Articles: low-back-pain.
-
Randomized Controlled Trial Clinical Trial
Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial.
Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain, a multidisciplinary rehabilitation programme for an outpatient group setting was developed. The main treatment components address the patient's physical functional capacity (functional restoring), cognitive and affective processes (pain management strategies), and behavioural and ergonomical aspects (back school elements). Short-term (immediately after intervention) and long-term effects (at 6-months follow-up) of the intervention were assessed in a randomized controlled study. ⋯ In contrast to post-treatment results, there were also significant improvements in strength and endurance. Overall results testify to the effectiveness of the intervention programme. Future studies (with larger sample sizes) should aim at a further improvement of functional capacity and disability perception, an analysis of differential treatment effects, and strategies for an improved long-term maintenance of the changes induced by the programme.
-
Fortschritte der Medizin · Dec 1996
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial[Flupirtine in comparison with chlormezanone in chronic musculoskeletal back pain. Results of a multicenter randomized double-blind study].
The analgesic and muscle-relaxing properties of flupirtine maleate, chlormezanone and placebo were compared in a total of 184 patients. Of these patients, 164 met the criteria of the treatment plan (intention to treat), and the data of 140 patients were finally evaluated in accordance with the test protocol. A positive response was defined as a reduction in pain intensity and muscle tension by 2 categories on the 5-category verbal scale "very severe/severe/moderate/mild/ none" on the seventh day of treatment. ⋯ In the per-protocol-analysis the responder rate was 60.9% for flupirtine, 47.8% for chlormezanone, and 43.8% for placebo, the difference between drugs and placebo not being significant. The overall assessment of the physicians involved was very good/ good in 47.8% and satisfactory in 37.0% of the flupirtine group, very good/good in 45.6% and satisfactory in 17.4% of the chlormezanone group, the corresponding figures for the placebo group being 33.4% and 20.6%, respectively. Flupirtine was thus superior to placebo (p = 0.007). The incidence of adverse drug reactions was 14.8% (8/54) for flupirtine, 19.3% (11/57) for chlormezanone, and 7.3% (4/55) for placebo.
-
Randomized Controlled Trial Clinical Trial
Should the gap be filled between guidelines and actual practice for management of low back pain in primary care? The Quebec experience.
A prospective cohort study. ⋯ Health services utilization for back pain in Quebec was equal or lower to what currently is practiced elsewhere, but access to specialists was not meeting the current recommendations. This would represent a 12% net increase in new specialist contacts and a quicker access in 39% who saw a specialist. Before such an effort can be considered, health care planners will need a better definition of the role of the specialist consultation in the guidelines and scientific evidence specifically addressing their benefit in primary care, especially in the absence of a specific diagnosis.
-
Randomized Controlled Trial Clinical Trial
Predicting poor outcomes for back pain seen in primary care using patients' own criteria.
A prospective cohort study of patients seen in primary care for low back pain. ⋯ The proportion of primary care patients with back pain who have poor outcomes appears to be higher than generally recognized. Ways of improving how primary care responds to patients with persisting pain should be investigated.
-
J Manipulative Physiol Ther · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialTrunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial.
To study the relative efficacy of three different treatment for chronic low back pain (CLBP). Two preplanned comparisons were made: (a) Spinal manipulative therapy (SMT) combined with trunk strengthening exercises (TSE) vs. SMT combined with trunk stretching exercises, and (b) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug (NSAID) therapy combined with TSE. ⋯ Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP. For the management of CLBP, trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile. The magnitude of nonspecific therapeutic (placebo) effects, cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies.