Aust J Physiother
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A systematic review of randomised clinical trials was conducted to assess the effect of spinal manipulative therapy on clinically relevant outcomes in patients with chronic low back pain. Databases searched included EMBASE, CINAHL, MEDLINE and PEDro. Methodological assessment of the trials was performed using the PEDro scale. ⋯ Spinal manipulative therapy reduced disability by 6 points (95% CI 1 to 12) on a 100-point disability questionnaire when compared with NSAIDs. It is concluded that spinal manipulation does not produce clinically worthwhile decreases in pain compared with sham treatment, and does not produce clinically worthwhile reductions in disability compared with NSAIDs for patients with chronic low back pain. It is not clear whether spinal manipulation is more effective than NSAIDs in reducing pain of patients with chronic low back pain.
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Comparative Study
Hospital stay and discharge outcomes after knee arthroplasty: implications for physiotherapy practice.
Patient outcomes at discharge from acute care after knee arthroplasty were investigated in a prospective observational outcome study at three Melbourne public acute care hospitals during a five-month period from November 1999 to March 2000. The participants were 105 consecutive patients (35 at each hospital), with a mean age of 71 years. Outcome measures were length of stay, destination (home or rehabilitation), knee range of movement, and functional mobility at discharge from the acute care facility. ⋯ The reasons identified for discharge to rehabilitation despite the achievement of sufficient functional independence included pressure on clinicians to decrease length of stay and the need to make decisions regarding discharge early in the post-operative recovery when the eventual patient outcome may still be unclear. Unnecessary discharges to rehabilitation increase the overall length of stay in the health care system and costs per patient. This finding suggests a method of risk screening is required to assist clinical decision making with regard to discharge.
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Coughing and huffing have been shown to be effective airway clearance techniques and some authors have anecdotally reported that a huff requires less energy than a series of coughs commencing and finishing at the same lung volume. The aim of this study was to determine whether there is a difference in the energy expenditure between periods of huffing and directed voluntary coughing commencing from the same initial lung volume in young asymptomatic subjects. Energy expenditure was measured using open-circuit indirect calorimetry equipment. ⋯ Each session was separated by a 5min washout period. No significant difference in energy expenditure was found between the huffing and directed coughing periods (mean difference 0.003 mL/kg/min (95% CI -0.160 to 0.114) and both produced significantly greater energy expenditure than rest (rest and huff mean difference 0.309 mL/kg/min (95% CI 0.080 to 0.549) and rest and cough mean difference 0.306 mL/kg/min (95% CI 0.074 to 0.508)). The suggested benefits of huffing versus coughing in terms of energy conservation are yet to be shown.
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Randomized Controlled Trial Clinical Trial
Combined physiotherapy and education is efficacious for chronic low back pain.
Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners. ⋯ The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.