A systematic review of the effectiveness of yoga on pain, physical function, and quality of life in older adults with chronic musculoskeletal conditions.

OBJECTIVES: Exercise interventions suitable for older adults can help to slow and manage age-related conditions. This systematic review looks at age-related musculoskeletal conditions in a population with a mean age over 50 years, evaluating the effectiveness of yoga for pain, physical function, and quality of life. METHODS: CENTRAL,CINAHL, Pubmed, PsycInfo, SCOPUS, Sports Discus, Web of Science Core Collection, and Google Scholar were searched. Study selection and quality screening using the Cochrane risk of bias tool were conducted by two reviewers to mitigate bias. PRISMA guidelines were followed in conducting and reporting the review. RESULTS: 11 studies met inclusion criteria with a total sample of 2221 (≥70% female). Eight studies measured pain, six showing significant effectiveness (p=≤0.05), for lower limb osteoarthritis (OA), hand OA, and neck pain. Nine studies measured physical function, four showing significant effects, for lower limb OA and sarcopenia. Significant quality of life effects were found for restless leg syndrome compared to baseline. CONCLUSION: Moderate evidence was found for pain effects, generalisable for OA based on sub-group analysis. Effective trials were mostly short-term using at minimum one 60-min group class, and an average of four 30-min home practice sessions weekly. Findings support the use of props and modifications to address age-related physical limitations. Yoga was well-received with good adherence, but effects on a par with other exercise. There was an absence of quality of life effects in short term. Mixed methods studies could lead to further insight into the qualitative aspects of yoga practice for older adults.

A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions.

OBJECTIVES: This systematic review aims to evaluate the effectiveness and delivery of Pilates to reduce pain and disability and to improve physical function and quality of life in middle-aged to older adults with a range of chronic musculoskeletal conditions. METHODS: Searches were conducted using CENTRAL, CINAHL, SCOPUS, Pubmed, PsycInfo, Web of Science Core Collection and Google Scholar. Inclusion criteria were controlled trials and observational studies, population mean age 50 years and over with chronic musculoskeletal conditions, using mat-based Pilates exercise. Outcomes included pain, disability, physical function and quality of life. RESULTS: Seven studies were included, with a combined total sample of 397 participants (73% female). Pilates was significantly effective (p ≤ 0.05) for reducing back pain, neck pain and pain associated with knee osteoarthritis and osteoporosis. Additional significant disability, physical functioning and quality of life effects were found for back pain, osteoporosis, and knee OA. Overall Pilates was as effective as other exercise. Adherence to group exercise was good, but poor for home exercise. No significant adverse effects were reported. CONCLUSION: Pilates is a safe and effective exercise intervention for adults over 50 with a diverse range of musculoskeletal conditions which may otherwise put them at risk of becoming sedentary. Although no overall significant superiority was found over other exercise, participants reported psychosocial benefits particular to the Pilates group exercise, with enjoyment a possible positive factor in adherence. Further research on Pilates exercises for various pathologies could inform teaching and improve engagement with older adults, including those with chronic conditions.

A qualitative systematic review of the views, experiences and perceptions of Pilates-trained physiotherapists and their patients.

OBJECTIVES: A review of qualitative studies exploring Pilates-trained physiotherapists and their patients' perspectives and experiences of Pilates, aiming to improve practice and provide a deeper insight into the way this method is being utilized along with its effects on participants. DESIGN: Qualitative evidence synthesis using meta-ethnography. DATA SOURCES: A comprehensive search strategy, limited to English language articles, was conducted to MEDLINE (PubMed), EMBASE, CINAHL, PEDro and Cochrane Central for the period of January 2000 (inception) to June 2020. This was supplemented by identification of Grey literature through Google Scholar, website searching and reference lists. STUDY SELECTION: Qualitative studies reporting experiences and perceptions of patients' or Pilates-trained physiotherapists' regarding the efficacy of Pilates for the management of chronic musculoskeletal conditions. After a process of exclusion, eight studies were included in the synthesis. DATA EXTRACTION: The textual data were analysed by a qualitative software program. Studies were critically appraised independently by two reviewers. DATA SYNTHESIS: Articles were synthesized using a technique of meta-ethnography. Three themes emerged from the process of reciprocal translation: (1) Benefits of the Pilates approach; (2) most effective ways to utilize and most beneficial parameters and (3) risks, precautions, contraindications and indications. CONCLUSION: This is the first qualitative evidence synthesis of practitioners' and patients' perspectives of Pilates. Findings support evidence for the various benefits of this approach and provide fresh insight into the way this method can be practiced to maximize efficiency and focus on the patients' needs. KEY RECOMMENDATIONS: Pilates-trained physiotherapists identified that Pilates can be tailored to individual requirements, preferences and needs, to promote self-management to facilitate clinical and cost-effective care.

"How do Pilates Trained Physiotherapists utilize and value Pilates Exercise for MSK conditions? A Qualitative Study".

BACKGROUND: Pilates is a popular exercise therapy approach offering numerous benefits, including muscular strength, flexibility, control, and core stability. Pilates has been widely utilized in the prevention and rehabilitation of a variety of musculoskeletal disorders. OBJECTIVES: The aim of this study was to explore the experiences and opinions of Pilates trained NHS and private practice physiotherapists in the UK, regarding the perceived benefits, risks, delivery and rationale for this exercise method. METHODS: This qualitative study used a self-designed electronic survey to retrieve the views of 30 physiotherapists, who had undertaken formal Pilates Instruction training, recruited by a purposive and snowball sampling method. Questions were either multiple choice or open-ended, examined via thematic analysis. RESULTS: Physiotherapists identified the most important benefits of Pilates as reduction in fear-avoidance, improving bodily awareness and increasing muscular strength. Exercises that promote general movement were highlighted as being particularly useful, with a majority recommending daily practice for optimum benefit. Participants recognized lack of core strength as a key indicator, whereas others criticized excessive focus on this principle. CONCLUSIONS: Physiotherapists identified a range of inter-linked benefits and recognized that Pilates is hugely modifiable. Individualizing exercises can further encourage participation and negate the restriction of some health conditions. NHS and Private Practice Therapists utilize Pilates in a similar way, although rationales for its use may differ, as the justification for Pilates exercise may be evolving. Pilates appears a valuable methodology in the NHS, which can help patients engage with activity.

A qualitative study of the experiences and perceptions of adults with chronic musculoskeletal conditions following a 12-week Pilates exercise programme.

INTRODUCTION: The aim of the present study was to explore the experiences and perceptions of adult patients with chronic musculoskeletal conditions following a Pilates exercise programme. A qualitative approach was taken to both data collection and analysis, with alignment to the philosophy of interpretive phenomenology. Participants included 15 women and seven men with a range of chronic musculoskeletal conditions, including nonspecific low back pain, peripheral joint osteoarthritis and a range of postsurgical conditions. The age range was from 36 years to 83 years, and the mean age was 57 years (standard deviation 14.1 years). METHODS: Data were collected via digital recordings of four focus groups in three North-West of England physiotherapy clinics. The data were transcribed verbatim and then analysed using a thematic framework. Data were verified by a researcher and randomly selected participants, and agreement was achieved between all parties. RESULTS: The results were organized into five main themes: physical improvements; Pilates promotes an active lifestyle: improved performance at work and hobbies; psychosocial benefits and improved confidence; increased autonomy in managing their own condition; and motivation to continue with exercise. CONCLUSION: The study was the first to investigate individual perceptions of the impact of Pilates on the daily lives of people with chronic conditions. The Pilates-based exercise programme enabled the participants to function better and manage their condition more effectively and independently. Further to previous work, the study revealed psychological and social benefits which increase motivation to adhere to the programme and promote a healthier lifestyle.

Perceived benefits, rationale and preferences of exercises utilized within Pilates group exercise programmes for people with chronic musculoskeletal conditions: A questionnaire of Pilates-trained physiotherapists.

INTRODUCTION: An estimated 29% of the population, around 17.8 million people, live with a musculoskeletal condition in the UK. Pilates exercise has positive benefits, including reducing pain and disability for people with musculoskeletal conditions. The aim of the present study was to explore the views of Pilates-trained physiotherapists in relation to the perceived benefits of, and clinical reasoning for, exercise prescription in Pilates classes. METHODS: A qualitative approach was taken to both data collection and analysis, using a thematic framework. Data were collected via electronic questionnaires using open-ended questions. Participants included 15 Pilates-trained physiotherapists who regularly ran Pilates exercise classes within seven private physiotherapy clinics for people with a range of chronic musculoskeletal conditions. RESULTS: The results were organized into six main themes: Perceived benefits 1: Improved function and increased levels of activity. Perceived benefits 2: Improved ability to manage their musculoskeletal condition autonomously; Efficacy of group Pilates exercise; Optimum combination of exercises used within a class; Physiotherapist rationale for the most effective exercises; Precautions with specific exercises. CONCLUSIONS: The study was the first to investigate perceived benefits, rationale and preference for choice of exercise among Pilates-trained physiotherapists. Physiotherapists felt that the Pilates classes facilitated an active lifestyle and self-management approach. They used a combination of exercises in each class to address all the main muscle groups, but some had specific exercise preferences related to the patients' needs. Exercises were linked to evidence around neuromuscular control, direction preference and biomechanical principles.

The effects of a back rehabilitation programme for patients with chronic low back pain.

AIM: The aim of this paper was to perform a pragmatic before-after analysis of a back rehabilitation programme (BRP) for patients with chronic low back pain (LBP). A total of 877 patients were recruited onto the BRP, which were carried out at four centres within the Wrightington, Wigan and Leigh NHS Trust. The BRP consisted of nine 2-hour group sessions of therapy run over 5 weeks and included 1 hour of exercise and 1 hour of education, advice problem solving and goal setting. METHOD: Using the Wilcoxen signed rank tests and paired t-tests levels of pain, disability, anxiety and depression were significantly reduced pre-post programme (P < 0.001). In addition, the levels of fitness and perceived control improved significantly (P < 0.001) suggesting that participants were better able to manage their LBP. CONCLUSION: Overall, the BRP proved to be effective in reducing pain, disability, anxiety and depression levels for people with chronic LBP. However, despite significant improvements in outcome measures only 50% of the patients completed the BRP and questionnaires post BRP. The implications of the findings are discussed with respect to modified programmes and alternative management for patients within different subgroups of LBP.

Static and dynamic balance deficiencies in chronic low back pain.

BACKGROUND: According to previously conducted studies, people with Low Back Pain (LBP) present with static balance deficiencies. OBJECTIVE: The aim of the present study was to compare static, as well as dynamic balance ability between Chronic Low Back Pain (CLBP) and healthy subjects. METHODS: The CLBP group comprised 17 subjects and the control group of 16 subjects, matched for age, BMI and gender. The protocol applied compared the balance ability when performing the Star Excursion Balance Test (SEBT) and the static 1-leg stance position. The innovation introduced in the protocol was that the participants performed not only the static 1-leg stance, but also the dynamic SEBT on a force plate which recorded the target sway (TS), i.e. the Center of Pressure (CoP) excursion. RESULTS: The CLBP group had significantly reduced performance in SEBT, coupled with greater static and dynamic TS values. Age and especially BMI also bear a significant effect on SEBT execution. The inclusion of SEBT and TS derived scores in a stepwise logistic regression equation lead to the correct classification of 85% of the subjects. CONCLUSIONS: Dynamic and static balance ability provide supplementary information for the identification of the presence of CLBP, with dynamic balance being more instrumental.

Developing clinical competency: Experiences and perceptions of Advanced Midwifery Practitioners in training.

This paper will describe the experiences and perception of a cohort of trainee Advanced Midwifery Practitioners (AMP's) during their training on an MSc in Advanced Practice. The educational philosophy underpinning the master's programme is interprofessional learning linked closely to work based learning and assessment. The focus group explored how the AMP's were developing core competencies within four domains: The links between the university and clinical assessments were instrumental in developing both midwifery and specialised skills required for extending their scope of practice. The changing demographics of their client group facilitated the need to provide safe assessment and management of ladies with complex health and social needs in pregnancy and childbirth; provide specialised clinics and the development of a robust staff training and assessment process. The generic competencies they gained improved collaborative working with their medical colleagues, raising the trainees profile and acceptance of their extended role. In addition to this, development of specialised midwifery skills promoted a high degree of decision making responsibilities within midwifery to facilitate service development and promote evidence based care.

Inter-professional work based learning within an MSc in Advanced Practice: lessons from one UK higher education programme.

This paper will describe the implementation of inter-professional work based education (IPE) in one postgraduate Advanced Practitioner programme in the UK. The concept of Advanced Practice has developed as a response of a number of drivers including change in junior doctor training; government policy and increasing demands on the central government funded UK health service (the NHS). The programme was commissioned by the then greater Manchester Strategic Health Authority (now NHS North West) to meet service needs. The educational philosophy underpinning the MSc Advanced Practice (health and social care) provided by the University of Salford is IPE linked to work based learning. The process of work based learning (WBL) and inter-professional learning underpinning the programme will be discussed in relation to feedback from university staff, Advanced Practitioner (AP) students and employer feedback taken from programme and module evaluations. We argue that IPE at this level facilitates a greater understanding of the connectivity between professionals working in the health care system in the UK; a better understanding of the skills and knowledge base of colleagues; more inter-professional working and appropriate referrals in the work place. This has raised the profile of Advanced Practice (AP) in the region and ultimately resulted in better patient care with more effective and efficient use of resources (Acton Shapiro, 2006, 2008).