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The Addition of Diacutaneous Fibrolysis to a Pharmacological Intervention in Patients with Tension-Type Headache: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11226716. [PMID: 36431193 PMCID: PMC9697407 DOI: 10.3390/jcm11226716] [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] [Received: 10/25/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Tension-type headache (TTH) is the most common headache worldwide. Pharmacological interventions are the most investigated therapies in patients with TTH. The addition of physical therapy treatments such as diacutaneous fibrolysis (DF) may have promising results. The aim of this study was to investigate the addition of three sessions of DF to a pharmacological intervention in patients with TTH. Methods: A single-blinded randomized controlled trial was carried out. Participants were randomly assigned to the standard care group or to the DF group. Both groups received a pharmacological intervention. Three sessions of DF in the thoracic and cervicocranial region were added in the DF group. The impact caused by headache (HIT-6), headache intensity, and cervical range of motion were measured by blinded assessors at baseline, after the intervention, and at 1 month follow-up. Results: Eighty-two patients with TTH were included (41 standard care group; 41 DF group). Statistically significant differences were found between both groups in all the variables after the intervention and at 1 month follow-up (p < 0.001). No adverse effects or side-effects were reported during the study. Conclusions: The addition of three sessions of DF to a pharmacological therapy provided improvements in the impact caused by headache, headache intensity, and cervical range of motion after the intervention and at 1 month follow-up compared to a pharmacological therapy in isolation. Further research is needed to investigate long-term effects.
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Cumplido-Trasmonte C, Fernández-González P, Alguacil-Diego IM, Molina-Rueda F. Manual therapy in adults with tension-type headache: A systematic review. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:537-547. [PMID: 34537167 DOI: 10.1016/j.nrleng.2017.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/01/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache. DEVELOPMENT We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients' well-being and improving the outcome measures analysed. CONCLUSIONS Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach.
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Affiliation(s)
| | - P Fernández-González
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor (LAMBECOM), Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - I M Alguacil-Diego
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor (LAMBECOM), Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - F Molina-Rueda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor (LAMBECOM), Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Satpute K, Bedekar N, Hall T. Effectiveness of Mulligan manual therapy over exercise on headache frequency, intensity and disability for patients with migraine, tension-type headache and cervicogenic headache - a protocol of a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2021; 22:243. [PMID: 33657998 PMCID: PMC7931349 DOI: 10.1186/s12891-021-04105-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Non - pharmacological management of migraine, tension-type headache (TTH), and cervicogenic headache (CGH) may include spinal manual therapy and exercise. Mulligan Manual Therapy (MMT) utilizes a protocol of headache elimination procedures to manage headache parameters and associated disability, but has only been evaluated in CGH. There is little evidence for its effectiveness in migraine and TTH. This study aims to determine the effectiveness of MMT and exercise over exercise and placebo in the management of migraine, TTH, and CGH. METHODS This pragmatic trial is designed as a prospective, three-armed randomised controlled trial in a clinical setting provided at a general hospital physiotherapy department. Two hundred ninety-seven participants with a diagnosis of migraine, TTH or CGH based on published headache classification guidelines will be included. An assessor blind to group allocation will measure outcomes pre-and post-intervention as well as 3 and 6 months after commencement of treatment. Participants will be allocated to one of the three groups: MMT and exercise; placebo and exercise; and exercise alone. The primary outcome measure is headache frequency. Secondary outcome measures are headache duration and intensity, medication intake, pressure pain threshold (PPT), range of motion recorded with the flexion rotation test, and headache disability recorded with Headache Activities of Daily Living Index (HADLI). The intention-to-treat principle will be followed for statistical analysis. Between groups differences for all outcome measures at baseline and at reassessment points and 95% confidence intervals will be calculated using a mixed model ANOVA. Post hoc tests will be conducted to identify any significant difference between groups and over time. DISCUSSION This pragmatic study will provide evidence for the effectiveness of MMT when compared with a placebo intervention and exercise on headache frequency, intensity, and disability. Limitations are that baseline evaluation of headache parameters may be affected by recall bias. External validity will be limited to the population with a minimum 1-year history of headache. The HADLI is not yet extensively evaluated for its psychometric properties and association between PPT and headache parameters is lacking. Performance bias is inevitable as a single therapist will be delivering all interventions. TRIAL REGISTRATION The trial was registered prospectively under the Clinical Trial Registry India (Registration number: CTRI/2019/06/019506 , dated on 03/06/2019). .
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Affiliation(s)
- Kiran Satpute
- Department of Musculoskeletal Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Off Westerly by Pass, Narhe, Pune, Maharashatra, 411041, India.
| | - Nilima Bedekar
- Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Thube Park, Shivaji Nagar, Pune, Maharashatra, 411001, India
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia
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Mukhtar NB, Meeus M, Gursen C, Mohammed J, De Pauw R, Cagnie B. Effectiveness of Hands-Off Therapy in the Management of Primary Headache: A Systematic Review and Meta-Analysis. Eval Health Prof 2021; 45:183-203. [PMID: 33406891 DOI: 10.1177/0163278720983408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A number of hands-off therapies have been widely reported and are used in the management of headache. This systematic review and meta-analysis aimed to assess evidence supporting these therapies on selected headache outcomes. A systematic literature search for randomized clinical trials reporting on the effects of hands-off therapies for headache was performed in two electronic databases; PubMed and Web of Science (PROSPERO: CRD42018093559). Risk of bias was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using Review Manager v5.4. Thirty-five studies, including 3,403 patients with migraine, tension-type or chronic headaches were included in the review. Methodological quality of the studies ranged from poor to good. Result-synthesis revealed moderate evidence for aerobic exercises, relaxation training and pain education for reducing pain intensity and disability. Other hands-off interventions were either weak or limited in evidence. Meta-analysis of 22 studies indicated that the effect of hands-off therapies significantly differed from one another for pain intensity, disability and quality of life (p < 0.05). Relaxation training, aerobic and active/stretching exercises had significant effect on pain intensity and disability (p < 0.05). To conclude, few hands-off therapies were effective on selected headache outcomes. Evidence to support other hands-off therapies is limited by paucity of studies.
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Affiliation(s)
- Naziru Bashir Mukhtar
- Department of Rehabilitation Sciences, 26656Ghent University, Belgium.,Department of Physiotherapy, 54714Bayero University Kano, Nigeria
| | - Mira Meeus
- Department of Rehabilitation Sciences, 26656Ghent University, Belgium.,Pain in Motion International Research group, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium
| | - Ceren Gursen
- Department of Physiotherapy and Rehabilitation, 37515Hacettepe University, Turkey
| | - Jibril Mohammed
- Department of Physiotherapy, 54714Bayero University Kano, Nigeria
| | - Robby De Pauw
- Department of Rehabilitation Sciences, 26656Ghent University, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, 26656Ghent University, Belgium
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Esin OR, Khairullin IK, Shamsutdinova RF. [Upper crossed syndrome of muscle imbalance in adolescents with tension-type headache]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:12-16. [PMID: 31626213 DOI: 10.17116/jnevro201911909112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the efficacy of elastic kinesiotaping in the treatment of upper crossed syndrome of muscle imbalance (UCSMI) in adolescents with tension type headache (TTH). MATERIAL AND METHODS The authors examined 65 adolescents, aged 14-17 years, with TTH with trigger zones of the pericranial muscles (myogenic trigger zones - MTZ). UCSMI was identified in all patients. The method of elastic kinesiotaping was used for the treatment of UCSMI. A number of days with headache (HA), intensity of HA assessed by the Visual Analogue Scale (VAS), pain threshold and pain tolerance threshold were evaluated. In the second stage of the study, patients were randomized into group A (33 adolescents, mean age 14.73±1.29 years, the number of days with HA 10.6±6.2, the intensity of HA 39.98±18.4 according to VAS); 2) group B (32 adolescents, mean age 13.59±2.27 years, the number of days with HA 12.4±4.5, the intensity of HA 44.8±18.8). For the next 28 days, patients of group A underwent elastic kinesio-taping, and patients of group B were taped with a medical non-elastic hypoallergenic patch (placebo). The third stage of the study included one month training. RESULTS AND CONCLUSION By the end of the study, a statically significant positive dynamics was noted (p<0.001) for all indicators in group A (number of days with HA 1.2±1.1, intensity of HA 9.42±2.7) compared to the results before treatment and to the results in group B after treatment (the number of days with HA 9.9±4.2, the intensity of HA 41.2±15.60).
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Affiliation(s)
- O R Esin
- Kazan Federal University, Kazan, Russia
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Efficiency of Kinesio Taping in Adolescents with Cervicogenic Headache: a Blind Placebo-Controlled Study. BIONANOSCIENCE 2018. [DOI: 10.1007/s12668-018-0506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chiropraktische Behandlung von Kopfschmerzen. MANUELLE MEDIZIN 2017. [DOI: 10.1007/s00337-017-0327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tassorelli C, Tramontano M, Berlangieri M, Schweiger V, D'Ippolito M, Palmerini V, Bonazza S, Rosa R, Cerbo R, Buzzi MG. Assessing and treating primary headaches and cranio-facial pain in patients undergoing rehabilitation for neurological diseases. J Headache Pain 2017; 18:99. [PMID: 28963668 PMCID: PMC5622014 DOI: 10.1186/s10194-017-0809-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/16/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pain is a very common condition in patient undergoing rehabilitation for neurological disease; however the presence of primary headaches and other cranio-facial pains, particularly when they are actually or apparently independent from the disability for which patient is undergoing rehabilitation, is often neglected. Diagnostic and therapeutic international and national guidelines, as well as tools for the subjective measure of head pain are available and should also be applied in the neurorehabilitation setting. This calls for searching the presence of head pain, independently from the rehabilitation needs, since pain, either episodic or chronic, interferes with patient performance by affecting physical and emotional status. Pain may also interfere with sleep and therefore hamper recovery. METHODS In our role of task force of the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN), we have elaborated specific recommendations for diagnosing and treating head pains in patients undergoing rehabilitation for neurological diseases. RESULTS AND CONCLUSION In this narrative review, we describe the available literature that has been evaluated in order to define the recommendations and outline the needs of epidemiological studies concerning headache and other cranio-facial pain in neurorehabilitation.
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Affiliation(s)
- Cristina Tassorelli
- IRCCS National Neurological Institute "C. Mondino", Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Marco Tramontano
- IRCCS Santa Lucia Foundation, Via Ardeatina, 306 00179, Rome, Italy
| | - Mariangela Berlangieri
- IRCCS National Neurological Institute "C. Mondino", Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | - Mariagrazia D'Ippolito
- IRCCS Santa Lucia Foundation, Via Ardeatina, 306 00179, Rome, Italy
- Department of Psychology, Sapienza University, Rome, Italy
| | | | - Sara Bonazza
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Rosa
- Clinical Medicine - Headache Center, Policlinico Umberto I, Rome, Italy
| | - Rosanna Cerbo
- Pain Therapy Hub, Policlinico Umberto I, Sapienza University, Rome, Italy
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Michiels S, Van de Heyning P, Truijen S, Hallemans A, De Hertogh W. Prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with cervicogenic somatic tinnitus. Musculoskelet Sci Pract 2017; 29:33-37. [PMID: 28286241 DOI: 10.1016/j.msksp.2017.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Tinnitus can be related to many different aetiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus(CST). Recently, a positive effect of multi-modal cervical physical therapy on tinnitus severity in patients with CST was demonstrated. To date however, the outcome of the intervention cannot be predicted. OBJECTIVE To identify prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with CST. PATIENTS Patients with moderate to severe subjective tinnitus (Tinnitus Functional Index(TFI):25-90points) and neck complaints (Neck Bournemouth Questionnaire(NBQ) > 14points). INTERVENTION All patients received multimodal cervical physical therapy for 6 weeks (12 sessions). This physical therapy contained a combination of manual mobilizations and exercises of the cervical spine. MEASUREMENTS TFI and NBQ-scores were documented at baseline, after treatment and after a 6-weeks follow-up period. Impairments in cervical spine mobility and muscle function were identified at baseline and after 6-weeks follow-up. RESULTS Patients with co-varying (increasing or decreasing simultaneously) tinnitus and neck complaints had significantly lower TFI-scores after treatment (p = 0.001) and follow-up (p = 0.03). The presence of this co-variation and a combination of low pitched tinnitus and increasing tinnitus during inadequate cervical spine postures are prognostic indicators for a decrease in TFI-scores after cervical physical therapy (adjusted R2 = 0.357). CONCLUSION Patients who experience a decrease in tinnitus annoyance from cervical physical therapy are those with co-varying tinnitus and neck complaints and those with a combination of low-pitched tinnitus and increasing tinnitus during inadequate cervical spine postures.
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Affiliation(s)
- S Michiels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.
| | - P Van de Heyning
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium; Multidisciplinary Motor Centre Antwerp, University of Antwerp, Antwerp, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - S Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Multidisciplinary Motor Centre Antwerp, University of Antwerp, Antwerp, Belgium
| | - A Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Multidisciplinary Motor Centre Antwerp, University of Antwerp, Antwerp, Belgium; Laboratory of Functional Morphology, Faculty of Science, University of Antwerp, Antwerp, Belgium
| | - W De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Caballero-Calixto L, Antón-Puescas P, Reyna-Ormeño J. The effect of manual therapy on tension headache. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Caballero-Calixto L, Antón-Puescas P, Reyna-Ormeño J. Efecto de la terapia manual en la cefalea tensional. Neurologia 2017; 32:201-202. [DOI: 10.1016/j.nrl.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 04/25/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022] Open
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Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache. Arch Phys Med Rehabil 2017; 98:211-219.e2. [DOI: 10.1016/j.apmr.2016.08.466] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 01/03/2023]
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Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus? ACTA ACUST UNITED AC 2016; 26:125-131. [DOI: 10.1016/j.math.2016.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 11/22/2022]
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Michiels S, De Hertogh W, Truijen S, Van de Heyning P. Physical therapy treatment in patients suffering from cervicogenic somatic tinnitus: study protocol for a randomized controlled trial. Trials 2014; 15:297. [PMID: 25056151 PMCID: PMC4222823 DOI: 10.1186/1745-6215-15-297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tinnitus occurs in a large part of the general population with prevalences ranging from 10% to 15% in an adult population. One subtype is cervicogenic somatic tinnitus, arising from cervical spine dysfunctions, justifying cervical spine assessment and treatment. This study aims to investigate the effect of a standardized physical therapy treatment, directed to the cervical spine, on tinnitus. Additionally, a second aim is to identify a subgroup within the tinnitus population that benefits from physical therapy treatment. METHODS AND DESIGN This study is designed as a randomized controlled trial with delayed treatment design. Patients with severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and 90 points), in combination with neck complaints (Neck Bournemouth Questionnaire (NBQ) >14 points) will be recruited from the University Hospital of Antwerp. Patients suffering from tinnitus with clear otological etiologies, severe depression, traumatic cervical spine injury, tumors, cervical spine surgery, or conditions in which physical therapy is contra-indicated, will be excluded.After screening for eligibility, baseline data such as TFI, NBQ, and a set of cervical biomechanical and sensorimotor tests will be collected. Patients are randomized in an immediate therapy group and in a group with a delayed start of therapy by 6 weeks. Patients will receive physical therapy with a maximum of 12 sessions of 30 min for a 6-week program. Data from the TFI and NBQ will be collected at baseline (week 0), at the start of therapy (weeks 0 or 6), at the end of therapy (weeks 6 or 12), 6 weeks after therapy (weeks 12 or 18), and 3 months after therapy (weeks 18 or 24). Secondary outcome measures will be collected at baseline and 6 weeks after the therapy (weeks 12 or 18), as the maximal therapy effect on the cervical spine dysfunctions is expected at that moment. DISCUSSION This study is the first to investigate the effect of a standardized physical therapy treatment protocol on somatic tinnitus with a prospective comparative delayed design and with blinded evaluator for baseline, end of therapy, and 6 and 12 weeks after therapy. TRIAL REGISTRATION 12 September 2013, ClinicalTrials.gov: NCT02016313.
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Affiliation(s)
- Sarah Michiels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp, University of Antwerp, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium
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Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap 2014; 22:12. [PMID: 24679336 PMCID: PMC3997823 DOI: 10.1186/2045-709x-22-12] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/24/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This systematic review updated and extended the "UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3, 2010) with respect to conditions/interventions that received an 'inconclusive' or 'negative' evidence rating or were not covered in the report. METHODS A literature search of more than 10 general medical and specialised databases was conducted in August 2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new categories not assessed by Bronfort were added. RESULTS 25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic reviews, 96 were randomised controlled trials, and 10 were non-randomised primary studies. Most 'inconclusive' or 'moderate' evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases (manipulation/mobilisation [with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions not previously considered; most of this evidence was rated as inconclusive. CONCLUSIONS Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.
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Affiliation(s)
- Christine Clar
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Alexander Tsertsvadze
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Rachel Court
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Gillian Lewando Hundt
- Social Science and Systems in Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Aileen Clarke
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Paul Sutcliffe
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
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The working mechanism of manual therapy in participants with chronic tension-type headache. J Orthop Sports Phys Ther 2013; 43:693-9. [PMID: 24256171 DOI: 10.2519/jospt.2013.4868] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective longitudinal study. OBJECTIVE To explore the working mechanism of manual therapy, we investigated whether 3 cervical spine variables were mediators of the effect of manual therapy on headache frequency. Background Manual therapy has been shown to reduce headache frequency in participants with chronic tension-type headache (CTTH). To what extent specific elements of treatment contribute to the effectiveness of manual therapy in CTTH is unknown. METHODS One hundred eighty-two participants with CTTH participated in a prospective longitudinal study: 142 underwent manual therapy and 40 participants received usual care by their general practitioner. Regression analysis was performed according to the steps described by Baron and Kenny, and the proportion of mediated effect was estimated for 3 potential mediators: (1) cervical range of motion, (2) neck flexor endurance, and (3) forward head posture. Outcome was defined as a 50% or greater reduction in headache days. RESULTS Neck flexor endurance mediated 24.5% of the effect of manual therapy. Cervical range of motion and forward head posture showed no mediated effect. CONCLUSIONS Increased neck flexor endurance appears to be a working mechanism of manual therapy. This finding supports isometric training of neck flexors in participants with CTTH. Trial registered with Netherlands Trial Register (TR 1074).
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Efectividad de la manipulación cervical en pacientes con cefalea de tipo tensional: revisión sistemática. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ft.2012.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Castien RF, Blankenstein AH, Windt DAWMVD, Dekker J. Minimal clinically important change on the Headache Impact Test-6 questionnaire in patients with chronic tension-type headache. Cephalalgia 2012; 32:710-4. [DOI: 10.1177/0333102412449933] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- René F Castien
- Health Care Center Haarlemmermeer, Hoofddorp, the Netherlands
- Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Annette H Blankenstein
- Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Joost Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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Sarchielli P, Granella F, Prudenzano MP, Pini LA, Guidetti V, Bono G, Pinessi L, Alessandri M, Antonaci F, Fanciullacci M, Ferrari A, Guazzelli M, Nappi G, Sances G, Sandrini G, Savi L, Tassorelli C, Zanchin G. Italian guidelines for primary headaches: 2012 revised version. J Headache Pain 2012; 13 Suppl 2:S31-70. [PMID: 22581120 PMCID: PMC3350623 DOI: 10.1007/s10194-012-0437-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105-190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version.
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Affiliation(s)
- Paola Sarchielli
- Headache Centre, Neurologic Clinic, University of Perugia, Perugia, Italy.
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Castien RF, van der Windt DAWM, Blankenstein AH, Heymans MW, Dekker J. Clinical variables associated with recovery in patients with chronic tension-type headache after treatment with manual therapy. Pain 2012; 153:893-899. [PMID: 22341998 DOI: 10.1016/j.pain.2012.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/12/2012] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
Abstract
The aims of this study were to describe the course of chronic tension-type headache (CTTH) in participants receiving manual therapy (MT), and to develop a prognostic model for predicting recovery in participants receiving MT. Outcomes in 145 adults with CTTH who received MT as participants in a previously published randomised clinical trial (n=41) or in a prospective cohort study (n=104) were evaluated. Assessments were made at baseline and at 8 and 26 weeks of follow-up. Recovery was defined as a 50% reduction in headache days in combination with a score of 'much improved' or 'very much improved' for global perceived improvement. Potential prognostic factors were analyzed by univariable and multivariable regression analysis. After 8 weeks 78% of the participants reported recovery after MT, and after 26 weeks the frequency of recovered participants was 73%. Prognostic factors related to recovery were co-existing migraine, absence of multiple-site pain, greater cervical range of motion and higher headache intensity. In participants classified as being likely to be recovered, the posterior probability for recovery at 8 weeks was 92%, whereas for those being classified at low probability of recovery this posterior probability was 61%. It is concluded that the course of CTTH is favourable in primary care patients receiving MT. The prognostic models provide additional information to improve prediction of outcome.
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Affiliation(s)
- René F Castien
- Health Care Center Haarlemmermeer, Hoofddorp, The Netherlands Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Arthritis Research UK Primary Care Centre, Keele University, UK Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands Department of Rehabilitation Medicine and Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Mousavi SA, Mirbod SM, Khorvash F. Comparison between efficacy of imipramine and transcutaneous electrical nerve stimulation in the prophylaxis of chronic tension-type headache: a randomized controlled clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2011; 16:923-7. [PMID: 22279461 PMCID: PMC3263106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 07/10/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic tension-type headache (CTTH) is recognized as the most common type of headache and can be further defined as either episodic or chronic. Regarding the chronic nature of CTTH and intolerance or side effects of drugs that are used for treatment, other methods of treatment such as Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a convenient and available method for treatment and prevention of CTTH. In the current study, we evaluated the efficacy of the imipramine versus TENS in the prevention of the CTTH as a prospective clinical trial. METHODS In this study, 138 patients with confirmed CTTH were randomized to be treated either with imipramine or TENS method. Sixty nine patients were treated with TENS and 69 cases were regarded as controls and were treated with imipramine. In the Imipramine group, treatment was performed by imipramine tablet, 25mg, twice daily. In the TENS group, patients were treated thrice weekly for ten weeks, each lasting 15 minutes in temporal and occipital regions. RESULTS Three months after treatment, both the TENS and imipramine significantly reduced the severity of tension headache (p < 0.05). However, imipramine was significantly more effective than TENS in reduction of the headache severity (p < 0.05). CONCLUSIONS It appears that TENS method may be a good alternative method for patients suffering from CTTH. To better evaluate the efficacy of this method in the prevention and treatment of CTTH, more studies are recommended.
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Affiliation(s)
- Sayed Ali Mousavi
- Associated Professor of Neurology, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohssen Mirbod
- Instructor, Department of Physical Therapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Assistant Professor of Neurology, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,
Corresponding Author: Fariborz Khorvash, E-mail:
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Posadzki P, Ernst E. Spinal manipulations for the treatment of migraine: A systematic review of randomized clinical trials. Cephalalgia 2011; 31:964-70. [DOI: 10.1177/0333102411405226] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: The objective of this systematic review was to assess the effectiveness of spinal manipulations as a treatment for migraine headaches. Method: Seven databases were searched from inception to November 2010. All randomized clinical trials (RCTs) investigating spinal manipulations performed by any type of healthcare professional for treating migraine headaches in human subjects were considered. The selection of studies, data extraction and validation were performed independently by two reviewers. Results: Three RCTs met the inclusion criteria. Their methodological quality was mostly poor and ranged between 1 and 3 on the Jadad scale. Two RCTs suggested no effect of spinal manipulations in terms of Headache Index or migraine duration and disability compared with drug therapy, spinal manipulation plus drug therapy, or mobilization. One RCT showed significant improvements in migraine frequency, intensity, duration and disability associated with migraine compared with detuned interferential therapy. The most rigorous RCT demonstrated no effect of chiropractic spinal manipulation compared with mobilization or spinal manipulation by medical practitioner or physiotherapist on migraine duration or disability. Conclusions: Current evidence does not support the use of spinal manipulations for the treatment for migraine headaches.
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Affiliation(s)
| | - E Ernst
- Universities of Exeter & Plymouth, UK
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Castien RF, van der Windt DAWM, Grooten A, Dekker J. Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial. Cephalalgia 2010; 31:133-43. [DOI: 10.1177/0333102410377362] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To evaluate the effectiveness of manual therapy (MT) in participants with chronic tension-type headache (CTTH). Subjects and Methods: We conducted a multicentre, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with CTTH were randomly assigned to MT or to usual care by the general practitioner (GP). Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function. Results: After 8 weeks ( n = 80) and 26 weeks ( n = 75), a significantly larger reduction of headache frequency was found for the MT group (mean difference at 8 weeks, −6.4 days; 95% CI −8.3 to −4.5; effect size, 1.6). Disability and cervical function showed significant differences in favour of the MT group at 8 weeks but were not significantly different at 26 weeks. Conclusions: Manual therapy is more effective than usual GP care in the short- and longer term in reducing symptoms of CTTH. Dutch Trial Registration no. TR 1074.
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Affiliation(s)
- René F Castien
- Healthcare Centre Haarlemmermeer, The Netherlands
- VU University Medical Centre, The Netherlands
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Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, Irnich D. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010; 11:32. [PMID: 20149248 PMCID: PMC2836281 DOI: 10.1186/1471-2474-11-32] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 02/11/2010] [Indexed: 12/15/2022] Open
Abstract
Background Myofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population. Current guidelines for the management of myofascial pain are not available. In this study we investigated how physicians on the basis of prescription behaviour evaluate the effectiveness of treatment options in their management of myofascial pain. Methods We conducted a cross-sectional, nationwide survey with a standardized questionnaire among 332 physicians (79.8% male, 25.6% female, 47.5 ± 9.6 years) experienced in treating patients with myofascial pain. Recruitment of physicians took place at three German meetings of pain therapists, rheumatologists and orthopaedists, respectively. Physicians estimated the prevalence of myofascial pain amongst patients in their practices, stated what treatments they used routinely and then rated the perceived treatment effectiveness on a six-point scale (with 1 being excellent). Data are expressed as mean ± standard deviation. Results The estimated overall prevalence of active myofascial trigger points is 46.1 ± 27.4%. Frequently prescribed treatments are analgesics, mainly metamizol/paracetamol (91.6%), non-steroidal anti-inflammatory drugs/coxibs (87.0%) or weak opioids (81.8%), and physical therapies, mainly manual therapy (81.1%), TENS (72.9%) or acupuncture (60.2%). Overall effectiveness ratings for analgesics (2.9 ± 0.7) and physical therapies were moderate (2.5 ± 0.8). Effectiveness ratings of the various treatment options between specialities were widely variant. 54.3% of all physicians characterized the available treatment options as insufficient. Conclusions Myofascial pain was estimated a prevalent condition. Despite a variety of commonly prescribed treatments, the moderate effectiveness ratings and the frequent characterizations of the available treatments as insufficient suggest an urgent need for clinical research to establish evidence-based guidelines for the treatment of myofascial pain syndrome.
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Affiliation(s)
- Johannes Fleckenstein
- Multidisciplinary Pain Centre, Department of Anaesthesiology, University of Munich, Munich, Germany
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Eine halbsteife Nackenorthese vermindert die Symptomatik radikulärer Armschmerzen. MANUELLE MEDIZIN 2009. [DOI: 10.1007/s00337-009-0722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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