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

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    ABSTRACT: The lumbosacral radicular syndrome causes pain in the leg and disability, often resulting in utilisation of healthcare resources and absenteeism from work. In general practice this syndrome is the most frequently seen specific low-back disorder. The aim of the research described in this thesis was to establish general practitionersâ?T and neurosurgeonsâ?T current management of patients with a lumbosacral radicular syndrome compared with their guidelines, and to assess the (cost) effectiveness of physical therapy in addition to the general practitionerâ?Ts care, in patients with an acute lumbosacral radicular syndrome. In two surveyâ?Ts it was concluded that the majority of the general practitioners and neurosurgeons support the content of the guideline and based on their current management of patients, they largely adhere with the guideline. The conclusion of the randomised clinical trial, at 12-months follow-up, was that physical therapy in addition to the general practitionerâ?Ts care is more effective in the treatment of patients with acute lumbosacral radicular syndrome than the general practitionerâ?Ts care alone. Furthermore, there are indications that physical therapy is particularly effective in patients reporting severe disability at presentation. The economic evaluation alongside this trial showed that physical therapy provided no cost effective addition to care in general practice for patients with a lumbosacral radicular syndrome.
    European Journal of Clinical Microbiology & Infectious Diseases - EUR J CLIN MICROBIOL INFECT D. 01/2006;
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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: Objectives : This study was purposed to investigate the possibility of traction therapy as treatment method of scoliosis, of which occurrence rate was increasing with teenagers in Korea. Methods : 63 literatures, history, classification, and effectiveness of traction therapy were reviewed and the occurrences rate of scoliosis with teenagers in Korea was investigated. Results : Traction therapy as a treatment method on scoliosis, was originally developed by Hippocrates(460~385 BC), based on the historical record. Traction therapy is classified according to the tools engaged, the postures, the traction methods, and the areas for traction. The opinions on the effect of traction as treatment method were different depending on whether it is in Korea or outside of the country. Within the country, 75% of reports were positive on the effects of traction therapy, while outside of the country, about 74% of reports were negative. On the other hand, the occurrence rates of scoliosis with teenagers in Korea were increasing from 1.46%(1977) to 11.08%(2008). Conclusions : Unfortunately the effects of traction therapy on scoliosis were unclear but it seems to be different in the effects of manipulative therapy and mechanical or apparatus traction therapy. Systematic studies on traction therapy are needed, because of the increasing rate of scoliosis in Korea with teenagers.
    Korean Journal of Acupuncture. 01/2012; 29(2).