Effectiveness of manual therapies: the UK evidence report

<p>Abstract</p> <p>Background</p> <p>The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.</p> <p>Methods</p> <p>The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs.</p> <p>Results</p> <p>By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.</p> <p>Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments.</p> <p>Conclusions</p> <p>Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.</p> <p>Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.</p

Dominant control of agriculture and irrigation on urban heat island in India

As is true in many regions, India experiences surface Urban Heat Island (UHI) effect that is well understood, but the causes of the more recently discovered Urban Cool Island (UCI) effect remain poorly constrained. This raises questions about our fundamental understanding of the drivers of rural-urban environmental gradients and hinders development of effective strategies for mitigation and adaptation to projected heat stress increases in rapidly urbanizing India. Here we show that more than 60% of Indian urban areas are observed to experience a day-time UCI. We use satellite observations and the Community Land Model (CLM) to identify the impact of irrigation and prove for the first time that UCI is caused by lack of vegetation and moisture in non-urban areas relative to cities. In contrast, urban areas in extensively irrigated landscapes generally experience the expected positive UHI effect. At night, UHI warming intensifies, occurring across a majority (90%) of India's urban areas. The magnitude of rural-urban temperature contrasts is largely controlled by agriculture and moisture availability from irrigation, but further analysis of model results indicate an important role for atmospheric aerosols. Thus both land-use decisions and aerosols are important factors governing, modulating, and even reversing the expected urban-rural temperature gradients.by Rahul Kumar, Vimal Mishra, Jonathan Buzan, Rohini Kumar, Drew Shindell and Matthew Hube