Journal of Manual & Manipulative Therapy最新文献

Objectives: This study aimed to determine if the first onset of symptoms (discomfort) during the straight leg raise (SLR) (hip flexion with an extended knee) and the Knee Extension Angle (KEA) tests (knee extension with 90°of hip flexion) results from nervous or muscular structures in asymptomatic individuals. The secondary objective was to investigate if the gender influences the structure related to the discomfort.

Methods: This cross-sectional study consisted of a single assessment session during which the structure related to participants' discomfort during the KEA and SLR was identified. For this identification, a structural differentiation (SD) was conducted during both tests using passive mobilization of the cervicothoracic spine in flexion and extension. Changes in participants' discomfort were monitored during the SD to determine whether a change or lack of change was consistent with variations in the load applied to the suspected structures either muscular or neural. If the structure related to the participants' discomfort could not be identified, two additional tests were conducted: the lateral SLR and the Slump test.

Results: One hundred and seventy-eight individuals were included. Median [IQR] age was 21 years [20;23], and 57.3% were female. The structure related to participants' discomfort was similar for the SLR and the KEA (p = 0.451): neural for 72.5% of participants in the SLR and 75.8% in the KEA. Gender only influenced the structure identified in the KEA test, with a significantly higher rate of nerve-related discomfort in females than males and a significantly higher rate of muscle-related discomfort in males (p = 0.002).

Conclusion: In asymptomatic individuals, the discomfort induced by the SLR and the KEA tests could be related to either muscular or neural structures. Therefore, structural differentiation is necessary to identify the structure causing the discomfort in both research and clinical practice.

Objective: The profession of physical therapy in the United States has evolved significantly since the American Physical Therapy Association introduced Vision 2020, advocating for consumers' direct access to physical therapy services. As the use of direct access expands, it becomes essential to examine successful models and resources, such as those that allow physical therapist referral for diagnostic imaging. This study aims to report the utilization, appropriateness, and reimbursement for diagnostic imaging referrals made by physical therapists during routine care across multiple health care organizations.

Methods: This study was a retrospective observational study of patients seeking care for neuromusculoskeletal conditions at ambulatory physical therapy clinics at three healthcare organizations. Data from each organization related to physical therapist referral for diagnostic imaging was reviewed to determine utilization rate, appropriateness, and reimbursement. American College of Radiology (ACR) criteria were used to determine appropriateness of diagnostic imaging referral.

Results: Seventy-five physical therapists signed 596 referrals for diagnostic imaging during 61,012 episodes of routine care. The utilization rate was 9.8 diagnostic imaging referrals per 1000 episodes of care. Ninety-one percent of the referrals were consistent with evidence based ACR guidelines and deemed appropriate. There were no instances of insurance denial when a physical therapist signed the referral for diagnostic imaging.

Conclusion: Physical therapists with privileges to directly refer for diagnostic imaging did so judiciously and followed ACR guidelines when referring patients for imaging. The absence of insurance reimbursement claim denial contrasts a common concern about physical therapist referral for diagnostic imaging. Physical therapists referred for appropriate imaging studies and are unlikely to contribute to diagnostic imaging overutilization.

Objectives: Tactile sensitivity is one of the most important skills for developing competence in manual palpation. There is a lack of studies aimed at analyzing the development of tactile sensitivity during different levels of physiotherapy education. The present study aims to compare manual tactile sensitivity in two groups of physiotherapy students.

Methods: Twenty first-year physiotherapy students (mean age 19.4 yrs ± 0.6) and twenty final-year physiotherapy students (mean age 23.7 yrs ± 3.7) participated in the study. For the tactile sensitivity test, 3 wooden tables were used, in which different geometric structures were engraved. Subjects were instructed to perform a tactile examination of the geometric structures and then reproduce them by drawing on a sheet of paper. The tactile time, drawing time, accuracy, and difficulty of the geometric structures were scored. A two-sample t-test was used for the between-groups comparison if more time in an educational program should result in differences in tactile time, drawing time, accuracy, and difficulty. Linear regression was used to compare the difficulty with the accuracy of all geometric structures. Wilcoxon test was used to test the intra-rater agreement.

Results: The accuracy of the reproduction of geometric structures 1, 2 and 3 were 77.5%, 27.5% and 45%, for all physiotherapy students respectively. Final-year physiotherapy students spent more time exploring geometric structure 2 (p = 0.014) and geometric structure 3 (p = 0.0018) compared to first-year physiotherapy students. No statistically significant differences were found between groups in drawing time, accuracy, and difficulty of geometric structures. The examiner showed a high intra-rater agreement in the assessment (over 96%).

Discussion/conclusion: The study showed that the level of education and gained experience during laboratory teaching may be important in improving the palpation skills of physiotherapy students. Tactile sensitivity exercises should be included in physiotherapy education programs.

Background: Individuals with low back pain (LBP) often exhibit weakness and the presence of trigger points in their Gluteus Medius (GMe) muscle.

Objectives: To examine the effectiveness of adding dry needling (DN) for the GMe to standard care of active physical therapy in patients with chronic nonspecific LBP.

Methods: A randomized, prospective, sham-controlled trial was conducted. Participants with chronic nonspecific LBP (N = 22, age range: 31-55 years) were randomly divided into intervention and control groups. Both groups received active physical therapy including exercises for 6 treatments. In addition, at each session, the intervention group received deep DN to their GMe muscle, and the control group received sham needling. Outcome measures included level of pain (using VAS scale), function (Oswestry disability index ODI), low back range of motion (ROM) (forward flexion and schober tests), and global rating of change. The research group was further divided into moderate and minimal disability according to the ODI.

Results: The research group showed greater improvement in pain level compared with control (p = 0.01). The change in ODI was higher in the moderate LBP group compared with the control group (B = 5.25, p < 0.05). The change in forward flexion distance test was higher in the moderate disability LBP group compared with the control group (B = 6.31, p < 0.01). Simple mean analysis also revealed a significant difference between the moderate and minimal disability groups (B = 6.16, p = 0.01).

Conclusions: Incorporating DN into physical therapy treatments for chronic nonspecific low back pain, can improve pain level and function.

Clinical trials registration no: NCT04498572 (clinicaltrial.gov).

Objectives: The physiotherapy literature lacks high-quality, registered systematic reviews (SRs) and 'trustworthy' randomized controlled trials (RCTs). It is unknown whether considering quality and 'trustworthiness' impact publication bias, heterogeneity, and the certainty of clinical recommendations observed in the literature.

Methods: We performed a methodological review of SRs investigating physiotherapy treatment of neuromusculoskeletal conditions indexed by MEDLINE, between 1 January 2018, and 25 October 2023. Blinded reviewers examined the prospective intent and quality of SRs and the 'trustworthiness' of RCTs included therein. Blinded reviewers extracted data for the variables of interest (Numeric Pain Rating Scale and Visual Analog Scale).

Results: Of the SRs identified (N = 677), 13 were included in the final review. These included a total of 109 RCTs, including duplicates. Only eight of these trials were deemed 'trustworthy.' Publication bias was identified, and heterogeneity across the trials (N = 55) included in the quantitative analysis was high (I² = 80.11%, 95% CI [75.88, 83.60]). Publication bias and heterogeneity were eliminated (I² = 0%, 95% CI [0.00, 37.44]) upon considering those prospectively registered (N = 14). Statistical significance, assessed via the p-value at baseline (<.001), was eliminated (p = .746) once prospective, external, and internal validity was considered. Statistical inference through estimation, evaluated via effect size, confidence intervals, and minimal detectable change, was not present at baseline and reduced throughout the screening process.

Discussion: Trials of musculoskeletal interventions to manage pain in patients with neuromusculoskeletal conditions lack certainty and confidence in their treatment effects and exhibit high heterogeneity. Statistically significant effects and heterogeneity are eliminated when considering 'trustworthy' quality evidence.

Conclusions: Consistent with previous findings, null effects, and low heterogeneity arise when considering the best available evidence. Meaningful effects are likely rare when assessed holistically using statistical inference through estimation and the confidence and certainty of the estimated effect.

Background: Individuals with shoulder pain have a higher occurrence of myofascial trigger points (MTrPs). In the past decade, dry needling (DN) has been used in physical therapy practice to treat MTrPs. Impaired blood flow is proposed as an underlying mechanism of MTrPs in neck-shoulder pain. However, whether DN would improve muscle blood flow in individuals with shoulder pathology has not been examined. Therefore, the primary purpose of this study was to use color Doppler imaging to examine the effects of DN on the blood flow of the infraspinatus muscle in individuals with shoulder pain. The secondary purpose was to examine the effects of DN on sensitivity to pressure and shoulder range of motion (ROM) of the infraspinatus muscle in individuals with shoulder pain.

Method: This randomized comparison trial utilized a sham-controlled design. Forty individuals with nonspecific shoulder pain and at least one MTrP in the infraspinatus muscle were randomly assigned to a real DN group or a sham DN group. Outcome measures, including blood flow parameters, ROMs of shoulder internal rotation and external rotation, and pressure pain threshold (PPT) were collected before and immediately after a single session of DN.

Results: The repeated measure ANOVA results revealed that real DN significantly decreased peak systolic velocity (PSV) and increased shoulder internal and external rotation ROM more than sham DN (p < 0.05). However, there were no significant differences in end diastolic velocity, resistive index, pulsatile index, and PPTs between real DN and sham DN (p > 0.05).

Conclusion: The results indicated that participants who received real DN exhibited a significant reduction in PSV, suggesting improved blood flow to the infraspinatus muscle. Participants who received real DN exhibited improvements in shoulder ROM but showed no reductions in sensitivity to pressure. These results may provide clinicians with evidence for the use of DN for individuals with shoulder pain.

Background: Pain Science Education (PSE) has been shown to reduce pain and disability in chronic low back pain (CLBP), a prevalent and disabling condition. PSE helps reconceptualize pain using aids like pictures, metaphors, and stories, and supports pain self-management. Due to variations in pain beliefs across different cultures, the PSE resources need to be customized to accommodate respective literacy levels, cultures and languages.

Objective: This study aimed to develop PSE booklets in three Indian languages: Bengali, Hindi and Kannada.

Method: Thirty chronic pain experts (i.e. physiotherapists, pain physicians, psychiatrists, psychologists, public health professionals, nurses) independently examined the PSE booklet's content and rated it under: (1) Content adequacy, (2) Simplicity and clarity, (3) Topical flow, (4) Metaphors' appropriateness (5) Illustration suitability (6) Color scheme and (7) Culture-specific content. Five people with lived CLBP experience contributed. The content validity ratio (CVR) was used to rate the content of the PSE booklet in seven domains (e.g. cultural relevance). A priori criterion for acceptance of the content was set at 70%.

Results: Five booklet chapters were developed and were deemed acceptable. Cultural relevance domain received the highest score.

Conclusion: This is the first study to develop culturally relevant PSE booklets in Bengali, Hindi, and Kannada, which are likely to be useful in educating patients with CLBP. The new intervention needs to be tested for effectiveness in respective language-speaking samples.

Introduction: Medial tibial stress syndrome (MTSS) is also called soleus syndrome because the resultant periostitis is localized to the medial insertion of the soleus muscle. This study explores the effectiveness of dry needling (DN) targeting soleus myofascial trigger points (MTrPs) in managing MTSS.

Aim: To assess the impact of DN on pain reduction and ankle range of motion (ROM) improvement in athletes with MTSS.

Study design: This randomized controlled trial (RCT) included 50 university-level athletes. (DN group = 25; control group = 25).

Method: Outcome variables, pain, and ankle dorsiflexion ROM were measured using the Numeric Pain Rating Scale (NPRS) and universal goniometer, respectively. The trial used statistical analyses like Wilcoxon rank test for within-group comparisons and Mann-Whitney U test for between-group comparisons. The trial was registered with the Clinical Trials Registry of India; CTRI/2023/10/058837.

Result: There were 24 Females (Age = 21.4 ± 2.06) & 26 Males (Age = 20.5 ± 2.35). DN significantly reduced pain in the intervention group from NPRS 7 ± 1.30 to 2 ± 0.87 (p < 0.001), but in the control group, the pain increased from NPRS 7 ± 0.99 to 7 ± 1.05 (p = 0.009). There was no improvement in ankle ROM.

Conclusion: DN effectively alleviated MTSS-associated pain in the short-term but was not effective in improving ankle ROM.