Footnote: what's new in the literature.

* Children with cerebral palsy (CP) may benefit from improved exercise programs that focus on lower-extremity muscle strength, cardiovascular fitness, or a combination, according to a literature review published in the May issue of American Journal of Physical Medicine & Rehabilitation (Vol 87, No 5)

The purpose of this review, regarding all types of exercise programs focusing on cardiovascular fitness (aerobic and anaerobic capacity) and/or lower-extremity muscle strength in children with CP, was to address the following questions: 1) What exercise programs focusing on muscle strength, cardiovascular fitness, or a combination are studied, and what are the effects of these exercise programs in children with CP? 2) What outcome measures were used to assess the effects of the exercise programs? and 3) what is the methodological quality of the studies?

The researchers searched the literature in electronic databases up to October 2006 and included 20 studies for evaluation. The methodological quality of the included trials was low. The outcome measures used in most studies were not intervention specific and often only focused on body function and activity level as defined by the International Classification of Function, Disability and Health. There is a need to determine the efficacy of exercise programs to improve the daily activity and participation level of children with CP and increase their self-competence or quality of life.

* Lower concentrations of Vitamin D are associated with significant back pain in older women but not in men in the same age group, says an article in the May issue of Journal of the American Geriatric Society (Vol 56, No 5). APTA member Gregory E Hicks, PT, PhD, was lead author.

The study's goal was to examine associations between vitamin D status and musculoskeletal pain in older adults and whether they differ by sex. The 958 participants age 65 or over were selected from city registries of Greve and Bagno a Ripoli in the Chianti geographic area near Tuscany, Italy. Pain was categorized as mild or no pain in the lower extremities and back; moderate-to- severe back pain, no lower extremity pain; moderate-to-severe lower extremity pain, no back pain; and moderate-to-severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L.

Results showed 58% of the women had at least moderate pain in some location, compared with 27% of the men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women but not in men.

Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, the researchers say these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.

* In a study of work-related back pain claims, workers treated by physical therapists, surgeons, or chiropractors expressed more satisfaction with their health care than those treated by physicians, says an article in the May-June issue of The Spine Journal (Vol 8, No 3). The study also showed that satisfaction with health care has a significant effect on jobless spells and varies significantly among provider types.

The Arizona State University Healthy Back Study (HBS) examined health care satisfaction by provider type and its effect on return to work. Researchers estimated satisfaction differentials by provider type, using two components of overall satisfaction: bedside manner and effectiveness of care. They also examined how health care satisfaction affects the duration of jobless claims.

Participating were 1,831 workers who completed a baseline interview, with follow-up interviews at 1 month, 6 months, and 1 year. The HBS merged demographic and claims characteristics from the workers' compensation claim files with self-reported severity measures, measures of satisfaction, and post-onset employment from worker interviews.

Outcome measures included overall and detailed satisfaction with treatment and workers' compensation claim duration. The duration analysis links differentials in health care satisfaction to differences in claim durations.

The study also found workers are more concerned with the effectiveness of care than with the bedside manner of their provider, and that one standard deviation improvement in satisfaction with the health care provider reduces claim duration by about 25%.

* Despite the advances in pharmacological therapy for ankylosing spondylitis, physical therapy remains an essential part of the management plan, says an article in the May issue of Current Opinion in Rheumatology (Vol 20, No 3).

Researchers at Case Western Reserve University School of Medicine reviewed studies of various physical therapy programs in ankylosing spondylitis and identified their benefits and potential indications for the treatment of this disease.

Clinical studies evaluating various exercise and physical therapy programs have shown that physical therapy under the supervision of a physical therapist improves posture, fitness, mobility, function, and mood. Water therapy may improve symptoms, function, and overall sense of health. Inpatient rehabilitation may provide rapid short-term improvement in pain and stiffness, mobility, function, and quality of life for patients with severe active disease. Home exercise programs also have been shown to improve symptoms, mobility, function, and overall quality of life.

Even though data are not sufficient to determine which specific physical therapy program should be recommended, physicians should implement physical therapy as part of a comprehensive management strategy for this disease. All patients should receive instructions on proper posture and home exercises and be encouraged to perform water exercises if they can. And in the most severe cases of ankylosing spondylitis, inpatient rehabilitation may be of benefit to select patients.

* Pelvic floor muscle training is recommended to be included in first-line conservative management programs for women with stress, urge, or mixed urinary incontinence, according to a Cochrane Review published in the March issue of European Journal of Physical and Rehabilitation Medicine (Vol 44, No 10).

The aim of the study review was to determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison with no treatment, placebo or sham treatments, or other inactive control treatments.

The Cochrane Incontinence Group Specialized Trials Register was searched through December 1, 2004. The review included randomized or quasi-randomized trials in women with stress, urge, or mixed urinary incontinence. One arm of the trials included pelvic floor muscle training; the other included either no treatment, placebo, sham, or other inactive control treatment. The trials were independently assessed for eligibility and methodological quality. Data were extracted, then cross-checked by the two authors. Disagreements were resolved by discussion. The data were processed as described in the Cochrane Handbook. The trials were subgrouped by diagnosis. Formal metaanalysis was not undertaken because of study heterogeneity.

Thirteen trials involving 714 women met the inclusion criteria, but only six trials (403 women) contributed to data analysis. Full text of the review is available with the abstract.

Full-text Cochrane Reviews are available to APTA members through Door.