Physiotherapy December 2001/vol 87/no 12

677

Letters

Uncertainty of Treatment for Myalgic EncephalopathyI AM replying to the letter by PeterWhite and Vanessa Naish in theSeptember edition of Physiotherapyconcerning my review of theExploration of Clinical Issues by Dr Charles Shepherd and Dr AbhijitChaudri about ME/CFS/PVFS. I appreciate work being done to findways of helping patients with thiscondition while the research continuesto find the causes. Robin Fox says in a Research Portfolio on CFS (1998): ‘I have seldom encountered a set oftypescripts with more “buts”. Apartfrom the conflicting data, the whole

area is beset with uncertainties aboutwhat is primary and what is secondary.’

The ME Association’s publication(2001) contains 93 references. In myreview I stated: ‘Approaches tomanagement of ME/CFS includepharmacological treatments.’ This is adetailed account of the many drugstried, the fact that few have beensubjected to organised, randomisedcontrolled trials, and that no singledrug treatment has been effective inthe majority of patients.

The section on activity managementincludes the advice to doctors to

provide ‘clear guidance on how to setrealistic goals, creating flexible plans to account for fluctuations in energylevels, and symptoms, and remainpositive about recovery’. The sectioncontinues: ‘Referral to anoccupational therapist orphysiotherapist who can design aprogramme aimed at appropriateactivity management can be helpful forthose who are having difficulty with thiscrucial aspect of management.’

The greatest difficulty in assessingthe condition or monitoring effects oftreatment is the dependence on

WITH respect to the paper ‘Stabilityand manoeuvrability of wheeledwalking frames’ which appeared in theAugust issue of Physiotherapy (Anslow etal, 2001) it was encouraging to see sucha critical evaluation of fall preventionand mobility innovations available inthe UK.

Your readers may be interested toknow that in Sweden such evaluationsbegan some 25 years ago when healthauthorities first became aware of theescalating costs of hospitalisation andrehabilitation due to falls among olderand mobility-impaired people. One ofthe outcomes of these studies was theidentification of four-wheeled walkersas the safest and most stable, practical,ergonomically-appropriate and cost-effective devices for fall prevention.

Since that time, the Swedishhealthcare industry has been extremelyactive in designing, developing andmarketing a wide range of both multi-purpose and specialist walkers basedon the four-wheeled concept and athriving export trade has beendeveloped, principally to Germany,USA and Japan as well as throughoutScandinavia. More than 3.5% of theSwedish population currently use sucha walking aid and this is claimed to beone reason why Sweden has one of theoldest populations in Europe; the

walkers improve mobility and enablepeople to live independently longer,substantially reducing public healthcosts because less home help isrequired.

This constantly-developing range of modern four-wheeled walkers isavailable in the UK but did not appearto feature in the Medical DevicesAgency evaluation project.

One of the casualties of the earlySwedish studies was the three-wheeledwalker format. Since 1988, no three-wheeled walker has been approved foruse in Sweden as all models subjectedfor SINTEF* testing have failed thestability ratings which are a mandatorypart of the testing procedure. Allwalking aids approved for use inSweden and elsewhere in Scandinaviamust carry SINTEF certification.

The MDA study did not attempt toestablish any causal relationshipbetween the use of a walker and theincidence of falls. Such a relationshiphas been established in Sweden in arecent project which also examined thesocio-economic relevance of a walker-based fall prevention strategy (Jönsson,1999, 2001).

I strongly endorse the MDA studyconclusion that individual user needsand environmental factors should befully considered before a walking aid is

prescribed or bought. Given theavailability of a wide range of optionscatering for several additionalimportant factors which did not fallwithin the evaluation criteria of theMDA study, it is indeed essential thatwalker choice is based upon individualclinical assessment.

Sonja Waara-ConwayCanterbury

*SINTEF Unimed is an independenttesting laboratory for walking aids,based at Blindern, Oslo, Norway,(www.sintef.no/units/unimed/fnh/Walker/Walker)

References

Anslow, R, Pinnington, L L, Pratt, D J,Spicer, J, Ward, D and Weyman, N(2001). ‘Stability and manoeuvrabilityof wheeled walking frames’,Physiotherapy, 87, 8, 402-412.

Jönsson, L (1999). ‘The importance ofthe walker for elderly women living intheir home environment’,Hjälpmedelsinstitutet (The SwedishHandicap Aids Institute), Box 510, 16215 Vällingby, Sweden. Order no 99203.

Jönsson, L (2001). ‘A follow-up study toa three-year investigation of theimportance of the walker for elderlywomen living in their homeenvironment’, Hjälpmedelsinstitutet(currently in translation).

Four-wheeled Walkers Help You Live Longer