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edical stroke care from randomised control tri-ls, systematic reviews, and meta-analyses to helpuide best clinical practice.

The book is organised into chapters cover-ng a thorough range of topics in all aspectsf stroke treatment from the organisation oftroke care, thrombolysis, and anticoagulationhrough to brain oedema control, surgical inter-entions, and the modification of vascular riskactors and lifestyle. The writing is clear and rel-tively easy to understand for the health-care pro-essional, despite the necessary research-relatederms. Though said to be for ‘stroke cliniciansnd their patients and families’, it is almostntirely concerned with medical interventionsnd research and not easily accessible for the layerson.

The chapters are logical and well organisedith subsections that address individual clinicalptions or practice within a topic. Each subsections divided into background detail, a summary ofhe evidence (including meta-analyses if appro-riate), and ‘comments’, which are the recom-endations drawn from the evidence, including

mplications for practice and research. Each chap-er also has a summary highlighting the author’sonclusions. There is extensive use of forest plotso present and compare the data from systematiceviews and meta-analyses. The graphs them-elves are often in very small print and difficult toead for detail, but as always, a useful graphicalay to contrast multiple studies. All material is

igorously referenced.The chapter on ‘Understanding Evidence’

s particularly helpful in reminding readers ofhe context of randomised control trials, system-tic reviews and meta-analyses—on which high-evel medical evidence is judged. The chapter onOrganised Stroke Care’ will be very familiar tonyone who has had cause to refer to the Royalollege of Physicians Stroke Guidelines or takenart in the National Sentinel Audit for Stroke.

While much of the work is not directly appli-able to physiotherapy practice, the book woulde an excellent reference source for multidisci-linary acute stroke teams. For physiotherapistsirectly involved with the very acute end of strokeare, it is a good review of acute medical issuesn early patient recovery after stroke and the cur-ent state of the research of medical and surgicalnterventions.

Sandy ChambersE-mail address: sandra.chambers@gstt.nhs.uk

oi: 10.1016/j.physio.2006.12.003

xercise Therapy—Prevention and Treatmentf Diseaseohn Gormley, Juliette Hussey, Blackwell Pub-

ishing, 2005, 280 pages, £25.99, ISBN 978105105279

This comprehensive textbook on exerciseherapy offers a dynamic insight into the applica-

Book reviews

tions of exercise therapy in disease managementand health promotion. It is wholly evidence-based and uses a systems-wide approach. With ascientific, and at the same time holistic, approachit engages with the preventative health agenda.This excellently referenced book is written partic-ularly for physiotherapists working clinically inall areas of health. However, it is also most valu-able for those professionals needing summarisedbroad evidence for the benefits of exercise tocommission or manage therapy services. It iswell written, understandable and comfortable toread for qualified physiotherapists and secondand third year physiotherapy degree students. It iswell illustrated with diagrams and photographs.

The contributors to the various chapters pro-vide perspectives from a variety of branches ofphysiotherapy and beyond. They give up-to-datereviews of the quantitative and qualitative, obser-vational and experimental research. This evi-dence is the base for the practical guidelines forthe physical management of all major groups ofailments.

After Hussey’s overview of exercise ther-apy, Bell and O’Sullivan give a comprehen-sive evaluation of the reviews on cardiovascu-lar responses to exercise. In the third chapter,Lane and Hawksworth provide good backgroundreading on the pulmonary system in relation toexercise. Davidson et al. present a very goodcomprehensive overview of the musculoskeletalsystem in Chapter 4. In Chapter 5, O’Gormanand Nolan link exercise to diabetes and obesity.In the following two chapters, Hussey gives a use-ful synopsis of measurements of physical activityand outlines guidelines for exercise prescription;essential reading for us all. Gormley follows thisup with a rundown of the reviews on the pre-vention and treatment of cardiovascular diseaseand includes very useful details on guidelinesin this area of therapy. O’Neill et al. succeedin summarising the large body of literature onexercise in the treatment of pulmonary diseasewith efficacy evaluation and practical guidelines.Wilson-O’Toole gives a concise, but still com-prehensive, overview of the scientific evidence ofexercise in the treatment of musculoskeletal dis-ease. In addition to the findings from controlledtrials, she uses indirect evidence and good logic torecommend practical ways to give exercise ther-apy and advice. Quinn and Hussey give a goodsynopsis of the exercise benefits and difficultiesof exercise adherence with obesity in adults andchildren.

Brownlee and Durward highlight evidence forthe need and effectiveness of strength trainingafter stroke. This excellently referenced chap-ter puts a different light on stroke rehabilitationand is especially relevant for encouraging exer-cise and activities after the acute phase. Gormley,and Dugdill and Graham complete the book withtheir chapters on exercise adherence and promot-

ing physical activity. They highlight the impor-tance of lifestyle and the role of the family andthe socio-cultural environment. Whilst providingsupport to the individual is important to increaseand maintain physical activity levels, society and

infrastructure will have to change to halt the riseof ailments caused by sedentary lifestyles.

The book is excellent value and I can whole-heartedly recommend it to any professional keenon helping people to improve their health throughexercise.

Adri HartveldE-mail address: adri@healus.co.uk

doi: 10.1016/j.physio.2006.12.005

Betraying the NHS: Health AbandonedMichael Mandelstam, Jessica Kingsley Publish-ers, 2006, 320 pages, £14.99, ISBN 1-84310-233-1

As can be seen by the title of this book, theintention to lay out strong criticisms of the gov-ernment policies for the health service is clear, yetit should not be dismissed as a personal crusade.The author has a long history as an independentlegal advisor for the NHS and social services andso has a rich body of experience on which to draw.The author provides strong arguments backed byreference to a large range of material, which isclearly documented in footnotes. Although muchof this evidence is quoted from newspaper arti-cles or reports, he uses many sources to supporteach point. These arguments are mainly centredon the health service in Suffolk.

It is a very depressing account of short termdecisions, poor consultation and constant erosionand contraction of services, with limited account-ability. It is, however, very biased. With headingssuch as ‘Consulting with the peasants’ it makesclear how the government intentions, which theauthor accepts in places are well intentioned, areoften poorly implemented at a local level to dis-astrous effect. For example, the PCTs in Suffolk,who he suggests failed to follow the governmentadvice on consultation, closed beds under theguise of a reorganisation. The book is support-ive of clinicians and places the blame at the doorsof the government and management, in particularthe management of PCTs. Individual physiother-apists are mentioned who, in the author’s words,had ‘bravely spoken out’ and ‘put forward sub-stantial and detailed concerns’, but to no avail.

In the latter chapters the author heavily crit-icises the policies around the division of healthand social care, and the service provided in thecommunity—‘putting them out to grass and mak-ing them pay’. In this section he uses severalpatient cases to illustrate how he feels care forpatients is being eroded and services reduced.Strong concerns are expressed that the vulnerableand elderly of our community are suffering, due tocuts in the NHS and social services. These latterchapters are more emotively written and personal

and illustrate that ultimately all polices impact onpeople. But in places the evidence provided is per-haps less compelling than in the earlier chapters,especially where he tries to predict what care mayor may not be provided in the future.

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Stephen Brown

Overall, I would recommend this book to any-ne as a good balance to the government infor-ation on the changes in the NHS. It is biased,

ut it makes no attempt to deny this and althoughn places it lapses into emotive language many ofhe arguments are articulate and evidenced. How-ver, if you are one of the clinicians experiencinghe ‘lowering moral of the workers’ or the ‘cuttinglinicians down to size’, it may be better to waitnd read this later, in case you give up all hope.

Heather ThorntonE-mail address: H.A.Thornton@herts.ac.uk

oi: 10.1016/j.physio.2006.12.006

PSS Survival Manual, 2nd ed.ulie Pallant, Open University Press, 2004, 336ages, £25.99, ISBN 0-335-216640-0

The author sets out to integrate researchesign and sound statistical analysis and for theost part this is achieved at the undergraduate

evel. The process is inclusive and comprehen-ive in respect to ensuring that the appropriateest is carried out and this certainly benefitsndergraduates and those new to statistics. Forhe main part the book is well referenced withupportive alternatives where appropriate. Theook is aimed primarily at parametric statisticalests with little attention to non-parametricnalysis. There are too few additional referencesn respect to non-parametric tests.

The examples in the data files and the associ-ted website are very useful and work well. Therere slight technical differences in procedure andata outputs with newer versions of SPSS, but thiss not the fault of the author.

The comparative analysis and correlation sec-ions are very well presented and the exampleso help the reader achieve a sound level of under-tanding. A wide range of tables and a reasonableange of figures are used to describe the data,lbeit without sufficient detail to lessen the frus-ration of relatively new users of SPSS.

More detail is required on how to generateertain SPSS outcomes, especially in terms ofenerating tables and graphs that can be used inifferent packages such as Word. There is a lackf depth and limited interpretation of reliabilitynd ANOVA analysis, but the reader is directed tother authors for most points. Follow-up analysisf ANOVA is evident but not sufficient for higher-evel researchers. There is no association withdvanced research designs such as randomisedontrol trials and appropriate data analysis.

The book is useful as an introductory textor undergraduate programmes and to somextent will assist Masters’ programmes and newesearchers. ANOVA was a test too far, but other-ise the book is useful as a generic approach toPSS and statistical analysis. The examples used

n the data files are useful generally, albeit lacking

irect relevance to physiotherapy.

Patrick DohertyE-mail address: p.doherty@yorksj.ac.uk

oi: 10.1016/j.physio.2006.12.007

Book reviews

Living and Loving after Prostate SurgeryGrace Dorey, Grace Dorey, 2005, 26 pages, £7.00,ISBN 0-9545393-2-X

This booklet is a welcome addition to theinformation available for patients undergoingprostate surgery. Unlike most previous publi-cations, it covers surgery for both benign andmalignant disease. Its primary purpose is to givepatients and their partners an understanding of theproblems of bladder control and erectile dysfunc-tion and how best to manage them. It achieves thisin clear and understandable text interspersed withhelpful and comical illustrations.

The first sections explain the relevantanatomy of the prostate and investigations thatpatients may expect prior to surgery. Benign andmalignant disease and the respective operationsperformed are covered in separate chapters. Theproblems of bladder and erectile dysfunction arethen dealt with as being common to all types ofsurgery. This is handled well and in some detail.The list of complications is comprehensive and upto date information is given regarding treatmentoptions. The anatomy and function of the pelvicfloor is clearly described and the importance ofexercise before and after surgery explained. Fur-ther sections are full of good advice on howpatients can best manage and treat the problemsthemselves through simple life-style measures,so much of which is missed out of a typicaldoctor-patient consultation. A novel inclusion isa self-assessment questionnaire designed to assistthe patient in deciding whether professional helpis needed. For those struggling with technicalterms there is a glossary and a ‘Frequently AskedQuestions’ section. A good reference section isincluded.

As well as helping patients contemplatingprostate surgery, this booklet will also serve asa useful resource to have at home should thepatient be unfortunate enough to have problemspost-operatively. I have only a minor criticism.Bladder control and erectile difficulties followinga prostate resection for benign disease are muchless common than following radical surgery forcancer. By grouping all types of prostate surgerytogether, there is a risk of implying relativelyhigh rates of bladder and erectile dysfunctionafter more minor endoscopic surgery, which isnot the case. A further comment for future publi-cation is that it would be helpful to have includedinformation about non-surgical treatments forcancer, such as external beam radiotherapy andbrachytherapy. When counselling patients withcancer, the choice of treatment is influenced byits impact on bladder and erectile function and theinclusion here of the significant effects of radio-therapy options handled in the same balanced waywould be most helpful.

E-mail address:Stephen.Brown@stockport.nhs.uk

doi: 10.1016/j.physio.2007.01.003

177

Biopsychosocial Medicine: An IntegratedApproach to Understanding IllnessPeter White, Oxford University Press, 2005, 272pages, £31.00, ISBN 0-19-853034-X

This book arose from a 2-day conferenceexamining the relevance of Engel’s biopsychoso-cial approach to chronic medical disease. Theconference was organised by the Novartis Foun-dation and One Health, a non-profit companyestablished to promote a system of healthcarebased on the biopsychology model of ill-health.Twenty-eight international experts were invitedto the conference and this book is a collectionof the twelve presentations that were given. Eachone is presented with a summary of the discussionthat took place at the conference. It is clear thatminimal editing of the discussions has taken placeand therefore the reader gains a realistic view ofthe controversial debates that followed each lec-ture. Indeed, the presentations relate to a widerange of controversial and challenging topics sur-rounding the delivery of biopsychosocial health-care, including questioning the importance ofthe biopsychosocial model and arguing whetherpatient-centred and biopsychosocial approachesare actually compatible.

As the contributors to presentations (bothspeaker and discussants) were multidisciplinary(e.g. psychiatry, psychology, medicine, physio-therapy, occupational therapy), the book containsa variety of different examples and applications.It is clear that the book was not written for aspecific medical profession or a specific level ofstudent (undergraduate or postgraduate) and maytherefore be considered appropriate for anyonewith a specific interest in learning more aboutthe historical background and controversialdebates surrounding biopsychosocial medicine.However, it is important to note that due to thenature of the book (a collection of presentationsfrom a conference) and the inclusion of examplesfrom so many disciplines, some of the terms andtheories are presented without clear definitions.Although this may not be a book to recommendto undergraduate students, some of the presen-tations could act as good stimuli for discussionand debate on the delivery of biopsychoso-cial medicine for postgraduate physiotherapystudents currently working within the field.

Maggie Donovan-HallE-mail address: mh699@soton.ac.uk

doi: 10.1016/j.physio.2007.01.004

Musculoskeletal Essentials: Applying the Pre-ferred Physical Therapist Practice PatternsMarilyn Moffat, Elaine Rosen, Sandra Rusnak-Smith, SLACK Incorporated, 2006, 448 pages,

£36.50, ISBN-10 1-55642-667-4, ISBN-13 978-1-55642-667-4

This American text is designed to aid clinicalreasoning and decision making for the muscu-