1
|
Cottone KA, Schumacher MR, Young JL, Rhon DI. The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials. J Man Manip Ther 2024; 32:478-494. [PMID: 38525785 PMCID: PMC11421161 DOI: 10.1080/10669817.2024.2327127] [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: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice. OBJECTIVE The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum. METHODS A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool. RESULTS A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias. CONCLUSION Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.
Collapse
Affiliation(s)
- Kyle A Cottone
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy and Health Science, Bradley University, Peoria, IL, USA
| | - Matthew R Schumacher
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, University of Mary, Bismarck, ND, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Stępnik J, Czaprowski D, Kędra A. Effect of manual osteopathic techniques on the autonomic nervous system, respiratory system function and head-cervical-shoulder complex-a systematic review. Front Med (Lausanne) 2024; 11:1358529. [PMID: 38660420 PMCID: PMC11040076 DOI: 10.3389/fmed.2024.1358529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Background Osteopathic manual techniques are now widely used in medicine worldwide. At present, there are no clear conclusions regarding the possibility of affecting the function of the autonomic nervous system (ANS), respiratory system and head-cervical-shoulder complex by manual osteopathic techniques. Objectives The aim of the study was to review the current literature regarding the possible impact of osteopathic manual techniques on the state of the autonomic nervous system, spirometric parameters of the respiratory system and the state of the head-collar-shoulder complex. Methods Publications have been searched in the following databases: PubMed, Virtual Health Library and Cochrane Central Register of Controlled Trials. The search strategy included keywords related to manual osteopathic treatment, autonomic nervous system, spirometry, respiratory function and head, neck and shoulder pain. The methodological quality of the included studies was assessed. The PRISMA guidelines were used for the systematic review. Studies from 2010 to 2023 were selected. Results Using the proposed descriptions and manual searches from the literature of other works, 40 studies were found, out of which 22 were rejected because they did not meet the inclusion criteria. The analysis included: 15 randomized controlled trials, 3 pilot studies. Conclusion Studies clearly show the effect of OMT on both spirometric parameters and the condition of the head-collar-shoulder complex. Most often this translates into improved ANS performance, but there are exceptions. Systematic review registration https://www.crd.york.ac.uk/prospero/, CRD42023476963.
Collapse
Affiliation(s)
- Jakub Stępnik
- Still Academy of Osteopathy, Warsaw, Poland
- SomaticMed Wołomin, Wołomin, Poland
| | - Dariusz Czaprowski
- Department of Physiotherapy, School of Public Health, University of Warmia and Mazury, Olsztyn, Poland
- Center of Body Posture, Olsztyn, Poland
| | - Agnieszka Kędra
- Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biała Podlaska, Poland
| |
Collapse
|
4
|
Suresh V, Venkatesan P, Babu K. Effect of proprioceptive neuromuscular facilitation and cranio-cervical flexor training on pain and function in chronic mechanical neck pain: A randomized clinical trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2058. [PMID: 37932913 DOI: 10.1002/pri.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Chronic neck pain is known to be caused by the weakness of the deep neck flexors and disturbances in the mechanoreceptors and the proprioceptors of the cervical spine. Proprioceptive neuromuscular facilitation (PNF) is hypothesized to balance the relative stiffness and weakness of the muscles and activate the mechanoreceptors and proprioceptors. OBJECTIVE To investigate PNF techniques and the craniocervical flexor training (CCFT) techniques for pain and function in chronic neck pain. METHODS A randomized clinical trial was conducted on 66 chronic mechanical neck pain patients randomly assigned to either the PNF or CCFT groups using block randomization for a duration of 4 weeks. Numerical Pain Rating Scale (NPRS), Neck disability Index (NDI) and Active cervical range of motion (ACROM) were measured at baseline and after 4 weeks of intervention. Data were analysed using independent t test and MANOVA. RESULTS The mean difference scores for NPRS and NDI were 2.18 and 15.72 in PNF group and 2.26 and 15.76 in the CCFT groups, respectively. Both the groups showed a change that was statistically significant. Also, the mean differences for the ACROM in all the planes in both the groups were statistically significant. However, the between group changes did not reveal any statistical significance in this study except for the right rotation in the CCFT group (p = 0.01). CONCLUSIONS This study concluded that the PNF treatment is also beneficial to pain and function in treating chronic mechanical neck pain patients as its results stand similar to the CCFT treatment, which is already established to be a reliable tool to treat this condition.
Collapse
Affiliation(s)
- Vaishnavi Suresh
- Department of Physiotherapy, Manipal College of Health Professions, MAHE, Manipal, India
| | - Prem Venkatesan
- Department of Physiotherapy, Manipal College of Health Professions, MAHE, Manipal, India
| | - Karthik Babu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust, Coimbatore, India
| |
Collapse
|
5
|
Kim J, Cho J. Effectiveness of mid thoracic spine mobilization on postural balance and gait ability in subacute stroke patients: A randomized clinical trial. J Back Musculoskelet Rehabil 2024; 37:233-240. [PMID: 37718778 DOI: 10.3233/bmr-230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Although mulligan sustained natural apophyseal glides (SNAG) and maitland mobilization (MM) are common interventions for musculoskeletal disease, no study has directly compared the effectiveness of mid-thoracic spine mobilization in subacute stroke patients. OBJECTIVE To investigate the effects of mid-thoracic spine mobilization (SNAG vs. MM) on postural balance and gait ability in subacute stroke patients. METHODS Fifty subacute stroke patients were randomly allocated to the SNAG (n= 17), MM (n= 16), and control (n= 17) groups, each receiving a neuro-developmental therapy program for four successive weeks. The SNAG and MM groups additionally received mid-thoracic spine mobilization (T4∼8). The primary outcome measure was postural sway, and secondary outcome measures included the five times sit-to-stand test (FTSST), functional reach test (FRT), 10-m walk test (10MWT), 6-minute walk test (6MWT) and global rating of change (GRC). RESULTS Participants reported no adverse events, and there was no loss to follow-up. The SNAG and MM group patients demonstrated significant improvements (p< 0.05) in postural sway, FTSST, FRT, 10MWT, and 6MWT compared with those in the control group, with no between-group differences. CONCLUSIONS Mid-thoracic spine mobilization allows significant improvements in postural balance and gait ability in subacute stroke patients, with no differences between the SNAG and MM techniques.
Collapse
Affiliation(s)
- Jinhong Kim
- Rehabilitation Medical Research Center, Korea Worker's Compensation & Welfare Service, Incheon Hospital, Incheon, Korea
| | - Juchul Cho
- Department of Physical Therapy, Daejeon Health Institute of Technology Chungjeong-ro, Dong-gu, Daejeon, Korea
| |
Collapse
|
6
|
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 PMCID: PMC11307017 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.
Collapse
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
| |
Collapse
|
7
|
LeBeau RT, Shaffer S, Earnshaw D. High-dose cervical mobilization to improve central sensitization for a patient with post-fusion neck pain. Physiother Theory Pract 2023; 39:453-460. [PMID: 34895037 DOI: 10.1080/09593985.2021.2015811] [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: 01/19/2023]
Abstract
BACKGROUND Few studies have addressed the appropriate joint mobilization dosage for neck pain. Furthermore, the efficacy of manual therapy in patients with post-spinal fusion neck pain is unreported. CASE DESCRIPTION A 63-year-old man with a 2-year history of unresolved neck pain post-cervical fusion presented to therapy with an exacerbation of neck and left-shoulder pain. The patient presented with cervical impairments of intervertebral hypo-mobility above and below the fusion site. He exhibited a high Numeric Pain Rating Scale (NPRS) score of 8/10 related to his neck pain. Additionally, he demonstrated marked loss of cervical mobility. Indicators of central sensitization were present, including both hyperalgesia and allodynia. High-dose cervical joint mobilization was applied for durations of up to 10 minutes. Corrective exercises were added to improve muscle strength and endurance. Treatment was applied for 12 sessions over 4 months. OUTCOMES At the time of discharge, this patient reported a full recovery of neck function. This treatment reduced pain, improved passive joint accessory motion, and restored upper quarter function. The patient demonstrated a 33-point improvement in his Neck Disability Index (NDI) score and his pain was reduced to 0-1/10 on the NPRS. Markers of central sensitization were resolved. Intervertebral passive accessory joint mobility was pain free in addition to concurrent restoration of functional mobility. CONCLUSION A paucity of evidence exists for appropriate dosage with manual therapy interventions. This case report demonstrates marked improvement of pain and function with the use of high-dose joint mobilization. Improved cervical accessory joint mobility and central pain modulation were achieved with high-dose joint mobilization.
Collapse
Affiliation(s)
- Robert T LeBeau
- College of Health and Human Sciences - Department of Physical Therapy, Northern Illinois University, DeKalb, IL, USA
| | - Stephen Shaffer
- College of Applied Health Sciences - Department of Physical Therapy, University of Illinois at Chicago, Chicago, Il, USA
| | - Darren Earnshaw
- College of Applied Health Sciences - Department of Physical Therapy, University of Illinois at Chicago, Chicago, Il, USA
| |
Collapse
|
8
|
TECAR Therapy Associated with High-Intensity Laser Therapy (Hilt) and Manual Therapy in the Treatment of Muscle Disorders: A Literature Review on the Theorised Effects Supporting Their Use. J Clin Med 2022; 11:jcm11206149. [PMID: 36294470 PMCID: PMC9604865 DOI: 10.3390/jcm11206149] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: It has been estimated that between 30 and 50 per cent of all injuries that take place throughout participation in a sport are the consequence of soft tissue injuries, and muscle injuries are the primary cause of physical disability. Methods: The current literature review was designed between October 2021 and April 2022, according to the PRISMA standards, using the PubMed, Scopus, and Web of Science databases. At the screening stage, we eliminated articles that did not fit into the themes developed in all subchapters of the study (n = 70), articles that dealt exclusively with orthopaedics (n = 34), 29 articles because the articles had only the abstract visible, and 17 articles that dealt exclusively with other techniques for the treatment of musculoskeletal disorders. The initial search revealed 343 titles in the databases, from which 56 duplicate articles were automatically removed, and 2 were added from other sources. Results: The combination of these three techniques results in the following advantages: It increases joint mobility, especially in stiff joints, it increases the range of motion, accelerates tissue repair, improves tissue stability, and extensibility, and it reduces soft tissue inflammation (manual therapy). In addition, it decreases the concentration of pro-inflammatory mediators and improves capillary permeability, resulting in the total eradication of inflammation (HILT). It warms the deep tissues, stimulates vascularity, promotes the repose of tissues (particularly muscle tissue), and stimulates drainage (TECAR). Conclusions: TECAR therapy, combined with manual therapy and High-Intensity Laser therapy in treating muscle diseases, presented optimal collaboration in the recovery process of all muscle diseases.
Collapse
|
9
|
Kang T, Kim B. Cervical and scapula-focused resistance exercise program versus trapezius massage in patients with chronic neck pain: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e30887. [PMID: 36181044 PMCID: PMC9524908 DOI: 10.1097/md.0000000000030887] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/24/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of resistance exercise in comparison with those of common exercise on chronic neck pain (CNP) to provide useful clinical guidelines for reducing pain or increasing cervical range of motion (ROM), upper trapezius tone, disability level, and quality of life (QOL). METHODS The subjects were randomized into a cervical and scapula-focused resistance exercise group (CSREG, n = 21) or trapezius massage group (TMG, n = 20). All groups received a 4-week, five times per week CSRE or TM program for CNP. The visual analogue scale (VAS) score, cervical ROM, myotonometer measures (upper trapezius tone, stiffness, and elasticity), neck disability index (NDI), and short form-36 (SF-36) were identified as the primary outcomes. RESULTS Within-group changes in VAS, cervical ROM, myotonometer measures, NDI, and SF-36 were significant in the CSREG and TMG (P < .05). The between-group changes in VAS, cervical rotation, myotonometer (upper trapezius tone and stiffness), NDI, and SF-36 after intervention showed significant differences between the CSREG and TMG (P < .05). CONCLUSION These results suggest that the CSRE program is effective in improving pain, cervical ROM, upper trapezius tone, disability level, and QOL in patients with CNP. More comprehensive studies with longer follow-up durations are needed to better understand the potential effects of the CSRE program in patients with CNP.
Collapse
Affiliation(s)
- Taewoo Kang
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, Wanju, Republic of Korea
| | - Beomryong Kim
- Department of Physical Therapy, Design Hospital, Jeonju, Republic of Korea
| |
Collapse
|
10
|
Effects of Sling-Based Thoracic Active Exercise on Pain and Function and Quality of Life in Female Patients with Neck Pain: A Randomized Controlled Trial. Healthcare (Basel) 2021; 9:healthcare9111514. [PMID: 34828560 PMCID: PMC8622558 DOI: 10.3390/healthcare9111514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the effects of sling-based thoracic active exercise on pain, function, and quality of life in female patients with neck pain. A total of 27 female patients with neck pain were divided into the sling-based thoracic active exercise group (n = 14) and the control group (n = 13). The study group performed a sling-based thoracic active exercise with cervical manual therapy for 50 min a day, twice a week for 4 weeks, whereas the control group performed a placebo exercise with cervical manual therapy in the same manner as the study group. Evaluation of the degree of pain before and after treatment was based on the pressure pain threshold and numeric pain rating scale scores. The craniovertebral angle and neck disability index (NDI) were used to evaluate neck function, and quality of life was measured using the Short Form-36. Afterwards, the patients’ pressure pain thresholds were significantly increased, and the numeric pain rating scale score was significantly decreased in both groups (p < 0.05). In terms of function, the craniovertebral angle was significantly increased in both groups (p < 0.05), and neck dysfunction significantly decreased (p < 0.05). The quality of life significantly increased in both groups (p < 0.05). The pressure pain threshold, craniovertebral angle, neck dysfunction index, and quality of life scores (p < 0.05) were significantly different between groups, except the numeric pain scale score. Our results showed that sling-based thoracic active exercise is effective in reducing pain and improving function and quality of life in female patients with neck pain, thus emphasizing the need for thoracic treatment for such patients.
Collapse
|
11
|
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.
Collapse
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;
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy. Musculoskelet Sci Pract 2021; 55:102427. [PMID: 34298491 DOI: 10.1016/j.msksp.2021.102427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Upper limb neurodynamic tests (ULNT) are used to diagnose neuropathic conditions such as cervical radiculopathy (CR). Within the literature, a positive ULNT is defined in markedly variable ways, which is likely why the diagnostic accuracy of these tests lacks consistency across studies. OBJECTIVES To determine the diagnostic accuracy of single and combined upper limb neurodynamic tests ((ULNT)1,2a, 2b and 3) for cervical radiculopathy using test findings that are similar to those used in practice. DESIGN Diagnostic accuracy study (prospective) design following the updated STARD 2015 reporting guideline. METHOD From 109 consecutively enrolled individuals with suspected CR. Of the 85 participants included, 27 (31.7%) were diagnosed with CR (mean age, 43.9years; Neck Disability Index 38,16%). ULNTs test were performed by a blind examiner to a CR reference standard of clinical diagnosis and magnetic resonance imaging verification provided by a neurosurgeon. RESULTS In general, the single tests were better at ruling in CR versus ruling out. Of the single ULNT, the ULNT3 demonstrated the strongest post-test probability change with a positive finding (73.28%). Three of four test combinations demonstrated the highest clinical utility for changing the post-test probability with a positive finding at 83.29% and with LR+ = 12.89 (95%CI: 3.10-53.62). Having none of the test's positive was able to rule out CR with LR- = 0.08 (95%CI: 0.01-0.56). CONCLUSION ULNTs fail to significantly alter post-test probability when used singularly for diagnosis of CR. However, combinations of ULNT (3 out of 4 positive) can rule in CR, and rule out CR when all ULNT are negative.
Collapse
|
14
|
Zosel KL, Dummar MK, Adams BG, Henderson NC, Westrick RB. Upper Extremity Superficial Vein Thromboses Presenting as Acute Neck Pain in a Young and Healthy Male: A Case Report. Int J Sports Phys Ther 2021; 16:854-861. [PMID: 34123537 PMCID: PMC8169024 DOI: 10.26603/001c.23429] [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: 07/16/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Neck pain in the United States is pervasive and contributes to disability. While the majority of neck pain in young and healthy individuals is neuromusculoskeletal in nature, screening for red flags is necessary for ruling-out serious medical pathologies. The purpose of this case report is to describe a young and healthy male subject with a primary complaint of acute neck pain with multiple underlying upper extremity superficial vein thromboses (UESVTs). CASE DESCRIPTION The subject was a 27-year-old male active-duty Soldier referred to physical therapy by his primary care provider (PCP) for acute left-sided neck pain. Prior to physical therapy, the subject had been treated with cyclobenzaprine, oxycodone-acetaminophen, trigger point injection and had undergone a D-dimer to rule out a potential thrombus due to air travel and lower extremity immobilization. OUTCOMES The subject underwent a D-dimer, Doppler ultrasound, pharmacological treatment of Rivaroxaban, and was referred to hematology/oncology to rule out systemic causes of SVTs. Evidence of subtle increases in blood pressure over the course of three months, a positive D-dimer, and symptoms incongruent with clinical presentation contributed to referral to a hematology/oncology specialist and a diagnosis of multiple UESVTs. The subject was able to return to his previous level of activity by six months and remained free of SVTs at two-year follow-up. DISCUSSION UESVT events are rare and can be challenging to identify. This case report describes a unique presentation of acute neck pain caused by underlying UESVTs in an otherwise healthy and active young male. LEVEL OF EVIDENCE Level 4.
Collapse
|
15
|
Albornoz-Cabello M, Barrios-Quinta CJ, Espejo-Antúnez L, Escobio-Prieto I, Casuso-Holgado MJ, Heredia-Rizo AM. Immediate clinical benefits of combining therapeutic exercise and interferential therapy in adults with chronic neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2021; 57:767-774. [PMID: 33759439 DOI: 10.23736/s1973-9087.21.06688-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Therapeutic exercise is highly recommended for the management of non-specific neck pain and has shown promising results combined with interferential current therapy. Yet, the clinical relevance of the pooled effect of these approaches remains uncertain. AIM To investigate the immediate clinical effect size of combining therapeutic exercise and interferential therapy, compared with the isolated use of therapeutic exercise, in adults with chronic non-specific neck pain. DESIGN Randomized, single-blinded, controlled, superiority trial. SETTING Outpatients, primary care center. POPULATION Forty-nine adults with chronic non-specific neck pain. METHODS Participants with neck pain (grades I or II) lasting for more than 12 weeks were allocated to a therapeutic exercise plus interferential currents group (n = 25) or to a therapeutic exercise only group (n = 24). All individuals underwent treatment 5 times a week for 2 weeks. The primary outcome was current neck pain intensity (11-point numeric pain rating scale). Secondary outcomes included neck disability (Neck Disability Index) and active cervical range-of-movement (CROM device). Measurements were taken at baseline and immediately after treatment. An intention-to-treat analysis was carried out. To quantify the effect size of the interventions, the relative risk, the absolute and relative risk reduction, and the number needed to treat were calculated. RESULTS A significant time*group effect was found for pain intensity, disability, and neck flexion and right rotation (all, p < 0.05). In the analysis for treatment benefit, the number needed to treat was 2 (95% CI: 2 to 4, p < 0.001) for neck pain and disability, and 3 (95% CI: 2 to 11, p = 0.029) for neck flexion. CONCLUSIONS Adding interferential therapy to therapeutic exercise is clinically more effective than therapeutic exercise alone to immediately improve neck pain and disability, but not active cervical range-of-movement, in adults with persistent neck pain. CLINICAL REHABILITATION IMPACT Our results suggest that this multimodal intervention can be a useful strategy for rehabilitation of patients with non-specific neck pain. This is the first study on this topic reporting findings in terms of clinical relevance, which is key to transfer research evidence into practice.
Collapse
Affiliation(s)
- Manuel Albornoz-Cabello
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapeutics, Faculty of Medicine, Extremadura University, Badajoz, Spain
| | - Isabel Escobio-Prieto
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | - María J Casuso-Holgado
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain -
| | - Alberto M Heredia-Rizo
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| |
Collapse
|
16
|
Moustafa I, Youssef ASA, Ahbouch A, Harrison D. Demonstration of Autonomic Nervous Function and Cervical Sensorimotor Control After Cervical Lordosis Rehabilitation: A Randomized Controlled Trial. J Athl Train 2021; 56:427-436. [PMID: 33543266 DOI: 10.4085/1062-6050-0481.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sagittal-plane cervical spine alignment has emerged as one of the most important clinical outcomes in health care. Nevertheless, the quantity and quality of research on the role that cervical sagittal alignment plays in improving sensorimotor and autonomic nervous functions are limited. OBJECTIVE To investigate the immediate and long-term effects of cervical lordosis restoration and correction of anterior head translation (AHT) on pain, disability, autonomic nervous system function, and cervical sensorimotor control in athletes with chronic nonspecific neck pain. DESIGN Randomized controlled clinical trial. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 110 patients (59 males, 51 females) with chronic nonspecific neck pain and a defined hypolordotic cervical spine and AHT posture. INTERVENTION(S) Patients were randomly assigned to the control or intervention group. Both groups received a multimodal program; the intervention group also received Denneroll cervical traction. Treatments were applied 3 times per week for 10 weeks. MAIN OUTCOME MEASURE(S) Outcome measures were cervical lordosis from C2 to C7, AHT, neck disability index, pain intensity, smooth pursuit neck torsion test, overall stability index, left and right rotation repositioning accuracy, and amplitude and latency of skin sympathetic response. The measures were assessed 3 times: at baseline, after 10 weeks of treatment, and at 1-year follow-up. RESULTS The general linear model with repeated measures indicated group × time effects in favor of the intervention group for the following management outcomes: cervical lordosis, AHT, neck disability index, pain intensity, smooth pursuit neck torsion test, overall stability index, left and right rotation repositioning accuracy, and amplitude and latency of the skin sympathetic response (P values < .001). CONCLUSIONS Restoration of cervical sagittal alignment in the athletic population had a direct influence on pain, disability, autonomic nervous system dysfunction, and sensorimotor control. Our results should guide treatment planning for athletes and optimize their recovery time.
Collapse
Affiliation(s)
- Ibrahim Moustafa
- Department of Physiotherapy, University of Sharjah, United Arab Emirates
| | - Ahmed S A Youssef
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China.,Faculty of Physical Therapy, Beni-Suef University, Egypt
| | - Amal Ahbouch
- Department of Physiotherapy, University of Sharjah, United Arab Emirates
| | | |
Collapse
|
17
|
Pool J, Maissan F, de Waele N, Wittink H, Ostelo R. Completeness of the description of manipulation and mobilisation techniques in randomized controlled trials in neck pain; A review using the TiDieR checklist. Musculoskelet Sci Pract 2020; 45:102098. [PMID: 32056823 DOI: 10.1016/j.msksp.2019.102098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/24/2019] [Accepted: 11/29/2019] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN A secondary analysis of a systematic review. BACKGROUND Manipulations or mobilizations are commonly used interventions in patients with mechanical neck pain. The treatment effects have often been studied in randomized controlled trials (RCT) which are generally considered the gold standard in evaluating the treatment effects, mainly due to its high internal validity. External validity is defined as the extent to which the effects can be generalised to clinical practice. An important prerequisite for this is that interventions used in clinical trials can be replicated in clinical practice. It can be questioned if interventions utilized in randomized controlled trials can be translated into clinical practice. OBJECTIVES The overall aim of this study is to examine whether the quality of the description of manipulation and mobilization interventions is sufficient for to replication of these interventions in clinical practice. METHODS A comprehensive literature search was performed. Two independent researchers used the Template for Intervention Description and Replication (TIDieR) which is a 12-item checklist for describing the completeness of the interventions. RESULTS Sixty-seven articles were included that used manipulation and/or mobilization interventions for patients with mechanical neck pain. None of the articles describe the intervention e.g. all the items on the TIDieR list. Considering item 8 (a-f) of the TIDieR checklist only one article described the used techniques completely. CONCLUSION Manipulation or a mobilization interventions are poorly reported in RCTs, which jeopardize the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions.
Collapse
Affiliation(s)
- Jan Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, the Netherlands.
| | - Francois Maissan
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, the Netherlands; Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | | | - Harriet Wittink
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, the Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VUMC, the Netherlands
| |
Collapse
|
18
|
The effect of treatment regimens on salivary cortisol levels in patients with chronic musculoskeletal disorders. J Bodyw Mov Ther 2020; 24:100-108. [PMID: 31987528 DOI: 10.1016/j.jbmt.2019.10.010] [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] [Received: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Increased levels of circulating cortisol have been associated with pain severity in patients with chronic musculoskeletal disorders (CMD). Little is known about the potential association between pain management and salivary cortisol alterations in CPM patients treated with different regimens. OBJECTIVES This prospective feasibility study aimed to determine the effect of two treatment regimens in comparison with sham therapy on pain intensity and disability and salivary cortisol concentration (SCC) in patients with CMD. METHODS Thirty patients were randomly assigned to 3 groups of 10: two experimental groups (A and B) and a control group (C). The experimental groups followed physiotherapy treatment (A) or acupuncture (B), while the control group (C) followed a sham therapy for 10 sessions. Pain data were collected using the Chronic Pain Grade (CPG) questionnaire and SCC was measured by enzyme-linked immunosorbent assay at pre- and posttreatment. RESULTS Repeated-measures analysis of variance showed that patients treated with acupuncture experienced greater decreases in pain intensity/pain disability (P < 0.05) than the physiotherapy and sham therapy groups. No statistical differences were found between the three groups for the SCC outcome variable. Bonferroni adjustments showed that the mean values of SCC were significantly decreased at posttreatment (P < 0.05) across the three groups. CONCLUSION There was a significant decrease in both pain and cortisol outcomes at posttreatment in patients with CMD. Because of the limitations of this study, we cannot draw conclusions regarding whether the lower SCC could be an indication of pain reduction in patients with CMD.
Collapse
|
19
|
Cho J, Lee E, Lee S. Upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise in individuals with forward head posture: A randomized clinical trial investigating their effectiveness. J Back Musculoskelet Rehabil 2019; 32:595-602. [PMID: 30584118 DOI: 10.3233/bmr-181228] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although commonly utilized treatments, no study has directly compared the effectiveness of joint mobilization and stabilization exercise in individuals with forward head posture (FHP). OBJECTIVE This study aimed to investigate the effects of upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise (DCFE) in individuals with FHP. METHODS Thirty-one participants with FHP were randomized into the mobilization (n= 15) or exercise (n= 16) group. The treatment period was 4 weeks with follow-up assessment at 4 weeks and 6 weeks after the initial examination. Outcomes assessed included the craniovertebral angle (CVA), numeric pain rating scale (NPRS), respiratory function, and the global rating of change (GRC). RESULTS Participants in the mobilization group demonstrated significant improvements (p< 0.05) in CVA, NPRS, and respiratory function, as compared to those in the exercise group. In addition, 9 of 15 (60%) participants in the mobilization group, as compared to 4 of 16 participants (25%) in the exercise group, had a GRC score of +4 or higher. CONCLUSIONS The combination of upper cervical and upper thoracic spine mobilization indicated better overall short-term outcomes in CVA, NPRS, respiratory function, and GRC compared with DCFE in individuals with FHP.
Collapse
Affiliation(s)
- Juchul Cho
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, Korea.,Department of Rehabilitation Medicine, Wellciti Hospital, Daejeon, Korea
| | - Eunsang Lee
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
| |
Collapse
|
20
|
Engell S, Triano JJ, Howarth SJ. Force transmission between thoracic and cervical segments of the spine during prone-lying high-velocity low-amplitude spinal manipulation: A proof of principle for the concept of regional interdependence. Clin Biomech (Bristol, Avon) 2019; 69:58-63. [PMID: 31302490 DOI: 10.1016/j.clinbiomech.2019.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regional interdependence is conceptually based on observations that applying manual therapy to a remote anatomical region has an effect in the area of the patient's primary complaint. The current model for regional interdependence depends on force transmissibility within the body. This investigation sought to determine transmissibility between forces applied to the thoracic spine during prone-lying high-velocity low-amplitude spinal manipulative therapy and the cervical spine. METHODS A chiropractic treatment table was modified to allow (or disallow) translation of the headrest in the caudal-cephalad direction when unlocked (or locked). Prone-lying high-velocity low-amplitude spinal manipulative therapy was applied to the thoracic region of 9 healthy participants with the headrest in both configurations. Head and thorax kinematics and kinetics were measured at interfaces between participant and the external environment, which included the clinician's hands. Compressive forces at the cervicothoracic junction and angular kinematics of the cervical spine were derived. Ratios between the clinician-applied forces (input) and the cervical compressive force (output) were also determined. FINDINGS The cervical spine extended during all high-velocity low-amplitude spinal manipulative therapy trials. Force input-to-output ratios exceeded 1 for high-velocity low-amplitude spinal manipulative therapy trials performed with the headrest in the locked configuration, which was greater than ratios for the unlocked configuration. INTERPRETATION Forces imparted to thoracic spine during high-velocity low-amplitude spinal manipulative therapy were transmitted to the cervical spine, which provided a precursor for the regional interdependence model for manual therapy. Friction between the participant's face and the treatment table's head rest likely amplified cervical compressive forces.
Collapse
Affiliation(s)
- Shawn Engell
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - John J Triano
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| |
Collapse
|
21
|
Lascurain-Aguirrebeña I, Newham DJ, Galindez-Ibarbengoetxea X, Casado-Zumeta X, Lertxundi A, Critchley DJ. Association between sympathoexcitatory changes and symptomatic improvement following cervical mobilisations in participants with neck pain. A double blind placebo controlled trial. Musculoskelet Sci Pract 2019; 42:90-97. [PMID: 31075730 DOI: 10.1016/j.msksp.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND sympathoexcitation observed with passive cervical mobilisations may imply activation of an endogenous pain inhibition system resulting in hypoalgesia. However, research is mostly in asymptomatic participants and there is very limited evidence of a relationship between sympathoexcitation and symptomatic improvement in people with clinical pain. OBJECTIVE to investigate the effects of cervical mobilisations on the sympathetic nervous system in participants with neck pain, and to explore the relationship between symptomatic improvement and sympathoexcitation. DESIGN double-blind randomised controlled trial. METHOD 40 participants with neck pain (aged 20-69 years, 25 female) were randomly allocated to either cervical mobilisations or motionless placebo. Skin conductance was measured before, during, and after intervention. After interventions were completed, their credibility was assessed. Participants were classified as responders or non-responders according to global symptom change. RESULTS participants receiving mobilisations were more likely to be classified as responders (odds ratio: 4.33, p = 0.03) and demonstrated greater change in most outcome measures of sympathoexcitation from baseline to during the intervention but not from during to after the intervention. There was no association between sympathoexcitation and symptomatic improvement. Mobilisations and placebo were equally credible. CONCLUSIONS These findings suggest sympathoexcitatory changes may be caused by an orienting response unrelated to the activation of an endogenous pain inhibition system Alternatively, the observed lack of an association may be explained by the existence of various mechanisms for pain relief. This study used single outcome measures of sympathoexcitation and symptomatic improvement and other measures may reveal different things. CLINICALTRIALS. GOV NUMBER M10/2016/095.
Collapse
Affiliation(s)
- Ion Lascurain-Aguirrebeña
- Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom; Department of Physiology, Faculty of Medicine & Infirmary, University of the Basque Country UPV/EHU, Leioa, 48940, Spain.
| | - Di J Newham
- Centre of Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom.
| | - Xabier Galindez-Ibarbengoetxea
- Department of Physiology, Faculty of Medicine & Infirmary, University of the Basque Country UPV/EHU, Leioa, 48940, Spain.
| | | | - Aitana Lertxundi
- Department of Preventive Medicine and Public Health, University of the Basque Country UPV/EHU, Leioa, 48940, Spain; Health Research Institute, Biodonostia, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - Duncan J Critchley
- Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom.
| |
Collapse
|
22
|
Youssef ASA, Xia N, Emara STE, Moustafa IM, Huang X. Addition of a new three-dimensional adjustable cervical thoracic orthosis to a multi-modal program in the treatment of nonspecific neck pain: study protocol for a randomised pilot trial. Trials 2019; 20:248. [PMID: 31036033 PMCID: PMC6489278 DOI: 10.1186/s13063-019-3337-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 03/30/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nonspecific neck pain (NSNP) is one of the most common musculoskeletal problems treated by orthopaedic physicians and physiotherapists. Posture has emerged as one of the major risk factors associated with NSNP, but most previous studies ignored correct posturing as an effective treatment. Therefore, one of the major challenges faced by clinicians is how to incorporate 3D posture findings into the treatment plane. The present study will evaluate the feasibility of conducting a larger randomized trial. This pilot study is designed to investigate the hypothesis that a multimodal programme supplemented with the addition of a 3D adjustable cervico thoracic posture corrective orthotic (CTPCO) will yield short- and long-term improvement on NSNP management outcomes. METHODS/DESIGN This pilot, single-blind, randomized controlled trial will divide 24 patients into two groups (study and control) using block randomization. Both groups will receive conventional treatment consisting of a moist hot pack, soft tissue mobilization, manual therapy and therapeutic exercise. The study group will undergo ambulatory mirror-image functional re-training wearing a 3D adjustable CTPCO. The primary outcome is feasibility, including recruitment (e.g., time to complete enrolment, recruitment rate), patient retention and adherence to treatment allocation (e.g., session attendance, home practice, use of non-study treatments). The secondary outcomes used to assess the effectiveness of the treatment will include neck pain (measures using the visual analogue scale (VAS)) and neck disability (measures using the neck disability index (NDI)), among other outcome measures, compared between the experimental and control groups. Three-dimensional posture parameters of head measurements will be provided by a Global Posture System (GPS). The outcome measures for determining the treatment effect will be assessed at three intervals: pre-treatment, after 10 weeks of intervention and after 3 months at follow-up. DISCUSSION This randomized controlled pilot trial will inform the design of a future full-scale trial. The outcomes will provide some resources for the incorporation of ambulatory mirror-image functional re-training intervention compared to a control group intervention for neck pain, disability and 3D posture parameters. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov, NCT03331120 . Registered on 22 October 2017.
Collapse
Affiliation(s)
- Ahmed S A Youssef
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jiefang Avenue, Wuhan, 430030, Hubei, China
- Basic science department, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | | | - Ibrahim M Moustafa
- Basic science department, Faculty of Physical Therapy, Cairo University, 7-Mohamed Hassan El-Gamel st, Naser City, Cairo, 002, Egypt.
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE.
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jiefang Avenue, Wuhan, 430030, Hubei, China.
| |
Collapse
|
23
|
Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis. PLoS One 2019; 14:e0211877. [PMID: 30759118 PMCID: PMC6373960 DOI: 10.1371/journal.pone.0211877] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP). Data sources Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018. Study selection Eligible studies were completed RCTs, written in English, had at least 2 groups with one group receiving TSM, had at least one measure of pain or disability, and included patients with MNP of any duration. The search identified 1717 potential articles, with 14 studies meeting inclusion criteria. Study appraisal and synthesis methods Methodological quality was evaluated independently by two authors using the guidelines published by the Cochrane Collaboration. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate mean differences (MD) and 95% confidence intervals for pain (VAS 0-100mm, NPRS 0-10pts; 0 = no pain) and disability (NDI and NPQ 0–100%; 0 = no disability). Results Across the included studies, there was increased risk of bias for inadequate provider and participant blinding. The GRADE approach demonstrated an overall level of evidence ranging from very low to moderate. Meta-analysis that compared TSM to thoracic or cervical mobilization revealed a significant effect favoring the TSM group for pain (MD -13.63; 95% CI: -21.79, -5.46) and disability (MD -9.93; 95% CI: -14.38, -5.48). Meta-analysis that compared TSM to standard care revealed a significant effect favoring the TSM group for pain (MD -13.21; 95% CI: -21.87, -4.55) and disability (MD -11.36; 95% CI: -18.93, -3.78) at short-term follow-up, and a significant effect for disability (MD -4.75; 95% CI: -6.54, -2.95) at long-term follow-up. Meta-analysis that compared TSM to cervical spine manipulation revealed a non-significant effect (MD 3.43; 95% CI: -7.26, 14.11) for pain without a distinction between immediate and short-term follow-up. Limitations The greatest limitation in this systematic review was the heterogeneity among the studies making it difficult to assess the true clinical benefit, as well as the overall level of quality of evidence. Conclusions TSM has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care in the short-term, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability. Trial registration PROSPERO CRD42017068287
Collapse
|
24
|
Lascurain-Aguirrebeña I, Newham DJ, Casado-Zumeta X, Lertxundi A, Critchley DJ. Immediate effects of cervical mobilisations on global perceived effect, movement associated pain and neck kinematics in patients with non-specific neck pain. A double blind placebo randomised controlled trial. Musculoskelet Sci Pract 2018; 38:83-90. [PMID: 30342295 DOI: 10.1016/j.msksp.2018.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Neck pain is prevalent, costly and disabling. Cervical mobilisations are frequently used to treat it but their effectiveness has been questioned by several systematic reviews. Evidence suggests that better outcomes are achieved with mobilisations when they are applied to specific patient subgroups. A criteria for patients suitable for neck mobilisations has been proposed, but the effectiveness on this patient subgroup has not been tested. OBJECTIVE To assess the effectiveness of cervical mobilisations applied to a subgroup of patients with neck pain who fulfil specific criteria. DESIGN Randomised controlled trial. METHOD 40 patients with neck pain attending a Physiotherapy clinic were recruited and randomised to a single session of either cervical mobilisations or motionless manual contact placebo. The immediate effects on global perceived effect, range of movement (ROM), movement velocity and movement associated pain were assessed. RESULTS mobilisation participants reported significantly better global perceived effect (p˂0.001) and improvements in movement associated pain (p = 0.041). Mobilisations produced a significant increase in ROM in side flexion (p = 0.006) and rotation (p = 0.044) when compared with placebo, but only in patients with pre-intervention ROM restriction. 29-47% of all movement associated pains were resolved following mobilisations and 11-27% following placebo. Patients in both groups showed a significant (p < 0.05) increase in movement velocity, but only in those who had a velocity restriction pre-intervention. CONCLUSIONS Cervical mobilisations are effective in improving movement-associated pain, increasing ROM and velocity, and patient perceived improvement when applied to patients with neck pain that fulfil a criteria. Their use should be advocated.
Collapse
Affiliation(s)
- Ion Lascurain-Aguirrebeña
- Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom; Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, 48940, Spain.
| | - Di J Newham
- Centre of Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom.
| | | | - Aitana Lertxundi
- Department of Preventive Medicine and Public Health, University of the Basque Country UPV/EHU, Leioa, 48940, Spain; Health Research Institute, Biodonostia, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - Duncan J Critchley
- Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom.
| |
Collapse
|
25
|
López-de-Uralde-Villanueva I, Beltran-Alacreu H, Fernández-Carnero J, La Touche R. Pain management using a multimodal physiotherapy program including a biobehavioral approach for chronic nonspecific neck pain: a randomized controlled trial. Physiother Theory Pract 2018; 36:45-62. [PMID: 29889599 DOI: 10.1080/09593985.2018.1480678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: To determine the effectiveness of a therapeutic patient education (TPE) intervention based on a biobehavioral approach combined with manual therapy (MT) to reduce pain in patients with chronic nonspecific neck pain (CNSNP). In addition, this study intended to assess the effectiveness of a multimodal physiotherapy program including TPE to reduce pain in patients with CNSNP. Design: Single-blind randomized controlled trial. Interventions: A total of 47 patients with CNSNP were randomized into three groups: (1) MT (control group); (2) MT plus TPE based on a biobehavioral approach (Exp1); and (3) MT plus TPE based on a biobehavioral approach, and therapeutic exercise (Exp2). Main Outcome Measurements: The clinical outcomes were recorded at baseline and at 1 and 4 months after the initiation of treatment. The primary outcome was pain intensity (Visual Analog Scale), and the secondary outcomes were pain catastrophizing (Pain Catastrophizing Scale), illness severity and global improvement (Clinical Global Impression Scale), and mechanosensitivity of the median nerve (Upper Limb Neural Test) and the cervical region (Modified Passive Neck Flexion Test). Results: Statistically significant differences in pain intensity were found when Exp2 was compared with Exp1 and the control group at 4 months (p = 0.015 and p = 0.001, respectively), but no difference was found between Exp1 and the control group at the same follow-up period (p = 0.86). Exp2 showed statistically significant differences in all of the secondary outcomes except for pain catastrophizing when compared with the control group at 4 months. Conclusions: The Exp2 group was more effective than Exp1 and the control group in terms of reducing pain intensity at 4 months; at post-treatment, only Exp2 was more effective than the control group.
Collapse
Affiliation(s)
- Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Hector Beltran-Alacreu
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Roy La Touche
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| |
Collapse
|
26
|
Anwer S, Alghadir A, Zafar H, Brismée JM. Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy 2018; 104:264-276. [PMID: 30030035 DOI: 10.1016/j.physio.2018.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/28/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This systematic review to aimed to evaluate the effects of orthopaedic manual therapy (OMT) on pain, improving function, and physical performance in patients with knee osteoarthritis (OA). DATA SOURCES Four databases (PubMed, Web of Science, CENTRAL, and CINAHL) were searched. STUDY SELECTION Trials were required to compare OMT alone or OMT in combination with exercise therapy, with exercise therapy alone or control. DATA EXTRACTION Data extraction and risk assessment were done by two independent reviewers. Outcome measures were visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, WOMAC function score, WOMAC global score, and stairs ascending-descending time. RESULTS Eleven randomized controlled trials were included (494 subjects), four of which had a PEDro score of 6 or higher, indicating adequate quality. The results of the meta-analysis indicated that reduction of VAS score in OMT compared with the control group was statistically insignificant (SDM: -0.59; 95% CI: -1.54 to -0.36; P=0.224). The reduction of VAS score in OMT compared with exercise therapy group was statistically significant (SDM: -0.78; 95% CI: -1.42 to -0.17; P=0.013). The reduction of WOMAC pain score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.79; 95% CI: -1.14 to -0.43; P=0.001). Similarly, the reduction of WOMAC function score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.85; 95% CI: -1.20 to -0.50; P=0.001). However, the reduction of WOMAC global score in OMT compared with the exercise therapy group was statistically insignificant (SDM: -0.23; 95% CI: -0.54 to -0.09; P=0.164). The reduction of stairs ascending-descending time in OMT compared with the exercise therapy group was statistically significant (SDM: -0.88; 95% CI: -1.48 to -0.29; P=0.004). CONCLUSIONS This review indicated OMT compared with exercise therapy alone provides short-term benefits in reducing pain, improving function, and physical performance in patients with knee OA. REVIEW REGISTRATION PROSPERO 2016:CRD42016032799.
Collapse
Affiliation(s)
- Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmad Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Hamayun Zafar
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| |
Collapse
|
27
|
Maissan F, Pool J, de Raaij E, Mollema J, Ostelo R, Wittink H. The clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete: A systematic review. Musculoskelet Sci Pract 2018; 35:8-17. [PMID: 29413949 DOI: 10.1016/j.msksp.2018.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Primarily to evaluate the completeness of the description of the clinical reasoning process in RCTs with patients with non-specific neck pain with an argued or diagnosed cause i.e. an impairment or activity limitation. Secondly, to determine the association between the completeness of the clinical reasoning process and the degree of risk of bias. DATA SOURCES Pubmed, Cinahl and PEDro were systematically searched from inception to July 2016. STUDY SELECTION RCTs (n = 122) with patients with non-specific neck pain receiving physiotherapy treatment published in English were included. DATA EXTRACTION Data extraction included study characteristics and important features of the clinical reasoning process based on the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II)]. DATA SYNTHESIS Thirty-seven studies (30%) had a complete clinical reasoning process of which 8 (6%) had a 'diagnosed cause' and 29 (24%) had an 'argued cause'. The Spearmans rho association between the extent of the clinical reasoning process and the risk of bias was -0.2. CONCLUSIONS In the majority of studies (70%) the described clinical reasoning process was incomplete. A very small proportion (6%) had a 'diagnosed cause'. Therefore, a better methodological quality does not necessarily imply a better described clinical reasoning process.
Collapse
Affiliation(s)
- Francois Maissan
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands; Department of Health Sciences, VU University, Amsterdam, The Netherlands; Amsterdam Movement Sciences, The Netherlands.
| | - Jan Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Edwin de Raaij
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands; Department of Health Sciences, VU University, Amsterdam, The Netherlands; Amsterdam Movement Sciences, The Netherlands
| | - Jürgen Mollema
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, VU University, Amsterdam, The Netherlands; Amsterdam Movement Sciences, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| |
Collapse
|
28
|
Pragmatically Applied Cervical and Thoracic Nonthrust Manipulation Versus Thrust Manipulation for Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2018; 48:137-145. [PMID: 29406835 DOI: 10.2519/jospt.2018.7738] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Randomized clinical trial. Background The comparative effectiveness between nonthrust manipulation (NTM) and thrust manipulation (TM) for mechanical neck pain has been investigated, with inconsistent results. Objective To compare the clinical effectiveness of concordant cervical and thoracic NTM and TM for patients with mechanical neck pain. Methods The Neck Disability Index (NDI) was the primary outcome. Secondary outcomes included the Patient-Specific Functional Scale (PSFS), numeric pain-rating scale (NPRS), deep cervical flexion endurance (DCF), global rating of change (GROC), number of visits, and duration of care. The covariate was clinical equipoise for intervention. Outcomes were collected at baseline, visit 2, and discharge. Patients were randomly assigned to receive either NTM or TM directed at the cervical and thoracic spines. Techniques and dosages were selected pragmatically and applied to the most symptomatic level. Two-way mixed-model analyses of covariance were used to assess clinical outcomes at 3 time points. Analyses of covariance were used to assess between-group differences for the GROC, number of visits, and duration of care at discharge. Results One hundred three patients were included in the analyses (NTM, n = 55 and TM, n = 48). The between-group analyses revealed no differences in outcomes on the NDI (P = .67), PSFS (P = .26), NPRS (P = .25), DCF (P = .98), GROC (P = .77), number of visits (P = .21), and duration of care (P = .61) for patients with mechanical neck pain who received either NTM or TM. Conclusion NTM and TM produce equivalent outcomes for patients with mechanical neck pain. The trial was registered with ClinicalTrials.gov (NCT02619500). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2018;48(3):137-145. Epub 6 Feb 2018. doi:10.2519/jospt.2018.7738.
Collapse
|
29
|
Meziat-Filho N, Lima M, Fernandez J, Reis FJ. Cognitive Functional Therapy (CFT) for chronic non-specific neck pain. J Bodyw Mov Ther 2018; 22:32-36. [DOI: 10.1016/j.jbmt.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 11/25/2022]
|
30
|
Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculoskelet Disord 2017; 18:525. [PMID: 29233164 PMCID: PMC5727966 DOI: 10.1186/s12891-017-1889-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/01/2017] [Indexed: 01/27/2023] Open
Abstract
Background Although upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP. Methods Thirty-two participants with FHP were randomized into the cervical group or the thoracic group. The treatment period was 4 weeks, with follow-up assessment at 4 and 6 weeks after the initial examination. Outcome measures including the craniovertebral angle (CVA), cervical range of motion, numeric pain rating scale (NPRS), pressure pain threshold, neck disability index (NDI), and global rating of change (GRC) were collected. Data were examined with a two-way repeated-measures analysis of variance (group × time). Results Participants in the thoracic group demonstrated significant improvements (p < .05) in CVA, cervical extension, NPRS, and NDI at the 6-week follow-up compared with those in the cervical group. In addition, 11 of 15 (68.8%) participants in the thoracic group compared with 8 of 16 participants (50%) in the cervical group showed a GRC score of +4 or higher at the 4-week follow-up. Conclusions The combination of upper thoracic spine mobilization and mobility exercise demonstrated better overall short-term outcomes in CVA (standing position), cervical extension, NPRS, NDI, and GRC compared with upper cervical spine mobilization and stabilization exercise in individuals with FHP. Trial registration KCT0002307, April 11, 2017 (retrospectively registered).
Collapse
Affiliation(s)
- Juchul Cho
- Department of Physical Therapy, Graduate School of Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, South Korea
| | - Eunsang Lee
- Department of Physical Therapy, Graduate School of Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, South Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, South Korea.
| |
Collapse
|
31
|
Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Back Musculoskelet Rehabil 2017; 30:1149-1169. [PMID: 28826164 PMCID: PMC5814665 DOI: 10.3233/bmr-169615] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To review and update the evidence for different forms of manual therapy (MT) and exercise for patients with different stages of non-specific neck pain (NP). DATA SOURCES MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE. METHOD A qualitative systematic review covering a period from January 2000 to December 2015 was conducted according to updated-guidelines. Specific inclusion criteria only on RCTs were used; including differentiation according to stages of NP (acute - subacute [ASNP] or chronic [CNP]), as well as sub-classification based on type of MT interventions: MT1 (HVLA manipulation); MT2 (mobilization and/or soft-tissue-techniques); MT3 (MT1 + MT2); and MT4 (Mobilization-with-Movement). In each sub-category, MT could be combined or not with exercise and/or usual medical care. RESULTS Initially 121 studies were identified for potential inclusion. Based on qualitative and quantitative evaluation criteria, 23 RCTs were identified for review. Evidence for ASNP: MODERATE-evidence: In favour of (i) MT1 to the cervical spine (Cx) combined with exercises when compared to MT1 to the thoracic spine (Tx) combined with exercises; (ii) MT3 to the Cx and Tx combined with exercise compared to MT2 to the Cx with exercise or compared to usual medical care for pain and satisfaction with care from short to long-term. Evidence for CNP: STRONG-evidence: Of no difference of efficacy between MT2 at the symptomatic Cx level(s) in comparison to MT2 on asymptomatic Cx level(s) for pain and function. MODERATE to STRONG-evidence: In favour of MT1 and MT3 on Cx and Tx with exercise in comparison to exercise or MT alone for pain, function, satisfaction with care and general-health from short to moderate-terms. MODERATE-evidence: In favour (i) of MT1 as compared to MT2 and MT4, all applied to the Cx, for neck mobility, and pain in the very short term; (ii) of MT2 using sof-tissue-techniques to the Cx and Tx or MT3 to the Cx and Tx in comparison to no-treatment in the short-term for pain and disability. CONCLUSION This systematic review updates the evidence for MT combined or not with exercise and/or usual medical care for different stages of NP and provides recommendations for future studies. Two majors points could be highlighted, the first one is that combining different forms of MT with exercise is better than MT or exercise alone, and the second one is that mobilization need not be applied at the symptomatic level(s) for improvements of NP patients. These both points may have clinical implications for reducing the risk involved with some MT techniques applied to the cervical spine.
Collapse
Affiliation(s)
- Benjamin Hidalgo
- Faculty of Motor Sciences at Université Catholique de Louvain-La-Neuve, Louvain, Belgium,High School Parnasse ISEI, Brussels, Belgium,Neuro Musculo Skeletal Lab (NMSK-UCL), Brussels, Belgium,Corresponding author: Benjamin Hidalgo, NMSK Lab, Pasteur
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Jean Bossert
- Faculty of Motor Sciences at Université Catholique de Louvain-La-Neuve, Louvain, Belgium
| | - Axel Dugeny
- Faculty of Motor Sciences at Université Catholique de Louvain-La-Neuve, Louvain, Belgium
| | - Barbara Cagnie
- Department of Rehabiliation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Laurent Pitance
- Faculty of Motor Sciences at Université Catholique de Louvain-La-Neuve, Louvain, Belgium,Neuro Musculo Skeletal Lab (NMSK-UCL), Brussels, Belgium
| |
Collapse
|
32
|
Gorrell LM, Brown B, Lystad RP, Engel RM. Predictive factors for reporting adverse events following spinal manipulation in randomized clinical trials - secondary analysis of a systematic review. Musculoskelet Sci Pract 2017; 30:34-41. [PMID: 28521180 DOI: 10.1016/j.msksp.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/11/2017] [Accepted: 05/08/2017] [Indexed: 02/09/2023]
Abstract
While spinal manipulative therapy (SMT) is recommended for the treatment of spinal disorders, concerns exist about adverse events associated with the intervention. Adequate reporting of adverse events in clinical trials would allow for more accurate estimations of incidence statistics through meta-analysis. However, it is not currently known if there are factors influencing adverse events reporting following SMT in randomized clinical trials (RCTs). Thus our objective was to investigate predictive factors for the reporting of adverse events in published RCTs involving SMT. The Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCTs involving SMT. Domains of interest included: sample size; publication date relative to the 2010 CONSORT statement; risk of bias; the region treated; and number of intervention sessions. 7398 records were identified, of which 368 articles were eligible for inclusion. A total of 140 (38.0%) articles reported on adverse events. Articles were more likely to report on adverse events if they possessed larger sample sizes, were published after the 2010 CONSORT statement, had a low risk of bias and involved multiple intervention sessions. The region treated was not a significant predictor for reporting on adverse events. Predictors for reporting on adverse events included larger sample size, publication after the 2010 CONSORT statement, low risk of bias and trials involving multiple intervention sessions. We recommend that researchers focus on developing robust methodologies and participant follow-up regimens for RCTs involving SMT.
Collapse
Affiliation(s)
- Lindsay M Gorrell
- Human Performance Laboratory, KNB 222, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, T2N 1N4, Canada.
| | - Benjamin Brown
- Department of Chiropractic, Macquarie University, Building C5C West, Sydney, 2109, Australia.
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, NSW, 2109, Australia.
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Building C5C West, Sydney, 2109, Australia.
| |
Collapse
|
33
|
Collins CK, Masaracchio M, Brismée JM. The future of orthopedic manual therapy: what are we missing? J Man Manip Ther 2017; 25:169-171. [PMID: 28912628 DOI: 10.1080/10669817.2017.1358249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Jean-Michel Brismée
- Editor-in-Chief, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| |
Collapse
|
34
|
Additional Effect of Static Ultrasound and Diadynamic Currents on Myofascial Trigger Points in a Manual Therapy Program for Patients With Chronic Neck Pain. Am J Phys Med Rehabil 2017; 96:243-252. [DOI: 10.1097/phm.0000000000000595] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Lee KS, Lee JH. Effect of maitland mobilization in cervical and thoracic spine and therapeutic exercise on functional impairment in individuals with chronic neck pain. J Phys Ther Sci 2017; 29:531-535. [PMID: 28356648 PMCID: PMC5361027 DOI: 10.1589/jpts.29.531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/14/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study evaluated joint mobilization and therapeutic exercise applied to the
cervical spine and upper thoracic spine for functional impairment caused by chronic neck
pain. [Subjects and Methods] Eighteen study subjects were randomly assigned to two groups
of nine people each. Therapeutic exercise only was applied to the cervical and upper
thoracic spine for Group I, while both therapeutic exercise and joint mobilization were
applied to Group II. The visual analog scale, neck disability index, active cervical range
of motion, static balance capacity, and muscle tone were assessed with a pre-test. The
intervention was carried out for 60 minutes a day, three times a week, for two weeks for
each group, followed by a post-test using the same protocol as the pre-test. [Results] The
visual analog scale, neck disability index, and active cervical range of motion improved
significantly in both groups. Group II improved significantly more on right lateral
flexion and rightward rotation. Muscle tone improved significantly in the upper trapezius
in both groups. [Conclusion] The joint mobilization and therapeutic exercise for
functional impairments caused by chronic neck pain had a significant effect on several
types of functional impairment.
Collapse
Affiliation(s)
- Keun-Su Lee
- Department of Physical Therapy, Graduate School of Health Sciences, Cheongju University, Republic of Korea
| | - Joon-Hee Lee
- Department of Physical Therapy, Cheongju University, Republic of Korea
| |
Collapse
|
36
|
Rose T, Butler J, Salinas N, Stolfus R, Wheatley T, Schenk R. Measurement of outcomes for patients with centralising versus non-centralising neck pain. J Man Manip Ther 2016; 24:264-268. [PMID: 27956819 DOI: 10.1179/2042618615y.0000000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The purpose of this study is to determine whether individuals with neck pain who demonstrate centralisation of symptoms have more favourable outcome than individuals who do not demonstrate centralisation. METHODS Eleven subjects with neck pain were evaluated and treated by two physical therapists certified in Mechanical Diagnosis and Therapy (MDT). Eleven physical therapy patients underwent a routine initial evaluation and were treated 2-3 times per week using MDT principles and other physical therapy interventions. The Neck Disability Index (NDI) tool was administered at the initial examination, approximately 2 weeks following the initial examination, each subsequent re-evaluation, and at discharge from the study to measure changes in functional outcomes for each subject. Patients continued with treatments until they were discharged or removed from the study. Four subjects were referred back to their physician by treating physical therapist secondary to non-centralisation (NC) and worsening of symptoms. RESULTS Of the 11 subjects, six demonstrated centralisation (CEN) and five demonstrated NC. At initial evaluation, the average NDI score for the CEN group was 51.0 (SD ± 19.4) and 56.4 (SD ± 17.6) for the NC group. For the CEN group, the average change in NDI score between initial evaluation and discharge was 41.2 (SD ± 13.2 and 12.2 (SD ± 13.0) for the NC group. The correlation coefficient of CEN and change in NDI score was 0.772 and was statistically significant (P = 0.005). CONCLUSIONS In this limited sample, people with neck pain demonstrated more favourable outcomes when the CEN phenomenon was observed. Future research on CEN should be investigated with a larger sample size and with a greater number of clinicians trained in the MDT approach.
Collapse
Affiliation(s)
| | | | | | - Ryan Stolfus
- Department of Physical Therapy, Daemen College, USA
| | | | - Ron Schenk
- Department of Physical Therapy, Daemen College, USA
| |
Collapse
|
37
|
Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G, Carroll LJ, Ameis A, Ammendolia C, Brison R, Nordin M, Stupar M, Taylor-Vaisey A. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J 2016; 16:1598-1630. [PMID: 26707074 DOI: 10.1016/j.spinee.2015.08.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 06/05/2015] [Accepted: 08/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). PURPOSE This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD. STUDY DESIGN/SETTING This is a systematic review and best evidence synthesis. SAMPLE The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention. OUTCOME MEASURES The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events. METHODS We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention's stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance. RESULTS We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I-II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I-II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I-II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits. CONCLUSIONS Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.
Collapse
Affiliation(s)
- Jessica J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Department of Graduate Studies, Canadian Memorial Chiropractic College.
| | - Heather M Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC)
| | - Silvano Mior
- Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC)
| | - Craig Jacobs
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Pierre Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT); Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT)
| | - Kristi Randhawa
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Danielle Southerst
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital
| | - Sharanya Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC); Division of Clinical Education, Canadian Memorial Chiropractic College, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative; Leslie Dan Faculty of Pharmacy, University of Toronto; Institute for Work and Health
| | - Linda J Carroll
- Alberta Centre for Injury Control and Research and School of Public Health, University of Alberta
| | - Arthur Ameis
- Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal
| | - Carlo Ammendolia
- Institute for Work and Health; Institute for Health Policy, Management and Evaluation, University of Toronto
| | - Robert Brison
- Clinical Research, Kingston General Hospital; Department of Emergency Medicine, School of Medicine, Queen's University
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University
| | - Maja Stupar
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC)
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC)
| |
Collapse
|
38
|
Bussières AE, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Hayden J, Hendrickson B, Hincapié C, Pagé I, Passmore S, Srbely J, Stupar M, Weisberg J, Ornelas J. The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther 2016; 39:523-564.e27. [DOI: 10.1016/j.jmpt.2016.08.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/14/2016] [Accepted: 08/10/2016] [Indexed: 12/25/2022]
|
39
|
Wall BA, Peiffer JJ, Losco B, Hebert JJ. The effect of manual therapy on pulmonary function in healthy adults. Sci Rep 2016; 6:33244. [PMID: 27616562 PMCID: PMC5019001 DOI: 10.1038/srep33244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/23/2016] [Indexed: 11/09/2022] Open
Abstract
Manual therapy is suggested as a potentially therapeutic intervention that may improve pulmonary function. However, this form of therapy is largely based on clinical observations and hypothetical models rather than mechanistic knowledge. This study examined the influence of a single session of manual therapy applied to the thoracic spine and thorax on dynamic pulmonary function over an extended time frame in healthy adults. 21 healthy individuals (14 males) aged 19-35 (mean [SD] age = 23 [3.9], BMI [SD] = 22.97 [2.41]) completed one experimental testing session consisting of five pulmonary function tests and the delivery of a manual therapy intervention. Pulmonary function was measured at baseline and 1 minute, 10 minutes, 20 minutes and 30 minutes following the intervention. Baseline mean (SD) forced vital capacity (FVC), forced expired volume in 1 second (FEV1) and maximal voluntary ventilation (MVV) were 5.55(1.23 L), 4.64(0.92 L) and 165.7(40.0L min(-1)) respectively. The mean (SD) FEV1/FVC ratio was 0.84(0.07). There were no statistically significant changes in any of the pulmonary function measures following the manual therapy intervention. Our findings do not support the use of manual therapy to provide a short-term benefit in respiratory function to healthy adults.
Collapse
Affiliation(s)
- Bradley A Wall
- School of Psychology and Exercise Science, Murdoch University, Murdoch, 6150, Australia
| | - Jeremiah J Peiffer
- School of Psychology and Exercise Science, Murdoch University, Murdoch, 6150, Australia
| | - Barrett Losco
- School of Health Professions, Murdoch University, Murdoch, 6150, Australia
| | - Jeffrey J Hebert
- School of Psychology and Exercise Science, Murdoch University, Murdoch, 6150, Australia.,Faculty of Kinesiology, University of New Brunswick, Fredericton, E3B 5A3, Canada
| |
Collapse
|
40
|
Moustafa IM, Diab AA, Taha S, Harrison DE. Addition of a Sagittal Cervical Posture Corrective Orthotic Device to a Multimodal Rehabilitation Program Improves Short- and Long-Term Outcomes in Patients With Discogenic Cervical Radiculopathy. Arch Phys Med Rehabil 2016; 97:2034-2044. [PMID: 27576192 DOI: 10.1016/j.apmr.2016.07.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the immediate and 1-year effects of a multimodal program, with cervical lordosis and anterior head translation (AHT) rehabilitation, on the intensity of pain, disability, and peripheral and central nervous system function in patients with discogenic cervical radiculopathy (CR). DESIGN A randomized controlled trial with 1-year and 10-week follow-up. SETTING University research laboratory. PARTICIPANTS Patients (N=60; 27 men) with chronic discogenic CR, a defined hypolordotic cervical spine, and AHT posture were randomly assigned to a control group (n=30; mean age, 43.9±6.2y) or an intervention group (n=30; mean age, 41.5±3.7y). INTERVENTIONS Both groups received the multimodal program; in addition, the intervention group received the Denneroll cervical traction device. MAIN OUTCOME MEASURES AHT distance, cervical lordosis, arm pain intensity, neck pain intensity, and disability (Neck Disability Index [NDI]), dermatomal somatosensory evoked potentials (DSSEPs), and central somatosensory conduction time (N13-N20). Measures were assessed at 3 time intervals: baseline, 10 weeks, and 1-year follow-up. RESULTS After 10 weeks of treatment, between-group analysis showed equal improvement in arm pain intensity (P=.40), neck pain intensity (P=.60), and latency of DSSEPs (P=.60) in both intervention and control groups. However, also at 10 weeks, there were significant differences between groups, favoring the intervention group for cervical lordosis (P<.0005), AHT distance (P<.0005), amplitude of DSSEPs (P<.0005), N13 to N20 conduction time (P<.0005), and NDI (P<.0005). Although at 1-year follow-up, between-group analysis identified a regression back to baseline values for the control group. Thus, all variables were significantly different, favoring the intervention group at 1-year follow-up: cervical lordosis (P<.0005), AHT distance (P<.0005), latency and amplitude of DSSEPs (P<.0005), N13 to N20 conduction time (P<.0005), intensity of neck and arm pain, and NDI (P<.0005). CONCLUSIONS The addition of the Denneroll cervical orthotic device to a multimodal program positively affected discogenic CR outcomes at long-term follow-up. We speculate that improved cervical lordosis and reduced AHT contributed to our findings.
Collapse
Affiliation(s)
- Ibrahim M Moustafa
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
| | - Aliaa A Diab
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Shimaa Taha
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | |
Collapse
|
41
|
Hazle CR, Lee M. Strategies to overcome size and mechanical disadvantages in manual therapy. J Man Manip Ther 2016; 24:120-7. [PMID: 27559282 DOI: 10.1080/10669817.2015.1119371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The practice of manual therapy (MT) is often difficult when providing care for large patients and for practitioners small in stature or with other physical limitations. Many MT techniques can be modified using simple principles to require less exertion, permitting consistency with standards of practice even in the presence of physical challenges. Commonly used MT techniques are herein described and demonstrated with alternative preparatory and movement methods, which can also be adopted for use in other techniques. These alternative techniques and the procedures used to adapt them warrant discussion among practitioners and educators in order to implement care, consistent with the best treatment evidence for many common musculoskeletal (MSK) conditions. The inclusion in educational curricula and MT training programs is recommended to enrich skill development in physical therapists (PTs), spanning entry-level practitioners to those pursuing advanced manual skills.
Collapse
Affiliation(s)
- Charles R Hazle
- Division of Physical Therapy, University of Kentucky, Lexington & Hazard, KY, USA
| | - Matthew Lee
- KORT-Nicholasville, Kentucky Orthopedic Rehab Team, Nicholasville, KY, USA
| |
Collapse
|
42
|
Sault JD, Emerson Kavchak AJ, Tow N, Courtney CA. Regional effects of orthopedic manual physical therapy in the successful management of chronic jaw pain. Cranio 2016; 34:124-32. [DOI: 10.1179/2151090314y.0000000039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
43
|
|
44
|
Utilization and Payments of Office-Based Physical Rehabilitation Services Among Individuals With Commercial Insurance in New York State. Phys Ther 2016; 96:202-11. [PMID: 26658150 DOI: 10.2522/ptj.20150060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 12/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited research exists on the utilization and payments of physical rehabilitation services, especially among individuals with commercial insurance. OBJECTIVE This study aimed to characterize the utilization and payments of office-based physical rehabilitation services among nonelderly individuals with commercial insurance from New York State. DESIGN This was a retrospective descriptive study with a cross-sectional design. METHODS A cohort of 1.8 million individuals in the 2012 Truven Health MarketScan Research Database was constructed for review. A total of 109,821 unique patients who received any type of physical rehabilitation provided by physical therapists, chiropractors, and physicians in the office setting were included for analyses. RESULTS Physical therapists provided the largest proportion of physical rehabilitation services (54.5%), followed by chiropractors (27.5%) and physicians (18.0%). Six out of 100 individuals used physical rehabilitation services in 2012. The mean annual payment of physical rehabilitation per patient was $820 (median=$323). Women and older individuals were more likely to use rehabilitation services and have higher annual utilization and payments. For the 5 most common physical rehabilitation services, payment rates for chiropractors were the highest and those for physical therapists were the lowest, with payment rates for physicians in between. LIMITATIONS This study was based on commercial insurance claims data from one state. CONCLUSIONS Findings from this study recognize that rehabilitation services are delivered by various types of health care professionals and the payment rates vary across provider specialties in New York State. Of particular interest is that although physical therapists provide the largest proportion of services, their payment rates are lower than the rates for chiropractors and physicians. Future research should assess regional variations and explore interprovider cost-effectiveness in delivering these interventions.
Collapse
|
45
|
Celenay ST, Kaya DO, Akbayrak T. Cervical and scapulothoracic stabilization exercises with and without connective tissue massage for chronic mechanical neck pain: A prospective, randomised controlled trial. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.math.2015.07.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
46
|
Beltran-Alacreu H, Lopez-de-Uralde-Villanueva I, La Touche R. Multimodal Physiotherapy Based on a Biobehavioral Approach as a Treatment for Chronic Tension-Type Headache: A Case Report. Anesth Pain Med 2015; 5:e32697. [PMID: 26705532 PMCID: PMC4688818 DOI: 10.5812/aapm.32697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 09/20/2015] [Accepted: 10/11/2015] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Tension-type headache (TTH) is the most common primary headache affecting the general population, which is characterized by bilateral headache and mild to moderate pain. This disorder causes high levels of disability and recent scientific evidence suggests that manual therapy (MT) and therapeutic exercise are effective in reducing medication intake and decreasing the frequency and intensity of headaches in patients with TTH. CASE PRESENTATION A 34-year-old woman was known to have chronic TTH. Initially, the patient presented moderate headaches 5 days per week, mechanical neck pain and no positive response to analgesics. A battery of self-reports was given to the patient to assess disability (using the Spanish versions of the Headache Impact Test-6 and the neck disability index), pain (visual analogue scale) and psychosocial issues (Spanish version of the pain catastrophizing scale) involved in the headaches. All measurements were taken four times during 161 days. Eleven sessions of treatment including MT, motor control therapeutic exercise (MCTE) and therapeutic patient education (TPE) were applied. CONCLUSIONS This biobehavioral-based multimodal physical rehabilitation treatment combining MT, TPE and MCTE produced a substantial reduction in pain intensity, pain catastrophizing, disability and the impact of headaches on patient's life.
Collapse
Affiliation(s)
- Hector Beltran-Alacreu
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain
- Research Group on Movement and Behavioural Science and Study of Pain, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Ibai Lopez-de-Uralde-Villanueva
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain
- Research Group on Movement and Behavioural Science and Study of Pain, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Roy La Touche
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain
- Research Group on Movement and Behavioural Science and Study of Pain, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Corresponding author: Roy La Touche, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain. Tel: +34-917401980, Fax: +34-913571730, E-mail:
| |
Collapse
|
47
|
Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain. Am J Phys Med Rehabil 2015; 94:887-97. [DOI: 10.1097/phm.0000000000000293] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
48
|
Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, Faber-Dobrescu M, Andres C, Graham N, Goldsmith CH, Brønfort G, Hoving JL, LeBlanc F. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015; 2015:CD004249. [PMID: 26397370 PMCID: PMC10883412 DOI: 10.1002/14651858.cd004249.pub4] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Manipulation and mobilisation are commonly used to treat neck pain. This is an update of a Cochrane review first published in 2003, and previously updated in 2010. OBJECTIVES To assess the effects of manipulation or mobilisation alone compared wiith those of an inactive control or another active treatment on pain, function, disability, patient satisfaction, quality of life and global perceived effect in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up. When appropriate, to assess the influence of treatment characteristics (i.e. technique, dosage), methodological quality, symptom duration and subtypes of neck disorder on treatment outcomes. SEARCH METHODS Review authors searched the following computerised databases to November 2014 to identify additional studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies. We updated this search in June 2015, but these results have not yet been incorporated. SELECTION CRITERIA Randomised controlled trials (RCTs) undertaken to assess whether manipulation or mobilisation improves clinical outcomes for adults with acute/subacute/chronic neck pain. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs). MAIN RESULTS We included 51 trials (2920 participants, 18 trials of manipulation/mobilisation versus control; 34 trials of manipulation/mobilisation versus another treatment, 1 trial had two comparisons). Cervical manipulation versus inactive control: For subacute and chronic neck pain, a single manipulation (three trials, no meta-analysis, 154 participants, ranged from very low to low quality) relieved pain at immediate- but not short-term follow-up. Cervical manipulation versus another active treatment: For acute and chronic neck pain, multiple sessions of cervical manipulation (two trials, 446 participants, ranged from moderate to high quality) produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction when compared with multiple sessions of cervical mobilisation at immediate-, short- and intermediate-term follow-up. For acute and subacute neck pain, multiple sessions of cervical manipulation were more effective than certain medications in improving pain and function at immediate- (one trial, 182 participants, moderate quality) and long-term follow-up (one trial, 181 participants, moderate quality). These findings are consistent for function at intermediate-term follow-up (one trial, 182 participants, moderate quality). For chronic CGH, multiple sessions of cervical manipulation (two trials, 125 participants, low quality) may be more effective than massage in improving pain and function at short/intermediate-term follow-up. Multiple sessions of cervical manipulation (one trial, 65 participants, very low quality) may be favoured over transcutaneous electrical nerve stimulation (TENS) for pain reduction at short-term follow-up. For acute neck pain, multiple sessions of cervical manipulation (one trial, 20 participants, very low quality) may be more effective than thoracic manipulation in improving pain and function at short/intermediate-term follow-up. Thoracic manipulation versus inactive control: Three trials (150 participants) using a single session were assessed at immediate-, short- and intermediate-term follow-up. At short-term follow-up, manipulation improved pain in participants with acute and subacute neck pain (five trials, 346 participants, moderate quality, pooled SMD -1.26, 95% confidence interval (CI) -1.86 to -0.66) and improved function (four trials, 258 participants, moderate quality, pooled SMD -1.40, 95% CI -2.24 to -0.55) in participants with acute and chronic neck pain. A funnel plot of these data suggests publication bias. These findings were consistent at intermediate follow-up for pain/function/quality of life (one trial, 111 participants, low quality). Thoracic manipulation versus another active treatment: No studies provided sufficient data for statistical analyses. A single session of thoracic manipulation (one trial, 100 participants, moderate quality) was comparable with thoracic mobilisation for pain relief at immediate-term follow-up for chronic neck pain. Mobilisation versus inactive control: Mobilisation as a stand-alone intervention (two trials, 57 participants, ranged from very low to low quality) may not reduce pain more than an inactive control. Mobilisation versus another active treatment: For acute and subacute neck pain, anterior-posterior mobilisation (one trial, 95 participants, very low quality) may favour pain reduction over rotatory or transverse mobilisations at immediate-term follow-up. For chronic CGH with temporomandibular joint (TMJ) dysfunction, multiple sessions of TMJ manual therapy (one trial, 38 participants, very low quality) may be more effective than cervical mobilisation in improving pain/function at immediate- and intermediate-term follow-up. For subacute and chronic neck pain, cervical mobilisation alone (four trials, 165 participants, ranged from low to very low quality) may not be different from ultrasound, TENS, acupuncture and massage in improving pain, function, QoL and participant satisfaction at immediate- and intermediate-term follow-up. Additionally, combining laser with manipulation may be superior to using manipulation or laser alone (one trial, 56 participants, very low quality). AUTHORS' CONCLUSIONS Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.
Collapse
Affiliation(s)
- Anita Gross
- School of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics, McMaster University, 1400 Main Street West, Hamilton, ON, Canada, L8S 1C7
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Pires PF, Packer AC, Dibai-Filho AV, Rodrigues-Bigaton D. Immediate and Short-Term Effects of Upper Thoracic Manipulation on Myoelectric Activity of Sternocleidomastoid Muscles in Young Women With Chronic Neck Pain: A Randomized Blind Clinical Trial. J Manipulative Physiol Ther 2015; 38:555-63. [PMID: 26387859 DOI: 10.1016/j.jmpt.2015.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/18/2014] [Accepted: 03/04/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to assess the immediate and short-term effects of upper thoracic spine manipulation on pain intensity and myoelectric activity of the sternocleidomastoid muscles in young women with chronic neck pain. METHODS A randomized clinical trial was carried out involving 32 women with chronic neck pain (mean age, 24.8 ± 5.4 years) allocated to an experimental group and a placebo group. Three evaluations were carried out: baseline, immediate postintervention, and short-term postintervention (48-72 hours after intervention). Myoelectric activity of the right and left sternocleidomastoid muscles was assessed at rest and during isometric contractions for cervical flexion and elevation of the shoulder girdle. Neck pain intensity was assessed at rest using a visual analog scale. Comparisons of the data were performed using 2-way repeated-measures analysis of variance with the Bonferroni correction. The level of significance was set at P < .05. RESULTS A moderate treatment effect on myoelectric activity of the right and left sternocleidomastoid muscles during isometric elevation of the shoulder girdle was found in the experimental group only on the short-term postintervention evaluation (d > 0.40). No statistically significant differences were found for any of the variables analyzed in the intergroup comparisons at the different evaluation times (P > .05). CONCLUSION No statistically significant differences were found in the intragroup or intergroup analyses of the experimental and placebo groups regarding myoelectric activity of the cervical muscles or the intensity of neck pain at rest in the immediate or short-term postintervention evaluations.
Collapse
Affiliation(s)
- Paulo Fernandes Pires
- Doctoral Student, Laboratory of Therapeutic Resources, Postgraduate Program in Science of Human Movement, Methodist University of Piracicaba, Piracicaba, SP, Brazil
| | - Amanda Carine Packer
- Master's Student, Laboratory of Therapeutic Resources, Postgraduate Program in Physical Therapy, Methodist University of Piracicaba, Piracicaba, SP, Brazil
| | - Almir Vieira Dibai-Filho
- Doctoral Student, Laboratory of Physiotherapeutic Resources, Postgraduate Program in Rehabilitation and Functional Performance, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Delaine Rodrigues-Bigaton
- Professor, Laboratory of Therapeutic Resources, Postgraduate Program in Science of Human Movement, Methodist University of Piracicaba, Piracicaba, SP, Brazil.
| |
Collapse
|
50
|
McDevitt A, Young J, Mintken P, Cleland J. Regional interdependence and manual therapy directed at the thoracic spine. J Man Manip Ther 2015; 23:139-46. [PMID: 26309384 DOI: 10.1179/2042618615y.0000000005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence (RI) approach. The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders. The intent of this narrative review is to describe the research supporting the RI concept and its application to the treatment of individuals with neck and/or shoulder pain. Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question. Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting from this intervention.
Collapse
Affiliation(s)
- Amy McDevitt
- University of Colorado, School of Medicine, Physical Therapy Program, Anschutz Medical Campus, Aurora, CO, USA
| | - Jodi Young
- Franklin Pierce University, Physical Therapy Program, Concord, NH, USA
| | - Paul Mintken
- University of Colorado, School of Medicine, Physical Therapy Program, Anschutz Medical Campus, Aurora, CO, USA
| | - Josh Cleland
- Franklin Pierce University, Physical Therapy Program, Concord, NH, USA
| |
Collapse
|