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Ho EK, Ferreira ML, Bauman A, Carvalho-E-Silva AP, Pinheiro MB, Hübscher M, Calais-Ferreira L, Simic M, Ferreira PH. Beneficial and harmful effects of physical activity on care-seeking for low back pain: the AUTBACK study. Eur Spine J 2024; 33:481-489. [PMID: 37728638 DOI: 10.1007/s00586-023-07935-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/11/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE People who seek more care for low back pain (LBP) tend to experience poorer recovery (e.g. higher pain and disability levels). Understanding the factors associated with care-seeking for LBP might improve patient outcomes and potentially alleviate the burden of LBP on global health systems. This study aimed to investigate the relationship between different intensities, volumes, and domains of physical activity and care-seeking behaviours, in people with a history of LBP. METHODS Longitudinal data from adult twins were drawn from the AUstralian Twin BACK study. The primary outcome was the total self-reported frequency (counts) of overall utilisation of care for LBP, over 1 year. Secondary outcomes were the utilisation of health services, and the utilisation of self-management strategies, for LBP (assessed as total frequency over 1 year). Explanatory variables were device-based measures of sedentary behaviour and moderate-to-vigorous intensity physical activity, and self-reported physical workload, and work, transport, household, and leisure domain physical activity, at baseline. RESULTS Data from 340 individuals were included. Median age was 56.4 years (IQR 44.9-62.3 years) and 73% of participants were female. Medium-to-high baseline volumes of sedentary behaviour were significantly associated with greater counts of overall care utilisation (IRR 1.60, 95%CI 1.04-2.44) and utilisation of self-management strategies (IRR 1.60, 95%CI 1.02-2.50) for LBP, over 1 year. Medium-to-high baseline volumes of household domain physical activity were significantly associated with greater counts of utilising self-management strategies for LBP over 1 year (IRR 1.62, 95%CI 1.04-2.53). No explanatory variables were associated with the utilisation of health services for LBP. CONCLUSION People who engage in higher baseline volumes of sedentary behaviour or physical activity in the household setting (e.g. housework, gardening, yard work, general household maintenance) utilise 1.6 times more care for LBP over 1 year. Findings suggest that higher volumes of these behaviours may be harmful for LBP. No intensities, volumes, or domains of physical activity demonstrated clear benefits for LBP. Where feasible, patients and clinicians should collaborate to screen and develop strategies to reduce engagement in sedentary behaviour or physical activity in the household setting. Contextual factors (e.g. patient symptom severity, sociocultural roles, occupational demands) should be considered when devising appropriate behaviour change strategies.
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Affiliation(s)
- E K Ho
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, NSW, Australia.
- University of Sydney, Level 7, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2050, Australia.
| | - M L Ferreira
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, NSW, Australia
| | - A Bauman
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - A P Carvalho-E-Silva
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health and Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 12, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, Australia
| | - M B Pinheiro
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, NSW, Australia
| | - M Hübscher
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - L Calais-Ferreira
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - M Simic
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - P H Ferreira
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Ho EK, Ferreira ML, Bauman A, Carvalho-E-Silva AP, Pinheiro MB, Hübscher M, Calais-Ferreira L, Simic M, Ferreira PH. Correction: Beneficial and harmful effects of physical activity on care‑seeking for low back pain: the AUTBACK study. Eur Spine J 2024; 33:364. [PMID: 37889329 DOI: 10.1007/s00586-023-07978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- E K Ho
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, NSW, Australia.
- University of Sydney, Level 7, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2050, Australia.
| | - M L Ferreira
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, NSW, Australia
| | - A Bauman
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - A P Carvalho-E-Silva
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health and Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 12, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, Australia
| | - M B Pinheiro
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, NSW, Australia
| | - M Hübscher
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - L Calais-Ferreira
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - M Simic
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - P H Ferreira
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Abstract
Joint pain attributable to osteoarthritis (OA) is complex and influenced by a myriad of factors beyond local joint pathology. Current practice continues to predominantly adopt a biomedical approach to OA despite emerging evidence of the importance of a more holistic approach. This paper will summarise evidence for the presence of multidimensional pain profiles in knee joint pain and the presence of subgroups characterized by systemic features such as psychological distress, high comorbidity load or sensitisation of the nervous system. These factors have the potential to influence patient outcomes making them relevant for clinicians and highlighting the necessity of a broader multifactorial approach to assessment and treatment. This review describes the current state of the evidence for treatments of people with knee OA-related pain, including those receiving strong recommendations from current clinical guidelines, namely exercise, weight loss, self-management advice and pharmacological approaches. Other pain-modulating treatment options are emerging such as sleep and psychological interventions, pain education and multisensory retraining. The evidence and rationale for these newer therapeutic approaches is discussed. Finally, this review will highlight some of the limitations of current international guidelines for the management of OA and make recommendations for future research.
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Affiliation(s)
- K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - M Hübscher
- Neuroscience Research Australia, Barker Street, Randwick, NSW 2031, Sydney, Australia.
| | - H O'Leary
- Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - N Moloney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Thrive Physiotherapy, Guernsey, Channel Islands, UK
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Baldwin JN, McKay MJ, Simic M, Hiller CE, Moloney N, Nightingale EJ, Burns J, McKay M, Chard A, Ferreira P, Fong Yan A, Hiller C, Lee (nee Zheng) F, Mackey M, Mousavi S, Nicholson L, Nightingale E, Pourkazemi F, Raymond J, Rose K, Simic M, Sman A, Wegener C, Refshauge K, Burns J, Moloney N, North K, Hübscher M, Vanicek N, Quinlan K. Self-reported knee pain and disability among healthy individuals: reference data and factors associated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and KOOS-Child. Osteoarthritis Cartilage 2017; 25:1282-1290. [PMID: 28323136 DOI: 10.1016/j.joca.2017.03.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop normative reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS) and KOOS-Child, as well as investigate socio-demographic, psychological and physical factors associated with knee pain and disability among healthy adults. METHOD The KOOS or KOOS-Child (each containing five subscales) was administered to participants aged 8-101 years within the 1000 Norms Project, an observational study of 1000 self-reported healthy individuals. Self-efficacy, physical activity, body mass index (BMI), lower limb alignment, knee frontal plane projection angle (FPPA), knee range of motion (ROM), knee and hip strength, six-minute walk, 30-second chair stand and timed up and down stairs tests were collected. KOOS data were dichotomised using established cut-off scores and logistic regression analyses were conducted for each subscale. RESULTS Socio-demographic characteristics were similar to the Australian population. Normative reference data were generated for children (8-17 years) and adults (18-101 years). Female adults were up to twice as likely to report knee pain, symptoms and sport/recreation (Sport/Rec) limitations compared to males (P < .05). Older age, lower self-efficacy, greater BMI, varus lower limb alignment, lower knee flexion ROM and lower hip external rotation (ER) strength were independently associated with knee pain and disability among adults. CONCLUSIONS Age- and gender-stratified reference data for the KOOS and KOOS-Child have been developed to guide interpretation of results in practice and research for individuals with knee disorders. Psychological and physical factors are linked with self-reported knee pain/disability among adults, and longitudinal studies to investigate causation are required.
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Affiliation(s)
- J N Baldwin
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia.
| | - M J McKay
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - M Simic
- Arthritis and Musculoskeletal Research Group, University of Sydney, Australia
| | - C E Hiller
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - N Moloney
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia; Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - E J Nightingale
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - J Burns
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), Australia
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Lee H, Mansell G, McAuley JH, Kamper SJ, Hübscher M, Moseley GL, Wolfenden L, Hodder RK, Williams CM. Causal mechanisms in the clinical course and treatment of back pain. Best Pract Res Clin Rheumatol 2017; 30:1074-1083. [PMID: 29103550 DOI: 10.1016/j.berh.2017.04.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022]
Abstract
In recent years, there has been increasing interest in studying causal mechanisms in the development and treatment of back pain. The aim of this article is to provide an overview of our current understanding of causal mechanisms in the field. In the first section, we introduce key concepts and terminology. In the second section, we provide a brief synopsis of systematic reviews of mechanism studies relevant to the clinical course and treatment of back pain. In the third section, we reflect on the findings of our review to explain how understanding causal mechanisms can inform clinical practice and the implementation of best practice. In the final sections, we introduce contemporary methodological advances, highlight the key assumptions of these methods, and discuss future directions to advance the quality of mechanism-related studies in the back pain field.
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Affiliation(s)
- H Lee
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia; Centre for Pain, Health and Lifestyle, Australia.
| | - G Mansell
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - J H McAuley
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - S J Kamper
- Centre for Pain, Health and Lifestyle, Australia; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - M Hübscher
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - G L Moseley
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - L Wolfenden
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Hunter New England Population Health, Hunter New England Local Health District, NSW, Australia
| | - R K Hodder
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Hunter New England Population Health, Hunter New England Local Health District, NSW, Australia
| | - C M Williams
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Centre for Pain, Health and Lifestyle, Australia; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
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Aguila M, Leaver A, Rebbeck T, Lagopoulos J, Brennan P, Hübscher M, Refshauge K. Clinical characteristics associated with perceived disability and GABA level in adults with migraine: insights for physiotherapy assessment. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wilke J, Vogt L, Niederer D, Hübscher M, Rothmayr J, Ivkovic D, Rickert M, Banzer W. Short-term effects of acupuncture and stretching on myofascial trigger point pain of the neck: a blinded, placebo-controlled RCT. Complement Ther Med 2014; 22:835-41. [PMID: 25440373 DOI: 10.1016/j.ctim.2014.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/26/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES This trial aimed to evaluate the short-term effectiveness of acupuncture plus stretching to reduce pain and improve range of motion in patients afflicted by cervical myofascial pain syndrome. DESIGN Randomized, blinded, placebo-controlled crossover study. INTERVENTION Nineteen patients (11 females, eight males, 33 ± 14 years) with myofascial neck pain in randomized order received the following treatments with one week washout between: acupuncture, acupuncture plus stretching, and placebo laser acupuncture. MAIN OUTCOME MEASURES Mechanical pain threshold (MPT, measured with a pressure algometer) represented the primary outcome. Secondary outcomes were motion-related pain (Visual Analogue Scale, VAS) and cervical range of motion (ROM, recorded by means of an ultrasonic 3D movement analysis system). Outcomes were assessed immediately prior as well as 5, 15 and 30 min post treatment. Friedman tests with post hoc Bonferroni-Holm correction were applied to compare differences between treatments. RESULTS Both acupuncture as well as acupuncture plus stretching increased MPT by five, respectively, 11 percent post treatment. However, only acupuncture in combination with stretching was superior to placebo (p<0.05). There were no significant differences between interventions at 15 and 30 min post treatment. VAS did not differ between treatments at any measurement. Five minutes after application of acupuncture plus stretching, ROM was significantly increased in the frontal and the transversal plane compared to placebo (p<0.05). CONCLUSIONS The combination of acupuncture and stretching could represent a suitable treatment option to improve cervical movement behavior and reduce trigger point pain in the short-term. However, additional studies further discriminating the placebo effects are still warranted.
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Affiliation(s)
- J Wilke
- Department of Sports Medicine, Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt am Main, Germany.
| | - L Vogt
- Department of Sports Medicine, Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt am Main, Germany
| | - D Niederer
- Department of Sports Medicine, Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt am Main, Germany
| | - M Hübscher
- Department of Sports Medicine, Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt am Main, Germany; Neuroscience Research Australia, Sydney, Australia
| | - J Rothmayr
- Department of Sports Medicine, Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt am Main, Germany
| | - D Ivkovic
- Department of Sports Medicine, Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt am Main, Germany
| | - M Rickert
- Department of Spine Diseases, Goethe University, Frankfurt am Main, Germany
| | - W Banzer
- Department of Sports Medicine, Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt am Main, Germany
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Schmidt K, Hübscher M, Vogt L, Klinkmüller U, Hildebrandt H, Fink M, Banzer W. Einflüsse einer Wirbelsäulenorthese auf Gangparameter und Alltagsfunktion bei postmenopausaler Osteoporose. Orthopäde 2011; 41:200-5. [DOI: 10.1007/s00132-011-1867-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hübscher M, Schmidt K, Fink M, Vogt L, Banzer W. Prospektive Evaluation funktions- und lebensqualitätsbezogener Effekte einer Wirbelsäulenorthese bei Frauen mit Osteoporose. Z Orthop Unfall 2010; 148:443-7. [DOI: 10.1055/s-0029-1240820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vogt L, Hübscher M, Brettmann K, Banzer W, Fink M. Postural correction by osteoporosis orthosis (Osteo-med): a randomized, placebo-controlled trial. Prosthet Orthot Int 2008; 32:103-10. [PMID: 18330809 DOI: 10.1080/03093640701838265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Currently available therapeutic options for the correction of osteoporotic posture changes are not effective. Rigid or semi-rigid orthoses are only applicable in the early phase after vertebral body fractures, and the knowledge about the efficacy of flexible spinal orthoses is limited. Therefore, the present study is aimed at investigating the efficacy of a flexible spinal orthosis without any stabilizing components in terms of posture improvement. Forty women aged (65.9 +/- 8.4 years) with a proven osteoporosis (DXA < or = -2.5) were randomized to receive either of three treatment regimens: (i) Orthosis (Thämert Osteomed) with paravertebral/lumbosacral air chamber pads (as commercially available); (ii) The same orthosis without air chamber pads; and (iii) Placebo body stocking. Measurements were performed with a 3D real-time ultrasound topometry system (Zebris(R) CMS 70). The posture correction was substantially and significantly more marked in the first group (38% of the maximally possible intentional erection) as compared to the second (21%) and third group (13%). The orthosis with air chamber pads causes a clinically meaningful trunk support in patients with osteoporotic posture changes. Since the device contains no rigid stabilizing elements, the change in posture is considered to be a result of muscle activation due to sensomotor stimulation by the air chamber pads.
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Affiliation(s)
- L Vogt
- Department Sports Medicine, Johann Wolfgang Goethe-University Frankfurt, Frankfurt am Main, Germany.
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Michael JWP, König DP, Imhoff AB, Martinek V, Braun S, Hübscher M, Koch C, Dreithaler B, Bernholt J, Preis S, Loew M, Rickert M, Speck M, Bös L, Bidner A, Eysel P. [Efficiency of a postoperative treatment after rotator cuff repair with a continuous passive motion device (CPM)]. ACTA ACUST UNITED AC 2006; 143:438-45. [PMID: 16118760 DOI: 10.1055/s-2005-836806] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The main objective of this study was to prove that a postoperative combined continuous passive motion (CPM) and physiotherapy treatment protocol (CPM group) can achieve 90 degrees active abduction in the shoulder joint earlier than physiotherapy alone (PT group). The indication was a complete tear of the rotator cuff. METHOD The study was conducted under in-patient and out-patient conditions. 55 patients were included in this study. The prospective, randomized multicenter study design complies with DIN EN 540. The primary endpoint was the time span until 90 degrees active abduction was achieved by the patients. RESULTS Patients in the CPM group reached the primary endpoint on average 12 days earlier than the control group. This difference was statistically significant (p = 0.0292). Analyzing the secondary endpoints, e. g., pain and disablement, the results in the CPM group showed again advantages of the combined treatment protocol (CPM + physiotherapy). CONCLUSION The postoperative treatment of a total tear of the rotator cuff with a combined continuous passive motion and physiotherapy protocol provided a significantly earlier range of motion in the shoulder joint than physiotherapy alone. There was no report of CPM-related adverse effects.
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Gloor M, Hübscher M, Friederich HC. [External treatment of acne vulgaris using tetracycline and estrogen]. Hautarzt 1974; 25:391-4. [PMID: 4278664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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