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RESULTS No significant differences were found between SMMRG vs SMG in pain intensity and disability post intervention and at follow-up. We found an overall significant difference between-groups for CNLBP disability (SMG-SMMRG mean difference of 5.0; 95% confidence interval of difference 9.9; -0.1), though this effect was not clinically important and was not sustained at follow-up. CONCLUSIONS We demonstrated that spinal manipulation combined with myofascial release was not more effective compared to spinal manipulation alone for patients with CNLBP. CLINICAL TRIAL REGISTRATION NUMBER NCT03113292. Health care provision is changing, and so is the information we use to guide decisions related to patient care. Increasingly, health practitioners will need to deal with genetics and 'big data' in the context of clinical practice. Indeed, commercial packages for consumer genetic testing are already widely available, and devices enabling self-monitoring of health are in daily use by many of our patients. "Precision health" (distinct from "precision medicine") provides a model, which allows us to bring our genome together with our external environment (lifestyles, societal influences etc.) and eventually, our transient internal environment (reflected by 'omics'), to optimise disease prevention and care. Such advancements have given rise to a need for primary health care clinicians to understand basic genetic and precision health concepts. This editorial meets this need, serving as a primer by providing the following an introduction to current primary health challenges; description of the key elements of the precision health model; an overview of basic genetic, and associated research concepts; a snapshot of some clinically pertinent research in the context of precision health; and a brief discussion of challenges and future directions. OBJECTIVE To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN Randomised clinical trial. SETTING University-based, outpatient, physical therapy clinic. SUBJECTS Fifty individuals with COPD. INTERVENTIONS Participants were assigned at random to the land group (LG; n=27) or the water group (WG; n=23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS Seventeen subjects completed the intervention in the LG nine males, mean age 64 [standard deviation (SD) 8] years, mean forced expiratory volume in 1 second (FEV1) 48 (SD 17) %predicted compared with 14 subjects in the WG [nine males, mean age 65 (SD 8) years, FEV1 51 (SD 15) %predicted]. Water-based exercise training had a positive effect on functional balance [TUG mean difference -1.17 (-1.93 to -0.41 95% confidence interval) seconds; P=0.006], whereas static balance remained unaltered for both groups. There was no between-group difference in postural balance after exercise training; however, a higher proportion of participants who had a clinically relevant improvement in the TUG were in the WG (LG 35%, WG 64%; P less then 0.001). CONCLUSION Functional balance improved after 3months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. click here CLINICAL TRIAL REGISTRATION NUMBER clinicalTrials.gov NCT01691131. OBJECTIVES Maintaining physical activity for older residents in care homes maximises their physical and mental health and wellbeing, independence, dignity and quality of life. Unfortunately, most residents do not participate in regular physical activity. Active Residents in Care Homes, ARCH, was designed to increase physical activity by facilitating whole-system change in a care home. We evaluated whether ARCH can be delivered, its effects on resident's physical activity, wellbeing and costs. DESIGN Feasibility study. SETTING Three residential care homes. PARTICIPANTS Care home residents and staff. INTERVENTION Occupational and physiotherapists implemented ARCH over 4 months with an 8-month follow-up. MAIN OUTCOME MEASURES Assessment of Physical Activity, Pool Activity Level, EQ5D-5L, Dementia Care Mapping, cost of implementing ARCH, health and social care utilisation. RESULTS After implementing ARCH, residents displayed more positive behaviours, better mood and engagement and higher physical activity levels, but these improvements were not sustained at 8-month follow-up. The cost (2016 prices) of implementing ARCH was £61,037, which equates to £1,650/resident. Healthcare utilisation was £295/resident (SD320) in the 4 months prior to ARCH, £308/resident (SD406) during the 4-month implementation and £676/resident (SD438) in the 8-month follow-up. CONCLUSIONS The ARCH programme can be delivered, it may have some short-term benefits and is affordable. Rather than have unrealistic increases in the health and longevity of older care home residents, ARCH may slow the decline in physical, mental and emotional well-being usually seen in older people in care homes, return some dignity and improve their quality of life in their last months or years. Crown All rights reserved.Shared decision making is integral to high-quality, evidence-based, and patient-centred physiotherapy practice. It involves therapists and patients collaboratively making a health-related decision after having discussed the options, the likely benefits and harms of each option, and considered the patient's values, preferences and circumstances. Despite being a crucial part of the final step in evidence-based practice, the skills needed to facilitate shared decision making are rarely taught to physiotherapists. This Debate article explores the reasons for the importance of shared decision making to physiotherapy practice; its fundamental role in improving therapist-patient communication, informed decision-making, and evidence-based care; and illustrates some of the processes involved using clinical scenarios.
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