title: Is percutaneous transluminal angioplasty better than exercise for claudication? Preliminary results from a prospective randomised trial. Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients. The significance of intensity of rehabilitation of stroke--a controlled trial. The benefits of group occupational therapy for patients with Parkinson's disease. Remedial therapy after stroke: a randomised controlled trial. A Controlled, Prospective Study to Evaluate the Effectiveness of a Back School in the Relief of Chronic Low Back Pain The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis--a randomized controlled trial. Physical therapy and Parkinson's disease Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Physical Training and Antiplatelet Treatment in Stage II Peripheral Arterial Occlusive Disease: Alone or Combined? The results of clinical trials in stroke rehabilitation research. Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study Physiotherapy exercises and back pain: a blinded review. Intermittent Claudication—Surgical Reconstruction or Physical Training?: A Prospective Randomized Trial of Treatment Efficiency The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial.
abstract: Percutaneous transluminal angioplasty ( PTA ) is a commonly performed procedure for the treatment of  intermittent claudication  despite the lack of controlled studies . The aim of this study was to compare PTA with supervised exercise therapy for patients with arterial occlusive disease judged suitable for PTA at angiography . Patients were assessed before treatment commenced and at three monthly intervals afterwards . Assessment included measurement of resting ankle brachial pressure indices ( ABPI ) , and claudicating and maximum walking distances on a treadmill up a 10 degrees incline .  Twenty patients were r and omised to receive PTA and 16 exercise .  The groups were similar in age , sex , smoking habits and arteriographic pattern of disease . In the PTA group two patients had angioplasties that were technically unsuccessful and two other patients subsequently required surgery . One patient in the exercise group subsequently had a PTA . After PTA , mean ABPI were significantly improved at 3 , 6 and 9 months ( P less than 0.01 ) without a corresponding significant increase in mean maximum walking distances . However in the exercise group despite no increase in mean ABPI , mean maximum walking distances increased progressively , with significant increases at 6 , 9 and 12 months ( P less than 0.01 ) The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented . We design ed a r and omized control , single-blinded study to demonstrate the effectiveness of intensive outpatient therapy . The treatment intervention consisted of 1 hr each of physical and occupational therapy , four times per week , for 12 wk ; therapy focused on neuromuscular facilitation and functional tasks . All subjects were screened before the therapies and after 3 mo and 9 mo . Forty-nine stroke survivors , who were at least l yr ( mean , 2.9 yr ) poststroke , were r and omized with two treated patients to each control ( no treatment supplied ) . All patients had received inpatient rehabilitation at the time of their acute stroke , but no patient had any ongoing therapy  within the last 6 mo . The outcome measures included the Functional Independence Measure ( FIM ) , Brunnstrom stages of motor recovery , timed mobility tasks , and the Jebson h and evaluation . We also evaluated the level of depression , self-esteem , and socialization . The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis . The change from time 0 to 3 mo was significant in the treated group but not in the controls . Treated patients maintained their gains at the 9-mo follow-up , and controls lost ground . The treated group improved in terms of socialization and self-esteem as evidence d by a lower Sickness Impact Profile , whereas the controls tended to get worse . There was a trend toward less depression , but this did not reach a P = 0.05 level of significance . This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor , despite prior inpatient rehabilitation services Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation . The patients were divided into two groups , an intensive and a normal treatment group . In this study , the functional recovery of stroke , measured by ADL and motor function was significantly better in the intensive treatment group . There was no difference in institutionalization or incidence of death between the groups . The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group . The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients The medical treatment of idiopathic Parkinson 's disease has improved the quality of life and increased survival of patients with Parkinson 's disease . However , as the illness progresses , impairments in daily living activities occur . A clinical trial for a group rehabilitation program was initiated to maintain the functional status of these patients . The research protocol consisted of a pretreatment evaluation , r and om assignment to experimental or control groups , and posttreatment evaluations after therapy , at 6 months and at 1 year . The results showed that the subjects of the treated experimental group maintained their functional status after 1 year , demonstrated a significant decrease of bradykinesia , and perceived a significant improvement in their psychological well-being . This study confirms the value of an occupational therapy group approach and its benefits to the functional independence , to the improvement of physical and motor symptoms , and to the quality of life of persons with Parkinson 's disease Of 1094 patients with a confirmed stroke admitted to Northwick Park , a district general hospital , 364 ( 33 % ) died while in hospital , 215 ( 20 % ) were fully recovered when discharged , and 329 ( 30 % ) were too frail or too ill from diseases other than stroke to be considered for active rehabilitation . Only 121 ( 11 % ) were suitable for intensive treatment .  They and 12 patients referred direct to out patients were allocated at r and om to one of three different courses of rehabilitation . Intensive was compared with conventional rehabilitation and with a third regimen which included no routine rehabilitation , but under which patients were encouraged to continue with exercises taught while in hospital and were regularly seen at home by a health visitor .  Progress at three months and 12 months was measured by an index of activities of daily living . Improvement was greatest in those receiving intensive treatment , intermediate in those receiving conventional treatment , and least in those receiving no routine treatment .  Decreasing intensity of treatment was associated with a significant increase in the proportions of patients who deteriorated and in the extent to which they deteriorated . Probably only a few stroke patients , mostly men , are suitable for  intensive outpatient rehabilitation  , but for those patients the treatment is effective and realistic Ninety-two chronic low back pain patients were r and omly allocated to two groups to evaluate the effectiveness of a back school compared with an exercise-only regimen according to specified outcome variables . The data from 78 patients with 7 years mean duration of symptoms was analyzed . Three assessment s were made : before treatment and 6 and 16 weeks after treatment . Changes in patients ' levels of pain , functional disability , and other related variables were compared in the two groups . Almost all variables showed an improvement at 6 weeks . At 16 weeks , functional disability and pain levels showed a significant difference . Back school patients continued to make an improvement . This method of managing low back pain makes maximal use of limited re sources and appears to be effective , especially in the longer term Fifty-three patients with ankylosing spondylitis ( AS ) were r and omly allocated ; 26 experimental patients received physiotherapy and disease education , 27 control patients received neither . The primary treatment outcome was change in spinal mobility measured at 4 months by fingertip-to-floor distance . Experimental patients had more improvement in fingertip-to-floor distance ( p2 less than 0.004 ) and in function ( p2 less than 0.001 ) than control patients . Physiotherapy with disease education is effective in the treatment of patients with AS In a r and omized , single-blind , crossover study , we evaluated physical disability in moderately advanced Parkinson 's disease ( PD ) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program .  We used a  timed motor task  and a st and  ard assessment of PD severity ( the Unified Parkinson 's Disease Rating Scale [ UPDRS ] with subscales for mentation , activities of daily living [ ADL ] , and motor function ) completed by an investigator blinded to the physical rehabilitation status of the patient . Following physical rehabilitation , there was significant improvement in the UPDRS ADL and motor scores , but no change in mentation score . During the 6 months following physical rehabilitation , patients did not regularly exercise , and the UPDRS scores returned to baseline . We conclude that physical disability in moderately advanced PD objective ly improves with a regular physical rehabilitation program , but this improvement is not sustained when normal activity is resumed OBJECTIVES To describe the impact of musculoskeletal pain ( MP ) ; to compare management of MP by the population and by primary care physicians ; and to identify misconceptions about treatment . METHODS 5803 people with MP and 1483 primary care physicians , r and omly selected , in eight European countries were interviewed by telephone . A structured question naire was used to ask about usual management of MP and perceived benefits and risks of treatment .  Current health status ( SF-12 ) was also assessed . RESULTS From primary care physicians ' perceptions , MP appears to be well managed . All presenting patients are offered some form of treatment , 90 % or more doctors are trying to improve patients ' quality of life , and most are aware and concerned about the risks of treatment with NSAIDs . From a population perspective , up to 27 % of people with pain do not seek medical help and of those who do , several wait months/years before seeing a doctor . 55 % or fewer patients who have seen a doctor are currently receiving prescription treatment for their pain . Communication between doctors and patients is poor ; few patients are given information about their condition ; and many have misconceptions about treatment . CONCLUSIONS Management of MP is similar across eight European countries , but there is discordance between physician and patient perspectives of care . Some people with pain have never sought medical help despite being in constant/daily pain . Those who do seek help receive little written information or explanation and many have misperceptions about the benefits and risks of treatment that limit their ability to actively participate in decisions about their care The efficacy of physical training alone or combined with antiplatelet thera py ( dipyridamole and aspirin ) was studied in 30 patients with stage II peripheral arterial occlusive disease ( PAOD ) . Patients were r and omly allocated to one of the following groups : Group A— dipyridamole 75 mg three times daily and aspirin 330 mg once daily : Group B— physical exercise ; Group C — physical exercise and dipyridamole 75 mg three time daily and aspirin 330 mg once daily . After six months ' treatment the pain-free walking time ( PFWT ) and the max imum walking time ( MWT ) improved significantly ( p < 0.05 ) in all three groups . In group A the PFWT lengthened by 35 % ( from 101.00 ± 34.56 to 137.32 ± 40.50 s ) and the MWT by 38 % ( from 150.34 ± 55.60 to 207.26 ± 60.67 s ) ; in group B the PFWT lengthened by 90 % ( from 90.65 ± 40.54 to 171.45 ± 55.60 s ) and the MWT by 86 % ( from 145.39 ± 60.50 to 270.63 ± 63.61 s ) . When physical exer cise was associated with drugs as in group C , the PFWT lengthened by 120 % ( from 89.51 ± 43.89 to 196.72 ±51.73 s ) and the MWT by 105 % ( from 160.43 ± 59.84 to 329.05 ± 63.96 s ) . No significant variations were observed at any stage of the study in the ankle/arm pressure ratio at rest and after st and ard treadmill exercise , in the plethysmographic rest and peak flows , or in the trans cutaneous oxygen pressure in basal conditions and in its half recovery time after an induced ischemia . The results confirm the benefits of regular exercise in stage II PAOD pa tients but suggest they may be enhanced by antiplatelet therapy UNLABELLED RESEARCH PROBLEM AND METHODS : There are currently 1.5 million stroke survivors in the United States . More than half of these individuals have significant residual physical disability and functional impairment .  Survivors of stroke constitute the largest group of patients receiving rehabilitation services in this country . We examined existing clinical trials investigating the effectiveness of stroke rehabilitation programs to improve functional outcomes and discharge destination .  One hundred twenty-four research reports were initially identified . From this sample , 36 trials meeting selected criteria were evaluated by the methods of meta- analysis . RESULTS A total of 3717 patients participated in the 36 clinical trials included in the meta- analysis . The results revealed a mean d-index of 0.40 + /- 0.33 . This effect size index was converted to a U3 value of 65.5 , indicating that the average patient receiving a program of focused stroke rehabilitation performed better than approximately 65.5 % of those patients in comparison groups ( 95 % confidence interval , 63.6 % to 67.3 % ) . The results also revealed a significant interaction between type of research design and method of recording the outcome of a clinical trial . Blind recording of the outcome measure appears to be an essential design characteristic in clinical trials that do not r and omize patients to conditions . CONCLUSIONS Programs of focused stroke rehabilitation may improve functional performance for some patients who have experienced a stroke . The improvement in performance appears related to early initiation of treatment , but not to the duration of intervention . Improvements are also associated with the patient 's age and the type of design . Research design should be considered an important moderator variable in planning and interpreting future clinical trials of treatment effectiveness in stroke rehabilitation Summary Several new studies have indicated that an active approach to patients with chronic disabling low back pain ( LBP ) seems effective . Some of these studies emphasize the importance of dealing with the patient 's total situation in comprehensive multidisciplinary programs — the bio-psycho-social model . However , these programs are expensive . The aim of this study was to evaluate the rehabilitation outcome from three different active programs in terms of : ( 1 ) return-to-work rate , ( 2 ) days of sick leave , ( 3 ) health-care contacts , ( 4 ) pain and disability scores , and ( 5 ) staying physically active . The subjects included 132 patients r and omized to the study , of whom 123 started one of the treatment programs . They had all had at least 6 months of chronic LBP . The patients were r and omized into one of three programs : group 1 — a full-time , intensive 3-week multidisciplinary program , including active physical and ergonomic training and psychological pain management , followed by 1 day weekly for the subsequent 3 weeks ; group 2 — active physical training , twice a week for 6 weeks , for a total of 24h ; group 3 — psychological pain management combined with active physical training , twice a week for 6 weeks , also for a total of 24h . The results presented here are based on data collected 4 months following treatment , which shows an 86 % response rate . The initial examination and the follow-up evaluation were performed by a blinded observer . The results show that 4 months after treatment , the intensive multidisciplinary program is superior to the less intensive programs in terms of return-to-work rate , health-care contacts , pain and disability scores , and staying physically active . In conclusion , it seems that although the multidisciplinary program is initially expensive compared to the less intensive programs , the savings in sick pay , early retirement pensions , and health care contacts make it economically worthwhile . Long-term follow-up will show whether this effect continues OBJECTIVE --To determine the quality of r and omised controlled trials of exercise therapy for back pain . DESIGN --Computer aided search of published papers and blinded assessment of the methods of studies . SUBJECTS--23 r and omised controlled trials , of which 16 studied exercise therapy given by physiotherapists to individual patients with back pain . Other conservative treatments could be included . MAIN OUTCOME MEASURES --Score for quality of methods ( based on four main categories : study population , interventions , measurement of effect , and data presentation and analysis ) and main conclusion of author(s ) with regard to exercise therapy . RESULTS --Only four studies scored more than 50 points ( maximum 100 ) , indicating that most were of poor quality . Six studies found that exercise was better than reference treatments and 10 reported it to be no better or worse than the reference treatment . Those reporting positive results tended to have higher methods scores ( 4/6 positive v 4/10 negative scored greater than or equal to 42 ) . CONCLUSIONS --No conclusion can be drawn about whether exercise therapy is better than other conservative treatments for back pain or whether a specific type of exercise is more effective . Further trials are needed in which greater attention is paid to methods of study This study reports the initial evaluation of treatment efficiency in 75 patients with intermittent claudication who were r and omized to three treatment groups : 1 ) reconstructive surgery , 2 ) recon structive surgery with subsequent physical training , and 3 ) physical training alone . Before treatment , there were no statistically significant differences between the groups in age , sex , smoking habits , symptom duration of claudication , ankle-arm blood pressure quotient ( ankle-index ) , maximal plethysmographic calf blood flow , symptom-free and maximal walking distance , the history of other atherosclerotic manifestations or in the medical treatment . The walking performance was improved in all three groups at follow-up 13 ± 0.5 months after r and omization . Surgery was most effective , but the addition of training to surgery improved the symptom-free walking distance even further . In pooled observations of the three groups , age , symptom duration , and a history of myocardial ischemic disease correlated negatively with walking performance after treatment . In the operated group , the duration of claudication and a history of myocardial ischemic disease correlated negatively with the walking performance . This was not the case when patients were censored if limited by other symptoms than intermittent claudication after treatment . In the trained group , the duration of claudication correlated negatively to symptom-free and maximal walking distance . Ankle-index and maximal plethysmographic calf blood flow after treatment and the change of these variables with treatment correlated positively with both symptom-free and maximal walking distance when results were pooled for all patients . Although this mainly was a consequence of the improved blood flow after surgery , the change of maximal plethysmographic calf blood flow also correlated with symptom-free but not with maximal walking distance in the trained group . The results demonstrate that , compared with physical training alone , operation alone or in combination with subsequent training are superior treatment modalities in patients with intermittent claudication OBJECTIVE To determine the effectiveness of exercise therapy in patients with osteoarthritis ( OA ) of the hip or knee . METHODS A r and omized single blind , clinical trial was conducted in a primary care setting . Patients with hip or knee OA by American College of Rheumatology criteria were selected . Two intervention groups were compared . Both groups received treatment from the patients ' general practitioner , including patient education and medication if necessary . The experimental group also received exercise therapy from a physiotherapist in primary care . The treatment period was 12 weeks . The main outcome measures were pain , medication use ( nonsteroidal antiinflammatory drugs , NSAID ) and observed disability . RESULTS A total of 201 patients were r and omized .  Exercise therapy was associated with a reduction of pain in the past week ( difference in change -17.0 ; 95 % CI -23.6 , -10.4 ) and observed disability ( -0.19 ; 95 % CI -0.38 ; -0.01 ) . Effect sizes were medium ( 0.58 ) and small ( 0.28 ) , respectively . No effect of  exercise therapy  was found for the use of NSAID . Additional beneficial effects ( p = 0.05 ) were found for the use of  paracetamol  ( effect size 0.33 ) , global effect as perceived by the patient ( effect size 0.68 ) , and muscle strength of the hip ( effect size 0.34 ) . CONCLUSION After 12 weeks , exercise therapy is effective in reducing pain and disability . The size of the effects is medium and small , respectively
target: Exercise therapy is effective for patients with knee osteoarthritis , sub-acute ( 6 to 12 weeks ) and chronic ( > or = 12 weeks ) low back pain , cystic fibrosis , chronic obstructive pulmonary disease , and intermittent claudication .
  Furthermore , there are indications that exercise therapy  is effective for patients with ankylosing spondylitis , hip osteoarthritis , Parkinson 's disease , and for patients who have suffered a stroke .
  There is insufficient evidence to support or refute the effectiveness of exercise therapy  for patients with neck pain , shoulder pain , repetitive strain injury , rheumatoid arthritis , asthma , and bronchiectasis .
  Exercise therapy is not effective for  patients with acute low back pain .
  It is concluded that exercise therapy is effective for a wide range of chronic disorders
background: The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy  for patients with disorders of the musculoskeletal , nervous , respiratory , and cardiovascular systems .