Physical therapy on low back pain and sciatica. An attempt at evaluation.

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    ABSTRACT: A randomised clinical trial in primary care with a 12-months follow-up period. About 135 patients with acute sciatica (recruited from May 2003 to November 2004) were randomised in two groups: (1) the intervention group received physical therapy (PT) added to the general practitioners' care, and (2) the control group with general practitioners' care only. To assess the effectiveness of PT additional to general practitioners' care compared to general practitioners' care alone, in patients with acute sciatica. There is a lack of knowledge concerning the effectiveness of PT in patients with sciatica. The primary outcome was patients' global perceived effect (GPE). Secondary outcomes were severity of leg and back pain, severity of disability, general health and absence from work. The outcomes were measured at 3, 6, 12 and 52 weeks after randomisation. At 3 months follow-up, 70% of the intervention group and 62% of the control group reported improvement (RR 1.1; 95% CI 0.9-1.5). At 12 months follow-up, 79% of the intervention group and 56% of the control group reported improvement (RR 1.4; 95% CI 1.1; 1.8). No significant differences regarding leg pain, functional status, fear of movement and health status were found at short-term or long-term follow-up. At 12 months follow-up, evidence was found that PT added to general practitioners' care is only more effective regarding GPE, and not more cost-effective in the treatment of patients with acute sciatica than general practitioners' care alone. There are indications that PT is especially effective regarding GPE in patients reporting severe disability at presentation.
    European Spine Journal 05/2008; 17(4):509-17. · 2.47 Impact Factor
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    ABSTRACT: There are numerous treatment approaches for sciatica. Previous systematic reviews have not compared all these strategies together. To compare the clinical effectiveness of different treatment strategies for sciatica simultaneously. Systematic review and network meta-analysis. We searched 28 electronic databases and online trial registries, along with bibliographies of previous reviews for comparative studies evaluating any intervention to treat sciatica in adults, with outcome data on global effect or pain intensity. Network meta-analysis methods were used to simultaneously compare all treatment strategies and allow indirect comparisons of treatments between studies. The study was funded by the UK National Institute for Health Research Health Technology Assessment program; there are no potential conflict of interests. We identified 122 relevant studies; 90 were randomized controlled trials (RCTs) or quasi-RCTs. Interventions were grouped into 21 treatment strategies. Internal and external validity of included studies was very low. For overall recovery as the outcome, compared with inactive control or conventional care, there was a statistically significant improvement following disc surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture. Traction, percutaneous discectomy, and exercise therapy were significantly inferior to epidural injections or surgery. For pain as the outcome, epidural injections and biological agents were significantly better than inactive control, but similar findings for disc surgery were not statistically significant. Biological agents were significantly better for pain reduction than bed rest, nonopioids, and opioids. Opioids, education/advice alone, bed rest, and percutaneous discectomy were inferior to most other treatment strategies; although these findings represented large effects, they were statistically equivocal. For the first time, many different treatment strategies for sciatica have been compared in the same systematic review and meta-analysis. This approach has provided new data to assist shared decision-making. The findings support the effectiveness of nonopioid medication, epidural injections, and disc surgery. They also suggest that spinal manipulation, acupuncture, and experimental treatments, such as anti-inflammatory biological agents, may be considered. The findings do not provide support for the effectiveness of opioid analgesia, bed rest, exercise therapy, education/advice (when used alone), percutaneous discectomy, or traction. The issue of how best to estimate the effectiveness of treatment approaches according to their order within a sequential treatment pathway remains an important challenge.
    The spine journal: official journal of the North American Spine Society 10/2013; · 2.90 Impact Factor
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    ABSTRACT: Luijsterburg PAJ, Verhagen AP, Ostelo RWJG, Van den Hoogen HJMM, Peul WC, Avezaat CJJ, Koes BW. Oefentherapie is effectief bij een lumbosacraal radiculair syndroom. Een gerandomiseerd klinisch onderzoek met een follow-up van 12 maanden. Huisarts Wet 2008;51(11):549-54. Inleiding Er is nog weinig bekend over de effectiviteit van oefentherapie als behandeling bij patiënten met een lumbosacraal radiculair syndroom (LRS). Methoden We randomiseerden 135 patiënten met een LRS in 2 groepen. De eerste groep kreeg fysiotherapie naast de behandeling van de huisarts en de tweede groep kreeg alleen de huisartsbehandeling. De patiënten vulden na 3, 6, 12 en 52 weken vragenlijsten in. Resultaten De 135 patiënten waren verdeeld over de fysiogroep (67 patiënten) en de huisartsengroep (68 patiënten). Na 12 weken follow-up rapporteerde 70% van de patiënten in de fysiogroep hersteld te zijn, tegen 62% in de huisartsengroep (RR 1,1; 95%-BI 0,9-1,5). Na 52 weken follow-up was dit verschil statistisch significant én klinisch relevant. Op dat moment rapporteerde 79% van de patiënten in de fysiogroep herstel, tegenover 56% in de huisartsgroep (RR 1,4; 95%-BI 1,1-1,8). Tijdens de follow-up vonden we echter geen verschillen in beenpijn, functioneren, angst om te bewegen en kwaliteit van leven. Conclusie Fysiotherapie naast de huisartsbehandeling is bij LRS op langere termijn effectief, echter alleen voor wat betreft het herstel zoals de patiënt dat zelf ervaart. oefentherapie-onderzoek-rugklachten-rugpijn-hernia nuclei pulposi
    Huisarts en wetenschap 01/2008; 51(11):549-554.