ECEMBER 1978 P H Y S I O T H E R A P Y  3

g p I T O R I A L

CONTROLLED TRIALS OF PHYSIOTHERAPY
It has been obvious fo r some tim e th a t the com fort- 

alj|e era o f em pirical p h y sio th erap y  has come to an 
e n d  On each p h y sio th erap ist rests the resp o n sib ility  fo r 
e n s u r i n g  th a t every treatm en t a p a tie n t receives is not 
only safe b u t also effective and efficient. T his entails 
full exam ination o f th e p atien t, selecting th e m ost 
suitable technique o r m odality and evaluating it in 
terms o f effect o r outcom e.

For this to com e about, controlled clinical trials, 
along sim ilar lines to  those em ployed in evaluating 
drug therapy, will have to be set up. Such trials w ill 

/' ') valid only if the p aram eters by w hich efficacy is 
measured are reasonable in term s o f expected outcom e, 
the conditions being treated b y  p h y sio th erap y  have 
been show n to respond to it and a m in im u m  o f bias is 
introduced.

Some interesting and a p p aren tly  co n trad icto ry  ex­
amples o f such trials have a p p eared  in recen t medical 
literature. G raham  a n d  Bradley (N . Engl. J. M ed. 299, 
6 2 4  - 627, 1978) assessed th e  efficacy o f chest physio­
therapy and in term itten t p o sitiv e pressure breathing 
(IPPB) in  the resolution o f p n eu m o n ia in  a random ized 
clinical trial. T hey concluded th a t th ere w as no statistical 
difference betw een th e control gro u p  and treated  groups, 
the latter having received IPPB  co n cu rren t w ith p ostural 
drainage, percussion and v ib ratio n . P aram eters m ea­
sured w ere d u ra tio n  o f fever, extent o f rad io g rap h ic 
clearing, d u ra tio n  o f h o sp ital stay and m o rtality . T his 
trial confirmed som ething w hich ph y sio th erap ists have

believed, w ith o u t controlled proof, fo r m any years.
In  an o th er study, N ew ton and Stephenson (Lancet

2, 228 - 229, 1978) describe the effect o f p h ysiotherapy 
on p u lm o n ary  function. E la b o ra te  lab o rato ry  tests w ere 
done on patients receiving p h y siotherapy w hilst suffer­
ing fro m  an acute ex acerb atio n  o f chronic b ro n ch itis. 
T hey concluded th a t th ere w as no statistical difference 
in the pulm onary fu n ctio n  o f the two groups. T hus 
the controversy over the ro le  o f p h y sio th erap y  in  chest 
disease rem ains, b u t fu rth e r investigation is being 
undertaken.

A  condensed re p o rt by Sims-Williams et al. (Brit. 
M ed. J., 2, 1338 - 1340, 1978) o f a controlled trial of 
m o b ilisatio n  and m a n ip u la tio n  fo r p atien ts w ith low 
b ack p a in  in general p ractice once m ore seem s to be 
inconclusive in that, alth o u g h  the treated  gro u p  show ed 
m ore im m ediate im provem ent, th ere was no significant 
difference betw een the two groups afte r a year.

T hese controlled studies should n o t discourage 
physiotherapists, b u t should serve as stim u latio n  fo r 
fu rth e r study. E xpertise in  research m ethodology and 
critical review  o f cu rren t know ledge an d  practice 
should enable the p h y sio th erap ist to establish w hich 
techniques can be applied to the benefit o f th e patient, 
to select those conditions w hich respond effectively to 
p h y sio th erap y  an d  to im prove o r m odify existing 
techniques to achieve p ositive result.

I f  a scientific ap p ro ach  is added to  the ab ility  to 
establish w arm  hu m an  contact w ith patients, physio­
th erap y  can only go fro m  strength to strength.

Contents —  Inhoud

Editorial/Van die Redaksie ..................................................... 3

Flexor and Extensor Tendon Injuries 4

The Physio.herapy o f Flexor Tendon Injuries to the Hand ... 6

Physiotherapy in a Specialised Hand Unit
Diastasis of the Pubic Symphysis with Special Consideration of

10

Pregnancy and Parturition ... 13
A ctivities o f the S.A. Society o f Physiotherapy —  A pril-O cto ber 1978 15
News from Special Interest Groups ........................................ 17, 19

Branch News/Taknuus ................................................................. 19, 20

International Federation of O rthopaedic Manipulative Therapists 21

Vacancies .......................................................................................... 23

Courses .......................................................................................... 23

Contents 1977 - 1978 24

Abstracts/O psom m ings ... .................................................... 24

Training Centres in the Republic o f South Africa 25
South African Neurodevelopmental Therapy Association 26
13th National Council Meeting ( 2 3 -2 7  A pril 1 9 7 9 ) ............... Centrespread

R
ep

ro
du

ce
d 

by
 S

ab
in

et
 G

at
ew

ay
 u

nd
er

 li
ce

nc
e 

gr
an

te
d 

by
 th

e 
P

ub
lis

he
r 

(d
at

ed
 2

01
3.

)