Journal of Manual & Manipulative Therapy最新文献

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 RCTs were excluded if they were pilot studies, non-randomized trials, unpublished work, or research that did not involve musculoskeletal interventions.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.

Objectives: To establish preliminary reference values for resting muscle stiffness and bilateral asymmetry in healthy young adults, and to explore associations with sex, age, BMI, and weekly exercise.

Design: Cross-sectional observational pilot study.

Setting: Osteopathic medical school facilities.

Participants: Twenty-six healthy individuals aged 18-29 years, 19 males and 7 females.

Main outcome measures: Resting muscle stiffness and left-right asymmetry across seven muscle groups, measured using the MyotonPRO. Associations with sex, age, BMI, and weekly exercise were analyzed.

Results: Sex was the only significant predictor of muscle stiffness overall, model F(4,21) = 2.88, p = 0.048, R² = 0.355, with higher stiffness in males, coefficient 44.6 N/m, p = 0.007. Global stiffness was greater in males than females, 236.2 ± 30.8 vs 196.2 ± 23.7 N/m, p = 0.017, Cohen d = 1.13. Age, BMI, and weekly exercise were not significant predictors, p = 0.388, 0.077, and 0.790, respectively. Sex-specific reference intervals, central 95%, for stiffness and asymmetry were derived for each muscle. Average bilateral asymmetry was small, about 10% to 14%, consistent with physiologic side-to-side differences.

Conclusions: This study demonstrates the feasibility of defining reference ranges for muscle stiffness and asymmetry using the MyotonPRO. These reference values may support musculoskeletal assessments in osteopathic and sports medicine and may help identify clinically meaningful deviations in tissue properties. Larger and more diverse cohorts are needed to refine intervals and to link stiffness to changes in patient outcomes.

Background: Evidence shows that dry needling (DN) influences biochemical substances linked to pain modulation and sleep regulation. Therefore, DN has the potential to be an effective intervention for sleep disturbance (SD) in patients with chronic neck pain (CNP). The aims of this study were to: (1) evaluate the feasibility of combining DN with therapeutic exercise (TE) to improve sleep in individuals with CNP and SD, and (2) explore preliminary effects of this intervention.

Methods: Twenty-eight individuals with CNP and SD were randomized to a DN+TE group (n = 14) or TE group (n = 14). The randomized controlled trial (RCT) was deemed feasible if: (1) 4-week attrition rate was < 20%, (2) no significant adverse responses, and (3) ≥ 75% of participants completed follow-up assessments. Outcome measures included sleep duration, sleep quality, pain intensity, and disability level. Sleep duration (via actigraphy) was measured at baseline and weekly for three weeks. Other outcomes-Pittsburgh Sleep Quality Index, Numerical Pain Rating Scale, Neck Disability Index- were assessed at baseline, 4 weeks and 12 weeks post-intervention.

Results: A large-scale RCT was determined to be feasible with an attrition rate of 6.7%, an absence of significant adverse responses, and 93.3% follow-up completion. Both groups demonstrated significant 12-week improvements in pain and disability, but only the DN+TE group demonstrated significant gains in sleep quality, greatest after the 4-week intervention.

Conclusion: Conducting a large-scale RCT appears feasible, and preliminary findings suggest that DN may improve sleep quality in individuals with CNP and SD. Further studies are required to confirm this finding.

Background: Chronic kidney disease (CKD) patients receiving hemodialysis often present with impaired pulmonary function, weakened respiratory muscles, and reduced functional capacity. Manual therapy techniques that target respiratory muscles and the diaphragm may enhance respiratory mechanics and exercise tolerance in this population.To determine the short-term effects of respiratory muscle and diaphragmatic mobilization combined with conventional physiotherapy on pulmonary function, respiratory muscle strength, and functional capacity in hemodialysis patients with CKD.

Methods: A two-arm, parallel, randomized controlled trial was conducted with 70 hemodialysis patients aged 18-65 years. Participants were randomized to either the intervention group (respiratory muscle and diaphragmatic mobilization plus conventional physiotherapy) or the control group (conventional physiotherapy alone) for one week on non-dialysis days. Primary outcomes included maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP); secondary outcomes were pulmonary function tests (FEV₁, FVC, FEV₁/FVC) and the 6-minute walk distance (6MWD). Analyses followed the intention-to-treat (ITT) principle using last observation carried forward (LOCF) for missing data. Correlational analyses assessed relationships between changes in respiratory and functional measures.

Results: Of 86 screened participants, 70 were randomized and 67 completed the study. The intervention group showed significantly greater improvements in MIP, MEP, FEV₁/FVC, and 6MWD (all p < 0.01) compared with controls. Strong positive correlations were observed between ΔMIP, ΔMEP, and Δ6MWD (p < 0.001).

Conclusion: Respiratory muscle and diaphragmatic mobilization significantly improve respiratory muscle strength, pulmonary function, and functional capacity in CKD patients undergoing hemodialysis. These findings support incorporating targeted manual therapy into physiotherapy for enhancing respiratory efficiency and exercise performance.

Aim: This study aimed to investigate the effects of post-isometric relaxation (PIR) technique and Pelvic floor relaxation exercises (PFRE) on disease symptoms and compare the methods.

Methods: 42 females with DD were assigned to the PIR (n = 21) or the PFRE group (n = 21), each receiving 8 sessions treatment. Constipation severity (Constipation Severity Instrument-CSI), pain intensity during and after defecation (Visual Analog Scale-VAS), defecation duration, quality of life (Constipation Quality of Life Questionnaire-PAC-QOL), pelvic floor muscle function (Electromyography-EMG), sexual function (Female Sexual Function Index-FSFI) and the impact of DD on pelvic floor functions (Pelvic Floor Impact Questionnaire-short form-PFIQ-7) were assessed at baseline, and at the end of weeks 2 and 4.

Results: Defecation duration, pain intensity during and after defecation, CSI and PAC-QOL scores and pelvic floor relaxation activity (p < 0.001) decreased in both groups, with decrease greater in the PIR group (p < 0.001). Pelvic floor muscle contraction activity increased in the PFRE group (p = 0.011), but no difference was found in the second and fourth weeks between the groups (p > 0.005). No significant change was found in the satisfaction score in the PIR group and in sexual desire, sexual arousal, lubrication and satisfaction scores in the PFRE group (p > 0.005). FSFI total (p = 0.001), sexual desire (p = 0.005), sexual arousal (p = 0.004), lubrication (p = 0.012), orgasm (p = 0.020), satisfaction (p = 0.042), and pain (p = 0.001) scores increased more in the PIR group than the PFRE group. PFIQ-7 summary (p < 0.001), Colorectal-Anal Impact Questionnaire (p < 0.001) and Pelvic Organ Prolapse Impact Questionnaire (p = 0.002) scores decreased more in the PIR group.

Conclusion: PIR and PFRE may be effective in managing symptoms and improving quality of life in women with DD, with PIR showing potentially greater benefits.

Background: Clinical reasoning (CR) is essential for effective physical therapy (PT) practice but remains inconsistently defined and under-researched, particularly in terms of its development across varying levels of clinical expertise. Diagnostic reasoning (DxR), a key component of CR, involves making decisions under uncertainty and is fundamental to accurate clinical judgment. The Script Concordance Test (SCT), grounded in Cognitive Script Theory, is a validated tool used to assess DxR by comparing examinee responses to those of experienced clinicians. Although SCT has seen broad use in medical education, its application in PT is still emerging.

Objectives: This study aimed to evaluate CR abilities of physical therapists (PTs) with different educational and clinical training backgrounds using an SCT focused on lumbar spine (LS) disorders. Specifically, it examined whether SCT scores varied significantly among final-year Doctor of Physical Therapy (DPT) students, board-certified Orthopedic Clinical Specialists (OCS), and Fellows of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT).

Methods: Fifty-eight participants were divided into three groups: final-year DPT students (n = 21), OCS-certified clinicians (n = 20), and FAAOMPT-trained reference panel clinicians (n = 17). After informed consent, participants completed a 50-item online SCT focused on LS dysfunction. A one-way between-subjects ANOVA was conducted, followed by Tukey's HSD post-hoc analysis.

Results: FAAOMPT-trained clinicians scored significantly higher than both OCS and student groups (p < .001). There was no statistically significant difference between OCS-certified clinicians and DPT students (p = .102).

Conclusion: This study used the SCT to assess CR among PTs with different training levels. The findings suggest that advanced post-professional training, such as fellowship education, is associated with higher DxR performance. Future research should expand SCT use across anatomical regions and educational stages to further support value-based, expertise-driven physical therapy care.

Introduction: Beneficial effects of thoracic manipulations (TM) have been demonstrated; however, there is a lack of clarity regarding their use in clinical practice.

Purpose: To investigate the knowledge and use of TM in primary care manual therapy in Belgium and the Netherlands.

Methods: An online survey hosted on Google Forms was designed and distributed across various platforms to manual therapists and students enrolled in a Master's/Postgraduate program in manual therapy. Data were collected regarding demographics, types of complaints, types of manipulation, and types of intervention. Participation occurred between 1 November 2022 and 31 July 2024.

Results: One hundred and seven surveys were analyzed. Thoracic complaints treated with TM were mostly muscular in origin (94%). Most participants (79%) did not utilize a specific screening tool, instead relying on clinical experience to exclude red flags. The majority agreed that metabolic bone diseases and metastatic diseases (n = 92) are contraindications and that thoracic fractures (n = 77) are a risk factor for TM. Almost half (44%) did not differentiate between the upper and lower thoracic spine. TM for other regions, mostly for the cervical spine (94%), was considered. TM was preferred for its biomechanical effects, followed by neurophysiological and placebo effects.

Conclusion: Most clinicians rely on experience rather than a pre-screening tool when assessing the thoracic region, focussing on excluding red flags and determining indications for TM, with biomechanical effects being the most favored rationale. Although most findings showed agreement, some inconsistencies were noted regarding screening and rationale, highlighting the importance of clinical reasoning for safe TM practice.

Introduction: Chronic pelvic pain syndrome (CPPS) involves complex interactions between the musculoskeletal system, nervous system, and psychosocial factors. A major challenge in managing CPPS is the lack of reliable assessment and classification systems. The Mechanical Diagnosis and Therapy (MDT) is a widely used and reliable classification system for assessing and managing painful musculoskeletal conditions affecting the spine and extremities. This study's primary objective was to assess the inter-rater reliability of the MDT assessment in diagnosing CPPS using clinical vignettes. Secondary objectives included determining the prevalence of MDT classification categories.

Methods: Five MDT clinicians classified clinical vignettes into three categories: 1) Spinal Derangement, 2) Pelvic Floor Contractile Dysfunction, or 3) MDT OTHER subgroups. The vignettes were developed from the McKenzie Pelvic Pain Assessment Form. Inter-rater reliability among clinicians was calculated using the Fleiss kappa statistic with 95% confidence intervals, and Cohen's kappa examined reliability between pairs of raters.

Results: A total of 76 vignettes were developed (40 females and 36 males). Good inter-rater reliability was found among clinicians (Fleiss kappa = 0.616, 95% CI = 0.598-0.633, p < 0.001). Inter-rater reliability was higher when classifying female vignettes (Fleiss kappa = 0.658, 95% CI = 0.634, 0.682) than male vignettes (Fleiss kappa = 0.546, 95% CI = 0.519, 0.573). The most common classification was Spinal Derangement (57%), followed by MDT OTHER subgroups (26%) and Pelvic Floor Contractile Dysfunction (17%).

Conclusions: The study indicates good inter-rater reliability among MDT clinicians in classifying pelvic pain syndrome. However, clinical vignettes may not fully capture the complexities of real participant interactions, potentially inflating agreement. Future studies should incorporate direct observation of real participant encounters alongside clinical vignettes to improve validity.

Objective: Forward head posture (FHP) and neck pain are common musculoskeletal complaints. This study aimed to evaluate the effect of the Integrated Neuromuscular Inhibition Technique (INIT) on the range of motion (ROM) and craniovertebral angle (CVA) in individuals with FHP and neck pain.

Methods: A total of 40 physical therapy participants (26 females and 14 males), aged 18 to 23 years (mean age: 20 ± 1.71 years), participated in this study. They were randomized into two groups: Group A received conventional therapy combined with Integrated Neuromuscular Inhibition Technique (INIT) targeting the upper trapezius and suboccipital muscles, while Group B received conventional therapy consisting of strengthening and stretching exercises only. The treatment was administered three times per week for one month.Photographic sessions were conducted using a mobile phone. A Realme 7 Pro camera and CorelDRAW software were employed to analyze the craniovertebral angle (CVA). A pressure algometer was used to measure the pressure pain threshold (PPT), while a visual analogue scale (VAS) was utilized to assess pain severity. Additionally, a clinometer application on an Android device was used to evaluate cervical range of motion (ROM).

Results: Both groups demonstrated significant improvements in craniovertebral angle (CVA) and visual analogue scale (VAS) scores, with Group A showing a 16.12% improvement in CVA and a 75.61% reduction in VAS, compared to a 7.20% improvement in CVA and a 57.14% reduction in VAS in Group B.Group A also showed a significantly greater post-treatment increase in CVA (p = 0.01), cervical range of motion (ROM) for flexion (p = 0.002), extension (p = 0.005), right bending (p = 0.001), left bending (p = 0.001), right rotation (p = 0.001), and left rotation (p = 0.001). Additionally, Group A exhibited a significantly greater decrease in VAS (p = 0.003) compared to Group B following treatment.

Conclusion: The Integrated Neuromuscular Inhibition (INI) technique, which combines ischemic compression, strain-counterstrain, and muscle energy techniques, yields superior outcomes compared to conventional therapy alone for individuals with forward head posture (FHP) and neck pain. It is particularly effective in improving craniovertebral angle (CVA), reducing pain levels, and enhancing cervical range of motion (ROM).