Sibylle Reinsch

Effectiveness of four conservative treatments for subacute low back pain: A randomized clinical trial

Study Design. A randomized, assessor-blinded clinical trial was conducted. Objective. To investigate the relative effectiveness of three manual treatments and back school for patients with subacute low back pain. Summary of Background Data. Literature comparing the relative effectiveness of specific therapies for low back pain is limited. Methods. Among the 5925 inquiries, 206 patients met the specific admission criteria, and 200 patients randomly received one of four treatments for 3 weeks: back school, joint manipulation, myofascial therapy, and combined joint manipulation and myofascial therapy. These patients received assessments at baseline, after 3 weeks of therapy, and 6 months after the completion of therapy. The primary outcomes were evaluated using visual analog pain scales and Roland–Morris activity scales. Results. All four groups showed significant improvement in pain and activity scores after 3 weeks of care, but did not show further significant improvement at the 6-month follow-up assessment. No statistically significant between-group differences were found either at the 3-week or 6-month reassessments. Conclusions. For subacute low back pain, combined joint manipulation and myofascial therapy was as effective as joint manipulation or myofascial therapy alone. Additionally, back school was as effective as three manual treatments.

S-Adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: A double-blind cross-over trial. [ISRCTN36233495]

BackgroundS-Adenosylmethionine (SAMe) is a dietary supplement used in the management of osteoarthritis (OA) symptoms. Studies evaluating SAMe in the management of OA have been limited to Non Steroidal Anti-inflammatory Drugs (NSAIDs) for comparison. The present study compares the effectiveness of SAMe to a cyclooxygenase-2 (COX-2) inhibitor (celecoxib) for pain control, functional improvement and to decrease side effects in people with osteoarthritis of the knee.MethodsA randomized double-blind cross-over study, comparing SAMe (1200 mg) with celecoxib (Celebrex 200 mg) for 16 weeks to reduce pain associated with OA of the knee. Sixty-one adults diagnosed with OA of the knee were enrolled and 56 completed the study. Subjects were tested for pain, functional health, mood status, isometric joint function tests, and side effects.ResultsOn the first month of Phase 1, celecoxib showed significantly more reduction in pain than SAMe (p = 0.024). By the second month of Phase 1, there was no significant difference between both groups (p < 0.01). The duration of treatment and the interaction of duration with type of treatment were statistically significant (ps ≤ 0.029). On most functional health measures both groups showed a notable improvement from baseline, however no significant difference between SAMe and celecoxib was observed. Isometric joint function tests appeared to be steadily improving over the entire study period regardless of treatment.ConclusionSAMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee osteoarthritis. Longer studies are needed to evaluate the long-term effectiveness of SAMe and the optimal dose to be used.

Visual Perception Dominance of Fallers Among Community-dwelling Older Adults

The authors postulated that older adult fallers show a greater tendency than older adult nonfallers to rely more on visual information sources in maintaining upright posture than on kinesthetic and vestibular cues. This paper presents descriptive statistics on 199 older adults living independently in the community. Their visual perception of the vertical and horizontal was analyzed with respect to age, sex, health status, and severity of injury as a result of a fail. The finding of significant impairments for fallers in visual perceptual abilities confirmed a trend previously established by one of the authors (Tobis). When the visual field entailed only misleading or ambiguous cues in the form of a tilted frame, fallers again showed a larger error than nonfallers in establishing the vertical and horizontal. The authors feel that this relatively greater dependence on visual sources may develop in response to impairment of feedback on posture and gait from the kinesthetic and vestibular systems as a result of age and chronic health problems. Errors in visual perception of the vertical and horizontal intercorrelated with age, sex, and a large number of medical problems. However, visual variables were more important in predicting faller status than physical characteristics.

Searching biomedical databases on complementary medicine: the use of controlled vocabulary among authors, indexers and investigators

BackgroundThe optimal retrieval of a literature search in biomedicine depends on the appropriate use of Medical Subject Headings (MeSH), descriptors and keywords among authors and indexers. We hypothesized that authors, investigators and indexers in four biomedical databases are not consistent in their use of terminology in Complementary and Alternative Medicine (CAM).MethodsBased on a research question addressing the validity of spinal palpation for the diagnosis of neuromuscular dysfunction, we developed four search concepts with their respective controlled vocabulary and key terms. We calculated the frequency of MeSH, descriptors, and keywords used by authors in titles and abstracts in comparison to standard practices in semantic and analytic indexing in MEDLINE, MANTIS, CINAHL, and Web of Science.ResultsMultiple searches resulted in the final selection of 38 relevant studies that were indexed at least in one of the four selected databases. Of the four search concepts, validity showed the greatest inconsistency in terminology among authors, indexers and investigators. The use of spinal terms showed the greatest consistency. Of the 22 neuromuscular dysfunction terms provided by the investigators, 11 were not contained in the controlled vocabulary and six were never used by authors or indexers. Most authors did not seem familiar with the controlled vocabulary for validity in the area of neuromuscular dysfunction. Recently, standard glossaries have been developed to assist in the research development of manual medicine.ConclusionsSearching biomedical databases for CAM is challenging due to inconsistent use of controlled vocabulary and indexing procedures in different databases. A standard terminology should be used by investigators in conducting their search strategies and authors when writing titles, abstracts and submitting keywords for publications.

Home Safety Intervention for the Prevention of Falls

Older adults may fail to adapt their homes to their changing capabilities and needs. Are they aware of the hazards and will they implement guidelines for the prevention of falls? After initial self-reported and objective home-safety assessments were conducted, 14 older adults received brochures and posters as well as reflective tape for safety. Fourteen control subjects were assessed but did not receive educational materials. Treatment participants did not implement more safety precautions than did controls. Both groups fell equally often. They were most concerned about falling at steps and stairs.

Why Do Healthy Older Adults Fall

Falls among elders at senior centers may be due more to behavioral and environmental risks than to impaired health, strength, and balance. We monitored 222 older adults at senior centers weekly for two years and documented 242 falls; their location (outdoors: inside the home, or in transition areas, such as garage or patio), activities associated with the fall, and consequences of the fall, such as parts of the body that received the impact of the fall and the associated level of injury. As hypothesized, healthy elderly fell more often outdoors and in transition areas than inside their home. They fell most often due to inattention and in association with hazardous activities.