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Barbari V, Carbone MM, Storari L, Testa M, Maselli F. The Effectiveness and Optimal Dose of Resistance Training in Patients With Subacute and Persistent Low Back-Related Leg Pain: A Systematic Review. Cureus 2024; 16:e57278. [PMID: 38559546 PMCID: PMC10981532 DOI: 10.7759/cureus.57278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/04/2024] Open
Abstract
A subgroup of patients with low back pain (LBP) suffers from low back-related leg pain (LBLP), which can be classified as radicular pain, or somatic referred pain without nerve root involvement. LBLP is considered an obstacle to recovery and a strong negative prognostic factor for medium- and long-term disability. In this review, we aimed to investigate the effectiveness and optimal dose of resistance training (RT) in patients with subacute or persistent LBLP to provide clinical recommendations for practice. This systematic review was conducted by adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the recommendations of the Cochrane Collaboration. We conducted a literature search on PubMed, PEDro, Cochrane Library, Scopus, and Web of Science databases. Only randomized controlled trials (RCTs) involving patients ≥18 years of age were included. The risk of bias in the included studies was assessed using "the Cochrane Collaboration's tool for assessing risk of bias" (RoB) and the inter-rater agreement for full-text selection was evaluated using Cohen's Kappa (K). The search elicited a total of 4.537 records, and two RCTs involving a total of 196 participants were identified through a selection process based on title, abstract, and full-text assessment. Both studies had a low to moderate risk of bias. The inter-examiner concordance index for the selection of full text was excellent (K=1). RT seems to be an effective and safe intervention for patients with LBLP, but its long-term effectiveness, superiority over other types of exercise-based therapies, and optimal dosage still constitute a gray area in the literature.
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Affiliation(s)
- Valerio Barbari
- Department of Human Neurosciences, Sapienza University of Rome, Rome, ITA
| | - Maria M Carbone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, ITA
| | - Lorenzo Storari
- Department of Human Neurosciences, Sapienza University of Rome, Rome, ITA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, ITA
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, ITA
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2
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Zhou T, Salman D, McGregor AH. What do we mean by 'self-management' for chronic low back pain? A narrative review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4377-4389. [PMID: 37640886 DOI: 10.1007/s00586-023-07900-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 03/29/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) is a highly prevalent musculoskeletal condition affecting 60-80% of the general population within their lifetime. Given the large numbers of people affected, self-management approaches have been introduced as a way to manage this condition with endorsement by the national institute for health and care excellence. Interventions are often termed self-management without defining either content or goals. Our study sought to determine the content, characteristics, and evidence for self-management of CLBP. METHODS This narrative review was conducted using a systematic approach to search journal articles in English that focused on CLBP self-management. MEDLINE, EMBASE, CINAHL, and PsycINFO databases were used to identify publications with terms relating to back pain and self-management from January 2016 until January 2022. RESULTS In total, 15 studies were found suitable for inclusion in the review. Core components of self-management strategies include exercise, education, and psychological interventions, but there was a lack of consistency with respect to content. Intervention characteristics were either under-reported or varied. Furthermore, outcome measures used to assess these self-management programmes were diverse, mainly focusing on functional disability and pain intensity. CONCLUSIONS Inconsistencies in the content of self-management interventions, intervention characteristics, and outcome measures used for assessing self-management programmes were found across the literature. Current self-management approaches do not consider the complex biopsychosocial nature of CLBP. A consensus on the key components of self-management interventions, and how they should be evaluated, will pave the way for research to determine whether self-management can effectively manage CLBP.
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Affiliation(s)
- Tianyu Zhou
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - David Salman
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Alison H McGregor
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK.
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Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:2255. [PMID: 38137856 PMCID: PMC10744707 DOI: 10.3390/life13122255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Lumbar radiculopathy causes lower back and lower extremity pain that may be managed with neural mobilization (NM) techniques. This meta-analysis aims to evaluate the effectiveness of NM in alleviating pain and reducing disability in patients with lumbar radiculopathy. We hypothesized that NM would reduce pain and improve disability in the lumbar radiculopathy population, leveraging the statistical power of multiple studies. Electronic databases from their inception up to October 2023 were searched for randomized controlled trials (RCTs) that explored the impact of NM on lumbar radiculopathy. Our primary outcome measure was the alteration in pain intensity, while the secondary one was the improvement of disability, standardized using Hedges' g. To combine the data, we employed a random-effects model. A total of 20 RCTs comprising 877 participants were included. NM yielded a significant reduction in pain intensity (Hedges' g = -1.097, 95% CI = -1.482 to -0.712, p < 0.001, I2 = 85.338%). Subgroup analyses indicated that NM effectively reduced pain, whether employed alone or in conjunction with other treatments. Furthermore, NM significantly alleviated disability, with a notable effect size (Hedges' g = -0.964, 95% CI = -1.475 to -0.453, p < 0.001, I2 = 88.550%), particularly in chronic cases. The findings provide valuable insights for clinicians seeking evidence-based interventions for this patient population. This study has limitations, including heterogeneity, potential publication bias, varied causal factors in lumbar radiculopathy, overall study quality, and the inability to explore the impact of neural pathology on NM treatment effectiveness, suggesting opportunities for future research improvements.
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Affiliation(s)
- Long-Huei Lin
- Kaohsiung Rukang Physiotherapy Clinic, Kaohsiung 83050, Taiwan;
| | - Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Yilan 26546, Taiwan;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
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What Modifies the Effect of an Exercise Treatment for Chronic Low Back Pain? A Meta-epidemiologic Regression Analysis of Risk of Bias and Comparative Effectiveness. J Orthop Sports Phys Ther 2022; 52:792-802. [PMID: 35960505 DOI: 10.2519/jospt.2022.11149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate how risk of bias and intervention type modify effect sizes of exercise interventions that are intended to reduce chronic low back pain intensity. DESIGN: Systematic review with meta-epidemiologic regression analysis. LITERATURE SEARCH: PubMed, CENTRAL, Embase, and CINAHL (until January 31, 2021). STUDY SELECTION CRITERIA: Systematic reviews with meta-analyses of randomized controlled exercise trials. DATA SYNTHESIS: The dependent variable was pain, calculated as standardized mean difference (SMD). Potential effect modifiers were risk of bias, exercise modes, study, and meta-analyses characteristics. Multilevel meta-regressions and inverse variance-weighted meta-regressions with random intercepts were modelled. RESULTS: Data from 26 systematic reviews (k = 349 effect sizes, n = 18,879 participants) were analysed. The overall mean effect was SMD: -0.35 (k = 349, [95% CI -0.02 to -0.7]). There was a clinically relevant effect overestimation in studies with a high risk of bias due to missing outcomes (each k = 197, Beta coefficient = -1.9 [95% CI -2.9 to -.9]) and low sample size (B = 0.01 [.001 to .01], [ie, one participant more leads to an SMD decrease of 0.01]). There was a clinically relevant underestimation of the effect when studies were at high risk of bias in allocation concealment (B = 1.3 [.5 to 2.1]) and outcome measurement (B = 1.3 [.44 to 2.0]). Motor control and stabilization training (B = -1.3 [-2.3 to -.37]) had the largest effects; stretching (B = 1.3 [-.03 to .5]) had the smallest effect. CONCLUSIONS: The effects of exercise trials at high risk of bias may be overestimated or underestimated. After accounting for risk of bias, motor control and stabilization exercises may represent the most effective exercise therapies for chronic low back pain. J Orthop Sports Phys Ther 2022;52(12):792-802. Epub: 12 August 2022. doi:10.2519/jospt.2022.11149.
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Nuñez de Arenas-Arroyo S, Martínez-Vizcaíno V, Cavero-Redondo I, Álvarez-Bueno C, Reina-Gutierrez S, Torres-Costoso A. The Effect of Neurodynamic Techniques on the Dispersion of Intraneural Edema: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14472. [PMID: 36361353 PMCID: PMC9655711 DOI: 10.3390/ijerph192114472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is evidence for the positive effects of neurodynamic techniques in some peripheral entrapment neuropathies, but the rationale for these effects has not been validated. We aimed to estimate the direct effect of neurodynamic techniques on the dispersion of artificially induced intraneural edema measured by dye spread in cadavers. METHODS We systematically searched the MEDLINE, WOS, Scopus, and the Cochrane databases from inception to February 2020 for experimental studies addressing the efficacy of neurodynamic techniques on the dispersion of artificially induced intraneural edema. The DerSimonian and Laird method was used to compute pooled estimates of the mean differences (MDs) and its respective 95% confidence intervals (CIs). Subgroup analyses were conducted according to the type of neurodynamic technique. In addition, a 95% prediction interval was calculated to reflect the variation in true treatment effects in different settings, including the effect to be expected in future patients. RESULTS Pooled results showed a significant increase in fluid dispersion (MD = 2.57 mm; 95%CI: 1.13 to 4.01). Subgroup analysis showed increased dye spread in the tensioning techniques group (MD = 2.22 mm; 95%CI: 0.86 to 3.57). CONCLUSION Neurodynamic techniques improved the intraneural edema dispersion and should be considered for the management of peripheral compression neuropathies. Furthermore, tensioning techniques appear to be effective in helping to disperse intraneural edema.
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Affiliation(s)
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 340000, Chile
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 340000, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Universidad Artística y Politécnica del Paraguay, Asunción 2024, Paraguay
| | - Sara Reina-Gutierrez
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - Ana Torres-Costoso
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
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Cuenca-Martínez F, La Touche R, Varangot-Reille C, Sardinoux M, Bahier J, Suso-Martí L, Fernández-Carnero J. Effects of Neural Mobilization on Pain Intensity, Disability, and Mechanosensitivity: An Umbrella Review With Meta-Meta-Analysis. Phys Ther 2022; 102:6566427. [PMID: 35421227 DOI: 10.1093/ptj/pzac040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/09/2021] [Accepted: 02/03/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the current evidence for the effects of neural mobilization (NM) treatments. METHODS Three umbrella reviews with meta-meta-analyses were conducted to determine the effects of NM on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in participants who were asymptomatic. The study used the grading criteria proposed by the Physical Activity Guidelines Advisory Committee to assess the quality of evidence. RESULTS One meta-meta-analysis revealed a statistically significant moderate effect on pain intensity (standardized mean difference [SMD] = -0.75, 95% CI = -1.12 to -0.38) but with evidence of heterogeneity (Q = 14.13; I2 = 65%). The study found a significantly large effect of NM on disability (SMD = -1.22, 95% CI = -2.19 to -0.26), again with evidence of heterogeneity (Q = 31.57; I2 = 87%). The third meta-meta-analysis showed a statistically significant moderate effect of NM on mechanosensitivity (SMD = 0.96, 95% CI = 0.35 to 1.57), with no evidence of heterogeneity (Q = 2.73; I2 = 63%). For all examined outcomes, the quality of evidence was limited. CONCLUSION Overall, the results indicated that although NM treatment had a moderate to large beneficial clinical effect on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in individuals who were asymptomatic, the quality of evidence was limited. IMPACT Neural mobilization treatments showed positive results on the pain intensity and disability in individuals with musculoskeletal conditions. Neural mobilization could be integrated into the physical therapy management, although more research is needed.
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Affiliation(s)
- Ferran Cuenca-Martínez
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain
| | - Clovis Varangot-Reille
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Maëva Sardinoux
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jade Bahier
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Suso-Martí
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor Grupo de Excelencia Investigadora URJC-Banco de Santander, Rey Juan Carlos University, Madrid, Spain
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Nee RJ, Coppieters MW, Boyd BS. Reliability of the straight leg raise test for suspected lumbar radicular pain: A systematic review with meta-analysis. Musculoskelet Sci Pract 2022; 59:102529. [PMID: 35245880 DOI: 10.1016/j.msksp.2022.102529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The passive straight leg raise (SLR) and crossed SLR are recommended tests for lumbar radicular pain. There are no recent reviews of test reliability. OBJECTIVES To summarize SLR and crossed SLR reliability in patients with suspected lumbar radicular pain. DESIGN Systematic review with meta-analysis. METHOD MEDLINE and CINAHL were searched for studies published before April 2021 that reported SLR or crossed SLR reliability in patients with low back-related leg pain. Supplemental analyses also included patients with low back pain only. Study selection, risk of bias assessment (QAREL), and data extraction were performed in duplicate. Kappa, intraclass correlation coefficients, and smallest detectable difference (SDD95) quantified reliability. Meta-analysis was performed when appropriate. Confidence in the evidence was determined by applying GRADE principles. RESULTS/FINDINGS Fifteen studies met selection criteria. One-hundred-eighty-nine participants had low back-related leg pain. Four-hundred-thirty-nine were included in supplemental analyses. Meta-analyses showed at least fair inter-rater reliability when a positive SLR required provocation of lower extremity symptoms or pain. SLR reliability was at least moderate when testing included structural differentiation (e.g., ankle dorsiflexion). A low prevalence of positive crossed SLR tests led to wide-ranging reliability estimates. Confidence in the evidence for identifying a positive SLR or crossed SLR was moderate to very low. SDD95 values for different raters measuring SLR range of motion ranged from 13 to 20°. CONCLUSIONS Reliability data support testing SLR with structural differentiation manoeuvres. Crossed SLR reliability data are inconclusive. Measurement error likely prohibits using SLR range of motion for clinical decision-making.
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Affiliation(s)
- Robert J Nee
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA.
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia; Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Benjamin S Boyd
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA
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Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J 2022; 22:660-676. [PMID: 34718177 DOI: 10.1016/j.spinee.2021.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have proposed that there is a relationship between low back pain (LBP) and morphology and composition of paraspinal muscles. However, results have been conflicting, especially regarding fatty infiltration of muscles. PURPOSE The primary goal of this study was to review and analyze results from imaging studies which investigated morphological and composition changes in the multifidus, erector spinae and psoas major muscles in people with LBP. STUDY DESIGN/SETTING Systematic review with meta-analysis. PATIENT SAMPLE A patient sample was not required OUTCOME MEASURES: This review did not have outcome measures. METHODS PubMed, Scopus, Web of Sciences, EMBASE and ProQuest were searched for eligible studies up to 31st July 2020 (all languages). A systematic search of electronic databases was conducted to identify studies investigating the association between the morphology and fat content of lumbar muscles in people with LBP compared with a (no LBP) control group. 13,795 articles were identified. Based on the screening for inclusion/ exclusion, 25 were included. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. From the 25 articles, 20 were included in the meta-analysis. RESULTS Results showed that the total cross-sectional area of the multifidus was smaller in people with LBP (Standardized mean difference, SMD = -0.24, 95% CI = -0.5 to 0.03). Combined SMDs showed a medium effect of LBP on increasing multifidus muscle fat infiltration (SMD = 0.61, 95% CI = 0.30 to 0.91). There were no LBP related differences identified in the morphology or composition of the lumbar erector spine and psoas major muscles. CONCLUSIONS People with LBP were found to have somewhat smaller multifidus muscles with a significant amount of intramuscular fat infiltration. Varying sample size, age and BMI of participants, quality of studies and the procedures used to measure fat infiltration are possible reasons for inconsistencies in results of previous studies.
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Baptista FM, Cruz EB, Afreixo V, Silva AG. Effectiveness of neural mobilization on pain intensity, disability, and physical performance in adults with musculoskeletal pain-A protocol for a systematic review of randomized and quasi-randomized controlled trials and planned meta-analysis. PLoS One 2022; 17:e0264230. [PMID: 35271600 PMCID: PMC8912212 DOI: 10.1371/journal.pone.0264230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/05/2022] [Indexed: 11/18/2022] Open
Abstract
Recent studies show that musculoskeletal conditions contribute significantly to years lived with disability considering the entire global population. Pain and functional disability are the main problems that people with these conditions suffer. Neural mobilization has been shown to be an effective intervention in the treatment of musculoskeletal pain within individual trials, also contributing to improved functionality. Some systematic reviews have been carried out during the last years with the aim of synthesizing the scientific evidence on the use of neural mobilization techniques in the treatment of musculoskeletal disorders. However, they varied a lot in the methodological approaches and, consequently, in the findings and conclusions. Thus, this document is a planned protocol of a comprehensive systematic review with meta-analysis that we intend to carry out to review the scientific literature regarding up-to-date evidence on the use of neural mobilization in the management of people suffering from musculoskeletal pain disorders. The study designs that we will consider as inclusion criteria will be randomized and quasi-randomized clinical trials. The target population will be adults and older adults with musculoskeletal pain. Any controlled trial using any neural mobilization technique as an intervention in one of the trial groups will be included. The main outcomes of interest will be pain, functional status, and physical performance tests (muscle strength, flexibility, and balance). There will be no restrictions on follow-up time or type of setting. The risk of bias of the included studies will be assessed by the RoB 2 tool and the certainty of the evidence will be evaluated using the comprehensive Assessment, Development and Assessment of Assessment Recommendation (GRADE) approach. We intend to present the findings through narrative descriptions and, if possible, through meta-analytic statistics. Trial registration: PROSPERO registration number. CRD42021288387.
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Affiliation(s)
| | - Eduardo Brazete Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Vera Afreixo
- CIDMA–Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro (UA), Aveiro, Portugal
| | - Anabela G. Silva
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Short-term Effects of Neurodynamic Techniques for Treating Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2021; 51:566-580. [PMID: 34784245 DOI: 10.2519/jospt.2021.10533] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020. STUDY SELECTION CRITERIA We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS. DATA SYNTHESIS Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison. RESULTS There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low-certainty evidence of neurodynamic techniques improving pain (SMD, -0.54; 95% CI: -0.95, -0.13) and function (SMD, -0.35; 95% CI: -0.61, -0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty). CONCLUSION Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence. J Orthop Sports Phys Ther 2021;51(12):566-580. Epub 16 Nov 2021.doi:10.2519/jospt.2021.10533.
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Varangot-Reille C, Cuenca-Martínez F, Arribas-Romano A, Bertoletti-Rodríguez R, Gutiérrez-Martín Á, Mateo-Perrino F, Suso-Martí L, Blanco-Díaz M, Calatayud J, Casaña J. Effectiveness of Neural Mobilisation Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report. PAIN MEDICINE 2021; 23:707-732. [PMID: 34633462 DOI: 10.1093/pm/pnab300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective was to assess the effectiveness of neural mobilisation (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). METHODS We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion and mechanosensitivity as the main outcome measures. RESULTS The systematic review included 22 studies (n = 978). More favourable outcomes were observed for NM on pain intensity compared with control interventions (standardised mean differences (SMDs) -0.92; 95% CI - 1.66--0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI - 0.02-2.15). Regarding neck pain intensity, no significant differences were found in favour of NM compared with OTs (SMD 0.37; 95% CI - 0.35-1.1). However, between-treatment differences were found in favour of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI - 0.06-0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD -0.08; 95% CI - 0.36--0.20, and SMD -1.44; 95% CI - 2.28--0.6, respectively). Finally, NM was associated with more favourable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). CONCLUSIONS NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.
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Affiliation(s)
- Clovis Varangot-Reille
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Rodrigo Bertoletti-Rodríguez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Álvaro Gutiérrez-Martín
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Fernando Mateo-Perrino
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
| | - María Blanco-Díaz
- Surgery and Medical Surgical Specialities Department, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Asturias, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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González ÁC, Berenguer SB, Luque Mañas JM, Martin-Pintado-Zugasti A. Validation of a sham novel neural mobilization technique in patients with non-specific low back pain: A randomized, placebo-controlled trial. Musculoskelet Sci Pract 2021; 53:102378. [PMID: 33930856 DOI: 10.1016/j.msksp.2021.102378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no validated sham neural mobilization (NM) intervention for lower quadrant conditions. A suitable sham NM comparator will allow to blind patients with low back pain (LBP) and reduce bias by limiting the confounding effects of expectations. OBJECTIVE The primary aim was to develop a sham NM technique in patients with non-specific LBP and assess its validity in supplying a suitable blinding. Secondly, we compared the short-term effects of NM and the sham comparator on pain and the straight leg raise. DESIGN A randomized placebo-controlled trial in which participants and assessors were blinded. METHOD Fifty one patients (20 men,31 women), aged 22-65 years (43 ± 12y) were allocated randomly to a NM group (n = 26) or a sham NM group (n = 25). The primary outcome of believability of the sham technique was measured one week after the intervention. Secondary outcomes of pain intensity and the straight leg raise range-of-motion were assessed at baseline, immediately after the intervention and one week after. RESULTS The believability of the sham technique in terms of the frequencies of perceived group assignment showed no differences between groups. Eighteen participants believed they had received the experimental NM technique in the experimental group (69.2%) and 14 in the placebo NM group (56%). Pain and the straight leg raise changes did not show differences between groups. CONCLUSIONS The novel sham NM demonstrated to be a believable intervention, capable of supplying a suitable blinding. Both groups showed similar short term perceived effects on pain and the straight leg raise.
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Affiliation(s)
| | | | | | - Aitor Martin-Pintado-Zugasti
- Department of Physiotherapy, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660, Boadilla Del Monte, Madrid, Spain.
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