COVID 19 and manual therapy: international lessons and perspectives on current and future clinical practice and education

BACKGROUND

The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual therapy has moved to online platforms with in-person instruction restricted. The global impact on the clinical practice of manual therapy and education has to date not been explored.

METHODS

a questionnaire survey methodology was used. A sample of convenience of global leaders in manual therapy practice and education received an electronic link to two surveys: one on clinical practice and one on education. Contributors could complete one or both surveys.

RESULTS

Twenty-five surveys were received on clinical practice and 23 on education in manual therapy, representing the six major continents. Global themes in clinical practice demonstrated a sudden and dramatic shift away from patient contact, with limited modifications to manual therapy in patient care currently adopted. Themes in education were of a major shift to online learning, development of new modes of student instruction including video-based assessment and virtual case-based instruction.

CONCLUSION

The international perspectives provided demonstrate a major change in manual therapy practice and education globally. Various approaches have been taken in practice and education without a uniform approach being demonstrated.

The effect of wearing loupes on upper extremity musculoskeletal disorders among dental hygienists

OBJECTIVES

It is well established that musculoskeletal disorders (MSD) are a significant occupational health issue for dentists and hygienists. Despite this, there has been little advancement in the application of ergonomic principles in the dental profession. While the use of loupes is often promoted as an ergonomic solution, there is little published research to robustly support this claim. The aim of the present study was to investigate the effect of the use of loupes on upper extremity MSD among dental hygienists.

METHODS

The study was conducted using an exploratory pretest and post-test design, comparing musculoskeletal measures in practising dental hygienists wearing loupes with final-year dental hygiene students who did not wear loupes. Pre- and post-test measures included valid self-reported and objective outcome measures and were measured at baseline and 6 months following the intervention. Statistical analysis was conducted as a series of mixed anovas with time and treatment as the independent variables.

RESULTS

The analysis revealed a significant interaction between time and treatment for the Disabilities of the Shoulder, Arm and Hand (DASH) scores (P < 0.04), indicating an improvement in symptoms for the treatment group but a reversed trend for the controls. There was also a significant mean increase in scapular position measures; however, this finding was evident in both groups, indicating that these were not a result of the intervention.

CONCLUSIONS

Overall, this study suggests that wearing loupes appears to have both positive and negative effects on upper extremity MSD among dental hygienists. Ongoing research is required to determine the long-term effects of loupes wear, over an extended period of time.

Determinants of passive hip range of motion in adult Greyhounds

OBJECTIVE

To determine the ranges of normal pelvic limb range of motion in adult Greyhound dogs, and to explore which factors influence hip range of motion in a population bred to meet the specific demands of racing. Design A cross-sectional study design.

METHOD

Thirty-two dogs (17 male and 15 female) 13 to 81 months old were randomly selected from a local pool of 160 Greyhounds. Goniometric measurements of hip, stifle and hock range of motion were recorded in triplicate. Signalment information collected included sex, weight and age of each Greyhound. The outcome factors for the study were range of hip flexion and hip extension. The theorised exposures, age, sex, weight, racing history and hock and stifle range of motion, were modelled against the outcome variables by linear regression analysis.

RESULTS

Male dogs were significantly heavier (P < 0.001) and older (P < 0.002) than female dogs. Mean hip flexion was 71.75 degrees and mean hip extension 128.10 degrees. The determinants of hip flexion were sex (P = 0.008) and range of stifle flexion (P = 0.002). Race training did not influence the range of hip flexion in the sample. Determinants of hip extension included range of stifle extension (P = 0.015), history of race training (P = 0.004) and hock flexion. The mean hip extension of raced Greyhounds was 134.95 degrees compared with 121.25 degrees for unraced Greyhounds (mean difference -13.70, 95% confidence interval -18.12, -9.29; P < 0.001).

CONCLUSIONS

This study has reported isolated pelvic limb joint range of motion in the racing Greyhound. Hip range of motion was affected by stifle range of motion, sex and race training. Dogs that had received race training had greater flexibility, possibly due to training having an active stretching role on muscles, tendons and other structures limiting the hip range of motion.