The purpose of this study was to evaluate the effects of chest physiotherapy on respiratory function during rest sitting and stationary bicycle in participants hospitalized for a period with respiratory involvement after SARS-CoV-2 infection.
Methods
This study was a randomized, single-blinded, controlled study. Forty-four participants after SARS-CoV-2 met the inclusion criteria and were randomly assigned to the 2 groups. The study intervention included a program of 10 sessions of supervised chest physiotherapy (intervention) and without any intervention (control) groups. They were assessed on 2 sessions before and after the intervention according to the respiratory function, including time of inspiration (TI), time of expiration (TE), peak inspiratory flow (PIF), peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume 1/forced vital capacity (FEV1/FVC). This assessment was done on 2 situations: during rest sitting position on the table and during stationary bicycle for 20 minutes.
Results
Analysis of variance revealed that the effect of time was significant for the PEF and FVC. Moreover, the interaction effect of “time and group” was significant for the TE, PEF, FEV1, and FEV1/FVC. A group difference was revealed for the TE, FEV1, and FEV1/FVC after the intervention. The paired t-test indicated that the PEF, FEV1, and FEV1/FVC increased in the intervention group when the spirometry was done in the sitting position (P ≤ .05). Independent t-test also showed that the FEV1 (P = .008) and FEV1/FVC (P = .004) significantly increased in the intervention group compared to the control group during sitting spirometry (P ≤ .05). Moreover, FEV1/FVC (P = .002) was decreased in the intervention group when the spirometry was done during stationary bicycle.
Conclusion
In this study, patients after SARS-CoV-2 had improved respiratory functions and functional activities after 10 sessions of therapy.
{"title":"Effects of Chest Physiotherapy on Respiratory Capacity in Patients With Severe Acute Respiratory Syndrome Coronavirus 2: A Randomized Controlled Trial","authors":"Fatemeh Ehsani , Rasool Bagheri , Marzieh Mortezanejad , Rozita Hedayati , Atefeh Aminianfar , Mohammad Memarian","doi":"10.1016/j.jmpt.2025.10.013","DOIUrl":"10.1016/j.jmpt.2025.10.013","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to evaluate the effects of chest physiotherapy on respiratory function during rest sitting and stationary bicycle in participants hospitalized for a period with respiratory involvement after SARS-CoV-2 infection.</div></div><div><h3>Methods</h3><div>This study was a randomized, single-blinded, controlled study. Forty-four participants after SARS-CoV-2 met the inclusion criteria and were randomly assigned to the 2 groups. The study intervention included a program of 10 sessions of supervised chest physiotherapy (intervention) and without any intervention (control) groups. They were assessed on 2 sessions before and after the intervention according to the respiratory function, including time of inspiration (TI), time of expiration (TE), peak inspiratory flow (PIF), peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume 1/forced vital capacity (FEV1/FVC). This assessment was done on 2 situations: during rest sitting position on the table and during stationary bicycle for 20 minutes.</div></div><div><h3>Results</h3><div>Analysis of variance revealed that the effect of time was significant for the PEF and FVC. Moreover, the interaction effect of “time and group” was significant for the TE, PEF, FEV1, and FEV1/FVC. A group difference was revealed for the TE, FEV1, and FEV1/FVC after the intervention. The paired t-test indicated that the PEF, FEV1, and FEV1/FVC increased in the intervention group when the spirometry was done in the sitting position (<em>P</em> ≤ .05). Independent t-test also showed that the FEV1 (<em>P</em> = .008) and FEV1/FVC (<em>P</em> = .004) significantly increased in the intervention group compared to the control group during sitting spirometry (<em>P</em> ≤ .05). Moreover, FEV1/FVC (<em>P</em> = .002) was decreased in the intervention group when the spirometry was done during stationary bicycle.</div></div><div><h3>Conclusion</h3><div>In this study, patients after SARS-CoV-2 had improved respiratory functions and functional activities after 10 sessions of therapy.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 733-741"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-11-28DOI: 10.1016/j.jmpt.2025.10.031
Chunxia Zhang MD , Tao Pang MD , Yuan Chen MD , Penghui Lai MD , Rongrong Nie MD , Yulong Wang MD , Shaohua Zhang MD
Objective
The purpose of this study was to examine brain function activity changes in patients with left basal ganglia ischemic stroke (LBGIS) in order to identify the specific brain regions associated with motor function.
Methods
The study compared 35 patients with LBGIS and 34 healthy control participants (HCs). Functional connectivity density (FCD) was calculated to explore brain functional activity difference between the 2 groups of participants, and receiver operating characteristics (ROC) curve was used to test the specificity of these different regions. Pearson’s correlation was employed to evaluate relationships between FCD values and clinical scores.
Results
In the LBGIS group, FCD values were increased in the left cerebellum 9 lobe (L_C9), right inferior temporal gyrus (R_ITG), left middle temporal gyrus (L_MTG), and right supplementary motor area (R_SMA) but decreased in the left calcarine sulcus (L_CS), right lingual gyrus (R_LG), right cuneus (R_C), right supramarginal gyrus (R_SG), right inferior frontal gyrus (R_IFG), and left inferior parietal gyrus (L_IPG). ROC curves demonstrated that these designated brain areas alone distinguished between the LBGIS and HC groups with high sensitivity and specificity. In patients with LBGIS, L_C9 and R_SMA displayed significant correlations with the Fugl–Meyer assessment and Barthel index scores.
Conclusions
Patients with LBGIS exhibit changes in the functional activity of multiple brain regions, and L_C9 and R_SMA may be key areas to promote motor function in people with LBGIS.
{"title":"Functional Connectivity Density in Patients with Left Basal Ganglia Ischemic Stroke: A Comparative Study","authors":"Chunxia Zhang MD , Tao Pang MD , Yuan Chen MD , Penghui Lai MD , Rongrong Nie MD , Yulong Wang MD , Shaohua Zhang MD","doi":"10.1016/j.jmpt.2025.10.031","DOIUrl":"10.1016/j.jmpt.2025.10.031","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to examine brain function activity changes in patients with left basal ganglia ischemic stroke (LBGIS) in order to identify the specific brain regions associated with motor function.</div></div><div><h3>Methods</h3><div>The study compared 35 patients with LBGIS and 34 healthy control participants (HCs). Functional connectivity density (FCD) was calculated to explore brain functional activity difference between the 2 groups of participants, and receiver operating characteristics (ROC) curve was used to test the specificity of these different regions. Pearson’s correlation was employed to evaluate relationships between FCD values and clinical scores.</div></div><div><h3>Results</h3><div>In the LBGIS group, FCD values were increased in the left cerebellum 9 lobe (L_C9), right inferior temporal gyrus (R_ITG), left middle temporal gyrus (L_MTG), and right supplementary motor area (R_SMA) but decreased in the left calcarine sulcus (L_CS), right lingual gyrus (R_LG), right cuneus (R_C), right supramarginal gyrus (R_SG), right inferior frontal gyrus (R_IFG), and left inferior parietal gyrus (L_IPG). ROC curves demonstrated that these designated brain areas alone distinguished between the LBGIS and HC groups with high sensitivity and specificity. In patients with LBGIS, L_C9 and R_SMA displayed significant correlations with the Fugl–Meyer assessment and Barthel index scores.</div></div><div><h3>Conclusions</h3><div>Patients with LBGIS exhibit changes in the functional activity of multiple brain regions, and L_C9 and R_SMA may be key areas to promote motor function in people with LBGIS.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 947-955"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-11-13DOI: 10.1016/j.jmpt.2025.10.035
Mônica de Oliveira Melo PhD, Marja Bochehin Do Valle MSC, Cláudia Tarragô Candotti PhD, Juliana Adami Sedrez PhD, Edgar Santiago Wagner Neto PhD, Emanuelle Francine Detogni Schmit PhD, Jefferson Fagundes Loss PhD
Objective
The purpose of this study was to evaluate the intra- and inter-rater reproducibility of the Flexicurve for assessing the flexion and extension range of motion of the thoracic and lumbar spine.
Methods
Intrarater reproducibility (n = 35) was assessed by a single rater on 2 different days, and inter-rater reproducibility (n = 37) was assessed on 1 day by 3 different raters. The assessment protocol involved palpation and identification of spinous processes (SP), molding of the Flexicurve along the maximum range of flexion and extension, marking of SP on the Flexicurve, careful removal of the Flexicurve, drawing of the curvature contours obtained by the Flexicurve on paper, identification of SP on the drawing, photographic recording of the drawn contour, and analysis of the photograph using MATLAB 8.5. Data were analyzed using intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (α < 0.05).
Results
Excellent ICCs were obtained for intrarater reproducibility of thoracic and lumbar spine flexion and extension, with SEM ranging from 0.7° to 1.7°. Except for lumbar spine extension, which achieved satisfactory ICC, inter-rater reproducibility showed excellent ICCs for other measures, with SEM ranging from 2° to 5°. Intrarater reproducibility of the software resulted in excellent ICCs, with SEM ranging from 0.7° to 4.4°.
Conclusion
Due to established reproducibility and precision, the Flexicurve can be used for assessments of thoracic and lumbar spinal range of motion. Rigorous methodological care is recommended for its protocol, especially regarding thoracic extension.
{"title":"Reproducibility of the Flexicurve for Assessment of Thoracic and Lumbar Spine Range of Motion","authors":"Mônica de Oliveira Melo PhD, Marja Bochehin Do Valle MSC, Cláudia Tarragô Candotti PhD, Juliana Adami Sedrez PhD, Edgar Santiago Wagner Neto PhD, Emanuelle Francine Detogni Schmit PhD, Jefferson Fagundes Loss PhD","doi":"10.1016/j.jmpt.2025.10.035","DOIUrl":"10.1016/j.jmpt.2025.10.035","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to evaluate the intra- and inter-rater reproducibility of the Flexicurve for assessing the flexion and extension range of motion of the thoracic and lumbar spine.</div></div><div><h3>Methods</h3><div>Intrarater reproducibility (<em>n</em> = 35) was assessed by a single rater on 2 different days, and inter-rater reproducibility (<em>n</em> = 37) was assessed on 1 day by 3 different raters. The assessment protocol involved palpation and identification of spinous processes (SP), molding of the Flexicurve along the maximum range of flexion and extension, marking of SP on the Flexicurve, careful removal of the Flexicurve, drawing of the curvature contours obtained by the Flexicurve on paper, identification of SP on the drawing, photographic recording of the drawn contour, and analysis of the photograph using MATLAB 8.5. Data were analyzed using intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (<em>α</em> < 0.05).</div></div><div><h3>Results</h3><div>Excellent ICCs were obtained for intrarater reproducibility of thoracic and lumbar spine flexion and extension, with SEM ranging from 0.7° to 1.7°. Except for lumbar spine extension, which achieved satisfactory ICC, inter-rater reproducibility showed excellent ICCs for other measures, with SEM ranging from 2° to 5°. Intrarater reproducibility of the software resulted in excellent ICCs, with SEM ranging from 0.7° to 4.4°.</div></div><div><h3>Conclusion</h3><div>Due to established reproducibility and precision, the Flexicurve can be used for assessments of thoracic and lumbar spinal range of motion. Rigorous methodological care is recommended for its protocol, especially regarding thoracic extension.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 750-758"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to assess both intra- and inter-examiner reliability of manual muscle testing (MMT) within Applied Kinesiology (AK) practice.
Methods
Comprehensive searches were conducted in Medline, Scopus, Ebsco, and Embase, alongside manual searches of reference lists, with no date restrictions through October 14, 2023. Only studies applying MMT according to AK principles were included. Methodological quality was assessed using QAREL and Part B of the COSMIN checklist. A qualitative data synthesis was done to analyze reliability data.
Results
From 8,720 initial records, 7 studies met the inclusion criteria. Four were rated as good or very good quality, while 3 were rated as poor or inadequate. Intraexaminer reliability was assessed in 3 studies: 1 demonstrated high reliability (ICC > 0.86), while 2 showed poor reliability (k = −0.14 to 0.29, with 27%-40% agreement). Inter-examiner reliability, evaluated in 6 studies, ranged widely from k = −0.51 to 0.91. A subgroup analysis including only studies that used MMT without additional challenge procedures showed inter-examiner reliability ranging from k = −0.05 to 0.91. The piriformis muscle demonstrated the highest reliability (k = 0.7 to 0.91), while the hamstrings had the lowest (k = −0.07 to 0.24).
Conclusion
The reliability of MMT in AK ranged from nonexistent to very strong, depending on the type of analysis. MMT involving nonmusculoskeletal challenges showed nonexistent reliability and therefore not recommended for clinical use. However, MMT without challenges may be clinically useful, particularly for the deltoid, gluteus maximus, piriformis, and iliopsoas, which demonstrated moderate to very strong reliability.
{"title":"Reliability of Manual Muscle Testing in Applied Kinesiology: A Systematic Review","authors":"Jonatan Raabe Soares BsC (Chiro) , Fábio Franciscatto Stieven PhD , Clarice Sperotto dos Santos Rocha PhD , Iã Ferreira Miranda MsC","doi":"10.1016/j.jmpt.2025.10.007","DOIUrl":"10.1016/j.jmpt.2025.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to assess both intra- and inter-examiner reliability of manual muscle testing (MMT) within Applied Kinesiology (AK) practice.</div></div><div><h3>Methods</h3><div>Comprehensive searches were conducted in Medline, Scopus, Ebsco, and Embase, alongside manual searches of reference lists, with no date restrictions through October 14, 2023. Only studies applying MMT according to AK principles were included. Methodological quality was assessed using QAREL and Part B of the COSMIN checklist. A qualitative data synthesis was done to analyze reliability data.</div></div><div><h3>Results</h3><div>From 8,720 initial records, 7 studies met the inclusion criteria. Four were rated as good or very good quality, while 3 were rated as poor or inadequate. Intraexaminer reliability was assessed in 3 studies: 1 demonstrated high reliability (ICC > 0.86), while 2 showed poor reliability (k = −0.14 to 0.29, with 27%-40% agreement). Inter-examiner reliability, evaluated in 6 studies, ranged widely from k = −0.51 to 0.91. A subgroup analysis including only studies that used MMT without additional challenge procedures showed inter-examiner reliability ranging from k = −0.05 to 0.91. The piriformis muscle demonstrated the highest reliability (k = 0.7 to 0.91), while the hamstrings had the lowest (k = −0.07 to 0.24).</div></div><div><h3>Conclusion</h3><div>The reliability of MMT in AK ranged from nonexistent to very strong, depending on the type of analysis. MMT involving nonmusculoskeletal challenges showed nonexistent reliability and therefore not recommended for clinical use. However, MMT without challenges may be clinically useful, particularly for the deltoid, gluteus maximus, piriformis, and iliopsoas, which demonstrated moderate to very strong reliability.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 862-870"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the effects of nonthrust joint mobilization on pain, functional disability, and range of motion in patients with adhesive capsulitis (AC) of the shoulder.
Methods
This meta-analysis included all English-language randomized controlled trials and prospective quasi-experimental studies evaluating the effects of joint mobilization on pain, disability, and range of motion in adult patients with any type of AC. PubMed and SCOPUS were searched for studies published before November 2021. Further studies were identified through manual screening of the reference lists. Cochrane Collaboration tool for risk of bias (RoB 2.0) was used for risk of bias assessment. Results were pooled using random effects meta-analysis.
Results
Nineteen articles involving 812 patients were included in the synthesis. Regarding the effect on pain, the overall weighted mean difference was –1.19 with significant heterogeneity. For functional disability, overall weighted mean differences were –8.69 with significant heterogeneity, 10.11 with significant heterogeneity, and –7.18 with heterogeneity for studies using SPADI, Constant Murley, and DASH scores, respectively. Regarding the effect of shoulder mobilization on flexion, abduction, external, and internal rotations, overall weighted mean differences of 17.71, 13.89, 9.68, and 11.75 degrees, all with significant heterogeneity, were reported.
Conclusions
This meta-analysis found statistically significant improvements in the reduction of pain, improvement in function, and restoring of range of motion among patients with adhesive capsulitis, regardless of the mobilization technique used. However, the results should be interpreted with some caution, because of high levels of heterogeneity and lack of high-quality studies in this field.
{"title":"Effects of Nonthrust Joint Mobilization on Clinical Outcomes of Patients With Adhesive Capsulitis of the Shoulder: A Meta-Analysis","authors":"Farzin Halabchi MD , Behnaz Mahdaviani MD , Nima Bagheri MD , Shaghayegh Rahimi MD , Sakineh Shab-Bidar PhD , Maryam Selk-Ghaffari MD","doi":"10.1016/j.jmpt.2025.10.016","DOIUrl":"10.1016/j.jmpt.2025.10.016","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the effects of nonthrust joint mobilization on pain, functional disability, and range of motion in patients with adhesive capsulitis (AC) of the shoulder.</div></div><div><h3>Methods</h3><div>This meta-analysis included all English-language randomized controlled trials and prospective quasi-experimental studies evaluating the effects of joint mobilization on pain, disability, and range of motion in adult patients with any type of AC. PubMed and SCOPUS were searched for studies published before November 2021. Further studies were identified through manual screening of the reference lists. Cochrane Collaboration tool for risk of bias (RoB 2.0) was used for risk of bias assessment. Results were pooled using random effects meta-analysis.</div></div><div><h3>Results</h3><div>Nineteen articles involving 812 patients were included in the synthesis. Regarding the effect on pain, the overall weighted mean difference was –1.19 with significant heterogeneity. For functional disability, overall weighted mean differences were –8.69 with significant heterogeneity, 10.11 with significant heterogeneity, and –7.18 with heterogeneity for studies using SPADI, Constant Murley, and DASH scores, respectively. Regarding the effect of shoulder mobilization on flexion, abduction, external, and internal rotations, overall weighted mean differences of 17.71, 13.89, 9.68, and 11.75 degrees, all with significant heterogeneity, were reported.</div></div><div><h3>Conclusions</h3><div>This meta-analysis found statistically significant improvements in the reduction of pain, improvement in function, and restoring of range of motion among patients with adhesive capsulitis, regardless of the mobilization technique used. However, the results should be interpreted with some caution, because of high levels of heterogeneity and lack of high-quality studies in this field.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 800-812"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The primary purpose of this study was to investigate the relationship of photographic posture analysis (PPA) with motor performance and trunk, and the reliability of PPA in the sitting position control in children with cerebral palsy (CP).
Methods
Sixty-five children with CP between 5 and 12 years of age were investigated by PPA in a sitting position. The angles calculated for the PPA were the craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle, thoracic kyphosis angle, lumbal lordosis angle, coronal head tilt, coronal shoulder angle, and coronal pelvic angle. Trunk control was measured by the Trunk Control Measurement Scale (TCMS), and motor functions were evaluated by the Gross Motor Function Measure (GMFM).
Results
We found that PPA had high intra- and inter-rater reliability in sitting posture in children with CP (ICC: 0.951-0.998). Additionally, “coronal head tilt” and “coronal pelvic angle” had moderate correlations with some TCMS and GMFM scores (P < .05). There was a negative moderate significant correlation between “coronal pelvic angle” and “standing” (r = 0.557, P = .001), “walking/running/jumping” (r = –0.549, P = .001), and “total” (r = –0.535, P = .001) GMFM scores. There was a negative moderate significant correlation between “coronal head tilt” and “static sitting” (r = –0.444, P = .001), “dynamic reach” (r = –0.437, P = .001), and “total” (r = 0.442, P = .001) scores of TCMS. There was a negative moderate significant correlation between “coronal pelvic angle” and “static sitting” (r = –0.479, P = .001) and “total” (r = –0.454, P = .001) scores of TCMS.
Conclusion
PPA was a reliable method for children with CP in a sitting posture. The findings suggest that posture and function may affect each other; in particular, coronal angles and gross motor and trunk functions may be related.
目的：探讨摄影姿势分析（PPA）与脑瘫儿童运动表现和躯干的关系，以及PPA在脑瘫儿童坐姿控制中的可靠性。方法：对65例5 ~ 12岁CP患儿进行坐位PPA检查。PPA计算的角度为颅椎角、矢状头倾斜角、矢状肩- c7角、胸后凸角、腰前凸角、冠状头倾斜角、冠状肩角、冠状骨盆角。躯干控制量表（TCMS）测量躯干控制，大运动功能量表（GMFM）评估运动功能。结果：PPA对CP患儿的坐姿具有较高的信度（ICC: 0.951-0.998）。此外，“冠状面头部倾斜”和“冠状面骨盆角”与部分TCMS和GMFM评分有中度相关性（P < 0.05）。“骨盆冠状角”与“站立”（r = 0.557, P = .001）、“走/跑/跳”（r = -0.549, P = .001）、“总”（r = -0.535, P = .001） GMFM得分呈负中显著相关。“冠状头倾斜”得分与“静坐”得分（r = -0.444, P = .001）、“动态到达”得分（r = -0.437, P = .001）、“总”得分（r = 0.442, P = .001）呈负中显著相关。“盆腔冠状角”评分与“静坐”评分（r = -0.479, P = .001）、“总分”评分（r = -0.454, P = .001）呈负中显著相关。结论：PPA是一种可靠的治疗小儿坐位CP的方法。研究结果表明，姿势和身体机能可能会相互影响；特别是，冠状角与大运动和躯干功能可能有关。
{"title":"Photographic Posture Analysis in Children With Cerebral Palsy and Its Relationship With Motor Performance and Trunk Control","authors":"Nilay Comuk Balci PhD , Betul Erbay Pt, MSc , Mert Demirsoz MSc , Bircan Yucekaya Pt, PhD","doi":"10.1016/j.jmpt.2025.10.021","DOIUrl":"10.1016/j.jmpt.2025.10.021","url":null,"abstract":"<div><h3>Objective</h3><div>The primary purpose of this study was to investigate the relationship of photographic posture analysis (PPA) with motor performance and trunk, and the reliability of PPA in the sitting position control in children with cerebral palsy (CP).</div></div><div><h3>Methods</h3><div>Sixty-five children with CP between 5 and 12 years of age were investigated by PPA in a sitting position. The angles calculated for the PPA were the craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle, thoracic kyphosis angle, lumbal lordosis angle, coronal head tilt, coronal shoulder angle, and coronal pelvic angle. Trunk control was measured by the Trunk Control Measurement Scale (TCMS), and motor functions were evaluated by the Gross Motor Function Measure (GMFM).</div></div><div><h3>Results</h3><div>We found that PPA had high intra- and inter-rater reliability in sitting posture in children with CP (ICC: 0.951-0.998). Additionally, “coronal head tilt” and “coronal pelvic angle” had moderate correlations with some TCMS and GMFM scores (<em>P</em> < .05). There was a negative moderate significant correlation between “coronal pelvic angle” and “standing” (<em>r</em> = 0.557, <em>P</em> = .001), “walking/running/jumping” (<em>r</em> = –0.549, <em>P</em> = .001), and “total” (<em>r</em> = –0.535, <em>P</em> = .001) GMFM scores. There was a negative moderate significant correlation between “coronal head tilt” and “static sitting” (<em>r</em> = –0.444, <em>P</em> = .001), “dynamic reach” (<em>r</em> = –0.437, <em>P</em> = .001), and “total” (<em>r</em> = 0.442, <em>P</em> = .001) scores of TCMS. There was a negative moderate significant correlation between “coronal pelvic angle” and “static sitting” (<em>r</em> = –0.479, <em>P</em> = .001) and “total” (<em>r</em> = –0.454, <em>P</em> = .001) scores of TCMS.</div></div><div><h3>Conclusion</h3><div>PPA was a reliable method for children with CP in a sitting posture. The findings suggest that posture and function may affect each other; in particular, coronal angles and gross motor and trunk functions may be related.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 759-769"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to investigate the inter-rater reliability of the 6-item movement control test battery (MCTB) in individuals with and without chronic non-specific low back pain (CNLBP) using different rating methods, including individual tests, summation, and direction-specific tests, for movement control impairment detection through real-time observation.
Methods
Forty-seven participants with and without CNLBP were recruited. Participants were asked to perform MCTB (flexion-specific tests: waiter’s bow, sitting knee extension, and quadruped rocking backward; extension-specific tests: pelvic tilt, prone knee flexion, and quadruped rocking forward), while 2 raters simultaneously and independently observed the movement control. Inter-rater reliability was analyzed using the chi-square test, percentage agreement (PA), kappa coefficient, and prevalence-adjusted and bias-adjusted kappa (PABAK).
Results
The chi-square showed significant associations (P < .05) between the 2 raters in all tests and grading methods. For PA, all grading methods showed an acceptable level (PA > 70%), except prone knee flexion and extension-specific tests. The acceptable kappa levels (kappa > 0.4) were obtained in the flexion-specific tests and all individual tests except the prone knee flexion. The kappa of the summation did not reach the acceptable agreement level; however, this method yielded acceptable inter-rater reliability after using PABAK (PABAK = 0.62).
Conclusions
The findings support inter-rater reliability of the flexion-specific tests, summation, and most individual tests for clinical use. However, the prone knee flexion and the extension-specific tests should be used with caution.
{"title":"Inter-Rater Reliability of a 6-Item Movement Control Test Battery in Individuals With and Without Chronic Non-Specific Low Back Pain","authors":"Thanwalai Thana-udomnan PT , Wunpen Chansirinukor PT, PhD , Sasithorn Kongoun PT , Katayan Klahan PT , Peemongkon Wattananon PT, PhD","doi":"10.1016/j.jmpt.2025.10.041","DOIUrl":"10.1016/j.jmpt.2025.10.041","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to investigate the inter-rater reliability of the 6-item movement control test battery (MCTB) in individuals with and without chronic non-specific low back pain (CNLBP) using different rating methods, including individual tests, summation, and direction-specific tests, for movement control impairment detection through real-time observation.</div></div><div><h3>Methods</h3><div>Forty-seven participants with and without CNLBP were recruited. Participants were asked to perform MCTB (flexion-specific tests: waiter’s bow, sitting knee extension, and quadruped rocking backward; extension-specific tests: pelvic tilt, prone knee flexion, and quadruped rocking forward), while 2 raters simultaneously and independently observed the movement control. Inter-rater reliability was analyzed using the chi-square test, percentage agreement (PA), kappa coefficient, and prevalence-adjusted and bias-adjusted kappa (PABAK).</div></div><div><h3>Results</h3><div>The chi-square showed significant associations (<em>P</em> < .05) between the 2 raters in all tests and grading methods. For PA, all grading methods showed an acceptable level (PA > 70%), except prone knee flexion and extension-specific tests. The acceptable kappa levels (kappa > 0.4) were obtained in the flexion-specific tests and all individual tests except the prone knee flexion. The kappa of the summation did not reach the acceptable agreement level; however, this method yielded acceptable inter-rater reliability after using PABAK (PABAK = 0.62).</div></div><div><h3>Conclusions</h3><div>The findings support inter-rater reliability of the flexion-specific tests, summation, and most individual tests for clinical use. However, the prone knee flexion and the extension-specific tests should be used with caution.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 853-861"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-11-21DOI: 10.1016/j.jmpt.2025.10.059
Yunan He , Xueli Chen MSc , Jie Lin PhD , Huaning Wang , Baolian Wang MSc , Jinbang Xu PhD , Ying Lin PhD
Objective
The purpose of this meta-analysis was to systematically review the effects of acupuncture with letrozole’s effect on polycystic ovary syndrome (PCOS) ovulation and pregnancy outcomes.
Methods
We searched 7 electronic databases for clinical studies of acupuncture combined with letrozole for PCOS published until August 31, 2024. Meta-analysis was done using RevMan 5.4, while funnel plot symmetry was evaluated using Stata 16.0.
Results
Fifteen randomized controlled trials, encompassing 1311 cases, were included. The meta-analysis revealed that acupuncture combined with letrozole significantly improved the clinical efficacy rate (RR = 1.27, 95% CI [1.17, 1.37], P < .001), pregnancy rate (RR = 1.84, 95% CI [1.59, 2.13], P < .001), ovulation rate [RR = 1.30, 95% CI [1.18, 1.43], P < .001), endometrial thickness (MD = 1.05, 95% CI [0.76, 1.34], P < .00001), serum estradiol levels (MD = 8.34, 95% CI [6.71, 9.96], P < .001) and the rate of A-type endometrium (RR = 2.19, 95% CI [1.35, 3.55], P < .001). Additionally, it significantly reduced the miscarriage rate (RR = 0.20, 95% CI [0.08, 0.51], P < .001), serum luteinizing hormone levels (MD = −2.10, 95% CI [−3.58, −0.62], P < .001), serum testosterone levels (MD for treatment ≤3 menstrual cycles = −0.43, 95% CI [−0.49, −0.37], P < .001; MD for treatment >3 menstrual cycles = −3.06, 95% CI [−5.12, −0.99], P < .001), ovarian volume (MD = −2.21, 95% CI [−2.99, −1.43], P < .001), and TCM syndrome scores (MD = −4.33, 95% CI [−5.43, −3.24], P < .001). Begg’s test for publication bias indicated some degree of bias (P ≤ .05).
Conclusion
Current evidence suggests that acupuncture combined with letrozole may be more effective for PCOS than letrozole alone; however, the quality of this evidence is low, necessitating further high-quality research to confirm these findings.
Protocol registration
Registered in PROSPERO on August 23 2024 (ID: CRD42024582344) .
目的：本荟萃分析的目的是系统回顾针刺联合来曲唑对多囊卵巢综合征（PCOS）排卵和妊娠结局的影响。方法：检索截至2024年8月31日发表的7个电子数据库中针灸联合来曲唑治疗PCOS的临床研究。meta分析采用RevMan 5.4，漏斗图对称性评价采用Stata 16.0。结果：纳入15项随机对照试验，共1311例。荟萃分析显示,针灸结合曲唑显著提高临床疗效率(RR = 1.27, 95%可信区间[1.17,1.37],P <措施),怀孕率(RR = 1.84, 95%可信区间[1.59,2.13],P <措施),排卵率(RR = 1.30, 95%可信区间[1.18,1.43],P <措施),子宫内膜厚度(MD = 1.05, 95% CI [0.76, 1.34], P < .00001)、血清雌二醇水平(MD = 8.34, 95% CI [6.71, 9.96], P <措施),a类型子宫内膜(RR = 2.19, 95%可信区间[1.35,3.55],P <措施)。此外，显著降低流产率（RR = 0.20, 95% CI [0.08, 0.51], P < 0.001）、血清黄体生成素水平（MD = -2.10, 95% CI [-3.58, -0.62], P < 0.001）、血清睾酮水平（治疗≤3个月经周期的MD = -0.43, 95% CI [-0.49, -0.37], P < 0.001）；治疗>3个月经周期的MD = -3.06, 95% CI [-5.12, -0.99], P < 0.001)、卵巢体积（MD = -2.21, 95% CI [-2.99, -1.43], P < 0.001）、中医证候评分（MD = -4.33, 95% CI [-5.43, -3.24], P < 0.001）。Begg发表偏倚检验表明存在一定程度的偏倚（P≤0.05）。结论：针刺联合来曲唑治疗PCOS可能比单用来曲唑更有效；然而，这些证据的质量很低，需要进一步的高质量研究来证实这些发现。协议注册：于2024年8月23日在PROSPERO注册（ID: CRD42024582344）。
{"title":"Meta-Analysis of the Effects of Acupuncture Combined With Letrozole on Ovulation Induction and Pregnancy Outcomes in Patients With Polycystic Ovary Syndrome","authors":"Yunan He , Xueli Chen MSc , Jie Lin PhD , Huaning Wang , Baolian Wang MSc , Jinbang Xu PhD , Ying Lin PhD","doi":"10.1016/j.jmpt.2025.10.059","DOIUrl":"10.1016/j.jmpt.2025.10.059","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this meta-analysis was to systematically review the effects of acupuncture with letrozole’s effect on polycystic ovary syndrome (PCOS) ovulation and pregnancy outcomes.</div></div><div><h3>Methods</h3><div>We searched 7 electronic databases for clinical studies of acupuncture combined with letrozole for PCOS published until August 31, 2024. Meta-analysis was done using RevMan 5.4, while funnel plot symmetry was evaluated using Stata 16.0.</div></div><div><h3>Results</h3><div>Fifteen randomized controlled trials, encompassing 1311 cases, were included. The meta-analysis revealed that acupuncture combined with letrozole significantly improved the clinical efficacy rate (RR = 1.27, 95% CI [1.17, 1.37], <em>P</em> < .001), pregnancy rate (RR = 1.84, 95% CI [1.59, 2.13], <em>P</em> < .001), ovulation rate [RR = 1.30, 95% CI [1.18, 1.43], <em>P</em> < .001), endometrial thickness (MD = 1.05, 95% CI [0.76, 1.34], <em>P</em> < .00001), serum estradiol levels (MD = 8.34, 95% CI [6.71, 9.96], <em>P</em> < .001) and the rate of A-type endometrium (RR = 2.19, 95% CI [1.35, 3.55], <em>P</em> < .001). Additionally, it significantly reduced the miscarriage rate (RR = 0.20, 95% CI [0.08, 0.51], <em>P</em> < .001), serum luteinizing hormone levels (MD = −2.10, 95% CI [−3.58, −0.62], <em>P</em> < .001), serum testosterone levels (MD for treatment ≤3 menstrual cycles = −0.43, 95% CI [−0.49, −0.37], <em>P</em> < .001; MD for treatment >3 menstrual cycles = −3.06, 95% CI [−5.12, −0.99], <em>P</em> < .001), ovarian volume (MD = −2.21, 95% CI [−2.99, −1.43], <em>P</em> < .001), and TCM syndrome scores (MD = −4.33, 95% CI [−5.43, −3.24], <em>P</em> < .001). Begg’s test for publication bias indicated some degree of bias (<em>P</em> ≤ .05).</div></div><div><h3>Conclusion</h3><div>Current evidence suggests that acupuncture combined with letrozole may be more effective for PCOS than letrozole alone; however, the quality of this evidence is low, necessitating further high-quality research to confirm these findings.</div></div><div><h3>Protocol registration</h3><div>Registered in PROSPERO on August 23 2024 (ID: CRD42024582344) .</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 935-946"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-11-19DOI: 10.1016/j.jmpt.2025.10.018
Kuokchon Pou BA, Qiuhong Zeng BA, Qian Chen BA, Yixuan Li BA, Lulu Cai BA, Zhen Huang BA, Yi Liao BA, Shujie Tang PhD
Objective
The aim of this study was to compare the biomechanical effects between localized and nonlocalized rotation manipulations on cervical spondylotic radiculopathy and to investigate the influence of cervical disc degeneration on the manipulations using finite element models.
Methods
In this study, 4 progressively degenerative finite element models of C3 to C7 segments were created to simulate cervical localized and nonlocalized rotation manipulations. In each model, disc degeneration was simulated at the C5 to C6 segment, a disc protrusion was assumed to be in the left posterolateral region of the C5 to C6 disc, and 2 rotation manipulations were performed on the right. Thirty nodes on the left posterolateral region of the C5 to C6 disc were selected, and the displacement and stress of the nodes, as well as the facet joint stress at the C5 to C6 level, were calculated and compared.
Results
The displacement and stress in the left posterolateral region of the disc, as well as the facet joint stress at the C5 to C6 level, were higher in localized rotation manipulation than those in nonlocalized rotation manipulation (P < .05). The displacement and stress in the left posterolateral region of the disc decreased with the severity of disc degeneration (P < .05).
Conclusion
Using finite element models, this study demonstrated that cervical spine degeneration can adversely affect the biomechanical effects of rotation manipulations, in that more severe disc degeneration may be associated with poorer biomechanical effect. However, for the same level of degeneration severity, localized rotation manipulation may be more specific than nonlocalized rotation manipulation.
{"title":"Comparison of the Biomechanical Effects of Cervical Localized and Nonlocalized Rotation Manipulations on Cervical Spondylotic Radiculopathy: A Finite Element Study","authors":"Kuokchon Pou BA, Qiuhong Zeng BA, Qian Chen BA, Yixuan Li BA, Lulu Cai BA, Zhen Huang BA, Yi Liao BA, Shujie Tang PhD","doi":"10.1016/j.jmpt.2025.10.018","DOIUrl":"10.1016/j.jmpt.2025.10.018","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to compare the biomechanical effects between localized and nonlocalized rotation manipulations on cervical spondylotic radiculopathy and to investigate the influence of cervical disc degeneration on the manipulations using finite element models.</div></div><div><h3>Methods</h3><div>In this study, 4 progressively degenerative finite element models of C3 to C7 segments were created to simulate cervical localized and nonlocalized rotation manipulations. In each model, disc degeneration was simulated at the C5 to C6 segment, a disc protrusion was assumed to be in the left posterolateral region of the C5 to C6 disc, and 2 rotation manipulations were performed on the right. Thirty nodes on the left posterolateral region of the C5 to C6 disc were selected, and the displacement and stress of the nodes, as well as the facet joint stress at the C5 to C6 level, were calculated and compared.</div></div><div><h3>Results</h3><div>The displacement and stress in the left posterolateral region of the disc, as well as the facet joint stress at the C5 to C6 level, were higher in localized rotation manipulation than those in nonlocalized rotation manipulation (<em>P</em> < .05). The displacement and stress in the left posterolateral region of the disc decreased with the severity of disc degeneration (<em>P</em> < .05).</div></div><div><h3>Conclusion</h3><div>Using finite element models, this study demonstrated that cervical spine degeneration can adversely affect the biomechanical effects of rotation manipulations, in that more severe disc degeneration may be associated with poorer biomechanical effect. However, for the same level of degeneration severity, localized rotation manipulation may be more specific than nonlocalized rotation manipulation.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 914-926"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-11-13DOI: 10.1016/j.jmpt.2025.10.058
Razak M. Gyasi PhD, PD , Simon Boateng PhD , Barnabas Addai Amanfo PhD , Benedict Osei Asibey PhD , Daniel Offei PhD , Simon Mariwah PhD , André Hajek PhD , Lee Smith PhD , David R. Phillips PhD
Objective
The purpose of this population-based study was to examine whether sedentary behavior (SB) and light physical activity intensity (LPA) are associated with pain in older adults. A further aim is to investigate the psychosomatic complaints as mediators between SB and pain.
Methods
Individuals aged ≥50 from the 2018 Study on Aging, Health, and Health-seeking Behavior reported on SB and LPA using the International Physical Activity Questionnaire and pain severity using a cross-culturally validated item from the bodily pain subscale of the MOS SF-36. Multivariable logistic regression models evaluated the associations of SB and LPA with pain. Bootstrapping analyses assessed whether psychosomatic complaints mediate the association between SB and pain.
Results
Among 1201 participants (mean ± SD age = 66.1 ± 11.9 years; women = 63.3%), the prevalence of SB and pain was 21.4% and 43.0%, respectively. Compared with <8 h/d, ≥8 h/d of SB was positively associated with pain (OR = 2.42, 95% CI = 1.71-3.42). However, LPA was associated with 11% lower odds of reporting pain (OR = 0.89, 95% CI = 0.81-0.98). Self-rated health (41.2%), anxiety (23.5%), comorbidity (20.6%), functional limitations (17.6%), depression (13.2%), and sleep problems (11.8%) were associated with pain and mediated the SB-pain link.
Conclusions
The present study observed that SB and LPA were associated with pain in older adults residing in Ghana, and psychosomatic complaints were identified as potential mechanisms in the pathway between SB and pain. Managing the pain burden in old age may require shifting the 24-hour behavior from SB to LPA and addressing the inherent psychosomatic complaints.
{"title":"Sedentary Time, Light Physical Activity Intensity, and Pain Severity: Findings From the Ghana Study on Aging","authors":"Razak M. Gyasi PhD, PD , Simon Boateng PhD , Barnabas Addai Amanfo PhD , Benedict Osei Asibey PhD , Daniel Offei PhD , Simon Mariwah PhD , André Hajek PhD , Lee Smith PhD , David R. Phillips PhD","doi":"10.1016/j.jmpt.2025.10.058","DOIUrl":"10.1016/j.jmpt.2025.10.058","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this population-based study was to examine whether sedentary behavior (SB) and light physical activity intensity (LPA) are associated with pain in older adults. A further aim is to investigate the psychosomatic complaints as mediators between SB and pain.</div></div><div><h3>Methods</h3><div>Individuals aged ≥50 from the 2018 Study on Aging, Health, and Health-seeking Behavior reported on SB and LPA using the International Physical Activity Questionnaire and pain severity using a cross-culturally validated item from the bodily pain subscale of the MOS SF-36. Multivariable logistic regression models evaluated the associations of SB and LPA with pain. Bootstrapping analyses assessed whether psychosomatic complaints mediate the association between SB and pain.</div></div><div><h3>Results</h3><div>Among 1201 participants (mean ± SD age = 66.1 ± 11.9 years; women = 63.3%), the prevalence of SB and pain was 21.4% and 43.0%, respectively. Compared with <8 h/d, ≥8 h/d of SB was positively associated with pain (OR = 2.42, 95% CI = 1.71-3.42). However, LPA was associated with 11% lower odds of reporting pain (OR = 0.89, 95% CI = 0.81-0.98). Self-rated health (41.2%), anxiety (23.5%), comorbidity (20.6%), functional limitations (17.6%), depression (13.2%), and sleep problems (11.8%) were associated with pain and mediated the SB-pain link.</div></div><div><h3>Conclusions</h3><div>The present study observed that SB and LPA were associated with pain in older adults residing in Ghana, and psychosomatic complaints were identified as potential mechanisms in the pathway between SB and pain. Managing the pain burden in old age may require shifting the 24-hour behavior from SB to LPA and addressing the inherent psychosomatic complaints.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 833-843"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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