NIHR Themed Review
Moving Forward - Physiotherapy for musculoskeletal health and wellbeing
Muskuloskeletal problems are the leading cause of pain and disability in the UK. Characterised by pain and loss of function, these conditions can diminish quality of life, impact on family and social relationships, make everyday activities difficult and limit a person’s capacity to work. Physiotherapy is important for preventing and reducing the negative impacts of musculoskeletal conditions.
Moving Forward provides an overview of research funded by the NIHR and others, focusing on physiothera...
Opioid drugs are no better than standard painkillers for long-term back and joint pain
People with long-term back pain, or osteoarthritis of their hips or knees, do not get better pain relief from opioid drugs and are more likely to get side effects than those who take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen.
A US study assigned 240 patients to either opioid or non-opioid pain relief drugs and measured their pain over 12 months. Those who were assigned opioid drugs had less relief of their pain and also were more likely to have si...
Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery
In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint replacement surgery as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug.
Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the r...
Mesh repair of small umbilical hernias reduces recurrence compared to sutures
Repairing small umbilical hernias with surgical mesh rather than sutures reduces the chance of the hernia returning. Complications such as wound infection and pain are not affected by the type of repair.
Adults with umbilical hernias need surgery to prevent serious bowel complications. There are no guidelines about how to best to treat them. In practice, larger hernias tend to be repaired with mesh, while smaller ones are repaired with sutures. This trial of adults with umbilical hernias of 1 t...
Exercise improves intermittent claudication leg pain on walking
People with intermittent claudication who participate in structured exercise programmes can walk about 80 metres further without experiencing leg pain than those who do not do the programme. They can also walk about 120 metres further overall.
Intermittent claudication is a cramp-like pain in the legs caused by narrowing of the arteries, which restricts blood flow to the muscles. There’s increasing evidence that maintaining physical activity can help. This updated systematic review combin...
Common osteoporosis drugs may prevent breast cancer spreading to bone
Drugs commonly prescribed to prevent bone thinning probably help prevent the spread of early breast cancer to the bones in a few women, when taken in addition to standard cancer therapies. However, the overall benefits may be small, for example preventing spread to bone or death in about one extra woman in every 100 treated for about five years. This is a complex area because many of the treatments for breast cancer are known to worsen bone thinning, but there are other bone strengthening benefi...
Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate
It seems safer to reduce the dose of biological drugs, rather than to stop them if people with rheumatoid arthritis and their doctors want to avoid relapse. Stopping these powerful drugs caused the disease to recur in 58% of people compared with 29% who continued them. Reducing the dose also led to more relapses for people in remission, but did not cause those with low-grade disease activity to worsen.
Rheumatoid arthritis is a chronic disease which causes pain, swelling and stiffness in the sm...
A surgical procedure for shoulder pain is less effective than previously thought
An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all.
This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. Th...
Two common operations to fix a broken tibia have similar outcomes
In people who had broken the lower part of their tibia (shin bone), fixation using a metal rod nailed to the insideof the bone was compared with a locking plate screwed onto the surface of the bone. There was no difference in the quality of life, disability or pain at 12 months for people who had fractures of the lower tibia fixed using either technique.
NICE guidance recommends that surgery takes place within 24 hours of injury but does not mandate which type of surgery to perform. This NIHR U...
Two nerve drugs are not suitable for treating long-term low back pain
The drugs gabapentin and pregabalin (gabapentinoids) were found not to help lower back pain that had lasted more than three months. Gabapentin gave no benefit compared with placebo, while pregabalin was less effective than other painkillers. Both were associated with several side effects, such as dizziness.
Long-term low back pain without clear cause is very common. It causes considerable loss of productivity and places a high demand on the healthcare service. It is difficult to treat, and peop...