Can you be a manual therapist without using your hands?

Long-term impact of self-mobilization via telerehabilitation vs. manual therapy and home exercise on pain and function in cervical degenerative disease

PURPOSE

Cervical Degenerative Disease (CDD) commonly leads to neck pain, functional impairment, and reduced quality of life. This study aimed to compare the long-term effects of home exercise, manual therapy, and telerehabilitation-assisted treatment on pain, functionality, and patient satisfaction in individuals with CDD.

PATIENTS AND METHODS

Sixty-six patients diagnosed with CDD were randomly assigned to three groups: home exercise (n = 23), manual therapy (n = 22), and telerehabilitation (n = 21). All groups participated in an 8-week exercise program, with the manual therapy and telerehabilitation groups receiving additional sessions twice a week. Pain was measured using the Visual Analogue Scale (VAS), pain threshold with an algometer, neck function with the Neck Disability Index and range of motion (ROM), and patient satisfaction with the Patient Satisfaction Questionnaire-18.

RESULTS

All groups significantly improved pain, function, and ROM over time (p < 0.05). But there were no significant differences between groups at the 6-month follow-up. Manual therapy and telerehabilitation significantly enhanced patient satisfaction, particularly in communication and technical quality (p < 0.05).

CONCLUSION

Home exercise, manual therapy, and telerehabilitation improve long-term outcomes in CDD. Manual therapy and telerehabilitation provide greater patient satisfaction, making them viable options for long-term management. Telerehabilitation can be used as an alternative when necessary.

Care at a distance: Understanding lived experiences of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth: A systematic rapid review

Background

Little is known about lived experience of synchronous telehealth in patients with musculoskeletal (MSK) disorders.

Objective

We conducted a rapid systematic review to answer: (1) what are the lived experiences and/or perspectives of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth; and (2) what clinical implications can be inferred from qualitative studies focusing on lived experiences for how telehealth is delivered in the management of MSK disorders?

Data sources

A comprehensive search of MEDLINE, CINAHL, PsycINFO, ProQuest, and Google Scholar from June 2010 to July 2023. Eligible qualitative and mixed methods studies capturing lived experiences of adults with MSK disorders receiving non-pharmacological interventions via synchronous telehealth were included.

Study methods

Systematic rapid review conducted according to WHO guidelines. Titles and abstracts screened by reviewers independently, eligible studies critically appraised, and data was extracted. Themes summarized using the Consolidated Framework for Implementation Research (CFIR). GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) used to assess confidence in synthesis findings.

Results

We identified 9782 references, screened 8029, and critically appraised 22, and included 17 studies. There is evidence to suggest that the experience of telehealth prior to and during the pandemic was shaped by (1) patient perception of telehealth, (2) existing relationships with practitioners, (3) availability and accessibility of telehealth technologies, and (4) perceptions about the importance of the role of the physical exam in assessing and treating MSK disorders.

Conclusion

The five identified implications could be used to inform future research, policy, and strategy development.

A new paradigm for musculoskeletal pain care: moving beyond structural impairments. Conclusion of a chiropractic and manual therapies thematic series

This commentary closes the thematic series "A new paradigm for musculoskeletal pain care: moving beyond structural impairments". The papers published in the series point to key aspects of shifting the paradigm of musculoskeletal care from clinician-led management often focused on addressing presumed structural anomalies to partnering with patients to find individual strategies that empower patients towards self-management. Several papers in the series highlighted the need for developing patient-centred models of care that respect individual patient's needs and preferences. Also, the series pointed to different options for modes of delivery including mHealth and the challenges and opportunities they present for developing person-centred strategies. For health care to provide effective support for people with musculoskeletal pain conditions, there is a need to recognise that contextual factors, including a strong patient-provider alliance, clearly play an important, perhaps primary, role. Health care professions dealing with musculoskeletal pain conditions should engage in research to investigate effective ways to move this understanding into practice including how to train providers. We hope the work collected in this series will stimulate further questions and more research as musculoskeletal pain providers seek to make their care more person-centred.