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KINESIO
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Artículos Seleccionados 1997 - ORTOPEDIA y TRAUMATOLOGIA
[Sprain of the cervical spine: early functional vs. immobilization treatment]
The effectiveness of chiropractic management of fibromyalgia patients: a pilot study.
Effect of exercise on sick leave due to low back pain. A randomized, comparative, long-term study.
[Treatment of metaphyseal fractures of the tibia by the Ilizarov external fixator]
[Conservative treatment of stress fractures of the tarsal navicular in athletes]
Reduction of sick leave for lumbar back and posterior pelvic pain in pregnancy.
Systematic home-based physical and functional therapy for older persons after hip fracture.
TITULO: Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Six-month follow-up.
AUTOR/ES: Skargren-EI; Oberg-BE; Carlsson-PG; Gade-M
DIRECCION: Department of Caring Sciences, Faculty of Health Sciences, Linkoping University, Sweden.
FUENTE: Spine. 1997 Sep 15; 22(18): 2167-77
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: STUDY DESIGN: A randomized, clinical trial was conducted in which patients with back/neck problems, visiting a general practitioner, were allocated to chiropractic or physiotherapy as primary management. OBJECTIVES: To compare outcome and costs of chiropractic and physiotherapy in managing patients with low back or neck pain. SUMMARY OF BACKGROUND DATA: Earlier studies on the treatment of back pain by spinal manipulation have shown inconsistent results. When a "new" strategy--chiropractic--in the treatment of back pain was introduced in public health care in Sweden, there was a need to compare the effects and costs of chiropractic with the established physiotherapy. METHODS: Three hundred twenty-three patients aged 18 to 60 years who had no contraindications to manipulation and who had not been treated within the previous month were included in the study. Treatment was carried out at the discretion of the therapist. Outcome measures were primarily changes in pain intensity and general health, both assessed with visual analog scale and Oswestry pain disability questionnaire. Direct and indirect costs were measured. RESULTS: For patients with low back or neck pain visiting the general practitioner in primary care, both chiropractic and physiotherapy as primary treatment reduced the symptoms. No difference in outcome or direct or indirect costs between the two groups could be seen, nor in subgroups defined as duration, history, or severity. CONCLUSIONS: The effectiveness and total costs of chiropractic or physiotherapy as primary treatment were similar to reach the same result after treatment and after 6 months.
TITULO: [Sprain of the cervical spine: early functional vs. immobilization treatment]
TITULO ORIGINAL: Die Distorsion der Halswirbelsaule: fruhfunktionelle vs. ruhigstellende Behandlung.
AUTOR/ES: Giebel-GD; Edelmann-M; Huser-R
DIRECCION: Il. Lehrstuhl fur Chirurgie, Universitat zu Koln.
FUENTE: Zentralbl-Chir. 1997; 122(7): 517-21
IDIOMA: GERMAN; NON-ENGLISH
PAIS: GERMANY
RESUMEN: Neck sprains are very common injuries often treated with immobilisation of different duration. The treatment with collars was tested against physiotherapy in a prospective randomised trial. Endpoints were defined as state of health, pain and costs. Ninety-seven patients with whiplash injuries were splitted by randomisation into two groups. One group was treated with a certain scheme of physiotherapy. Another group was treated with collar immobilisation for 3 weeks. Concerning symptoms at the time of admittance, age and sex distribution the groups were comparable. Fifty healthy persons with the same age and sex distribution served as a control group. Regarding to physical state of health and pain, which were examined by valid questionnaires, significant advantages of physiotherapy after two weeks were found. After 12 weeks the physical state of health corresponds to that of the control group. No influence on psychical state of health was seen. Physiotherapy for treatment of neck sprain is highly recommended. It has clear advantages over the treatment with collars with regard to state of health and pain, and it seems to be economically favourable.
TITULO: The effectiveness of chiropractic management of fibromyalgia patients: a pilot study.
AUTOR/ES: Blunt-KL; Rajwani-MH; Guerriero-RC
DIRECCION: Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
FUENTE: J-Manipulative-Physiol-Ther. 1997 Jul-Aug; 20(6): 389-99
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: OBJECTIVE: To demonstrate the effectiveness of chiropractic management for fibromyalgia patients using reported pain levels, cervical and lumbar ranges of motion, strength, flexibility, tender points, myalgic score and perceived functional ability as outcome measures. DESIGN: A. Preliminary randomized control crossover trial. B. Before and after design. PATIENTS: Twenty-one rheumatology patients (25-70 yr). CHIROPRACTIC INTERVENTIONS: Treatment consisted of 4 wk of spinal manipulation, soft tissue therapy and passive stretching at the chiropractors' discretion. CONTROL INTERVENTION: Chiropractic management withheld for 4 wk with continuation of prescribed medication. MAIN OUTCOME MEASURES: Changes in scores on the Oswestry Pain Disability Index, Neck Disability Index, Visual Analogue Scale, straight leg raise and lumbar and cervical ranges of motion were observed. RESULTS: Chiropractic management improved patients' cervical and lumbar ranges of motion, straight leg raise and reported pain levels. These changes were judged to be clinically important within the confines of our sample only. CONCLUSIONS: Further study with a sample size of 81 (for 80% power at alpha < or = .05) is recommended to determine if these findings are generalizable to the target population of fibromyalgia suffers.
TITULO: Effect of exercise on sick leave due to low back pain. A randomized, comparative, long-term study.
AUTOR/ES: Ljunggren-AE; Weber-H; Kogstad-O; Thom-E; Kirkesola-G
DIRECCION: Division for Physical Therapy Science, University of Bergen, Norway.
FUENTE: Spine. 1997 Jul 15; 22(14): 1610-6; discussion 1617
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: STUDY DESIGN: The study was carried out as an open, randomized, multicenter, parallel-group study with an observation period of 12 months. Four norwegian physiotherapy institutes took part. Patients were subsequently followed for 12 months of home exercise on their own, without for 12 months of home exercise on their own, without the supervision of a physiotherapist. OBJECTIVES: 1) To investigate and compare the effects of two different exercise programs on low back problems in patients after a 1-year training program under the supervision of a physiotherapist. 2) To investigate the effect supervision by, and motivation from, physiotherapists has on training compliance and efficacy. SUMMARY OF BACKGROUND DATA: After ordinary physiotherapy treatment for low back problems, patients were randomly allocated either to a conventional training program designed by physiotherapists or to a training program using a new Norwegian-developed training apparatus called the TerapiMaster. The study included 153 patients with low back problems, all of whom had been referred to physiotherapy by their general practitioners. One hundred twenty-six patients were followed for an additional 12 months when performing home exercise programs on their own. METHODS: Monitoring patient satisfaction with the training program, compliance with the program, and absenteeism from work during the training period. RESULTS: Patient satisfaction with both training programs was high, with about 83% of participating patients completing the study in accordance with the protocol. Mean absenteeism (SD) during the preceding year totaled 82.5 days (19.8) in the conventional training group and 61.6 days (14.7) in the TerapiMaster group. Significant reductions to 17.2 days (6.0) and 16.4 days (5.3) in the two groups, respectively, were recorded during the training period, corresponding to a 75% to 80% reduction compared with the preceding 1-year period. Mean absenteeism showed a further significant decline during the 12-month period without supervised training. The average values were 9.9 days (3.2) for conventional training and 9.3 days (3.1) for the TerapiMaster, respectively. CONCLUSIONS: Both exercise programs reduced absenteeism significantly (75-80%). No difference in the effects of the two different programs was discernible. Regular follow-up through encouragement and variation in the training programs appear to be important factors for motivating patients to adhere to regular exercise programs for low back problems. This thesis was corroborated by the 12-month study of unsupervised exercise.
TITULO: A prospective outcome study of rehabilitation programs and anterior cruciate ligament reconstruction.
AUTOR/ES: Schenck-RC Jr; Blaschak-MJ; Lance-ED; Turturro-TC; Holmes-CF
DIRECCION: Department of Orthopaedics, University of Texas Health Science Center at San Antonio 78284-7774, USA.
FUENTE: Arthroscopy. 1997 Jun; 13(3): 285-90
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: We evaluated the outcome of and compared two rehabilitation programs (clinic-based versus home) after a mid-third patellar autograft reconstruction of the anterior cruciate ligament. Thirty-seven patients (28 male, 9 female; average age, 24.1 years) completed the study. Fifteen of these patients received clinic-based rehabilitation (three visits per week for 6 weeks prescribed), and 22 patients received home-based physical therapy (number of visits determined by patient response). Knee ROM, Lysholm, Visual Analogy Scale, (VAS) pain rating, hop test, KT-1000, and Sickness Impact Profile (SIP) were evaluated preoperatively and postoperatively. All patients reported good satisfaction with the function of their knee at average follow-up of 21.6 months (range, 12 to 48). Patients managed by home rehabilitation averaged 2.85 visits as compared with 14.2 for clinic-centered patient (P < .05). There were no differences in functional or subjective outcomes in the different postoperative rehabilitation regimens, with both groups reporting high satisfaction and improved quality of life. Cost savings in the home rehabilitation group were significant.
TITULO: The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients.
AUTOR/ES: Chiarello-CM; Gundersen-L; O'Halloran-T
DIRECCION: Columbia University, Program in Physical Therapy, New York, NY 10032, USA.
FUENTE: J-Orthop-Sports-Phys-Ther. 1997 Feb; 25(2): 119-27
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: There is insufficient information on continuous passive motion (CPM) parameters in total knee arthroplasty patients for optimal patient outcomes. We compared CPM duration and increments on active and passive range of motion (ROM) in patients who underwent a unilateral total knee arthroplasty due to degenerative joint disease. Forty-five total knee arthroplasty patients were randomly assigned to either a control group, a short CPM duration (3-5 hours per day) group with CPM ROM increased 5 degrees twice daily, a short CPM duration group with CPM ROM increased daily to patient tolerance, a long CPM duration (10-12 hours per day) group with CPM ROM increased 5 degrees twice daily, or a long CPM duration group with CPM ROM increased daily to patient tolerance. Active and passive flexion and extension were measured goniometrically on each postoperative day that the patient was treated by physical therapy. No statistically significant differences between groups were found for baseline and final postoperative ROM. The CPM groups did not maintain the parameters assigned and were combined, revealing an enhanced rate of change of flexion. Most patients opted for a CPM duration of between 4 and 8 hours per day and the patient-preferred CPM incremental increase in ROM was 6-7 degrees/day.
TITULO: [Treatment of metaphyseal fractures of the tibia by the Ilizarov external fixator]
TITULO ORIGINAL: Traitement des fractures metaphysaires proximales du tibia par fixateur externe d'Ilizarov.
AUTOR/ES: de-la-Caffiniere-JY; Zeitoun-JM; Segonds-JM; Lacaze-F
DIRECCION: Service de Chirurgie Orthopedique et Traumatologique, CHG de Saint-Denis.
FUENTE: Rev-Chir-Orthop-Reparatrice-Appar-Mot. 1997; 83(2): 123-32
IDIOMA: FRENCH; NON-ENGLISH
PAIS: FRANCE
RESUMEN: PURPOSE: This external fixation was used for 46 of 60 cases of proximal tibial metaphyseal fractures, over a 10 years period. The choice of an external fixation was determined by the poor reputation of internal fixation for even complex closed fractures. The reasons for the choice of the Ilizarov device were: the possibility of fitting the fixation pins close to the knee joint if necessary, the circular nature of the system, and finally the possibility of adding an intrafocal mounting (I.F.M.) which can bring the displaced bone fragments together using shaped blockstops pins. The program theoretically foresaw an initial sequence using external fixation until bone continuity was achieved, followed by a complementary plaster for one or two months. MATERIALS: 7 of the 46 fractures were lost for follow-up. Of the remaining 39 cases, there were 5 early complications: one knee septic arthritis which led to stop the method before the second month. Each of these 5 failures were due to improper use of the method. 34 cases have been followed for more than two years. RESULTS: 29 cases of consolidation of which 3 initial displacements were wrongly considered as acceptable. There was no case of displacement while the fixation was in place. There were 5 nonunions: 2 at the diaphyseal level in long metaphyso-diaphyseal fractures, 2 were comminutive metaphyseal fractures in which the fixation had been removed by error before the third month. With this fixation, neither the traumatic opening, nor the presence of a fibular fracture significantly affected consolidation. The healing period was however longer when the fracture was more extensive and comminutive. The bone gaps were treated by interfocal mounting (I.F.M.) but loss of bone stock persisted; they affected the occurrence of nonunion. CONCLUSION: Each failure of the method is explained by its improper use. The Ilizarov fixation is an excellent mechanical response to these fractures: on condition that the technical rules are respected, that an intrafocal mounting is used to remove interfragmentary gaps, and that the fixator is kept in place long enough, according to the size and comminutive nature of the fracture. This fixation is reliable in these conditions but does not compensate intrafocal bone loss exceeding 40 per cent of the metaphyseal bone mass.
TITULO: [Conservative treatment of stress fractures of the tarsal navicular in athletes]
TITULO ORIGINAL: Traitement conservateur des fractures de contrainte du scaphoide tarsien chez le sportif.
AUTOR/ES: Bojanic-I; Pecina-MM
DIRECCION: Department of Orthopaedic Surgery, Zagreb, Croatie.
FUENTE: Rev-Chir-Orthop-Reparatrice-Appar-Mot. 1997; 83(2): 133-8
IDIOMA: FRENCH; NON-ENGLISH
PAIS: FRANCE
RESUMEN: PURPOSE OF THE STUDY: The purpose of the study was to propose an algorhythm for nonoperative treatment of partial tarsal navicular stress fractures in athletes, based on the results of the authors prospective research, conducted in 17 athletes. MATERIALS AND METHODS: The series included 17 patients with 18 partial tarsal navicular stress fractures (9 women and 8 men), average age 20.1 years. Patients were 10 track and field athletes mainly sprinters, 3 basketball players, two handball players, one soccer player and one volleyball player. After undergoing detailed physical examination which included x-ray examination, all patients also underwent bone scanning, and some kind of tomographic imaging (CT, MR) was done in all patients. Since all patients suffered from partial tarsal navicular stress fracture (fracture spreaded saggitally to maximal dorsal half of the bone) nonoperative treatment was conducted. Immobilization in a non weight bearing short-leg cast for a period of 6-8 weeks was followed by rehabilitation treatment consisting of 4 consecutive stages, each lasting 2 weeks. Control examination after each stage determined if patients could proceed to the following stage or if they should remain in the same stage for another two weeks. RESULTS: Patients were followed up from one to five years (average 33.9 months) and proposed algorhythm of nonoperative treatment resulted in all, except two athletes, returning to their previous level of competition activity. The average time period between initiation of treatment and resumption of full sports activity was 24 weeks (range 17 to 32 weeks). One stress fracture recurrence was encountered although all patients returned to sports activities and are constantly being monitored. DISCUSSION: No complex tarsal navicular stress fractures was found in our series. In our opinion the diminishing number of complete fractures is a consequence if quicker and more precise diagnosis. The period between the onset of symptoms and the time of correct diagnosis is becoming shorter. In our patients, this period was 3.3 months. The nonoperative treatment for tarsal navicular stress fractures was suggested with a wide variety of procedures. Based on the results if their prospective study the authors propose an algorhythm of conservative procedures in the treatment of partial tarsal navicular stress fracture. CONCLUSION: If clinical indication of tarsal navicular stress fracture is confirmed by a positive bone-scan, a CT or MRI exploration is required to distinguish stress reaction from stress fracture. In partial tarsal navicular stress fractures, immobilisation in a short-leg cast with nonweightbearing for 6 to 8 weeks depending of the magnitude of the fracture is required. This is followed by a treatment consisting of 4 two-weeks stages which clinically monitored. The previous phase can be repeated for another two weeks, depending of clinical findings. This algorhythm of nonoperative treatment of partial tarsal navicular stress fractures allowed in all athletes a return to competitive activity.
TITULO: Reduction of sick leave for lumbar back and posterior pelvic pain in pregnancy.
AUTOR/ES: Noren-L; Ostgaard-S; Nielsen-TF; Ostgaard-HC
DIRECCION: Department of Physiotherapy, Trandared Primary Care Unit, Boras, Sweden.
FUENTE: Spine. 1997 Sep 15; 22(18): 2157-60
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: STUDY DESIGN: In this prospective, consecutive, controlled cohort study, the authors analyzed the impact of a differentiated, individual-based treatment program on sick leave during pregnancy for women experiencing lumbar back or posterior pelvic pain during pregnancy. OBJECTIVE: To identify patients with pain early in pregnancy and, by means of individual information and differentiated physiotherapy, reduce sick leave during pregnancy. SUMMARY OF BACKGROUND DATA: Sick leave for back pain during pregnancy is common, and treatment programs have been aimed at reducing pain, for that reason. In Sweden, the average sick leave due to back pain during pregnancy is 7 weeks. METHODS: All pregnant women who attended a specific antenatal clinic and experienced lumbar back or posterior pelvic pain were included in an intervention group, and results were compared with women in a control group from another antenatal clinic. RESULTS: The intervention group comprised 54 women, compared with 81 women in the control group. Thirty-three women were on sick leave for an average of 30 days in the intervention group versus 45 women for an average of 54 days in the control group (P < 0.001). The reduction in sick leave reduced insurance costs by approximately $53,000 U.S. CONCLUSIONS: Sick leave for lumbar back and posterior pelvic pain in the intervention group was significantly reduced with the program, and the program was cost effective.
TITULO: Systematic home-based physical and functional therapy for older persons after hip fracture.
AUTOR/ES: Tinetti-ME; Baker-DI; Gottschalk-M; Garrett-P; McGeary-S; Pollack-D; Charpentier-P
DIRECCION: Department of Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
FUENTE: Arch-Phys-Med-Rehabil. 1997 Nov; 78(11): 1237-47
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: OBJECTIVE: To describe the development, implementation, and results of a home-based rehabilitation protocol for older persons after hip fracture. DESIGN: Demonstration study. SETTING: Community. PARTICIPANTS: One hundred forty-eight community-living, nondemented participants at least 65 years of age who underwent repair of a fractured hip at two local hospitals. INTERVENTION: A linked assessment-intervention, home-based rehabilitation strategy. The physical therapy (PT) component of the intervention was designed to identify and ameliorate impairments in balance, strength, transfers, gait, and stair climbing; the functional therapy (FT) component was designed to identify and improve unsafe and/or inefficient performance of specific activities of daily living (ADL). MAIN OUTCOME MEASURES: The percentage of participants able to complete each component and the extent of progress noted in strength, balance, transfers, gait, and daily functioning. RESULTS: A total of 104 of the 148 participants (70%) completed the 6-month PT and FT program; 4 completed only PT and 6 refused both PT and FT. The remaining 32 participants (22%) received partial PT and FT that was terminated by death, hospitalization, or institutionalization. Seventy-seven percent of participants reported performing at least half of the recommended daily exercise sessions. Ninety-four percent and 96% of participants progressed in upper and lower extremity conditioning respectively; 33% progressed to the highest level in the graduated resisted exercise program. All participants progressed in the competency-based graded balance program, with 55% progressing to the fifth (most difficult) level. Similarly, the majority progressed in transfer maneuvers, stair climbing, and outdoor gait. One repetition maximum (RM) elbow extension increased from a mean of 5.8 (SD 4.6) pounds at baseline to 7.2 (SD 3.8) pounds at 6mo (t 2.22; p < .02). One RM knee extension increased from 5.8 (SD 5.8) pounds to 10.8 (SD 5.4) pounds (t = 8.06; p < .0001). The number of gait deviations decreased from 2.1 (SD 1.3) to 0.6 (SD 0.9) (p < .0001), while the mean modified Berg Balance Scale Score increased from 13.0 (SD 4.8) to 20.5 (SD 6.8) (t = 16.6; p < .0001). Finally, the Total ADL Score increased from a mean of 48.2 (SD 15.0) to 77.7 (SD 18.8) (t = 17.03; p = .0001). CONCLUSIONS: This systematic assessment and intervention protocol, targeting impairments and ADL, was feasible, safe, and effective. Protocols such as the one presented should enhance the ability to implement rehabilitation programs for the increasing number of multiply impaired older persons receiving home-based therapy and to document the process and outcomes of this care.
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