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Objective: To determine if pre-operative interventions for hip and knee osteoarthritis provide benefit before and after joint replacement.Method: Systematic review with meta-analysis of randomised controlled trials (RCTs) of pre-operative interventions for people with hip or knee osteoarthritis awaiting joint replacement surgery. Standardised mean differences (SMD) were calculated for pain, musculoskeletal impairment, activity limitation, quality of life, and health service utilisation (length of stay and discharge destination). The GRADE approach was used to determine the quality of the evidence.Results: Twenty-three RCTs involving 1461 participants awaiting hip or knee replacement surgery were identified. Meta-analysis provided moderate quality evidence that pre-operative exercise interventions for knee osteoarthritis reduced pain prior to knee replacement surgery (SMD (95% CI)=0.43 [0.13, 0.73]). None of the other meta-analyses investigating pre-operative interventions for knee osteoarthritis demonstrated any effect. Meta-analyses provided low to moderate quality evidence that exercise interventions for hip osteoarthritis reduced pain (SMD (95% CI)=0.52 [0.04, 1.01]) and improved activity (SMD (95% CI)=0.47 [0.11, 0.83]) prior to hip replacement surgery. Meta-analyses provided low quality evidence that exercise with education programs improved activity after hip replacement with reduced time to reach functional milestones during hospital stay (e.g., SMD (95% CI)=0.50 [0.10, 0.90] for first day walking).Conclusion: Low to moderate evidence from mostly small RCTs demonstrated that pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement. [ABSTRACT FROM AUTHOR]

Question: Does progressive resistance training improve muscle strength and physical function in adolescents with Down syndrome? Design: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: 23 adolescents with Down syndrome (17 boys, 6 girls; mean age 15.6 +/- 1.6 years) were randomly assigned to either an experimental group (n = 11) or a control group (n = 12). Intervention: The intervention was a student-led progressive resistance training program, comprising 6 exercises using weight machines performed twice a week for 10 weeks. Participants completed 3 sets of 12 repetitions of each exercise or until they reached fatigue. The intervention took place in a community gymnasium. The control group continued with their usual activities. Outcome measures: The outcomes measured at baseline and immediately after the intervention phase were muscle strength (1 repetition maximum), a timed stairs test, and the grocery shelving task. Results: The experimental group attended 90% of their scheduled sessions. They demonstrated improvement in lower limb muscle strength compared to the control group (MD 36 kg, 95% CI 15 to 58). There were no significant differences between the groups for upper limb muscle strength or physical function measures. No major adverse events were recorded. Conclusion: Progressive resistance training is a feasible and safe exercise option that can improve lower limb muscle strength in adolescents with Down syndrome. Trial registration: ACTRN12608000261314. [ABSTRACT FROM AUTHOR]

Question: Is progressive resistance exercise a safe and effective form of exercise to improve glycaemic control in people with type 2 diabetes? Design: Systematic review with meta-analysis of randomised controlled trials. Participants: People with type 2 diabetes mellitus. Intervention: Progressive resistance exercise. Outcome measures: The primary outcome was glycaemic control measured as percentage glycosylated haemoglobin (HbA1c). Secondary outcomes were body composition (lean body and fat free mass in kg), and muscle strength (% change in 1RM, dynamometry, change in maximum weight lifted). Results: The search yielded nine relevant trials that evaluated 372 people with type 2 diabetes. Compared to not exercising, progressive resistance exercise led to small and statistically significant absolute reductions in HbA1c of 0.3% (SMD -0.25, 95% CI -0.47 to -0.03). When compared to aerobic exercise there were no significant differences in HbA1c. Progressive resistance exercise resulted in large improvements in strength when compared to aerobic (SMD 1.44, 95% CI 0.83 to 2.05) or no exercise (SMD 0.95, 95% CI 0.58 to 1.31). There were no significant changes in body composition. Conclusions: Progressive resistance exercise increases strength and leads to small reductions in glycosylated haemoglobin that are likely to be clinically significant for people with type 2 diabetes. Progressive resistance exercise is a feasible option in the management of glycaemia for this population. [ABSTRACT FROM AUTHOR]

Question: Do clinical tests accurately diagnose rotator cuff pathology? Design: A systematic review of investigations into the diagnostic accuracy of clinical tests for rotator cuff pathology. Participants: People with shoulder pain who underwent clinical testing in order to diagnose rotator cuff pathology. Outcome measures: The diagnostic accuracy of clinical tests was determined using likelihood ratios. Results: Thirteen studies met the inclusion criteria. The 13 studies evaluated 14 clinical tests in 89 separate evaluations of diagnostic accuracy. Only one evaluation, palpation for supraspinatus ruptures, resulted in significant positive and negative likelihood ratios. Eight of the 89 evaluations resulted in either significant positive or negative likelihood ratios. However, none of these eight positive or negative likelihood ratios were found in other studies. Of the 89 evaluations of clinical tests 71 (80%) did not result in either significant positive or negative likelihood ratio evaluations across different studies. Conclusion: Overall, most tests for rotator cuff pathology were inaccurate and cannot be recommended for clinical use. At best, suspicion of a rotator cuff tear may be heightened by a positive palpation, combined Hawkins/painful arc/ infraspinatus test, Napoleon test, lift-off test, belly-press test, or drop-arm test, and it may be reduced by a negative palpation, empty can test or Hawkins-Kennedy test. [ABSTRACT FROM AUTHOR]

Questions: Does a 12-week, predominantly home-based program of progressive resistance exercises reduce impairments, activity limitations, and participation restrictions in people with chronic obstructive pulmonary disease? Are any gains maintained 12 weeks after the cessation of the program? Design: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: 54 people with moderately severe chronic obstructive pulmonary disease not undergoing pulmonary rehabilitation. Intervention: The experimental group performed six progressive resistance exercises three times per week (once a week hospital-based, twice a week home-based) for 12 weeks. Exercise intensity was three sets of 8 to 12 repetition maximum progressed against elasticised bands of increasing resistance. The control group received no intervention. Outcome measures: Primary outcomes were strength (knee extensor, hip abductor, shoulder horizontal flexor, shoulder flexor) measured using hand-held dynamometry, and walking capacity measured by the 6-minute Walk Test performed before and after intervention and again at 12 weeks after the cessation of intervention. Results: The experimental group increased their knee extensor strength by 4.9 kg (95% CI 1.1 to 8.7) more than the control group by Week 12. However, this gain was not maintained at Week 24. No difference between the groups was found for any of the other primary outcomes. Conclusions: A predominantly home-based progressive resistance exercise program led to modest improvements in knee extensor strength in people with chronic obstructive pulmonary disease. However, 44% of the experimental group were unable to complete the exercise program, highlighting the need to understand factors influencing adherence to exercise in this population. [ABSTRACT FROM AUTHOR]

Question: Is additional Saturday physiotherapy intervention beneficial for inpatients undergoing rehabilitation? Design: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Two hundred and sixty-two inpatients undergoing rehabilitation in an Australian metropolitan hospital. Intervention: The experimental group received physiotherapy intervention from Monday to Saturday and the control group from Monday to Friday. Outcome measures: Primary outcomes were hospital and physiotherapy length of stay. Secondary measures were collected to reflect patient outcomes (health state, independence, activity, flexibility and strength) and burden of care (discharge destination, adverse events, and follow-up physiotherapy intervention). Results: There was a 3.2 day reduction for the experimental group (95% CI -0.5 to 6.9) in hospital length of stay and a 2.5 day reduction (95% CI -0.9 to 5.9) in physiotherapy length of stay. There was no significant between-group difference in change from admission to discharge for most of the secondary patient outcomes (health state, independence, activity, flexibility). The risk of the experimental group being categorised as strong relative to the control group was 1.2 (95% CI 0.99 to 1.50). The risk of not being discharged home, of having an adverse event, or requiring follow-up physiotherapy intervention was no greater for the experimental group than the control group. Conclusion: The provision of additional Saturday physiotherapy intervention resulted in a trend to shorter hospital and physiotherapy length of stay without affecting patient outcome unfavourably or increasing burden of care, suggesting that a larger multicentre trial is warranted. [ABSTRACT FROM AUTHOR]

Question: Is therapeutic exercise of benefit? Design: A summary of systematic reviews on therapeutic exercise published from 2002 to September 2005. Participants: People with neurological, musculoskeletal, cardiopulmonary, and other conditions who would be expected to consult a physiotherapist. Intervention: Therapeutic exercise was defined as the prescription of a physical activity program that involves the client undertaking voluntary muscle contraction and/or body movement with the aim of relieving symptoms, improving function or improving, retaining or slowing deterioration of health. Outcome measures: Effect of therapeutic exercise in terms of impairment, activity limitations, or participation restriction. Results: The search yielded 38 systematic reviews of reasonable or good quality. The results provided high level evidence that therapeutic exercise was beneficial for patients across broad areas of physiotherapy practice, including people with conditions such as multiple sclerosis, osteoarthritis of the knee, chronic low back pain, coronary heart disease, chronic heart failure, and chronic obstructive pulmonary disease. Therapeutic exercise was more likely to be effective if it was relatively intense and there were indications that more targeted and individualised exercise programs might be more beneficial than standardised programs. There were few adverse events reported. However, in many areas of practice there was no evidence that one type of exercise was more beneficial than another. Conclusion: Therapeutic exercise was beneficial for patients across broad areas of physiotherapy practice. Further high quality research is required to determine the effectiveness of therapeutic exercise in emerging areas of practice. [ABSTRACT FROM AUTHOR]