Archive for category: KDT Blog

Wertli MM et al 

Spine J. May 2014

BACKGROUND CONTEXT:
Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain (LBP).

PURPOSE:
The purpose of this study was to determine the prognostic importance of fear avoidance beliefs as assessed by the Fear Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale of Kinesiophobia for clinically relevant outcomes in patients with nonspecific LBP.

RESULTS:
The most convincing evidence was found supporting fear avoidance beliefs to be a prognostic factor for work-related outcomes in patients with subacute LBP (ie, 4 weeks-3 months of LBP), researchers found an increased risk for work-related outcomes (not returning to work, sick days) with elevated FABQ scores. Fear avoidance beliefs in very acute LBP (<2 weeks) and chronic LBP (>3 months) was mostly not predictive.

CONCLUSIONS:
Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute LBP, and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity.

Cochrane Database Syst Rev. 2015 Mar 16;(3)

Duivenvoorden T, Brouwer RW, et al

BACKGROUND:
Individuals with osteoarthritis (OA) of the knee can be treated with a knee brace or a foot/ankle orthosis. The main purpose of these aids is to reduce pain, improve physical function and, possibly, slow disease progression. This is the second update of the original review published in Issue 1, 2005, and first updated in 2007.

OBJECTIVES:
To assess the benefits and harms of braces and foot/ankle orthoses in the treatment of patients with OA of the knee.

CONCLUSIONS:
Evidence was inconclusive for the benefits of bracing for pain, stiffness, function and quality of life in the treatment of patients with knee OA. On the basis of one laterally wedged insole versus no treatment study, we conclude that evidence of an effect on pain in patients with varus knee OA is lacking. Moderate-quality evidence shows lack of an effect on improvement in pain, stiffness and function between patients treated with a laterally wedged insole and those treated with a neutral insole. Low-quality evidence shows lack of an effect on improvement in pain, stiffness and function between patients treated with a valgus knee brace and those treated with a laterally wedged insole. The optimal choice for an orthosis remains unclear, and long-term implications are lacking.

Note: It’s interesting how committed we can be to certain ‘ideas, concepts and procedures’ when in fact there is (and perhaps never was) any real scientific backing for them(?)….

Kerr D1, Zhao W, Lurie JD. Clin ortho res 2014

BACKGROUND:
Although previous studies have illustrated improvements in surgical cohorts for patients with disc herniation, there are limited data on long-term outcomes comparing surgical and nonsurgical outcomes.

METHODS:
Patients with symptomatic lumbar radiculopathy for at least 6 weeks associated with nerve root irritation or neurologic deficit on examination and a confirmed disc herniation.Those who declined randomization entered the observational cohort group based on treatment preference but were otherwise treated and followed identically to the randomized cohort. Of those in the randomized cohort, 309 of 501 (62%) provided 8-year data and in the observational group 469 of 743 (63%). Patients were treated with either surgical discectomy or usual nonoperative care. By 8 years, only 148 of 245 (60%) of those randomized to surgery had undergone surgery, whereas 122 of 256 (48%) of those randomized to nonoperative treatment had undergone surgery.

RESULTS:
The intent-to-treat analysis of the randomized cohort at 8 years showed no difference between surgical and nonoperative treatment for the primary outcome measures. Secondary outcome measures of sciatica bothersomeness, leg pain, satisfaction with symptoms, and self-rated improvement showed greater improvement in the group randomized to surgery despite high levels of crossover. The as-treated analysis of the combined randomized and observational cohorts, adjusted for potential confounders, showed advantages for surgery for all primary outcome measures; however, this has the potential for confounding from other unrecognized variables. Smokers and patients with depression or comorbid joint problems had worse functional outcomes overall (with surgery and nonoperative care) but similar surgical treatment effects. Patients with sequestered fragments, symptom duration greater than 6 months, those with higher levels of low back pain, or who were neither working nor disabled at baseline showed greater surgical treatment effects.

CONCLUSIONS:
The intent-to-treat analysis showed no difference over 8 years for primary outcomes of overall pain & physical function….sequestered fragments, higher levels of baseline back pain with radiculopathy, a longer duration of symptoms, and those who were neither working nor disabled at baseline with a greater relative advantage from surgery at 8 years.

Ndetan H Evans MW Jr, Hawk C, Walker C.
J Comp Med Dec. 2012

OBJECTIVES:
The aim of this study was to describe use of chiropractic and/or osteopathic manipulation by children in the United States along with the specific health conditions for which they sought care.

RESULTS:
National estimates indicated that 2.3 million children (2.3%) in the United States had used Complementary procedures in 2007. SMT was the most common complementary and alternative medicine procedure. Children aged 12-18 years were more likely to have seen these providers than were younger age groups.
The most common complaints were back and neck pain. Other conditions for which children were seen included other musculoskeletal conditions, sinusitis, allergies, and non-migraine headaches.

CONCLUSIONS:
Chiropractic or osteopathic manipulation is primarily used for back and neck pain, which is increasing in prevalence in children. Teens are more likely to use it than are younger children.