Mapping of the Evidence From Systematic Reviews of the Cochrane Collaboration for Decision-Making Within Physiotherapy.

Mapping of the evidence from systematic reviews of the Cochrane Collaboration for decision-making within physiotherapy.

Sao Paulo Med J. 2013 Mar; 131(1): 39-45
Versiani AH, Martimbianco AC, Peccin MS

CONTEXT AND OBJECTIVE Evidence-based clinical practice emerged with the aim of guiding clinical issues in order to reduce the degree of uncertainty in decision-making. The Cochrane Collaboration has been developing systematic reviews on randomized controlled trials as high-quality intervention study subjects. Today, physiotherapy methods are widely required in treatments within many fields of healthcare. Therefore, it is extremely important to map out the situation regarding scientific evidence within physiotherapy. The aim of this study was to identify systematic reviews on physiotherapeutic interventions and investigate the scientific evidence and recommendations regarding whether further studies would be needed. TYPE OF STUDY AND SETTING Cross-sectional study conducted within the postgraduate program on Internal Medicine and Therapeutics and at the Brazilian Cochrane Center. METHODS Systematic reviews presenting physiotherapeutic interventions as the main investigation, in the Cochrane Reviews Group, edition 2/2009, were identified and classified. RESULTS Out of the 3,826 reviews, 207 (5.41%) that fulfilled the inclusion criteria were selected. Only 0.5% of the reviews concluded that the intervention presented a positive effect and that further studies were not recommended; 45.9% found that there seemed to be a positive effect but recommended further research; and 46.9% found that the evidence was insufficient for clinical practice and suggested that further research should be conducted. CONCLUSION Only one systematic review (“Pulmonary rehabilitation for chronic obstructive pulmonary disease”) indicated that the intervention tested could be used with certainty that it would be effective. Most of the systematic reviews recommended further studies with greater rigor of methodological quality. HubMed – rehab

Reliability of Isometric Lower-Extremity Muscle Strength Measurements in Children With Cerebral Palsy: Implications for Measurement Design.

Phys Ther. 2013 Mar 28;
Willemse L, Brehm MA, Scholtes VA, Jansen L, Woudenberg-Vos H, Dallmeijer AJ

OBJECTIVE: To determine test-retest reliability and measurement error of isometric lower extremity strength measurements in children with cerebral palsy (CP) using hand-held dynamometry (HHD), and to assess implications for measurement design. METHODS: Fourteen children with hemiplegic (n=6) or diplegic (n=8) spastic CP (GMFCS I-III), aged 7- 13 years, were assessed for isometric strength on two separate days (occasions) using HHD, with three trials per muscle group. The intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable difference (SDD) were calculated for different measurement designs. RESULTS: ICC values of single measurements for all muscle groups ranged from 0.70 to 0.90 and SDD was large (>30%). Regarding measurement error, the largest source of variability was found for occasion. A two-occasion mean decreased the SDD by 9-14%. For trials, a greater improvement in SDD was found when two trials were averaged, instead of three. A measurement design of two trials – two occasions was superior to the often-used approach of three trials – one occasion. CONCLUSION: HHD is reliable, and can be used to detect changes in isometric muscle strength in children with CP, when using the mean of at least two trials. To further improve reliability, taking the average of two occasions on separate days is recommended, depending on group size and muscle group. HubMed – rehab

Sense of Coherence Affects Adherence and Response to Resistance Training in Older People with Hip Fracture History.

J Aging Phys Act. 2013 Mar 26;
Portegijs E, Read S, Pakkala I, Kallinen M, Heinonen A, Rantanen T, Alen M, Kiviranta I, Sihvonen S, Sipilä S

Our aim was to study the effects of sense of coherence (SOC) on training adherence and inter-individual changes in muscle strength, mobility and balance after resistance training in older people with hip fracture history. These are secondary analyses of a 12-week randomized controlled trial of progressive resistance training in 60-85-years-old community-dwelling people 0.5-7 years following hip fracture (n=45;ISRCTN34271567). Pre- and post-trial assessments included SOC, knee extension strength, walking speed, timed up-and-go (TUG), and Berg Balance Scale (BBS). Group by SOC interaction effects (repeated measures ANOVA) were statistically significant for TUG (p=0.005) and BBS (p=0.040), but not for knee extension strength or walking speed. Weaker SOC was associated with poorer training adherence (mixed model; p=0.009). Thus, more complicated physical tasks did not improve in those with weaker SOC, independently of training adherence. Older people with weaker SOC may need additional psychosocial support in physical rehabilitation programs to optimize training response. HubMed – rehab

Wrist electrogoniometry: are current mathematical correction procedures effective in reducing crosstalk in functional assessment?

Rev Bras Fisioter. 2013 Feb; 17(1): 32-40
Foltran FA, Silva LC, Sato TO, Coury HJ

The recording of human movement is an essential requirement for biomechanical, clinical, and occupational analysis, allowing assessment of postural variation, occupational risks, and preventive programs in physical therapy and rehabilitation. The flexible electrogoniometer (EGM), considered a reliable and accurate device, is used for dynamic recordings of different joints. Despite these advantages, the EGM is susceptible to measurement errors, known as crosstalk. There are two known types of crosstalk: crosstalk due to sensor rotation and inherent crosstalk. Correction procedures have been proposed to correct these errors; however no study has used both procedures in clinical measures for wrist movements with the aim to optimize the correction.To evaluate the effects of mathematical correction procedures on: 1) crosstalk due to forearm rotation, 2) inherent sensor crosstalk; and 3) the combination of these two procedures.43 healthy subjects had their maximum range of motion of wrist flexion/extension and ulnar/radials deviation recorded by EGM. The results were analyzed descriptively, and procedures were compared by differences.There was no significant difference in measurements before and after the application of correction procedures (P<0.05). Furthermore, the differences between the correction procedures were less than 5° in most cases, having little impact on the measurements.Considering the time-consuming data analysis, the specific technical knowledge involved, and the inefficient results, the correction procedures are not recommended for wrist recordings by EGM. HubMed – rehab

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