Abstract:Scoliosis is a common condition that every primary care provider will encounter. There are many treatments available in its management, including observation, physical therapy, pain management strategies, casting, bracing and surgery. In this narrative review, the roles of each of the non-operative strategies in managing adult and paediatric scoliosis are explored, and the evidence supporting each is summarised. Scoliosis affects people at every stage of life, and an understanding of the treatments available will aid in counselling patients and making appropriate referrals.
• Casting and bracing have roles in the growing skeleton only
• Physical therapy has limited evidence in both adult and paediatric deformity
• Alternative therapies have no proven use in the management of scoliosis
The majority of patients with scoliosis can be observed
Reliable patient information is critical
There is limited evidence that physiotherapy is effective, and no evidence that alternative therapies are effective in treating scoliosis
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The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm
Kevin D. Gross PT, PhD, Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, MA, U.S.A. David J. Hunter MBBS, PhD, Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, MA, U.S.A.
Despite the increasing prevalence of symptomatic knee osteoarthritis, many uncertainties exist pertaining to its management. Many putative risk factors are characterized by excessive loading of vulnerable joint structures. Clinical examination includes assessment of knee function and the influence of modifiable risks such as malalignment, muscle strength, and obesity. Knee braces, footwear, exercises, and dieting are prescribed for the purpose of improving the distribution of loads on the knee, and reducing the likelihood that osteoarthritis (OA) and its symptoms will worsen. In this conservative approach, pharmaceuticals of low toxicity are preferred and given only when other methods fail to achieve functional improvement. Key words: knee osteoarthritis, mechanical risk factors, nonpharmacologic management, physiotherapy, joint replacement.
Translating Evidence into Clinical Practice: A Falls Prevention Program for Community-Dwelling Seniors
Susan Maddock, RPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.
Susan Gal, BScPE, BHScPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.
MaryJane McIntyre, BScPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.
Rory H. Fisher, MB, FRCP(Ed)(C), Division of Geriatric Medicine, Department of Medicine, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.
Barbara A. Liu, MD, FRCPC, Division of Geriatric Medicine, Department of Medicine, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto; Program Director, Regional Geriatric Program of Toronto, Toronto, ON.
The Falls Prevention Program at Sunnybrook & Women’s College Health Sciences Centre was developed to provide patients with an evidence-based, multidisciplinary intervention to prevent falls. The goals of the program are to decrease the incidence of falls and improve patient confidence. Participants in the program are 65 or older with a history of falls or near-falls and are living in the community. Participants complete a 45-minute exercise circuit, twice a week for six weeks. In addition, patients undergo geriatric medical assessment and are seen by an occupational therapist for home safety education. Patients report fewer falls during the intervention and at follow-up, and subjectively report that they benefit from the program. The positive effects of this program support existing evidence that multidisciplinary intervention plays an important role in fall prevention.
The Role of Rehabilitation in Parkinson’s Disease: A Review of the Evidence
K.H.O. Deane, BSc, PhD and C.E. Clarke, BSc, MD, FRCP, Department of Neurosciences, The University of Birmingham and City Hospital, Birmingham, UK.
Many clinicians, therapists and patients support the use of rehabilitation in the treatment of Parkinson's disease. However, systematic reviews reveal a lack of conclusive evidence to support the use of common forms of rehabilitation therapy in this movement disorder. Lack of evidence of efficacy is not proof of lack of effect. Large pragmatic randomized controlled trials are required to determine the effectiveness and safety of rehabilitation therapies for people with Parkinson's disease. Key words: Parkinson's disease, occupational therapy, physiotherapy, speech therapy, rehabilitation.