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Support for PEDro comes from the Koninklijk Nederlands Genootschap voor Fysiotherapie and Axxon
We thank Koninklijk Nederlands Genootschap voor Fysiotherapie and Axxon who have just renewed their partnership with PEDro for another year.
Anne Moseley reflects on the value of PEDro at #WCPT2019
Associate Professor Anne Moseley was recently interviewed at the World Confederation for Physical Therapy 2019 Congress in Geneva about the value of PEDro. At the Congress she received the prestigious Mildred Elson award for her leadership and commitment to the promotion of evidence-based physiotherapy through PEDro.
Watch the video to find out how PEDro started out as a clinical pearl and gradually snowballed to become the preeminent evidence-based resource for physiotherapists worldwide.
#MyPTArticleOfTheMonth – what is Kate Scrivener reading?
Dr Kate Scrivener is a clinician, researcher and educator in neurological physiotherapy in Sydney, Australia. Kate has expertise in rehabilitation after stroke, with a particular interest in using exercise and technology to empower people with stroke to drive their rehabilitation. She is a Senior Lecturer at Macquarie University and is part of the StrokeEd Collaboration. As the head of neurology at Concentric Rehabilitation Centre, Kate is a consultant physiotherapist as well as a mentor to staff. An important aspect of this role is ensuring that all staff are actively engaged with translating the latest evidence into their clinical practice.
A major challenge in stroke rehabilitation is how best to drive recovery in arm function and prevent secondary complications like pain. Kate has recently read three research articles on this topic.
Rodgers H, et al. Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial. Lancet 2019 May 21:Epub ahead of print
This is a rigorous, large-scale (n=770) randomised controlled trial involving people with stroke who had moderate to severe limitation in arm function. There were three treatment arms: robot-assisted training, intensive repetitive practice, and usual care. Both the robot-assisted and intensive repetitive practice groups completed about 24 hours of arm training over the over a 12-week period. There were no between-group differences in the primary outcome (Action Research Arm Test) at the 3-month follow-up. This means that robot-assisted training was not superior to usual care, and nor was intensive repetitive practice. Kate says: “In Australia there is minimal access to robotics in clinical practice. This large trial suggests that there is no advantage to having robotics over usual care.” Kate was interested that 42-50% of participants in each group made a clinically meaningful change in their Action Research Arm Test score. Kate says: “This suggests that change in arm function is possible for some individuals after stroke, and there is research in progress to better determine who those individuals are.”
Ward NS, et al. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry 2019;90(5):498-506
This article also challenges the assumption that it is not possible to improve arm function after stroke, especially in the chronic phase. This is a single-group, uncontrolled study involving a large cohort (N=224) of people with stroke (but people with with complete paralysis and severe spasticity were excluded), with intervention starting an average of 18 months post-stroke. The intervention involved repetitive task practice and was intensive, with 90 hours of intervention delivered over a 3-week period. At the 6-month follow up 62% of participants had made a clinically meaningful change in their Action Research Arm Test score. Kate says: “This article shows us how much practice is possible. A 90-hour intervention is substantial, I have not seen this intensity of practice reported in previous research.” Kate is mindful, however, that the article only reports the change scores for a single group and that the intervention does need to be evaluated in a randomised controlled trial.
Andringa A, et al. Effectiveness of botulinum toxin treatment for upper limb spasticity after stroke over different ICF domains: a systematic review and meta-analysis. Arch Phys Med Rehabil 2019 Feb 22:Epub ahead of print
This large (40 trials, 2,718 participants) systematic review and meta-analysis quantifies the effects of botulinum toxin on upper limb spasticity after stroke. Interestingly, the outcomes were reported using the International Classification of Functioning, Disability and Health framework. The review concludes that botulinum toxin reduces resistance to passive movement and improves self care, but does not change arm or hand function, pain or range of motion. Kate says: “I find this review very useful because patients commonly ask me about this treatment. This review provides data to empowers individuals with stroke (and therapists) to make informed decisions about treatment.”
#MyPTArticleOfTheMonth #PhysicalTherapy #physio
#MyPTArticleOfTheMonth resource – 95% confidence intervals explained
The purpose of conducting a randomised controlled trial, or a systematic review of randomised controlled trials, is to determine the size of the treatment effect (or the difference in outcome for the treatments being compared). The mean (or average) difference in outcome between the treatment groups is called the point estimate. The point estimate is our best guess of the true value of the treatment effect.
But the point estimate comes with some uncertainty, and this uncertainty can be quantified using confidence intervals. At the centre of the confidence interval is the point estimate, but now there is some room on either side of the point estimate for uncertainty. Confidence intervals always have a lower and an upper limit, which indicates that the true effect may be somewhere within this interval, and the width of the confidence interval represents the precision of the treatment effect estimate. If the confidence interval is narrow, the size of the treatment effect is known more precisely. Different levels of confidence intervals can be calculated (eg, 95%, 99%), but the type most commonly reported in trials and reviews is the 95% confidence interval.
Interpretation of confidence intervals will be explained using a hypothetical trial that found a mean difference of 2 points in a 0-10 pain scale between treatment A and treatment B (control) with a 95% confidence interval ranging from 1 to 3 points. That is, at the end of the trial patients receiving treatment A had 2 (out of 10) points lower pain, on average, compared to patients receiving treatment B. A simple interpretation of the confidence interval is that if the same trial was repeated 100 times, in 95 of the repeats the point estimate would fall between 1 and 3 points. Alternatively, we can say that we are 95% confident that the true effect of the intervention lies somewhere between 1 and 3 points.
Reporting of the point estimate and its confidence interval provides physiotherapists reading trials (and reviews) with richer information than just reporting the probability value (or p-value) produced by statistical testing. P-values only indicate if the observed difference is statistically significant (p<0.05) or not (p>0.05). Point estimates and confidence intervals indicate the magnitude and precision of the effect. The confidence interval also indicates the results of statistical testing - if the 95% confidence interval includes “0” (no effect) there is no statistical difference between the groups (p>0.05).
The good news for physiotherapists is that the use of confidence intervals in trial reports is increasing steadily over time. In 2016, 42% of physiotherapy trials reported confidence intervals.
Your ability to read scientific articles will improve with practice. Make the commitment to read at least one article per month and share your reading with the global physiotherapy community in #MyPTArticleOfTheMonth.
PEDro #MyPTArticleOfTheMonth challenge spreads to Dutch-speaking physiotherapists
A new partner, Koninklijk Nederlands Genootschap voor Fysiotherapie, has joined the PEDro #MyPTArticleOfTheMonth challenge.
Many physiotherapists have signed up for the #MyPTArticleOfTheMonth challenge and have started sharing their reading with the global physiotherapy community. We invite all physiotherapists to join in the challenge.
To support this global challenge, the PEDro #MyPTArticleOfTheMonth video is now available in Portuguese, French, and Dutch.
Don’t forget to share your reading with the global physiotherapy community by using the hashtag #MyPTArticleOfTheMonth on Twitter or Facebook.
PEDro update (1 July 2019)
PEDro contains 43,951 records. In the 1 July 2019 update you will find:
- 34,361 reports of randomised controlled trials (33,522 of these trials have confirmed ratings of methodological quality using the PEDro scale)
- 8,906 reports of systematic reviews, and
- 684 reports of evidence-based clinical practice guidelines.
PEDro update (July 2019)
PEDro was updated on 1 July 2019. For latest guidelines, reviews and trials in physiotherapy visit Evidence in your inbox.
Next PEDro update (July 2019)
The next PEDro update is on Monday 1 July 2019.
Systematic review found that non-invasive positive pressure ventilation may reduce hospital mortality in people with acute cardiogenic pulmonary oedema
This Cochrane systematic review evaluated the effectiveness and safety of non-invasive positive pressure ventilation compared to standard care for adults with acute cardiogenic pulmonary oedema. Randomised controlled trials recruiting participants aged 18 years and older with a diagnosis of acute cardiogenic pulmonary oedema that evaluated nasal or face mask non-invasive positive pressure ventilation (continuous positive airway pressure, bilevel non-invasive positive pressure ventilation, or both) were included. Cross-over and cluster trials were excluded. The primary outcome was hospital mortality. Secondary outcomes included endotracheal intubation, incidence of acute myocardial infarction during hospitalisation, after starting treatment. The quality of the evidence was assessed using the GRADE approach.
24 trials (n = 2,664 participants) were included. Most trials were conducted in emergency departments or intensive care units. The mean age of the population was 73 (SD 9) years. There was low-quality evidence that non-invasive positive pressure ventilation may reduce hospital mortality compared to standard care (relative risk 0.65, 95% confidence interval (CI) 0.51 to 0.82; n = 2,484 participants; number needed to treat = 17). There was moderate quality evidence that non-invasive positive pressure ventilation probably reduces endotracheal intubation rates (RR 0.49 95% CI 0.38 to 0.62; n = 2,449 participants; number needed to treat = 13). There was moderate quality evidence that non-invasive positive pressure ventilation probably does not reduce the incidence of acute myocardial infarction compared to standard care (RR 1.03 95% CI 0.91 to 1.16; n = 1,313 participants; number needed to treat = 5). The use of non-invasive positive pressure ventilation in patients with acute cardiogenic pulmonary oedema may reduce mortality and probably reduces the risk of endotracheal intubation.
Berbenetz N et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2019;Issue 4
Read more on PEDro.
Support for PEDro comes from the Australian Physiotherapy Association, Physiotherapy New Zealand, Norsk Fysioterapeutforbund, Associação Espanola de Fisioterapeutas, Taiwan Physical Therapy Association, Félag Sjúkraþjálfara, Suomen Fysioterapeutit, Association Luxembourgeoise Des Kinésithérapeutes, Società Italiana di Fisioterapia, Komora Fizioterapeuta Crne Gore, UNIFY ČR, Lietuvos Kineziterapeutų Draugija and Physiotherapeuten Verband Fürstentum Liechtenstein
- Australian Physiotherapy Association
- Physiotherapy New Zealand
- Norsk Fysioterapeutforbund
- Associação Espanola de Fisioterapeutas
- Taiwan Physical Therapy Association
- Félag Sjúkraþjálfara
- Suomen Fysioterapeutit
- Association Luxembourgeoise Des Kinésithérapeutes
- Società Italiana di Fisioterapia
- Komora Fizioterapeuta Crne Gore
- UNIFY ČR
- Lietuvos Kineziterapeutų Draugija
- Physiotherapeuten Verband Fürstentum Liechtenstein