Journal of Manual & Manipulative Therapy最新文献

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.

Objectives: To identify the effects of thoracic mobilization/manipulation on autonomic nervous system responses.

Methods: Four electronic databases were searched for controlled trials published before February 2024. Studies on mobilization/manipulation of the thoracic spine were included evaluating effects on the autonomic nervous system (ANS). Risk of bias was assessed by two independent assessors using the Cochrane risk-of-bias tool 2, the RoB-2 tool for crossover studies or the ROBINS-I tool. Meta-analyses using random-effects models present the overall combined mean effects.

Results: 2139 articles were identified, 20 studies (863 participants) were included in the qualitative data analysis and 15 in meta-analyses. Four studies had a high risk of bias in one or more domains. Meta-analyses indicated no statistically significant effect of mobilization or manipulation on markers of the ANS. The ratio of low-frequency-to-high-frequency power did not significantly decrease after thoracic mobilization/manipulation compared to any type of control intervention (-0.28; 95% CI -0.59 to 0.04; p=0.09). Skin conductance and root mean square of successive RR interval differences as well as LFab (ms^2; absolute power of the low-frequency band) did not significantly increase after thoracic mobilization/manipulation. Subgroup and sensitivity-analyses indicated no significant effects.

Discussion: Methodological limitations and heterogeneity (I²=0-94%) in reported outcomes, reduce the level of evidence. Future studies with a rigorous methodological approach and studies on symptomatic participants with longer follow-ups are warranted.

Conclusion: No significant effects of mobilization/manipulation of the thoracic spine on ANS markers were found. The direction of changes towards increased or decreased sympathetic or parasympathetic nervous system activity was ambiguous.

Introduction: Neurological testing is commonly used in outpatient physical therapy (PT) for patients with suspected neurological involvement. However, limited data exist on the prevalence of abnormal neurological findings in patients without a peripheral neuropathic pain (PNP) diagnosis. Understanding the frequency of these findings may help refine screening practices and improve patient care. This study aimed to determine the prevalence of abnormal neurological findings in patients attending PT without a clinical PNP diagnosis.

Methods: This observational study included 104 adult patients attending PT for upper or lower quadrant pain. Each patient underwent a series of clinical neurologic tests (strength, sensation, and reflexes) and neurodynamic (ND) tests. Patients were categorized as having either a clinical PNP diagnosis or a non-PNP diagnosis based on physician and/or physical therapist assessment.

Results: Of the participants, 22% had a clinical PNP diagnosis. Among those without a PNP diagnosis, clinical neurologic test abnormalities were common, with 50.6% exhibiting abnormal reflexes, 48.1% showing strength deficits, and 21% having sensory impairments. ND test abnormalities were less frequent in this group, with 18.5% experiencing symptom reproduction during testing.

Discussion: These findings suggest that abnormal neurological test results are not exclusive to patients with a clinical PNP diagnosis. The high prevalence of clinical neurologic test abnormalities in patients without a PNP diagnosis raises questions about the sensitivity of current screening approaches.

Conclusion: Neurological abnormalities may be overlooked when screening is based solely on clinical diagnosis or reported symptoms. Expanding neurological testing to a broader patient population may enhance diagnostic accuracy and treatment planning. Further research is needed to determine the clinical significance of these findings and the potential benefits of routine neurological screening in outpatient PT.

Objective: Clinical guidelines recommend combining exercise with other interventions, including dry needling (DN), for chronic neck pain (NP). The aim was to compare the effects of adding DN, applied locally or distant to the myofascial trigger point (MTrP) site location, to home exercise (HE) on pain, disability, and pressure pain sensitivity for chronic mechanical NP.

Methods: A single-blind parallel randomized controlled trial was conducted, including 68 adults (78.7% females, mean age: 47 ± 8.2 years) with chronic NP. All participants were assigned to one of the four groups: local DN + HE; distant DN + HE; sham DN + HE; or HE alone. A 12-week HE program was combined with three DN sessions over 4 weeks. The primary outcome was pain intensity at rest in neutral position, highest pain during cervical rotation and in the last 24 h, and pain in the previous week. The arithmetic mean (overall pain) of these ratings was calculated. Secondary measures included neck disability, pressure pain thresholds (PPTs) at muscular and neural sites, and the global rating of change (GROC). Data were collected at baseline, 4 weeks, and at 3- and 6-months.

Results: A group-by-time interaction was found for pain intensity at rest in neutral position, and for PPTs at ulnar nerve (both sides) and median nerve, anterior scalene, and splenius cervicis (all, left side only; p < 0.05). Post hoc comparisons showed a decrease of overall pain intensity at 6-months in the local DN vs. sham DN groups: estimated ratio ± standard error, 0.55 ± 0.09, p = 0.017. There were no differences between local or distant DN, except for the GROC at discharge.

Conclusions: Combining DN with HE reduces pain intensity in the medium term compared with HE alone. There were no differences between DN site locations (whether local or distant to the MTrP).

Objectives: Systematic reviews (SRs) of randomized clinical trials (RCTs) on the efficacy and dosing of pain neuroscience education (PNE) suggest a lack of reliable RCTs. We sought to determine if PNE combined with another singular physical therapy (PT) intervention was more effective than the singular intervention alone, and to identify the optimal dosage of the intervention, providing reliable clinical practice recommendations.

Methods: We included RCTs involving patients with neuromusculoskeletal impairments treated with PNE and any singular intervention, compared with the singular intervention alone, between 1 January 2010, and 13 February 2025. Included studies were prospectively registered, had established external validity, had moderate to large internal validity, and had a moderate to low risk of bias. RCTs were excluded if they were pilot studies, non-randomized trials, unpublished work, or research that did not involve musculoskeletal interventions. The search included RCTs indexed in CINAHL (via EBSCOhost), EMBASE (via Elsevier), PEDro, PsycINFO (via EBSCOhost), and PubMed (National Library of Medicine). Given the limited number of identified RCTs and the methodological heterogeneity, we conducted a qualitative analysis.

Results: Five RCTs were identified that all involved different patient populations, interventions, and dosing of the PNE. The qualitative synthesis indicated PNE does not decrease pain or improve function. There may be clinically meaningful effects on pain self-efficacy, pain biology/neurophysiology knowledge, pressure pain threshold, and kinesophobia.

Discussion/conclusion: Few RCTs with verifiable research integrity can be accurately assessed for external validity, internal validity, and confidence in the estimated effects. These RCTs exhibit high methodological heterogeneity, feature numerous primary outcomes, and make conclusions exclusively based on statistical significance. There is no reliable evidence that PNE used in conjunction with any singular form of PT intervention is more effective than the single intervention itself in patients where pain and function are their primary concerns.