Journal of Manual & Manipulative Therapy最新文献

Objective: To identify self-reported characteristics of physical therapists who consistently achieve superior outcomes in the management of cervical and lumbar conditions.

Methods: Mixed-methods study combining quantitative analysis of risk-adjusted patient-reported outcome data with qualitative surveys and structured interviews. Clinicians from Jefferson Moss-Magee Rehab were included if their Focus on Therapeutic Outcomes (FOTO) scores for cervical or lumbar patients met or exceeded risk-adjusted national benchmarks from 2021-2023. High-performing therapists were surveyed regarding demographics, clinical experience, post-professional education, and treatment approaches. A subset participated in structured interviews, and thematic analysis was used to identify common characteristics contributing to success.

Results: For the lumbar cohort, 32 therapists met criteria; for the cervical cohort, 11 met criteria. Surveys were completed by 20 lumbar and 6 cervical cohort members; 18 participated in interviews. Thematic analysis revealed four key characteristics among high performers: (1) use of evidence-informed practice, (2) commitment to lifelong learning via post-professional training, (3) strong therapeutic alliance, and (4) clinical experience with spinal conditions.

Discussion/conclusion: Effective management of cervical and lumbar conditions is linked not only to clinical expertise but also to key clinician attributes, such as ongoing professional growth and strong interpersonal skills. These findings may guide professional development and quality improvement efforts in musculoskeletal physical therapy practice.

Background: Sacroiliac joint (SIJ) pain is a common diagnosed lumbosacral condition with historical diagnostic uncertainty. Recent literature suggests that effective diagnosis of SIJ pain should begin with screening the thoracolumbar spine, as SIJ regional pain is often linked to referral patterns originating from this area.

Objective: The aim of this systematic review was to evaluate the screening methods of the thoracolumbar spine in randomized controlled trials (RCT) for the evaluation and treatment of SIJ pain or dysfunction.

Methods: A search of PubMed, CINAHL, and CENTRAL was conducted for RCTs published from inception up to 31 March 2024. RCTs focusing on SIJ pain as the primary diagnosis, treated with conservative interventions such as manual therapy, exercise, or modalities in adult patients, were included. Data on thoracolumbar spine screening methods were extracted, categorized, and reported with means, standard deviations, and frequency counts. The Revised Cochrane Risk of Bias tool was used to assess each RCT.

Results: A total of 2,719 articles were retrieved. After removing duplicates and screening titles, abstracts, and full texts, 43 RCTs were included for data extraction. Two trials (4.7%) performed a reasonable thoracolumbar spine screening process, nine (20.9%) partially completed, and 32 (74.4%) did not perform a thoracolumbar screening process prior to formulating an SIJ diagnosis. Every RCT had at least some of risk of bias.

Discussion/conclusion: More than 95% of RCT's reported minimal-to-no thoracolumbar screening process prior to developing an SIJ diagnosis, highlighting significant variability and scarcity. The role of screening the thoracolumbar spine prior to diagnosing SIJ pain is notably underrepresented in RCTs providing treatment recommendations for this condition, undermining the strength of the conclusions derived from these studies. This finding highlights the need for further research to establish a standardized clinical thoracolumbar screening process for SIJ pain to ultimately improve patient outcomes for this condition.

Musculoskeletal extremity pain is frequently diagnosed based on symptom location and region-specific musculoskeletal special tests despite evidence demonstrating limited diagnostic accuracy and increased risk of misdiagnosis. Literature suggests that a proportion of extremity pain is influenced by nociceptive spinally mediated somatic referred pain, which can occur in the absence of spinal symptoms, often misclassified as radicular pain or radiculopathy. Overreliance on pain location and special tests with poor clinometric properties increases the likelihood that spinal contributions are overlooked, potentially resulting in suboptimal management strategies. Nociceptive input from spinal structures can produce non-dermatomal extremity pain patterns through mechanisms of spinal convergence and cortical reorganization. This clinical commentary proposes a structured approach to spinal screening in patients presenting with extremity pain, emphasizing targeted subjective questioning, spinal motion assessment, neurological and neurodynamic testing, and identification of a comparable sign using a test-treat-retest framework. Incorporating spinal screening into extremity evaluations may support more effective hypothesis-driven clinical decision-making and promote more effective management of musculoskeletal extremity pain.

Objectives: The aims of this pilot study were to explore the effects of specific physiotherapy techniques targeted at improving upper cervical rotation in unilateral migraine sufferers with neck pain and asymmetry in upper cervical rotation. This will provide directions for any future modifications for a larger clinical trial.

Methods: A single cohort pilot study using non-randomized participants with unilateral migraine, asymmetrical neck rotation range of motion and palpatory findings at C1/2. Primary outcomes included measures of migraine frequency, cervical flexion rotation test (CFRT) and global perceived effect (GPE) immediately post and 3 months following treatment. Secondary outcome measures were neck disability index (NDI) and headache impact test (HIT-6).

Results: Ten female eligible participants were recruited within 10 weeks and completed treatment, with no dropouts or adverse events. At the post-treatment assessment, 9/10 participants had a normalized CFRT, 6/10 had a significant reduced migraine frequency (>50%) and 8/10 were significantly or completely satisfied with treatment on GPE. At 3 months post treatment, 8/10 had a significantly reduced migraine frequency and 5/10 were significantly or completely satisfied with their overall result on GPE. Improvements in one outcome measure, however, did not necessarily align with others, indicating a refinement of these measures may be necessary in future studies.

Conclusions: The pilot study suggests that a subgroup of migraine patients may benefit from this specific physiotherapy approach. The results provide justification for a larger controlled trial, utilizing refined outcome measures and longer-term follow-up.

Clinical trial registry number: ACTRN12625000069459.

A double-blind randomized controlled trial was conducted. Thirty-five individuals with hip-related groin pain were randomized into an experimental group (EG) or a sham group (SG). Both groups performed four sessions (two per week) over two consecutive weeks. The primary outcomes were pain intensity and passive hip ROM. The secondary outcomes were muscle function, physical function, QoL, and self-perceived improvement. Data were collected at baseline and post-treatment. Results: Significant between-group differences in favor of EG were found at post-treatment forpain intensity (in the last week, in sport activities, and in pain provocation tests); peak asymptomatic force and peak force in the squeeze test; passive hip ROM (except for adduction); physical function (sport and recreation and participation physical activities); QoL; and self-perceived improvement. Conclusion: High-force hip lateral distraction mobilization was more effective than sham hiplateral distraction mobilization for improving pain intensity, force in the squeeze test, passivehip ROM, physical function, and QoL in individuals with hip-related groin pain.

Objectives: Although irritability is traditionally theorized to reflect tissue damage, individuals with irritable shoulder pain may also have elevated pain sensitivity and negative psychological factors providing novel treatment targets. This pilot study aimed to evaluate the feasibility of a randomized controlled trial comparing a biomedical and biopsychosocial approach to treating irritable shoulder pain. A secondary aim was to report preliminary outcomes.

Methods: This pilot study randomly assigned individuals with moderate or high irritability shoulder pain to a biomedical intervention based on tissue healing (n = 10) or a biopsychosocial intervention based on graded exercise with pain education (n = 10). Participants completed eight intervention sessions over four weeks (2x/week), including exercise, stretching, and education based on their assigned group. Shoulder pain intensity on the 101-point Numeric Pain Rating Scale (NPRS), disability on the quickDASH, and psychological factors (pain catastrophizing, fear-avoidance beliefs, and anxiety) were measured at baseline and after the eighth session.

Results: The results of this study showed 100% treatment retention rates and 95% adherence rates with no adverse effects. The biopsychosocial group demonstrated greater mean improvements in shoulder pain (mean difference ± standard deviation = 28.80 ± 15.99) and disability (19.32 ± 11.25) compared to the biomedical group (pain: 5.67 ± 18.90, disability: 0.45 ± 8.62). For psychosocial factors, the biopsychosocial group showed notable decreases in pain catastrophizing (PCS: -8.50 ± 6.98), fear avoidance beliefs (FABQ-PA: -2.80 ± 5.92), and pain anxiety (PASS-20: -9.80 ± 12.74) when compared to the biomedical group who demonstrated very small increases (PCS: 0.70 ± 5.56, FABQ-PA: 0.10 ± 6.35, PASS-20: 1.40 ± 3.84).

Conclusion: The protocols performed in this study displayed high feasibility providing support for this protocol potentially being implemented in larger randomized controlled trials. The biopsychosocial group demonstrated larger mean improvements in pain intensity, disability, and psychological factors compared to the biomedical group.