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FOR THE PRESS

Annals of Internal Medicine Tip Sheet
June 20, 2017


Below is information about articles published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Contact Angela Collom, Media Relations Manager, at acollom@acponline.org or 215-351-2653 for full text or author contact information.


1. Yoga is an effective alternative to physical therapy for easing low back pain

Trial was unique in that it focused on underserved, racially diverse patients

Video available: HD video soundbites of experts discussing yoga and physical therapy available at http://www.dssimon.com/MM/ACP-yoga.
Abstract: http://annals.org/aim/article/doi/10.7326/M16-2579
Editorial: http://annals.org/aim/article/doi/10.7326/M17-1263
Free Summary for Patients: http://annals.org/aim/article/doi/10.7326/P17-9039

A study of 320 predominantly low-income, racially diverse adults with chronic low back pain found that yoga was as safe and effective as physical therapy for restoring function and relieving pain. Compared to an education only intervention, patients who did yoga or physical therapy were also less likely to take pain medications at 12 weeks. The findings are published in Annals of Internal Medicine.

Chronic low back pain affects approximately 10 percent of U.S. adults and has a greater impact on racial or ethnic minorities and in people of lower socioeconomic status. Physical therapy is the most common evidence-based, reimbursable, and non-pharmacologic therapy prescribed by physicians, but clinical guidelines, meta-analyses, and several large randomized controlled trials also support yoga. How these two therapies stack up against one another has not been studied. Moreover, little is known about yoga’s effectiveness in underserved patients with more severe functional disability and pain.

Researchers from Boston Medical Center randomly assigned participants to 12 weekly yoga classes, 15 physical therapy visits, or an educational book and newsletters about coping with chronic low back pain. Following the intervention phase, participants continued with a maintenance phase and were followed to one year. The goal of the noninferiority trial was to determine if yoga was statistically as effective as physical therapy.

The researchers found that a yoga class designed for chronic low back pain patients was as effective as physical therapy for reducing pain, improving function, and lowering use of pain medication. Improvements in yoga and physical therapy groups were maintained at 1 year with no differences between maintenance strategies. The researchers conclude that yoga may be a reasonable alternative to physical therapy depending upon patient preferences, availability, and cost.

2. Survey: Concern for patients likely to sway physicians to support fines for antibiotic overprescribing

Abstract: http://annals.org/aim/article/doi/10.7326/L17-0102

Physician support of financial penalties for inappropriate antibiotic prescribing varies based on rationale used to present the argument. Being presented with information about patient harms was more persuasive than information about societal or institutional harms. The findings are published in Annals of Internal Medicine.

Despite recommendations, physicians commonly prescribe antibiotics for uncomplicated upper respiratory infections. Researchers at the University of Pennsylvania conducted a randomized web-based survey of members of the American College of Physicians to determine whether physician support of financial penalties for antibiotic misuse would be influenced by emphasis on patient, societal, or institutional harms of such prescribing. Physicians were randomly assigned one of four versions of the principal question. The first version described harms to patients, such as increased costs and iatrogenic infections. The second described harms to society, such as increased bacterial resistance to antibiotics and diversion of limited health care resources to less productive uses. The third described harms as increased costs to hospitals and insurers as institutions. And a fourth control version provided no information. The researchers used clinical vignettes to measure how likely respondents were to recommend antibiotics for uncomplicated upper respiratory infection. Physician attitudes about cost control in patient care were also evaluated.

The researchers found that 31 percent of respondents supported financial penalties for inappropriate antibiotic prescribing, but responses varied by survey version. Fort-one percent of recipients of the patient harm version, 23 percent of recipients of the societal harm version, 36 percent of recipients of the institutional harm version, and 25 percent of the recipients of the control version supported such penalties. These results suggest that policymakers might increase the acceptability of penalties by implementing them while explicitly emphasizing the harms and costs to patients.

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