Physiotherapy, driving and smoking

No time to read the journals? Let Dr Suzanne Hunter guide you through the best research.

Research of the week

Sports injuries in children
Br J Sports Med 2007;41:627-38

Given the rise in obesity in children, it is important to encourage them to participate in regular sporting activities.

As well as the discomfort and inconvenience of sports injuries for children and parents, they can remove children from the habit of exercise. This systematic review looked for effective strategies for avoiding sports injuries.

They found that head protection and knee braces were ineffective, but pre-season training, pre-match warm-up and agility exercises, and general proprioceptive exercises were all of benefit. I hope this message gets through to sports teachers and coaches. 

Physiotherapy after knee replacement
BMJ, doi:10.1136/bmj.39311.460093.BE

Over 55,000 total knee replacements were performed in the UK in 2005. Post-operative stays are getting shorter and therefore patients receive less structured physiotherapy and rehabilitation.

This systematic review evaluated the effectiveness of physiotherapy after arthroplasty. The results will be a comfort for those who have advocated earlier release from hospital. Although those receiving exercise interventions with exercises based on functional activities showed an initial improvement, by a year there was no difference between these patients and those who had received traditional home exercise and advice programmes.

Driving and vision
J Public Health (Oxf) 2007;29:230-5

On a road in Wales, with the assistance of the police, this research team stopped 301 car and motorcycle drivers and tested their eyesight.

Around 2 per cent failed the test. Across the UK this would equate to half a million drivers. The problem was worse in drivers over 45. Given the importance of eyesight for preventing accidents, this represents a significant problem.

Cigarette pricing and smoking
Am J Public Health 2007;97:1,873-7

One of the justifications for increasing the tax on cigarettes is that the increase in price will put people off smoking, or make them cut down.

This piece of research rather debunks that myth. They compared smoking levels among different income groups against cigarette prices in the period 1984-2004.

Although a rise in price had an effect on the wealthier population, leading to less smoking, it had no effect on the level of smoking in the poorest.

Perindopril in coronary artery disease
Heart 2007;93:1,081-6

The HOPE study confirmed that ACE inhibitors were effective in reducing cardiovascular events in patients who did not have heart failure. There is currently debate about the 'added value' of angiotensin II receptor blockers. So I was surprised to come across an article that mentioned an ACE inhibitor.

The European trial on reduction of cardiac events with perindopril (EUROPA) confirmed that the use of perindopril in these patients with stable coronary artery disease resulted in a 1.9 per cent absolute risk reduction in cardiovascular death, MI or cardiac arrest.

This paper concludes by stating that cost effectiveness varies with risk characteristics. It found that 97 per cent of patients randomised to perindopril would have an incremental cost per QALY gained below £30,000.

Inequalities in care of patients with CHD
Heart 2007;93:1,256-62

It is known that CHD risk factors such as smoking, obesity and diabetes are more common in patients with schizophrenia and bipolar disorder. This study explored whether patients with CHD and schizophrenia were likely to receive a poorer level of care.

The authors concluded that for the majority of CHD care indicators, such as achievement of target BP or cholesterol levels, there was no significant difference between patients with schizophrenia and bipolar disorder and those without.

However, patients with schizophrenia showed significant deficits in recording of their cholesterol values and prescription of statins.

Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals.

The quick study
Knee replacement patients show no greater improvement if given home exercise programmes.

Regular eye checks should be encouraged in drivers to reduce accidents.

Smokers do not necessarily cut down following increases in the price of cigarettes.

Perindopril may be cost-effective in reducing risk of cardiovascular events in patients with stable coronary artery disease.

Mental health patients with CHD may be receiving worse cardiovascular care than their counterparts.

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