Martin Sattelmayer

Is power training or conventional resistance training better for function in elderly persons? A meta-analysis

OBJECTIVE to determine the effects of power training with high movement velocity compared with conventional resistance training with low movement velocity for older community-dwelling people. DESIGN systematic review of randomised controlled trials. DATA SOURCES the Cochrane Central Register of Controlled TRIALS, PubMed (Medline), EMBASE, CINAHL, PEDro and Scholar-Google. TRIALS all randomised or quasi-randomised trials investigating power training with high movement velocity versus conventional resistance training with low movement velocity in elderly persons over the age of 60 years. The primary outcomes were measures of functional outcomes; secondary outcomes were balance, gait, strength, power, muscle volume and adverse effects. RESULTS eleven trials were identified involving 377 subjects. The pooled effect size for the follow-up values of the functional outcomes was 0.32 in favour of the power training (95% CI 0.06 to 0.57) and 0.38 (95% CI -0.51 to 1.28) for the change value. The pooled effect from three studies for self-reported function was 0.16 in favour of power training (95% CI -0.17 to 0.49). CONCLUSION power training is feasible for elderly persons and has a small advantage over strength training for functional outcomes. No firm conclusion can be made for safety.

Predictive value of the Acute Low Back Pain Screening Questionnaire and the Örebro Musculoskeletal Pain Screening Questionnaire for persisting problems

IntroductionA small proportion of individuals with non-specific low back pain (NSLBP) develop persistent problems. Up to 80% of the total costs for NSLBP are owing to chronic NSLBP. Psychosocial factors have been described to be important in the transition from acute to chronic NSLBP. Guidelines recommend the use of the Acute Low Back Pain Screening Questionnaire (ALBPSQ) and the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) to identify individuals at risk of developing persistent problems, such as long-term absence of work, persistent restriction in function or persistent pain. These instruments can be used with a cutoff value, where patients with values above the threshold are further assessed with a more comprehensive examination.MethodsWe systematically reviewed studies evaluating the accuracy of the ALBPSQ and ÖMPSQ to predict persistent problems.ResultsThe 13 included studies used different cutoff values for the screening questionnaires ranging from 68 to 147. The pooled sensitivity was 0.59 (0.43–0.74), while the pooled specificity was 0.77 (0.66–0.86). Heterogeneity (I2) was 90.02% for sensitivity and 95.41% for specificity.ConclusionThus, we do not recommend the use of one cutoff value, but the use of a prediction model with all the individual items.

Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs

Objective To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement. Design Systematic review and meta-analysis of randomised trials. Data sources Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017. Study selection criteria Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments. Results For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) −0.94, 95% CI −1.69 to −0.19). Specific exercises were superior to generic exercises (SMD −0.65, 95% CI −0.99 to −0.32). Corticosteroid injections were superior to no treatment (SMD −0.65, 95% CI −1.04 to −0.26), and ultrasound guided injections were superior to non-guided injections (SMD −0.51, 95% CI −0.89 to −0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of −0.29 (95% CI −0.53 to −0.05) compared with placebo. Manual therapy was superior to placebo (SMD −0.35, 95% CI −0.69 to −0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD −0.32, 95% CI −0.62 to −0.01). Laser was superior to sham laser (SMD −0.88, 95% CI −1.48 to −0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (−0.39, 95% CI −0.78 to –0.01) and tape was superior to sham (−0.64, 95% CI −1.16 to −0.12), with small to moderate SMDs. Conclusion Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.

A systematic review of assessments for procedural skills in physiotherapy education

Abstract Introduction Learning of procedural skills is important in the education of physiotherapists. It is the aim of physiotherapy degree programmes that graduates are able to practice selected procedures safely and efficiently. Procedural competency is threatened by an increasing and diverse amount of procedures that are incorporated in university curricula. As a consequence, less time is available for the learning of each specific procedure. Incorrectly performed procedures in physiotherapy might be ineffective and may result in injuries to patients and physiotherapists. The aim of this review was to synthesise relevant literature systematically to appraise current knowledge relating to assessments for procedural skills in physiotherapy education. Method A systematic search strategy was developed to screen five relevant databases (CINAHL, Cochrane Central, SportDISCUS, ERIC and MEDLINE) for eligible studies. The included assessments were evaluated for evidence of their reliability and validity. Results The search of electronic databases identified 560 potential records. Seven studies were included into this systematic review. The studies reported eight assessments of procedural skills. Six of the assessments were designed for a specific procedure and two assessments were considered for the evaluation of more than one procedure. Evidence to support the measurement properties of the assessment was not available for all categories. Discussion It was not possible to recommend a single assessment of procedural skills in physiotherapy education following this systematic review. There is a need for further development of new assessments to allow valid and reliable assessments of the broad spectrum of physiotherapeutic practice