JOURNAL WATCH

THE INTERNATIONAL CLASSIFICATION OF

FUNCTIONING, DISABILITY AND HEALTH: RELEVANCE AND APPLICABILITY TO

PHYSIOTHERAPY. Sykes C. Advances in Physiotherapy 2008;10:110-118

This article focuses on the International Classification of Functioning, Disability and Health (ICF) and the role of the World Health Organization in maintaining and updating it. The ICF is an important tool that can augment physical therapy practice by providing a framework and common language. It can aid the collection of consistent and reliable information with which to appraise physical therapy practice, facilitate communication across settings and disciplines, and select or develop consistent outcomes measures.

sportEX comment Physical therapy in sport is a

highly specialised branch of medicine and good communication is essential not only between disciplines but also between countries. Think of the number of international players. Their medical advisors often need to liaise with colleagues in other counties. The ICF framework provides a valuable role in this.

ELITE MALE ADOLESCENT GYMNAST WHO ACHIEVED UNION OF A PERSISTENT BILATERAL PARS DEFECT. Vrable A, Sherman AL. American Journal of Physical Medicine and Rehabilitation. 2009;88:156–160

An adolescent 15-year-old male competitive gymnast presented to a university-based multidisciplinary spine institute with a persistent lower back pain for 18 months. Although the results of X-rays were negative, his pain rendered him unable to compete in his sport any longer. A computed tomography (CT) scan was performed, which showed a bilateral pars fracture at L5, without spondylolisthesis. A nuclear medicine bone scan revealed negative findings, confirming chronic non-union. The patient completed a 4-week course of physical therapy for 6 months, without any relief of pain or radiological evidence of healing. He was subsequently treated with a bone stimulator for 4 hours/day and was recommended to wear a warm-and-form-type brace. Isometric core trunk exercises were also initiated. After 6 weeks of treatment, the subject showed clinical improvement at the follow-up visit. A CT scan performed 12 weeks after the initial scan showed complete union of the fracture, correlating with clinical improvement. Two years later, the athlete remains completely pain-free, is training regularly, and is able to compete on a national and, possibly, international level.

sportEX comment Many people working in sports medicine will have had similar patients who present with

lower back pain and produce negative X-rays results and yet fail to improve with conservative treatment. The CT scan may answer the diagnostic problem. Bone growth stimulation is the technique of promoting bone growth in difficult-to-heal fractures by applying a low electrical current or ultrasound to the fracture. The theory behind this is based on the fact that the concave side of the bone becomes negatively charged and the convex side is positively charged. It is believed that artificially encouraging this by charging with an electric current will speed healing.

PHYSICAL ACTIVITY HABITS OF DOCTORS AND MEDICAL STUDENTS INFLUENCE THEIR COUNSELLING PRACTICES. Lobelo F, Duperly J, Frank E. British Journal of Sports Medicine 2009;43:89–92

Doctors are a respected source of health-related information and can provide continuing preventive

counselling and follow-up; they may

have ethical obligations to prescribe PA. Several barriers to PA counselling exist, including insufficient training and motivation of doctors Rates of exercise counselling

by doctors remain low; only 34% of US adults report exercise counselling at their last medical visit. Research shows that clinical providers who themselves act on the advice they give provide better counselling and motivation of their patients to adopt such health advice. There is compelling evidence that the health of doctors matters and that doctors’ own PA practices influence their clinical attitudes towards PA.

sportEX comment This essay is a warning: practise

what you preach. The evidence is that physicians’ own attitudes are passed on to patients. It is reasonable to extrapolate the evidence to include the practices of all health professional rather than only doctors.

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