Physiospot CAM

Cost-effectiveness of naturopathic care for chronic low back pain.

Herman PM, Szczurko O, Cooley K, Mills EJ

The purpose of this study was to determine the cost-effectiveness of naturopathic care (acupuncture, relaxation exercises, exercise and dietary advice, and a back care booklet) compared to standardized physiotherapy education and a back care booklet (control treatment) for low back pain. The results showed that naturopathic care significantly improved quality-adjusted life-years over the 6-month study period and also significantly reduced costs of adjunctive care per participant and reduced costs for the employer.

This economic evaluation alongside a pragmatic randomized control trial shows naturopathic care to be more cost-effective than a standardized physiotherapy education regimen in the treatment of chronic low back pain.

Alternative Therapies in Health and Medicine, 2008, 14(2), 32-9

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Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot studystar, open

Natalia E. Morone, Carol M. Greco and Debra K. Weiner 

The objectives of this pilot study were to assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults with chronic low back pain (CLBP) and to develop initial estimates of treatment effects. 37 community-dwelling older adults aged 65 years and older with CLBP were randomized to an 8-week mindfulness-based meditation program or to a wait-list control group. At the end of the intervention 30/37 (81%) participants completed 8-week assessments. Average class attendance of the intervention arm was 6.7 out of 8. They meditated an average of 4.3 days a week and the average minutes per day was 31.6. Compared to the control group, the intervention group displayed significant improvement.

An 8-week mindfulness-based meditation program is feasible for older adults with CLBP. The program may lead to improvement in pain acceptance and physical function.

Pain, 2008, 134(3), 310-319

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An evaluation of the effect of differing lengths of spa therapy upon patients with osteoarthritis (OA)

Vaht, M., Birkenfeldt, R. and Ubner, M. (2007)

Spa therapy is commonly used in Estonia in the management of rheumatic diseases, which usually consists of a course of up to 3-4 weeks in duration.  This study sought to determine whethere there was any difference in the alleviation of symptoms between a 6 day and 23 day course of spa therapy in the management of osteoarthritis (OA).  296 patients participated in the research which included treatments such as mud and paraffin-ozokerite applications, pearl baths, underwater shower-massage, manual massage, and therapeutic exercises in the gym and pool.  The aim was not to consider the effectiveness of a specific therapy but to gain an insight into the length of time required to obtain positive symptom relief.

In both the 6 day and 12 day group, there was a significant decrease in VAS and Lequesne Index scores, and while there were no significant differences found between the groups, this study does suggest that spa therapy has a positive effect by reducing pain and improving clinical status in patients suffering from osteoarthritis.

Complementary Therapies in Clinical Practice (2007) Article in Press Corrected Proof

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Mindfulness-based stress reduction: What processes are at work?

Dobkin, P. (2007)

Mindfulness-Based Stress Reduction (MBSR) has been shown to be beneficial for clinical and non-clinical populations, however little work has been published concerning the processes underlying improvements seen.

Women who had completed medical treatment for breast cancer were asked to complete questionnaires pre- and post-MBSR and were interviewed to gain qualitative data, with the aim of exploring mechanisms underlying changes.

The Mindfulness Attention Awareness Scale was found to be a useful process measure to assess changes in mindfulness.

The study corroborated that of Shapiro et al - that over time participants in an MBSR program "reperceive" what they encounter in their daily experiences.

Complementary Therapies in Clinical Practice (2007) Article in Press Corrected Proof

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Complementary medicine use in multi-ethnic paediatric outpatients

Robinson, N., Blair, M., Lorenc, A., Gully, N., Fox, P. and Mitchell, K. (2007)

The aim of this study was to determine the prevelance and determinants of complementary medicine (CM) use in a multi-ethnic paediatric outpatient population.  Parents of children attending paediatric general and sub-specialist outpatients clinics at a North West London hospital were asked to complete a questionnaire survey between September and December 2005.

The use of CM was found to be higher than expected at 37%, and was correlated with parental use of CM and education but was independent of ethnic group.

The main reasons for use of CM were word of mouth (45%), with the main source of information being from friends and family (51%).  The most popular treatments were found to be homeopathy and herbal medicine, with 88% of CM being purchased over the counter, and 53% not being reported to their doctor.

The study concludes that the use of CM amongst children was higher than previously estimated in the UK, which would suggest the need for greater professional awareness of CM as a part of clinical care.

Complementary Therapies in Clinical Practice (2007) Article in Press Corrected Proof

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Anthroposophic vs. conventional therapy for chronic low back pain: a prospective comparative study.

Hamre HJ, Witt CM, Glockmann A, Wegscheider K, Ziegler R, Willich SN, Kiene H

The purpose of this study was to compare anthroposophic treatment (eurythmy, rhythmical massage or art therapy; counselling, anthroposophic medication) and conventional treatment for low back pain (LBP) under routine conditions.  62 consecutive outpatients from 38 medical practices in Germany, consulting an anthroposophic (A-) or conventional (C-) physician with LBP of >or= 6 weeks duration participated in a prospective non-randomised comparative study.

Analysis showed significant improvements in both groups and after adjustment for age, gender, LBP duration, and education, improvements were still significant in both groups. However, compared to C-patients, A-patients had significantly more pronounced improvements of three SF-36 scales (Mental Health, General Health and Vitality).

The authors conclude that compared to conventional therapy, anthroposophic therapy for chronic LBP was associated with at least comparable improvements.

European Journal of Medical Research, 2007, 12(7), 302-10

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Effect of Mindfulness-Based stress reduction in rheumatoid arthritis patients

Pradhan, E.K., Baumgarten, M., Langenberg, P., Handwerger, B., Kaplan Gilpin, A., Maygari, T., Hochberg, M.C. and Berman, B.M. (2007)

The aim of this randomised, waitlist-controlled pilot study was to assess the effect of a meditative training program, Mindfulness-Based Stress Reduction (MBSR), on depressive symptoms, psychological status, and disease activity in patients with rheumatoid arthritis (RA).

Patients were randomised into either MBSR group or a waitlist control group.  The intervention group received an 8-week course and 4 month maintenence program of MBSR, whereas the control group attended all assessment visits and received MBSR after the study concluded.  All patients received usual care from their rheumatologists during the trial.

63 patients were originally randomised, with 31 assigned to the MBSR group and 32 to the control group.  At 2 months, there was not found to be any statistical differences between the groups, however at six months there was significant improvement in psychological distress and wellbeing, and marginally significant improvement in depressive symptoms and mindfulness.  There was found to be a 35% reduction in psychological distress amongst those treated, and the intervention did not have any impact on RA disease activity.

Arthritis Care and Research (2007) 57:7 1134-1142

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Does acupuncture work for stroke rehabilitation: what do recent clinical trials really show?

Shiflett, S.C. (2007)

This study reviews a number of recently published randomised controlled trials of acupuncture for stroke recovery, a number of which suffered from methodological flaws which tended to obscure and reduce the reported effect size.  this included inadaquate statistical analysis, failure to adaquately account for baseline stroke severity, and the use of an inadaquate post-treatment assessment period.

This study suggests that when these flaws are taken individually or in combination, under-reporting of acupuncture effects affected five of the papers considered.  It is suggested that by applying adjustments to these results, the author suggests that the effects of acupuncture is probably much more effective in assisting stroke recovery than generally reported, especially in the moderately severe range.

The general conclusion of this study is that there is substatial evidence that acupuncture is effective as an adjunctive treatment for facilitating stroke recovery.

Topics in Stroke Rehabiliation (2007) 14:4 40-58

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Qigong and Exercise Therapy in Patients With Long-term Neck Pain: A Prospective Randomized Trial.

Lansinger, B., Larsson, E., Persson, L.C., Carlsson, J.Y. (2007)

This study compares the effectiveness of qigong and exercise therapy in subjects with long-term nonspecific neck pain.

122 patients were randomly assigned to receive either qigong (n=60) or exercise therapy (n=62).  The majority were women (70%) with a mean age of 44.  Up to a maximum of 12 treatments were given over a period of three months, with a battery of tests being administered pre-intervention, immediately post-intervention, and at 6 & 12 months post intervention.

The study found no difference between the qigong and exercise therapy groups, but both groups significantly improved immediately after treatment which was maintained at the 6 month and 12 month follow up in 5 out of 8 outcome variables.

This study suggests that treatments including supervised qigong and exercise therapy resulted in reduced pain and disability, and can be recommended for persons with long-term nonspecific neck pain.

Spine (2007) 32:22 2415-2422

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Tae Kwon Do: an effective exercise for improving balance and walking ability in older adults.

Tae Kwon Do is an exercise which trains the dynamic components of balance and walking which are often diminished in older adults in an effort to achieve a more stable walking pattern.  This study considered 20 participants from a Tae Kwon Do exercise class (average age 72.7 years) and 20 non-exercising controls (average age 73.8 years).

Balance and walking ability were measured using single leg stance (SLS), Multidirection Reach Test (MDRT), Timed Up-And-Go (TUG), walking velocity, cadence, gait stability ratio (GSR) and sit-and-reach (S&R).  These were assessed pre- and post intervention.

No differences were found in non-exercising controls between pre-test and post-test measures, however Tae Kwon Do participants experiences significant improvements in the MDRT when reaching backwards, right and left.  TUG, walking velocity, GSR, and S&R also showed significant improvement in this group.

Cromwell, R.L., Meyers, P.M., Meyers, P.E., Newton, R.A. (2007)

This study suggests that Tae Kwon Do exercise was effective for improving balance and walking ability amongst community-dwelling older adults, which was attributed to the movements involved which include dynamic movement components often reduced amongst this population.

Journals of Gerontology Series A: Biological Sciences and Medical Sciences Online. (2007)

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