Bmc Musculoskel Dis
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Bmc Musculoskel Dis · Jan 2012
Randomized Controlled Trial Comparative StudySustainability of return to work in sick-listed employees with low-back pain. Two-year follow-up in a randomized clinical trial comparing multidisciplinary and brief intervention.
Sick-listed employees with low back pain had similar return to work (RTW) rates at one-year follow-up in a randomized trial comparing two interventions, but the effects were modified by specific workplace related factors. The present study addressed the sustainability of the intervention effects by performing a two-year follow-up and by using different outcome measures. ⋯ The effects of the brief and multidisciplinary interventions at the two-year follow-up were in general similar to the effects at one-year follow-up.
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Bmc Musculoskel Dis · Jan 2012
Randomized Controlled TrialManual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial.
Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. ⋯ This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly.
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Bmc Musculoskel Dis · Jan 2012
Randomized Controlled TrialTotal knee replacement plus physical and medical therapy or treatment with physical and medical therapy alone: a randomised controlled trial in patients with knee osteoarthritis (the MEDIC-study).
There is a lack of high quality evidence concerning the efficacy of total knee arthroplasty (TKA). According to international evidence-based guidelines, treatment of knee osteoarthritis (KOA) should include patient education, exercise and weight loss. Insoles and pharmacological treatment can be included as supplementary treatments. If the combination of these non-surgical treatment modalities is ineffective, TKA may be indicated. The purpose of this randomised controlled trial is to examine whether TKA provides further improvement in pain, function and quality of life in addition to optimised non-surgical treatment in patients with KOA defined as definite radiographic OA and up to moderate pain. ⋯ This is the first randomised controlled trial to investigate the efficacy of TKA as an adjunct treatment to optimised non-surgical treatment in patients with KOA. The results will significantly contribute to evidence-based recommendations for the treatment of patients with KOA.
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Bmc Musculoskel Dis · Jan 2012
Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery.
Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. ⋯ We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.
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Bmc Musculoskel Dis · Jan 2012
The Dutch Lower Extremity Functional Scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study.
The WOMAC is the most widely used self-report measure to evaluate physical functioning in hip or knee osteoarthritis, however its ability to discriminate pain and physical functioning (i.e. discriminate validity) has repeatedly been questioned. Little to no data is available on the discriminant validity of alternative questionnaires that measure the same construct, for instance the Hip and Knee Osteoarthritis Outcome Score (HOOS and KOOS, respectively) and the Lower Extremity Function Scale (LEFS). Therefore, we translated the LEFS to Dutch and studied its psychometric properties (i.e. validity, reliability and responsiveness). In addition, we assessed the discriminate validity of the LEFS, HOOS and KOOS. ⋯ Considering the LEFS' good psychometric qualities and ability to discriminate between pain and functioning, we recommend the LEFS as the outcome measure of choice to assess self-reported physical functioning in individuals with hip or knee osteoarthritis.