Effective occupational therapy interventions in the rehabilitation of individuals with work-related low back injuries and illnesses: a systematic review.

A systematic review of the literature related to effective occupational therapy interventions in rehabilitation of individuals with work-related low back injuries and illnesses was carried out as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. This review evaluated research on a broad range of occupational therapy-related intervention procedures and approaches. Findings from the review indicate that the evidence is insufficient to support or refute the effectiveness of exercise therapy and other conservative treatments for subacute and chronic low back injuries. The research reviewed strongly suggests that for interventions to be effective, occupational therapy practitioners should use a holistic, client-centered approach. The research supports the need for occupational therapy practitioners to consider multiple strategies for addressing clients' needs. Specifically, interventions for individuals with low back injuries and illnesses should incorporate a biopsychosocial, client-centered approach that includes actively involving the client in the rehabilitation process at the beginning of the intervention process and addressing the client's psychosocial needs in addition to his or her physical impairments. The implications for occupational therapy practice, research, and education are also discussed.

A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation.

Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.

Aquatic therapy: making a wave in the treatment of low back injuries.

Aquatic therapy is a viable rehabilitation alternative for the treatment of spinal pain and dysfunction. The unique physical properties of the water make it an ideal medium for the rehabilitation of low back injuries. Aquatic programs can be used in conjunction with a land-based program or as a sole treatment approach. Orthopaedic specialists should consider aquatic rehabilitation in management of spinal injuries to enhance the injured patient's overall functional outcomes.

Physical therapy for the equine back.

Before a physical therapy and rehabilitation program is suggested, the end requirement must be considered. All physiotherapeutic machines are subject to laboratory screening. In the United States, the approval of the Food and Drug Administration is required; in the United Kingdom, certification by the National Physics Laboratory has been required by law since January 1996. Laboratory experiments are continually conducted to examine and evaluate the effects on tissues of varied electrical waveforms, low-intensity electrical currents, sound waves, and light rays delivered by a variety of therapeutic apparatuses. It is interesting to note that the tissues used for this work are derived from the rabbit, rat, and chick embryo. If these investigative procedures demonstrate benefit to tissue behavior following trauma in laboratory animals, they are then considered to be of benefit to humans. Surely, it must follow that equal benefit is to be derived by other species with similar tissues. Despite veterinarian prejudice to the contrary and by careful case selection rather than random application, horses can profit from the application of electrotherapy and derive benefit from rehabilitation; thus, an informed physical therapist should be considered a useful member of a "care" team. Because no two cases are ever the same, it is impossible to write a "recipe" book stating exactly the dosage, treatment time, or applications per week or per day. Success depends on an in-depth assessment of individual needs followed by an informed choice of therapy. In the case of physical therapy, this necessitates the use of the appropriate modality at the appropriate time, always taking into account the fact that tissue is living and is therefore in a continually changing state. The art of the physical therapist is to read the situation each time a patient is seen and to proceed according to the findings of the moment. The author regrets that there are no double-blind trials to quote or published research available to substantiate rehabilitation methods. The therapy principles relating to proprioceptive input, cortical re-education, muscle recoordination, and atrophy following both micro- and macrotrauma have been transferred in field work from humans to horses.