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rwillcott -> Re: Core Exercises (June 8, 2006 1:55:00 AM)
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ysumpt2006,
I would be careful when interpreting the Koumantakis study. You are right when you say that this study found no difference between general trunk exercises and specific stability exercisies. In fact the general trunk exercise group did better on disability scores in the short term.
However, all patients presenting with clinical signs suggesting spinal instability were excluded from the study! Thats correct! They excluded the very group of patients that would benefit from these exercises ( abberant movement, catching pain, thigh climbing, spondylolisthesis, positive prone stability test etc.)
As a colleague explained to me once, it's equivalent to performing a study on the effectiveness of appendectomies. However, prior to beginning the study you exclude all patients with cardinal signs and symptoms of appendicits. Then make the conclusion that appendectomies are not effective for the treatment of abdominal pain.
The treatment of back pain is no different. Back pain is caused by many factors. This is where the use of clinical practice guidleines is useful.
This study is an example of being careful what the results are telling us. One positive aspect of this study is that it tells us that if a patient does not meet the clinical prediction rules for spinal stability exercies then they propably won't benefit from these exercises. However, if you were to select the appropriate patients you will notice that they will benefit from specific stability exercises.
Rob
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