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Lin A, Liu ZQ, Yao JP, Liu YH, Wan H. A Review of the Extent of Pain Catastrophizing in Patients Who Have Undergone Total Knee Replacement. Pain Manag Nurs 2024; 25:e192-e200. [PMID: 38461044 DOI: 10.1016/j.pmn.2023.12.014] [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: 02/13/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVES This study aimed to analyze the current status and influencing factors of pain catastrophizing in patients undergoing total knee replacement (TKR) and to provide a basis and reference for the clinical improvement of pain catastrophizing in these patients. DESIGN This study was designed in accordance with PRISMA guidelines. DATA SOURCES PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu and Chinese Biomedical Literature Databases. REVIEW/ANALYSIS METHODS A scoping review was performed using PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu, and Chinese Biomedical Literature Databases, and after literature screening and data extraction, the results were summarized. RESULTS A total of 23 articles were included in the study. Pain catastrophizing is mostly assessed using the Pain Catastrophizing Scale and the Coping Strategies Questionnaire. The level of pain catastrophizing is an independent predictor of pain in patients undergoing TKR and is influenced by demographic, psychological, co-morbid, and prognostic factors. Pain catastrophizing interventions mainly consist of surgery, physiotherapy, medication, and psychological therapy. CONCLUSIONS Pain catastrophizing involves multiple factors, and it is necessary to explore the predictors affecting pain catastrophizing, improve the systematic evaluation of pain catastrophizing and adopt the appropriate intervention methods.
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Affiliation(s)
- Ai Lin
- The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, China
| | - Zhi Qun Liu
- Department of Emergency Medicine, Clinical Research Center For Emergency and Critical Care In Hunan Province, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Jia Pei Yao
- Department of Nursing, The Second People's Hospital of Changzhou, Changzhou, China
| | - Yan Hui Liu
- The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, China
| | - Huan Wan
- Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China.
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Osborne D, Jadhakhan F, Falla D. The effects of neck exercise in comparison to passive or no intervention on quantitative sensory testing measurements in adults with chronic neck pain: A systematic review. PLoS One 2024; 19:e0303166. [PMID: 38701102 PMCID: PMC11068209 DOI: 10.1371/journal.pone.0303166] [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: 10/06/2023] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Previous systematic reviews have identified the benefits of exercise for chronic neck pain on subjective reports of pain, but not with objective measures such as quantitative sensory testing (QST). A systematic review was conducted to identify the effects of neck specific exercise on QST measures in adults with chronic neck pain to synthesise existing literature and provide clinical recommendations. METHODS The study protocol was registered prospectively with PROSPERO (PROSPERO CRD42021297383). For both randomised and non-randomised trials, the following databases and trial registries were searched: AMED, CINAHL, Embase, Google Scholar, Medline, PEDro, PubMed, Scopus, SPORTDiscus, Science Citation Index and Social Science Citation Index from Web of Science Core Collection, clinicaltrials.gov, GreyOpen, and ISRCTN registry. These searches were conducted from inception to February 2022 and were updated until September 2023. Reference lists of eligible studies were screened. Study selection was performed independently by two reviewers, with data extraction and quality appraisal completed by one reviewer and independently ratified by a second reviewer. Due to high heterogeneity, narrative synthesis was performed with results grouped by exercise type. FINDINGS Three trials were included. Risk of bias was rated as moderate and the certainty of evidence as low or moderate for all studies. All exercise groups demonstrated statistically significant improvement at an intermediate-term follow-up, with progressive resistance training combined with graded physical training demonstrating the highest certainty of evidence. Fixed resistance training demonstrated statistically significant improvement in QST measures at a short-term assessment. INTERPRETATION Fixed resistance training is effective for short-term changes in pain sensitivity based on low-quality evidence, whilst moderate-quality evidence supports progressive resistance training combined with graded physical training for intermediate-term changes in pain sensitivity.
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Affiliation(s)
- Daniel Osborne
- 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, Edgbaston, Birmingham, United Kingdom
| | - Ferozkhan Jadhakhan
- Faculty of Health, Education and Life Sciences, City South Campus, Birmingham City University, 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, Edgbaston, Birmingham, United Kingdom
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Wenger LE, Barrett DR, Rhon DI, Young JL. Evaluating and Characterizing the Scope of Care for Interventions Labeled as Manual Therapy in Low Back Pain Trials: A Scoping Review. Phys Ther 2024; 104:pzad178. [PMID: 38157290 DOI: 10.1093/ptj/pzad178] [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: 02/16/2023] [Revised: 07/07/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The purpose of this scoping review was to evaluate and characterize the scope of care for low back pain that falls under the specific label of manual therapy. METHODS PubMed database, Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and SPORTDiscus were searched from journal inception through May 2022 for randomized controlled trials that investigated the treatment of low back pain using manual therapy. Terminology used to define manual therapy was extracted and categorized by using only the words included in the description of the intervention. An expert consultation phase was undertaken to gather feedback. RESULTS One hundred seventy-six trials met final inclusion criteria, and 169 unique terms labeled as manual therapy for the treatment of low back pain were found. The most frequent terms were mobilization (29.0%), manipulation (16.0%), and thrust (6.4%). Eight percent of trials did not define or specify what type of manual therapy was used in the study. After removing duplicates, 169 unique terms emerged within 18 categories. CONCLUSIONS Manual therapy intervention labels used in low back pain trials are highly variable. With such variation, the heterogeneity of the intervention in trials is likely large, and the likelihood that different trials are comparing the same interventions is low. Researchers should consider being more judicious with the use of the term manual therapy and provide greater detail in titles, methods, and supplementary appendices in order to improve clarity, clinical applicability, and usefulness of future research. IMPACT The ability to interpret and apply findings from manual therapy-related research for low back pain is challenging due to the heterogeneity of interventions under this umbrella term. A clear use of terminology and description of interventions by researchers will allow for improved understanding for the role of manual therapy in managing back pain.
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Affiliation(s)
- Laura E Wenger
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Dustin R Barrett
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | - Daniel I Rhon
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
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Bostan A, Kaya P. Effect of instrument-assisted soft tissue mobilization combined with exercise therapy on pain and muscle endurance in patients with chronic neck pain: a randomized controlled study. J Man Manip Ther 2024; 32:131-140. [PMID: 37272310 PMCID: PMC10956932 DOI: 10.1080/10669817.2023.2213989] [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: 09/11/2022] [Accepted: 05/06/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES The use of instrument-assisted soft tissue mobilization (IASTM) has been documented to be effective for improving pain and function, but it is unclear whether it helps improve muscle performance in musculoskeletal diseases. This study investigated the effects of IASTM combined with exercise therapy on muscle endurance and pain intensity in patients with chronic neck pain. METHODS Forty-eight individuals with chronic neck pain were randomly divided into exercise therapy (ET, n = 24) and combined therapy (CT, n = 24) groups. For 4 weeks, each group underwent exercise therapy 3 days a week for a total of 12 sessions. The ET group received exercise therapy only. The CT group received IASTM combined with exercise therapy twice per week for a total of 8 sessions. The muscle endurance of the participants was assessed with the Deep Neck Flexor Muscle Endurance (DNFE) test and pain intensity with Visual Analogue Scale (VAS) at baseline and post-treatment. RESULTS While both groups showed significant improvement in pain intensity (p < 0.05), the CT group showed a greater effect size for pain (CT group: Cohen's d = 3.28; ET group: Cohen's d = 2.12). The CT group showed significant improvement for muscle endurance (p < 0.05), whereas the ET group did not (p > 0.05). CONCLUSION In the current study, the IASTM intervention combined with ET improved pain and muscular endurance in participants with chronic neck pain compared to exercise therapy alone. As an alternative method, IASTM intervention before exercise seems to increase the short-term recovery effect in chronic neck pain conditions.
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Affiliation(s)
- Aysegul Bostan
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Bahcesehir University, Istanbul, Turkey
| | - Pinar Kaya
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Istanbul Medipol University, Istanbul, Turkey
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Cottone KA, Schumacher MR, Young JL, Rhon DI. The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials. J Man Manip Ther 2024:1-17. [PMID: 38525785 DOI: 10.1080/10669817.2024.2327127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice. OBJECTIVE The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum. METHODS A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool. RESULTS A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias. CONCLUSION Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.
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Affiliation(s)
- Kyle A Cottone
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy and Health Science, Bradley University, Peoria, IL, USA
| | - Matthew R Schumacher
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, University of Mary, Bismarck, ND, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Chen X, Zhu M, Li W, Wang D, Liu J. Daoyin therapy in chronic neck pain: study protocol for a randomized controlled trial. BMC Complement Med Ther 2024; 24:123. [PMID: 38491439 PMCID: PMC10941558 DOI: 10.1186/s12906-024-04386-5] [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: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Daoyin therapy (DT), an ancient therapeutic approach with a history spanning thousands of years, has traditionally been employed to address musculoskeletal pain and psychosomatic disorders. However, the application of DT for chronic neck pain (CNP) has received limited attention in the existing literature, and systematic randomized clinical trials (RCTs) in this context remain scarce. This manuscript outlines an RCT protocol designed to investigate whether DT is more effective at alleviating CNP in adult individuals compared to other interventions. METHODS A 12-week RCT was conducted, with participants undergoing randomization into one of three groups: DT, Meditation + Fitness Exercise (M+FE), or a control group. Participants in the DT and M + FE groups attended their respective training classes three times per week for 12 weeks. Participants in the control group were required to attend health education workshops every 2 weeks. Following the 12-week intervention period, all participants underwent follow-up assessments at the 16th week. Outcome measures encompassed the Simplified Chinese Neck Pain and Disability Scale (SC-NPAD) and Visual Analog Scale (VAS) for pain assessment, Static Neck Posture Assessment (SNPA) to evaluate neck and shoulder posture and function, Short Form-36 (SF-36) to assess quality of life, and blood tests measuring 5-Hydroxytryptamine (5-HT), Norepinephrine/Noradrenaline (NE/NA), γ-aminobutyric acid (GABA), Adreno-Cortico-Tropic-Hormone (ACTH), β-Endorphin (β-EP), and Calcitonin-Gene-Related Peptide (CGRP) levels via high-performance liquid chromatography (HPLC), chemiluminescence immunoassay (CLIA), enzyme-linked immunosorbent assay (ELISA), and radioimmunoassay (RIA). Brain activity changes were monitored through MRI scans. Repeated measures analyses of variance (ANOVAs) will be used to evaluate the outcomes at baseline, at the 12th week, and at the 16th week. Generalized Estimating Equation (GEE) models will be applied to analyze changes in outcomes over time and differences between groups. DISCUSSION This trial aims to evaluate the efficacy of DT in comparison to other interventions and explore the neuroendocrine mechanisms underlying its effects in adults with CNP. If the intervention and procedures demonstrate feasibility and acceptability, there are plans to conduct a more extensive controlled trial. This could potentially pave the way for the broader application of DT, not only in the context of CNP but also for other chronic diseases. TRIAL REGISTRATION This trial has been registered with the Chinese Clinical Trial Registry (Registration ID: [ChiCTR2400079571]).
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Affiliation(s)
- Xiangxu Chen
- Department of Traditional Chinese Sports and Health, College of Martial Arts, Shanghai University of Sport, No. 399 Changhai Street, Shanghai City, China
| | - Mingze Zhu
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Wei Li
- Department of Athletic Training and Instruction, College of Graduate, Guangzhou Sport University, No. 1268 Guangzhou Avenue Central, Guangzhou City, China
| | - Daan Wang
- Department of Physical Education and Health, Hainan Tropical Ocean University, No.1 Yucai Street, Sanya City, China
| | - Jing Liu
- Department of Traditional Chinese Sports and Health, College of Martial Arts, Shanghai University of Sport, No. 399 Changhai Street, Shanghai City, China.
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Gross AR, Lee H, Ezzo J, Chacko N, Gelley G, Forget M, Morien A, Graham N, Santaguida PL, Rice M, Dixon C. Massage for neck pain. Cochrane Database Syst Rev 2024; 2:CD004871. [PMID: 38415786 PMCID: PMC10900303 DOI: 10.1002/14651858.cd004871.pub5] [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] [Indexed: 02/29/2024]
Abstract
BACKGROUND Massage is widely used for neck pain, but its effectiveness remains unclear. OBJECTIVES To assess the benefits and harms of massage compared to placebo or sham, no treatment or exercise as an adjuvant to the same co-intervention for acute to chronic persisting neck pain in adults with or without radiculopathy, including whiplash-associated disorders and cervicogenic headache. SEARCH METHODS We searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, Index to Chiropractic Literature, trial registries) to 1 October 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any type of massage with sham or placebo, no treatment or wait-list, or massage as an adjuvant treatment, in adults with acute, subacute or chronic neck pain. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. We transformed outcomes to standardise the direction of the effect (a smaller score is better). We used a partially contextualised approach relative to identified thresholds to report the effect size as slight-small, moderate or large-substantive. MAIN RESULTS We included 33 studies (1994 participants analysed). Selection (82%) and detection bias (94%) were common; multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding to the placebo was effective. Massage was compared with placebo (n = 10) or no treatment (n = 8), or assessed as an adjuvant to the same co-treatment (n = 15). The trials studied adults aged 18 to 70 years, 70% female, with mean pain severity of 51.8 (standard deviation (SD) 14.1) on a visual analogue scale (0 to 100). Neck pain was subacute-chronic and classified as non-specific neck pain (85%, including n = 1 whiplash), radiculopathy (6%) or cervicogenic headache (9%). Trials were conducted in outpatient settings in Asia (n = 11), America (n = 5), Africa (n = 1), Europe (n = 12) and the Middle East (n = 4). Trials received research funding (15%) from research institutes. We report the main results for the comparison of massage versus placebo. Low-certainty evidence indicates that massage probably results in little to no difference in pain, function-disability and health-related quality of life when compared against a placebo for subacute-chronic neck pain at up to 12 weeks follow-up. It may slightly improve participant-reported treatment success. Subgroup analysis by dose showed a clinically important difference favouring a high dose (≥ 8 sessions over four weeks for ≥ 30 minutes duration). There is very low-certainty evidence for total adverse events. Data on patient satisfaction and serious adverse events were not available. Pain was a mean of 20.55 points with placebo and improved by 3.43 points with massage (95% confidence interval (CI) 8.16 better to 1.29 worse) on a 0 to 100 scale, where a lower score indicates less pain (8 studies, 403 participants; I2 = 39%). We downgraded the evidence to low-certainty due to indirectness; most trials in the placebo comparison used suboptimal massage doses (only single sessions). Selection, performance and detection bias were evident as multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding was effective, respectively. Function-disability was a mean of 30.90 points with placebo and improved by 9.69 points with massage (95% CI 17.57 better to 1.81 better) on the Neck Disability Index 0 to 100, where a lower score indicates better function (2 studies, 68 participants; I2 = 0%). We downgraded the evidence to low-certainty due to imprecision (the wide CI represents slight to moderate benefit that does not rule in or rule out a clinically important change) and risk of selection, performance and detection biases. Participant-reported treatment success was a mean of 3.1 points with placebo and improved by 0.80 points with massage (95% CI 1.39 better to 0.21 better) on a Global Improvement 1 to 7 scale, where a lower score indicates very much improved (1 study, 54 participants). We downgraded the evidence to low-certainty due to imprecision (single study with a wide CI that does not rule in or rule out a clinically important change) and risk of performance as well as detection bias. Health-related quality of life was a mean of 43.2 points with placebo and improved by 5.30 points with massage (95% CI 8.24 better to 2.36 better) on the SF-12 (physical) 0 to 100 scale, where 0 indicates the lowest level of health (1 study, 54 participants). We downgraded the evidence once for imprecision (a single small study) and risk of performance and detection bias. We are uncertain whether massage results in increased total adverse events, such as treatment soreness, sweating or low blood pressure (RR 0.99, 95% CI 0.08 to 11.55; 2 studies, 175 participants; I2 = 77%). We downgraded the evidence to very low-certainty due to unexplained inconsistency, risk of performance and detection bias, and imprecision (the CI was extremely wide and the total number of events was very small, i.e < 200 events). AUTHORS' CONCLUSIONS The contribution of massage to the management of neck pain remains uncertain given the predominance of low-certainty evidence in this field. For subacute and chronic neck pain (closest to 12 weeks follow-up), massage may result in a little or no difference in improving pain, function-disability, health-related quality of life and participant-reported treatment success when compared to a placebo. Inadequate reporting on adverse events precluded analysis. Focused planning for larger, adequately dosed, well-designed trials is needed.
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Affiliation(s)
- Anita R Gross
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Haejung Lee
- Department of Physical Therapy, Silla University, Busan, Korea, South
| | - Jeanette Ezzo
- Research Director, JME Enterprises, Baltimore, Maryland, USA
| | - Nejin Chacko
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Geoffrey Gelley
- Applied Health Sciences PhD Program, University of Manitoba, Winnipeg, MB, Canada
- Integrative Medicine, University of Manitoba, Winnipeg, Canada
| | - Mario Forget
- Canadian Forces Health Services Group | Groupe de services de santé des Forces Canadiennes, National Defense | Défense Nationale, Kingston, Canada
| | - Annie Morien
- Research Department, Florida School of Massage, Gainesville, FL, USA
| | - Nadine Graham
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Pasqualina L Santaguida
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Craig Dixon
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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Colman D, Demoulin C, Vanderthommen M, Saive O, Durieux N, Cagnie B, Kaux JF, Grosdent S. Exercise therapy including the cervical extensor muscles in individuals with neck pain: A systematic review. Clin Rehabil 2023; 37:1579-1610. [PMID: 37424506 DOI: 10.1177/02692155231184973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To review the use (dosage parameters and combination with other therapeutic interventions) of cervical extensor muscle exercises and their effect on pain, disability (primary outcomes), range of motion, endurance and strength (secondary outcomes) in people with neck pain. DATA SOURCES An extensive literature search was conducted through MEDLINE (Ovid), Scopus (Elsevier) and Physiotherapy Evidence Database (PEDro) up to May 2023. The reference lists of all included studies and relevant reviews were screened for additional studies. REVIEW METHODS Randomised controlled trials reporting the use of cervical extensor muscle exercises (alone or combined) applied to adults with idiopathic or traumatic neck pain were included. Study selection, data extraction and critical appraisal (PEDro assessment scale) were performed by two blinded reviewers. Data extraction included dosage parameters, other modalities combined with these exercises and outcomes. RESULTS Thirty-five randomised controlled trails (eight of which were complementary analyses) with 2409 participants fulfilled the inclusion criteria. Twenty-six were of moderate to high quality. In most studies, cervical extensor muscle exercises were combined with various other therapeutic modalities and applied at different dosages. Only two studies (one high and one low quality) specifically assessed their effectiveness. The high-quality study showed significant improvements in neck pain and disability, pressure point threshold and neck mobility after both low load and high load training for 6 weeks. CONCLUSION The results suggest cervical extensor muscle exercises may reduce neck pain and disability; however firm conclusions cannot be drawn because of the few studies that addressed this question and the heterogeneity of the dosage parameters.
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Affiliation(s)
- David Colman
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
- Physical and Rehabilitation Medicine, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Marc Vanderthommen
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Olivier Saive
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Nancy Durieux
- Research Unit for a Life-Course Perspective on Health & Education-RUCHE, Faculty of Psychology, Speech and Language Therapy and Educational Sciences, University of Liège, Liège, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, University of Gent, Gent, Belgium
| | - Jean-François Kaux
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
- Physical and Rehabilitation Medicine, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Stéphanie Grosdent
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
- Physical and Rehabilitation Medicine, University Hospital of Liège, University of Liège, Liège, Belgium
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Hamdy HA, Grase MO, El-hafez HM, Abd-Elazim ASS. Instrument Assisted Soft Tissue Mobilization versus Integrated Neuromuscular Inhibition Technique in Nonspecific Chronic Neck Pain: Single-blinding Randomized Trial. J Chiropr Med 2023; 22:247-256. [PMID: 38205222 PMCID: PMC10774614 DOI: 10.1016/j.jcm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/13/2023] [Accepted: 07/21/2023] [Indexed: 01/12/2024] Open
Abstract
Objective This study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain. Methods We performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks. Results In the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only. Conclusion In this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.
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Affiliation(s)
- Hend Ahmed Hamdy
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Mariam Omran Grase
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Wilhelm M, Cleland J, Carroll A, Marinch M, Imhoff M, Severini N, Donaldson M. The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: A systematic review with meta-analysis. J Man Manip Ther 2023; 31:393-407. [PMID: 37092822 PMCID: PMC10642331 DOI: 10.1080/10669817.2023.2202895] [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: 10/13/2022] [Accepted: 04/07/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Neck pain is among the most prevalent and costly musculoskeletal disorders. Manual therapy and exercise are two standard treatment approaches to manage neck pain. In addition, clinical practice guidelines recommend a multi-modal approach, including both manual therapy and exercise for the treatment of neck pain; however, the specific effects of these combined interventions have not recently been reported in the literature. OBJECTIVE To perform a systematic review and meta-analysis to determine the effect of manual therapy combined with exercise on pain, disability, and quality of life in individuals with nonspecific neck pain. DESIGN Systematic Review and Meta-Analysis. METHODS Electronic database searches were completed in PubMed, CINAHL, Cochrane, EMBASE, Ovid, and SportDiscus, with publication dates of January 2000 to December 2022. The risk of bias in the included articles was completed using the Revised Cochrane Risk of Bias Tool (RoB 2). Raw data were pooled using standardized mean differences and mean differences for pain, disability, and quality of life outcomes, and forest plots were computed in the meta-analysis. RESULTS Twenty-two studies were included in the final review. With moderate certainty of evidence, three studies demonstrated no significant difference between manual therapy plus exercise and manual therapy alone in pain (SMD of -0.25 (95% CI: -0.52, 0.02)) or disability (-0.37 (95% CI: -0.92, 0.18)). With a low certainty of evidence, 16 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing pain (-0.95 (95%CI: -1.38, -0.51)). Similarly, with low certainty of evidence, 13 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing disability (-0.59 (95% CI: -0.90, -0.28)). Four studies demonstrated that manual therapy plus exercise is significantly better than a control intervention for reducing pain (moderate certainty) (-2.15 (95%CI: -3.58, -0.73)) and disability (low certainty) (-2.39 (95% CI: -3.80, -0.98)). With a high certainty of evidence, four studies demonstrated no significant difference between manual therapy plus exercise and exercise alone in quality of life (SMD of -0.02 (95% CI: -0.21, 0.18)). CONCLUSION Based on this systematic review and meta-analysis, a multi-modal treatment approach including exercise and manual therapy appears to provide similar effects as manual therapy alone, but is more effective than exercise alone or other interventions (control, placebo, 'conventional physical therapy', etc.) for the treatment of nonspecific neck pain and related disability. Some caution needs to be taken when interpreting these results given the general low to moderate certainty of the quality of the evidence.
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Affiliation(s)
- Mark Wilhelm
- Physical Therapy Program, Tufts University, Boston, MA, USA
| | - Joshua Cleland
- Physical Therapy Program, Tufts University, Boston, MA, USA
| | | | - Mark Marinch
- Physical Therapy Program, Tufts University, Boston, MA, USA
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Cho WS, Park CB, Kim BG. Effects of exercise therapy on pain and disability in patients with non-specific neck pain: A systematic review and meta-analysis. J Bodyw Mov Ther 2023; 36:213-220. [PMID: 37949563 DOI: 10.1016/j.jbmt.2023.07.010] [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: 03/18/2022] [Revised: 05/07/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Existing systematic reviews and meta-analyses have only focused on patients with chronic non-specific neck pain (NNP), analyzing exercise therapy (ET) only as therapeutic exercise. Therefore, it is necessary to comprehensively review the effects of ET through a meta-analysis comprising a wide range of ETs that are not limited to therapeutic exercise. OBJECTIVES This study aimed to investigate the effects of ET on pain and disability in patients with NNP. DESIGN Systematic review and meta-analysis. METHOD The studies selected for this study were based on the PICO-SD tool as follows: P (patient)-acute, subacute, and chronic NNP patents, I (intervention)-ET, C (comparison)-control and other therapy groups, O (outcome)-pain and disability, and SD (study design)-randomized controlled trial. RESULTS Twenty-one studies were included. The effects of ET on pain and disability in patients with chronic NNP were significantly different (pain: SMD -1.47, 95% CI: -1.89 to -1.06, I2: 94%; disability: SMD -1.79, 95% CI: -2.31 to -1.27, I2: 94%). The effects of ET on pain (ET vs control: SMD: -1.60, 95% CI: -2.09 to -1.11, I2: 94%; ET vs sham therapy: SMD: -8.75, 95% CI: -10.71 to -6.79) and disability (ET vs control: SMD: -2.16, 95% CI: -2.80 to -1.52, I2: 94%; ET vs sham therapy: SMD: -1.73, 95% CI: -2.42 to -1.05) in NNP patients were significantly different. CONCLUSIONS This study verified the efficacy of ET in improving pain and disability in patients with chronic NNP. However, evidence supporting the efficacy of ET in patients with acute and subacute NNP is still lacking.
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Affiliation(s)
- Woon Su Cho
- Department of Physical Therapy, Nambu University, Gwangju, 62271, South Korea
| | - Chi Bok Park
- Department of Physical Therapy, Nambu University, Gwangju, 62271, South Korea
| | - Byeong Geun Kim
- Department of Physical Therapy, Nambu University, Gwangju, 62271, South Korea; Bareun Physiotherapy Research Institute, Gwangju, 62271, South Korea.
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Chen L, Zhang Q, Huang Z, Da W, Liu S, Xue C, Ding C, Chen D, Fan T, Shi Q, Li X. Efficacy of Combining Traditional Chinese Manual Therapy (Tuina) and Specific Therapeutic Neck Exercise in Young Adults with Non-Specific Chronic Neck Pain: Study Protocol for a Randomized Controlled Trial. J Pain Res 2023; 16:3119-3131. [PMID: 37724170 PMCID: PMC10505386 DOI: 10.2147/jpr.s424812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
Purpose Non-specific chronic neck pain (NSCNP) is an increasingly common musculoskeletal disease and an important issue in the global healthcare system. Some studies have shown that the combination of manual therapy and exercise is effective in treating NSCNP but still with several limitations. Traditional Chinese manual therapy (tuina) is a Chinese manual therapy that consists of soft tissue manipulation and spinal manipulation. This study aims to design a randomized controlled trial to assess the effect of a tuina combined with specific therapeutic neck exercise modified protocol for NSCNP patients. Patients and Methods This is a study protocol for a randomized, participant-, assessor- and analyst-blinded controlled trial. Eighty-eight eligible NSCNP patients will be randomly allocated into tuina combined with specific therapeutic neck exercise group (TSTE group) and tuina combined with sham therapeutic neck exercise group (TS group) in a ratio of 1:1. All participants will receive 8 treatment sessions applied in 4 weeks and then be followed up for another 12 weeks. Clinical data will be collected at baseline, during treatment phase (at the 2- and 4-week) and at the 8-, 12-, 16-week follow-ups. The primary outcome is the changes in neck pain intensity (visual analogue scale). The secondary outcomes include neck disability (Neck Disability Index), cervical range of motion (ROM), neck muscle endurance, cervical muscle cross-sectional area, cervical curvature and analgesic consumption. Adverse events will be collected and recorded throughout the study. Conclusion We will discuss whether our tuina combined with specific therapeutic neck exercise modified protocol is more effective at improving pericervical muscle endurance, ROM, cervical muscle cross-sectional area and cervical curvature than tuina alone, thereby decreases neck pain and disability in individuals with NSCNP more effectively. Trial Registration Chinese Clinical Trials Registry, ChiCTR2300067903. Registered on 31 January 2023.
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Affiliation(s)
- Lin Chen
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Qi Zhang
- Department of Traditional Chinese Medicine, Xuhui District Tianping Street Community Health Center, Shanghai, People’s Republic of China
| | - Zheng Huang
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Weiwei Da
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Shuang Liu
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Chunchun Xue
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Chao Ding
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Deta Chen
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Tianyou Fan
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Qi Shi
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiaofeng Li
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Neves Antonio GL, Almeida MQ, Avila MA, de Noronha MA, Approbato Selistre LF. Efficacy of telerehabilitation exercise in patients with chronic neck pain: a protocol for a non-inferiority randomized controlled trial. Pain Manag 2023; 13:497-507. [PMID: 37850374 DOI: 10.2217/pmt-2023-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
The aim of this study is to investigate if telerehabilitation is just as effective as the same face-to-face exercise program in patients with chronic neck pain (NP). 140 participants will participate in this non-inferiority randomized controlled trial. Primary outcomes will be pain intensity and disability, and secondary outcomes will be kinesiophobia, catastrophizing, fear avoidance beliefs, anxiety and depression symptoms, self-efficacy for pain and global perceived effect. It will be collected at baseline, 6 weeks and 6 months after intervention. The analysis of non-inferiority will be calculated by mixed linear models considering the non-inferiority margin. The results of this clinical trial will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with NP. Brazilian Clinical Trials Registry (RBR-6VBSMB). Clinical Trial Registration: REBEC (Brazilian Registry of Clinical Trials) RBR-6VBSMB (ClinicalTrials.gov).
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Affiliation(s)
| | | | - Mariana Arias Avila
- Department of Physical Therapy, Federal University of São Carlos (UFSCar) São Carlos, São Paulo, Brazil
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Debucean D, Mihaiu J, Maghiar AM, Marcu F, Marcu OA. A Multidisciplinary Approach to Swallowing Rehabilitation in Patients with Forward Head Posture. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1580. [PMID: 37763700 PMCID: PMC10536936 DOI: 10.3390/medicina59091580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
(1) Background and Objectives: The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles. The tongue has relations with the suprahyoid and the infrahyoid muscles. The pattern of swallowing evolves gradually from birth to the age of four. If this developmental transition does not occur, the result is persistent infantile or atypical swallowing-an orofacial myofunctional disorder with the tongue in improper position during swallowing, causing strain and stress on the jaw, face, head and neck. In FHP, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement during swallowing. This study assesses the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with FHP. The underlying hypothesis is that without addressing FHP, swallowing rehabilitation remains challenged and potentially incomplete. (2) Materials and Methods: A total of 61 participants (12-26 years) meeting the inclusion criteria (FHP and atypical swallowing) were divided into two similar groups. Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, group B only one OMT session per week, for 20 weeks. Exclusion criteria were as follows: ankyloglossia, neurological impairment affecting tongue and swallowing, cervical osteoarticular pathology, other previous or ongoing treatments for FHP and atypical swallowing. (3) Results: There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR techniques. (4) Conclusions: The combined therapy proved to be more effective than single OMT therapy.
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Affiliation(s)
- Daiana Debucean
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
| | - Judit Mihaiu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
| | - Adrian Marius Maghiar
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.M.M.); (O.A.M.)
| | - Florin Marcu
- Department of Psychoneuroscience and Rehabilitation, University of Oradea, 410087 Oradea, Romania;
| | - Olivia Andreea Marcu
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.M.M.); (O.A.M.)
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Mueller J, Weinig J, Niederer D, Tenberg S, Mueller S. Resistance, Motor Control, and Mindfulness-Based Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and Dose-Response Meta-Regression. J Orthop Sports Phys Ther 2023; 53:420–459. [PMID: 37339388 DOI: 10.2519/jospt.2023.11820] [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] [Indexed: 06/22/2023]
Abstract
OBJECTIVE: We aimed to analyze the effects and dose-response relationship of the most effective exercises for improving pain and disability in people with chronic nonspecific neck pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched the PubMed, PEDro, and CENTRAL databases from their inception to September 30, 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials that involved people with chronic neck pain adopting a longitudinal exercise intervention and assessed one pain and/or disability outcome. DATA SYNTHESIS: Restricted maximum-likelihood random-effects meta-analyses were modeled separately for resistance, mindfulness-based, and motor control exercises; standardized mean differences (Hedge's g, standardized mean difference [SMD]) were effect estimators. Meta-regressions (dependent variable: effect sizes of the interventions; independent variables: training dose and control group effects) were conducted to explore the dose-response relationship for therapy success of any exercise type. RESULTS: We included 68 trials. Compared to true control, effects on pain and disability were significantly larger for resistance exercise (pain: SMD, -1.27; 95% confidence interval [CI]: -2.26, -0.28; |2 = 96%; disability: SMD, -1.76; 95% CI: -3.16, -0.37; |2 = 98%), motor control exercise (pain: SMD, -2.29; 95% CI: -3.82, -0.75; |2 = 98%; disability: SMD, -2.42; 95% CI: -3.38, -1.47; |2 = 94%), and Yoga/Pilates/Tai Chi/Qui Gong exercise (pain: SMD, 1.91; 95% CI:-3.28, -0.55; |2 = 96%; disability: SMD, -0.62; 95% CI: -0.85, -0.38; |2 = 0%). Yoga/Pilates/Tai Chi/Qui Gong exercise was more effective than other exercises (SMD, -0.84; 95% CI: -1.553, -0.13; |2 = 86%) for reducing pain. For disability, motor control exercise was superior to other exercises (SMD, -0.70; 95% CI: -1.23, -0.17; |2 = 98%). There was no dose-response relationship for resistance exercise (R2 = 0.32). Higher frequencies (estimate = -0.10) and longer durations (estimate = -0.11) of motor control exercise had larger effects on pain (R2 = 0.72). Longer sessions (estimate = -0.13) of motor control exercise had larger effects on disability (R2 = 0.61). CONCLUSION: Resistance, mindfulness-based, and motor control exercises were effective for reducing neck pain (very low- to moderate-certainty evidence). Higher frequencies and longer duration of sessions had a significant effect on pain for motor control exercise. J Orthop Sports Phys Ther 2023;53(8):1-41. Epub: 20 June 2023. doi:10.2519/jospt.2023.11820.
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Liu Z, Shi J, Huang Y, Zhou X, Huang H, Wu H, Lv L, Lv Z. A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain. Complement Ther Clin Pract 2023; 52:101751. [PMID: 37084588 DOI: 10.1016/j.ctcp.2023.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/23/2023] [Accepted: 03/26/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND An increasing number of people suffer from chronic neck pain due to increased telecommuting. Manual therapy is considered a safe and less painful method and has been increasingly used to alleviate chronic neck pain. However, there is controversy about the effectiveness of manipulation therapy on chronic neck pain. Therefore, this systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of manipulative therapy for chronic neck pain. METHODS A search of the literature was conducted on seven databases (PubMed, Cochrane Center Register of Controlled Trials, Embase, Medline, CNKI, WanFang, and SinoMed) from the establishment of the databases to May 2022. This study included RCTs on chronic neck pain managed with manipulative therapy compared with sham, exercise, and other physical therapies. The retrieved records were independently reviewed by two researchers. Further, the methodological quality was evaluated using the PEDro scale. All statistical analyses were performed using RevMan V.5.3 software. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was used to evaluate the quality of the study results. RESULTS Seventeen RCTs, including 1190 participants, were included in this meta-analysis. Manipulative therapy showed better results regarding pain intensity and neck disability than the control group. Manipulative therapy was shown to relieve pain intensity (SMD = -0.83; 95% confidence interval [CI] = [-1.04 to -0.62]; p < 0.0001) and neck disability (MD = -3.65; 95% CI = [-5.67 to - 1.62]; p = 0.004). However, the studies had high heterogeneity, which could be explained by the type and control interventions. In addition, there were no significant differences in adverse events between the intervention and the control groups. CONCLUSIONS Manipulative therapy reduces the degree of chronic neck pain and neck disabilities.
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Affiliation(s)
- Zhen Liu
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiao Shi
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Yubo Huang
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Xingchen Zhou
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Huazhi Huang
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongjiao Wu
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Lijiang Lv
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China; Department of Tuina, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
| | - Zhizhen Lv
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China; Department of Tuina, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Clinical and Psychological Variables in Female Patients with Cervical Syndromes: A Cross-Sectional and Correlational Study. Healthcare (Basel) 2022; 10:healthcare10122398. [PMID: 36553923 PMCID: PMC9777707 DOI: 10.3390/healthcare10122398] [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: 10/18/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background: The objectives of this study were: (1) to compare the pain intensity, cervical range of motion (ROM), psychological distress and kinesiophobia in patients with cervicogenic dizziness (CGD), tension-type headache (TTH), and mechanical chronic neck pain (MCNP); and (2) to investigate the relationships between pain intensity and cervical ROM and between psychological distress and kinesiophobia. Methods: a cross-sectional and correlational study was designed. In total, 109 patients (32 patients with CGD, 33 with TTH and 44 with MCNP) were included. Pain intensity, cervical ROM, psychological distress and kinesiophobia were assessed. Results: Statistically significant differences were found between the groups in pain intensity, psychological distress and kinesiophobia. The patients with MCNP showed higher pain intensity compared to the other groups (p < 0.001). The patients with CGD showed higher depression and kinesiophobia values compared to the MCNP and TTH groups (p < 0.05). No differences were found for cervical flexion, extension, lateral flexion, or rotation ROM (p > 0.05). The CGD and MCNP groups found a moderate positive correlation between psychological distress and kinesiophobia (p < 0.05). The patients with TTH and MCNP showed a moderate positive correlation between pain intensity, psychological distress and kinesiophobia (p < 0.05). Conclusion: Pain intensity, psychological distress and kinesiophobia should be considered in the three groups. Psychological distress was correlated with kinesiophobia in the CGD and MCNP groups. The MCNP group showed a correlation between pain intensity, psychological distress and kinesiophobia.
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Randomized Feasibility Pilot Trial of Adding a New Three-Dimensional Adjustable Posture-Corrective Orthotic to a Multi-Modal Program for the Treatment of Nonspecific Neck Pain. J Clin Med 2022; 11:jcm11237028. [PMID: 36498603 PMCID: PMC9737469 DOI: 10.3390/jcm11237028] [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: 09/12/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate the feasibility and effect of a multimodal program for the management of chronic nonspecific neck pain CNSNP with the addition of a 3D adjustable posture corrective orthotic (PCO), with a focus on patient recruitment and retention. This report describes a prospective, randomized controlled pilot study with twenty-four participants with CNSNP and definite 3D postural deviations who were randomly assigned to control and study groups. Both groups received the same multimodal program; additionally, the study group received a 3D PCO to perform mirror image® therapy for 20−30 min while the patient was walking on a treadmill 2−3 times per week for 10 weeks. Primary outcomes included feasibility, recruitment, adherence, safety, and sample size calculation. Secondary outcomes included neck pain intensity by numeric pain rating scale (NPRS), neck disability index (NDI), active cervical ROM, and 3D posture parameters of the head in relation to the thoracic region. Measures were assessed at baseline and after 10 weeks of intervention. Overall, 54 participants were screened for eligibility, and 24 (100%) were enrolled for study participation. Three participants (12.5%) were lost to reassessment before finishing 10 weeks of treatment. The between-group mean differences in change scores indicated greater improvements in the study group receiving the new PCO intervention. Using an effect size of 0.797, α > 0.05, β = 80% between-group improvements for NDI identified that 42 participants were required for a full-scale RCT. This pilot study demonstrated the feasibility of recruitment, compliance, and safety for the treatment of CNSNP using a 3D PCO to a multimodal program to positively affect CNSNP management.
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Demir O, Atıcı E, Torlak MS. Therapeutic and stabilization exercises after manual therapy in patients with non-specific chronic neck pain. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Anarte-Lazo E, Bernal-Utrera C, Lopez-Amor M, Porras-Valencia E, Ruy-Diaz-Rojas FJ, Falla D, Rodriguez-Blanco C. Exercise-induced hypoalgesia after aerobic versus neck-specific exercise in people with acute/subacute whiplash-associated disorders: protocol for a randomised controlled trial. BMJ Open 2022; 12:e061679. [PMID: 36137629 PMCID: PMC9511575 DOI: 10.1136/bmjopen-2022-061679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A disturbance in exercise-induced hypoalgesia (EIH) has been observed in patients with chronic whiplash-associated disorders (WAD). Yet, no studies have examined whether EIH occurs in people with acute/subacute WAD. This study will determine whether EIH occurs immediately after and 24 hours after aerobic exercise (AE) and neck-specific exercise (NSE) in people with acute/subacute WAD. METHODS AND ANALYSIS A randomised controlled trial has been designed and is reported in line with the Standard Protocol Items: Recommendations for Interventional Trials. EIH will be assessed immediately after and 24 hours after AE, NSE and a control intervention (randomly allocated). As dependent variables of the study, we will measure pressure pain thresholds measured over the region of the spinous process of C2 and C5, the muscle belly of the tibialis anterior and over the three main peripheral nerve trunks, Neck Pain Intensity, Neck-Disability Index, Pain Catastrophizing Scale, Tampa Scale Kinesiophobia-11, self-reported Leeds Assessment of Neuropathic Symptoms and Signs Scale. ETHICS APPROVAL AND DISSEMINATION Ethical approval has been granted by the Ethics Committee from University Rey Juan Carlos (Madrid, Spain; reference number 0707202116721). The results of this study will be disseminated through presentations at scientific conferences and publication in scientific journals. TRIAL REGISTRATION NUMBER RBR-9tqr2jt, https://ensaiosclinicos.gov.br/observador/submissao/sumario/11551.
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Affiliation(s)
- Ernesto Anarte-Lazo
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department of Physiotherapy, University of Seville, Sevilla, Andalucía, Spain
| | - Carlos Bernal-Utrera
- Department of Physiotherapy, University of Seville, Sevilla, Andalucía, Spain
- Department of Physiotherapy, Fisiosur I+D Research Institute, Almeria, Andalucía, Spain
| | | | | | | | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Cleofas Rodriguez-Blanco
- Department of Physiotherapy, University of Seville, Sevilla, Andalucía, Spain
- Department of Physiotherapy, Fisiosur I+D Research Institute, Almeria, Andalucía, Spain
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21
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Wang C, Gu Z, Yu J, Zhang P, Yang F. Clinical observation of Long chiropractic treatment on patients with neurogenic cervical spondylosis: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2022; 101:e28861. [PMID: 35244040 PMCID: PMC8896486 DOI: 10.1097/md.0000000000028861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
Neurogenic cervical spondylosis is the most common type of cervical spondylosis, accounting for approximately 60% percent of the incidence of cervical spondylosis. Cervical spine Long manipulation and sling exercise training (SET) have obtained good therapeutic results in clinical rehabilitation. The aim of this study was to evaluate the effect of Long manipulation combined with SET on neurogenic cervical spondylosis. In this assessor-blind, randomized controlled trial, 90 eligible patients will be randomized into a combination treatment group (Long manipulation combined with SET), a Long manipulation group and a conventional massage group. The visual analogue score, the Neck Disability Index score, and muscle fatigue in the bilateral upper oblique and Musculus sternocleidomastoideus, using mean power frequency and median frequency from the surface electromyography frequency domain index, will be assessed before and after the intervention at 0 and 4 weeks, respectively.Trial registration: Registered in the Chinese Clinical Trial Registration Center with the number ChiCTR2100054978. Registered December 30, 2021.
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Affiliation(s)
- Chen Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Zhongping Gu
- Department of Rehabilitation, Faculty of Health Services and Management, Ningbo College of Health Science, Ningbo, China
| | - Junwu Yu
- Department of Rehabilitation, Faculty of Health Services and Management, Ningbo College of Health Science, Ningbo, China
| | - Peizhen Zhang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Faming Yang
- Department of Rehabilitation, Faculty of Health Services and Management, Ningbo College of Health Science, Ningbo, China
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22
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Voulgarakis P, Iakovidis P, Lytras D, Chatziprodromidou IP, Kottaras A, Apostolou T. Effects of Joint Mobilization Versus Acupuncture on Pain and Functional Ability in People with Chronic Neck Pain: A Randomized Controlled Trial of Comparative Effectiveness. J Acupunct Meridian Stud 2021; 14:231-237. [DOI: 10.51507/j.jams.2021.14.6.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/30/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Petros Voulgarakis
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Paris Iakovidis
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Dimitrios Lytras
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Ioanna P. Chatziprodromidou
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Anastasios Kottaras
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Thomas Apostolou
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
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23
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Rodríguez-Sanz J, Malo-Urriés M, Lucha-López MO, López-de-Celis C, Pérez-Bellmunt A, Corral-de-Toro J, Hidalgo-García C. Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial. PeerJ 2021; 9:e12546. [PMID: 34900443 PMCID: PMC8627131 DOI: 10.7717/peerj.12546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cervical exercise has been shown to be an effective treatment for neck pain, but there is still a need for more clinical trials evaluating the effectiveness of adding manual therapy to the exercise approach. There is a lack of evidence on the effect of these techniques in patients with neck pain and upper cervical rotation restriction. Purpose To compare the effectiveness of adding manual therapy to a cervical exercise protocol for the treatment of patients with chronic neck pain and upper cervical rotation restriction. Methods Single-blind randomized clinical trial. Fifty-eight subjects: 29 for the Manual Therapy+Exercise (MT+Exercise) Group and 29 for the Exercise group. Neck disability index, pain intensity (0–10), pressure pain threshold (kPa), flexion-rotation test (°), and cervical range of motion (°) were measured at the beginning and at the end of the intervention, and at 3-and 6-month follow-ups. The MT+Exercise Group received one 20-min session of manual therapy and exercise once a week for 4 weeks and home exercise. The Exercise Group received one 20-min session of exercise once a week for 4 weeks and home exercise. Results The MT+Exercise Group showed significant better values post-intervention in all variables: neck disability index: 0% patient with moderate, severe, or complete disability compared to 31% in the Exercise Group (p = 0.000) at 6-months; flexion-rotation test (p = 0.000) and pain intensity (p = 0.000) from the first follow-up to the end of the study; cervical flexion (p = 0.002), extension (p = 0.002), right lateral-flexion (p = 0.000), left lateral-flexion (p = 0.001), right rotation (p = 0.000) and left rotation (p = 0.005) at 6-months of the study, except for flexion, with significative changes from 3-months of follow up; pressure pain threshold from the first follow-up to the end of the study (p values range: 0.003–0.000). Conclusion Four 20-min sessions of manual therapy and exercise, along with a home-exercise program, was found to be more effective than an exercise protocol and a home-exercise program in improving the neck disability index, flexion-rotation test, pain intensity, and pressure pain threshold, in the short, medium, and medium-long term in patients with chronic neck pain and upper rotation restriction. Cervical range of motion improved with the addition of manual therapy in the medium and medium-long term. The high dropout rate may have compromised the external validity of the study.
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Affiliation(s)
- Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - María Orosia Lucha-López
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Jaime Corral-de-Toro
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - César Hidalgo-García
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
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24
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Martin-Vera D, Fernández-Carnero J, Rodríguez-Sanz D, Calvo-Lobo C, López-de-Uralde-Villanueva I, Arribas-Romano A, Martínez-Lozano P, Pecos-Martín D. Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial. J Clin Med 2021; 10:jcm10215178. [PMID: 34768696 PMCID: PMC8584397 DOI: 10.3390/jcm10215178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 01/02/2023] Open
Abstract
Background: This study aimed to compare the effectiveness of cervical lateral glide (CLG) added to median nerve neural mobilization (MNNM) in patients with neck pain (NP). Methods: A single-blinded randomized controlled clinical trial was carried out in a Pain Management Unit from a Hospital. A total sample of 72 patients with NP was recruited from a hospital. Patients were randomized to receive isolated CLG (n = 36) or CLG + MNNM (n = 36). Bilateral elbow extension range of motion (ROM) on upper limb neurodynamic test 1 (ULNT1), bilateral pressure pain thresholds (PPT) on the median nerve at elbow joint, C6 zygapophyseal joint and tibialis anterior, Visual analogue scale (VAS), body chart distribution of pain, active cervical ROM (CROM), Neck Disability Index (NDI), and Tampa Scale of Kinesiophobia (TSK-11) were measured at baseline as well as immediately, 15 days, and 1 month after treatment. Results: There were no statistically significant interactions (p > 0.05) between treatment and time for median nerve mechanosensitivity outcomes, pain intensity, symptom distribution, and PPT of the widespread pain assessment, as well as cervical function, and kinesiophobia. Conclusions: MNNM gave no additional benefit to CLG in patients with NP regarding pain intensity, symptom distribution, mechanosensitivity, functionality, and kinesiophobia. Only two treatment sessions and the short follow-up are important issues, therefore, justifying further studies to answer the research question with better methodology.
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Affiliation(s)
- Daniel Martin-Vera
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28005 Madrid, Spain; (D.M.-V.); (P.M.-L.)
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain;
- La Paz Hospital Institute for Health Research, IdiPAZ, 261, 28046 Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora, URJC-Banco de Santander, 28922 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, 28049 Madrid, Spain
- Grupo de Investigación de Dolor musculoesqueletico y Control Motor, Universidad Europea de Madrid, 28005 Madrid, Spain
- Correspondence: ; Tel.: +34-914888949
| | - David Rodríguez-Sanz
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28606 Madrid, Spain; (D.R.-S.); (C.C.-L.)
| | - Cesar Calvo-Lobo
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28606 Madrid, Spain; (D.R.-S.); (C.C.-L.)
| | | | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain;
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Pedro Martínez-Lozano
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28005 Madrid, Spain; (D.M.-V.); (P.M.-L.)
| | - Daniel Pecos-Martín
- Physiotherapy and Pain Research Center, General Foundation of the University of Alcalá, 28805 Madrid, Spain;
- Department of Physical Therapy, Alcalá University, 28805 Alcalá de Henares, Spain
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