Cardiometabolic effects of physical activity interventions for people with schizophrenia

Abstract

Objectives: To identify and evaluate the recent evidence of physical activity (PA) with or without diet counselling on cardiometabolic parameters in people who have schizophrenia.

Methods: Keyword searches were used to identify articles since 2003 up to August 2009 from PubMed, SPORTDiscus, Cochrane Central Register of Controlled Trials, EMBASE, PEDro, DARE, ProQuest Dissertations and Theses and PsycINFO. There were no limitations in terms of study design and sample size. Data were extracted from each included study using key items that included participants, study design, intervention modalities, and outcome measures.

Results: Thirteen studies met the inclusion criteria. Physical activity with or without diet counselling results in modest weight loss, reductions in systolic and diastolic blood pressure and decreases in fasting plasma concentrations of glucose and insulin. Identifying an optimal dose or intervention strategy for PA is not yet possible. Compliance to PA seems to be an important predictor of the PA response.

Discussion: There is evidence that PA with or without diet counselling is feasible and effective in reducing weight and improving obesity-related cardiometabolic risk profile in people with schizophrenia. More research focussing on the effectiveness of different PA interventions in prevention and treatment of the metabolic syndrome in people with schizophrenia is highly needed.     

Ethics knowledge in physical therapy: a narrative review of the literature since 2000

Abstract

Objective: The purpose of this narrative review is to assess current physical therapy ethics knowledge by synthesizing literature published since 2000.

Method: This review builds on an earlier analysis.6 A rigorous search of major databases (including Medline, CINAHL, and PubMed) was conducted using specific keywords and explicit inclusion and exclusion criteria. The final review included 27 peer-reviewed articles and three editorials/lectures.

Results: Four themes of papers were identified that focused on (1) development of physical therapy ethics knowledge, (2) ethical issues related to conducting research, (3) how ethical issues are identified and managed and how ethical practice is taught, and (4) development of theoretical ethical decision-making models.

Discussion: The literature reflects a steady growth in interest in physical therapy ethics. Some 'gaps' in knowledge have been addressed but others have not, such as the impact of the institutional environment and cultural dimensions of practice on ethical reasoning. Research studies, using mostly qualitative approaches, identify similar issues but a synthesis of the findings is made difficult by lack of consistency in purpose and study design. While inclusion of ethics content in physical therapy curricula is recommended, little is known about how this is currently being achieved. Ethical theories are poorly integrated into the discussion of ethics in practice.

Conclusion: This review reveals the continuing need to ensure the development of physical therapy ethical knowledge by consistently incorporating both ethical theories and practice knowledge in education curricula and establishing a rigorous research agenda that accurately reflects the unique and multidimensional nature of clinical practice.     

Physical Activity Benefits the Skeleton of Children Genetically Predisposed to Lower Bone Density in Adulthood

Both genetics and physical activity (PA) contribute to bone mineral density (BMD), but it is unknown if the benefits of physical activity on childhood bone accretion depend on genetic risk. We, therefore, aimed to determine if PA influenced the effect of bone fragility genetic variants on BMD in childhood. Our sample comprised US children of European ancestry enrolled in the Bone Mineral Density in Childhood Study (N = 918, aged 5 to 19 years, and 52.4% female). We used a questionnaire to estimate hours per day spent in total, high‐, and low‐impact PA. We calculated a BMD genetic score (% BMD lowering alleles) using adult genome‐wide association study (GWAS)‐implicated BMD variants. We used dual‐energy X‐ray absorptiometry to estimate femoral neck, total hip, and spine areal‐BMD and total body less head (TBLH) bone mineral content (BMC) Z‐scores. The BMD genetic score was negatively associated with each bone Z‐score (eg, TBLH‐BMC: estimate = –0.03, p = 1.3 × 10^?6). Total PA was positively associated with bone Z‐scores; these associations were driven by time spent in high‐impact PA (eg, TBLH‐BMC: estimate = 0.05, p = 4.0 × 10^?10) and were observed even for children with lower than average bone Z‐scores. We found no evidence of PA‐adult genetic score interactions (p interaction > 0.05) at any skeletal site, and there was no evidence of PA‐genetic score–Tanner stage interactions at any skeletal site (p interaction > 0.05). However, exploratory analyses at the individual variant level revealed that PA statistically interacted with rs2887571 (ERC1/WNT5B) to influence TBLH‐BMC in males (p interaction = 7.1 × 10^?5), where PA was associated with higher TBLH‐BMC Z‐score among the BMD‐lowering allele carriers (rs2887571 AA homozygotes: estimate = 0.08 [95% CI 0.06, 0.11], p = 2.7 × 10^?9). In conclusion, the beneficial effect of PA on bone, especially high‐impact PA, applies to the average child and those genetically predisposed to lower adult BMD (based on GWAS‐implicated BMD variants). Independent replication of our exploratory individual variant findings is warranted. © 2016 American Society for Bone and Mineral Research.     

Back Pain-Inducing Test,a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study

To detect painful vertebral fractures (VFs) in back pain populations at risk of osteoporosis, we designed a physical examination test (the Back Pain-Inducing Test [BPIT]) that included three movements: lying supine, rolling over, and sitting up. If back pain is induced during any of these movements, the result is defined as positive, thereby establishing a presumptive diagnosis of painful VFs. Pain severity is quantified using a self-reported numerical rating scale (NRS). The presence or absence of painful VFs is verified by whole-spine magnetic resonance imaging (MRI), the gold standard for final diagnosis. According to the standards for reporting diagnostic accuracy, a real-world, prospective, and observational study was performed on 510 back pain patients (enrolled from a single institute) at risk of osteoporosis. The sensitivity, specificity, and accuracy of the BPIT for identifying painful VFs were 99.1% (95% CI, 97.5% to 99.8%), 67.9% (95% CI, 60.4% to 74.5%), and 89.0%, respectively. The positive and negative predictive values were 86.6% (95% CI, 82.9% to 89.6%) and 97.4% (95% CI, 92.6% to 99.3%), respectively. Cutoff NRS scores for lying supine, rolling over, and sitting up were 3, 0, and 2, respectively. The corresponding area under the receiver operating characteristic curves (AUROCs) of each movement was 0.898 (95% CI, 0.868 to 0.922), 0.884 (95% CI, 0.854 to 0.911), and 0.910 (95% CI, 0.882 to 0.933), respectively. Although the high prevalence of VFs in the enrolled cohort partially limits the external validity of the predictive value in the general population, we conclude that the BPIT is potentially effective for detecting painful VFs in back pain populations at risk of osteoporosis. This test may be used as a stratification tool in decision-making on subsequent imaging procedures: a negative BPIT rules out painful VFs and indicates that an MRI should be spared, whereas a positive BPIT means that an MRI is necessary and is likely to identify painful VFs. © 2019 American Society for Bone and Mineral Research.     

Sex-Specific Muscular Mediation of the Relationship Between Physical Activity and Cortical Bone in Young Adults

Muscle mass is a commonly cited mediator of the relationship between physical activity (PA) and bone, representing the mechanical forces generated during PA. However, neuromuscular properties (eg, peak force) also account for unique portions of variance in skeletal outcomes. We used serial multiple mediation to explore the intermediary role of muscle mass and force in the relationships between cortical bone and moderate-to-vigorous intensity PA (MVPA). In a cross-sectional sample of young adults (n = 147, 19.7 ± 0.7 years old, 52.4% female) cortical diaphyseal bone was assessed via peripheral quantitative computed tomography at the mid-tibia. Peak isokinetic torque in knee extension was assessed via Biodex dynamometer. Thigh fat-free soft tissue (FFST) mass, assessed via dual-energy X-ray absorptiometry, represented the muscular aspect of tibial mechanical forces. Habitual MVPA was assessed objectively over 7 days using Actigraph GT3X+ accelerometers. Participants exceeded MVPA guidelines (89.14 ± 27.29 min/day), with males performing 44.5% more vigorous-intensity activity relative to females (p < 0.05). Males had greater knee extension torque and thigh FFST mass compared to females (55.3%, and 34.2%, respectively, all p < 0.05). In combined-sex models, controlling for tibia length and age, MVPA was associated with strength strain index (pSSI) through two indirect pathways: (i) thigh FFST mass (b = 1.11 ± 0.37; 95% CI, 0.47 to 1.93), and (i) thigh FFST mass and knee extensor torque in sequence (b = 0.30 ± 0.16; 95% CI, 0.09 to 0.73). However, in sex-specific models MVPA was associated with pSSI indirectly through its relationship with knee extensor torque in males (b = 0.78 ± 0.48; 95% CI, 0.04 to 2.02) and thigh FFST mass in females (b = 1.12 ± 0.50; 95% CI, 0.37 to 2.46). Bootstrapped CIs confirmed these mediation pathways. The relationship between MVPA and cortical structure appears to be mediated by muscle in young adults, with potential sex-differences in the muscular pathway. If confirmed, these findings may highlight novel avenues for the promotion of bone strength in young adults. © 2019 American Society for Bone and Mineral Research.     

Winnicott's Notion of ‘Holding’ as Applied to Serious Physical Illness

In this paper, I describe some of the ways in which D.W. Winnicott's notion of ‘holding’ might be seen as something intimates do for one another across the life cycle. Drawing on a wide selection of Winnicott's writings on the subject, I identify five characteristics of holding that many, perhaps most, Western adults take for granted in ordinary life. Holding enables us to split off catastrophe. It reduces our dependence and increases our sense of autonomy. It contains unmourned losses and sponsors transitional experience. It enables us to form psychosomatic communities with others. I then consider some of the ways in which these characteristics are thrown into jeopardy when serious physical illness arises.     

Physical Therapy Exercise Intervention Based on Classification Using the Patient Response Method: A Systematic Review of the Literature

Abstract

It has been suggested that inclusion into a study that categorizes patients in mutually exclusive, clinometric classifications should improve the outcome of an exercise based randomized clinical trial. This review examined the evidence regarding the effectiveness of physical therapist-directed therapeutic exercises when patients were classified using the patient response method. This systematic literature review restricted article inclusion to English-only articles that classified homogenous samples of low back pain patients using the patient response based method, demonstrated physical therapist-directed exercise interventions, and used specific outcome criteria for assessment of patient improvement. The PEDro scale was used to rate the methodological quality of the studies. Of 82 articles reviewed only 5 articles were accepted. All 5 met the PEDro standards for a high-quality study. Of the 5 articles, 4 demonstrated that physical therapy exercise intervention based on the patient response method of classification were significantly better than the pragmatic control comparisons; the remaining article indicated that exercise was less effective than manipulation. There appears to be a trend toward positive outcomes with physical therapy exercise intervention in trials restricted to the patient response method of classification; however, few studies have investigated this phenomenon.     

A History of Manipulative Therapy Through the Ages and Up to the Current Controversy in the United States

Abstract

Joint manipulation is an ancient art and science that can trace its origins to the earliest medical and lay practitioners. Today, it is practiced principally by physical therapists and chiropractors and to a lesser degree, by osteopathic and medical physicians. Self-manipulation of both joint and soft tissues is also a common practice in those who “crack” their own knuckles and spines. This article traces the history and development of manipulation from its origins to the present with a special emphasis on developments in the United States as a background for understanding current licensure and practice issues.

Since the beginning of this century, physical therapy has enjoyed a close relationship with medicine and has developed its knowledge base and practice in spinal and extremity manipulation from the medical profession. Manipulation in physical therapy has become a significant part of its rehabilitation practice, often encompassed in the terms therapeutic exercise, active and passive movement, or manual therapy. Instruction in manipulation begins with pre-professional education; for those who wish to specialize in this field, instruction continues at the post-professional level, following the medical model of specialization. Since the 1960's, physical therapists have developed their own body of knowledge in manipulation, emphasizing pain relief and enhanced physical function.

By contrast, since its independent origins in the late 19th century, chiropractic has practiced manipulation for most of its history as a primary therapeutic tool to correct spinal subluxation. It provides spinal adjustments to facilitate the free flow of nerve energy, which, in turn, relieves many human ailments. Unlike physical therapy, chiropractic has not been practiced in cooperation with medicine but has existed as an alternative during most of its history. In recent years, the chiropractic profession has divided along philosophical lines: those who strongly defend the subluxation theory (straights) to those who do not (mixers), with the later group now holding sway. This change in chiropractic philosophy and practice has brought practitioners into a practice model more closely aligned with the comprehensive model of rehabilitation therapy modeled by physical therapists. Consequently, many chiropractors now use physical therapy procedures even though they are prohibited from calling themselves physical therapists. As a result, competition in the market place has heightened, with concomitant licensure and political challenges.

This article discusses the history and evolution of the practice of manipulation against a background of other key developments in health care; as such, it should provide understanding for today's current practice scene.     

Trigger Point Dry Needling

Abstract

Trigger point dry needling is a treatment technique used by physical therapists around the world. In the United States, trigger point dry needling has been approved as within the scope of physical therapy practice in a growing number of states. There are several dry needling techniques, based on different models, including the radiculopathy model and the trigger point model, which are discussed here in detail. Special attention is paid to the clinical evidence for trigger point dry needling and the underlying mechanisms. Comparisons with injection therapy and acupuncture are reviewed. Trigger point dry needling is a relatively new technique used in combination with other physical therapy interventions.     

Downhill skiing injuries: associated factors and prevention strategies

Abstract

Downhill skiing is a unique sport with respect to its technique and equipment. A variety of injuries have been reported, which include tears of the anterior cruciate and medial collateral ligaments of the knee, tear of the ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb, ankle sprain, fracture of the lower leg, soft tissue injury of the shoulder, tear of the medial meniscus of the knee, muscle strains, and lumbar spine strain. The findings from research into factors associated with injury are often equivocal. The main findings reported include: beginner–intermediate level of skiing ability, between one and four days of skiing, between two and three hours of skiing on the day of injury, fine weather, slow speed of skiing, slopes classified as 'easy', lack of professional instruction, and failure of bindings to release prior to injury. Further research into pre-season training and pre-skiing warm-up is required. General injury prevention recommendations have been made, however, thorough injury prevention strategies are yet to be developed. Recommendations include: equipment modifications, skiing specific pre-season training and pre-skiing warm-up with attention to a wide variety of body areas, professional instruction, and current information regarding risk factors and injury prevention to be made available to appropriate health professionals and the skiing public.