Physio findings: HIV guidelines, musculoskeletal, neurology

Guidelines tailor exercise to suit older patients

Researchers in Canada have developed exercise guidelines for older people with HIV, to help patients deal with their other health conditions.

Kelly O’Brien, of the physical therapy department at the University of Toronto, and colleagues looked at health problems that are frequently encountered by people with HIV. These included bone and joint disorders, cancer, stroke, cardiovascular disease, mental health, cognitive impairment, chronic obstructive pulmonary disease (COPD) and diabetes.

The team pored through 150 studies covering rehabilitation relevant to older people living with HIV. They found that various combinations of aerobic and resistance exercise could be useful, depending the patient’s goals, ability and condition. As a result, they give 52 specific recommendations and eight overarching guidelines.

‘The frequency, intensity, time and type of exercise should be individually tailored to the specific goals and capacity of the individual and the specific comorbidity,’ say the authors.

The study is published in the open-access journal BMJ Open. So, for details of the recommendations, you can read the full study online, free of charge. O’Brien KK et al. Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis. BMJ Open 2014.

Musculoskeletal

Physios help heels without harming
People whose jobs keep them standing for long periods are at increased risk of foot problems such as plantar fasciopathy, a disorder of the connective tissue supporting the arch, which causes sharp heel pain.

Exercise and steroid injections are common treatments, so a Canadian team set out to compare their effectiveness.

Michael Ryan, of the University of British Columbia, and colleagues recruited 56 workers with chronic heel pain, who spent at least five hours a day standing. The patients’ diagnosis of plantar fasciopathy was confirmed by ultrasound.

They were divided into two groups, one of which received a dexamethasone injection while the others took part in a physiotherapy programme.

The physio group were given seven exercises – including stretching, strengthening and balance work – to be carried out every day for 12 weeks.

‘The exercises used in this study are relatively simple to perform, are without side effects or adverse events, and use equipment that, for the most part, is easy to find in the workplace,’ say the authors.

At the end, both groups had made similar improvements in pain and disability. The exercise results were as good as those in the dexamethasone group, say the team, ‘but without exposing the worker to a steroid injection procedure and the associated risk of ligament rupture’. Ryan M et al. Comparison of a physiotherapy program versus dexamethasone injections for plantar fasciopathy in prolonged standing workers: a randomized clinical trial. Clinical Journal of Sport Medicine 2014.

Neurology

Cochrane calls for Parkinson’s research
How can physiotherapists best help people with Parkinson’s? NICE recommends that physiotherapy should be available at all stages of the disease and it has been proved effective, at least in the short term.

The number of patients receiving treatment has been rapidly increasing. A 2008 survey of 13,000 Parkinson’s UK members found that 54 per cent had seen a physio, compared with just 27 per cent of the 1,693 surveyed a decade earlier.

‘However, which physiotherapy intervention is most effective remains unclear,’ says a team from the Cochrane Movement Disorders Group.

Claire Tomlinson, of Birmingham University’s clinical trials unit, and colleagues did a literature search and found 43 suitable randomised trials with 1673 participants. The trials covered general physiotherapy, exercise, dance, martial arts, treadmill training or cueing (using a prompt to overcome ‘freezing’).

But the Cochrane team found there were too many different interventions with different aims, using different criteria and with the outcomes measured in different ways, to suggest what was most likely to help.

‘There is a need for more specific trials with improved treatment strategies to underpin the most appropriate choice of physiotherapy intervention and the outcomes measured,’ say the authors.Tomlinson CL et al. Physiotherapy for Parkinson’s disease: a comparison of techniques. Cochrane Database of Systematic Reviews 2014.

Comments Conclusions

New joint replacement devices are being used on patients without good evidence to back them, say researchers. Their review of 118 studies covered five new kinds of implant. ‘Existing devices may be safer to use in total hip or knee replacement,’ say the team, calling for better regulation and supervision to protect patients from innovations used ‘without proper evidence of improved clinical efficacy and safety’.
Nieuwenhuijse MJ et al. BMJ 2014.
 
Taking benzodiazepine drugs – used to treat anxiety or insomnia  –  is linked with an increased risk of developing Alzheimer’s, say researchers, warning against long-term use. Billioti de Gage S et al. BMJ 2014.

MRI scans can predict the likely progression of hand arthritis, by showing the level of conditions such as joint-space narrowing, bone-marrow lesions and synovitis (inflammation of the joint lining). Haugen I et al. Annals of the Rheumatic Diseases 2014.
 
Working-class men have lower cholesterol levels than middle-class men, according to a study of social class and blood-fat levels, which also found surprising inequalities between the sexes. Shohaimi  S et al. BMC Public Health 2014.

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