Evidence-Based Practice

This was an analysis of over 15,000 patient records within the Military Health Services. The purpose of the study was to measure provider adherence to an evidence-based clinical practice guideline for acute low back pain and to determine its impact on clinical outcomes and cost. Multivariable regression analyses controlling for demographic variables and perceived health indicated that clinical practice guidelines adherence was related to superior functional outcomes, patient satisfaction and general health, and lower healthcare costs. Higher levels of adherence to the evidence-based clinical practice guidelines were related to better clinical outcomes.
Pain 2006;124:140-9.

Seniors Can Protect Themselves

Researchers examined the associations between physical activity, physical function and occurrence of low back pain in an elderly population. A total of 1,387 persons aged 70-100 provided data on physical activity, overall physical function and low back pain at baseline and at follow-up two years later.

Performing strenuous physical activity (e.g., more than 30 minutes of walking, heavy gardening, dancing, bike riding, other sports) at baseline was strongly protective against having any low back pain and having 30 days or more of low back pain during the past year.

Participants with poor initial physical function experienced the strongest protective effect of strenuous physical activity. A dose-response association between increasing frequency of strenuous physical activity and magnitude of this protective effect were found (e.g., exercise 2x/week is better than 1x/week). These findings add to the evidence that afflictions associated with aging can be reduced by participating in regular activity. Strenuous physical activity at least once a week is protective for occurrence of low back pain in seniors.
Spine 2007;32:76-81.

Effective & Ineffective Low Back Pain Therapies

This was a scientific review investigating the benefits and risks of nonpharmacologic therapies in patients with acute and chronic low back pain. English-language studies were identified through searches of MEDLINE (through November 2006) and the Cochrane Database of Systematic Reviews (2006, Issue 4). These electronic searches were supplemented by hand searching reference lists and additional citations suggested by experts. Information was abstracted about study design, population characteristics, interventions, outcomes, and adverse events. The Oxman criteria for systematic reviews and the Cochrane Back Review Group criteria for individual trials were used to grade methodological quality.

Effective Acute Low Back Pain Treatments
Chiropractic manipulation and superficial heat
Not effective: spinal specific exercise, functional restoration

Effective Chronic or Subacute Low Back Pain Treatments
Chiropractic manipulation, yoga, acupuncture, cognitive-behavioral treatment, massage therapy, spinal specific exercise
Not effective: shortwave diathermy, traction

Effective Radiculopathy or Sciatica Treatments
Chiropractic manipulation
Not effective: traction

There are numerous nonpharmacologic treatments that demonstrate effectiveness with rare adverse events. Chiropractic manipulation is the only common denominator.
Ann Intern Med 2007;147:492-504.

Exercise Has a Protective Role

This was prospective study that examined the relationship between physical activity and risk of invasive and in situ breast cancer. This study enrolled over 110,000 women aged 20 to 79 years with no history of breast cancer and followed them for more than 6 years. For this study moderate activities were defined as brisk walking, golf, volleyball, etc. and strenuous activities were defined as swimming laps, running, aerobics, etc.

Breast cancer risk was inversely associated with long-term strenuous activity of 5 hours or more per week.These findings support the protective role of strenuous long-term exercise activity against breast cancer.

This study is supported by other research teams. Macera demonstrated that more physical activity was associated with a lower risk of breast cancer in post menopausal women. McTiernan showed that the exercise intensity need not be strenuous to gain a reduced risk for breast cancer.
Arch Intern Med 2007;167:408-15.

Add Years to Your Life

This clinical trial tested the benefits of the traditional Mediterranean diet (TMD) and a low-fat diet. A total of 372 subjects at high cardiovascular risk (210 women and 162 men; age range, 55- 80 years) were recruited, and changes in low-density lipoprotein were evaluate. After 3-month diet, average low-density lipoprotein levels decreased for those on the TMD but there were no changes in the low-fat diet group.

These findings provide additional evidence to recommend the TMD as a useful method against risk factors for coronary heart disease. Previous studies found that the TMD is associated with a reduction in coronary heart disease, cancer and overall mortality. The protective effect of this diet is thought to be associated with its richness in antioxidants. Yet, the effect of antioxidants has been inconsistent. No benefit has been demonstrated in trials with antioxidant vitamin supplements.

TMD Diet
The typical TMD diet includes (1) the use of olive oil for cooking and dressing; (2) increased consumption of vegetables, nuts, and fish products; (3) consumption of white meat instead of red or processed meat; (4) preparation of homemade sauce by simmering tomato, garlic, onion, and aromatic herbs with olive oil to dress vegetables, pasta, rice, and other dishes; and (5) for alcohol drinkers, following a moderate pattern of red wine consumption.
Arch Intern Med 2007;167:1195-203.