Physiotherapy

To develop and test the feasibility of an energy conservation programme to manage fatigue in multiple sclerosis. A pilot randomized controlled trial. Community setting. People with multiple sclerosis reporting fatigue. An energy conservation programme was compared to a peer support group. Both interventions were delivered in group format with 2-hour sessions once a week for five weeks. Patients' views about the interventions were sought in discussion groups one week post intervention. The primary feasibility outcomes were recruitment and adherence. Other outcome measures were the Fatigue Impact Scale, Fatigue Severity Scale, MS-Impact Scale-29, MS Self-efficacy Scale, Beck's Depression Scale-Fast Screen and Epworth Sleepiness Scale. Outcomes were administered at baseline, post intervention, 6-week and 3-month follow-up. Almost 30% of the people approached to take part in the study did not commit to participation because of transport/time issues. Twenty-three patients took part in the study. Three patients dropped out, one reporting adverse effects. A power calculation indicated that a sample of 56 (28 per group) would be required for a main randomized controlled trial. Patients valued peer support and those in the energy conservation group described the programme as useful, but reported difficulties completing some practice activities. An energy conservation programme in the community is feasible and welcomed by people with multiple sclerosis. However, future research needs to consider longer follow-ups and practical issues to improve recruitment rate by accommodating to patients' needs.

People with a stoma believe that there is a link between their surgery and low back pain (LBP). To explore factors relating to (i) core stability in people with a stoma and LBP and (ii) biopsychosocial factors related to LBP. Adults with an ileostomy and LBP (n = 17) completed (i) a range of standardised instruments, (ii) clinical tests and (iii) an ultrasound scan of right and left transversus abdominis (TrA). The findings showed moderate pain and disability: RMDQ: median = 12 (IQR: 9.5-13), EQ-5D health state: mean = 6.9 (±1.75), BPI pain severity: median = 4.5 (IQR: 2.87-5.4). The TrA contraction was less on the operated than the unoperated side and this was linked to less control for BKFO to the operated side, and the presence of a parastomal hernia. Co-morbidities were associated with greater balance problems during the stork test (p < 0.05). Men had more fear avoidance (p < 0.05) on the FABQ regarding physical activity. Abdominal function may be altered after stoma surgery leading to reduced ability to perform functional tasks and a possible increased risk of back pain. These results should be viewed with caution due to the small sample size.

The abdominal muscles play a vital role in lumbar stability. The stoma surgery creates a permanent flaw in the abdominal wall and this may increase the risk of low back pain for people with a stoma. To determine whether there was a difference in back pain experience between the two stoma groups: ileostomy and colostomy. A postal questionnaire sent to people in Northern Ireland with an ileostomy or colostomy. Over half (56.7%, n = 417) had back pain in the last 6 months and the primary perceived cause was the stoma surgery. There was a statistically significant deterioration in functional activities in those with back pain when 'today' was compared with 'before surgery'. Those with a colostomy had generally poorer outcomes in respect of pain and disability, than those with an ileostomy. Low back pain in people with a stoma is a real and complex issue, especially as there are significant differences between those with an ileostomy when compared with people with a colostomy. Many factors are likely to contribute to a person developing low back pain, not least, the underlying reason for the surgery and the surgical procedure itself.

To investigate whether low back pain (LBP) is a problem for people with a stoma. Following ethical approval, a postal questionnaire was sent to the Ileostomy Association of Northern Ireland (n = 402). The response rate was 81.6%. Two hundred ninety three (72.8%) were included in the analysis. The participants fell into three groups: those who never had LBP (n = 102, 34.8%), those who had LBP but not within the last 6 months (n = 26, 8.9%) and those who had LBP within the last 6 months (n = 165, 56.3%). Participants with LBP (n = 165) compared the ease with which they could carry out everyday tasks: 'before' and 'since' surgery. There was a mean increased difficulty of between 1.75 and 2.26 points across all tasks. The Roland Morris Disability Questionnaire scores ranged from 0 to 24 with 50% having a score of 8/24 or higher. Some participants (n = 76, 46.1%) believed that the stoma surgery was the reason for their back pain, followed by 27.9% (n = 46) blaming weak muscles. Others (53.3%) thought their back pain was worsening. There was a significant rise in the incidence of first episode back pain within a year of surgery. These results suggest that LBP is a problem for people with a stoma.