You don't - a large majority of LBP are non specific and we should be
treating on outcome not on whether we have matched a diagnosis or pathology
A
Anna Lee.
Principal, Work Ready
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-----Original Message-----
From: kevin reese <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Saturday, 27 February 1999 5:52
Subject: Re: BACK CARE BIAS?
>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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