Journal of Manual & Manipulative Therapy最新文献

Background: Patellofemoral Pain Syndrome is a common musculoskeletal condition characterized by anterior knee pain, especially among athletes and active individuals. Taping techniques such as Kinesio taping and rigid taping are widely used as conservative interventions. However, the effectiveness of taping on pain reduction and functional improvement remains debated.

Objective: To systematically review and synthesize the evidence on the effect of taping on pain and function in athletes with patellofemoral pain syndrome. Methods A comprehensive literature search was conducted across databases, including PubMed, Scopus, PEDro, and Web of Science. Randomized trials evaluating the effect of taping on pain with or without function in athletes with PFPS were included. Methodological quality was assessed by PEDro. Risk of bias was assessed by Cochrane's Risk of Bias Tool Version 2. Meta-analysis was conducted using Review Manager (RevMan 5.4).

Results: Out of 39 records retrieved, 20 full-text articles were assessed, and 5 studies met the inclusion criteria. Qualitative and quantitative analysis (pain: Z = 1.94, p = 0.05, SMD = -1.71, 95% CI = -3.44 and function: Z = 2.0, p = 0.05, SMD = 1.06, 95% CI = 0.02) showed a significant reduction in pain and improvement in function with taping, especially when combined with exercise therapy. Rigid taping showed more significant results than Kinesio taping.

Conclusion: This review concludes that rigid taping provides short-term benefits in reducing pain and improving function in patients with PFPS, especially when integrated with exercise-based rehabilitation.

Background: Cystic fibrosis (CF) is a severe hereditary disease that affects multiple organ systems. Among these, the musculoskeletal system is an under-explored area. This interview study aimed to explore experiences of musculoskeletal symptoms and of manual therapies as complementary care in this context.

Methods: Semi-structured interviews were used to collect data from ten respondents. The data were subsequently analyzed through content analysis with an inductive approach in accordance with the method of Elo and Kyngäs.

Results: The analysis resulted in three main categories; 1) Living with CF involves musculoskeletal health challenges, 2) Manual therapies impact daily life for people with CF, and 3) People with CF aspire for broader and more collaborative respiratory care.

Conclusion: The respondents described musculoskeletal symptoms in and around the thoracic cage. They experienced symptom relief and increased body awareness following manual therapy interventions (MTI) and recommended that these methods be offered as complementary care to enhance quality of life.

Background: Dry needling (DN) is a skilled intervention commonly used for pain relief and the management of movement disorders in neuromusculoskeletal conditions. Although systematic reviews indicate its effectiveness, variations in treatment parameters exist. This study surveyed U.S. healthcare professionals who utilize DN, examining their clinical techniques, rationale, and use of electrostimulation.

Methods: An electronic survey was created and distributed via Qualtrics™ to healthcare providers performing DN. The survey link was shared through social media and e-mail, and data were analyzed using non-parametric statistical methods (Mann-Whitney U, Spearman's rho) to identify significant patterns in DN practices.

Results: A total of 1,399 healthcare providers completed the survey, predominantly physical therapists (93.3%) with an average of 13.5 years of clinical experience and 5.2 years in DN. Most worked in outpatient orthopedics (90.3%). Common DN techniques included trigger point needling (95.8%) and deep needling (82.0%), with 44.5% using periosteal pecking. The majority of practitioners used up to 4 needles per session (68.1%), while 63.8% used more than 4. Electro-stimulation (e-stim) was commonly applied, with 62.5% using it after needle insertion and 55.6% combining it with needle manipulation. Differences in techniques were noted between physical and nonphysical therapists, particularly in the practice of leaving needles in place without manipulation.

Conclusion: This study highlights the widespread use and evolving methodologies of DN practices in the U.S. noting the integration of electrostimulation and multimodal approaches. It also highlights inconsistencies in treatment parameters, underscoring the need for standardized protocols to enhance clinical effectiveness and research validity. Future research should focus on the long-term efficacy of various DN techniques and their applications in neurological rehabilitation.

Objective: Describe the influence of maladaptive coping behaviors on the clinical presentation and management of an acute lumbar lateral shift.

Case description: A 39-year-old male sought chiropractic care for acute low back pain with an associated lumbar lateral shift of three days duration. The symptoms had remained refractory to chiropractic care and medication provided by visits to the emergency room and an orthopedist. In response to the severity of symptoms, heightened cognitive and emotional factors propagated passive coping that resulted in bed rest and work absenteeism.

Outcome: Providing an understanding of pain from a biopsychosocial perspective combined with self-management strategies involving the method of manual shift correction and graded exposure exercises decreased pain and catastrophizing in four visits over five days. The Revised Low Back Oswestry scored 82%, 0%, and 2% disability and the Yellow Flag Risk Form scored 96, 8, and 34 at intake, discharge and six months follow up.

Conclusion: The method of manual shift correction is discussed as a favorable biomedical procedure for lumbar lateral shifts, with little attribution to the multidimensional nature of low back pain. This case depicts the influence of maladaptive coping behaviors on a lumbar lateral shift.

Introduction: Despite the recommendations to use a bio-psycho-social framework, many physiotherapists still manage their patients mainly from a biomedical point of view. The purpose of this study is to analyze the impact of two different e-learning interventions on knowledge, attitudes, and clinical decision-making of physiotherapists managing low back pain (LBP) to increase guideline-consistent care.

Methods: Physiotherapists were allocated (1/1) either to an experimental or a traditional e-learning intervention. Baseline and post-intervention assessment included the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), and a clinical vignette. Participants had 2 weeks to complete the post-intervention assessment. Statistics were processed using ANCOVA and Fisher's t-tests.

Results: Four hundred nineteen physiotherapists were included in the analysis. Mean scores of HC-PAIRS, Back-PAQ, and NPQ significantly improved post-intervention in both groups. There was a significant effect of the intervention type (experimental versus traditional) on the scores of HC-PAIRS (p < .001; η²_p = .243) and Back-PAQ (p < .001; η²_p = .135) but not on NPQ scores. Return to work, recommendations assessed with the clinical vignette were significantly more guideline-consistent in the experimental group (p < .001) post-intervention.

Conclusion: An interactive e-learning intervention which includes concrete clinical examples and focused on patient's reassurance, self-management, and importance of screening psycho-social factors had more impact than a traditional e-learning intervention to enhance physiotherapists' knowledge, attitudes, and clinical decision-making regarding LBP.

Adhesive capsulitis (AC) is common in women aged 40-60, overlapping with the population at higher risk for breast cancer. Many breast cancer survivors develop shoulder dysfunction, including AC, due to cancer treatments such as surgery, chemotherapy, and radiation, leading to pain, limited mobility, altered biomechanics, and soft tissue contracture. Despite the prevalence of AC in this population, clinical guidelines for its management remain underexplored. Manual therapy can play a key role in improving quality of life for these individuals.Understanding the pain mechanisms - nociceptive, neuropathic, and nociplastic - can inform appropriate treatment strategies for breast cancer survivors with AC. This clinical perspective integrates manual therapy principles into the evaluation and management of AC in this population. As breast cancer cases continue to rise, clinicians must recognize the impact of cancer treatment sequelae on orthopedic conditions to optimize patient care.

Objectives: The aim of this study was to determine whether a short-term online clinical mentoring program was more effective than asynchronous online lectures at improving physical therapists' (PT) practice and their patients' outcomes.

Methods: In this randomized controlled trial, 27 PTs were randomized with allocation concealment to 6 h of online clinical mentoring sessions (experimental group) or 6-h of asynchronous online lectures (control group). The primary patient outcome was function, assessed using the Patient-Specific Functional Scale (PSFS), evaluated at baseline (initial consultation) and 4-week follow-up. Secondary patient outcomes were the Functional Rating Index (FRI) and Global Rating of Change Scale (GRC). Clinician (PT) outcomes were the 'Clinician Confidence Questionnaire for Patients with Spinal Pain' and the 'Self-Reflection Insight Scale', which were evaluated before and after the professional development interventions by blinded assessors. Linear mixed model regression analysis was used to explore differences in patient outcomes. PT outcomes were analyzed using analyses of covariance to control for any baseline differences.

Results: Twenty-three PTs and 122 patients completed follow-up assessments. There were no between-group differences for any patient clinical outcomes (PSFS MD = 0.02, 95% CI -0.83, 0.79, p = 0.95; FRI MD = -3.01, 95% CI -10.71, 4.69, p = 0.42; Global Rating of Change MD = -0.08, 95% CI -1.09, 0.92, p = 0.86). There were also no differences between groups in terms of PTs confidence (MD = -2.17, 95% CI -9.11, 4.76, p = 0.52) or self-reflection insight (MD = 3.66, 95% CI -1.94, 9.27, p = 0.19).

Conclusion: A 6-h online clinical mentoring program did not significantly influence PT confidence, self-reflection nor the outcomes of their patients when compared to 6 h of asynchronous online lectures.

Impact: The results from this study may inform those designing or seeking professional development. Future online clinical mentoring should consider alternative program designs, target PTs with capacity to improve their patient outcomes, and evaluate effects on patients with chronic pain.

Trial registration: ACTRN12622000123741.