesis that physical activity is of benefit in reducing cardiovascular risk. There was a lower level of fibrinogen in those who were most active but this relationship was not significant after adjustment for possible confounding factors. There was also a lower level of fibrinogen those who were most fit (VO2 max) and this relationship persisted even after adjustment for possible confounding factors.

Does preseason screening for cardiac disease really work?: the British perspective

Sudden cardiac death is always a tragedy. Sudden death during sport is particularly poignant because people tend to associate sport with health and fitness. Both the public and the medical profession would like to prevent such events, and preparticipation medical screening is often promoted as one such method. When we examine the risk of death, the prevalence of at-risk conditions, the natural history of disease, and the screening methods available, it is clear that widespread screening would not be useful. Systematic preparticipation screening is not undertaken widely in the United Kingdom, but this practice has evolved and is not the result of a definite policy decision.

Physical activity, lipids, apolipoproteins, and Lp(a) in the Northern Ireland Health and Activity Survey

In a cross-sectional study using a two-stage probability sample (N = 1,600) of the population of Northern Ireland, there was an inverse association between the highest recorded recent activity and total cholesterol (P < or = 0.01), LDL (P < or = 0.01), triglyceride (P < or = 0.05) and Chol:HDL ratio (P < or = 0.001) in males, and total cholesterol (P < or = 0.001), LDL (P < or = 0.001), and triglyceride (P < or = 0.01) in females; between habitual activity and HDL (P < or = 0.05) in males and total cholesterol (P < or = 0.05) and triglyceride (P < or = 0.01) in females. There was a relationship between the highest recorded activity and apoAI (P < or = 0.01) and apoB (P < or = 0.01) in males and with apoB (P < or = 0.001) in females; between habitual activity and apoAI (P < or = 0.01) and apoAII (P < or = 0.05) in males and apoB (P < or = 0.01) in females; between past activity and Lp(a) in females (P < or = 0.05). After adjustment for possible confounding factors, total cholesterol (P < or = 0.05) and LDL (P < or = 0.05) were unexpectedly higher in males who were active throughout life. Total cholesterol (P < or = 0.05) and LDL (P < or = 0.001) were higher in females with highest recorded activity and triglycerides lower (P < or = 0.05) in those habitually active. An association between highest recorded activity and apoAI (P < or = 0.01), and past activity and apoAI:apoB ratio (P < or = 0.05) was shown in males and in females, after adjustment, and between apoB (P < or = 0.05) and highest recorded activity.

The European Perspective: Ankle injuries: same joint, different sports

Specific information on the incidence of ankle injury is not easy to establish, and studies use variable methodology and recording systems. There are problems in recording injury in many sports injury studies (23) as we often cannot calculate the relative risks without denominator data. Although we can estimate that ankle injuries make up about 10-15% of sports-related injury and that soccer and rugby are responsible for most sports-related injury in the United Kingdom, it is difficult to be more specific. Prevention and treatment strategies are also different, and taping and strapping is not widely practiced. Soccer has a particular injury pattern with some injuries particularly associated with the sport.

Genetic consultations in primary care: GPs’ responses to three scenarios

Objective This study investigated general practitioners’ responses to three scenarios in which patients consulted regarding genetic conditions. Design. Self-completed postal study. Setting. Primary care in Northern Ireland. Subjects Questionnaire were distributed to all the GPs in Northern Ireland (n=1079). A total of 541 GPs participated (50%). Main outcome measures Responses to three scenarios in which patients consulted regarding their family history and risk of bowel cancer, breast cancer, and cystic fibrosis. Results. Most GPs correctly identified the patients’ risk of bowel cancer, recommended regular colonoscopy, advised lifestyle changes, and did not refer to the genetic clinic. GPs who were qualified for longer were more likely to recommend colonoscopy and less likely to advise lifestyle changes. With the breast cancer patient GPs adopted a cautious approach; most would refer to the genetic and mammography clinics. With the cystic fibrosis example, most correctly identified the patients risk of carrying the gene, would refer to the genetic clinic, and would encourage the patient to discuss the risk with his partner. In general, doctors were unsure, but would pass on genetic information to insurance companies if requested. Conclusion The study suggests that, in most cases, general practitioners correctly identify at-risk individuals but there may still be some uncertainty regarding referrals. The results suggest that ways of educating GPs should be explored. Educational interventions should be linked to a greater understanding of factors involved in referral (including the influence of gender and experience). The guidelines provided to GPs in relation to the provision of genetic information to insurance companies may need to be reviewed in some countries.

Reducing risk of injury due to exercise

Papers p 468 It used to be so simple. Prevention of musculoskeletal injury during exercise meant conditioning, warm up, and stretching. We could not argue with these basic principles—until we began to look for the evidence to support such advice. Stretching is long established as one of the fundamental principles in athletic care. No competition is complete without countless athletes throwing shapes along the trackside, trainers and coaches each favouring their own particular exercises, and locker room experts, kinesiologists, and self appointed specialists inventing new contortions for long forgotten muscle groups. Sport is rife with pseudoscience, and it is difficult to disentangle the evangelical enthusiasm of the locker room from research evidence. But in this issue, Herbert and Gabriel (see p 468) question conventional wisdom and conclude that stretching before exercising does not reduce the risk of injury or muscle soreness.1 They are not the first group to examine the evidence behind stretching and injury …

Physical fitness, lipids, and apolipoproteins in the Northern Ireland Health and Activity Survey.

The objective of this study was to investigate the relationship between physical fitness, lipids, and apolipoproteins in a cross-sectional study using a two-stage probability sample of the population of Northern Ireland. The main outcome measures were physical fitness using VO2max estimated by extrapolation from submaximal oxygen uptake while walking on a motor driven treadmill, and total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, HDL2 and HDL3, and Lp(a). There were no significant relationships with fitness, after adjustment for possible confounders, with the exception of a positive relationship with HDL2 in males (P < or = 0.01) and Lp(a) in females (P < or = 0.05). There was also a relationship between physical fitness and HDL:apo AI ratio in males and females after adjustment for possible confounders (P < or = 0.05). We concluded that there were few relationships between lipid parameters and physical fitness after adjustment for possible confounders. The relationship between physical fitness and Lp(a) in females suggests a benefit associated with physical fitness and the relationship between physical fitness and HDL:apo AI ratio was in keeping with improved HDL cholesterol transport.