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Silvernail JL, Deyle GD, Jensen GM, Chaconas E, Cleland J, Cook C, Courtney CA, Fritz J, Mintken P, Lonnemann ME. Orthopaedic Manual Physical Therapy: A Modern Definition and Description. Phys Ther 2024:pzae036. [PMID: 38457654 DOI: 10.1093/ptj/pzae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/04/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature.
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Affiliation(s)
| | | | | | | | - Joshua Cleland
- Tufts University School of Medicine, Boston, Massachusetts
| | - Chad Cook
- Duke University, Durham, North Carolina
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Pugliese MS, Brismée JM, Allen B, Riley SP, Tammany J, Mintken P. Mentorship and self-efficacy are associated with lower burnout in physical therapists in the United States: a cross-sectional survey study. J Educ Eval Health Prof 2023; 20:27. [PMID: 37927039 PMCID: PMC10632729 DOI: 10.3352/jeehp.2023.20.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study investigated the prevalence of burnout in physical therapists in the United States and the relationships between burnout and education, mentorship, and self-efficacy. METHODS This was a cross-sectional survey study. An electronic survey was distributed to practicing physical therapists across the United States over a 6-week period from December 2020 to January 2021. The survey was completed by 2,813 physical therapists from all states. The majority were female (68.72%), White or Caucasian (80.13%), and employed full-time (77.14%). Respondents completed questions on demographics, education, mentorship, self-efficacy, and burnout. The Burnout Clinical Subtypes Questionnaire 12 (BCSQ-12) and self-reports were used to quantify burnout, and the General Self-Efficacy Scale (GSES) was used to measure self-efficacy. Descriptive and inferential analyses were performed. RESULTS Respondents from home health (median BCSQ-12=42.00) and skilled nursing facility settings (median BCSQ-12=42.00) displayed the highest burnout scores. Burnout was significantly lower among those who provided formal mentorship (median BCSQ-12=39.00, P=0.0001) compared to no mentorship (median BCSQ-12=41.00). Respondents who received formal mentorship (median BCSQ-12=38.00, P=0.0028) displayed significantly lower burnout than those who received no mentorship (median BCSQ-12=41.00). A moderate negative correlation (rho=-0.49) was observed between the GSES and burnout scores. A strong positive correlation was found between self-reported burnout status and burnout scores (rrb=0.61). CONCLUSION Burnout is prevalent in the physical therapy profession, as almost half of respondents (49.34%) reported burnout. Providing or receiving mentorship and higher self-efficacy were associated with lower burnout. Organizations should consider measuring burnout levels, investing in mentorship programs, and implementing strategies to improve self-efficacy.
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Affiliation(s)
- Matthew S. Pugliese
- Department of Physical Therapy, Hospital for Special Surgery, New York, NY, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Brad Allen
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sean P. Riley
- Hartford Healthcare Rehabilitation Network, Glastonbury, CT, USA
| | - Justin Tammany
- Department of Physical Therapy, Hardin-Simmons University, Abilene, TX, USA
| | - Paul Mintken
- Doctor of Physical Therapy Program, Graduate College of Health Sciences, Hawai‘i Pacific University, Honolulu, HI, USA
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Louw A, Louw C, Podalak J, Zimney K, DeLorenzo J, Maiers N, Puentedura EJ, Mintken P. Pain Neuroscience Education in Elementary and Middle Schools. Pediatr Phys Ther 2023:00001577-990000000-00059. [PMID: 37171390 DOI: 10.1097/pep.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The purpose of this study was to deliver pain neuroscience education (PNE) to participants in grades 3 to 8 to determine whether participants in these grades had positive shifts in pain knowledge and beliefs. METHODS Three hundred twenty participants, grades 3 to 8, received a 1-time, 30-minute PNE lecture. The Neurophysiology of Pain Questionnaire and the Health Care Provider's Pain and Impairment Relationship Scale were administered before and after the PNE lecture. RESULTS All grades improved in pain knowledge and beliefs. Higher-grade school participants (sixth to eighth grades) experienced larger shifts in pain knowledge and attitudes and beliefs than lower-grade (third to fifth grades) participants. CONCLUSION PNE results in changes in pain knowledge and beliefs in school participants in grades 3 to 8.
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Affiliation(s)
- Adriaan Louw
- Evidence in Motion (Dr Louw), Story City, Iowa; Ortho Spine and Pain Clinic (Ms Louw), Story City, Iowa; Phileo Health (Dr Podalak), Eau Claire, Wisconsin; Department of Physical Therapy (Dr Zimney), School of Health Sciences, University of South Dakota, Vermillion, South Dakota; Doctor of Physical Therapy Program (Dr Mintken), College of Health and Society, Hawai'i Pacific University, Honolulu, Hawaii; DeLorenzo Therapy and Wellness (Ms DeLorenzo), Alexandria, Virginia; Physical Therapy Education (Dr Maiers), Des Moines University, Des Moines, Iowa; Department of Physical Therapy (Puentedura), Baylor University, Waco, Texas
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Bialosky JE, Cleland JA, Mintken P, Beneciuk JM, Bishop MD. The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain. J Man Manip Ther 2021; 30:68-77. [PMID: 34657575 DOI: 10.1080/10669817.2021.1989754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The preferences a person has for care are associated with outcomes for patients presenting with musculoskeletal pain conditions. These include preferences for differing levels of involvement in the decision-making process, preferences for the provider attributes, and preferences for particular interventions. In this paper, we discuss these various forms of preference, as well as how they influence clinical care within shared decision-making frameworks. We also present a conceptual framing for how patient preferences can be incorporated in clinical decision-making by orthopedic manual physical therapists. Finally, research implications for interpreting findings from clinical studies are discussed.
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Affiliation(s)
- Joel E Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA.,Brooks-PHHP Research Collaboration, Gainesville, Florida, USA
| | - Josh A Cleland
- Department of Physical Therapy, Tufts University, Boston, Massachusetts, USA
| | - Paul Mintken
- Department of Physical Therapy, University of Colorado Physical Medicine and Rehabilitation- Physical Therapy, Aurora, Colorado, USA
| | - Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA
| | - Mark D Bishop
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA
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Lonnemann E, Olson KA, Deyle GD, Silvernail JL, Plock H, Puentedura E, Mintken P, Rhon DI, Hutting N, Paris S. What is in a Name? Perhaps your Professional Identity and Practice - A Call to Maintain IFOMPT as the International Federation of Orthopedic Manipulative Physical Therapists. J Man Manip Ther 2021; 29:201-202. [PMID: 34378490 DOI: 10.1080/10669817.2021.1955518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Elaine Lonnemann
- University of St. Augustine for Health Sciences, St. Augustine, FL, USA
| | - Kenneth A Olson
- Northern Rehab Physical Therapy Specialists, DeKalb, IL, USA
| | - Gail D Deyle
- Brooke Army Medical Center, San Antonio, TX, USA
| | | | | | | | - Paul Mintken
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Nathan Hutting
- HAN University of Applied Sciences, Delegate Representative to IFOMPT of the Dutch Association for Manual Therapy (NVMT), Nijmegen, The Netherlands
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McDevitt AW, Cleland JA, Strickland C, Mintken P, Leibold MB, Borg M, Altic R, Snodgrass S. Accuracy of long head of the biceps tendon palpation by physical therapists; an ultrasonographic study. J Phys Ther Sci 2020; 32:760-767. [PMID: 33281293 PMCID: PMC7708007 DOI: 10.1589/jpts.32.760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/22/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Examination and treatment of the long head of the biceps tendon (LHBT)
requires accurate palpation. The purpose of this study was to determine physical
therapists’ reliability and ability to accurately palpate the LHBT in two arm positions
with ultrasound as the gold standard. [Participants and Methods] Examiners palpated the
LHBT within the intertubercular groove (ITG) of the humerus on the bilateral shoulders of
32 asymptomatic (21 female; 24.3 ± 1.9 years) participants in 2 arm positions. The
magnitude of distance between a marker and the border of the ITG was compared between 2
positions using an independent t-test. Percent accuracy was calculated. [Results]
Inter-rater reliability was poor (position 1, k=1.04; position 2,
k=0.016). Overall accuracy rate was 45.7% (117/256). Accuracy was 49.2%
(63/128) and 42.2% (54/128) for testing position 1 and position 2 respectively. Mean
distance palpated from the groove was M=2.58 mm (± 6.2 mm) for position 1
and M=3.77 mm (± 6.6 mm) for position 2. Inaccurate palpation occurred
medially 72.3% (47/65) and 93.2% (69/74) in position 1 and position 2 respectively.
[Conclusion] Results of this study did not support one arm position being more accurate
over another for LHBT palpation.
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Affiliation(s)
- Amy W McDevitt
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus: 13121 E. 17th Avenue, ED2S, Aurora, CO 80045, USA.,Sports Medicine and Rehabilitation, University of Colorado Health, USA.,School of Health Sciences, The University of Newcastle, Australia
| | | | - Colin Strickland
- Sports Medicine and Rehabilitation, University of Colorado Health, USA
| | - Paul Mintken
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus: 13121 E. 17th Avenue, ED2S, Aurora, CO 80045, USA
| | | | - Maria Borg
- Sports Medicine and Rehabilitation, University of Colorado Health, USA
| | - Rebecca Altic
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus: 13121 E. 17th Avenue, ED2S, Aurora, CO 80045, USA
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Nijs J, Wijma AJ, Willaert W, Huysmans E, Mintken P, Smeets R, Goossens M, van Wilgen CP, Van Bogaert W, Louw A, Cleland J, Donaldson M. Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians. Phys Ther 2020; 100:846-859. [PMID: 31995191 DOI: 10.1093/ptj/pzaa021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/07/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022]
Abstract
Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients' pain beliefs/perceptions to facilitate the acquisition of adaptive pain-coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain.
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Affiliation(s)
- Jo Nijs
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Building F-KIMA, Laarbeeklaan 103, BE-1090 Brussels, Belgium; and Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels, Brussels, Belgium
| | - Amarins J Wijma
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel; Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels; and Transcare Pain, Transdisciplinary Treatment Center, Groningen, the Netherlands
| | - Ward Willaert
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group,Vrije Universiteit Brussel; Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels; and Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Eva Huysmans
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel; Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels; Research Foundation-Flanders (FWO); and Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Paul Mintken
- Department of Physical Therapy, School of Medicine, University of Colorado, Aurora, Colorado, and Wardenburg Health Center, University of Colorado, Boulder, Colorado
| | - Rob Smeets
- Research School CAPHRI, Maastricht University, Maastricht, the Netherlands, and CIR Revalidatie Eindhoven/Zwolle, Eindhoven/Zwolle, the Netherlands
| | - Mariëlle Goossens
- Research School CAPHRI, Maastricht University, and CIR Revalidatie Eindhoven/Zwolle
| | - C Paul van Wilgen
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel; and Transcare Pain, Transdisciplinary Treatment Center
| | - Wouter Van Bogaert
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel
| | - Adriaan Louw
- Department of Physical Therapy, International Spine and Pain Institute, Louisville, Kentucky
| | - Josh Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, New Hampshire
| | - Megan Donaldson
- Physical Therapy Program, School of Medicine, Tufts University, Boston, Massachusetts
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Bishop MD, Mintken P, Bialosky JE, Cleland JA. Factors shaping expectations for complete relief from symptoms during rehabilitation for patients with spine pain. Physiother Theory Pract 2018; 35:70-79. [PMID: 29452024 DOI: 10.1080/09593985.2018.1440676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Patient expectations are related to treatment outcome across a broad variety of patient conditions. Here we sought to examine factors associated with the expectation of complete relief from treatment for spinal pain. DESIGN Secondary analysis of data pooled from two randomized controlled trials of conservative rehabilitation interventions. PATIENTS 252 patients (103 men, 149 women) with neck (n = 140) or back (n = 112) pain. METHODS We used logistic regression model with backward elimination to test which patient clinical or demographic factors were most related to the expectation of complete relief. MAIN OUTCOME MEASURES The expectation of complete recovery, which was collected at the baseline examination visit in the primary trials. RESULTS The final model examining the contributions of patient and clinical characteristics to the expectation of complete relief included two significant interactions. First, increasing disability was associated with increased odds of expecting complete recovery in women while there was very little change for men across levels of disability (OR 0.9 [95%CI 0.8, 0.9]). Second, patients with low fear and a sudden onset of pain had higher odds of expecting recovery than patients with a gradual onset of pain (OR 0.7 [95%CI 0.5, 0.97]). A main effect for education level of the patient was also significant with better odds for expecting complete recovery for college educated patients compared to those with graduate school education (OR 5.0 [95%CI 1.9, 13.4]). CONCLUSION The results should assist physical therapists to recognize patients who may have lower expectations of recovery and plan pre-treatment education interventions.
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Affiliation(s)
- Mark D Bishop
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Center for Pain Research and Behavioral Health , University of Florida , Gainesville , FL , USA
| | - Paul Mintken
- c Department of Physical Therapy , University of Colorado , Aurora , CO , USA.,d Wardenburg Health Center , University of Colorado Boulder , Boulder , CO , USA
| | - Joel E Bialosky
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Center for Pain Research and Behavioral Health , University of Florida , Gainesville , FL , USA
| | - Joshua A Cleland
- e Department of Physical Therapy , Franklin Pierce University , Concord , NH , USA.,f Rehabilitation Services , Concord Hospital , Concord , NH , USA
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Karas S, Mintken P, Brismée JM. We need to debate the value of manipulative therapy and recognize that we do not always understand from what to attribute our success. J Man Manip Ther 2018; 26:1-2. [PMID: 29456441 DOI: 10.1080/10669817.2018.1426241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Steve Karas
- North American Institute for Orthopedic Manual Therapy Research Director & Associate Professor, Chatham University, Pittsburgh, PA, USA.,Professor, University of Colorado School of Medicine, Aurora, CO, USA.,Editor-in-Chief JMMT, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Paul Mintken
- Professor, University of Colorado School of Medicine, Aurora, CO, USA.,Editor-in-Chief JMMT, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jean-Michel Brismée
- Editor-in-Chief JMMT, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Mitchell UH, Helgeson K, Mintken P. Physiological effects of physical therapy interventions on lumbar intervertebral discs: A systematic review. Physiother Theory Pract 2017; 33:695-705. [PMID: 28715273 DOI: 10.1080/09593985.2017.1345026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND CONTEXT The use of physical therapy has been recommended in the treatment of low back pain based on primarily mechanical and neurophysiological effects. Recent studies have measured the physiological effects of physical therapy interventions, including manual therapy and traction, on the intervertebral discs (IVD), and these findings may have implications for the long-term management or even prevention of low back pain. PURPOSE The objective of this systematic review is to investigate the literature regarding possible physiological effects of physical therapy interventions on the intervertebral disc (IVD). STUDY DESIGN Systematic Review. METHODS A literature search of published articles through December 2014 resulted in the retrieval of 8 clinical studies assessing the influence of physical therapy interventions on the physiology of the IVD. RESULTS Three studies, including two using animal models, investigated the effects of 30-minute intermittent traction on disc height. One in vivo animal study and two studies using human subjects assessed changes of disc height associated with static traction. Three studies investigated the effects of lumbar spine manipulation and mobilization on changes in water diffusion within the IVD. All studies confirmed, either directly or indirectly, that their respective intervention influenced disc physiology primarily through water flow. CONCLUSION Physical therapy interventions may have an effect on the physiology of the IVD, primarily through water diffusion and molecular transport, which are important for the health of the IVD.
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Affiliation(s)
- Ulrike H Mitchell
- a Department of Exercise Sciences , Brigham Young University , Provo , UT , USA
| | - Kevin Helgeson
- b Department of Physical Therapy, Rocky Mountain University of Health Professions , Provo , UT , USA
| | - Paul Mintken
- c Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine , Aurora , CO , USA
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Salamh PA, Reiman M, Cleland J, Mintken P, Rodeghero J, Cook CE. Risk Stratification for 4,837 Individuals with Knee Pain Who Receive Physical Therapy Treatment. Musculoskeletal Care 2017; 15:122-130. [PMID: 27374889 DOI: 10.1002/msc.1150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Risk stratification is a modelling method that is designed to target interventions toward patients with specific needs. The objective of the present study was to identify predictive characteristics related to patients with knee impairments who had a high risk of a bad prognosis (exceptional non-responders) as well as those who were at low risk of a bad prognosis (exceptional responders). A cohort of 4,837 patients with knee pain seen for physical therapy was retrospective analysed using univariate and multivariate multinomial regression analyses. Modelling was used to identify characteristics associated with those who were exceptional responders and those who were exceptional non-responders. Exceptional non-responders were significantly associated with older age, female gender, longer duration of symptoms, surgical history, lower functional status at baseline and a payer type. Exceptional responders were significantly associated with younger age, no previous surgical history, higher functional status at baseline and a payer type. Findings may be used for managing processes involving intensity of care service and in understanding probable prognoses for each patient. Future research should continue to examine variables predictive of treatment response in patients with knee pain. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Paul Mintken
- University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
INTRODUCTION The aim of the present study was to identify predictive characteristics related to patients with neck impairments who have a high risk of a poor prognosis (lowest functional recovery compared to visit utilization) as well as those who are at low risk of a poor prognosis (highest functional recovery compared to visit utilization). METHODS A retrospective cohort of 3,137 patients with neck pain who were seen for physiotherapy care was included in the study. All patients were seen at physiotherapy clinics in the United States and were provided with care in a manner in which the physiotherapists felt was appropriate and necessary. Univariate and multivariate multinomial regression analyses were used to identify significant patient characteristics predictive of treatment response. RESULTS Statistically significant predictors of high-risk categorization included longer duration of symptoms, surgical history and lower comparative levels of disability at baseline. Statistically significant predictors of low-risk categorization were younger age, shorter duration of symptoms, no surgical history, fewer comorbidities and higher comparative disability levels of function at baseline. DISCUSSION Few studies have analysed risk stratification models for neck pain, and the findings of the present study suggest that predictors of poor success are similar to those in most musculoskeletal prognostic models. Limitations of the study included those inherent in secondary analysis and the inability to identify the diagnoses of the patients. CONCLUSIONS Future research should continue to examine the variables predictive of treatment response in patients with neck pain. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Jason Rodeghero
- OSF Saint James - John W. Albrecht Medical Center, Pontiac, IL, USA
| | | | - Paul Mintken
- University of Colorado, School of Medicine, Aurora, CO, USA
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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.
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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
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Louw A, Puentedura E“L, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: A case report. Physiother Theory Pract 2011; 28:50-62. [DOI: 10.3109/09593985.2011.562602] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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