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Sélection Cochrane pour les physiothérapeutes: AOUT (Issue 8, 2012)

Rédigé par le Mercredi 5 Septembre 2012



Sélection Cochrane pour les physiothérapeutes: AOUT (Issue 8, 2012)
Voici la sélection de Aout (Issue 8, 2012) des titres des nouvelles revues systématiques Cochrane publiées ou mises à jour en rapport avec la pratique des kinésithérapeutes / physiothérapeutes:

1. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old

Objectives The main objective was to determine the efficacy of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. A secondary objective was to determine the efficacy of different techniques of chest physiotherapy (for example, vibration and percussion and passive forced exhalation).

Authors' conclusions Since the last publication of this review new good-quality evidence has appeared, strengthening the conclusions of the review. Chest physiotherapy does not improve the severity of the disease, respiratory parameters, or reduce length of hospital stay or oxygen requirements in hospitalised infants with acute bronchiolitis not on mechanical ventilation. Chest physiotherapy modalities (vibration and percussion or forced expiratory techniques) have shown equally negative results.


2. Compression for preventing recurrence of venous ulcers

Objectives To assess the effects of compression (socks, stockings, tights, bandages) in preventing the recurrence of venous ulcers. If compression does prevent ulceration compared with no compression, then to identify whether there is evidence to recommend particular levels of compression (high, medium or low, for example), types of compression, or brands of compression to prevent ulcer recurrence after healing.

Authors' conclusions There is evidence from one trial that compression hosiery reduces rates of reulceration of venous ulcers compared with no compression. Results from one trial suggest that recurrence is lower in high-compression hosiery than in medium-compression hosiery at three years whilst another trial found no difference at 5 years. Rates of patient intolerance of compression hosiery were high. There is insufficient evidence to aid selection of different types, brands, or lengths of compression hosiery.


3. Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults

Objectives To assess the effects of workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck MSDs in adults.

Authors' conclusions We found moderate-quality evidence to suggest that the use of arm support with alternative mouse may reduce the incidence of neck/shoulder MSDs, but not right upper limb MSDs. Moreover, we found moderate-quality evidence to suggest that the incidence of neck/shoulder and right upper limb MSDs is not reduced when comparing alternative and conventional mouse with and without arm support. However, given there were multiple comparisons made involving a number of interventions and outcomes, high-quality evidence is needed to determine the effectiveness of these interventions clearly. While we found very-low- to low-quality evidence to suggest that other ergonomic interventions do not prevent work-related MSDs of the upper limb and neck, this was limited by the paucity and heterogeneity of available studies. This review highlights the need for high-quality RCTs examining the prevention of MSDs of the upper limb and neck.


4. Exercise interventions on health-related quality of life for cancer survivors

Objectives To evaluate the effectiveness of exercise on overall HRQoL and HRQoL domains among adult post-treatment cancer survivors.

Authors' conclusions This systematic review indicates that exercise may have beneficial effects on HRQoL and certain HRQoL domains including cancer-specific concerns (e.g. breast cancer), body image/self-esteem, emotional well-being, sexuality, sleep disturbance, social functioning, anxiety, fatigue, and pain at varying follow-up periods. The positive results must be interpreted cautiously due to the heterogeneity of exercise programs tested and measures used to assess HRQoL and HRQoL domains, and the risk of bias in many trials. Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains


5. Exercise interventions on health-related quality of life for people with cancer during active treatment


Objectives To evaluate the effectiveness of exercise on overall HRQoL outcomes and specific HRQoL domains among adults with cancer during active treatment.

Authors' conclusions This systematic review indicates that exercise may have beneficial effects at varying follow-up periods on HRQoL and certain HRQoL domains including physical functioning, role function, social functioning, and fatigue. Positive effects of exercise interventions are more pronounced with moderate- or vigorous-intensity versus mild-intensity exercise programs. The positive results must be interpreted cautiously because of the heterogeneity of exercise programs tested and measures used to assess HRQoL and HRQoL domains, and the risk of bias in many trials. Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains.


6. Exercises for adolescent idiopathic scoliosis

Objectives To evaluate the efficacy of SSE in adolescent patients with AIS.

Authors' conclusions There is a lack of high quality evidence to recommend the use of SSE for AIS. One very low quality study suggested that these exercises may be more effective than electrostimulation, traction and postural training to avoid scoliosis progression, but better quality research needs to be conducted before the use of SSE can be recommended in clinical practice.


7. Exercises for mechanical neck disorders

Objectives To improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain.

Authors' conclusions Low to moderate quality evidence supports the use of specific cervical and scapular stretching and strengthening exercise for chronic neck pain immediately post treatment and intermediate term, and cervicogenic headaches in the long term. Low to moderate evidence suggests no benefit for some upper extremity stretching and strengthening exercises or a general exercise program. Future trials should consider using an exercise classification system to establish similarity between protocols and adequate sample sizes. Factorial trials would help determine the active treatment agent within a treatment regimen where a standardized representation of dosage is essential. Standardized reporting of adverse events is needed for balancing the likelihood of treatment benefits over potential harms.


8. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft

Objectives Update the previously published systematic review to compare the effects of IS for preventing postoperative pulmonary complications in adults undergoing coronary artery bypass graft (CABG).

Authors' conclusions Our update review suggests there is no evidence of benefit from IS in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing CABG. In view of the modest number of patients studied, methodological shortcomings and poor reporting of the included trials, these results should still be interpreted cautiously. An appropriately powered trial of high methodological rigour is needed to determine if there are patients who may derive benefit from IS following CABG.


9. Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people

Objectives To assess the effects of interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people

Authors' conclusions Compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.


10. Physiotherapy versus placebo or no intervention in Parkinson's disease

Objectives To assess the effectiveness of physiotherapy intervention compared with no intervention in patients with PD

Authors' conclusions Benefit for physiotherapy was found in most outcomes over the short-term (i.e. < three months), but was only significant for velocity, two- or six-minute walk test, step length, Timed Up & Go, Functional Reach Test, Berg Balance Scale and clinician-rated UPDRS. Most of the observed differences between the treatments were small. However, for some outcomes (e.g. velocity, Berg Balance Scale and UPDRS), the differences observed were at, or approaching, what are considered minimally clinical important changes.

The review illustrates that a wide range of approaches are employed by physiotherapists to treat PD. However, there was no evidence of differences in treatment effect between the different types of physiotherapy interventions being used, though this was based on indirect comparisons. There is a need to develop a consensus menu of 'best-practice' physiotherapy, and to perform large well-designed randomised controlled trials to demonstrate the longer-term efficacy and cost-effectiveness of 'best practice' physiotherapy in PD


11. Relaxation therapy for preventing and treating preterm labour

Objectives To assess the effectiveness of relaxation therapies for preventing or treating PTL and preventing PTB.

Authors' conclusions According to the results of this review, there is some evidence that relaxation during pregnancy reduces stress and anxiety. However, there was no effect on PTL/PTB. These results should be interpreted with caution as they were drawn from included studies with limited quality


12. Surgical versus conservative interventions for treating ankle fractures in adults

Objectives To assess the effects of surgical versus conservative interventions for treating ankle fractures in adults.

Authors' conclusions There is currently insufficient evidence to conclude whether surgical or conservative treatment produces superior long-term outcomes for ankle fractures in adults. The identification of several ongoing randomised trials means that better evidence to inform this question is likely to be available in future.


13. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults

Objectives To assess the effectiveness of dietary and physical activity interventions based on the transtheoretical model, to produce sustainable weight loss in overweight and obese adults.

Authors' conclusions TTM SOC and a combination of physical activity, diet and other interventions resulted in minimal weight loss, and there was no conclusive evidence for sustainable weight loss. The impact of TTM SOC as theoretical framework in weight loss management may depend on how it is used as a framework for intervention and in combination with other strategies like diet and physical activities.


Les revues ont été sélectionnées par un comité de lecteurs indépendants.

Retrouvez la lettre d'information et les titres des revues en ligne sur le site du centre Cochrane français


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1.Posté par sebastin le 05/09/2012 22:27 | Alerter
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bonjour,

Juste deux questions:

Pourquoi un grand nombre des études dans l'EBP portent-elles essentiellement sur les mêmes thèmes càd la cervicalgie, la lombalgie, la maladie de parkinson et les entorses de chevilles , en tout cas parmi celles que vous sélectionnez?

D'autre part, que me conseillerez-vous pour travailler la proprio sur les entorses de chevilles car selon l'EBP cela serait inefficace, comment font-ils aux USA, en Australie ou au Canada où l'EBP règne en maître?
Quelles sont les limites de l'EBP?

Merci

Cordialement,

Sébastien

2.Posté par sebastin le 05/09/2012 22:29 | Alerter
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et j'oubliais la bronchiolite

3.Posté par JL E le 06/09/2012 08:15 | Alerter
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Bonjour
Concernant la rééducation de l'entorse de cheville, nous nous sommes fait l'écho à maintes reprises de la pratique consistant à renforcer les stabilisateurs latéraux et les rotateurs latéraux de hanche. Ce concept est repris dans toutes les études depuis des années maintenant. Tout semble indiquer qu'il s'agisse de la voie à suivre.
Vous trouverez assurément les liens vers les articles développant ce concept en faisant une recherche sur le site.

4.Posté par sebastien le 06/09/2012 20:51 | Alerter
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merci

Nouveau commentaire :

Merci d'apporter des commentaires constructifs et adaptés et de ne pas porter de propos diffamatoires ou portant atteinte à l'honneur à la profession

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