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Inventarisatie van effectonderzoek naar regelmatig toegepaste fysiotherapeutische behandelingen bij chronisch benigne pijn (Review of research on the effectiveness of regular physical therapy for chronic benign pain) [Dutch]
Kroese MEA, de Vet HCW, Scholten RJP
Nederlands Tijdschrift voor Fysiotherapie [Dutch Journal of Physical Therapy] 2002 Apr;112(2):42-49
systematic review

OBJECTIVE: This review concerns research on the effectiveness of commonly applied treatments in the Netherlands for a number of chronic benign pain disorders (tension headache, low back pain, neck pain, shoulder pain, and fibromyalgia). The aim is to identify treatments for which the effectiveness is shown and to identify treatments that need to be studied further, by means of either a systematic review (SR) or a new randomized clinical trial (RCT). This article presents the findings for physical therapy and related treatments. DESIGN: A search for recent SRS was conducted in Medline, Embase, Psyclit, and the Cochrane Library. We also checked the references of the retrieved relevant publications. If no recent reviews were available, we searched for RCT's. The methodological quality of SRS was assessed, but only the abstracts of RCT's were considered. Per syndrome and treatment an overview was made of the number of SRS and their quality, the number of RCT's, a statement on the degree of effectiveness or recommendations for further research. RESULTS: For tension headache, relaxation exercises seem effective, based on the studied RCT'S but a good systematic review is needed to summarize the evidence; the same is true for the effects of cognitive therapy. The effects of exercise therapy and massage therapy on tension headache need to be further studied in RCT's. For low back pain, the effectiveness of cognitive-behavioural programmes (compared to waiting list controls or no treatment) has been shown in a recent SR. In another SR, exercise therapy appeared to be more effective than care by the general practitioner, but not more effective than other forms of physical therapy. New RCT's are advised for massage, exercise therapy according to Mensendieck, and swimming. For neck pain, new RCT's are needed on the effect of physical therapy because there have been few trials on cognitive-behavioural therapy and because of the conflicting results of these RCT's. For shoulder pain, the existing SRS on the effect of physical therapy are inconclusive, so new RCT's are needed. Also new RCT's are advocated for cognitive-behavioural therapy, rest/avoidance of provocative factors, and massage. For primary fibromyalgia syndrome, RCT's on the effect of cognitive-behavioural r therapy and physical therapy are scarce, so new RCT's are advocated. For fitness/aerobics a SR is needed because the results of the many RCT'S performed are inconsistent. CONCLUSION: The effectiveness of most of the commonly applied treatments in the Netherlands for tension headache, back, neck and shoulder pain, and fibromyalgia is not yet proven. Positive exceptions are cognitive-behavioural treatment and exercise therapy for chronic low back pain. With respect to the need for future research, for some treatments SRs are needed, but for most treatments new RCT'S are recommended.

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