Press releases Monday 19 October to Friday 23 October 2009

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(1) Exercise therapy best for knee pain
(1) Concern over alcohol use among UK South Asians

(1) Exercise therapy best for knee pain
(Research: Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.b4074

For patients with severe knee pain, supervised exercise therapy is more effective at reducing pain and improving function than usual care, finds a study published on bmj.com today.

Patellofemoral pain syndrome is a condition in which pain occurs at the front of the knee during or after exercise and is a common reason to visit the doctor. Women are more likely to be affected than men, and symptoms usually start during adolescence when participation in sporting activities is high.

General advice is to rest during periods of pain and to avoid pain provoking activities. This "wait and see" approach is considered usual care.

A recent study reported only limited evidence for the effectiveness of exercise therapy with respect to pain reduction, while there is conflicting evidence with respect to functional improvement.

So researchers based in the Netherlands investigated the effectiveness of supervised exercise therapy compared with usual care in 131 patients aged between 14 and 40 years with patellofemoral pain syndrome.

A total of 131 participants were included in the study, 65 to a supervised exercise program (intervention group) and 66 to usual care (control group). Both groups received similar written information about the syndrome and similar instructions for home exercises, as well as advice to refrain from painful activities.

Patients rated their recovery, pain at rest, pain on activity, and function scores at the start of the study and again at three and 12 months.

After three months, the intervention group reported significantly less pain and better function than the control group. At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain at rest and pain on activity, but not function.

A higher proportion of patients in the exercise group than in the control group reported recovery (42% v 35% at three months and 62% v 51% at 12 months), but these results were not significantly different between the two groups.

This study provides evidence that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for pain at rest, pain on activity, and function at three and 12 months, say the authors. However, supervised exercise therapy had no effect on perceived recovery.

Further research is needed to understand how exercise therapy results in better outcome, they conclude.

Contacts:
Research: Peter Fleming, Professor of Robbart van Linschoten, Sports Physician, Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
Email: r.v.linschoten@hccnet.nl

Alcohol use in South Asians in the UK is under-recognised, and alcohol related harm is disproportionately high, warn researchers in an editorial published on bmj.com today.

They argue that some subgroups of South Asians in the UK have a major problem with alcohol and seem to be more susceptible to its effects. Yet the government’s health strategy for alcohol continues to perpetuate the myth that alcohol related harm is low in all UK South Asians.

The evidence base is limited, write Dr Rashid Zaman and colleagues, but if place of birth is used as a proxy for ethnicity, alcohol related mortality in England and Wales is about the national average for Eastern European men and women, Sri Lankan men, and East African men, whereas men and women born in the Middle East, North Africa, West Africa, Bangladesh, Pakistan, China, and the West Indies and women born in India, Sri Lanka, and East Africa have lower mortality.

Surprisingly, men born in India reportedly drink less than the general population, yet Indian men have higher rates of alcohol related admission to hospital in England than do British white men.

In fact, the degree and pattern of alcohol use among UK South Asians varies greatly, explain Dr Rashid Zaman and colleagues. Differences in religion, culture, history, and socioeconomic position all play a part, while differences between generations and increased alcohol consumption from acculturation further complicate the picture.

Understanding how these differences interact with biology is the key to making sense of the evidence and developing equitable services to tackle the problem, they say.

Strategies should include outreach workers developing trusted links with the relevant South Asian communities and actively promoting community services, specialist inpatient services, and residential rehabilitation services.

Delivering tailored health messages that are consistent with differing health beliefs and world views would also improve awareness.

They believe the UK’s current health strategy for alcohol is failing a substantial proportion of citizens, and they call for more research to improve our understanding of alcohol related harm among different ethnic groups.

Contacts:
Dr Rashid Zaman, Consultant Psychiatrist, Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
Email: rz218@cam.ac.uk

Dr Gurprit Pannu, Consultant Psychiatrist, Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
Email: drpannu@sahf.org.uk

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