1
|
Rampazo ÉP, Rehder-Santos P, de Andrade ALM, Catai AM, Liebano RE. Cardiac autonomic response to acute painful stimulus in individuals with chronic neck pain: A case-control study. Musculoskelet Sci Pract 2024; 73:103141. [PMID: 39018751 DOI: 10.1016/j.msksp.2024.103141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/30/2024] [Accepted: 07/05/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE Characterize heart rate and cardiac autonomic response to painful stimulus on neck pain. METHODS Twenty-five individuals with neck pain and 25 healthy subjects were included. Heart rate variability and heart rate were assessed in the conditioned pain modulation test at pretest rest, during testing and in recovery. Heart rate variability indices were obtained using linear and nonlinear methods. RESULTS No significant differences were observed between groups regarding heart rate and the linear methods (p > 0.05). However, significant difference was observed between groups regarding nonlinear methods (standard deviation of the instantaneous variability of beat-to-beat interval variability, p = 0.005) CONCLUSIONS: Individuals with chronic neck pain showed autonomic responses similar to those of their healthy counterparts during the conditioning stimulus.
Collapse
Affiliation(s)
- Érika P Rampazo
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos, SP, CEP: 13565-905, Brazil.
| | - Patrícia Rehder-Santos
- Cardiovascular Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Ana Laura M de Andrade
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Aparecida M Catai
- Cardiovascular Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Richard E Liebano
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos, SP, CEP: 13565-905, Brazil; Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| |
Collapse
|
2
|
Sun X, Chai L, Huang Q, Zhou H, Liu H. Effects of exercise combined with cervicothoracic spine self-mobilization on chronic non-specific neck pain. Sci Rep 2024; 14:5298. [PMID: 38438448 PMCID: PMC10912754 DOI: 10.1038/s41598-024-55181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
To investigate the short-term effects and differences between exercise alone and exercise combined with self-mobilization training on chronic non-specific neck pain (CNSNP). Thirty subjects who met the criteria were recruited and randomly assigned to the exercise training group, the exercise combined with cervical self-mobilization training group (ECCM), and the exercise combined with cervicothoracic self-mobilization training group (ECCTM). The exercise training group received 6 weeks of deep neck flexor under biofeedback and scapular stability training, and the other two groups received 6 weeks of cervical self-mobilization and cervicothoracic self-mobilization, respectively, in addition to exercise training. Neck pain, cervical range of motion (ROM), neck disability, strength and endurance of deep neck flexor and quality of life were assessed before and after 6 weeks of training. The study results showed that all the three training programs for 6 weeks increased the strength and endurance of deep neck flexor, increased cervical ROM, reduced pain, and improved neck function (P < 0.05). The exercise combined with self-mobilization two groups compared with only the exercise training group had better improvement in ROM of extension, lateral flexion, rotation and quality of life (P < 0.05). Compared with exercise alone and exercise combined with cervical self-mobilization training, the exercise combined with cervicothoracic self-mobilization training was the best in improving ROM of right lateral flexion (exercise training group vs ECCTM: P < 0.01, d = 1.61, ECCM vs ECCTM: P < 0.05, d = 1.14) and pain (exercise training group vs ECCTM: P < 0.05, d = 1.34, ECCM vs ECCTM: P < 0.05, d = 1.23). Deep flexor muscle and shoulder stability training can improve the endurance and strength of the deep flexor muscles of the neck and coordinate the movement patterns of the shoulder and neck. Self-mobilization techniques can promote improvements in cervical lateral flexion and rotation range of motion, alleviate neck disability and further improve quality of life. A combination of exercise and cervicothoracic self-mobilization training appears beneficial for the management of neck pain.
Collapse
Affiliation(s)
- Ximei Sun
- Capital University of Physical Education and sports, Beijing, China
| | - Liangwei Chai
- Capital University of Physical Education and sports, Beijing, China
| | - Qiuyu Huang
- West Yunnan University of Applied Sciences, Dali, Yunnan, China
| | - Hua Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
| | - Hua Liu
- Capital University of Physical Education and sports, Beijing, China.
| |
Collapse
|
3
|
Gross AR, Lee H, Ezzo J, Chacko N, Gelley G, Forget M, Morien A, Graham N, Santaguida PL, Rice M, Dixon C. Massage for neck pain. Cochrane Database Syst Rev 2024; 2:CD004871. [PMID: 38415786 PMCID: PMC10900303 DOI: 10.1002/14651858.cd004871.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Massage is widely used for neck pain, but its effectiveness remains unclear. OBJECTIVES To assess the benefits and harms of massage compared to placebo or sham, no treatment or exercise as an adjuvant to the same co-intervention for acute to chronic persisting neck pain in adults with or without radiculopathy, including whiplash-associated disorders and cervicogenic headache. SEARCH METHODS We searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, Index to Chiropractic Literature, trial registries) to 1 October 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any type of massage with sham or placebo, no treatment or wait-list, or massage as an adjuvant treatment, in adults with acute, subacute or chronic neck pain. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. We transformed outcomes to standardise the direction of the effect (a smaller score is better). We used a partially contextualised approach relative to identified thresholds to report the effect size as slight-small, moderate or large-substantive. MAIN RESULTS We included 33 studies (1994 participants analysed). Selection (82%) and detection bias (94%) were common; multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding to the placebo was effective. Massage was compared with placebo (n = 10) or no treatment (n = 8), or assessed as an adjuvant to the same co-treatment (n = 15). The trials studied adults aged 18 to 70 years, 70% female, with mean pain severity of 51.8 (standard deviation (SD) 14.1) on a visual analogue scale (0 to 100). Neck pain was subacute-chronic and classified as non-specific neck pain (85%, including n = 1 whiplash), radiculopathy (6%) or cervicogenic headache (9%). Trials were conducted in outpatient settings in Asia (n = 11), America (n = 5), Africa (n = 1), Europe (n = 12) and the Middle East (n = 4). Trials received research funding (15%) from research institutes. We report the main results for the comparison of massage versus placebo. Low-certainty evidence indicates that massage probably results in little to no difference in pain, function-disability and health-related quality of life when compared against a placebo for subacute-chronic neck pain at up to 12 weeks follow-up. It may slightly improve participant-reported treatment success. Subgroup analysis by dose showed a clinically important difference favouring a high dose (≥ 8 sessions over four weeks for ≥ 30 minutes duration). There is very low-certainty evidence for total adverse events. Data on patient satisfaction and serious adverse events were not available. Pain was a mean of 20.55 points with placebo and improved by 3.43 points with massage (95% confidence interval (CI) 8.16 better to 1.29 worse) on a 0 to 100 scale, where a lower score indicates less pain (8 studies, 403 participants; I2 = 39%). We downgraded the evidence to low-certainty due to indirectness; most trials in the placebo comparison used suboptimal massage doses (only single sessions). Selection, performance and detection bias were evident as multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding was effective, respectively. Function-disability was a mean of 30.90 points with placebo and improved by 9.69 points with massage (95% CI 17.57 better to 1.81 better) on the Neck Disability Index 0 to 100, where a lower score indicates better function (2 studies, 68 participants; I2 = 0%). We downgraded the evidence to low-certainty due to imprecision (the wide CI represents slight to moderate benefit that does not rule in or rule out a clinically important change) and risk of selection, performance and detection biases. Participant-reported treatment success was a mean of 3.1 points with placebo and improved by 0.80 points with massage (95% CI 1.39 better to 0.21 better) on a Global Improvement 1 to 7 scale, where a lower score indicates very much improved (1 study, 54 participants). We downgraded the evidence to low-certainty due to imprecision (single study with a wide CI that does not rule in or rule out a clinically important change) and risk of performance as well as detection bias. Health-related quality of life was a mean of 43.2 points with placebo and improved by 5.30 points with massage (95% CI 8.24 better to 2.36 better) on the SF-12 (physical) 0 to 100 scale, where 0 indicates the lowest level of health (1 study, 54 participants). We downgraded the evidence once for imprecision (a single small study) and risk of performance and detection bias. We are uncertain whether massage results in increased total adverse events, such as treatment soreness, sweating or low blood pressure (RR 0.99, 95% CI 0.08 to 11.55; 2 studies, 175 participants; I2 = 77%). We downgraded the evidence to very low-certainty due to unexplained inconsistency, risk of performance and detection bias, and imprecision (the CI was extremely wide and the total number of events was very small, i.e < 200 events). AUTHORS' CONCLUSIONS The contribution of massage to the management of neck pain remains uncertain given the predominance of low-certainty evidence in this field. For subacute and chronic neck pain (closest to 12 weeks follow-up), massage may result in a little or no difference in improving pain, function-disability, health-related quality of life and participant-reported treatment success when compared to a placebo. Inadequate reporting on adverse events precluded analysis. Focused planning for larger, adequately dosed, well-designed trials is needed.
Collapse
Affiliation(s)
- Anita R Gross
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Haejung Lee
- Department of Physical Therapy, Silla University, Busan, Korea, South
| | - Jeanette Ezzo
- Research Director, JME Enterprises, Baltimore, Maryland, USA
| | - Nejin Chacko
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Geoffrey Gelley
- Applied Health Sciences PhD Program, University of Manitoba, Winnipeg, MB, Canada
- Integrative Medicine, University of Manitoba, Winnipeg, Canada
| | - Mario Forget
- Canadian Forces Health Services Group | Groupe de services de santé des Forces Canadiennes, National Defense | Défense Nationale, Kingston, Canada
| | - Annie Morien
- Research Department, Florida School of Massage, Gainesville, FL, USA
| | - Nadine Graham
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Pasqualina L Santaguida
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Craig Dixon
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
4
|
Fiore A, Papuga MO. Multimodal Care of a Patient With Functional Movement Disorders Following a Motor Vehicle Accident: A Case Report. J Chiropr Med 2023; 22:239-245. [PMID: 37644994 PMCID: PMC10461147 DOI: 10.1016/j.jcm.2023.03.010] [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: 09/21/2022] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 08/31/2023] Open
Abstract
Objective The purpose of this case report was to describe the multimodal care of a patient with the sudden onset of truncal tremors. Clinical Features A 30-year-old female patient presented for chiropractic care with truncal tremors following a motor vehicle accident. Initial outcome measures included the Neck Disability Index (50%) and Oswestry Disability Index (62). The patient's truncal tremors became worse during spinal cord compression testing that included passive cervical flexion and slouched posture. The Romberg test was positive for swaying. Assessments of active range of motions of the cervical, thoracic, and lumbar spine were moderately reduced in all ranges. Case history, physical examinations, diagnostic imaging, and neurology consultations led to a diagnosis of functional truncal tremors. The patient was being concurrently managed by other health care providers. Magnetic resonance imaging studies were ordered by a neurologist and primary medical physician, which showed no structural abnormalities in brain neuroanatomy or spine. Intervention and Outcome The multimodal chiropractic care included whole-body vibration therapy (WBVT), spinal manipulative therapy (SMT), and acupuncture therapy. The treatment plan included 8 weekly appointments in which the patient received WBVT and SMT. During treatment weeks 2 to 6, the patient received acupuncture therapy, which occurred immediately following their treatment appointment for WBVT and SMT. The patient practiced stress reduction techniques, as advised by the neurologist, eliminated caffeine, and performed daily yoga exercises for 30 minutes. The Romberg test was negative after the third treatment. The patient was discharged after chiropractic visit 12, 95 days post-accident, as she reached maximal medical improvement. Truncal tremors were still present, but the patient described them as "barely noticeable." Conclusion The patient reported improvement under a course of chiropractic care using a multimodal approach, including behavioral, pharmacological, and manual therapies. This case study suggests that WBVT, SMT, and acupuncture therapy may assist some patients with functional movement disorders.
Collapse
Affiliation(s)
- Alexandra Fiore
- Northeast College of Health Sciences, Seneca Falls, New York
| | - M. Owen Papuga
- Northeast College of Health Sciences, Seneca Falls, New York
| |
Collapse
|
5
|
Mete O, Kaya DO, Keskin M, Celenay ST. Western Massage Therapies in the Management of Neck Pain: A Systematic Review. J Manipulative Physiol Ther 2023:S0161-4754(23)00024-6. [PMID: 37422753 DOI: 10.1016/j.jmpt.2023.05.003] [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: 06/21/2022] [Revised: 04/16/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The purpose of this review was to compare types of Western massage therapy (MT) to other therapies, placebo, and no-treatment controls in neck pain (NP) in randomized and nonrandomized clinical trials. METHODS An electronic, systematic search was performed in 7 English and 2 Turkish databases (PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence-Based Database, ULAKBIM National Medical Database, and the Reference Directory of Turkey). The search terms "NP" and "massage" were used. Studies published between January 2012 and July 2021 were searched. Methodological quality was evaluated with Downs and Black Scale and version 2 of the Cochrane risk-of-bias tool. RESULTS A total of 932 articles were identified; 8 of them were eligible. The Downs and Black score ranged from 15 to 26 points. Two studies were rated as "fair," 3 studies as "good," and 3 studies as "excellent." According to version 2 of the Cochrane risk-of-bias tool, 3 studies had a low risk of bias, 3 studies had some concerns, and 2 studies had a high risk of bias. Fair evidence found that myofascial release therapy improved pain intensity and pain threshold compared to no intervention in the short term. Excellent evidence found that connective tissue massage with exercise improved pain intensity and pain threshold compared to exercise alone in the short term. No Western MTs were superior to other active therapies according to short-term and immediate effects. CONCLUSION This review suggests that Western MTs (myofascial release therapy and connective tissue massage) may improve NP, but studies are limited. This review showed that Western MTs were not superior to other active therapies for improving NP. The reviewed studies reported only immediate and short-term effects of Western MT; thus, high-quality randomized clinical trials investigating the long-term effects of Western MT are needed.
Collapse
Affiliation(s)
- Oguzhan Mete
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Katip Celebi University, İzmir, Turkey
| | - Merve Keskin
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Katip Celebi University, İzmir, Turkey
| | - Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey.
| |
Collapse
|
6
|
Budgell BS, Injeyan HS, Teodorczyk-Injeyan J. Effect of Seated Cervical Spinal Manipulation on Autonomic Nervous System Activity as Measured by Heart Rate Variability and Plasma Norepinephrine Levels: A randomized Pre- and Poststudy. J Manipulative Physiol Ther 2023; 46:220-228. [PMID: 38483415 DOI: 10.1016/j.jmpt.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 11/22/2023] [Accepted: 02/02/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE The objective of this study was to determine whether seated cervical manipulation produced changes in autonomic nervous system activity, as measured by heart rate variability and plasma norepinephrine levels. METHODS Ninety-five healthy young adults (ages 20-48 years) were recruited into a single-blinded physiological study, with 47 randomized to a seated cervical manipulation and 44 randomized to a sham procedure. Heart rate variability in the frequency domain, and plasma norepinephrine levels were measured prior to, immediately following, and 5 minutes following the intervention. RESULTS Electrocardiograms were obtained from 39 subjects in the sham group and 43 subjects in the manipulation group. No statistically significant changes were found in measures of heart rate variability in the frequency domain in either the manipulation or sham groups. Blood samples were obtained from 22 subjects in the sham group and 27 subjects in the manipulation group. Plasma norepinephrine levels, as measured by spectrophotometry, declined in both groups from pre- to immediately postintervention, and they remained at decreased levels 5 minutes after the interventions. There were no statistically significant differences between groups in pre- or postintervention norepinephrine levels. CONCLUSIONS Measures of heart rate variability and plasma norepinephrine levels did not show that seated cervical manipulation produced short-term changes in autonomic nervous system activity compared to a sham procedure in healthy young adults.
Collapse
Affiliation(s)
- Brian S Budgell
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - H Stephen Injeyan
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Julita Teodorczyk-Injeyan
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Cholewicki J, Popovich JM, Reeves NP, DeStefano LA, Rowan JJ, Francisco TJ, Prokop LL, Zatkin MA, Lee AS, Sikorskii A, Pathak PK, Choi J, Radcliffe CJ, Ramadan A. The effects of osteopathic manipulative treatment on pain and disability in patients with chronic neck pain: A single-blinded randomized controlled trial. PM R 2022; 14:1417-1429. [PMID: 34719122 PMCID: PMC9054945 DOI: 10.1002/pmrj.12732] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neck pain (NP) affects up to 70% of individuals at some point in their lives. Systematic reviews indicate that manual treatments can be moderately effective in the management of chronic, nonspecific NP. However, there is a paucity of studies specifically evaluating the efficacy of osteopathic manipulative treatment (OMT). OBJECTIVE To evaluate the efficacy of OMT in reducing pain and disability in patients with chronic NP. DESIGN Single-blinded, cross-over, randomized-controlled trial. SETTING University-based, osteopathic manipulative medicine outpatient clinic. PARTICIPANTS Ninety-seven participants, 21 to 65 years of age, with chronic, nonspecific NP. INTERVENTIONS Participants were randomized to two trial arms: immediate OMT intervention or waiting period first. The intervention consisted of three to four OMT sessions over 4 to 6 weeks, after which the participants switched groups. MAIN OUTCOME MEASURES Primary outcome measures were pain intensity (average and current) on the numerical rating scale and Neck Disability Index. Secondary outcomes included Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) health domains and Fear Avoidance Beliefs Questionnaire. Outcomes obtained prior to the cross-over allocation were evaluated using general linear models and after adjusting for baseline values. RESULTS A total of 38 and 37 participants were available for the analysis in the OMT and waiting period groups, respectively. The results showed significantly better primary outcomes in the immediate OMT group for reductions in average pain (-1.02, 95% confidence interval [CI] -1.72, -0.32; p = .005), current pain (-1.02, 95% CI -1.75, -0.30; p = .006), disability (-5.30%, 95% CI -9.2%, -1.3%; p = .010) and improved secondary outcomes (PROMIS) related to sleep (-3.25, 95% CI -6.95, -1.54; p = .003), fatigue (-3.26, 95% CI -6.04, -0.48; p = .022), and depression (-2.59, 95% CI -4.73, -0.45; p = .018). The effect sizes were in the clinically meaningful range between 0.5 and 1 standard deviation. No study-related serious adverse events were reported. CONCLUSIONS OMT is relatively safe and effective in reducing pain and disability along with improving sleep, fatigue, and depression in patients with chronic NP immediately following treatment delivered over approximately 4 to 6 weeks.
Collapse
Affiliation(s)
- Jacek Cholewicki
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Center for Neuromusculoskeletal Clinical Research (CNCR), Michigan State University, East Lansing, Michigan, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - John M. Popovich
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Center for Neuromusculoskeletal Clinical Research (CNCR), Michigan State University, East Lansing, Michigan, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - N. Peter Reeves
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Sumaq Life, LLC, East Lansing, Michigan, USA
| | - Lisa A. DeStefano
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Center for Neuromusculoskeletal Clinical Research (CNCR), Michigan State University, East Lansing, Michigan, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Jacob J. Rowan
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Center for Neuromusculoskeletal Clinical Research (CNCR), Michigan State University, East Lansing, Michigan, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Timothy J. Francisco
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Lawrence L. Prokop
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Department of Physical Medicine & Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Mathew A. Zatkin
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Center for Neuromusculoskeletal Clinical Research (CNCR), Michigan State University, East Lansing, Michigan, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Angela S. Lee
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Center for Neuromusculoskeletal Clinical Research (CNCR), Michigan State University, East Lansing, Michigan, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Pramod K. Pathak
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Department of Statistics and Probability, College of Natural Science, Michigan State University, East Lansing, Michigan, USA
| | - Jongeun Choi
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing, Michigan, USA
- Department of Electrical and Computer Engineering, College of Engineering, Michigan State University, East Lansing, Michigan, USA
- Present affiliation: School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Clark J. Radcliffe
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Ahmed Ramadan
- Center for Orthopedic Research (MSUCOR), Michigan State University, East Lansing, Michigan, USA
- Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing, Michigan, USA
- Present affiliation: Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
8
|
Zhang X, Yang Y, Shen YW, Zhang KR, Ma LT, Ding C, Wang BY, Meng Y, Liu H. Quality of online video resources concerning patient education for neck pain: A YouTube-based quality-control study. Front Public Health 2022; 10:972348. [PMID: 36211682 PMCID: PMC9533122 DOI: 10.3389/fpubh.2022.972348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/24/2022] [Indexed: 01/25/2023] Open
Abstract
Background More than 70 percent of the world's population is tortured with neck pain more than once in their vast life, of which 50-85% recur within 1-5 years of the initial episode. With medical resources affected by the epidemic, more and more people seek health-related knowledge via YouTube. This article aims to assess the quality and reliability of the medical information shared on YouTube regarding neck pain. Methods We searched on YouTube using the keyword "neck pain" to include the top 50 videos by relevance, then divided them into five and seven categories based on their content and source. Each video was quantitatively assessed using the Journal of American Medical Association (JAMA), DISCERN, Global Quality Score (GQS), Neck Pain-Specific Score (NPSS), and video power index (VPI). Spearman correlation analysis was used to evaluate the correlation between JAMA, GQS, DISCERN, NPSS and VPI. A multiple linear regression analysis was applied to identify video features affecting JAMA, GQS, DISCERN, and NPSS. Results The videos had a mean JAMA score of 2.56 (SD = 0.43), DISCERN of 2.55 (SD = 0.44), GQS of 2.86 (SD = 0.72), and NPSS of 2.90 (SD = 2.23). Classification by video upload source, non-physician videos had the greatest share at 38%, and sorted by video content, exercise training comprised 40% of the videos. Significant differences between the uploading sources were observed for VPI (P = 0.012), JAMA (P < 0.001), DISCERN (P < 0.001), GQS (P = 0.001), and NPSS (P = 0.007). Spearman correlation analysis showed that JAMA, DISCERN, GQS, and NPSS significantly correlated with each other (JAMA vs. DISCERN, p < 0.001, JAMA vs. GQS, p < 0.001, JAMA vs. NPSS, p < 0.001, DISCERN vs. GQS, p < 0.001, DISCERN vs. NPSS, p < 0.001, GQS vs. NPSS, p < 0.001). Multiple linear regression analysis suggested that a higher JAMA score, DISCERN, or GQS score were closely related to a higher probability of an academic, physician, non-physician or medical upload source (P < 0.005), and a higher NPSS score was associated with a higher probability of an academic source (P = 0.001) than of an individual upload source. Conclusions YouTube videos pertaining to neck pain contain low quality, low reliability, and incomplete information. Patients may be put at risk for health complications due to inaccurate, and incomplete information, particularly during the COVID-19 crisis. Academic groups should be committed to high-quality video production and promotion to YouTube users.
Collapse
|
9
|
Zhao J, Cai Q, Jiang D, Wang L, He H, Chen S, Jia W, Zhang C. The Impact of COVID-19 on SARSCoV-2-Negative Elderly Patients with Hip Fractures: A Single-Center Retrospective Study from Shanghai, China. Clin Interv Aging 2022; 17:991-999. [PMID: 35799949 PMCID: PMC9255716 DOI: 10.2147/cia.s374083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) has brought an unprecedented change in wellbeing globally. The spread of the pandemic reportedly reduced the incidence of activity-related trauma, while that of fragility fractures remained stable. Here, we aimed to identify the risk factors associated with the prognosis of SARS-CoV-2 negative elderly patients with hip fractures. Patients and Methods This retrospective study included elderly patients with hip fractures between 1st January and 9th May during the COVID-19 pandemic (Experiment group) and the same period from 2017 to 2019 (Control group). Perioperative mortality, complications, and functional recovery were compared between two groups of different time frame in the total cohort and patients who received surgical treatment. Multiple linear regression was carried out to identify the risk factors influencing the prognosis of COVID-negative elderly patients with hip fractures. Results The proportion of patients with admission time less than 24 hours and the 6-month postoperative Parker score were significantly decreased during COVID-19 compared with the pre-COVID-19 period (p < 0.001). Multiple linear regression demonstrated that TTA (defined as time from injury to admission), rehabilitation after discharge and outpatient follow-up were associated with the 6-month Parker score in the total population (p < 0.001) and in patients who received surgical treatment (p < 0.001). Conclusion Elderly patients with hip fractures had a poorer prognosis in epidemic period despite being COVID-19 negative. Factors including timely admission, postoperative follow-up, and rehabilitation could optimize safety and significantly improve the prognosis of elderly COVID-19 negative patients with hip fractures, even during a pandemic.
Collapse
Affiliation(s)
- Jinhui Zhao
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Qianying Cai
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Dajun Jiang
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Lingtian Wang
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Haiyan He
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Shengbao Chen
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Weitao Jia
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Correspondence: Weitao Jia; Changqing Zhang, Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China, Tel +86-18930173388; +86-21-64701361, Email ;
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Shanghai Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| |
Collapse
|
10
|
Xue F, Chen Z, Yang H, Chen T, Li Y. Effects of cervical rotatory manipulation on the cervical spinal cord: a finite element study. J Orthop Surg Res 2021; 16:737. [PMID: 34952620 PMCID: PMC8710013 DOI: 10.1186/s13018-021-02885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little information is available concerning the biomechanism involved in the spinal cord injury after cervical rotatory manipulation (CRM). The primary purpose of this study was to explore the biomechanical and kinematic effects of CRM on a healthy spinal cord. METHODS A finite element (FE) model of the basilaris cranii, C1-C7 vertebral bodies, nerve root complex and vertebral canal contents was constructed and validated against in vivo and in vitro published data. The FE model simulated CRM in the flexion, extension and neutral positions. The stress distribution, forma and relative position of the spinal cord were observed. RESULTS Lower von Mises stress was observed on the spinal cord after CRM in the flexion position. The spinal cord in CRM in the flexion and neutral positions had a lower sagittal diameter and cross-sectional area. In addition, the spinal cord was anteriorly positioned after CRM in the flexion position, while the spinal cord was posteriorly positioned after CRM in the extension and neutral positions. CONCLUSION CRM in the flexion position is less likely to injure the spinal cord, but caution is warranted when posterior vertebral osteophytes or disc herniations exist.
Collapse
Affiliation(s)
- Fan Xue
- School of Traditional Chinese Medicine, Southern Medical University, Baiyun District, Guangzhou, Guangdong Province, China
| | - Zujiang Chen
- School of Traditional Chinese Medicine, Southern Medical University, Baiyun District, Guangzhou, Guangdong Province, China
| | - Han Yang
- School of Traditional Chinese Medicine, Southern Medical University, Baiyun District, Guangzhou, Guangdong Province, China
| | - Taijun Chen
- Zunyi Medical and Pharmaceutical College, Pingan District, Zunyi, Guizhou Province, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Baiyun District, Guangzhou, Guangdong Province, China.
| |
Collapse
|
11
|
Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. FRONTIERS IN PAIN RESEARCH 2021; 2:765921. [PMID: 35295422 PMCID: PMC8915715 DOI: 10.3389/fpain.2021.765921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.
Collapse
Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Arantxa Ortega de Mues
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Mathieu Piché
| |
Collapse
|
12
|
Gao Z, Yin T, Lan L, Li D, Sun R, Ha G, Jiang C, Shao X, He Z, Ji L, Zeng F. Efficacy and central mechanism of acupuncture treatment in patients with neck pain: study protocol for a randomized controlled trial. Trials 2021; 22:536. [PMID: 34391451 PMCID: PMC8364082 DOI: 10.1186/s13063-021-05507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acupuncture is effective for reducing the symptoms of neck pain (NP). However, the underlying mechanisms are not fully elucidated. Based on evaluating the efficacy of two acupuncture prescriptions for treating NP, this study aims to investigate the potential central mechanism of acupuncture treatment for NP by functional magnetic resonance imaging (fMRI). Methods This is a randomized controlled trial; 86 patients will be randomly assigned into two acupuncture treatment groups at a ratio of 1:1. The whole study period includes 2 weeks baseline, 2 weeks treatments, and 12 weeks follow-up (4 and 12 weeks after treatment). The pain severity, the neck disability index, the cervical range of motion, and the pressure pain threshold, etc., will be used to evaluate the clinical efficacy of two acupuncture prescriptions for NP treatment. The MRI scans will be performed to detect cerebral activity changes of 20 patients in each group. The clinical data and MRI data will be analyzed, respectively. Pearson correlation coefficient will be used to evaluate the association between changes of cerebral activity features and improvement of clinical symptoms. Discussion The results will provide further evidence for the clinical application of acupuncture in the treatment of NP. Trial registration Chinese Clinical Trial Registry ChiCTR2000040930. Registered on 16 December 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05507-y.
Collapse
Affiliation(s)
- Zhen Gao
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Tao Yin
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Lei Lan
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Dehua Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Ruirui Sun
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Guodong Ha
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Caili Jiang
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Xin Shao
- Sichuan Integrated Medicine Hospital, Chengdu, 610041, Sichuan, China
| | - Zhaoxuan He
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Laixi Ji
- Graduate Faculty, Shanxi University of Traditional Chinese Medicine, 121# University Street, Jinzhong, 030619, Shanxi, China.
| | - Fang Zeng
- Brain Research Center, Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.
| |
Collapse
|
13
|
George SZ, Lentz TA, Goertz CM. Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health. Transl Res 2021; 234:129-140. [PMID: 33901699 PMCID: PMC8340679 DOI: 10.1016/j.trsl.2021.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain. First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.
Collapse
Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Trevor A Lentz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine M Goertz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| |
Collapse
|
14
|
Rampazo ÉP, Martignago CCS, de Noronha M, Liebano RE. Transcutaneous electrical stimulation in neck pain: A systematic review and meta-analysis. Eur J Pain 2021; 26:18-42. [PMID: 34288255 DOI: 10.1002/ejp.1845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this systematic review was to investigate the effectiveness of electrical stimulation (ES) for neck pain (NP). DATABASES AND DATA TREATMENT The databases CINAHL, Embase, MEDLINE (via OVID), PEDro and Web of Science were searched, with no date restrictions. Two independent reviewers selected randomized controlled trials (RCTs) reporting pain, range of motion or psychosocial factors in people with NP, in which ES was applied. Methodological quality was assessed using the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the quality of evidence. Thirty studies met eligibility criteria. RESULTS Main results showed evidence of moderate quality that ES combined with other intervention significantly decreases the pain intensity compared to other intervention immediately post-treatment and at short-term follow-up; evidence of low quality showed significant effects of ES combined with other intervention in decreasing neck disability compared to other intervention immediately post-treatment; evidence of very-low quality that ES increased the pressure pain threshold compared to placebo immediately post-treatment and that ES + other intervention also increased the pressure pain threshold compared to other intervention at short-term follow-up. CONCLUSIONS ES combined with other intervention seems to be useful to relieve pain and to improve disability in people with NP, however, more studies are needed. SIGNIFICANCE Electrical stimulation seems to be effective for improving pain intensity, immediately post-treatment in people with neck pain, mainly as an adjunct therapeutic modality. Nevertheless, high-quality RCTs are still needed to investigate the efficacy of electrical stimulation in neck pain.
Collapse
Affiliation(s)
- Érika Patrícia Rampazo
- Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Cintia Cristina Santi Martignago
- Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Marcos de Noronha
- Rural Department of Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| |
Collapse
|
15
|
Rampazo ÉP, da Silva VR, de Andrade ALM, Back CGN, Madeleine PM, Arendt-Nielsen L, Liebano RE. Sensory, Motor, and Psychosocial Characteristics of Individuals With Chronic Neck Pain: A Case-Control Study. Phys Ther 2021; 101:pzab104. [PMID: 33774667 DOI: 10.1093/ptj/pzab104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Given the complex and unclear etiology of neck pain, it is important to understand the differences in central sensitization as well as psychosocial factors in individuals with chronic neck pain and healthy controls. The purpose of this study was to benchmark differences in central sensitization, psychosocial factors, and range of motion between people with nonspecific chronic neck pain and healthy controls and to analyze the correlation between pain intensity, neck disability, and psychosocial factors in people with chronic neck pain. METHODS Thirty individuals with chronic neck pain and 30 healthy controls were included in this case-control study. Outcome measures were as follows: central sensitization (pressure pain threshold, temporal summation, and conditioned pain modulation), psychosocial factors (depressive symptoms, pain catastrophizing, and quality of life), and active cervical range of motion. RESULTS People with neck pain had lower local pressure pain threshold, a decrease in conditioned pain modulation, more depressive symptoms, greater pain catastrophizing, lower quality of life, and reduced range of motion for neck rotation when compared with healthy controls. In people with neck pain, moderate correlations were observed between pain intensity and quality of life (ρ = -0.479), disability and pain catastrophizing (ρ = 0.379), and disability and quality of life (ρ = -0.456). CONCLUSIONS People with neck pain have local hyperalgesia, impaired conditioning pain modulation, depressive symptoms, pain catastrophizing, low quality of life, and reduced active range of motion during neck rotation, which should be taken into account during assessment and treatment. IMPACT This study shows that important outcomes, such as central sensitization and psychosocial factors, should be considered during assessment and treatment of individuals with nonspecific chronic neck pain. In addition, pain intensity and neck disability are correlated with psychosocial factors.
Collapse
Affiliation(s)
- É P Rampazo
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - V R da Silva
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - A L M de Andrade
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - C G N Back
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - P M Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - L Arendt-Nielsen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology School of Medicine, Aalborg University, Aalborg, Denmark
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP Brazil, CEP: 13565-905
| |
Collapse
|
16
|
Qing W, Shi X, Zhang Q, Peng L, He C, Wei Q. Effect of Therapeutic Ultrasound for Neck Pain: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 102:2219-2230. [PMID: 33722564 DOI: 10.1016/j.apmr.2021.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/18/2020] [Accepted: 02/02/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the effects and safety of therapeutic ultrasound in patients with neck pain. DATA SOURCES The PubMed, EMBASE, CENTRAL, and Physiotherapy Evidence databases were searched for articles published before December 1, 2020. STUDY SELECTION Randomized controlled trials that compared the effects of therapeutic ultrasound on neck pain were included in this review. The included studies compared therapeutic ultrasound plus other treatments with the other treatments alone or compared therapeutic ultrasound with sham or no treatment. Outcome measures involved the effects on pain, disability, and quality of life. Other treatments included all nonultrasonic therapies (eg, various exercises, massage, electrotherapy). DATA EXTRACTION Data on the study population, therapeutic ultrasound intervention, combined intervention, outcome measures, and follow-up were extracted. DATA SYNTHESIS Twelve randomized controlled trials (705 patients) fulfilled the inclusion criteria. Seven studies compared therapeutic ultrasound plus other treatments vs the other treatments alone (449 patients). Therapeutic ultrasound yielded additional benefits for pain, but there was high heterogeneity and we could not draw a clear conclusion. Ultrasound did not have a better effect on disability or quality of life when it was combined with other treatments. Five studies compared therapeutic ultrasound with sham or no treatment (256 patients), and the pooled data showed that therapeutic ultrasound significantly reduced pain intensity. No adverse events of therapeutic ultrasound were reported in the included studies. CONCLUSIONS Therapeutic ultrasound may reduce the intensity of pain more than sham or no treatment, and it is a safe treatment. Whether therapeutic ultrasound in combination with other conventional treatments produced additional benefits on pain intensity, disability, or quality of life is not clear. The randomized trials included in this review had different levels of quality and high heterogeneity. A large trial using a valid methodology is warranted.
Collapse
Affiliation(s)
- Wanyi Qing
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Xian Shi
- School of Medicine, Guilin Medical University, Guilin, Guangxi, PR China
| | - Qing Zhang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China.
| |
Collapse
|
17
|
Duquette SA, Starmer DJ, Plener JB, BSc DAG. A pilot study to determine the consistency of peak forces during cervical spine manipulation utilizing mannequins. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:8-13. [PMID: 32930333 PMCID: PMC7958664 DOI: 10.7899/jce-18-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/04/2019] [Accepted: 10/15/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Cervical spine manipulation is a complex motor skill used to treat musculoskeletal ailments such as neck pain. There is evidence demonstrating the effectiveness of objective feedback and mannequins for the teaching of spinal manipulation (SM) in the thoracic and lumbar spine. This paper examines the effectiveness of an educational intervention combining both mannequins and force-sensing technology for teaching cervical SM. METHODS Fourth-year chiropractic interns were separated into 2 groups: an intervention group and a group trained with the standard curriculum. The intervention included a 60-minute educational session focused on targeting 100 N total peak force cervical manipulations on mannequins, with objective feedback through force-sensing table technology. Pre- and post-CMs were recorded on both a mannequin and a paired student partner, with an attempt to have a target total peak force of 100 N. RESULTS Ninety students were recruited. The invention group (n = 46) scored significantly better at the outcome compared to the control group (n = 44) when manipulating the mannequin (p = .003). These improvements did not carry over when manipulating a paired human partner (p = .067). CONCLUSION Following a 1-hour cervical SM educational intervention utilizing thrusting on mannequins and force-sensing table technology, students demonstrated improved peak force control for SM delivered on the mannequin. However, this improvement was not carried over to SM delivered on human subjects.
Collapse
|
18
|
Corum M, Aydin T, Medin Ceylan C, Kesiktas FN. The comparative effects of spinal manipulation, myofascial release and exercise in tension-type headache patients with neck pain: A randomized controlled trial. Complement Ther Clin Pract 2021; 43:101319. [PMID: 33517104 DOI: 10.1016/j.ctcp.2021.101319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/19/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the effects of two manual treatment methods on pain, disability, and pressure pain threshold (PPT) in tension-type headache (TTH) patients with and neck pain. METHODS Forty-five patients with TTH were randomly assigned to one of three groups and received eight sessions treatment: manipulation plus exercise (manipulation), suboccipital inhibition plus exercise (myofascial release), and exercise only (control). Headache frequency, pain severity (VAS-headache, VAS-neck pain) and headache and neck disability (HIT-6 and NDI, respectively) were measured at baseline, posttreatment, and at the third month follow-up. PPT was also evaluated on the temporalis muscle. RESULTS Manipulation group was statistically better than myofascial release group in terms of headache frequency, headache severity, and PPT scores. Also, manipulation group showed statistically significant improvements in all outcome criteria when compared control group. CONCLUSIONS Manipulation and exercise, in addition to pharmacologic treatment in TTH patients with cervical dysfunction appear to be a promising approach.
Collapse
Affiliation(s)
- Mustafa Corum
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey.
| | - Tugba Aydin
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey.
| | - Cansın Medin Ceylan
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey.
| | - Fatma Nur Kesiktas
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey.
| |
Collapse
|
19
|
Affiliation(s)
- Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
| |
Collapse
|
20
|
Dorji K, Graham N, Macedo L, Gravesande J, Goldsmith CH, Gelley G, Rice M, Solomon P. The effect of ultrasound or phonophoresis as an adjuvant treatment for non-specific neck pain: systematic review of randomised controlled trials. Disabil Rehabil 2020; 44:2968-2974. [PMID: 33253599 DOI: 10.1080/09638288.2020.1851785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the effectiveness of ultrasound/phonophoresis as an adjuvant to exercise or manual therapy for the improvement of patient-centred outcomes in adults with non-specific neck pain (NSNP). METHODS Seven electronic databases were systematically searched up to September 2020. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to judge the Quality of Evidence (QoE). RESULTS Six studies involving 249 participants were included. The QoE was very low GRADE. Phonophoresis with capsaicin plus exercise improved pain at immediate post-treatment (MD: -3.30 [-4.05, -2.55]) but not with diclofenac sodium plus exercise as compared to exercise. Continuous ultrasound (CUS) plus exercise improved pain and pressure pain threshold (PPT) at immediate post-treatment (pain: MD: -3.42 [-4.08, -2.7]); (PPT: MD: 0.91 [0.68, 1.14]) and at intermediate-term as compared to exercise. CUS or high power pain threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD: -0.75 [-2.08, 0.58]) did not improve function/disability (MD: -1.05 [-4.27, 2.17]) at immediate or short-term as compared to manual therapy and exercise. CONCLUSIONS Due to high risk of bias, inconsistency, and indirectness the QoE is very low in support of benefit of ultrasound/phonophoresis as an adjuvant treatment for NSNP.Implication for rehabilitationDue to high risk of bias, inconsistency, and indirectness the quality of evidence (QoE) is very low in support of benefit of adding ultrasound or phonophoresis to exercise or manual therapy for pain reduction or improvement in function/disability for those with sub-acute and chronic myofascial associated neck pain. However, our confidence in the findings is very low and conclusions are likely to change as more evidences emerges.Clinicians using ultrasound therapy as an adjuvant intervention for management of chronic myofascial associated neck pain should carefully consider the available evidence on ultrasound, including the benefits and costs involved.
Collapse
Affiliation(s)
- Kinley Dorji
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Nadine Graham
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | | | - Charles H Goldsmith
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Geoffrey Gelley
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Maureen Rice
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| |
Collapse
|
21
|
Hok P, Hlustik P. Modulation of the human sensorimotor system by afferent somatosensory input: evidence from experimental pressure stimulation and physiotherapy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:371-379. [PMID: 33205755 DOI: 10.5507/bp.2020.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
Peripheral afferent input is critical for human motor control and motor learning. Both skin and deep muscle mechanoreceptors can affect motor behaviour when stimulated. Whereas some modalities such as vibration have been employed for decades to alter cutaneous and proprioceptive input, both experimentally and therapeutically, the central effects of mechanical pressure stimulation have been studied less frequently. This discrepancy is especially striking when considering the limited knowledge of the neurobiological principles of frequently used physiotherapeutic techniques that utilise peripheral stimulation, such as reflex locomotion therapy. Our review of the available literature pertaining to pressure stimulation focused on transcranial magnetic stimulation (TMS) and neuroimaging studies, including both experimental studies in healthy subjects and clinical trials. Our search revealed a limited number of neuroimaging papers related to peripheral pressure stimulation and no evidence of effects on cortical excitability. In general, the majority of imaging studies agreed on the significant involvement of cortical motor areas during the processing of pressure stimulation. Recent data also point to the specific role of subcortical structures, such as putamen or brainstem reticular formation. A thorough comparison of the published results often demonstrated, however, major inconsistencies which are thought to be due to variable stimulation protocols and statistical power. In conclusion, localised peripheral sustained pressure is a potent stimulus inducing changes in cortical activation within sensory and motor areas. Despite historical evidence for modulation of motor behaviour, no direct link can be established based on available fMRI and electrophysiological data. We highlight the limited amount of research devoted to this stimulus modality, emphasise current knowledge gaps, present recent developments in the field and accentuate evidence awaiting replication or confirmation in future neuroimaging and electrophysiological studies.
Collapse
Affiliation(s)
- Pavel Hok
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc, and University Hospital Olomouc, Czech Republic
| | - Petr Hlustik
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc, and University Hospital Olomouc, Czech Republic
| |
Collapse
|
22
|
Coffeng SM, Jacobs B, de Koning ME, Hageman G, Roks G, van der Naalt J. Patients with mild traumatic brain injury and acute neck pain at the emergency department are a distinct category within the mTBI spectrum: a prospective multicentre cohort study. BMC Neurol 2020; 20:315. [PMID: 32847526 PMCID: PMC7450585 DOI: 10.1186/s12883-020-01887-x] [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: 01/03/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute neck pain (ANP) has recently been demonstrated to be a predictor of persistent posttraumatic complaints after mild traumatic brain injury (mTBI). The aim of this study was to determine specific characteristics of patients with ANP following mTBI, their posttraumatic complaints and relationship with functional outcome. METHODS Data from a prospective follow-up study of 922 mTBI patients admitted to the emergency department (ED) in three level-one trauma centres were analysed. Patients were divided into two groups: 156 ANP patients and 766 no acute neck pain (nANP) patients. Posttraumatic complaints were evaluated 2 weeks and 6 months post-injury using standardized questionnaires and functional outcome was evaluated at 6 months with the Glasgow Outcome Scale Extended (GOSE). RESULTS ANP patients were more often female (p < 0.01), younger (38 vs. 47 years, p < 0.01) with more associated acute symptoms at the ED (p < 0.05) compared to nANP patients. More motor vehicle accidents (12% vs. 6%, p = 0.01) and less head wounds (58% vs. 73%, p < 0.01) in ANP patients indicated 'high-energy low-impact' trauma mechanisms. ANP patients showed more posttraumatic complaints 2 weeks and 6 months post-injury (p < 0.05) and more often incomplete recovery (GOSE < 8) was present after 6 months (56% vs. 40%, p = 0.01). CONCLUSIONS MTBI patients with acute neck pain at the ED constitute a distinct group within the mTBI spectrum with specific injury and demographic characteristics. Early identification of this at risk group already at the ED might allow specific and timely treatment to avoid development of incomplete recovery.
Collapse
Affiliation(s)
- Sophie M Coffeng
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Myrthe E de Koning
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerard Hageman
- Department of Neurology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth Tweesteden Hospital Tilburg, Tilburg, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
23
|
Joshi S, Balthillaya G, Neelapala YVR. Immediate effects of cervicothoracic junction mobilization versus thoracic manipulation on the range of motion and pain in mechanical neck pain with cervicothoracic junction dysfunction: a pilot randomized controlled trial. Chiropr Man Therap 2020; 28:38. [PMID: 32762708 PMCID: PMC7412667 DOI: 10.1186/s12998-020-00327-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Cervicothoracic (CT) junction hypomobility has been proposed as a contributing factor for neck pain. However, there are limited studies that compared the effect of CT junction mobilization against an effective intervention in neck pain. Thoracic spine manipulation is a nonspecific intervention for neck pain where remote spinal segments are treated based on the concept of regional interdependence. The effectiveness of segment-specific spinal mobilization in the cervical spine has been researched in the last few years, and no definite conclusions could be made from the previous studies. The above reasons warrant the investigation of the effects of a specific CT junction mobilization against a nonspecific thoracic manipulation intervention in neck pain. The present study aims to compare the immediate effects of C7-T1 Maitland mobilization with thoracic manipulation in individuals with mechanical neck pain presenting with CT junction dysfunction specifically. Methods A randomized clinical trial is conducted where participants with complaints of mechanical neck pain and CT junction dysfunction randomly assigned to either C7-T1 level Maitland mobilization group or mid-thoracic (T3-T6) manipulation group (active control group). In both the groups, the post graduate student (SJ) pursuing Master’s in orthopedic physiotherapy delivered the intervention. The outcomes of cervical flexion, extension, side flexion & rotation range of motion (ROM) were measured before & after the intervention with a cervical range of motion (CROM) device. Self-reported pain intensity was measured with the numerical pain rating scale (NPRS). The post-intervention between-group comparison was performed using a one-way ANCOVA test. Results Forty-two participants with mean age CT junction group: 35.14 ± 10.13 and Thoracic manipulation group: 38.47 ± 11.47 were recruited for the study. No significant differences in the post-intervention baseline adjusted outcomes of cervical ROM & self-reported pain intensity were identified between the groups after the treatment (p = 0.08, 0.95, 0.01, 0.39, 0.29, 0.27for flexion, extension, bilateral lateral flexion & rotations respectively) & neck pain intensity (p = 0.68). However, within-group, pre, and post comparison showed significant improvements in cervical ROM and pain in both groups. Conclusion This preliminary study identified that CT junction mobilization is not superior to thoracic manipulation on the outcomes of cervical ROM and neck pain when level-specific CT junction mobilization was compared with remote mid-thoracic manipulation in individuals with mechanical neck pain and CT junction dysfunction. Trial registration CTRI: 2018/04/013088, Registered 6 April 2018, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24418
Collapse
Affiliation(s)
- Shriya Joshi
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Balthillaya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Y V Raghava Neelapala
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| |
Collapse
|
24
|
Short-term effects of chiropractic application and dry needling treatment on chronic mechanical neck pain. MANUELLE MEDIZIN 2020. [DOI: 10.1007/s00337-020-00695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
25
|
Primary odynophonia: When pain is out of proportion to dysphonia. Laryngoscope 2020; 130:E183-E189. [DOI: 10.1002/lary.28154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/14/2019] [Accepted: 06/10/2019] [Indexed: 11/07/2022]
|
26
|
Neck Muscle Stiffness Measured With Shear Wave Elastography in Women With Chronic Nonspecific Neck Pain. J Orthop Sports Phys Ther 2020; 50:179-188. [PMID: 31905095 DOI: 10.2519/jospt.2020.8821] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Utilizing shear wave elastography, we compared the stiffness of the neck extensor muscles and the stiffness in muscle-specific regions between women with chronic nonspecific neck pain and asymptomatic controls. DESIGN Cross-sectional observational study. METHODS We measured the average muscle stiffness over multiple neck extensor muscles and in regions corresponding approximately to the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles using ultrasound shear wave elastography in 20 women with chronic nonspecific neck pain and 18 asymptomatic women during multiple tasks. The measurements were automatically quality controlled and computer processed over the complete visible neck region or a large muscle-specific region. RESULTS Pooled over all tasks, neck muscle stiffness was not significantly different between those with neck pain and asymptomatic controls (neck pain median, 11.6 kPa; interquartile range, 8.9 kPa and control median, 13.3 kPa; interquartile range, 8.6 kPa; P = .175). The measure of neck muscle stiffness was not correlated with the intensity of neck pain or perceived disability. CONCLUSION Shear wave elastography revealed similar muscle stiffness in people with and without chronic neck pain, despite the sensation of increased neck stiffness in those with chronic neck pain. Therapeutic interventions aiming to reduce neck muscle tone are often based on the assumption that perceived neck stiffness corresponds to objective muscle stiffness. The current results question this assumption. J Orthop Sports Phys Ther 2020;50(4):179-188. Epub 6 Jan 2020. doi:10.2519/jospt.2020.8821.
Collapse
|
27
|
Stuart S, Armstrong M, Sewell J, Dixon C, Morris R. Acupuncture for whiplash-associated disorder following road traffic collision: a physiotherapy service evaluation. Acupunct Med 2020; 38:272-278. [PMID: 32026700 DOI: 10.1177/0964528419899660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whiplash-associated disorder (WAD) is a common musculoskeletal condition that frequently occurs following a road traffic collision. Physiotherapy is often prescribed to help with the symptoms and injuries. Research evidence has demonstrated that acupuncture may be beneficial, but no studies have examined the routine clinical use of acupuncture by physiotherapists for treatment of WAD. Therefore, a physiotherapy service evaluation was conducted to examine the effects of acupuncture on WAD following a road traffic collision. METHODS This study involved 87 patients who attended a private physiotherapy practice following a road traffic collision after referral by their solicitor as part of a personal injury claim. Patients were included if they had been diagnosed with WAD (grades I-III) and received acupuncture as part of their treatment. An average of three sessions of acupuncture were received, which primarily involved needling of traditional acupuncture points and/or myofascial trigger points of the neck and upper/lower back. RESULTS Pain significantly reduced (p < 0.001). Musculoskeletal outcome measures including neck disability index, Oswestry low back pain scale and Quick disabilities of the arm, shoulder and hand (Quick-DASH) scale also significantly improved (all p < 0.001). Adverse events were minor. The majority of the patients (n = 66) were able to return to full-work duties following treatment. CONCLUSION Acupuncture appears to be an effective clinical treatment for WAD following a road traffic collision and should be considered by physiotherapists working with such patient groups.
Collapse
Affiliation(s)
- Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Department of Neurology, Oregon Health & Science University, Portland, OR, USA.,Institute of Neuroscience and Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Armstrong
- The North East Clinic, On Medical Ltd., Newcastle upon Tyne, UK.,Newcastle United Football Club Academy, Newcastle upon Tyne, UK
| | - Jennifer Sewell
- The North East Clinic, On Medical Ltd., Newcastle upon Tyne, UK
| | - Cheryl Dixon
- The North East Clinic, On Medical Ltd., Newcastle upon Tyne, UK
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Department of Neurology, Oregon Health & Science University, Portland, OR, USA.,Institute of Neuroscience and Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
28
|
Rodríguez-Huguet M, Rodríguez-Almagro D, Rodríguez-Huguet P, Martín-Valero R, Lomas-Vega R. Treatment of Neck Pain With Myofascial Therapies: A Single Blind Randomized Controlled Trial. J Manipulative Physiol Ther 2020; 43:160-170. [DOI: 10.1016/j.jmpt.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 10/24/2022]
|
29
|
Kovacs FM, Seco-Calvo J, Fernández-Félix BM, Zamora J, Royuela A, Muriel A. Predicting the evolution of neck pain episodes in routine clinical practice. BMC Musculoskelet Disord 2019; 20:620. [PMID: 31878906 PMCID: PMC6933702 DOI: 10.1186/s12891-019-2962-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The objective of this study was to develop models for predicting the evolution of a neck pain (NP) episode. METHODS Three thousand two hundred twenty-five acute and chronic patients seeking care for NP, were recruited consecutively in 47 health care centers. Data on 37 variables were gathered, including gender, age, employment status, duration of pain, intensity of NP and pain referred down to the arm (AP), disability, history of neck surgery, diagnostic procedures undertaken, imaging findings, clinical diagnosis, and treatments used. Three separate multivariable logistic regression models were developed for predicting a clinically relevant improvement in NP, AP and disability at 3 months. RESULTS Three thousand one (93.5%%) patients attended follow-up. For all the models calibration was good. The area under the ROC curve was ≥0.717 for pain and 0.664 for disability. Factors associated with a better prognosis were: a) For all the outcomes: pain being acute (vs. chronic) and having received neuro-reflexotherapy. b) For NP: nonspecific pain (vs. pain caused by disc herniation or spinal stenosis), no signs of disc degeneration on imaging, staying at work, and being female. c) For AP: nonspecific NP and no signs of disc degeneration on imaging. d) For disability: staying at work and no signs of facet joint degeneration on imaging. CONCLUSIONS A prospective registry can be used for developing valid predictive models to quantify the odds that a given patient with NP will experience a clinically relevant improvement.
Collapse
Affiliation(s)
- Francisco M. Kovacs
- Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa. University Hospital, Avenida de Menéndez Pelayo, 67, 28009 Madrid, Spain
- Spanish Back Pain Research Network, Madrid, Spain
| | - Jesús Seco-Calvo
- Spanish Back Pain Research Network, Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of León, Spain, León, Spain
- University of the Basque Country, Spain.CampusUniversitario, 24071 León, Spain
| | - Borja M. Fernández-Félix
- Spanish Back Pain Research Network, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal. IRICYS, Madrid, Spain
| | - Javier Zamora
- Spanish Back Pain Research Network, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal. IRICYS, Madrid, Spain
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ana Royuela
- Spanish Back Pain Research Network, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Puerta de Hierro University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHISA), Madrid, Spain
| | - Alfonso Muriel
- Spanish Back Pain Research Network, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal. IRICYS, Madrid, Spain
| |
Collapse
|
30
|
Yung E, Oh C, Wong M, Grimes JK, Barton EM, Ali MI, Breakey A. Non-thrust cervical manipulations reduce short-term pain and decrease systolic blood pressure during intervention in mechanical neck pain: a randomized clinical trial. J Man Manip Ther 2019; 28:82-93. [PMID: 31379301 DOI: 10.1080/10669817.2019.1646985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objectives: To evaluate the association of resting blood pressure with pain response and evaluate the cardiovascular effects of anterior-to-posterior [AP] versus lateral [LAT] techniques of cervical spine non-thrust manipulation [NTM].Methods: Forty-three (23 females) participants with non-chronic neck pain (mean age 29.00 ± SD 9.09 years) randomly received AP or LAT NTM to the cervical spine. Blood pressure and heart rate were measured before, during, and after the intervention. Disability and pain were measured pre- and post-intervention.Results: Resting systolic blood pressure (SBP) was significantly associated with average pain reduction two days later on univariate and multivariate analyses (coefficients -0.029 ± SD 0.013, p = 0.036; -0.026 ± 0.012, p = 0.032).No significant differences existed between AP and LAT NTM groups in disability, pain reduction, and cardiovascular variables. The decrease in 'worst neck pain' rating 2-days post-intervention was clinically significant within the AP (mean -2.43 ± SD 2.66) group. Mixed-effect model ANOVA revealed a significant change in SBP over time (estimate -1.94 ± SD 0.70, p = 0.007).Discussion: This spinal NTM study was the first to relate resting SBP with short-term pain reduction, demonstrating SBP-related hypoalgesia. In normotensive individuals with unilateral non-chronic neck pain, each 10 mmHg higher resting SBP was associated with a 0.29-unit decrease in average pain at follow-up when holding baseline pain constant.AP and LAT NTM equally reduced short-term pain and decreased SBP during-intervention, suggesting SBP-sympathoinhibition. These techniques have previously been shown to be sympatho-excitatory when delivered under different dosage parameters. SBP's mediating and moderating role should be investigated."Level of Evidence: 1b."
Collapse
Affiliation(s)
- Emmanuel Yung
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Michael Wong
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
| | - Jason K Grimes
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
| | - Erica Mae Barton
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
| | - Muhammad I Ali
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
| | - Allison Breakey
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
| |
Collapse
|
31
|
Hok P, Opavský J, Labounek R, Kutín M, Šlachtová M, Tüdös Z, Kaňovský P, Hluštík P. Differential Effects of Sustained Manual Pressure Stimulation According to Site of Action. Front Neurosci 2019; 13:722. [PMID: 31379481 PMCID: PMC6650750 DOI: 10.3389/fnins.2019.00722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
Sustained pressure stimulation of the body surface has been used in several physiotherapeutic techniques, such as reflex locomotion therapy. Clinical observations of global motor responses and subsequent motor behavioral changes after stimulation in certain sites suggest modulation of central sensorimotor control, however, the neuroanatomical correlates remain undescribed. We hypothesized that different body sites would specifically influence the sensorimotor system during the stimulation. We tested the hypothesis using functional magnetic resonance imaging (fMRI) in thirty healthy volunteers (mean age 24.2) scanned twice during intermittent manual pressure stimulation, once at the right lateral heel according to reflex locomotion therapy, and once at the right lateral ankle (control site). A flexible modeling approach with finite impulse response basis functions was employed since non-canonical hemodynamic response was expected. Subsequently, a clustering algorithm was used to separate areas with differential timecourses. Stimulation at both sites induced responses throughout the sensorimotor system that could be mostly separated into two anti-correlated subsystems with transient positive or negative signal change and rapid adaptation, although in heel stimulation, insulo-opercular cortices and pons showed sustained activation. In direct voxel-wise comparison, heel stimulation was associated with significantly higher activation levels in the contralateral primary motor cortex and decreased activation in the posterior parietal cortex. Thus, we demonstrate that the manual pressure stimulation affects multiple brain structures involved in motor control and the choice of stimulation site impacts the shape and amplitude of the blood oxygenation level-dependent response. We further discuss the relationship between the affected structures and behavioral changes after reflex locomotion therapy.
Collapse
Affiliation(s)
- Pavel Hok
- Department of Neurology, University Hospital Olomouc, Olomouc, Czechia.,Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Jaroslav Opavský
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - René Labounek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital Olomouc, Olomouc, Czechia
| | | | - Martina Šlachtová
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Zbyněk Tüdös
- Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia.,Department of Radiology, University Hospital Olomouc, Olomouc, Czechia
| | - Petr Kaňovský
- Department of Neurology, University Hospital Olomouc, Olomouc, Czechia.,Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Petr Hluštík
- Department of Neurology, University Hospital Olomouc, Olomouc, Czechia.,Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| |
Collapse
|
32
|
Corso M, Mior SA, Batley S, Tuff T, da Silva-Oolup S, Howitt S, Srbely J. The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence. Chiropr Man Therap 2019; 27:25. [PMID: 31183076 PMCID: PMC6555009 DOI: 10.1186/s12998-019-0246-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/26/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction The effectiveness of spinal manipulative therapy (SMT) for improving athletic performance in healthy athletes is unclear. Assessing the effect of SMT on other performance outcomes in asymptomatic populations may provide insight into the management of athletes where direct evidence may not be available. Our objective was to systematically review the literature on the effect of SMT on performance-related outcomes in asymptomatic adults. Methods MEDLINE, CINAHL, SPORTDiscus, and Cochrane Central Register of Controlled Trials were systematically searched from 1990 to March 23, 2018. Inclusion criteria was any study examining a performance-related outcome of SMT in asymptomatic adults. Methodological quality was assessed using the SIGN criteria. Studies with a low risk of bias were considered scientifically admissible for a best evidence synthesis. We calculated the between group mean change and 95% confidence intervals. Results Of 1415 articles screened, 20 studies had low risk of bias, seven were randomized crossover trials, 10 were randomized controlled trials (RCT) and three were RCT pilot trials. Four studies showed SMT had no effect on physiological parameters at rest or during exercise. There was no effect of SMT on scapular kinematics or transversus abdominus thickness. Three studies identified changes in muscle activation of the upper or lower limb, compared to two that did not. Five studies showed changes in range of motion (ROM). One study showed an increase lumbar proprioception and two identified changes in baropodometric variables after SMT. Sport-specific studies show no effect of SMT except for a small increase in basketball free-throw accuracy. Conclusion The preponderance of evidence suggests that SMT in comparison to sham or other interventions does not enhance performance-based outcomes in asymptomatic adult population. All studies are exploratory with immediate effects. In the few studies suggesting a positive immediate effect, the importance of such change is uncertain. Further high-quality performance specific studies are required to confirm these preliminary findings. Electronic supplementary material The online version of this article (10.1186/s12998-019-0246-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Melissa Corso
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, ON M2H 3J1 Canada
| | - Silvano A Mior
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, ON M2H 3J1 Canada
| | - Sarah Batley
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, ON M2H 3J1 Canada
| | - Taylor Tuff
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, ON M2H 3J1 Canada
| | - Sophia da Silva-Oolup
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, ON M2H 3J1 Canada
| | - Scott Howitt
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, ON M2H 3J1 Canada
| | - John Srbely
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, ON M2H 3J1 Canada.,2University of Guelph, Guelph, ON Canada
| |
Collapse
|
33
|
Tenenbaum A, Nordeman L, Sunnerhagen KS, Gunnarsson R. A risk stratification tool for prehospital triage of patients exposed to a whiplash trauma. PLoS One 2019; 14:e0216694. [PMID: 31086405 PMCID: PMC6516661 DOI: 10.1371/journal.pone.0216694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/26/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our aim was to develop a risk stratification model to predict the presence of a potentially more sinister injury in patients exposed to a whiplash trauma. METHODS The study base comprised of 3,115 residents who first sought healthcare contact within one week after being exposed to a whiplash trauma between 1999-2008, from within a defined geographical area, Skaraborg County in south-western Sweden. Information about gender, age, time elapsed prior to seeking care, type of health care contact, and hospitalisation was retrieved. Seventeen potential risk factors were identified and evaluated using multivariable logistic regression. RESULTS Of 3,115 patients, 215 (6.9%) required hospital admission so theoretically 93% could have been initially assessed by primary health care. However, only 46% had their first contact in primary health care. All patients had symptoms resulting in a diagnosis of whiplash injury. Four risk factors were found to be associated with hospital admission: commotio cerebri (OR 31, 19-51), fracture / luxation (OR 11, 5.1-22), serious injury (OR 41, 8.0-210), and the patient sought care during the same day as the trauma (OR 5.9, 3.7-9.5). These four risk factors explained 27% of the variation for hospital admission and the area under curve (AUC) was 0.77 (0.74-0.80). Ninety-six percent of patients (2,985) had only a whiplash injury with no other injury. These could be split into those attending health care the same day as the trauma, 1,737 (56%) with a 7.1% risk for hospital admission, and those attending health care later, 1,248 (40%) with a 1.3% risk for hospital admission. CONCLUSION Patients with no signs of commotio cerebri, no fracture/luxation injury, no serious injury, comprising 96% of all patients exposed to a whiplash trauma can initially be referred to primary health care for initial assessment. However, those contacting the health care the same day as the trauma should be referred to a hospital for evaluation if they can't get an appointment with a general practitioner the same day.
Collapse
Affiliation(s)
- Artur Tenenbaum
- Hälsan & Arbetslivet, Occupational Health Care Unit, Region Västra Götaland, Alingsås, Sweden
- Department of Public Health and Community Medicine Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Nordeman
- Research and Development Center Södra Älvsborg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Institute of Clinical Neuroscience—Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ronny Gunnarsson
- Department of Public Health and Community Medicine Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Center Södra Älvsborg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
34
|
Côté P, Boyle E, Shearer HM, Stupar M, Jacobs C, Cassidy JD, Carette S, van der Velde G, Wong JJ, Hogg-Johnson S, Ammendolia C, Hayden JA, van Tulder M, Frank JW. Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial. BMJ Open 2019; 9:e021283. [PMID: 30679283 PMCID: PMC6347946 DOI: 10.1136/bmjopen-2017-021283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I-II. DESIGN Pragmatic randomised clinical trial with blinded outcome assessment. SETTING Multidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada. PARTICIPANTS 340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury. INTERVENTIONS Participants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury. RESULTS The median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ2=3.96; 2 df: p=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported. CONCLUSIONS Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life. TRIAL REGISTRATION NUMBER NCT00546806.
Collapse
Affiliation(s)
- Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Heather M Shearer
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Maja Stupar
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Craig Jacobs
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - John David Cassidy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Simon Carette
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, University Health Network, Toronto, Ontario, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jessica J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jill Alison Hayden
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - John W Frank
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
35
|
Valera-Calero A, Lluch Girbés E, Gallego-Izquierdo T, Malfliet A, Pecos-Martín D. Endocrine response after cervical manipulation and mobilization in people with chronic mechanical neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2019; 55:792-805. [PMID: 30621368 DOI: 10.23736/s1973-9087.19.05475-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most of the research on the effects of spinal manipulation on endocrine function has been done on healthy subjects and has yielded contradictory results. The potential role of cervical manual therapy intervention in order to induce changes in the endocrine system has not yet been investigated. AIM The aim of this trial is to compare the effects on salivary cortisol levels and clinical outcomes of cervical manipulation versus cervical mobilization or sham manipulation in patients with chronic mechanical neck pain. DESIGN Randomized controlled trial. SETTING University of Alcala de Henares: outpatient (referrals from office workers). POPULATION A total of 83 patients with chronic mechanical neck pain. METHODS Participants were randomized to receive one session of cervical manipulation, cervical mobilization, or sham manipulation. The measured variables were salivary cortisol levels, neck pain and disability, pressure pain thresholds (PPT), and cervical range of motion (ROM). They were obtained at baseline, immediately after treatment (except neck disability), and at one-week follow-up (except cortisol). RESULTS A significant and comparable increase in cortisol levels was observed immediately after cervical manipulation and mobilization (both P<0.001). Neck disability improved to a similar degree in the cervical manipulation and mobilization groups at the one-week follow-up (both P<0.001). Neck pain was reduced immediately after cervical manipulation (P<0.001), cervical mobilization (P=0.001), and sham manipulation (P<0.001). There were no significant changes in most ROM directions after either treatment. No significant interaction effect was observed for PPT. CONCLUSIONS Cervical manipulation and mobilization resulted in a similar increase in cortisol concentrations immediately post-treatment in people with chronic mechanical neck pain. Supraspinal mechanisms may thus play a role in the hypoalgesic effects that follow the application of both interventions. CLINICAL REHABILITATION IMPACT The increase in cortisol levels was similar with cervical manipulation and mobilization so induced stress levels can be similar in both interventions.
Collapse
Affiliation(s)
| | - Enrique Lluch Girbés
- Department of Physical Therapy, University of Valencia, Valencia, Spain - .,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Free University of Brussels, Brussels, Belgium
| | | | - Anneleen Malfliet
- Department of Physical Therapy, University of Valencia, Valencia, Spain.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | | |
Collapse
|
36
|
Anderst WJ, Gale T, LeVasseur C, Raj S, Gongaware K, Schneider M. Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine J 2018; 18:2333-2342. [PMID: 30142458 DOI: 10.1016/j.spinee.2018.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neck pain is one of the most commonly reported symptoms in primary care settings, and a major contributor to health-care costs. Cervical manipulation is a common and clinically effective intervention for neck pain. However, the in vivo biomechanics of manipulation are unknown due to previous challenges with accurately measuring intervertebral kinematics in vivo during the manipulation. PURPOSE The objectives were to characterize manual forces and facet joint gapping during cervical spine manipulation and to assess changes in clinical and functional outcomes after manipulation. It was hypothesized that patient-reported pain would decrease and intervertebral range of motion (ROM) would increase after manipulation. STUDY DESIGN/SETTING Laboratory-based prospective observational study. PATIENT SAMPLE 12 patients with acute mechanical neck pain (4 men and 8 women; average age 40 ± 15 years). OUTCOME MEASURES Amount and rate of cervical facet joint gapping during manipulation, amount and rate of force applied during manipulation, change in active intervertebral ROM from before to after manipulation, and numeric pain rating scale (NPRS) to measure change in pain after manipulation. METHODS Initially, all participants completed a NPRS (0-10). Participants then performed full ROM flexion-extension, rotation, and lateral bending while seated within a custom biplane radiography system. Synchronized biplane radiographs were collected at 30 images/s for 3 seconds during each movement trial. Next, synchronized, 2.0-milliseconds duration pulsed biplane radiographs were collected at 160 images/s for 0.8 seconds during the manipulation. The manipulation was performed by a licensed chiropractor using an articular pillar push technique. For the final five participants, two pressure sensors placed on the thumb of the chiropractor (Novel pliance system) recorded pressure at 160 Hz. After manipulation, all participants repeated the full ROM movement testing and once again completed the NPRS. A validated volumetric model-based tracking process that matched subject-specific bone models (from computed tomography) to the biplane radiographs was used to track bone motion with submillimeter accuracy. Facet joint gapping was calculated as the average distance between adjacent articular facet surfaces. Pre- to postmanipulation changes were assessed using the Wilcoxon signed-rank test. RESULTS The facet gap increased 0.9 ± 0.40 mm during manipulation. The average rate of facet gapping was 6.2 ± 3.9 mm/s. The peak force and rate of force application during manipulation were 65 ± 4 N and 440 ± 58 N/s. Pain score improved from 3.7 ± 1.2 before manipulation to 2.0 ± 1.4 after manipulation (p <. 001). Intervertebral ROM increased after manipulation by 1.2° (p = .006), 2.1° (p = .01), and 3.9° (p = .003) at the C4/C5, C5/C6, and C6/C7 motion segments, respectively, during flexion-extension; by 1.5° (p = .028), 1.9° (p = .005), and 1.3° (p = .050) at the C3/C4, C4/C5, and C5/C6 motion segments, respectively, during rotation; and by 1.3° (p = .034) and 1.1° (p = .050) at the C4/C5 and C5/C6 motion segments, respectively, during lateral bending. Global head ROM relative to the torso increased after manipulation by 8º (p = .023), 10º (p = .002), and 13º (p = .019) during lateral bending, axial rotation and flexion-extension, respectively, after manipulation. CONCLUSIONS This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments. This study demonstrates the feasibility of characterizing in real time the manual inputs and biological responses that comprise cervical manipulation, including clinician-applied force, facet gapping, and increased intervertebral ROM. This provides a basis for future clinical trials to identify the mechanisms behind manipulation and to optimize the mechanical factors that reliably and sufficiently impact the key mechanisms behind manipulation.
Collapse
Affiliation(s)
- William J Anderst
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA.
| | - Tom Gale
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Clarissa LeVasseur
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Sandesh Raj
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Kris Gongaware
- Department of Physical Therapy, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| |
Collapse
|
37
|
Real-World Effectiveness of Physical Therapy for Common Neck Pain Diagnoses: A Multivariate Analysis of 1554 Patients. Clin Spine Surg 2018; 31:395-399. [PMID: 30015651 DOI: 10.1097/bsd.0000000000000691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
STUDY DESIGN Retrospective cohort study (Level of evidence-3). OBJECTIVE The objective of this study was to investigate the real-life effectiveness of physical therapy (PT) for patients initially presenting with common neck pain diagnoses. SUMMARY OF BACKGROUND DATA Neck pain is a common cause of morbidity and a leading cause of disability in the United States. PT is prescribed as a first-line treatment for the vast majority of patients with neck pain; however, there is limited literature supporting the effectiveness of these treatments. METHODS A total of 1554 patients enrolled in PT for the nonoperative treatment of neck pain were included in the study. Three primary patient-reported outcome (PRO) measures [neck disability index (NDI), resting numeric pain rating scale (NPRS), and activity NPRS] were recorded before and at conclusion of therapy. Improvement was noted if patients met a threshold value for a minimal clinically important difference (MCID). Bivariate analysis using a χ test and multiple logistic regression analysis were performed to determine risk factors predictive of treatment failure. RESULTS About 40.5% of patients achieved MCID for NDI with an average change of -6.31 points. For resting NPRS and activity NPRS scores, 50.6% and 52.1% of patients achieved MCID with an average change of -1.93 and -2.36, respectively. After multiple logistic regression analysis, worker's compensation status was found to be an independent predictor for treatment failure in all groups; whereas, Medicare status was found predictive of achieving MCID in the activity NPRS group. CONCLUSIONS We observed that up to half of the patients analyzed met the minimum criteria for improvement in neck pain with respect to the PRO measures, suggesting that real-life effectiveness of PT for common neck pain diagnoses may approach 50%.
Collapse
|
38
|
Puerma-Castillo MC, García-Ríos MC, Pérez-Gómez ME, Aguilar-Ferrándiz ME, Peralta-Ramírez MI. Effectiveness of kinesio taping in addition to conventional rehabilitation treatment on pain, cervical range of motion and quality of life in patients with neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2018; 31:453-464. [PMID: 28946540 DOI: 10.3233/bmr-170835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Kinesio taping (KT) is a new taping modality frequently used in the clinical setting. However there is contradictory evidence about its effectiveness in patients with neck pain. OBJECTIVE To determine the effectiveness of KT as a supplementary treatment in addition to conventional rehabilitation in patients with neck pain. METHODS Forty-five subjects with neck pain were included in this controlled trial and were assigned to the following groups: Kinesio Taping, placebo (P), and conventional rehabilitation control (CR). A daily self-assessment record of perceived pain, medication intake, quality of life and range of motion was registered at baseline, posttreatment and follow-up. RESULTS Cohen's coefficient showed large effects in terms of reducing pain perception in all three groups. ANOVAs showed that the course of treatment differed across groups only for neck flexion (p= 0.043). We found significant differences in neck flexion when comparing baseline and one-month follow-up values and neck flexion significantly increased in all three groups: KT (p= 0.05); P (p= 0.01); and CR (p= 0.04). Between-group analyses showed no significant differences for any of the measurements. CONCLUSIONS A protocol of manual therapy and physical exercises, significantly improved pain and mobility in patients with neck pain. We obtained no evidence of additional benefits from the use of KT in this population.
Collapse
|
39
|
Lee S, Jo DH, Kim KH. Acupuncture for treating whiplash-associated disorder: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2018; 97:e12654. [PMID: 30313054 PMCID: PMC6203494 DOI: 10.1097/md.0000000000012654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This review aims to evaluate the effectiveness and safety of acupuncture treatment for patients with whiplash-associated disorder (WAD). METHODS We will search the following databases from their inception to October 2018: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, 1 Chinese database (China National Knowledge Infrastructure), 1 Japanese database (Japan Science and Technology Information Aggregator, Electronic), and 5 Korean databases (KoreaMed, Research Information Service System, Korean Studies Information Service System, Database Periodical Information Academic, and Oriental Medicine Advanced Searching Integrated System). All randomized controlled trials of acupuncture for WAD will be considered for inclusion without language restrictions. The risk of bias will be assessed using the Cochrane risk of bias tool. The mean difference or standard mean difference for continuous data and risk ratio for dichotomous data will be calculated with 95% confidence intervals. DISSEMINATION The results of this review will be disseminated through peer-reviewed journal articles or conference presentations, and may provide important guidance for clinicians and patients regarding the use of acupuncture treatment for treating WAD. TRIAL REGISTRATION NUMBER PROSPERO 2018: CRD42018106964.
Collapse
Affiliation(s)
| | - Dae-Hyun Jo
- Department of Acupuncture & Moxibustion Medicine, Graduate School, Kyung Hee University, Seoul
| | - Kun Hyung Kim
- Department of Acupuncture & Moxibustion, School of Korean Medicine, Pusan National University, Yangsan, South Korea
| |
Collapse
|
40
|
Haas M, Bronfort G, Evans R, Schulz C, Vavrek D, Takaki L, Hanson L, Leininger B, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J 2018; 18:1741-1754. [PMID: 29481979 PMCID: PMC6107442 DOI: 10.1016/j.spinee.2018.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The optimal number of visits for the care of cervicogenic headache (CGH) with spinal manipulative therapy (SMT) is unknown. PURPOSE The present study aimed to identify the dose-response relationship between visits for SMT and chronic CGH outcomes and to evaluate the efficacy of SMT by comparison with a light-massage control. STUDY DESIGN/SETTING This is a two-site, open-label randomized controlled trial. PATIENT SAMPLE Participants were 256 adults with chronic CGH. OUTCOME MEASURES The primary outcome was days with CGH in the previous 4 weeks evaluated at the 12- and 24-week primary end points. Secondary outcomes included CGH days at remaining end points, pain intensity, disability, perceived improvement, medication use, and patient satisfaction. METHODS Participants were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. They were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. Linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 24, 39, and 52 weeks. The present study was funded by the National Center for Complementary and Integrative Health (R01AT006330) and is registered at ClinicalTrials.gov (NCT01530321). The authors declare no conflicts of interest. RESULTS A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/4 weeks per additional 6 SMT visits (p<.05); a maximal effective dose could not be determined. Cervicogenic headache days/4 weeks were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits. Mean differences in CGH days/4 weeks between 18 SMT visits and control were -3.3 (p=.004) and -2.9 (p=.017) at the primary end points, and were similar in magnitude at the remaining end points (p<.05). Differences between other SMT doses and control were smaller in magnitude (p>.05). Cervicogenic headache intensity showed no important improvement nor differed by dose. Other secondary outcomes were generally supportive of the primary outcome. CONCLUSIONS There was a linear dose-response relationship between SMT visits and days with CGH. For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.
Collapse
Affiliation(s)
- Mitchell Haas
- Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Gert Bronfort
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Roni Evans
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Craig Schulz
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Darcy Vavrek
- Illumina, Inc, 5200 Illumina Way, San Diego, CA, USA, 92122
| | - Leslie Takaki
- University of Western States, 2900 NE 132 nd Avenue,
Portland, Oregon, USA, 97230
| | - Linda Hanson
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Brent Leininger
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle,
WA, USA, 98112
| |
Collapse
|
41
|
Beinert K, Lutz B, Zieglgänsberger W, Diers M. Seeing the site of treatment improves habitual pain but not cervical joint position sense immediately after manual therapy in chronic neck pain patients. Eur J Pain 2018; 23:117-123. [DOI: 10.1002/ejp.1290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2018] [Indexed: 11/07/2022]
Affiliation(s)
- K. Beinert
- Hochschule für Gesundheitsorientierte Wissenschaften Rhein‐Neckar University of Applied Science Mannheim Germany
| | - B. Lutz
- Hochschule für Gesundheitsorientierte Wissenschaften Rhein‐Neckar University of Applied Science Mannheim Germany
| | - W. Zieglgänsberger
- Department of Clinical Neuropharmacology Max Planck Institute of Psychiatry Munich Germany
| | - M. Diers
- Department of Psychosomatic Medicine and Psychotherapy LWL University Hospital Ruhr‐University Bochum Germany
| |
Collapse
|
42
|
Hutting N, Kerry R, Coppieters MW, Scholten-Peeters GGM. Considerations to improve the safety of cervical spine manual therapy. Musculoskelet Sci Pract 2018; 33:41-45. [PMID: 29153924 DOI: 10.1016/j.msksp.2017.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/25/2017] [Accepted: 11/02/2017] [Indexed: 12/20/2022]
Abstract
Manipulation and mobilisation of the cervical spine are well established interventions in the management of patients with headache and/or neck pain. However, their benefits are accompanied by potential, yet rare risks in terms of serious adverse events, including neurovascular insult to the brain. A recent international framework for risk assessment and management offers directions in the mitigation of this risk by facilitating sound clinical reasoning. The aim of this article is to critically reflect on and summarize the current knowledge about cervical spine manual therapy and to provide guidance for clinical reasoning for cervical spine manual therapy.
Collapse
Affiliation(s)
- Nathan Hutting
- Het Centrum, Centre for Physiotherapy & Manual Therapy, Rijen, The Netherlands; HAN University of Applied Sciences, Department of Occupation & Health, Nijmegen, The Netherlands.
| | - Roger Kerry
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, United Kingdom; Department of Philosophy, University of Nottingham, Nottingham, United Kingdom
| | - Michel W Coppieters
- Menzies Health Institute Queensland, School of Allied Health Sciences, Faculty of Health, Griffith University, Gold Coast, Australia; Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | | |
Collapse
|
43
|
Effects of Myofascial Release on Pressure Pain Thresholds in Patients With Neck Pain: A Single-Blind Randomized Controlled Trial. Am J Phys Med Rehabil 2017; 97:16-22. [PMID: 28678033 DOI: 10.1097/phm.0000000000000790] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to investigate the efficacy of myofascial release therapy (MRT) for improving pressure pain thresholds (PPTs) and pain in patients with mechanical neck pain. DESIGN Forty-one participants with neck pain were randomly allocated to either a MRT group (five sessions) or a physical therapy (PT) group (ten sessions) for 2 wks. The multimodal PT program included ultrasound therapy (US), transcutaneous electric nerve stimulation, and massage. Visual analog scale (VAS) and PPTs in suboccipital and upper trapezius muscles were measured at baseline, at the end of treatment, and at 1 month follow-up. RESULTS At the end of treatment, significant mean differences in VAS (-0.99, 95% confidence interval [CI] = -1.82 to -0.16), in both left (0.28, 95% CI = 0.06 to 0.50) and right (0.40, 95% CI = 0.16 to 0.63) suboccipital PPTs and in the right trapezius PPT (0.38, 95% CI = 0.07 to 0.69) were observed. At 1-month follow-up, significant mean differences were found for VAS (-1.85, 95% CI = -2.76 to -0.94) and both left (0.46, 95% CI = 0.12 to 0.80) and right (0.38, 95% CI = 0.06 to 0.69) suboccipital PPTs. CONCLUSIONS This study provides evidence that MRT could be better than a multimodal PT program for short-term improvement of pain and PPTs in patients with neck pain.
Collapse
|
44
|
Persson LCG, Lansinger B, Carlsson J, Gard G. Expectations of Qigong and Exercise Therapy in Patients With Long-term Neck Pain: An Analysis of a Prospective Randomized Study. J Manipulative Physiol Ther 2017; 40:676-684. [PMID: 29229058 DOI: 10.1016/j.jmpt.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 06/26/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the present study was to study differences in treatment expectations after participating in qigong and exercise therapy among participants with long-term neck pain, the impact of total group expectations on treatment outcomes, and the relationship between these treatment expectations and pain and disability. METHOD Reliable questionnaires were used. Differences between qigong and exercise was studied in a randomized, controlled, multicenter trial (n = 122). The impact of total group expectations on treatment outcomes and the association between these treatment expectations and pain and disability were studied with nonparametric statistical analysis and Spearman's correlation coefficient. RESULTS The exercise group had higher expectations than the qigong group before the intervention on how logical treatment seemed to be and after the intervention on treatment credibility (ie, that the treatment would reduce/eliminate neck pain). The exercise group was also more confident that the treatment could reduce neck pain and significantly increased their expectations of reduced neck pain over the 3-month intervention period. Both treatment groups had high expectations of the assigned treatment. Those with high expectations had better treatment outcomes in pain and disability. The relationship between treatment expectations and credibility, pain, and disability was weak. CONCLUSIONS The current findings support the role of assessment of expectation/credibility for positive treatment results. An understanding of each patient's treatment expectations may be helpful in guiding patients with respect to appropriate interventions and as an indication of risk of poor outcome.
Collapse
Affiliation(s)
- Liselott C G Persson
- Division of Physiotherapy, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Birgitta Lansinger
- Institute of Neuroscience and Physiology/Physiotherapy, Gothenburg University, Gothenburg, Sweden
| | - Jane Carlsson
- Institute of Neuroscience and Physiology/Physiotherapy, Gothenburg University, Gothenburg, Sweden
| | - Gunvor Gard
- Division of Physiotherapy, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
45
|
Prevalence, patterns, and predictors of massage practitioner utilization: Results of a US nationally representative survey. Musculoskelet Sci Pract 2017; 32:31-37. [PMID: 28802839 DOI: 10.1016/j.msksp.2017.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The use of massage therapy is common, especially in patients with musculoskeletal pain. The purpose of this study was to examine the prevalence, utilization, socio-demographic and health-related predictors of massage practitioner consultations in the US population. METHODS Cross-sectional data from the 2012 National Health Interview Survey for adults (n = 34,525). RESULTS Prevalence of massage practitioner utilization were 12.8% (lifetime) and 6.8% (last 12 months). Compared to non-users, those who used massage in the last year were more likely: female, at least high school educated, annual income ≥ US$ 15,000, diagnosed with spinal pain or arthritis, report moderate physical activity level as compared to low level, and consume alcohol as compared to being abstinent. Massage was mainly used for general wellness or disease prevention (56.3%), but also for specific, typically musculoskeletal, health problems (41.9%) for which 85.2% reported massage helped to some or a great deal. Most (59.1%) did not disclose massage use to their health care provider, despite 69.4% reporting massage therapy combined with medical treatment would be helpful. CONCLUSIONS Approximately 7% (15.4 million) of US adults used massage therapy in the past year, mainly for general disease prevention, wellness or musculoskeletal pain. The majority of respondents reported positive outcomes of massage on specific health problems and overall well-being. Massage utilization was rarely covered by health insurance. Despite the majority of massage users considered massage therapy combined with medical care helpful, most did not disclose massage therapy use to their health care provider.
Collapse
|
46
|
Jain NB, Schneider BJ, Kuhn JE, Murrell WD, Stark S, Archer KR. What's New in Orthopaedic Rehabilitation. J Bone Joint Surg Am 2017; 99:1956-1963. [PMID: 29135672 DOI: 10.2106/jbjs.17.00905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Nitin B Jain
- 1Departments of Physical Medicine and Rehabilitation (N.B.J., B.J.S., S.S., and K.R.A.) and Orthopaedics (N.B.J., J.E.K., and K.R.A.) and Division of Epidemiology (N.B.J.), Vanderbilt University Medical Center, Nashville, Tennessee 2Integra Medical and Surgical Center, Emirates Hospitals Group, Dubai, United Arab Emirates 3Department of Orthopaedics, Rehabilitation, and Podiatry, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | | | | | | | | | | |
Collapse
|
47
|
Acupotomy Therapy for Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:6197308. [PMID: 29138644 PMCID: PMC5613650 DOI: 10.1155/2017/6197308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
Abstract
Objective This review is to assess the efficacy and safety of acupotomy therapy in chronic nonspecific neck pain. Methods We searched six computerised databases. Randomized controlled trials incorporating acupotomy therapy alone or combined with other conventional treatments for chronic nonspecific neck pain were included. Two reviewers screened each literature and extracted data independently according to Cochrane Reviews' Handbook (5.1). The Cochrane Collaboration's RevMan 5.3 software was applied for meta-analysis. Results A total of ten trials involving 433 patients were enrolled. The pooled analysis indicated that acupotomy therapy showed a significant improving short-term and long-term effect on effective rate and cure rate. Meta-analysis demonstrated that acupotomy therapy group was superior to control group in restoring cervical lordosis and debasing VAS score. The result of continuous data did not support statistical significance of acupotomy therapy in adjusting clinical symptom score. For adverse events, acupotomy group did not reveal obvious superiority compared to control group. Conclusions Acupotomy therapy may be beneficial to chronic nonspecific neck pain patients. To strengthen supportive evidence, future, more rigorously designed clinical trials, adequate adverse events, and follow-up project are recommended.
Collapse
|
48
|
Groeneweg R, van Assen L, Kropman H, Leopold H, Mulder J, Smits-Engelsman BCM, Ostelo RWJG, Oostendorp RAB, van Tulder MW. Manual therapy compared with physical therapy in patients with non-specific neck pain: a randomized controlled trial. Chiropr Man Therap 2017; 25:12. [PMID: 28465824 PMCID: PMC5408403 DOI: 10.1186/s12998-017-0141-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/05/2017] [Indexed: 12/16/2022] Open
Abstract
Background Manual therapy according to the School of Manual Therapy Utrecht (MTU) is a specific type of passive manual joint mobilization. MTU has not yet been systematically compared to other manual therapies and physical therapy. In this study the effectiveness of MTU is compared to physical therapy, particularly active exercise therapy (PT) in patients with non-specific neck pain. Methods Patients neck pain, aged between 18–70 years, were included in a pragmatic randomized controlled trial with a one-year follow-up. Primary outcome measures were global perceived effect and functioning (Neck Disability Index), the secondary outcome was pain intensity (Numeric Rating Scale for Pain). Outcomes were measured at 3, 7, 13, 26 and 52 weeks. Multilevel analyses (intention-to-treat) were the primary analyses for overall between-group differences. Additional to the primary and secondary outcomes the number of treatment sessions of the MTU group and PT group was analyzed. Data were collected from September 2008 to February 2011. Results A total of 181 patients were included. Multilevel analyses showed no statistically significant overall differences at one year between the MTU and PT groups on any of the primary and secondary outcomes. The MTU group showed significantly lower treatment sessions compared to the PT group (respectively 3.1 vs. 5.9 after 7 weeks; 6.1 vs. 10.0 after 52 weeks). Conclusions Patients with neck pain improved in both groups without statistical significantly or clinically relevant differences between the MTU and PT groups during one-year follow-up. Trial registration ClinicalTrials.gov Identifier: NCT00713843.
Collapse
Affiliation(s)
- Ruud Groeneweg
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands.,Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.,Avans+, University of Applied Science, Heerbaan 14-40, 4817 NL Breda, The Netherlands
| | - Luite van Assen
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands
| | - Hans Kropman
- Avans+, University of Applied Science, Heerbaan 14-40, 4817 NL Breda, The Netherlands
| | - Huco Leopold
- Avans+, University of Applied Science, Heerbaan 14-40, 4817 NL Breda, The Netherlands
| | - Jan Mulder
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands
| | - Bouwien C M Smits-Engelsman
- Department of Health and Rehabilitation Sciences, University of Cape Town, Anzio Road 7935, Cape Town, South Africa
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics & EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Rob A B Oostendorp
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands.,Department of Manual Therapy, Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Brussels, Belgium
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
49
|
Castaldo M, Catena A, Chiarotto A, Fernández-de-Las-Peñas C, Arendt-Nielsen L. Do Subjects with Whiplash-Associated Disorders Respond Differently in the Short-Term to Manual Therapy and Exercise than Those with Mechanical Neck Pain? PAIN MEDICINE 2017; 18:791-803. [PMID: 28034987 DOI: 10.1093/pm/pnw266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders. Methods Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses. Results Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P = 0.021), larger pain area ( P = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P < 0.01). No changes in pressure pain thresholds were observed in either group after treatment ( P > 0.222). Conclusions The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises.
Collapse
Affiliation(s)
- Matteo Castaldo
- Private practice, Poliambulatorio FisioCenter, Collecchio, Parma, Italy.,SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Physical Therapy, University of Siena, Siena, Italy
| | - Antonella Catena
- Private practice, Poliambulatorio FisioCenter, Collecchio, Parma, Italy
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - César Fernández-de-Las-Peñas
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lars Arendt-Nielsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
50
|
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 .
Collapse
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.
| |
Collapse
|