Effectiveness Of Physiotherapy Interventions Research Articles

Perceived Effectiveness and Barriers to Physical Therapy Services for Families and Children With Friedreich Ataxia

To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents. Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data. Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and children's preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences. Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.

Effect of Iliotibial Band Stretching on Pain and Functional Activities in Patients with Knee Osteoarthritis

Background: The iliotibial band is a long, non elastic collagen structure which crosses both hip and knee joints on the lateral thigh. The normal aging process brings changes in normal muscle functions including strength, endurance, agility and flexibility. Tight muscles further contribute to early degeneration of the joint. Routine physiotherapy includes hamstring, rectus femoris, and tendoachilis in the management of osteoarthritis. Thus, study aims to evaluate & compare effects of physical therapy intervention to improve the length of tight iliotibial band with respect to improvement in functional outcomes along with conventional physical therapy intervention. Materials and Methods: 60 subjects having knee osteoarthritis with iliotibial muscle tightness participated in the study. They were divided into 2 groups: Group A and Group B, of 30 subjects each. Group A was given-iliotibial band stretching in Ober's test position and Conventional physical therapy (Ultrasound + Exercises). Group B was given- Conventional physical therapy only. Both the groups received the treatment for a period of 5 days. Results: Results showed a statistically significant improvement on inter group comparison in the pain scores (on VAS) for walking, medial mobility of patella and Q angle. (p<0.001) Conclusion: Conventional physical therapy is effective in improving pain and functional activities but Iliotibial band stretching has an added effect on functional activity of walking.

Management of musculoskeletal neck pain through physiotherapeutic intervention: a pre-post design analysis

Among computer operators, risk factors associated with work-related musculoskeletal neck pain, include the integration of biomechanical factors such as static muscular overload, repetitive motions, conditions related to the work station, work environment and issues related to the working organisation, as well as those associated with the psychosocial aspects of work. These problems if ignored can prove debilitating and can cause crippling injuries forcing one to change the profession itself. There is an urgent need to understand the dynamics of these problems and prevent it from assuming epidemic proportions. With more and more jobs available in IT sector today, it is all the more important to be aware of the problems and follow necessary preventive steps to check the progression of computer related health problems. This study provides evidences to the effectiveness of physiotherapy interventions in combating musculoskeletal disorder (MSD) neck pain.

Postural Instability in Patients with Parkinson’s Disease

Postural instability is one of the cardinal signs in Parkinson's disease (PD). It can be present even at diagnosis, but becomes more prevalent and worsens with disease progression. It represents one of the most disabling symptoms in the advanced stages of the disease, as it is associated with increased falls and loss of independence. Clinical and posturographic studies have contributed to significant advances in unravelling the complex pathophysiology of postural instability in patients with PD, but it still remains yet to be fully clarified, partly due to the difficulty in distinguishing between the disease process and the compensatory mechanisms, but also due to the fact that non-standardized techniques are used to measure balance and postural instability. There is increasing evidence that physical therapy, especially highly challenging balance exercises, can improve postural stability and reduce the risk of falls, although the long-term effects of physical therapy interventions on postural stability need to be explored given the progressive nature of PD. Pharmacotherapy with dopaminergic medications can provide significant improvements in postural instability in early- to mid-stage PD but the effects tend to wane with time consistent with spread of the disease process to non-dopaminergic pathways in advanced PD. Donepezil has been associated with a reduced risk of falls and methylphenidate has shown potential benefit against freezing of gait, but the results are yet to be replicated in large randomized studies. Surgical treatments, including lesioning and deep brain stimulation surgery targeting the subthalamic nucleus and the globus pallidus internus, tend to only provide modest benefit for postural instability. New surgical targets such as the pedunculopontine nucleus have emerged as a potential specific therapy for postural instability and gait disorder but remain experimental.

Effectiveness of physiotherapy intervention with home exercise programme versus patient directed home exercise programme following a total knee replacement

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Is physiotherapy effective for patients with a chronic mid-body Achilles tendinopathy? A systematic review of non-surgical and non-pharmacological interventions

AbstractObjectiveTo assess the effectiveness of physiotherapy interventions (non-surgical and non-pharmacological) for a chronic mid-body Achilles tendinopathy.Materials and methodsA search of published and grey literature databases was undertaken (January 1999 to January 2011). Two reviewers independently assessed the studies for eligibility using a strict inclusion and exclusion criteria. All eligible articles were assessed critically using the PEDro score. Data on cohort characteristics, diagnostic criteria, treatment intervention, outcome measures, and results were extracted. A narrative research synthesis method was adopted since there were insufficient data to conduct a meta-analysis.ResultsTwo hundred and ninety studies were identified. Nine publications met the review inclusion criteria. Methodological quality was adequate for all nine studies; however, blinding was a limitation for most. Interventions investigated were; exercises (n = 2), low-level laser therapy (n = 1), low-energy shockwave trea...

Poster 262 Balance Treatments in Subjects With Multiple Sclerosis: Effects of Physical Therapy Interventions With and Without Biofeedback and/or Forceplate Training

Poster 262 Balance Treatments in Subjects With Multiple Sclerosis: Effects of Physical Therapy Interventions With and Without Biofeedback and/or Forceplate Training

Reeducação Postural Global: uma revisão da literatura

The Global Postural Re-education (GPR) method has been widely used in clinical practice, with reported benefits for prevention and rehabilitation of musculoskeletal dysfunctions. In parallel with almost two decades of clinical implementation, research studies have tested and verified the effectiveness of GPR in treating different clinical conditions and have also compared this method with other physical therapy resources. However, few studies focused on the verification of the principles of mechanisms of action defended by the author of the method making the arguments in favor of the method weak. To perform a critical systematic review of the effects of physical therapy intervention that use the GPR method. We searched Medline, SciELO, LILACS and PeDRO, from 2000 to 2010, considering the key words: Global Postural Re-education, global and active stretching. We found 25 studies, 13 about GPR and 8 about global and active stretching in addition to three books and a thesis. After analysis, 20 references were included. Some of the studies indicated that the GPR method was more effective than other physical therapy interventions, while others demonstrated similar results of GPR when compared to other physical therapy interventions. Studies showed benefits of the GPR in improving the respiratory muscle strength, chest expansion, maximal respiratory pressure and in reducing pain, loss of urine in incontinent women, increasing flexibility, the electromyographic activity in temporomandibular disorders and postural stability in lower limb orthopedic alterations. Methodological limitations observed suggest the need for greater rigor in future research.

Intervenção fisioterapêutica nas sequelas de drenagem linfática manual iatrogênica: relato de caso

Atualmente, a drenagem linfática manual (DLM) é um dos recursos de grande destaque no tratamento de edemas, linfedemas e condições inestéticas, porém, na prática clínica têm-se observado sua aplicação de forma iatrogênica. Os objetivos deste relato de caso foram apontar as sequelas da aplicação iatrogênica da DLM, em uma jovem caucasiana, e verificar os efeitos da intervenção fisioterapêutica no tratamento dessas. Voluntária de 27 anos, apresentava-se com uma equimose importante na região lateral da coxa esquerda (28 x 9,5 cm), telangiectasias, microvaricosidades e petéquias em ambas as coxas e pernas, dor de forte intensidade e edema, após ter se submetido a um procedimento manual iatrogênico com finalidade estética há dois dias. As condutas fisioterapêuticas adotadas foram: Ultrassom 3 MHz, pulsado (2 ms on, 8 ms off), 0,4 W/cm² SATP na região da equimose e DLM (Método Leduc) durante 20 minutos, na coxa esquerda. Foram realizadas nove sessões até a alta no 16º dia pós-lesão, observando-se apenas a redução gradativa da dor e da equimose. Verificou-se a efetividade da intervenção fisioterapêutica em apenas algumas das sequelas provocadas pela iatrogenia, sem desconsiderar que a remissão espontânea dos sinais e sintomas também pode ter contribuído para tal. Destaca-se a importância de conscientizar os fisioterapeutas que atuam com este procedimento para que o aplique de forma adequada, evitando tais iatrogenias.

Physiotherapy interventions for the management of whiplash injuries

Age dependent decrease in androgen levels is the main and most important mechanism responsible for involutional osteoporosis in men. Decreased physical activity may contribute to the development of osteoporosis. Supplementation with DHEA and increased physical activity may counteract the development of male osteoporosis and decrease fracture risk. DHEA may increase bone formation after conversion to testosterone, and exercise — by activation of the canonical Wnt/β-catenin pathway. The aim of the present study was to examine the effect of DHEA and moderate exercise on mechanical properties of long bones in rats with androgen deficiency induced by orchidectomy. The experiments were carried out on 3-month-old Wistar rats, divided into following groups (n=8–10 rats per group): non-orchidectomized control rats, orchidectomized (ORX) control rats, ORX rats receiving DHEA, ORX rats submitted to exercise, ORX rats receiving DHEA submitted to exercise. The rats were submitted to the moderate exercise on the treadmill once daily (1 hour) for 8 weeks. DHEA was administered at a dose 7 mg/kg p.o. once daily for 8 weeks. Mechanical properties of tibial metaphysis and femoral diaphysis (in three-point bending tests) and femoral neck (in a compression test), bone turnover markers (serum osteocalcin and C-terminal telopeptide of type I collagen fragments), geometric parameters, mass, and mass of bone mineral in the tibia and femur were studied. Androgen deficiency inhibited bone formation and resorption. It weakened mechanical properties of tibial metaphysis as well as femoral neck and diaphysis, and decreased bone mass and mass of bone mineral. Exercise increased bone formation and counteracted unfavorable changes in mechanical properties of tibial metaphysis and femoral neck, induced by androgen deficiency. DHEA increased bone formation and significantly inhibited the effect of androgen deficiency on the mechanical properties of the tibial metaphysis. Administration of DHAE combined with exercise counteracted unfavorable changes in bone mechanical properties (especially in the tibial metaphysis) induced by androgen deficiency. This article is part of a Special Issue entitled ECTS 2011. Disclosure of interest: None declared. doi:10.1016/j.bone.2011.03.670 PP540-T Physiotherapy interventions for the management of whiplash injuries V. Barkatsa ⁎, C. Iliadis , V. Moraitis , N. Syrmos , M. Tzagarakis , K. Tsipras d a Physiotherapy, Greece b Neurosurgery, Venizeleion General Hospital, Heraklion, Greece c Pathology, General Hospital, Rethymno, Greece d Endocrinology, Greek Institute of Social Security, Athens, Greece Abstract: Introduction/background: Whiplash injuries are associated with motor Introduction/background: Whiplash injuries are associated with motor vehicle accidents or in sporting mishaps after an acceleration–deceleration mechanism of energy transfer to the neck. The injury results in a series of clinical manifestations (mainly cervical pain 88% and headaches) known as Whiplash Associated Disorder. The syndrome involves trauma to amultiplicity of tissues in the cervical spine and it may affect other areas of the vertebral column. Clinicians are challenged to use different treatments in order to relieve symptoms and to improve body function. Method: systematic review of the effectiveness of physiotherapy interventions in the management of whiplash injuries using MEDLINE, CINAHL, Cochrane database systematic reviews and published guidelines. Results: In the acute stage (0 to 2 weeks after injury) physiotherapy interventions recommended for pain reduction are active exercises, manual mobilisation, use of TENS, education and advice and relaxation techniques compared to electrotherapy, traction, and the use of soft collar. There is insufficient evidence to support the use of massage and acupuncture. In the sub acute stage (2–12 weeks after injury) and in the chronic stage( after 12 weeks) a multimodal programme including active exercises, postural training, manual techniques, physical agents and psychosocial support should be used to reduce pain and enable people to return to normal activities. Conclusion: Recovery is improved by early active management and early return to pre-accidental activities. This article is part of a Special Issue entitled ECTS 2011.

Core Journals That Publish Clinical Trials of Physical Therapy Interventions

The objective of this study was to identify core journals in physical therapy by identifying those that publish the most randomized controlled trials of physical therapy interventions, provide the highest-quality reports of randomized controlled trials, and have the highest journal impact factors. This study was an audit of a bibliographic database. All trials indexed in the Physiotherapy Evidence Database (PEDro) were analyzed. Journals that had published at least 80 trials were selected. The journals were ranked in 4 ways: number of trials published; mean total PEDro score of the trials published in the journal, regardless of publication year; mean total PEDro score of the trials published in the journal from 2000 to 2009; and 2008 journal impact factor. The top 5 core journals in physical therapy, ranked by the total number of trials published, were Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Spine, British Medical Journal (BMJ), and Chest. When the mean total PEDro score was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, Journal of the American Medical Association (JAMA), Stroke, Spine, and Clinical Rehabilitation. When the mean total PEDro score of the trials published from 2000 to 2009 was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, JAMA, Lancet, BMJ, and Pain. The most highly ranked physical therapy-specific journals were Physical Therapy (ranked eighth on the basis of the number of trials published) and Journal of Physiotherapy (ranked first on the basis of the quality of trials). Finally, when the 2008 impact factor was used for ranking, the top 5 journals were JAMA, Lancet, BMJ, American Journal of Respiratory and Critical Care Medicine, and Thorax. There were no significant relationships among the rankings on the basis of trial quality, number of trials, or journal impact factor. Physical therapists who are trying to keep up-to-date by reading the best available evidence on the effects of physical therapy interventions have to read more broadly than just physical therapy-specific journals. Readers of articles on physical therapy trials should be aware that high-quality trials are not necessarily published in journals with high impact factors.

Clinician's Commentary

Jennifer Robertson, Janice Eng, and Chihya Hung are to be commended for conducting a clinical trial on the effects of functional electrical stimulation (FES) on gait and balance for individuals recovering from stroke. Stroke rehabilitation is a major emphasis of physical therapy, yet despite the activity limitations and participation restrictions associated with this common condition, evidence for physical therapy outcomes is only just beginning to accumulate. For this reason, trials that report data on the effects of specific physical therapy interventions are valuable. One of the positive findings of Robertson et al.'s study was that some stroke patients showed improvements in toe clearance during the swing phase of gait after four sessions of FES training. Others showed improvements in balance function. Changes in gait speed and balance confidence, as measured on the Activities-specific Balance Confidence Scale (ABC),1 were not found to be significant in this small sample of community-based persons living with stroke. Robertson et al.'s paper highlights the challenges of reporting and conducting controlled trials on the effectiveness, efficacy, or outcomes of physical therapy interventions post-stroke. One of the biggest challenges is to recruit a sufficiently large sample to detect statistically and clinically significant effects of a given intervention. Robertson et al. tested a convenience sample of 15 chronic stroke patients; as they point out in their paper, a sample of 59 participants would have been required to identify changes in balance with FES as measured by the ABC. It is also possible that effect sizes might have been larger in a more acute sample of stroke patients, given that most recovery occurs in the first 6 months following an infarct or haemorrhage. In addition, the effect sizes might have been larger if patients had received a dosage of therapy greater than 8 hours spread over a 1-month period. Another challenge is to select the research design most appropriate to address the research questions under consideration. Robertson et al. used a before–after study design in which all stroke patients were measured before and after four 2-hour sessions of physical therapy that incorporated FES training. While this design allows change scores to be reported, it does not control for practice effects or for the specific effects of physical therapy; changes in performance can occur that are not attributable to the specific interventions used (in this case, FES). The non-specific effects of being treated or tested and/or the effects of the passage of time may contribute to the changes noted. For this reason, some advocate the use of randomized controlled clinical trial (RCT) designs, in which patients are randomly allocated to one or more physical therapy interventions or to a no-treatment comparison group. By comparing the relative changes in two or more such groups, researchers can obtain more information on the specific effects of therapies such as FES. Nevertheless, sometimes it can be useful to report data from small samples using a before–after design, in order to gain effect-size data that can then be used to determine the sample size required for a large-scale RCT. Yet another challenge is to determine the most appropriate measurement tools to quantify balance. Robertson et al. used the ABC as a measure of balance confidence and fear of falling, and the Berg Balance Scale (BBS) to measure balance. The extent to which these tools measure similar or different constructs remains open to question. Moreover, one of the underlying assumptions of the study was that improving toe clearance during the swing phase of gait using FES would reduce the risk of trips and falls. Trips and falls were not monitored, however, and doing so would require a comprehensive method of data collection. The gold standard for collecting data on falls is the annual falls calendar, a tool whereby patients record the frequency and outcomes of falls on a daily basis for 12 months.2 Implementing a 12-month data-collection process would be time consuming; nevertheless, if the aim is to understand the nexus between balance and falls, such a method would probably be worth the investment of resources. Conducting trials that measure the effects of physical therapy interventions is challenging, yet such trials are very much needed. Robertson et al. are to be commended for embarking on the ambitious task of quantifying how physical therapy incorporating FES can affect gait and balance. Their well-written paper adds valuable information that can be used in clinical practice. Clinical trial guidelines, such as those documented by the Consolidated Standards of Reporting Trials (CONSORT) statement,3 provide further information on optimal methods for reporting the findings of RCTs of physical therapy and other interventions.

A Systematic Review and Meta-analysis of the Effectiveness of Physical Therapy Interventions for Musculoskeletal Disorders

A Systematic Review and Meta-analysis of the Effectiveness of Physical Therapy Interventions for Musculoskeletal Disorders

Effectiveness of Manual Physical Therapy for Painful Shoulder Conditions: A Systematic Review

Multiple disease-specific systematic reviews on the effectiveness of physical therapy intervention for shoulder dysfunction have been inconclusive. To date, there have been two systematic reviews that examined manual therapy specifically but both considered effects within diagnoses. The purpose of this systematic review was to identify the effectiveness of manual therapy to the glenohumeral joint across all painful shoulder conditions. A search of MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Randomized Controlled Trials for articles dated 1996 to June 2009 was performed. Inclusion for review were manual therapy performed to the glenohumeral joint only; non-surgical painful shoulder disorders; subjects 18-80 years; and outcomes of range of motion, pain, function, and/or quality of life. Quality assessment was performed using the PEDro scale with subsequent data extraction. Seventeen related articles were found with seven fitting the inclusion criteria. The average PEDro score was 7.86, meeting the cutoff score for high quality. Significant heterogeneity in outcome measures prohibited meta-analysis. Five studies demonstrated benefits utilizing manual therapy for mobility, and four demonstrated a trend towards decreasing pain values. Functional outcomes and quality-of-life measures varied greatly among all studies. Manual therapy appears to increase either active or passive mobility of the shoulder. A trend was found favoring manual therapy for decreasing pain, but the effect on function and quality of life remains inconclusive. Future research utilizing consistent outcome measurements is necessary.

Some benefit from physiotherapy intervention in the subgroup of patients with severe ankle sprain as determined by the ankle function score: a randomised trial

Do patients with a severe ankle injury (baseline ankle function score < or = 40) do worse in the short-term than patients with a mild injury (score > 40)? Does physiotherapy intervention have more effect on patients with a severe injury compared with a mild injury in the short- or long-term? Is self-reported recovery related to ankle function score over time? Subgroup analysis of a randomised trial. 102 adults with an acute lateral ankle sprain. The experimental group received physiotherapist-supervised exercises in addition to conventional intervention. Outcomes were self-reported recovery, pain, and instability all measured on a 10-point visual analogue scale, and incidence of re-sprain. Measurements were collected at baseline, 4 and 8 weeks, 3 and 12 months. Participants with a severe injury did worse in 3 out of 7 outcomes than those with a mild injury at 4 weeks but not at 8 weeks. There was no difference in effect of physiotherapy intervention in those with a severe injury compared with a mild injury, at 8 weeks or 12 months. However, there was an effect of physiotherapy intervention in those with a severe injury in 3 out of 7 outcomes at 8 weeks. Self-reported recovery was related to ankle function score at all points in time (r = 0.48 to 0.79). The results of this study only partially support the recommendations regarding the use of the ankle function score in the 'Acute Ankle Injury' guideline of the Royal Dutch Society of Physiotherapists.

SCIRehab Project Series: The Physical Therapy Taxonomy

Background/Objective: Outcomes research is in need of a classification system of physical therapy (PT) interventions for acute traumatic spinal cord injury (SCI) rehabilitation in the United States. The objective of this study was to describe a taxonomy (system to categorize and classify interventions) to examine the effects of PT interventions on rehabilitation outcomes.Methods: The SCIRehab study uses the rigorous observational practice-based evidence methodology to examine current treatment processes without changing existing practice. PT clinicians and researchers from 6 centers developed a taxonomy to describe details of each PT session.Results: The PT taxonomy consists of 19 treatment activities (eg, bed mobility, transfers, wheelchair mobility, strengthening and stretching exercises) and supplementary information to describe the associated therapeutic interventions. Details that focus on patient assistance needs and family involvement are included as additional descriptors to help to describe and justify PT activity selection. Time spent on each activity is used as the measure of intensity.Conclusion: The detailed PT taxonomy documentation process, which offers efficiency in data collection, is being used for all PT sessions with 1,500 patients with acute traumatic SCI at the 6 participating centers. It might be the first attempt to document the many details of the PT rehabilitation process for patients with SCI in the United States.

Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review

. Anttila H., Autti‐Rämö I., Suoranta J., Mäkelä M. &amp; Malmivaara A. ( 2008 ) , 8 , 14 . DOI: 10.1186/1471‐2431‐8‐14 . Aim To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).Methods A search was made in Medline, Cinahl, PEDro and the Cochrane Library for the period from 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health.Results Twenty‐two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint‐induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited because of low methodological quality and the statistically insignificant results of the studies.Conclusion Because of limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well‐designed trials are needed especially for focused PT interventions.

Integrated Physical Therapy Intervention for a Person With Pectus Excavatum and Bilateral Shoulder Pain: A Single-Case Study

Canavan PK, Cahalin L. Integrated physical therapy intervention for a person with pectus excavatum and bilateral shoulder pain: a single-case study. Objective To examine the effects of an individualized physical therapy (PT) program for a subject with pectus excavatum and bilateral shoulder pain. Design Single-case study of a man diagnosed with moderate-to-severe pectus excavatum and constant bilateral shoulder pain. Exercise tolerance was measured through the Bruce protocol and home exercise log, pulmonary function, ventilatory muscle strength, echocardiography, chest wall and abdominal excursion, self-perception of pectus excavatum, and a variety of anthropometric and volumetric tests before and after PT. Setting University laboratory. Participant A 22-year-old man. Intervention A 3-month PT program including breathing exercises and therapeutic exercises. Main Outcome Measures Exercise tolerance, ventilatory muscle strength, chest wall and abdominal excursion, self-perception of the pectus excavatum, and other anthropometric and volumetric tests. Results The most striking anthropometric and volumetric test change was the pectus severity index (in H 2O), which decreased from 50 to 20mL H 2O (60% change). The subject reported no shoulder pain at rest and with recreational activity after 8 weeks of intervention. Conclusion An individualized PT program provided minimal-to-moderate improvements on many characteristics of pectus excavatum. Bilateral shoulder pain was eliminated. An individualized PT program integrating cardiopulmonary and musculoskeletal interventions that is provided to other patients with pectus excavatum may provide similar results. However, PT provided to younger patients with the pectus excavatum may be of even greater benefit because of a less mature skeleton. Further investigation of the effects of PT intervention provided to younger and older persons with the pectus excavatum is needed.

Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review

BackgroundTo assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).MethodsA search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF).ResultsTwenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies.ConclusionDue to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.

Running-related hamstring injuries: a neuromuscular approach

Hamstring injuries are common in running and sprinting sports and have a high recurrence rate. Prevention and management of these injuries has focused on traditional outcomes of strength, flexibility and endurance. The aim of this review is to explore the stabilising function of the hamstring muscle group, described as increasing the stiffness of the sacro-iliac and the knee joints during weight acceptance of stance. Loss of stability of segments proximal or distal to the hamstring muscles may lead to altered muscle recruitment, potentially increasing the loading of this muscle group and, thereby, posing an increased injury risk. Intrinsic risk factors to be considered are previous knee, groin or lumbopelvic injuries; extrinsic factors include footwear and training surfaces. The effect of physiotherapy interventions on the stabilising function of the hamstrings needs to be investigated. Such research will contribute to a clearer understanding of the reasons for the high injury recurrence rate of this muscle group.