TITLE

Austrian catalogue of services of physical medicine - empirical basis of the effectiveness of the contents

AUTHOR(S)
Wilbacher, Ingrid; Brandst├Ątter, Silvia; Kruzic, Nives; Gerner, Gabriele; Kiesl, Ute
PUB. DATE
January 2013
SOURCE
GMS Health Technology Assessment;2013, Vol. 9, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: An existing catalogue of services of physical medicine as a basic guideline for contracts with physicians and institutes in the Austrian Social Health Insurance Setting was checked for the evidence of the services. The main focus for this is the outpatient setting. Method: Based on the level of services (not indications) nine systematic literature reviews were done using the databases Pubmed, PEDRO and Cochrane and were concluded in this overview-report. Results: More than 180 studies were included in the several literature reviews. There is good evidence for active exercises like aerobic, strengthening, stretching, graded activity, training of the back muscles and coordination training. Positive results are reported for pain decrease, and functional increase especially for chronic musculoskeletal disorders. However, exercise is not a universal remedy: there are negative results for the effectiveness of exercise for indications like asthma, dysmenorrheal, epilepsy and psychiatric disorders. Limited evidence was found for exercise supported by mechanical devices, the studies found mainly focus on traction. Manual therapies and mobilization do not show clear evidence for a recommendation, and they have an unclear potential of harm. There is fair positive evidence for electro physical therapy (TENS) for indications connected with pain and conflicting evidence for middle- and high frequent electro therapy modalities. Thermotherapy does not show clear advantages over placebo. Conclusion: There is positive evidence for the effectiveness of active exercises and conflicting evidence for passive treatment modalities for musculoskeletal conditions. There are methodical limitations due to the comparability in many of the studies using different outcomes, different scores for outcome measurement, subjective outcome indicators and a huge range of different indications where physical therapy modalities are done. Additional therapies, like pain medication, and adverse events are not reported in many of the studies. It is difficult to delimit between different settings like therapy, rehabilitation and wellness. Studies about physical therapy modalities show a uniform focus on a (short-term) symptomatic approach and quality of life. It is difficult to estimate the effect on morbidity or mortality (i.e. in reduced needed surgery).
ACCESSION #
94955592

 

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