Background

Low back pain (LBP) with or without leg pain, is one of the most common causes of pain and disability and a frequent cause of attendance to emergency departments (ED). Increasing numbers of patients create a difficult challenge for clinicians to effectively and appropriately manage patients with LBP in an urgent care setting.

Aim: To assess the value of physiotherapy in the treatment of patients with subacromial impingement syndrome.

Methods: Patients with subacromial impingement syndrome were identified. Those who had not previously had any physiotherapy and had failed to respond to other types of non-surgical management were selected and placed on the waiting list for subacromial decompression. These patients were randomised into two groups. One group was referred for physiotherapy while waiting for surgery. The control group had no intervention prior to surgery. The patients in the physiotherapy group underwent an assessment and treatment by a single physiotherapist. All patients were evaluated independently after each of three and six months. The Constant Score was used to assess all patients initially and at each visit.

Results: Physiotherapy group: All patients (n=42) increased their Constant score. Eleven of the 42 patients (26%) improved to an extent that surgery was no longer required. In patients not requiring surgery, the mean improvement in the Constant score was 25 (range: 12 to 45) In the patients requiring surgery, (n=31), the mean improvement was 21 (range: three to 34). Patients not requiring surgery had a higher initial Constant score, 65 (range: 30–84) than those requiring surgery 48 (range: 17 to 59). Patients not requiring surgery also tended to be younger 52 (range: 27 to 68) than those requiring surgery 59 (range: 48 to 68).

Control Group: All patients (n=23) went on to have surgery. The mean improvement in Constant score was two (Range: −16 to 12).

Conclusions: All patients with subacromial impingement syndrome improved with physiotherapy when compared with a control group that did not receive physiotherapy. Some patients in the physiotherapy group (26%) improved to the extent that surgery was no longer required.

The purpose of this study was to assess the value of physiotherapy in the treatment of patients with subacromial impingement syndrome

Patients with subacromial impingement syndrome were identified. Those who had not previously had any physiotherapy and had failed to respond to non-surgical management were selected and placed on the waiting list for subacromial decompression. Patients were randomised into two groups. One group was referred for physiotherapy while waiting for surgery. The control group had no intervention prior to surgery. The patients in the physiotherapy arm underwent assessment and treatment by a single physiotherapist. All patients were evaluated independently at three and six months. The Constant Score was used to assess all patients initially and at each visit.

For the physiotherapy group, all patients (n=42) increased their Constant score. Eleven of the 42 patients improved to an extent that surgery was no longer required (26%). In patients not requiring surgery, the mean improvement in Constant score was 25 (12–45). In patients requiring surgery (n=31), the mean improvement was 21 (3–34). Patients not requiring surgery had a higher initial Constant score, 65 (30–84) than those requiring surgery 48 (17–59). Patients not requiring surgery also tended to be younger 52 (27–68) than those requiring surgery 59 (48–68).

For the control group, all patients (n=23) went on to have surgery. The mean improvement in Constant score was two (−16 to 12)

All patients with subacromial impingement syndrome improved with physiotherapy when compared to a control group that did not receive physiotherapy. Some patients in the physiotherapy group improved to the extent that surgery was no longer required (26%)

Background: In an effort to reduce the waiting times for outpatient appointments and surgery ‘Direct Access Arthroscopy Services’ have been set up in some centres whereby GP’s assess patients with acute knee injuries.

The value of a physiotherapist in the Back Pain clinic is well known, however their effectiveness in an Acute Knee Injury Clinic has not been documented despite the fact that they have already been used in some centres to triage these injuries.

Purpose of study: This study was therefore set up to determine if an experienced physiotherapist can accurately diagnose an acute knee injury and formulate a treatment plan.

Methods: 50 consecutive patients with acute knee injuries were seen in the fracture clinic. They were each assessed and a diagnosis made and treatment plan formulated by the consultant, an orthopaedic SHO and two experienced physiotherapists in random order. Evaluation was by history, examination and X Rays. Final diagnosis was based on arthroscopic findings, further investigations or response to conservative treatment.

Results: We found no statistically significant difference in the clinical diagnosis and treatment plans made by the consultant and the orthopaedic physiotherapist p> 0.05 (Mc Nemar’s Test). In addition the physiotherapist had a higher proportion of correct diagnoses compared to the SHO. Again this difference was not statistically significant.

Conclusion: The results suggest that an experienced physiotherapist can safely and effectively be used to assess patients with an acute knee injury in the outpatient clinic setting.