Opinion, but no data, in support of Superthumb. (Reply by Maher et al to comment by Molnar P, and Laird R and Kent P, Australian Journal of Physiotherapy 48: ….)

We cannot agree with any of the points Molnar raises. The Superthumb web page explicitly states that the device reduces hand pain and fatigue (Superthumb 2002) so the writer misleads the readers of the Journal by stating that the information provided on Superthumb only refers to thumb pain and does not mention wrist or hand pain. We are disappointed that he has done this

Prescription of activity for low back pain: What works?

This paper provides evidence-based guidelines for the prescription of activity in the management of non-specific low back pain (NSLBP). The 62 clinical trials published between 1966 and 1997, identified by a search of the Medline and Cinahl databases, were reviewed to provide the basis for the guidelines. The available evidence suggests that physiotherapists should advise patients with acute and sub-acute NSLBP to avoid bed rest and to return to normal activity using time rather than pain as the guide to activity resumption. While structured exercise programs have not been shown to provide a benefit for acute NSLBP, there is strong evidence to support their use for patients with sub-acute and chronic NSLBP and in the prevention of NSLBP

Efficacy of “therapist-selected” versus “randomly selected” mobilisation techniques for the treatment of low back pain: A randomised controlled trial

The aim of this study was to establish whether the mobilisation technique selected by the treating physiotherapist is more effective in relieving low back pain than a randomly selected mobilisation technique. Two manipulative physiotherapists and 140 subjects suffering non-specific low back pain participated. Baseline measurements were taken before treatment allocation; the therapist then assessed subjects and nominated the preferred treatment grade, spinal level to be treated and mobilisation technique to be used. The subjects were then randomly allocated to one of two groups. One group received the preferred mobilisation technique as selected by the therapist; the other group received a randomly assigned mobilisation technique. All mobilisation treatments were applied to the nominated spinal level using the nominated treatment grade. Follow-up measures were taken immediately after intervention. Two-way ANOVA was used to analyse the data; the first factor was the treatment group and the second factor was the direction of the patient's most painful movement. The choice of mobilisation treatment had no effect on any outcome measure investigated in this study; however, post hoc tests revealed that mobilisation treatment applied to the lower lumbar levels had a greater analgesic effect than when applied to upper lumbar levels. The results of this study confirm that lumbar mobilisation treatment has an immediate effect in relieving low back pain, however the specific technique used seems unimportant

Seagrass meadows

List of excluded full-text articles and the primary reason for exclusion. (DOCX 45 kb

A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol

Background: Whiplash is the most common injury following a motor vehicle accident. Approximately 60% of people suffer persistent pain and disability six months post injury. Two forms of exercise; specific motor relearning exercises and graded activity, have been found to be effective treatments for this condition. Although the effect sizes for these exercise programs, individually, are modest, pilot data suggest much larger effects on pain and disability are achieved when these two treatments are combined. The aim of this study is to investigate the effectiveness and cost-effectiveness of this comprehensive exercise approach for chronic whiplash

Manipulative therapy and/or NSAIDs for acute low back pain: design of a randomized controlled trial [ACTRN012605000036617]

BACKGROUND: Acute low back pain is a common condition resulting in pain and disability. Current national and international guidelines advocate general practitioner care including advice and paracetamol (4 g daily in otherwise well adults) as the first line of care for people with acute low back pain. Non-steroidal anti-inflammatory drugs (NSAIDs) and spinal manipulative therapy (SMT) are advocated in many guidelines as second line management options for patients with acute low back pain who are not recovering. No studies have explored the role of NSAIDs and/or SMT in addition to first line management for acute low back pain. The primary aim of this study is to investigate if NSAIDs and/or SMT in addition to general practitioner advice and paracetamol results in shorter recovery times for patients with acute low back pain. The secondary aims of the study are to evaluate whether the addition of SMT and/or NSAIDs influences pain, disability and global perceived effect at 1, 2, 4 and 12 weeks after onset of therapy for patients with significant acute low back pain. METHODS/DESIGN: This paper presents the rationale and design of a randomised controlled trial examining the addition of NSAIDs and/or SMT in 240 people who present to their general practitioner with significant acute low back pain

Generating sustainable collective action: Models of community control and governance of alcohol supply in Indigenous minority populations

Restrictions on the supply of alcohol are amongst the most effective and cost effective interventions to address harmful use. However, despite international human rights bodies recognising that self determination must be pre-eminent in efforts to improve Indigenous health, little is known about the role of Indigenous communities in designing and implementing alcohol controls as well as the degree to which government resourcing and/or regulation is utilised. This commentary explores Australian examples of the governance models used to ensure Indigenous participation and leadership when developing regulatory interventions for alcohol control within communities. We identify four models of Indigenous governance: alcohol control interventions that were community conceived and implemented, government-facilitated community-led, community coalitions backed by government intervention and government initiated community partnerships. Each model is underpinned by specific governance arrangements which incorporate rules and processes that determine authority, accountability and Indigenous participation in decision-making. The aim of this paper is to benchmark these models of governance along a spectrum of community engagement beginning with forms of non-participation and ending with full citizen control. In addition, we put forward recommendations for governments at all levels to facilitate culturally acceptable and robust models of Indigenous governance that have the potential to improve health and social outcomes

Evaluation of a treatment-based classification algorithm for low back pain

Poster Presentation Theme: How can we better translate evidence into clinical practice? Background: Several studies have investigated criteria for classifying patients with low back pain into treatment-based subgroups. A comprehensive algorithm was recently created to translate these criteria into a clinical decision-making guide. This study investigated the translation of the individual subgroup criteria into a comprehensive algorithm by studying the prevalence of patients meeting each treatment subgroup, more than one treatment subgroup, and none of the treatment subgroups. The reliability of the classification decision was also investigated