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  1. Robert D Herbert, senior lecturer (R.Herbert@cchs.usyd.edu.au)a,
  2. Chris G Maher, senior lecturera,
  3. Anne M Moseley, lecturerc,
  4. Catherine Sherrington, research managerb
  1. a School of Physiotherapy, University of Sydney, PO Box 170, Lidcombe NSW 1825, Australia
  2. b Prince of Wales Medical Research Institute, PO Box 42, St Pauls NSW 2031, Australia
  3. c Rehabilitation Studies Unit, University of Sydney, PO Box 6, Ryde NSW 1680, Australia
  1. Correspondence to: R D Herbert

    Publication of randomised trials and systematic reviews in physiotherapy has increased spectacularly over the past few years. There are more than 2700 randomised trials and systematic reviews in physiotherapy, of which more than 800 have been published since 1997.1 The evidence from the best of these trials confirms the value of some current physiotherapy practices and the ineffectiveness of others. Some little used interventions have been found to be remarkably beneficial. This article describes some advances in our understanding of physiotherapy that have arisen from recent clinical trials.

    Summary points

    Early provision of reassurance and advice to return to activity can prevent chronic disability associated with back pain

    Massage and electrotherapy are not useful for chronic pain, but exercise programmes can reduce disability

    Women with urinary incontinence can be helped with pelvic floor muscle training

    Multidisciplinary stroke rehabilitation programmes reduce the risk of disability and death and institutionalised care or dependency

    Prophylactic chest physiotherapy reduces postoperative complications in high risk patients

    Pulmonary rehabilitation programmes for people with asthma and chronic obstructive pulmonary disease reduce dyspnoea and increase walking distance

    Tailored exercise programmes reduce the risk of falls in elderly people

    Methods

    With the help of several organisations and many volunteers, we have produced a web based database of randomised trials and systematic reviews in physiotherapy (PEDro).1 Trials on the database are rated for methodological quality by using a modification of the Delphi list.2 To produce this article, we scanned the database looking for recent systematic reviews or high quality clinical trials with clear conclusions and with potential to improve quality of life. We present selected findings of these trials and reviews.


    Embedded Image

    Isometric exercise for back extensor muscles: exercise can reduce disability associated with chronic low back pain

    Chronic musculoskeletal pain

    Musculoskeletal disorders are the most common cause of chronic incapacity in industrialised countries. …

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