What Makes a Great Physiotherapy Clinical Trial? Article of The Week #2

Every Monday you will find a top quality research study summarised for you here on Physiospot. The articles are chosen as  they are high quality and high impact and likely to shape your clinical practice. After all it’s difficult finding the gems in all the research that’s published daily. So let us do the hard work for you. 

There are some amazing examples of primary research led by physiotherapists. To celebrate the 20th anniversary of PEDro physiotherapists were invited to nominate RCTs published between 2015-2019 that answered important clinical questions. The submissions were judged by an expert panel and they nominated a top 5 based on innovation, clinical impact and robust methodology. Looking at these top 5 articles we can draw out themes which we can use to direct future research.

What Were the Top 5?

LIPPSMAck POP – Lung Infection Prevention Post Surgery – Major Abdominal with Pre-Operative Physiotherapy

Conclusion:  In a general population of patients listed for elective upper abdominal surgery, a 30 minute preoperative physiotherapy session provided within existing hospital multidisciplinary preadmission clinics halves the incidence of PPCs and specifically hospital acquired pneumonia

Surgery & Physiotherapy

SARAH – Exercises to Improve Function of The Rheumatoid Hand 

Conclusion: We [the researchers] have shown that a tailored hand exercise programme is a worthwhile, low-cost intervention to provide as an adjunct to various drug regimens. Maximisation of the benefits of biological and DMARD regimens in terms of function, disability, and health-related quality of life should be an important treatment aim.

Rheumatoid Hand

AVERT – Efficacy and Safety of Very Early Mobilisation Within 24hrs of Stroke Onset

Conclusion – First mobilisation took place within 24 h for most patients in this trial. The higher dose, very early mobilisation protocol was associated with a reduction in the odds of a favourable outcome at 3 months. Early mobilisation after stroke is recommended in many clinical practice guidelines worldwide, and our findings should affect clinical practice by refining present guidelines; however, clinical recommendations should be informed by future analyses of dose–response associations.

Stroke Rehab

HIHO – Effect of Inpatient Rehabilitation vs A Monitored Home-Based Program on Mobility in Patients with Total Knee Arthroplasty

Conclusion – Among adults undergoing uncomplicated total knee arthroplasty, the use of inpatient rehabilitation compared with a monitored home-based program did not improve mobility at 26 weeks after surgery. These findings do not support inpatient rehabilitation for this group of patients.

TKR Rehabilitation

UK FASHIoN – Hip Arthroscopy Versus Best Conservative Care for The Treatment of Femoroacetabular Impingement Syndrome

Conclusion – Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement than did personalised hip therapy, and this difference was clinically significant. Further follow-up will reveal whether the clinical benefits of hip arthroscopy are maintained and whether it is cost effective in the long term.

Hip Impingement

What Makes These Studies Exceptional?

Each of these studies scored highly on PEDro (8/10) and all have follow-up rates of 89-99%, moderate/large sample sizes (165-2104) and recruited from multiple sites. The drop out / follow up rate is worth particular mention as this is something which is often poor / low in physiotherapy research. It is also important to consider that both AVERT and HIHO has negative outcomes which highlighted a need to change clinical practice. Arguably the most important commonality between all 5 studies is that they aimed to answer important clinical questions which challenge conventional thinking and result in immediate implications for clinical practice.