Mindy C. Cairns

Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain

Study Design. Pragmatic, multicentered randomized controlled trial, with 12-month follow-up. Objective. To evaluate the effect of adding specific spinal stabilization exercises to conventional physiotherapy for patients with recurrent low back pain (LBP) in the United Kingdom. Summary of Background Data. Spinal stabilization exercises are a popular form of physiotherapy management for LBP, and previous small-scale studies on specific LBP subgroups have identified improvement in outcomes as a result. Methods. A total of 97 patients (18–60 years old) with recurrent LBP were recruited. Stratified randomization was undertaken into 2 groups: “conventional,” physiotherapy consisting of general active exercise and manual therapy; and conventional physiotherapy plus specific spinal stabilization exercises. Stratifying variables used were laterality of symptoms, duration of symptoms, and Roland Morris Disability Questionnaire score at baseline. Both groups received The Back Book, by Roland et al. Back-specific functional disability (Roland Morris Disability Questionnaire) at 12 months was the primary outcome. Pain, quality of life, and psychologic measures were also collected at 6 and 12 months. Analysis was by intention to treat. Results. A total of 68 patients (70%) provided 12-month follow-up data. Both groups showed improved physical functioning, reduced pain intensity, and an improvement in the physical component of quality of life. Mean change in physical functioning, measured by the Roland Morris Disability Questionnaire, was −5.1 (95% confidence interval −6.3 to −3.9) for the specific spinal stabilization exercises group and −5.4 (95% confidence interval −6.5 to −4.2) for the conventional physiotherapy group. No statistically significant differences between the 2 groups were shown for any of the outcomes measured, at any time. Conclusions. Patients with LBP had improvement with both treatment packages to a similar degree. There was no additional benefit of adding specific spinal stabilization exercises to a conventional physiotherapy package for patients with recurrent LBP.

Use of ultrasound imaging by physiotherapists: a pilot study to survey use, skills and training.

OBJECTIVE This study aimed to design and pilot a questionnaire to survey the use of ultrasound imaging (USI) by physiotherapists in the United Kingdom (UK), the type and content of ultrasound training physiotherapists using USI had undertaken and their perceived future training needs. BACKGROUND The use of USI by physiotherapists is becoming increasingly common but is highly operator dependent and there are safety and professional issues regarding use in physiotherapy practice. Currently there are no specific training guidelines relating to physiotherapists using USI. METHODS A questionnaire was developed, based on research literature and guidelines. Twelve experts in USI commented on the content and design. The electronic on-line questionnaire was piloted on groups that were likely to be users of USI. RESULTS Forty-six respondents completed the questionnaire. Results indicated that USI is used predominantly for biofeedback and there are many unmet training needs. Respondents reported a mismatch between techniques for which they had received training and those that they used in practice and indicated a more structured training framework is required. CONCLUSIONS The development and piloting of the questionnaire provides a starting point for a more extensive evaluation of how USI is being used, the training needs of physiotherapists and benefits as a biofeedback tool. Refinement is needed and replication in a larger sample. Results could assist the development of a structured formal training framework encompassing key skills.

Investigation of optimal cues to instruction for pelvic floor muscle contraction: a pilot study using 2D ultrasound imaging in pre-menopausal, nulliparous, continent women.

Optimal urethrovesical positioning (UVP) may be important for continence. Pelvic floor muscle contraction (PFMC) influences UVP. PFMC instruction cues vary and often encourage anterior PFM recruitment that may result in sub‐maximal posterior facilitation. Study hypothesis: posterior or combined cues are more influential in optimizing UVP during PFMC following a brief practice period than anterior cue.

Dietary Advice and Collaborative Working: Do Pharmacists and Allied Health Professionals Other Than Dietitians Have a Role?

Long term health conditions either wholly or partly diet-related continue to increase. Although pharmacists and allied health professionals (AHPs) have a role in the management of patients with long term conditions, there is limited research exploring whether pharmacists and AHPs other than dietitians have a role in the delivery of dietary advice. This research aimed to explore their views regarding the provision of dietary advice to patients. The research involved a qualitative methodology utilising five uni-professional focus groups with a total of 23 participants. All groups considered the provision of dietary advice in the context of their own professional roles, discussed issues relating to referral to the dietitian for specialist advice and most discussed the need for written information. Interprofessional and collaborative working is needed to maximise the role in the delivery of dietary advice, access to evidence based nutritional information and utlisation of referral pathways across pharmacists and AHPs to ensure the timely provision of nutritional advice to patients. There is a potential role for dietitians to take the lead and further research should focus on this area.

A multidisciplinary approach to providing nutritional advice : the views and experiences of allied health professionals and dietitians

The role of professional placements in the development of dietetic competencies is widely accepted. There is a surprising lack of scholarship to assess what extent and how practice-based learning exposures contribute to competency accumulation across the different domains of practice. This qualitative study explored the experience of recent dietetic graduates whilst on placements across three domains of nutrition and dietetic practice, including clinical, food service and public health nutrition practice. This investigation focused particularly on the various factors infl uencing competency development in the placement environment. Qualitative interviews (n = 30) were conducted with recent graduates from 3 Universities in Australia, from 2 under-graduate and 1 post-graduate program. A semi structured interview technique was used to explore the experience of students whilst on each placement. These interviews were administered, recorded, and transcribed by a trained interviewer. All members of the research team reviewed the transcripts and compared, clarifi ed and interpreted the key response themes (research triangulation). Students consistently reported that professional placements forced accelerated competency development. Physical (the work environment) and interpersonal factors (such as attributes of the supervisor) were identifi ed as major infl uences on competency development. The following factors were also thematically identified as major contributors to the students learning experience: work space, organisation within departments, orientation to placement, organisational climate, supervisor communication, personality, interpersonal skills and teaching ability. Personal attributes of the student were also found to impact on competency development. These themes were consistent across practice domains. This study provides valuable evidence for academics and practitioners when developing placement programs.Abstract of poster presented at Dietitians Association of Australia 16th International Congress of Dietetics, 5-8 September 2012, Sydney Convention & Exhibition Centre, Sydney, Australia. Disciplines Arts and Humanities | Life Sciences | Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Baker, J., Fish, J., Walton, K. L., McMahon, A., Brewer, C. J., Manning, F., Grafenauer, S., Kennedy, M. A. & Probst, Y. (2012). If a picture tells a thousand words, how useful are they as a teaching tool? Evaluating a digital food photo resource within a first year tertiary nutrition subject. Nutrition and Dietetics, 69 (Suppl. S1), 158-158. Authors Joanna Baker, Janaye Fish, Karen L. Walton, Anne Therese McMahon, Christine J. Brewer, Fiona Manning, Sara Grafenauer, Meredith A. Kennedy, and Yasmine Probst This journal article is available at Research Online: http://ro.uow.edu.au/hbspapers/3193The role of Australian general practitioners (GPs) in providing nutrition care to patients for chronic disease management is currently receiving increased attention. However, limited literature explores the experiences of patients receiving nutrition care in this setting, as well as the nutrition-related expectations placed upon GPs by patients. This study explored the nutrition-related experiences, expectations and satisfaction of individuals diagnosed with Type II Diabetes under the care of an Australian GP. A cross-sectional retrospective online survey was developed using a review of relevant literature and practice guidelines for management of Type II diabetes in general practice to guide specifi c lines of enquiry. The survey was sent to all members of Diabetes Australia, Queensland with a registered author-address. Sixty-three survey items were clustered into fi ve groups, including general and diabetesrelated demographics; nutrition-related self effi cacy; perspectives on ideal GP nutrition care; and refl ections of previous GP nutrition care. Nine hundred and seventeen participants completed the survey (RR = 11%). Despite 81% of participants claiming that receiving nutrition care will be benefi cial to their diabetes management, only 49% of participants state that their GP has provided some nutrition care in relation to their diabetes. Of these participants, 86% are satisfi ed with the nutrition care received; however only 27% of participants believe that the nutrition care they have received from their GP has positively infl uenced their diabetes management. Patients report high levels of satisfaction with nutrition care received by GPs however varied perceptions regarding the effectiveness of this care.

A Pragmatic Randomised Controlled Trial of Specific Spinal Stabilisation Exercises in the Management of Recurrent Lumbar Spine Pain and Dysfunction – Pilot results

N E Foster, C Wright School of Health and Social Science, Coventry University Aims: The particular problem of recurrent low back pain (LBP), estimated at between 20% and 69% for one-year prevalence (Von Korff et al, 1993) and the associated escalating costs have highlighted the need to provide efficient, cost-effective interventions. Studies have suggested that addressing the muscular dysfunction shown to exist in subjects with LBP improves both objective and subjective outcomes of treatment (O’Sullivan et al, 1997). A pilot trial was undertaken in order to complete power calculations for the sample size required for a study examining the effect of incorporating specific spinal stabilisation exercises (SSSE) within the treatment of recurrent LBP, and assess the appropriateness of exclusion criteria.

Exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers–Danlos syndrome – hypermobility type

Abstract Purpose: To explore exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers–Danlos syndrome – hypermobility type and to explore patient experiences of physiotherapy. Methods: A cross sectional questionnaire survey design was used to collect quantitative and qualitative data from adult members of the Hypermobility Syndromes Association and Ehlers–Danlos Syndrome Support UK. Descriptive and inferential statistics were used to analyse the data. Qualitative data was analysed thematically. Results: 946 questionnaires were returned and analysed. Participants who received exercise advice from a physiotherapist were 1.75 more likely to report high volumes of weekly exercise (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.30–2.36, p < 0.001) than those with no advice. Participants who believed that exercise is important for long-term management were 2.76 times more likely to report a high volume of weekly exercise compared to the participants who did not hold this belief (OR = 2.76, 95% CI = 1.38–5.50, p = 0.004). Three themes emerged regarding experience of physiotherapy; physiotherapist as a partner, communication – knowledge, experience and safety. Conclusion: Pain, fatigue and fear are common barriers to exercise. Advice from a physiotherapist and beliefs about the benefits of exercise influenced the reported exercise behaviours of individuals with Ehlers–Danlos syndrome – hypermobility type in this survey. Implications for rehabilitation Exercise is a cornerstone of treatment for Ehlers–Danlos syndrome/Ehlers–Danlos syndrome – hypermobility type. Pain, fatigue and fear of injury are frequently reported barriers to exercise. Advice from physiotherapists may significantly influence exercise behaviour. Physiotherapists with condition specific knowledge and good verbal and non-verbal communication facilitate a positive therapeutic experience.

Clarification of reporting in stability systematic review

First, as has been the topic of discussion previously in these pages (Smidt et al 2005), systematic reviews are inevitably out of date by the time they are published and thus may not provide the most up-to-date evidence. This is certainly the case with the current review where a number of RCTs have subsequently been undertaken in this area (Shaughnessy & Caulfield 2004, Lewis et al 2005, Critchley et al 2006).