John S. Magel

Bio: John S. Magel is an academic researcher from University of Utah. The author has contributed to research in topics: Health care & Medicine. The author has an hindex of 6, co-authored 15 publications receiving 510 citations. Previous affiliations of John S. Magel include Intermountain Healthcare.

Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain: A Randomized Clinical Trial

Abstract: Importance Low back pain (LBP) is common in primary care. Guidelines recommend delaying referrals for physical therapy. Objective To evaluate whether early physical therapy (manipulation and exercise) is more effective than usual care in improving disability for patients with LBP fitting a decision rule. Design, Setting, and Participants Randomized clinical trial with 220 participants recruited between March 2011 and November 2013. Participants with no LBP treatment in the past 6 months, aged 18 through 60 years (mean age, 37.4 years [SD, 10.3]), an Oswestry Disability Index (ODI) score of 20 or higher, symptom duration less than 16 days, and no symptoms distal to the knee in the past 72 hours were enrolled following a primary care visit. Interventions All participants received education. Early physical therapy (n = 108) consisted of 4 physical therapy sessions. Usual care (n = 112) involved no additional interventions during the first 4 weeks. Main Outcomes and Measures Primary outcome was change in the ODI score (range: 0-100; higher scores indicate greater disability; minimum clinically important difference, 6 points) at 3 months. Secondary outcomes included changes in the ODI score at 4-week and 1-year follow-up, and change in pain intensity, Pain Catastrophizing Scale (PCS) score, fear-avoidance beliefs, quality of life, patient-reported success, and health care utilization at 4-week, 3-month, and 1-year follow-up. Results One-year follow-up was completed by 207 participants (94.1%). Using analysis of covariance, early physical therapy showed improvement relative to usual care in disability after 3 months (mean ODI score: early physical therapy group, 41.3 [95% CI, 38.7 to 44.0] at baseline to 6.6 [95% CI, 4.7 to 8.5] at 3 months; usual care group, 40.9 [95% CI, 38.6 to 43.1] at baseline to 9.8 [95% CI, 7.9 to 11.7] at 3 months; between-group difference, −3.2 [95% CI, −5.9 to −0.47], P = .02). A significant difference was found between groups for the ODI score after 4 weeks (between-group difference, −3.5 [95% CI, −6.8 to −0.08], P = .045]), but not at 1-year follow-up (between-group difference, −2.0 [95% CI, −5.0 to 1.0], P = .19). There was no improvement in pain intensity at 4-week, 3-month, or 1-year follow-up (between-group difference, −0.42 [95% CI, −0.90 to 0.02] at 4-week follow-up; −0.38 [95% CI, −0.84 to 0.09] at 3-month follow-up; and −0.17 [95% CI, −0.62 to 0.27] at 1-year follow-up). The PCS scores improved at 4 weeks and 3 months but not at 1-year follow-up (between-group difference, −2.7 [95% CI, −4.6 to −0.85] at 4-week follow-up; −2.2 [95% CI, −3.9 to −0.49] at 3-month follow-up; and −0.92 [95% CI, −2.7 to 0.61] at 1-year follow-up). There were no differences in health care utilization at any point. Conclusions and Relevance Among adults with recent-onset LBP, early physical therapy resulted in statistically significant improvement in disability, but the improvement was modest and did not achieve the minimum clinically important difference compared with usual care. Trial Registration clinicaltrials.gov Identifier:NCT01726803

Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial.

Abstract: Background Few studies have examined primary care management for acute sciatica, including referral to physical therapy. Objective To evaluate whether early referral to physical therapy reduced disability more than usual care (UC) alone for patients with acute sciatica. Design Randomized controlled clinical trial. (ClinicalTrials.gov: NCT02391350). Setting 2 health care systems in Salt Lake City, Utah. Patients 220 adults aged 18 to 60 years with sciatica of less than 90 days' duration who were making an initial primary care consultation. Intervention All participants received imaging and medication at the discretion of the primary care provider before enrollment. A total of 110 participants randomly assigned to UC were provided 1 session of education, and 110 participants randomly assigned to early physical therapy (EPT) were provided 1 education session and then referred for 4 weeks of physical therapy, including exercise and manual therapy. Measurements The primary outcome was the Oswestry Disability Index (OSW) score after 6 months. Secondary outcomes were pain intensity, patient-reported treatment success, health care use, and missed workdays. Results Participants in the EPT group had greater improvement from baseline to 6 months for the primary outcome (relative difference, -5.4 points [95% CI, -9.4 to -1.3 points]; P = 0.009). The OSW and several secondary outcomes favored EPT after 4 weeks. After 1 year, between-group differences favored EPT for the OSW (relative difference, -4.8 points [CI, -8.9 to -0.7 points]) and back pain intensity (relative difference, -1.0 points [CI, -1.6 to -0.4 points]). The EPT group was more likely to self-report treatment success after 1 year (45.2%) than the UC group (27.6%) (relative risk, 1.6 [CI, 1.1 to 2.4]). There were no significant differences in health care use or missed workdays. Limitation The patients and providers were unblinded, and specific physical therapy interventions responsible for effects could not be determined. Conclusion Referral from primary care to physical therapy for recent-onset sciatica improved disability and other outcomes compared with UC. Primary funding source Agency for Healthcare Research and Quality.

Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline

Abstract: This systematic review for a clinical practice guideline by the ACP summarizes evidence about the benefits and harms of nonpharmacologic therapies, including acupuncture, exercise, tai chi, yoga, m...

Textbook of Orthopaedic Medicine

Abstract: Soft-tissue rheumatism is common, and we are all familiar with and often quote figures for days of work lost because of its various forms. Nevertheless, understanding of the causes and treatment of the various types of soft-tissue rheumatism is very limited. This is a field that James Cyriax has made his own and likes to term 'orthopaedic medicine'. In this new and enlarged volume of his textbook he explains that his approach is as the physician counterpart of the orthopaedic surgeon. He describes the diagnosis and assessment of numerous syndromes and dwells in detail on the clinical history and physical examination. In general, x-rays and other objective tests such as blood tests are of little value. The physician 'must take great pains to be right, for contrary evidence is often not available to bring an error to his notice'. However, this is the nub of the problem. Without support from pathological studies there is generally no consensus view about these syndromes. Equally, the management of them is described in rather a didactic fashion, yet we lack knowledge of their natural histories and remission rates and controlled trials of alternative forms of therapy. Low back pain receives special attention Here Cyriax believes that most cases are due to disc lesions. He mentions specific spinal diseases such as ankylosing spondylitis but denies vehemently that back pain can be due to facet joint lesions. The more defined rheumatic diseases are dealt with relatively briefly. Here one feels on firmer ground, yet there are points of disagreement. For example, polymyalgia rheumatica is described as bilateral monarticular rheumatoid arthritis of the shoulders. In inflammatory arthritis there is an emphasis on the use of intraarticular triamcinolone that seems excessive. Cyriax is to be congratulated for concentrating on an extremely difficult field. Although there is much that is controversial, this volume should stimulate us to think more deeply about these common problems. M. JAYSON New Directions for Research in Systemic Lupus Erythematosus. Proceedings of a conference sponsored by the Arthritis Foundation. Arthritis and Rheumatism, 21, No. 5 (Supplement), June 1978. (US $15; $10 for orders of 100 or more.) Arthritis Foundation, 3400 Peachtree Road NE, Suite 1101, Atlanta, Ga 30326, USA. 1978.

Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus musculature

Abstract: OBJECTIVES To evaluate the intraexaminer and interexaminer reliability of rehabilitative ultrasound imaging (RUSI) in obtaining thickness measurements of the transversus abdominis (TrA) and lumbar multifidus muscles at rest and during contractions. DESIGN Single-group repeated-measures reliability study. SETTING University and orthopedic physical therapy clinic. PARTICIPANTS A volunteer sample of adults (N=30) with current nonspecific low back pain (LBP) was examined by 2 clinicians with minimal RUSI experience. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Thickness measurements of the TrA and lumbar multifidus muscles at rest and during contractions were obtained by using RUSI during 2 sessions 1 to 3 days apart. Percent thickness change was calculated as thickness(contracted)-thickness(rest)/thickness(rest). Intraclass correlation coefficients (ICC) were used to estimate reliability. RESULTS By using the mean of 2 measures, intraexaminer reliability point estimates (ICC(3,2)) ranged from 0.96 to 0.99 for same-day comparisons and from 0.87 to 0.98 for between-day comparisons. Interexaminer reliability estimates (ICC(2,2)) ranged from 0.88 to 0.94 for within-day comparisons and from 0.80 to 0.92 for between-day comparisons. Reliability estimates comparing measurements by the 2 examiners of the same image (ICC(2,2)) ranged from 0.96 to 0.98. Reliability estimates were lower for percent thickness change measures than the corresponding single thickness measures for all conditions. CONCLUSIONS RUSI thickness measurements of the TrA and lumbar multifidus muscles in patients with LBP, when based on the mean of 2 measures, are highly reliable when taken by a single examiner and adequately reliable when taken by different examiners.

Core Stability Training for Injury Prevention

Abstract: Context:Enhancing core stability through exercise is common to musculoskeletal injury prevention programs. Definitive evidence demonstrating an association between core instability and injury is la...

Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States.

Abstract: Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches—acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S -adenosylmethionine), tai chi, and yoga—as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines.