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Abu El Kasem ST, Alaa FAA, Abd El-Raoof NA, Abd-Elazeim AS. Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial. J Man Manip Ther 2024:1-10. [PMID: 38618993 DOI: 10.1080/10669817.2024.2341453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome. METHODS Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention). RESULTS After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05). CONCLUSION Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.
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Affiliation(s)
- Shimaa T Abu El Kasem
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Basic Science, Faculty of Physical Therapy, Galala University, Suez, Egypt
| | - Fatma Alzahraa A Alaa
- Department of Basic Science, Faculty of Physical Therapy, 6th October University, Giza, Egypt
| | - Neveen A Abd El-Raoof
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Brindisino F, Garzonio F, Giovannico G, Isaia F, Fiorentino F, Cavaggion C, Mourad F, Innocenti T. Spinal manipulation does not improve short-term pain and function in persons with painful shoulder: a systematic review with meta-analysis. Disabil Rehabil 2024:1-18. [PMID: 38420943 DOI: 10.1080/09638288.2024.2322025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To investigate the benefit of spinal high-velocity low-amplitude thrust (HVLAT) in improving pain and disability in persons with painful shoulder as primary outcomes. Function, quality of life, persons (and clinicians) satisfaction, adverse events rate, and time for recovery were secondary outcomes. METHODS A systematic review with meta-analysis was conducted and MEDLINE, CENTRAL, Embase, and PEDro until 20 September 2023 were investigated. Two thousand eight hundred and ninety-nine records were retrieved and nine studies were included. Risk of bias of included studies was assessed through the Revised Cochrane risk-of-bias tool. The certainty of evidence of the pooled results was graded with GRADE approach. RESULTS The analysis included nine studies (441 persons). The pooled results showed non-significant differences between HVLAT versus sham in pain at pre-post follow-up (MD -0.13, 95% confidence interval (CI) -0.60; 0.35; p = 0.61, I2 = 0%), and at <4 days follow-up (SMD 0.16, 95%CI -0.16; 0.48; p = 0.34, I2 = 23%); in function at <4 days follow-up (SMD -0.29, 95%CI -0.69; 0.11; p = 0.16, I2 = 50%). The certainty of evidence ranged from low to very low. CONCLUSIONS HVLAT was not more effective than sham in improving pain and function at pre-post and at <4 days follow-up. When used as an "add-on technique", HVLAT did not improve pain nor disability.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Fabiola Garzonio
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | | | - Fabio Fiorentino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Claudia Cavaggion
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Antwerp, Belgium
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- GIMBE Foundation, Bologna, Italy
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Failla MJ, Mintken PE, McDevitt AW, Michener LA. Trajectory of patient-rated outcomes and association with patient acceptable symptom state in patients with musculoskeletal shoulder pain. J Man Manip Ther 2023; 31:279-286. [PMID: 36300352 PMCID: PMC10324443 DOI: 10.1080/10669817.2022.2137350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Characterize trajectory and predictors of patient acceptable symptom state (PASS) defined recovery at 6 months. METHODS Individuals with musculoskeletal shoulder pain (n = 140) completed patient-reported disability and PASS at baseline, 1 and 6 months. The PASS was categorized into 3 trajectory groups; 1.) Early Recovery (answered yes to PASS at 1 and 6-months), 2.) Delayed Recovery (PASS-yes only at 6-months), and 3.) Unrecovered. Mixed models characterized the trajectory between PASS-groups using SPADI and QDASH disability change scores. Logistic regression identified predictors of Early Recovery versus Delayed+Unrecovered groups. RESULTS PASS-defined recovery rates by group were Early Recovery (58%), Delayed Recovery (22%), and Unrecovered (20%). A group main effect indicated lower disability over time in the Early Recovery versus Unrecovered (QDASH mean difference = 11(2.4); p = 0.001; SPADI mean difference = 12(3); p < 0.001). The odds of an Early Recovery slightly increased with greater change scores on the SPADI (odds ratio = 1.06, 95%CI:1.02,1.11; p = 0.004) and QDASH (odds ratio = 1.08, 95%CI:1.03,1.13; p = 0.003) over the first month of treatment. CONCLUSION Recovery trajectories of patients indicate differing responses to treatment despite overall improvements over the first month of treatment. Incorporating both patient-reported disability (SPADI, QDASH) and acceptable satisfaction (PASS) may aid in determining recovery trajectory, but more evidence is needed to be clinically useful.
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Affiliation(s)
- Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont 5, Burlington, VT, USA
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Paul E. Mintken
- Physical Therapy Program, University of Colorado School of Medicine, Colorado, USA
- Wardenburg Health Center, University of Colorado-Boulder, Boulder, Colorad
| | - Amy W. McDevitt
- Physical Therapy Program, University of Colorado School of Medicine, Colorado, USA
- Sports Physical Therapy and Rehabilitation, University of Colorado Health, Denver, Colorad
| | - Lori A. Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Rastogi R, Rosedale R, Kidd J, Lynch G, Supp G, Robbins SM. Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study. J Man Manip Ther 2022; 30:172-179. [PMID: 35076353 PMCID: PMC9255208 DOI: 10.1080/10669817.2022.2030625] [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: 01/27/2023] Open
Abstract
OBJECTIVE To explore indicators that predict whether patients with extremity pain have a spinal or extremity source of pain. METHODS The data were from a prospective cohort study (n = 369). Potential indicators were gathered from a typical Mechanical Diagnosis and Therapy (MDT) history and examination. A stepwise logistic regression with a backward elimination was performed to determine which indicators predict classification into spinal or extremity source groups. A Receiver Operating Characteristic (ROC) curve was constructed to examine the number of significant indicators that could predict group classification. RESULTS Five indicators were identified to predict group classification. Classification into the spinal group was associated with the presence of paresthesia [odds ratio (OR) 1.984], change in symptoms with sitting/neck or trunk flexion/turning neck/when still (OR 2.642), change in symptoms with posture change (OR 3.956), restrictions in spinal movements (OR 2.633), and no restrictions in extremity movements (OR 2.241). The optimal number of indicators for classification was two (sensitivity = 0.638, specificity = 0.807). DISCUSSION This study provides guidance on clinical indicators that predict the source of symptoms for isolated extremity pain. The clinical indicators will allow clinicians to supplement their decision-making process in regard to spinal and extremity differentiation so as to appropriately target their examinations and interventions.
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Affiliation(s)
- Ravi Rastogi
- Physiotherapist, London Health Sciences Centre, London, Canada,CONTACT Ravi Rastogi Physiotherapist, London Health Sciences Centre, London, Canada
| | - Richard Rosedale
- Physiotherapist/International Director of Education, McKenzie Institute International, London, Canada
| | - Josh Kidd
- Physiotherapist, Advance Sports and Spine Physical Therapy, Portland, OR, USA
| | - Greg Lynch
- Physiotherapist, Inform Physiotherapy Limited, New Zealand
| | - Georg Supp
- Physiotherapist, Pulz Physiotherapy, Freiburg, Germany
| | - Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Existing validated clinical prediction rules for predicting response to physiotherapy interventions for musculoskeletal conditions have limited clinical value: A systematic review. J Clin Epidemiol 2021; 135:90-102. [PMID: 33577988 DOI: 10.1016/j.jclinepi.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/18/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically review clinical prediction rules (CPRs) that have undergone validation testing for predicting response to physiotherapy-related interventions for musculoskeletal conditions. STUDY DESIGN AND SETTING PubMed, EMBASE, CINAHL and Cochrane Library were systematically searched to September 2020. Search terms included musculoskeletal (MSK) conditions, physiotherapy interventions and clinical prediction rules. Controlled studies that validated a prescriptive CPR for physiotherapy treatment response in musculoskeletal conditions were included. Two independent reviewers assessed eligibility. Original derivation studies of each CPR were identified. Risk of bias was assessed with the PROBAST tool (derivation studies) and the Cochrane Effective Practice and Organisation of Care group criteria (validation studies). RESULTS Nine studies aimed to validate seven prescriptive CPRs for treatment response for MSK conditions including back pain, neck pain, shoulder pain and carpal tunnel syndrome. Treatments included manipulation, traction and exercise. Seven studies failed to demonstrate an association between CPR prediction and outcome. Methodological quality of derivation studies was poor and for validation studies was good overall. CONCLUSION Results do not support the use of any CPRs identified to aid physiotherapy treatment selection for common musculoskeletal conditions, due to methodological shortcomings in the derivation studies and lack of association between CPR and outcome in validation studies.
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Amano T, Tanaka R, Tanaka S. Clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty: A prospective cohort study. Phys Ther Res 2021; 23:202-208. [PMID: 33489660 DOI: 10.1298/ptr.e10044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/18/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To derive a clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty. METHODS This prospective cohort study evaluated the data of 273 individuals undergoing primary total knee arthroplasty. The individual factors, the physical and motor function data were assessed preoperatively upon admission as a baseline survey. The knee joint extension angle and knee joint flexion angle were re-evaluated on postoperative day 14 as a follow-up. The recovery group comprised individuals with a knee joint extension angle of more than -5 degrees and knee joint flexion angle of more than 110 degrees on postoperative day 14. The other patients constituted the non-recovery group. Multivariate logistic regression analysis was used for deriving a clinical prediction rule. RESULTS The results indicated that the use of a cane, knee joint extension and flexion angles, and Timed Up and Go test time were significant factors for predicting early recovery of knee range of motion after total knee arthroplasty. Furthermore, a clinical prediction rule was derived and included the use of a cane, knee joint extension angle ≥ -15 degrees, knee joint flexion angle ≥ 125 degrees, and a Timed Up and Go test time < 11.2 s. A total clinical prediction rule score ≥ 8 indicated a positive likelihood ratio of more than 10 for a successful outcome and the post-test probability was approximately 95%. CONCLUSIONS The derived clinical prediction rule might be a useful screening tool for proper postoperative goal setting and the establishment of individualized physical therapy programs.
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Affiliation(s)
- Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University
| | - Shigeharu Tanaka
- Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services
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McCoy RC, Bittencourt E, Clifton W. Cervicothoracic Manipulation Techniques Reviewed Utilizing Three-Dimensional Spine Model. Cureus 2019; 11:e5836. [PMID: 31754571 PMCID: PMC6827709 DOI: 10.7759/cureus.5836] [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] [Indexed: 11/29/2022] Open
Abstract
Currently, there is a paucity of studies that describe prone cervicothoracic joint high-velocity low-amplitude (HVLA) thrust techniques using an anatomically accurate, biomimetic three-dimensional (3D) spine model for educational demonstration. The purpose of this technical report was to present a learning model for two prone cervicothoracic HVLA thrust techniques using a 3D model, review intersegmental mobility observed on a 3D spine model with application of the techniques, and lastly discuss potential applications of this learning model.
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Affiliation(s)
- Ryan C McCoy
- Physical Therapy, Mayo Clinic, Jacksonville, USA
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Maccio JR, Carlton L, Levesque K, Maccio JG, Egan L. Directional preference of the extremity: a preliminary investigation. J Man Manip Ther 2018; 26:272-280. [PMID: 30455554 DOI: 10.1080/10669817.2018.1505022] [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] [Received: 05/21/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022] Open
Abstract
Background: Mechanical diagnosis and therapy (MDT) is a specific classification-based musculoskeletal examination and intervention system that uses repeated end range and sustained movement to classify patients into mechanical syndromes. Research has recently demonstrated increased prevalence, reliability, and efficacy of MDT syndromes in varied peripheral musculoskeletal populations. There is currently no research analyzing if predictive variables exist for establishing directional preference in peripheral joints, other than the wrist. The aim of this study was to examine the clinical application of predictive variables for establishing directional preference and spinal referral in patients with isolated peripheral joint pain. Case Description: Thirty-seven consecutive patients with isolated peripheral pain were evaluated and classified using MDT assessment. Secondary analysis of predetermined variables was performed for association with directional preference and identification of spinal referral in Derangement syndrome. Results: All 37 patients were classified using MDT assessment. Thirty-three (89.2%) were classified as Derangement syndrome: 17 as spinal Derangement (45.9%) and 16 as peripheral Derangement (43.2%). One peripheral derangement also had an underlying Articular Dysfunction. Additionally, there were four patients classified as Other (10.8%). Discussion: Historical and physical examination findings were analyzed to determine if there were associated variables of directional preference or spinal referral. Mechanical stress was found to be the most associated factor in predicting directional preference. No peripheral movement loss, paresthesia, and constant pain were more associated with spinal referral. These findings may lead to a greater understanding of peripheral MDT assessment, which may lead to increased identification of directional preference and improved patient outcomes. Level of Evidence: 4.
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