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Sélection Cochrane pour les physiothérapeutes: AVRIL (Issue 4, 2012)

Rédigé par le Vendredi 4 Mai 2012



Sélection Cochrane pour les physiothérapeutes: AVRIL (Issue 4, 2012)
Voici la sélection de AVRIL (Issue 4, 2012) des titres des nouvelles revues systématiques Cochrane publiées ou mises à jour en rapport avec la pratique des kinésithérapeutes / physiothérapeutes:

1. Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer

Objectives
To evaluate the effectiveness and safety of exercise interventions for the treatment of shoulder dysfunction caused by the treatment of head and neck cancer.).

Authors' conclusions
Limited evidence from two RCTs demonstrated that PRT is more effective than standard physiotherapy treatment for shoulder dysfunction in patients treated for head and neck cancer, improving pain, disability and range of motion of the shoulder joint, but it does not improve quality of life. However, although statistically significant the measured benefits of the intervention may be small. Other exercise regimes were not shown to be effective compared to routine postoperative physiotherapy. Further studies which apply other exercise interventions in head and neck cancer patients in the early postoperative and radiotherapy period are needed, with long-term follow-up


2. Interventions for the management of temporomandibular joint osteoarthritis

Objectives
To investigate the effects of different surgical and non-surgical therapeutic options for the management of TMJ OA in adult patients.

Authors' conclusions
In view of the paucity of high level evidence for the effectiveness of interventions for the management of TMJ OA, small parallel group RCTs which include participants with a clear diagnosis of TMJ OA should be encouraged and especially studies evaluating some of the possible surgical interventions.

3. Interventions for treating acute elbow dislocations in adults

Objectives
To assess the effects of various forms of treatment for acute simple elbow dislocations in adults.

Authors' conclusions
There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for simple dislocations of the elbow in adults. Although weak and inconclusive, the available evidence from a trial comparing surgery versus conservative treatment does not suggest that the surgical repair of elbow ligaments for simple elbow dislocation improves long-term function. Future research should focus on questions relating to non-surgical treatment, such as the duration of immobilisation.

4. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV)

Objectives
To assess whether the various modifications of the Epley manoeuvre for posterior canal BPPV enhance its efficacy in clinical practice.

Authors' conclusions
There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised. Specific patients who experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright may be treated with the Epley manoeuvre alone and still expect to be cured in most instances.
There is insufficient evidence to support the routine application of mastoid oscillation during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither treatment is associated with adverse outcomes. Further studies should employ a rigorous randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike test as an outcome measure and longer-term follow-up of patients.

5. Patellar taping for patellofemoral pain syndrome in adults

Objectives
The objective was to assess the effects, primarily on pain and function, of patellar taping for treating patellofemoral pain syndrome in adults.

Authors' conclusions
The currently available evidence from trials reporting clinically relevant outcomes is low quality and insufficient to draw conclusions on the effects of taping, whether used on its own or as part of a treatment programme. Further research involving large, preferably multi-centre, good quality and well reported randomised controlled trials that measure clinically important outcomes and long-term results is warranted. Before this, consensus is required on the diagnosis of patellofemoral pain syndrome, the standardisation of outcome measurement and an acceptable approach for patellar taping.

6. Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease

Objectives
To systematically assess the effect of interventions on muscle cramps as a primary or secondary endpoint or adverse event in people with ALS/MND.

Authors' conclusions
There is no evidence to support the use of any intervention for muscle cramps in ALS/MND. More and larger randomised controlled trials evaluating treatments for muscle cramps in ALS/MND are needed.


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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