Abstracts / Physiotherapy 91 (2005) 49–60 53

ResultsFifty-four relevant RCTs were identified, of which51 were scored for methodological quality. Sixteen RCTsinvolving 1730 patients qualified for inclusion in this reviewbased upon their methodological quality, and chronicity ofsymptoms; exercise had a positive effect in all 16 trials.Seventy-five percent of programmes (n= 12) incorporatedstrengthening exercises, of which 85% (n= 10) maintainedtheir positive results at follow-up. Supervision and adequatecompliance were common aspects of trials. Seventy-twopercent of trials supervised maintained their positive resultsat follow-up. A wide variety of outcome measures wereused. Outcome measures did not adequately represent theguidelines for impairment, activity and participation, andimpairment measures were over-represented at the expenseof others[2].

ConclusionsThe review highlighted the diversity of exer-cise programmes offered. The key finding is that exercisehas a positive effect on chronic low back pain patients, andresults are largely maintained at follow-up, despite this di-versity. Strengthening is a common component of exercise

∗ Corresponding author.E-mail address:sd.liddle@ulster.uk (S.D. Liddle)doi:10.1016/j.physio.2004.09.008

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programmes; however, the role of exercise co-interventionsmust not be overlooked. More high-quality trials are neededto accurately assess the role of supervision and follow-up, together with the use of more appropriate outcomemeasures.

Acknowledgment

The authors acknowledge grant support from the Depart-ment of Employment and Learning (NI).

Reference

[1] Bombardier C. Outcome assessments in the evaluation of treatmentof spinal disorders: summary and general recommendations. Spine2000;25:3100–3.

[2] World Health Organisation. International Classification of Functioningand Disability (ICIDH-2). Geneva: WHO; 2000, Full version.

ared

ut ofviceed inwereostse of, butd bys are

6

A national survey of accident awritten advice fo

R. Nakasha,∗, J. Perryb, E.J. PaaWarwick Emergency Care, Centre for Primb Physiotherapy Subject Division, School o

RelevanceLong-term complications occur in about 30%people who suffer acute neck sprain. Effective early magement is believed to be critical to resolution of symptoThis includes promoting positive messages about recovand avoiding the use of soft collars and rest.

Subjects Lead consultants from all 316 UK accident aemergency departments serving catchment areas of grthan 50 000 people.

MethodsPostal survey. Consultants were asked to indicthe use of a range of treatments (including ice, rest andlars, imaging, referral to psychological or physical therapmedications, method of follow up) and the frequency wwhich these treatments were used (all, some, selectedor no cases). They were also requested to provide a saof the written advice material given to patients.

Analysis Survey data were summarised using frequecounts. Two independent reviewers undertook content a

emergency consultant practice aacute neck sprain

elda, M. Williamsa, S.E. Lamba,Health Care Studies, University of Warwick, UKalth and Social Science, Coventry University, UK

,

er

ee

-

ysis of written materials, and key messages were compagainst those recommended by McClune et al.[1].

ResultsThe response rate was 79% (251 responses o316). The most common intervention was verbal adto exercise, reported by 84% of respondents to be usmost or all cases. Other treatments used frequentlywritten advice and anti-inflammatory medication. Mdepartments stated that they advised against the ucollars. Physiotherapy was used in 60% of departmentsfor selected cases only. Written materials were provide34% of consultants. The results of the content analysishown below:

Positive message about recovery (%)

Promote early return to work/activity (%) 5

Advice for/against collar (%) 49/16

Exercise (%) 79

How to contact a solicitor (%) 63

54 Abstracts / Physiotherapy 91 (2005) 49–60

Conclusion Advice is the primary method of treatingacute neck sprain, but the content and quality is variable.Research is required to establish and compare effectivemodels of advice with other forms of early managementincluding physical therapies.

∗ Corresponding author.E-mail address:Rachel.nakash@warwick.ac.uk (R. Nakash).doi:10.1016/j.physio.2004.09.009

The effect of knee pain and knee osteoarthritis onbalance and function

M.C. Halla,∗, S.P. Mocketta, M. Dohertyb

aDivision of Physiotherapy Education, University of Nottingham, Nottingham, UKb Academic Rheumatology, University of Nottingham, Nottingham, UK

PurposeTo assess the relative impact of knee osteoarthritisand knee pain on balance and function in adults over 55years of age.

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Persthe

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93.

Reference

[1] McClune T, Burton AK, Waddell G. Whiplash associated disorders:a review of the literature to guide patient information and advice.Emerg Med J 2002;19:499–506.

function were found between all groups. Subjects withknee pain, regardless of the presence of structural changes,had significantly greater disability than normal subjects( gesw ins mea-s

D nflu-e rmin-i uss sub-j sub-j rfor-m dif-f nablet had ag eaterm exactn

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eases

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[ dultsre for

RelevanceMeasures of balance (postural sway)[1] andphysical function[2] have been shown to deteriorate isubjects with symptomatic knee osteoarthritis. Howevthe relative influence of pain and radiographic changesthese measures has yet to be established.

SubjectsOne hundred and forty-two community subjecwere purposively recruited and assigned to one of fogroups based on the presence or absence of radiograosteoarthritis and knee pain.

Methods Radiographic changes were scored using tKellgren and Lawrence system, and pain was assessedtwo verbal questions taken from the National Health aNutrition Examination Survey[3] and a visual analoguescale. Postural sway was measured using the Balanceformance Monitor in bipedal standing under two condition(eyes open and closed). Function was assessed usingWestern Ontario and McMaster Universities OsteoarthriIndex (WOMAC).

Analysis Non-parametric tests (Kruskal–Wallis anMann–Whitney U) were used to assess differencespostural sway and WOMAC scores between groupCorrelations between the two measures were calculausing Spearman’s rho non-parametric test.

Results No significant differences in postural sway werfound between the four groups. Significant differences

∗ Corresponding author. Tel.: +44 115 8404879; fax: +44 115 84048E-mail address:michelle.hall@nottingham.ac.uk (M.C. Hall).doi:10.1016/j.physio.2004.09.010

-

z=−7.26,P< 0.001) and subjects with structural chanithout pain (z=− 3.36,P< 0.001). Increased disabilityubjects with knee pain was associated with increasedures of postural sway (r = 0.39,P< 0.01).

iscussionThe presence of knee pain has a greater ince than the presence of structural changes in dete

ng the functional ability in older adults. As with previotudies, there were indications of reduced balance inects with knee osteoarthritis compared with normalects. However, the data collected by the Balance Pe

ance Monitor did not consistently reveal a significanterence between the four groups and was therefore uo determine whether structural changes or knee painreater influence on postural sway. It is possible that greasurement/instrument precision would reveal theature of the relationships.

eferences

1] Hassan BS, Mockett S, Doherty M. Static postural sway, proception and maximal voluntary contraction in patients with kosteoarthritis and normal control subjects. Ann Rheumatic Dis2001;6:612–8.

2] Miller ME, Rejeski WJ, Messier SP, Loeser RF. Modifiers of chain physical functioning in older adults with knee pain: theservational Arthritis Study in Seniors (OASIS). Arthritis Rhe2001;45:313–9.

3] Basic data on arthritis of the knee, hip and sacroiliac joints in aaged 25–74 years, United States, 1971–1975. National CentHealth Statistics series 11, no. 213;1979.