Healthcare Library Current Awareness Bulletin – Physiotherapy

July 2015

This quarterly Current Awareness Bulletin is produced by the Healthcare Library to provide Salisbury NHS Foundation Trust staff with a range of resources to support practice. It includes recently published guidelines and research articles, news, and details of new library resources.

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Guidelines

National Institute for Health and Care Excellence (NICE)

Physical activity: encouraging activity in all people in contact with the NHS NICE quality standard [QS84] Published date: March 2015

Falls in older people: assessment after a fall and preventing further falls NICE quality standard [QS86] Published date: March 2015

Violence and aggression: short-term management in mental health, health and community settings NICE guidelines [NG10] Published date: May 2015

Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges NICE guidelines [NG11] Published date: May 2015

College of Occupational Therapists

Splinting for the prevention and correction of contractures in adults with neurological dysfunction

New and Updated Cochrane Systematic Reviews

New Reviews – March 2015

Physical rehabilitation for critical illness myopathy and neuropathy

Standard (head-down tilt) versus modified (without head-down tilt) postural drainage in infants and young children with cystic fibrosis

Updated Reviews – March 2015

Braces and orthoses for treating osteoarthritis of the knee

New Reviews – April 2015

Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis

New Reviews – May 2015

Manual lymphatic drainage for lymphedema following breast cancer treatment

New Reviews – June2015

Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections

Updated Reviews – June 2015

Physical exercise training for cystic fibrosis

Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis

Transcutaneous electrical nerve stimulation for acute pain

Journal Articles

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Table of Contents

1. A Systematic Review of Resistance Training Versus Endurance Training in COPD. 2. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. 3. Acceptability of the aquatic environment for exercise training by people with chronic obstructive pulmonary disease with physical comorbidities: Additional results from a randomised controlled trial. 4. Acupuncture for chronic nonspecific low back pain: An overview of systematic reviews 5.Addition of motivational interventions to exercise and traditional Physiotherapy: A review and meta-analysis 6. Aerobic Capacity in Persons with Multiple Sclerosis: A Systematic Review and Meta-Analysis. 7. Can combined aerobic and muscle strength training improve aerobic fitness, muscle strength, function and quality of life in people with spinal cord injury? A systematic review. . 8. Determining the level of evidence for the effectiveness of spinal manipulation in upper limb pain: A systematic review and meta-analysis. 9. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. 10. Does Perturbation-Based Balance Training Prevent Falls? Systematic Review and Meta-Analysis of Preliminary Randomized Controlled Trials. . 11. Effectiveness of Dry Needling for Myofascial Trigger Points Associated With Neck and Shoulder Pain: A Systematic Review and Meta-Analysis. 12. Effectiveness of Postoperative Physical Therapy for Upper-Limb Impairments After Breast Cancer Treatment: A Systematic Review.

13. Effect of increased intensity of physiotherapy on patient outcomes after stroke: An evidence-based analysis

14. Effect of pilates exercise for improving balance in older adults: A systematic review with meta-analysis 15. Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials. 16. Efficacy of Aerobic Exercise for Treatment of Chronic Low Back Pain 17. Falls prevention interventions in older adults with cognitive impairment: A systematic review of reviews. 18. Functional Electrical Stimulation Improves Activity After Stroke: A Systematic Review With Meta-Analysis. 19. Gait behaviors as an objective surgical outcome in low back disorders: A systematic review. 20. Immunological effects of massage after exercise: A systematic review. 21. Management of Falls in Community- Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association.

22. Musculoskeletal physiotherapists' use of psychological interventions: a systematic review of therapists' perceptions and practice. 23. Novel methods of instruction in ACL injury prevention programs, a systematic review. 24. Physiotherapeutic interventions before and after surgery for degenerative lumbar conditions: a systematic review. 25. Research Report. Effect of Taping on Spinal Pain and Disability: Systematic Review and Meta-Analysis of Randomized Trials. 26. Research Report. How Strongly Is Aerobic Capacity Correlated With Walking Speed and Distance After Stroke? Systematic Review and Meta-Analysis. 27. Return to sport after hip surgery for femoroacetabular impingement: a systematic review. 28. Risk factors for groin injury in sport: an updated systematic review 29. Stabilizing characteristics of rotator cuff muscles: a systematic review. 30. Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients. 31. The Efficacy of Manual Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta-analysis. 32. The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial. 1.Title: A Systematic Review of Resistance Training Versus Endurance Training in COPD. Citation: Journal of Cardiopulmonary Rehabilitation & Prevention, 01 May 2015, vol./is. 35/3(163-172), 19327501 Author(s): Iepsen, Ulrik Winning, Jørgensen, Karsten Juhl, Ringbaek, Thomas, Hansen, Henrik, Skrubbeltrang, Conni, Lange, Peter Language: English Abstract: PURPOSE: Endurance training (ET) as part of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to improve exercise capacity and health-related quality of life, but dyspnea limits the exercise intensity. Therefore, resistance training (RT), which may cause less dyspnea, could be an alternative. The purpose of this review was to formulate evidence-based recommendations on the use of RT in pulmonary rehabilitation of patients with COPD. Our primary outcomes were health-related quality of life, activities of daily living, dyspnea, possible harm, and total mortality. Our secondary outcomes were walking distance, lean body mass, muscle strength, and exercise capacity. METHODS: We identified randomized controlled trials through a systematic multidatabase search. One author checked titles and abstracts for relevance using broad inclusion criteria, whereas 2 authors independently checked the full-text articles for eligibility. Two authors independently extracted data and assessed the risk of bias and quality of evidence. Meta-analyses were performed when deemed feasible based on the quality and amount of data. RESULTS: We included 8 randomized controlled trials (328 participants). On the basis of moderate- to very low-quality evidence, we found no clinically important difference between RT and ET. We did not find sufficient data for a meta-analysis of total mortality, adverse events, dyspnea, or lean body mass. CONCLUSIONS: We found that in patients with COPD, RT seems to induce the same beneficial effects as ET. Therefore, we recommend that RT should be considered according to patient preferences when designing a pulmonary rehabilitation program for patients with COPD. Publication Type: journal article Source: CINAHL

2.Title: A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Citation: Disability & Rehabilitation, 15 July 2015, vol./is. 37/15(1316-1323), 09638288 Author(s): Meyer, Matthew J., Pereira, Shelialah, McClure, Andrew, Teasell, Robert, Thind, Amardeep, Koval, John, Richardson, Marina, Speechley, Mark Language: English Abstract: Purpose: This systematic review summarizes the utility of variables available at acute discharge after stroke for predicting functional independence at discharge from inpatient rehabilitation. Methods: A systematic review of four electronic databases (Medline, EMBASE, PsycINFO and CINAHL) was conducted to identify studies reporting multivariable models predicting post-rehabilitation Barthel Index (BI) or Functional Independence Measure (FIM®) scores. In studies meeting inclusion criteria, the frequency with which candidate predictors were found statistically significant was calculated and summarized. Results: A total of 3260 articles were screened, of which 27 were included and 63 multivariable models of discharge BI or FIM® were reported. In all, 126 candidate predictors of BI or FIM® were explored. Variables found to be significant most frequently included admission functional level (BI or FIM®), National Institute of Health Stroke Scale (NIHSS), dysphasia, impulsivity, neglect, previous stroke, and age.

Conclusions: Only a selected group of variables have repeatedly proven to be significant predictors of functional ability after post-stroke inpatient rehabilitation. Publication Type: journal article Source: CINAHL

3.Title: Acceptability of the aquatic environment for exercise training by people with chronic obstructive pulmonary disease with physical comorbidities: Additional results from a randomised controlled trial. Citation: Physiotherapy, 01 June 2015, vol./is. 101/2(187-192), 00319406 Author(s): McNamara, Renae J., McKeough, Zoe J., McKenzie, David K., Alison, Jennifer A. Language: English Abstract: Objectives Water-based exercise training is a relatively new concept in the management of people with COPD. This study aimed to examine the acceptability of the aquatic environment as a medium for exercise training in people with COPD with physical comorbidities. Design Following a supervised eight week, three times a week, water-based exercise training programme conducted in a hospital hydrotherapy pool as part of a randomised controlled trial, participants completed a questionnaire about their experience with exercise training in the pool including adverse events, barriers and factors enabling exercise programme completion, satisfaction with the aquatic environment and their preference for an exercise training environment. Results All 18 participants (mean (SD) age 72 (10) years; FEV1% predicted 60 (10) %) who commenced the water-based exercise training programme completed the questionnaire. Three participants withdrew from training. High acceptability of the water and air temperature, shower and change-room facilities, staff assistance and modes of pool entry was reported (94% to 100%). Six factors were highly rated as enabling exercise programme adherence and completion: staff support (chosen by 93% of participants), enjoyment (80%), sense of achievement (80%), noticeable improvements (73%), personal motivation (73%) and participant support (53%). Eighty-nine percent of the participants indicated they would continue with water-based exercise. Conclusions This study provides the first insight into the acceptability of the aquatic environment for exercise training in people with COPD and indicates water-based exercise and the aquatic environment is well accepted. Publication Type: journal article Source: CINAHL

4.Title: Acupuncture for chronic nonspecific low back pain: An overview of systematic reviews Citation: European Journal of Integrative Medicine, April 2015, vol./is. 7/2(94-107), 1876-3820;1876-3839 (01 Apr 2015) Author(s): Zeng Y., Chung J.W.-Y. Language: English Abstract: Introduction: Chronic nonspecific low back pain (cnLBP), which cannot be attributed to a specific pathology is very common. As a result acupuncture is frequently used by patients as a treatment option.This overview aimed to summarize and evaluate the available systematic reviews on the clinical effectiveness and cost-effectiveness of acupuncture for the management of cnLBP, and to identify the safety of acupuncture for the management of cnLBP. Methods: Systematic reviews of acupuncture and cnLBP were sourced from five databases. Publications between January 2003 and May 2014 were included for analysis. Quality appraisal of included systematic reviews was assessed by the Overview Quality Assessment Questionnaire. Results: Seventeen systematic reviews were included. Five found that acupuncture was more effective when compared with a no treatment/waiting list control, as there were eight systematic reviews and meta-analysis providing positive and consistent findings. Seven systematic reviews providing positive findings of the comparison of acupuncture to sham acupuncture/passive modality treatment. Three systematic reviews of multiple RCTs also indicated positive and consistent findings of the comparison of acupuncture plus an intervention vs an intervention alone. Overall, findings on the effectiveness of acupuncture for cnLBP were consistent. Conclusions: As there is a range of diverse acupuncture styles used for patients with cnLBP, future trials are needed to establish the standardization of acupuncture in terms of the length of treatment sessions, frequency of sessions, number of needles needed per treatment, placement of needle insertion, depth of needle insertion, and whether needle stimulation achieves De Qi. Publication type: Journal: Review Source: EMBASE

5.Title: Addition of motivational interventions to exercise and traditional Physiotherapy: A review and meta-analysis Citation: Physiotherapy (United Kingdom), March 2015, vol./is. 101/1(1-12), 0031-9406;1873-1465 (01 Mar 2015) Author(s): McGrane N., Galvin R., Cusack T., Stokes E.

Language: English Abstract: Background: Incontestable epidemiological trends indicate that, for the foreseeable future, mortality and morbidity will be dominated by an escalation in chronic lifestyle-related diseases. International guidelines recommend the implementation of evidence-based approaches to bring about health behaviour changes. Motivational interventions to increase adherence and physical activity are not part of traditional physiotherapy for any condition. Objective: To evaluate the evidence for the effectiveness of adding motivational interventions to traditional physiotherapy to increase physical activity and short- and long-term adherence to exercise prescriptions. Data sources: A literature search of PubMed, EMBASE, Scopus, CINAHL, PsychINFO, AMED and Allied Health Evidence database using keywords and subject headings. Study selection: Only randomised controlled trials comparing two or more arms, with one arm focused on motivational interventions influencing exercise and one control arm, were included. The search identified 493 titles, of which 14 studies (comprising 1504 participants) were included. Data extraction: The principal investigator extracted data that were reviewed independently by another author. Methodological quality was assessed independently by two authors using the Cochrane Risk of Bias tool and the PEDro scale. Outcomes were measured at the level of impairment, activity limitation and participation restriction. The standardised mean difference between the control and intervention groups at follow-up time points was used as the mode of analysis. I²<50% was used as the cut-off point for acceptable heterogeneity, above which a random effects model was applied. Results: Exercise attendance was measured in six studies (n=378), and the results indicate that there was no significant difference in exercise attendance between the groups (Random effects model, standardised mean difference 0.33, 95% confidence interval -0.03 to 0.68, I² 62%). Perceived self-efficacy results were pooled from six studies (n=722), and a significant difference was found between the groups in favour of the interventions (Fixed effects model, standardised mean difference 0.71, 95% confidence interval 0.55 to 0.87, I² 41%). The results for levels of activity limitation were pooled (n=550), and a significant difference was found between the groups in favour of the interventions (REM, standardised mean difference -0.37, 95% confidence interval -0.65 to -0.08, I² 61%). Limitations: The majority of the included studies were of medium quality, and four studies were of low quality. Data were pooled from a wide variety of different populations and settings, increasing the assortment of study characteristics. Conclusions: Motivational interventions can help adherence to exercise, have a positive effect on long-term exercise behaviour, improve self-efficacy and reduce levels of activity limitation. The optimal theory choice and the most beneficial length and type of intervention have not been defined, although all interventions showed benefits. There is a need to determine how practising physiotherapists currently optimise adherence, and their current levels of knowledge about motivational interventions. Implications of key findings: The results indicate that motivational interventions are successful for increasing healthy physical activity behaviour. Physiotherapists are ideally placed to take on this role, and motivational interventions must become part of physiotherapy practice. Publication type: Journal: Review Source: EMBASE

6.Title: Aerobic Capacity in Persons with Multiple Sclerosis: A Systematic Review and Meta-Analysis. Citation: Sports Medicine, 01 June 2015, vol./is. 45/6(905-923), 01121642 Author(s): Langeskov-Christensen, Martin, Heine, Martin, Kwakkel, Gert, Dalgas, Ulrik Language: English Abstract: Background: Aerobic capacity ( VO) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO in PwMS. Objectives: The objectives of this study were to (1) systematically review the psychometric properties of the VO test; (2) systematically review the literature on VO compared with healthy populations; (3) summarize correlates of VO; and (4) to review and conduct a meta-analysis of longitudinal exercise studies evaluating training-induced effects on VO in PwMS. Data Sources and Study Selection: A systematic literature search of six databases (PubMed, EMBASE, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to (1) enrol participants with definite MS according to defined criteria; (2) assess aerobic capacity ( VO) by means of a graded exercise test to voluntary exhaustion; (3) had undergone peer review; and (4) be available in English, Danish or Dutch. Study Appraisal and Synthesis Methods: The psychometric properties of the VO test in PwMS were reviewed with respect to reliability, validity and responsiveness. Simple Pearson correlation analysis was used to assess the relation between key study characteristics and the reported mean VO. The methodological quality of the intervention studies was evaluated using the original 11-item Physiotherapy Evidence Database (PEDro) scale. A random coefficient model was used to summarize individual, weighted, standardized effects of studies that assessed the effects of exercise on aerobic capacity in PwMS. Results: A total of 40 studies, covering 165 healthy controls and 1,137 PwMS, fulfilled the inclusion criteria. VO testing in PwMS can be considered a valid measure of aerobic capacity, at least in PwMS having

low-to-mild disability, and an ∼10 % change between two tests performed on separate days can be considered the smallest reliable change (with 95 % certainty) in VO in PwMS. The average body-weight-adjusted VO was significantly lower in PwMS (25.5 ± 5.2 mL·kg·min) compared with healthy controls (30.9 ± 5.4 mL·kg·min). The analysis of VO correlates revealed associations with a variety of outcomes covering all levels of the International Classification of Functioning, Disability and Health (ICF) model. The meta-analysis showed that aerobic training in PwMS may improve VO by as much as 3.5 mL·kg·min. Conclusions: A valid and reliable test can be performed, in at least ambulant PwMS, by the gold standard whole-body maximal exercise test. Aerobic capacity in PwMS is impaired compared with healthy people, and is significantly associated with factors on all levels of the ICF model, including disease severity. Aerobic training can improve aerobic capacity in PwMS to a degree that is associated with secondary health benefits. Publication Type: journal article Source: CINAHL

7.Title: Can combined aerobic and muscle strength training improve aerobic fitness, muscle strength, function and quality of life in people with spinal cord injury? A systematic review. Citation: Spinal Cord, 01 June 2015, vol./is. 53/6(418-431), 13624393 Author(s): Bochkezanian, V, Raymond, J, de Oliveira, C Q, Davis, G M Language: English Abstract: Study design:A systematic review.Objectives:The aim of this systematic review was to establish whether combined aerobic training and muscle strength training is effective in improving aerobic fitness, muscle strength, function and/or quality of life (QoL) in people with spinal cord injury (SCI).Settings:Faculty of Health Sciences. University of Sydney, NSW, Australia.Methods:A search was conducted for randomized controlled trials (RCTs), controlled trials, uncontrolled clinical trials, case series and cross-over studies involving exercise interventions that included a combination of aerobic and strength components, either in circuit-mode or in sequence for people with SCI. Methodological quality was independently rated using the PEDro scale and key findings were extracted from trials by two reviewers.Results:The search identified 7981 abstracts, from which nine trials met the inclusion criteria. From the nine selected trials, seven reported aerobic outcomes, two of which showed a statistically significant within-group difference in aerobic fitness. Five studies reported muscle strength outcomes, four of them showed a statistically significant within-group mean difference on at least one outcome measure. Two studies looked at QoL, one of them found a statistically significant between-group difference on one outcome measure.Conclusion:Our systematic review showed that literature on SCI population is scarce, of low quality and findings of existing studies are inconsistent. Thus, further RCTs with larger number of participants are needed to make a definite conclusion about the influence of combined aerobic and muscle strength training on aerobic fitness, muscle strength and QoL in people with SCI. Publication Type: journal article Source: CINAHL Full Text: Available from Nature Publishing Group in Spinal Cord

8.Title: Determining the level of evidence for the effectiveness of spinal manipulation in upper limb pain: A systematic review and meta-analysis. Citation: Manual Therapy, 01 August 2015, vol./is. 20/4(515-523), 1356689X Author(s): Aoyagi, Masashi, Mani, Ramakrishnan, Jayamoorthy, Jacob, Tumilty, Steve Language: English Abstract: Background The use of spinal manipulation (SM) for upper limb pain has been advocated based on the concept of regional interdependence. However, its evidence has not been established. Objective To determine the level of evidence for the effectiveness of SM in patients with upper limb pain as part of the concept of regional interdependence. Methods MeSH and Key words representing two broad subject areas: SM and upper limb disorders were used to conduct an electronic search in sixteen electronic databases. Randomized controlled trials and/or controlled clinical trials investigating the effects of SM in patients with upper limb pain were included. Studies including pain in the neck or scapular region and those using spinal mobilization were excluded. Meta-analysis was conducted to examine the effects of SM on upper limb pain. The overall quality of evidence was assessed using the GRADE system. Results Out of 3307 studies, six trials met inclusion criteria for this review. Of these, three studies were included in meta-analysis. Meta-analysis results suggested there were no statistical differences between SM and other interventions in the effects on reducing upper limb pain. The overall quality of evidence was very low. Conclusion The number of studies regarding the current topic is limited. There is very low quality evidence that SM is not better nor inferior than other interventions in the management of upper limb pain. Publication Type: journal article

Source: CINAHL Full Text: Available from MANUAL THERAPY in Salisbury District Hospital Healthcare Library Available from Elsevier in Manual Therapy

9.Title: Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. Citation: British Journal of Sports Medicine, 15 May 2015, vol./is. 49/10(673-680), 03063674 Author(s): Pappas, Evangelos, Nightingale, Elizabeth J, Simic, Milena, Ford, Kevin R, Hewett, Timothy E, Myer, Gregory D Language: English Abstract: OBJECTIVE: Some injury prevention programmes aim to reduce the risk of ACL rupture. Although the most common athletic task leading to ACL rupture is cutting, there is currently no consensus on how injury prevention programmes influence cutting task biomechanics. To systematically review and synthesise the scientific literature regarding the influence of injury prevention programme exercises on cutting task biomechanics. DESIGN: The three largest databases (Medline, EMBASE and CINAHL) were searched for studies that investigated the effect of injury prevention programmes on cutting task biomechanics. When possible meta-analyses were performed. RESULTS: Seven studies met the inclusion criteria. Across all studies, a total of 100 participants received exercises that are part of ACL injury prevention programmes and 76 participants served in control groups. Most studies evaluated variables associated with the quadriceps dominance theory. The meta-analysis revealed decreased lateral hamstrings electromyography activity (p<=0.05) while single studies revealed decreased quadriceps and increased medial hamstrings activity and decreased peak knee flexion moment. Findings from single studies reported that ACL injury prevention exercises reduce neuromuscular deficits (knee valgus moment, lateral trunk leaning) associated with the ligament and trunk dominance theories, respectively. The programmes we analysed appear most effective when they emphasise individualised biomechanical technique correction and target postpubertal women. CONCLUSIONS: The exercises used in injury prevention programmes have the potential to improve cutting task biomechanics by ameliorating neuromuscular deficits linked to ACL rupture, especially when they emphasise individualised biomechanical technique correction and target postpubertal female athletes. Publication Type: journal article Source: CINAHL Full Text: Available from Highwire Press in British Journal of Sports Medicine

10.Title: Does Perturbation-Based Balance Training Prevent Falls? Systematic Review and Meta-Analysis of Preliminary Randomized Controlled Trials. Citation: Physical Therapy, 01 May 2015, vol./is. 95/5(700-709), 00319023 Author(s): Mansfield, Avril, Wong, Jennifer S., Bryce, Jessica, Knorr, Svetlana, Patterson, Kara K. Language: English Abstract: Background. Older adults and individuals with neurological conditions are at an increased risk for falls. Although physical exercise can prevent falls, certain types of exercise may be more effective. Perturbation-based balance training is a novel intervention involving repeated postural perturbations aiming to improve control of rapid balance reactions. Purpose. The purpose of this study was to estimate the effect of perturbation-based balance training on falls in daily life. Data Sources. MEDLINE (1946-July 2014), EMBASE (1974-July 2014), PEDro (all dates), CENTRAL (1991-July 2014), and Google Scholar (all dates) were the data sources used in this study. Study Selection. Randomized controlled trials written in English were included if they focused on perturbation-based balance training among older adults or individuals with neurological conditions and collected falls data posttraining. Data Extraction. Two investigators extracted data independently. Study authors were contacted to obtain missing information. A PEDro score was obtained for each study. Primary outcomes were proportion of participants who reported one or more falls (ie, number of "fallers") and the total number of falls. The risk ratio (proportion of fallers) and rate ratio (number of falls) were entered into the analysis. Data Synthesis. Eight studies involving 404 participants were included. Participants who completed perturbation-based balance training were less likely to report a fall (overall risk ratio=0.71; 95% confidence interval=0.52, 0.96; P=.02) and reported fewer falls than those in the control groups (overall rate ratio=0.54; 95% confidence interval=0.34, 0.85; P=.007). Limitations. Study authors do not always identify that they have included perturbation training in their intervention; therefore, it is possible that some appropriate studies were not included. Study designs were heterogeneous, preventing subanalyses. Conclusions. Perturbation-based balance training appears to reduce fall risk among older adults and individuals with Parkinson disease. Publication Type: journal article Source: CINAHL

Full Text: Available from EBSCOhost in Physical Therapy Available from EBSCOhost EJS in Physical Therapy Available from Highwire Press in Physical Therapy Available from ProQuest in Physical Therapy

11.Title: Effectiveness of Dry Needling for Myofascial Trigger Points Associated With Neck and Shoulder Pain: A Systematic Review and Meta-Analysis. Citation: Archives of Physical Medicine & Rehabilitation, 01 May 2015, vol./is. 96/5(944-955), 00039993 Author(s): Liu, Lin, Huang, Qiang-Min, Liu, Qing-Guang, Ye, Gang, Bo, Cheng-Zhi, Chen, Meng-Jin, Li, Ping Language: English Abstract: Objective To evaluate current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with neck and shoulder pain. Data Sources PubMed, EBSCO, Physiotherapy Evidence Database, ScienceDirect, The Cochrane Library, ClinicalKey, Wanfang Data Chinese database, China Knowledge Resource Integrated Database, Chinese Chongqing VIP Information, and SpringerLink databases were searched from database inception to January 2014. Study Selection Randomized controlled trials were performed to determine whether dry needling was used as the main treatment and whether pain intensity was included as an outcome. Participants were diagnosed with MTrPs associated with neck and shoulder pain. Data Extraction Two reviewers independently screened the articles, scored methodological quality, and extracted data. The results of the study of pain intensity were extracted in the form of mean and SD data. Twenty randomized controlled trials involving 839 patients were identified for meta-analysis. Data Synthesis Meta-analyses were performed using RevMan version 5.2 and Stata version 12.0. The results suggested that compared with control/sham, dry needling of MTrPs was effective in the short term (immediately to 3 days) (standardized mean difference [SMD]=−1.91; 95% confidence interval [CI], −3.10 to −.73; P =.002) and medium term (SMD=−1.07; 95% CI, −1.87 to −.27; P =.009); however, wet needling (including lidocaine) was superior to dry needling in relieving MTrP pain in the medium term (SMD=1.69; 95% CI, .40–2.98; P =.01). Other therapies (including physiotherapy) were more effective than dry needling in treating MTrP pain in the medium term (9–28d) (SMD=.62; 95% CI, .02–1.21; P =.04). Conclusions Dry needling can be recommended for relieving MTrP pain in neck and shoulders in the short and medium term, but wet needling is found to be more effective than dry needling in relieving MTrP pain in neck and shoulders in the medium term. Publication Type: journal article Source: CINAHL Full Text: Available from Elsevier in Archives of Physical Medicine and Rehabilitation Available from ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION in Salisbury District Hospital Healthcare Library

12.Title: Effectiveness of Postoperative Physical Therapy for Upper-Limb Impairments After Breast Cancer Treatment: A Systematic Review. Citation: Archives of Physical Medicine & Rehabilitation, 01 June 2015, vol./is. 96/6(1140-1153), 00039993 Author(s): De Groef, An, Van Kampen, Marijke, Dieltjens, Evi, Christiaens, Marie-Rose, Neven, Patrick, Geraerts, Inge, Devoogdt, Nele Language: English Abstract: Objective To systematically review the effectiveness of various postoperative physical therapy modalities and timing of physical therapy after treatment of breast cancer on pain and impaired range of motion (ROM) of the upper limb. Data Sources We searched the following databases: PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Physiotherapy Evidence Database, and Cochrane. Articles published until October 2012 were included. Study Selection Only (pseudo) randomized controlled trials and nonrandomized experimental trials investigating the effectiveness of passive mobilization, manual stretching, myofascial therapy, and/or exercise therapy and timing of physical therapy after treatment for breast cancer are reviewed. Primary outcomes are pain of the upper limb and/or ROM of the shoulder. Secondary outcomes are decreased shoulder strength, arm lymphedema, limitations in activities of daily living, decreased quality of life, and wound drainage volume. Physical therapy modalities had to be started in the first 6 weeks after surgery. Data Extraction Articles were selected by 2 independent researchers in 3 phases and compared for consensus. First the titles were analyzed, and then the selected abstracts and finally the full texts were reviewed. Data Synthesis Eighteen randomized controlled trials were included in the review. Three studies investigated the effect of multifactorial therapy: 2 studies confirmed that the combination of general exercises and stretching is effective for the treatment of impaired ROM another study showed that passive mobilization combined with massage had no beneficial effects on pain and impaired ROM. Fifteen studies investigated the effectiveness of a single physical therapy modality. One study of poor quality found evidence supporting the beneficial effects of passive mobilization. The only study investigating the effect of

stretching did not find any beneficial effects. No studies were found about the effectiveness of myofascial therapy in the postoperative phase. Five studies found that active exercises were more effective than no therapy or information on the treatment of impairments of the upper limb. Three studies supported the early start of exercises for recovery of shoulder ROM, whereas 4 studies supported the delay of exercises to avoid prolonged wound healing. Conclusions Multifactorial physical therapy (ie, stretching, exercises) and active exercises were effective to treat postoperative pain and impaired ROM after treatment for breast cancer. High-quality studies are necessary to determine the effectiveness of passive mobilization, stretching, and myofascial therapy as part of the multifactorial treatment. In addition, the appropriate timing and content of the exercise programs need to be further investigated. Publication Type: journal article Source: CINAHL Full Text: Available from Elsevier in Archives of Physical Medicine and Rehabilitation Available from ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION in Salisbury District Hospital Healthcare Library

13. Title: Effect of increased intensity of physiotherapy on patient outcomes after stroke: An evidence-based analysis Citation: Ontario Health Technology Assessment Series, March 2015, vol./is. 15/6, 1915-7398 (01 Mar 2015) Author(s): Sehatzadeh S. Language: English Abstract: Background: After stroke, impairment of the upper and lower limb can limit patients' motor function and ability to perform activities of daily living (ADL). Physiotherapy (PT) is an established clinical practice for stroke patients, playing an important role in improving limb function. Recently, several randomized trials have evaluated the effect of higher-intensity physiotherapy (increased duration and/or frequency) on patients' functional ability. Objectives: Our objective is to investigate whether an increased intensity of PT after stroke results in better outcomes for patients. Data Sources: A literature search was performed on June 7, 2013, for English-language randomized controlled trials published from January 1, 2003, to June 7, 2013. Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews were searched. Review Methods: We reviewed the full text of articles that compared 2 or more levels of PT intensity. Outcomes of interest included motor function, ADL, and quality of life (QOL). Results: High-quality evidence showed that higher-intensity upper-limb PT and higher-intensity lower-limb PT both resulted in significantly greater improvements in motor function. Moderate-quality evidence showed that higher-intensity general PT did not. Moderate-quality evidence showed a significant improvement in ADL performance with higher-intensity upper-limb PT, but no improvement with higher-intensity general PT; no studies reported on ADL outcomes on lower-limb PT specifically. According to moderate-quality evidence, patient QOL did not change significantly after increased intensity of upper-limb, lower-limb, or general PT. When considering the results, one difference should be noted: Compared with the studies examining upper- and lower-limb PT, the studies examining general PT looked at a smaller increase-2 hours or less of additional therapy per week. Limitations: This analysis is limited to the earlier post-stroke phase and is not equipped to comment on expected outcomes of later-stage PT. Conclusions: Overall, this analysis found support for the use of more intensive PT to improve motor function and ability to perform ADL after stroke. Publication Type: Journal: Article Source: EMBASE

14.Title: Effect of pilates exercise for improving balance in older adults: A systematic review with meta-analysis Citation: Archives of Physical Medicine and Rehabilitation, April 2015, vol./is. 96/4(715-723), 0003-9993;1532-821X (01 Apr 2015) Author(s): Barker A.L., Bird M.-L., Talevski J. Language: English Abstract: Objectives To investigate the effect of Pilates on balance and falls in older adults, and whether programs tested in prior studies met best-practice recommendations for exercise to prevent falls. Data Sources MEDLINE, SPORTDiscus, CINAHL, PubMed, Physiotherapy Evidence Database, and The Cochrane Library were searched from earliest record to July 2014. Study Selection Randomized and controlled clinical trials evaluating the effect of Pilates on balance and/or falls in older adults. Data Extraction Two reviewers independently extracted demographic, intervention, and outcome data. Six studies were included in this review. Data Synthesis High-quality studies in this area are lacking. When compared with nonactive control groups, Pilates was shown to improve balance (standardized mean difference [SMD]=.84; 95% confidence interval [CI],.44-1.23; 6 studies) and reduce the number of falls (SMD=-2.03; 95% CI, -2.66 to -1.40; 1 study). Three studies provided sufficient detail to enable assessment of

compliance with the recommendation of exercises providing a moderate or high challenge to balance. In these studies, 2% to 36% of exercises were assessed as providing a moderate or high challenge to balance. All studies provided >2 hours of exercise per week, and 1 study provided >50 hours of exercise during the study period. Conclusions The evidence suggests Pilates can improve balance, an important risk factor for falls in older adults. However, there is limited data on the impact of Pilates on falls. Effects may have been overestimated because of the low methodological quality of studies. Best-practice recommendations were rarely applied in prior studies, indicating greater effects may have been achieved if recommendations were incorporated. Publication type: Journal: Review Source: EMBASE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library

15.Title: Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials. Citation: Physiotherapy, 01 June 2015, vol./is. 101/2(103-110), 00319406 Author(s): Anderson, A., Alexanders, J., Sinani, C., Hayes, S., Fogarty, M. Language: English Abstract: Background Ventilator hyperinflation (VHI) and manual hyperinflation (MHI) are thought to improve secretion clearance, atelectasis and oxygenation in adults receiving mechanical ventilation. However, to the authors' knowledge, a systematic review of their relative effectiveness has not been undertaken previously. Objective To determine whether VHI is more effective than MHI for the improvement of clinical outcomes in adults receiving mechanical ventilation. Data sources The electronic databases PubMed, Cochrane Library, CINHAL Plus, Wiley Online Library, ScienceDirect and PEDro were searched from January 1993 until August 2013. OpenGrey, the metaRegister of Controlled Trials (mRCT) and the reference lists of all potentially relevant studies were also searched. Study eligibility criteria Full English reports of randomised clinical trials comparing at least one effect of VHI and MHI in adults receiving mechanical ventilation. Study synthesis and appraisal Included studies were appraised using the Cochrane risk of bias tool. The findings were synthesised using a purely qualitative approach. Results All four included studies reported no significant differences in sputum wet weight, dynamic and static pulmonary compliance, oxygenation and cardiovascular stability between VHI and MHI. Limitations All of the included studies had considerable limitations related to the protocols, equipment, participants and outcome measures. Furthermore, the overall risk of bias was judged to be high for three studies and unclear for one study. Conclusion Only four studies, all of which had a high or unclear risk of bias and significant additional limitations, have compared the effects of VHI and MHI in adults receiving mechanical ventilation. As such, further research in this area is clearly warranted. Publication Type: journal article Source: CINAHL

16.Title: Efficacy of Aerobic Exercise for Treatment of Chronic Low Back Pain. Citation: American Journal of Physical Medicine & Rehabilitation, 01 May 2015, vol./is. 94/5(358-365), 08949115 Author(s): Xian-Guo Meng, Shou-Wei Yue Language: English Abstract: Objective: A meta-analysis of relevant cohort studies was performed to investigate the efficacy of aerobic exercise for the treatment of patients with chronic low back pain (CLBP). Method: A range of electronic databases were searched : MEDLINE (1966-2013), the Cochrane Library Database (issue 12, 2013), EMBASE (1980-2013), CINAHL (1982-2013), Web of Science (1945-2013), and the Chinese Biomedical Database (1982-2013), without language restrictions. The Roland-Morris Disability Questionnaire, the Oswestry Disability Questionnaire, the McGill Pain Questionnaire, visual analog scale, and heart rate, sit-and-reach test, and maximum oxygen consumption were used to evaluate the efficacy of aerobic exercise. Meta-analysis was performed with the use of the STATA statistical software. The standardized mean difference (SMD) with its corresponding 95% confidence interval (CI) was calculated. Eight clinical cohort studies with a total of 310 CLBP patients were included in the meta-analysis. Results: The results of this meta-analysis indicated that CLBP patients exhibited positive decreases in scores on the Roland-Morris Disability Questionnaire (SMD, 0.44; 95% CI, 0.20-0.68 ; P < 0.001), Oswestry Disability Questionnaire (SMD, 1.03; 95% CI, 0.67 -1.39 ; P < 0.001), Hospital Anxiety and Depression Scale (SMD, 1.35; 95% CI, 0.34 -2.37 ; P = 0.009), and McGill Pain Questionnaire (SMD, 0.32; 95% CI, 0.07-0.56 ; P = 0.011) after aerobic exercise. It was also observed that aerobic exercise could markedly reduce the visual analog scale score for pain of CLBP patients (SMD,

0.75; 95% CI, 0.48-1.02; P < 0.001). Nevertheless, this study's findings showed that aerobic exercise had no effects on heart rate, sit-and-reach test, and maximum oxygen consumption of CLBP patients (all P > 0.05). Conclusion: The current meta-analysis provides reliable evidence that aerobic exercise could effectively diminish pain intensity and improve the physical and psychologic functioning of CLBP patients. Thus, aerobic exercise may be a good choice in the treatment for CLBP. Publication Type: journal article Source: CINAHL Full Text: Available from Ovid in American Journal of Physical Medicine and Rehabilitation

17.Title: Falls prevention interventions in older adults with cognitive impairment: A systematic review of reviews. Citation: International Journal of Therapy & Rehabilitation, 01 June 2015, vol./is. 22/6(289-296), 17411645 Author(s): Booth, Vicky, Logan, Pip, Harwood, Rowan, Hood, Victoria Language: English Abstract: Aim: This critical review explores the review material on falls prevention interventions in older adults with cognitive impairment, such as dementia. Method: A systematic review of reviews was conducted using the following bibliographic databases: PubMed/Medline, EMBASE, AMED, CINAHL and the Cochrane electronic library. The search terms used were: 'falls'; 'rehabilitation'; 'falls prevention'; 'interventions'; 'cognitive impairment'; 'dementia'; and 'Alzheimer's disease'. All available studies were marked against predetermined inclusion and exclusion criteria. Results: Of the seven review articles that met the inclusion criteria, only one had a homogenous population of adults with a cognitive impairment. The most reported intervention was exercise, which was included in all seven reviews of 91 studies. Multifactorial and multicomponent falls prevention programmes were also frequently reported. Reports of efficacy were inconsistent for all the interventions reported. Conclusion: Evidence for falls prevention interventions for adults with cognitive impairment is varied and inconclusive. When compared with the literature on falls interventions in healthy older adult populations, both primary and synthesis studies in older adults with cognitive impairment are lacking in number, quality and homogeneity of sample population and interventions. Promising results are emerging but clinical recommendations cannot be made at this time. Publication Type: journal article Source: CINAHL Full Text: Available from EBSCOhost in International Journal of Therapy & Rehabilitation

18. Title: Functional Electrical Stimulation Improves Activity After Stroke: A Systematic Review With Meta-Analysis. Citation: Archives of Physical Medicine & Rehabilitation, 01 May 2015, vol./is. 96/5(934-943), 00039993 Author(s): Howlett, Owen A., Lannin, Natasha A., Ada, Louise, McKinstry, Carol Language: English Abstract: Objective To investigate the effect of functional electrical stimulation (FES) in improving activity and to investigate whether FES is more effective than training alone. Data Sources Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness. Study Selection Randomized and controlled trials up to June 22, 2014, were included following predetermined search and selection criteria. Data Extraction Data extraction occurred by 2 people independently using a predetermined data collection form. Methodologic quality was assessed by 2 reviewers using the PEDro methodologic rating scale. Meta-analysis was conducted separately for the 2 research objectives. Data Synthesis Eighteen trials (19 comparisons) were eligible for inclusion in the review. FES had a moderate effect on activity (standardized mean difference [SMD], .40; 95% confidence interval [CI], .09–.72) compared with no or placebo intervention. FES had a moderate effect on activity (SMD, .56; 95% CI, .29–.92) compared with training alone. When subgroup analyses were performed, FES had a large effect on upper-limb activity (SMD, 0.69; 95% CI, 0.33–1.05) and a small effect on walking speed (mean difference, .08m/s; 95% CI, .02–.15) compared with control groups. Conclusions FES appears to moderately improve activity compared with both no intervention and training alone. These findings suggest that FES should be used in stroke rehabilitation to improve the ability to perform activities. Publication Type: journal article Source: CINAHL Full Text: Available from Elsevier in Archives of Physical Medicine and Rehabilitation Available from ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION in Salisbury District Hospital Healthcare Library

19. Title: Gait behaviors as an objective surgical outcome in low back disorders: A systematic review.

Citation: Clinical Biomechanics, 01 July 2015, vol./is. 30/6(528-536), 02680033 Author(s): Toosizadeh, Nima, Yen, Tzu Chuan, Howe, Carol, Dohm, Michael, Mohler, Jane, Najafi, Bijan Language: English Abstract: Background Objective motor performance measures, especially gait assessment, could improve evaluation of low back disorder surgeries. However, no study has compared the relative effectiveness of gait parameters for assessing motor performance in low back disorders after surgery. The purpose of the current review was to determine the sensitive gait parameters that address physical improvements in each specific spinal disorder after surgical intervention. Methods Articles were searched with the following inclusion criteria: 1) population studied consisted of individuals with low back disorders requiring surgery; 2) low back disorder was measured objectively using gait assessment tests pre- and post-surgery. The quality of the selected studies was assessed using Delphi consensus, and meta-analysis was performed to compare pre- and post-surgical changes. Findings Thirteen articles met inclusion criteria, which, almost exclusively, addressed two types of spinal disorders/interventions: 1) scoliosis/spinal fusion; and 2) stenosis/decompression. For patients with scoliosis, improvements in hip and shoulder motion (effect size = 0.32–1.58), energy expenditure (effect size = 0.59–1.18), and activity symmetry of upper-body muscles during gait were present after spinal fusion. For patients with spinal stenosis, increases in gait speed, stride length, cadence, symmetry, walking smoothness, and walking endurance (effect size = 0.60–2.50), and decrease in gait variability (effect size = 1.45) were observed after decompression surgery. Interpretation For patients with scoliosis, gait improvements can be better assessed by measuring upper-body motion and EMG rather than the lower extremities. For patients with spinal stenosis, motor performance improvements can be captured by measuring walking spatio-temporal parameters, gait patterns, and walking endurance. Publication Type: journal article Source: CINAHL

20. Title: Immunological effects of massage after exercise: A systematic review. Citation: Physical Therapy in Sport, 01 May 2015, vol./is. 16/2(187-192), 1466853X Author(s): Tejero-Fernández, Victor, Membrilla-Mesa, Miguel, Galiano-Castillo, Noelia, Arroyo-Morales, Manuel Language: English Abstract: Objective: The objective of this review was to determine whether immune parameters can be modulated by massage after intense physical activity. Methods: A search was conducted in Pub Med Medline, PEDro, and Cochrane databases, using the key words: "massage", "myofascial release", "acupressure", "recovery", and "warm up" combined with "exercise", "exercise-induced muscle damage", "sport", "immunology", and lymphocytes" independently. Only controlled studies published between 1970 and 2012 were selected, with no restrictions regarding publication language. The CONSORT Declaration was applied to assess the quality of the selected studies. Results: The initial search identified 739 publications in the databases, of which only 5 met the review inclusion criteria. A positive relationship between immunological recovery and post-exercise massage was reported by some of these studies but not by others. Conclusion: There is preliminary evidence that massage may modulate immune parameters when applied after exercise, but more research is needed to confirm this possibility. Publication Type: journal article Source: CINAHL

21. Title: Management of Falls in Community- Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Citation: Physical Therapy, 01 June 2015, vol./is. 95/6(815-834), 00319023 Author(s): Avin, Keith G., Hanke, Timothy A., Kirk-Sanche, Neva, McDonough, Christine M., Shubert, Tiffany E., Hardage, Jason, Hartley, Greg Language: English Abstract: Background. Falls in older adults are a major public health concern due to high prevalence, impact on health outcomes and quality of life, and treatment costs. Physical therapists can play a major role in reducing fall risk for older adults; however, existing clinical practice guidelines (CPGs) related to fall prevention and management are not targeted to physical therapists. Objective. The purpose of this clinical guidance statement (CGS) is to provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults. N. Kirk-Sanchez, PT, PhD, Department of Physical Therapy, University of Miami, Coral Gables, Florida. C.M. McDonough, PT, PhD, Department of Health Policy and Management, Health and Disabil ity Research Institute, Boston University School of Public Health, Boston, Massachusetts, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. T.E. Shubert, PT, PhD, Shubert Consulting, Chapel Hill, North Carolina. Design and Methods. The Subcommittee on Evidence-Based Documents of the Practice Committee of the Academy of Geriatric Physical Therapy developed this CGS. Existing CPGs were identified by systematic search and

critically appraised using the Appraisal of Guidelines, Research, and Evaluation in Europe II (AGREE II) tool. Through this process, 3 CPGs were recommended for inclusion in the CGS and were synthesized and summarized. Results. Screening recommendations include asking all older adults in contact with a health care provider whether they have fallen in the previous year or have concerns about balance or walking. Follow-up should include screening for balance and mobility impairments. Older adults who screen positive should have a targeted multifactorial assessment and targeted intervention. The components of this assessment and intervention are reviewed in this CGS, and barriers and issues related to implementation are discussed. Limitations. A gap analysis supports the need for the development of a physical therapy-specific CPG to provide more precise recommendations for screening and assessment measures, exercise parameters, and delivery models. Conclusion. This CGS provides recommendations to assist physical therapists in the identification and management of fall risk in older community-dwelling adults. Publication Type: journal article Source: CINAHL Full Text: Available from EBSCOhost in Physical Therapy Available from EBSCOhost EJS in Physical Therapy Available from Highwire Press in Physical Therapy Available from ProQuest in Physical Therapy

22. Title: Musculoskeletal physiotherapists' use of psychological interventions: a systematic review of therapists' perceptions and practice. Citation: Physiotherapy, 01 June 2015, vol./is. 101/2(95-102), 00319406 Author(s): Alexanders, Jenny, Anderson, Anna, Henderson, Sarah Language: English Abstract: Background Research has demonstrated that incorporating psychological interventions within physiotherapy practice has numerous potential benefits. Despite this physiotherapists have reported feeling inadequately trained to confidently use such interventions in their day-to-day practice. Objective To systematically review musculoskeletal physiotherapists' perceptions regarding the use of psychological interventions within physiotherapy practice. Data sources Eligible studies were identified through a rigorous search of AMED, CINAHL, EMBASE, MEDLINE and PsychINFO from January 2002 until August 2013. Study eligibility criteria Full text qualitative, quantitative and mixed methodology studies published in English language investigating musculoskeletal physiotherapists' perceptions regarding their use of psychological interventions within physiotherapy practice. Study synthesis and appraisal Included studies were appraised for risk of bias using the Critical Appraisal Skills Programme qualitative checklist. Meta-analysis was not possible due to study heterogeneity. Results Six studies, all with a low risk of bias, met the inclusion criteria. These studies highlighted that physiotherapists appreciate the importance of using psychological interventions within their practice, but report inadequate understanding and consequent underutilisation of these interventions. Limitations These results should be noted with some degree of caution due to various limitations associated with the included studies and with this review, including the use of a qualitative appraisal tool for mixed methodology/quantitative studies. Conclusion These findings suggest that musculoskeletal physiotherapists are aware of the potential benefits of incorporating psychological interventions within their practice but feel insufficiently trained to optimise their use of such interventions; hence highlighting a need for further research in this area and a review of physiotherapist training. Publication Type: journal article Source: CINAHL

23. Title: Novel methods of instruction in ACL injury prevention programs, a systematic review. Citation: Physical Therapy in Sport, 01 May 2015, vol./is. 16/2(176-186), 1466853X Author(s): Benjaminse, Anne, Welling, Wouter, Otten, Bert, Gokeler, Alli Language: English Abstract: Anterior cruciate ligament (ACL) injury prevention programs have been successful in the short term. Motor learning strategies with an internal focus (IF) to body movements have traditionally been utilized, but may be less suitable than an external focus (EF) for the acquisition and control of complex motor skills required for sport. To investigate the available literature and provide an overview of the effect of IF and EF instructions on jump landing technique. Systematic searches were conducted in PubMed (1966 to May 2014), CINAHL (1981 to May 2014) and PsycInfo (1989 to May 2014). A priori defined inclusion criteria were: (i) full text; (ii) published in English, German or Dutch; (iii) healthy adult subjects (mean age ≥18 years); (iv) jump and landing performance tested and (v) study used comparison between an EF and IF. Performance (jump height and distance) and technique (kinematics and kinetics) were the primary outcome variables of interest. Nine papers were included. Significant better motor performance

and movement technique was found with an EF compared to an IF. Considering the beneficial results in the included studies when utilizing an EF, it is suggested to implement these strategies into ACL injury prevention programs. Publication Type: journal article Source: CINAHL

24. Title: Physiotherapeutic interventions before and after surgery for degenerative lumbar conditions: a systematic review. Citation: Physiotherapy, 01 June 2015, vol./is. 101/2(111-118), 00319406 Author(s): Gilmore, S. J., McClelland, J. A., Davidson, M. Language: English Abstract: Background Physiotherapeutic management of patients immediately following lumbar spinal surgery is common. However, there is considerable variability in the interventions provided. Objectives To assess the effect of peri-operative physiotherapeutic intervention in adults undergoing surgery for the management of degenerative lumbar conditions. Data sources The Cochrane Library, Medline, Embase, CINAHL and PEDro were searched from inception to August 2012. Study selection Randomised controlled trials investigating physiotherapeutic interventions prior to and immediately following surgery for degenerative lumbar conditions were included. Data extraction and synthesis Two reviewers extracted data independently using a standardised form. Risk of bias was assessed using a modified version of the Cochrane Collaboration tool. The quality of evidence was assessed using the GRADE approach, and the treatment effect size was calculated where comparable outcome measures were used across multiple trials. Results Four studies were included. There is very-low-quality evidence that pre- and post-operative exercise in addition to standard physiotherapeutic care may reduce pain, time taken to achieve post-operative functional milestones, and post-operative time off work. Results from one study indicated that there is no clear benefit or risk of harm from performing either prone or side-lying transfers. Conclusion and implications of key findings Very-low-quality evidence suggests that physiotherapy may improve pain and function following lumbar surgery. Due to low numbers of included studies and variation in the interventions assessed, the current evidence provides limited guidance for physiotherapeutic practice. Further research is required to determine the effectiveness of physiotherapeutic interventions in this population. Publication Type: journal article Source: CINAHL

25.Title: Research Report. Effect of Taping on Spinal Pain and Disability: Systematic Review and Meta-Analysis of Randomized Trials. Citation: Physical Therapy, 01 April 2015, vol./is. 95/4(493-506), 00319023 Author(s): Vanti, Carla, Bertozzi, Lucia, Gardenghi, Ivan, Turoni, Francesca, Guccione, Andrew A., Pillastrini, Paolo Language: English Abstract: Background. Taping is a widely used therapeutic tool for the treatment of musculoskeletal disorders, nevertheless its effectiveness is still uncertain. Purpose. The purpose of this study was to conduct a current review of randomized controlled trials (RCTs) concerning the effects of elastic and nonelastic taping on spinal pain and disability. Data Sources. MEDLINE, CINAHL, EMBASE, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, IS1 Web of Knowledge, and SPORTDiscus databases were searched. Study Selection. All published RCTs on symptomatic adults with a diagnosis of specific or nonspecific spinal pain, myofascial pain syndrome, or whiplash-associated disorders (WAD) were considered. Data Extraction. Two reviewers independently selected the studies and extracted the results. The quality of individual studies was assessed using the PEDro scale, and the evidence was assessed using GRADE criteria. Data Synthesis. Eight RCTs were included. Meta-analysis of 4 RCTs on low back pain demonstrated that elastic taping does not significantly reduce pain or disability immediately posttreatment, with a standardized mean difference of —0.31 (95% confidence interval = — 0.64, 0.02) and —0.23 (95% confidence interval= — 0.49, 0.03), respectively. Results from single trials indicated that both elastic and nonelastic taping are not better than placebo or no treatment on spinal disability. Positive results were found only for elastic taping and only for short-term pain reduction in WAD or specific neck pain. Generally, the effect sizes were very small or not clinically relevant, and all results were supported by low-quality evidence. Limitations. The paucity of studies does not permit us to draw any final conclusions. Conclusion. Although different types of taping were investigated, the results of this systematic review did not show any firm support for their effectiveness. Publication Type: journal article Source: CINAHL Full Text: Available from EBSCOhost in Physical Therapy Available from EBSCOhost EJS in Physical Therapy Available from Highwire Press in Physical Therapy

Available from ProQuest in Physical Therapy

26.Title: Research Report. How Strongly Is Aerobic Capacity Correlated With Walking Speed and Distance After Stroke? Systematic Review and Meta-Analysis. Citation: Physical Therapy, 01 June 2015, vol./is. 95/6(835-853), 00319023 Author(s): Outermans, Jacqueline, van de Port, Ingrid, Wittink, Harriet, de Groot, Janke, Kwakkel, Gert Language: English Abstract: Background. Restoration of walking capacity, as reflected by walking speed and walking distance, is a primary goal after stroke. Peak aerobic capacity (peak oxygen consumption [Vo₂peak]) is suggested to be correlated with walking capacity after stroke. Although the strength of this correlation is unclear, physical therapy programs often target walking capacity by means of aerobic training. Purpose. The purpose of this systematic review was to summarize the available evidence on the correlation between Vo₂peak and walking capacity. Data Sources. The databases MEDLINE, CINAHL, EMBASE, Cochrane Library, and SPORTDiscus were searched up to May 2014. Study Selection. Cross-sectional studies reporting correlation coefficients between Vo₂peak and walking capacity in stroke were included, along with longitudinal studies reporting these correlation coefficients at baseline. Data Extraction. The methodological quality of the studies was assessed using a checklist of 27 items for observational research. Information on study design, stroke severity and recovery, and assessments and outcome of Vo2peak and walking capacity, as well as the reported correlation coefficients, were extracted. Data Synthesis. Thirteen studies involving 454 participants were included. Meta-analyses showed combined correlation coefficients (r_m) for Vo2peak and walk ing speed and for Vo2peak and walking distance of .42 (95% credibility interval=.31, .54) and .52 (95% credibility interval = .42, .62), respectively. Limitations. The studies included in the present review had small sample sizes and low methodological quality. Clinical and methodological diversity challenged the comparability of the included studies, despite statistical homogeneity. Relevant data of 3 studies could not be retrieved. Conclusions. The strength of the correlation of Vo2peak with walking speed was low and moderate for Vo₂peak and walking distance, respectively, indicating that other factors, besides Vo₂peak, determine walking capacity after stroke. Publication Type: journal article Source: CINAHL Full Text: Available from EBSCOhost in Physical Therapy Available from EBSCOhost EJS in Physical Therapy Available from Highwire Press in Physical Therapy Available from ProQuest in Physical Therapy

27.Title: Return to sport after hip surgery for femoroacetabular impingement: a systematic review. Citation: British Journal of Sports Medicine, 15 June 2015, vol./is. 49/12(819-824), 03063674 Author(s): Casartelli, Nicola C, Leunig, Michael, Maffiuletti, Nicola A, Bizzini, Mario Language: English Abstract: BACKGROUND: We aimed to appraise (1) the rate of return to sport of athletes after hip surgery for femoroacetabular impingement (FAI) and (2) some aspects that may influence the return to sport. METHODS: Four databases (EMBASE, PubMed, Web of Science, Cochrane Library) were searched until 21 October 2014. Studies evaluated return to sport of athletes who underwent hip surgery for the treatment of symptomatic FAI. A validated tool was used for quality evaluation of the studies. RESULTS: A total of 18 case series (level of evidence IV) with moderate-to-high methodological quality were included. On average, 87% of athletes returned to sport after hip surgery for FAI and 82% returned to the same sport level as before the occurrence of the symptoms. Professional athletes seem to return to sport at a higher rate compared with recreational and collegiate athletes. Sport participation after hip arthroscopy tends to decrease for professional athletes at short-term and mid-term follow-ups. Diffuse hip osteoarthritis at the time of surgery may not allow athletes to return to sport. CONCLUSIONS: Most athletes return to sport after hip surgery for the treatment of symptomatic FAI. The level of competition, time of evaluation after hip surgery and presence of articular cartilage lesions at the time of surgery may influence return to sport. Future studies with higher levels of evidence should describe and evaluate return to sport protocols after hip surgery for FAI. Publication Type: journal article Source: CINAHL Full Text: Available from Highwire Press in British Journal of Sports Medicine

28.Title: Risk factors for groin injury in sport: an updated systematic review.

Citation: British Journal of Sports Medicine, 15 June 2015, vol./is. 49/12(803-809), 03063674 Author(s): Whittaker, Jackie L, Small, Claire, Maffey, Lorrie, Emery, Carolyn A Language: English Abstract: BACKGROUND: The identification of risk factors for groin injury in sport is important to develop and implement injury prevention strategies. OBJECTIVE: To identify and evaluate the evidence examining risk factors for groin injury in sport. MATERIAL AND METHODS: Nine electronic databases were systematically searched to June 2014. Studies selected met the following criteria: original data; analytic design; investigated a risk factor(s); included outcomes for groin injury sustained during sport participation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed and two independent authors assessed the quality and level of evidence with the Downs and Black (DB) criteria and Oxford Centre of Evidence-Based Medicine model, respectively. RESULTS: Of 2521 potentially relevant studies, 29 were included and scored. Heterogeneity in methodology and injury definition precluded meta-analyses. The most common risk factors investigated included age, hip range of motion, hip adductor strength and height. The median DB score across studies was 11/33 (range 6-20). The majority of studies represented level 2 evidence (cohort studies) however few considered the inter-relationships between risk factors. There is level 1 and 2 evidence that previous groin injury, higher-level of play, reduced hip adductor (absolute and relative to the hip abductors) strength and lower levels of sport-specific training are associated with increased risk of groin injury in sport. CONCLUSIONS: We recommended that investigators focus on developing and evaluating preparticipation screening and groin injury prevention programmes through high-quality randomised controlled trials targeting athletes at greater risk of injury. Publication Type: journal article Source: CINAHL Full Text: Available from Highwire Press in British Journal of Sports Medicine

29.Title: Stabilizing characteristics of rotator cuff muscles: a systematic review. Citation: Disability & Rehabilitation, 15 June 2015, vol./is. 37/12(1033-1043), 09638288 Author(s): Sangwan, Sangeeta, Green, Rodney A., Taylor, Nicholas F. Language: English Abstract: Purpose: To systematically review the evidence in support of the purported function of the rotator cuff muscles as dynamic stabilizers of the glenohumeral joint. Methods: Electronic searches were conducted using AMED, CINAHL, Medline and SPORT Discus. Studies were required to include at least one characteristic of a stabilizer muscle. Quality analysis was completed by two assessors independently. Data were extracted for four main characteristics of stabilizer muscles: (1) moment arm length, (2) onset of muscle activity, (3) joint stiffness as measured by contribution of muscle activity to prevent joint translation, (4) co-contraction as demonstrated by electromyography muscle activity and co-activation ratio. Results: Twenty of the 1726 identified studies were selected for the review. Rotator cuff muscles can limit joint translation (five studies) and contribute to joint stiffness (one study), possess shorter moment arms in some movements (three studies), but show limited evidence for stabilizing characteristics of early onset (seven studies) and co-contraction (seven studies). Conclusion: The rotator cuff muscles exhibited some stabilization characteristics but not all. On the basis of our current low to moderate quality evidence, the most likely, but as yet unverified, stabilization role for the rotator cuff muscles appears to be limiting of translation in a direction-specific manner. Publication Type: journal article Source: CINAHL

30.Title: Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients. Citation: Disability & Rehabilitation, 01 July 2015, vol./is. 37/14(1209-1213), 09638288 Author(s): Conceição, Cristiano Sena da, Gomes Neto, Mansueto, Mendes, Selena M. D., S, Kátia Nunes, Baptista, Abrahão Fontes Language: English Abstract: Purpose: This meta-analysis examined the effects of foot orthoses (FO) on pain and disability in rheumatoid arthritis (RA) patients. Methods: MEDLINE, Cochrane Controlled Trials Register, EMBASE, SPORT Scielo, and CINAHL were searched through July 2014 for randomized controlled trials (RCTs) examining the effects of orthoses on pain and disability in RA patients. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test. Results: Three studies, involving 110 patients who received FO and 108 control patients, met the study criteria. Relative to controls, FO had a positive impact on pain (WMD 0.40; 95% CI 0.04-0.57). Between group differences in disability were not statistically significant. Conclusions: FO may improve pain in RA patients, but their

impact on disability remains undetermined. Additional large RCTs are needed to investigate the effects of these devices in RA patients. Publication Type: journal article Source: CINAHL

31.Title: The Efficacy of Manual Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta-analysis. Citation: Journal of Orthopaedic & Sports Physical Therapy, 01 May 2015, vol./is. 45/5(330-350), 01906011 Author(s): Desjardins-Charbonneau, Ariel, Roy, Jean-SÉBastien, Dionne, Clermont E., FrÉMont, Pierre, Macdermid, Joy C., Desmeules, FranÇOis Language: English Abstract: * STUDY DESIGN: Systematic review and meta-analysis. * OBJECTIVES: To evaluate the efficacy of manual therapy (MT) for patients with rotator cuff (RC) tendinopathy. * BACKGROUND: Rotator cuff tendinopathy is a highly prevalent musculoskeletal disorder, for which MT is a common intervention used by physical therapists. However, evidence regarding the efficacy of MT is inconclusive. * METHODS: A literature search using terms related to shoulder, RC tendinopathy, and MT was conducted in 4 databases to identify randomized controlled trials that compared MT to any other type of intervention to treat RC tendinopathy. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses or qualitative syntheses of evidence were performed. * RESULTS: Twenty-one studies were included. The majority had a high risk of bias. Only 5 studies had a score of 69% or greater, indicating a moderate to low risk of bias. A small but statistically significant overall effect for pain reduction of MT compared with a placebo or in addition to another intervention was observed (n = 406), which may or may not be clinically important, given a mean difference of 1.1 (95% confidence interval: 0.6,1.6) on a 10-cm visual analog scale. Adding MT to an exercise program (n = 226) significantly decreased pain (mean difference, 1.0; 95% confidence interval: 0.7,1.4), as reported on a 10-cm visual analog scale, which may or may not be clinically important. Based on qualitative analyses, it is unclear whether MT used alone or added to an exercise program improves function. * CONCLUSION: For patients with RC tendinopathy, based on low- to moderate-quality evidence, MT may decrease pain; however, it is unclear whether it can improve function. More methodologically sound studies are needed to make definitive conclusions. * LEVEL OF EVIDENCE: Therapy, level 1a -. Publication Type: journal article Source: CINAHL

32.Title: The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial. Citation: Manual Therapy, 01 August 2015, vol./is. 20/4(603-609), 1356689X Author(s): Magalhães, Mauricio Oliveira, Muzi, Luzilauri Harumi, Comachio, Josielli, Burke, Thomaz Nogueira, Renovato França, Fabio Jorge, Vidal Ramos, Luiz Armando, Leão Almeida, Gabriel Peixoto, de Moura Campos Carvalho-e-Silva, Ana Paula, Marques, Amélia Pasqual Language: English Abstract: Background Chronic low back pain is one of the most common problematic health conditions worldwide and is highly associated with disability, quality of life, emotional changes, and work absenteeism. Graded activity programs, based on cognitive behavioral therapy, and exercises are common treatments for patients with low back pain. However, recent evidence has shown that there is no evidence to support graded activity for patients with chronic nonspecific low back pain. Aim to compare the effectiveness of graded activity and physiotherapy in patients with chronic nonspecific low back pain. Methods A total of 66 patients with chronic nonspecific low back pain were randomized to perform either graded activity (moderate intensity treadmill walking, brief education and strength exercises) or physiotherapy (strengthening, stretching and motor control). These patients received individual sessions twice a week for six weeks. The primary measures were intensity of pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire). Results After six weeks, significant improvements have been observed in all outcome measures of both groups, with a non-significant difference between the groups. For intensity of pain (mean difference = 0.1 points, 95% confidence interval [CI] = −1.1–1.3) and disability (mean difference = 0.8 points, 95% confidence interval [CI] = −2.6–4.2). No differences were found in the remaining outcomes. Conclusion The results of this study suggest that graded activity and physiotherapy showed to be effective and have similar effects for patients with chronic nonspecific low back pain. Publication Type: journal article Source: CINAHL Full Text: Available from MANUAL THERAPY in Salisbury District Hospital Healthcare Library Available from Elsevier in Manual Therapy

News

The Chartered Society of Physiotherapy (CSP) http://www.csp.org.uk/news

NHS Choices

Having a spine similar to a chimp could lead to back pain Monday Apr 27 2015 "People with lower back problems are more likely to have a spine similar in shape to the chimpanzee," BBC News reports. Research suggests that humans with similar shaped vertebrae to chimps are more vulnerable to developing a slipped disc…

Library Resources

New Books

New books available from Healthcare Library. To search the library catalogue visit www.swims.nhs.uk

Physiotherapy in respiratory and cardiac care: an evidence-based approach. Alexandra Hough (2014). Andover: Cengage Learning. ISBN 9781408074824 Shelfmark: WF146 HOU

Tidy's physiotherapy. edited by Stuart Porter (2013). Edinburgh: Saunders. ISBN 9780702043444 Shelfmark: WB460

Physiotherapy for respiratory and cardiac problems: adults and paediatrics. edited by Jennifer A. Pryor, S. Ammani Prasad (2008). Edinburgh: Churchill Livingstone. ISBN 9780080449852 Shelfmark: WF145

Evidence-based therapeutic massage: a practical guide for therapists. [edited by] Elizabeth Holey, Eileen Cook (2011). Edinburgh: Churchill Livingstone. ISBN 9780702032295 Shelfmark: WB537

Human movement: an introductory text edited by Tony Everett and Clare Kell (2010).. Edinburgh: Churchill Livingstone. ISBN 9780702031342 Shelfmark: WE60

Managing sports injuries: a guide for students and clinicians. Christopher M. Norris (2011). Churchill Livingstone. ISBN 9780702034732 Shelfmark: WD500

A selection of the physiotherapy-related topics available on UpToDate: -

Exercise-based therapy for low back pain

Pelvic floor physical therapy for management of myofascial pelvic pain syndrome in women

Rotator cuff tendinopathy

Overview of geriatric rehabilitation: Program components and settings for rehabilitation

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This current awareness bulletin contains a selection of information which is not intended to be exhaustive, and although library staff have made every effort to link only to reputable and reliable websites, the information

contained in this bulletin has not been critically appraised by library staff. It is therefore the responsibility of the reader to appraise this information for accuracy and relevance.

This bulletin was produced by Caroline Thomas, Librarian, Salisbury NHS Foundation Trust Healthcare Library. If you have any comments to make about this bulletin please contact caroline.thomas@salisbury.nhs.uk