MN APTA COMMITTTEES & WORKGROUPS:
MN APTA COMMITTTEES & WORKGROUPS: |
Please scroll down or select a topic from the menu below to view past issues of 'Evidence in Action,' which addresses evidence-based physical therapy treatments and solutions.
Published in Soundwaves, January-February 2008; Reviewed by Kim Peters, PT, and the MN APTA Research Committee
Clinical Question:
What types of exercises are most beneficial for patients with ankylosing spondylitis?
Evidence:
A sample of 30 patients with ankylosing spondylitis (mean age 34.9 years) participated in the study. Subjects had disease duration of nine years + 6.02 years. Subjects were randomly assigned to either an exercise group or to a control group. Both groups received medical treatment and were informed about what exercises would be beneficial; however, only the exercise group received supervised exercise training. The exercise group participated in 50 minutes of multimodal exercises, including aerobics, stretching, and pulmonary exercises, three times a week for three months. The outcome measurements of chest expansion, chin-to-chest distance, Modified Schober Flexion test, and occiput-to-wall distance were significantly better for subjects in the exercise group than for those in the control group. Spinal movements, physical work capacity, and vital capacity were also significantly improved for the exercise group at the end of the exercise program.
Clinical Decision:
This research study demonstrated that patients with ankylosing spondylitis may benefit from a multimodal exercise program that includes aerobics, stretching, and pulmonary exercises.
Clinical Question:
Can overweight children gain lasting benefits from a high-intensity, structured exercise program?
Evidence:
Childhood obesity, type 2 diabetes, hyperlipidemia, and hypertension are increasing at a significant rate. Many overweight children become overweight adults, increasing their risk for diabetes, heart disease, and stroke. Physical therapists are in a unique position to promote overall wellness in this population by encouraging physical activity. Low to moderate intensity aerobic exercise has traditionally been used for weight loss programs. Two recent studies examined the effects of a biweekly high intensity exercise program lasting 3-6 months. These studies reported significant reductions in BMI and total cholesterol, and increased leisure time physical activity in groups of overweight children participating in structured high intensity exercise programs. In both studies, the positive results were maintained at a 1-year follow-up as the participants continued with physical activity independently.
Clinical Decision:
Supervised exercise is an important component of a multidisciplinary approach to minimize the impact of childhood obesity. Physical therapists can play a central role by developing structured exercise programs and teaching children how to exercise in order to maintain a healthy lifestyle.
References:
Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim O. Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics. 2005;115(4):443-449.
Savoye M, Shaw M, Dziura J, et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized controlled trial. JAMA. 2007;297:2697-2704.
Clinical Question:
You are asked to evaluate a patient who has undergone a coronary artery bypass graft (CABG). She must follow typical sternal precautions such as no lifting over 10 pounds, no excessive movements at shoulder end range of motion, and no pushing or pulling with the upper extremities. Is there evidence to guide what upper extremity movements or factors may place her at higher risk for post-operative sternotomy complications?
Evidence:
Two recent articles published in Acute Care Perspectives examined the effects of upper extremity movement on sternal skin stress. In the first study1, measurements of sternal skin tension were taken just superior to the xiphoid process while healthy subjects performed full shoulder flexion, extension, and horizontal abduction range of motion. The second study2 measured skin distortion inferior to the sternal angle during shoulder flexion, extension, abduction, external rotation at 90o of abduction, external rotation at neutral, and horizontal abduction. This study also included the anthropometric variables of body mass index (BMI) and breast size. Measurements were taken during bilateral and unilateral arm movements in both studies.
Results:
In both studies, significantly greater skin stress occurred with bilateral than unilateral movements. Skin stress was also found to be significantly greater with shoulder flexion and abduction than the other movements tested, with flexion creating the most skin distortion. A significant correlation was found between breast size and sternal stress during movement in the second study.
Clinical Decision:
The patient was educated in traditional sternal precautions with emphasis on avoiding excessive shoulder flexion and abduction. She was taught to utilize unilateral arm movements as able to assist with transfers and bed mobility within the constraints of her precautions.
References:
1 Irion G, Benefield P, Bolton R, et al. Effects of shoulder range of motion on sternal skin stress. Acute Care Perspectives. 2005;14(1):13-14.
2 Irion G, Boyer S, McGinnis T, et al. Effect of upper extremity movement on sternal skin stress. Acute Care Perspectives. 2006;15(3):1-6.
Published in Soundwaves July-August 2007; Reviewed by the MN APTA Research Committee
Clinical Question:
A patient presents to physical therapy with a painful mid-portion Achilles tendon that has progressively gotten worse over the past 6 months. What is the evidence for supporting an eccentric exercise program?
Evidence:
Conservative management of chronic tendinopathy is typically the first line of treatment where eccentric exercises have been suggested to be a part of these rehabilitation programs. Shalabi et al investigated the effects of a three-month eccentric exercise program on twenty-five subjects with chronic Achilles tendinopathy. Each subject was instructed by a physical therapist on how to correctly perform 3 sets of 15 eccentric loading exercises that were to be done twice daily. Outcome measures taken prior to and after three months included tendon volume and an intratendinous signal of the Achilles tendon as evaluated by MRI. A questionnaire regarding pain and functional impairment was also administered.
Results:
Three months of eccentric training of the Achilles tendon resulted in a 14% decrease of tendon volume and a 23% decrease in proton density-weighted images as evaluated by MRI. These changes were significantly different than seen in the asymptomatic contralateral tendon at the three-month follow-up. A significant decrease in the pain and function questionnaire score was also observed, which was significantly correlated with a decrease in the intratendinous signal.
Clinical Application:
A three-month eccentric exercise program can reduce pain and improve function in persons with chronic Achilles tendinopathy, which is supported by pathological changes as evaluated by MRI.
References:
Shalabi A, Kristoffersen-Wilber M, Svensson L, Aspelin P, Movin T. Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med. 2004;32(5):1286-1296.
Minnesota Chapter American Physical Therapy Association (MN APTA)
970 Raymond Avenue | Suite G-40 | Saint Paul, MN 55114
Phone: 651-635-0902 | Fax: 651-635-0903 | E-mail: info@mnapta.org | Online: www.mnapta.org
All contents © 2008 Minnesota Chapter American Physical Therapy Association. All Rights Reserved.
| Disclaimer |