Andrewssutherland2217

BACKGROUND Total hip (THR) and knee replacement (TKR) are two of the most common elective orthopaedic procedures worldwide. Physiotherapy is core to the recovery of people following joint replacement. However, there remains uncertainty as to physiotherapy provision at a national level. OBJECTIVES To examine the relationship between patient impairment and geographical variation on the provision of physiotherapy among patients who undergo primary total hip or knee replacement (THR/TKR). DESIGN Population-based observational cohort study. METHODS Patients undergoing THR (n=17,338) or TKR (n=20,260) recorded in the National Joint Registry for England (NJR) between 2009 and 2010 and completed Patient Reported Outcome Measures (PROMs) questionnaires at Baseline and 12 months postoperatively. Data were analysed on the frequency of physiotherapy over the first postoperative year across England's Strategic Health Authorities (SHAs). Logistic regression analyses examined the relationship between a range of patient and geographical characteristics and physiotherapy provision. RESULTS Following THR, patients were less likely to receive physiotherapy than following TKR patients ('some' treatment by a physiotherapist within 1st post operative year 53% vs 79%). People with worse functional outcomes 12 months postoperatively, received more physiotherapy after THR and TKR. There was substantial variation in provision of physiotherapy according to age (younger people received more physiotherapy), gender (females received more physiotherapy) ethnicity (non-whites received more physiotherapy) and geographical location (40% of patients from South West received some physiotherapy compared to 40 73% in London after THR). CONCLUSIONS There is substantial variation in the provision of physiotherapy nationally. selleck inhibitor This variation is not explained by differences in the patient's clinical presentation. BACKGROUND Parkinson's is a common progressive neurological condition characterised by impairments of movement and balance; and non-motor deficits. It is now accepted that physical activity is a fundamental for people with Parkinson's (PwP), despite this PwP remain inactive. There is a social and financial drive to increase physical activity for PwP through physical self-management, however little is known about this concept. OBJECTIVE This scoping review provides an overview of the literature concerning physical self-management for PwP and its provision, participation and uptake by PwP. DESIGN AND SOURCES OF EVIDENCE Systematic search of the databases; Medline, EMBASE, HMIC, CDSR, Cochrane Methods Studies, DARE, CINAHL, PEDro, PsycINFO and Cochrane Library using the search terms 'Parkinson*' and 'self-manag*' was undertaken alongside citation and grey literature searching and a consultation exercise. CHARTING METHODS A narrative summary was undertaken to describe the current state of the literature. RESULTS 1959 studies were identified with nineteen papers from seventeen studies meeting the inclusion criteria - Three reviews, four experimental studies, three pre-post-test designs, six cross-sectional designs, one qualitative interview design and two mixed method designs. CONCLUSION The findings of this scoping review suggest a need for clarity on what 'physical self-management' means and involves, with a gap between what the evidence promotes and what is being achieved by PwP. Further research should focus on the amount, type, intensity and duration of physical self-management models including behavioural change approaches and how, where and by whom this should be implemented. OBJECTIVE To compare the effects of different cryotherapeutic preparations. DESIGN Randomised, single-blind, crossover trial. SETTING University laboratory. PARTICIPANTS Sixteen healthy women. INTERVENTIONS Participants were randomised to receive three cryotherapeutic preparations pure ice (500g), watered ice (500g of ice in 500ml of water) and wetted ice (500g of ice in 50ml of water). MAIN OUTCOME MEASURES The primary outcome was skin surface temperature after cryotherapy, measured at the central point of application, and the minimum temperature of the region of interest (ROI). The secondary outcome was the surface area cooled to less then 13.6°C, which is the recommended temperature to achieve therapeutic effects. RESULTS After application of ice, mean skin surface temperature at the central point was 4.6 [standard deviation (SD) 1.9] °C for the pure ice preparation, 4.9 (SD 2.5) °C for the wetted ice preparation, and 9.6 (SD 1.8) °C for the watered ice preparation. When compared with the watered ice preparation, this represented a mean difference (MD) of 5.0°C for the pure ice preparation [95% confidence interval (CI) 4.0 to 6.0; P less then 0.001] and an MD of 4.7°C for the wetted ice preparation (95% CI 2.5 to 6.8; P less then 0.001). The minimum temperatures in the ROI were also lower for the pure ice preparation 3.0 (SD 0.9) °C and the wetted ice preparation 2.8 (SD 0.6) °C than the watered ice preparation 7.9 (SD 1.5) °C. This represented an MD of 4.8°C for the pure ice preparation (95% CI 4.0 to 5.7; P less then 0.001) and 5.1°C for the wetted ice preparation (95% CI 4.0 to 6.2; P less then 0.001]. CONCLUSIONS Application of pure ice or wetted ice led to a greater decrease in skin surface temperature compared with watered ice. For clinical purposes, combining equal parts of water and ice could decrease this effect. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov (NCT03414346). OBJECTIVE To investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone, in individuals with chronic non-specific low back pain (CNLBP). DESIGN Randomized controlled trial with three months follow-up. SETTING Rehabilitation clinic. PARTICIPANTS Seventy-two individuals (between 18 and 50 years of age; CNLBP ≥12 consecutive weeks) were enrolled and randomly allocated to one of two groups (1) Spinal manipulation and myofascial release - SMMRG; n=36) or (2) Spinal manipulation alone (SMG; n=36). INTERVENTIONS Combined spinal manipulation (characterized by high velocity/low amplitude thrusts) of the sacroiliac and lumbar spine and myofascial release of lumbar and sacroiliac muscles vs manipulation of the sacroiliac and lumbar spine alone, twice a week, for three weeks. MAIN OUTCOME MEASURES Assessments were performed at baseline, three weeks post intervention and three months follow-up. Primary outcomes were pain intensity and disability. Secondary outcomes were quality of life, pressure pain-threshold and dynamic balance.