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Carrasco-Uribarren A, Pardos-Aguilella P, Jiménez-Del-Barrio S, Cabanillas-Barea S, Pérez-Guillén S, Ceballos-Laita L. Cervical manipulation versus thoracic or cervicothoracic manipulations for the management of neck pain. A systematic review and meta-analysis. Musculoskelet Sci Pract 2024; 71:102927. [PMID: 38492291 DOI: 10.1016/j.msksp.2024.102927] [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: 10/02/2023] [Revised: 01/16/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Cervical and thoracic thrust or non-thrust manipulations have shown to be effective in patients with neck pain, but there is a lack of studies comparing both interventions in patients with neck pain. OBJECTIVE To investigate the effects of cervical thrust or non-thrust manipulations compared to thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. DESIGN Systematic review and meta-analysis. METHOD Searches were performed in PubMed, PEDro, Cochrane Library, CINHAL, and Web of Science databases from inception to May 22, 2023. Randomized clinical trials comparing cervical thrust or non-thrust manipulations to thoracic or cervicothoracic manipulations were included. Methodological quality was assessed with PEDro scale, and the certainty of evidence was evaluated using GRADE guidelines. RESULTS Six studies were included. Meta-analyses revealed no differences between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations in pain intensity, disability, or cervical range of motion in any plane. The certainty of evidence was downgraded to very low for pain intensity, to moderate or very low for disability and to low or very low for cervical range of motion. CONCLUSION There is moderate to very low certainty evidence that there is no difference in effectiveness between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. PROSPERO REGISTRATION CRD42023429933.
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Affiliation(s)
- Andoni Carrasco-Uribarren
- Departamento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Cataluña, Barcelona, España
| | - Pilar Pardos-Aguilella
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, España
| | - Sandra Jiménez-Del-Barrio
- Grupo de Investigación Clínica en Ciencias de la Salud, Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Valladolid, Soria, España.
| | - Sara Cabanillas-Barea
- Departamento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Cataluña, Barcelona, España
| | - Silvia Pérez-Guillén
- Departamento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Cataluña, Barcelona, España
| | - Luis Ceballos-Laita
- Grupo de Investigación Clínica en Ciencias de la Salud, Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Valladolid, Soria, España
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Whetstone KS, Matsel KA, Patton AS, Gehres SE, Schwartzkopf-Phifer K. Reliability and Validity of Visual Estimation in Determining Thorax Rotation Mobility using the Quadruped Lumbar-Locked Position. Int J Sports Phys Ther 2024; 19:581-590. [PMID: 38707852 PMCID: PMC11065767 DOI: 10.26603/001c.116154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Background Thoracic rotation mobility is crucial for athletes in rotational sports such as baseball, golf, and swimming to maintain the proper biomechanics associated with the sport. Accurate differentiation between normal mobility and active and passive physiological deficits in the thoracic region is critical for identifying the need for intervention to the thorax. Purpose To establish the reliability and discriminant validity of visual estimation of thorax rotation range of motion across clinicians of differing experience levels in determining normal mobility and active or passive physiological deficits when utilizing the quadruped lumbar-locked position. Study Design Cross-sectional. Methods Thirty-eight subjects (21 female, 17 male) with a mean age of 27 years ± 6.67 were assessed with the quadruped lumbar-locked thorax rotation test by three examiners with various clinical experience in real-time and again one week later. Bilateral active and passive lumbar-locked thorax rotation mobility was assessed by all raters and categorized as "Unrestricted" (≥50°) or "Restricted" (<50°) while a research assistant simultaneously measured the motion with a digital inclinometer. All raters were blinded to the results. All results were analyzed for intra-rater reliability and agreement. Results Test-retest intra-rater reliability ranged from 0.55-0.72 and percent absolute agreement ranged from 0.82-0.89. Inter-rater reliability ranged from 0.45-0.59 while percent absolute agreement between raters ranged from 0.74-0.84. There was a significant difference in range of motion between "Unrestricted" and "Restricted" categories for both active (Unrestricted=54.6-58.9; Restricted=40.4-44.4; p<0.001) and passive motion (Unrestricted=61.3-63.5; Restricted=39.2-39.7; p<0.001). The only interaction effect was for passive left rotation [Rater A Restricted x ® =34.3(30.4-38.2); Rater C Restricted (x ) ®=43.8(41.3-46.4); p=.000]. Conclusion The quadruped lumbar-locked thorax rotation test demonstrates moderate to substantial test-retest intra-rater and inter-rater reliability regardless of clinical experience. The quadruped lumbar-locked thorax rotation test can accurately discriminate between individuals with active and passive physiological deficits regardless of rater experience using visual estimation. Level of Evidence 3b.
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Akgüller T, Coşkun R, Analay Akbaba Y. Comparison of the Effects of Cervical Thrust Manipulation and Exercise in Mechanical Neck Pain: A Randomized Controlled Trial. Physiother Theory Pract 2024; 40:789-803. [PMID: 36637358 DOI: 10.1080/09593985.2022.2164475] [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: 07/09/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to compare the effectiveness of cervical thrust manipulation and exercise in patients with mechanical neck pain (MNP). METHOD Sixty (mean age 31.45 ± 7.31 years) patients were randomized into three groups: manipulation (Group 1); exercise (Group 2); and manipulation plus exercise (Group 3). All interventions were performed 2 days a week for 6 weeks. The visual analog scale (VAS) and Neck Disability Index (NDI) were primary outcome measures; pressure pain threshold (PPT), range of motion (ROM), Short form-36 (SF-36), and Global Rating of Change (GROC) were secondary outcome measures. RESULTS All parameters improved in all groups (p < .05). Only the minimal clinically important difference (MCID) for NDI was achieved in Group 3. Group 3 had greater improvement in: VAS-rest (p = .004); NDI (p < .001); PPT-left (p = .012); and vitality (p = .002), as well as higher GROC compared to the other groups (p = .043). Group 3 was superior to Group 2 in terms of: ROM (Lateral flexion [LF]-right, p = .003/left, p = .003, rotation-right, p = .012/left, p = .010), PPT-right (p = .022); and emotional well-being (p = .003). Group 1 was superior to Group 2 in terms of ROM (LF-left, p = .043/rotation-left, p = .049). The between-group effect sizes were large (0.12-0.36). CONCLUSION The combined application of cervical thrust manipulation and exercise in MNP resulted in greater improvement in clinical parameters, especially function, and higher patient satisfaction in the short term compared to their application alone. Because of its positive effects, cervical thrust manipulation can be added to the exercise program according to the patient's needs and suitability for manipulation.
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Affiliation(s)
- Tuğba Akgüller
- Division of Physiotherapy, Vocational School, Istanbul Arel University, Zeytinburnu/Istanbul, Turkey
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Büyükçekmece/Istanbul, Turkey
| | - Reşat Coşkun
- Department of Physıotherapy and Rehabılıtatıon, Nisantasi Hospital, Sisli/Istanbul, Turkey
| | - Yıldız Analay Akbaba
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Büyükçekmece/Istanbul, Turkey
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Niamsuwan P, Suriyaamarit D, Chiradejnant A. Spinal displacement during thoracic manipulative therapy in mechanical neck pain patients: an observational study. J Man Manip Ther 2024; 32:159-165. [PMID: 37393578 PMCID: PMC10956907 DOI: 10.1080/10669817.2023.2230010] [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: 05/16/2022] [Accepted: 06/18/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Thoracic manipulative therapy (TMT) is recommended for treating patients with mechanical neck pain (MNP). However, there are multiple proposed recommendations for the mechanism for neck pain reduction. OBJECTIVE To investigate displacement of the cervicothoracic spine during the application of TMT in patients with MNP. METHODS Thirty-five male patients with MNP were recruited. Displacements of C3, C5, C7, T2, T4 and T6 were measured using a motion capture system while a therapist applied a grade III central posteroanterior TMT (cpa-TMT) to T6. RESULTS Mean (SD) displacement ranged from 2.2 (0.62) to 5.5 (1.1) mm. A significant decrease in neck pain intensity at rest was found after the application of the cpa-TMT (mean difference 17 mm, p < 0.001). A downward trend in spinal displacement was noted, with the largest and smallest displacement occurring at T6 and C3, respectively. Correlations between the displacement of T6 and adjacent spinal levels were moderate to high (Pearson's r range 0.70-0.90, p < 0.001). It was showed that cpa-TMT applied to T6 produced the PA displacement toward the upper cervical spine. CONCLUSION TMT produces spinal segmental displacements toward the upper cervical spine in MNP patients. These segmental displacements would activate the alleviation effect at both the spinal and supraspinal levels resulting in neck pain reduction. These findings would provide supporting evidence for the use of TMT in neck pain reduction.
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Affiliation(s)
- Phak Niamsuwan
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Duangporn Suriyaamarit
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Adit Chiradejnant
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Rodgers LJ, Bialosky JE, Minick SA, Coronado RA. An overview of systematic reviews examining the quantitative sensory testing-derived hypoalgesic effects of manual therapy for musculoskeletal pain. J Man Manip Ther 2024; 32:67-84. [PMID: 37908101 PMCID: PMC10795637 DOI: 10.1080/10669817.2023.2267954] [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] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Changes in quantitative sensory testing (QST) after manual therapy can provide insight into pain relief mechanisms. Prior systematic reviews have evaluated manual-therapy-induced QST change. This overview of systematic reviews aims to consolidate this body of literature and critically review evidence on the hypoalgesic effects of manual therapy in clinical populations. METHODS A comprehensive search was conducted on PubMed, CINAHL, PsycInfo, and Embase. Peer-reviewed systematic reviews with or without meta-analysis were eligible if the reviews examined the effect of manual therapy compared to non-manual therapy interventions on QST outcomes in clinical populations. Methodological quality was assessed with the AMSTAR 2 tool. Meta-analysis results and qualitative (non-meta-analysis) interpretations were summarized by type of manual therapy. Overlap of studies was examined with the corrected covered area (CCA) index. RESULTS Thirty systematic reviews, including 11 meta-analyses, met inclusion. There was a slight overlap in studies (CCA of 1.72% for all reviews and 1.69% for meta-analyses). Methodological quality was predominantly low to critically low. Eight (27%) reviews examined studies with a range of manual therapy types, 13 (43%) reviews focused on joint-biased manual therapy, 7 (23%) reviews focused on muscle-biased manual therapy, and 2 (7%) reviews focused on nerve-biased manual therapy. Twenty-nine (97%) reviews reported on pressure pain threshold (PPT). Meta-analytic results demonstrated conflicting evidence that manual therapy results in greater hypoalgesic effects compared to other interventions or controls. CONCLUSION Our overview of QST effects, which has relevance to mechanisms underlying hypoalgesia, shows conflicting evidence from mostly low to critically low systematic reviews.
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Affiliation(s)
- Logan J. Rodgers
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Joel E. Bialosky
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- Brooks-UF-PHHP Research Collaboration, Gainesville, FL, USA
| | - Sophie A. Minick
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rogelio A. Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Trager RJ, Riffle CP, Tao C. Notalgia Paresthetica Responding Positively to Chiropractic Spinal Manipulation: A Case Report. Cureus 2024; 16:e53382. [PMID: 38435142 PMCID: PMC10907986 DOI: 10.7759/cureus.53382] [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] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Notalgia paresthetica (NP) is a chronic cutaneous neuropathy characterized by localized pruritus and pain, numbness, and/or paresthesia, often linked to degenerative cervicothoracic changes. Treatment options for NP are limited. This case report details a 54-year-old woman with a six-year history of right-sided periscapular pruritus and cervicothoracic discomfort who presented to a chiropractor upon referral with a prior diagnosis of NP. Prior topical treatments yielded minimal relief. Radiographs revealed degenerative spinal changes at C5/6 and C6/7 which correlated with her periscapular symptom distribution. The patient responded positively to chiropractic spinal manipulative therapy (SMT), focusing on the cervicothoracic region, coupled with myofascial release. Symptoms significantly improved after a single SMT session and resolved after a second session, with no pruritus returning over one-month follow-up. While this case highlights the potential benefits of SMT for NP, further research is needed to explore the effectiveness of this treatment.
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Affiliation(s)
- Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
- Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA
- Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, USA
| | - Curtis P Riffle
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Cliff Tao
- Radiology, Private Practice of Chiropractic Radiology, Irvine, USA
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Yang J, Zhao S, Zhang R, Huang C, Huang KY, Cheng Y, He CQ, Li LX. Effectiveness and safety of thoracic manipulation in the treatment of neck pain: An updated systematic review and meta-analysis. Technol Health Care 2024; 32:385-402. [PMID: 38759063 DOI: 10.3233/thc-248034] [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: 05/19/2024]
Abstract
BACKGROUND The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). OBJECTIVE The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). METHODS Seven electronic databases were searched from their inception through October 2023 by two authors. The methodological quality assessments were performed with the Physiotherapy Evidence Database (PEDro) scale. Pain, cervical range of motion (ROM), disability, and quality of life (QOL) were estimated for TM treatment in patients with NP. RESULTS Eighteen randomized controlled trials (RCTs) with 914 patients were included with a PEDro score of 6.923 ± 3.120. Pooled effect sizes of pain (SMD =-0.481, 95% CI -0.653 to -0.309, P= 0.000), disability (SMD =-1.435, 95% CI -2.480 to -0.390, P= 0.007), QOL-physical component score (PCS) (SMD = 0.658, 95% CI 0.290 to 1.025, P= 0.000), ROM of flexion (SMD = 0.921, 95% CI 0.287 to 1.555, P= 0.000), ROM of extension (SMD = 0.572, 95% CI 0.321 to 0.822, P= 0.000), ROM of left lateral flexion (SMD = 0.593, 95% CI 0.075 to 1.112, P= 0.025) and ROM of left rotation (SMD = 0.230, 95% CI 0.010 to 0.450, P= 0.04) were favored by the TM group. CONCLUSIONS TM provides short-term effect on relieving neck pain, increasing cervical ROM, and disability in patients with NP without serious side effects. Continuous therapy and distraction therapy are recommended as optimal choice on reducing pain and improving cervical ROM, especially in patients with chronic NP (> 3 months). The TM-induced improvements in the QOL of patients with NP should be verified by more further high-quality RCTs.
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Affiliation(s)
- Jiao Yang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Sha Zhao
- Department of Critical Care Medicine, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Rui Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Cheng Huang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Ke-Yao Huang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Cheng
- Cheng Clinic Limited, Colchester, United Kingdom
| | - Cheng-Qi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Xin Li
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Khalaf ZM, Margulies P, Moussa MK, Bohu Y, Lefevre N, Hardy A. Valid and Invalid Indications for Osteopathic Interventions: A Systematic Review of Evidence-Based Practices and French Healthcare Society Recommendations. Cureus 2023; 15:e49674. [PMID: 38161897 PMCID: PMC10756711 DOI: 10.7759/cureus.49674] [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] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
The main aim of this study was to determine the level of evidence in the literature for the main indications of osteopathy as recommended by the French osteopathy societies. This systematic review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and evaluated articles published between January 2012 and January 2022 with one modification: when level one evidence studies were available, level two to five studies were excluded. Sources included PubMed, the Cochrane library, the French National Health Authority (HAS) and its affiliates. Inclusion criteria were level one published studies on the indications for osteopathic treatment in French and English, and level two to three studies when no level one studies were available. The level of evidence assessment was based on the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence classification. The primary outcome was the level of evidence in the literature supporting osteopathic practices. The secondary outcome was to assess French professional osteopathy recommendations and French HAS guidelines in relation to the scientific literature. A total of 51 articles and nine recommendations from the HAS and its affiliates met the inclusion criteria for the systematic review. Analysis of the studies revealed 41 osteopathic indications from French osteopathy societies for musculoskeletal, neurosensory, psychological, pediatric, gynecological, digestive, and pulmonary disorders. High-level scientific evidence supported the use of osteopathy for low back pain, sciatica, cervical radiculopathy, and ankle sprain. There was moderate evidence for tension headache, temporomandibular joint disorder, endometriosis, and low back and pelvic pain in pregnant women. HAS recommended five indications, while nine indications were supported in the scientific literature. Osteopathy has been shown to have evidence-based benefits for a range of conditions, in particular for musculoskeletal and neurosensory disorders.
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Affiliation(s)
- Zeinab M Khalaf
- Endocrinology, Diabetes, and Metabolism, clinique du Sport, Paris, FRA
| | | | | | - Yoann Bohu
- Orthopedic Surgery, Clinique du Sport, Paris, FRA
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Ramirez MM, Shepherd MH, Melnick SJ, Hanebuth C, Bazemore C, Couce L, Hendren S, Horn ME. Patient-reported outcome measures in physical therapy practice for neck pain: an overview of reviews. J Patient Rep Outcomes 2023; 7:97. [PMID: 37782344 PMCID: PMC10545655 DOI: 10.1186/s41687-023-00637-0] [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: 05/21/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Understanding which patient-reported outcome measures are being collected and utilized in clinical practice and research for patients with neck pain will help to inform recommendations for a core set of measures that provide value to patients and clinicians during diagnosis, clinical decision-making, goal setting and evaluation of responsiveness to treatment. Therefore, the aim of this study was to conduct a review of systematic reviews using a qualitative synthesis on the use of patient-reported outcome measures (PROMs) for patients presenting with neck pain to physical therapy. METHODS An electronic search of systematic reviews and guideline publications was performed using MEDLINE (OVID), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Web of Science (Clarivate) databases to identify reviews that evaluated physical therapy interventions or interventions commonly performed by a physical therapist for individuals with neck pain and included at least one patient-reported outcome measure. The frequency and variability in which the outcome measures were reported among the studies in the review and the constructs for which they measured were evaluated. The evaluation of a core set of outcome measures was assessed. Risk of bias and quality assessment was performed using A Measurement Tool to Assess systematic Reviews 2. RESULTS Of the initial 7,003 articles, a total of 37 studies were included in the final review. Thirty-one PROMs were represented within the 37 reviews with eleven patient-reported outcome measures in three or more reviews. The eleven PROMs assessed the constructs of disability, pain intensity, psychosocial factors and quality of life. The greatest variability was found amongst individual measures assessing psychosocial factors. Assessment of psychosocial factors was the least represented construct in the included studies. Overall, the most frequently utilized patient reported outcome measures were the Neck Disability Index, Visual Analog Scale, and Numeric Pain Rating Scale. The most frequently used measures evaluating the constructs of disability, pain intensity, quality of life and psychosocial functioning included the Neck Disability Index, Visual Analog Scale, Short-Form-36 health survey and Fear Avoidance Belief Questionnaire respectively. Overall risk of bias and quality assessment confidence levels ranged from critically low (2 studies), low (12 studies), moderate (8 studies), and high (15 studies). CONCLUSION This study identified a core set of patient-reported outcome measures that represented the constructs of disability, pain intensity and quality of life. This review recommends the collection and use of the Neck Disability Index and the Numeric Pain Rating Scale or Visual Analog Scale. Recommendation for a QoL measure needs to be considered in the context of available resources and administrative burden. Further research is needed to confidently recommend a QoL and psychosocial measure for patients presenting with neck pain. Other measures that were not included in this review but should be further evaluated for patients with neck pain are the Patient Reported Outcomes Measurement Information System (PROMIS) Physical function, PROMIS Pain Interference and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool.
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Affiliation(s)
- Michelle M Ramirez
- Department of Population Health Sciences, Department of Orthopaedic Surgery, Duke University School of Medicine, 215 Morris Street, Suite 200, Durham, NC, 27708, USA.
| | - Mark H Shepherd
- Department of Physical Therapy, Bellin College, 3201 Eaton Rd, Greenbay, WI, 54311, USA
| | - S Jacob Melnick
- Doctor of Physical Therapy Program, Hawai'i Pacific University, 500 Ala Moana Blvd, Honolulu, HI, 96813, USA
| | - Cannon Hanebuth
- Division of Physical Therapy, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
| | - Caroline Bazemore
- Division of Physical Therapy, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
| | - Logan Couce
- Sugar House Health Center, University of Utah, 1280 E. Stringham Ave, Salt Lake City, UT, 84106, USA
| | - Steph Hendren
- Research & Education Librarian, Duke University Medical Center Library & Archives, Seeley G. Mudd Bldg., 103, Durham, NC, 27710, USA
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Division of Physical Therapy, Department of Population Health Sciences, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
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10
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Thoomes E, Tilborghs G, Heneghan NR, Falla D, de Graaf M. Effectiveness of thoracic spine manipulation for upper quadrant musculoskeletal disorders: protocol for a systematic review. BMJ Open 2023; 13:e076143. [PMID: 37714676 PMCID: PMC10510929 DOI: 10.1136/bmjopen-2023-076143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Upper quadrant musculoskeletal disorders (UQMD), comprising of cranial, cervical, shoulder and upper extremity disorders, are among the most frequently reported disorders in clinical practice. Thoracic high velocity low amplitude thrust (Tx-HVLAT) manipulation is a form of conservative management recommended in systematic reviews as an effective treatment option for aspects of UQMD disorders such headache, shoulder pain and lateral elbow pain. However, no recent systematic reviews have assessed the effectiveness across UQMD. Therefore, this systematic review aims to update the current evidence on the effectiveness of Tx-HVLAT for patients with UQMD on (1) patient-reported outcomes, (2) performance measures or (3) psychosocial outcomes. METHODS AND ANALYSIS The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PEDro and Index to Chiropractic Literature will be searched from inception using Medical Subject Headings (MeSH), Thesaurus and/or free-text words. Combinations will be made based on localisation, disorder, intervention and design. Following guidelines as advised by the Cochrane Back Review Group, published randomised controlled trials will be included. Two review authors will independently assess the risk of bias (ROB) using the Cochrane Back Review Group's recommended ROB2 tool and will independently extract the data using a standardised data extraction form. Overall quality of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. For continuous data, we will calculate standardised mean differences with 95% CIs. For dichotomous outcomes, relative risks and 95% CIs will be calculated. Where possible we will present a subgroup analysis by disorder. For pooling, a random-effects model will be used. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review. The study findings will be submitted to a relevant peer-reviewed journal for dissemination and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42023429996.
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Affiliation(s)
- Erik Thoomes
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham College of Life and Environmental Sciences, Birmingham, UK
- Research Department, Fysio-Experts, Hazerswoude, The Netherlands
| | - Gus Tilborghs
- Department of Manual Therapy, Breederode College, Rotterdam, The Netherlands
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham College of Life and Environmental Sciences, Birmingham, UK
| | - Marloes de Graaf
- Research Department, Fysio-Experts, Hazerswoude, The Netherlands
- Department of Manual Therapy, Breederode College, Rotterdam, The Netherlands
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Qiu XH, Yang XY, Wang YY, Tian SL, Yan YB, Xu AP, Fu F, Wen FY, Yang Y, Zhang Y, Zhang YQ, Yang ZW, Xu C, Sun QH, Wu XL, Dai XY, Li N, Cheng K. Myofascial acupuncture versus routine acupuncture for mechanical neck pain: a protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e068129. [PMID: 37652590 PMCID: PMC10476120 DOI: 10.1136/bmjopen-2022-068129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Mechanical neck pain (MNP) is defined as pain in the area of the neck and/or neck-shoulder provoked by body mechanics and which adversely affects physical, psychological and social function. The treatments for MNP are limited. Previous studies and clinical experience have indicated that myofascial acupuncture might be a better treatment option for MNP, but the efficacy is controversial. Therefore, our aim is to compare the efficacy of myofascial acupuncture and routine acupuncture for MNP. METHODS AND ANALYSIS The study is a multicentre, prospective randomised clinical trial. Patients will be recruited from four tertiary hospitals in China. A total of 438 participants with MNP will be randomly assigned into two groups, namely the 'Sancai-Tianbu' myofascial acupuncture group and the routine acupuncture group, at a ratio of 1:1. Each group will receive the acupuncture treatment twice a week for 21 days, totalling six sessions. The primary outcome will be the Visual Analogue Scale score. The secondary outcomes will be the Neck Disability Index, the cervical range of motion and the MOS 36-Item Short Form Health Survey. The assessments will be performed at baseline (immediately after allocation), pretreatment (5 min before every treatment), post-treatment (within 10 min after every treatment), postcourse (within 1 day after the course), and at 1, 3 and 6 months after the course. All patients will be included in the intent-to-treat analysis. Repeated-measure analysis of covariance will be used to determine the effects of the intervention on the outcome measures. ETHICS AND DISSEMINATION Ethics approval was obtained from China Aerospace Science & Industry Corporation 731 Hospital, with permission number 2022-0204-01. Written informed consent will be obtained from the enrolled patients. Trial results will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2200061453.
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Affiliation(s)
- Xing-Hua Qiu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xing-Yue Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Yu Wang
- Department of Acupuncture-Moxibustion, Sunsimiao Hospital Affiliated to Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
| | - Su-Ling Tian
- Chengs TCM Acupuncture-Moxibustion Hospital, Beijing, China
| | - Yan-Bin Yan
- Department of Acupuncture-Moxibustion, Sunsimiao Hospital Affiliated to Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
| | - An-Ping Xu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Fei Fu
- Department of Acupuncture-Moxibustion, Sunsimiao Hospital Affiliated to Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
| | - Feng-Yun Wen
- Department of Acupuncture-Moxibustion, Langfang Hospital of Traditional Chinese Medicine, Langfang, Hebei, China
| | - Yang Yang
- Department of Acupuncture-Moxibustion, Sunsimiao Hospital Affiliated to Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
| | - Yang Zhang
- Department of Traditional Chinese Medicine, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Yu-Qin Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-Wen Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chang Xu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Qian-Hui Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Ling Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xing-Ye Dai
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Na Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Kai Cheng
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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12
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Riley SP, Swanson BT, Shaffer SM, Cook CE. Protocol for the development of a 'trustworthy' living systematic review and meta analyses of manual therapy interventions to treat neuromusculoskeletal impairments. J Man Manip Ther 2023; 31:220-230. [PMID: 36082787 PMCID: PMC10324442 DOI: 10.1080/10669817.2022.2119528] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Preprocessed research resources are believed to be highly 'trustworthy' when translating research to clinical practice. However, the overall 'trustworthiness' is unknown if this evidence contains randomized clinical trials (RCTs) where prospective has not been/cannot be verified, has low confidence in estimated effects, and if they are not up to date. OBJECTIVES This protocol will be used to create a baseline benchmark for a series of trustworthy living systematic reviews (SRs) regarding manual therapy interventions. METHODS Data will originate from RCTs related to manual therapy neuromusculoskeletal interventions, indexed in 6 search engines in English from 1 January 2010, to the present. Two blinded reviewers will identify the RCTs and extract data using Covidence. The data will be synthesized based on consensus and analyzed using the Cochrane collaboration's Review Manager. EXPECTED OUTCOMES It is expected that there will be a shortage of RCTs with at least a moderate confidence in estimated effects that will allow for strong practice recommendations. DISCUSSION Identifying evidence that can be translated into strong practice recommendations is essential to identify beneficial and harmful interventions, decrease practice variability, and identify neuromusculoskeletal manual therapy interventions that require further disciplined methodological focus.
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Affiliation(s)
- Sean P. Riley
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
- Duke Center for Excellence in Manual and Manipulative Therapy, Duke University, Durham, NC, USA
| | - Brian T. Swanson
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Stephen M. Shaffer
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Chad E. Cook
- Duke Center for Excellence in Manual and Manipulative Therapy, Duke University, Durham, NC, USA
- Doctor of Physical Therapy (DPT) Division, Duke University, Durham, NC, USA
- Department of Orthopaedics, Duke University, Durham, NC, USA
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13
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Riley SP, Shaffer SM, Flowers DW, Hofbauer MA, Swanson BT. Manual therapy for non-radicular cervical spine related impairments: establishing a 'Trustworthy' living systematic review and meta-analysis. J Man Manip Ther 2023; 31:231-245. [PMID: 37067434 PMCID: PMC10324451 DOI: 10.1080/10669817.2023.2201917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES To establish a 'trustworthy' living systematic review (SR) with a meta-analysis of manual therapy for treating non-radicular cervical impairments. DESIGN SR with meta-analysis. LITERATURE SEARCH Articles published between January 2010 and September 2022 were included from: Cochrane Central Register of Controlled Trials (CENTRAL); CINAHL; MEDLINE; PubMed; PEDro, and ProQuest Nursing and Allied Health. METHODS This SR included English-language randomized clinical trials (RCTs) of manual therapy involving adults used to treat non-radicular cervical impairments. The primary outcomes were pain and region-specific outcome measures. Cervicogenic headaches and whiplash were excluded to improve homogeneity. Two reviewers independently assessed RCTs. The prospective plan was to synthesize results with high confidence in estimated effects using GRADE. RESULTS Thirty-five RCTs were screened for registration status. Twenty-eight were not registered or registered prospectively. In 5 studies, the discussion and conclusion did not match the registry, or this could not be determined. One study did not meet the external validity criterion, and another was rated as having a high risk of bias. One study met the inclusion and exclusion criteria, so practice recommendations could not be made. The remaining study did not identify any clinically meaningful group differences. DISCUSSION Only one prospectively registered RCT met this SR's strict, high-quality standards. The single identified paper provides initial high-quality evidence on this topic. CONCLUSION This SR establishes a foundation of trustworthiness and can be used to generate research agendas to determine the potential clinical utility of manual therapy directed at the cervical spine for non-radicular cervical complaints.
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Affiliation(s)
- Sean P. Riley
- Doctor of Physical Therapy Program, University of Hartford, West Hartford, CT, USA
- Duke Center for Excellence in Manual and Manipulative Therapy, Duke University, Durham, NC, USA
| | - Stephen M. Shaffer
- Doctor of Physical Therapy Program, University of Hartford, West Hartford, CT, USA
| | - Daniel W. Flowers
- Duke Center for Excellence in Manual and Manipulative Therapy, Duke University, Durham, NC, USA
- Doctor of Physical Therapy Program, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Margaret A. Hofbauer
- Doctor of Physical Therapy Program, University of Hartford, West Hartford, CT, USA
| | - Brian T. Swanson
- Doctor of Physical Therapy Program, University of Hartford, West Hartford, CT, USA
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Gong Z, Guo Y, Liu X, Ai K, Li W, Li J. Bibliometric Analysis of Research Trends on Tuina Manipulation for Neck Pain Treatment Over the Past 10 Years. J Pain Res 2023; 16:2063-2077. [PMID: 37342612 PMCID: PMC10278146 DOI: 10.2147/jpr.s410603] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
Tuina is an effective treatment for neck pain (NP). However, there has been no bibliometric analysis of the global application and emerging trends of tuina performed for NP. Therefore, this study aimed to provide an overview of the current state and future trends in the field. Articles about tuina for NP, published from January 1, 2013, to January 1, 2023, were searched in the Web of Science Core Collection database. CiteSpace (6.1.R6) and VOSviewer (1.6.18) software were used to analyze annual trends in literature posts, countries, institutions, authors, cited references, and knowledge graphs of keyword co-occurrence, clustering, and burst using standard bibliometric indicators. The final analysis comprised 505 valid documents. The results demonstrate that the number of articles in the field of tuina therapy for NP has gradually increased over the years, showing the most active countries, institutions, journals, and authors. There were 323 keywords in the field, 322 research authors, and 292 research institutions, with the USA having the most publications (n = 140). The most published institution is Vrije University Amsterdam, and the most published journal is the Cochrane Database of Systematic Reviews. Peter R Blanpied is the most influential and most-cited author. Interventions (dry needling, massage therapy, and muscle energy techniques), common treatment sites for NP (upper trapezius), and complications (cervicogenic headache) are the top three frontiers mentioned in the field of tuina research for NP. The bibliometric study showed the current status and trends in clinical research on treating patients with NP using tuina, which may help researchers identify topics of interest and scope for future research in this field.
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Affiliation(s)
- Zhichao Gong
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China
| | - Yi Guo
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China
| | - Xiaowei Liu
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China
| | - Kun Ai
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China
| | - Wu Li
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China
| | - Jiangshan Li
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China
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15
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Carlisle C, Polley K, Panda C, Barron K, Hamrock M, Dominique A, Metzger B, Le Brun-Blashka S, Komarnytsky S. Alleviation of Pain, PAIN Interference, and Oxidative Stress by a Novel Combination of Hemp Oil, Calamari Oil, and Broccoli: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2023; 15:2654. [PMID: 37375558 DOI: 10.3390/nu15122654] [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: 04/28/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic pain is a critical health issue in the US that is routinely managed pharmacologically with diminishing results. The widespread misuse and abuse of prescription opioid pain medications have caused both healthcare providers and patients to seek alternative therapeutic options. Several dietary ingredients have been traditionally used for pain relief and are known to have potential analgesic properties. This double-blind, placebo-controlled randomized clinical trial aimed to test whether a novel combination of full spectrum hemp oil (phytocannabinoids), calamari oil (omega-3 fatty acids), and broccoli (glucosinolates) could reduce chronic pain and attenuate damage from oxidative stress in adults seeking chiropractic care. Participants (average age = 54.8 ± 13.6 years old) were randomly assigned to consume a whole-food, multi-ingredient supplement (n = 12, intervention and standard chiropractic care) or placebo (n = 13, mineral oil and standard chiropractic care) daily for 12 weeks. The subjects' self-reported perceived pain, pain interference, and reactive oxygen species (ROS) status in the peripheral blood mononuclear cells (PBMC) were quantified at baseline, mid-checkpoint, and postintervention. The intervention was positively associated with a 52% decrease in pain intensity and several parameters of pain interference, including quality of sleep. Decreases in the markers of oxidative stress were also observed in the participants from the intervention group (29.4% decrease in PMBC ROS). Our findings indicated that supplementation with a novel combination of hemp oil, calamari oil, and broccoli has the potential to manage chronic pain when combined with standard chiropractic care, as suggested by its effects on pain intensity and oxidative stress.
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Affiliation(s)
- Carolina Carlisle
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Kristine Polley
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Chinmayee Panda
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Keri Barron
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Meghan Hamrock
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Ashley Dominique
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Brandon Metzger
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Sara Le Brun-Blashka
- Nutrition Innovation Center, Standard Process Inc., 150 N Research Campus Drive, Kannapolis, NC 28081, USA
| | - Slavko Komarnytsky
- Plants for Human Health Institute, North Carolina State University, 600 Laureate Way, Kannapolis, NC 28081, USA
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, 400 Dan Allen Drive, Raleigh, NC 27695, USA
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16
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Stickler K, Kearns G. Spinal manipulation and adverse event reporting in the pregnant patient limits estimation of relative risk: a narrative review. J Man Manip Ther 2023; 31:162-173. [PMID: 36047253 PMCID: PMC10288923 DOI: 10.1080/10669817.2022.2118653] [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: 10/14/2022] Open
Abstract
OBJECTIVE To describe variability in spinal manipulation technique details and adverse event (AE) documentation of spinal manipulation during pregnancy. METHODS Five databases were searched for peer-reviewed investigations of spinal manipulation during pregnancy. Criteria for inclusion was as follows: high velocity, low amplitude thrust manipulation performed, subjects pregnant during manipulation, and English language. Studies were excluded when participants were not currently pregnant, and when the manipulation performed was not high-velocity, low-amplitude thrust. Data extraction included study design, number of participants, gestational age, spinal region, number of manipulations, manipulation technique details, profession of manipulator, AE reporting (Yes vs. No), type, and number of AE. RESULTS Out of 18 studies included in the review, only three provide details of the spinal manipulation technique. The reported variables include patient position, practitioner position, and direction of thrust. Fourteen studies documented AE; however, only seven provide AE details. DISCUSSION Reporting of spinal manipulation techniques and AE during pregnancy were inconsistent. Replication of methods in future investigations is limited without more detailed documentation of manipulation techniques performed. Furthermore, determining the relative risk and safety of spinal manipulation during pregnancy is not possible without more detailed reporting of AE. Due to these inconsistencies, a checklist is proposed for standardized reporting of spinal manipulation techniques and AE. With more consistent reporting of these parameters, results of future investigations may allow for more definitive and generalizable safety recommendations on spinal manipulation during pregnancy.
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Affiliation(s)
- Kellie Stickler
- Cerner Corporation, Workforce Health Services, Overland Park, Kansas, USA
| | - Gary Kearns
- Texas Tech University Health Sciences Center, DPT Program, Lubbock, Texas, USA
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Naye F, Décary S, Houle C, LeBlanc A, Cook C, Dugas M, Skidmore B, Tousignant-Laflamme Y. Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review. Phys Ther 2023; 103:7066982. [PMID: 37245218 DOI: 10.1093/ptj/pzad021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 01/06/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to identify and appraise externally validated prognostic models to predict a patient's health outcomes relevant to physical rehabilitation of musculoskeletal (MSK) conditions. METHODS We systematically reviewed 8 databases and reported our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. An information specialist designed a search strategy to identify externally validated prognostic models for MSK conditions. Paired reviewers independently screened the title, abstract, and full text and conducted data extraction. We extracted characteristics of included studies (eg, country and study design), prognostic models (eg, performance measures and type of model) and predicted clinical outcomes (eg, pain and disability). We assessed the risk of bias and concerns of applicability using the prediction model risk of bias assessment tool. We proposed and used a 5-step method to determine which prognostic models were clinically valuable. RESULTS We found 4896 citations, read 300 full-text articles, and included 46 papers (37 distinct models). Prognostic models were externally validated for the spine, upper limb, lower limb conditions, and MSK trauma, injuries, and pain. All studies presented a high risk of bias. Half of the models showed low concerns for applicability. Reporting of calibration and discrimination performance measures was often lacking. We found 6 externally validated models with adequate measures, which could be deemed clinically valuable [ie, (1) STart Back Screening Tool, (2) Wallis Occupational Rehabilitation RisK model, (3) Da Silva model, (4) PICKUP model, (5) Schellingerhout rule, and (6) Keene model]. Despite having a high risk of bias, which is mostly explained by the very conservative properties of the PROBAST tool, the 6 models remain clinically relevant. CONCLUSION We found 6 externally validated prognostic models developed to predict patients' health outcomes that were clinically relevant to the physical rehabilitation of MSK conditions. IMPACT Our results provide clinicians with externally validated prognostic models to help them better predict patients' clinical outcomes and facilitate personalized treatment plans. Incorporating clinically valuable prognostic models could inherently improve the value of care provided by physical therapists.
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Affiliation(s)
- Florian Naye
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Simon Décary
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec, Quebec, Canada
| | - Catherine Houle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
| | - Chad Cook
- Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - Michèle Dugas
- VITAM Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
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18
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Chu ECP. Remission of cervicogenic dysphagia associated with biomechanical dysfunction following chiropractic therapy. J Med Life 2023; 16:794-798. [PMID: 37520480 PMCID: PMC10375352 DOI: 10.25122/jml-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/09/2023] [Indexed: 08/01/2023] Open
Abstract
Cervicogenic dysphagia is a complex condition that can arise from biomechanical dysfunction in the cervical spine. Conventional treatment outcomes are not always guaranteed. Chiropractic treatment is considered an alternative treatment for dysphagia, yet there is a lack of evidence supporting its effectiveness. We present the case of a 48-year-old male who had difficulty swallowing for eight months. He had a feeling of food stuck in his throat when eating hard food but without any pain when swallowing, and eventually, he could not swallow any dry food. He was diagnosed with dysphagia associated with an anxiety disorder and was treated with medication, but there was no improvement in his condition. A full-spine radiograph revealed biomechanical dysfunction, including reduced cervical lordosis and levoscoliosis of the upper thoracic spine. After nine months of conventional physiotherapy, the patient completely recovered from his symptoms, with significantly improved biomechanical parameters. This study highlights the potential mechanism of cervicogenic dysphagia and the effect of chiropractic treatment in managing it. Applying chiropractic treatment, including spinal manipulative therapy, instrument-assisted soft tissue manipulation, and mechanical traction, might bring a positive outcome for dysphagia patients with careful consideration.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong, China
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Evans DW, Lucas N. What is manipulation? A new definition. BMC Musculoskelet Disord 2023; 24:194. [PMID: 36918833 PMCID: PMC10015914 DOI: 10.1186/s12891-023-06298-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Definitions are important in healthcare. Unfortunately, problems can be found withall existing definitions of manipulation. METHODS This paper derives a set of eligibility criteria from prior definitions of manipulation to inform what should (and should not) be incorporated within a valid definition. These criteria were then used to select components from currently available empirical data to create a new definition. RESULTS The resulting definition of manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint, caused by a force applied perpendicularly to those articular surfaces, that results in cavitation within the synovial fluid of that joint." The corresponding definition for the mechanical response of a manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint that results in cavitation within the synovial fluid of that joint." In turn, the action of a manipulation can be defined as: "A force applied perpendicularly to the articular surfaces." CONCLUSIONS We believe these definitions to be valid (derived from and consistent with all available empirical data), complete (containing all necessary components), minimally sufficient (minimal redundancy, and sufficient to distinguish manipulation from other physical interventions), and robust (able to withstand important limitations embodied within sensible eligibility criteria). It is hoped that the simplicity and clarity of these definitions, and the transparency of their formation, will encourage their wide adoption in clinical, research, educational and professional settings.
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Affiliation(s)
- David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK. .,Research Centre, University College of Osteopathy, London, UK.
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Chu ECP, Trager RJ, Tao C. Improvement of Chronic Neck Pain After Posterior Atlantoaxial Surgical Fusion via Multimodal Chiropractic Care: A Case Report. Cureus 2023; 15:e34630. [PMID: 36891015 PMCID: PMC9988189 DOI: 10.7759/cureus.34630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
There is a lack of research regarding the effectiveness and safety of manual therapies, including spinal manipulative therapy (SMT), for patients with previous cervical spine surgery. A 66-year-old, otherwise healthy, woman who underwent C1/2 posterior surgical fusion for rotatory instability during adolescence presented to a chiropractor with a six-month history of progressive worsening of chronic neck pain and headaches despite acetaminophen, tramadol, and physical therapy. Upon examination, the chiropractor noted postural changes, limited cervical range of motion, and muscle hypertonicity. Computed tomography revealed a successful C1/2 fusion, and degenerative findings at C0/1, C2/3, C3/4, and C5/6, without cord compression. As the patient had no neurologic deficits or myelopathy and tolerated spinal mobilization well, the chiropractor applied cervical SMT, along with soft tissue manipulation, ultrasound therapy, mechanical traction, and thoracic SMT. The patient's pain was reduced to a mild level and the range of motion improved over three weeks of treatment. Benefits were maintained over a three-month follow-up as treatments were spaced apart. Despite the apparent success in the current case, evidence for manual therapies and SMT in patients with cervical spine surgery remains limited, and these therapies should be used with caution on an individual patient basis. Further research is needed to examine the safety of manual therapies and SMT in patients following cervical spine surgery and determine predictors of treatment response.
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Affiliation(s)
- Eric Chun-Pu Chu
- Department of Chiropractic and Physiotherapy, New York Chiropractic and Physiotherapy Centre, Kowloon, HKG
| | - Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Cliff Tao
- Radiology, Private Practice of Chiropractic Radiology, Irvine, USA
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Tsegay GS, Gebregergs GB, Weleslassie GG, Hailemariam TT. Effectiveness of Thoracic Spine Manipulation on the Management of Neck Pain: A Systematic Review and Meta-Analysis of Randomized Control Trials. J Pain Res 2023; 16:597-609. [PMID: 36875686 PMCID: PMC9983435 DOI: 10.2147/jpr.s368910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 02/04/2023] [Indexed: 03/02/2023] Open
Abstract
There are contradicting findings regarding the effect of thoracic spine manipulation in decreasing pain and disability in patients with chronic mechanical neck pain. Hence, the purpose of this review was to evaluate the current evidence on the effectiveness of thoracic spine thrust manipulation in decreasing pain intensity, and neck disability among subjects with chronic mechanical neck pain. We made a comprehensive search of literature published between 2010 and 2020 from the electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro). We adhered to Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA). The methodological quality was assessed by the PEDro scale, and the level of evidence rated by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) software. Finally, a meta-analysis was done using RevMan 5.3 with a random-effects model to calculate the mean difference (MD) and 95% confidence intervals for pain and disability. Eight eligible randomized controlled trials were identified with a total of 457 participants. The quality assessment of the included studies was found to be fair in quality (mean PEDro score of 6.63/10). The overall GRADE of the review showed low to moderate level of evidence. Effect size estimates of the studies showed modest differences in pain reduction, as it revealed a significant effect in Visual Analog Scale ((VAS) 0-100mm) (MD -12.46; 95% CI: -17.29, -7.64), and Pain Numeric Rating Scale ((PNRS) 0-10 pts) (MD -0.8; 95% CI: -1.60, -0.10). The thoracic manipulation also resulted in a significant effect in decreasing neck disability, in which the mean difference in Neck disability index (NDI) showed (MD -6.46; 95% CI: -10.43 -2.50). This review suggested that thoracic spine manipulation was effective in reducing pain and neck disability in all adults with chronic mechanical neck pain compared to other interventions.
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Affiliation(s)
- Gebrerufael Solomon Tsegay
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gebremedhin Berhe Gebregergs
- Department of Epidemiology, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gidey Gomera Weleslassie
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Teklehaimanot Tekle Hailemariam
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia
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22
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Koppenhaver SL, Morel T, Dredge G, Baeder M, Young BA, Petersen EJ, Fernández-de-Las-Peñas C, Gill N. The validity of the cervical rotation lateral flexion test in predicting benefit after manipulation treatment to the first and second rib. Musculoskelet Sci Pract 2022; 62:102629. [PMID: 35872564 DOI: 10.1016/j.msksp.2022.102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Prospective cohort study. BACKGROUND The cervical rotation lateral flexion (CRLF) test is frequently used in clinical practice to determine whether a thrust manipulation targeting the first rib should be performed. OBJECTIVES To evaluate the predictive validity of the CRLF test and manual examination in determining whether patients with neck pain are likely to benefit from manipulative treatment to the first and second rib. METHODS A physical examination incorporating the CRLF test was performed on 50 participants with neck pain followed by manipulation treatment to the first and second ribs. Clinical improvement was assessed immediately and one week after treatment. Participants who experienced at least a 30% improvement in their Neck Disability Index (NDI) score were considered "improved." Predictive validity was assessed by calculating sensitivity, specificity, and negative and positive likelihood ratios. RESULTS Neither the CRLF test nor manual examination were predictive of clinical improvement after manipulative treatment to the first and second rib. However, being male, of older age, and exhibiting T1 and/or T2 restricted end-feel were associated with improved neck related-disability at one-week follow-up. CONCLUSION The CRLF test does not appear to be helpful in determining whether patients with neck pain are likely to benefit from manipulative treatment to the first and second rib. Other factors from the history and clinical examination may be more helpful when selecting manipulative treatment including age and gender and possibly the presence of T1/T2 restricted end-feel.
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Affiliation(s)
| | - Tracy Morel
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Garry Dredge
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Michele Baeder
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Brian A Young
- Baylor University Doctoral Program in Physical Therapy, Waco, TX, USA
| | - Evan J Petersen
- Bowling Green State University, Doctoral Program in Physical Therapy, Bowling Green, OH, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
| | - Norman Gill
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
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23
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Yoshida R, Yasuda T, Kuruma H. Analysis of cervical and upper thoracic spinal segmental rotation angles during end-range neck rotation: Comparison with and without neck pain. J Man Manip Ther 2022; 30:328-333. [PMID: 35384789 PMCID: PMC9621240 DOI: 10.1080/10669817.2022.2056309] [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: 01/07/2023] Open
Abstract
BACKGROUND Neck pain is a common manifestation of musculoskeletal disorders of the cervical and thoracic spine. Manual therapy interventions to the thoracic spine are recommended for treating patients with several types of neck pain. However, only a few studies have investigated the thoracic spine mobility associated with neck movement. OBJECTIVES Compare cervical and upper thoracic rotation angles in subjects with and without neck pain. METHODS The subjects included nine individuals who experienced neck pain (pain, Group P) and 11 who did not (non-pain, Group N). The rotation angle was measured using MRI. The imaging limb position was at 90% of the maximum neck rotation. The MR images were analyzed using image analysis software to calculate the rotation angle of C1 to Th3. The rotation angle of the segment was then calculated by subtracting the rotation angle corresponding to the lower vertebra from that corresponding to the upper vertebra. The total rotation of each segment was calculated as the sum of the right and left rotation angle. Then, the segmental rotation angles were compared between groups. RESULTS/FINDINGS The rotation angles of C3-C4, C7-Th1, and Th1-Th2 were significantly smaller in Group P than in Group N, and C5-C6 and C6-C7 were significantly larger in Group P than in Group N. There was no statistical difference in rotational angle at all other spinal levels measured. CONCLUSIONS The results of this study indicate subjects with neck pain had hypermobility of the lower cervical spine and hypomobility of the cervico-thoracic junction and upper thoracic spine compared with subjects without neck pain. These results add to current understanding of biomechanical factors that may be related to neck pain.
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Affiliation(s)
- Ryota Yoshida
- Department of Physiotherapy, Tokyo Metropolitan University, Arakawa-ku, Japan,Department of Rehabilitation, Yomiuri Clinic, Chiyoda-ku, Japan,CONTACT Ryota Yoshida Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo116-8551, Japan
| | - Toru Yasuda
- Department of Physiotherapy, Tokyo Metropolitan University, Arakawa-ku, Japan,Department of Rehabilitation, Zama General Hospital, Zama City, Japan
| | - Hironobu Kuruma
- Department of Physiotherapy, Tokyo Metropolitan University, Arakawa-ku, Japan
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24
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Alanazi FS, Mysore SB, Farghaly AA. The Impact of the COVID-19 Lockdown on Physical Therapy Undergraduates and Their Families. A Qualitative Study from the United Arab Emirates. Int J Gen Med 2022; 15:6373-6380. [PMID: 35935101 PMCID: PMC9355017 DOI: 10.2147/ijgm.s371717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
Background The COVID-19 pandemic closed most establishments in the United Arab Emirates except health care and other essential services from 8 March 2020 until 24 June. By 22 March, most citizens were working online, including physical therapy students, and a no-movement policy restricted exercise to homes. The lockdown ended partially in August 2021 and almost complete by January 2022. Objective We aimed (1) to explore the physical activities of advanced undergraduate physical therapy students and their families during the lockdown, (2) to discuss how participants helped promote and maintain their own and their family’s physical health, and (3) to identify what knowledge and skills gained in their physical therapy study students utilized during the lockdown. Methods We took a qualitative approach; a one-to-one semi-structured interviews were conducted by Year 4 physical students who at the time were registered for a module covering qualitative research methods. The students interviewed other physical therapy students from year 4 and 5 who were recruited using convenience sampling from a health sciences educational institution. Interviews were conducted and recorded on the Zoom platform and transcribed verbatim. Thematic analysis was utilised to analyse the data. Findings Forty-six students agreed to participate, and data saturation was achieved with interviews of 24 students. During the COVID-19 Stay Home—Stay Safe initiative, students of physical therapy were found to be physically active and to have designed home exercise programs for themselves and their families. Adherence to regular exercise was high among the students but low among family members. Three overarching themes, each with three subthemes, emerged through synthesis, coding, and categorizing. Conclusion Undergraduate students can effectively promote their own and their family’s health. Energy imbalance and increasing neck, shoulder, and back pain among youth and lack of exercise among adults, midlife, and older, raise health concerns.
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Affiliation(s)
- Fahad Salam Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Qurayat, Al-Jouf Region, Saudi Arabia
| | | | - Abeer Ahmed Farghaly
- Department of Physiotherapy, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates.,Department of Physical Therapy for Cardiopulmonary & Geriatric, Cairo University, Giza, Egypt
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25
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Nim CG, Downie A, O'Neill S, Kawchuk GN, Perle SM, Leboeuf-Yde C. The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review. Sci Rep 2021; 11:23415. [PMID: 34862434 PMCID: PMC8642385 DOI: 10.1038/s41598-021-02882-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
The concept that spinal manipulation therapy (SMT) outcomes are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use (candidate sites). This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere (non-candidate sites). Eligible study designs were randomized controlled trials that investigated the effect of spinal manipulation applied to candidate versus non-candidate sites for spinal pain. We obtained data from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. We extracted between-group differences for any reported outcome or, when not reported, calculated effect sizes from the within-group changes. We compared outcomes for SMT applied at a 'relevant' site to SMT applied elsewhere. We prioritized methodologically robust studies when interpreting results. Ten studies, all of acceptable quality, were included that reported 33 between-group differences-five compared treatments within the same spinal region and five at different spinal regions. None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI - 1.9 to - 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that "clinically-relevant" SMT has a superior outcome on any outcome compared to "not clinically-relevant" SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.
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Affiliation(s)
- Casper G Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Aron Downie
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia
| | - Søren O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Gregory N Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Stephen M Perle
- School of Chiropractic, College of Health Sciences, University of Bridgeport, Bridgeport, USA
| | - Charlotte Leboeuf-Yde
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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26
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Chaibi A, Stavem K, Russell MB. Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. J Clin Med 2021; 10:jcm10215011. [PMID: 34768531 PMCID: PMC8584283 DOI: 10.3390/jcm10215011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); (2) Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, respectively; (3) Results: Six studies were included. The overall pooled effect size for neck pain was very large −1.37 (95% CI, −2.41, −0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((−2.8 (46%) (95% CI, −2.1, −3.4) vs. −1.7 (30%) (95% CI, −1.1, −2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported; (4) Conclusions: SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings.
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Affiliation(s)
- Aleksander Chaibi
- Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, 1478 Oslo, Norway;
- Department for Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, 0317 Oslo, Norway
- Correspondence: ; Tel.: +47-91135213
| | - Knut Stavem
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, 1478 Nordbyhagen, Norway;
- Department of Pulmonary Medicine, Akershus University Hospital, 1478 Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, 1478 Oslo, Norway;
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, 1478 Nordbyhagen, Norway;
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27
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Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. FRONTIERS IN PAIN RESEARCH 2021; 2:765921. [PMID: 35295422 PMCID: PMC8915715 DOI: 10.3389/fpain.2021.765921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Arantxa Ortega de Mues
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Mathieu Piché
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28
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Busse JW, Pallapothu S, Vinh B, Lee V, Abril L, Canga A, Riva JJ, Viggiani D, Dilauro M, Harvey MP, Pagé I, Bhela AK, Sandhu S, Makanjuola O, Hassan MT, Moore A, Gauthier CA, Price DJ. Attitudes towards chiropractic: a repeated cross-sectional survey of Canadian family physicians. BMC FAMILY PRACTICE 2021; 22:188. [PMID: 34525953 PMCID: PMC8442384 DOI: 10.1186/s12875-021-01535-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes. METHODS A 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores. RESULTS Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (- 1.55 points for each 10-year increment from age 28; 95%CI - 2.67 to - 0.44), belief that adverse events are common with chiropractic care (- 1.41 points; 95% CI - 2.59 to - 0.23) and reported use of the research literature (- 6.04 points; 95% CI - 8.47 to - 3.61) or medical school (- 5.03 points; 95% CI - 7.89 to - 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic. CONCLUSIONS Although generally positive, Canadian family physicians' attitudes towards chiropractic are diverse, and most physicians felt that practice diversity among chiropractors was a barrier to interprofessional collaboration.
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Affiliation(s)
- Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. .,Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, HSC-2V9, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | | | - Brian Vinh
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Vivienne Lee
- The School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada
| | - Lina Abril
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Albana Canga
- Institute for Work & Health, Toronto, ON, Canada
| | - John J Riva
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Daniel Viggiani
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Marc Dilauro
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Marie-Pierre Harvey
- Département de chiropratique, Université du Québec à Trois-Rivières, QC, Trois-Rivières, Canada
| | - Isabelle Pagé
- Département de chiropratique, Université du Québec à Trois-Rivières, QC, Trois-Rivières, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC, Canada
| | - Avneet K Bhela
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Serena Sandhu
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | | | | | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David J Price
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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29
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McDevitt AW, Cleland JA, Rhon DI, Altic RAK, Courtney DJ, Glynn PE, Mintken PE. Thoracic spine thrust manipulation for individuals with cervicogenic headache: a crossover randomized clinical trial. J Man Manip Ther 2021; 30:78-95. [PMID: 34269160 DOI: 10.1080/10669817.2021.1947663] [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: 10/20/2022] Open
Abstract
Objective: To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH).Methods: A randomized controlled crossover trial was conducted on 48 participants (mean age: 34.4 years) with CeH symptoms. Participants were randomized to 6 sessions of TSM or no treatment (Hold) and after 4-weeks, groups crossed over. Outcomes were collected at 4, 8 and 12 weeks and included: headache disability inventory (HDI), neck disability index (NDI), and the global rating of change (GRC). Outcomes were analyzed using a linear mixed-effects model with Bonferroni correction. Odds of achieving the minimal clinically important difference (MCID) on the GRC of +4 or greater were also calculated. Scores at 4 weeks represent the only timepoint where 1 group is fully treated and other group has not received any treatment.Results: Comparing hold to active treatment, HDI were not significantly different between groups (mean difference = 7.39, 95 CI: -4.39 to 19.18; P = 0.214) at any timepoint; the NDI was significant (mean difference = 6.90, 95 CI: 0.05 to 13.75; P = 0.048) at 4 weeks. Odds of achieving the +4 MCID on the GRC (OR = 38.0, 95 CI: 6.6 to 220.0; p < 0.001) favored TSM at 4 weeks.Conclusion: TSM had no effect on headache-related disability but resulted in significant improvements in neck-related disability and participant reported perceived improvement. Future studies are needed to examine the long-term impact of TSM in this population.
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Affiliation(s)
- Amy W McDevitt
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Rebecca A K Altic
- CU Sports Physical Therapy and Rehabilitation, University of Colorado Health, Denver, Colorado, USA
| | - Drew J Courtney
- DBS Fitness San Diego Physical Therapy, San Diego, California, USA
| | - Paul E Glynn
- Glynn Physical Therapy, Lexington, Massachusetts, USA
| | - Paul E Mintken
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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30
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Cerritelli F, Chiera M, Abbro M, Megale V, Esteves J, Gallace A, Manzotti A. The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies. Front Neurol 2021; 12:700211. [PMID: 34276550 PMCID: PMC8278005 DOI: 10.3389/fneur.2021.700211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.
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Affiliation(s)
| | | | - Marco Abbro
- Foundation COME Collaboration, Pescara, Italy
| | | | | | | | - Andrea Manzotti
- Foundation COME Collaboration, Pescara, Italy
- RAISE Lab, Foundation COME Collaboration, Milan, Italy
- SOMA Istituto Osteopatia Milano, Milan, Italy
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Shabbir M, Arshad N, Naz A, Saleem N. Clinical outcomes of maitland mobilization in patients with Myofascial Chronic Neck Pain: A randomized controlled trial. Pak J Med Sci 2021; 37:1172-1178. [PMID: 34290803 PMCID: PMC8281150 DOI: 10.12669/pjms.37.4.4220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objective Myofascial neck pain is a common musculoskeletal problem caused by presence of trigger points and local and referred pain patterns. Chronic neck pain is responsible for the involvement of joints, ligaments, fascia and connective tissue as well. The objective of this study was to assess the effect of Maitland mobilization in patients with myofascial chronic neck pain. Methods In this randomized, placebo treatment-controlled trial, 30 patients consecutively aged 25-45 years meeting inclusion criteria were isolated into two groups. The study group was treated with Maitland mobilization consistently for eight weeks while the control group got placebo treatment for a similar timeframe. Visual analog Scale (VAS), Neck disability index (NDI) and cervical range of motion (ROM) questionnaire was filled by patients before, intermediate and after the intervention to evaluate the severity of pain, functional ability and range of motion. Results Following eight weeks of treatment, when compared the post treatment effects of both groups, the significance value for VAS was 0.008, for NDI p=0.030, for Flexion p=0.573, for extension p=0.001, for right rotation p<0.001, for left rotation p=0.002, for right and left side bending p<0.001. Conclusion The study concluded that Maitland mobilization grades (I-IV) are effective in reducing pain and improving functional level of NDI scale and the ranges of cervical spine in patients with myofascial chronic neck pain.
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Affiliation(s)
- Maryam Shabbir
- Dr. Maryam Shabbir, Ph.D. (Rehab) scholar, Associate Professor, Riphah International University, Lahore Pakistan
| | - Naveed Arshad
- Dr. Naveed Arshad, M.Phil. (Rehab), Assistant Professor, Islamabad Medical and Dental College, Islamabad Pakistan
| | - Anam Naz
- Dr. Anam Naz, MS (Rehab), Senior Lecturer, The University of Lahore, Lahore Pakistan
| | - Nadia Saleem
- Dr. Nadia Saleem, MS (Rehab), Assistant Professor, Bakhtawar Amin College of Rehabilitation Sciences, Multan Pakistan
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Fernández-De-Las-Peñas C, Plaza-Manzano G, Sanchez-Infante J, Gómez-Chiguano GF, Cleland JA, Arias-Buría JL, López-de-Uralde-Villanueva I, Navarro-Santana MJ. Is Dry Needling Effective When Combined with Other Therapies for Myofascial Trigger Points Associated with Neck Pain Symptoms? A Systematic Review and Meta-Analysis. Pain Res Manag 2021; 2021:8836427. [PMID: 33603940 PMCID: PMC7872772 DOI: 10.1155/2021/8836427] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/20/2021] [Indexed: 12/29/2022]
Abstract
Objective To evaluate the effects of combining dry needling with other physical therapy interventions versus the application of the other interventions or dry needling alone applied over trigger points (TrPs) associated to neck pain. Databases and Data Treatment. Electronic databases were searched for randomized controlled trials where at least one group received dry needling combined with other interventions for TrPs associated with neck pain. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool, methodological quality was assessed with PEDro score, and the quality of evidence was assessed by using the GRADE approach. Between-groups mean differences (MD) and standardized mean difference (SMD) were calculated. Results Eight trials were included. Dry needling combined with other interventions reduced pain intensity at short-term (SMD -1.46, 95% CI -2.25 to -0.67) and midterm (SMD -0.38, 95% CI -0.74 to -0.03) but not immediately after or at long-term compared with the other interventions alone. A small effect on pain-related disability was observed at short-term (SMD -0.45, 95% CI -0.87 to -0.03) but not at midterm or long-term. The inclusion of dry needling was also effective for improving pressure pain thresholds only at short-term (MD 112.02 kPa, 95% CI 27.99 to 196.06). No significant effects on cervical range of motion or pain catastrophism were observed. Conclusion Low-to-moderate evidence suggests a positive effect to the combination of dry needling with other interventions for improving pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion in people with neck pain associated with TrPs at short-term. No midterm or long-term effects were observed.
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Affiliation(s)
- César Fernández-De-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Jorge Sanchez-Infante
- Performance and sport rehabilitation Laboratory, Faculty of sport sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Guido F Gómez-Chiguano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
- Clínica Dinamia Fisioterapia, Madrid, Spain
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | | | - Marcos J. Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
- Rehabilitación San Fernando, Madrid, Spain
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Affiliation(s)
- Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
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Thoracic thrust joint manipulation: An international survey of current practice and knowledge in IFOMPT member countries. Musculoskelet Sci Pract 2020; 50:102251. [PMID: 32992076 DOI: 10.1016/j.msksp.2020.102251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to a growth in evidence supporting use in practice. Yet adverse events (AE) have been documented following TTJM. Knowledge of current practice is therefore required to support further research. PURPOSE To investigate TTJM knowledge and pre-TTJM examination across IFOMPT Member Organisations (MO) and Registered Interest Groups (RIG). METHODS An e-survey was designed based on existing evidence and piloted. Eligibility criteria: physiotherapists from member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) who use TTJM. Recruitment was through IFOMPT networks (May 2018-March 2019). Data analyses included descriptive analyses and content analysis for free text data. RESULTS Respondents (n = 363) from 20 countries. Pre-TTJM examination included patient history (22%, n = 81) and physical examination (69%, n = 248). Across presentations (>80% threshold of agreement) contraindications included osteomyelitis, fracture and metastatic disease. Spinal deformity, respiratory disease, serious joint disease and hypermobility achieved >60% agreement as precautions. Consent was obtained by 93% respondents (n = 250). Preferred technique was PA/AP thrust (61%, n = 144). Perception of primary effect was neurophysiological (52%, n = 134), biomechanical (42%, n = 109) and placebo (3%, n = 8). From those who reported AE (n = 100), these included fractures (36%, n = 42) and cord signs/symptoms (6%, n = 7). CONCLUSION Pre-TTJM examination is common, although bias towards physical examination. Differential testing for upper versus lower thoracic spine is limited. Inconsistencies across knowledge of contraindications and precautions, and beliefs for biomechanical effect were found. Findings highlight the importance of high levels of clinical reasoning during patient history for TTJM.
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Joshi S, Balthillaya G, Neelapala YVR. Immediate effects of cervicothoracic junction mobilization versus thoracic manipulation on the range of motion and pain in mechanical neck pain with cervicothoracic junction dysfunction: a pilot randomized controlled trial. Chiropr Man Therap 2020; 28:38. [PMID: 32762708 PMCID: PMC7412667 DOI: 10.1186/s12998-020-00327-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Cervicothoracic (CT) junction hypomobility has been proposed as a contributing factor for neck pain. However, there are limited studies that compared the effect of CT junction mobilization against an effective intervention in neck pain. Thoracic spine manipulation is a nonspecific intervention for neck pain where remote spinal segments are treated based on the concept of regional interdependence. The effectiveness of segment-specific spinal mobilization in the cervical spine has been researched in the last few years, and no definite conclusions could be made from the previous studies. The above reasons warrant the investigation of the effects of a specific CT junction mobilization against a nonspecific thoracic manipulation intervention in neck pain. The present study aims to compare the immediate effects of C7-T1 Maitland mobilization with thoracic manipulation in individuals with mechanical neck pain presenting with CT junction dysfunction specifically. Methods A randomized clinical trial is conducted where participants with complaints of mechanical neck pain and CT junction dysfunction randomly assigned to either C7-T1 level Maitland mobilization group or mid-thoracic (T3-T6) manipulation group (active control group). In both the groups, the post graduate student (SJ) pursuing Master’s in orthopedic physiotherapy delivered the intervention. The outcomes of cervical flexion, extension, side flexion & rotation range of motion (ROM) were measured before & after the intervention with a cervical range of motion (CROM) device. Self-reported pain intensity was measured with the numerical pain rating scale (NPRS). The post-intervention between-group comparison was performed using a one-way ANCOVA test. Results Forty-two participants with mean age CT junction group: 35.14 ± 10.13 and Thoracic manipulation group: 38.47 ± 11.47 were recruited for the study. No significant differences in the post-intervention baseline adjusted outcomes of cervical ROM & self-reported pain intensity were identified between the groups after the treatment (p = 0.08, 0.95, 0.01, 0.39, 0.29, 0.27for flexion, extension, bilateral lateral flexion & rotations respectively) & neck pain intensity (p = 0.68). However, within-group, pre, and post comparison showed significant improvements in cervical ROM and pain in both groups. Conclusion This preliminary study identified that CT junction mobilization is not superior to thoracic manipulation on the outcomes of cervical ROM and neck pain when level-specific CT junction mobilization was compared with remote mid-thoracic manipulation in individuals with mechanical neck pain and CT junction dysfunction. Trial registration CTRI: 2018/04/013088, Registered 6 April 2018, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24418
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Affiliation(s)
- Shriya Joshi
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Balthillaya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Y V Raghava Neelapala
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Heneghan NR, Pup C, Koulidis K, Rushton A. Thoracic adverse events following spinal manipulative therapy: a systematic review and narrative synthesis. J Man Manip Ther 2020; 28:275-286. [PMID: 32148185 DOI: 10.1080/10669817.2020.1725277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Spinal manipulative therapy (SMT) is widely used by manual therapists to manage spinal complaints. Notwithstanding the perceived relative safety of SMT, instances of severe thoracic adverse events (AE) have been documented. An evidence synthesis is required to understand the nature, severity and characteristics of thoracic AE following all SMT. The primary objective of this study was to report thoracic AE following SMT and secondly to report patient characteristics to inform further research for safe practice. Methods: A systematic review and data synthesis were conducted according to a registered protocol (PROSPERO CRD42019123140). A sensitive topic-based search strategy for key databases, gray literature and registers used study population terms and keywords, to search to 12/6/19. Two reviewers were involved at each stage. Using the Oxford Center for Evidence-based Medicine (CEBM) the level evidence was evaluated with grade presented for each AE. Results were reported in the context of overall quality. Results: From 1013 studies identified from searches, 19 studies (15 single case studies and 4 case series) reporting 21 unique thoracic AE involving the spinal cord tissues [nonvascular (n = 7), vascular (n = 6)], pneumothorax or hemothorax (n = 3), fracture (n = 3), esophageal rupture (n = 1), rupture of thoracic aorta (n = 1), partial pancreatic transection (n = 1). Reported outcomes included fully recovery (n = 8), permanent neurological deficit (n = 5), and death (n = 4). Conclusion: Although causality cannot be confirmed, serious thoracic AE to include permanent neurological deficit and death have been reported following SMT. Findings highlight the importance of clinical reasoning, including pre-thrust examination, as part of best and safe practice for SMT.
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Affiliation(s)
- Nicola R Heneghan
- Senior Lecturer in Musculoskeletal Rehabilitation Sciences, Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham , Edgbaston, Birmingham, UK
| | - Ciprian Pup
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham , Edgbaston, Birmingham, UK
| | - Konstantinos Koulidis
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham , Edgbaston, Birmingham, UK
| | - Alison Rushton
- Reader in Musculoskeletal Rehabilitation, Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham , Edgbaston, Birmingham, UK
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Weber Ii KA, Wager TD, Mackey S, Elliott JM, Liu WC, Sparks CL. Evidence for decreased Neurologic Pain Signature activation following thoracic spinal manipulation in healthy volunteers and participants with neck pain. NEUROIMAGE-CLINICAL 2019; 24:102042. [PMID: 31670070 PMCID: PMC6831903 DOI: 10.1016/j.nicl.2019.102042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/18/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
The use of brain-based models of pain were explored in two clinical studies. Neurologic pain signature activation decreased following spinal manipulation. Spinal manipulation altered the processing of pain-related brain activity. We provide evidence for a centrally mediated therapeutic action of spinal manipulation. Brain-based models have potential as objective clinical biomarkers of pain.
Background Context Spinal manipulation (SM) is a common treatment for neck and back pain, theorized to mechanically affect the spine leading to therapeutic mechanical changes. The link between specific mechanical effects and clinical improvement is not well supported. SM's therapeutic action may instead be partially mediated within the central nervous system. Purpose To introduce brain-based models of pain for spinal pain and manual therapy research, characterize the distributed central mechanisms of SM, and advance the preliminary validation of brain-based models as potential clinical biomarkers of pain. Study Design Secondary analysis of two functional magnetic resonance imaging studies investigating the effect of thoracic SM on pain-related brain activity: A non-controlled, non-blinded study in healthy volunteers (Study 1, n = 10, 5 females, and mean age = 31.2 ± 10.0 years) and a randomized controlled study in participants with acute to subacute neck pain (Study 2, n = 24, 16 females, mean age = 38.0 ± 15.1 years). Methods Functional magnetic resonance imaging was performed during noxious mechanical stimulation of the right index finger cuticle pre- and post-intervention. The effect of SM on pain-related activity was studied within brain regions defined by the Neurologic Pain Signature (NPS) that are predictive of physical pain. Results In Study 1, evoked mechanical pain (p < 0.001) and NPS activation (p = 0.010) decreased following SM, and the changes in evoked pain and NPS activation were correlated (rRM2 = 0.418, p = 0.016). Activation within the NPS subregions of the dorsal anterior cingulate cortex (dACC, p = 0.012) and right secondary somatosensory cortex/operculum (rS2_Op, p = 0.045) also decreased following SM, and evoked pain was correlated with dACC activity (rRM2 = 0.477, p = 0.019). In Study 2, neck pain (p = 0.046) and NPS (p = 0.033) activation decreased following verum but not sham SM. Associations between evoked pain, neck pain, and NPS activation, were not significant and less clear, possibly due to inadequate power, methodological limitations, or other confounding factors. Conclusions The findings provide preliminary evidence that SM may alter the processing of pain-related brain activity within specific pain-related brain regions and support the use of brain-based models as clinical biomarkers of pain.
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Affiliation(s)
- Kenneth A Weber Ii
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.
| | - Tor D Wager
- Psychology and Neuroscience, Center for Neuroscience, Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - James M Elliott
- Northern Sydney Local Health District, The Kolling Research Institute and The Faculty of Health Sciences, The University of Sydney, St. Leonards, NSW, Australia
| | - Wen-Ching Liu
- Center for Collaborative Brain Research, Department of Radiology, OSF HealthCare Saint Francis Medical Center, Peoria, IL, United States
| | - Cheryl L Sparks
- Center of Expertise, Rehabilitation and Occupational Health, OSF HealthCare, Peoria, IL, United States; School of Physical Therapy, South College, Knoxville, TN, United States
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