- •Unit 10 married at 12
- •1. Before Reading Tasks.
- •Married at 12: but that’s normal around here Alice looks young enough to be this man’s granddaughter. Amazingly, she’s his wife
- •Reading Comprehension
- •3. Making up a summary
- •4. Reviewing the Article
- •Unit 11 sleeping beauty
- •Before Reading Tasks
- •Sleeping beauty.
- •2. Reading Comprehension
- •Detailed Comprehension
- •3. Making up a Summary
- •4. Reviewing the Article
- •Unit 12 life and death
- •Before Reading Tasks
- •Words in Context
- •Life and death
- •2. Reading Comprehension
- •3. Making up a Summary
- •4. Reviewing the Article
- •Unit 13 frank blake will soon swim lake champlain
- •Before Reading Tasks
- •Frank blake will swim lake champlain
- •2. Reading Comprehension
- •3. Making up a Summary
- •4. Reviewing the Article.
- •Unit 14 Lottery Win
- •1. Before Reading Tasks
- •Lottery win
- •2. Reading Comprehension
- •3. Making up a Summary
- •4. Reviewing the Article
- •Appendix 1 a possible scheme of revieing newspaper articles
- •Appendix 2 useful vocabulary
- •Appendix 3 example reviewing ensure a fun birthday: throw your own party
- •Appendix 4 press in britain
- •Appendix 5 more articles to read and review
- •By Shirley Sloan Fader
- •When He Eats Little, She Eats Less
- •Physiotherapy Doesn’t Work for Back Pain, Study Says
- •Virtue Can Seriously Damage Your Fun
- •Salesman “Who Wasted Time at Work on Affair” Sued for &250 000
- •Reference list
Physiotherapy Doesn’t Work for Back Pain, Study Says
Sarah Boseley
Health Editor
Physiotherapy for people who suffer from mild to moderate lower back pain is a waste of time and a poor use of NHS money, according to a major study published today.
Up to 85 per cent of people have back pain at some time in their lives, and 10 per cent have chronic back pain which interferes with their lives. Walking upright instead of on all fours has always been a strain, but increasingly sedentary lives, spent at the desk or in the car, are making things worse. GPs send 1.3 million back pain suffers a year to a physiotherapist on the NHS.
But the study published in the British Medical Journal could change all that. Researchers from Warwick and Oxford investigated the effectiveness or routine physiotherapy against a single session of advice on exercise in two separate groups of patients and found that there was no difference in the outcome after a year.
«I think one can draw the conclusion that physiotherapy that is routinely offered in the NHS for lower back pain of mold to moderate severity doesn’t do any good», said Sarah Stewart-Brown, professor of public health at Warwick University ad one of the authors.
«If I had back pain I wouldn’t want to spend my time going for NHS physiotherapy. You are wasting your time. It isn’t going to help you».
The study followed two groups of patients, totaling 286 – although full results were obtained from 200 – who had suffered low back pain for more than six weeks.
Half the group were allocated to routine physiotherapy and underwent a variety of treatments including joint mobilization and manipulation, stretching and strengthening exercises and heat and cold treatment. The other group saw a physiotherapist for a single session where they were examined and given general advice to remain active. All the patients were given an advice book.
Patients who received treatment were more likely than those in the advice group to say they felt better, but when they filled in a questionnaire on their pain and their level of disability, there was no difference between them, said Professor Stewart-Brown.
«It feels nice to have someone looking after you and mobilising your joints», she said. «Hands-on therapy feels good». But their pain levels were not improved, even though, curiously, those who had physiotherapy spent more on over-the-counter medication than others did.
Research has shown, say the authors in their paper, that exercise is the best thing, although many people with back pain are fearful of making it worse.
Those who do best, said Dr Stewart-Brown, are often those who not only do the recommended back exercises but also join fitness classes or take up yoga. There is some evidence that disciplines teaching awareness of the body, such as the Alexander technique and Pilates, may have some effect.
«One of the key messages is that you can’t expect someone to solve your back pain for you passively», she said.
In a commentary in the BMJ, Domhnall MacAuley, a Belfast GP, says the consultation with a patient complaining of back pain is not easy. «That we have no answers for a common condition comes as a surprise to a frustrated patient with high expectations of medical intervention».
Physiotherapy has always been an easy option, he writes. «It gives the doctor some time and the patient is having treatment. But NHS physiotherapy adds little to an advice sheet. In a resource limited health service we should ask serious questions about the use of resources, appropriate management of patients and referral patterns. Is back pain an occupational health, a lifestyle or even a medical problem?»
A new model of health care for back pain may be needed, he writes. «Perhaps we should attempt to demedicalise back pain and refer patients to specially trained fitness instructors at a gym».
The Chartered Society of Physiotherapists pointed out that the group in the study who were not treated also saw a physiotherapist for advice. «The findings of the study make no suggestion that physiotherapy doesn’t work», they argued.
Prof Stewart-Brown said, however, that the advice could equally well be given by a GP, although she accepted patients would probably prefer the longer consultation they would get with a physiotherapist.
The society also pointed to some improvements after 12 months in the treatment over the advice group, but Professor Stewart-Brown said these were not significant.
(«The Guardian», 24.09.2004)