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Managing musculoskeletal complaints with rehabilitation therapy: summary of the Philadelphia Panel evidence-based clinical practice guidelines on musculoskeletal rehabilitation interventions.

OBJECTIVE: The Philadelphia Panel recently formulated evidence-based guidelines for selected rehabilitation interventions in the management of low back, knee, neck, and shoulder pain. STUDY DESIGN: The guidelines were developed with the use of a 5-step process: define the intervention, collect evidence, synthesize results, make recommendations based on the research, and grade the strength of the recommendations. POPULATION: Outpatient adults with low back, knee, neck, or shoulder pain without vertebral disk involvement, scoliosis, cancer, or pulmonary, neurologic, cardiac, dermatologic, or psychiatric conditions were included in the review. OUTCOMES MEASURED: To prepare the data, systematic reviews were performed for low back, knee, neck, and shoulder pain. Therapeutic exercise, massage, transcutaneous electrical nerve stimulation, thermotherapy, ultrasound, electrical stimulation, and combinations of these therapies were included in the literature search. Studies were identified and analyzed based on study type, clinical significance, and statistical significance. CONCLUSIONS: The Philadelphia Panel guidelines recommend continued normal activity for acute, uncomplicated low back pain and therapeutic exercise for chronic, subacute, and postsurgical low back pain; transcutaneous electrical nerve stimulation and exercise for knee osteoarthritis; proprioceptive and therapeutic exercise for chronic neck pain; and the use of therapeutic ultrasound in the treatment of calcific tendonitis of the shoulder.

Acute Disease↗

[Prosthetic rehabilitation with a force-distribution prosthesis. Clinical and statistical evaluation of the results obtained in 79 oral rehabilitations].

The results obtained with 79 odontoprosthetic rehabilitations by means of removable force distribution prosthesis are reported. Using half-round section wires, this prosthesis distributed masticatory forces axially on the abutment teeth and also distributes them evenly over the edentulous crest, thus achieving a mixed dental and mucous support. Clinical and statistical assessment takes in 79 patients of both sexes aged between 22 and 69 treated over the fifteen year period since 1964. All types of edentulism according to the Kennedy classification were treated. The clinical results were considered, particularly the periodontal situation and the mechanical results, above all friction between retention and function elements of the connecting wires. Clinically, 82,2% of results were positive and 74.6% of the results were mechanically positive also.

Adult↗

[Rehabilitation of the coronary patient. Secondary prevention. A document of the Working Group on Cardiac Rehabilitation of the Sociedad Española de Cardiología].

There is scientific evidence that these measures of secondary prevention and cardiac rehabilitation, not only diminishes the mortality and morbidity of the patients but also favour the return to work, reduce incapacities and improve the quality of life. The economic cost of these methods must not be an obstacle for the Administration, as recent studies about the cost-benefit analysis of these programmes have demonstrated.

Cardiology↗

[Integrated physical therapy in psychiatry, neuro-rehabilitation and rehabilitation of the aged].

Physiotherapy forms a main part of modern therapy, however it only can be optimal in full integration with pharmacotherapy, psychotherapy and sociotherapy. Gerontopsychiatry offers a large field for physiotherapists. Besides highly specialised physiotherapy the dimension of recreation, fun-giving and amelioration of life quality must not be forgotten in physiotherapy. These possibilities from an important function within a human and humanitarian medicine. A further main condition for amelioration is to involve relatives fully in the therapeutical concept. Our experience has shown that within the domestic surrounding rehabilitative progress can well arrive; however, only if systematically prepared and uninterrupted stimulated.

Adult↗

Shoulder rehabilitation: clinical application, evaluation, and rehabilitation protocols.

This chapter has discussed and illustrated a shoulder rehabilitation protocol based on restoration of the anatomy, biomechanics, physiology, and motor firing organization that is responsible for normal shoulder function. Many protocols exist in the literature, most of which appear to achieve good results. There are no outcomes data to suggest the most efficacious protocols. Adherence to the basic principles outlined in these chapters appears to allow the best framework for constructing a good program.

Athletic Injuries↗

[Rehabilitation group (team) in neuro-rehabilitation--self evaluation and patient satisfaction].

The bio-psychosocial entity man demands multidimensional therapeutical approach. Our institution could offer fluent transition from acute neurology to neuro-rehabilitation. Thus could easily be examined the coordination of the 3 main therapeutical activities: medication, physiotherapy and integrated psychotherapy. We demanded judgements by patients, doctors, physiotherapists, nursing persons, ergotherapeuts, music-therapeuts and logopeds. We ourself were astonished about the high judgement by patients which gave 91% very good to good action of therapy. Within differentiating evaluation of single methods we found very similar judgements within the different professional groups. Besides a good action on to the patients there was to be found a positive action to the team-spirit. There were wishes for more professional education, more communication and more time for the patients. We consider this a good sign for the working climate that has developed under these circumstances.

Aged↗