A randomized controlled clinical trial for low back pain treated by acupressure and physical therapy

BACKGROUND: Although acupressure has been reported to be effective in managing various types of pain, its efficacy in relieving pain associated with low back pain (LBP) remains unclear. The aim of this study is to compare the efficacy of acupressure with that of physical therapy in reducing low back pain. METHODS: A randomized controlled clinical trial in an orthopedic referral hospital in Taiwan was conducted between December 20, 2000, and March 2, 2001. A total of 146 participants with chronic low back pain were randomly assigned to the acupressure group (69) or the physical therapy group (77), each with a different treatment technique. Self-appraised pain scores were obtained before treatment as baseline and after treatment as outcomes using the Chinese version of Short-Form Pain Questionnaire (SF-PQ). RESULTS: There were no significant differences in baseline characteristics among patients randomized into the two groups. The mean of posttreatment pain score after a 4-week treatment (2.28, SD = 2.62) in the acupressure group was significantly lower than that in the physical therapy group (5.05, SD = 5.11) (P = 0.0002). At the 6-month follow-up assessment, the mean of pain score in the acupressure group (1.08, SD = 1.43) was still significantly lower than that in the physical therapy group (3.15, SD = 3.62) (P = 0.0004). CONCLUSIONS: Our results suggest that acupressure is another effective alternative medicine in reducing low back pain, although the standard operating procedures involved with acupressure treatment should be carefully assessed in the future.     

Surgical drainage of the pancreatic duct in patients with chronic pancreatitis is more effective than endoscopic drainage: randomized trial]

OBJECTIVE: To compare endoscopic and surgical drainage of the pancreatic duct for ductal decompression in patients with severe pain due to chronic pancreatitis and a dilated pancreatic duct. DESIGN: Randomized clinical trial. METHOD: All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct, but without an inflammatory mass, were eligible for this study. Patients were randomized to endoscopic transampullary pancreatic duct drainage or to operative pancreaticojejunostomy. The primary end point was the average Izbicki pain score, measured during 2 years of follow-up. The secondary endpoints were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, hospital stay and number of procedures performed. RESULTS: Of 118 patients who were evaluated between January 2000-October 2004 39 patients were randomized; 19 were treated endoscopically (16 of whom underwent lithotripsy) and 20 by operative pancreaticojejunostomy. During 24 months of follow-up, compared with endoscopic drainage, surgery was associated with lower Izbicki pain scores (51 versus 25; p < 0.001) and better SF-36 physical health summary scores (p = 0.003). Furthermore, at the end of follow-up, pain relief was achieved in 32% of patients randomized to endoscopic drainage and 75% of patients randomized to surgical drainage (p = 0.007). Complication rates and hospital stay were similar, but endoscopic treatment required more procedures (median 8 versus 3; p < 0.001).     

Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain

In a randomized controlled trial plus a nonrandomized cohort, the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in randomized and nonrandomized patients. In 2001, German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group. Persons who did not consent to randomization were included in a nonrandomized acupuncture group. All patients were allowed to receive routine medical care in addition to study treatment. Back function (Hannover Functional Ability Questionnaire), pain, and quality of life were assessed at baseline and after 3 and 6 months, and cost-effectiveness was analyzed. Of 11,630 patients (mean age=52.9 years (standard deviation, 13.7); 59% female), 1,549 were randomized to the acupuncture group and 1,544 to the control group; 8,537 were included in the nonrandomized acupuncture group. At 3 months, back function improved by 12.1 (standard error (SE), 0.4) to 74.5 (SE, 0.4) points in the acupuncture group and by 2.7 (SE, 0.4) to 65.1 (SE, 0.4) points among controls (difference=9.4 points (95% confidence interval 8.3, 10.5); p<0.001). Nonrandomized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in randomized patients. The incremental cost-effectiveness ratio was euro10,526 (euros) per quality-adjusted life year. Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective.     

A randomized clinical trial of continuous low-level heat therapy for acute muscular low back pain in the workplace

OBJECTIVES: We sought to compare the therapeutic benefits of ThermaCare Heat Wrap combined with an education program to an education-only program on reducing pain and disability from acute work-related low back pain. METHODS: Forty-three eligible patients, aged 20 to 62 years who presented to an occupational injury clinic, were randomized into one of two intervention arms: 1) education regarding back therapy and pain management alone or 2) education regarding back therapy and pain management combined with three consecutive days of topical heat therapy (104 degrees F or 40 degrees C for 8 hours). The primary endpoints in this trial were measures of pain intensity and pain relief levels obtained approximately four times per day for the three consecutive working days of treatment, followed by measures of pain intensity and pain relief levels obtained in three follow-up visits at day 4 and 14 from treatment initiation. The secondary measures were overall impairment due to injury and disability caused by low back pain assessed at Intake, Visit 2 (day 4), 3 (day 7), and 4 (day 14). RESULTS AND CONCLUSION: A total of 18 individuals enrolled in the education-only group and 25 in the treatment group completed the intervention and all follow-up visits. The general linear model adjusting for age, sex, baseline pain intensity, and pain medication indicated that the topical heat therapy had significantly reduced pain intensity, increased pain relief, and improved disability scores during and after treatment.     

Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651]

Background  

Chronic low back pain (LBP) is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW) is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW.     

运动疗法治疗慢性腰腿痛效果分析

目的比较腰椎间盘突出与腰椎间管狭窄运动疗法的治疗效果。方法采取自愿报名的办法,在社区选择明确诊断的腰椎间盘突出患者和腰椎间管狭窄患者各60例,进行腰背部活动度、腰背部肌力和腰背部肌肉耐力训练,时间1年,干预前后分别进行疼痛强度、身体损害程度、生活功能障碍指数评定。结果运动治疗后,腰椎间盘突出患者在疼痛程度、身体损害程度、活动能力、社会参与能力方面明显改善,腰椎间管狭窄患者改善不明显。结论运动疗法可以巩固腰椎间盘突出症的治疗效果,是在社区进行推广,而运动疗法对于腰椎间管狭窄者效果不明显。     

Daily iron supplementation is more effective than twice weekly iron supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial

In the context of limited effectiveness of iron supplementation programs, intermittent iron supplementation is currently under debate as a possible alternative strategy that may enhance the effectiveness of operational programs. This field-based trial assessed the outcome of twice weekly iron supplementation compared to daily in Pakistan. A double-blind, randomized, clinical trial was conducted in Northern Pakistan. Anemic pregnant women (n = 191) were assigned to receive daily (200 mg ferrous sulfate) or twice weekly (2 x 200 mg ferrous sulfate) iron supplementation. Hemoglobin was measured at baseline and at 4-wk intervals for up to 12 wk. Serum ferritin was measured at baseline and 8 or 12 wk. Analysis was by intention to treat. The two groups did not differ in age, parity, sociodemographic characteristics, hemoglobin or serum ferritin concentrations at baseline. Women who received iron daily had a greater rise in hemoglobin compared with women who received iron twice weekly (17.8 +/- 1.8 vs. 3.8 +/- 1.2 g/L, P < 0.001). The serum ferritin concentrations increased by 17.7 +/- 3.9 microgram/L (P < 0.001) in the daily supplemented group and did not change in the twice weekly group. Daily iron supplementation remained superior to twice weekly supplementation after controlling initial hemoglobin Z-scores and duration of treatment. The body mass index (BMI) modified the effect of daily versus twice weekly iron supplementation. For every unit increase in BMI, the difference between the two treatment groups was reduced by 0.0014 (final hemoglobin Z-score; P = 0.027). We recommend continuation of daily iron supplementation as opposed to intermittent iron supplementation in pregnant women in developing countries.     

The effect of occupational therapy in patients with chronic obstructive pulmonary disease: A randomized controlled trial

Aim The main aim of this study was to evaluate the effect of individualized occupational therapy in patients with chronic obstructive pulmonary disease (COPD). Additionally, the authors wanted to explore the occupational problems experienced in daily life by individuals with COPD. Methods A total of 52 patients were randomly assigned to the intervention group (occupational therapy) or control group (treatment as usual). The primary outcome was assessed using the Canadian Occupational Performance Measure (COPM), and participants were assessed at baseline and after four and 12 months. Results There were no treatment effects on occupational performance or satisfaction with performance, as measured by the COPM. However, we found a significant effect in favour of the intervention group at exertion when performing an individually chosen activity, and in the activity dimension of St George’s Respiratory Questionnaire. A total of 595 occupational problems were reported, most frequently within mobility, active recreation, and household management. Conclusions The results show that, compared with the usual care, individualized occupational therapy did not improve occupational performance or satisfaction with performance. Small but significant changes in activity performance in favour of the intervention group were found in some of the secondary outcomes.     

In a controlled trial training general practitioners and occupational physicians to collaborate did not influence sickleave of patients with low back pain

OBJECTIVE: The objective of this study was to determine the effectiveness of a training to increase collaboration between general practitioners and occupational health physicians in the treatment of patients with low back pain (LBP) because more collaboration might improve a patient's recovery and shorten sick leave. METHODS: In a controlled trial, the intervention in one region was compared with usual care in a control region. Participating physicians enrolled patients with LBP on sick leave for 3-12 weeks. Patients filled out three questionnaires: at inclusion, at 3 months, and at 6 months. Information on sick leave was gathered from occupational health services. All analyses were performed on an intention-to-treat basis. RESULTS: Fifty-six patients with LBP were enrolled in each region. There was little collaboration between physicians during the project. Patients in the intervention region returned to work significantly later (P=.005) but were significantly more satisfied with their occupational health physician (P=.01). No differences were found between the intervention and control patients for pain, disability, quality of life, and medical consumption. CONCLUSION: Our study does not show a positive effect of the training to increase collaboration between general practitioners and occupational health physicians. The training may not have improved collaboration enough to influence the prognosis of LBP.     

Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up

Objective: To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints. Methods: A randomized controlled trial with a 1-year follow-up was carried out. Thirty-eight subjects were allocated to multidisciplinary treatment (intervention, n=23), or to usual care provided by occupational health services (n=15). The intervention consisted of psychological and physical sessions provided by a medical specialist, a psychologist, a physiotherapist and an occupational therapist. It aims at reconditioning, “de-medicalizing”, unrestrained moving and return-to-work. The intervention process was evaluated on compliance to the protocol and the effectiveness of its components. The individual outcome variable was the severity of complaints. The societal outcomes included return-to-work and costs. Measurements were performed at baseline and after 2, 6 and 12 months. Mixed model analyses were used for analysis. Results: The intervention achieves its aims: physical disabilities (P=0.039), kinesiophobia (P<0.001) and physical functioning (P=0.016) improved significantly as compared to usual care. In addition, the intervention was significantly more effective in reducing the severity of complaints than usual care. The intervention was equally effective compared to usual care in terms of return-to-work (86% in the intervention group vs. 73% in the usual care group). The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months. Conclusion: Multidisciplinary treatment affects individuals positively, but shows no significant difference in (cost-) effectiveness on the societal level as compared to usual care.     

From the Cochrane Library: topical antibiotic treatment is more effective than systemic antibiotic treatment for chronic otitis media with eardrum perforation and purulent discharge

Chronic suppurative otitis media with underlying persistent eardrum perforation is a common cause of preventable hearing impairment. A Cochrane systematic review compared topical treatment (antibiotics or antiseptics) with systemic antibiotics to identify which is best. Nine randomised controlled trials were included (833 randomised patients; 842 analysed patients or ears). Topical treatment with quinolones was more effective in stopping (purulent) discharge than systemic treatment with quinolones or non-quinolones. No benefit from adding systemic treatment to topical antibiotics was detected. The effects of topical non-quinolone antibiotics or antiseptics were not clear. Little is known about secondary outcomes (prevention of complications, healing the eardrum, and improving hearing) or about the efficacy and safety of topical antibiotics in the long term.     

Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial

BACKGROUND: Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF). OBJECTIVE: The objective was to compare the recovery rates among children with moderate and severe wasting, kwashiorkor, or both receiving either home-based therapy with RUTF or standard inpatient therapy. DESIGN: A controlled, comparative, clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children. Children were systematically allocated to either standard therapy (186 children) or home-based therapy with RUTF (992 children) according to a stepped wedge design to control for bias introduced by the season of the year. Recovery, defined as reaching a weight-for-height z score > -2, and relapse or death were the primary outcomes. The rate of weight gain and the prevalence of fever, cough, and diarrhea were the secondary outcomes. RESULTS: Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received standard therapy (79% compared with 46%; P < 0.001) and were less likely to relapse or die (8.7% compared with 16.7%; P < 0.001). Children who received home-based therapy with RUTF had greater rates of weight gain (3.5 compared with 2.0 g . kg(-1) . d(-1); difference: 1.5; 95% CI: 1.0, 2.0 g . kg(-1) . d(-1)) and a lower prevalence of fever, cough, and diarrhea than did children who received standard therapy. CONCLUSION: Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.     

The Mini Nutritional Assessment-Short Form is more effective in predicting clinical outcomes among hospitalised patients with overweight than the Nutritional Risk Screening-2002

Understanding of the association between nutritional risk and clinical outcomes in hospitalised patients with overweight is still at an early stage. Given the lack of specific tools for the patient with overweight, the objective of this study was to compare two of the main general screening instruments for assessing nutritional risk in predicting clinical outcomes in a population of hospitalised patients with overweight. A retrospective study was carried out in a medium-sized hospital in Brazil, with patients ≥20 years old admitted between July 2017 and December 2019. Patients who were overweight and had records of Nutritional Risk Screening-2002 (NRS-2002) and Mini-Nutritional Assessment-Short Form (MNA-SF) in their medical files were included in the study. Clinical outcomes data (longer length of stay, readmission during the study period and mortality before the end of study or during hospitalisation) were obtained. The Kappa coefficient assessed agreement between both tools, and their performance for predicting outcomes was analysed using characteristic receiver operating curves (ROC). Data were collected from 643 patients. The prevalence of nutritional risk was 17.7% and 36.1% according to the NRS-2002 and MNA-SF (k = 0.390; p < 0.001), respectively. According to both tools, all clinical outcomes were significantly more common among individuals at nutritional risk (p < 0.05). Only the MNA-SF showed a significant percentage of predictions for readmission (57.2%) and death during hospitalisation (65.7%). For mortality until the end of the study, the area under the ROC curve was similar for MNA-SF (60.5%) and NRS-2002 (60.7%; p = 0.057). The MNA-SF detected a greater proportion of nutritional risk among hospitalised patients with overweight and better predicted all clinical outcomes compared to the NRS-2002 and should be used to screen patients with overweight for nutritional risk.     

What factors explain the number of physical therapy treatment sessions in patients referred with low back pain; a multilevel analysis

Background  

It is well-known that the number of physical therapy treatment sessions varies over treatment episodes. Information is lacking, however, on the source and explanation of the variation. The purposes of the current study are: 1) to determine how the variance in the number of physical therapy treatment sessions in patients with non-specific low back pain (LBP) in the Netherlands is distributed over patient level, therapist level and practice level; and 2) to determine the factors that explain the variance.