Peter G. Osmotherly

Urinary incontinence is associated with an increase in falls: a systematic review

QUESTIONnIs urinary incontinence associated with falls in community-dwelling older people?nnnDESIGNnA systematic review and meta-analysis of observational studies investigating falls and urinary incontinence.nnnPARTICIPANTSnCommunity-dwelling older people.nnnOUTCOME MEASURESnFalls rather than fracture or injury, and any type of urinary incontinence.nnnRESULTSnOdds ratios of nine studies were included in the meta-analysis. The odds of falling were 1.45 (95% CI 1.36 to 1.54) in the presence of any type of urinary incontinence. The odds of falling were 1.54 (95% CI 1.41 to 1.69) in the presence of urge incontinence. The odds of falling were 1.11 (95% CI 1.00 to 1.23) in the presence of stress incontinence. The odds of falling were 1.92 (95% CI 1.69 to 2.18) in the presence of mixed incontinence.nnnCONCLUSIONnUrge urinary incontinence, but not stress urinary incontinence, is associated with a modest increase in falls. Falls prevention programs need to include an assessment of incontinence and referral for interventions to ameliorate the symptoms of urge incontinence.

Clinical prediction rules in the physiotherapy management of low back pain: A systematic review

OBJECTIVEnTo identify, appraise and determine the clinical readiness of diagnostic, prescriptive and prognostic Clinical Prediction Rules (CPRs) in the physiotherapy management of Low Back Pain (LBP).nnnDATA SOURCESnMEDLINE, EMBASE, CINAHL, AMED and the Cochrane Database of Systematic Reviews were searched from 1990 to January 2010 using sensitive search strategies for identifying CPR and LBP studies. Citation tracking and hand-searching of relevant journals were used as supplemental strategies.nnnSTUDY SELECTIONnTwo independent reviewers used a two-phase selection procedure to identify studies that explicitly aimed to develop one or more CPRs involving the physiotherapy management of LBP. Diagnostic, prescriptive and prognostic studies investigating CPRs at any stage of their development, derivation, validation, or impact-analysis, were considered for inclusion using a priori criteria. 7453 unique records were screened with 23 studies composing the final included sample.nnnDATA EXTRACTIONnTwo reviewers independently extracted relevant data into evidence tables using a standardised instrument.nnnDATA SYNTHESISnIdentified studies were qualitatively synthesized. No attempt was made to statistically pool the results of individual studies. The 23 scientifically admissible studies described the development of 25 unique CPRs, including 15 diagnostic, 7 prescriptive and 3 prognostic rules. The majority (65%) of studies described the initial derivation of one or more CPRs. No studies investigating the impact phase of rule development were identified.nnnCONCLUSIONSnThe current body of evidence does not enable confident direct clinical application of any of the identified CPRs. Further validation studies utilizing appropriate research designs and rigorous methodology are required to determine the performance and generalizability of the derived CPRs to other patient populations, clinicians and clinical settings.

Physiotherapy for accessory nerve shoulder dysfunction following neck dissection surgery: A literature review

Neck dissection is an operation that can result in accessory nerve injury. Accessory nerve shoulder dysfunction (ANSD) describes the pain and impaired range of motion that may occur following neck dissection. The aim of this review was to establish the level of evidence for the effectiveness of physiotherapy in the postoperative management of ANSD.

An Examination of Outcome Measures for Pain and Dysfunction in the Cervical Spine : A Factor Analysis

Study Design. Cross-sectional design. Objective. To examine and compare the factorial structure of 4 validated neck pain and dysfunction scales. Summary of Background Data. Neck pain and dysfunction is commonly measured using 1 of 4 validated self-reporting questionnaires: the Neck Disability Index (NDI), the Northwick Park Neck Pain Questionnaire (NPQ), the Copenhagen Neck Functional Disability Scale (CNFDS), and the Neck Pain and Disability Scale (NPDS). Although used interchangeably in the literature, recent studies suggest that the 4 scales differ in the number and type of factors that they examine and the weighting of these factors. To date, there have been no direct comparisons made of these scales when applied simultaneously to the same patient population. Methods. Data were collected from 88 patients with mechanical neck pain who completed all 4 questionnaires. Exploratory principal components factor analyses were conducted to expose the underlying factors within each of the scales. Identified factors were examined, characterized, and compared. Results. Factor analysis revealed a single factor for the NDI, 2 factors for the NPQ, and 3 factors for both the CNFDS and NPDS. Factors identified include neck pain, dysfunction related to general activities, neck-specific function, cognition, emotion, and the influence of participation restriction on psychosocial functioning. The 3 NPDS factors appear to assess the multidimensional nature of neck pain and dysfunction most comprehensively. Conclusion. When selecting and interpreting a neck pain and dysfunction scale, clinicians and researchers are encouraged to take into account the factors measured by the NDI, NPQ, CNFDS, and NPDS and their applicability to the specific neck patient population under examination. The decision of which factors are of greatest interest will influence the selection of an appropriate outcome instrument.

Does Scapula Taping Facilitate Recovery for Shoulder Impingement Symptoms? A Pilot Randomized Controlled Trial

Abstract Scapula taping is a commonly used adjunctive treatment for shoulder im- pingement pathology. However, this intervention has not previously been subject to formal investigation. A pilot single-blind randomized controlled trial was conducted to evaluate facilitatory taping as an adjunct to routine physiotherapy management. Twenty-two sub- jects with unilateral shoulder impingement symptoms were randomized into a taping with routine physiotherapy or a routine physiotherapy only group. The intervention group had scapula taping applied three times per week for the first two weeks of their treatment. All subjects were assessed at baseline, then at 2 and 6 weeks after the commencement of treat- ment. Pain and functional ability were assessed using the Shoulder Pain and Disability In- dex, range of shoulder elevation, and self-reported pain on elevation. At 2 weeks, the taping group demonstrated a strong trend toward reduced pain both on self-reported activity (SPADI pain subscale mean for taping 27.0 versus 41.5 for control) and pain during mea- sured abduction (mean VAS 22.8 for taped, 46.8 for control), statistical power being limited by small sample size. No similar trend was evident in the SPADI disability subscale. The magnitude of the differences was reduced at 6-week follow-up. This study provides prelimi- nary evidence for a short-term role for scapula taping as an adjunct to routine physiother- apy in the management of shoulder impingement symptoms but also highlights the need for consideration on a case basis relating to risk factors for skin reaction.

Lymphoedema following treatment for head and neck cancer: impact on patients, and beliefs of health professionals.

Cervicofacial lymphoedema is a recognised side-effect that may result following treatment for head and neck cancer. This study aimed to investigate the perspectives of affected patients and the beliefs that treating health professionals hold about head and neck lymphoedema. Ten patients with head and neck lymphoedema and 10 health professionals experienced in the treatment of head and neck cancer patients agreed to participate in semi-structured face to face interviews. Interviews were recorded, audio files were transcribed and coded and then analysed for themes. Themes of experiences of patients with head and neck lymphoedema and the beliefs of health professionals largely overlapped. Given its visible deformity, the main effect of lymphoedema in head and neck cancer patients was on appearance. In some cases this lead to negative psychosocial sequelae such as reduced self-esteem, and poor socialisation. Clinicians need to be aware of those patients more likely to experience lymphoedema following treatment for head and neck cancer, and how they are affected. Understanding how patients with facial lymphoedema are affected psychologically and physically, and the importance of prompt referral for lymphoedema treatment, might ultimately improve outcomes and ensure optimal management.

Validation and impact analysis of prognostic clinical prediction rules for low back pain is needed: a systematic review

OBJECTIVESnTo identify prognostic forms of clinical prediction rules (CPRs) related to the nonsurgical management of adults with low back pain (LBP) and to evaluate their current stage of development.nnnSTUDY DESIGN AND SETTINGnSystematic review using a sensitive search strategy across seven databases with hand searching and citation tracking.nnnRESULTSnA total of 10,005 records were screened for eligibility with 35 studies included in the review. The included studies report on the development of 30 prognostic LBP CPRs. Most of the identified CPRs are in their initial phase of development. Three CPRs were found to have undergone validation--the Cassandra rule for predicting long-term significant functional limitations and the five-item and two-item Flynn manipulation CPRs for predicting a favorable functional prognosis in patients being treated with lumbopelvic manipulation. No studies were identified that investigated whether the implementation of a CPR resulted in beneficial patient outcomes or improved resource efficiencies.nnnCONCLUSIONnMost of the identified prognostic CPRs for LBP are in the initial phase of development and are consequently not recommended for direct application in clinical practice at this time. The body of evidence provides emergent confidence in the limited predictive performance of the Cassandra rule and the five-item Flynn manipulation CPR in comparable clinical settings and patient populations.

Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique

Background: Adhesive capsulitis often is difficult to diagnose in its early stage and to differentiate from other commonly seen shoulder disorders with the potential to cause pain and limited range of movement. Objectives: The purpose of this study was to establish consensus among a group of experts regarding the clinical identifiers for the first or early stage of primary (idiopathic) adhesive capsulitis. Design: A correspondence-based Delphi technique was used in this study. Methods: Three sequential questionnaires, each building on the results of the previous round, were used to establish consensus. Results: A total of 70 experts from Australia and New Zealand involved in the diagnosis and treatment of adhesive capsulitis completed the 3 rounds of questionnaires. Following round 3, descriptive statistics were used to screen the data into a meaningful subset. Cronbach alpha and factor analysis then were used to determine agreement among the experts. Consensus was achieved on 8 clinical identifiers. These identifiers clustered into 2 discrete domains of pain and movement. For pain, the clinical identifiers were a strong component of night pain, pain with rapid or unguarded movement, discomfort lying on the affected shoulder, and pain easily aggravated by movement. For movement, the clinical identifiers included a global loss of active and passive range of movement, with pain at the end-range in all directions. Onset of the disorder was at greater than 35 years of age. Conclusions: This is the first study to use the Delphi technique to establish clinical identifiers indicative of the early stage of primary (idiopathic) adhesive capsulitis. Although limited in differential diagnostic ability, these identifiers may assist the clinician in recognizing early-stage adhesive capsulitis and may inform management, as well as facilitate future research.

Maximizing shoulder function after accessory nerve injury and neck dissection surgery: A multicenter randomized controlled trial.

Shoulder pain and dysfunction after neck dissection may result from injury to the accessory nerve. The effect of early physical therapy in the form of intensive scapular strengthening exercises is unknown.

The effect of wearing loupes on upper extremity musculoskeletal disorders among dental hygienists.

OBJECTIVESnIt is well established that musculoskeletal disorders (MSD) are a significant occupational health issue for dentists and hygienists. Despite this, there has been little advancement in the application of ergonomic principles in the dental profession. While the use of loupes is often promoted as an ergonomic solution, there is little published research to robustly support this claim. The aim of the present study was to investigate the effect of the use of loupes on upper extremity MSD among dental hygienists.nnnMETHODSnThe study was conducted using an exploratory pretest and post-test design, comparing musculoskeletal measures in practising dental hygienists wearing loupes with final-year dental hygiene students who did not wear loupes. Pre- and post-test measures included valid self-reported and objective outcome measures and were measured at baseline and 6 months following the intervention. Statistical analysis was conducted as a series of mixed anovas with time and treatment as the independent variables.nnnRESULTSnThe analysis revealed a significant interaction between time and treatment for the Disabilities of the Shoulder, Arm and Hand (DASH) scores (P < 0.04), indicating an improvement in symptoms for the treatment group but a reversed trend for the controls. There was also a significant mean increase in scapular position measures; however, this finding was evident in both groups, indicating that these were not a result of the intervention.nnnCONCLUSIONSnOverall, this study suggests that wearing loupes appears to have both positive and negative effects on upper extremity MSD among dental hygienists. Ongoing research is required to determine the long-term effects of loupes wear, over an extended period of time.