Journal of Manipulative and Physiological Therapeutics最新文献

英文中文

Factors Associated With Pain Medication Use and the Relationship to Chiropractic Treatment Outcomes for Patients With Low Back and Neck Pain: A Cross-Sectional Study 与疼痛药物使用相关的因素以及与下背部和颈部疼痛患者捏脊治疗结果的关系:一项横断面研究

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-10-01 DOI: 10.1016/j.jmpt.2023.03.002

Corinne R. Minder MChiroMed , Christoph Gorbach DC, MD , Cynthia K. Peterson RN, DC, MMedEd

Objective

The study objectives were to identify baseline factors associated with pain medication use and determine any differences in chiropractic treatment outcomes in patients with low back pain (LBP) and neck pain (NP) depending on their use of pain medication.

Methods

This cross-sectional, prospective outcomes study included 1077 adults with acute or chronic LBP and 845 adults with acute or chronic NP recruited from Swiss chiropractors in their offices within 4 years. Demographic data and the responses to the Patient's Global Impression of Change scale collected at 1 week, 1 month, 3 months, 6 months, and 1 year were analyzed with the χ² test. Baseline pain and disability levels were measured using the numeric rating scale (NRS), Oswestry questionnaire for LBP, and Bournemouth questionnaire for patients with NP and analyzed with the Mann-Whitney U test between the 2 groups. To detect significant predictors of medication use at baseline, logistic regression analysis was performed.

Results

Patients with acute LBP and NP were more likely than those with chronic pain to take pain medication (P < .001 LBP; P = .003 NP). Medication use was more likely with patients with radiculopathy (P < .001 LBP; P = .05 NP) who were smokers (P = .008 LBP; P = .024 NP) and those reporting below-average general health (P < .001 LBP and NP). Pain medication users had higher baseline pain (P < .001 LBP and NP) and disability (P < .001 LBP and NP) scores.

Conclusion

Patients with LBP and NP had significantly higher pain and disability levels at baseline, tended to have radiculopathy and poor health, were smokers, and presented during the acute phase. However, for this sample of patients, there were no differences in subjective improvement between users and non-users of pain medication for any data collection time point, which has management implications.

研究目的是确定与止痛药使用相关的基线因素，并确定腰痛(LBP)和颈痛(NP)患者的捏脊治疗结果是否存在差异，这取决于他们使用止痛药的情况。方法:这项横断面前瞻性研究包括1077名急性或慢性腰痛患者和845名急性或慢性NP患者，这些患者是在4年内从瑞士的脊医办公室招募的。采用χ2检验对1周、1个月、3个月、6个月和1年收集的人口统计数据和患者对总体变化印象量表的反应进行分析。采用数字评定量表(NRS)测量基线疼痛和残疾水平，采用Oswestry问卷测量腰痛，采用Bournemouth问卷测量NP患者的基线疼痛和残疾水平，并采用Mann-Whitney U检验对两组患者进行分析。为了检测基线时药物使用的显著预测因子，进行了逻辑回归分析。结果急性腰痛和NP患者比慢性疼痛患者更倾向于服用止痛药(P <措施枸杞多糖;P = 0.003 np)。神经根病患者更容易使用药物(P <措施枸杞多糖;P = 0.05 NP)吸烟者(P = 0.008 LBP;P = 0.024 NP)和报告总体健康状况低于平均水平的人(P <.001 LBP和NP)。止痛药使用者有较高的基线疼痛(P <.001 LBP和NP)和残疾(P <.001 LBP和NP)评分。结论LBP和NP患者在基线时疼痛和残疾水平较高，有神经根病倾向，健康状况较差，吸烟，出现在急性期。然而，对于该患者样本，在任何数据收集时间点，使用和不使用止痛药的患者在主观改善方面没有差异，这具有管理意义。

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引用次数: 0

TOC 技术选择委员会

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-10-01 DOI: 10.1016/S0161-4754(23)00034-9

引用次数: 0

Best Practices for Chiropractic Management of Adult Patients With Mechanical Low Back Pain: A Clinical Practice Guideline for Chiropractors in the United States 成年机械性腰痛患者捏脊治疗的最佳实践:美国捏脊医生临床实践指南

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-10-01 DOI: 10.1016/j.jmpt.2023.04.010

Wayne M. Whalen DC , Cheryl Hawk DC, PhD , Ronald J. Farabaugh DC , Clinton J. Daniels DC, MS , David N. Taylor DC , Kristian R. Anderson DC, MS , Louis S. Crivelli DC, MS , Derek R. Anderson PhD , Lisa M. Thomson DC , Richard L. Sarnat MD

Objective

The purpose of this paper was to update the previously published 2016 best-practice recommendations for chiropractic management of adults with mechanical low back pain (LBP) in the United States.

Methods

Two experienced health librarians conducted the literature searches for clinical practice guidelines and other relevant literature, and the investigators performed quality assessment of included studies. PubMed was searched from March 2015 to September 2021. A steering committee of 10 experts in chiropractic research, education, and practice used the most current relevant guidelines and publications to update care recommendations. A panel of 69 experts used a modified Delphi process to rate the recommendations.

Results

The literature search yielded 14 clinical practice guidelines, 10 systematic reviews, and 5 randomized controlled trials (all high quality). Sixty-nine members of the panel rated 38 recommendations. All but 1 statement achieved consensus in the first round, and the final statement reached consensus in the second round. Recommendations covered the clinical encounter from history, physical examination, and diagnostic considerations through informed consent, co-management, and treatment considerations for patients with mechanical LBP.

Conclusion

This paper updates a previously published best-practice document for chiropractic management of adults with mechanical LBP.

本文的目的是更新先前发布的2016年美国成人机械性腰痛(LBP)捏脊治疗最佳实践建议。方法由两名经验丰富的卫生图书馆员对临床实践指南及相关文献进行文献检索，研究者对纳入的研究进行质量评价。PubMed检索时间为2015年3月至2021年9月。一个由脊椎指压研究、教育和实践方面的10名专家组成的指导委员会使用最新的相关指南和出版物来更新护理建议。一个由69名专家组成的小组使用一种改进的德尔菲程序对这些建议进行评级。结果检索到14份临床实践指南，10篇系统评价，5篇随机对照试验(均为高质量)。该小组的69名成员对38项建议进行了评估。除1项声明外，其余声明均在第一轮达成共识，最后一项声明在第二轮达成共识。建议涵盖了从病史、体格检查、通过知情同意的诊断考虑、共同管理和对机械性腰痛患者的治疗考虑的临床遭遇。结论:本文更新了先前发表的关于成人机械腰痛捏脊治疗的最佳实践文献。

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引用次数: 0

Information for Readers 读者资讯

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-09-01 DOI: 10.1016/S0161-4754(23)00004-0

引用次数: 0

Inside front cover Editorial board 内页封面编辑委员会

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-09-01 DOI: 10.1016/S0161-4754(23)00002-7

引用次数: 0

Immediate Effects of Adding Dry Needling to Thoracic Manipulation and Exercise in Cervical Range of Motion for Adults With Neck Pain: A Randomized Clinical Trial 干针加胸椎手法和颈椎活动度锻炼对成人颈部疼痛的直接影响:一项随机临床试验

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-09-01 DOI: 10.1016/j.jmpt.2022.10.002

Brian A. Young PT, DSc , David M. Boland PT, PhD , Abby Manzo DPT , Haley Yaw DPT , Brian Carlson DPT , Spencer Carrier DPT , Kameryn Corcoran DPT , Megan Dial DPT , Robert B. Briggs PT, PhD , Bradley Tragord PT, DSc , Shane L. Koppenhaver PT, PhD

Objective

The purpose of this study was to determine the immediate effects of adding dry needling (DN) to thoracic spine manipulation and neck-specific exercise in individuals with neck pain.

Methods

Forty-two participants with neck pain were randomized to either the true (n = 21) or sham (n = 21) DN groups, receiving treatment on the initial visit and 2 to 3 days later. Outcomes were assessed on day 1, both at baseline and immediately after the initial treatment, at the second treatment 2 to 3 days later, and at the final visit 5 to 7 days after visit 2. Primary outcomes were Neck Disability Index (NDI) (0-50) and current pain via numeric pain rating scale (0-10). Secondary outcomes were cervical range of motion, pain pressure threshold, and global rating of change.

Results

Repeated measures analysis of covariance with baseline value as covariate revealed no significant difference in NDI scores at either follow-up time point with adjusted mean differences (95% confidence interval) of -0.11 (-2.70 to 2.48) and 0.31 (-1.96 to 2.57). There were no between-group differences in pain at any time point via Independent-Samples Median Test (P value range of .54-1.0). Secondary outcome measures were similarly not statistically different between groups except for immediate improvements in rotation to the side opposite of pain, which favored DN, with an adjusted mean difference (95% confidence interval) of 7.85 (3.54-12.15) degrees.

Conclusion

The addition of DN to thoracic spinal manipulation and neck-specific exercise did not affect improvements in NDI score or numeric pain rating scale but showed an increase in cervical range of motion.

目的本研究的目的是确定在胸椎操作和颈部特定运动中加入干针(DN)对颈部疼痛患者的直接影响。方法42例颈部疼痛患者随机分为真DN组(n = 21)和假DN组(n = 21)，分别在首次就诊和2 ~ 3天后接受治疗。在第1天评估结果，包括基线和初始治疗后立即评估结果，在第二次治疗2至3天后评估结果，在第2次访问后5至7天评估结果。主要结果是颈部残疾指数(NDI)(0-50)和通过数字疼痛评定量表(0-10)进行的当前疼痛。次要结果为颈椎活动度、痛压阈值和整体变化评分。结果以基线值为协变量的重复测量协方差分析显示，随访时间点NDI评分无显著差异，调整后的平均差异(95%置信区间)为-0.11(-2.70 ~ 2.48)和0.31(-1.96 ~ 2.57)。独立样本中位数检验各组疼痛在各时间点均无差异(P值范围为0.54 ~ 1.0)。次要结局指标在两组之间相似地无统计学差异，除了向疼痛的另一侧旋转的立即改善，这有利于DN，调整后的平均差异(95%置信区间)为7.85(3.54-12.15)度。结论在胸椎操作和颈部专项运动的基础上增加DN并不影响NDI评分或数值疼痛评定量表的改善，但显示出颈椎活动范围的增加。

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引用次数: 1

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process 孕妇和产后患者捏脊治疗的最佳实践建议:共识过程的结果

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-09-01 DOI: 10.1016/j.jmpt.2021.03.002

Carol Ann Weis MSc, DC , Katherine Pohlman DC, PhD , Jon Barrett MBBch, MD , Susan Clinton PT , Sophia da Silva-Oolup DC , Crystal Draper DC , Joyce Lee DC , Rupali Kumar MD , Maeve O'Beirne MD, PhD , Kent Stuber DC, MSc , Cheryl Hawk DC, PhD

Objective

The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.

Methods

A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale.

Results

Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included.

Conclusion

An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.

目的:本项目旨在为腰痛(LBP)、骨盆带痛(PGP)或两者兼有的孕妇和产后患者的捏脊治疗制定一份最佳实践文件。方法采用改进的德尔菲共识法。一个由11名卫生保健专业人员组成的多学科指导委员会根据他们的临床经验和相关文献制定了71份种子声明。来自7个国家的78名小组成员被要求对这些建议进行评分(70名脊椎按摩师和来自其他4个卫生专业的代表)。当至少80%的小组成员认为该陈述是适当的，并且在9分制的中位数回答至少为7分时，达成共识。结果经过3轮分配，共有71项意见达成共识。声明包括知情同意和风险，多学科护理，妊娠期腰痛、妊娠期PGP和妊娠期合并疼痛的关键内容，以及产后LBP、PGP和合并疼痛的关键内容。包括检查、诊断影像、干预和生活方式因素陈述。结论专家小组召开会议，制定了第一份关于腰痛或PGP孕妇和产后患者捏脊护理的最佳实践共识文件。该文件包括71份关于腰痛和PGP孕妇和产后患者捏脊护理的声明。

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引用次数: 3

Variability of Intradiscal Pressure During Cervical Spine Posterior-Anterior Mobilization: A Cadaveric Investigation 颈椎前后移位过程中椎间盘内压力的变异性:一项尸体调查

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-09-01 DOI: 10.1016/j.jmpt.2022.10.003

Carla M. James PT, ScD , Jean-Michel Brismée PT, ScD , Marc-Olivier St-Pierre PhD , Martin Descarreaux DC, PhD , Troy L. Hooper PT, LAT, ATC, PhD , François Nougarou PhD , Emile Marineau Bélanger DC , Stéphane Sobczak PT, PhD

Objectives

The purpose of this study was to investigate in cadaveric specimens the reliability of measuring cervical intradiscal pressure (CIDP) and if posterior-anterior (PA) mobilizations targeting the cervical spine were associated with CIDP changes.

Methods

Cervical PA mobilizations were performed on the spinous processes of 7 (3 men, 4 women) cadaveric specimens using a servo-controlled linear actuator to provide 25N and 45N forces. CIDP measurements were performed at C4-5, C5-6, C6-7, and C7-T1 intervertebral discs (IVDs) using a fiberoptic catheter system that recorded CIDP for each IVD cervical segment. To assess CIDP measurement reliability, the intraclass correlation coefficient (ICC [3,k]) was calculated. Repeated measures Friedman analysis of variance assessed effect of cervical mobilizations on CIDP for before, during, and immediately after mobilization at 25N and 45N forces for each cervical IVD segment.

Results

All CIDP measurements demonstrated excellent reliability (ICC >0.98). During the 25N mobilizations, the median CIDP varied from -0.12 to 0.91 (interquartile range, 5.22-5.36), while for 45N mobilizations the median ranged from -0.94 to 1.21 (interquartile range, -7.74 to 43.49). These changes were not statistically significant (P > .40) during 25N and 45N PA mobilizations, with the exception of C5-6 CIDP at 25N and 45N (P = .05 and .018, respectively).

Conclusion

There was high CIDP variability between cadavers during and after mobilization. Mobilizations of 1 cervical vertebra resulted in both CIDP increase or decrease at adjacent and remote cervical IVD segments that were not consistent. Cervical PA mobilizations produced variable CIDP changes at adjacent and remote cervical segments in cadavers.

目的本研究的目的是探讨在尸体标本中测量颈椎椎间盘内压(CIDP)的可靠性，以及针对颈椎的后前路(PA)活动是否与CIDP变化有关。方法采用伺服控制线性致动器对7例(男3例，女4例)尸体棘突进行颈椎PA动员，施加25N和45N力。使用光纤导管系统测量C4-5、C5-6、C6-7和C7-T1椎间盘(IVD)的CIDP，记录每个IVD颈椎段的CIDP。为了评估CIDP测量的可靠性，我们计算了类内相关系数(ICC [3,k])。重复测量弗里德曼方差分析评估了在每个IVD节段以25N和45N的力动员前、期间和之后，颈椎动员对CIDP的影响。结果所有CIDP测量值具有良好的信度(ICC >0.98)。在25N的动员过程中，CIDP的中位数从-0.12到0.91(四分位数范围为5.22-5.36)，而在45N的动员过程中，CIDP的中位数从-0.94到1.21(四分位数范围为-7.74到43.49)。这些变化没有统计学意义(P >在25N和45N PA动员期间，C5-6 cbp在25N和45N动员期间(P分别= 0.05和0.018)，P值为0.40)。结论尸体在活动期间和活动后的CIDP差异较大。1个颈椎的活动导致相邻和远端颈椎IVD节段的CIDP升高或降低，但不一致。颈椎PA动员在尸体的邻近和远端颈椎节段产生可变的CIDP变化。

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引用次数: 0

Angular Kinematics of Chiropractic Supine Cervical Spine Manipulation: Rotational Measures and Comparisons to Doctor and Recipient Perceptions 脊椎指压仰卧位颈椎操作的角度运动学:旋转测量和医生和接受者感知的比较

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-09-01 DOI: 10.1016/j.jmpt.2022.12.002

Brent S. Russell MS, DC , Mackenzie Keller DC , Shari E. Wynd MASC, DC, PHD , Ronald S. Hosek PhD, DC, MPH , Edward F. Owens Jr MS, DC , Kathryn T. Hoiriis DC

Objectives

The primary purposes of this study were to measure axial rotation during supine cervical spinal manipulative therapy (cSMT) and to record recipients’ and doctors’ perceptions of rotational magnitudes.

Methods

Experienced doctors of chiropractic (DCs) provided supine cSMT and acted as recipients of cSMT. Participants who received SMT wore inertial measurement units attached to the forehead and sternum for motion capture. Afterward, recipients and DCs completed questionnaires asking about their perceptions of motion. Data were analyzed for magnitudes of axial rotation at peak thrust and correlations with patient and doctor perceptions. Secondary analyses included angular velocity, angular acceleration, and other kinematic variables.

Results

We recorded 23 SMT events with 14 DCs. Rotation at thrust peaks averaged 32.4° (17.4°). Doctors’ and recipients’ perceptions of rotation were higher than measured values 45% and 50% of the time, respectively. Maximum angular velocity and acceleration averaged 221.9°/s (124.9) and 4786.5°/s² (2456.6), respectively. We found no correlation between perceptions and velocity or acceleration; doctors’ perceptions had an inverse correlation with measurements.

Conclusion

On average, we found rotation during supine cSMT to be 32°. Both DCs and SMT recipients overestimated rotation compared with actual measurements. These factors should be considered in discussions of rotation and SMT.

目的本研究的主要目的是测量仰卧颈椎推拿治疗(cSMT)期间的轴向旋转，并记录受术者和医生对旋转幅度的感知。方法由经验丰富的捏脊医师提供仰卧位cSMT，并作为cSMT的接受者。接受SMT的参与者在前额和胸骨上佩戴了惯性测量装置，用于运动捕捉。之后，接受者和实验对象完成问卷调查，询问他们对运动的感知。数据分析了峰值推力时轴向旋转的大小以及与患者和医生感知的相关性。二次分析包括角速度、角加速度和其他运动学变量。结果共记录23例SMT事件，14例DCs。推力峰值处的旋转平均为32.4°(17.4°)。医生和接受者对轮转的感知分别高于45%和50%的测量值。最大角速度和加速度平均分别为221.9°/s(124.9)和4786.5°/s2(2456.6)。我们发现知觉和速度或加速度之间没有关联;医生的感知与测量结果呈负相关。结论平卧位cSMT的平均旋转角度为32°。与实际测量值相比，DCs和SMT接受者都高估了旋转。在讨论旋转和SMT时应考虑这些因素。

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引用次数: 0

TOC 技术选择委员会

IF 1.3 4区医学 Q1 Health Professions

Journal of Manipulative and Physiological Therapeutics

Pub Date : 2022-09-01 DOI: 10.1016/S0161-4754(23)00003-9

引用次数: 0

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