Journal of Manual & Manipulative Therapy最新文献

Objectives: Most patients seen in physical therapy (PT) clinics for low back pain (LBP) are treated for chronic low back pain (CLBP), yet PT interventions suggest minimal effectiveness. The Cochrane Back Review Group proposed 'Holy Grail' questions, one being: 'What are the most important (preventable) predictors of chronicity' for patients with LBP? Subsequently, prognostic factors influencing outcomes for CLBP have been described, however results remain conflicting due to methodological weaknesses.

Methods: This retrospective observational cohort study examined prognostic risk factors for PT outcomes in CLBP treatment using a sub-type of AI. Bootstrap random forest supervised machine learning analysis was employed to identify the outcomes-associated variables.

Results: The top variables identified as predictive were: FOTO™ predicted functional status (FS) change score; FOTO™ predicted number of visits; initial FS score, age; history of jogging/walking, obesity, and previous treatments; provider education level; medication use; gender.

Conclusion: This article presents how AI can be used to predict risk prognostic factors in healthcare research. Improving predictive accuracy helps clinicians predict outcomes and determine most appropriate plans of care and may impact research attrition rates.

Objective: Neck pain is a prevalent global health concern often accompanied by musculoskeletal symptoms. This randomized controlled trial attempted to contrast the impacts of non-thrust Maitland mobilization and Autogenic inhibition muscle energy technique on chronic mechanical neck pain associated with cervico-thoracic junction hypo-mobility.

Methods: Sixty participants (24 males and 36 females, aged 18-45 years) were allocated randomly into three equally sized groups (A, B, C). Group A: Maitland mobilization plus conventional treatment, Group B: Autogenic Muscle energy technique plus conventional treatment, while; Group C solely received conventional treatment. Treatment was administered for four weeks, three times a week. Outcome measures: neck pain (The primary outcome measure) assessed by Visual Analog Scale (VAS), disability evaluated through Neck Disability Index (NDI), active range of motion (AROM), and joint position error (JPE) as an indicator of cervical proprioception. All measures were assessed both at baseline and after four weeks of intervention.

Results: Results showed significant improvements in VAS, NDI, and increased ROM across all groups post-treatment (p < 0.001). While Groups A and B demonstrated superior outcomes compared to Group C, differences between Groups A and B were not statistically significant (p > 0.05). For VAS and NDI, Cohen-d between Groups A and B was 0.31 and 0.31, and for ROM, Cohen-d was 0.37, 0.16, 0.07, 0.29, 0.36, and 0.53 for flexion, extension, right rotation, left rotation, right bending, and left bending, respectively. Furthermore, all groups experienced a significant decrease in JPE, with Groups A and B showing greater improvement than Group C (p < 0.01). Group B exhibited significantly greater improvement in reducing JPE related to specific motions compared to Group A (p < 0.05).

Conclusion: Cervico-thoracic junction mobilization and the Autogenic muscle energy technique offer enhanced management for mechanical neck pain by improving pain, function, ROM, and cervical proprioception.

In this letter to the editor, we discuss additional viewpoints and identify relevant literature to supplement the evidence statement of the authors. We want to make a positive contribution to the discussion about Pediatric Manual Therapy.

Introduction: Neck pain is a common musculoskeletal disorder, with a prevalence rate (age-standardized) of 27.0 per 1000 in 2019. Approximately 50-85% of individuals with acute neck pain do not experience complete resolution of symptoms, experiencing chronic pain. Manual therapy is a widely employed treatment approach for nonspecific neck pain (NSNP), cervical radiculopathy (CR) and cervicogenic headaches (CGH). This umbrella review synthesized systematic reviews examining manual physical therapy for individuals with cervical disorders.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with Prospero registration (CRD42022327434). Four databases were searched from January 2016 to May 2023 for systematic reviews with or without meta-analysis examining manual therapy for individuals with neck pain of any stage. Interventions included any manual physical therapy of the cervical or thoracic spine as well as neuromobilization of the upper quarter. Primary outcomes included pain and disability. Two reviewers screened for eligibility and completed data extraction. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool.

Results: A total of 35 SRs were included: 15 NSNP, 7 cervical radiculopathy, 9 CGH and 4 samples with combined diagnoses. AMSTAR 2 ratings of the SRs support high confidence in results for 10 reviews, moderate confidence in 12 reviews and low to critically low confidence in 13 reviews. For NSNP, there was high confidence in the results showing manual therapy combined with exercise was superior to either treatment in isolation. In cervical radiculopathy, neural mobilization, distraction, soft tissue treatment and mobilization/manipulation to cervical and thoracic spine were supported with moderate confidence in results. For CGH, there was high confidence in the results supporting the use of cervical spine mobilization/manipulation, soft tissue mobilization, and manual therapy combined with exercise. Original authors of SRs reported varying quality of primary studies with lack of consistent high quality/low risk of bias designs.

Conclusion: Manual therapy plus exercise, cervical or thoracic mobilization and manipulation, neuromobilization, and other types of manual therapy were supported as effective interventions in the management of pain and disability for individuals with NSNP, CGH, or CR in the short-term.

Objectives: We aimed to determine the effect duration of a talocrural mobilization on individuals with restricted dorsiflexion during a static weight bearing lunge test (WBLT) and dynamic 3D motion capture-based peak ankle dorsiflexion during a forward step down (FSD) task. Secondarily, we aimed to correlate any immediate changes in ankle mobility with concurrent changes in proximal joint kinematics during the FSD post-mobilization.

Methods: Seventy-six individuals were screened for dorsiflexion restriction, of which 26 (15 females, 22.3 ± 2.2 years old, body mass index 25.2 ± 2.9 kg/m2) qualified with a WBLT of ≤ 35° on at least one limb. A baseline WBLT measure and 3D motion capture of 5 consecutive FSD repetitions on a 6-inch box were obtained. Participants then viewed an instructional video of a talocrural joint self-mobilization using a resistance band. WBLT and FSD were collected again immediately post-mobilization and at 5-min intervals for 60 min or until the WBLT returned to baseline for 2 consecutive measures.

Results: WBLT dorsiflexion showed a mean increase of 6.5 degrees (p < 0.001) post-mobilization. The effect faded over time and no longer differed from baseline 25 min post-mobilization (p = 0.964). Dynamic peak ankle dorsiflexion did not change post-mobilization at any time point (p ≥ 0.546). No 3D kinematic time-course changes were observed at the hip or knee. However, immediate raw alterations in dorsiflexion correlated with alterations for hip and knee flexion.

Discussion/conclusion: A talocrural joint mobilization increased static dorsiflexion per the WBLT for a 20-25-min period with regression to baseline. However, increased dynamic ankle dorsiflexion was not observed during the FSD task. Improved mobility alone does not appear to change movement patterns. Clinicians should be aware of both effect duration and the potential need for task-specific training to better facilitate dynamic utilization of increased mobility.

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.