Physio Findings: study sheds light on nerve pain symptoms

Neuropathic pain, caused by damaged nerves, is harder to treat than normal pain, which travels along healthy nerves from damaged tissue.

Researchers in Toronto set out to see whether a patient’s risk of having neuropathic pain, five
years after knee replacement surgery, was related to factors that could be spotted earlier.

They used data on 47 women and 16 men who completed questionnaires five years after their operations. None of the patients, whose average age was then 67, had had surgical complications or failure of the new joint. Nine of them reported neuropathic pain.

The team looked at data from before the operation such as patients’ age, sex, disability, other health problems and confidence in their ability to cope with symptoms. They found nothing linking any of these with likelihood of neuropathic pain five years afterwards.

But they also looked at the patients’ level of disability 12 months after knee replacement.

At that stage, the nine who later reported neuropathic pain already had more stiffness, pain and difficulty moving than other patients. Four years further on, they still had more of these symptoms than the others and also reported more depression and less satisfaction.

Razmjou H et al. Association between neuropathic pain and reported disability after total knee arthroplasty, Physiotherapy Canada 2015. 

• Janet Wright

Journal Findings

Physiotherapy editor Michele Harms highlights the latest articles in press in the journal

Management of rotator cuff repairs

There is little consensus on the best rehabilitation programme following surgical repair of the rotator cuff. Commonly used modalities include exercise therapy, continuous passive motion machines and aquatic therapy. So the authors undertook a systematic review to provide clinical guidance on post-surgical management. They conclude that following rotator cuff repair, patients should expect improvement in pain, range of movement and function; however they found no one superior rehabilitation method.

Based on the results of the review, the authors have produced some particularly useful sections for the clinician including: recommendations for clinical practice to enhance pre-operative success; recommendations for clinical practice for most effective rehabilitation protocol post- operatively; and expected time for recovery.

Thomson S et al.Rehabilitation following surgical repair of the rotator cuff: a systematic review, DOI: http://dx.doi.org/10.1016/j.physio.2015.08.003

Falls in mental health settings

A series of open access papers, available online, include a review of the policies in England and Wales relating to falls screening and assessment tools used in mental health units.

The authors obtained relevant falls policies from 35 mental health trusts. The St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT) were the most common tools specified. However, the authors question the predictive validity of these tools and their operational usefulness. Further work is required in their use in the area of mental health, the authors say.

Narayanan V et al. Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales. DOI: http://dx.doi.org/10.1016/j.physio.2015.04.010

Taping for chronic ankle instability

Chronic ankle instability is common in children and athletes. Authors from Germany looked at the stabilisation effects of elastic taping, non-elastic taping and bracing when compared to being barefoot.

They found that non-elastic taping reduced midfoot movement in the frontal plane (inclination of the medial arch), but elastic taping (Kinesiotaping) and bracing in a soft ankle support had no effect. In healthy subjects, both non-elastic taping and bracing reduced movement. All three methods reduced maximum plantar flexion. They conclude that non-elastic taping stabilised the midfoot best in patients with chronic ankle instability, while Kinesiotaping did not influence foot kinematics other than to stabilise the hindfoot in the sagittal plane.Kuni B et al.Effect of kinesiotaping, non-elastic taping and bracing on segmental foot kinematics during drop landing in healthy subjects and subjects with chronic ankle instability   

How well do physios engage with evidence- based practice?

A team of researchers from Dublin carried out a scoping review to examine the ability of physiotherapists to undertake evidence-based practice (EBP). Their review included 25 studies which reported on the skill of physiotherapists in EBP.

Although they found some research to show how evidence was acquired and appraised, they discussed a number of limitations of how evidence was being used and the lack of impact of EBP on patient outcomes. Their findings suggested that  ‘physiotherapists report using their peers and other trusted sources in preference to literature, primarily due to time but also due to divergence between the literature-based evidence and other evidence that they use
and value’. 

Condon C et al. Ability of physiotherapists to undertake evidence-based practice steps: a scoping review DOI: http://dx.doi.org/10.1016/j.physio.2015.06.003

These reports feature in the latest issue of the CSP journal, Physiotherapy (Physiotherapy September 2015;101(3)). The reports  are only available online. CSP members can access them free of charge online,via the CSP website.

Comments and conclusions

Pressure by lobby groups may be fuelling excessive use of calcium and vitamin D supplements, say researchers, despite evidence that these are not effective against osteoporosis and may be harmful.

Grey A & Bolland M. BMJ 2015; http://dx.doi.org/10.1136/bmj.h3170

Obese people with asthma can reduce the severity of their symptoms and improve asthma control, lung function and quality of life by losing weight, according to a study of 22 obese patients who lost on average 16.5 kilos. Their activity levels also increased significantly.

Pakhale S et al. Chest 2015; http://dx.doi.org/10.1378/chest.14-3105

Pregnant women who take moderate exercise and avoid excessive weight gain reduce their risk of developing a type of temporary diabetes, say researchers who analysed 13 trials involving more than 2,800 women. Gestational diabetes can cause dangerous pregnancy complications and long-term conditions, including type 2 diabetes.

Sanabria-Martínez G et al. British Journal of Obstetrics and Gynaecology 2015; http://dx.doi.org/10.1111/1471-0528.13429

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