Question
Why do we need to absolutely and specifically identify pathology in order to
assertain if a therapy is effective in LBP ? Kevin.
-----Original Message-----
From: Herb Silver <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 24 February 1999 22:21
Subject: RE: BACK CARE BIAS?
>At 09:28 AM 2/24/99 -0500, you wrote:
>>Owen:
>>
>>Is there any evidence that conclusively supports what you seem to imply -
>>i.e. that physio is HIGHLY effective for low back pain? Feel free to use
>>any specific pathology that can be definitely ascertained by a physical
>>examination.Best of luck mate!!
>
>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.
>>I'm not being a smart__se, but the conclusion that PT is not that great is
>>quite reasonable, based on the research so far.
>>
>>
>>Michael Meddows
>>Virginia Beach
>>
>>-----Original Message-----
>>From: Owen Allen [SMTP:[log in to unmask]]
>>Sent: Wednesday, February 24, 1999 4:43 AM
>>To: [log in to unmask]
>>Subject: Re: BACK CARE BIAS?
>>
>>At 22:58 22/02/99 -0500, you wrote:
>>>..." But this is really not exactly fair. If I had a tumor, a
>>>kidney infection, etc, that caused back pain, I am sure I would be more
>>>satisfied with an MD. If I had a herniated disk unresponsive to
>>>chiropractic care or physical therapy, I would be more satified with a
>>>ortho or neuro surgeon. If I had "garden variety" low back pain, I would
>>>be most satisfied with doing some home exercises and walking either with
>>>instruction by a PT or a DC or an MD".
>>---------------------------------
>>In similar vein, last year I read a brief of a research report from a
>>professor of General Practice in Canada who purported to have studied the
>>effect of physiotherapy on low back pain, and found the efficacy to be
low.
>>I was baffled by the suggestion in this report that 'physiotherapy' is a
>>treatment technique or protocol, and that low back pain is a specific
>>pathology. It is of great concern that leaders of health sciences either
>>fail to be rigorous in the definition of their research variables, or
their
>>communication of that research. Whichever the case, in this era of
>>information it is a failure of duty of care for scientists to be that
>>sloppy. Although I would go so far as to suggest that some researchers
>>might
>>be downright mischievous, for their own gain.
>>
>>
>>Owen Allen
>>Atherton Hospital
>>P.O. Box 183
>>Atherton 4883
>>Queensland, Australia.
>>Ph: 07 40910261
>>F: 07 40913502
>>
>Herb Silver
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