NIHR Signal Physiotherapy education before major abdominal surgery reduces lung complications

NIHR Signal Physiotherapy education before major abdominal surgery reduces lung complications


Published on 3 April 2018


A physiotherapy session before planned abdominal surgery, explaining the importance of breathing exercises and sitting out of bed as soon after surgery as possible, halves the risk of pneumonia.


https://discover.dc.nihr.ac.uk/content/signal-00579/physiotherapy-before-abdominal-surgery-helps-prevent-pneumonia


From the NIHR Dissemination Centre

Physios in Valentine's campaign to encourage men and women to ‘pucker up’

Physiotherapists are using Valentine’s Day to highlight that pelvic floor training is not just for bladder problems but also for sexual function.
Read more about the Chartered Society of Physiotherapy campaign at http://www.csp.org.uk/news/2018/02/13/physios-valentines-campaign-encourage-men-women-pucker

UHCW publication: pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1):56–63
Abstract

Aims: Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

Patients and Methods: A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions.

Results: A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS4 composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups.

Conclusion: This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further. Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00010&D=ovft&PDF=y (UHCW Athens login required)

UHCW publication: Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers.
Smith, Darren A; Saranga, Jacob; Pritchard, Andrew; Kommatas, Nikolaos A; Punnoose, Shinu Kovelal; et al.
Journal of bodywork and movement therapies Vol. 22, Iss. 1, (January 2018): 13-17.


Abstract

Background
Mulligan's mobilisation-with-movement (MWM) techniques are proposed to achieve their clinical benefit via neurophysiological mechanisms. However, previous research has focussed on responses in the sympathetic nervous system only, and is not conclusive. An alternative measure of neurophysiological response to MWM is required to support or refute this mechanism of action. Recently, vibration threshold (VT) has been used to quantify changes in the sensory nervous system in patients experiencing musculoskeletal pain.

Objective
To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.

Methods
Fifteen asymptomatic volunteers participated in this single-blinded, randomised, within-subject, placebo, control design. Participants received each of three interventions in a randomised order; a lateral glide MWM of the hip joint into flexion, a placebo MWM, and a control intervention. Vibration threshold (VT) measures were taken at baseline and immediately after each intervention. Mean change in VT from baseline was calculated for each intervention and then analysed for between group differences using a one-way analysis of variance (ANOVA).

Results
A one-way ANOVA revealed no statistically significant differences between the three experimental conditions (P = 0.812).

Conclusion
This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

PPA study day: Physio professor outlines new model of pain

Physiotherapists need a new model of pain that takes account of a ‘predictive’ sensory and cognitive interaction, and the influence of people’s emotions and expectations. T

his was the message from CSP fellow Mick Thacker, associate professor at London South Bank University at the Physiotherapy Pain Association (PPA) event on 26 January.

NICE draft guideline on rheumatoid arthritis - consultation open

NICE draft guidelines on rheumatoid arthritis in adults are open for consultation until 1st March 2018.


The proposals include giving adults with rheumatoid arthritis access to specialist physiotherapy to help manage their condition and improve their fitness, flexibility and strength.


See the draft guidelines and register to contribute to the consultation process at https://www.nice.org.uk/guidance/indevelopment/gid-ng10014/consultation/html-content-2

Artificial intelligence could help NHS physios with exercise compliance

New research published by the think tank Reform, Thinking on its own, suggests that Artificial intelligence (AI) can analyse data collected on wearable technology and help NHS clinicians support changes in patients’ behaviour.

• Chartered Society of Physiotherapy news item
• Thinking on its own: AI in the NHS

Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

J Bodyw Mov Ther. 2018 Jan;22(1):13-17. doi: 10.1016/j.jbmt.2016.10.001. Epub 2016 Oct 21.

OBJECTIVE: To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.
METHODS:

CONCLUSION: This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

UHCW Research: A Pritchard

Standard for physiotherapy degree apprenticeship gets seal of approval

The CSP has received confirmation that the Institute for Apprenticeships has approved the standard for the physiotherapy degree apprenticeship.

The standard sets out the knowledge, skills and behaviours that individuals will need to demonstrate as they progress through the new apprenticeship route to qualify as a physiotherapist.

It makes clear that the apprenticeship will be at honours degree level and that all apprentices will need to follow a degree programme, for which Health and Care Professions Council approval and CSP accreditation have been secured.

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

Bone Joint J. 2018 Jan;100-B(1):56-63. doi: 10.1302/0301-620X.100B1.BJJ-2017-0918.R1.

Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

UHCW Research: Smith NA, Wright, D, Spalding, T and Thompson, P

Chelsea and Westminster Hospital physios help develop hand therapy app

Physiotherapists at Chelsea and Westminster Hospital NHS Trust have been instrumental in developing an app to support people with hand injuries.

It provides patients with bespoke exercises prescribed by their therapist to aid recovery, according to a spokesperson for the trust, which treats more than 4,500 hand injury patients every year.

The app also contains a library of more than 80 instructional videos and audio tutorials, which patients can follow and replicate at home.

CSP launches survey to identify physiotherapy research priorities

The CSP is seeking opinions from physiotherapy staff, patients and carers about what areas of research the profession should prioritise.

Linked routine data can replace randomised control trials, think tank hears

Expensive randomised control trials involving physiotherapy could be replaced by using the data routinely collected during healthcare interventions and linking them together, according to the leader of one of the world’s largest research studies.

Managers endorse CSP’s flexible working guide

The Building a better balance guide, already available to stewards, has been re-issued by the Chartered Society of Physiotherapists with specific guidance for managers dealing with requests for flexible working.

Physios win praise for cutting hospital admissions

Physiotherapists in Cumbria have been praised for an initiative with social care, which has reduced the number of people who need to be admitted to hospital.

The team worked with social care staff from the local Eden Community Response Team to strengthen assessment and care in the community, so reducing the number of people who need to be admitted to hospital.

UCLH robots help stroke patients regain upper limb movement

Staff at UCLH’s stroke rehabilitation unit have become the first in the NHS to use robotic devices in conjunction with more traditional therapies to help patients regain arm and hand movement.

The robots, which help patients practise exercises to build up strength and dexterity, can be supervised by a physiotherapy assistant and were introduced as part of UCLH’s intensive three-week upper limb neuro rehabilitation programme.

NIHR Signal Breathing exercises improve asthma and can be learned by DVD

Breathing exercises taught by a physiotherapist in person or on DVD both improved the quality of life of adults with poorly controlled asthma to a small but similar extent. The DVD was the cheapest option, and it could lead to inexpensive internet delivery in the future.

This NIHR-funded trial recruited 655 UK adults with poorly controlled asthma. It showed about 63% of those receiving the breathing exercises had clinically important improvements in their asthma-related quality of life over a year, compared to 56% who improved receiving usual care.
Exercises did not improve formally measured lung function, suggesting the underlying biology of the asthma was unchanged.

The findings imply that breathing exercise programmes – currently recommended in the 2016 British guideline on the management of asthma when delivered by a physiotherapist – may be equally effective, and cheaper when delivered via DVD (or another video).

From the NIHR Dissemination Centre

Physios help reduce London’s neuromuscular emergency admissions

Physiotherapists have helped cut the number of emergency admissions and readmissions for people with neuromuscular conditions in London and the South East over the last five years.

An audit led by consultant neurologist Michael Hanna has revealed that emergency admissions for neuromuscular patients fell from 63 per cent to 32.8 per cent between 2012 and 2017, while readmissions halved from 25.1 per cent to 12.4 per cent.

The mortality rate over the same period dropped from 4.5 per cent to 0.3 per cent, with only one death in the 2017 sample compared to 24 in 2012.

One major factor in these improvements has been better coordination between specialist neuromuscular teams, including physios, and hospital staff. 

Physiotherapy app wins top rehabilitation award

A physiotherapy company specialising in the assessment and treatment of musculoskeletal conditions has won the Rehabilitation First training award for its ‘one-stop shop’ healthcare app.

The device includes a secure self-help and education website as well as tailored video exercise regimes, instant messaging, blogs and webinars.

It also offers a visual triage service which enables clinicians to see their patient and make a detailed on-the-spot assessment of their condition. They can then send patients tailored video exercises and check on screen they are being followed correctly.

First contact physio scheme to be rolled out across England

NHS England’s national primary care director Dr Arvind Madan told last week’s Royal College of General Practitioners’ conference that, following successful pilots, his ambition was to begin rolling out the physio first scheme across the country in 2018.

It would mean that ‘patients with musculoskeletal issues can have direct access to musculoskeletal professionals and they don't always, necessarily, go by the GP consulting room,’ he said.

Around one fifth of all patients visiting a GP present with musculoskeletal problems but at present many do not get to see a physio until their symptoms have significantly worsened.

See also this case study on Improving Access with Physio First.