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Koppenhaver SL, Morel T, Dredge G, Baeder M, Young BA, Petersen EJ, Fernández-de-Las-Peñas C, Gill N. The validity of the cervical rotation lateral flexion test in predicting benefit after manipulation treatment to the first and second rib. Musculoskelet Sci Pract 2022; 62:102629. [PMID: 35872564 DOI: 10.1016/j.msksp.2022.102629] [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: 03/16/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Prospective cohort study. BACKGROUND The cervical rotation lateral flexion (CRLF) test is frequently used in clinical practice to determine whether a thrust manipulation targeting the first rib should be performed. OBJECTIVES To evaluate the predictive validity of the CRLF test and manual examination in determining whether patients with neck pain are likely to benefit from manipulative treatment to the first and second rib. METHODS A physical examination incorporating the CRLF test was performed on 50 participants with neck pain followed by manipulation treatment to the first and second ribs. Clinical improvement was assessed immediately and one week after treatment. Participants who experienced at least a 30% improvement in their Neck Disability Index (NDI) score were considered "improved." Predictive validity was assessed by calculating sensitivity, specificity, and negative and positive likelihood ratios. RESULTS Neither the CRLF test nor manual examination were predictive of clinical improvement after manipulative treatment to the first and second rib. However, being male, of older age, and exhibiting T1 and/or T2 restricted end-feel were associated with improved neck related-disability at one-week follow-up. CONCLUSION The CRLF test does not appear to be helpful in determining whether patients with neck pain are likely to benefit from manipulative treatment to the first and second rib. Other factors from the history and clinical examination may be more helpful when selecting manipulative treatment including age and gender and possibly the presence of T1/T2 restricted end-feel.
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Affiliation(s)
| | - Tracy Morel
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Garry Dredge
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Michele Baeder
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Brian A Young
- Baylor University Doctoral Program in Physical Therapy, Waco, TX, USA
| | - Evan J Petersen
- Bowling Green State University, Doctoral Program in Physical Therapy, Bowling Green, OH, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
| | - Norman Gill
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
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Jin H, Ma X, Liu Y, Liu M, Yin X, Fan W, Zhu J, Zhao JH, Chen L, Su N, Xie Y, Yang J, Liu P. Back pain from painful osteoporotic vertebral fractures: discrepancy between the actual fracture location and the location suggested by patient-reported pain or physical examination findings. Osteoporos Int 2020; 31:1721-1732. [PMID: 32346773 DOI: 10.1007/s00198-020-05434-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/22/2020] [Indexed: 01/23/2023]
Abstract
UNLABELLED Caution is necessary when using symptom or physical examination findings to localize the osteoporotic vertebral fractures (VFs) attributable to the discrepant colocalized relationship. INTRODUCTION Whether the location of symptoms or physical examination findings delineates the appropriate spinal range for imaging has not been thoroughly investigated for VFs. The present study aims to analyze the consistency between the fractural vertebrae location and the location suggested by patient-reported pain or physical examination findings. METHODS This observational study, following a prospective design, enrolled 358 patients with VFs. The locations of two symptoms (patient-reported back pain [P-RBP], radiating pain [RP]) and findings from two physical examinations (spinal palpation tenderness [SPT], axial spinal percussion pain [ASPP]) were used to locate the VF segments identified using whole-spine magnetic resonance imaging (MRI). The percentage of agreements and kappa coefficient were calculated. RESULTS In 20.7% (74/358), the P-RBP site and VF segments were in the same location (kappa = 0.153); 21.2% (76/358) presented with concomitant RP in 93.4% (71/76) of whom the RP dermatome was colocalized with the VF segments (kappa = 0.924); 55.0% (197/358) and 23.2% (83/358) of patients presented with positive SPT and ASPP, respectively; and in 49.2% (97/197) and 96.4% (80/83) of patients with positive SPT (kappa = 0.435) and ASPP (kappa = 0.963), the positive finding and the VF segments were consistently colocalized. CONCLUSIONS The positive finding of RP or ASPP is useful in determining the spinal range for imaging tests, while an MRI scan covering the whole thoracic and lumbar spine is necessary in VF-suspected patients with P-RBP or positive SPT, indicating that caution is necessary when using symptoms or physical examination findings to localize VFs.
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Affiliation(s)
- H Jin
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
- Department of Orthopedics and Neurosurgery, Army 954th Hospital, Shannan, Tibet, China
| | - X Ma
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - Y Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - M Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - X Yin
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - W Fan
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - J Zhu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - J H Zhao
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - L Chen
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - N Su
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - Y Xie
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - J Yang
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - P Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China.
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Takatalo J, Ylinen J, Pienimäki T, Häkkinen A. Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain. BMC Musculoskelet Disord 2020; 21:529. [PMID: 32778081 PMCID: PMC7418198 DOI: 10.1186/s12891-020-03551-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. Trial registration Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1
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Affiliation(s)
- Jani Takatalo
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland. .,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Jari Ylinen
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Tuomo Pienimäki
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland.,Central Finland Central Hospital, Jyväskylä, Finland
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Effects of Inspiratory Muscles Training Plus Rib Cage Mobilization on Chest Expansion, Inspiratory Accessory Muscles Activity and Pulmonary Function in Stroke Patients. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10155178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
After stroke, limited ribcage movement may lead to impaired respiratory function. Combining threshold inspiratory muscle training with rib cage joint mobilization has been shown to enhance the recovery of respiratory function in patients with stroke. The present study investigated whether the combination of rib cage joint mobilization and inspiratory muscle training would improve chest expansion, inspiratory muscle activity, and pulmonary function after stroke. Thirty stroke patients were recruited and randomly assigned to one of the two groups, namely 6-week rib cage joint mobilization with inspiratory muscle training (experimental group) or inspiratory muscle training alone (control group). Outcome measures included upper and lower chest expansion, activity of accessory inspiratory muscles (latissimus dorsi (LD) and upper trapezius (UT)), and pulmonary function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF)). All evaluations were conducted at baseline and after 6 weeks of inspiratory muscle training. Significant increases were observed in upper and lower chest expansion, LD and UT muscle activity, FVC, FEV1, and PEF in both the groups. Upper and lower chest expansion and muscle activity of UT and LD were significantly higher in the experimental group than in the control group. No significant differences were observed in FVC, FEV1, and PEF between the groups. Inspiratory muscle training is effective in improving chest expansion, inspiratory muscle activity, and pulmonary function after stroke. The addition of rib cage joint mobilization further increases chest expansion and inspiratory muscle activity.
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Sillevis R, Swanick K. Musculoskeletal ultrasound imaging and clinical reasoning in the management of a patient with cervicogenic headache: a case report. Physiother Theory Pract 2019; 37:1252-1262. [PMID: 31686564 DOI: 10.1080/09593985.2019.1686793] [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: 10/25/2022]
Abstract
Background: Clinical decision-making within the physical therapy treatment process typically follows the hypothetical-deductive method. The accuracy and reliability of clinical tests affect this reasoning process. Musculoskeletal ultrasound imaging (MSK US) is an emerging valid and reliable diagnostic tool in physical therapy. MSK US allows for dynamic visualization of tissues in real time with devices that are often portable.Case Description: The patient was a 55-year-old female, who presented by direct access. She had been suffering from cervicogenic headaches since the age of 18. It was hypothesized that this patient presented with a right rotation positional default of atlas and facet hypomobility at C5-6.Outcomes: After six visits (over 7 weeks) of manual therapy interventions, the patient reported that her headaches and neck pain were no longer present. Her physical therapy goals had been met and she was discharged with the instruction to continue working on her posture correction and self-management.Discussion: This case report describes the use of MSK US imaging as part of the clinical decision-making process when treating a patient with cervicogenic headaches. This case illustrates the successful management using manual therapy to restore position, mobility, decrease muscle tone, and normalize upright posture. Complementary research is necessary to further validate MSK US imaging as the preferred method to objectivize joint mobility and guide decision-making. Additionally, the cause-effect relationship between the treatment and positive outcomes in this case report has to be further validated.
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Affiliation(s)
- Rob Sillevis
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Kathy Swanick
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
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Beynon AM, Hebert JJ, Walker BF. The interrater reliability of static palpation of the thoracic spine for eliciting tenderness and stiffness to test for a manipulable lesion. Chiropr Man Therap 2018; 26:49. [PMID: 30524705 PMCID: PMC6278006 DOI: 10.1186/s12998-018-0218-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite widespread use by manual therapists, there is little evidence regarding the reliability of thoracic spine static palpation to test for a manipulable lesion using stiffness or tenderness as diagnostic markers. We aimed to determine the interrater agreement of thoracic spine static palpation for segmental tenderness and stiffness and determine the effect of standardised training for examiners. The secondary aim was to explore expert consensus on the level of segmental tenderness required to locate a “manipulable lesion”. Methods Two experienced chiropractors used static palpation of thoracic vertebrae on two occasions (pragmatic and standardised approaches). Participants rated tenderness on an 11-point numerical pain rating scale (NPRS) and raters judged segmental stiffness based on their experience and perception of normal mobility with the requested outcomes of hypomobile or normal mobility. We calculated interrater agreement using percent agreement, Cohen’s Kappa coefficients (κ) and prevalence-adjusted bias-adjusted Kappa coefficients (PABAK). In a preliminary study, an expert panel of 10 chiropractors took part in a Delphi process to identify the level of meaningful segmental tenderness required to locate a “manipulable lesion”. Results Thirty-six participants (20 female) were enrolled for the reliability study on the 13th March 2017. Mean (SD) age was 22.4 (3.4) years with an equal distribution of asymptomatic (n = 17) and symptomatic (n = 17) participants. Overall, the interrater agreement for spinal segmental stiffness had Kappa values indicating less than chance agreement [κ range − 0.11, 0.53]. When adjusted for prevalence and bias, the PABAK ranged from slight to substantial agreement [0.12–0.76] with moderate or substantial agreement demonstrated at the majority of spinal levels (T1, T2 and T6 to T12). Generally, there was fair to substantial agreement for segmental tenderness [Kappa range 0.22–0.77]. Training did not significantly improve interrater agreement for stiffness or tenderness. The Delphi process indicated that an NPRS score of 2 out of 10 identified a potential “manipulable lesion”. Conclusion Static palpation was overall moderately reliable for the identification of segmental thoracic spine stiffness and tenderness, with tenderness demonstrating a higher reliability. Also, an increased agreement was found within the mid-thoracic spine. A brief training intervention failed to improve reliability. Electronic supplementary material The online version of this article (10.1186/s12998-018-0218-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amber M Beynon
- 1School of Health Professions, Murdoch University, 90 South Street, Murdoch, WA 6150 Australia
| | - Jeffrey J Hebert
- 2Faculty of Kinesiology, University of New Brunswick, 3 Bailey Drive, Fredericton, NB E3B 5A3 Canada.,3School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, 6150 WA Australia
| | - Bruce F Walker
- 1School of Health Professions, Murdoch University, 90 South Street, Murdoch, WA 6150 Australia
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Holt K, Russell D, Cooperstein R, Young M, Sherson M, Haavik H. Interexaminer Reliability of Seated Motion Palpation for the Stiffest Spinal Site. J Manipulative Physiol Ther 2018; 41:571-579. [DOI: 10.1016/j.jmpt.2017.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/22/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
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Karas S, Olson Hunt MJ, Temes B, Thiel M, Swoverland T, Windsor B. The effect of direction specific thoracic spine manipulation on the cervical spine: a randomized controlled trial. J Man Manip Ther 2018; 26:3-10. [PMID: 29456442 PMCID: PMC5810769 DOI: 10.1080/10669817.2016.1260674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To determine the difference on neck outcomes with directional manipulation to the thoracic spine. There is evidence that thoracic spine manipulation is effective in treating patients with neck pain. However, there is no research that determines if the assessment of directional hypomobility and the selection of thrust direction offer improved outcomes. METHODS A total of 69 patients with cervical spine pain were randomly assigned to receive either a manipulation that was consistent with their thoracic spine motion loss (matched) or opposite their motion loss (unmatched). The patient was given care consistent with the orthopedic section guidelines for neck pain and the physical therapist's clinical reasoning. Baseline outcome measures (NPRS, NDI, GROC) were taken and reassessed two days and two weeks after treatment. RESULTS Both groups had positive results when pain, neck disability index, and global rating of change were assessed. There was no difference between the matched and unmatched groups. DISCUSSION Directional manipulation of hypomobile thoracic spine segments may not be required to improved outcomes in patients with neck pain. Future studies should assess a variety of factors when determining the best available treatment, including manual therapy procedures, exercise, and patient selection. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Steve Karas
- Physical Therapy, Chatham University, Pittsburgh, PA, USA
| | - Megan J. Olson Hunt
- Natural and Applied Sciences (Statistics), University of Wisconsin-Green Bay, Green Bay, WI, USA
| | - Bill Temes
- Therapeutic Associates Physical Therapy, Instructor North American Institute of Orthopedic Manual Therapy, Eugene, OR, USA
| | - Martin Thiel
- Department of Physiotherapy and Rehabilitation, Baltic Sea-Clinic, Bad Schwartau, Germany
| | | | - Brett Windsor
- North American Institute of Orthopedic Manual Therapy, Eugene, OR, USA
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Cooperstein R, Young M. The reliability of spinal motion palpation determination of the location of the stiffest spinal site is influenced by confidence ratings: a secondary analysis of three studies. Chiropr Man Therap 2016; 24:50. [PMID: 28031786 PMCID: PMC5170895 DOI: 10.1186/s12998-016-0131-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 11/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background This is a secondary analysis of three previous studies on the cervical, thoracic, and lumbar spines. It uses continuous analysis of the stiffest spinal site rather than more typical level-by-level analysis to assess interexaminer reliability, and the impacts of examiner confidence and spinal region. The primary goal was secondary analysis of the combined data; secondary goal was de novo analysis of combined data emphasizing absolute indices of examiner agreement; and tertiary goal was analysis of actual vs. simulated data to determine to what degree the information provided by motion palpation impacted interexaminer reliability. Methods This study emphasized Median Absolute Examiner Differences and Bland-Altman Limits of Agreement to calculate examiner differences, which are immune to subject homogeneity, and de-emphasized intraclass correlation, which is not. It calculated Median Absolute Deviation to determine data dispersion. The study analyzed the entire n = 113 combined dataset, as well as subgroups stratified by examiner confidence and spinal region. Simulations were run using a random number generator to provide chance data for examiners' findings of the stiffest spinal site, the analysis of which was compared with that of the actual data. Results Median Absolute Examiner Differences for the combined dataset were 0.7 of one vertebral level, suggesting examiners usually agreed on the stiffest spinal site or the motion segment including it. When both examiners were confident in their findings (53.4%), the median examiner difference decreased to 0.6 levels, increasing to 1.0 levels when one lacked confidence and to 1.8 levels when both lacked confidence. Reliability was greater in the cervical and lumbar spines (each 0.6 vertebral levels examiner differences) than in the thoracic spine (1.1 levels examiner differences). The actual information provided by motion palpation compared to simulated data improved interexaminer reliability by a factor ranging from 1.8 times to 4.7 times, depending on the regional subset analyzed. Conclusions Examiner decisions regarding the location of the stiffest spinal site were deemed adequately reliable, especially when the examiners were confident. Researchers and clinicians alike might best design their study protocols and practice methods using the stiffest segment protocol as an alternative to level-by-level spinal analysis.
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Affiliation(s)
- Robert Cooperstein
- Palmer College of Chiropractic, San Jose, 90 East Tasman Drive, San Jose, CA 94577 USA
| | - Morgan Young
- Palmer College of Chiropractic, San Jose, 90 East Tasman Drive, San Jose, CA 94577 USA
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Satpute K, Hall T, Kumar S, Deodhar A. A new method of measuring shoulder hand behind back movement: Reliability, values in symptomatic and asymptomatic people, effect of hand dominance, and side-to-side variability. Physiother Theory Pract 2016; 32:520-7. [DOI: 10.1080/09593985.2016.1222041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pires PF, Packer AC, Dibai-Filho AV, Rodrigues-Bigaton D. Immediate and Short-Term Effects of Upper Thoracic Manipulation on Myoelectric Activity of Sternocleidomastoid Muscles in Young Women With Chronic Neck Pain: A Randomized Blind Clinical Trial. J Manipulative Physiol Ther 2015; 38:555-63. [PMID: 26387859 DOI: 10.1016/j.jmpt.2015.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/18/2014] [Accepted: 03/04/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to assess the immediate and short-term effects of upper thoracic spine manipulation on pain intensity and myoelectric activity of the sternocleidomastoid muscles in young women with chronic neck pain. METHODS A randomized clinical trial was carried out involving 32 women with chronic neck pain (mean age, 24.8 ± 5.4 years) allocated to an experimental group and a placebo group. Three evaluations were carried out: baseline, immediate postintervention, and short-term postintervention (48-72 hours after intervention). Myoelectric activity of the right and left sternocleidomastoid muscles was assessed at rest and during isometric contractions for cervical flexion and elevation of the shoulder girdle. Neck pain intensity was assessed at rest using a visual analog scale. Comparisons of the data were performed using 2-way repeated-measures analysis of variance with the Bonferroni correction. The level of significance was set at P < .05. RESULTS A moderate treatment effect on myoelectric activity of the right and left sternocleidomastoid muscles during isometric elevation of the shoulder girdle was found in the experimental group only on the short-term postintervention evaluation (d > 0.40). No statistically significant differences were found for any of the variables analyzed in the intergroup comparisons at the different evaluation times (P > .05). CONCLUSION No statistically significant differences were found in the intragroup or intergroup analyses of the experimental and placebo groups regarding myoelectric activity of the cervical muscles or the intensity of neck pain at rest in the immediate or short-term postintervention evaluations.
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Affiliation(s)
- Paulo Fernandes Pires
- Doctoral Student, Laboratory of Therapeutic Resources, Postgraduate Program in Science of Human Movement, Methodist University of Piracicaba, Piracicaba, SP, Brazil
| | - Amanda Carine Packer
- Master's Student, Laboratory of Therapeutic Resources, Postgraduate Program in Physical Therapy, Methodist University of Piracicaba, Piracicaba, SP, Brazil
| | - Almir Vieira Dibai-Filho
- Doctoral Student, Laboratory of Physiotherapeutic Resources, Postgraduate Program in Rehabilitation and Functional Performance, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Delaine Rodrigues-Bigaton
- Professor, Laboratory of Therapeutic Resources, Postgraduate Program in Science of Human Movement, Methodist University of Piracicaba, Piracicaba, SP, Brazil.
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Interrater Reliability of Motion Palpation in the Thoracic Spine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:815407. [PMID: 26170883 PMCID: PMC4480941 DOI: 10.1155/2015/815407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/25/2015] [Indexed: 11/17/2022]
Abstract
Introduction. Manual therapists commonly use assessments of intervertebral motion to determine the need for spinal manipulation, but the reliability of these procedures demonstrates conflicting results. The objectives of this study were to investigate the interrater reliability of thoracic spine motion palpation for perceived joint restriction and pain. Methods. Twenty-five participants between the ages of 18 and 70, with or without mid-back pain, were enrolled. Two raters motion palpated marked T5–T12 levels using two methods (standardised and pragmatic) and noted any restricted or painful segments. We calculated agreement between two raters by generating raw agreement percentages and Kappa coefficients with 95% confidence intervals. Results. There was poor to low level of agreement between the raters for both joint stiffness and pain localization using both pragmatic and standardized approaches. The results did not improve significantly when we conducted a post hoc analysis where three spinal levels were collapsed as one and right and left sides were also combined. Conclusions. The results for interrater reliability were poor for motion restriction and pain. These findings may have unfavourable implications for all manual therapists who use motion palpation to select patients appropriate for spinal manipulation.
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Reproducibility of the Kinematics in Rotational High-Velocity, Low-Amplitude Thrust of the Upper Cervical Spine: A Cadaveric Study. J Manipulative Physiol Ther 2015; 38:51-58. [DOI: 10.1016/j.jmpt.2014.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/18/2014] [Accepted: 03/28/2014] [Indexed: 11/20/2022]
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Karas S, Olson Hunt MJ. A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain. J Man Manip Ther 2014; 22:108-14. [PMID: 24976754 DOI: 10.1179/2042618613y.0000000052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
DESIGN Randomized clinical trial. OBJECTIVES To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes. METHODS A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention. RESULTS Pain reduction (post-treatment-pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation compared to the seated thoracic manipulation (P<0.05). Although not significant, we did observe greater improvement in flexion ROM in the targeted supine thoracic manipulation group. The results of this study indicate that a targeted supine thoracic manipulation may be more effective in reducing cervical spine pain and improving cervical flexion ROM than a seated thoracic manipulation. Future studies should include a variety of patients and physical therapists (PTs) to validate our findings.
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Affiliation(s)
- Steve Karas
- Physical Therapy Program, Chatham University, Pittsburgh, PA, USA
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Snider EJ, Pamperin K, Johnson JC, Shurtz NR, Degenhardt BF. Assessing palpation thresholds of osteopathic medical students using static models of the lumbar spine. J Osteopath Med 2014; 114:460-9. [PMID: 24917633 DOI: 10.7556/jaoa.2014.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Although spinal somatic dysfunction diagnosis is taught at all colleges of osteopathic medicine, few objective measures have been used to evaluate student accuracy. OBJECTIVE To assess the palpatory skills of osteopathic medical students in evaluating positional asymmetry in the transverse plane using static block transverse process and lumbar spine models. METHODS For this observational study, first-year osteopathic medical students completed 3 palpatory assessments using uncovered and covered block transverse process and lumbar spine models to simulate a range of positional asymmetries of the transverse processes. With use of logistic regression, 80%, 90%, and 95% thresholds were defined as the magnitude of asymmetry for which the predicted probability of students correctly determining the direction of asymmetry exceeded a specified amount (.80, .90, or .95). RESULTS A total of 346 students completed the assessments. For the uncovered block transverse process model (assessment 1), students correctly identified the direction of asymmetry with .89 probability at 1 mm of asymmetry (80% threshold), .94 probability at 2 mm (90% threshold), and .95 probability at 3 mm (95% threshold). For the covered block transverse process model, students correctly identified the direction of asymmetry with .80 probability at 1 mm (80% threshold), .92 probability at 2 mm (90% threshold), and .98 probability at 3 mm (95% threshold) by the third assessment. For the uncovered lumbar spine model (assessment 2), students correctly identified the direction of asymmetry with .93 probability at 2 mm (80% and 90% thresholds) and .95 probability at 3 mm (95% threshold). For the covered lumbar spine model (assessments 2 and 3), students correctly identified the direction of asymmetry with .87 probability at 4 mm (80% threshold); 90% and 95% thresholds were not reached with the range of asymmetries tested. CONCLUSION Most first-year osteopathic medical students were able to discern the direction of positional asymmetry of transverse processes on static models. Depending on the model type, student performance improved (block transverse process models) or declined (lumbar spine models) over time. Future studies should evaluate whether accuracy of palpating lumbar spine models translates to accuracy of palpating human lumbar spines.
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Affiliation(s)
- Eric J Snider
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Kenneth Pamperin
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Jane C Johnson
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Natalie R Shurtz
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Brian F Degenhardt
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
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Hanney WJ, George SZ, Kolber MJ, Young I, Salamh PA, Cleland JA. Inter-rater reliability of select physical examination procedures in patients with neck pain. Physiother Theory Pract 2013; 30:345-52. [DOI: 10.3109/09593985.2013.870267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van den Dolder PA, Ferreira PH, Refshauge K. Intra- and inter-rater reliability of a modified measure of hand behind back range of motion. ACTA ACUST UNITED AC 2013; 19:72-6. [PMID: 24269329 DOI: 10.1016/j.math.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 11/30/2022]
Abstract
The aim of this reliability study was to identify the clinimetric properties, specifically intra- and inter-rater reliability, for measuring the functionally and clinically important hand behind back (combined shoulder internal rotation/adduction and elbow flexion) range of motion using a modified technique. Sixty asymptomatic participants (20 male, 40 female) aged 45.4 ± 11.7 years (mean ± SD). Hand behind back was measured as the distance from the mid-line between the posterior superior iliac spines (PSIS) to the tip of the thumb and recorded in centimetres above the PSIS (a positive measure) or below the PSIS (a negative measure). The intra- and inter-rater reliability for the measurement were excellent, with ICC (2,1) of 0.95 for intra-rater and ICC (2,2) of 0.96 for inter-rater reliability. The standard error of the measurement (SEM) and smallest real difference (SRD) values showed acceptable levels of measurement error, SEM 4.3 mm and SRD 12.8 mm for intra-rater reliability and SEM 2.6 mm and SRD 7.7 mm for inter-rater reliability. The assessment of hand-behind-back motion from a point equidistant between the PSISs to the tip of the thumb is more reliable than traditional methods and a useful clinical tool.
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Affiliation(s)
- Paul A van den Dolder
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Illawarra Shoalhaven Local Health District, Wollongong, Australia.
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Kathryn Refshauge
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Triano JJ, Budgell B, Bagnulo A, Roffey B, Bergmann T, Cooperstein R, Gleberzon B, Good C, Perron J, Tepe R. Review of methods used by chiropractors to determine the site for applying manipulation. Chiropr Man Therap 2013; 21:36. [PMID: 24499598 PMCID: PMC4028787 DOI: 10.1186/2045-709x-21-36] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/29/2013] [Indexed: 01/13/2023] Open
Abstract
Background With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.
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Affiliation(s)
- John J Triano
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Brian Budgell
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | | | | | - Thomas Bergmann
- Northwestern Health Sciences University, Bloomington, MN, USA
| | | | - Brian Gleberzon
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Christopher Good
- University of Bridgeport College of Chiropractic, Bridgeport, CT, USA
| | | | - Rodger Tepe
- Logan College of Chiropractic, Chesterfield, MO, USA
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Interexaminer reliability of the Johnston and Friedman percussion scan of the thoracic spine: secondary data analysis using modified methods. J Chiropr Med 2012; 11:154-9. [DOI: 10.1016/j.jcm.2012.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/31/2012] [Accepted: 06/05/2012] [Indexed: 11/17/2022] Open
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Sebastian D. T2 radiculopathy: A differential screen for upper extremity radicular pain. Physiother Theory Pract 2012; 29:75-85. [DOI: 10.3109/09593985.2012.700001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fölsch C, Schlögel S, Lakemeier S, Wolf U, Timmesfeld N, Skwara A. Test-retest reliability of 3D ultrasound measurements of the thoracic spine. PM R 2012; 4:335-41. [PMID: 22464951 DOI: 10.1016/j.pmrj.2012.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 12/27/2011] [Accepted: 01/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore the reliability of the Zebris CMS 20 ultrasound analysis system with pointer application for measuring end-range flexion, end-range extension, and neutral kyphosis angle of the thoracic spine. SETTING The study was performed within the School of Physiotherapy in cooperation with the Orthopedic Department at a University Hospital. PARTICIPANTS The thoracic spines of 28 healthy subjects were measured. METHODS Measurements for neutral kyphosis angle, end-range flexion, and end-range extension were taken once at each time point. The bone landmarks were palpated by one examiner and marked with a pointer containing 2 transmitters using a frequency of 40 kHz. A third transmitter was fixed to the pelvis, and 3 microphones were used as receiver. The real angle was calculated by the software. Bland-Altman plots with 95% limits of agreement, intraclass correlations (ICC), standard deviations of mean measurements, and standard error of measurements were used for statistical analyses. The test-retest reliability in this study was measured within a 24-hour interval. MAIN OUTCOME MEASUREMENTS Statistical parameters were used to judge reliability. RESULTS The mean kyphosis angle was 44.8° with a standard deviation of 17.3° at the first measurement and a mean of 45.8° with a standard deviation of 16.2° the following day. The ICC was high at 0.95 for the neutral kyphosis angle, and the Bland-Altman 95% limits of agreement were within clinical acceptable margins. The ICC was 0.71 for end-range flexion and 0.34 for end-range extension, whereas the Bland-Altman 95% limits of agreement were wider than with the static measurement of kyphosis. Compared with static measurements, the analysis of motion with 3-dimensional ultrasound showed an increased standard deviation for test-retest measurements. CONCLUSIONS The test-retest reliability of ultrasound measuring of the neutral kyphosis angle of the thoracic spine was demonstrated within 24 hours. Bland-Altman 95% limits of agreement and the standard deviation of differences did not appear to be clinically acceptable for measuring flexion and extension.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
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Cooperstein R, Haneline M, Young M. Interexaminer reliability of thoracic motion palpation using confidence ratings and continuous analysis. J Chiropr Med 2011; 9:99-106. [PMID: 22027031 DOI: 10.1016/j.jcm.2010.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 05/28/2010] [Accepted: 06/16/2010] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Motion palpation is integral to most chiropractic techniques and can be found in curricula of most every chiropractic college. Paradoxically, most studies do not show strong reliability for motion palpation. The purpose of this study was to determine if allowing motion palpators to rate their confidence in their findings, as well using a continuous data analytic method, would influence the level of concordance. METHODS Subjects were 52 asymptomatic chiropractic student volunteers. Two palpators assessed posterior to anterior glide of T3-10 in the prone position, alternating in their order and blinded as to each other's results. Each examiner identified the location of maximal restriction in this range and also whether they were "very confident" or "not confident" in their finding. RESULTS For all subjects combined, the examiners' calls were "poor": intraclass correlation coefficient [2,1] = .3110 (95% CI, .0458-.5358). In contrast, interexaminer agreement was "good" when both examiners were very confident: intraclass correlation coefficient [2,1] = .8266 (95% CI, 0.6257-0.9253). CONCLUSION When each examiner was "very confident" as to the most fixated thoracic segment, the levels they identified were very close. This corresponds to "good" agreement, an uncommon result in most interexaminer motion palpation studies. Thus, the confidence level of examiners had an effect on the interexaminer reliability of thoracic spine. Our novel continuous measures, statistical methodology, and subtyping the subjects according to the confidence of the palpators seem more capable than level-by-level discrete analysis of detecting interexaminer agreement.
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Heiderscheit B, Boissonnault W. Reliability of joint mobility and pain assessment of the thoracic spine and rib cage in asymptomatic individuals. J Man Manip Ther 2011; 16:210-6. [PMID: 19771193 DOI: 10.1179/106698108790818369] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Despite the importance of correctly diagnosing a spinal dysfunction, limited research exists related to physical therapists' ability to reliably identify a joint exhibiting signs of dysfunction. The purpose of this investigation was to determine the inter- and intra-examiner reliability of a thoracic spine and rib cage joint mobility and pain assessment between two experienced manipulative physical therapists. Nine healthy subjects (3 male, 6 female; ages 23-35) without history of mid- or low back pain participated. Posterior-to-anterior pressures were applied to the thoracic spine and rib articulations with anterior-to-posterior pressures applied to the costosternal joints of each subject by two examiners to evaluate joint mobility and pain provocation. Both examiners assessed all subjects twice and were blinded to subject identity. Kappa statistics were calculated using a strict and expanded definition of agreement to determine the between- and within-examiner reliability for each outcome. Intra-examiner reliability of joint mobility assessment ranged from slight to fair based on the strict agreement but improved to good when findings were compared across +/- 1 spinal/rib level. Pain provocation reliability increased to very good under the expanded agreement; however, this finding should be viewed with caution due to limited pain prevalence in the subject sample. Selected clinical prediction rules, applied to the care of individuals with back pain, characterize the patient's regional mobility simply as hypomobile, normal, or hypermobile; consequently, we feel the results of an expanded definition of agreement may be more appropriate for clinic practice. Further research is needed to determine the reliability in individuals with thoracic spine and rib cage symptoms.
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Krauss J, Creighton D, Ely JD, Podlewska-Ely J. The immediate effects of upper thoracic translatoric spinal manipulation on cervical pain and range of motion: a randomized clinical trial. J Man Manip Ther 2011; 16:93-9. [PMID: 19119394 DOI: 10.1179/106698108790818530] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4) segments. Active cervical rotation range of motion was measured re- and post-intervention with a cervical inclinometer (CROM), and cervical pain status was monitored before and after manipulation with a Faces Pain Scale. Study participants included a sample of convenience that included 32 patients referred to physical therapy with complaints of pain in the mid-cervical region and restricted active cervical rotation. Twenty-two patients were randomly assigned to the experimental group and ten were assigned to the control group. Pre- and post-intervention cervical range of motion and pain scale measurements were taken by a physical therapist assistant who was blinded to group assignment. The experimental group received TSM to hypomobile upper thoracic segments. The control group received no intervention. Paired t-tests were used to analyze within-group changes in cervical rotation and pain, and a 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. Significance was accepted at p = 0.05. Significant changes that exceeded the MDC(95) were detected for cervical rotation both within group and between groups with the TSM group demonstrating increased mean (SD) in right rotation of 8.23 degrees (7.41 degrees ) and left rotation of 7.09 degrees (5.83 degrees ). Pain levels perceived during post-intervention cervical rotation showed significant improvement during right rotation for patients experiencing pain during bilateral rotation only (p=.05). This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation.
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Affiliation(s)
- John Krauss
- Associate Professor, Program in Physical Therapy, School of Health Sciences, Oakland University, Rochester, MI
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Stovall BA, Bae S, Kumar S. Anterior superior iliac spine asymmetry assessment on a novel pelvic model: an investigation of accuracy and reliability. J Manipulative Physiol Ther 2010; 33:378-85. [PMID: 20605557 DOI: 10.1016/j.jmpt.2010.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 03/27/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a novel pelvic model and determine the accuracy and the inter- and intraexaminer reliability of anterior superior iliac spine (ASIS) positional asymmetry assessment from both sides of the model by osteopathic predoctoral fellows and osteopathic physicians and to evaluate the effect of training. METHODS Five osteopathic predoctoral fellows and 5 osteopathic physicians assessed 13 settings of varied ASIS asymmetry of a novel pelvic model for superior/inferior positional asymmetry from both sides of the model in a random order. Assessment from the right and left sides of the model occurred on 2 separate days. Fellows were trained for a week and retested. RESULTS Average interexaminer reliability was greatest from the left side of the model for physicians and from the right side for fellows (physicians: kappa = 0.46, fellows: kappa = 0.37), whereas intraexaminer reliability was greatest from the right in both groups (physicians: kappa = 0.49, fellows: kappa = 0.52). Following training of fellows, interexaminer reliability remained highest from the right side of the model (right: kappa = 0.48, left: kappa = 0.36), whereas intraexaminer reliability was higher from the left side (right: kappa = 0.53, left: kappa = 0.59). Physicians and fellows before training were more accurate from the right side of the model (kappa = 0.56 and kappa = 0.52, respectively). Following training of fellows, accuracy increased from both sides of the model (right: kappa = 0.59, left: kappa = 0.53). CONCLUSIONS A novel pelvic model was developed to allow assessment of accuracy and reliability of ASIS asymmetry assessment. Individually, physicians and fellows varied in accuracy and inter-/intraexaminer reliability. Further investigation is warranted to understand the clinical and educational application of these results.
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Affiliation(s)
- Bradley A Stovall
- Department of Osteopathic Manipulative Medicine, University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, TX 76107, USA
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Jowsey P, Perry J. Sympathetic nervous system effects in the hands following a grade III postero-anterior rotatory mobilisation technique applied to T4: A randomised, placebo-controlled trial. ACTA ACUST UNITED AC 2010; 15:248-53. [DOI: 10.1016/j.math.2009.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 11/05/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
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Abstract
The musculoskeletal system is a recognized source of chest pain. However, despite the apparently benign origin, patients with musculoskeletal chest pain remain under-diagnosed, untreated, and potentially continuously disabled in terms of anxiety, depression, and activities of daily living. Several overlapping conditions and syndromes of focal disorders, including Tietze syndrome, costochondritis, chest wall syndrome, muscle tenderness, slipping rib, cervical angina, and segmental dysfunction of the cervical and thoracic spine, have been reported to cause pain. For most of these syndromes, evidence arises mainly from case stories and empiric knowledge. For segmental dysfunction, clinical features of musculoskeletal chest pain have been characterized in a few clinical trials. This article summarizes the most commonly encountered syndromes of focal musculoskeletal disorders in clinical practice.
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Brunse MH, Stochkendahl MJ, Vach W, Kongsted A, Poulsen E, Hartvigsen J, Christensen HW. Examination of musculoskeletal chest pain – An inter-observer reliability study. ACTA ACUST UNITED AC 2010; 15:167-72. [DOI: 10.1016/j.math.2009.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/23/2009] [Accepted: 10/07/2009] [Indexed: 11/25/2022]
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Cattrysse E, Provyn S, Kool P, Clarys JP, Roy PV. Reproducibility of global three-dimensional motion during manual atlanto-axial rotation mobilization: an in vitro study. J Man Manip Ther 2010; 18:15-21. [PMID: 21655419 DOI: 10.1179/106698110x12595770849489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The reproducibility of the three-dimensional (3D) kinematic aspects of motion coupling patterns during manual mobilizing techniques is still a debatable matter. The present in vitro study analysed segmental 3D motion of the atlanto-axial joint during manual axial rotation mobilization. Twenty fresh frozen human cervical specimens were studied in a test-retest situation with two examiners. The specimens were manually mobilized using three different techniques: (1) a regional mobilization technique of the cervical spine; (2) a segmental mobilization technique of the atlas with manual fixation of the axis; and (3) a segmental mobilization of the atlas on the axis applying a locking technique. Segmental atlanto-axial kinematics was registered with a Zebris CMS-20 ultrasound-based tracking system. The Euclidian norm was used as a representation of overall 3D motion. The results indicated good reproducibility (mean intraclass correlation coefficient, ICC: 0.87). Intraobserver reproducibility was slightly higher (mean ICC: 0.91; range: 0.76-0.99) than interobserver reproducibility (mean ICC: 0.85; range: 0.56-0.98) (P < 0.05). The total range of motion expressed as the Euclidean norm of 3D motion components was a parameter with good reproducibility in the study of segmental kinematics of manual atlanto-axial mobilization. Although previous studies have demonstrated poor inter-rater reliability of manual examination and mobilization of segmental motion components, the results of the present study shed a new and more positive light on the reproducibility of techniques for manual mobilization of the upper cervical spine.
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Affiliation(s)
- Erik Cattrysse
- Department of Experimental Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
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Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther 2010; 17:230-6. [PMID: 20140154 DOI: 10.1179/106698109791352102] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Shoulder pain is a common orthopedic condition seen by physical therapists, with many potential contributing factors and proposed treatments. Although manual physical therapy interventions for the cervicothoracic spine and ribs have been investigated for this patient population, the specific effects of these treatments have not been reported. The purpose of this investigational study is to report the immediate effects of thoracic spine and rib manipulation in patients with primary complaints of shoulder pain. Using a test-retest design, 21 subjects with shoulder pain were treated during a single treatment session with high-velocity thrust manipulation to the thoracic spine or upper ribs. Post-treatment effects demonstrated a 51% (32mm) reduction in shoulder pain, a corresponding increase in shoulder range of motion (30 degrees -38 degrees ), and a mean patient-perceived global rating of change of 4.2 (median 5). These immediate post-treatment results suggest that thoracic and rib manipulative therapy is associated with improved shoulder pain and motion in patients with shoulder pain, and further these interventions support the concept of a regional interdependence between the thoracic spine, upper ribs, and shoulder.
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Paulet T, Fryer G. Inter-examiner reliability of palpation for tissue texture abnormality in the thoracic paraspinal region. INT J OSTEOPATH MED 2009. [DOI: 10.1016/j.ijosm.2008.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Validation of a noninvasive dynamic spinal stiffness assessment methodology in an animal model of intervertebral disc degeneration. Spine (Phila Pa 1976) 2009; 34:1900-5. [PMID: 19680098 DOI: 10.1097/brs.0b013e3181afea9d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An experimental in vivo ovine model of intervertebral disc degeneration was used to quantify the dynamic motion response of the lumbar spine. OBJECTIVE The purpose of this study was to: (1) compare invasively measured lumbar vertebral bone acceleration responses to noninvasive displacement responses, and (2) determine the effects of a single level degenerative intervertebral disc lesion on these responses. SUMMARY OF BACKGROUND DATA Biomechanical techniques have been established to quantify vertebral motion responses, yet their invasiveness limits their use in a clinical setting. METHODS Twenty-five Merino sheep were examined; 15 with surgically induced disc degeneration at L1-L2 and 10 controls. Triaxial accelerometers were rigidly fixed to the L1 and L2 spinous processes and dorsoventral (DV) mechanical excitation (20-80 N, 100 milliseconds) was applied to L3 using a spinal dynamometer. Peak force and displacement and peak-peak acceleration responses were computed for each trial and a least squares regression analysis assessed the correlation between L3 displacement and adjacent (L2) segment acceleration responses. An analysis of covariance (ANCOVA) was performed to test the homogeneity of slopes derived from the regression analysis and to assess the mean differences. RESULTS A significant, positive, linear correlation was found between the DV displacement of L3 and the DV acceleration measured at L2 for both normal (R = 0.482, P < 0.001) and degenerated disc groups (R = 0.831, P < 0.001). The L3 DV displacement was significantly lower (ANCOVA, P < 0.001) for the degenerated group (mean: 10.39 mm) in comparison to the normal group (mean: 9.07 mm). Mean peak-peak L2-L1 DV acceleration transfer was also significantly reduced from 12.40 m/s to 5.50 m/s in the degenerated animal group (ANCOVA, P < 0.001). CONCLUSION The findings indicate that noninvasive displacement measurements of the prone-lying animal can be used to estimate the segmental and intersegmental motions in both normal and pathologic spines.
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Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5. ACTA ACUST UNITED AC 2009; 14:409-14. [DOI: 10.1016/j.math.2008.06.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 06/05/2008] [Accepted: 06/29/2008] [Indexed: 11/18/2022]
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Haneline MT, Young M. A Review of Intraexaminer and Interexaminer Reliability of Static Spinal Palpation: A Literature Synthesis. J Manipulative Physiol Ther 2009; 32:379-86. [PMID: 19539121 DOI: 10.1016/j.jmpt.2009.04.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/02/2009] [Accepted: 01/12/2009] [Indexed: 11/19/2022]
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Cattrysse E, Provyn S, Kool P, Gagey O, Clarys JP, Van Roy P. Reproducibility of kinematic motion coupling parameters during manual upper cervical axial rotation mobilization: A 3-dimensional in vitro study of the atlanto-axial joint. J Electromyogr Kinesiol 2009; 19:93-104. [PMID: 17728151 DOI: 10.1016/j.jelekin.2007.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 06/21/2007] [Accepted: 06/21/2007] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The reproducibility of the 3-dimensional (3D) kinematic aspects of motion coupling patterns of segmental manual mobilizing techniques is not yet known. This study analyzes the segmental 3D aspects of manual mobilization of the atlanto-axial joint in vitro. METHODS AND MATERIALS Twenty fresh human cervical specimens were studied in a test-retest situation with two examiners. The specimens were manually mobilized using three different techniques: a regional mobilization technique, a segmental mobilization technique on the atlas with manual fixation of the axis and a segmental mobilization applying a locking technique. Segmental kinematics were registered with a Zebris CMS20 ultrasound-based tracking system. The 3D aspects of motion coupling between main axial rotation and coupled lateral bending were analyzed by six parameters: the range of motion the three motion components, the cross-correlation, the ratio and the shift. RESULTS The results indicate stronger intra- than inter-examiner reproducibility. The range of motion of the axial rotation component shows a substantial level of intra- and inter-examiner reproducibility (ICC's 0.67-0.76). The parameters describing the coupling patterns show only moderate to substantial intra-examiner reproducibility for the more experienced of the two examiners (ICC's 0.55-0.68). All other correlations were not significant and no differences could be observed between regional versus segmental techniques. CONCLUSION Reproducibility of segmental 3D-aspects of manual mobilization of the atlanto-axial joint in an in vitro situation can differ between examiners. The results of the present study may indicate a possible tendency to higher reproducibility if mobilizations are performed by an examiner with high expertise and experience in applying the specific techniques. Continued investigation including more examiners with different levels of experience and different techniques is necessary to confirm these observations.
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Affiliation(s)
- E Cattrysse
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Department of Experimental Anatomy, Laarbeeklaan 103, B1090 Brussels, Belgium.
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Haneline MT, Cooperstein R, Young M, Birkeland K. Spinal Motion Palpation: A Comparison of Studies That Assessed Intersegmental End Feel Vs Excursion. J Manipulative Physiol Ther 2008; 31:616-26. [DOI: 10.1016/j.jmpt.2008.09.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 05/30/2008] [Accepted: 07/02/2008] [Indexed: 11/16/2022]
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Murphy DR, Hurwitz EL, Nelson CF. A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature. CHIROPRACTIC & OSTEOPATHY 2008; 16:7. [PMID: 18694490 PMCID: PMC2538525 DOI: 10.1186/1746-1340-16-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 08/11/2008] [Indexed: 01/08/2023]
Abstract
Background Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented. Methods The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source) and 3 (which investigates perpetuating factors of the pain experience). In addition, the reference list of identified papers and authors' libraries were searched. Results A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity. Conclusion Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.
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Muscular Tenderness in the Anterior Chest Wall in Patients With Stable Angina Pectoris is Associated With Normal Myocardial Perfusion. J Manipulative Physiol Ther 2008; 31:344-7. [DOI: 10.1016/j.jmpt.2008.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 02/28/2008] [Accepted: 03/06/2008] [Indexed: 11/18/2022]
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Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage 2008; 35:544-62. [PMID: 18280103 DOI: 10.1016/j.jpainsymman.2007.07.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 07/06/2007] [Accepted: 07/17/2007] [Indexed: 01/01/2023]
Abstract
Chiropractic was defined by D.D. Palmer as "a science of healing without drugs." About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic. The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic. A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews. Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.
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Affiliation(s)
- Edzard Ernst
- Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, United Kingdom.
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Buchmann J, Blümel G, Beyer L. Objektivierbare apparative Messung der Gewebespannung mittels Tissue Tensiometer (TTM). MANUELLE MEDIZIN 2007. [DOI: 10.1007/s00337-007-0504-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Geelhoed MA, McGaugh J, Brewer PA, Murphy D. A new model to facilitate palpation of the level of the transverse processes of the thoracic spine. J Orthop Sports Phys Ther 2006; 36:876-81. [PMID: 17154141 DOI: 10.2519/jospt.2006.2243] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Nonexperimental, normative research design. OBJECTIVES To test a proposed model to locate the level of the transverse processes (TPs) of the thoracic spine through surface palpation. BACKGROUND Palpation of the TPs of the thoracic spine is challenging because of their depth relative to the more superficial structures of the spine. Many clinicians use the more superficial spinous processes (SPs) of the thoracic spine to orient themselves for palpation of the TPs. In 1979, Mitchell described a "rule of threes," which attempted to predict the location of the level of the thoracic TPs relative to their corresponding SPs. We previously conducted a pilot study to investigate the validity of the rule of threes and concluded that it is not an accurate predictor of the level of the location of the TPs of the thoracic spine. Based on that previous work, we hypothesized that a more accurate model for predicting the level of the TPs would be that they are generally at the level of the SP of the adjacent cranial thoracic vertebra throughout the thoracic spine. METHODS AND MEASURES We dissected 15 cadavers and measured the vertical distance between the transverse (horizontal) plane of the TPs of 1 vertebra and the SP of the adjacent cranial thoracic vertebra for all levels of the thoracic spine. RESULTS Mean vertical distances ranged from 2.0 to 4.0 mm. The means for all thoracic vertebral levels except for T11 and T12 were significantly less than the normal 6-mm threshold of 2-point discrimination of the fingertips (P<.01). CONCLUSION The results of this study indicate that the TPs of each thoracic vertebra are generally at the level of the SP of the vertebra 1 level above, throughout the thoracic spine. It may be more difficult to predict the location of the TPs of the 2 most caudal levels (T11 and T12), given their greater variability of position.
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Affiliation(s)
- Michael A Geelhoed
- Department of Physical Therapy, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 6427, San Antonio, TX 78229, USA.
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Budgell B, Polus B. The Effects of Thoracic Manipulation on Heart Rate Variability: A Controlled Crossover Trial. J Manipulative Physiol Ther 2006; 29:603-10. [PMID: 17045093 DOI: 10.1016/j.jmpt.2006.08.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 06/24/2006] [Accepted: 07/02/2006] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of this study was to measure the effects of thoracic spinal manipulation on heart rate variability (HRV) in a cohort of healthy young adults. METHODS A controlled crossover trial that was conducted on 28 healthy young adults (23 men and 5 women; age range, 18-45 years; mean age, 29 +/- 7 years) measured HRV before and after a sham procedure and a thoracic spinal manipulation. RESULTS In healthy young adults, thoracic spinal manipulation was associated with changes in HRV that were not duplicated by the sham procedure. The ratio of the powers of the low-frequency and high-frequency components increased from 0.9562 +/- 0.9192 to 1.304 +/- 1.118 (P = .0030, Wilcoxon signed rank test). In subjects undergoing sham spinal manipulation, there was no statistically significant change in the low-frequency or the high-frequency component of the power spectrum; neither was there any in the ratio of the two regardless of whether the comparison was made using the paired t test or the Wilcoxon signed rank test. CONCLUSION High-velocity and low-amplitude manipulation of the thoracic spine appears to be able to influence autonomic output to the heart in ways that are not duplicated by a sham procedure or by other forms of somatic/physical therapies.
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Affiliation(s)
- Brian Budgell
- School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan.
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Cleland JA, Childs JD, Fritz JM, Whitman JM. Interrater Reliability of the History and Physical Examination in Patients With Mechanical Neck Pain. Arch Phys Med Rehabil 2006; 87:1388-95. [PMID: 17023251 DOI: 10.1016/j.apmr.2006.06.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 06/20/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the interrater reliability of the history and physical examination in patients with mechanical neck pain. DESIGN Single-group repeated measures for interrater reliability. SETTING Outpatient physical therapy clinic. PARTICIPANTS Twenty-two patients with mechanical neck pain underwent a standardized history and physical examination by a physical therapist. INTERVENTION Following a 5-minute break, a second therapist who was blind to the findings of examiner 1 performed the second standardized history and physical examination. MAIN OUTCOME MEASURES The Cohen kappa and weighted kappa were used to calculate the interrater reliability of ordinal level data from the history and physical examination. Intraclass correlation coefficients model 2,1 (ICC(2,1)) and the 95% confidence intervals were calculated to determine the interrater reliability for continuous variables. RESULTS The kappa coefficients ranged from -.06 to .90 for the variables obtained from the history. Reliability values for categorical data collected during the physical examination ranged from no to substantial agreement depending on the particular test and measure. ICC(2,1) for cervical range of motion (ROM) measurements ranged between .66 and .78. CONCLUSIONS We have reported the interrater reliability of the history and physical examination in a group of patients with a primary report of neck pain. The reliability variables varied considerably for manual assessment techniques and were significantly higher for the examination of muscle length and cervical ROM. Ultimately, it will be up to each clinician to determine if a particular test or measure poses adequate reliability to assist in the clinical decision making process.
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Affiliation(s)
- Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce College, Concord, NH, USA.
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Stochkendahl MJ, Christensen HW, Hartvigsen J, Vach W, Haas M, Hestbaek L, Adams A, Bronfort G. Manual Examination of the Spine: A Systematic Critical Literature Review of Reproducibility. J Manipulative Physiol Ther 2006; 29:475-85, 485.e1-10. [PMID: 16904495 DOI: 10.1016/j.jmpt.2006.06.011] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 02/02/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Poor reproducibility of spinal palpation has been reported in previously published literature, and authors of recent reviews have posted criticism on study quality. This article critically analyzes the literature pertaining to the inter- and intraobserver reproducibility of spinal palpation to investigate the consistency of study results and assess the level of evidence for reproducibility. METHODS Systematic review and meta-analysis were performed on relevant literature published from 1965 to 2005, identified using the electronic databases MEDLINE, MANTIS, and CINAHL and checking of reference lists. Descriptive data from included articles were extracted independently by 2 reviewers. A 6-point scale was constructed to assess the methodological quality of original studies. A meta-analysis was conducted among the high-quality studies to investigate the consistency of data, separately on motion palpation, static palpation, osseous pain, soft tissue pain, soft tissue changes, and global assessment. A standardized method was used to determine the level of evidence. RESULTS The quality score of 48 included studies ranged from 0% to 100%. There was strong evidence that the interobserver reproducibility of osseous and soft tissue pain is clinically acceptable (kappa > or = 0.4) and that intraobserver reproducibility of soft tissue pain and global assessment are clinically acceptable. Other spinal procedures are either not reproducible or the evidence is conflicting or preliminary.
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Affiliation(s)
- Mette Jensen Stochkendahl
- Nordic Institute of Chiropractic and Clinical Biomechanics Research Department, Part of Clinical Locomotion Science, Odense, Denmark.
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Potter L, McCarthy C, Oldham J. Intraexaminer Reliability of Identifying a Dysfunctional Segment in the Thoracic and Lumbar Spine. J Manipulative Physiol Ther 2006; 29:203-7. [PMID: 16584944 DOI: 10.1016/j.jmpt.2006.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 07/20/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the intrarater reliability of identifying a manipulable lesion in the lumbar and thoracic spine. METHODS An experienced osteopath used dynamic and static examination to assess 12 asymptomatic subjects for signs of joint dysfunction in the thoracic and lumbar spine. The selected segment was marked with an UV invisible mark. A second examiner visualized these marks with an UV lamp and recorded them on acetates for analysis; this process was then repeated an hour later. The distance from the marks to a fixed point was measured and within-day intrarater reliability was calculated using intraclass correlation coefficients (ICCs). RESULTS The ICC(1,1) for the thoracic spine was 0.70 (95% confidence interval [CI], 0.27-0.90). In the lumbar spine the ICC(1,1) was 0.96 (95% CI, 0.87-0.99). CONCLUSION This study shows that the lumbar spine joint perceived to be the joint most likely to benefit from a high-velocity low-amplitude thrust can be identified with good within-day reliability in an asymptomatic sample using a defined examination protocol. However, the reliability in identifying a joint exhibiting signs of segmental dysfunction in the thoracic spine was poor.
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Affiliation(s)
- Louise Potter
- Centre for Rehabilitation Science, University of Manchester, Central Manchester and Manchester Children's University Hospital's NHS Trust, Manchester, UK.
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Christensen HW, Vach W, Gichangi A, Manniche C, Haghfelt T, Høilund-Carlsen PF. Manual Therapy for Patients With Stable Angina Pectoris: A Nonrandomized Open Prospective Trial. J Manipulative Physiol Ther 2005; 28:654-61. [PMID: 16326234 DOI: 10.1016/j.jmpt.2005.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 06/06/2005] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine if participants with chest pain originating from the spine would benefit from manual therapy. METHODS A nonrandomized, open, prospective trial was performed at a tertiary hospital. Patients who were referred for coronary angiography because of known or suspected stable angina pectoris were invited to participate in this study. A total of 275 took part, 50 were diagnosed as cervicothoracic angina (CTA)-positive (chest pain from the cervicothoracic spine) and 225 as CTA-negative. The intervention performed was manual therapy according to chiropractic standards. Patient self reported questionnaires at baseline and 4-week follow-up, including pain measured with an 11-point box scale, Short Form 36 (quality of life), and perceived improvement. RESULTS Approximately 75% of CTA-positive patients reported improvement of pain and of general health after treatment, compared with 22% to 25% of CTA-negative patients (P < .0001). Pain intensity decreased in both groups with consistently larger decreases for all measures of pain among CTA-positive patients. Short Form 36 scores increased in the CTA-positive group in 5 of 8 scales and remained unchanged in the CTA-negative group. CONCLUSION This study suggested that patients with known or suspected angina pectoris and a diagnosis of CTA may benefit from chiropractic manual therapy. Methodologically, sound randomized clinical trials are needed to corroborate our results.
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van Trijffel E, Anderegg Q, Bossuyt PMM, Lucas C. Inter-examiner reliability of passive assessment of intervertebral motion in the cervical and lumbar spine: A systematic review. ACTA ACUST UNITED AC 2005; 10:256-69. [PMID: 15994114 DOI: 10.1016/j.math.2005.04.008] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 03/28/2005] [Accepted: 04/27/2005] [Indexed: 11/28/2022]
Abstract
A systematic review was conducted to determine inter-examiner reliability of passive assessment of segmental intervertebral motion in the cervical and lumbar spine as well as to explore sources of heterogeneity. Passive assessment of motion is used to decide on treatments for neck and low-back pain patients. Inter-examiner reliability has been a matter of debate, resulting in questions about professional credibility and accountability. A structured search for relevant studies in MEDLINE and CINAHL was followed by extensive reference tracing and hand searching. Studies presenting estimates of reliability for individual motion segments were included. No language restrictions were imposed. Study quality was assessed using criteria derived from the Standards for Reporting of Diagnostic Accuracy (STARD) statement and a quality assessment tool for studies of diagnostic accuracy included in systematic reviews (QUADAS). Study selection, quality assessment, and data extraction were performed by two reviewers independently. Qualitative analyses and additional subgroup analyses were conducted. Nineteen studies were included. Two studies satisfied criteria for external and internal validity, of which one found fair to moderate reliability. Assessment of motion segments C1-C2 and C2-C3 almost consistently reached at least fair reliability. Overall, inter-examiner reliability was poor to fair. However, most studies were found to be of poor methodological quality. We propose explicit recommendations for the conduct and reporting of future research.
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Affiliation(s)
- E van Trijffel
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. ACTA ACUST UNITED AC 2005; 10:127-35. [PMID: 15922233 DOI: 10.1016/j.math.2004.08.005] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2003] [Revised: 07/14/2004] [Accepted: 08/18/2004] [Indexed: 11/22/2022]
Abstract
Mechanical neck pain is a common occurrence in the general population resulting in a considerable economic burden. Often physical therapists will incorporate manual therapies directed at the cervical spine including joint mobilization and manipulation into the management of patients with cervical pain. Although the effectiveness of mobilization and manipulation of the cervical spine has been well documented, the small inherent risks associated with these techniques has led clinicians to frequently utilize manipulation directed at the thoracic spine in this patient population. It is hypothesized that thoracic spine manipulation may elicit similar therapeutic benefits as cervical spine manipulation while minimizing the magnitude of risk associated with the cervical technique. The purpose of this randomized clinical trial was to investigate the immediate effects of thoracic spine manipulation on perceived pain levels in patients presenting with neck pain. The results suggest that thoracic spine manipulation results in immediate analgesic effects in patients with mechanical neck pain. Further studies are needed to determine the effects of thoracic spine manipulation in patients with neck pain on long-term outcomes including function and disability.
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Affiliation(s)
- Joshua A Cleland
- Physical Therapy Program, Franklin Pierce College, 5 Chenell Drive, Concord, NH 03301, USA.
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Christensen HW, Vach W, Gichangi A, Manniche C, Haghfelt T, Høilund-Carlsen PF. Cervicothoracic Angina Identified by Case History and Palpation Findings in Patients with Stable Angina Pectoris. J Manipulative Physiol Ther 2005; 28:303-11. [PMID: 15965404 DOI: 10.1016/j.jmpt.2005.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the decision-making process of an experienced chiropractor in diagnosing noncardiac musculoskeletal chest pain of cervicothoracic angina in patients with stable angina pectoris, based on patient history and clinical examination. Secondly, to examine the possibility of obtaining an objective diagnostic rule tool for the identification of cervicothoracic angina and to validate the diagnosis of this disorder. METHODS A nonrandomized prospective trial was performed at a university hospital. A total of 516 of 972 consecutive patients referred for coronary angiography because of known or suspected angina pectoris were asked to participate in the study. Of these, 275 gave informed consent to a standardized manual examination of their spine and thorax. Diagnoses of an experienced chiropractor on cervicothoracic angina patients. Myocardial perfusion imaging and coronary angiography were used for validation. A set of candidate variables from patient history and clinical examination were tested for their role in the decision-making process. RESULTS Eighteen percent of the patients were diagnosed with cervicothoracic angina. Of these, 80% had normal myocardial perfusion compared to 50% of cervicothoracic angina-negative patients. The main determinants of the decision-making process could be identified. CONCLUSION An experienced chiropractor could identify a subset of patients with angina pectoris as having cervicothoracic angina. Systematic manual palpation of the spine and thorax could be used as part of the clinical examination together with basic cardiological variables to screen patients with chest pain allowing for improvements in referral patterns for specialist opinion or angiography.
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Buchmann J, Wende K, Kundt G, Haessler F. Manual treatment effects to the upper cervical apophysial joints before, during, and after endotracheal anesthesia: a placebo-controlled comparison. Am J Phys Med Rehabil 2005; 84:251-7. [PMID: 15785257 DOI: 10.1097/01.phm.0000156895.80533.c1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In this preliminary, placebo-controlled clinical trial, two different manual treatments were compared, spinal manipulation and postisometric relaxation, for dysfunctional motion segments of the upper cervical spinal column. The influence of the muscular portion on the joint-play restriction of a motion segment can be ignored in anesthesia, and the manual evaluation of this joint-play restriction must be focused on nonmuscular structures. By retesting in anesthesia, it is possible to examine whether mobilization and manipulation affect exclusively the muscular structures or also affect the other parts of the motion segment. Conclusions can be drawn about the superiority of one or both treatments and about the structural basis of the restricted joint play and its palpation. DESIGN A total of 26 inpatients at the surgical or orthopedic department of the University of Rostock were examined manually at four testing times: before and after manual treatment, in anesthesia, and within 24 hrs of completing anesthesia. They were randomized into three groups: postisometric relaxation (mobilization), spinal manipulation (thrust technique), and placebo. RESULTS A highly significant effect for both treatments was found posttherapeutically (P < 0.01) but not for placebo. In anesthesia, the treatment effect of spinal manipulation was further significant (P < 0.01) when compared with placebo. For postisometric relaxation, however, it was not (P = 0.160). A significant difference between spinal manipulation and postisometric relaxation was not found in anesthesia (P = 0.137). The treatment effect postnarcotically was further significant when compared with placebo only for spinal manipulation (P = 0.011). CONCLUSIONS Both treatments are superior to placebo. Postisometric relaxation seems to affect mainly the muscular parts of the treated segments and less so the other parts, such as the joint capsule or the segmental affiliated ligaments and fascia. Spinal manipulation seems to influence all other segmental parts more effectively, and the treatment effect persists longer. A joint-play restriction cannot be an exclusively muscular tension phenomenon. Segmental motion dysfunctions show a high variability in their spontaneous course.
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Affiliation(s)
- Johannes Buchmann
- Department of Child and Adolescent Neuropsychiatry, University of Rostock, Rostock, Germany
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