Ja Oldham

An evaluation of exercise regimes for patients with osteoarthritis of the knee: a single-blind randomized controlled trial:

Osteoarthritis (OA) of the knee is a major public health problem in the United Kingdom and various forms of physiotherapy are used in the treatment of this condition despite the lack of studies evaluating its efficacy. The purpose of this study was to compare the efficacy of two different forms of physiotherapy exercise management with a control group. Twenty-seven patients with OA knee were recruited from routine orthopaedic clinics and were on the waiting-list for physiotherapy. Patients were randomly allocated to three groups. Group 1 (n = 9) consisted of a control group; Group 2 (n = 8) consisted of supervised sessions of exercises; Group 3 (n = 10) consisted of an advice and instruction session plus a functional home exercise regime. Parameters measured were: pain; range of motion; quadriceps strength; knee joint swelling; exercise tolerance. Results were analysed using a Kruskal-Wallis analysis of variance and a Mann-Whitney U-test with the significance level set at p <0.05. The results showed no significant difference (p >0.05) between any of the outcome measures of the three groups. This study concludes that patients with OA knee can be helped most economically by one session of advice and a functional home exercise regime. This can be done in a group setting under supervision of one physiotherapist.

Paraspinal muscle EMG fatigue testing with two methods in healthy volunteers. Reliability in the context of clinical applications

OBJECTIVEnComparison of the accuracy of surface electromyogram for back muscle endurance assessment with two different tests.nnnDESIGNnTest-retest measurements in 16 healthy volunteers on two separate occasions for each test under controlled conditions.nnnBACKGROUNDnBack muscle endurance is considered important in low back pain rehabilitation. Reliability of paraspinal muscle endurance assessment is a pre-requisite for accurate and meaningful clinical applications of the technique.nnnMETHODSnAll participants performed each test twice. A direct comparison was made between two popular fatigue testing methods, the modified Biering-Sørensen and a 60% maximum voluntary isometric contraction in the upright position during which time fatigue was assessed from the electromyogram spectral and amplitude analysis.nnnRESULTSnReproducibility of initial median frequency was excellent for both tests. Normalised median frequency slope values were more reliable with the 60% maximum voluntary contraction upright test. The clinical applicability of these measures in detecting significant differences after patient rehabilitation is recommended. Root mean square had very large between-day error for both tests.

Pulsed electromagnetic energy treatment offers no clinical benefit in reducing the pain of knee osteoarthritis: a systematic review

BackgroundThe rehabilitation of knee osteoarthritis often includes electrotherapeutic modalities as well as advice and exercise. One commonly used modality is pulsed electromagnetic field therapy (PEMF). PEMF uses electro magnetically generated fields to promote tissue repair and healing rates. Its equivocal benefit over placebo treatment has been previously suggested however recently a number of randomised controlled trials have been published that have allowed a systematic review to be conducted.MethodsA systematic review of the literature from 1966 to 2005 was undertaken. Relevant computerised bibliographic databases were searched and papers reviewed independently by two reviewers for quality using validated criteria for assessment. The key outcomes of pain and functional disability were analysed with weighted and standardised mean differences being calculated.ResultsFive randomised controlled trials comparing PEMF with placebo were identified. The weighted mean differences of the five papers for improvement in pain and function, were small and their 95% confidence intervals included the null.ConclusionThis systematic review provides further evidence that PEMF has little value in the management of knee osteoarthritis. There appears to be clear evidence for the recommendation that PEMF does not significantly reduce the pain of knee osteoarthritis.

Respiratory Dysfunction in Chronic Neck Pain Patients. A Pilot Study

The aim of this pilot study was to add weight to a hypothesis according to which patients presenting with chronic neck pain could have a predisposition towards respiratory dysfunction. Twelve patients with chronic neck pain and 12 matched controls participated in this study. Spirometric values, maximal static pressures, forward head posture and functional tests were examined in all subjects. According to the results, chronic neck patients presented with a statistically significant decreased maximal voluntary ventilation (P = 0.042) and respiratory muscle strength (Pimax and Pemax), (P = 0.001 and P = 0.002, respectively). Furthermore, the current study demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck pateits. The connection of neck pain and respiratory function could be an important consideration in relation to patient assessment, rehabilitation and consumption of pharmacological agents.

The reproducibility of multi-joint isokinetic and isometric assessments in a healthy and patient population.

DESIGNnTest re-test reliability design.nnnOBJECTIVEnTo determine a reproducible protocol for lower limb simultaneous multi-joint assessments on a healthy group of subjects and a patient group with patellofemoral pain syndrome.nnnBACKGROUNDnAlthough single joint assessment with isokinetic dynamometers has been utilised for many years in knee rehabilitation, simultaneous multi-joint assessment has not attracted comparable attention.nnnMETHODSnTwenty healthy volunteers mean age 30.6 years and 16 patients with patellofemoral pain syndrome mean age 29.6 years performed isometric maximum voluntary contractions and concentric isokinetic contractions of the lower limb. Data were collected on three separate days for resultant extension/flexion peak torque, average power and total work which were analysed using intraclass correlation coefficients with a 95% level of confidence.nnnRESULTSnIn healthy subjects, intraclass correlation coefficients estimates were > or =0.75 for isokinetic peak torque and >0.83 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.82. In the patient group, intraclass correlation coefficients estimates were >0.82 for isokinetic peak torque and > or =0.75 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.89. Discarding the first sessions data for both groups improved the intraclass correlation coefficients estimates for virtually all assessments.nnnCONCLUSIONSnThis study has demonstrated high reproducibility of lower limb multi-joint testing for peak torque, average power, and total work on healthy subjects and then has employed the protocol to demonstrate similarly high reliability on a patient group. It has also highlighted the need for a practice session before the data can be said to be reliable.nnnRELEVANCEnReliability studies often use healthy subject groups, which although useful, have limited relevance to patient populations. This study has not only gained comprehensive reproducibility data on multi-joint assessment in healthy subjects, it has also shown that multi-joint testing can be used safely and reliably in patients with patellofemoral pain syndrome. Clinicians may now be able to measure objectively lower limb function in this patient group both pre and post treatment.

An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial

Objective: To evaluate a new pattern of electrical of electrical stimulation as a treatment for stress incontinence. Design: A randomized, double-blind, controlled trial. Setting: The study took place on three clinical sites. Subjects: Patients (n= 27) with urodynamically proven stress incontinence recruited via consultant referral. Interventions: Patients were randomly allocated to one of two groups: the new pattern of stimulation or sham stimulation. Main outcome measures: Patients were assessed pre, mid and post treatment using: perineometry, digital assessment and pad testing. The following were only used pre and post treatment: seven-day frequency/ volume chart, SF-36, the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Results: No significant between-group differences were highlighted except when quality of life was assessed with the Urogenital Distress Inventory (p= 0.01). A significant reduction in scores was observed in the stimulation group (p= 0.03) However, improvements were seen in both the strength and endurance characteristics of the pelvic floor musculature, although these changes were not translated into a reduction in symptoms. Conclusion: Although promising, the improvement in pelvic floor function did not result in a reduction in symptoms in all patients. Further research is required to investigate the effects of the new stimulation in combination with pelvic floor exercises and to compare the new stimulation pattern with existing forms of electrical stimulation.

The reliability of the clinical tests and questions recommended in international guidelines for low back pain.

Study Design. An intertester reliability study of the questions and tests recommended in guidelines for the management of low back pain (LBP). Objective. This study undertook a reliability study to evaluate the reliability of the items of the LBP clinical examination with a large sample of LBP patients. Summary of Background Data. A crucial part of the diagnostic triage process, recommended by many national and international guidelines for the management of LBP, is the clinical examination. The questions and tests used in this process have never been rigorously evaluated for their intertester reliability in first contact clinicians who are not medically trained. Methods. Patients, referred to physiotherapy departments across the United Kingdom with LBP (n = 301) were recruited in a sample of convenience. The 50 questions and physical tests were administered by a physiotherapist and then repeated by another physiotherapist within the same day. Data were analyzed using kappa and weighted kappa correlation coefficients (&kgr;). Confidence intervals (95% CIs) were calculated. Results. Eighty-six percent (n = 43) of the questions and test demonstrated &kgr; of 0.41 (fair agreement) or above. Five questions and 2 physical tests (prone knee bend and myotomal assessment) demonstrated agreement of only slight levels. CIs were generally narrow and the uncertainty regarding the kappa coefficients demonstrated correspondingly low. Conclusions. This study has rigorously evaluated the intertester reliability of the clinical examination process of the diagnostic triage. These clinicians generally demonstrated fair agreement when testing features of the “nerve root,” “yellow” and “red flag” presentations recommended in international guidelines for the management of LBP and nonspecific LBP. However, reliance on single tests with only fair levels of agreement may be unwise. Further work is required to investigate the validity of the tests.

Association of low back pain on physical, sociodemographic and lifestyle factors across a general population sample within Greece

BACKGROUNDnAlthough low back pain (LBP) is a debilitating problem internationally, there is not a lot of research on its impact on physical, psychosocial and lifestyle factors. Especially in mediterranean countries, such as Greece, it is not sufficiently explored whether physical (pain location, activity limitation etc.), sociodemographic (education, smoking etc.) or lifestyle factors (i.e. quality of life or anxiety) are influenced by LBP.nnnOBJECTIVEnTo estimate LBP prevalence in the Greek general population and explore its association with particular sociodemographic, physical and lifestyle factors.nnnMETHODnA sample of 3125 people of the Greek adult population was randomly selected by stratified sampling encompassing rural and urban representation within the Greek mainland. An extended survey form was developed entailing three sections; personal (sociodemographic) information, questions on symptomatology and physical factors (i.e. pain characteristics, recurrence, physical disability etc.) and 3 self-administered questionnaires (including mostly lifestyle factors); Hospital Anxiety and Depression (HAD) scale for anxiety and depression, SF-12 for quality of life (QoL) and Roland-Morris for disability.nnnRESULTSnA total of 471 (15%) people reported LBP (210 males, mean age: 47.04 ± 15.03). Amongst them 60% reported sciatica, 76% suffered recurrent LBP and 70% received specialist care. Low disability levels, moderate to high pain intensity, gender differences and good self-reported QoL and psychosocial status were reported. Sociodemographic characteristics (income, smoking, marital status etc.) were not associated with LBP physical factors, apart from age which correlated with physical disability and wellness (r being 0.446 and 0.405, respectively, p< 0.001). Physical factors (particularly pain intensity and location) correlated with lifestyle factors (QoL) and disability (r ranging between 0.396 and 0.543, p< 0.001). Mental wellness, anxiety and depression (as lifestyle factors) were not associated with sociodemographic or physical factors.nnnCONCLUSIONSnPhysical parameters were amongst the most prevalent characteristics of the Greek sample, thus offering a direction towards a more targeted treatment and rehabilitation planning. Unlike previous literature, most sociodemographic characteristics were not correlated with any LBP physical or lifestyle factors, thus possibly indicating a different socioeconomic background and aetiology domain to that of the usual non-specific LBP spectrum.