Sep
5
2023

Cost-effectiveness of an active implementation strategy

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

Massage Therapy Can Decrease Pain

Massage Therapy Can Decrease Pain

GLENVIEW, IL, Aug. 15, 2008—For those who experience lingering pain following exercise, a relaxing deep massage can help relieve musculoskeletal pain associated with exercise-induced pain, according to research reported in The Journal of Pain.

Researchers at the University of Iowa performed a double-blinded, randomized controlled trial to study the effects of massage on pressure-pain thresholds and perceived pain using delayed muscle soreness following exercise as the pain measurement. Trial participants were divided into three groups: no-treatment (control), superficial touch and deep tissue massage. Pain was assessed before treatment, after exercise and before and after treatment.

Massage has been used for rehabilitation and relaxation for thousands of years with no adverse effects. Unfortunately, few well-controlled trials of massage exist either in clinical or experimentally induced pain populations. The purpose for the study, therefore, was to determine the effects of massage using an endogenous muscle-pain model in otherwise healthy individuals.

The authors found that subjects given deep-tissue massage were able to increase their pain thresholds and decrease stretch pain compared with the no-treatment group. When combining the deep-tissue massage and light-touch groups, they found that stretch-pain reductions remained significantly better than in the control group although the light-touch treatment was not significantly better than no treatment.

The authors concluded that their study demonstrates that soft-tissue massage can reduce hyperalgesia and pain using a delayed onset muscle soreness model. The findings support use of massage to reduce stretch-pain perception and hyperalgesia.

Source: Massage Reduces Pain Perception and Hyperalgesia in Experimental Muscle Pain: A randomized, Controlled Trial; Laura A. Frey Law, Stephanie Evans, Jill Knudson, Steven Nus, Kerri Scholl and Kathleen Sluka; University of Iowa, Program in Physical Therapy and Rehabilitation Science.

Sep
5
2023

Push ups: Measure of Fitness

The push-up is the ultimate barometer of fitness. It tests the whole body, engaging muscle groups in the arms, chest, abdomen, hips and legs. It requires the body to be taut like a plank with toes and palms on the floor. The act of lifting and lowering one’s entire weight is taxing even for the very fit.

“You are just using your own body and your body’s weight,” said Steven G. Estes, a physical education professor and dean of the college of professional studies at Missouri Western State University. “If you’re going to demonstrate any kind of physical strength and power, that’s the easiest, simplest, fastest way to do it.”

But many people simply can’t do push-ups. Health and fitness experts, including the American College of Sports Medicine, have urged more focus on upper-body fitness. The aerobics movement has emphasized cardiovascular fitness but has also shifted attention from strength training exercises.

Moreover, as the nation gains weight, arms are buckling under the extra load of our own bodies. And as budgets shrink, public schools often do not offer physical education classes — and the calisthenics that were once a childhood staple.

In a 2001 study, researchers at East Carolina University administered push-up tests to about 70 students ages 10 to 13. Almost half the boys and three-quarters of the girls didn’t pass.

Push-ups are important for older people, too. The ability to do them more than once and with proper form is an important indicator of the capacity to withstand the rigors of aging.

Researchers who study the biomechanics of aging, for instance, note that push-ups can provide the strength and muscle memory to reach out and break a fall. When people fall forward, they typically reach out to catch themselves, ending in a move that mimics the push-up. The hands hit the ground, the wrists and arms absorb much of the impact, and the elbows bend slightly to reduce the force.

In studies of falling, researchers have shown that the wrist alone is subjected to an impact force equal to about one body weight, says James Ashton-Miller, director of the biomechanics research laboratory at the University of Michigan.

“What so many people really need to do is develop enough strength so they can break a fall safely without hitting their head on the ground,” Dr. Ashton-Miller said. “If you can’t do a single push-up, it’s going to be difficult to resist that kind of loading on your wrists in a fall.” And people who can’t do a push-up may not be able to help themselves up if they do fall. “To get up, you’ve got to have upper-body strength,” said Peter M. McGinnis, professor of kinesiology at State University of New York College at Cortland who consults on pole-vaulting biomechanics for U.S.A. Track and Field, the national governing body for track.

Natural aging causes nerves to die off and muscles to weaken. People lose as much as 30 percent of their strength between 20 and 70. But regular exercise enlarges muscle fibers and can stave off the decline by increasing the strength of the muscle you have left.

Women are at a particular disadvantage because they start off with about 20 percent less muscle than men. Many women bend their knees to lower the amount of weight they must support. And while anybody can do a push-up, the exercise has typically been part of the male fitness culture. “It’s sort of a gender-specific symbol of vitality,” said R. Scott Kretchmar, a professor of exercise and sports science at Penn State. “I don’t see women saying: ‘I’m in good health. Watch me drop down and do some push-ups.’ ”

Based on national averages, a 40-year-old woman should be able to do 16 push-ups and a man the same age should be able to do 27. By the age of 60, those numbers drop to 17 for men and 6 for women. Those numbers are just slightly less than what is required of Army soldiers who are subjected to regular push-up tests.

If the floor-based push-up is too difficult, start by leaning against a countertop at a 45-degree angle and pressing up and down. Eventually move to stairs and then the floor.