Archive for category: News

A new study published in the journal of The Lancet showed that chronic low back pain can be permanently relieved with cognitive functional therapy.

Targeting unhelpful pain-related thoughts, feelings, and behaviors that lead to pain and impairment, cognitive functional therapy (CFT) is an individualized method.

Biofeedback via movement sensors may improve the effectiveness of therapy. For patients with persistent, incapacitating low back pain, this study sought to evaluate the cost-effectiveness and efficacy of CFT, administered with or without movement sensor biofeedback, with standard therapy.

20 primary care physiotherapy clinics in Australia participated in the phase 3 study RESTORE, which was randomized, controlled, three-arm, parallel group. This study looked for people (≥18 years old) who had at least significant pain-related physical activity restriction and low back discomfort that had persisted for more than three months.

Serious spinal, any medical condition that prevented physical activity, pregnancy or childbirth within the last three months, having a skin allergy to hypoallergenic tape adhesives, having surgery within three months, or not wanting to travel to trial sites were all reasons for exclusion.

Through a centralized adaptable schedule, participants were randomized (1:1:1) to receive normal treatment, CFT alone, or CFT with biofeedback. Using the Roland Morris Disability Questionnaire, which has 24 points, participants self-reported activity restriction at 13 weeks, which was the main clinical outcome. The quality-adjusted life-years (QALYs) were the main economic result. 

Thus, to determine eligibility, this work evaluated 1011 patients between October 23, 2018, and August 3, 2020. 

This research randomly allocated 492 (48·7%) participants; 164 (33%) were randomized to CFT alone, 163 (33%) to CFT with biofeedback, and 165 (34%) to usual care. For activity restriction at 13 weeks (the primary endpoint), both treatments were superior to standard care (CFT only mean difference –4·6 [95% CI –5·9 to –3·4] and CFT plus biofeedback mean difference –4·6 [–5·8 to –3·3]). 

At 52 weeks, effect sizes were comparable. In addition, both treatments were significantly less expensive in terms of societal costs (direct and indirect expenses as well as productivity losses; –AU$5276 [–10 529 to –24] and –8211 [–12 923 to –3500]) and more effective than standard care for QALYs.

Overall, for those with persistent, incapacitating low back pain, CFT can result in significant and long-lasting benefits at a far lower cost to society than standard therapy.

Reference:

Kent, P., Haines, T., O’Sullivan, P., Smith, A., Campbell, A., Schutze, R., Attwell, S., Caneiro, J. P., Laird, R., O’Sullivan, K., McGregor, A., Hartvigsen, J., Lee, D.-C. A., Vickery, A., Hancock, M., & RESTORE trial team. (2023). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. Lancet, 401(10391), 1866–1877. https://doi.org/10.1016/S0140-6736(23)00441-5

People with both type 2 diabetes (T2D) and obstructive sleep apnoea have a higher risk of death, but treatment with continuous positive airway pressure (CPAP) may reduce that risk by around 26%, according to new research being presented at this year’s Annual Meeting of The European Association for the Study of Diabetes (EASD), Vienna (15-19 Sept).

The Swedish researchers said the results underscore the importance of treating sleep apnoea as part of a broader effort to control type 2 diabetes and improve long-term survival.

Obstructive sleep apnoea is when throat muscles relax during sleep, blocking the airway, causing a person to wake up repeatedly to breathe. This disrupted sleep pattern can lower oxygen levels, affecting the brain. If left untreated, it can lead to serious health problems, including high blood pressure, heart trouble, and T2D.

CPAP machines treat sleep apnoea by delivering pressurised air through a mask to keep the airway open during sleep. However, research on the effects of CPAP on survival has produced mixed results.

Obstructive sleep apnoea affects around 1 billion of the world’s adults aged 30-69 years [1], and an estimated 50–80% of adults with T2D [2], most of whom are undiagnosed, increasing the risk of complications. In people with T2D, sleep apnoea is associated with more than a 50% increased risk of cardiovascular disease (including heart failure and stroke) and a 24% higher risk of dying from any cause compared to those without sleep apnoea [3].

“Despite the substantial impact of obstructive sleep apnoea on cardiovascular disease and survival, it often goes undiagnosed in people with type 2 diabetes and is not routinely addressed as part of diabetes management,” said lead author Dr Jonas Aghome from Linköping University in Sweden. “What’s more, the impact of treatment with CPAP on survival in people with T2D hasn’t been clear.”

Previous studies in patients with both T2D and obstructive sleep apnoea have been limited by short follow-up periods and a focus on metabolic endpoints, rather than on longer-term clinical outcomes such as survival.

To answer these questions, Swedish researchers analysed data from five Swedish national registers between 2010 and 2024 to identify 12,388 T2D patients with obstructive sleep apnoea who had been prescribed CPAP and 737,911 T2D patients (whose obstructive sleep apnoea status was unknown) who were never prescribed CPAP, to compare long-term survival.

Dr Agholme explains, “Despite potential dilution from including individuals without obstructive sleep apnoea in the control group, the high prevalence of obstructive sleep apnoea in people with T2D, together with the higher risk of illness associated with having both T2D and obstructive sleep apnoea, should allow any clinically relevant associations of CPAP to be detected.”

The CPAP treatment group included less women ( 31% vs. 43%), was younger (average age 58 years vs. 65 years), but had a higher average body mass index (BMI, 34.7 kg/m² vs. 30.6 kg/m²).

Of those prescribed CPAP, 764 people (6.1%) died within 14 years compared to 212,336 people (28.7%) of those who did not receive CPAP.

After adjusting for potential confounders including age, sex, and prior cardiovascular disease, as well as factors that may vary during follow-up including BMI, smoking, cholesterol, kidney function, blood pressure, and pharmacological treatment, they found that patients who were prescribed CPAP had a 26% lower risk of dying from any cause over the 14-year period, compared with patients who never received CPAP.

“This new study using real-world data highlights the potential benefits of CPAP in people with T2D and obstructive sleep apnoea, a clinical conundrum that has long awaited answers,” said Dr Agholme. “The findings suggest that CPAP may play an important role in improving patient outcomes and survival, and they underline the value of early OSA diagnosis in people with T2D. Still, more rigorous research is needed to determine the causal effect of CPAP treatment. ”

Reference:

Breathing device could have profound impact on survival for people with sleep apnoea and type 2 diabetes, European Association for the Study of Diabetes, Meeting: Annual Meeting of the European Association for the Study of Diabetes (EASD).

Researchers have found in a new study that tooth loss is highly associated with stroke risk, with patients having increased tooth loss having a considerably higher risk of stroke. The research provides robust evidence of the association between tooth loss and stroke, with additional missing teeth increasing risk by 2%. The study was published in the Journal of Stroke and Cerebrovascular Diseases by Dajin Li. and colleagues.