Herb:
The only article I could find from your list (thanks for the
references) was the one from Spine.
Correct me if I am wrong (i mean it - I am no expert on research
methods), but this study showed that a specific manual therapy
treatment was superior to standard physiotherapy. That doesn't really
show that getting Physio Rx is any better than any other option,
including no treatment at all. It may well be that "usual" PT is
actually harmful !! (as suggested by Deyo I think ) Usual
Physio treatment can be harmful by emphasizing a passive role for
the patient in recieving treatments such as ice, heat, "myofascial
release", short-wave etc. thus delaying resumption of normal activity
and promoting the "sick role" for the LBP sufferer. However it may be
true that the specific Rx given in the study is superior to letting
the natural Hx of the disorder take its course - can't tell.
Is there anything to say that PT is better than no treatment at all
in acute or sub acute LBP, aside from manip/mobilization??
If you find that reference from Britain please let me know.Thanks
Michael Meddows
Virginia Beach
> Date: Wed, 24 Feb 1999 17:16:48 -0500
> Subject: RE: BACK CARE BIAS?
> From: Herb Silver <[log in to unmask]>
> To: [log in to unmask]
> Reply-to: [log in to unmask]
> >Is there any evidence that conclusively supports what you seem to imply -
> >i.e. that physio is HIGHLY effective for low back pain?
>> Michael Meddows
> The BEST studies that I have seen were studies performed by the Department
> of Family Medicine Uppsala University, Uppsal Sweden. The primary
> researcher was Stefan Blomberg. They are published in book form under the
> title "A pragmatic approach to low-back pain including manual therapy and
> steroid injections: A multicentre Study in pPrimary Health Care" ACTA
> UNIVERSITATIS UPSALIENSIS Comprehensive Summaries of Uppsala Dissertations
> from the Faculty of Medicine 394, 1993. The specific articles are as follows
>
> Blomberg S, et al. A controlled, multicentre trial of manuall therapy in
> low-back pain; iniitial status, sick-leave and pain score during follow-up.
> Scandianaviouan Journal of Prmary Health CAre 1992; 10:170-78
>
> Blomberg S Eet al. A randomized study of manual therapy with steroid
> injections i low-back pain; telephone interview folow-up pain, disabliity,
> recovery and rug consumption. European Spine Journal 1994;3:246-54
>
> Blomberg S, et al. Manual therapy with steroid injections-a new approach
> to treatment of low back pain; a controlled multicenter trial with an
> evaluation by orhtopedic surgeons. Spine 1994;19:569-77
>
> Blomberg S, Tibblin G. A controlled, multicnetre trial of manual therpay
> with steroid injections in low back pain; function variables, side effects
> and complications during four months follow-u. Clinical Rehabilitation
> 1993;7:49-62
>
> Blomberg S, et al. manual therapy with steroid injections in low back
> pain; improvement of quality of life in a controlled trial with four
> months' follow-up. Scandinavian Journal of Primary Health Car 1993;11:83-90
>
> This was a very interesting series of well performed research that suggests
> a "pragmatic approach". In other words, treatment must take into account
> that back pain has multiple etiologies. Other studies that I don't have in
> front of me are the studies so often cited by chiropractors on the efficacy
> of "manipulation" on acute back pain. The studies which were referenced
> were actually studies performed in England by PHYSICAL THERAPISTS using
> Maitland mobilization techniques (as I remember the studies). Since so
> many members of this board are based in England, maybe someone could give
> those references--I don't have them off hand. Hope this helps clear up
> that there are studies that show statistical and clinical evidence of the
> efficacy of physical therapy (the studies although stating "manual therapy"
> actually used a mutltifaceted approach of PT including exercise...Also, the
> number of injections used was less than an average of 1/patient--this
> people were not given a lot of cortisone.
> >
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