Physiotherapy rehabilitation following lumbar spinal fusion:a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE: To evaluate the effectiveness of physiotherapy intervention following lumbar spinal fusion. DESIGN: Systematic review and meta-analysis. 2 independent reviewers searched information sources, assessed studies for inclusion and evaluated risk of bias. Quantitative synthesis using standardised mean differences was conducted on comparable outcomes across trials with similar interventions. INFORMATION SOURCES: Predefined terms were employed to search electronic databases. Additional studies were identified from key journals, reference lists, authors and experts. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES: Randomised control trials published in English prior to 30 September 2011 investigating physiotherapy outpatient management of patients (>16 years), following lumbar spinal fusion, with measurements reported on one or more outcome of disability, function and health were included. RESULTS: 2 Randomised control trials (188 participants) from two countries were included. Both trials included a behavioural and an exercise intervention. 1 trial was evaluated as high risk of bias and one as unclear. 159 participants were incorporated in the meta-analysis. Although evidence from both trials suggested that intervention might reduce back pain short term (6 months) and long term (12 months and 2 years), and a behavioural intervention might be more beneficial than an exercise intervention, the pooled effects (0.72, 95% CI −0.25 to 1.69 at 6 months; 0.52, 95% CI −0.45 to 1.49 at 12 months and 0.75, 95% CI −0.46 to 1.96 at 2 years) did not demonstrate statistically significant effects. There was no evidence that intervention changes pain in the short (6 months) or long term (12 months and 2 years). The wide CI for pooled effects indicated that intervention could be potentially beneficial or harmful. Considerable heterogeneity was evident. CONCLUSIONS: Inconclusive, very low-quality evidence exists for the effectiveness of physiotherapy management following lumbar spinal fusion. Best practice remains unclear. Limited comparability of outcomes and retrieval of only two trials reflect a lack of research in this area that requires urgent consideration

Factors affecting myofascial pain pattern recognition in musculoskeletal therapists:An exploratory study

Aims: To evaluate the ability of experienced musculoskeletal physiotherapists to recall and identify myofascial trigger point (MTrP) pain referral patterns associated with the cervical spine, and to determine the factors affecting myofascial pain pattern recognition in experienced musculoskeletal physiotherapists. Methodology: A questionnaire-based descriptive survey using mixed methods was employed. A specially constructed questionnaire was used in the study. Responses were subjected to descriptive, statistical, and thematic analysis. Results: Twenty-five experienced musculoskeletal (MSK) physiotherapists (mean qualification period=10.3 years, mean specialist MSK experience=7.52 years) took part in the study. 100% completed the questionnaire. The MTrP pattern recognition rate was 23.33%. Thematic analysis of the qualitative data revealed a number of factors that may help to explain this low rate within the study sample. Conclusions: This exploratory study highlights deficiencies in the ability of experienced musculoskeletal physiotherapists to recall and identify MTrP pain referral patterns associated with the cervical spine. Several factors were identified that may have contributed to the observed deficiencies in this area including: lack of education, knowledge and experience, difficulty with clinical recall, and notions surrounding clinical relevance. </jats:sec