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Re: LB exercise vs. general physical activity

 
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Re: LB exercise vs. general physical activity - December 1, 2005 8:45:00 AM   
Jon Newman

 

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From: Amherst, WI
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I do think there is a difference between specific advice (or even exercise) and specific exercise "for the back". I'm hoping to try to do an analysis ala Bill Egan and Bob Nee over at NOI following a similar report in October of 2004. Once I post what I've got, please add to and comment on it.

jon

If someone else beats me to it, feel free to post what you've got. I see I already need to collect another article for a fuller appreciation of protocols. For anyone interested, they need to look up the following citation.

Hursitz EL, Morgenstern H Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low-back pain: six-month follow-up outcomes from the UCLA Low Back Pain Study. Spine 2002;27:2193-2204

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Re: LB exercise vs. general physical activity - December 1, 2005 7:01:00 PM   
Jon Newman

 

Posts: 1733
Joined: April 25, 2004
From: Amherst, WI
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Here?s my attempt to analyze this study as modeled by Bill Egan and Bob Nee as mentioned before. Since this is a learning experience for me, please chime in.

1. Was the assignment randomized and list concealed?

Upon my reading of the article, the answer to this question is yes. From the article appearing in Spine

[QUOTE]The study statistician ran a computer program to generate randomized assignments in blocks of 12, stratified by site. The statistician placed each treatment assignment in a numbered security envelope. A separate series of sequentially numbered sealed envelopes was provided for each of the three sites. When each patient consented to be in the study, the field coordinator opened the site-specific envelope in sequence and documented the patient for whom the assignment was made and the time of the assignment. After completing the baseline questionnaire, each patient reported to the assigned medical or chiropractic provider on the same day.
[/QUOTE]2. Was the follow-up sufficiently long and complete?

These folks had an amazing response rate (90% at 18 months). It would make any researcher incredulous. The outcomes measures and time frames are a strong point of this study.

3. Were all the patients analyzed in the groups to which they were assigned?

Here lies one major point of contention. While there was an amazing 90% response rate at 18 months, there was also an amazing no show rate for those assigned to physical therapy; a whopping 33%! I?m sure there is room for commentary here regarding the statistics of this dilemma (intention to treat analysis). I?ll let those with a knack for statistics address that issue. I think for a physician however, they have to realize that their patients may not ever show up to PT when sent. So to that limited extent, those statistics are informative. Too bad patients can?t just show up to PT without being sent. That way we?d actually treat those who wanted to be treated by us. But that?s another story. The answer to the rest of this question is that they seem to adequately account for their patients.

4. Were the patient?s clinicians kept blind?

I don?t think this is necessary for this type of study. It would be helpful if the outcome collectors were blinded but I couldn?t tell from the study if this was the case.

5. Were groups treated equally?

No, but that also was not the intent of this type of study. The groups were treated, as chance would have it. This is something MD?s must deal with when referring patients. Importantly, in the case of PT, there was what I would consider an awful representation of PT treatment as those who post regularly here at rehabedge likely practice it. For example, the most common interventions in the PT group were heat or cold therapy (71%), supervised therapeutic exercises (59.5%), US (45%), EMS (33.6%), and mobilization (19%).

6. Were groups similar at the start of the trial?

The article did address this and contends that groups were not significantly different. I don?t see a very compelling reason to argue this point.

Lastly,

7. Are the results of this randomized trial important?

What are your thoughts?

jon

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Re: LB exercise vs. general physical activity - December 5, 2005 1:24:00 PM   
apolipo

 

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The reason I posted this article was not because it was particularly good or valid. I wanted others to see it so that we are all aware of other groups trying to spread the "PT doesn't work" message (please note the lead author is a DC).

"7. Are the results of this randomized trial important?"

For those practicing based on evidence, logic and reason, no it is not.

For those wishing to benefit from decreased usage of PT services, yes it is.

mike t

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Post #: 23
Re: LB exercise vs. general physical activity - December 5, 2005 6:18:00 PM   
Jon Newman

 

Posts: 1733
Joined: April 25, 2004
From: Amherst, WI
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Hi Mike,

I'm glad you posted this article as I think it highlights

1. Why its important to critically read an article
2. Our peers' actions reflect on the profession. If you know someone practicing this way, you may want to engage in a conversation or some such thing.

I think the research is important but perhaps not generalizable to those who practice differently than those in this study. Also, as I pointed out in another thread, the dates that PT was rendered in this study was a decade ago; things have changed.

Still there are some valid insights in this study and their conclusion

[QUOTE] These results suggest that individuals with low back pain should refrain from specific back exercises and instead focus on nonspecific physical activities to reduce pain and improve psychological health [/QUOTE]doesn't bother me so much although I can see how it would bother some people. If they phrased it, "refrain from pain relieving activities..." I might be more edgy.

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