Abstract:
BACKGROUND:Advice and exercise are widely recommended for subacute low back pain, but the effectiveness of these interventions is unclear. OBJECTIVE:To investigate the effectiveness of physiotherapist-prescribed exercise, advice, or both for subacute low back pain. DESIGN:Factorial randomized, placebo-controlled trial. SETTING:7 university hospitals and primary care clinics in Australia and New Zealand. PATIENTS:259 persons with subacute low back pain (>6 weeks and <3 months in duration). INTERVENTION:Participants received 12 physiotherapist-directed exercise or sham exercise sessions and 3 physiotherapist-directed advice or sham advice sessions over 6 weeks. MEASUREMENTS:Primary outcomes were average pain over the past week (scale, 0 to 10), function (Patient-Specific Functional Scale), and global perceived effect (11-point scale) at 6 weeks and 12 months. Secondary outcomes were disability (Roland-Morris Disability Questionnaire), number of health care contacts, and depression (Depression Anxiety Stress Scales-21). RESULTS:Exercise and advice were each slightly more effective than placebo at 6 weeks but not at 12 months. The effect of advice on the pain scale was -0.7 point (95% CI, -1.2 to -0.2 point; P = 0.011) at 6 weeks and -0.4 point (CI, -1.0 to 0.3 point; P = 0.27) at 12 months, whereras the effect of exercise was -0.8 point (CI, -1.3 to -0.3 point; P = 0.004) at 6 weeks and -0.5 point (CI, -1.1 to 0.2 point; P = 0.14) at 12 months. The effect of advice on the function scale was 0.7 point (CI, 0.1 to 1.3 points; P = 0.014) at 6 weeks and 0.6 point (CI, 0.1 to 1.2 points; P = 0.023) at 12 months, and the effect of exercise was 0.4 point (CI, -0.2 to 1.0 point; P = 0.174) at 6 weeks and 0.5 point (CI, -0.1 to 1.0 point; P = 0.094) at 12 months. The effect of advice on the global perceived effect scale was 0.8 point (CI, 0.3 to 1.2 points; P < 0.001) at 6 weeks and 0.3 point (CI, -0.2 to 0.9 point; P = 0.24) at 12 months, and the effect of exercise was 0.5 point (CI, 0.1 to 1.0 point; P = 0.017) at 6 weeks and 0.4 point (CI, -0.1 to 1.0 point; P = 0.134) at 12 months. When administered together, exercise and advice had larger effects on all outcomes at 6 weeks (effect on pain, -1.5 [CI -2.2 to -0.7 point; P = 0.001], with similar results for other primary outcomes); however, by 12 months, there was a statistically significant effect only for function (effect, 1.1 points [CI, 0.3 to 1.8 points]; P = 0.005). LIMITATION:Physiotherapists were not blinded. CONCLUSIONS:In participants with subacute low back pain, physiotherapist-directed exercise and advice were each slightly more effective than placebo at 6 weeks. The effect was greatest when the interventions were combined. At 12 months, the only effect that persisted was a small effect on participant-reported function. AUSTRALIAN CLINICAL TRIALS REGISTRY REGISTRATION NUMBER: 12605000039684.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Pengel LH,Refshauge KM,Maher CG,Nicholas MK,Herbert RD,McNair Pdoi
10.7326/0003-4819-146-11-200706050-00007subject
Has Abstractpub_date
2007-06-05 00:00:00pages
787-96issue
11eissn
0003-4819issn
1539-3704pii
146/11/787journal_volume
146pub_type
杂志文章,多中心研究,随机对照试验abstract:DESCRIPTION:Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for breast cancer. METHODS:The USPSTF reviewed the evidence on the following: effectiveness of breast cancer screening in reducing breast cancer-specific and all-cause mortality, as well as the incidence of advanced...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/M15-2886
更新日期:2016-02-16 00:00:00
abstract::Eighty-six patients who required heparin therapy were randomly assigned to receive bovine or porcine heparin. Abnormal concentrations of alanine transaminase and aspartate transaminase developed during treatment in 59.3% and 26.7% of patients, respectively. Patient characteristics that significantly influenced the dev...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-100-5-646
更新日期:1984-05-01 00:00:00
abstract::Nine of 81 members of two families were found to have renal problems. Three patients in one family had renal-retinal dysplasia with probable recessive inheritance. Of the 6 patients in the second family, one received a kidney transplant from his brother who initially had no detectable renal abnormality but later devel...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-84-2-157
更新日期:1976-02-01 00:00:00
abstract::Coronary artery spasm is an important pathogenetic mechanism in some forms of myocardial ischemic disease. Factors that may be important in the genesis of spasm include the autonomic nervous system, prostaglandins, endoperoxides, thromboxanes, and the calcium availability to the contractile apparatus. Spasm results in...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-91-3-441
更新日期:1979-09-01 00:00:00
abstract::In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-123-12-199512150-00008
更新日期:1995-12-15 00:00:00
abstract::[Figure: see text]. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-1897
更新日期:2020-05-19 00:00:00
abstract:STUDY OBJECTIVE:To determine the efficacy of continuous intravenous infusion of prostacyclin (epoprostenol) in primary pulmonary hypertension. DESIGN:Randomized trial with 8-week treatment periods and nonrandomized treatment for up to 18 months. SETTING:Four referral centers. PATIENTS:Sequential sample of 24 patient...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-112-7-485
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVE:To determine the following: a reference range for serum calcitriol during hypercalcemia in a control group of patients with myeloma in whom calcitriol production is known to be appropriately suppressed; the incidence of elevated serum calcitriol levels in hypercalcemic patients with non-Hodgkin lymphoma accor...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-121-9-199411010-00001
更新日期:1994-11-01 00:00:00
abstract::We developed a model to project morbidity, mortality, and costs attributable to type A influenza virus infections in nursing homes and to evaluate the relative benefits and costs of programs for prevention and control. Influenza vaccination was the most cost-effective intervention under various simulations in the mode...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-5-732
更新日期:1987-11-01 00:00:00
abstract::We isolated a high molecular weight antigen of the Legionnaires' disease (LD) bacterium by column chromatography. The antigen was composed of 35% carbohydrate, 2.6% protein, 1.8% phospholipid, and 1% 2-keto-3-deoxyoctonate and was important in the host's antibody response because it inhibited the indirect immunofluore...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-4-638
更新日期:1979-04-01 00:00:00
abstract:OBJECTIVE:To determine the effect of treating Helicobacter pylori infection on the recurrence of gastric and duodenal ulcer disease. DESIGN:Follow-up of up to 2 years in patients with healed ulcers who had participated in randomized, controlled trials. SETTING:A Veterans Affairs hospital. PARTICIPANTS:A total of 109...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-116-9-705
更新日期:1992-05-01 00:00:00
abstract::Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their relationship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities d...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-146-9-200705010-00155
更新日期:2007-05-01 00:00:00
abstract:Description:The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline update an...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/M17-2640
更新日期:2018-03-20 00:00:00
abstract::There has been considerable change in the practice of internal medicine in the past quarter century, including the rise of specialization, increasing time pressure, the hospitalist movement, and the rapidly changing responsibilities of internists in inpatient and outpatient settings. Training programs have not adequat...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-144-12-200606200-00010
更新日期:2006-06-20 00:00:00
abstract::The microorganisms that regularly infect patients with the acquired immunodeficiency syndrome (AIDS) have become well recognized. Most take advantage of defects in T-lymphocyte function, but others, such as Streptococcus pneumoniae and Haemophilus influenzae, take advantage of B-cell defects. Still others, such as Sta...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-103-5-738
更新日期:1985-11-01 00:00:00
abstract:BACKGROUND:Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients. OBJECTIVE:To compare three pharmacologic protocols for opioid detoxification in a primary care setting. DESIGN:Randomized, double-blind clinical trial wit...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-127-7-199710010-00004
更新日期:1997-10-01 00:00:00
abstract::In five patients with hypertension and marked impairment of renal function due to renal artery stenosis in a solitary functioning kidney, a nonsurgical technique, percutaneous transluminal angioplasty, was used to dilate the stenotic renal artery. Blood pressure improved in all five patients, and renal function improv...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-5-684
更新日期:1979-11-01 00:00:00
abstract:BACKGROUND:Smokers with medical illnesses are at particular risk for complications caused by tobacco. Clinical trial data on the effectiveness of triple-combination pharmacotherapy for tobacco dependence treatment in these high-risk smokers are not available. OBJECTIVE:To evaluate extended duration of a triple-medicat...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-150-7-200904070-00004
更新日期:2009-04-07 00:00:00
abstract:OBJECTIVE:To determine the number and distribution of internists in subspecialty training and compare with data collected since 1976; to determine the distribution of activity of subspecialty fellows; and to focus on hematology and oncology. DESIGN:Repeated mail survey with telephone follow-up. PARTICIPANTS:All direc...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-1-36
更新日期:1991-01-01 00:00:00
abstract::Past efforts to reverse or limit the effects of acute stroke have been largely unsuccessful, in part because of the inability to evaluate and treat most patients soon after stroke onset. One important factor in the delay of treatment has been the nihilistic attitude of medical personnel, including physicians, toward t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-04-15 00:00:00
abstract:PURPOSE:To review prospective epidemiologic studies and randomized trials regarding the role of antioxidant vitamins (vitamins E and C and beta-carotene) in the prevention of cardiovascular disease, with emphasis on differences in results obtained by these two types of studies. DATA SOURCES:Computerized and manual sea...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-123-11-199512010-00009
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVE:To prospectively study the clinical features, pathophysiology, treatment and prognosis of Wegener granulomatosis. DESIGN:Of the 180 patients with Wegener granulomatosis referred to the National Institute of Allergy and Infectious Diseases during the past 24 years, 158 have been followed for 6 months to 24 ye...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-6-488
更新日期:1992-03-15 00:00:00
abstract:BACKGROUND:Adiponectin and resistin are recently discovered adipokines that may provide a molecular link between adiposity and type 2 diabetes. OBJECTIVE:To evaluate whether total and high-molecular-weight adiponectin and resistin are associated with future risk for type 2 diabetes, independent of obesity and other kn...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-149-5-200809020-00005
更新日期:2008-09-02 00:00:00
abstract:PURPOSE:To review the available data on the treatment of chronic stable angina and formulate a rational approach to the use of pharmacologic therapy, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass graft surgery (CABG). DATA SOURCES:A MEDLINE search of English-language literature publ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-128-3-199802010-00008
更新日期:1998-02-01 00:00:00
abstract:BACKGROUND:The vast scientific literature on smoking and health contains few large studies with direct estimates of long-term mortality by smoking habits. Data have been lacking, particularly for women. OBJECTIVE:To study smoking and deaths and causes of death in women and men of middle age (40 to 70 years of age). D...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-144-6-200603210-00004
更新日期:2006-03-21 00:00:00
abstract:BACKGROUND:Successful outcomes after cardiopulmonary resuscitation remain disappointingly infrequent, in animal studies, administration of exogenous vasopressin during closed- and open-chest cardiopulmonary resuscitation has recently been shown to be more effective than optimal doses of epinephrine in improving vital o...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-12-199606150-00006
更新日期:1996-06-15 00:00:00
abstract::This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for family and intimate partner violence, based on the USPSTF's examination of evidence specific to family and intimate partner violence, and updates the 1996 recommendations on this topic. In 1996, the USPSTF found...
journal_title:Annals of internal medicine
pub_type: 指南,杂志文章,实务指引
doi:10.7326/0003-4819-140-5-200403020-00014
更新日期:2004-03-02 00:00:00
abstract:BACKGROUND:Lateral epicondylitis is a common condition for which botulinum toxin has been reported to have a therapeutic role in uncontrolled studies. OBJECTIVE:To determine if an injection of botulinum toxin is more effective than placebo for reducing pain in adults with lateral epicondylitis. DESIGN:Randomized, dou...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-143-11-200512060-00007
更新日期:2005-12-06 00:00:00
abstract:BACKGROUND:An effective national biosurveillance system expedites outbreak recognition and facilitates response coordination at the federal, state, and local levels. The BioSense system, used at the Centers for Disease Control and Prevention, incorporates chief complaints but not data from the whole encounter note into...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-156-1-201201030-00003
更新日期:2012-01-03 00:00:00
abstract:BACKGROUND:Many constituents of fruits and vegetables may reduce the risk for coronary heart disease, but data on the relationship between fruit and vegetable consumption and risk for coronary heart disease are sparse. OBJECTIVE:To evaluate the association of fruit and vegetable consumption with risk for coronary hear...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-134-12-200106190-00010
更新日期:2001-06-19 00:00:00