Physical therapy
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Low back pain is commonly seen in physical therapy practice, and many methods of treatment are used to reduce it. In this article, we discuss the magnitude of the low back pain problem, outline the various treatment methods, and develop a strategy to classify and standardize the treatment of the patient who has low back pain. We will develop this thought process by discussing five management considerations: (1) the dilemma of diagnosis, (2) the information gained from the assessment, (3) a patient classification system, (4) the objectives of the low back treatment process, and (5) a proposed physical therapy intervention model that matches the objectives of treatment to the classification of the patient.
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Randomized Controlled Trial Clinical Trial
Efficacy of high voltage pulsed current for healing of pressure ulcers in patients with spinal cord injury.
The purpose of this study was to assess the efficacy of high voltage pulsed direct current (HVPC) for healing of pressure ulcers in patients with spinal cord injury. Seventeen patients having pressure ulcers in the pelvic region were randomly assigned to either an HVPC group or a placebo HVPC group. Treatments were given for 1 hour a day for 20 consecutive days. ⋯ Percentage of change compared with pretreatment ulcer size was calculated for each measurement time. Ulcers in the HVPC group demonstrated significantly greater percentage-of-change decreases from their pretreatment size than did ulcers in the placebo group at days 5, 15, and 20. The results suggest that HVPC, in conjunction with good nursing care, can significantly increase the healing rate of pelvic ulcers in patients with spinal cord injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of effects of transcutaneous electrical nerve stimulation of auricular, somatic, and the combination of auricular and somatic acupuncture points on experimental pain threshold.
This study compared the effects of high intensity, low frequency transcutaneous electrical nerve stimulation of auricular, somatic, and combined auricular and somatic acupuncture points on experimental pain threshold measured at the wrist. Sixty-seven healthy adults, aged 18 to 39 years, were assigned randomly to one of four groups: 1) the Auricular Group (n = 17) received TENS to auricular acupuncture points, 2) the Somatic Group (n = 17) received TENS to somatic acupuncture points, 3) the Combined Group (n = 17) received TENS to both auricular and somatic acupuncture points, and 4) the Control Group (n = 16) received no TENS and served as controls. ⋯ The Control Group demonstrated no statistically significant change in pain threshold. The results indicate that TENS applied to any of the three sets of acupuncture points equally increases pain threshold, thus possibly increasing options in choosing stimulation sites for treating patients with pain.
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We have described the process of the initial development of an expert-based decision-support system for the management of patients with low back syndrome. Important considerations for developing decision-support systems are reviewed, both generally and specifically. ⋯ Our work so far involved congregation of a number of experts and compilation of a testing protocol. We are now refining the system for specific populations and purposes.