Background: Balance is commonly affected by multiple factors, especially among the elderly population. Visual biofeedback (VBF) is an intervention tool that can be used in balance rehabilitation. Aim: This study aimed to systematically review randomized controlled trials that examine whether VBF training is effective in improving balance in an elderly population. Data sources: Three databases were searched: CIAHL, EMBASE, and MEDLINE. The searches were limited to the period from 2010 to 2016. Eligibility criteria: Healthy adults, aged 65 years, with no specific disorders were included. Interventions were any VBF intervention with the aim of improving balance and were compared to no intervention, traditional exercises, placebo, or standard care. The outcome measures were balance as measured by any validated outcome measure. Studies appraisal method: The Physiotherapy Evidence Database quality assessment tool and The Cochrane Collaboration tool for assessing risk of bias were used by two independent authors (HA and FM) in order to appraise the included studies. Results: The database search resulted in 879 articles, of which five papers were included. VBF was compared to no intervention, a placebo, and traditional exercise. The total number of participants in all the five included studies was 181, with a mean age of 74.3 years (standard deviation 6.7). Two studies were rated as high-quality studies, and three were rated as fair quality. Conclusion: Engaging elderly people living in the community in VBF training was found to be effective and could improve their balance ability. However, the variation between studies in methodology, intervention protocol, and outcomes utilized made it difficult to inform a definitive statement regarding the potential application of VBF for balance training with the elderly. Furthermore, high-quality randomized control trials are required. The systematic review level of evidence is moderate, and the strength of recommendation is that VBF is likely to be beneficial.

The results provide early, exploratory evidence that patients with persistent shoulder pain treated by physiotherapists using palpation-guided SSNBs achieve clinically important changes in pain and function in the short and medium term.

Relevance: This report highlights the key themes of evidence based practice and service change. Injection therapy has been a modality within the scope of UK Physical Therapy practice for the past 20 years and its prevalence may be set to expand with the introduction of prescribing rights for UK Physical Therapists. Suprascapular Nerve Blocks (SSNB) have been used for many years to treat refractory shoulder pain. The evidence outlined below would suggest that there is value in adopting this technique into routine physiotherapy practice.Purpose: Shoulder pathologies such as arthritis, or capsulitis can be difficult to treat, with some patients having high pain and disability scores. The effectiveness of SSNB's for patients with common musculoskeletal causes of shoulder pain has been poorly understood in the published literature, and uncertainty regarding the effectiveness of this intervention has led to this technique being rarely used in Orthopaedic or Musculoskeletal settings.Methods/analysis: A critically appraised topic was used to find and appraise the most relevant and rigorous literature within a time scale appropriate to clinical practice.53 studies initially reviewed. 11 studies potentially relevant. Two studies answered the PICO topic and included in the final analysis.Results: One large multicentre RCT (n = 108) found significant decreases in pain with SSNB in patients with shoulder pain >3 months. Mean VAS improvements between 13 and 22 on a 100 point VAS scale and consistently better than placebo (P < 0.05). The benefits were still noticeable at 12 weeks. A modest but significant improvement in disability was also noted with SSNB compared to placebo injection (P < 0.01).A systematic review into interventions for adhesive capsulitis also identified three studies of relevance. One trial compared Bupivacaine SSNB with placebo SSNB (n = 34). They observed a 62% overall reduction in pain with SSNB compared to 13% in the placebo group (P = 0.03). Another high quality RCT compared a single SSNB with a series of intra-articular corticosteroid injections (n = 30) and demonstrated significantly better pain relief (P = 0.001) and ROM (P = <0.05) at 12 weeks. A low quality study also favoured SSNB for pain relief and ROM 30 minutes post treatment when compared to acupuncture (n = 100).