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Geist K, Frierson E, Hudson O, Lavin S, Myers M, McDaniel L, Carter V. The utilization of dry needling and an upper extremity exercise program for individuals with cervicogenic headaches: A pilot study. Cranio 2024; 42:470-480. [PMID: 34689708 DOI: 10.1080/08869634.2021.1994226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate whether a combination of dry-needling treatments and upper extremity neuromuscular reeducation exercises can significantly improve neck pain and/or headache-related disability, joint position error, cervical range of motion, and pain pressure threshold in individuals suffering from cervicogenic headache (CGH). METHODS This study is a quasi-experimental design. Seven participants met the inclusion criteria and received dry needling to three muscles that reproduced the participant's headache symptoms and completed the Neck Disability Index (NDI), Headache Disability Inventory (HDI), Visual Analog Scale (VAS), and Numeric Pain Rating Scale (NPRS). Participants performed an exercise regimen designed to address strength and mobility of cervical and scapulothoracic musculature. RESULTS There were significant improvements seen in cervical range of motion and neck pain-related disability (NDI) during the 4-week treatment period. CONCLUSION Dry needling and neuromuscular re-education (NMR) exercises could be effective components of treatment for individuals suffering from CGH to reduce disability and pain.
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Affiliation(s)
- Kathleen Geist
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Frierson
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Hudson
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Lavin
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Maddy Myers
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Leda McDaniel
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Vincent Carter
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
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AlDahas A, Devecchi V, Deane JA, Falla D. Responsiveness of the cervical joint position error test to detect changes in neck proprioception following four weeks of home-based proprioceptive training. PLoS One 2024; 19:e0303066. [PMID: 38728251 PMCID: PMC11086922 DOI: 10.1371/journal.pone.0303066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION People with chronic neck pain (CNP) commonly exhibit a range of physical impairments including cervical proprioceptive deficits. Assessing proprioception using a head mounted laser to assess joint position error (JPE) is a reliable and valid measure. However, the responsiveness of this measure has not been assessed. OBJECTIVE To assess the responsiveness of the measure of cervical JPE after a 4-week home-based neck proprioceptive training intervention in people with CNP. DESIGN An observational study to assess the responsiveness of the measure of cervical JPE. METHODS The JPE test was assessed in people with CNP before and after 4 weeks of neck proprioception training. JPE was assessed as participants performed neck joint position sense tests for flexion, extension, right rotation, and left rotation in sitting and standing which were performed in a random order. Both the absolute and constant JPE were assessed. The intervention consisted of neck repositioning exercises as well as movement sense exercises. Cohen's d effect size was used to assess the internal responsiveness of the JPE test. The Pearson's correlation was used to assess the change of scores of the laser pointer and measures from inertial measurement units (IMUs) (external responsiveness). RESULTS After 4 weeks of proprioception training, JPE assessed in sitting reduced from 2.69◦-3.57◦ to 1.88◦-1.98◦ for flexion, extension, and right rotation with large effect sizes (Cohen's d range: 1.25-2.00). For left rotation, JPE reduced from 3.23◦ to 1.9◦, and the effect size was close to being large (Cohen's d: 0.79). When assessed in standing, JPE reduced from 3.49◦-4.52◦ to 1.5◦-2.33◦ with large effect sizes (Cohen's d range: 0.89-1.25) for flexion, extension, right rotation, and left rotation. Large effect sizes were not observed for the constant JPE when assessed in either sitting or standing. The assessment of the external responsiveness revealed weak correlations between the change of scores obtained from the laser pointer and the IMUs for all movements, apart from the constant JPE in sitting for left rotation, which showed a strong correlation (r = 0.7). CONCLUSION The results of this study showed that the measure of the JPE has sufficient internal responsiveness, however, the external responsiveness was inadequate. Further research is advised.
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Affiliation(s)
- Ahmad AlDahas
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Physical Therapy, Al-Sabah Medical Hospital, Ministry of Public Health, Shuwaikh Industrial, Kuwait
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Janet A. Deane
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
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de la Barra Ortiz HA, Arias M, Liebano RE. A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain. Lasers Med Sci 2024; 39:124. [PMID: 38709332 DOI: 10.1007/s10103-024-04069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).
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Affiliation(s)
- Hernán Andrés de la Barra Ortiz
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Avenida Fernández Concha 700, 7591538, Las Condes, Santiago de Chile, Chile.
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil.
| | - Mariana Arias
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
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Altmis Kacar H, Ozkul C, Baran A, Guclu-Gunduz A. Effects of cervical stabilization training in patients with headache: A single-blinded randomized controlled trial. Eur J Pain 2024; 28:633-648. [PMID: 37970662 DOI: 10.1002/ejp.2208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND This study aimed to investigate the effects of Cervical Stabilization Training (CST) on the headache, neck pain and cervical musculoskeletal system in patients with headache compared to the control group. METHODS A total of 90 female patients with migraine, tension-type headache and cervicogenic headache (CGH) participated in this study. The patients were divided into the cervical stabilization training group (CSTG) and the control group (CG). The CSTG performed the CST three times a week for 8 weeks while the CG continued their ongoing medical treatment. The pain intensity was assessed by Visual Analogue Scale, forward head posture by craniovertebral angle measurement, the endurance of deep cervical flexor muscles by craniocervical flexion test and the endurance of cervical muscles by flexor and extensor endurance tests before and after 8 weeks. In addition, disability levels, health-related quality of life, sleep quality and mood were assessed by the Migraine Disability Assessment questionnaire, Neck Disability Index (NDI), Short Form 36 Quality of Life Scale, the Pittsburgh Sleep Quality Index and Beck Depression Scale, respectively. RESULTS Headache frequency, duration and intensity, neck pain intensity and forward head posture reduced while activation and performance of deep cervical flexor muscles, the endurance of cervical flexor and extensor muscles increased in the CSTG (p < 0.05). Furthermore, the disability levels, quality of life, sleep quality and mood also improved in the CSTG (p < 0.05). CONCLUSIONS This study suggests that CST reduces headaches and neck pain by improving the cervical musculoskeletal system in patients with headache. SIGNIFICANCE The CST improved the headache frequency, duration and intensity, neck pain intensity, cervical posture, activation of deep cervical flexor muscles and endurance of cervical muscles in patients with headache. In addition, improvements in the cervical musculoskeletal system contributed to a reduction in the intensity of headaches and neck pain. Therefore, CST may be preferred in the treatment of headaches, especially with coexisting neck pain.
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Affiliation(s)
- H Altmis Kacar
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Gazi University, Ankara, Turkey
| | - C Ozkul
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - A Baran
- Department of Neurology, Medical Park Hospital, Ankara, Turkey
| | - A Guclu-Gunduz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Liu C, Wang Y, Yu W, Xiang J, Ding G, Liu W. Comparative effectiveness of noninvasive therapeutic interventions for myofascial pain syndrome: a network meta-analysis of randomized controlled trials. Int J Surg 2024; 110:1099-1112. [PMID: 37939115 PMCID: PMC10871620 DOI: 10.1097/js9.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Myofascial pain syndrome (MPS) has an impact on physical health and quality of life for patients, with various noninvasive methods used for relieving myofascial pain. The authors aimed to compare the effectiveness of different noninvasive therapeutic interventions for MPS. MATERIALS AND METHODS The authors searched PubMed, Embase, CINAHL Complete, Web of Science, Cochrane, and Scopus to identify randomized controlled trials describing the effects of any noninvasive treatments in patients with MPS. The primary outcome was pain intensity, while pressure pain threshold and pain-related disability were secondary outcomes. RESULTS The analysis included 40 studies. Manual therapy [mean difference (MD) of pain: -1.60, 95% CI: -2.17 to -1.03; MD of pressure pain threshold: 0.52, 95% CI: 0.19 to 0.86; MD of pain-related disability: -5.34, 95% CI: -8.09 to -2.58], laser therapy (MD of pain: -1.15, 95% CI: -1.83 to -0.46; MD of pressure pain threshold: 1.00, 95% CI: 0.46 to 1.54; MD of pain-related disability: -4.58, 95% CI: -7.80 to -1.36), extracorporeal shock wave therapy (MD of pain: -1.61, 95% CI: -2.43 to -0.78; MD of pressure pain threshold: 0.84, 95% CI: 0.33 to 1.35; MD of pain-related disability: -5.78, 95% CI: -9.45 to -2.12), and ultrasound therapy (MD of pain: -1.54, 95% CI: -2.24 to -0.84; MD of pressure pain threshold: 0.77, 95% CI: 0.31 to 1.22) were more effective than no treatment. CONCLUSION Our findings support that manual therapy, laser therapy, and extracorporeal shock wave therapy could effectively reduce pain intensity, pressure pain threshold, and pain-related disability with statistical significance when compared with placebo. This finding may provide clinicians with appropriate therapeutic modalities for patients with MPS among different scenarios.
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Affiliation(s)
| | - Yang Wang
- Department of Plastic and Reconstructive Surgery, Cell and Matrix Research Institute, Kyungpook National University School of Medicine, Daegu, Korea
| | - Wenli Yu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, People’s Republic of China
| | | | - Guoyong Ding
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong
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Vogel K, Muhammad LN, Song J, Neogi T, Bingham CO, Bolster MB, Marder W, Wohlfahrt A, Clauw DJ, Dunlop D, Lee YC. Sex Differences in Pain and Quantitative Sensory Testing in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:2472-2480. [PMID: 37365745 PMCID: PMC10704379 DOI: 10.1002/acr.25178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/01/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Women with rheumatoid arthritis (RA) have higher pain and worse functional outcomes compared to men, even when treated with similar medications. The objective of this study was to identify sex differences in pain intensity, pain interference, and quantitative sensory tests (QST), which are independent of inflammation, in patients with RA. METHODS This study is a post hoc analysis of participants in the Central Pain in Rheumatoid Arthritis cohort. Pain intensity was assessed using a 0-10 numeric rating scale. Pain interference was measured using a Patient-Reported Outcomes Measurement Information System computerized adaptive test. QST included pressure pain detection thresholds, temporal summation, and conditioned pain modulation. Women and men were compared using multiple linear regression, adjusted for age, education, race, research site, depression, obesity, RA disease duration, swollen joint count, and C-reactive protein. RESULTS Mean ± SD pain intensity was 5.32 ± 2.29 among women with RA, compared to 4.60 ± 2.23 among men with RA (adjusted difference 0.83 [95% confidence interval (95% CI) 0.14, 1.53]). Women with RA had lower pressure pain detection thresholds at the trapezius (adjusted difference -1.22 [95% CI -1.73, -0.72]), wrist (adjusted difference -0.57 [95% CI -1.07, -0.06]), and knee (adjusted difference -1.10 [95% CI -2.00, -0.21]). No statistically significant differences in pain interference, temporal summation, and conditioned pain modulation were observed. CONCLUSION Women reported higher pain intensity and lower pressure pain detection thresholds (higher pain sensitivity) than men. However, pain interference, temporal summation, and conditioned pain modulation did not differ between men and women.
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Affiliation(s)
- Kelly Vogel
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jing Song
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Wendy Marder
- University of Michigan Medical School, Ann Arbor
| | | | | | - Dorothy Dunlop
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yvonne C Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Bellosta-López P, Simonsen MB, Palsson TS, Djurtoft C, Hirata RP, Christensen SWM. Validity of an inertial measurement unit for the assessment of range and quality of movement during head and thoracic spine movements. Musculoskelet Sci Pract 2023; 66:102826. [PMID: 37433251 DOI: 10.1016/j.msksp.2023.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Patients with spinal pain often exhibit movement limitations and altered motor control, which can be challenging to measure accurately in clinical practice. Inertial measurement sensors present a promising new opportunity to develop valid, low-cost, and easy-to-use methods for assessing and monitoring spinal motion in a clinical setting. AIM This study aimed to investigate the agreement of an inertial sensor and a 3D camera system for assessing the range of motion (ROM) and quality of movement (QOM) in head and trunk single-plane movements. METHODS Thirty-three healthy, pain-free volunteers were included. Each participant performed movements of the head (cervical flexion, extension, and lateral flexion) and trunk (trunk flexion, extension, rotation, and lateral flexion), which were simultaneously recorded by a 3D camera system and an inertial measurement unit (MOTI, Aalborg, Denmark). Agreement and consistency were analyzed for ROM and QOM by determining intraclass correlation coefficients (ICC), mean bias, and with Bland-Altman plots. RESULTS The agreement between systems was excellent for all movements (ICC between 0.91 and 1.00) for ROM and good to excellent for the QOM (ICC between 0.84 and 0.95). The mean bias for all movements (0.1-0.8°) was below the minimum acceptable difference between devices. The Bland-Altman plot indicated that MOTI systematically measured a slightly greater ROM and QOM than the 3D camera system for all neck and trunk movements. CONCLUSION This study showed that MOTI is a feasible and potentially applicable option to assess ROM and QOM for head and trunk movements in experimental and clinical settings.
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Affiliation(s)
- Pablo Bellosta-López
- Universidad San Jorge. Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain.
| | - Morten Bilde Simonsen
- Department of Materials and Production, Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
| | - Thorvaldur Skuli Palsson
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Chris Djurtoft
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Rogerio Pessoto Hirata
- ExerciseTech Research Group, Department of Health Science and Technology Aalborg University, Denmark
| | - Steffan Wittrup McPhee Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
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Ding BTK, Chan ML, Yu CS, Oh JYL. Return to Driving Is Safe 6 Weeks After Anterior Cervical Surgery for Symptomatic Cervical Degenerative Disc Disease. Clin Spine Surg 2023; 36:E218-E225. [PMID: 36696465 DOI: 10.1097/bsd.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/13/2022] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Prospective Cohort Study. OBJECTIVES This study aims to determine the timing and clinical parameters for a safe return to driving. SUMMARY OF BACKGROUND DATE Returning to driving after cervical spine surgery remains a controversial topic, with no clear consensus on how to best assess a patient's fitness to drive. Previous studies using brake reaction time or subjective questionnaires recommend a return to driving 6 weeks after surgery. METHODS Patients above 18 years of age who underwent anterior cervical spine surgery for symptomatic cervical degenerative disk disease and possessed a valid motorcar driving license were recruited from 2018 to 2020. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scores, range of motion, and functional strength of the cervical spine were collected preoperatively and at 2-, 4-, 6- and 12 weeks postsurgery. Patients underwent a standard functional driving assessment protocol at the institution to determine their fitness to drive. This comprised of a clinic-based off-road screening tests and on-road driving test in a real-world environment. RESULTS Twenty-one patients were recruited. The mean age was 56.6±8.9 years. Eighty-one percent of the patients passed the on-road driving assessment at 6 weeks. Patients who passed the driving assessment had lower mean NDI scores, 3.4±3.1 versus 10.8±8.0 ( P =0.006), and higher mean mJOA scores 16.1±0.6 versus 15.0±1.8 ( P =0.045). Patients who passed the driving assessment also had higher functional cervical flexor strength, 21.1s±5.8s versus 13.0s±10.2s ( P =0.042) in a supine position but not correlated with a range of motion of the spine in all directions. CONCLUSION Most patients undergoing single or dual-level anterior cervical surgery for symptomatic cervical degenerative disk disease demonstrate the ability to pass a standardized driving assessment and are safe to return to driving more than 6 weeks after surgery. Driving ability appears to be correlated with NDI scores ≤3 ( P =0.006), mJOA scores ≥16 ( P =0.045), and cervical flexion endurance of ≥21s ( P =0.042). LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Mei Leng Chan
- Department of Occupational Therapy, Tan Tock Seng Hospital
- Department of Occupational Therapy, Health and Social Science Cluster, Singapore Institute of Technology
| | - Chun Sing Yu
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Moloney N, Rabey M, Hush J, Sanders D, Dube T, Marcuzzi A. Is low intensity exercise sufficient to induce exercise-induced pain threshold modulation in people with persistent pain? Musculoskelet Sci Pract 2022; 62:102643. [PMID: 35963040 DOI: 10.1016/j.msksp.2022.102643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated whether a 12-min walk test (12MWT) yielded exercise-induced pain threshold modulation (EIPM) within people with persistent pain and whether baseline self-report and pain sensitivity measures differed according to these responses. DESIGN Cross-sectional study. METHODS Two cohorts (tertiary/community) (n = 88) with persistent pain underwent pressure pain threshold (PPT) testing before and after a 12MWT to determine exercise-induced pain threshold modulation responses. Baseline self-report (pain severity, pain distribution, psychological distress, sleep) and baseline widespread pain sensitivity (WPS) (high/low) were recorded. Within and between-group differences were analysed using paired t-tests and repeated measure analyses of covariance. Individual EIPM responses were categorised as hyperalgesic, no change and hypoalgesic responses. Differences in baseline self-report and pain sensitivity measures between EIPM categories were investigated. RESULTS No significant within- or between-group differences in PPT following the 12MWT were detected (p > 0.05). Individual responses showed that up to 30% of the community and 44% of the tertiary cohort demonstrated >20% change in PPT (in either direction). Significant differences were shown in pain distribution (p = 0.002) and baseline WPS (p = 0.001) between people with hyperalgesic, no change, hypoalgesic responses. People with 4-5 pain regions were more likely hyperalgesic (χ2 = 9.0, p = 0.003); people with low baseline WPS were more likely to demonstrate no change (p = 0.002). CONCLUSION Low or self-selected intensity exercise was insufficient to induce exercise-induced pain modulation at group level. Individual responses were variable with pain distribution and baseline WPS differing between responses. Future research could evaluate responses and associated factors in larger samples with high baseline pain sensitivity specifically.
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Affiliation(s)
- Niamh Moloney
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Department of Exercise Sciences, Faculty of Science, University of Auckland, New Zealand; THRIVE Physiotherapy, Channel Islands, Guernsey.
| | - Martin Rabey
- THRIVE Physiotherapy, Channel Islands, Guernsey; School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Julia Hush
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Duncan Sanders
- Pain Management Research Centre, The University of Sydney, NSW, Australia
| | - Tumelo Dube
- Pain Management Research Centre, The University of Sydney, NSW, Australia
| | - Anna Marcuzzi
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Siddiqui M, Akhter S, Baig AAM. Effects of autogenic and reciprocal inhibition techniques with conventional therapy in mechanical neck pain - a randomized control trial. BMC Musculoskelet Disord 2022; 23:704. [PMID: 35879756 PMCID: PMC9309448 DOI: 10.1186/s12891-022-05668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Neck pain is a common musculoskeletal issue that has been seen as high in terms of disability. Muscle Energy Techniques (MET) are advanced soft tissue techniques to treat Mechanical Neck Pain (MNP). This study compares the Autogenic inhibition (AI) technique with the Reciprocal Inhibition (RI) technique providing conventional treatment to improve functional outcomes. Methods A randomized control trial was conducted at Sindh Institute of Physical Medicine & Rehabilitation, Karachi, Pakistan from August 28, 2021, to December 31, 2021 among 20–50 years old patients with Moderate intensity MNP for more than 4 weeks and with limited Neck ROMs. The sample were divided randomly and allocated into two groups (groups 1 and 2). Group 1 and 2 received 12 sessions of AI and RI with Conventional therapy respectively. The randomization sheet was generated online from randomization.com for a sample size of 80 and two groups of study ‘AI’ and ‘RI’ with a ratio of 1:1 by an independent statistician. Pain (primary outcome), range of motion, and functional disability (secondary outcomes) were assessed through visual analog scale (VAS), Goniometer, and Neck disability index (NDI) at baseline, 1st, and last session respectively. Mean and standard deviation, frequency, and percentages were calculated. Chi-square test and independent t-test compare baseline characteristics. The Repeated Measure Two-Way ANOVA compared mean VAS, NDI, and ROM. The significant P-value was less than 0.05. Results The mean duration of neck pain was 8 weeks. There was a more significant (p < 0.001) improvement in pain (ES = 0.975), disability (ES = 0.887), neck ROMs; flexion (ES = 0.975), extension (ES = 0.965), right and left lateral flexion (ES = 0.949 and 0.951), and right and left rotation (ES = 0.966 and 0.975) in the AI group than the RI group at 12th session. Conclusion The Autogenic Inhibition-MET is more beneficial than Reciprocal Inhibition-MET in improving Pain, Range of Motion, and Functional Disability in patients with Sub-Acute and Chronic Mechanical Neck Pain. Therefore, it is a beneficial technique to add with conventional neck pain therapy to get better treatment outcomes in MNP patients. Trial Registration Prospectively registered on ClincalTrials.Gov with ID: NCT05044078.
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Affiliation(s)
- Mahrukh Siddiqui
- Department of physiotherapy, Institute of Physical Medicine and Rehabilitation, Dow University of Health and sciences, Karachi, Pakistan
| | - Saeed Akhter
- Department of physiotherapy, Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan
| | - Aftab Ahmed Mirza Baig
- Department of physiotherapy, Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan.
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Kasch H, Carstensen T, Ravn SL, Andersen TE, Frostholm L. Cervical Motor and Nociceptive Dysfunction After an Acute Whiplash Injury and the Association With Long-Term Non-Recovery: Revisiting a One-Year Prospective Cohort With Ankle Injured Controls. FRONTIERS IN PAIN RESEARCH 2022; 3:906638. [PMID: 35875480 PMCID: PMC9300940 DOI: 10.3389/fpain.2022.906638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Aims To explore the development of cervical motor and nociceptive dysfunction in patients with whiplash (WPs) and non-recovery based on injury-related work disability 1-year after injury when compared with ankle-injured controls (ACs). Methods A 1-year observational prospective study examining consecutive WPs and age- and sex-matched ACs at 1 week,3 months, 6 months, and 1 year post-injury using semi-structured interviews; global pain rating (VAS0-10) and the pain rating index (PRI-T) and number-of-words-chosen (NWC) from the McGill Pain Questionnaire; examining nociceptive functioning using the cold pressor test (CPT), pressure algometry, and methodic palpation, and central pain processing using counter-stimulation; and examining motor functioning by active cervical range-of-motion (CROM), and neck strength [maximal voluntary contraction flexion/extension (MVC)]. One-year work disability/non-recovery was determined using a semi-structured interview. Results A total of 141 WPs and 40 ACs were included. Total pain rating index (PRI-T) NWC were higher in ACs after 1 week but higher in WPs after 3 months, 6 months, and 1 year. Ongoing global pain was higher in WPs after 1 week and after 3 and 6 months but not after 1 year. Pressure pain thresholds were reduced, and palpation was higher in the neck and jaw in WPs after 1 week but was not consistently different afterward from ACs. Cervical mobility was reduced in WPs after 1 week, 3 months, and 6 months but not after 1 year, and MVC was significantly reduced in WPs when compared with ACs after 1 week and 1 year but not after 3 and 6 months. One-year non-recovery was only encountered in 11 WPs and not in the AC group. Non-recovered WPs (N-WPs) had consistently significantly higher VAS0−10, PRI-T, NWC, reduced pressure pain thresholds, raised muscle-tenderness, reduced active cervical range-of-motion, reduced active-neck-flexion/extension, and reported higher neck disability scores than recovered WPs. Of special interest, there was increasing tenderness in trigeminal-derived muscles based on palpation scores, and marked reduction of PPDT was most pronounced in N-WPs when compared with recovered WPs and ACs. Conclusion Cervical motor dysfunction and segmental nociceptive sensitization were present from early after injury in WPs and prolonged in N-WPs. Differences in trigeminal and cervical motor and sensory function in N-WPs could be of interest for future treatment studies.
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Affiliation(s)
- Helge Kasch
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Helge Kasch
| | - Tina Carstensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sophie Lykkegaard Ravn
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Romeo A, Baccini M, Carreras G, Sagripanti M, Ruggeri M, Pillastrini P, Di Bari M. Reliability, Validity, and Responsiveness of the Craniocervical Flexion Test in People Who Are Asymptomatic and Patients With Nonspecific Neck Pain: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:6585158. [PMID: 35554598 DOI: 10.1093/ptj/pzac054] [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] [Received: 07/07/2021] [Revised: 12/08/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Among the tests designed to evaluate neck neuromuscular function, the craniocervical flexion test (CCFT) assesses the function of the deep cervical flexor muscles (DCFs). The purpose of this study was to conduct a review and meta-analysis of published articles about all measurement properties of the different CCFT versions (CCFT Activation Score [CCFT-AS], CCFT Performance Index [CCFT-PI], CCFT Cumulative Performance Index [CCFT-CPI], and CCFT alternative procedures for measuring activation level (CCFT1) or endurance (CCFT2) in people who were asymptomatic and people with nonspecific neck pain. METHODS PubMed Central, MEDLINE, CINAHL, Scopus, Web of Science, and Google Scholar were searched from inception to June 30, 2020. Studies were selected if they reported data on reliability, validity, and/or responsiveness of the CCFT in adults who were asymptomatic or who had nonspecific neck pain. Two reviewers independently selected the studies, conducted quality assessment, and extracted the results. All meta-analyses used a random-effects model. RESULTS Twenty-one studies met the inclusion criteria. The rating of interrater reliability (assessed for CCFT-AS and CCFT-CPI) was positive only for using the test at a group level. The same rating was ascribed to the intrarater reliability of CCFT-AS, CCFT1, and CCFT2, whereas CCFT-PI and CCFT-CPI showed positive intrarater reliability for assessment of individuals as well. CCFT validity was rated as positive for expressly assessing DCF action when measuring DCF activation through electromyography-not through ultrasonography-or craniocervical flexion motion as well as for differentiating patients who were asymptomatic and patients who had nonspecific neck pain (only the AS version). CCFT validity was rated as negative for investigating the CCFT performance correlation with the severity of nonspecific neck pain. CCFT responsiveness was rated as negative. CONCLUSIONS The CCFT is a potentially useful tool for detecting impairment in DCF control and identifying patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the limited reliability affects its suitability for that purpose. Further research on the reliability of different CCFT versions in which the raters are thoroughly trained is strongly recommended. IMPACT The CCFT might help to detect impairment in DCF control and identify patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the poor reliability of most versions of the test greatly limits its application in clinical practice. Only CCFT-PI and CCFT-CPI seem reliable enough to help in clinical decision-making at the individual level.
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Affiliation(s)
- Antonio Romeo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Baccini
- PROMISE Lab, IRCCS Fondazione Don Gnocchi Firenze, Florence, Italy
| | - Giulia Carreras
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Sagripanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Martina Ruggeri
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Di Bari
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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13
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De Vestel C, Vereeck L, Reid SA, Van Rompaey V, Lemmens J, De Hertogh W. Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness. J Man Manip Ther 2022; 30:273-283. [PMID: 35383538 PMCID: PMC9487935 DOI: 10.1080/10669817.2022.2033044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Patients with cervicogenic dizziness (CGD) present with dizziness, cervical spine dysfunctions, and postural imbalance, symptoms that can significantly impact their daily functioning. OBJECTIVES To provide evidence-based recommendations for the management of patients with CGD. METHODS Three databases were searched for randomized controlled trials (RCTs) (last search 15 May 2021). Outcome measures included dizziness, cervical spine, and balance parameters. Cochrane standard methodological procedures were used and included the RoB 2.0 and GRADE. Where possible, RCTs were pooled for meta-analysis. RESULTS Thirteen RCTs (n = 898 patients) of high (two RCTs), moderate (five RCTs), and low (six RCTs) methodological quality were analyzed. Six RCTs were included in the meta-analysis. Only three RCTs specified the cause of CGD. They showed inconsistent findings for the effectiveness of exercise therapy in patients with traumatic CGD. Manual therapy and manual therapy combined with exercise therapy may reduce CGD, cervical spine, and balance dysfunctions. CONCLUSION There is moderate quality of evidence that manual therapy reduces CGD, cervical spine, and balance symptoms. When manual therapy is combined with exercise therapy, the positive effect on CGD, cervical spine, and balance symptoms is even stronger. However, the quality of the evidence here is very low.
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Affiliation(s)
- Charlotte De Vestel
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Susan A Reid
- Department of Physiotherapy, Faculty of Health, Australian Catholic University, North Sydney, Australia
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joris Lemmens
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
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14
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Rodrigues A, Florencio LL, Martins J, Bragatto MM, Fernández-de-Las-Penãs C, Dach F, Bevilaqua-Grossi D. Craniocervical flexion test in patients with migraine: Discriminative validity and accuracy. Int J Clin Pract 2021; 75:e14248. [PMID: 33884715 DOI: 10.1111/ijcp.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate the discriminative validity and provide a clinical cut-off of the craniocervical flexion test (CCFT) in migraineurs stratified by the report of neck pain, headache-related disability and neck disability. METHODS Fifty women without headache and 102 women with migraine were recruited by convenience from a local tertiary care setting. Migraine diagnosis followed the International Classification of Headache Disorders. All volunteers underwent the CCFT. Patients with migraine answered the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) questionnaires. Discriminative validity was verified by group comparison, and the clinical cut-off was obtained and classified according to the diagnostic accuracy of the CCFT. RESULTS The CCFT presented discriminative validity for comparing control (median = 28, IQR = 6) with migraine (median = 26, IQR = 4, P = .01) and migraine with neck pain (median = 26, IQR = 4, P = .01), but not among the migraine subtypes with disability by migraine or neck pain-related disability on the MIDAS and NDI. The diagnostic accuracies were classified between poor and not discriminating with the area under the receiver operating characteristic curve ranging from 57% to 69% and non-acceptable values of sensitivity, specificity and positive and negative likelihood ratios. CONCLUSION The CCFT can discriminate asymptomatic controls from migraine patients with and without neck pain. However, it cannot discriminate patients with migraine according to their pain-related disability. Also, the CCFT does not offer an optimal cut-off value in migraine patients adequate to clinical practice.
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Affiliation(s)
- Amanda Rodrigues
- Department of Health Sciences-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lidiane Lima Florencio
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, King Juan Carlos University, Madrid, Spain
| | - Jaqueline Martins
- Department of Health Sciences-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcela Mendes Bragatto
- Department of Health Sciences-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - César Fernández-de-Las-Penãs
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, King Juan Carlos University, Madrid, Spain
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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15
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Clark NG, Hill CJ, Koppenhaver SL, Massie T, Cleland JA. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskelet Sci Pract 2021; 53:102366. [PMID: 33831698 DOI: 10.1016/j.msksp.2021.102366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dry needling (DN) has been consistently shown to decrease pain sensitivity and increase flexibility local to the site of treatment, however it is unclear whether these effects are limited to the region of treatment or can be observed remote to the area of treatment. OBJECTIVE To determine the immediate, short-term effects of DN to the thoracolumbar junction on regional and remote flexibility, and to observe if changes in pain sensitivity can occur remote to site of treatment. DESIGN Double-blind randomized clinical trial. METHODS Fifty-four subjects with low back pain and decreased length in at least one hamstring were randomized to receive either DN or sham DN to the T12 and L1 multifidi. Participants underwent regional (fingertip-to-floor) and remote flexibility (passive knee extension, passive straight leg raise) and pressure pain threshold (PPT) testing of the upper and lower extremity before, immediately after and 1 day after treatment. ANCOVAs were used to analyze flexibility data, with the covariate of pre-treatment values. Paired t-tests were used for difference in remote pain sensitivity. RESULTS Statistically larger improvements in regional flexibility, but not remote flexibility, were observed immediately post-treatment in those who received DN than in those receiving sham DN (p = .0495; adjusted difference 1.2, 95% CI 0.002-2.3). Differences between upper and lower extremity PPT were not significant. CONCLUSION DN can potentially have immediate changes in regional flexibility, but effects are not sustained at 24-h follow-up. DN may not affect remote flexibility or segmental pain sensitivity.
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Affiliation(s)
- Nicole G Clark
- Stefani Doctor of Physical Therapy Program, University of Saint Mary, 4100 South 4th St, Leavenworth, KS, 66048, USA.
| | - Cheryl J Hill
- Doctor of Physical Therapy Program, Dr. Pallavi Patel College of Healthcare Sciences, Nova Southeastern University, 3200 South University, Dr. Ft. Lauderdale, FL, 33328, USA.
| | - Shane L Koppenhaver
- Baylor University, Doctoral Program in Physical Therapy, 1 Bear Place #97264, Waco, TX, 76798, USA.
| | - Thomas Massie
- Stefani Doctor of Physical Therapy Program, University of Saint Mary, 4100 South 4th St, Leavenworth, KS, 66048, USA.
| | - Joshua A Cleland
- Director of Research and Faculty Development, Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA.
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16
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Kim SY, An CM, Cha YS, Kim DH. Effects of sling-based manual therapy on cervicothoracic junction in patients with neck pain and forward head posture: A randomized clinical trial. J Bodyw Mov Ther 2021; 27:447-454. [PMID: 34391270 DOI: 10.1016/j.jbmt.2021.03.007] [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: 12/14/2020] [Revised: 02/17/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of 4 weeks of sling-based manual therapy on the cervicothoracic junction (CTJ) area in patients with neck pain and forward head posture. DESIGN Single-blind randomized controlled trial. SETTING Outpatient, Chonbuk National University hospital, Republic of Korea. SUBJECTS A total of 22 participants with neck pain (Numeric Pain Rating Scale >3) and forward head posture (craniovertebral angle <51) were randomly assigned to a CTJ group or a control group (n = 11 each). INTERVENTION In the control group, joint mobilization and motor control training was applied for the upper cervical spine (C0-C1). The CTJ group applied the same intervention to the upper cervical spine and cervicothoracic junction (C7-T3). MAIN MEASURES Numeric pain rating scale and neck disability index, craniovertebral angle, active range of motion, and muscle activity were evaluated before and after 4 weeks of intervention. RESULT The CTJ group participants showed significant improvement in the craniovertebral angle and cervical extension range after the intervention than the control group (P = 0.025, P = 0.001). While both groups presented significant differences after the intervention regarding Numeric pain rating scale, neck disability index, and muscle activity (sternocleidomastoid and anterior scalene muscle), there were no statistically significant differences between the groups (P > 0.05). CONCLUSION Our results suggest that the CTJ and the upper cervical region in patients with neck pain and forward head posture represent an area which if approached by manual therapy, improves cervical mobility and posture.
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Affiliation(s)
- Suhn-Yeop Kim
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Republic of Korea.
| | - Chang-Man An
- Department of Physical Therapy, Chonbuk National University Hospital, Republic of Korea.
| | - Yoon-Sang Cha
- Department of Physical Therapy, Chonbuk National University Hospital, Republic of Korea.
| | - Dae-Hyun Kim
- Department of Physical Therapy, Chonbuk National University Hospital, Republic of Korea.
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17
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Vichiansiri R, Johns NP, Thankham A, Padumanonda T. Comparative Effectiveness of Thai Herbal Formula (Thor-Ra-Nee-San-Tha-Kat) Versus Naproxen for Chronic Myofascial Pain: A Pilot Randomized-Controlled Trial. J Altern Complement Med 2020; 27:73-79. [PMID: 33216613 DOI: 10.1089/acm.2020.0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Myofascial pain syndrome (MPS) is a painful musculoskeletal condition. The prevalence of MPS ranges from 5.9% to 38.7% in the general population. "Thor-ra-nee-san-tha-kat" (TRK) is a traditional formula included in the Thailand National List of Essential Medicines for the treatment for muscle pain caused by abdominal rigidity and for severe constipation. Objectives: The authors employed a pilot single-blind, randomized-controlled trial to compare the effectiveness of TRK and naproxen for the treatment of chronic upper trapezius MPS. Materials and Methods: Seventy-six male and female subjects, ages 25-55 years, who met the inclusion criteria were equally randomized into two groups to receive either two 500 mg capsules of TRK once daily before bed or two 250 mg naproxen tablets twice a day after meals for 14 days. Subjects assessed their level of pain using the numerical rating scale. Cervical range of motion (CROM) was determined using a goniometer, and pressure pain threshold (PPT) was assessed using an algometer. Adverse drug reactions were recorded and all items were compared within and between groups, before and after treatment. Results: The results revealed that patient pain scores after 14 days of treatment were much improved with mean differences exceeding the reference minimum clinically important difference (MCID) in both groups. However, the changes in CROM and PPT values were small and did not surpass their respective reference MCIDs except for the right lateral bending CROM for naproxen treatment. The adverse drug reactions were mild, with watery stools reported by 47% of patients in the TRK-treated group and constipation reported by 24% of those in the naproxen group. Conclusion: The administration of TRK formula for 14 days was safe and as effective as naproxen at providing short-term relief of pain in patients with chronic upper trapezius pain.
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Affiliation(s)
- Ratana Vichiansiri
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Amonwat Thankham
- Department of Thai Traditional Medicine, Faculty of Science, Udonthani Rajabhat University, Udonthani, Thailand
| | - Tanit Padumanonda
- Division of Pharmacognosy and Toxicology, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
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18
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Espí-López GV, Aguilar-Rodríguez M, Zarzoso M, Serra-Añó P, Martínez DE LA Fuente JM, Inglés M, Marques-Sule E. Efficacy of a proprioceptive exercise program in patients with nonspecific neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2020; 57:397-405. [PMID: 33047944 DOI: 10.23736/s1973-9087.20.06302-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nonspecific neck pain is associated with chronic pain, disability, reduced cervical mobility, postural control disorders and impaired proprioceptive control. AIM The aim of this study was to compare the effectiveness of two therapeutic exercise programs (i.e. cervical proprioception and cervical mobility) in reducing pain and disability in individuals with nonspecific neck pain. We further aimed to compare the effectiveness of the two treatments in improving pressure pain threshold, cervical range of motion and head repositioning accuracy. DESIGN This study was designed as a randomized controlled trial. SETTING This study took place in a private rehabilitation clinic. POPULATION Forty-two participants diagnosed with nonspecific neck pain, aged 18-65 years, were randomized to a cervical mobility group (N.=22) or a proprioception group (N.=20). METHODS The cervical mobility group combined a passive treatment and active mobility exercises, whereas the Proprioception group combined a passive treatment and proprioceptive exercises. Pain intensity, disability, pressure pain threshold, range of motion, and head repositioning accuracy were assessed at baseline and after 10 sessions. RESULTS Pain intensity and disability significantly improved for both interventions (p<0.01), but such improvement was greater for pain intensity in the proprioception group than in the cervical mobility group (P<0.01). Pressure pain threshold, range of motion and head repositioning accuracy improved only in the proprioception group (P<0.01). CONCLUSIONS A program based on cervical proprioception exercises demonstrated to improve pain, disability, pressure pain threshold, range of motion and head repositioning accuracy in patients with nonspecific neck pain. However, a program based on cervical mobility exercises only showed to improve pain intensity and disability, while such improvement was not clinically relevant. CLINICAL REHABILITATION IMPACT The proprioceptive exercise program may be considered as the treatment of choice in patients with nonspecific neck pain.
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Affiliation(s)
- Gemma V Espí-López
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Manuel Zarzoso
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Pilar Serra-Añó
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Marta Inglés
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain -
| | - Elena Marques-Sule
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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19
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Micarelli A, Viziano A, Carlino P, Granito I, Micarelli RX, Alessandrini M. Reciprocal roles of joint position error, visual dependency and subjective perception in cervicogenic dizziness. Somatosens Mot Res 2020; 37:262-270. [DOI: 10.1080/08990220.2020.1803257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alessandro Micarelli
- ITER Center for Balance and Rehabilitation (ICBRR), Rome, Italy
- Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Ivan Granito
- ITER Center for Balance and Rehabilitation (ICBRR), Rome, Italy
| | | | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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20
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Evaluation of a Cervical Stabilization Exercise Program for Pain, Disability, and Physical Impairments in University Violinists with Nonspecific Neck Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155430. [PMID: 32731521 PMCID: PMC7432242 DOI: 10.3390/ijerph17155430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
Cervical stabilization exercises are frequently used to reduce pain, maximize function, and improve physical impairments for people with nonspecific neck pain. We conducted a single arm study to evaluate the effects of a home-based cervical stabilization exercise program for university violin players with nonspecific neck pain who frequently assume an asymmetrical neck posture and activate their superficial cervical flexors to stabilize the violin. Twenty violin players with nonspecific neck pain from university symphony orchestras participated in this study. All participants received assessments twice before the intervention and once immediately after a 6-week cervical stabilization exercise program. No significant differences were found between the two pretests before the intervention. After the intervention, the Numeric Rating Scale, the Neck Disability Index, the craniocervical flexion test, muscle endurance tests, cervical range of motion (all directions except flexion) tests, and cervicocephalic relocation tests (flexion and left rotation) showed improvements. The forward head posture indicated by the craniovertebral angle also slightly improved. The results of this single arm study suggest that cervical stabilization exercise is feasible and has the potential to improve physical health for collegiate violin players with nonspecific neck pain.
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21
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Araujo FXD, Ferreira GE, Scholl Schell M, Castro MPD, Ribeiro DC, Silva MF. Measurement Properties of the Craniocervical Flexion Test: A Systematic Review. Phys Ther 2020; 100:1094-1117. [PMID: 32313944 DOI: 10.1093/ptj/pzaa072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 12/19/2019] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles. METHODS The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as "positive," "indeterminate," or "negative." The overall rating was accompanied with a level of evidence. RESULTS Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included. CONCLUSIONS The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted.
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Effectiveness of an Eye-Cervical Re-Education Program in Chronic Neck Pain: A Randomized Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:2760413. [PMID: 32184889 PMCID: PMC7061123 DOI: 10.1155/2020/2760413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 12/04/2022]
Abstract
Objectives Proprioceptive training is popularly applied as a therapeutic exercise method in physiotherapy. Its effects on pain and range of motion are only poorly evaluated. Therefore, this study assesses the effectiveness of proprioceptive training with an Eye-Cervical Re-education Program to decrease pain and increase the joint range in chronic neck pain patients. Material and Methods. Design A randomized, no-blinded, controlled clinical trial. Setting. Physiotherapy consultation. Participants. 44 people were divided into two groups. Interventions. All patients were treated with a multimodal physiotherapy intervention. The experimental group was supplemented with an exercise program that included eye-cervical proprioception. Outcomes. The primary outcomes included pain pressure thresholds (upper trapezius, levator scapulae, and splenius capitis) and cervical range of motion. The secondary outcomes included pain measured by the Visual Analogical Scale and the McGillSpv Questionnaire. Results The proprioception treatment was effective in reducing the pain pressure threshold in the right upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius ( Conclusions The Eye-Cervical Re-education Program is effective at relieving pain pressure thresholds in the upper trapezius, right levator scapula, and left splenius capitis and especially effective for increasing the cervical range of motion. This trial is registered with NCT03197285 (retrospective registration).
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Salehi R, Negahban H, Saghayezhian N, Saadat M. The Responsiveness of the Persian Version of Neck Disability Index and Functional Rating Index Following Physiotherapy Intervention in People with Chronic Neck Pain. IRANIAN JOURNAL OF MEDICAL SCIENCES 2019; 44:390-396. [PMID: 31582863 PMCID: PMC6754531 DOI: 10.30476/ijms.2019.44963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Clinicians and researchers commonly use responsive outcome measures to interpret changes in a patient’s condition as a result of an intervention. This study was conducted to assess the ability of the Persian version of Neck Disability Index and Functional Rating Index to detect responsiveness in the patients with neck pain.
Methods: A diagnostic accuracy study was done in Ahvaz, Iran, 2016. A convenience sample of 57 Persian-speaking patients with non-specific chronic neck pain completed the Neck Disability Index and the Functional Rating Index at the beginning and after physiotherapy intervention. The responsiveness was investigated by the receiver operating characteristics method and the correlation analysis. Statistical analysis was done using SPSS (version 21), with a P<0.05 as the level of significance.
Results: The Functional Rating Index showed that the area under the curve was greater than 0.70 (range=0.651-0.942). The optimal cutoff points for the Functional Rating Index and the Neck Disability Index were 9.5 and 7.5, respectively. Gamma correlation between change scores of the Functional Rating Index and the Neck Disability Index and the Global Rating of Change Scores was 0.53 and 0.33, respectively.
Conclusion: The results indicated that the Persian version of the Functional Rating Index could detect clinical changes following physiotherapy intervention in a group of patients with chronic non-specific neck pain. Therefore, we recommend that this instrument be used as a responsive measure of neck pain disability in patients with neck pain.
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Affiliation(s)
- Reza Salehi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Saghayezhian
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Saadat
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Pecos-Martin D, Ponce-Castro MJ, Jiménez-Rejano JJ, Nunez-Nagy S, Calvo-Lobo C, Gallego-Izquierdo T. Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial. Acupunct Med 2019; 37:141-150. [PMID: 31060367 DOI: 10.1136/acupmed-2018-011738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Latent myofascial trigger points (MTrPs) of the levator scapulae have a high prevalence and may influenceconditions of the neck and shoulder. The pressure release technique is one of the most recommended manual therapy techniques. The aim of this study was to determine the effect of varying durations of the pressure release technique application on latent MTrPs of the levator scapulae. METHODS In a three-arm (1:1:1 ratio), double-blinded, parallel, randomised clinical trial, 60 healthy university students (23 men, 37 women) with a mean±SD age of 20.0±2.67 years were recruited. Subjects were assigned to receive pressure release in one latent MTrP of the levator scapulae lasting 30s (T30s; n=17), 60s (T60s; n=22) or 90s (T90s; n=21). Active cervical range of movement (CROM), strength, pressure pain threshold (PPT) and neck pain intensity at full stretch were measured immediately before and after treatment. RESULTS Mixed-model analyses of variance showed statistically significant differences for PPT (P=0.045; partial Eta2=0.103), comparing T60s versus T30s (P=0.009; Cohen's d=1.044) and T90s versus T30s groups (P=0.001; Cohen's d=1.253), and for left side bending strength (P=0.043; partial Eta2=0.105), comparing T90s versus T30s (P=0.023; Cohen's d=0.907). The rest of the comparisons did not present any significant differences (P⩾0.05). CONCLUSIONS The 60 s and 90 s applications of the pressure release technique may be recommended to increase PPT and strength, respectively, in latent MTrPs of the levator scapulae in the short term. TRIAL REGISTRATION NUMBER NCT03006822.
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Affiliation(s)
- Daniel Pecos-Martin
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
| | - Manuel José Ponce-Castro
- 2 Faculty of Physical Therapy, Nursing and Podiatry, University of Sevilla, Sevilla, Sevilla, Spain
| | | | - Susana Nunez-Nagy
- 4 Physiotherapy and Nursing Departament, Alcalá University, Alcalá de Henares, Spain
| | - César Calvo-Lobo
- 5 Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, Spain
| | - Tomás Gallego-Izquierdo
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
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