Jg McVeigh

The Effectiveness of Physiotherapy Exercises in Subacromial Impingement Syndrome: A Systematic Review and Meta-Analysis

OBJECTIVE To evaluate the effectiveness of exercise in the treatment of people with subacromial impingement syndrome (SAIS). METHODS A systematic review and meta-analysis were conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were randomized controlled trials investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarized qualitatively using a best evidence synthesis. Treatment effect size and variance of individual studies were used to give an overall summary effect and data were converted to standardized mean difference with 95% confidence intervals (standardized mean difference (SMD) (CI)). RESULTS Sixteen studies were included (n = 1162). There was strong evidence that exercise decreases pain and improves function at short-term follow-up. There was also moderate evidence that exercise results in short-term improvement in mental well-being and a long-term improvement in function for those with SAIS. The most common risk of bias across the studies was inadequately concealed treatment allocation. Six studies in the review were suitable for meta-analysis. Exercise had a small positive effect on strength of the rotator cuff in the short term (SMD -0.46 (-0.76, 0.16); P = 0.003) and a small positive effect on long-term function (SMD -0.31 (-0.57, 0.04); P = 0.02). CONCLUSIONS Physiotherapy exercises are effective in the management of SAIS. However, heterogeneity of the exercise interventions, coupled with poor reporting of exercise protocols, prevented conclusions being drawn about which specific components of the exercise protocols (ie, type, intensity, frequency and duration) are associated with best outcomes.

The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review

Hydrotherapy is often used in the treatment of fibromyalgia syndrome (FMS), however there has been limited evaluation of its effectiveness. The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS. AMED, BNI, CINAHL, The Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, Science Direct and Web of Science were searched (1990–July 2006). Key words used ‘fibromyalgia’ and ‘hydrotherapy’, ‘balneotherapy’, ‘aqua therapy’, ‘pool therapy’, ‘water therapy’, ‘swimming’, ‘hydrogalvanic’, ‘spa therapy’, ‘physiotherapy’, ‘physical therapy’ and ‘rehabilitation’. Searches were supplemented with hand searches of selected journals. Randomised controlled trials (RCTs) were assessed for methodological quality using the van Tulder scale. Ten RCTs met the inclusion criteria. Mean methodological quality was 4.5/9 on the van Tulder scale. Positive outcomes were reported for pain, health-status and tender point count. There is strong evidence for the use of hydrotherapy in the management of FMS.

A systematic review of the effects of dynamic exercise in rheumatoid arthritis

Exercise is commonly used in the management of patients with rheumatoid arthritis (RA); however, there is little consensus in the literature to support its use. This systemic review aimed to determine the effects of dynamic exercise on patients with RA. A systematic search of Medline (1949–2007), Cinahl (1982–2007), Embase (1974–2007) and Cochrane library was performed for randomised-controlled trials using the keywords “rheumatoid arthritis” and “exercise” or “training” or “sport”. The methodological quality of studies was assessed using a ten-point scale. Eighteen papers relating to 12 different studies met inclusion criteria. The mean methodological quality score was 6.9/10. Studies using aerobic training, strength training and combinations of both were included. Patients with early, stable, and active RA were studied. A number of studies reported improvement in muscle strength, physical function and aerobic capacity with dynamic exercise. Some studies also reported improvements in disease activity measures, and small improvements in hip bone mineral density. One study reported significantly less progression of small joint radiographic damage of the feet in the dynamic exercise group. However, one study also reported worse large joint radiographic damage in patients using dynamic exercise who had pre-existing large joint damage, though this was a retrospective analysis. No studies reported worse outcomes for function, disease activity or aerobic capacity with dynamic exercise. Cardiovascular outcomes were not reported in any study, and no data were presented to assess the effect of exercise on patients with significant underlying cardiovascular disease. This systematic review suggests that the majority of patients with RA should be encouraged to undertake aerobic and/or strength training exercise. Exercise programmes should be carefully tailored to the individual, particularly for patients with underlying large joint damage or pre-existing cardiovascular disease.

Effects of a prolonged exercise program on key health outcomes in women with fibromyalgia: a randomized controlled trial.

OBJECTIVE To assess the impact of a long-term exercise programme vs usual care on perceived health status, functional capacity and depression in patients with fibromyalgia. DESIGN Randomized controlled trial. SUBJECTS Forty-two women with fibromyalgia were allocated randomly to 1 of 2 groups: an experimental group that carried out aerobic, strength and flexibility exercises for 24 weeks and a usual care control group. METHODS Health status and functional capacity were evaluated using the Fibromyalgia Impact Questionnaire and the Short Form Health Survey 36. Depression was evaluated with the Beck Depression Inventory. RESULTS Significant improvements were observed in health status and functional capacity for the exercise group over the control group. The magnitude of the effect size of these improvements, expressed as Cohens d, was medium. The effect size (95% confidence interval) for the Fibromyalgia Impact Questionnaire was 0.58 (-14.12, -2.35), for the Short Form Health Survey 36. global score 0.54 (1.28, 14.52), and in the mental health domain of the Short Form Health Survey 36. 0.51 (1.20, 16.26). There was a large effect size in vitality. All the aforementioned improvements can be considered as clinically important changes. CONCLUSION Results confirm that a long-term combination of aerobic exercise, strengthening and flexibility improves psychological health status and health-related quality of life in patients with fibromyalgia.

Effects of exercise training and detraining in patients with fibromyalgia syndrome: a 3-yr longitudinal study.

ObjectiveThis study aimed to evaluate the immediate effects of a 6-mo combined exercise program on quality-of-life, physical function, depression, and aerobic capacity in women with fibromyalgia syndrome and to determine the impact of repeated delivery of the intervention. DesignForty-one women with fibromyalgia were randomly assigned to a training group (EG; n = 21) and a control group (CG; n = 20). Quality-of-life and physical function were assessed using the 36-item Short-Form Health Survey (SF-36) and the Fibromyalgia Impact Questionnaire, and depression was measured using the Beck Depression Inventory. Physical fitness was measured using the 6-min Walk Test. Outcomes were assessed at baseline and after each 6-mo intervention, which was delivered over 30 mos (6 mos of training and 6 mos of detraining). ResultsAfter a 6-mo combined exercise program, there was a significant improvement in the Fibromyalgia Impact Questionnaire (P < 0.0005) for the training group over the control group. Repeated-measures analysis of variance across all time points demonstrated significant main effects for time for the Fibromyalgia Impact Questionnaire, SF-36, Beck Depression Inventory and the 6-min Walk Test, but there were no between-group interaction effects. For the EG, there were significant within-group changes in the Fibromyalgia Impact Questionnaire, SF-36, and Beck Depression Inventory at the final time point; however, there were no within-group changes for the control group. Improvement achieved for the training group were maintained during the detraining period. ConclusionsA long-term exercise program can produce immediate improvements in key health domains in women with fibromyalgia. The benefits achieved with regular training can be maintained for 30 mos. The lack of difference between groups over time may be caused by attrition and consequent lack of power at the final time point.

The effectiveness of working wrist splints in adults with rheumatoid arthritis: a mixed methods systematic review.

OBJECTIVE To evaluate the effectiveness of working wrist splints in people with rheumatoid arthritis. DATA SOURCES AND STUDY SELECTION This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Ten databases were searched from inception until September 2012 for quantitative and qualitative studies on the effectiveness of working wrist splints in rheumatoid arthritis. DATA EXTRACTION Data was extracted on participants, interventions, outcome measures and results. Experimental studies were evaluated using the van Tulder scale and the Cochrane Risk of Bias tool. Data was extracted by a single reviewer and all studies were reviewed by two blind reviewers. DATA SYNTHESIS Twenty-three studies were included in the review (n = 1,492), 13 experimental studies including 9 randomized controlled trials (RCTs) and 2 qualitative studies. Data was summarized using best evidence synthesis and a meta-ethnographical approach guided qualitative evidence synthesis. There is strong quantitative evidence (including 9 RCTs), supported by conclusions from qualitative literature, that working wrist splints reduce pain (d = 0.7-0.8), moderate evidence that grip strength is improved (d = 0.3-0.4) and dexterity impaired and insufficient evidence of their effect on function. CONCLUSIONS Working wrist splints reduce pain and improve grip in rheumatoid arthritis. The effect of splints on function is not yet clear.

International FItness Scale (IFIS): Construct Validity and Reliability in Women With Fibromyalgia: The al-Ándalus Project

OBJECTIVES To examine the construct validity of the International FItness Scale (IFIS) (ie, self-reported fitness) against objectively measured physical fitness in women with fibromyalgia and in healthy women; and to study the test-retest reliability of the IFIS in women with fibromyalgia. DESIGN Cross-sectional study. SETTING Fibromyalgia patient support groups. PARTICIPANTS Women with fibromyalgia (n=413) and healthy women (controls) (n=195) for validity purposes and women with fibromyalgia (n=101) for the reliability study. The total sample was N=709. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fitness level was both self-reported (IFIS) and measured using performance-based fitness tests. For the reliability study the IFIS was completed on 2 occasions, 1 week apart. RESULTS Women with fibromyalgia who reported average fitness had better measured fitness than those reporting very poor fitness (all P<.001, except 6-minute walk test where P<.05), with similar trends observed in healthy control women. The test-retest reliability of the IFIS, as measured by the average weighted κ, was .45. CONCLUSIONS The IFIS was able to identify women with fibromyalgia who had very low fitness and distinguish them from those with higher fitness levels. Furthermore, the IFIS was moderately reliable in women with fibromyalgia.

Herbal medicinal products or preparations for neuropathic pain and fibromyalgia

Reason for withdrawal from publication At August 2016, this protocol has been withdrawn due to the full review not meeting the quality standards and expectations of Cochrane and the PaPaS review group.

The TIDieR checklist will benefit the physiotherapy profession

Evidence-based practice involves physiotherapists incorporating high-quality clinical research on treatment efficacy into their clinical decision making.1 However, if clinical interventions are not adequately reported in the literature, physiotherapists face an important barrier to using effective interventions with their patients. Previous studies have reported that incomplete description of interventions is a problem in reports of randomized controlled trials in many health areas.2–4 One of these studies4 examined 133 trials of non-pharmacological interventions. The experimental intervention was inadequately described in more than 60% of the trials, and descriptions of the control interventions were even worse. A recent study5 evaluated the completeness of descriptions of the physiotherapy interventions in a sample of 200 randomized controlled trials published in 2013. Overall, the interventions were poorly described. For the intervention groups, about one-quarter of the trials did not fulfil at least half of the criteria. Reporting for the control groups was even worse, with around threequarters of trials not fulfilling at least half of the criteria. In other words, for the majority of the physiotherapy trials, clinicians and researchers would be unable to replicate the interventions that were tested. Describing a treatment may seem like a simple task, but physiotherapy interventions can be very complex. Some interventions are multi-modal, involving the use of manual techniques, consumable materials, equipment, education, training, and feedback. Some interventions are tailored to each patient’s specific health state, including the patient’s immediate response to the application of the treatment. When the intervention involves a course of treatments, the intensity or dose may be progressed over time. The descriptions of physiotherapy interventions in trial reports often do not capture all these components of the interventions or detail their complexity. If researchers do not comprehensively report all aspects of the interventions, the trial results cannot be incorporated into clinical practice or the intervention could be implemented incorrectly. Incorrect implementation may make the treatment ineffective, wasting the clinician’s and patient’s time and health care resources. Inadequate reporting of interventions also poses a barrier to incorporating a trial’s results into secondary research such as systematic reviews and clinical practice guidelines, as well as to the usability of these resources. This means that the resources that were invested in undertaking the trial have been wasted. Such resources are extensive, including direct trial costs (e.g., payment of researchers, consumables), use of infrastructure (e.g., clinic space, equipment), human resources (e.g., ethics committee review, granting body review), and the goodwill of patients who agree to participate. Currently, there is a growing realization that we need strategies to reduce waste in clinical research.6 When the list of resources involved in a single study is considered, improving the reproducibility of interventions through better reporting could markedly reduce waste in research.7 The TIDieR checklist and guide were developed to improve the reporting of interventions in any evaluative study, including randomized trials.8 The checklist contains 12 items and was developed as an extension of the CONSORT 20109 and SPIRIT 201310 statements to provide further guidance for authors on the key information to include in trial reports. TIDieR items include the name of the intervention; intervention rationale for essential elements; intervention materials and details about how to access them; description of the intervention procedures; details of intervention providers; mode of delivery of intervention; location of intervention delivery and key infrastructure; details about the number, duration, intensity, and dose of intervention sessions; details of

The effectiveness of night splints in achilles tendinopathy: A Pilot Study

Background: This study aimed to investigate the effectiveness of night splints in the management of Achilles tendinopathy, and to test the feasibility of conducting a larger randomised controlled trial (RCT) in this area. Methods: Eleven participants with Achilles tendinopathy (6M, 5F) were randomly assigned to a control group (eccentric exercise only) or an intervention group (eccentric exercise and night splint). Participants were assessed at baseline and after 12 weeks using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire and a functional heel-rise test. Results: Both groups recorded an increase in the mean VISA-A score (intervention group 28.8, control group 21.3), and the mean number of heel raises performed (intervention group 4.0, control group 4.3), from baseline to follow-up 12 weeks later. The changes suggest greater improvements for the intervention group over control group, the however, the small sample size did not permit between group analysis. Compliance with night splints did not present as a problem for participants. Conclusion: This study demonstrated that eccentric exercise combined with a night splint can improve outcomes in Achilles tendinopathy; however the extent to which outcomes are better than eccentric exercises alone needs further study.