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ABSTRACT



This study aimed to review the literature addressing motor physical therapy for intensive care unit adult patients. A literature search was conducted in the databases, PubMed, MedLine (International Literature and Health), LILACS (Latin American and Caribbean Health Sciences) and Cochrane between 1995 and December 2008 using the keywords: physical therapy, mobilization and intensive care unit. For comparison purposes we selected randomized controlled trials and prospective studies, addressing the subject motor physical therapy for intensive care unit adult patients. Pediatric and experimental studies, systematic reviews and meta-analysis were excluded. Of the 121 articles identified, only 4 met the inclusion criteria. Among these, three focused early motor physical therapy in patients with a range of diagnoses, showing that these patients left the bed and walked earlier, and stayed shorter both in the intensive care unit and hospital. Furthermore, patients on early motor physical therapy had shorter mechanical ventilation duration. Another paper compares the use of electrical stimulation associated with physical therapy in chronic obstructive pulmonary disease patients, showing increased muscle strength and shorter time for these patients bed to chair transference as compared with those only receiving physiotherapy. The risks of immobilization in mechanically ventilated critically ill patients are not fully understood. However, it is clear that the survivors show impaired quality of life due to persistent weakness and fatigue. Early mobilization is a new area, with little evidence so far. However, recent studies have confirmed that mechanically ventilated patients mobilization is safe and feasible, reducing both the intensive care unit and hospital stay. However, more studies are warranted to identify the exercise type, duration, intensity and impact for of early motor therapy in specific groups of patients.



Keywords: Physical therapy modalities; Adult; Intensive care

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In many cases, patients who endured weeks of immobilization as a result of traction, casts, external fixators, and amputation, are just beginning to regain mobility through physiotherapy.

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"If you have a website, take it down NOW."



"REMOVE all the blue MCA [McTimoney Chiropractic Association] patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them. DO NOT USE them until further notice."

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"Si tiene una página web, retírela DE INMEDIATO."



"ELIMINE todos los folletos azules de la MCA [McTimoney Chiropractic Association] para los pacientes, o cualquier folleto de información para los pacientes de su propiedad que sostenga que usted trata latigazo cervical, cólicos o cualquier otro problema pediátrico en su clínica o en cualquier otro lugar que muestre sus detalles de contacto. NO LOS USE hasta próximo aviso."

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Question: Does behavioural graded activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee?



Design: Analysis of secondary outcomes of a cluster-randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis.



Participants: Two hundred patients with hip and/or knee osteoarthritis.



Intervention: Experimental group received 18 sessions of behavioural graded activity over 12 weeks and up to 7 booster sessions over the next year. The control group received 18 sessions of usual care over 12 weeks according to the Dutch physiotherapy guideline. Outcome measures: Exercise adherence was measured using a questionnaire and physical activity was measured using the SQUASH questionnaire at baseline, 13, and 65 weeks.



Results: Adherence to recommended exercises was significantly higher in the experimental group than in the control group at 13 weeks (OR 4.3, 95% CI 2.1 to 9.0) and at 65 weeks (OR 3.0, 95% CI 1.5 to 6.0). Significantly more of the experimental than the control group met the recommendations for physical activity at 13 weeks (OR 5.3, 95% CI 1.9 to 14.8) and at 65 weeks (OR 2.9, 95% CI 1.2 to 6.7).



Conclusion: Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee, both in the short- and long-term.

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Question: Does a new positive expiratory pressure device (conical-PEP) decrease lung hyperinflation during exercise in patients with chronic obstructive pulmonary disease compared to normal breathing? Does it increase the duration of exercise?



Design: A randomised, cross-over trial with concealed allocation.



Participants: Thirteen patients with moderate to severe chronic obstructive pulmonary disease (mean FEV1 61% predicted).



Intervention: The experimental intervention was conical-PEP breathing with a positive expiratory pressure of 4-20 cmH2O during 30% of 1 RM alternate knee extension exercise at 70% age-predicted HRmax to fatigue. The control intervention was normal breathing.



Outcome measures: Total lung capacity (inspiratory capacity and slow vital capacity), breathlessness, and leg discomfort were measured pre and post exercise. Cardiorespiratory function was measured pre and during the last 30 s of exercise. Duration of exercise was recorded.



Results: After the experimental intervention, inspiratory capacity increased 200 ml (95% CI 0 to 400) and slow vital capacity increased 200 ml (95% CI 0 to 400) more than the control intervention. Participants exercised for 107 s (95% CI -23 to 238) more during the experimental intervention than the control intervention. Conical-PEP breathing during exercise resulted in 6.1 fewer breaths/min (95% CI 1.4 to 10.8) than normal breathing; it did not have any adverse effects on CO2 retention or oxygen saturation.



Conclusion: The novel conical-PEP device decreases lung hyperinflation, is safe to use, and tends to increase the duration of exercise.

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Question: Is there any difference between the effect of therapeutic ultrasound and antibiotics (amoxicillin) on pain and congestion for acute bacterial rhinosinusitis in the short-term? Is there any difference in patient satisfaction, preferred future intervention, side-effects and relapses in the long-term?



Design: A randomised trial with concealed allocation and intention-to-treat analysis.



Participants: 48 patients (6 dropouts) with clinically diagnosed acute bacterial rhinosinusitis in primary care.



Intervention: The experimental group received 4 consecutive days of ultrasound and the control group received a 10-day course of antibiotics.



Outcome measures: Pain and congestion around the nose and in the forehead and teeth were measured on a 0-10 numeric rating scale at baseline, Day 4, and Day 21. Satisfaction, preferred future intervention, side-effects, and relapses were measured one year later.



Results: By Day 4, pain around the nose had decreased by 1.5 points out of 10 (95% CI 0.6 to 2.5) more in the experimental group than the control group. There were no other differences in decrease in pain and congestion between the groups at Day 4 or 21. At one year follow-up, the experimental group were more likely to prefer ultrasound than the control group were to prefer antibiotics to manage a future episode (RR 2.75, 95% CI 1.19 to 7.91). There were no other differences between the groups in terms of satisfaction with intervention, number of side-effects, or number of relapses.



Conclusion: The results of this study suggest that therapeutic ultrasound is a viable alternative to antibiotics in the management of acute bacterial rhinosinusitis.

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Abstract



Introduction and hypothesis

Pelvic floor muscle training (PFMT) is considered to be the first-line treatment for female stress urinary incontinence (SUI). There are few studies that have tested the efficacy of unsupervised PFMT. The aim of this study was to compare the effectiveness of intensive supervised PFMT to unsupervised PFMT in the treatment of female SUI.



Methods

Sixty-two women with SUI were randomized to either supervised or unsupervised PFMT after undergoing supervised training sessions. They were evaluated before and after the treatment with the Oxford grading system, pad test, quality of life questionnaire, subjective evaluation, and exercise compliance.



Results

After treatment, there were no differences between the two groups regarding PFM strength (p  = 0.20), International Consultation on Incontinence Questionnaire-Short Form score (p = 0.76), pad test (p = 0.78), weekly exercise compliance (p = 0.079), and subjective evaluation of urinary loss (p = 0.145).



Conclusions

Both intensive supervised PFMT and unsupervised PFMT are effective to treat female SUI if training session is provided.

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Abstract



Background and Purpose

The study aimed to investigate the thermal and non-thermal effects of pulsed short wave therapy (PSWT) using high and low dose of PSWT together with placebo and control conditions in healthy subjects.



Method

A single-blind, crossover design was employed with 31 subjects who all participated in three conditions: High PSWT (PD 200µ sec, PRR 800 Hz, MP 24 W, 10 minutes), Low PSWT (PD 100µ sec, PRR 200 Hz, MP 3 W, 10 minutes), and Placebo PSWT (PD 20µ sec, PRR 50 Hz, MP 0.05 W, 10 minutes). Fourteen subjects additionally participated in a Control condition (no treatment, 10 minutes). Measurements of skin temperature, blood flow, heart rate, and core temperature were taken before, during, and after the application of PSWT. Data were analyzed using a repeated measures analysis of variance (ANOVA) model with a Bonferroni post-hoc comparison.



Results

A significant increase in blood volume and skin temperature with both the high- and low-dose applications during the treatment period was demonstrated. There were significant differences between time periods and between treated and untreated limbs compared with the control condition. The blood flow changes during the low-dose application were not significantly different from placebo. Some subjects were unable to detect significant changes in skin temperature.



Conclusion

Significant physiological changes associated with the application of PSWT have been demonstrated, challenging the notion of a lack of effect of this therapy. The study also demonstrated a measurable increase in skin temperature, which was not associated with thermal sensory perception; thus, skin sensation may not be clinically reliable for detecting real changes in temperature. Subjects with a wide age range of ages were deliberately recruited; however, these results may not extrapolate to a patient population who could react differently to the same intervention. Further studies in the clinical environment are therefore needed.

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Background and purpose The optimal treatment for isolated patellofemoral osteoarthritis is unclear at present. We systematically reviewed the highest level of available evidence on the nonoperative and operative treatment of isolated patellofemoral osteoarthritis to develop an evidenced-based discussion of treatment options.



Methods A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), and EMBASE) was performed in March 2009. The quality of the studies was assessed independently by two authors using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.



Results We extracted data from 44 articles. The best available evidence for treatment of isolated patellofemoral osteoarthritis is sparse and of generally low methodological quality. Nonoperative treatment using physiotherapy (GRADE: high quality, weak recommendation for use), taping (GRADE: moderate quality, weak recommendation for use), or injection therapy (GRADE: very low quality, weak recommendation for use) may result in short-term relief. Joint-preserving surgical treatment may result in insufficient, unpredictable, or only short-term improvement (GRADE: low quality, weak recommendation against use). Total knee replacement with patellar resurfacing results in predictable and good, durable results (GRADE: low quality, weak recommendation for use). Outcome after patellofemoral arthroplasty in selected patients is good to excellent (GRADE: low quality, weak recommendation for use).



Interpretation Methodologically good quality comparative studies, preferably using a patient-relevant outcome instrument, are needed to establish the optimal treatment strategy for patients with isolated patellofemoral osteoarthritis.

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Abstract



Background

Despite conflicting evidence, chest physiotherapy has been widely used as an adjunctive treatment for adults with pneumonia.



Objectives

To assess the effectiveness and safety of chest physiotherapy for pneumonia in adults.



Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 3); MEDLINE (1966 to August 2009); EMBASE (1974 to August 2009); CBM (1978 to August 2009); the National Research Register (August 2009) and Physiotherapy Evidence Database (PEDro) (1929 to August 2009).



Selection criteria

Randomised controlled trials (RCTs) assessing the efficacy of chest physiotherapy for treating pneumonia in adults.



Data collection and analysis

Two authors independently assessed trial eligibility, extracted data and appraised trial quality. Primary outcomes were mortality and cure rate. We used risk ratios (RR) and mean difference (MD) for individual trial results in the data analysis. We performed meta-analysis and measured all outcomes with 95% confidence intervals (CI).



Main results

Six RCTs (434 participants) appraised four types of chest physiotherapy (conventional chest physiotherapy; osteopathic manipulative treatment (which includes paraspinal inhibition, rib raising and myofascial release); active cycle of breathing techniques (which include active breathing control, thoracic expansion exercises and forced expiration techniques); and positive expiratory pressure).



None of the physiotherapies (versus no physiotherapy or placebo) improved mortality rates of adults with pneumonia.



Conventional chest physiotherapy (versus no physiotherapy), active cycle of breathing techniques (versus no physiotherapy) and osteopathic manipulative treatment (versus placebo) did not increase the cure rate or chest X-ray improvement rate.



Osteopathic manipulative treatment (versus placebo) and positive expiratory pressure (versus no physiotherapy) reduced mean duration of hospital stay by 2.0 days (mean difference (MD) -2.0 days, 95% CI -3.5 to -0.6) and 1.4 days (MD -1.4 days, 95% CI -2.8 to -0.0), respectively. Conventional chest physiotherapy and active cycle of breathing techniques did not.



Positive expiratory pressure (versus no physiotherapy) reduced fever duration (MD -0.7 day, 95% CI -1.4 to -0.0). Osteopathic manipulative treatment did not.



Osteopathic manipulative treatment (versus placebo) reduced duration of intravenous (MD -2.1 days, 95% CI -3.4 to -0.9) and total antibiotic treatment (MD -1.9 days, 95% CI -3.1 to -0.7).



Limitations of this review are that the studies addressing osteopathic manipulative treatment were small, and that the six published studies which appear to meet the inclusion criteria are awaiting classification.



Authors' conclusions

Based on current limited evidence, chest physiotherapy might not be recommended as routine adjunctive treatment for pneumonia in adults.

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ABSTRACT



Complex regional pain syndrome (CRPS), formerly known as Sudeck's dystrophy and causalgia, is a disabling and distressing pain syndrome. We here provide a review based on the current literature concerning the epidemiology, etiology, pathophysiology, diagnosis, and therapy of CRPS. CRPS may develop following fractures, limb trauma or lesions of the peripheral or CNS. The clinical picture comprises a characteristic clinical triad of symptoms including autonomic (disturbances of skin temperature, color, presence of sweating abnormalities), sensory (pain and hyperalgesia), and motor (paresis, tremor, dystonia) disturbances. Diagnosis is mainly based on clinical signs. Several pathophysiological concepts have been proposed to explain the complex symptoms of CRPS: (i) facilitated neurogenic inflammation; (ii) pathological sympatho-afferent coupling; and (iii) neuroplastic changes within the CNS. Furthermore, there is accumulating evidence that genetic factors may predispose for CRPS. Therapy is based on a multidisciplinary approach. Non-pharmacological approaches include physiotherapy and occupational therapy. Pharmacotherapy is based on individual symptoms and includes steroids, free radical scavengers, treatment of neuropathic pain, and finally agents interfering with bone metabolism (calcitonin, biphosphonates). Invasive therapeutic concepts include implantation of spinal cord stimulators. This review covers new aspects of pathophysiology and therapy of CRPS.

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Abstract

This review presents the physical performance outcomes of randomised trials investigating exercise programmes that included balance exercise for older people with dementia. A systematic literature search through five computerised bibliographic databases until February 2009 was carried out. Of 1,038 potentially relevant published articles, only seven met the inclusion criteria and were extracted. Findings from the review for a total of 632 participants showed that almost all of the included studies addressed exercise or physical activities as the main intervention; however, only two of the studies focused on balance exercise. The effect size values varied from no effect (0.00) to a large effect (3.29) of the interventions for a range of physical performance outcome measures. Findings also suggest that it is feasible to conduct exercise programmes with older people with dementia. However, further studies with more specific exercise designed to improve balance performance in order to prevent falls are required for older people with dementia.