Spine
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Randomized Controlled Trial Comparative Study Clinical Trial
One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.
A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy. ⋯ Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.
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Randomized Controlled Trial Clinical Trial
The ability of lumbar medial branch blocks to anesthetize the zygapophysial joint. A physiologic challenge.
Randomized, controlled, single blinded study. ⋯ There was a significant effect of 2% lidocaine (versus saline) medial branch injections on anesthetization of the zygapophysial joint when venous uptake was avoided during these injections. When properly performed, lumbar medial branch blocks successfully inhibit pain associated with capsular distention of the lumbar zygapophysial joints at a rate of 89%.
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Randomized Controlled Trial Clinical Trial
Can it be predicted which patients with chronic low back pain should be offered tertiary rehabilitation in a functional restoration program? A search for demographic, socioeconomic, and physical predictors.
A prospective clinical trial was conducted that involved six groups of patients with chronic low back pain selected from a large cohort (N = 816). ⋯ Different factors can be identified as predictive of outcome in a functional restoration program, but most of these factors were also shown to predict success for shorter control outpatient programs or of no treatment.
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Randomized Controlled Trial Clinical Trial
A randomized, double-blind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome.
In a randomized, double-blind study, two dosage strengths of botulinum toxin type A were compared with normal saline injected into symptomatic trigger points in the cervicothoracic paraspinal muscles. ⋯ Although no statistically significant benefit of botulinum toxin type A over placebo was demonstrated in this study, the high incidence of patients who were asymptomatic after a second injection suggests that further research is needed to determine whether higher dosages and sequential injections in a larger cohort might show a botulinum toxin type A effect.
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Randomized Controlled Trial Clinical Trial
Functional restoration for chronic low back pain. Two-year follow-up of two randomized clinical trials.
Two randomized, prospective clinical trials involving 238 chronic low back disability patients were carried out. Results at 2-year follow-up are presented. ⋯ The functional restoration program seems effective in various parameters compared with the less intensive programs, but the differences in outcome in the two parallel studies indicate the necessity of testing a treatment program in different settings, in that the statistical variation may be a major factor in results of different studies.