Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the complementary and alternative medical therapy movement. A meta-analysis was conducted of studies that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT's largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy. No moderators were statistically significant, though continued testing is needed. The limitations of a medical model of MT are discussed, and it is proposed that new MT theories and research use a psychotherapy perspective.

/pdf/a-meta-analysis-of-massage-therapy-research-4w9x4ju652.pdf

A meta-analysis of massage therapy research.

Background Physical functioning is a core outcome domain to be measured in nonspecific low back pain (NSLBP). A panel of experts recommended the Roland-Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) to measure this domain. The original 24-item RMDQ and ODI 2.1a are recommended by their developers.

Purpose The purpose of this study was to evaluate whether the 24-item RMDQ or the ODI 2.1a has better measurement properties than the other to measure physical functioning in adult patients with NSLBP.

Data Sources Bibliographic databases (MEDLINE, Embase, CINAHL, SportDiscus, PsycINFO, and Google Scholar), references of existing reviews, and citation tracking were the data sources.

Study Selection Two reviewers selected studies performing a head-to-head comparison of measurement properties (reliability, validity, and responsiveness) of the 2 questionnaires. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of these studies.

Data Extraction The studies' characteristics and results were extracted by 2 reviewers. A meta-analysis was conducted when there was sufficient clinical and methodological homogeneity among studies.

Data Synthesis Nine articles were included, for a total of 11 studies assessing 5 measurement properties. All studies were classified as having poor or fair methodological quality. The ODI displayed better test-retest reliability and smaller measurement error, whereas the RMDQ presented better construct validity as a measure of physical functioning. There was conflicting evidence for both instruments regarding responsiveness and inconclusive evidence for internal consistency.

Limitations The results of this review are not generalizable to all available versions of these questionnaires or to patients with specific causes for their LBP.

Conclusions Based on existing head-to-head comparison studies, there are no strong reasons to prefer 1 of these 2 instruments to measure physical functioning in patients with NSLBP, but studies of higher quality are needed to confirm this conclusion. Foremost, content, structural, and cross-cultural validity of these questionnaires in patients with NSLBP should be assessed and compared.

/pdf/roland-morris-disability-questionnaire-and-oswestry-218ww5v7er.pdf

Roland-Morris Disability Questionnaire. and Oswestry Disability Index: Which Has Better Measurement Properties for Measuring Physical Functioning in Nonspecific Low Back Pain? Systematic Review and Meta-Analysis

There is limited data on the cost-utility of low-back surgical procedures. The EuroQol-5D (EQ-5D) is a generic health-related quality of life (HRQL) instrument, which was designed for cost-utility analyses and for comparisons of therapeutic effects across different diseases. Disease-specific (HRQL) instruments cannot be used for such purposes. However, there is little evidence of the usefulness of the EQ-5D in the field of low-back surgery, and it might be too general to assess specific conditions. We therefore tested its validity and responsiveness against a widely used disease-specific HRQL instrument [the Oswestry disability index (ODI)], in a prospective study on 326 patients operated for degenerative disorders in the lumbar spine. The reliability of the EQ-5D was also evaluated. Follow-up time was 12 months. Cross-sectional construct validity of the EQ-5D and ODI in the assessments of pain, functional status, health state and employment status were equal. The ODI performed better only in the assessment of walking capability. Only small differences in responsiveness were found. The reliability of the EQ-5D was solid. Our results indicate that the EQ-5D is useful for estimating health state values and for monitoring outcome of patients undergoing low-back surgery. Hence, this instrument would provide valid data for cost–utility analyses.

Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery.

Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes.

Background Exercise benefits patients with chronic nonspecific low back pain; however, the most effective type of exercise remains unknown.

Objective This study compared outcomes after motor control exercises, sling exercises, and general exercises for low back pain.

Design This was a randomized controlled trial with a 1-year follow-up.

Setting The study was conducted in a primary care setting in Norway.

Patients The participants were patients with chronic nonspecific low back pain (n=109).

Interventions The interventions in this study were low-load motor control exercises, high-load sling exercises, or general exercises, all delivered by experienced physical therapists, once a week for 8 weeks.

Measurements The primary outcome measure was pain reported on the Numeric Pain Rating Scale after treatment and at a 1-year follow-up. Secondary outcome measures were self-reported activity limitation (assessed with the Oswestry Disability Index), clinically examined function (assessed with the Fingertip-to-Floor Test), and fear-avoidance beliefs after intervention.

Results The postintervention assessment showed no significant differences among groups with respect to pain (overall group difference) or any of the outcome measures. Mean (95% confidence interval) group differences for pain reduction after treatment and after 1 year were 0.3 (−0.7 to 1.3) and 0.4 (−0.7 to 1.4) for motor control exercises versus sling exercises, 0.7 (−0.6 to 2.0) and 0.3 (−0.8 to 1.4) for sling exercises versus general exercises, and 1.0 (−0.1 to 2.0) and 0.7 (−0.3 to 1.7) for motor control exercises versus general exercises.

Limitations The nature of the interventions made blinding impossible.

Conclusions This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.

/pdf/motor-control-exercises-sling-exercises-and-general-3tp12f0z5a.pdf

Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1-year follow-up.

Back Pain: New approaches to rehabilitation and education

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Back Pain: New approaches to rehabilitation and education