Even Lærum

The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle Pain After Pregnancy: A Randomized Controlled Trial

Study Design. A randomized controlled trial with stratified block design. Objectives. To evaluate a treatment program focusing on whether specific stabilizing exercises for patients with pelvic girdle pain after pregnancy reduce pain, improve functional status, and improve quality of life. Summary of Background Data. The evidence of effectiveness of treatment for pelvic girdle pain is weak. Recent research has focused on the importance of activation of muscles for motor control and stability of the lumbopelvic region. To the authors’ knowledge, the efficacy of applying these principles for pelvic girdle pain has not previously been evaluated in a randomized controlled trial. Methods. Eighty-one women with pelvic girdle pain were assigned randomly to two treatment groups for 20 weeks. One group received physical therapy with a focus on specific stabilizing exercises. The other group received individualized physical therapy without specific stabilizing exercises. Assessments were administered by a blinded assessor, at baseline, after intervention and 1 year post partum. Main outcome measures were pain, functional status and quality of life. Results. There were no dropouts. After intervention and at 1 year post partum, the specific stabilizing exercise group showed statistically and clinically significant lower pain intensity, lower disability, and higher quality of life compared with the control group. Group difference in median values for evening pain after treatment was 30 mm on the Visual Analog Scale. Disability was reduced by more than 50% for the exercise group; changes were negligible in the control group. Significant differences were also observed for physical tests, in favor of the specific exercise group. Conclusion. An individualized treatment approach with specific stabilizing exercises appears to be more effective than physical therapy without specific stabilizing exercises for women with pelvic girdle pain after pregnancy.

The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle Pain After Pregnancy: A Two-year Follow-up of a Randomized Clinical Trial

Study Design. A randomized clinical trial. Objectives. To examine the effects of a treatment program focusing on specific stabilizing exercises after a 2-year follow-up period. Summary of Background Data. An individualized treatment approach with specific stabilizing exercises is shown to be effective for women with pelvic girdle pain 1 year after delivery. No previous study has examined the long-term effects of treatment for women with postpartum pelvic girdle pain. Methods. Eighty-one women with pelvic girdle pain postpartum were assigned randomly to 2 treatment groups for 20 weeks. Patient self-reported questionnaires measuring pain, disability, and health-related quality of life were collected after 20 weeks of treatment and 1 and 2 years postpartum. Results. All 81 women returned the questionnaires for the 2-year follow-up. Sixteen were excluded from the analysis, mainly due to new pregnancies. The significant differences between the groups in functional status, pain, and physical health (SF-36) were maintained 2 years after delivery. Minimal disability was found in 85% of the specific stabilizing exercise group as compared to 47% in the control group. The control group showed significant improvement in functional status with median change score of 6.0 (Q1–Q3 of −12–0). Minimal evening pain was reported by 68% in the specific stabilizing exercise group versus 23% in the control group. However, the group differences disappeared for all measures when controlling for score level 1 year after delivery by regression analysis. Conclusion. The significant differences between the groups persisted with continued low levels of pain and disability in the specific stabilizing exercise group 2 years after delivery. Significant reduction in disability was found within the control group. Those with the highest level of disability and greatest potential for improvements recovered most, regardless of intervention group.

Thiazide prophylaxis of urolithiasis. A double-blind study in general practice

Fifty recurrent stone formers were included in a double-blind randomized study (median 3 years) performed in a Norwegian general practice to compare twice daily administration of 25 mg hydrochlorothiazide versus placebo. The number of patients with new stones was significantly higher in the placebo group than in the thiazide group (p = 0.05, one-tailed test). If a new stone was formed, thiazide, but not placebo, had the effect of prolonging the stone-free interval (p less than or equal to 0.01). The probability of not forming a new stone during the treatment period was 45% for the placebo group and 75% for the thiazide group. The thiazide effect seemed to be independent of urinary calcium, but was less beneficial in patients with hyperuricosuria. The placebo group also showed a substantial decrease in the expected number of new stones (p less than or equal to 0.01), emphasizing the importance of an adequate control group.

Oral diclofenac in the prophylactic treatment of recurrent renal colic. A double-blind comparison with placebo.

We have conducted a double-blind, randomized, placebo-controlled trial with oral diclofenac to study the prophylactic effect on renal colic recurrence and spontaneous stone expulsion rate. Forty-one patients were given 50 mg oral diclofenac 3 times a day for 7 days after being discharged for a colic episode from Oslo Emergency Hospital (< 24 h stay) and 39 patients were given matching placebo tablets. The number of new renal colic episodes per accumulated patient treatment days was 64/287 in the diclofenac group and 119/273 in the placebo group (p < 0.01). This difference was greatest during the first 4 treatment days. A similar trend was found for pain intensity (0-10 cm VAS) with the greatest difference on day 1 (4.3 vs. 2.8, p = 0.05). Side effects, mainly gastrointestinal, were reported for 14% of the treatment days in both treatment groups. Stone expulsion rate was almost identical (28 vs. 29 days), regardless of stone size. Readmission rate to Oslo Emergency Hospital/other hospitals were 10 and 67% (p < 0.001). In conclusion, oral treatment with diclofenac was effective as short-term prophylaxis of new colic episodes, especially during the first 4 days, and reduces the number of hospital readmissions significantly. The stone passage rate appears not to be affected.

The Brief Approach/Avoidance Coping Questionnaire: Development and validation

The objective of the research was to construct a brief coping questionnaire designed to assess the approach-avoidance dichotomy. A 20-item questionnaire was designed and tested in samples of 206 students and 93 patients. Based on empirical analyses and interviews with patients, 12 items were chosen for the final scale, which was named the Brief Approach/Avoidance Coping Questionnaire (BACQ). BACQ was then tested in a clinical sample of 299 primary care patients. A Cronbachs alpha of 0.68 was found in a primary care sample. In testing concurrent validity, BACQ indexes correlated significantly with relevant COPE sub-scales in a 0.34 to 0.57 range. A factor structure based on a two-factor solution gave one bipolar factor, ranging from active approach to resignation and withdrawal, and a second factor with items indicating diversion. In conclusion, the 12-item BACQ is a brief measure of coping strategies with satisfactory psychometric properties. The instrument is designed to measure a general concept of approach versus avoidance oriented coping, but the findings also point to two sub-dimensions of avoidant coping, resignation/withdrawal and diversion.

Beliefs about low back pain in the Norwegian general population: are they related to pain experiences and health professionals?

Study Design. A baseline study of the general population and the health care providers in 3 Norwegian counties. Objective. To investigate if beliefs about low back pain (LBP) are related to personal experiences and profession sought for care. Summary of Background Data. Myths about LBP that are abandoned by health professionals are still alive in the public. Such myths represent pain avoidance beliefs and passive coping strategies that may hinder normal spontaneous recovery from an episode of LBP. Methods. A sample of 1502 randomly selected people was interviewed by telephone, and all the 1105 physicians, physiotherapists, and chiropractors in the area were sent a questionnaire in April 2002. All respondents gave their responses in terms of degree of agreement to 6 statements reflecting beliefs about LBP. Results. Personal back pain experiences were important for beliefs about LBP. People with a history of previous back pain had more faith in the 2 statements “Back pain recovers best by itself” (52.2%) and “In most cases back pain recovers by itself in a couple of weeks” (32.5%) than those with current pain (36.9% and 20.9%, respectively, P < 0.000). There were significant differences in beliefs between physicians and the chiropractors concerning the same 2 statements, and these differences were also reflected in the beliefs of patients treated by the different professional groups. Conclusions. Belief in spontaneous recovery from LBP seems to be positively correlated to previous experience with LBP without current pain. Patients of the various health care providers seem to have a faith in spontaneous recovery similar to that of their health care provider. These differences may frustrate the public and patients who visit more than one provider, and hinder collaboration among professional groups.

Learning to have less pain - is it possible? A one-year follow-up study of the effects of a personal construct group learning programme on patients with chronic musculoskeletal pain.

A randomised controlled study with the objective to explore the effects of a group learning programme based on a phenomenological epistemology and personal construct theory. Main outcome measures were: experienced pain, pain coping strategies, absenteeism, disability pension and health care consumption. One hundred and twenty-one patients with chronic musculoskeletal pain and high absenteeism were included in this study. The intervention group (n=77) consisted of nine smaller groups with 6-10 persons in each and were counselled by health personnel with special training. The control group consisted of 44 persons. The learning programme emphasised awareness, possible relations between bodily symptoms, emotions, mind and life situation, and change of focus from pain and disability to resources and potentials. One year after the end of the learning programme (T3), patients in the intervention group reported significant pain reduction, increased pain-coping abilities and a higher reduction of health care consumption than the control group (P<0.05). Absenteeism was not significantly reduced compared to the control group, but there were fewer persons receiving disability pension in the intervention group at T3 (38 versus 59%) (P<0.05). This group-learning programme should be considered an important adjunct to the therapy of patients with chronic muscular pain.

Low back pain media campaign: No effect on sickness behaviour

OBJECTIVE To evaluate the effect of a media campaign on popular beliefs about LBP, and eventual changes in sick leave, imaging examinations, and surgery. METHODS Quasi-experimental telephone survey of 1500 randomly chosen people before, during, and after a media campaign in two Norwegian counties, with residents of an adjacent county as the control group. Data on sickness absence, surgery rates for disc herniation and imaging examinations on LBP in the area were collected at the same intervals. RESULTS The campaign led to a small but statistically significant shift in beliefs about LBP in the general public. In particular, beliefs about the use of X-rays, and the importance of remaining active and at work, seemed to have changed in response to the campaign messages. However, this change in attitude and understanding of the condition did not lead to any corresponding change in sickness behaviour. CONCLUSIONS Although the media campaign seemed to somewhat improve beliefs about LBP in the general public, the magnitude of this was too small to produce any significant change in behaviour. PRACTICE IMPLICATIONS A media campaign on LBP should not be limited to small areas and low-budget. A much larger investment is needed for a media campaign to have sufficient impact on publics beliefs on LBP to lead to altered sickness behaviour.

Salt restriction: effects on lipids and insulin production in hypertensive patients

The object of the study was to evaluate blood pressure, insulin and glucose metabolism, and serum lipids in hypertensive patients, during 8 weeks on a moderately salt-restricted diet. A double-blind, cross-over study was conducted with hypertensive patients following a moderately salt-restricted diet. Patients were randomised to sodium capsules in one period and placebo capsules during the other period. After a 1-month run-in period, 13 males and three females with mild to moderate essential hypertension (mean age 50 years) complied with a salt-reduced diet. They were randomized to a salt-supplemented group (5 capsules of 10 mmol sodium per capsule) or a salt reduced diet group (5 capsules of placebo) with cross-over after 8 weeks. Serum insulin, insulin C-peptide, and glucose were measured, fasting and 30 min after a 75-g glucose load. Serum lipids and lipoproteins constituting an atherogenic index were measured, along with blood pressure and 24-h urine excretion of sodium and chloride. Non-significant reductions of systolic and diastolic blood pressure (4 mmHg, p = 0.06, and 2 mmHg, p = 0.13, respectively) were observed during the reduced-salt period. The changes observed for fasting insulin, insulin C-peptide, glucose, serum lipids and the atherogenic index were also non-significant. It is concluded that moderate salt restriction seems not to adversely influence insulin resistance or serum lipids in hypertensive patients.

A RANDOMIZED STUDY OF NEW SLING EXERCISE TREATMENT VS TRADITIONAL PHYSIOTHERAPY FOR PATIENTS WITH CHRONIC WHIPLASH-ASSOCIATED DISORDERS WITH UNSETTLED COMPENSATION CLAIMS

BACKGROUND Many patients with chronic whiplash-associated disorders have reduced neuromuscular control of the neck and head. It has been proposed that a new sling exercise therapy may promote neuromuscular control of the neck. OBJECTIVES To compare the effects of traditional physiotherapy vs traditional physiotherapy combined with a new sling exercise therapy on discomfort and function in patients with chronic whiplash-associated disorders who have unsettled compensation claims; and to investigate possible additional effects of guided, long-term home training. DESIGN A randomized multi-centre trial with 4 parallel groups. METHODS A total of 214 patients were assigned randomly to 4 treatment groups, and received either traditional physiotherapy with or without home training, or new sling exercise therapy with or without home training. Outcome measures were pain, disability, psychological distress, sick leave and physical tests. RESULTS A total of 171 patients (80%) completed the study. There were no important statistical or clinical differences between the groups after 4 months of treatment. There was a small statistically significant effect at 12-month follow-up in both groups with home training regarding pain during rest (p = 0.05) and reported fatigue in the final week (p = 0.02). CONCLUSION No statistically significant differences were found between the traditional physiotherapy group and the new sling exercise group, with or without home training. Since the groups were not compared with a control group without treatment, we cannot conclude that the studied treatments are effective for patients with whiplash-associated disorder, only that they did not differ in our study.