Abstract:
OBJECTIVE:To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN:Randomised clinical trial. SETTING:Primary health care in the Netherlands. PATIENTS:256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years. INTERVENTIONS:At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes). MAIN OUTCOME MEASURES:Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients. RESULTS:Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments. CONCLUSIONS:Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Koes BW,Bouter LM,van Mameren H,Essers AH,Verstegen GM,Hofhuizen DM,Houben JP,Knipschild PGdoi
10.1136/bmj.304.6827.601keywords:
subject
Has Abstractpub_date
1992-03-07 00:00:00pages
601-5issue
6827eissn
0959-8138issn
1756-1833journal_volume
304pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVE:To assess the incidence and severity of physical and psychosexual symptoms in young women due to ovarian failure caused by total body irradiation for leukaemia and the women's response to hormone treatment. DESIGN:Postal questionnaire and interview. SETTING:Leukaemia unit of oncology hospital. PATIENTS:Con...
journal_title:BMJ (Clinical research ed.)
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更新日期:1989-12-16 00:00:00
abstract:OBJECTIVES:To measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time. DESIGN:Population study using routine data from hospital records, aggregated for small areas. SUBJECTS:Female te...
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更新日期:2001-07-28 00:00:00
abstract:OBJECTIVE:To examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China. DESIGN:Observational study. SETTING:China's National Maternal Near Miss Surveillance Sy...
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doi:10.1136/bmj.k817
更新日期:2018-03-05 00:00:00
abstract::Care in the community for insane people today is more a matter of expert provision than communal support. In consequence, although they are no longer confined to hospital, mentally ill people largely remain marginalised in a society that does not have the resources, nor often the inclination, to take responsibility fo...
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pub_type: 历史文章,杂志文章
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abstract:OBJECTIVE:To investigate the association between birth weight of offspring and mortality among fathers and mothers in the west of Scotland. DESIGN:Prospective observational study. PARTICIPANTS:794 married couples in Renfrew district of the west of Scotland. MAIN OUTCOME MEASURES:Mortality from all causes and from ca...
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更新日期:1995-01-28 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of elective single embryo transfer versus double embryo transfer on the outcomes of live birth, multiple live birth, miscarriage, preterm birth, term singleton birth, and low birth weight after fresh embryo transfer, and on the outcomes of cumulative live birth and multiple live b...
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更新日期:2010-12-21 00:00:00
abstract:OBJECTIVES:To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm(3) at start of antiretroviral therapy. DESIGN:Cohort study. SETTING:Outpatient HIV c...
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abstract:OBJECTIVE:To examine the protective efficacy of measles vaccination in infants in a low income country before 9 months of age. DESIGN:Randomised clinical trial. PARTICIPANTS:1333 infants aged 4.5 months: 441 in treatment group and 892 in control group. SETTING:Urban area in Guinea-Bissau. INTERVENTION:Measles vacci...
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更新日期:2008-07-24 00:00:00
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更新日期:1994-09-10 00:00:00
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更新日期:1997-05-10 00:00:00
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更新日期:2013-07-23 00:00:00
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更新日期:2014-03-13 00:00:00
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更新日期:2005-02-12 00:00:00
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更新日期:2015-09-21 00:00:00
abstract:OBJECTIVES:Analysis of incidence and characteristics of congenital abdominal wall defects, with special reference to the differences between the incidence of gastroschisis and exomphalos (omphalocele). DESIGN:Retrospective analysis using data from the Office of Population Censuses and Surveys (recoded to differentiate...
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更新日期:2002-10-05 00:00:00
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更新日期:2013-03-18 00:00:00
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更新日期:2016-05-04 00:00:00
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更新日期:1999-09-18 00:00:00