A Delphi study investigating consensus among expert physiotherapists in relation to the management of low back pain.

OBJECTIVES: Low back pain (LBP) affects a large proportion of the adult population, with over 90% of people expected to experience symptoms associated with it. LBP is one of the most common conditions managed by primary health care practitioners, and physiotherapists are the largest professional group responsible for its management. Clinical guidelines exist for the management of LBP and are based on the best available evidence. However, there is currently no consensus on the actual physiotherapy management of this condition. METHODS: A three-round Delphi study was conducted among expert physiotherapists (n = 34). A focus group was initially convened to review the key questions, developed following a review of the literature. An expert panel then produced their responses, which were ranked in subsequent rounds, using a five-point Likert scale, until a predetermined point of consensus was reached. RESULTS: The results of this study indicated that it is possible to establish consensus among expert clinicians in relation to the management of LBP, with consensus reached on 64 (67.3%) of the 95 responses identified. The results also showed that, in general, physiotherapy management within the location studied conformed to current LBP evidence-based clinical guidelines. In addition, the expert panel identified the importance of a biopsychosocial approach to LBP management. CONCLUSIONS: Although the study identified that consensus existed in relation to many aspects of physiotherapy management of LBP, it was also noted that confusion existed in relation to several key areas of practice, highlighting the need for further work.

The effects of progressive resistance training for children with cerebral palsy.

OBJECTIVES: To investigate the effects of progressive resistance training of quadriceps and hamstrings muscles in children with cerebral palsy (CP). DESIGN: Pilot study using a repeated measures design with measurements at baseline, immediately after six weeks training then at four-week follow-up. SETTING: The project was undertaken within the physiotherapy department of two special schools in Glasgow. SUBJECTS: A convenience sample of eight children aged between six and 12 years, with hypertonic CP. INTERVENTION: The subjects participated three times per week in a six-week, progressive, free-weight, strengthening programme. OUTCOME MEASURES: Maximum isometric muscle strength and resistance to passive stretch were measured with a hand-held myometer. The Gross Motor Function Measure and a 10-metre timed walking test, were used to assess function and gait parameters respectively. RESULTS: Muscle strength increased, with the quadriceps to hamstrings strength ratio moving towards normal. These changes were retained at follow-up. Muscle tone decreased and continued to decrease to follow-up. The standing (D) and walking, running and jumping (E) goal areas of the Gross Motor Function Measure showed improvement that continued towards follow-up. Walking speed and step rate increased. CONCLUSIONS: A future large-scale randomized controlled study would be of value to substantiate these results as the small convenience sample and lack of control group limit this study. However, the finding that no adverse effect accompanied the positive outcomes in strength and function may encourage clinicians to consider resistance training alongside standard therapeutic interventions.