Physio Charlie - research

Outcome Measures

noreply@blogspirit.com (PhysioCharlie) — Thu, 05 Nov 2009 22:39:50 +0100

This was recently posted on iCSP:

Outcome Measures

Added by: rfergusonthomas
Posted: 28 October 2009 12:31

We have been asked to look at implementing an outcome measure that can be used from acute in-patient stay, through to intermediate care and then onto the domiciliary setting. As you can imagine this has stirred up a huge debate as to relevance, validity, etc so I was putting this out there to see if it something that has been done in other parts of the country?
The commisioners are wanting something that will measure patient satisfaction (with their outcomes/achievements, not the services involved) but we also feel we need to look objectively at the changes that occur. It needs to be multi-agency (health and adult community care) and multi-disciplinary and so needs to be easily understood and administered with inter-rater reliability.
I would appreciate any pointers!
Thanks,
Rhiannon

Title: euroquol
Added by: bwre002
Posted: 30 October 2009 08:38
Have you looked at euroquol? It has its own website - google it. Very generic so might be useful.
Title: Outcome measures
Added by: laurenreuter
Posted: 29 October 2009 18:25
How about PROMS/CROMS?

Patient-Reported Outcome Measures (PROMs)
Patient-reported outcome measures (PROMs) provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life. These instruments can be completed by a patient or individual about themselves, or by others on their behalf.

The CROMS is for clinicians.
Title: OCM
Added by: John Mclennan
Posted: 28 October 2009 14:24
have you considered the Patient Global Impression of Change? There has been widespread use of the PGIC in recent chronic pain clinical trials (e.g. Dunkl et al., 2000; Farrar et al., 2001), and the data provide a responsive and readily interpretable measure of participants’ assessments of the clinical importance of their improvement or worsening. Impression of change scores using different verbal outcome categories have also been used to determine the minimally important changes in quality of life measures (e.g. Guyatt et al., 2002; Hagg et al., 2003). These measures appear to have validity.

Guy, 1976 W. Guy, ECDEU assessment manual for psychopharmacology (DHEW Publication No. ADM 76–338), US Government Printing Office, Washington, DC (1976).
Farrar et al., 2001 J.T. Farrar, J.P. Young, L. LaMoreaux, J.L. Werth and R.M. Poole, Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale, Pain 94 (2001), pp. 149–158.
[sorry, don't have more refs]

Upper limb disorders Occupational aspects of management

noreply@blogspirit.com (PhysioCharlie) — Mon, 26 Oct 2009 16:29:10 +0100

Upper limb disorders Occupational aspects of management

This is a very up to date look at the evidence for the management of ULD's in the workplace. As with a lot of research, the only good evidence they have found is that multidisiplinary treatment with a biopsychosocial approach for non specific arm pain and changing a keyboard for carpal tunnel are better than usual care.

Occupational health course

noreply@blogspirit.com (PhysioCharlie) — Fri, 23 Oct 2009 17:45:00 +0200

I attended an Occupational health course on 30 sept - 2nd Oct 2009 run by Nicoloa Hunter and Amanda Jones.

It was very informative. Things I learnt were:

1. Occupational epidemiology - statistics relating to occupational health and musculoskeletal disorders, i.e. Nurses have statistically more back pain than many other professions. In Lithuania whiplash does not exist as they have no compensation culture. NIOSH epidemiology of MSD's

2. Evidence based practice and LBP - there has been a republication of the NICE guidelines; non-specific low back pain that has lasted for more than 6 weeks, but for less than 12 months. Back in work for NHS employes is also a good guide and has soem great assessment tools. Functional restoration programmes are useful after 12/52 of LBP. The OREBRO questionnaire is a good outcome measure, scoring. The OREBRO (ÖMPQ) is a ‘yellow flag’ screening tool that predicts long-term disability and failure to return to work when completed four to 12 weeks following a soft tissue injury2. A cut-off score of 105 has been found to predict those who will recover (with 95 per cent accuracy), those who will have no further sick leave in the next six months (with 81 per cent accuracy), and those who will have long-term sick leave (with 67 per cent accuracy).

3. Evidence based practice and neck apin - there is no evidence for any clinical tests. Level 1 evidence for advising incresed movement and reassurance.

4. Confidentiality and consent - we must have the patient sign consent to discuss their problem with the occupational health dept. We can document this in our notes. The Disability Discrimination Act is important here.

Red Flags

noreply@blogspirit.com (PhysioCharlie) — Thu, 15 Oct 2009 23:01:32 +0200

I was reading iCSP today and came across a debate about red flags. Something that came up was a "band of pain" across the abdomen and back as a red flag. See articles below:

Henschke, N., Maher, C. G. and Refshauge, K. M. (2007). "Screening for malignancy in low back pain patients: a systematic review." Eur Spine J 16(10): 1673-9.
Henschke, N., Maher, C. G. and Refshauge, K. M. (2008). "A systematic review identifies five "red flags" to screen for vertebral fracture in patients with low back pain." J Clin Epidemiol 61(2): 110-118.
Jarvik, J. G. and Deyo, R. A. (2002). "Diagnostic evaluation of low back pain with emphasis on imaging." Ann Intern Med 137(7): 586-97.
Mylona, E., Samarkos, M., Kakalou, E., Fanourgiakis, P. and Skoutelis, A. (2009). "Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics." Semin Arthritis Rheum 39(1): 10-17.

Systematic review of tests to identify the disc,

noreply@blogspirit.com (PhysioCharlie) — Wed, 22 Jul 2009 00:57:00 +0200

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2078309&blobtype=pdf

M. J. Hancock, C. G. Maher, J. Latimer, M. F. Spindler, J. H. McAuley, M. Laslett, N. Bogduk

This is a good review suggesting just how hard it is for any test to accurately diagnose pathology. It states that a combination of SI jt tests are relevant and that clinical reasoning is important...nothing we didn't already know really.

OA knee ESCAPE programme

noreply@blogspirit.com (PhysioCharlie) — Mon, 22 Jun 2009 23:42:12 +0200

Just found some interesting evidence for an OA knee exercise programme:

http://www.kcl.ac.uk/content/1/c6/04/79/67/escapeprogramme.pdf

The guide is very good and it gives ideas for handouts for patients, here is an outline:

Objective

Chronic knee pain is a major cause of disability and healthcare expenditure, but there

are concerns about efficacy, cost and side-effects associated with usual management.

Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the

efficacy of a rehabilitation programme (Enabling Self-management and Coping with Arthritic

knee Pain through Exercise, ESCAPE-knee pain) of improving function in people with chronic

knee pain better than usual primary care, delivered to individuals or groups of people.

Methods

This was a single blind, pragmatic, cluster randomised controlled trial. Participants aged

50 years and over, complaining of knee pain for more than 6 months, were recruited from a

random sample of 54 inner city primary care practices. Usual primary care was compared with

participation on a rehabilitation programme (integrating exercise, self-management and active

coping strategies) delivered to participants individually or groups of 8 participants. Primary

outcome was self-reported function (WOMAC-func) 6 months after completing rehabilitation.

Results 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events.

Rehabilitated participants had better function than participants continuing usual primary care (-

3.33 WOMAC-func points, CI -5.88 to -0.78; p=0.01). Improvements were similar whether

participants received individual (-3.53, CI -6.52 to -0.55) or group rehabilitation (-3.16, CI -6.55

to -0.12). The number needed to treat was 7 (CI 4 to 27).

Conclusions

ESCAPE-knee pain provides a safe, clinically practicable intervention for chronic

knee pain, and is equally effective whether delivered to individuals or groups of participants.

New website!!

noreply@blogspirit.com (PhysioCharlie) — Mon, 09 Mar 2009 19:22:00 +0100

I have a new website!!

http://physiocharlie.vpweb.co.uk

SI Joint

noreply@blogspirit.com (PhysioCharlie) — Wed, 18 Feb 2009 20:19:00 +0100

SI jt Ax:

http://www.youtube.com/watch?v=Eu9JaM9S0Ak&feature=PlayList&p=4C3ECA6E484A19AF&playnext=1&index=1

http://www.youtube.com/watch?v=ifO9SgdEfgk

http://www.youtube.com/watch?v=sPgVu2NjVHE&feature=related

I found this on youtube about SI manip; "Chicago"

http://www.youtube.com/watch?v=y9-dRk91AXI&NR=1

Also: Taping for anterior innominate

http://www.youtube.com/watch?v=QPppVRgdORE&feature=related

Piriformis release:

http://www.youtube.com/watch?v=UFXWrYoS9ho&NR=1

http://www.youtube.com/watch?v=uuozn0i-De8

Flouroscopically guided SI injections:

http://emedicine.medscape.com/article/96054-media

Foot Posture Index

noreply@blogspirit.com (PhysioCharlie) — Wed, 04 Feb 2009 16:18:21 +0100

http://learn.clinicsinmotion.com/moodle/course/view.php?id=7 From the CSP conference 2008:

K. Reilly, K. Barker, M. Newman, S. Sandall

Foot Posture Index

Published 2006 Redmond et al

Free to download on the internet:

http://www.leeds.ac.uk/medicine/FASTER/FPI/FPI%20Reference%20sheets.pdf

The measurements are of two anatomical segments taken in three planes

Gives clear indication of foot posture with a numerical score:

nNormal 0 to +5

Pronated +6 to +9

Highly pronated 10+

Supinated -1 to -4

Highly supinated -5 to -12

Evidence for use of Acupuncture

noreply@blogspirit.com (PhysioCharlie) — Tue, 27 Jan 2009 14:36:37 +0100

I found this discussion on the CSP website:

Added by: barbaracavan
Posted: 22 January 2009 13:58

I am a new band 6 physio working in a physio department which employs a very 'hands off' approach to treatment. We see mostly chronic conditions. I am the only AACP approved physio working there. Other physios in the department practice acupuncture, but do so very rarely. Some physios have considered doing a full 80 hour AACP course but they have put this on hold due to 'lack of evidence' to support the use of acupuncture. Can anyone point me in the direction of some recent sound studies/ guidelines supporting the use of acupuncture? I personally have good results but understandably they want to see sound evidence and studies.

Any information would be appreciated. Thanks

Showing 1 to 10 of 10

Title:	Acupuncture evidence
Added by:	jetturner
Posted:	22 January 2009 14:47

There are several good articals in recient years the most recient that I've seen is by Haake et al 2007. German acupuncture trials (GERAC) for chronic LBP. Arch Intern Med 167 (17):1892-1998.

Nice have reciently publisted their draft guidelines for LBP in which they recomend that acupuncture is a safe, effective treatment for chronic LBP. The full guideline whic are published on the NICE website include the artical referrances that they have used to support their recomendations.

Hope this helps.

Title:	acupuncture
Added by:	nakky
Posted:	22 January 2009 14:49

There is certainly a growing amount of evidence that supports the effectiveness of needling. If you have a look at the journal of Acupuncture in Medicine you will find lots of positive research. It is probably also worth your while to contact the acupuncture association of chartered physiotherapists directly, as they will be aware of the latest research in the field.

Title:	Acupuncture
Added by:	apurvamurthy
Posted:	22 January 2009 15:33

Quiet a few positive research findings in the recent journal of acupuncture in medicine.
Iam sure it will be of help.

Title:	Some evidence exists
Added by:	rhisiart
Posted:	22 January 2009 15:44

Although systematic reviews can sometimes hide useful data, they nevertheless offer the best source of evidence for any treatment approach. Here are some Cochrane systematic review conclusions:

1. Acupuncture for tension-type headache (Klaus L et al 2009). "Acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches."

2. Acupuncture for shoulder pain (Green S et al 2005). "From the little evidence that there is, acupuncture may improve pain and function over the short term."

3. Acupcunture for low back pain (Furlan AD et al 2005). "The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment."

4. Acupuncture for neck pain (Trinh K et al 2006). "There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list."

Not startling evidence (acupuncture does appear to be better than no treatment in some cases) and many other systematic reviews provide little evidence for the use of acupuncture in areas such as stroke management.

Even where acupuncture presents better than no treatment, the placebo effect is difficult to eliminate entirely.

The lack of robust evidence for acupuncture is often undermined by poor research methods. As better studies come forward, we may be gain a greater understanding of the presence or absence of potential non-placebo clinical benefits.

Title:	evidence for acupuncture
Added by:	michellerogers
Posted:	22 January 2009 16:01

I would also suggest contacting Panos Barlos at Keele university.He appears to have 100's of research papers on the use/efficacy of acupuncture.Good luck

Title:	Acupuncture evidence
Added by:	stucam
Posted:	22 January 2009 16:15

Acupuncture in medicine journal is a good source of information or visit the website www.acupunctureinmedicine.org.uk

The AACP could also point you in the right direction.

I work privately and find I have some very good results with acupuncture but I get to spend a little longer than the usual 20minute nhs appointment. Is it difficult to administer acupuncture in this time period?

Title:	Evidence for use of Acupuncture
Added by:	TJCSmith
Posted:	22 January 2009 19:00

http://www.ncbi.nlm.nih.gov/pubmed/

Hello

A quick search using the link above with give you loads of articles to support the use of acupuncture. There are also plenty of articles that will cause you to question the use of acupuncture but they are also worth reading and considering.

I hope that helps.

Title:	Evidence
Added by:	AACP Chair
Posted:	23 January 2009 17:49

If you are looking for evidence then there is a plethera of it in terms of systematic reviews, pain, inflammation etc. But, whilst you are at it ,and if you have access to the athens, science direct or such databases tell me the evidence for:
electrotherapy
manual therapy
traction
Massage
Mobs?

Be careful you are not singling out acupuncture, which has probably the most robust evidence available, when other modalitities have little or non, other than exercise.

Title:	Acupuncture
Added by:	timpowell
Posted:	26 January 2009 09:29

You are not the first to come across this problem and as other people such as Jennie Longbottom have pointed out - you could argue the evidence for every form of treatment we offer.

Just because a condition is 'chronic' does not necessarily mean it should be treated with advice and exercise only - although I agree that this can make up a big proportion of your treatment plan. However, there is a need to be pragmatic and judge each case on its merits and apply clincal reasoning .

Try flipping the coin round on your colleagues and get them to lit review their hands off approach - I will bet 'core stabilty' is a recurrent theme in the treatments - get them to compare the efficacy of this for back pain.

Title:	Other therapies?
Added by:	rhisiart
Posted:	26 January 2009 12:28

The AACP Chair makes a valid point about not singling out acupuncture for evidence-based scrutiny.

The Randomised Control Trial (RCT) remains the gold standard for testing therapies. However, complex treatments involving multiple variables make RCTs hard to conduct.

This often the case when examining any physiotherapeutic treatment, be it acupuncture, mobilisations, educating patients etc.

This is in part due to the immense difficulty in accurately measuring the effects of the clinician-patient relationship and separating these effects from the actual effects of the passive treatment (e.g. acupuncture or mobs).

I challenge anyone to come up with an ethically sound RCT that can single out any modality (acupuncture, mobs or whatever) that completely excludes the relationship between the physiotherapist and the patient.

Of course, this would be the only way to critically assess the technical ‘cold’ aspect of the passive treatment itself.