Physio findings: can attitude affect treatment?

People with shoulder pain should be assessed for psychological as well as physical factors before starting physiotherapy, according to a new study. 

 

And doctors should encourage them to expect good results.

 

‘Prognostic factors associated with the outcome of physiotherapy for shoulder pain are unclear, and currently cannot support clinical decision-making,’ say Rachel Chester, of the faculty of health sciences at the University of East Anglia, and colleagues. 

 

So the team set out to discover what factors, in the patient’s personality and circumstances as well as their body, were linked with best outcomes. 

 

They looked at 71 possible factors in 1,030 patients starting physiotherapy for shoulder pain. 

 

They then checked how each person had got on after an initial six weeks and then again after a further six months.

 

The patients who fared best were those who, to start with, had less pain at rest and higher expectations of a full recovery. They also had higher self-efficacy, or confidence in their ability to do things despite the pain. Among those of working age, students and employed people also had better outcomes. 

 

‘Psychological factors, such as patient expectation and pain self-efficacy, should be formally assessed using standardised measures,’ say the authors. Chester R et al. Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study, British Journal of Sports Medicine 2016 - open access.

 

Physiotherapy editor Michele Harms highlights the latest articles online (known as articles in press) and in print (Volume 102, Issue 3 and online).

 

Wong, Levine and Deo et al conduct a systematic review to challenge the tenet that a frozen shoulder progresses through a self-limiting natural history of painful, stiff and recovery phases, leading to full recovery without treatment. 

 

Yet experience tells us that the persistent limitations of frozen shoulder can last for years. 

 

Of 508 citations, only seven were suitable for review. The authors state that there was little evidence to support the theory of progression through recovery phases to full resolution without treatment. 

 

They did however find that most improvement occurred early in the recovery phase and not late.

 

CK Wong, WN Levine, K Deo, et al Systematic review of the natural history of frozen shoulder: fact or fiction? 

 

Researchers in Ireland report an investigation on the leadership frames of physiotherapy managers. 

 

They believe that, to be effective leaders, physiotherapy managers must employ a comprehensive, adaptable and balanced leadership style. 

 

A total of 45 physiotherapy managers responded to the survey and completed the Bolman and Deal Leadership Orientations Index. This questionnaire asks you to describe yourself as a manager and leader.

 

The human resource frame, defined as leaders who emphasise the importance of people, was the most frequently used and the political frame was the least used. 

 

Of those responding 33 per cent gave themselves the top rating for effectiveness as a manager, whereas 19 per cent gave themselves the top rating for their leadership effectiveness. 

 

The authors recommend the development of underused skills to enhance the leadership skill set and make physiotherapy managers more confident as leaders. McGowan E, Walsh C, Stokes E Physiotherapy managers’ perceptions of their leadership effectiveness: a multi-frame analysis. 

 

This article in press describes a study which targets 96 patients with non-reducible discogenic pain (NRDP) of between six weeks’ and six months’ duration, within a multi-centre trial. 

 

Patients received a functional restoration programme with guideline-based advice. This was compared to two sessions of advice alone. 

 

Each functional restoration programme provided 10 sessions over a 10-week period and was individualised to pathoanatomical, psychosocial and neurophysiological factors. The study was conducted in 15 primary care physiotherapy clinics. 

 

The results suggest that patients following a functional restoration programme demonstrate improved primary outcomes and that these differences are clinically important. Alexander YP Chan et al Individualised functional restoration plus guideline-based advice versus advice alone for non-reducible discogenic low back pain: a randomised controlled trial.  Accepted Manuscript pdf

These reports feature online in the CSP journal, Physiotherapy. CSP members can access them free of charge online, via the CSP website.

Researchers and clinicians should engage with the media to spread accurate information about concussion, according to a new study. 

 

News reports of sports players having ‘mild’ or ‘slight’ concussion can give the wrong impression of this brain injury, say the authors. 

 

‘The way concussion is reported has the potential to impact on a wide audience and affect their understanding of the injury,’ says Osman Ahmed, a lecturer at Bournemouth University and physio to the Football Association. 

 

After analysing the language used in 153 online news reports, Dr Ahmed and Eric Hall of Elon University, USA, produced a checklist for journalists.

 

They explain that a person with concussion does not necessarily lose consciousness, and that concussion cannot be ‘shaken off’ during a game. They recommend using the term ‘brain injury’ and avoiding expressions such as ‘bump to the head’ that downplay its seriousness. 

 

Concussion is a public health issue, say the authors. So specialists ‘need to engage with mass media to lead the discussion correctly’.Ahmed OH & Hall E, ‘It was only a mild concussion’: Exploring the description of sports concussion in online news articles, Physical Therapy in Sport 2016 - open access.