I have heard the same criticism before - that the WHOLE therapy
regimen should be evaluated as one thing. I appreciate your point and
am not trying to contradict you.
But why do you think this is the case ? I have seen one treatment
work for some pathologies e.g. exercise for AMBRII shoulder
instability, and placebo ultrasound can decrease swelling by itself.
Why would it be different for other musculoskeletal pathologies, like
our multifaceted sore back?
Cheers etc
michael (yep, i do have something better to do!) meddows
> Date: Thu, 25 Feb 1999 17:13:30 -0500
> Subject: RE: BACK CARE BIAS?
> From: Herb Silver <[log in to unmask]>
> To: [log in to unmask]
> Reply-to: [log in to unmask]
> I don't know what the article in Spine covered--the series showed the
> effects of a relatively "comprehensive" PT intervention of therapeutic
> modalities, massage, exercise, aquatic therapy as compared to all of those
> interventions with the addition of joint mobilization and an occasional
> cortisone injection (average of 1 per patient) with 6, 12 and 24 month
> follow up. What was found was that the incorporation of joint mobilization
> (various techniques at the descretion of the PT based on the evaluation
> which is the typical manner in which mobilization is used--what is used
> depends on the objective findings that day and changes from visit to visit)
> and, when needed, cortisone injection, allowed for statistically better
> results than without joint mobilization and cortisone injections. In
> Sweden, the use of "active" interventions is standaard of care, with
> outcomes that are better than "passive" interventions. Furthermore, the
> benefit of these studies is they acknowledge that back pain is multifaceted
> (pardon the pun) and requires joint mobility, muscle flexibility, muscle
> strengthening both dynamically and aerobically and at times requires the
> use of modalities to control pain and inflammation. Any one treatment in
> isolation will not show statistical significance on a large population of
> patients. This is one of the points made in the research and the reason
> they did not try and isolate one treatment by itself but rather one
> treatment IN
> ADDITION to a standard protocol. If spine research went this direction,
> there would be many more answers than questions. This is the main
> criticism I have of Deyo's research is that it has tried to look at "one
> intervention" which may work for disease but, from my experience, does not
> work for musculoskeletal. Just as an example, take the typical acute
> injury intervention (RICE for rest, ice, compression and elevation and
> exercise) All of this interventions have an impact on swelling--the
> combination has a dramatic influence. If you looked at any of these alone,
> the effects aren't as dramatic (which I have done. For those interested,
> compression and elevation have the most immediate effect, exercise the most
> long term effect at keeping the swelling down, with ice coming in last but
> having the effect of preventing further fluid leakage). Anyway, these are
> some of my thoughts on back research.
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