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Yu H, Southerst D, Wong JJ, Verville L, Connell G, Ead L, Mior S, Hestbaek L, Swain M, Brunton G, Shearer HM, Papaconstantinou E, To D, Germann D, Pohlman K, Cedraschi C, Cancelliere C. Rehabilitation of back pain in the pediatric population: a mixed studies systematic review. Chiropr Man Therap 2024; 32:14. [PMID: 38720355 PMCID: PMC11080233 DOI: 10.1186/s12998-024-00538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND A significant proportion of children and adolescents experience back pain. However, a comprehensive systematic review on the effectiveness of rehabilitation interventions is lacking. OBJECTIVES To evaluate benefits and harms of rehabilitation interventions for non-specific low back pain (LBP) or thoracic spine pain in the pediatric population. METHODS Seven bibliographic electronic databases were searched from inception to June 16, 2023. Moreover, reference lists of relevant studies and systematic reviews, three targeted websites, and the WHO International Clinical Trials Registry Platform were searched. Paired reviewers independently conducted screening, assessed risk of bias, and extracted data related to study characteristics, methodology, subjects, and results. Certainty of evidence was evaluated based on the GRADE approach. RESULTS We screened 8461 citations and 307 full-text articles. Ten quantitative studies (i.e., 8 RCTs, 2 non-randomized clinical trials) and one qualitative study were included. With very low to moderate certainty evidence, in adolescents with LBP, spinal manipulation (1-2 sessions/week over 12 weeks, 1 RCT) plus exercise may be associated with a greater likelihood of experiencing clinically important pain reduction versus exercise alone; and group-based exercise over 8 weeks (2 RCTs and 1 non-randomized trial) may reduce pain intensity. The qualitative study found information provided via education/advice and compliance of treatment were related to effective treatment. No economic studies or studies examining thoracic spine pain were identified. CONCLUSIONS Spinal manipulation and group-based exercise may be beneficial in reducing LBP intensity in adolescents. Education should be provided as part of a care program. The overall evidence is sparse. Methodologically rigorous studies are needed. TRIAL REGISTRATION CRD42019135009 (PROSPERO).
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Affiliation(s)
- Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada.
| | - Danielle Southerst
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
| | - Leslie Verville
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
| | - Gaelan Connell
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
| | - Lauren Ead
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Lise Hestbaek
- The Chiropractic Knowledge Hub, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Michael Swain
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia
| | - Ginny Brunton
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Efrosini Papaconstantinou
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
| | - Daphne To
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Darrin Germann
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | | | - Christine Cedraschi
- Division of General Medical Rehabilitation, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, L1G 0C5, Canada
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Fjaagesund SD, Graham W, Jones E, Ladhams A, Sayers M, Campbell G, Hou XY, Ungureanu MI, Oprescu F. Chiropractors in Multidisciplinary Teams: Enablers of Colocation Integration in GP-Led Primary Healthcare. Healthcare (Basel) 2024; 12:926. [PMID: 38727483 PMCID: PMC11083756 DOI: 10.3390/healthcare12090926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
The aim of this study was to explore and document the enablers and barriers of chiropractic care colocation in general practice at a large-scale private primary care centre in Australia. This study focused on the perceptions of healthcare professionals regarding this integration. The research setting was a large integrated primary care centre located in an outer metro, low-socioeconomic area in the City of Moreton Bay, Queensland, Australia. Participant inclusion criteria included general medical practitioners, practice nurses, and medical managers who self-reported interactions with the physically collocated and integrated chiropractic practice. Data was collected from 22 participants using face-to-face, qualitative, semi-structured interviews with an average duration of 32 min. The data collected included perceptions of chiropractic treatment, enablers to patient referral pathways, and views of the integrated chiropractic care model. A reflexive thematic analysis was conducted on the data set. All participants reported that this was their first exposure to the colocation of a chiropractor within a general medical practice. Four key enablers of chiropractic care integration were identified: (1) the practitioner [chiropractor], (2) the organisation [general practice], (3) consumer flow, and (4) the environment [shared spaces and tenant ecosystem]. The chiropractic integration enhanced knowledge sharing and interprofessional trust among healthcare providers. The formal reporting of patient outcomes and understanding of the chiropractor's scope of practice further enabled referrals to the service. Shared administrative and business processes, including patient records, booking systems, and clinical meetings, facilitated relationship development between the chiropractor and referring health providers. Colocation as part of a larger primary care centre created proximity and convenience for health providers in terms of interprofessional communication, and for patients, in terms of access to chiropractic services. Existing governance structures supported communication, professional education, and shared values related to the delivery of patient-centred care. Identified barriers included limited public funding for chiropractic services resulting in reduced access for patients of low-socioeconomic status. Additionally, scepticism or negativity towards the discipline of chiropractic care was identified as an initial barrier to refer patients. In most cases, this view towards the chiropractor was overcome by regular patient reporting of positive treatment outcomes to their GP, the delivery of education sessions by the chiropractor for the health providers, and the development of interprofessional trust between the chiropractor and referring health providers. This study provides preliminary evidence and a conceptual framework of factors influencing the successful integration of chiropractic care within an Australian large primary care centre. The data collected indicated that integration of chiropractic care into a primary care centre serving a low-socioeconomic region can be achieved with a high degree of health provider satisfaction.
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Affiliation(s)
- Shauna Dawn Fjaagesund
- School of Health, University of the Sunshine Coast, Sippy Downs 4556, Australia (M.S.)
- Health Developments Corporation, Morayfield 4506, Australia
| | - Wayne Graham
- School of Business and Creative Industries, University of the Sunshine Coast, Sippy Downs 4556, Australia
| | - Evan Jones
- School of Health, University of the Sunshine Coast, Sippy Downs 4556, Australia (M.S.)
- Health Developments Corporation, Morayfield 4506, Australia
| | - Andrew Ladhams
- Faculty of Medicine, University of Queensland, St. Lucia 4072, Australia
| | - Mark Sayers
- School of Health, University of the Sunshine Coast, Sippy Downs 4556, Australia (M.S.)
| | - Gary Campbell
- Brain Treatment Centre Australia, Morayfield 4506, Australia;
| | - Xiang-Yu Hou
- Centre for Health Research, University of Southern Queensland, Toowoomba 4350, Australia;
| | - Marius-Ionut Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania;
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Florin Oprescu
- School of Health, University of the Sunshine Coast, Sippy Downs 4556, Australia (M.S.)
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Emary PC, Stuber KJ. A commentary on the use of mixed methods in chiropractic research: Part 3: integration of qualitative research with randomized controlled trials. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2024; 68:26-34. [PMID: 38840964 PMCID: PMC11149692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
This is the third of three papers in our series of articles on the use of mixed methods in chiropractic research. In this commentary, we discuss the mixed methods experimental (or intervention) design. This design is a complex mixed methods research design in which qualitative research is integrated with randomized controlled trials. We provide a brief overview of this study design as well as a case example from the literature to illustrate how this approach can be applied to research within the chiropractic profession.
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Affiliation(s)
- Peter C. Emary
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario
- Chiropractic Department, D’Youville University, Buffalo, New York
- Private Practice, Langs Community Health Centre, Cambridge, Ontario
| | - Kent J. Stuber
- Parker University Research Center, Parker University, Dallas, Texas
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario
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4
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Grenier JP, Rothmund M. A critical review of the role of manual therapy in the treatment of individuals with low back pain. J Man Manip Ther 2024:1-14. [PMID: 38381584 DOI: 10.1080/10669817.2024.2316393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/04/2024] [Indexed: 02/23/2024] Open
Abstract
The number of low back pain (LBP) cases is projected to increase to more than 800 million by 2050. To address the substantial burden of disease associated with this rise in prevalence, effective treatments are needed. While clinical practice guidelines (CPG) consistently recommend non-pharmacological therapies as first-line treatments, recommendations regarding manual therapy (MT) in treating low back pain vary. The goal of this narrative review was to critically summarize the available evidence for MT behind these recommendations, to scrutinize its mechanisms of action, and propose some actionable steps for clinicians on how this knowledge can be integrated into a person-centered approach. Despite disparate recommendations from CPG, MT is as effective as other available treatments and may be offered to patients with LBP, especially as part of a treatment package with exercise and education. Most of the effects of MT are not specific to the technique. MT and other interventions share several mechanisms of action that mediate treatment success. These mechanisms can encompass patients' expectations, prior experiences, beliefs and convictions, epistemic trust, and nonspecific contextual effects. Although MT is safer than opioids for patients with LBP, this alone is insufficient. Our goal is to encourage clinicians to shift away from outdated and refuted ideas in MT and embrace a person-centered approach rooted in a comprehensive biopsychosocial framework while incorporating patients' beliefs, addressing illness behaviors, and seeking to understand each patient's journey.
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Affiliation(s)
- Jean-Pascal Grenier
- Department of Physiotherapy, Health University of Applied Sciences Tyrol, Innsbruck, Austria
- Department of Internal Medicine II, University Clinic Innsbruck, Innsbruck, Austria
| | - Maria Rothmund
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic for Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
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5
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Cancelliere C, Verville L, Southerst D, Yu H, Hayden JA, Ogilvie R, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Wong JJ, Shearer HM, Connell G, Hincapié CA. Systematic Review Procedures for the World Health Organization (WHO) Evidence Syntheses on Benefits and Harms of Structured and Standardized Education/Advice, Structured Exercise Programs, Transcutaneous Electrical Nerve Stimulation (TENS), and Needling Therapies for the Management of Chronic Low Back Pain in Adults. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:618-624. [PMID: 37991645 DOI: 10.1007/s10926-023-10156-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
As commissioned by the WHO, we updated and expanded the scope of four systematic reviews to inform its (in development) clinical practice guideline for the management of CPLBP in adults, including older adults. Methodological details and results of each review are described in the respective articles in this series. In the last article of this series, we discuss methodological considerations, clinical implications and recommendations for future research.
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Affiliation(s)
- Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
| | - Leslie Verville
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Danielle Southerst
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - André Bussières
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, (Québec), Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Québec, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Paulo Pereira
- Spine Unit, Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ginny Brunton
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- EPPI-Centre, UCL Institute of Education, University College London, London, England, UK
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, USA
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Gaelan Connell
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
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6
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Verville L, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Connell G, Shearer HM, Wong JJ, Hofstetter L, Romanelli A, Guist B, To D, Stuber K, da Silva-Oolup S, Stupar M, Myrtos D, Lee JGB, DeSouza A, Muñoz Laguna J, Murnaghan K, Cancelliere C. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Primary Low Back Pain in Adults. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:651-660. [PMID: 37991646 PMCID: PMC10684422 DOI: 10.1007/s10926-023-10121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. Eligible RCTs targeted TENS compared to placebo/sham, usual care, no intervention, or interventions with isolated TENS effects (i.e., combined TENS with treatment B versus treatment B alone) in adults with CPLBP. We extracted outcomes requested by the WHO Guideline Development Group, appraised the risk of bias, conducted meta-analyses where appropriate, and graded the certainty of evidence using GRADE. RESULTS Seventeen RCTs (adults, n = 1027; adults ≥ 60 years, n = 28) out of 2010 records and 89 full text RCTs screened were included. The evidence suggested that TENS resulted in a marginal reduction in pain compared to sham (9 RCTs) in the immediate term (2 weeks) (mean difference (MD) = -0.90, 95% confidence interval -1.54 to -0.26), and a reduction in pain catastrophizing in the short term (3 months) with TENS versus no intervention or interventions with TENS specific effects (1 RCT) (MD = -11.20, 95% CI -17.88 to -3.52). For other outcomes, little or no difference was found between TENS and the comparison interventions. The certainty of the evidence for all outcomes was very low. CONCLUSIONS Based on very low certainty evidence, TENS resulted in brief and marginal reductions in pain (not deemed clinically important) and a short-term reduction in pain catastrophizing in adults with CPLBP, while little to no differences were found for other outcomes.
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Affiliation(s)
- Leslie Verville
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
| | - Danielle Southerst
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - André Bussières
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Québec, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Québec, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Paulo Pereira
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ginny Brunton
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- EPPI-Centre, UCL Institute of Education, University College London, England, United Kingdom
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, United States
| | - Gaelan Connell
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Andrew Romanelli
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Brett Guist
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Kent Stuber
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Parker University Research Center, Dallas, United States
| | - Sophia da Silva-Oolup
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Maja Stupar
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Danny Myrtos
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Joyce G B Lee
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Astrid DeSouza
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Javier Muñoz Laguna
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Kent Murnaghan
- Library and Information Services, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
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Southerst D, Hincapié CA, Yu H, Verville L, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Wong JJ, Connell G, Shearer HM, DeSouza A, Muñoz Laguna J, Lee JGB, To D, Lalji R, Stuber K, Funabashi M, Hofstetter L, Myrtos D, Romanelli A, Guist B, Young JJ, da Silva-Oolup S, Stupar M, Wang D, Murnaghan K, Cancelliere C. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:625-635. [PMID: 37991651 PMCID: PMC10684630 DOI: 10.1007/s10926-023-10120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence. RESULTS We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low. CONCLUSION Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.
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Affiliation(s)
- Danielle Southerst
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Leslie Verville
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - André Bussières
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Québec, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Paulo Pereira
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ginny Brunton
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- EPPI-Centre, UCL Institute of Education, University College London, England, United Kingdom
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, United States
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Gaelan Connell
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Astrid DeSouza
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Javier Muñoz Laguna
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Joyce G B Lee
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Rahim Lalji
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Kent Stuber
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Parker University Research Center, Dallas, United States
| | - Martha Funabashi
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Danny Myrtos
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Andrew Romanelli
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Brett Guist
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - James J Young
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Sophia da Silva-Oolup
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Maja Stupar
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Dan Wang
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Kent Murnaghan
- Library and Information Services, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
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8
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Verville L, Ogilvie R, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Connell G, Wong JJ, Shearer HM, Lee JGB, Wang D, Hayden JA, Cancelliere C. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:636-650. [PMID: 37991647 PMCID: PMC10684665 DOI: 10.1007/s10926-023-10124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE. RESULTS We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95% CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence). CONCLUSIONS With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.
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Affiliation(s)
- Leslie Verville
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Rachel Ogilvie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
| | - Danielle Southerst
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - André Bussières
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Paulo Pereira
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ginny Brunton
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- EPPI-Centre, UCL Institute of Education, University College London, London, England, UK
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Canada
| | - Margareta Nordin
- Department of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, United States
| | - Gaelan Connell
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Joyce G B Lee
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Dan Wang
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
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9
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Huang L, Li J, Xiao B, Tang Y, Huang J, Li Y, Fang F. Bibliometric Analysis of Research Trends on Manual Therapy for Low Back Pain Over Past 2 Decades. J Pain Res 2023; 16:3045-3060. [PMID: 37701559 PMCID: PMC10493154 DOI: 10.2147/jpr.s418458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose Low back pain (LBP) is a prevalent musculoskeletal disorder, and manual therapy (MT) is frequently employed as a non-pharmacological treatment for LBP. This study aims to explore the research hotspots and trends in MT for LBP. MT has gained widespread acceptance in clinical practice due to its proven safety and effectiveness. The study aims to analyze the developments in the field of MT for LBP over the past 23 years, including leading countries, institutions, authoritative authors, journals, keywords, and references. It endeavors to provide a comprehensive summary of the existing research foundation and to analyze the current cutting-edge research trends. Methods Relevant articles between 2000 and 2023 were retrieved from the Web of Science Core Collection (WOSCC) database. We used the software VOSviewer and CiteSpace to perform the analysis and summarize current research hotspots and emerging trends. Results Through screening, we included 1643 papers from 2000 to 2023. In general, the number of articles published each year showed an upward trend. The United States had the highest number of publications and citations. Canadian Memorial Chiropractic College was the most published research institution. The University of Pittsburgh in the United States had the most collaboration with other research institutions. Long, Cynthia R. was the active author. Journal of Manipulative and Physiological Therapeutics was the most prolific journal with 234 publications. Conclusion This study provides an overview of the current status and trends of clinical studies on MT for LBP in the past 23 years using the visualization software, which may help researchers identify potential collaborators and collaborating institutions, hot topics, and new perspectives in research frontiers, while providing new clinical practice ideas for the treatment of LBP.
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Affiliation(s)
- Lele Huang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, People’s Republic of China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Jiamin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Baiyang Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
- Department of Traditional Chinese Medicine, Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Yin Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Jinghui Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Ying Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Fanfu Fang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
- Department of Traditional Chinese Medicine, Naval Medical University, Shanghai, 200433, People’s Republic of China
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10
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Abstract
BACKGROUND Spinal cord stimulation (SCS) is a surgical intervention used to treat persistent low back pain. SCS is thought to modulate pain by sending electrical signals via implanted electrodes into the spinal cord. The long term benefits and harms of SCS for people with low back pain are uncertain. OBJECTIVES To assess the effects, including benefits and harms, of SCS for people with low back pain. SEARCH METHODS On 10 June 2022, we searched CENTRAL, MEDLINE, Embase, and one other database for published trials. We also searched three clinical trials registers for ongoing trials. SELECTION CRITERIA We included all randomised controlled trials and cross-over trials comparing SCS with placebo or no treatment for low back pain. The primary comparison was SCS versus placebo, at the longest time point measured in the trials. Major outcomes were mean low back pain intensity, function, health-related quality of life, global assessment of efficacy, withdrawals due to adverse events, adverse events, and serious adverse events. Our primary time point was long-term follow-up (≥ 12 months). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 13 studies with 699 participants: 55% of participants were female; mean age ranged from 47 to 59 years; and all participants had chronic low back pain with mean duration of symptoms ranging from five to 12 years. Ten cross-over trials compared SCS with placebo. Three parallel-group trials assessed the addition of SCS to medical management. Most studies were at risk of performance and detection bias from inadequate blinding and selective reporting bias. The placebo-controlled trials had other important biases, including lack of accounting for period and carryover effects. Two of the three parallel trials assessing SCS as an addition to medical management were at risk of attrition bias, and all three had substantial cross-over to the SCS group for time points beyond six months. In the parallel-group trials, we considered the lack of placebo control to be an important source of bias. None of our included studies evaluated the impact of SCS on mean low back pain intensity in the long term (≥ 12 months). The studies most often assessed outcomes in the immediate term (less than one month). At six months, the only available evidence was from a single cross-over trial (50 participants). There was moderate-certainty evidence that SCS probably does not improve back or leg pain, function, or quality of life compared with placebo. Pain was 61 points (on a 0- to 100-point scale, 0 = no pain) at six months with placebo, and 4 points better (8.2 points better to 0.2 points worse) with SCS. Function was 35.4 points (on a 0- to 100-point scale, 0 = no disability or best function) at six months with placebo, and 1.3 points better (3.9 points better to 1.3 points worse) with SCS. Health-related quality of life was 0.44 points out of 1 (0 to 1 index, 0 = worst quality of life) at six months with placebo, and 0.04 points better (0.16 points better to 0.08 points worse) with SCS. In that same study, nine participants (18%) experienced adverse events and four (8%) required revision surgery. Serious adverse events with SCS included infections, neurological damage, and lead migration requiring repeated surgery. We could not provide effect estimates of the relative risks as events were not reported for the placebo period. In parallel trials assessing SCS as an addition to medical management, it is uncertain whether, in the medium or long term, SCS can reduce low back pain, leg pain, or health-related quality of life, or if it increases the number of people reporting a 50% improvement or better, because the certainty of the evidence was very low. Low-certainty evidence suggests that adding SCS to medical management may slightly improve function and slightly reduce opioid use. In the medium term, mean function (0- to 100-point scale; lower is better) was 16.2 points better with the addition of SCS to medical management compared with medical management alone (95% confidence interval (CI) 19.4 points better to 13.0 points better; I2 = 95%; 3 studies, 430 participants; low-certainty evidence). The number of participants reporting opioid medicine use was 15% lower with the addition of SCS to medical management (95% CI 27% lower to 0% lower; I2 = 0%; 2 studies, 290 participants; low-certainty evidence). Adverse events with SCS were poorly reported but included infection and lead migration. One study found that, at 24 months, 13 of 42 people (31%) receiving SCS required revision surgery. It is uncertain to what extent the addition of SCS to medical management increases the risk of withdrawals due to adverse events, adverse events, or serious adverse events, because the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Data in this review do not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.
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Affiliation(s)
- Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Stephen E Gilbert
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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11
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Cuenca-Martínez F, Suso-Martí L, Peréz-Domínguez B, Calatayud J, López-Bueno R, Gargallo P, Blanco-Díaz M, Casaña J. Movement Representation Strategies as a Tool for Educational Innovation in Physiotherapy Students: A Randomized Single-Blind Controlled-Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4473. [PMID: 36901484 PMCID: PMC10001722 DOI: 10.3390/ijerph20054473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/18/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Physiotherapy has a strictly theoretical body of knowledge, but for the most part, the physiotherapist's learning is practical. The practical part is fundamental to acquire clinical skills that the physiotherapist will later use in professional practice. The main aim of this study was to assess the effectiveness of movement representation strategies (MRS) in the improvement of manual skills of physiotherapy students as an educational innovation strategy. We randomly assigned 30 participants to an action observation practice (AOP), motor imagery practice (MIP), or sham observation (SO) group. A high velocity, low amplitude lumbar manipulation technique that is widely used in clinical physiotherapy practice was taught in one session. The primary outcomes were required time and test score. The secondary outcomes were perceived mental fatigue and perceived difficulty for learning. The outcomes were assessed preintervention and immediately after the intervention (postintervention). The main results showed that both AOP and MIP improved the total time required and the test score, as well as entailed less perceived difficulty for learning. However, both strategies showed a higher level of mental fatigue after the intervention, which was higher in the MIP group. Based on the results obtained, it seems that the application of MRS promotes greater learning of manual motor tasks in physiotherapy students and could be used as educational innovation strategies.
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Affiliation(s)
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Borja Peréz-Domínguez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Pedro Gargallo
- Department of Physiotherapy, Faculty of Medicine and Health Science, Catholic University of Valencia, 46001 Valencia, Spain
| | - María Blanco-Díaz
- Surgery and Medical Surgical Specialties Department, Faculty of Medicine and Health Sciences, University of Oviedo, 33003 Oviedo, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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12
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Wong CM, Rugg B, Geere JA. The effects of Pilates exercise in comparison to other forms of exercise on pain and disability in individuals with chronic non-specific low back pain: A systematic review with meta-analysis. Musculoskeletal Care 2023; 21:78-96. [PMID: 36912214 DOI: 10.1002/msc.1667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the effects of Pilates exercise (PE) with other forms of exercise on pain and disability in individuals with chronic non-specific low back pain (CNSLBP) and to inform clinical practice and future research. STUDY DESIGN Systematic review with meta-analysis conducted and reported in line the Preferred Reporting Items for Systematic review and Meta-analysis. LITERATURE SEARCH Six electronic databases were searched from inception to April 2021. STUDY SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effect of PE with other forms of exercise for adults with CNSLBP on pain and disability. DATA SYNTHESIS Two reviewers assessed the risk of bias of the trials, guided by the Cochrane RoB2 tool. Available data were extracted for meta-analysis with subgroup analysis. Pilates exercise was compared to general exercise (GE), direction-specific exercise (DSE) and spinal stabilisation exercise (SSE). Certainty of evidence was interpreted following the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Eleven RCTs were included. A low certainty of evidence supported PE was more effective than GE in pain reduction [Effect size (ES) 0.44]. Moreover, very low levels of certainty were revealed for effectiveness of PE compared with DSE for pain reduction (ES 0.65) and equivalence of PE and SSE for pain and disability. CONCLUSIONS This review found no strong evidence for using one type of exercise intervention over another when managing patients with CNSLBP. Existing evidence does not allow this review to draw definitive recommendations. In the absence of a superior exercise form clinicians should work collaboratively with the patient, using the individual's goals and preferences to guide exercise selection. Further appropriately designed research is warranted to explore this topic further.
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Affiliation(s)
- Chi Ming Wong
- School of Health Sciences, University of East Anglia, Norwich, UK.,Locomotor Services, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Bradley Rugg
- School of Health Sciences, University of East Anglia, Norwich, UK.,The Clementine Churchill Hospital, Harrow, UK
| | - Jo-Anne Geere
- School of Health Sciences, University of East Anglia, Norwich, UK
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13
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Park SC, Kang MS, Yang JH, Kim TH. Assessment and nonsurgical management of low back pain: a narrative review. Korean J Intern Med 2023; 38:16-26. [PMID: 36420562 PMCID: PMC9816685 DOI: 10.3904/kjim.2022.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs ("red flags") indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.
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Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Min-Seok Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Tae-Hoon Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
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14
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Knoop J, van Lankveld W, Beijer L, Geerdink FJB, Heymans MW, Hoogeboom TJ, Hoppenbrouwers S, van Overmeeren E, Soer R, Veenhof C, Vissers KCP, van der Wees PJ, Sappelli M, Staal JB. Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care. BMC Musculoskelet Disord 2022; 23:834. [PMID: 36057717 PMCID: PMC9440317 DOI: 10.1186/s12891-022-05718-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background While low back pain occurs in nearly everybody and is the leading cause of disability worldwide, we lack instruments to accurately predict persistence of acute low back pain. We aimed to develop and internally validate a machine learning model predicting non-recovery in acute low back pain and to compare this with current practice and ‘traditional’ prediction modeling. Methods Prognostic cohort-study in primary care physiotherapy. Patients (n = 247) with acute low back pain (≤ one month) consulting physiotherapists were included. Candidate predictors were assessed by questionnaire at baseline and (to capture early recovery) after one and two weeks. Primary outcome was non-recovery after three months, defined as at least mild pain (Numeric Rating Scale > 2/10). Machine learning models to predict non-recovery were developed and internally validated, and compared with two current practices in physiotherapy (STarT Back tool and physiotherapists’ expectation) and ‘traditional’ logistic regression analysis. Results Forty-seven percent of the participants did not recover at three months. The best performing machine learning model showed acceptable predictive performance (area under the curve: 0.66). Although this was no better than a’traditional’ logistic regression model, it outperformed current practice. Conclusions We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. Our prognostic models have the potential of integration in a clinical decision support system to facilitate data-driven, personalized treatment of acute low back pain, but needs external validation first. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05718-7.
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Affiliation(s)
- J Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.
| | - W van Lankveld
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands
| | - L Beijer
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Research and Innovation Department, Sint Maartenskliniek, Nijmegen, Netherlands
| | - F J B Geerdink
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands
| | - M W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - T J Hoogeboom
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - S Hoppenbrouwers
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands.,Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - E van Overmeeren
- Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands
| | - R Soer
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Pain Center, Groningen, Netherlands
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht, Netherlands
| | - K C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - P J van der Wees
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - M Sappelli
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - J B Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
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[Therapeutic injections and manual medicine in low-back pain : Bimodal synergies between evidence and empiricism]. DER ORTHOPADE 2022; 51:307-324. [PMID: 35238966 PMCID: PMC8967746 DOI: 10.1007/s00132-022-04235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
Hintergrund Angelehnt an die zielorientierte Therapieplanung und -führung in der Versorgung chronisch Rheumakranker, plädiert der Autor bei Patienten mit (chronischem) degenerativem tiefem Rückenschmerz (TRS), orientiert an den differenzialtherapeutischen Grundsätzen der Manuellen Medizin (MM), und unter Kenntnis von Techniken und Evidenzen therapeutischer Lokalinfiltrationen (TLI), für die Etablierung eines strukturierten mechanismenbasierten Therapiekonzeptes im Sinne des „treat to target“ (T2T) im ambulanten schmerztherapeutischen Versorgungsbereich. Diagnostik Dies setzt eine konsequente (Primär‑)Diagnostik mit Schmerzanalyse unter der Prämisse, dass TRS, wenn strukturell-funktionell bedingt, immer spezifisch ist, voraus. Eine breite biopsychosoziale Anamnese und strukturbezogene klinisch-bildgebende (Ausschluss‑)Diagnostik mit funktioneller Differenzierung nach MM-Grundsätzen und ggf. interventionelle Blocks, sollten am Ende zur Formulierung einer 3‑Ebenen-Diagnose als Voraussetzung zu einer mechanismenbasiert-zielorientiert-hierarchischen Stufentherapie bei TRS führen. Diese wird in diesem Artikel pragmatisch fallorientiert, unter Implementierung von Techniken und Evidenzen der TLI und MM, vorgestellt.
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Traeger AC, Gilbert S, Moeschler S, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Hippokratia 2021. [DOI: 10.1002/14651858.cd014789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Adrian C Traeger
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- School of Public Health, Faculty of Medicine and Health; The University of Sydney; Sydney Australia
| | - Stephen Gilbert
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- School of Public Health, Faculty of Medicine and Health; The University of Sydney; Sydney Australia
| | - Susan Moeschler
- Department of Anesthesiology; Mayo Clinic College of Medicine; Rochester MN USA
| | - Ian A Harris
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- South West Sydney Clinical School; University of New South Wales; Liverpool Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- School of Public Health; Faculty of Medicine and Health, The University of Sydney; Sydney Australia
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Chiropractic treatment of low back pain. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-021-00770-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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18
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Chiropraktische Behandlung bei unteren Rückenschmerzen. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-021-00769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Montrose S, Vogel M, Barber KR. Use of osteopathic manipulative treatment for low back pain patients with and without pain medication history. J Osteopath Med 2021; 121:63-69. [PMID: 33512387 DOI: 10.1515/jom-2019-0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Low back pain is one of the most frequent diagnoses in primary care, and prescription pain medication is commonly used for management. Osteopathic physicians may use osteopathic manipulative treatment (OMT) as an additional tool to help alleviate pain. Objective To determine if nonpharmacological options can improve back pain with the use of OMT. Methods Two groups were studied: patients receiving OMT but not using prescribed pain medications (OMT-only group) and patients who received prescribed pain medication and began receiving OMT after three months of pharmacologic therapy (OMT + medication group). All patients were enrolled in the study for one year. The amount of time between treatments was determined by the physician performing the OMT and the patient's pain improvement. The Keele STarT survey and Oswestry Disability Index tool were used at each appointment to assess the patient's functionality and pain. Results Thirty-six patients enrolled in the study: 26 in the OMT-only group and 10 in the OMT + medication group. Each group reported improvement in low back pain (LBP) according to both scales used. The OMT-only group reported improvement according to the Keele STarT survey (30% relative decrease in the mean score) and the Oswestry Disability Index tool (18% relative decrease in disability index), while patients in the OMT + medication group also reported improvement according to the Keele STarT survey (29.5% relative decrease in the mean score) and the Oswestry Disability Index tool (18% relative decrease in disability index). A decrease in Cyclobenzaprine usage was also observed in the OMT + medication group. Conclusion Both groups showed significant decreases in overall pain, and this similar effect in each group may indicate a lack of need for medications when OMT is used. Additional research on efficacy of OMT in this patient population is needed with larger, multicenter, randomized trials.
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Affiliation(s)
- Stephanie Montrose
- Department of Family Medicine , Ascension Genesys Hospital , Grand Blanc , MI , USA
| | - Mark Vogel
- Department of Family Medicine , Ascension Genesys Hospital , Grand Blanc , MI , USA
| | - Kimberly R Barber
- Department of Research , Ascension Genesys Hospital , Grand Blanc , MI , USA
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20
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Sturion LA, Nowotny AH, Barillec F, Barette G, Santos GK, Teixeira FA, Fernandes KP, da Silva R. Comparison between high-velocity low-amplitude manipulation and muscle energy technique on pain and trunk neuromuscular postural control in male workers with chronic low back pain: A randomised crossover trial. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1420. [PMID: 33241157 PMCID: PMC7669951 DOI: 10.4102/sajp.v76i1.1420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/14/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A therapeutic recommendation for restoring function in individuals with chronic low back pain (CLBP) is manual therapy through manipulative spinal or muscle energy techniques. OBJECTIVES To compare the effectiveness of two osteopathic manipulative techniques on clinical low back symptoms and trunk neuromuscular postural control in male workers with CLBP. METHOD Ten male workers with CLBP were randomly allocated to two groups: high-velocity low-amplitude (HVLA) manipulation or muscle energy techniques (MET). Each group received one therapy per week for both techniques during 7 weeks of treatment. Pain and function were measured by using the Numeric Pain-Rating Scale, the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. The lumbar flexibility was assessed by Modified Schober Test. Electromyography (EMG) and force platform measurements were used for evaluation of trunk muscular activation and postural balance, respectively at three different times: baseline, post intervention, and 15 days later. RESULTS Both techniques were effective (p < 0.01) in reducing pain with large clinical differences (-1.8 to -2.8) across immediate and after 15 days. However, no significant effect between groups and times was found for other variables, namely neuromuscular activation and postural balance measures. CONCLUSION Both techniques (HVLA thrust manipulation and MET) were effective in reducing back pain immediately and 15 days later. Neither technique changed the trunk neuromuscular activation patterns nor postural balance in male workers with LBP. CLINICAL IMPLICATIONS These results may facilitate clinical decision-making for CLBP management in physiotherapy programs.
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Affiliation(s)
- Leandro A. Sturion
- Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Faculty of Physical therapy, Universidade Pitagoras, Londrina, Brazil
| | - Alexandre H. Nowotny
- Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Faculty of Physical therapy, Universidade Pitagoras, Londrina, Brazil
| | - Fabrice Barillec
- Département des Thérapie Manuelle, Gilles Barette Formations, Saint Cyr du Ronceray, Valorbiquet, France
| | - Gilles Barette
- Département des Cadre de santé-kinésithérapeute, Thérapie Manuelle, Gilles Barette Formations, Valorbiquet, France
| | - Gabriela K. Santos
- Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Faculty of Physical therapy, Universidade Pitagoras, Londrina, Brazil
| | | | - Karen P. Fernandes
- Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Faculty of Physical therapy, Universidade Pitagoras, Londrina, Brazil
| | - Rubens da Silva
- Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Faculty of Physical therapy, Universidade Pitagoras, Londrina, Brazil
- Département des sciences de la santé, Lab BioNR, CUpht, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
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Bailey E, Heneghan NR, Cassidy NJ, Falla D, Rushton AB. Clinical effectiveness of manipulation and mobilisation interventions for the treatment of non-specific neck pain: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e037783. [PMID: 33040001 PMCID: PMC7549443 DOI: 10.1136/bmjopen-2020-037783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/28/2020] [Accepted: 07/10/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Non-specific neck pain (NSNP) is a common musculoskeletal condition resulting in pain, physical limitations and associated functional disability. Current guidelines recommend manipulation and/or mobilisation as part of the multimodal management of NSNP. This study focuses on intervention at the articular level and aims to identify whether joint mobilisation or joint manipulation has a greater effect on function, range of movement or pain outcomes in the management of NSNP. METHODS AND ANALYSIS A systematic review protocol has been designed and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A targeted search strategy will enable searching of key databases from inception to 31 March 2020: CINAHL, PEDro, AMED, EMBASE, OVID, MEDLINE, Web of Science, PubMed and Google Scholar. Key journals will be searched using predefined keywords determined from preliminary scoping searches for randomised controlled trials of manipulation and mobilisation modalities for adults with NSNP in the absence of radiculopathy or whiplash, published in English. Grey literature and unpublished studies will also be searched. Studies will be screened by title and abstract and full text. Two independent reviewers will conduct the searches independently, extract data, assess risk of bias (Cochrane Risk of Bias Tool 2) and assess overall strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation). Meta-analysis will be performed where individual studies measure comparable outcomes including performance-based outcome measures such as range of movement or patient reported outcome measures such as Neck Disability Index; and where interventions are comparable in their delivery such as number of oscillations and Maitland grading. Where not possible, data will be presented descriptively. ETHICS AND DISSEMINATION This study does not require ethical approval. Findings will be submitted for publication to relevant peer-reviewed journals and will be presented at profession-specific conferences. PROSPERO REGISTRATION NUMBER CRD42020164457.
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Affiliation(s)
- Elizabeth Bailey
- Physiotherapy, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- School of Physical Therapy, Western University, London, Ontario, Canada
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Computer Kinesiology: New Diagnostic and Therapeutic Tool for Lower Back Pain Treatment (Pilot Study). BIOMED RESEARCH INTERNATIONAL 2020; 2020:2987696. [PMID: 32908878 PMCID: PMC7463396 DOI: 10.1155/2020/2987696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022]
Abstract
The aim of this study was to demonstrate the effectiveness of the diagnostic and therapeutic medical information system Computer Kinesiology in physiotherapy in patients with low back pain who were not responding to conventional therapy. Computer Kinesiology is primarily intended for the diagnostics and therapy of functional disorders of the locomotor system. This pilot study population included 55 patients (Group 1) with acute and chronic back pain and 51 persons (Group 2) without back pain. The third group was a control group of 67 healthy volunteers with no evidence of musculoskeletal pathologies and no back pain. All 173 subjects were examined three times by the diagnostic part of the Computer Kinesiology method. Groups 1 and 2 were treated after every diagnostics. Group 3 was not treated. The effect was evaluated by H score. Improvements after therapy were defined by reducing the H score by at least 1 point. In Group 1, the H score decreased by at least 1 point in 87.3% (95% CI: 75.5-94.7) and in Group 2 in 78.4% (95% CI: 64.7-88.7). There was no change of distribution of H Score grade in Group 3. The improvement neither depended on gender, age, and BMI nor was it influenced by the length of the therapy. This study demonstrated a high therapeutic efficacy of the Computer Kinesiology system in patients with back pain (Group 1) and in persons without back pain (Group 2) who used the Computer Kinesiology system for primary and secondary prevention of back pain.
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Karlsson M, Bergenheim A, Larsson MEH, Nordeman L, van Tulder M, Bernhardsson S. Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews. Syst Rev 2020; 9:182. [PMID: 32795336 PMCID: PMC7427286 DOI: 10.1186/s13643-020-01412-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute low back pain is associated with pain and disability, but symptoms are often self-healing. The effectiveness of exercise therapy for acute low back pain remains uncertain with conflicting evidence from systematic reviews. The aim of this systematic review of systematic reviews was to assess the overall certainty of evidence for the effects of exercise therapy, compared with other interventions, on pain, disability, recurrence, and adverse effects in adult patients with acute low back pain. METHODS PubMed, the Cochrane library, CINAHL, PEDro, Open Grey, Web of Science, and PROSPERO were searched for systematic reviews of randomized controlled trials. Methodological quality was assessed independently by two authors using AMSTAR. Meta-analyses were performed if possible, using data from the original studies. Data for pain, disability, recurrence, and adverse effects were analyzed. Certainty of evidence was assessed using GRADE. RESULTS The searches retrieved 2602 records, of which 134 publications were selected for full-text screening. Twenty-four reviews were included, in which 21 randomized controlled trials (n = 2685) presented data for an acute population, related to 69 comparisons. Overlap was high, 76%, with a corrected covered area of 0.14. Methodological quality varied from low to high. Exercise therapy was categorized into general exercise therapy, stabilization exercise, and McKenzie therapy. No important difference in pain or disability was evident when exercise therapy was compared with sham ultrasound, nor for the comparators usual care, spinal manipulative therapy, advice to stay active, and educational booklet. Neither McKenzie therapy nor stabilization exercise yielded any important difference in effects compared with other types of exercise therapy. Certainty of evidence varied from very low to moderate. CONCLUSIONS The findings suggest very low to moderate certainty of evidence that exercise therapy may result in little or no important difference in pain or disability, compared with other interventions, in adult patients with acute low back pain. A limitation of this systematic review is that some included reviews were of low quality. When implementing findings of this systematic review in clinical practice, patients' preferences and the clinician's expertise also should be considered, to determine if and when exercise therapy should be the intervention of choice. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD46146, available at: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146 .
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Affiliation(s)
- Marc Karlsson
- Region Skåne, Healthcare Centre Oxie, Malmö, Sweden.,Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bergenheim
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Uddevalla Rehabilitation, Uddevalla, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Lena Nordeman
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department Physiotherapy & Occupational Therapy, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Susanne Bernhardsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden.
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Pourahmadi M, Sahebalam M, Bagheri R. Effectiveness of Proprioceptive Neuromuscular Facilitation on Pain Intensity and Functional Disability in Patients with Low Back Pain: A Systematic Review and Meta-Analysis. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:479-501. [PMID: 32884969 PMCID: PMC7443075 DOI: 10.22038/abjs.2020.45455.2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND This systematic review aimed to investigate the effectiveness of proprioceptive neuromuscular facilitation (PNF) training on back pain intensity and functional disability in people with low back pain (LBP). METHODS Totally, five electronic databases, including PubMed/Medline (NLM), Scopus, Google Scholar, PEDro, and Cochrane Central Register of Controlled Clinical Trials were searched up to October 31, 2018. Clinical trials with a concurrent comparison group (s) that compared the effectiveness of PNF training with any other physical therapy intervention were selected. Publication language was restricted to English language articles. Methodologic quality was assessed using the PEDro scale. The measures of continuous variables were summarized as Hedges's g. RESULTS In total, 20 eligible trials were identified with 965 LBP patients. A large effect size (standardized mean difference [SMD]=-2.14, 95% confidence interval [CI]=3.23 to -1.05) and significant effect were observed favoring the use of PNF training to alleviate back pain intensity in patients with LBP. Moreover, large effect size and the significant result were also determined for the effect of PNF training on functional disability improvement (SMD=-2.68, 95% CI=-3.36 to -2.00) in population with LBP. A qualitative synthesis of results indicated that PNF training can significantly improve sagittal spine ROM. Statistical heterogeneity analysis showed that there was considerable statistical heterogeneity among the selected trials for the primary outcomes (I2 ≥ 86.6%). CONCLUSION There is a low quality of evidence and weak strength of recommendation that PNF training has positive effects on back pain and disability in LBP people. Further high-quality randomized clinical trials regarding long-term effects of PNF training versus validated control intervention in a clinical setting is recommendable.
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Affiliation(s)
- Mohammadreza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebalam
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Oliveira VHB, Mendonça KMPP, Monteiro KS, Silva IS, Santino TA, Nogueira PAMS. Physical therapies for postural abnormalities in people with cystic fibrosis. Cochrane Database Syst Rev 2020; 3:CD013018. [PMID: 32227599 PMCID: PMC7104790 DOI: 10.1002/14651858.cd013018.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is the most common life-threatening, inherited disease in white populations which causes several dysfunctions, including postural abnormalities. Physical therapy may help in some consequences of these postural abnormalities, such as pain, trunk deformity and quality of life. OBJECTIVES To determine the effects of a range of physical therapies for managing postural abnormalities in people with cystic fibrosis, specifically on quality of life, pain and trunk deformity. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches, hand-searched journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Additional searches were conducted on ClinicalTrials.gov and on the WHO International Clinical Trials Registry Platform for any planned, ongoing and unpublished studies. Date of the last search: 19 March 2020. SELECTION CRITERIA Randomised controlled trials examining any modality of physical therapy considered relevant for treating postural disorders compared with each other, no physical therapy, sham treatment or usual care in people with CF (of any age or disease severity). DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible trials, assessed the risk of bias in each trial and extracted the data. We contacted trial authors to obtain missing or additional information. We assessed the quality of the evidence using the GRADE criteria. MAIN RESULTS Two trials, involving a total of 50 participants with CF and postural abnormalities, were included in this review. One was in people with stable disease (lasting three months) and one in hospital inpatients experiencing an exacerbation (20 days). Both trials compared manual therapy comprising mobilizations to the rib cage and thoracic spine, treatment of specific muscle dysfunction or tight muscle groups; and postural awareness and education versus medical usual care. The age of participants ranged from 17 years to 58 years. Both trials were conducted in the UK. The following outcomes were measured: change in quality of life, change in pain, change in trunk deformity and change in pulmonary function. Manual therapy may make little or no difference to the change in trunk deformity compared to usual care (low-quality evidence). No results could be analysed for quality of life (very low-quality evidence) and pain outcomes (very low-quality evidence) because of the high heterogeneity between trials. It is uncertain whether the intervention improves lung function: forced vital capacity (very low-quality evidence); forced expiratory volume in one second (very low-quality evidence); or Tiffeneau's index (ratio of forced expiratory volume at one second (FEV1) and forced vital capacity (FVC)). Only one trial (15 participants) measured functional capacity, and the change in walked distance seemed to favour intervention over usual care, but with the possibility of no effect due to wide confidence intervals. The same trial also reported that six participants in the intervention group had positive comments about the intervention and no adverse events were mentioned. AUTHORS' CONCLUSIONS Due to methodological limitations in the included trials, and in addition to the very low to low quality of the current evidence, there is limited evidence about the benefits of physical therapies on postural abnormalities in people with CF. Therefore, further well-conducted trials with robust methodologies are required considering a prior inclusion criterion to identify the participants who have postural abnormalities.
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Affiliation(s)
- Victor HB Oliveira
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Karla MPP Mendonça
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 300Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Karolinne S Monteiro
- Federal University of Rio Grande do NorteFaculty of Health Science of TrairiVila Trairi, S/N ‐ Centro.Santa CruzRio Grande do NorteBrazil59200‐000
| | - Ivanizia S Silva
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Thayla A Santino
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Patricia Angelica MS Nogueira
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
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Corso M, Cancelliere C, Mior S, Taylor-Vaisey A, Côté P. The safety of spinal manipulative therapy in children under 10 years: a rapid review. Chiropr Man Therap 2020; 28:12. [PMID: 32093727 PMCID: PMC7041232 DOI: 10.1186/s12998-020-0299-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue. OBJECTIVES We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incidence of adverse events; and 3) determine whether SMT increases the risk of adverse events compared to other interventions. EVIDENCE REVIEW We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (case reports/series, cohort studies and randomized controlled trials) were critically appraised. Studies of high and acceptable methodological quality were included. The lead author extracted data. Data extraction was independently validated by a second reviewer. We conducted a qualitative synthesis of the evidence. FINDINGS Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown. CONCLUSION The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.
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Affiliation(s)
- Melissa Corso
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada.
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Maxwell CM, Lauchlan DT, Dall PM. The effects of spinal manipulative therapy on lower limb neurodynamic test outcomes in adults: a systematic review. J Man Manip Ther 2020; 28:4-14. [PMID: 30935328 PMCID: PMC7006656 DOI: 10.1080/10669817.2019.1569300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Spinal Manipulative Therapy (SMT) is a routinely applied treatment modality for various musculoskeletal conditions, including low back pain. The precise mechanisms by which SMT elicits its effects are largely unknown, but recent research supports a multi-system explanation recognizing both biomechanical and neurophysiological mechanisms. Although the evaluation of changes in clinical presentation is complex, objective neurophysiological measures of sensitivity to movement (e.g. neurodynamic tests) can be a valuable clinical indicator in evaluating the effects of SMT. This review aimed to synthesize current literature investigating the effects of SMT on lower limb neurodynamics.Method: Eight electronic databases were systematically searched for randomized controlled trials (RCT) that applied SMT (against any control) and evaluated lower limb neurodynamics (Passive Straight Leg Raise or Slump Test). Selection and data extraction were conducted by one researcher, reviewed by a second author. Risk of bias (RoB) was assessed using the Cochrane Back Review Group criteria.Results: Eight RCTs were included, one with high RoB. SMT produced a clinically meaningful (≥6⁰) difference in five of these studies compared with inert control, hamstring stretching, and as an adjunct to conventional physiotherapy, but not compared with standard care, as an adjunct to home exercise and advice, or when comparing different SMT techniques. Findings compared to sham were mixed. When reported, effects tentatively lasted up to 6 weeks post-intervention.Conclusion: Limited evidence suggests SMT-improved range of motion and was more effective than some other interventions. Future research, using standardized Neurodynamic tests, should explore technique types and evaluate longer-term effects.Level of Evidence: 1a.
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Nottidge BA, Odole AC, Odunaiya NA, Akpa MO, Fawole OI, Akinpelu AO. Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire. Ghana Med J 2019; 53:126-134. [PMID: 31481808 PMCID: PMC6697772 DOI: 10.4314/gmj.v53i2.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment. Objective This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ). Methods Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version. Results The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP. Conclusion A scale for assessing disability in LBP is made available for use in Nigeria and similar populations. Funding None declared
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Affiliation(s)
- Bolanle A Nottidge
- Department of Physiotherapy, University of Uyo Teaching Hospital, Uyo, Akwa-Ibom State, Nigeria
| | - Adesola C Odole
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - Nse A Odunaiya
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - Matthew O Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Aderonke O Akinpelu
- Department of Physiotherapy, University of Uyo Teaching Hospital, Uyo, Akwa-Ibom State, Nigeria.,Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria.,Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
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Gianola S, Castellini G, Andreano A, Corbetta D, Frigerio P, Pecoraro V, Redaelli V, Tettamanti A, Turolla A, Moja L, Valsecchi MG. Effectiveness of treatments for acute and sub-acute mechanical non-specific low back pain: protocol for a systematic review and network meta-analysis. Syst Rev 2019; 8:196. [PMID: 31395091 PMCID: PMC6688358 DOI: 10.1186/s13643-019-1116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Non-specific low back pain (LBP) is the leading cause of disability worldwide. Acute LBP usually has a good prognosis, with rapid improvement within the first 6 weeks. However, the majority of patients develop chronic LBP and suffer from recurrences. For clinical management, a plethora of treatments is currently available but evidence of the most effective options is lacking. The objective of this study will be to identify the most effective interventions to relieve pain and reduce disability in acute and sub-acute non-specific LBP. METHODS/DESIGN We will search electronic databases (MEDLINE, Embase, CENTRAL) from inception onwards. The eligible population will be individuals with non-specific LBP older than 18 years, both males and females, who experience pain less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Eligible interventions and comparators will include all conservative rehabilitation or pharmacological treatments provided by any health professional; the only eligible study design will be a randomized controlled trial. The primary outcomes will be pain intensity and back-specific functional status. Secondary outcomes will be any adverse events. Studies published in languages other than English will also potentially be included. Two reviewers will independently screen the titles and abstracts retrieved from a literature search, as well as potentially relevant full-text articles. General characteristics, potential effect modifiers, and outcome data will be extracted from the included studies, and the risk of bias will be appraised. Conflicts at all levels of screening and abstraction will be resolved through team discussions. After describing the results of the review, if appropriate, a random effects meta-analysis and network meta-analysis will be conducted in a frequentist setting, assuming equal heterogeneity across all treatment comparisons and accounting for correlations induced by multi-arm studies using a multivariate normal model. DISCUSSION Our systematic review will address the uncertainties in the use of pharmacological or non-pharmacological treatments, and their relative efficacy, for acute and subacute LBP. These findings will be useful for patients, healthcare providers, and policymakers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018102527.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anita Andreano
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Davide Corbetta
- Rehabilitation and Functional Recovery Department, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pamela Frigerio
- Child and Adolescent Neuropsychiatric Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valentina Pecoraro
- Department of Laboratory Medicine, OCSAE, Azienda USL of Modena, Modena, Italy
| | | | - Andrea Tettamanti
- Rehabilitation and Functional Recovery Department, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Turolla
- Laboratory for Neurorehabilitation Technologies, Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - Lorenzo Moja
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Driehuis F, Hoogeboom TJ, Nijhuis-van der Sanden MWG, de Bie RA, Staal JB. Spinal manual therapy in infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes. PLoS One 2019; 14:e0218940. [PMID: 31237917 PMCID: PMC6592551 DOI: 10.1371/journal.pone.0218940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking. OBJECTIVE To conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. METHODS PubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed. RESULTS Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment. CONCLUSIONS Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rob A. de Bie
- Caphri Research School, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - J. Bart Staal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Meyer T, Wulff K. Issues of comorbidity in clinical guidelines and systematic reviews from a rehabilitation perspective. Eur J Phys Rehabil Med 2019; 55:364-371. [DOI: 10.23736/s1973-9087.19.05786-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chow DHK, Lee TY, Pope MH. Effects of whole body vibration on spinal proprioception in healthy individuals. Work 2019; 61:403-411. [PMID: 30373993 DOI: 10.3233/wor-182816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a common health problem with high reoccurrence rate. As patients with LBP are often found to be proprioception impaired, new proprioception exercises should be explored. Whole body vibration (WBV) has been proven to improve muscle function and proprioception. OBJECTIVE The aim of this study was to determine the effects of WBV on spinal proprioception when WBV was administered in standing and seated postures. METHODS Twenty healthy male individuals (mean age: 23.2±1.2 years) were recruited and randomly assigned to two WBV groups: WBV in standing or WBV in seated posture. Their body posture, lumbar repositioning ability, maximum reaching distance and lumbopelvic coordination during dynamic motion in flexion and extension were assessed before, immediately after, 30 minutes after and 1 hour after 5 minutes of WBV (18 Hz, 6 mm amplitude) exposure. A Mixed ANOVA was used to analyze the effects of group and time factors on these four outcome measures. RESULTS There were no significant interaction (group and time) and group effects on all outcome measures. Participants were found to have significant different time effect on body posture, lumbar repositioning ability, maximum reaching distance and lumbopelvic coordination. CONCLUSIONS WBV could significantly improve spinal proprioception including body posture, lumbar repositioning ability, maximum reaching distance and lumbopelvic coordination in healthy individuals. WBV protocol is recommended to confirm its clinical application for improving spinal proprioception and its effects on patients with LBP is warranted.
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Affiliation(s)
- D H K Chow
- Department of Health & Physical Education, The Education University of Hong Kong, Tai Po, New Territories, Hong Kong
| | - T Y Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - M H Pope
- Department of Occupational Medicine, University of Aberdeen, Aberdeen, Scotland, UK
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Complementary medicine use, views, and experiences: a national survey in England. BJGP Open 2018; 2:bjgpopen18X101614. [PMID: 30723800 PMCID: PMC6348322 DOI: 10.3399/bjgpopen18x101614] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022] Open
Abstract
Background In 2005,12% of the English population visited a complementary and alternative medicine (CAM) practitioner. Aim To obtain up-to-date general population figures for practitioner-led CAM use in England, and to discover people's views and experiences regarding access. Design & setting A face-to-face questionnaire survey was commissioned. A nationally representative adult quota sample (aged ≥15 years) was used. Method Ten questions were included within Ipsos MORI’s weekly population-based survey. The questions explored 12-month practitioner-led CAM use, reasons for non-use, views on NHS-provided CAM, and willingness to pay. Results Of 4862 adults surveyed, 766 (16%) had seen a CAM practitioner. People most commonly visited CAM practitioners for manual therapies (massage, osteopathy, chiropractic) and acupuncture, as well as yoga, pilates, reflexology, and mindfulness or meditation. Women, people with higher socioeconomic status (SES) and those in south England were more likely to access CAM. Musculoskeletal conditions (mainly back pain) accounted for 68% of use, and mental health 12%. Most was through self-referral (70%) and self-financing. GPs (17%) or NHS professionals (4%) referred and/or recommended CAM to users. These CAM users were more often unemployed, with lower income and social grade, and receiving NHS-funded CAM. Responders were willing to pay varying amounts for CAM; 22% would not pay anything. Almost two in five responders felt NHS funding and GP referral and/or endorsement would increase their CAM use. Conclusion CAM use in England is common for musculoskeletal and mental health problems, but varies by sex, geography, and SES. It is mainly self-referred and self-financed; some is GP-endorsed and/or referred, especially for individuals of lower SES. Researchers, patients, and commissioners should collaborate to research the effectiveness and cost-effectiveness of CAM and consider its availability on the NHS.
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[Nonpharmacological pain therapy for chronic pain]. Z Gerontol Geriatr 2018; 51:859-864. [PMID: 30374702 DOI: 10.1007/s00391-018-01465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
The treatment of chronic pain should be a multimodal combination of pharmacological and nonpharmacological components. This article describes some of the nonpharmacological treatment options and their evidence (e.g. physical therapy, massage, manual therapy, electrotherapy, acupuncture and music therapy). The evidence for an empirically detected effectiveness of all these forms of therapy is not very high and often inconsistent. Nevertheless, this does not mean that these forms of treatment should not be used but that they should be selected on an individual basis to improve the well-being of patients by being adjusted to their needs.
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Lorenc A, Feder G, MacPherson H, Little P, Mercer SW, Sharp D. Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions. BMJ Open 2018; 8:e020222. [PMID: 30327397 PMCID: PMC6196876 DOI: 10.1136/bmjopen-2017-020222] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify potentially effective complementary approaches for musculoskeletal (MSK)-mental health (MH) comorbidity, by synthesising evidence on effectiveness, cost-effectiveness and safety from systematic reviews (SRs). DESIGN Scoping review of SRs. METHODS We searched literature databases, registries and reference lists, and contacted key authors and professional organisations to identify SRs of randomised controlled trials for complementary medicine for MSK or MH. Inclusion criteria were: published after 2004, studying adults, in English and scoring >50% on Assessing the Methodological Quality of Systematic Reviews (AMSTAR); quality appraisal checklist). SRs were synthesised to identify research priorities, based on moderate/good quality evidence, sample size and indication of cost-effectiveness and safety. RESULTS We included 84 MSK SRs and 27 MH SRs. Only one focused on MSK-MH comorbidity. Meditative approaches and yoga may improve MH outcomes in MSK populations. Yoga and tai chi had moderate/good evidence for MSK and MH conditions. SRs reported moderate/good quality evidence (any comparator) in a moderate/large population for: low back pain (LBP) (yoga, acupuncture, spinal manipulation/mobilisation, osteopathy), osteoarthritis (OA) (acupuncture, tai chi), neck pain (acupuncture, manipulation/manual therapy), myofascial trigger point pain (acupuncture), depression (mindfulness-based stress reduction (MBSR), meditation, tai chi, relaxation), anxiety (meditation/MBSR, moving meditation, yoga), sleep disorders (meditative/mind-body movement) and stress/distress (mindfulness). The majority of these complementary approaches had some evidence of safety-only three had evidence of harm. There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP, and manual therapy/manipulation for neck pain, but few SRs reviewed cost-effectiveness and many found no data. CONCLUSIONS Only one SR studied MSK-MH comorbidity. Research priorities for complementary medicine for both MSK and MH (LBP, OA, depression, anxiety and sleep problems) are yoga, mindfulness and tai chi. Despite the large number of SRs and the prevalence of comorbidity, more high-quality, large randomised controlled trials in comorbid populations are needed.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | - Paul Little
- Primary Care and Population Science Unit, University of Southampton, Southampton, UK
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Sharp
- Population Health Sciences, Bristol Medical School, Bristol, UK
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Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Briggs AM, Wluka AE. Patients' perceived needs for allied health, and complementary and alternative medicines for low back pain: A systematic scoping review. Health Expect 2018; 21:824-847. [PMID: 29983004 PMCID: PMC6186543 DOI: 10.1111/hex.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Allied health and complementary and alternative medicines (CAM) are therapeutic therapies commonly accessed by consumers to manage low back pain (LBP). We aimed to identify the literature regarding patients' perceived needs for physiotherapy, chiropractic therapy and CAM for the management of LBP. METHODS A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016) was conducted to identify studies examining patients' perceived needs for allied health and CAM for LBP. Data regarding study design and methodology were extracted. Areas of patients' perceived need for allied health and CAM were aggregated. RESULTS Forty-four studies from 2202 were included: 25 qualitative, 18 quantitative and 1 mixed-methods study. Three areas of need emerged: (i) physiotherapy was viewed as important, particularly when individually tailored. However, patients had concerns about adherence, adverse outcomes and correct exercise technique. (ii) Chiropractic therapy was perceived to be effective and needed by some patients, but others were concerned about adverse outcomes. (iii) An inconsistent need for CAM was identified with some patients perceiving a need, while others questioning the legitimacy and short-term duration of these therapies. CONCLUSIONS Our findings regarding patients' perceived needs for allied health and CAM for LBP may assist in informing development of more patient-centred guidelines and service models for LBP. Understanding patients' concerns regarding active-based physiotherapy, which is recommended in most guidelines, and issues surrounding chiropractic and CAM, which are generally not, may help inform management that better aligns patient's perceived needs with effective treatments, to improve outcomes for both patients and the health-care system.
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Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Tom A. Ranger
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Waruna Peiris
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Donna M. Urquhart
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Andrew M. Briggs
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWAAustralia
- Move: Muscle, Bone & Joint HealthMelbourneVicAustralia
| | - Anita E. Wluka
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
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Oostendorp RAB. Credibility of manual therapy is at stake 'Where do we go from here?'. J Man Manip Ther 2018; 26:189-192. [PMID: 30083042 DOI: 10.1080/10669817.2018.1472948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Rob A B Oostendorp
- Emeritus Professor, Radboud University Medical Centre, Nijmegen, The Netherlands.,Emeritus Professor, Vrije Universiteit Brussel, Brussels, Belgium
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Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation: A Nonrandomized Clinical Trial. Clin J Pain 2018; 34:68-75. [PMID: 29200015 PMCID: PMC5728592 DOI: 10.1097/ajp.0000000000000507] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The involvement of inflammatory components in the pathophysiology of low back pain (LBP) is poorly understood. It has been suggested that spinal manipulative therapy (SMT) may exert anti-inflammatory effects. PURPOSE The purpose of this study was to determine the involvement of inflammation-associated chemokines (CC series) in the pathogenesis of nonspecific LBP and to evaluate the effect of SMT on that process. METHODS Patients presenting with nonradicular, nonspecific LBP (minimum pain score 3 on 10-point visual analog scale) were recruited according to stringent inclusion criteria. They were evaluated for appropriateness to treat using a high velocity low amplitude manipulative thrust in the lumbar-lumbosacral region. Blood samples were obtained at baseline and following the administration of a series of 6 high velocity low amplitude manipulative thrusts on alternate days over the period of 2 weeks. The in vitro levels of CC chemokine ligands (CCL2, CCL3, and CCL4) production and plasma levels of an inflammatory biomarker, soluble E-selectin (sE-selectin), were determined at baseline and at the termination of treatments 2 weeks later. RESULTS Compared with asymptomatic controls baseline production of all chemokines was significantly elevated in acute (P=0.004 to <0.0001), and that of CCL2 and CCL4 in chronic LBP patients (P<0.0001). Furthermore, CCL4 production was significantly higher (P<0.0001) in the acute versus chronic LBP group. sE-selectin levels were significantly higher (P=0.003) in chronic but not in acute LBP patients. Following SMT, patient-reported outcomes showed significant (P<0.0001) improvements in visual analog scale and Oswestry Disability Index scores. This was accompanied by a significant decline in CCL3 production (P<0.0001) in both groups of patients. Change scores for CCL4 production differed significantly (P<0.0001) only for the acute LBP cohort, and no effect on the production of CCL2 or plasma sE-selectin levels was noted in either group. CONCLUSIONS The production of chemotactic cytokines is significantly and protractedly elevated in LBP patients. Changes in chemokine production levels, which might be related to SMT, differ in the acute and chronic LBP patient cohorts.
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Thiry P, Reumont F, Brismée JM, Dierick F. Short-term increase in discs' apparent diffusion is associated with pain and mobility improvements after spinal mobilization for low back pain. Sci Rep 2018; 8:8281. [PMID: 29844484 PMCID: PMC5974269 DOI: 10.1038/s41598-018-26697-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/17/2018] [Indexed: 12/17/2022] Open
Abstract
Pain perception, trunk mobility and apparent diffusion coefficient (ADC) within all lumbar intervertebral discs (IVDs) were collected before and shortly after posterior-to-anterior (PA) mobilizations in 16 adults with acute low back pain. Using a pragmatic approach, a trained orthopaedic manual physical therapist applied PA mobilizations to the participants' spine, in accordance with his examination findings. ADC all was computed from diffusion maps as the mean of anterior (ADC ant ), middle (ADC mid ), and posterior (ADC post ) portions of the IVD. After mobilization, pain ratings and trunk mobility were significantly improved and a significant increase in ADC all values was observed. The greatest ADC all changes were observed at the L3-L4 and L4-L5 levels and were mainly explained by changes in ADC ant and ADC post , respectively. No significant changes in ADC were observed at L5-S1 level. The reduction in pain and largest changes in ADC observed at the periphery of the hyperintense IVD region suggest that increased peripheral random motion of water molecules is implicated in the IVD nociceptive response modulation. Additionally, ADC changes were observed at remote IVD anatomical levels that did not coincide with the PA spinal mobilization application level.
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Affiliation(s)
- Paul Thiry
- OMT Skills, Private physical therapy practice, La Louvière, 7100, Belgium
| | - François Reumont
- OMT Skills, Private physical therapy practice, La Louvière, 7100, Belgium
| | - Jean-Michel Brismée
- Center for Rehabilitation Research and Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Frédéric Dierick
- Forme & Fonctionnement Humain Lab, Physical Therapy Department, CERISIC, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, 6061, Belgium. .,Université catholique de Louvain, Faculty of Motor Sciences, Louvain-la-Neuve, 1348, Belgium.
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Oliveira VHB, Mendonça KMPP, Monteiro KS, Silva IS, Santino TA, Nogueira PAMS. Physical therapies for postural abnormalities in people with cystic fibrosis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Victor HB Oliveira
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Avenida Senador Salgado Filho 3000, Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
| | - Karla MPP Mendonça
- Federal University of Rio Grande do Norte; PhD Program in Physical Therapy; Avenida Senador Salgado Filho, 300 Bairro Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
| | - Karolinne S Monteiro
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Avenida Senador Salgado Filho 3000, Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
| | - Ivanizia S Silva
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Avenida Senador Salgado Filho 3000, Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
| | - Thayla A Santino
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Avenida Senador Salgado Filho 3000, Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
| | - Patricia Angelica MS Nogueira
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Avenida Senador Salgado Filho 3000, Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
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Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Gabriele Schorr S. Non-Specific Low Back Pain. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:883-890. [PMID: 29321099 PMCID: PMC5769319 DOI: 10.3238/arztebl.2017.0883] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 07/28/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND For many years, low back pain has been both the leading cause of days lost from work and the leading indication for medical rehabilitation. The goal of the German Disease Management Guideline (NDMG) on nonspecific low back pain is to improve the treatment of patients with this condition. METHODS The current update of the NDMG on non-specific low back pain is based on articles retrieved by a systematic search of the literature for systematic reviews. Its recommendations for diagnosis and treatment were developed by a collaborative effort of 29 scientific medical societies and organizations and approved in a formal consensus process. RESULTS If the history and physical examination do not arouse any suspicion of a dangerous underlying cause, no further diagnostic evaluation is indicated for the time being. Passive, reactive measures should be taken only in combination with activating measures, or not at all. When drugs are used for symptomatic treatment, patients should be treated with the most suitable drug in the lowest possible dose and for as short a time as possible. CONCLUSION A physician should be in charge of the overall care process. The patient should be kept well informed over the entire course of his or her illness and should be encouraged to adopt a healthful lifestyle, including regular physical exercise.
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Affiliation(s)
- Jean-François Chenot
- Section Family Medicine, Institute for Community Medicine, University Hospital of Greifswald
| | | | - Bernd Kladny
- Department of Orthopedics, Fachklinik Herzogenaurach
| | - Frank Petzke
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
| | - Michael Pfingsten
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
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DiMond ME. Rehabilitative Principles in the Management of Thoracolumbar Syndrome: A Case Report. J Chiropr Med 2017; 16:331-339. [PMID: 29276466 DOI: 10.1016/j.jcm.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 01/07/2023] Open
Abstract
Objective The purpose of this case report was to describe the chiropractic management of thoracolumbar syndrome using multimodal therapies. Clinical Features A 33-year-old woman with 3 weeks of back pain presented to a chiropractic clinic. Nerve tension tests and local tenderness were present in a pattern described by Maigne, and she was diagnosed with thoracolumbar syndrome (Maigne syndrome) at her initial visit. Intervention and Outcomes The Oswestry Disability Index for low back pain (62%), STarT low back screen tool for clinical outcomes (6 points total, with a 2-point subscale), numeric pain rating scale (6/10 constant, 10/10 with provocation), and test-retest exercise audits were outcome measures. She received 3 treatment sessions, each with progressive exercise audits, and discharged with advice. At discharge, the patient scores substantially improved (Oswestry Disability Index: 8%, STarT: 1 point total, numeric pain rating scale: 1/10, 10% of the time), and she exhibited greater confidence in home care. Endurance tests were performed to establish baselines for future care, which included static back endurance test (timed 52 seconds) and side bridge endurance test (timed 43 seconds). Conclusion The patient responded positively to chiropractic care. After a short course of care, the patient reported reduced pain, alleviated symptoms, and improved physical function.
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Affiliation(s)
- Mathew E DiMond
- UB Clinics, University of Bridgeport, Bridgeport, Connecticut
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Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017; 10:CD012509. [PMID: 29084357 PMCID: PMC6485910 DOI: 10.1002/14651858.cd012509.pub2] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic pain is common and can be challenging to manage. Despite increased utilisation of opioids, the safety and efficacy of long-term use of these compounds for chronic non-cancer pain (CNCP) remains controversial. This overview of Cochrane Reviews complements the overview entitled 'High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews'. OBJECTIVES To provide an overview of the occurrence and nature of adverse events associated with any opioid agent (any dose, frequency, or route of administration) used on a medium- or long-term basis for the treatment of CNCP in adults. METHODS We searched the Cochrane Database of Systematic Reviews (the Cochrane Library) Issue 3, 2017 on 8 March 2017 to identify all Cochrane Reviews of studies of medium- or long-term opioid use (2 weeks or more) for CNCP in adults aged 18 and over. We assessed the quality of the reviews using the AMSTAR criteria (Assessing the Methodological Quality of Systematic Reviews) as adapted for Cochrane Overviews. We assessed the quality of the evidence for the outcomes using the GRADE framework. MAIN RESULTS We included a total of 16 reviews in our overview, of which 14 presented unique quantitative data. These 14 Cochrane Reviews investigated 14 different opioid agents that were administered for time periods of two weeks or longer. The longest study was 13 months in duration, with most in the 6- to 16-week range. The quality of the included reviews was high using AMSTAR criteria, with 11 reviews meeting all 10 criteria, and 5 of the reviews meeting 9 out of 10, not scoring a point for either duplicate study selection and data extraction, or searching for articles irrespective of language and publication type. The quality of the evidence for the generic adverse event outcomes according to GRADE ranged from very low to moderate, with risk of bias and imprecision being identified for the following generic adverse event outcomes: any adverse event, any serious adverse event, and withdrawals due to adverse events. A GRADE assessment of the quality of the evidence for specific adverse events led to a downgrading to very low- to moderate-quality evidence due to risk of bias, indirectness, and imprecision.We calculated the equivalent milligrams of morphine per 24 hours for each opioid studied (buprenorphine, codeine, dextropropoxyphene, dihydrocodeine, fentanyl, hydromorphone, levorphanol, methadone, morphine, oxycodone, oxymorphone, tapentadol, tilidine, and tramadol). In the 14 Cochrane Reviews providing unique quantitative data, there were 61 studies with a total of 18,679 randomised participants; 12 of these studies had a cross-over design with two to four arms and a total of 796 participants. Based on the 14 selected Cochrane Reviews, there was a significantly increased risk of experiencing any adverse event with opioids compared to placebo (risk ratio (RR) 1.42, 95% confidence interval (CI) 1.22 to 1.66) as well as with opioids compared to a non-opioid active pharmacological comparator, with a similar risk ratio (RR 1.21, 95% CI 1.10 to 1.33). There was also a significantly increased risk of experiencing a serious adverse event with opioids compared to placebo (RR 2.75, 95% CI 2.06 to 3.67). Furthermore, we found significantly increased risk ratios with opioids compared to placebo for a number of specific adverse events: constipation, dizziness, drowsiness, fatigue, hot flushes, increased sweating, nausea, pruritus, and vomiting.There was no data on any of the following prespecified adverse events of interest in any of the included reviews in this overview of Cochrane Reviews: addiction, cognitive dysfunction, depressive symptoms or mood disturbances, hypogonadism or other endocrine dysfunction, respiratory depression, sexual dysfunction, and sleep apnoea or sleep-disordered breathing. We found no data for adverse events analysed by sex or ethnicity. AUTHORS' CONCLUSIONS A number of adverse events, including serious adverse events, are associated with the medium- and long-term use of opioids for CNCP. The absolute event rate for any adverse event with opioids in trials using a placebo as comparison was 78%, with an absolute event rate of 7.5% for any serious adverse event. Based on the adverse events identified, clinically relevant benefit would need to be clearly demonstrated before long-term use could be considered in people with CNCP in clinical practice. A number of adverse events that we would have expected to occur with opioid use were not reported in the included Cochrane Reviews. Going forward, we recommend more rigorous identification and reporting of all adverse events in randomised controlled trials and systematic reviews on opioid therapy. The absence of data for many adverse events represents a serious limitation of the evidence on opioids. We also recommend extending study follow-up, as a latency of onset may exist for some adverse events.
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Affiliation(s)
- Charl Els
- University of AlbertaDepartment of PsychiatryEdmontonAlbertaCanada
| | - Tanya D Jackson
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
| | - Diane Kunyk
- University of AlbertaFaculty of NursingEdmontonAlbertaCanada
| | - Vernon G Lappi
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
| | - Barend Sonnenberg
- Workers' Compensation Board of AlbertaMedical ServicesEdmontonAlbertaCanada
| | - Reidar Hagtvedt
- University of AlbertaAOIS, Alberta School of BusinessEdmontonAlbertaCanada
| | - Sangita Sharma
- Department of Medicine, University of AlbertaIndigenous and Global Health Research GroupEdmontonAlbertaCanada
| | - Fariba Kolahdooz
- Department of Medicine, University of AlbertaIndigenous and Global Health Research GroupEdmontonAlbertaCanada
| | - Sebastian Straube
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
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Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One 2017; 12:e0178621. [PMID: 28640822 PMCID: PMC5480856 DOI: 10.1371/journal.pone.0178621] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/16/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. METHODS A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. RESULTS Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. CONCLUSION This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
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Affiliation(s)
- Opeyemi O. Babatunde
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Danielle A. Van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Jonathan C. Hill
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Nadine E. Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
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Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, Branson R, Tang B, Morton SC, Shekelle PG. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA 2017; 317:1451-1460. [PMID: 28399251 PMCID: PMC5470352 DOI: 10.1001/jama.2017.3086] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Acute low back pain is common and spinal manipulative therapy (SMT) is a treatment option. Randomized clinical trials (RCTs) and meta-analyses have reported different conclusions about the effectiveness of SMT. OBJECTIVE To systematically review studies of the effectiveness and harms of SMT for acute (≤6 weeks) low back pain. DATA SOURCES Search of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from January 1, 2011, through February 6, 2017, as well as identified systematic reviews and RCTs, for RCTs of adults with low back pain treated in ambulatory settings with SMT compared with sham or alternative treatments, and that measured pain or function outcomes for up to 6 weeks. Observational studies were included to assess harms. DATA EXTRACTION AND SYNTHESIS Data extraction was done in duplicate. Study quality was assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool. This tool has 11 items in the following domains: randomization, concealment, baseline differences, blinding (patient), blinding (care provider [care provider is a specific quality metric used by the CBN Risk of Bias tool]), blinding (outcome), co-interventions, compliance, dropouts, timing, and intention to treat. Prior research has shown the CBN Risk of Bias tool identifies studies at an increased risk of bias using a threshold of 5 or 6 as a summary score. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. MAIN OUTCOMES AND MEASURES Pain (measured by either the 100-mm visual analog scale, 11-point numeric rating scale, or other numeric pain scale), function (measured by the 24-point Roland Morris Disability Questionnaire or Oswestry Disability Index [range, 0-100]), or any harms measured within 6 weeks. FINDINGS Of 26 eligible RCTs identified, 15 RCTs (1711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain (pooled mean improvement in the 100-mm visual analog pain scale, -9.95 [95% CI, -15.6 to -4.3]). Twelve RCTs (1381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function (pooled mean effect size, -0.39 [95% CI, -0.71 to -0.07]). Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies. No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50% to 67% of the time in large case series of patients treated with SMT. CONCLUSIONS AND RELEVANCE Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.
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Affiliation(s)
- Neil M. Paige
- West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
| | - Isomi M. Miake-Lye
- West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
- University of California, Los Angeles Fielding School of Public Health, Los Angeles
| | - Marika Suttorp Booth
- RAND Corporation, Southern California Evidence-based Practice Center, Santa Monica
| | - Jessica M. Beroes
- West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
| | - Aram S. Mardian
- Phoenix Veterans Affairs Healthcare System, Phoenix, Arizona
| | - Paul Dougherty
- Canandaigua Veterans Affairs Medical Center, Rochester, New York
| | - Richard Branson
- Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Baron Tang
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont
| | | | - Paul G. Shekelle
- West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
- RAND Corporation, Southern California Evidence-based Practice Center, Santa Monica
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Manning MA, Allan GM. Spinal manipulative therapy for low back pain. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:294. [PMID: 28404706 PMCID: PMC5389762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - G Michael Allan
- Professor and Director of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta in Edmonton
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Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev 2017; 6:64. [PMID: 28340595 PMCID: PMC5366149 DOI: 10.1186/s13643-017-0458-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT. METHODS We searched five electronic databases from inception to December 8, 2015. We included reviews on any type of studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, we used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated. RESULTS We identified 283 eligible reviews, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe. CONCLUSIONS It is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015030068 .
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Affiliation(s)
- Sabrina Mai Nielsen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Simon Tarp
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Henning Bliddal
- Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Louise Klokker
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Marius Henriksen
- Physiotherapy and Biomechanics Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark.
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Abstract
Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review. The clinical course of low back pain is often favourable, thus many patients require little if any formal medical care. Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided. The overuse of imaging, opioids, and surgery remains a widespread problem.
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Affiliation(s)
- Chris Maher
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, Melbourne, VIC, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Shin BC, Kim MR, Cho JH, Jung JY, Kim KW, Lee JH, Nam K, Lee MH, Hwang EH, Heo KH, Kim N, Ha IH. Comparative effectiveness and cost-effectiveness of Chuna manual therapy versus conventional usual care for nonacute low back pain: study protocol for a pilot multicenter, pragmatic randomized controlled trial (pCRN study). Trials 2017; 18:26. [PMID: 28095892 PMCID: PMC5240424 DOI: 10.1186/s13063-016-1756-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/14/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND While Chuna manual therapy is a Korean manual therapy widely used primarily for low back pain (LBP)-related disorders in Korea, well-designed studies on the comparative effectiveness of Chuna manual therapy are scarce. METHODS/DESIGN This study is the protocol for a three-armed, multicenter, pragmatic randomized controlled pilot trial. Sixty severe nonacute LBP patients (pain duration of at least 3 weeks, Numeric Rating Scale (NRS) ≥5) will be recruited at four Korean medicine hospitals. Participants will be randomly allocated to the Chuna group (n = 20), usual care group (n = 20), or Chuna plus usual care group (n = 20) for 6 weeks of treatment. Usual care will consist of orally administered conventional medicine, physical therapy, and back pain care education. The trial will be conducted with outcome assessor and statistician blinding. The primary endpoint will be NRS of LBP at week 7 post randomization. Secondary outcomes include NRS of leg pain, the Oswestry Disability Index (ODI), the Patient Global Impression of Change (PGIC), the Credibility and Expectancy Questionnaire, lumbar range of motion (ROM), the EuroQol-5 Dimension (EQ-5D) health survey, the Health Utility Index III (HUI-III), and economic evaluation and safety data. Post-treatment follow-ups will be conducted at 1, 4, and 10 weeks after conclusion of treatment. DISCUSSION This study will assess the comparative effectiveness of Chuna manual therapy compared to conventional usual care. Costs and effectiveness (utility) data will be analyzed for exploratory cost-effectiveness analysis. If this pilot study does not reach a definite conclusion due to its small sample size, these results will be used as preliminary results to calculate sample size for future large-scale clinical trials and contribute in the assessment of feasibility of a full-scale multicenter trial. TRIAL REGISTRATION Clinical Research Information Service (CRIS), KCT0001850 . Registered on 17 March 2016.
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Affiliation(s)
- Byung-Cheul Shin
- Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Department of Korean Rehabilitation Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Me-riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896 Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Young Jung
- Department of Korean Rehabilitation Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Medicine Life Science, University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kibong Nam
- Mokhuri Neck and Back Hospital, Seoul, Republic of Korea
| | - Min ho Lee
- Mokhuri Neck and Back Hospital, Seoul, Republic of Korea
| | - Eui-Hyoung Hwang
- Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Department of Korean Rehabilitation Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Kwang-Ho Heo
- Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Department of Korean Rehabilitation Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Namkwen Kim
- Center for Comparative Effectiveness Research and Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896 Republic of Korea
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50
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Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G, Carroll LJ, Ameis A, Ammendolia C, Brison R, Nordin M, Stupar M, Taylor-Vaisey A. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J 2016; 16:1598-1630. [PMID: 26707074 DOI: 10.1016/j.spinee.2015.08.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 06/05/2015] [Accepted: 08/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). PURPOSE This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD. STUDY DESIGN/SETTING This is a systematic review and best evidence synthesis. SAMPLE The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention. OUTCOME MEASURES The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events. METHODS We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention's stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance. RESULTS We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I-II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I-II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I-II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits. CONCLUSIONS Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.
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Affiliation(s)
- Jessica J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Department of Graduate Studies, Canadian Memorial Chiropractic College.
| | - Heather M Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC)
| | - Silvano Mior
- Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC)
| | - Craig Jacobs
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Pierre Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT); Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT)
| | - Kristi Randhawa
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Danielle Southerst
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital
| | - Sharanya Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative; Leslie Dan Faculty of Pharmacy, University of Toronto; Institute for Work and Health
| | - Linda J Carroll
- Alberta Centre for Injury Control and Research and School of Public Health, University of Alberta
| | - Arthur Ameis
- Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal
| | - Carlo Ammendolia
- Institute for Work and Health; Institute for Health Policy, Management and Evaluation, University of Toronto
| | - Robert Brison
- Clinical Research, Kingston General Hospital; Department of Emergency Medicine, School of Medicine, Queen's University
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University
| | - Maja Stupar
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC)
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC)
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