Journal of Manual & Manipulative Therapy最新文献

Introduction: Migraine is a complex neurological disorder characterized by different signs and symptoms, often presenting with an altered pain sensitivity and cervical musculoskeletal impairments. Thus, the management of migraine patients should include the assessment and eventually a specific treatment of these characteristics.

Purpose: Physiotherapists play a key role in identifying and managing cervical musculoskeletal impairments and altered pain sensitivity in migraine patients. This manuscript provides evidence-based guidance on assessment techniques and clinical reasoning strategies to help physiotherapists effectively evaluate and interpret these characteristics in clinical practice.

Implication: This manuscript serves as a practical guide for physiotherapists by: Outlining physiotherapy assessment techniques for migraine patients.Providing reference cutoff values to identify increased pain sensitivity and cervical dysfunctions.Supporting individualized clinical reasoning to understand these characteristics within each patient's overall condition.Clarifying the rationale behind physiotherapy interventions and integrating hands-on and hands-off therapeutic approaches based on patient-specific needs.

Objectives: Temporal summation (TS) via a thermal stimulus is a form of dynamic quantitative sensory testing that is often used as an indirect measure of central sensitization. While TS is frequently used as an outcome measure to assess the effectiveness of various interventions, the reliability of this measure has yet to be fully assessed in the lumbar spine. Therefore, the primary purpose of this study was to determine the test-retest reliability of TS using a thermal stimulus at the lumbar spine (LS). The secondary purpose was to compare the thermal TS values in the LS to that of the tibialis anterior (TA) and the thenar eminence (TE).

Methods: Adults with no activity limiting pain conditions between the ages of 18 and 40 were recruited to participate in this study. TS was measured following a series of heat-pulses administered by the Medoc Thermal Sensory Analyzer-II system. After undergoing an optimization session, TS was taken at the LS, the muscle belly of the TA, and the TE, all on the right side. A second thermal TS measurement was taken once again a week later.

Results: A total of 25 (n = 11 female) individuals participated in this study. ICC values in the lumbar spine ranged from moderate to good (0.591 to 0.836) depending on the calculation method. This compared to the TA with ICC values ranging from 0.621 to 0.772 and the TE with values ranging from 0.572 to 0.751. Correlations of the thermal TS values were high between the LS and the TA (r = 0.745), moderate between the TA and the TE (r = 0.631), and weak between the LS and the TE (r = 0.443).

Discussion/conclusion: Thermal TS taken at the LS is a reliable measure with ICC values that are comparable to ICC values found at the TA and the TE.

Objectives: The purpose of this study was to describe patient demographics and medical history, clinical care characteristics, and short-term serious adverse events associated with SMT in adults with prior spine surgery.

Methods: This study was a retrospective chart review of adult (at least 18 years of age) patients with any prior spine surgery who underwent SMT between January 2010 and December 2021 at an academic medical center in the United States. Eligible charts were reviewed, and data were extracted and transcribed onto an a priori Microsoft Excel data extraction tool. Adverse events were defined as vertebral artery dissection, cauda equina syndrome, fracture in the location of SMT, or spine surgery hardware failure in the same spinal region of SMT within 10-days following SMT.

Results: A total of 418 unique patient's charts were eligible for review. The mean patient age was 50.6 years. The majority of patients were female (52.6%), White (90.7%), and non-Hispanic (97.8%). The most common types of spine surgeries were lumbar fusion (28.7%), cervical fusion (27.8%), and lumbar discectomy with laminectomy/foraminotomy (34.7%). The median time after surgery to first SMT was 311 days. There were no short-term incidents of vertebrobasilar/cervical artery injury, acute cauda equina, fractures in the same region of SMT application, or hardware failure.

Conclusion: There were no incidents of serious adverse events in the short-term following SMT in individuals with prior spine surgery in this study. Findings from this study aid in evaluating the safety profile of SMT for patients with prior spine surgery. In addition, findings contribute to the development of future high-quality study designs for investigating the clinical effectiveness of SMT in this patient population.

Background: Individuals with low back pain (LBP) often exhibit weakness and the presence of trigger points in their Gluteus Medius (GMe) muscle.

Objectives: To examine the effectiveness of adding dry needling (DN) for the GMe to standard care of active physical therapy in patients with chronic nonspecific LBP.

Methods: A randomized, prospective, sham-controlled trial was conducted. Participants with chronic nonspecific LBP (N = 22, age range: 31-55 years) were randomly divided into intervention and control groups. Both groups received active physical therapy including exercises for 6 treatments. In addition, at each session, the intervention group received deep DN to their GMe muscle, and the control group received sham needling. Outcome measures included level of pain (using VAS scale), function (Oswestry disability index ODI), low back range of motion (ROM) (forward flexion and schober tests), and global rating of change. The research group was further divided into moderate and minimal disability according to the ODI.

Results: The research group showed greater improvement in pain level compared with control (p = 0.01). The change in ODI was higher in the moderate LBP group compared with the control group (B = 5.25, p < 0.05). The change in forward flexion distance test was higher in the moderate disability LBP group compared with the control group (B = 6.31, p < 0.01). Simple mean analysis also revealed a significant difference between the moderate and minimal disability groups (B = 6.16, p = 0.01).

Conclusions: Incorporating DN into physical therapy treatments for chronic nonspecific low back pain, can improve pain level and function.

Clinical trials registration no: NCT04498572 (clinicaltrial.gov).

Objective: To explore the foundational needs for a decision aid on receiving physiotherapy neck manipulation and mobilization from a broad age spectrum.

Method: An e-survey was conducted from January to 30 April 2024, targeted child/infant-parent dyads, adolescents, adults, and adult-caretaker dyads with neck pain who received physiotherapy treatment in Canada and the United States. The survey method captured knowledge and attitudes to manual therapy, treatment expectations (10 items from the Treatment Expectation Questionnaire (TEX-Q), decision conflict (Decisional Conflict Scale (DCS)) and participant demographics. Descriptive analyses were used to assess responses.

Results: Out of 146 participants who started the survey, 48 adults (mean age 48) completed it fully. Due to low response rates, the survey lacked insights into adolescent, child/infant-parent, or adult-caretaker dyads. Most respondents were familiar with mobilization (86%) and manipulation (82%). Mobilization was preferred (67%) and viewed more favorably compared to manipulation (7%), which was seen as riskier. Stroke was identified as the top risk/adverse event for techniques and was more commonly associated with manipulation (52%) than mobilization (25%). Other perceived risks included soreness, pain, headache, stiffness, tenderness, dizziness, and fatigue, reported more often for mobilization (57%) than manipulation (41%). The TEX-Q showed that respondents' treatment expectations were largely met, indicating positive expectations. Additionally, low scores on the DCS subscales and total scores (mean 16.26, SD 21.00) reflected minimal decisional conflict among respondents.

Conclusion: The study found that adults with neck pain who received physiotherapy involving neck manipulation or mobilization were well informed about the benefits, risks, and potential major and minor adverse events of their treatment. Their expectations for treatment were generally positive, and they experienced minimal decisional conflict. To further support shared decision-making, we recommend adding a qualitative component, such as structured interviews or focus groups with inter-professional child/infant-parent dyads, to help clinicians improve patient counseling and decision-making guidance.

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: De Quervain's tenosynovitis is characterized by thickening and swelling of the extensor retinaculum. The most reported symptoms are pain, swelling, and discomfort over the radial styloid.

Objective: To determine the short-term effects of oscillatory Mobilization and Mobilization with movement on pain, Range of Motion and Disability among De-Quervain's tenosynovitis.

Methods: This single-blinded randomized clinical trial with parallel assignment was conducted at Arif Memorial Teaching Hospital on 28 patients from August 2023 to October 2023. The subjects were allocated to groups A and B, with 14 patients in each group. Group A received mobilization with movement, and Group B received oscillatory mobilization for two weeks with three sessions per week. Data were taken of each patient before and after treatment through a numeric pain rating scale for pain, a goniometer for a range of motion, and patient-related wrist evaluation for Disability. The data were analyzed using SPSS V. 22, and appropriate statistical tests were used based on data distribution and taking p < 0.05 as significant.

Results: The study comprised 28(100%) participants, with 14 (50%) in each group. There were 08 males (57.1%) and 6 (42.9%) female participants in group A, whereas there were seven male (50.0%) and 7 (50.0%) female participants in group B. The mean age of patients in group A was 32.857 ± 5.815, and in group B was 31.642 ± 5.838. The pain pretreatment in Group A was 8.28 ± 1.49, while in Group B was 8.50 ± 1.22, whereas the post-treatment in Group A was 3.50 ± 0.94 while in Group B was 4.28 ± 1.14. The paired t-test showed a significant difference between the pre-and post-treatment pain scores, disability index, and range of motion with a p-value < 0.05. The Patient Rated Wrist Evaluation score value at pretreatment in Group A was 78.71 ± 4.16; in Group B, it was 76.86 ± 3.09, whereas the post-treatment in Group A was 33.39 ± 5.48, while in Group B was 38.96 ± 3.66. The independent t-test showed a significant difference between both groups for pain disability index and range of motion with a p-value < 0.05.

Conclusion: The study concluded that both treatments have short-term effects, but Mobilization with movement was more effective than Oscillatory movements for pain, ROM, and Disability in patients with De Quervain's tenosynovitis.

Clinical trial registry: IRCT20220604055072N2.

Objectives: Chronic nonspecific neck pain (CNNP) affects millions of people; nonetheless, several mechanistic details remain unknown. Oxidative stress (OS) is believed to be a contributing factor; however, its connection with manual therapy (MT), the current CNNP treatment, remains poorly investigated. Herein, the effects of low-velocity low-amplitude (LVLA) and high-velocity high-amplitude (HVLA) MT on pain relief, disability, and OS levels of CNNP patients are investigated.

Methods: The study follows a double-blind randomized pilot study design. OS is assessed using blood serum lipid hydroperoxides (LOOH). MT is assessed by using the Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI). Finally, the results are compared with those of patients receiving a sham intervention.

Results: Mixed ANOVA revealed that MT affects blood serum LOOH levels in CNNP patients. Pre-intervention, mean LOOH levels of CNNP patients (n = 11) were 3.3-fold higher compared to those of healthy individuals (n = 10; p-value < 0.001); whereas, following nine treatment sessions, a regression to healthy levels was documented. On the contrary, LOOH levels of patients following a sham intervention (n = 11), decreased by 0.7-fold during the first treatment session (p-value < 0.001), and remained unchanged even after the nine sessions (p-value > 0.99). Regarding NPRS, the MT group had a pre-intervention mean score of 4.91, which decreased to 1.36 after nine sessions (p-value < 0.001), whereas the sham group had a pre-intervention mean score of 5.27, which regressed to 4.64 post-intervention (p-value = 0.2208). Regarding NDI, the MT group had a pre-intervention mean score of 21.82, which decreased to 6.36 after nine sessions (p-value = 0.007). Conversely, the sham group had a pre-intervention mean score of 21.45, which increased to 25.09 post-intervention (p-value = 0.4392).

Discussion/conclusion: The results indicate that HVLA-LVLA MT causes significant decreases in pain and OS levels and improves function. Therefore, OS assessment in patients with CNNP could assist the evaluation of MT effectiveness in pain relief.

Background: Cervicogenic headache is a common condition frequently associated with cervical spine disorders. It significantly impairs physical and psychological well-being. To date, no study has prospectively investigated the predictors of Cervicogenic headache. Identifying these predictors is essential for early intervention and the development of targeted management strategies.

Purpose: To examine the predictors of cervicogenic headache in patients with chronic neck pain at the 6-month follow-up period.

Methods: A prospective study was conducted. A total of 321 patients with chronic neck pain were selected for this study. Data were collected at baseline and at the 6-month follow-up. Cervical X-rays were taken to assess the Cervical Cobb angle, and self-reported questionnaires were used to assess sleep quality, pain intensity, depression, anxiety, fatigue, and disability in patients with chronic neck pain. Binary logistic regression and Mann-Whitney U test were employed for the analysis.

Results: The study found that cervical Cobb angle 95% CI (.85, .96), p = .001, sleep quality 95% CI (1.32, 1.81), p < .001, depression 95% CI (1.09, 1.55), p = .003 and anxiety 95% CI (1.15, 1.59), p < .001 were significant predictors of cervicogenic headache in patients with chronic neck pain at 6-month follow-up period.

Conclusion: Our results suggest that altered cervical Cobb angle, poor sleep quality, and psychological status may serve as potential predictors of cervicogenic headache in patients with chronic neck pain. These findings highlight the importance of a comprehensive approach to managing cervicogenic headache and neck pain that addresses both physical and psychological factors. By targeting these comorbidities, health-care providers may be able to improve outcomes and prevent the development of cervicogenic headache in patients with chronic neck pain.

Registration number (phrc/hc/1339/23): The study was registered in August 2023.