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PubMed2002

Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial.

BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled trial. SETTING: Outpatient care setting in the Netherlands. PATIENTS: 183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks. INTERVENTION: 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education). MEASUREMENTS: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. RESULTS: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant. CONCLUSION: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.

Adolescent↗
PubMed2005

A comparison of the OARSI response criteria with patient's global assessment in patients with osteoarthritis of the hip treated with a non-pharmacological intervention.

OBJECTIVE: To compare the Osteoarthritis Research Society International (OARSI) response criteria for clinical trials with patient's global assessment in patients with osteoarthritis (OA) of the hip receiving a non-pharmacological intervention, i.e., manual therapy or exercise therapy. METHODS: Data of a randomized clinical trial on manual therapy and exercise therapy in patients with OA of the hip (n = 109) were used. Change scores of measures of hip function, range of joint motion and pain were compared between patients who were differently classified by the OARSI response criteria and the patient's global assessment (using a t test, 95% CI). Furthermore, risk ratios (with 95% CI) were calculated for the contrast between treatment outcome, using the OARSI criteria or patient's global assessment. RESULTS: Few patients were classified as improved (i.e., responders) with the OARSI response criteria as compared to patient's global assessment. Significantly worse outcome for hip function and pain was observed in patients who were classified as non-responders (OARSI criteria), but who considered themselves as improved (patient's global assessment). Risk ratios for the contrast between the two treatment programs (manual therapy vs exercise therapy) were similar, when using the OARSI criteria or patient's global assessment. CONCLUSION: The validity of the OARSI response criteria has been previously demonstrated in OA patients treated with pharmacological interventions. The present study demonstrates the validity of the OARSI response criteria in OA patients treated with a non-pharmacological intervention, i.e., manual therapy and exercise therapy.

Aged↗
PubMed1999

[Effectiveness and practice of dietary therapy and exercise].

Dietary therapy and physical activity are cornerstones for lipid lowering and prevention of cardiovascular disease. The efficacy of dietary therapy has been established in several primary and secondary prevention studies. Exercise is believed to be useful to prevent atherosclerosis, but there has been no mega trial performed. The beneficial effect of physical activity may be mediated in several ways, such as reduction in VLDL, increase in HDL, reduction in body weight and reduction in blood pressure. According to the guideline of Japan Atherosclerosis Society, dietary modification is recommended to perform in three steps and practical use of the guideline was described. For exercise, aerobic activity, such as brisk walking, jogging, swimming and bicycling are recommended. Intensity, amount and frequency of exercise were described.

Exercise Therapy↗
PubMed2005

Treatments for chronic fatigue syndrome.

AIMS: To review studies evaluating the treatment of chronic fatigue and chronic fatigue syndrome, to describe predictors of response to treatment and to discuss the role of the occupational health physician. METHODS: A literature search was carried out using Medline and PsychInfo. RESULTS: Studies evaluating cognitive behaviour therapy, graded exercise therapy, pharmacological interventions (e.g. antidepressants and corticosteroids), immunological interventions and nutritional supplements were reviewed. The most promising results have been found with cognitive behaviour therapy and graded exercise therapy, and some predictors of outcome have been identified. Most of the other interventions were evaluated in just one or two studies and therefore evidence is insufficient to draw firm conclusions. CONCLUSIONS: By applying the models of fatigue that form the bases for cognitive behaviour therapy and graded exercise therapy, occupational health physicians may play an important role in helping the patients with chronic fatigue syndrome to reduce their symptoms, improve their functioning and return to work.

Cognitive Behavioral Therapy↗
PubMed2005

A systematic review of the outcomes of cardiovascular exercise programs for people with Down syndrome.

OBJECTIVE: To determine if cardiovascular exercise programs are beneficial and safe for people with Down syndrome. DATA SOURCES: Electronic databases were searched from the earliest time available through to October 2004 using the following key words: Down syndrome or trisomy 21 in combination with physical fitness, exercise, physical activity, exercise therapy, exercise training, physical training, and aerobic. Additional articles were identified by manual searching and citation tracking. STUDY SELECTION: Two reviewers independently assessed the articles identified in the initial search for the following inclusion criteria: (1) participants with Down syndrome, (2) an exercise program that conformed with the American College of Sports Medicine guidelines for increasing cardiovascular fitness, (3) assessed changes in body structure or function, activity limitation, or societal participation, and (4) used a prospective clinical controlled research design with or without random allocation to groups. Trials of low methodologic quality were excluded (PEDro score, <4). Of the 156 articles initially identified, only 4 met the inclusion criteria and underwent detailed review. DATA EXTRACTION: Data relating to changes in body structure and function, activity limitation, participation restriction, and contextual factors from the included studies were independently extracted by the reviewers on a standardized form. Study quality was assessed using the PEDro scale. DATA SYNTHESIS: Meta-analyses found that cardiovascular exercise programs were effective in increasing peak oxygen consumption (d=.75; 95% confidence interval [CI], 0.34-1.15), peak minute ventilation (d=.71; 95% CI, 0.15-1.28), the maximum workload achieved (d=.96; 95% CI, 0.45-1.45), and the time to exhaustion (d=.72; 95% CI, 0.29-1.15) in people with Down syndrome. No changes were found for body weight (d=.09; 95% CI, -.39 to .57). No adverse effects were reported in any of the studies. CONCLUSIONS: The result of our review support the use of programs designed to improve cardiovascular fitness among people with Down syndrome. However, because only 4 studies were included, the findings need to be interpreted cautiously. High-quality randomized controlled trials should be completed in the future to determine the effect of these programs on activity and social participation.

Down Syndrome↗
PubMed2001

Using outcome evaluations to assess interdisciplinary acute and chronic pain programs.

BACKGROUND: Outcome evaluations can be useful for reassuring patients that their time and effort are well spent on treatment and for providing staff with confidence in their treatment provision. Outcome evaluations were carried out in 1997 and 1999 to assess two initiatives for the treatment of patients within the Regina Health District (RHD), Saskatchewan, Canada-the Chronic Pain Team Evaluation and Management (CP TEAM) Service and the Acute Injury Management (AIM) Program. STUDY 1: The CP Team Service was an individualized interdisciplinary treatment program intended to serve patients with chronic pain. Of 47 eligible chronic pain patients, 36 participants completed treatment within 15 months, and 27 completed follow-up questionnaires on discharge; the comparison group was composed of the remaining 11 nontreated participants, 8 of whom responded to follow-up questionnaires. Only patients in the treatment group reported a decrease in pain and a decrease in interference in activities. Overall, satisfaction with treatment received was high. STUDY 2: The AIM Program was intended to aid employees with acute musculoskeletal injuries who could not perform regular job duties. Following injury, employees were contacted by an occupational health nurse and informed of the program. If the employee was interested, the AIM coordinator carried out an assessment and designed an individualized treatment package, including physical therapy, exercise therapy, and/or occupational therapy. Treatment was expected to continue until the employee returned to normal duties. Of 72 eligible employees, 43 employees participated and 29 opted not to participate-15 of whom agreed to participate as control participants for this study. Of the employees receiving AIM, 20 agreed to participate in this study. Of the employees not participating in AIM, 15 agreed to participate as control participants. Although pain and interference were greater among AIM participants before commencing treatment, by the end of treatment participants had improved more in level of pain severity and interference compared with controls. All participants reported improved job function over time. AIM participants, however, reported lower job function before treatment than control participants and similar job function after treatment- and indicated they were highly satisfied with the service they received. SUMMARY AND CONCLUSIONS: Evaluations are not only used to assess program outcomes but are an important aspect of program validation and development. Data collection was incorporated, as much as possible, into routine treatment protocols and staff focused on obtaining essential information regarding patient outcomes rather than the whole scope of information.

Acute Disease↗
PubMed2000

The role of electrotherapy in contemporary physiotherapy practice.

Although electrotherapy has a well established role within physiotherapy practice, the current concepts that influence its application vary considerably from those proposed historically. It is argued that there is a place for electrophysical modalities in contemporary practice, and several basic principles are considered together with more specific information regarding two modalities namely, ultrasound and interferential therapy. Electrophysical agents are utilised to bring about physiological effects, and it is these changes which bring about the therapeutic benefit rather than the modality itself. Clinical decision protocols employing the available evidence should enable the most appropriate modality to be employed for a particular patient. Indiscriminate use of electrotherapy is unlikely to yield significant benefit, however used at the right time, it has the potential to achieve beneficial effect. The patient management programme which combines manual therapy, exercise therapy and electrotherapy, based on current evidence, should enable the most efficacious management of a patients' dysfunction. This paper aims to consider some of the current concepts in electrotherapy and to relate this to both general and specific treatments.

Electric Stimulation Therapy↗
PubMed2005

Daily expression of clock genes in whole blood cells in healthy subjects and a patient with circadian rhythm sleep disorder.

In recent years, circadian rhythm sleep disorders in humans have been increasing. Clinical features characteristic of this disorder are well known, but the specific causes remain unknown. However, various derangements of circadian expression of the clock gene are a probable cause of this disease. We have attempted to elucidate the relationship between the expression of the clock genes in whole blood cells and the clinical features characteristic of this disorder. In this study, we indicate the daily expression of clock genes period (Per) 1, 2, 3, Bmal1, and Clock in whole blood cells in 12 healthy male subjects. The peak phase of Per1, Per2, and Per3 appeared in the early morning, whereas that of Bmal1 and Clock appeared in the midnight hours. Furthermore, in one patient case with circadian rhythm sleep disorder, we observed variations of the peak phase in clock genes by treatments such as light therapy, exercise therapy, and medicinal therapy. This study suggested that the monitoring of human clock genes in whole blood cells, which may be functionally important for the molecular control of the circadian pacemaker as well as in suprachiasmatic nucleus, might be useful to evaluate internal synchronization.

ARNTL Transcription Factors↗
PubMed2005

Optimal diabetes management during medical weight loss for cardiovascular risk reduction.

Obesity has long been recognized as a significant risk factor for type 2 diabetes. Both obesity and type 2 diabetes are associated with an increase in cardiovascular risk. As cardiovascular disease continues to be the number one killer in the USA and western adult populations, the rise in prevalence of obesity and type 2 diabetes is alarming. This is especially disturbing in the tripling of overweight children and adolescents, accompanied by the increase in prevalence of pediatric type 2 diabetes. Optimal strategies for long-term diabetes management aim at effectively controlling, reducing and ultimately preventing obesity. This review explores the clinical recommendations in place, new clinical investigations, diet therapy, medical nutrition therapy, meal replacements, behavior therapy, exercise therapy, pharmacotherapy and surgical therapy as strategies to achieve weight-loss success in diabetic patients and ultimately reduce cardiovascular disease.

Cardiovascular Diseases↗
PubMedDate not supplied

Application of the ICIDH in survey research on rehabilitation: the emergence of the functional diagnosis.

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) has been hypothesized to be an excellent conceptual framework for the functional diagnosis, i.e. the evaluation of health problems by rehabilitation specialists. The ICIDH-based functional diagnosis was assessed in a series of survey studies on physical therapy, exercise therapy, occupational therapy, podiatry, and speech therapy. The results show that the functional diagnosis tends to be reliable; that treatment goals, derived from the diagnosis, offer a sensible characterization of care given by rehabilitation specialists; and that treatment goals validity predict the selection of interventions by rehabilitation specialists. It is concluded that the application of the ICIDH in research on the functional diagnosis is highly appropriate. In future studies the concept of the functional diagnosis and the diagnostic procedures should be further developed.

Disability Evaluation↗
PubMed1992

Interventions related to activity and movement.

Ten nursing interventions related to human activity phenomena with definitions and a combined total of 246 defining activities were developed from literature reviews and concept synthesis. A two-round Delphi survey of highly experienced master's-prepared rehabilitation nurses confirmed the content validity of the interventions. Round 1 responses resulted in major revisions of several interventions that were questioned and viewed as being outside the domain of nursing practice. Respondents also indicated that some of the activities listed were "idealistic" and that factors such as limited staffing, institutional policy, and physical characteristics of the unit would limit implementation. None of the activities rated in round 2 were deleted for means less than 0.50. The interventions with the highest ICV scores were Swallowing Therapy (0.86), Exercise Therapy: Ambulation (0.85), and Exercise Therapy: Mobility (0.84). Although all of the interventions were conceptualized for nursing across settings, these are modest levels of agreement and may reflect the practice of nursing in more structured institutional settings where exercise and activity therapies are performed by specialty rehabilitation professionals. On the other hand, the 72% round 2 response rate and the volume of written feedback received attests to the level of commitment and attention given to the task by the nurse experts. This affirms the value of seeking systematically to identify, verify, and build nursing science.

Activities of Daily Living↗
PubMed1992

Exercise-induced bronchospasm: epidemiology, pathophysiology, and therapy.

Exercise induced bronchospasm (EIB) is a common clinical problem seen in most individuals with chronic asthma and in nearly half the allergic population. Bronchospasm is typically present 5-15 min after cessation of activity, with spontaneous resolution usually occurring within 20-60 min. The stimulus for EIB is apparently a combination of airway cooling and drying, which results in pulmonary mast cell mediator release. Bronchospasm is generally more severe if there is greater baseline bronchial hyperreactivity or higher intensity of exercise. The treatment of choice for EIB is preexercise administration of a beta-adrenergic agonist. Other useful therapies may include cromolyn, theophylline, calcium channel blockers, anticholinergics, and antihistamines. The crucial step for clinicians caring for these patients is making the diagnosis of EIB. The condition responds well to therapy, and treatment may allow for greater enjoyment of activity and enhanced athletic performance.

Asthma, Exercise-Induced↗
PubMed2001

Physical therapy and exercise in pain management.

Physical therapy and exercise are fundamental to the interdisciplinary approach to pain management in the elderly. Physical modalities used in combination with exercise provide pain relief and help to prevent future pathology and physiologic changes in the elderly that often result in significant pain syndromes. This article provides an overview of effective modalities for pathology prevention, treatment of pain, and restoration of function that are the basis for pain management in geriatric patients.

Aged↗
PubMed2004

[Development of 'Ordnungstherapie' by Bircher-Benner in naturopathy of the 20th century].

BACKGROUND: The German term 'Ordnungstherapie' is one of the five therapeutics which defines naturopathy in German-speaking countries. OBJECTIVE: Who formed the term Ordnungstherapie in naturopathy and what does it mean? MATERIAL AND METHODS: Heuristics and criticism of literature of the 20th century as well as database research. RESULTS: Nowadays in German-language medical books Ordnungstherpie belongs to the five therapeutics which define European naturopathy. Yet, the interpretation ranges from health education to body-orientated forms of psychotherapy. The term Ordnungstherapie is often related with the German priest and hydropath Sebastian Kneipp, however, term and definition have been founded by the Swiss physician Maximillian Bircher-Benner. In 1937 he defined Ordnungstherapie as a complex concept of natural healing. It is based upon the rather nosological idea that health is order/harmony in the human body (physically, psychologically), the environment and the daily course. Illness occurs if disorder appears in one of these fields. The therapeutic setting of Ordnungstherapy is defined by 9 rules of conduct to maintain order, which include nutrition, the skin as an organ (exposure to light, air, water), breathing, movement, rhythm of life, and psyche. For all these aspects Bircher-Benner himself uses the terms somatotherapy (dietotherapy, sun and light therapy, hydrotherapy, exercise therapy, breathing technique, order of the rhythm of live) and psychotherapy. He chose these complementary methods subjectively after learning them from 1897 onwards in an eclectic manner and after gaining therapeutic empiricism. Nevertheless his ideas of the Ordnungstherapie correlate with the socio-political context of the 1940ies. CONCLUSIONS: The term Ordnungstherapie was introduced by Bircher-Benner as an umbrella term in 1937 to describe a complex concept of naturopathic therapies. It comprises, with certain limitations for phytotherapy, the therapies which nowadays define European naturopathy. Yet, in European naturopathy today Ordnungstherapie is mostly considered as one out of 5 constituents of naturopathy (dietotherapy, hydrotherapy, exercise therapy, phytotherapy, Ordnungstherapie). The classification of Ordnungstherapie as one of the 5 pillars of the Kneipp therapy was only done by Kneipp physicians in the middle of the 20th century and needs to be thought over.

Germany↗