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García-González J, Romero-del Rey R, Martínez-Martín V, Requena-Mullor M, Alarcón-Rodríguez R. Comparison of Short-Term Effects of Different Spinal Manipulations in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:1348. [PMID: 38998882 PMCID: PMC11241534 DOI: 10.3390/healthcare12131348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Spinal manipulations for chronic non-specific neck pain (CNNP) include cervical, cervicothoracic junction, and thoracic spine (CCT) manipulations as well as upper cervical spine (UCS) manipulations. This study aimed to compare the short-term effects of UCS manipulation versus a combination of CCT spine manipulations on pain intensity, disability, and cervical range of motion (CROM) in CNNP patients. In a private physiotherapy clinic, 186 participants with CNNP were randomly assigned to either the UCS (n = 93) or CCT (n = 93) manipulation groups. Neck pain, disability, and CROM were measured before and one week after the intervention. No significant differences were found between the groups regarding pain intensity and CROM. However, there was a statistically significant difference in neck disability, with the CCT group showing a slightly greater decrease (CCT: 16.9 ± 3.8 vs. UCS: 19.5 ± 6.8; p = 0.01). The findings suggest that a combination of manipulations in the CCT spine results in a slightly more pronounced decrease in self-perceived disability compared to UCS manipulation in patients with CNNP after one week. However, no statistically significant differences were observed between the groups in terms of pain intensity or CROM.
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Affiliation(s)
| | - Raúl Romero-del Rey
- Department of Nursing, Physiotherapy, and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (J.G.-G.); (M.R.-M.); (R.A.-R.)
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2
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Cottone KA, Schumacher MR, Young JL, Rhon DI. The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials. J Man Manip Ther 2024:1-17. [PMID: 38525785 DOI: 10.1080/10669817.2024.2327127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice. OBJECTIVE The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum. METHODS A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool. RESULTS A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias. CONCLUSION Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.
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Affiliation(s)
- Kyle A Cottone
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy and Health Science, Bradley University, Peoria, IL, USA
| | - Matthew R Schumacher
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, University of Mary, Bismarck, ND, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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3
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Rehman Y, Kirsch J, Wang MYF, Ferguson H, Bingham J, Senger B, Swogger SE, Johnston R, Snider KT. Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: systematic review and meta-analysis. J Osteopath Med 2023; 123:91-101. [PMID: 36220009 DOI: 10.1515/jom-2022-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/31/2022] [Indexed: 01/27/2023]
Abstract
CONTEXT Osteopathic manipulative treatment (OMT) has been utilized by osteopathic clinicians as primary or adjunctive management for dizziness caused by neuro-otologic disorders. To our knowledge, no current systematic reviews provide pooled estimates that evaluate the impact of OMT on dizziness. OBJECTIVES We aimed to systematically evaluate the effectiveness and safety of OMT and analogous techniques in the treatment of dizziness. METHODS We performed a literature search in CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database (AMED), EMCare, Physiotherapy Evidence Database (PEDro), PubMed, PsycINFO, Osteopathic Medicine Digital Library (OSTMED.DR), and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2021 for randomized controlled trials (RCTs) and prospective or retrospective observational studies of adult patients experiencing dizziness from neuro-otological disorders. Eligible studies compared the effectiveness of OMT or OMT analogous techniques with a comparator intervention, such as a sham manipulation, a different manual technique, standard of care, or a nonpharmacological intervention like exercise or behavioral therapy. Assessed outcomes included disability associated with dizziness, dizziness severity, dizziness frequency, risk of fall, improvement in quality of life (QOL), and return to work (RTW). Assessed harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse events. The meta-analysis was based on the similarities between the OMT or OMT analogous technique and the comparator interventions. The risk of bias (ROB) was assessed utilizing a modified version of the Cochrane Risk of Bias Tool for RCTs and the Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) for observational studies. The quality of evidence was determined utilizing the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS There were 3,375 studies identified and screened, and the full text of 47 of them were reviewed. Among those, 12 (11 RCTs, 1 observational study, n=367 participants) met the inclusion criteria for data extraction. Moderate-quality evidence showed that articular OMT techniques were associated with decreases (all p<0.01) in disability associated with dizziness (n=141, mean difference [MD]=-11, 95% confidence interval [CI]=-16.2 to -5.9), dizziness severity (n=158, MD=-1.6, 95% CI=-2.4 to -0.7), and dizziness frequency (n=136, MD=-0.6, 95% CI=-1.1 to -0.2). Low-quality evidence showed that articular OMT was not associated with ACD rates (odds ratio [OR]=2.2, 95% CI=0.5 to 10.2, p=0.31). When data were pooled for any type of OMT technique, findings were similar; however, disability associated with dizziness and ACD rates had high heterogeneity (I2=59 and 46%). No studies met all of the criteria for ROB. CONCLUSIONS The current review found moderate-quality evidence that treatment with articular OMT techniques was significantly associated with decreased disability associated with dizziness, dizziness severity, and dizziness frequency. However, our findings should be interpreted cautiously because of the high ROB and small sample sizes in the eligible studies.
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Affiliation(s)
- Yasir Rehman
- Health Research Methodology and Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Ontario, Canada; and Medical Sciences for the Canadian Academy of Osteopathy, Hamilton, Ontario, Canada.,Medical Science, Canadian Academy of Osteopathy, Hamilton, Ontario, Canada.,Research Consultant, A.T. Still University Research Institute- Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Jonathon Kirsch
- Department of Osteopathic Manipulative Medicine, A.T. Still University - Kirksville College of Osteopathic Medicine, Kirksville, MO, USA.,Medical Science, Canadian Academy of Osteopathy, Hamilton, Ontario, Canada
| | - Mary Ying-Fang Wang
- Department of Research Support, A.T. Still University - Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Hannah Ferguson
- Medical Science, Canadian Academy of Osteopathy, Hamilton, Ontario, Canada
| | - Jonathan Bingham
- Department of Osteopathic Manipulative Medicine, A.T. Still University - Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Barbara Senger
- Department of Osteopathic Manipulative Medicine, A.T. Still University - Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Susan E Swogger
- David W. Howe Memorial Library, University of Vermont, Burlington, VT, USA
| | - Robert Johnston
- Medical Science, Canadian Academy of Osteopathy, Hamilton, Ontario, Canada
| | - Karen T Snider
- Assistant Dean for Osteopathic Principles and Practice Integration and Department of Osteopathic Manipulative Medicine, A.T. Still University - Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
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López-de-Celis C, Zegarra-Chávez D, Cadellans-Arróniz A, Carrasco-Uribarren A, Izquierdo-Nebreda P, Canet-Vintró M, Rodríguez-Sanz J, Pérez-Bellmunt A. Study on Balance and Postural Control According to the Stabilometry in Indoor Skydivers: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010635. [PMID: 36612956 PMCID: PMC9819957 DOI: 10.3390/ijerph20010635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The wind tunnel is a compression cabin through which a stream of air rises homogeneously, generated by fans. To perform different acrobatics, indoor skydivers have to change their body position by turning their body and orientation in reference to the space. Thus, the vestibular, visual and somatosensory systems are subjected to multiple disturbances. Postural control could be affected by altering the visual, vestibular and somatosensory systems during indoor skydiving in the wind tunnel. The aim of this study is to describe the influence of a standard wind tunnel training session on postural control in a normal gravitational situation in indoor skydiving. METHODS Ten indoor skydivers registered with the Royal Spanish Aeronautical Federation, who had participated in national or international competitions one year ago, were recruited. A single 30 min training session was performed. Postural control was assessed through posturographic analysis using a stabilometric platform immediately before and after the training session. The variables studied were related to the relative position and length of the centre of pressure. RESULTS No statistically significant changes were found between the initial and final assessment for the posturographic variables studied. CONCLUSIONS No differences in postural control were found after a standard wind tunnel training session in indoor competition skydivers.
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Affiliation(s)
- Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
- Fundació Institut, Universitari per a La Recerca a l’Atenció, Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08028 Barcelona, Spain
| | - Daniel Zegarra-Chávez
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
| | - Aïda Cadellans-Arróniz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
| | - Andoni Carrasco-Uribarren
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
| | - Pedro Izquierdo-Nebreda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
| | - Max Canet-Vintró
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
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Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. J Clin Med 2022; 11:jcm11216293. [DOI: 10.3390/jcm11216293] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 01/17/2023] Open
Abstract
Basic science and clinical evidence suggest that cervical spine disorders can lead to dizziness. The cervical spine has highly developed proprioceptive receptors, whose input information is integrated with the visual and vestibular systems in the central nervous system, acting on the neck and eye muscles to maintain the coordinative motion of the head, eyes, neck, and body through various reflex activities. When the cervical proprioceptive input changes due to the mismatch or conflict between vestibular, visual, and proprioceptive inputs, cervicogenic dizziness may occur. The diagnosis of cervicogenic dizziness can be determined based on clinical features, diagnostic tests, and the exclusion of other possible sources of dizziness. The cervical torsion test appears to be the best diagnostic method for cervicogenic dizziness. Based on the available evidence, we first developed the diagnostic criteria for cervicogenic dizziness. Treatment for cervicogenic dizziness is similar to that for neck pain, and manual therapy is most widely recommended.
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Combination of Two Manipulative Techniques for the Treatment of Cervicogenic Dizziness: A Randomized Controlled Trial. Life (Basel) 2022; 12:life12071023. [PMID: 35888111 PMCID: PMC9318906 DOI: 10.3390/life12071023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022] Open
Abstract
Cervicogenic dizziness is clinically associated with upper cervical spine dysfunctions. It seems that manual therapy decreases the intensity of dizziness in these subjects, but what happens to pain measured by pressure pain threshold (PPT) has not been studied. Purpose: analyze the short-term effects of combination two manipulation techniques protocol in worst dizziness intensity (wVAS), dizziness and cervical disability, upper cervical spine mobility and mechanosensivity of cervical tissue. Methods: Assessor-blinded randomized controlled trial was developed. A total of 40 patients with cervicogenic dizziness were randomly divided into two groups. The experimental group received three treatments consisting of a functional massage and a manipulation technique, and compared with a control group. The wVAS, dizziness handicap inventory (DHI), neck disability index (NDI), UCS mobility, and PPTs were measured. Measurements were made at the baseline, first follow-up 48 h after intervention and second follow-up 1 month after the intervention. Results: at second follow-up wVAS (p < 0.001), NDI (p < 0.001), DHI (p < 0.001), and upper right trapezius (p < 0.022) and right suboccipital (p < 0.043) PPTs showed a difference between groups in favor of the experimental group. Conclusions: apparently, the proposed intervention protocol decreases the intensity of dizziness and the mechanosensitivity of the cervical tissue and improves the feeling of disability due to neck pain and dizziness.
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De Vestel C, Vereeck L, Reid SA, Van Rompaey V, Lemmens J, De Hertogh W. Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness. J Man Manip Ther 2022; 30:273-283. [PMID: 35383538 PMCID: PMC9487935 DOI: 10.1080/10669817.2022.2033044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Patients with cervicogenic dizziness (CGD) present with dizziness, cervical spine dysfunctions, and postural imbalance, symptoms that can significantly impact their daily functioning. OBJECTIVES To provide evidence-based recommendations for the management of patients with CGD. METHODS Three databases were searched for randomized controlled trials (RCTs) (last search 15 May 2021). Outcome measures included dizziness, cervical spine, and balance parameters. Cochrane standard methodological procedures were used and included the RoB 2.0 and GRADE. Where possible, RCTs were pooled for meta-analysis. RESULTS Thirteen RCTs (n = 898 patients) of high (two RCTs), moderate (five RCTs), and low (six RCTs) methodological quality were analyzed. Six RCTs were included in the meta-analysis. Only three RCTs specified the cause of CGD. They showed inconsistent findings for the effectiveness of exercise therapy in patients with traumatic CGD. Manual therapy and manual therapy combined with exercise therapy may reduce CGD, cervical spine, and balance dysfunctions. CONCLUSION There is moderate quality of evidence that manual therapy reduces CGD, cervical spine, and balance symptoms. When manual therapy is combined with exercise therapy, the positive effect on CGD, cervical spine, and balance symptoms is even stronger. However, the quality of the evidence here is very low.
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Affiliation(s)
- Charlotte De Vestel
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Susan A Reid
- Department of Physiotherapy, Faculty of Health, Australian Catholic University, North Sydney, Australia
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joris Lemmens
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
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Cánovas-Ambit G, García-Vidal JA, Martín-San Agustín R, Dalla-Vecchia AA, Sánchez-Barbadora M, Medina-Mirapeix F. Validity and reliability of Veloflex to measure active cervical range of motion in asymptomatic and symptomatic subjects. PeerJ 2021; 9:e11228. [PMID: 33868830 PMCID: PMC8029663 DOI: 10.7717/peerj.11228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neck pain has a high annual incidence and decreases the cervical active range of motion (ROM). Clinicians use various methods to evaluate cervical range of motion (CROM) that some of them have also been proposed to give instant feedback. Accordingly, this study aimed to examine the validity and reliability of Veloflex (VF) to measure the CROM by comparison with the cervical range of motion (CROM) device, and to examine their test-retest reliability. METHODS Thirty-eight healthy and 20 symptomatic participants were evaluated. Cervical flexion-extension, side bending, and rotations were tested in two sessions, first by the CROM and VF and in the second only with the VF. To evaluate the concurrent validity and agreement between CROM and VF, Pearson correlation coefficient (r) and Bland-Altmann plots were used. Reliability were evaluated using intra-class correlation (ICC), standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS CROM and VF showed excellent correlation for all movements (r > 0.960). Both devices provided small mean 'bias' (≤1.29%) in all movements regarding CROM measures. The intra-rater and inter-rater reliability of the VF was excellent (ICC > 0.98). SEMs ranging from 0.72% to 2.38% and the MDC ranging from 1.22° to 2.60° in all participants. The results support the validity and reliability of VF to measure CROM. For its use, with a basic training is enough to get reliable measurements.
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