Aust J Physiother
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Randomized Controlled Trial Clinical Trial
Physiotherapy following cardiac surgery: is it necessary during the intubation period?
This randomised controlled clinical trial investigated whether physiotherapy during the period of mechanical ventilation following cardiac surgery influenced subject outcomes. Two hundred and thirty-six subjects admitted to the intensive care unit (ICU) following elective or semi-urgent cardiac surgery were randomised to either a treatment group, which received physiotherapy during the intubated phase, or a control group where physiotherapy was commenced only once the subject was extubated. No significant differences between the two groups were detected for length of intubation period, length of ICU stay, length of hospital stay, maximal daily incentive spirometry values or the incidence of post-operative pulmonary complications. For individuals following routine uncomplicated cardiac surgery, the provision of physiotherapy interventions during the post-operative intubation period does not improve outcomes.
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Professor Patrick Wall changed the way we think about pain. Until the middle of the 20th Century, pain was considered primarily to be a symptom of disease or injury. ⋯ The implication of this view was that pain could only result from clear tissue pathology, with the result that physiotherapy treatment was often directed at the peripheral source of the pain. However, this does not fit with clinical observation, in that there is little correlation between the amount of tissue damage suffered by patients and the degree of pain that they feel.
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Central pain mechanisms are deeply embodied in the psychophysical problem of pain. They are located in the brain and spinal cord and are becoming increasingly recognised as playing a major role in the generation and maintenance of pain and disability associated with neuromusculoskeletal problems. Central mechanisms participate in all pain states, acute and chronic. ⋯ In reality, as key players in the healing process, central mechanisms are profoundly affected by manual therapy even when it is directed at a peripheral problem. Treatment of peripheral mechanisms can be performed through central techniques because both peripheral and central mechanisms are always part of the same clinical problem. Consequently, manual therapy must change its mindset from a peripheral standpoint and integrate central mechanisms into clinical practice as a means of improving therapeutic efficacy and to prevent the descent of acute pain into chronic.