The authors acknowledge that the trial was underpowered with only

The authors acknowledge that the trial was underpowered with only 40 participants, which resulted in fairly imprecise effect sizes. The trial showed promising results with benefits in physical function, pain, and psychological measures. As expected,

the effects on pain and function started declining when treatment sessions ended. However, benefits in psychological measures persisted as far as 48 weeks. The study should be replicated on a larger scale in order to confirm the results. Current guidelines consider non-pharmacological treatment modalities as the cornerstones in modern management of OA with information, exercise, and weight loss as core treatments (NICE 2008). Although this trial involved instruction by a Tai Chi master and selected participants, the study results might encourage physiotherapists to consider Tai Chi as an alternative, or additional, form of exercise for persons with knee OA. “
“Summary of: Engebretsen K, Grotle M, Bautz-Holter E, Sandvik L, Juel NG, Ekeberg OM, et al (2009) inhibitors radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind

randomised study. BMJ 339: b3360. [Prepared by Nicholas Taylor, CAP Editor.] Question: Do supervised exercises improve shoulder pain and disability more than radial extracorporeal shockwave treatment in patients with subacromial impingement of the shoulder? Design: Randomised, controlled trial with concealed allocation and blinded RAD001 in vivo outcome assessment. Setting: An outpatient clinic in Norway. Participants: Adults with shoulder pain however for at least 3 months and with clinical signs of subacromial impingement were included. Key exclusion criteria included previous shoulder surgery, shoulder instability, and rheumatoid

arthritis. Randomisation allocated 52 patients to supervised exercises and 52 patients to radial extracorporeal shockwave therapy. Interventions: The exercise group participated in two 45-minute sessions each week for up to 12 weeks. The exercise sessions were supervised by a physiotherapist and emphasised reducing subacromial stress (including the use of manual techniques), relearning normal movement patterns, and progressing to loaded rotator cuff endurance training. The comparison group received radial extracorporeal shockwave treatment administered to 3–5 tender points once a week for 4–6 weeks. Outcome measures: The primary outcome was the difference in shoulder pain and disability at 6, 12, and 18 weeks. It was measured with the shoulder pain and disability index (SPADI)-a self-report questionnaire with scores ranging from 0 to 100; higher scores indicate worse shoulder pain and disability. Secondary outcome measures included pain intensity during rest and activity, specific questions about shoulder function, and work status. Results: One hundred participants completed the study.

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