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Mine K, Ono K, Tanpo N. The reliability of palpatory examinations for pelvic landmarks to determine pelvic asymmetry: a systematic review and meta-analysis. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2019368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Koya Mine
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Kenta Ono
- Department of Rehabilitation, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Nobuhito Tanpo
- Department of Rehabilitation, Takeda General Hospital, Fukushima, Japan
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Thornton JS, Caneiro JP, Hartvigsen J, Ardern CL, Vinther A, Wilkie K, Trease L, Ackerman KE, Dane K, McDonnell SJ, Mockler D, Gissane C, Wilson F. Treating low back pain in athletes: a systematic review with meta-analysis. Br J Sports Med 2020; 55:656-662. [PMID: 33355180 DOI: 10.1136/bjsports-2020-102723] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement. DATA SOURCES Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS). RESULTS Among 1629 references, 14 randomised controlled trials (RCTs) involving 541 athletes were included. The trials had biases across multiple domains including performance, attrition and reporting. Treatments included exercise, biomechanical modifications and manual therapy. There were no trials evaluating the efficacy of surgery or injections. Exercise was the most frequently investigated treatment; no RTS data were reported for any exercise intervention. There was a reduction in pain and disability reported after all treatments. CONCLUSIONS While several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.
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Affiliation(s)
- Jane S Thornton
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - J P Caneiro
- Physiotherapy, Curtin University, Perth, Western Australia, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Clare L Ardern
- Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Anders Vinther
- Physiotherapy and Occupational Therapy and QD research-unit, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Kellie Wilkie
- Tasmania Institute of Sport, Hobart, Tasmania, Australia
| | - Larissa Trease
- Heathcare in remote and extreme environments, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Orthopedics ACT, Canberra, New South Wales, Australia
| | - Kathryn E Ackerman
- Sports Medicine Division, Boston Children's Hospital, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn Dane
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - David Mockler
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Conor Gissane
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fiona Wilson
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Low M. A novel clinical framework: The use of dispositions in clinical practice. A person centred approach. J Eval Clin Pract 2017; 23:1062-1070. [PMID: 28220638 DOI: 10.1111/jep.12713] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 11/16/2016] [Accepted: 12/30/2016] [Indexed: 12/16/2022]
Abstract
This paper explores a novel clinical framework that is underpinned by a specific philosophical perspective of causation and its utility in clinical practice. A dispositional theory of causation may overcome challenges that clinicians face in complex clinical presentations including those that are medically unexplained. Dispositionalism identifies causes not as regular events necessitating an effect but rather phenomena, which are highly complex, context-sensitive, and which tend toward an effect. Diagnostic uncertainty and causal explanation are significant challenges in terms of clinical reasoning, communication, and the overall therapeutic outcome. This novel framework aims to facilitate improved collaborative clinical reasoning, enhanced patient-practitioner interaction, and supported treatment planning. The paper uses a real case study of a patient with nonspecific spinal pain to demonstrate the clinical framework as used in clinical practice.
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Affiliation(s)
- Matthew Low
- The Royal Bournemouth and Christchurch NHS Trust, Bournemouth, UK
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Reiman MP, Sylvain J, Loudon JK, Goode A. Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis. Br J Sports Med 2015; 50:221-30. [PMID: 26491033 DOI: 10.1136/bjsports-2015-094691] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. METHODS A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0-16 points). RESULTS The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I(2)=63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). CONCLUSIONS Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.
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Affiliation(s)
- Michael P Reiman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan Sylvain
- Department of Rehabilitation and Sports Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Janice K Loudon
- Department of Physical Therapy Education, Rockhurst University, Kansas City, Missouri, USA
| | - Adam Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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