Journal of Manual & Manipulative Therapy最新文献

Background: Manual therapy is widely used in temporomandibular joint disorders (TMD), but its effectiveness across different professional practices and techniques remains unclear. This systematic review of randomized controlled trials (RCTs) aims to evaluate the efficacy of manual therapy in alleviating pain and improving functional recovery in patients with different TMD subtypes, considering the roles of various healthcare professionals.

Methods: A systematic search was conducted across PubMed, Scopus, Cochrane and Web of Science to identify RCTs presenting participants with a diagnosis of TMD, manual therapies as interventions; other therapeutic modalities, placebo, or sham therapy as comparisons; pain intensity and maximum mouth opening (MMO) as outcomes.

Results: From 561 initial records, 18 RCTs met the inclusion criteria and were included in the analysis. Overall, manual therapy was associated with reductions in pain and improvements in MMO across different professional background and techniques. However, the certainty of evidence was limited, and effects were predominantly observed in the short term. Physiotherapists in rehabilitation settings showed the most consistent outcomes, particularly documented in Brazil. Chiropractic approaches were common in Australia, USA, and England, while Japan focused on intra-oral manipulations by dental and maxillofacial specialists. Italy, Spain, Greece and Turkey stand out for their interdisciplinary approach independently by chiropractors, physiotherapists, or osteopaths in TMD management.

Conclusions: This systematic review suggests that manual therapy may be associated with short-term improvements. Variability in techniques, professional settings, and study designs precludes firm conclusions regarding long-term effectiveness or superiority of specific approaches. Physiotherapy manipulation emerged as the most used technique. Further research should explore long-term outcomes and multiprofessional collaboration.

Objective: To validate the Neck Disability Index (NDI) and Mandibular Functional Impairment Questionnaire (MFIQ) instruments for telephone applications in patients with temporomandibular dysfunction (TMD).

Methods: This cross-sectional study invited participants with TMD to answer the NDI and MFIQ on two randomized occasions, face-to-face and by telephone, 5 to 7 days apart. The order of the assessments was randomized. The Student's t-test was used to assess statistically significant differences between the scores obtained face-to-face and by telephone. The Intraclass Correlation Coefficient (ICC) and weighted kappa were used to assess the level of agreement between the total scores and the scores for each item.

Results: Seventy participants (18 men; mean age, 29 years; standard deviation, 12 years) were included. No statistically significant difference was found between the scores obtained using the two methods (face-to-face and telephone). Regarding the level of agreement of the total scores obtained on the two occasions, high ICCs were found: 0.97 NDI, NDI and 0.96 for the MFIQ. Considering the agreement for each item obtained in the two occasions, the NDI scores showed substantial agreement for nine items (0.55≥Kappa ≥0.79) and moderate agreement for one item (Kappa = 0.42), while in the MFIQ all the items showed substantial agreement (0.52≥Kappa ≥0.78).

Conclusion: Telephone-based administration of the NDI and MFIQ is valid for the assessment of individuals with TMD.

Background: Fibromyalgia (FM) is a complex and multifactorial syndrome characterized by widespread pain, fatigue, cognitive impairment, and other systemic symptoms. The absence of specific biomarkers and the heterogeneous clinical presentation pose significant diagnostic challenges.

Objective: This scoping review aims to explore the current applications of artificial intelligence (AI) and machine learning (ML) in the diagnosis and clinical management of FM.

Methods: A systematic search was conducted in PubMed, EMBASE, and the Cochrane Library using defined keywords related to FM and AI/ML. Studies were included if they addressed ML applications in FM patients. Following PRISMA-ScR guidelines, 43 studies published between 2011 and 2024 were included and analyzed for ML techniques used, diagnostic targets, data types, and clinical relevance.

Results: As expected, the majority of studies done so far focused on improving diagnostic accuracy through supervised algorithms such as support vector machines, neural networks, and ensemble models, as well as unsupervised clustering and dimensionality reduction techniques. Notable findings include the identification of neurophysiological signatures via fMRI, gene expression patterns, retinal imaging changes, and metabolomic biomarkers that distinguish FM patients from controls. For instance, one study investigating circulating microRNAs used a Random Forest model to identify 11 microRNAs (e.g. hsa-miR-28-5p, hsa-miR-29a-3p, hsa-miR-150-5p) capable of differentiating patients with FM, ME/CFS, and healthy controls, suggesting their potential as biomarkers for more accurate diagnoses. Reported model accuracies ranged from 82% to 100%, although most studies were pilot-based with small and imbalanced samples, limiting generalizability.

Conclusion: AI and ML offer promising tools to overcome longstanding limitations in FM diagnosis and treatment. While current findings demonstrate significant potential, larger, multicenter studies with rigorous validation protocols are essential to finally establish these approaches as clinically reliable solutions.

Objectives: Three-dimensional (3D) technologies such as virtual reality (VR) may facilitate the teaching and learning of manual therapy (MT). Teachers play a pivotal role in determining how new tools and technology are adopted and applied in the curriculum. Moreover, educators' feedback can guide the development of tools tailored to MT training needs. This qualitative study aimed to explore MT educators' perceptions of current teaching methods, the role of 3D technologies in MT education, and the barriers and enablers to their integration.

Design: In-depth interviews; data were analyzed using thematic analysis.

Setting: online.

Participants: 13 educators (9 males, 4 females; 10 physiotherapy, 3 osteopathy) from five different countries participated in this study.

Results: Five themes were identified that appeared to influence participants' perception of the role of technology in manual therapy education. These were (1) Teaching strategies in MT, (2) Paradigm shift in MT education, (3) Complexities in teaching MT - Tacit and embodied challenges of palpation and specificity, (4) Role of educators in MT education and (5) Future directions and technological integration in MT education. These five themes collectively highlight both the challenges and opportunities in MT education.

Discussion and conclusion: The participants not only critiqued the current teaching methods employed in MT but also their role as an MT educator. While acknowledging the paradigm shift in MT education, participants believed that emerging technologies such as VR are transformative tools for MT education. Future research to explore the added utility of technology such as VR to traditional teaching methods is required.

Introduction: Individuals with hip-related groin pain typically present reduced hip range of motion (ROM), particularly hip internal rotation. This movement restriction may increase stress on pelvic structures contributing to pain, altered muscle function, and reduced physical function, thereby affecting quality of life (QoL). Manual therapy techniques aimed at improving hip ROM may therefore have beneficial effects in this population. The objective of this study is to compare the effects of a high-force hip lateral distraction mobilization to a sham hip lateral distraction mobilization in individuals with hip-related groin pain.

Methods: 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 for pain 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 hip lateral distraction mobilization for improving pain intensity, force in the squeeze test, passive hip ROM, physical function, and QoL in individuals with hip-related groin pain.