Physio findings: diabetes, evidence, research news

Diabetes: study reveals ‘insidious’ damage

People with diabetes are more likely than others to have problems with their hands or shoulders, according to a study published in Physiotherapy journal online.  

‘Upper-extremity impairments in this sample of patients with diabetes were common, severe and related to complaints of pain and disability,’ say KM Shah and colleagues, of Washington University School of Medicine in St Louis, USA.

Nearly two thirds of 236 people attending an outpatient diabetes clinic reported ‘substantial’ pain or disability. Compared with a group of healthy volunteers, they had less strength, mobility and sensation in their hands and shoulders.

But the conditions are often painless in the early stages: for example, as range of motion becomes limited. Therefore, many patients don’t complain until the changes are advanced and the damage may be harder to deal with.

‘This study characterised insidious upper-extremity impairments in patients with diabetes, and these results may help to develop appropriate treatment strategies,’ say the authors. Shah KM et al. Upper-extremity impairments, pain and disability in patients with diabetes mellitus, Physiotherapy 2014.

CSP members can read all Physiotherapy studies in full, free of charge, by accessing the journal through the CSP website.

Evidence: PEDro celebrates 15 years with 15 top trials

It’s 15 years since the Centre for Evidence-Based Physiotherapy set up its free evidence database, known as PEDro.

To celebrate, the centre invited PEDro users to nominate top physiotherapy trials and has published links to the 15 best.

‘These are ground-breaking trials that changed the way people are treated for a variety of conditions seen by physiotherapists and other healthcare professionals,’ say the organisers.

Among the winners are papers showing the value of supervised exercise for chronic back pain, of physiotherapy rather than medical care for tennis elbow, of structured warm-up exercises to prevent knee and ankle injuries in young athletes, and of pelvic-floor muscle training against stress incontinence.

‘Some of these trials set the stage for breakthroughs, some represent a paradigm shift, and all of them mark important milestones in the evolution of physiotherapy treatment,’ say PEDro organisers.

Based at the George Institute for Global Health in Sydney, it now holds 28,600 randomised trials, systematic reviews and clinical practice guidelines.

Users are invited to send in suggestions for papers worth adding. To be included, papers have to meet strict criteria and are independently assessed. Although they need to be relevant to physiotherapy as it is (or could be) practised, age is no barrier: the earliest in the database dates from 1929. See the whole list here.

Member news

Clinical specialist physio Hannah Parkinson addressed the north American cystic fibrosis conference in Atlanta, Georgia, last month. Ms Parkinson, of the cystic fibrosis team at King’s College hospital, London, was invited to report on the team’s innovative home-care service.

Home visits have proved popular with patients over the past four years, she said. The service recently included some joint visits with a psychologist, helping the team develop their skills.

‘Open discussions and real-life observations made in the home environment can provide additional information to guide clinical decisions,’ say the team, whose abstracts can be found here on pages 390 and 433.  Find out more from: charles.reilly@nhs.net

Comments & Conclusions

A self-referral scheme with telephone triage, in an urban Yorkshire physiotherapy service, provides equally good care yet cost nearly a third less than the traditional GP-referral pathway. Mallett R et al. Musculoskeletal Care 2014.

Women who had physiotherapy before as well as after a mastectomy with lymph-gland removal had regained more independence, 15 days after the operation, than patients who only had the post-operative physiotherapy. Ribeiro S et al. Archives of Physical Medicine and Rehabilitation 2014. 
 
Working more than 55 hours a week in a low-status job is linked with a 30 per cent increased risk of developing diabetes – whether or not this is shift work, which is known to increase diabetes risk. Long hours in a middle-class occupation showed no similar risk, researchers at University College London found. Kivimäki M et al. Lancet Diabetes & Endocrinology 2014.
 
Aquatic exercise has ‘moderate’ good effects on pain, physical function and quality of life in adults with musculoskeletal conditions, a review of 26 randomised controlled trials reports. Barker AL et al. Archives of Physical Medicine and Rehabilitation 2014.
 
People who are depressed, even mildly, are less likely to make a good recovery from surgery on lumbar spinal stenosis (where nerves in the lower back are painfully compressed). Pakarinen M et al. Spine Journal 2014.  
 
Sedentary people who take up physical activity three times a week could reduce their risk of depression by 16 per cent, say researchers at University College London. The link between activity and improved mood held across the general population – not just groups at high risk of depression. Pinto Pereira SM et al. JAMA Psychiatry 2014.

Author