Dutch Physiotherapy Guidelines for Low Back Pain

Many guidelines for the management of low back pain in primary care have been published during recent years, but guidelines for physiotherapy do not yet exist. Therefore, physiotherapy guidelines have been developed, reflecting the consequences of the current state of knowledge of effective and appropriate physiotherapy for low back pain. They aim to improve the efficiency and effectiveness of physiotherapeutic care for patients with low back pain.The guidelines were constructed on the basis of the phases of the physiotherapy process, using the Dutch method of developing physiotherapy guidelines. Scientific evidence of systematic reviews was used as the basis for the recommendations. A computerised literature search of Medline, Cinahl, the Cochrane Database of Systematic Reviews and the Database of the Dutch National Institute of Allied Health Professions was conducted to identify relevant systematic reviews. If no evidence was available, consensus between experts was obtained.The guidelines were pilot tested among one hundred physiotherapists and reviewed by an external multi-disciplinary panel.The guidelines recommend that the diagnostic process should focus on disability and participation problems resulting from back pain. The treatment should consist of an active approach, in which the patients learn to take control over their back pain. For patients with a normal course, where activities and participation gradually increase, reassurance, adequate information and advice to stay active are the most important recommendations. For patients with an abnormal course, where activities and participation do not increase, exercise therapy should also be provided, with a behavioural approach if necessary.These are the first national physiotherapy guidelines for low back pain. The recommendations are largely in line with other primary care guidelines for low back pain. Implementation will be a major challenge for the near future.     

Researches into the Effectiveness of Physiotherapy in Rheumatoid Arthritis of the Hand

People presenting with rheumatoid arthritis affecting the hands are often referred for physiotherapy. There is little research which shows that physiotherapy is effective in managing this condition. This paper reviews some of the modalities which have been investigated and the contribution they have made to the treatment of the hands of patients with rheumatoid arthritis. Some of the limitations and omissions in these researches are discussed. Suggestions are forwarded which take account of the need for a balance between the qualitative and quantitative methods employed in the investigation of physiotherapy, especially when exercises are administered in the management programme. It is suggested that research methods which take heed of the science as well as the art of physiotherapy may facilitate a more accurate evaluation of the effectiveness of physiotherapy in practice.     

Physiotherapy for Myotonic Dystrophy

The aim of this paper is to provide clinical physiotherapists with an understanding of myotonic dystrophy. This knowledge has been integrated into guidelines for treating patients with myotonic dystrophy when encountered in various clinical situations. Such patients may be treated after surgery, or for respiratory dysfunction, or need remedial or preventive exercise programmes. Choice of mobility aids is also addressed. An holistic approach to management of patients with myotonic dystrophy is encouraged.     

Community Based Physiotherapy in the Trent Region: A Survey

A survey was carried out to investigate community based physiotherapists employed by Trent Regional Health Authority. Questionnaires were distributed to 150 community based physiotherapists employed by Trent RHA, of which 97 (65%) were returned. Information was obtained on personal details, geographical location and distribution, transport, referral mechanisms, treatment, patient details, equipment, educational background, assistant availability and interdisciplinary communication.The majority of therapists had been recruited during the past five years, and had been qualified for 11–15 years. The most common venue for treatment was the patient's own home, resulting in an average of 16% of the working day spent in transit. Most referrals came from GPs, but therapists were often dissatisfied with the information given in the referral documentation. Conditions referred for community based physiotherapy included strokes and other neurological problems, mobility cases, the elderly, soft tissue injuries, rheumatological conditions, trauma and orthopaedics, and back and neck problems. A majority (68.4%) of respondents stated that they were not involved in any formal health education/health promotion activities.There was general satisfaction with access to equipment, with in-service training, and with the links with other community based professionals. Areas for further investigation include case-load analysis, referral documentation, administrative support, use of assistants, provision of paediatric physiotherapy, and the potential for health education/health promotion strategies.     

运动疗法对膝骨关节炎的疗效观察

目的探讨运动疗法对膝骨关节炎治疗效果的影响。方法 40例膝骨关节炎患者分为对照组(n=20)和治疗组(n=20),对照组采用常规理疗、针灸、熏洗、按摩等治疗,治疗组在常规治疗基础上加入运动疗法,包括肌力训练、关节活动度训练。治疗前后采用Lysholm膝关节评分量表和视觉模拟评分法(VAS)进行评定。结果两组患者VAS和Lysholm膝关节量表评分均改善,治疗组较对照组改善更明显(P<0.01)。结论运用运动疗法能进一步改善膝骨关节炎患者膝关节功能,缓解疼痛。     

血友病性慢性滑膜炎的物理治疗

目的探讨运用物理治疗的方法治疗血友病性慢性滑膜炎。方法10例诊断为血友病性慢性滑膜炎的患者接受为期4周的综合物理治疗,比较治疗前后疼痛、关节肿胀程度和肌肉萎缩程度的变化。结果疼痛、关节肿胀治疗前后相比有显著差异(P<0.01),肌肉萎缩治疗前后差异不显著(P>0.05)。结论综合物理治疗对血友病性慢性滑膜炎的疼痛和关节肿胀有显著缓解作用,而肌肉萎缩的改善需要更长时间的训练。     

在康复治疗学专业运动疗法方向教学中开设双语教学的设想

在康复治疗学专业中开展双语教学具有重要的意义，也是教学方法改革的必然趋势。作者通过分析在康复治疗学专业运动疗法方向教学中开展双语教学的必然趋势，探讨开展双语教学存在的问题和对策，以及对课程的选择和对教师与学生的具体要求，提出双语教学实施的具体方案。     

Physiotherapy in knee osteoarthrosis: Effect on pain and walking

Patients with knee osteoarthrosis are often referred for physiotherapy and many different types of treatment are given. The value of many of these treatments has been questioned. This study was intended to evaluate the effect of commonly used physiotherapy treatments in a training programme on patients with medial knee osteoarthrosis, scheduled for surgery. The results from this study also provide useful data for further evaluation of different physiotherapy treatments to this patient group. Thirty-four patients were randomised to physiotherapy three times a week for 5 weeks and the other 34 received no treatment. The training programme is described in detail. The patients were evaluated by clinical examination, step test, gait analysis and isokinetic measurements of thigh muscle strength before and after treatment. The patients in the treatment group experienced a feeling of overall improvement in the knee and the ability to descend steps improved when compared to the control group. There were no significant differences in gait, range of motion or isokinetic measurements of muscle strength between the groups. We conclude that physiotherapy as given here made our patients feel better and their ability to descend stairs improved. These improvements are beneficial to the patients and support the positive effects of exercises and activity. Whilst the objective improvements were small, suggesting that this treatment may not be justified, patients in the treatment group believed that they were improved.