Yudu - sportEX medicine - 1999-2010

JOURNAL WATCH Journal Watch

A total of 131 participants with a new episode of patellofemoral pain syndrome were recruited by their general practitioner or sport physician. They were randomised into an intervention group (n=65) that underwent a standardised exercise programme for 6 weeks. This was tailored to individual performance and supervised by a physical therapist and they were instructed to practise the tailored exercises at home for 3 months. The control group (n=66) was assigned to usual care, namely a “wait and see” approach that involved rest during periods of pain and refraining from pain-provoking activities. Both groups group received written information about patellofemoral pain syndrome and general instructions for home exercises. The primary outcomes were self-reported recovery (7-point Likert scale), pain at rest and pain on activity (0–10 point numerical rating scale), and function (Kujala scale) at 3 months and 12 months follow-up. After 3 months, the intervention group showed better outcomes than the control group with regard to pain at rest, pain on activity and function. At 12

SUPERVISED EXERCISE THERAPY VERSUS USUAL CARE FOR PATELLOFEMORAL PAIN SYNDROME: AN OPEN LABEL RANDOMISED CONTROLLED TRIAL. Van Linschoten R, Van Middelkoop M et al. BMJ 2009;339:b4074.

months, the intervention group continued to show better outcomes than the control group with regard to pain at rest

and pain on activity, but not function. A higher proportion of patients in the exercise group than in the control group reported recovery (41.9% vs 35.0% at 3 months and 62.1% vs 50.8% at 12 months), although the differences in self-reported recovery between the two groups were not statistically significant. Analyses revealed that patients recruited by sport physicians (n=30) did not benefit from the intervention, whereas those recruited by general practitioners (n=101) showed significant and clinically relevant differences in pain and function in favour of the intervention group.

Note: The Likert scale (named after designer

Rensis Likert) is a psychometric scale commonly used in questionnaires. Respondents specify their level of agreement to statements that usually range from “strongly agree” to “strongly disagree”.

RATE OF UNDESIRABLE EVENTS AT BEGINNING OF ACADEMIC YEAR: RETROSPECTIVE COHORT STUDY. Haller G, Myles S, et al. BMJ 2009;339:b3974.

The objective of this study was to determine whether an increase in the rate of undesirable events occurs when care is provided by clinical trainees at the beginning of the academic year. It examined 19,560 patients undergoing an anaesthetic procedure carried out by first to fifth ayear trainees starting work for the first time at a university

hospital in Melbourne, Australia between 1995 and 2000. The conclusion was that the rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year. There were 137 events vs 107 events per 1000 patient hours across the time period. This excess risk was seen for all trainees, regardless of their level of seniority. The excess risk decreased progressively over the first month of the semester, and the trend disappeared fully in the fourth month. The most important decreases were seen in injuries to central and peripheral nerves, inadequate oxygenation of patients, vomiting/aspiration in theatre, and technical failures during tracheal tube placement.

sportEX comment Clearly you should try not to go into hospital in the first semester! The most shocking result is that the rate of undesirable events at the start of the year was greater among trainees at the beginning of the academic year, regardless of their level of clinical experience, which tends to suggest that within-hospital factors – such as knowledge of the working environment, teamwork, and communication – might contribute to the increase in undesirable events. This research is about doctors, but it’s possible that a similar situation may arise with other health professionals. Think about the changing placements of physiotherapy students and departmental rotations of the newly qualified. How good is the standard of care they deliver?

The Kujala scale is a specific questionnaire for determining patellofemoral pain during activities of daily living. The final score ranges from 0 to 100, with the higher score being better.

sportEX comment Another study with “wait and see”

as a treatment modality. At least this one comes down in favour of doing something. As doing nothing is described as “usual care” does this mean that this has become the norm? And is this why the patient group referred by their GPs did better? Are they used to not being given treatment and therefore pleasantly surprised and respond positively when they do? Note also that both groups received written information about their problem. Was this an active intervention in itself? Might it have given them more of an insight into a self- healing process?