Journal of Manual & Manipulative Therapy最新文献

Introduction: Knee osteoarthritis (OA), affecting both tibiofemoral and patellofemoral compartments, causes pain and reduced quality of life. The Mulligan Concept of mobilization with movement (MWM) may relieve symptoms by modifying sensory input, enhancing central inhibition, and improving motor activation. This study conducted a systematic review and meta-analysis with subgroup analysis to evaluate MWM's efficacy in improving pain and disability in knee OA.

Methods: Electronic databases were searched from inception to January 2025 for randomized controlled trials (RCTs) on the effects of MWM on knee OA. Pain intensity and disability improvement, standardized using Hedges' g, were the primary and secondary outcomes. Two reviewers independently assessed study quality, extracted data, and performed a meta-analysis using a random-effects model. Subgroup analyses considered intervention regimens, technique including weight-bearing or not, Kellgren-Lawrence (K-L) classification grades, and control group comparisons.

Results: From 23 RCTs (996 participants; mean age 37-61 years), MWM significantly reduced pain (Hedges' g = -0.984, 95% CI = -1.375 to -0.593) and improved disability (Hedges' g = -1.041, 95% CI = -1.477 to - 0.606).. Greater effect sizes were observed when MWM was combined with other therapies, including weight-bearing positions, and among participants without advanced K-L grades. MWM also demonstrated significant effects in comparison with active controls.

Conclusion: This meta-analysis showed that MWM reduces pain and disability in individuals with knee osteoarthritis, especially when incorporated into treatment protocols featuring weight-bearing positions and combined physical therapies. Clinically, MWM could be incorporated into rehabilitation programs to enhance pain relief and functional recovery. Future studies should extend follow-ups and address bias.

Objectives: Neurodynamic tests are clinical tests used to identify heightened nerve mechanosensitivity but may be negative in the presence of severe neuropathy, as seen in people with carpal tunnel syndrome and type 2 diabetes. It is not known if this also occurs in people with diabetic peripheral neuropathy (DPN) from type 1 diabetes mellitus (T1DM). The primary aim of this study is to determine the proportion of positive neurodynamic tests in people with T1DM and DPN. The secondary aim is to assess whether the severity of DPN influences the presence of a positive neurodynamic test.

Methods: This is a cross-sectional study. Forty-three participants with T1DM and DPN were assessed using straight leg raise (SLR) and slump neurodynamic tests to determine a positive and negative test. DPN severity was graded according to Toronto Clinical Scoring System (TCSS).

Results: Forty-six percent and 56% of participants had positive SLR and slump tests, respectively, indicating heightened nerve mechanosensitivity. There was a statistically significant association between negative neurodynamic tests and DPN severity (p < 0.0001). In addition, participants with negative neurodynamic tests had significantly higher TCSS scores compared to participants with positive neurodynamic tests (p < 0.0001).

Discussion/conclusion: People with T1DM and severe DPN, as graded by TCSS, are more likely to demonstrate negative neurodynamic tests than those with mild DPN. Future studies should investigate the relationship between neurodynamic tests and nerve function in other conditions. This supports previous research on negative neurodynamic tests in severe neuropathy, suggesting that neurodynamic tests should not be used alone to determine nerve involvement.

Background: The posterior talar glide test (PTGT) is recommended for ankle sprain assessment, but it has limited scientific support. Therefore, the aims of this study were to assess the reproducibility of PTGT in two conditions: 1) the clinical experience of the clinician and 2) in a modified setting using a referential horizontal plane in three clinical conditions (chronic ankle instability (CAI), copers, and healthy controls).

Methods: Twenty-eight participants were recruited. PTGT measurements were performed using two raters, i.e., novice and experienced, and performed twice with and without the referential horizontal plane with each rater on each ankle. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated.

Results: PTGT reported excellent intra-rater reliability for both novice (ICC = 0.97, SEM = 2.2°, MDC = 4.1°) and experienced rater (ICC = 0.94, SEM = 2.4°, MDC = 4.3°). Modified PTGT provided excellent intra-rater reliability for both experienced (ICC = 0.96, SEM = 1.4°, MDC = 3.3°) and novice rater (ICC = 0.96, SEM = 2.3°, MDC = 4.2°). Inter-rater reliability increases along with the addition of the referential horizontal plane, being poor to good for PTGT (ICC = 0.64, SEM = 2.8°, MDC = 4.7°), whereas moderate to good for modified PTGT (ICC = 0.78, SEM = 2.3°, MDC = 4.2°).

Conclusion: The PTGT appears reproducible enough to be used in a clinical setting. Its modified version, i.e., with a referential horizontal plane, offers a greater inter-rater reliability, making it a better option for research purposes.

Introduction: Beneficial effects of thoracic manipulations (TM) have been demonstrated; however, there is a lack of clarity regarding their use in clinical practice.

Purpose: To investigate the knowledge and use of TM in primary care manual therapy in Belgium and the Netherlands.

Methods: An online survey hosted on Google Forms was designed and distributed across various platforms to manual therapists and students enrolled in a Master's/Postgraduate program in manual therapy. Data were collected regarding demographics, types of complaints, types of manipulation, and types of intervention. Participation occurred between 1 November 2022 and 31 July 2024.

Results: One hundred and seven surveys were analyzed. Thoracic complaints treated with TM were mostly muscular in origin (94%). Most participants (79%) did not utilize a specific screening tool, instead relying on clinical experience to exclude red flags. The majority agreed that metabolic bone diseases and metastatic diseases (n = 92) are contraindications and that thoracic fractures (n = 77) are a risk factor for TM. Almost half (44%) did not differentiate between the upper and lower thoracic spine. TM for other regions, mostly for the cervical spine (94%), was considered. TM was preferred for its biomechanical effects, followed by neurophysiological and placebo effects.

Conclusion: Most clinicians rely on experience rather than a pre-screening tool when assessing the thoracic region, focussing on excluding red flags and determining indications for TM, with biomechanical effects being the most favored rationale. Although most findings showed agreement, some inconsistencies were noted regarding screening and rationale, highlighting the importance of clinical reasoning for safe TM practice.

Background: Cervicogenic headache is a common condition frequently associated with cervical spine disorders. It significantly impairs physical and psychological well-being. To date, no study has prospectively investigated the predictors of Cervicogenic headache. Identifying these predictors is essential for early intervention and the development of targeted management strategies.

Purpose: To examine the predictors of cervicogenic headache in patients with chronic neck pain at the 6-month follow-up period.

Methods: A prospective study was conducted. A total of 321 patients with chronic neck pain were selected for this study. Data were collected at baseline and at the 6-month follow-up. Cervical X-rays were taken to assess the Cervical Cobb angle, and self-reported questionnaires were used to assess sleep quality, pain intensity, depression, anxiety, fatigue, and disability in patients with chronic neck pain. Binary logistic regression and Mann-Whitney U test were employed for the analysis.

Results: The study found that cervical Cobb angle 95% CI (.85, .96), p = .001, sleep quality 95% CI (1.32, 1.81), p < .001, depression 95% CI (1.09, 1.55), p = .003 and anxiety 95% CI (1.15, 1.59), p < .001 were significant predictors of cervicogenic headache in patients with chronic neck pain at 6-month follow-up period.

Conclusion: Our results suggest that altered cervical Cobb angle, poor sleep quality, and psychological status may serve as potential predictors of cervicogenic headache in patients with chronic neck pain. These findings highlight the importance of a comprehensive approach to managing cervicogenic headache and neck pain that addresses both physical and psychological factors. By targeting these comorbidities, health-care providers may be able to improve outcomes and prevent the development of cervicogenic headache in patients with chronic neck pain.

Registration number (phrc/hc/1339/23): The study was registered in August 2023.

Objectives: Shoulder mobilization techniques, with and without movement, may restore the range of intra-articular glenohumeral motions and expand the subacromial space during arm abduction. The primary purpose of this study was to measure and compare the acromiohumeral distance at three static angles of passive scapular arm abduction (no arm abduction, 45° of arm abduction, and 60° of arm abduction) in overhead athletes diagnosed with primary subacromial impingement syndrome, before and after shoulder mobilization techniques with and without movement, combined with contemporary physical therapy.

Methods: Fifty-one overhead athletes diagnosed with primary subacromial impingement syndrome were randomly assigned to three parallel groups. One intervention group received the Mulligan shoulder mobilization techniques, whereas the other intervention group received the Maitland shoulder mobilization techniques. Both mobilization approaches were accompanied by contemporary physical therapy and were administered every other day for two weeks. The control group received no specific intervention for two weeks. Using an ultrasound device, the acromiohumeral distance was assessed in the intervention groups one day before and one day after treatment with manual therapy and in the control group at two-week intervals.

Results: Both the Mulligan and Maitland approaches significantly increased the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001). In contrast, no significant changes were observed in the control group (p-values > 0.317).The Mulligan approach, compared to the Maitland approach, exhibited significantly greater increases in the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001).

Conclusions: Both the Mulligan and Maitland shoulder mobilization techniques, combined with contemporary physical therapy, significantly increased the acromiohumeral distance at static angles of passive scapular arm abduction in individuals suffering from primary subacromial impingement syndrome. Moreover, the Mulligan approach provided significantly greater improvements in the acromiohumeral distance compared to the Maitland approach.