Monday, June 22, 2009

OA knee ESCAPE programme

Just found some interesting evidence for an OA knee exercise programme:

http://www.kcl.ac.uk/content/1/c6/04/79/67/escapeprogramm...

The guide is very good and it gives ideas for handouts for patients, here is an outline:

Objective

Chronic knee pain is a major cause of disability and healthcare expenditure, but there

are concerns about efficacy, cost and side-effects associated with usual management.

Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the

efficacy of a rehabilitation programme (Enabling Self-management and Coping with Arthritic

knee Pain through Exercise, ESCAPE-knee pain) of improving function in people with chronic

knee pain better than usual primary care, delivered to individuals or groups of people.

Methods

This was a single blind, pragmatic, cluster randomised controlled trial. Participants aged

50 years and over, complaining of knee pain for more than 6 months, were recruited from a

random sample of 54 inner city primary care practices. Usual primary care was compared with

participation on a rehabilitation programme (integrating exercise, self-management and active

coping strategies) delivered to participants individually or groups of 8 participants. Primary

outcome was self-reported function (WOMAC-func) 6 months after completing rehabilitation.

Results 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events.

Rehabilitated participants had better function than participants continuing usual primary care (-

3.33 WOMAC-func points, CI -5.88 to -0.78; p=0.01). Improvements were similar whether

participants received individual (-3.53, CI -6.52 to -0.55) or group rehabilitation (-3.16, CI -6.55

to -0.12). The number needed to treat was 7 (CI 4 to 27).

Conclusions

ESCAPE-knee pain provides a safe, clinically practicable intervention for chronic

knee pain, and is equally effective whether delivered to individuals or groups of participants.

Tuesday, May 05, 2009

Restless Leg Syndrome and acupuncture

Title: Restless Leg Syndrome
Added by: Anne Williams
Posted: 24 October 2007 19:58
I feel I have had some success several times treating restless leg syndrome by opening up the girdle vessel , which is one of the Extraordinary vessels .Opening point GB 41 Coupled point TB 5

acupuncture for migrane

acupuncture for migrane

From the iCSP website:

Added by: barbaracavan
Posted: 22 April 2009 08:43

I have limited experience in treating patients with headaches with acupuncture. I have reviewed some of the recent literature and it looks quite postive for 'real' and sham acupuncture. Can anyone give me some ideas for point selection including type of headache and any stimulation used.

Thanks

 

Lynn Pearce:

Hi - this is directed at the other headache query as well really!!

I run a day on headache and acupuncture and the pathology of headache can be complex - the International Headache Society offer at least 10 sub-gorups when trying to classify headaches, and migraine is a group all on it's own.

A few pointers - face pain - where is this?? Likely to be a referral from the opthalmic branch of the trigeminal cranial nerve. Also, this nerve ( and you'll have got this from Dean Watson's course ) can be involved in a structure known as the TCN - the trigemino-cervical nucleus - it's anatomical location puts it in the brainstem and extending down into the cervical spine. Dean feels this structure is effected with mobilising C0 - C 3.

HOWEVER!!! - the neural supply to this region can come from the upper thoracic levels ( notably T 1 - 4, which in turn supplies the superior cervical ganglia and this in turn supplies the C0 - C 3 region.

REAL migraine ( and I say this, as a lot of people say they get migraine when they don;t - they can easily have upper cervical spine driven headache which appears as if it's 'migraine' in the public eye... ) can be treated from a number of points. GB 20 has always been considered THE headache point, but there are a number of ways to effect this area, and ALWAYS assume it's coming from the thoracic / cervical spines until they've been eliminated!!

Bl 10 ( and there are two different locations ) can be useful too, but each patient gets assessed on their own merit and a treatment tailored to them, there is no ' headache recipe'.

If you're looking at the Andrew Vickers study, you'll see that there was a point point suggested, but no 'exact formula'. The common points are GB 21, GB 20, but I would have many other suggestions, based on more clinical info regarding these headaches and how they present.

A word on the other presentation - it is possible that it is Cluster Headache' which is hard to diagnose, more common in men, and harder to treat.!!!

Food for thought for now....

Regards


Lynn P
AACP Tutor
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