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Shangguan L, Ding M, Wang Y, Xu H, Liao B. Denosumab ameliorates osteoarthritis by protecting cartilage against degradation and modulating subchondral bone remodeling. Regen Ther 2024; 27:181-190. [PMID: 38840731 PMCID: PMC11150975 DOI: 10.1016/j.reth.2024.03.019] [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: 11/16/2023] [Revised: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 06/07/2024] Open
Abstract
Osteoarthritis (OA) is the most prevalent degenerative joint disease worldwide. Effective management for early-stage OA is crucial. Denosumab (DS) has been widely used to treat osteoporosis (OP) and rheumatoid arthritis, but its potential for managing OA remains clear. We assessed the effects of DS on osteoclast activity and chondrocyte apoptosis using tartrate-resistant acid phosphatase (TRAP) assay, quantitative real-time polymerase chain reaction (qRT-PCR), flow cytometry, and TUNEL staining. To assess the impact of DS on the NF-κB pathway, we performed Western blot and immunofluorescence staining. Additionally, we used an OA model to explore the influence of DS on subchondral bone remodeling and cartilage degeneration in vivo. We found that DS hindered receptor activator of nuclear factor kappa B ligand (RANKL)-induced osteoclastogenesis by inhibiting the activity of the NF-κB pathway. Besides, DS alleviated reactive oxygen species (ROS)-induced apoptosis in chondrocytes by regulating the expression of genes related to apoptosis. Moreover, we observed an attenuation of OA-related subchondral bone remodeling and cartilage degeneration in vivo. Our findings indicate that DS could effectively suppress osteoclast activity and chondrocyte apoptosis, thereby mitigating OA-related subchondral bone remodeling and cartilage degeneration. These results provide a mechanistic basis for using DS to treat OA.
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Affiliation(s)
- Lei Shangguan
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ming Ding
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yingchun Wang
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Hu Xu
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Binghui Liao
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Ferreira RM, Martins PN, Gonçalves RS. Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: An umbrella review 5-year update. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100497. [PMID: 39040626 PMCID: PMC11261791 DOI: 10.1016/j.ocarto.2024.100497] [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: 03/11/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Objective This umbrella review aimed to summarize (and update) the effectiveness of non-pharmacological and non-surgical interventions for patients with knee osteoarthritis. Methods The study followed the PRISMA guidelines. Manual and electronic databases were searched, to identify systematic reviews, following the P (knee osteoarthritis) I (non-pharmacological and non-surgical treatments) C (pharmacological, surgical, placebo, no intervention, or other non-pharmacological/non-surgical conservative treatments) O (pain, function, quality of life, and other knee-specific measures) model. The quality of evidence was assessed using the R-AMSTAR checklist and GRADE principles. Results The search yielded 4086 records, of which 61 met the eligibility criteria. After evaluation with R-AMSTAR, four systematic reviews were excluded, resulting in 57 included systematic reviews, with an overall score of 29.6. The systematic reviews were published between 2018 and 2022 (29.8% in 2022), conducted in 19 countries (52.6% in China), and explored 24 distinct interventions. The systematic reviews encompassed 714 trials (mean of 13 ± 7.7 studies per systematic review), and 59,343 participants (mean 1041 ± 1002 per systematic review, and 82 ± 59.2 per study). The majority of participants were older obese women (61.6 ± 4.2 years, 30.2 ± 3.6 kg/m2, 70%, respectively). Conclusions Based on the systematic reviews findings, Diet Therapy, Patient Education, and Resistance Training are strongly supported as core interventions for managing patients with knee osteoarthritis. Aquatic Therapy, Balance Training, Balneology, Dietary Supplements, Extracorporeal Shockwave Therapy, and Tai Ji show moderate support. For other interventions, the evidence quality was low, results were mixed or inconclusive, or there was not sufficient efficacy to support their use.
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Affiliation(s)
- Ricardo Maia Ferreira
- Polytechnic Institute of Maia, N2i, Social Sciences, Education and Sport School, Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal
- Polytechnic Institute of Coimbra, Coimbra Health School, Scientific-Pedagogical Unit of Physioterapy, Rua 5 de Outubro, São Martinho do Bispo, 3045-043 Coimbra, Portugal
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), 4960-320 Melgaço, Portugal
| | - Pedro Nunes Martins
- Polytechnic Institute of Maia, N2i, Social Sciences, Education and Sport School, Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal
| | - Rui Soles Gonçalves
- Polytechnic Institute of Coimbra, Coimbra Health School, Scientific-Pedagogical Unit of Physioterapy, Rua 5 de Outubro, São Martinho do Bispo, 3045-043 Coimbra, Portugal
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Reischl S, Ziebart C, Johnston Z, Ma J, Pham D, Salloum JF, Sithganesan M, Wikkerink S, Munro K, MacDermid JC. Patient Experience of Stiffness With Knee Osteoarthritis: An Interpretative Description Study. Musculoskeletal Care 2024; 22:e1922. [PMID: 39073278 DOI: 10.1002/msc.1922] [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: 06/30/2024] [Revised: 07/09/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Knee OA (KOA) can lead to pain, loss of muscle strength, and changes in gait. Knee stiffness is a classic feature of KOA that can increase the risk of falls but has been understudied. OBJECTIVE To evaluate the impact of knee stiffness, the factors influencing the severity of stiffness, and the repercussions on participation for patients with KOA. METHODS This qualitative study used an interpretive description approach. Purposeful sampling was used for patients with KOA over 45 years of age, fluent in English, diagnosed with KOA and reported KOA stiffness within the last 6 months. Participants were recruited through social media and Ontario clinics. Semi-structured interviews were conducted over the phone or using zoom, recorded, and transcribed verbatim. Open, axial, and selective coding were used to identify clinically relevant themes. RESULTS Twelve participants (5F, 7M) with a mean age of 60 years were included. The five themes identified include elusive and variable perceptions of joint stiffness, inactivity or too much activity exacerbates stiffness, adapting to the ebb and flow of symptoms, risk experiences and safety fears leads to reduced participation, and KOA stiffness impairs quality of life. CONCLUSION This study highlights characteristics of knee stiffness, consequences on participation, and quality of life for people with KOA. Monitoring knee stiffness for KOA is recommended for more appropriate treatment intensity, which could improve adherence to a home programme and potentially reduce the risk of falls.
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Affiliation(s)
- S Reischl
- School of Physical Therapy, Western University, London, Canada
| | - C Ziebart
- School of Physical Therapy, Western University, London, Canada
| | - Z Johnston
- School of Physical Therapy, Western University, London, Canada
| | - J Ma
- School of Physical Therapy, Western University, London, Canada
| | - D Pham
- School of Physical Therapy, Western University, London, Canada
| | - J F Salloum
- School of Physical Therapy, Western University, London, Canada
| | - M Sithganesan
- School of Physical Therapy, Western University, London, Canada
| | - S Wikkerink
- School of Physical Therapy, Western University, London, Canada
| | - K Munro
- Hand and Upper Limb Centre, St. Joseph's Healthcare, London, Canada
| | - J C MacDermid
- School of Physical Therapy, Western University, London, Canada
- Hand and Upper Limb Centre, St. Joseph's Healthcare, London, Canada
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Arribas-Romano A, Fernández-Carnero J, Rodríguez-Lagos L, Molina-Álvarez M, Zabala-Zambrano J, Lezaun-Hernández L, Contreras-Padilla L, Mercado F. CPM-Related Mechanisms Could Play a Key Role in the Effects on Pain Sensitivity Induced by Manual Therapy: Three Crossover Trials Investigating the Effects of Manual Pressure. J Clin Med 2024; 13:3648. [PMID: 38999214 PMCID: PMC11242484 DOI: 10.3390/jcm13133648] [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: 04/30/2024] [Revised: 06/15/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Objective: The aim of this study is to assess whether pain-inducing manual pressure (PIMP) leads to effects on pressure pain threshold (PPT) mediated by conditioned pain modulation (CPM) and whether these effects are influenced by the intensity and repetition of the stimulus. Additionally, the influence of psychological factors and physical activity on the response to PIMP was explored. Methods: A total of 72 pain-free students were randomly assigned to three crossover trials. Trial 1 compared the effects of PIMP with the cold pressor task and pain-inducing electrostimulation. Trial 2 compared the effects of manual pressure that elicited moderate pain, mild pain, and no pain. Trial 3 compared a single PIMP stimulation with four stimuli applied at the same site or at different sites. Results: PIMP produced a lower increase in PPT than cold pressor task and no difference with electrostimulation. Manual pressure that caused moderate pain led to a greater increase in PPT compared to mild pain and pain-free application. Repetition of PIMP stimulus, whether at the same or different sites, did not significantly increase PPT compared to a single stimulation. No association with psychological factors or physical activity was found. Conclusions: PIMP produces an increase in PPT, suggesting the involvement of CPM-related mechanisms.
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Affiliation(s)
- Alberto Arribas-Romano
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (A.A.-R.); (L.R.-L.)
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Josué Fernández-Carnero
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, 28049 Madrid, Spain; (J.Z.-Z.); (L.L.-H.)
- La Paz Hospital Institute for Health Research, IdiPAZ, 28029 Madrid, Spain
| | - Leonardo Rodríguez-Lagos
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (A.A.-R.); (L.R.-L.)
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
| | - Miguel Molina-Álvarez
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Rey Juan Carlos University, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, 28922 Alcorcón, Spain
| | - Jesús Zabala-Zambrano
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, 28049 Madrid, Spain; (J.Z.-Z.); (L.L.-H.)
- Advance Rehabilitation Center Sanitas, 28046 Madrid, Spain
| | - Lucas Lezaun-Hernández
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, 28049 Madrid, Spain; (J.Z.-Z.); (L.L.-H.)
- Edurne Esquide Fisioterapia, 31200 Estella, Spain
| | - Lucía Contreras-Padilla
- iCentro Fix You, 28009 Madrid, Spain;
- School of Physiotherapy ONCE, Universidad Autónoma de Madrid, 28022 Madrid, Spain
| | - Francisco Mercado
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain
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Yanuck SB, Fox SK, Harting BR, Motyka TM. Effect of manual manipulation on mechanical gait parameters. J Osteopath Med 2024; 0:jom-2023-0203. [PMID: 38807459 DOI: 10.1515/jom-2023-0203] [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: 08/31/2023] [Accepted: 04/09/2024] [Indexed: 05/30/2024]
Abstract
CONTEXT A variety of manual manipulation techniques are utilized in clinical practice to alleviate pain and improve musculoskeletal function. Many manual practitioners analyze gait patterns and asymmetries in their assessment of the patient, and an increasing number of gait motion capture studies are taking place with recent improvements in motion capture technology. This study is the first systematic review of whether these manual modalities have been shown to produce an objectively measurable change in gait mechanics. OBJECTIVES This study was designed to perform a systematic review of the literature to assess the impact of manual medicine modalities on biomechanical parameters of gait. METHODS A master search term composed of keywords and Medical Subject Headings (MeSH) search terms from an initial scan of relevant articles was utilized to search six databases. We screened the titles and abstracts of the resulting papers for relevance and then assessed their quality with the Cochrane Risk of Bias Tool. Clinical trials that featured both a manual manipulation intervention and multiple mechanical gait parameters were included. Case reports and other studies that only measured gait speed or other subjective measures of mobility were excluded. RESULTS We included 20 studies in our final analysis. They utilize manipulation techniques primarily from osteopathic, chiropractic, massage, and physiotherapy backgrounds. The conditions studied primarily included problems with the back, knee, and ankle, as well as healthy patients and Parkinson's patients. Control groups were highly variable, if not absent. Most studies measured their gait parameters utilizing either multicamera motion capture systems or force platforms. CONCLUSIONS Twelve of 20 papers included in the final analysis demonstrated a significant effect of manipulation on gait variables, many of which included either step length, walking speed, or sagittal range of motion (ROM) in joints of the lower extremity. However, the results and study design are too heterogeneous to draw robust conclusions from these studies as a whole. While there are initial indications that certain modalities may yield a change in certain gait parameters, the quality of evidence is low and there is insufficient evidence to conclude that manual therapies induce changes in biomechanical gait parameters. Studies are heterogeneous with respect to the populations studied and the interventions performed. Comparators were variable or absent across the studies, as were the outcome variables measured. More could be learned in the future with consistent methodology around blinding and sham treatment, and if the gait parameters measured were standardized and of a more robust clinical significance.
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Affiliation(s)
- Solomon B Yanuck
- Leon Levine Hall of Medical Sciences, 364432 Campbell University Jerry M. Wallace School of Osteopathic Medicine , Lillington, NC, USA
| | - Sarah K Fox
- Leon Levine Hall of Medical Sciences, 364432 Campbell University Jerry M. Wallace School of Osteopathic Medicine , Lillington, NC, USA
| | - Bethany R Harting
- Leon Levine Hall of Medical Sciences, 364432 Campbell University Jerry M. Wallace School of Osteopathic Medicine , Lillington, NC, USA
| | - Thomas M Motyka
- Department of Osteopathic Manipulative Medicine, 364432 Campbell University Jerry M. Wallace School of Osteopathic Medicine , Lillington, NC, USA
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Chen L, Zhou H, Gong Y, Tang Y, Su H, Jin Z, Chen G, Tong P. How Do Muscle Function and Quality Affect the Progression of KOA? A Narrative Review. Orthop Surg 2024; 16:802-810. [PMID: 38438160 PMCID: PMC10984828 DOI: 10.1111/os.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Knee osteoarthritis (KOA) is widely recognized as a chronic joint disease characterized by degeneration of knee cartilage and subsequent bone hyperplasia. However, it is important to acknowledge the significant role of muscles in the development and progression of KOA. Muscle function (MF) and muscle quality (MQ) are key factors in understanding the involvement of muscles in KOA. Quantitative indices such as muscle mass, muscle strength, muscle cross-sectional area, muscle thickness, and muscle fatigue are crucial in assessing MF and MQ. Despite the growing interest in KOA, there is a scarcity of studies investigating the relationship between muscles and this condition. This review aims to examine the commonly used indices and measurement methods for assessing MF and MQ in clinical settings, while also exploring the association between muscles and KOA. Furthermore, this article highlights the importance of restoring MF and MQ to enhance symptom management and improve the quality of life for patients with KOA.
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Affiliation(s)
- Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Haojing Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Yi Tang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Guoqian Chen
- Department of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Peijian Tong
- Department of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
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Delafontaine A, Vialleron T, Barbier G, Lardon A, Barrière M, García-Escudero M, Fabeck L, Descarreaux M. Effects of Manual Therapy on Parkinson's Gait: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:354. [PMID: 38257446 PMCID: PMC10820786 DOI: 10.3390/s24020354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Manual therapy (MT) is commonly used in rehabilitation to deal with motor impairments in Parkinson's disease (PD). However, is MT an efficient method to improve gait in PD? To answer the question, a systematic review of clinical controlled trials was conducted. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome when sufficient data were available. If data were lacking, p values were reported. The PEDro scale was used for the quality assessment. Three studies were included in the review. MT improved Dynamic Gait Index (SMD = 1.47; 95% CI: 0.62, 2.32; PEDro score: 5/10, moderate level of evidence). MT also improved gait performances in terms of stride length, velocity of arm movements, linear velocities of the shoulder and the hip (p < 0.05; PEDro score: 2/10, limited level of evidence). There was no significant difference between groups after MT for any joint's range of motion during gait (p > 0.05; PEDro score: 6/10, moderate level of evidence). There is no strong level of evidence supporting the beneficial effect of MT to improve gait in PD. Further randomized controlled trials are needed to understand the impact of MT on gait in PD.
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Affiliation(s)
- Arnaud Delafontaine
- Department of Orthopedic Surgery, Université Libre de Bruxelles, 1050 Bruxelles, Belgium;
- Department of Sciences of Physical Activity, Université Québec Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada; (M.B.); (M.D.)
| | - Thomas Vialleron
- Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages (LINP2), UFR STAPS, Université Paris Nanterre, 92000 Nanterre, France;
| | - Gaëtan Barbier
- Institut Franco-Européen de Chiropraxie, 94200 Ivry-sur-Seine, France; (G.B.); (A.L.)
- Complexité, Innovation, Activités Motrices et Sportives (CIAMS) Laboratory, Université Paris-Saclay, CEDEX 91405 Orsay, France
- Complexité, Innovation, Activités Motrices et Sportives (CIAMS) Laboratory, Université d’Orléans, 45067 Orléans, France
| | - Arnaud Lardon
- Institut Franco-Européen de Chiropraxie, 94200 Ivry-sur-Seine, France; (G.B.); (A.L.)
| | - Mélodie Barrière
- Department of Sciences of Physical Activity, Université Québec Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada; (M.B.); (M.D.)
| | - María García-Escudero
- Faculté de Médecine et des Sciences de la Santé, Université Catholique de Valence, San Vicente Martir, 46900 Valence, Spain;
| | - Laurent Fabeck
- Department of Orthopedic Surgery, Université Libre de Bruxelles, 1050 Bruxelles, Belgium;
| | - Martin Descarreaux
- Department of Sciences of Physical Activity, Université Québec Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada; (M.B.); (M.D.)
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Adams KR, Famuyide AO, Young JL, Maddox CD, Rhon DI. Pragmatism in manual therapy trials for knee osteoarthritis: a systematic review. Arch Physiother 2024; 14:1-10. [PMID: 38444787 PMCID: PMC10898243 DOI: 10.33393/aop.2024.2916] [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: 06/29/2023] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Manual therapy is an often-utilized intervention for the management of knee osteoarthritis (OA). The interpretation of results presented by these trials can be affected by how well the study designs align applicability to real-world clinical settings. Aim To examine the existing body of clinical trials investigating manual therapy for knee OA to determine where they fall on the efficacy-effectiveness spectrum. Methods This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials that investigated manual therapy treatments for adults with knee OA were retrieved via searches of multiple databases to identify trials published prior to April 2023. The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool was used to objectively rate the efficacy-effectiveness nature of each trial design. The Cochrane Risk of Bias 2.0 assessment tool (RoB-2) was used to assess the risk of bias across five domains. Results Of the 36 trials, a higher percentage of trials had a greater emphasis on efficacy within all four domains: participant characteristics (75.0%), trial setting (77.8%), flexibility of intervention (58.3%), and clinical relevance of experimental and comparison intervention (47.2%). In addition, 13.9% of the trials had low risk of bias, 41.7% had high risk of bias, and 44.4% had some concerns regarding bias. Conclusions While many trials support manual therapy as effective for the management of knee OA, a greater focus on study designs with an emphasis on effectiveness would improve the applicability and generalizability of future trials.
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Affiliation(s)
- Kyle R. Adams
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Department of Physical Therapy, Baylor University, Waco, Texas - USA
| | - Ayodeji O. Famuyide
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Greater Baton Rouge Physical Therapy, Baton Rouge, Louisiana - USA
| | - Jodi L. Young
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
| | - C. Daniel Maddox
- Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, Georgia - USA
- Upstream Rehab Institute, Smyrna, Georgia - USA
| | - Daniel I. Rhon
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland - USA
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Colonna S, Borghi C. Rhizarthrosis Part II: A New Approach of Manual Therapy and Therapeutic Exercise. Cureus 2024; 16:e52999. [PMID: 38406083 PMCID: PMC10894662 DOI: 10.7759/cureus.52999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Rhizarthrosis (RA), also known as trapezium-metacarpal osteoarthritis, is a degenerative condition affecting the thumb's first joint, leading to functional impairment and pain. Conservative treatment options are preferred for mild to moderate cases (Eaton-Littler grades I and II) and typically encompass a range of therapeutic modalities, including manual therapy. However, for the existing manual therapy techniques, there is a lack of comparative studies for efficacy, and therapeutic exercises are often generic and non-specific to RA. This study proposes a novel treatment protocol that combines manual therapy with specific therapeutic exercises grounded in the biomechanical analysis of the trapeziometacarpal joint. The focus is on enhancing joint stability, reducing pain, and improving function. The manual therapy component includes three phases. A passive phase, during which joint distractions are applied to alleviate discomfort and improve joint mobility. An active phase that addresses joint mobility on the adduction-abduction plane, the first plane of movement to suffer limitation: the therapist facilitates the isometric adduction of the thumb, followed by an assisted abduction. A second active phase is where Mulligan's Mobilization With Movement concept is applied. This technique involves passive pain-free joint mobilization with simultaneous active finger movements, to provide additional therapeutic benefits. The therapeutic exercises component focuses on strengthening the first dorsal interosseous muscle as an abductor to reduce thumb adductor muscle activation and joint stress. Patients are encouraged to perform finger spreading exercises using a rubber band between the first and fifth fingers, emphasizing first dorsal interosseous activation and stability of the thumb. This type of muscle strengthening does not involve movement of the trapeziometacarpal joint. It is recommended to start performing 5-10 repetitions or 5 seconds of isometric contraction, repeat throughout the day, and progressively increase the load by adding a turn to the rubber band or changing it, increasing the number of repetitions bringing it to 15 and/or increase the isometric contraction time to 10/15 seconds. The proposed therapeutic rationale, informed by biomechanical insights, lays a promising foundation for further investigation. Nevertheless, empirical validation through rigorous clinical trials remains essential to substantiate its clinical utility and advance the management of RA.
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Affiliation(s)
- Saverio Colonna
- Osteopathic Spine Center Education, Spine Center, Bologna, ITA
| | - Corrado Borghi
- Osteopathic Spine Center Education, Spine Center, Bologna, ITA
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Gherghina FL, Mîndrilă I, Buteică SA, Bică G, Pisoschi CG, Biță CE, Paliu IA, Rogoveanu OC. The Potential Benefic Effect of Nicotinamide Riboside in Treating a Murine Model of Monoiodoacetate-Induced Knee Osteoarthritis. J Clin Med 2023; 12:6920. [PMID: 37959383 PMCID: PMC10650314 DOI: 10.3390/jcm12216920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Knee osteoarthritis (KOA), one of the most common orthopedic disorders concerning the adult population worldwide, is a condition characterized by progressive destruction of the articular cartilage and the presence of an inflammatory process. The aim of our study was to assess whether nicotinamide riboside (NR), a popular anti-aging supplement, can reduce the rate of cartilage destruction and alleviate the inflammatory response compared to the commonly prescribed collagen supplement in a murine monoiodoacetate (MIA)-induced KOA model. Twenty Wistar rats were randomly assigned to 4 groups: sham (S), MIA and NR, MIA and hydrolyzed collagen (HC), and MIA. At the end of the experiment, the right knees and blood samples were collected for histological assessment and biochemical evaluation of nitric oxide, malondialdehyde, total antioxidant capacity, reduced glutathione, glutathione peroxidase, superoxide dismutase, catalase, myeloperoxidase, and tumoral necrosis factor-alpha (TNF-α). The study determined that the treatment with NR in a similar dose with HC decreased blood/serum levels of oxidative stress biomarkers and the histological lesions in almost the same manner. The present findings suggest that NR may exhibit chondroprotective and anti-inflammatory effects in MIA-induced KOA in rats.
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Affiliation(s)
- Florin-Liviu Gherghina
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania
| | - Ion Mîndrilă
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania;
| | - Sandra-Alice Buteică
- Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania;
| | - George Bică
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania
| | - Cătălina-Gabriela Pisoschi
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania;
| | - Cristina-Elena Biță
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania;
| | - Iulia-Alexandra Paliu
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania;
| | - Otilia-Constantina Rogoveanu
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania
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11
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Serrano-García B, Forriol-Campos F, Zuil-Escobar JC. Active Neurodynamics at Home in Patients with Knee Osteoarthritis: A Feasibility Study. J Clin Med 2023; 12:6635. [PMID: 37892772 PMCID: PMC10607651 DOI: 10.3390/jcm12206635] [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: 07/29/2023] [Revised: 09/23/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The aim was to evaluate the feasibility of a home-based neurodynamic programme for patients with knee osteoarthritis (KO). Thirty participants (70% women) ≥ 50 years old with KO (Kellgren-Lawrence grades I-II) were included. Active mobilisation of the femoral nerve was performed at home over a period of 6-8 weeks. The feasibility of the programme was assessed using a survey that included questions related to understanding of the activity; adherence to the intervention; the burden caused by the intervention; self-perceived effects on the participant; follow-up; the barriers; and facilitators. Pain intensity, using the numerical rating scale (NRS); pressure pain thresholds (PPT); temporal assessment; pain modulation; Knee Injury and Osteoarthritis Outcome Score (KOOS), 12-item Short Form Survey questionnaire (SF-12), and the Central Sensitization Inventory questionnaire (CSI) were also collected, before and after the intervention. All patients performed the intervention, completed at least 42 days of activity, and considered the exercise adequate, with 28 participants (93.3%) reporting that the intervention was good for them. Statistically significant values (p < 0.05) were found for NRS, elbow PPT, external knee PPT, internal knee PPT, elbow CPM, CSI, and KOOS. Home-based active neurodynamic treatment has been shown to be a feasible and safe intervention for KO patients. In addition, this intervention has shown positive effects on pain and function.
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Affiliation(s)
- Beatriz Serrano-García
- Escuela Internacional de Doctorado (CEINDO), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain
- Hospital Ruber Juan Bravo, Calle Maldonado 52, 28006 Madrid, Spain
| | - Francisco Forriol-Campos
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain;
| | - Juan Carlos Zuil-Escobar
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain;
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12
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Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
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Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
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13
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Feng T, Wang X, Jin Z, Qin X, Sun C, Qi B, Zhang Y, Zhu L, Wei X. Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses. Front Public Health 2023; 11:1081238. [PMID: 36908468 PMCID: PMC9999021 DOI: 10.3389/fpubh.2023.1081238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
Background Manual therapy has been used as an alternative approach to treat knee osteoarthritis (KOA) for many years. Numerous systematic reviews (SRs) or meta-analyses (MAs) were published to evaluate its effectiveness and safety. Nevertheless, the conclusions of SRs/MAs are inconsistent, and the uneven quality needs to be critically appraised. Objectives To conduct a comprehensive overview of the effectiveness and safety of manual therapy for KOA and the quality of relevant SRs/MAs, thus providing critical evidence and valuable direction for future researchers to promote the generation of advanced evidence. Methods The pre-defined search strategies were applied to eight electronic databases from inception to September 2022. Suitable SRs/MAs were included in accordance with the inclusion and exclusion criteria. The methodological quality, risk of bias, reporting quality, and evidence quality were assessed by two independent reviewers who used respectively the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Version (PRISMA 2020), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) based on the method of narrative synthesis. We excluded the overlapping randomized controlled trials (RCTs) and performed a re-meta-analysis of the total effective rate. Results A total of eleven relevant SRs/MAs were included: nine SRs/MAs were rated critically low quality, and two were rated low quality by AMSTAR-2. According to ROBIS, all SRs/MAs were rated low risk in Phase 1 (assessing relevance) and Domain 1 (study eligibility criteria) of Phase 2. Three SRs/MAs (27.27%) were rated low risk in Domain 2 (identification and selection of studies). Ten SRs/MAs (90.91%) were rated low risk in Domain 3 (data collection and study appraisal). Five SRs/MAs (45.45%) were rated low risk in Domain 4 (synthesis and findings). And five SRs/MAs (45.45%) were rated low risk in Phase 3 (risk of bias in the review). By PRISMA 2020, there were some reporting deficiencies in the aspects of abstract (2/11, 18.18%), search strategy (0/11, 0%), preprocessing of merging data (0/11, 0%), heterogeneity exploration (6/11, 54.55%), sensitivity analysis (4/11, 36.36%), publication bias (5/11, 45.45%), evidence quality (3/11, 27.27%), the list of excluded references (3/11, 27.27%), protocol and registration (1/11, 9.09%), funding (1/11, 9.09%), conflict of interest (3/11, 27.27%), and approach to relevant information (0/11, 0%). In GRADE, the evidence quality was defined as moderate quality (8 items, 21.05%), low quality (16 items, 42.11%), and critically low quality (14 items, 36.84%). Among the downgraded factors, risk of bias, inconsistency, imprecision, and publication bias were the main factors. A re-meta-analysis revealed that manual therapy can increase the total effective rate in KOA patients (risk ratio = 1.15, 95% confidence interval [1.12, 1.18], p < 0.00001; I2 = 0, p = 0.84). There are four reviews that narratively report adverse effects, and no severe adverse reactions occurred in the manual therapy group. Conclusions Manual therapy may be clinically effective and safe for patients with KOA. However, this conclusion must be interpreted with caution because of the generally unsatisfactory study quality and inconsistent conclusions of the included SRs/MAs. Further rigorous and normative SRs/MAs are expected to be carried out to provide robust evidence for definitive conclusions. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42022364672.
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Affiliation(s)
- Tianxiao Feng
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Wang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zikai Jin
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaokuan Qin
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chuanrui Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baoyu Qi
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yili Zhang
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Liguo Zhu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Wei
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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14
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Reep NC, Leverett SN, Heywood RM, Baker RT, Barnes DL, Cheatham SW. The Efficacy of the Mulligan Concept to Treat Meniscal Pathology: A Systematic Review. Int J Sports Phys Ther 2022; 17:1219-1235. [PMID: 36518834 PMCID: PMC9718724 DOI: 10.26603/001c.55540] [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: 07/15/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2023] Open
Abstract
Background Meniscal pathologies are common knee injuries and arthroscopic surgery is the current accepted gold standard for treatment. However, there is evidence to support the use of the Mulligan Concept (MC) Mobilization with Movement (MWM) for meniscal pathologies including the 'Squeeze' technique, tibial internal rotation (IR), and tibial external rotation (ER). Hypothesis/Purpose The purpose of this systematic review was to critically appraise the literature to investigate the effectiveness of MC MWMs for meniscal lesions on patient reported pain, function, and multi-dimensional health status in patients with clinically diagnosed meniscal pathologies. Study Design Systematic Review. Methods A literature search was completed across multiple databases using combinations of the words "knee, function, mobilization with movement, MWM, mulligan concept, MC, meniscal pathology, meniscal derangement, and meniscal tear." Studies written within the prior 10 years that examined MC MWM techniques to treat knee meniscal injury were included. Articles that met the inclusion criteria (used MC MWM 'Squeeze' technique, tibial IR, or tibial ER for treatment of clinically diagnosed meniscal pathologies; Patient reported outcome [PRO] measures had to be used in the assessment of knee pain or function) were analyzed for quality. Randomized control trials were analyzed using the PEDro scale and the Downs & Black (D&B) checklist, case series were analyzed using the Joanna Briggs Institute (JBI) checklist, and case reports were analyzed using the CARES checklist. Results Six articles met the inclusion criteria and were included in this review, two randomized controlled studies, two case series, and two case reports consisting of 72 subjects. All six papers included reports of improvements in pain and function that were either statistically significant or met the minimal clinically important difference (MCID). Five studies reported the Disablement in the Physically Active (DPA) scale that also demonstrated statistically significant differences or met the MCID. The MC MWM 'Squeeze' technique, tibial IR, or tibial ER demonstrated the ability to reduce pain, improve function, and improve patient perceived disability following treatment of a clinically diagnosed meniscal pathology. These studies demonstrated short term results lasting from one week to 21 weeks. Conclusion Treatment interventions incorporating MC MWM techniques demonstrated reduction of pain and improvement in function in the short term in patients with clinically diagnosed meniscal pathologies. Level of Evidence 2a.
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Affiliation(s)
| | | | | | - Russell T Baker
- Department of Movement Sciences University of Idaho
- WWAMI Medical Education University of Idaho
| | | | - Scott W Cheatham
- Department of Kinesiology California State University Dominguez Hills
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15
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Khemani S, Shah S, Mhase S, Khan SN, Nimje AM, Patil MS. Pragmatic Effect of Lower Limb McKenzie in Grade One Osteoarthritis: A Novel Case Report. Cureus 2022; 14:e29945. [DOI: 10.7759/cureus.29945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
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16
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Pianese L, Bordoni B. The Use of Instrument-Assisted Soft-Tissue Mobilization for Manual Medicine: Aiding Hand Health in Clinical Practice. Cureus 2022; 14:e28623. [PMID: 36059328 PMCID: PMC9429822 DOI: 10.7759/cureus.28623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/07/2022] Open
Abstract
Instrument-assisted soft-tissue mobilization (IASTM) represents a treatment strategy for soft tissue (skin) and musculoskeletal tissue (myofascia). There are different morphologies of these tools that are used by clinicians and manual therapists for the management of scars, fibrotic formations, muscle-joint pain, and movement limitations. The literature demonstrates the effectiveness of IASTMs in different clinical areas. However, the literature does not consider the use of these tools for the protection of the clinician’s hands. The main objective of this article is to draw attention to the fact that IASTM can protect clinicians from professional joint injuries of the hands and can likely become a preventive tool for the operator. Further research is needed to fully determine the positive adaptations in operators who use IASTMs compared to those who do not use them.
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17
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Rossettini G, Colombi A, Carlino E, Manoni M, Mirandola M, Polli A, Camerone EM, Testa M. Unraveling Negative Expectations and Nocebo-Related Effects in Musculoskeletal Pain. Front Psychol 2022; 13:789377. [PMID: 35369173 PMCID: PMC8966654 DOI: 10.3389/fpsyg.2022.789377] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/24/2022] [Indexed: 12/16/2022] Open
Abstract
This Perspective adapts the ViolEx Model, a framework validated in several clinical conditions, to better understand the role of expectations in the recovery and/or maintenance of musculoskeletal (MSK) pain. Here, particular attention is given to the condition in which dysfunctional expectations are maintained despite no longer being supported by confirmatory evidence (i.e., belief-lifting the arm leads to permanent tendon damage; evidence-after the patient lifts the arm no tendon damage occurs). While the ViolEx Model suggests that cognitive immunization strategies are responsible for the maintenance of dysfunctional expectations, we suggest that such phenomenon can also be understood from a Bayesian Brain perspective, according to which the level of precision of the priors (i.e., expectations) is the determinant factor accounting for the extent of priors' updating (i.e., we merge the two frameworks, suggesting that highly precise prior can lead to cognitive immunization responses). Importantly, this Perspective translates the theory behind these two frameworks into clinical suggestions. Precisely, it is argued that different strategies should be implemented when treating MSK pain patients, depending on the nature of their expectations (i.e., positive or negative and the level of their precision).
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,School of Physiotherapy, University of Verona, Verona, Italy
| | - Andrea Colombi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Mattia Manoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Andrea Polli
- Pain in Motion (PAIN) Department, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Research Foundation, Flanders (FWO) Postdoctoral Fellow, Brussels, Belgium
| | - Eleonora Maria Camerone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Conservative Trio-Therapy for Varus Knee Osteoarthritis: A Prospective Case-Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040460. [PMID: 35454299 PMCID: PMC9028347 DOI: 10.3390/medicina58040460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/27/2022]
Abstract
Background and Objectives: Knee osteoarthritis (OA) is a frequent cause of pain, functional limitations, and a common reason for surgical treatment, such as joint replacement. Conservative therapies can reduce pain and improve function; thus, delaying or even preventing surgical intervention. Various individual conservative therapies show benefits, but combination therapies remain underexplored. The aim of this prospective case-study was to assess the effect of a conservative combination therapy in patients with painful varus knee OA. Materials and Methods: With strong inclusion and exclusion criteria, nine patients with painful varus knee OA (mean age 56 years (range 51−63 years) were selected and monitored over six months, using the following clinical outcome scores: pain visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC score), short-form−36 items (SF-36) quality of life score, and the sports frequency score. All patients received a standardized conservative trio-therapy with varus-reducing hindfoot shoe-insoles with a lateral hindfoot wedge, oral viscosupplementation, and physiotherapy for six months. Results: The pain was reduced significantly from initial VAS values of 5.4 points (range, 3−10) to values of 0.6 points (range, 0−3; p < 0.01), at the end of treatment. After six months, seven out of nine patients reported no pain at all (VAS 0). The WOMAC score improved significantly, from initial values of 35 (range, 10−56) to values of 2 (range, 0−9; p < 0.01). The SF-36 score showed significant improvement after six months in all four domains of physical health (p < 0.01) and in two of the four domains of mental health (p < 0.05). The sports frequency score increased by at least one level in six out of nine patients after six months. Conclusions: The conservative trio-therapy in patients with varus knee OA showed positive initial clinical results: less pain, higher function, better quality of life, and higher sport activity. Further studies are required to evaluate the long-term effect.
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