Australian Journal of Physiotherapy最新文献

Question

Do females with patellofemoral pain syndrome have decreased hip muscle strength compared with the unaffected side and with healthy controls?

Design

A systematic review of observational studies published up to January 2008.

Participants

Females with patellofemoral pain syndrome and healthy controls.

Outcome measures

Strength for at least one hip muscle group had to be included in the study. Hip muscle strength was recorded as force or torque.

Results

Five cross-sectional studies with a mean Newcastle-Ottawa Assessment Scale score of 6 out of 9 met the inclusion criteria. Strong evidence was found for a deficit in hip external rotation, abduction and extension strength, moderate evidence for a deficit in hip flexion and internal rotation strength, and no evidence for a deficit in hip adduction strength compared with healthy controls. Moderate evidence was found for a decrease in hip external rotation and abduction strength but no evidence for a decrease in hip extension, flexion, adduction and internal rotation strength compared with the unaffected side.

Conclusion

Females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy controls.

Question

What predicts short- and medium-term activity limitation in people after ankle fracture?

Design

Inception cohort observational study.

Participants

Adults with ankle fracture recruited within days following cast removal from physiotherapy departments of teaching hospitals in Sydney, Australia.

Outcome measures

The predictive value of variables that were injury-related (fracture management, fracture severity, angle of the ankle during cast immobilisation, and time from cast removal to baseline) and performance-related (activity limitation, pain, mobility, and dorsiflexion range of motion measured soon after cast removal) were examined in one dataset (n = 150) using univariate linear regression. Significant variables (p ≤ 0.20) were further examined with a multivariate linear model. A clinical prediction rule was derived then validated using data from an independent dataset (n = 94).

Results

Fracture management, fracture severity, baseline activity limitation, pain, mobility, and dorsiflexion had significant but weak univariate associations with activity limitation. Only pain and dorsiflexion range of motion contributed independently to the clinical prediction rule. When applied to the validation data, the rule explained 12% of the short-term and 9% of the medium-term variance in activity limitation.

Conclusion

Performance-related variables were stronger predictors than injury-related variables. A clinical prediction rule consisting of pain and dorsiflexion range of motion explained a small amount of the variance in short- and medium-term activity limitation, suggesting that it may be appropriate to identify people with high levels of pain and restricted dorsiflexion after ankle fracture and target intervention accordingly.

Question

Does regular airway clearance using an oscillating positive expiratory pressure (PEP) device improve quality of life, sputum volume, respiratory function, and exercise capacity in people with bronchiectasis?

Design

Randomised, crossover, controlled trial with 3-month intervention periods separated by a 1-month washout period.

Setting

Acute teaching hospital in Scotland.

Participants

20 adults with radiologically diagnosed bronchiectasis and chronic sputum expectoration, who were not performing regular physiotherapy for airway clearance. Smoking, asthma, emphysema, and cystic fibrosis were exclusion criteria.

Interventions

While in the intervention arm, participants performed 20–30 minutes of airway clearance twice daily. Each session consisted of three cycles of 10 breaths through an oscillating positive expiratory pressure (PEP) device called the Acapella, followed by the forced expiratory technique and coughing. Each participant's technique was reviewed by a physiotherapist monthly during the intervention arm. During the control arm, the device was retained by the investigators and participants performed no physiotherapy for airway clearance. Throughout the study, both groups received all other standard management including antibiotics when exacerbation criteria were met. Any changes to the participants’ usual medication regimen were noted.

Outcome measures

The primary outcome was the Leicester Cough Questionnaire (LCQ) – a 19-point, patient-reported measure of the impact of cough severity on quality of life with three domains (physical, psychological, and social). Secondary outcomes included the St George's Respiratory Questionnaire (SGRQ), 24-hour sputum volume, lung function, maximum respiratory pressures, and the incremental shuttle walk test, measured at the end of each intervention arm.

Results

All participants completed the study with no adverse events during airway clearance. During the 3-month intervention period, the total LCQ score showed significantly greater improvement than during the control period: difference in medians for total LCQ score 1.3 points, p = 0.002. Each of the three domains within the LCQ also showed significant benefits. Other outcomes that showed significantly greater improvements due to the airway clearance intervention were the SGRQ (difference in medians 8.5 points, p = 0.005), 24-hr sputum volume (difference in medians 3 ml, p = 0.02), and the incremental shuttle walk distance (difference in medians 40 m, p = 0.001). The groups did not differ significantly on the remaining secondary outcomes.

Conclusion

Regular airway clearance with oscillating PEP improves diseaserelated quality of life and exercise capacity in people with bronchiectasis.

Question

What is the effect of the addition of arthroscopy to physiotherapy and medication in patients with osteoarthritis (OA) of the knee?

Design

Randomised, controlled trial with blinded outcome assessment and intention-to-treat analysis.

Setting

A university sports medicine clinic in Ontario, Canada.

Participants

Adults with idiopathic or secondary moderate-to-severe OA of the knee (Grade 2, 3, or 4 radiographic severity on the modified Kellgren-Lawrence classification). Key exclusion criteria were large meniscal tears, inflammatory arthritis, previous arthroscopic treatment for knee OA and more than 5 degrees of lateral deformity. Randomisation of 188 participants allotted 94 to an intervention group and 94 to a control group.

Interventions

The intervention group underwent arthroscopy within 6 weeks after randomisation and a standard physiotherapy and medication regimen was initiated within 7 days after surgery. The control group initiated the same physiotherapy and medication regimen at an equivalent time. Physiotherapy was provided for 1 hour once a week for 12 weeks. It included range-of-motion and strengthening exercises to be performed at home twice daily, information about activities of daily living, instruction in the use of heat and cold, and an educational video. Exercises were individualised according to the severity of OA and age. After the 12-week period, participants were advised to continue the exercise program. Medications (potentially including paracetamol, non-steroidal anti-inflammatory drugs, hyaluronic acid, and glucosamine) were prescribed according to standard guidelines.

Outcome measures

The primary outcome was the WOMAC score at 2 years follow up. The WOMAC is scored from 0 (worst) to 2400, with subscales for pain, stiffness, and physical function. Secondary outcomes included the Physical Component Summary Score of the Short Form-36 (0 to 100); the McMaster Toronto Arthritis patient preference (MACTAR) questionnaire (0 to 500); and the Arthritis Self- Efficacy Scale (ASES) (10 to 100).

Results

168 participants completed the study. After 2 years, the mean (SD) WOMAC scores were 874 (624) in the intervention group and 897 (583) in the control group, mean difference 23 (95% CI –208 to 161). The groups differed on the SF-36 by only 0.2 (95% CI –3.2 to 3.6), on the MACTAR questionnaire by only 6 (95% CI –37 to 49), and on each of the ASES subscales by less than 6 (all non-significant).

Conclusion: The addition of arthroscopy to a regimen of physiotherapy and medication does not improve physical function, pain, or health-related quality of life in patients with moderate-to-severe OA of the knee.