Hurley, Deirdre A.

The aim of this study was to identify the physiotherapeutic management of patients with fibromyalgia syndrome (FMS) in Northern Ireland. A postal questionnaire was distributed to physiotherapists working in outpatient settings in this region (n = 106). A response rate of 71% (n = 75) was achieved. Patients with FMS featured in the caseloads of all respondents. The most important reported goal of treatment was to ‘increase daily function’ (n = 24; 32%). Exercise (n = 44; 58.7%) and hydrotherapy (n = 12; 16.0%) were the most common treatment approaches. A total of 45.3% (n = 34) of respondents stated that they did not believe they could adequately assess patients with FMS and 41.3% (n = 31) reported that they had no training in the management of FMS. Private practitioners were significantly (P = 0.05) more likely to believe that physiotherapy was beneficial for patients with FMS than their NHS counterparts. In conclusion, physiotherapy treatments for patients with FMS in Northern Ireland are consistent with current evidence. However, practice varies and physiotherapists are uncomfortable with their level of training in FMS.

Objectives: To assess the clinical effectiveness of Low Level Laser Therapy (LLLT) in the treatment of tendinopathy. Secondary objectives were to determine the relevance of irradiation parameters to outcomes, and the validity of current dosage recommendations for the treatment of tendinopathy. Background: LLLT is proposed as a possible treatment for tendon injuries. However, the clinical effectiveness of this modality remains controversial, with limited agreement on the most efficacious dosage and parameter choices. Method: The following databases were searched from inception to 1 st August 2008: MEDLINE, PubMed, CINAHL, AMED, EMBASE, All EBM reviews, PEDro (Physiotherapy Evidence Database), SCOPUS. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified as: high (≥6 out of 10 on the PEDro scale) or low (<6) to grade the strength of evidence. Accuracy and clinical appropriateness of treatment parameters were assessed using established recommendations and guidelines. Results: Twenty-five controlled clinical trials met the inclusion criteria. There were conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies would support the existence of an effective dosage window that closely resembled current recommended guidelines. In two instances where pooling of data was possible, LLLT showed a positive effect size; in studies of lateral epicondylitis that scored ≥6 on the PEDro scale, participants' grip strength was 9.59 kg higher than that of the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: LLLT can potentially be effective in treating tendinopathy when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.