Journal of Manual & Manipulative Therapy最新文献

Objective: Post-professional education in orthopedic manual physical therapy (OMPT) provides a unique pathway for clinicians to refine clinical skills and reasoning in pursuit of professional excellence. Despite these benefits, fellowship training demands significant personal and financial investment. Therefore, understanding whether fellowship education promotes professional growth, job satisfaction, and return on investment is essential. The aim of this study was to explore fellowship-trained OMPTs' self-reported perceptions of pursuing fellowship education in the United States (US), while identifying predictors that may be associated with career success following fellowship education.

Methods: A convergent parallel mixed-methods design via online survey and one-on-one semi-structured interviews was used. A thematic coding process was implemented for qualitative analysis. Descriptive statistics were calculated for demographic data. Binary logistic regression models assessed relationships between demographic variables and the personal and professional impact of fellowship training.

Results: One hundred and nine participants completed the survey, and 23 underwent focused interviews, meeting data saturation. Merging of analyses revealed five themes related to personal and professional impacts of fellowship including clinical outcomes, job satisfaction, barriers, clinical excellence, and professional opportunities. Board-certified clinicians had greater odds (OR = 4.47, 95% CI 1.17-15.93, p = .03) of reporting fellowship training enhancing their application of current research. Those with a doctorate degree reported greater odds (OR = 9.18, 95% CI 2.31-36.56, p = .002) of establishing impactful mentors through fellowship. PTs with < 10 years of practice were more likely to report fellowship training positively affecting their salary (OR = 4.28, 95% CI 1.50-12.24, p = .01) and self-perception as expert clinicians (OR = 7.29, 95% CI 1.65-32.22, p = .01).

Discussion/conclusion: This study is the first to examine personal and professional outcomes among US fellowship-trained clinicians, highlighting the positive impact on clinical reasoning, mentorship, and compensation - especially among novice clinicians. Fellowship enhances job satisfaction, career growth, and clinical excellence, offering insights for prospective fellows and future research directions.

Objectives: Determining the prevalence of different shoulder subclassification-based diagnoses using a defined exclusion-type diagnostic algorithm. Analyzing the relationships between cervical contribution and other shoulder diagnoses.

Methods: A proposal of a shoulder pain diagnosis based on functional subclassification was carried out in all subjects. The included diagnoses were cervical contribution, acromioclavicular joint pain, stiff shoulder, atraumatic unstable shoulder, rotator cuff-related shoulder pain, and 'Others'. Each diagnosis was based on a defined exclusion-type diagnostic algorithm. Cervical contribution was considered if a > 30% shoulder symptom modification in pain intensity was recorded after a cervical spine screening. Since a > 30% change in symptoms does not definitively indicate a categorical diagnosis, cervical contribution was presumed to potentially coexist with other diagnostic labels in these cases. If there was a complete (100%) resolution of shoulder symptoms after the cervical spine screening, cervical contribution was deemed the sole diagnosis.

Results: Sixty subjects were analyzed. Rotator cuff-related shoulder pain was the most prevalent diagnosis (36.7%, n = 22), followed by stiff shoulder, being present in 30% (n = 18) of subjects. Cervical contribution (13.3%, n = 8), atraumatic unstable shoulder (11.7%, n = 7), others (6.7%, n = 4) and acromioclavicular joint pain (1,7%, n = 1) completed the results. In patients diagnosed with rotator cuff-related shoulder pain, cervical contribution coexisted in 71,4% of them. Thus, a statistically significant association between cervical contribution and rotator cuff-related shoulder pain was found (p = 0,002). This association was not observed in any of the other diagnoses.

Discussions/conclusions: Rotator cuff-related shoulder pain was the most prevalent diagnosis, followed by stiff shoulder and cervical contribution. Cervical contribution may coexist with other diagnoses or even be considered as a unique diagnosis itself. Patients diagnosed with rotator cuff-related shoulder pain are more likely to have cervical contribution.

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.

Objective: To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP).

Methods: We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results: Five trials (n = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy.

Conclusion: We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.

The historical development of manual therapy is an area of ongoing debate impacting clinical practice, education, and practice regulations. Primary professions utilizing manual therapy include chiropractic, manual medicine, osteopathy, and physiotherapy. A survey was developed to explore perceptions, experiences, and opinions across professions, and was disseminated globally. It was completed by 194 individuals. Results demonstrated this topic is of significance with over 80% reporting that knowledge of historical development informs professional identity. Of the respondents, 64% had over 20 years professional experience. Student participation was low (<1%). Over 95% acknowledged an ancient basis for manual therapy, with 67% emphasizing bonesetter contributions. North America was reported as the primary area for the development of modern manual therapies by all except physiotherapy, which identified Northern Europe. Osteopathy's impact on current practice was recognized, though each profession ranked its own impact highest. Of respondents, 85% agreed there was conflict between professions over history. Thematic elements identified a shift for respondents from their initial education to a more nuanced understanding of the history over time, and an appreciation that there is not one profession that owns or developed manual therapy. Practice limitations were identified, as 19% of respondents reported limitations due to inaccurate historical understanding. This study highlights a lack of historical knowledge and its potential benefits for practice, education, regulation and interprofessional relations if recaptured. (the abstract was rewritten per reviewer comments to reformat).

Introduction: Neck pain and headaches are common, with a reported lifetime prevalence of up to 66%. Upper cervical segmental dysfunction has been implicated as meaningful in neck pain and multiple headache types. Several tests have been described to assess upper cervical joint dysfunction, including the flexion-rotation test (FRT), the side bend-rotation test (SBRT), and joint play assessment (PA). The purpose of this study was to determine the diagnostic validity of the SBRT to detect C1-2 dysfunction in a sample of people with medically diagnosed sinus headaches and controls.

Methods: Design: prospective diagnostic accuracy study, occurring during an observational case-control study in a sample of individuals with medically diagnosed sinus headaches. All participants were assessed using the SBRT, FRT, and C1-2 joint play assessments. The diagnostic accuracy of the SBRT was assessed using a reference standard of concurrent positive FRT (a loss of at least 10° from expected ROM (≤34°)) and restriction of C1-2 joint play. Cut-off scores for the SBRT were determined using ROC curve analysis, and tests of diagnostic accuracy were calculated using 2 × 2contingency tables.

Results: A total of 80 individuals (40 headache, 64 female, mean age 32.9 ± 13.8 yrs.) were included in the study. Mean ROM for the tests was: SBRT 31.4 ± 9.4°, FRT 44.9 ± 9.5°, and C1-2 mobility 22 hypomobile/58 normal. An SBRT cutoff score of <25° was confirmed using ROC curves. Using this cutoff score, the SBRT demonstrated 100% sensitivity and 62% specificity to detect C1-2 hypomobility.

Discussion/conclusion: The SBRT, using a cutoff score of ≤25°, appears to be a sensitive test to detect C1-2 dysfunction. Based on the strong sensitivity and negative predictive values, scores greater than 25° may effectively rule-out C1-2 dysfunction. The SBRT should be considered as part of a sequential clinical decision-making process when screening for C1-2 dysfunction, although further research is required to improve generalizability of these findings.

Background: Neck pain is common among people with headache, including migraines, tension headache, and cervicogenic headache. Neck pain has also been associated with self-reported sinus headache in individuals who were not formally diagnosed with headache attributed to rhinosinusitis (HAR). Neck pain, in individuals diagnosed with HAR according to the International Classification of Headache Disorders, has not been investigated.

Objective: The primary objective of this study was to compare the report of neck pain in people with and without HAR. A secondary purpose was to compare measures of cervical musculoskeletal dysfunction between groups.

Methods: This was an observational study. There were 80 total participants, age and sex-matched with 40 per group. HAR group participants completed the Headache Impact Test, Sino-Nasal Outcome Test-22, Neck Disability Index (NDI), and Visual Analog Scale Score (VASS) to rate headache. All participants underwent examination of neck range of motion, neck muscle endurance, and segmental examination.

Results: There were significant between-group differences for reported neck pain (82.5% in HAR group; 22.5% in control group, p < .001) and NDI score (mean difference [95% CI] = 15.7 [11.1, 20.2], p < .001). There was a moderate and significant positive correlation between HAR and segmental dysfunction in the upper cervical spine (O-C3) (0.425, p < .001) but not the lower cervical spine.

Conclusion: Neck pain may be associated with HAR, and patients perceive this neck pain as impacting their quality of life. Upper cervical segmental dysfunction was common and significantly different in the HAR group. Causation of both the subjective and objective findings remains unclear.

Background: Manual therapy is routinely used in the management of upper back pain (UBP), a disabling condition. However, the approach to diagnosis and treatment techniques used by manipulative physiotherapists and osteopaths is largely unknown.

Objectives: To explore knowledge about UBP, including diagnosis and treatment, by New Zealand (NZ) osteopaths and manipulative physiotherapists and to investigate differences (if any) in the self-reported approaches to diagnosis and management of UBP between the professions.

Design: A cross-sectional survey administered through an online platform (Qualtrics) between September 2023 and January 2024.

Participants: One hundred and ten NZ osteopaths and manipulative physiotherapists completed the survey.

Results: Forty-eight percent (n = 53) of respondents identified their profession as physiotherapists and 52% (n = 57) as osteopaths. Over three-quarters of respondents (77%) 'strongly agreed' that a multimodal approach is essential for effective UBP management. Osteopaths were significantly more likely to often proffer 'wear and tear/degeneration' (p < 0.01) and 'visceral referred pain' (p = 0.02) as the cause of a patient's UBP. In terms of management, osteopaths were significantly more likely to use soft tissue techniques (p < 0.01), spinal manipulations (p < 0.01), rib manipulations (p < 0.01), rib mobilizations (p < 0.01), and visceral techniques (p < 0.01), compared to physiotherapists.

Conclusions: The survey highlights a strong consensus among respondents that a multimodal approach is essential for effective UBP management. The survey also identified profession-specific approaches to the diagnosis and management of UBP. Future research using qualitative methods is required to further explore these profession-specific differences and explore outcomes of care.

Background: Perspectives on the historical genesis of manual therapy for chiropractic, manual medicine, osteopathy, and physiotherapy are limited.

Objective: This study sought to identify themes and narratives related to the genesis of manual therapy; the potential of a common root for manual therapy in 19^th century Northern Europe; and the potential impact of a current 'broken history' for manual therapy.

Methods: An exploratory phenomenological approach was utilized, based upon structured one-hour interviews of 21 professionals across four professions who had previously completed a survey on the historical genesis of manual therapy.

Results: Descriptive and hermeneutic themes were developed based upon the lived experience of individuals relating to interview questions and a presented historical narrative. Support for a common genesis in Northern Europe was present within physiotherapists, but for all other professions North America was primary. Multiple themes and quotes of significance were developed from the study, including the importance of history within professional identity. An archetypal analysis was completed to answer specific assumptions related to the historical genesis of manual therapy including points of genesis for manual therapy and scientific necessity within manual therapy.

Conclusion: The findings of this study provide new perspectives to consider on the value, criticality, and impact of manual therapy, and its history's for the four professions in practice, education, and regulations.