Journal of Manual & Manipulative Therapy最新文献

Objectives: Neurodynamic tests are clinical tests used to identify heightened nerve mechanosensitivity but may be negative in the presence of severe neuropathy, as seen in people with carpal tunnel syndrome and type 2 diabetes. It is not known if this also occurs in people with diabetic peripheral neuropathy (DPN) from type 1 diabetes mellitus (T1DM). The primary aim of this study is to determine the proportion of positive neurodynamic tests in people with T1DM and DPN. The secondary aim is to assess whether the severity of DPN influences the presence of a positive neurodynamic test.

Methods: This is a cross-sectional study. Forty-three participants with T1DM and DPN were assessed using straight leg raise (SLR) and slump neurodynamic tests to determine a positive and negative test. DPN severity was graded according to Toronto Clinical Scoring System (TCSS).

Results: Forty-six percent and 56% of participants had positive SLR and slump tests, respectively, indicating heightened nerve mechanosensitivity. There was a statistically significant association between negative neurodynamic tests and DPN severity (p < 0.0001). In addition, participants with negative neurodynamic tests had significantly higher TCSS scores compared to participants with positive neurodynamic tests (p < 0.0001).

Discussion/conclusion: People with T1DM and severe DPN, as graded by TCSS, are more likely to demonstrate negative neurodynamic tests than those with mild DPN. Future studies should investigate the relationship between neurodynamic tests and nerve function in other conditions. This supports previous research on negative neurodynamic tests in severe neuropathy, suggesting that neurodynamic tests should not be used alone to determine nerve involvement.

Objectives: Shoulder mobilization techniques, with and without movement, may restore the range of intra-articular glenohumeral motions and expand the subacromial space during arm abduction. The primary purpose of this study was to measure and compare the acromiohumeral distance at three static angles of passive scapular arm abduction (no arm abduction, 45° of arm abduction, and 60° of arm abduction) in overhead athletes diagnosed with primary subacromial impingement syndrome, before and after shoulder mobilization techniques with and without movement, combined with contemporary physical therapy.

Methods: Fifty-one overhead athletes diagnosed with primary subacromial impingement syndrome were randomly assigned to three parallel groups. One intervention group received the Mulligan shoulder mobilization techniques, whereas the other intervention group received the Maitland shoulder mobilization techniques. Both mobilization approaches were accompanied by contemporary physical therapy and were administered every other day for two weeks. The control group received no specific intervention for two weeks. Using an ultrasound device, the acromiohumeral distance was assessed in the intervention groups one day before and one day after treatment with manual therapy and in the control group at two-week intervals.

Results: Both the Mulligan and Maitland approaches significantly increased the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001). In contrast, no significant changes were observed in the control group (p-values > 0.317).The Mulligan approach, compared to the Maitland approach, exhibited significantly greater increases in the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001).

Conclusions: Both the Mulligan and Maitland shoulder mobilization techniques, combined with contemporary physical therapy, significantly increased the acromiohumeral distance at static angles of passive scapular arm abduction in individuals suffering from primary subacromial impingement syndrome. Moreover, the Mulligan approach provided significantly greater improvements in the acromiohumeral distance compared to the Maitland approach.

Objectives: To describe the current status of spinal and pelvic thrust joint manipulation (TJM) educationin entry-level Doctor of Physical Therapy (DPT) programs within the United States.

Methods: Accredited DPT programs were recruited through electronic communications to take part in an anonymous survey and optional follow up interview. The study evaluated TJMJ curriculum design, faculty qualifications, and perceived barriers to teaching and learning TJM.

Results: Seventy-eight programs met the study's inclusion criteria (response rate: 28%). All participating programs taught TJM of the spine or pelvis, with 96% believing it to be an achievable entry-level skill. However, variability was noted in the specific spinal regions covered within TJM curricula. Faculty credentials primarily included orthopedic certified specialist (80%). Didactic hours devoted to TJM were commonly 1-10 hours for lecture (65%) and 10-20 hours for laboratory instruction (42%), with a typical faculty-to-student ratio of 1:10 (65%). Competency assessments most often consisted of practical exams (87%) and skills checks (82.1%). Faculty cited multiple barriers to TJM education and emphasized the need for post-professional instructor training, greater opportunities for experiential learning, and more consistent integration of TJM across the core curriculum.

Discussion/conclusion: Contemporary TJM curricula appear generally consistent to those reported a decade ago, although a larger proportion of programs now use competency-based assessments. Despite this progress, educators identified persistent barriers to TJM education and advocated for enhancements in faculty development and curriculum integration.

Background: Neck pain is a common condition that is often difficult to diagnose. Previous literature has investigated diagnostic accuracy of examination measures, but the strength and clinical applicability are limited. This overview of systematic reviews aimed to investigate clinical features for diagnosing neck pain and its associated disorders.

Methods: An overview of systematic reviews was conducted searching four electronic databases for systematic reviews evaluating diagnostic criteria for neck pain. Quality and risk of bias were assessed using the AMSTAR 2 and ROBIS. Clinical features for neck pain were investigated for diagnostic utility.

Results: Twenty-seven systematic reviews were included. Hand radiculopathy and numbness have good specificities (0.89-0.92) for facet and uncinate joint hypertrophy. For facet-related dysfunction, the extension rotation test (ERT) and manual assessment have good sensitivities and moderate-good specificities. Positive ERT combined with positive manual assessment findings (+LR = 4.71; Sp = 0.83) improves diagnostic accuracy compared to positive ERT alone (+LR = 2.01; Sp = 0.59). Canadian C-spine Rules and Nexus criteria have excellent validity in screening for cervical fracture or instability. Imaging appears to have validity in diagnosing ligamentous disruption or fractures but lacks clarity on predicting future neck pain. Increased fatty infiltrates have been found with whiplash-associated disorders and mechanical neck pain.

Conclusions: This review found limited indicators providing strong diagnostic utility for diagnosing neck pain. Strength of recommendations are limited by heterogeneous outcomes, methodology, and classification systems. Future research should investigate new differential diagnostic criteria for specific structures contributing to neck pain.

Objectives: Tactile sensitivity is one of the most important skills for developing competence in manual palpation. There is a lack of studies aimed at analyzing the development of tactile sensitivity during different levels of physiotherapy education. The present study aims to compare manual tactile sensitivity in two groups of physiotherapy students.

Methods: Twenty first-year physiotherapy students (mean age 19.4 yrs ± 0.6) and twenty final-year physiotherapy students (mean age 23.7 yrs ± 3.7) participated in the study. For the tactile sensitivity test, 3 wooden tables were used, in which different geometric structures were engraved. Subjects were instructed to perform a tactile examination of the geometric structures and then reproduce them by drawing on a sheet of paper. The tactile time, drawing time, accuracy, and difficulty of the geometric structures were scored. A two-sample t-test was used for the between-groups comparison if more time in an educational program should result in differences in tactile time, drawing time, accuracy, and difficulty. Linear regression was used to compare the difficulty with the accuracy of all geometric structures. Wilcoxon test was used to test the intra-rater agreement.

Results: The accuracy of the reproduction of geometric structures 1, 2 and 3 were 77.5%, 27.5% and 45%, for all physiotherapy students respectively. Final-year physiotherapy students spent more time exploring geometric structure 2 (p = 0.014) and geometric structure 3 (p = 0.0018) compared to first-year physiotherapy students. No statistically significant differences were found between groups in drawing time, accuracy, and difficulty of geometric structures. The examiner showed a high intra-rater agreement in the assessment (over 96%).

Discussion/conclusion: The study showed that the level of education and gained experience during laboratory teaching may be important in improving the palpation skills of physiotherapy students. Tactile sensitivity exercises should be included in physiotherapy education programs.

Objectives: Spinal mobility is clinically important in managing mechanical low back pain. Manual methods are commonly used for diagnosis and treatment in orthopedic practice. This study quantified changes in sagittal plane lumbar segmental motion using ultrasound imaging (USI) following common joint mobilization techniques in asymptomatic individuals. Additionally, tibial H-reflexes and sagittal plane trunk motion in standing were evaluated for association with lumbar segmental motion.Participants aged ≤ 30 or ≥ 50 years were recruited from among students, faculty, and affiliates of the Department of Physical Therapy at Winston-Salem State University and randomized to receive L4 central posterior-to-anterior (CPA) mobilization or left lumbar rotation mobilization interventions. Joint laxity was assessed using the Beighton score, and standing sagittal plane trunk motion was measured using the fingertip-to-floor method. Lumbar segmental motion was evaluated using USI in neutral, extension, and flexion positions at baseline, immediately following joint mobilization, and following 5 minutes of prone resting. Tibial H-reflexes were measured at baseline, immediately following joint mobilization, and in real-time during CPA mobilization. The primary outcome was lumbar segmental motion analyzed by position, mobilization group, sex, age category, and Beighton risk.

Results: Repeated measures ANOVA revealed significant increases in L4/5 flexion (p = .01, ƞ²=.21) and combined flexion and extension (p = .03, ƞ²=.15). These changes persisted following 5 minutes of prone resting, regardless of mobilization technique. Significant interactions between segmental motion, sex, and/or Beighton risk were observed.

Discussion/conclusion: Significant increases were observed in L4/5 flexion immediately following joint mobilization regardless of mobilization group, with significant statistical interactions observed between segmental motion, sex, and/or Beighton risk. This is the first investigation to demonstrate the value of USI for quantifying lumbar segmental motion following joint mobilization. Quantifying lumbar segmental motion helps clarify the underlying mechanisms of manual therapy. Future studies should include patients with low back pain.

Background: Individuals with shoulder pain have a higher occurrence of myofascial trigger points (MTrPs). In the past decade, dry needling (DN) has been used in physical therapy practice to treat MTrPs. Impaired blood flow is proposed as an underlying mechanism of MTrPs in neck-shoulder pain. However, whether DN would improve muscle blood flow in individuals with shoulder pathology has not been examined. Therefore, the primary purpose of this study was to use color Doppler imaging to examine the effects of DN on the blood flow of the infraspinatus muscle in individuals with shoulder pain. The secondary purpose was to examine the effects of DN on sensitivity to pressure and shoulder range of motion (ROM) of the infraspinatus muscle in individuals with shoulder pain.

Method: This randomized comparison trial utilized a sham-controlled design. Forty individuals with nonspecific shoulder pain and at least one MTrP in the infraspinatus muscle were randomly assigned to a real DN group or a sham DN group. Outcome measures, including blood flow parameters, ROMs of shoulder internal rotation and external rotation, and pressure pain threshold (PPT) were collected before and immediately after a single session of DN.

Results: The repeated measure ANOVA results revealed that real DN significantly decreased peak systolic velocity (PSV) and increased shoulder internal and external rotation ROM more than sham DN (p < 0.05). However, there were no significant differences in end diastolic velocity, resistive index, pulsatile index, and PPTs between real DN and sham DN (p > 0.05).

Conclusion: The results indicated that participants who received real DN exhibited a significant reduction in PSV, suggesting improved blood flow to the infraspinatus muscle. Participants who received real DN exhibited improvements in shoulder ROM but showed no reductions in sensitivity to pressure. These results may provide clinicians with evidence for the use of DN for individuals with shoulder pain.

Objective: The profession of physical therapy in the United States has evolved significantly since the American Physical Therapy Association introduced Vision 2020, advocating for consumers' direct access to physical therapy services. As the use of direct access expands, it becomes essential to examine successful models and resources, such as those that allow physical therapist referral for diagnostic imaging. This study aims to report the utilization, appropriateness, and reimbursement for diagnostic imaging referrals made by physical therapists during routine care across multiple health care organizations.

Methods: This study was a retrospective observational study of patients seeking care for neuromusculoskeletal conditions at ambulatory physical therapy clinics at three healthcare organizations. Data from each organization related to physical therapist referral for diagnostic imaging was reviewed to determine utilization rate, appropriateness, and reimbursement. American College of Radiology (ACR) criteria were used to determine appropriateness of diagnostic imaging referral.

Results: Seventy-five physical therapists signed 596 referrals for diagnostic imaging during 61,012 episodes of routine care. The utilization rate was 9.8 diagnostic imaging referrals per 1000 episodes of care. Ninety-one percent of the referrals were consistent with evidence based ACR guidelines and deemed appropriate. There were no instances of insurance denial when a physical therapist signed the referral for diagnostic imaging.

Conclusion: Physical therapists with privileges to directly refer for diagnostic imaging did so judiciously and followed ACR guidelines when referring patients for imaging. The absence of insurance reimbursement claim denial contrasts a common concern about physical therapist referral for diagnostic imaging. Physical therapists referred for appropriate imaging studies and are unlikely to contribute to diagnostic imaging overutilization.

Objectives: This study aimed to determine if the first onset of symptoms (discomfort) during the straight leg raise (SLR) (hip flexion with an extended knee) and the Knee Extension Angle (KEA) tests (knee extension with 90°of hip flexion) results from nervous or muscular structures in asymptomatic individuals. The secondary objective was to investigate if the gender influences the structure related to the discomfort.

Methods: This cross-sectional study consisted of a single assessment session during which the structure related to participants' discomfort during the KEA and SLR was identified. For this identification, a structural differentiation (SD) was conducted during both tests using passive mobilization of the cervicothoracic spine in flexion and extension. Changes in participants' discomfort were monitored during the SD to determine whether a change or lack of change was consistent with variations in the load applied to the suspected structures either muscular or neural. If the structure related to the participants' discomfort could not be identified, two additional tests were conducted: the lateral SLR and the Slump test.

Results: One hundred and seventy-eight individuals were included. Median [IQR] age was 21 years [20;23], and 57.3% were female. The structure related to participants' discomfort was similar for the SLR and the KEA (p = 0.451): neural for 72.5% of participants in the SLR and 75.8% in the KEA. Gender only influenced the structure identified in the KEA test, with a significantly higher rate of nerve-related discomfort in females than males and a significantly higher rate of muscle-related discomfort in males (p = 0.002).

Conclusion: In asymptomatic individuals, the discomfort induced by the SLR and the KEA tests could be related to either muscular or neural structures. Therefore, structural differentiation is necessary to identify the structure causing the discomfort in both research and clinical practice.

This paper offers a contemporary, evidence-based perspective on how point of care ultrasonography imaging (POCUS) has the potential to impact orthopedic and sports physical therapists' examination and treatment. Clinical use of POCUS has increased in medicine and is emerging in physical therapist practice. Greater affordability, portability, ease of use, and evidence supporting its' diagnostic value have contributed to increased use. Modern ultrasound devices have improved resolution allowing for the differentiation of anatomical structures. Physical therapists use POCUS in clinical practice as an extension of the physical examination to confirm, refute, expand, or narrow a differential diagnosis. Doctor of Physical Therapy professional education provides entry-level student physical therapists with the foundational knowledge necessary for the clinical application of POCUS. A physical therapist's use of POCUS complements the clinical evaluation and contrasts with the approach of referring out for diagnostic imaging and waiting for results. We present current evidence for expanded use of POCUS by physical therapists in clinical practice. We advocate for using ultrasound imaging in orthopedic and sports physical therapists' practice. Integrating POCUS into physical therapist patient management, could decrease patient healthcare costs through increased diagnostic efficiency.