Sep
5
2023
Health Policy. 2005 Dec;75(1):85-98.
Cost-effectiveness of an active implementation strategy for the Dutch physiotherapy guideline for low back pain.
Hoeijenbos M, Bekkering T, Lamers L, Hendriks E, van Tulder M, Koopmanschap M.
Institute for Medical Technology Assessment, during research, Erasmus Medical Centre Rotterdam, The Netherlands.
BACKGROUND AND PURPOSE: The treatment for patients with low back pain varies considerably. The Dutch Physiotherapy Association issued an evidence-based physiotherapy guideline for non-specific low back pain. To establish changes in daily practice an active implementation strategy was developed. We evaluated the cost-effectiveness of this implementation strategy.
SUBJECTS: 113 physiotherapists included 500 patients with low back pain.
METHODS: In the intervention group the guideline was implemented actively, in the control group the standard method of dissemination was used. The patients filled in questionnaires at baseline and 6, 12, 26 and 52 weeks later. Direct medical costs, productivity costs (due to absenteeism) and quality of life (EQ-5D) were calculated.
RESULTS: During the 1-year follow up, no differences were found in the quality of life, direct medical costs and productivity costs.
CONCLUSION: The active implementation strategy appears not to be cost effective as compared to the standard strategy.
Sep
5
2023
Weerapong P, Hume PA, Kolt GS
Many coaches, athletes and sports medicine personnel hold the belief, based on observations and experiences, that massage can provide several benefits to the body such as increased blood flow, reduced muscle tension and neurological excitability, and an increased sense of well-being.
Massage can produce mechanical pressure, which is expected to increase muscle compliance resulting in increased range of joint motion, decreased passive stiffness and decreased active stiffness (biomechanical mechanisms). Mechanical pressure might help to increase blood flow by increasing the arteriolar pressure, as well as increasing muscle temperature from rubbing. Depending on the massage technique, mechanical pressure on the muscle is expected to increase or decrease neural excitability as measured by the Hoffman reflex (neurological mechanisms).
Changes in parasympathetic activity (as measured by heart rate, blood pressure and heart rate variability) and hormonal levels (as measured by cortisol levels) following massage result in a relaxation response (physiological mechanisms). A reduction in anxiety and an improvement in mood state also cause relaxation (psychological mechanisms) after massage.
Therefore, these benefits of massage are expected to help athletes by enhancing performance and reducing injury risk. However, limited research has investigated the effects of pre-exercise massage on performance and injury prevention. Massage between events is widely investigated because it is believed that massage might help to enhance recovery and prepare athletes for the next event. Unfortunately, very little scientific data has supported this claim. The majority of research on psychological effects of massage has concluded that massage produces positive effects on recovery (psychological mechanisms).
Post-exercise massage has been shown to reduce the severity of muscle soreness but massage has no effects on muscle functional loss. Notwithstanding the belief that massage has benefits for athletes, the effects of different types of massage (e.g. petrissage, effleurage, friction) or the appropriate timing of massage (pre-exercise vs post-exercise) on performance, recovery from injury, or as an injury prevention method are not clear.
Explanations are lacking, as the mechanisms of each massage technique have not been widely investigated. Therefore, this article discusses the possible mechanisms of massage and provides a discussion of the limited evidence of massage on performance, recovery and muscle injury prevention. The limitations of previous research are described and further research is recommended.
Sports Medicine – 2005;35(3):235-56 – abstract
Sep
5
2023
Researchers are reporting that two of the most commonly used scents in aromatherapy do nothing to heal wounds, relieve pain or enhance immune status, although one did briefly improve mood. In fact, in some cases, distilled water showed more of a salutary effect, the study found.
The study results are published online in the April issue of the journal Psychoneuroendocrinology.
Used for thousands of years in countries such as India and Egypt, aromatherapy has many adherents who say the concentrated oils extracted from flowers improve health and emotional well-being, according to the Cleveland Clinic. Despite its widespread use, there’s little scientific data on the effectiveness of the therapy, the study authors stated.
“This is by far the largest and most comprehensive study of actual physiological outcomes,” Kiecolt-Glaser said. “There are different perspectives on why odors should work in terms of changing physiology, if they do. A lot of aromatherapy literature thinks of it as a drug-specific mechanism.” In other words, that scents work much like drugs work, with very specific effects.
Using this point of view as a starting point, Kiecolt-Glaser and her colleagues, who included husband Dr. Ronald Glaser, looked at the two odors that have been most researched: lemon, which is purported to be stimulating and a mood enhancer, and lavender, which is supposed to be relaxing and is used as a sleep aid. Distilled water was used as a control.
Potential study participants were first screened to see if they had an adequate sense of smell. Fifty-six people were then admitted into the study. During three half-day sessions, half the group was handed an envelope that explained the scent they were about to smell and what to expect. The other participants were simply told they’d be smelling a variety of fruit and floral odors.
Then the researchers taped cotton balls laced with either lemon oil, lavender oil or distilled water below the volunteers’ noses for the duration of the tests. The participants were monitored for blood pressure and heart rate, and the researchers took regular blood samples from each volunteer. The samples were analyzed for changes in different biochemical markers, including Interleukin-6 and Interleukin10, as well as the stress hormones cortisol and norepinephrine.
The researchers then tested the volunteers’ ability to heal by using a standard test in which tape is applied and removed repeatedly on a specific site on the skin. The scientists also tested the volunteers’ reaction to pain by placing their feet in 32-degree water. Finally, the participants filled out three standard psychological tests to assess mood and stress during each session.While lemon oil showed a clear mood enhancement, lavender oil did not, the researchers said. Neither smell had any positive impact on any of the biochemical markers for stress, pain control or wound healing.
Still, research in the field is limited, and it’s doubtful these findings will prove anything.
