Journal of Manual & Manipulative Therapy最新文献

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.

Introduction: There has been an emergence of evidence in the area of frozen shoulder (FS) within the past decade related to risk factors, etiology, diagnosis, and management. It has become increasingly challenging for clinicians and researchers to stay up to date in these areas, particularly with the clinical practice guidelines that are available being few and outdated. To this end, the aim of this study was to produce an international consensus on the risk factors, etiology, diagnosis and management for individuals with FS.

Methods: During phase one a steering committee was formed in order to identify experts in the area of FS, examine the current evidence related to FS and identify key areas lacking consensus. Phase two consisted of inviting experts to participate in a three-round survey with a priori consensus level set at 80%. Descriptive statistics were utilized to determine the characteristics of the expert panel, response rate, and level of consensus.

Results: A total of 14 international experts responded to all three rounds of the Delphi survey with 100% response rate following round one. Consensus was reached for 101 items (57 in the first round, 37 in the second round and 7 in the third and final round). Specific to key topic areas, the following number of items reached consensus; etiology 9 items (diabetes mellitus, trauma, shoulder arthroscopy, thyroid disease, prolonged immobilization, adrenocorticotropic hormone deficiency, metabolic synderome, connective tissue disorders, and hyperlipidemia), risk factors 40 items (including biophysical factors for developing FS and biophysical and psychosocial factors influencing the Management and course of outcomes related to FS), diagnosis 19 items (4 confounding the diagnosis and 15 signs and symptoms associated with FS), Management 33 items overall and categorized into effectiveness for early and later stages of FS).

Conclusion: The results of this international Delphi study help to provide a consensus on key elements to consider in clinical practice related to etiology, risk factors, diagnosis, and management for those with FS.

Background: Sacroiliac joint (SIJ) pain is a common diagnosed lumbosacral condition with historical diagnostic uncertainty. Recent literature suggests that effective diagnosis of SIJ pain should begin with screening the thoracolumbar spine, as SIJ regional pain is often linked to referral patterns originating from this area.

Objective: The aim of this systematic review was to evaluate the screening methods of the thoracolumbar spine in randomized controlled trials (RCT) for the evaluation and treatment of SIJ pain or dysfunction.

Methods: A search of PubMed, CINAHL, and CENTRAL was conducted for RCTs published from inception up to 31 March 2024. RCTs focusing on SIJ pain as the primary diagnosis, treated with conservative interventions such as manual therapy, exercise, or modalities in adult patients, were included. Data on thoracolumbar spine screening methods were extracted, categorized, and reported with means, standard deviations, and frequency counts. The Revised Cochrane Risk of Bias tool was used to assess each RCT.

Results: A total of 2,719 articles were retrieved. After removing duplicates and screening titles, abstracts, and full texts, 43 RCTs were included for data extraction. Two trials (4.7%) performed a reasonable thoracolumbar spine screening process, nine (20.9%) partially completed, and 32 (74.4%) did not perform a thoracolumbar screening process prior to formulating an SIJ diagnosis. Every RCT had at least some of risk of bias.

Discussion/conclusion: More than 95% of RCT's reported minimal-to-no thoracolumbar screening process prior to developing an SIJ diagnosis, highlighting significant variability and scarcity. The role of screening the thoracolumbar spine prior to diagnosing SIJ pain is notably underrepresented in RCTs providing treatment recommendations for this condition, undermining the strength of the conclusions derived from these studies. This finding highlights the need for further research to establish a standardized clinical thoracolumbar screening process for SIJ pain to ultimately improve patient outcomes for this condition.

Background: The posterior talar glide test (PTGT) is recommended for ankle sprain assessment, but it has limited scientific support. Therefore, the aims of this study were to assess the reproducibility of PTGT in two conditions: 1) the clinical experience of the clinician and 2) in a modified setting using a referential horizontal plane in three clinical conditions (chronic ankle instability (CAI), copers, and healthy controls).

Methods: Twenty-eight participants were recruited. PTGT measurements were performed using two raters, i.e., novice and experienced, and performed twice with and without the referential horizontal plane with each rater on each ankle. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated.

Results: PTGT reported excellent intra-rater reliability for both novice (ICC = 0.97, SEM = 2.2°, MDC = 4.1°) and experienced rater (ICC = 0.94, SEM = 2.4°, MDC = 4.3°). Modified PTGT provided excellent intra-rater reliability for both experienced (ICC = 0.96, SEM = 1.4°, MDC = 3.3°) and novice rater (ICC = 0.96, SEM = 2.3°, MDC = 4.2°). Inter-rater reliability increases along with the addition of the referential horizontal plane, being poor to good for PTGT (ICC = 0.64, SEM = 2.8°, MDC = 4.7°), whereas moderate to good for modified PTGT (ICC = 0.78, SEM = 2.3°, MDC = 4.2°).

Conclusion: The PTGT appears reproducible enough to be used in a clinical setting. Its modified version, i.e., with a referential horizontal plane, offers a greater inter-rater reliability, making it a better option for research purposes.

Objectives: Low back pain (LBP) and thoracic spinal pain are significant global health burdens, and the Graston Technique (GT), a form of instrument-assisted soft tissue mobilization (IASTM), has gained popularity as a treatment option. This systematic review and meta-analysis aim to evaluate the effectiveness of GT for reducing pain and preventing disability in individuals with LBP and thoracic spinal pain.

Methods: We conducted a comprehensive literature search across PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Library, identifying four eligible studies from inception to August 2024. Both randomized and non-randomized controlled trials were included. The primary outcomes were changes in Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. Quantitative data were analyzed using meta-analysis, and qualitative synthesis was conducted for secondary outcomes. Statistical analyses were conducted using Review Manager (RevMan) version 5.4.

Results: The pooled analysis showed a significant reduction in VAS scores when comparing GT to placebo controls (Mean difference = -1.45, 95%CI [-2.24, -0.66]), suggesting that GT may effectively reduce pain. However, no significant difference was observed when compared to active interventions. The meta-analysis revealed no significant improvement in ODI scores with GT compared to placebo. Qualitative synthesis indicated potential benefits in range of motion, flexibility, proprioception, and quality of life.

Conclusion: The GT may reduce spinal pain, particularly compared to placebo. However, these preliminary results require confirmation from further studies as its impact on functional outcomes and superiority over other treatments remain uncertain. Further high-quality research is necessary to confirm these findings and establish GT's role in clinical practice.

Objective: To investigate physical therapist adherence to the Academy of Orthopaedic Physical Therapy's (AOPT) clinical practice guidelines (CPGs) for the management of neck and low back pain (LBP) and to compare adherence among varying clinical specializations.

Design: Electronic cross-sectional survey.

Methods: The survey was sent to 17,348 AOPT members and 7,000 American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) members. Participants selected the best diagnosis and intervention(s) for six case vignettes based on the current AOPT CPGs for neck and LBP. Diagnostic and intervention adherence rates were reported as total percentages and delineated by the highest level of clinical specialization - fellowship training (PTFs), orthopedic residency training (PTRs), Board Certified Clinical Specialist in Orthopaedic Physical Therapy (PTSs), orthopedic background without clinical specialization (PTOs). Binary logistic regression analyses were performed to determine the effects of clinical specialization (PTFs, PTRs, or PTSs) compared to PTOs on the likelihood of guideline adherence for all six cases.

Results: Of the 159 participants who responded to the survey, 152 were eligible and 145 completed demographic data. Participant responses declined as the survey progressed from 125 completing case one to 106 completing case six. The odds ratio from binary logistic regression analyses were not significant for any specialization in all six cases (OR = 0.16; 95% CI: 0.02, 1.11; p = 0.064).

Conclusions: The results of this manuscript demonstrated variable adherence rates across subgroups of patients with neck and LBP with no significant association between clinical specialization and adherence. Adherence to CPGs is dependent on the clinical presentation of various patient cohorts.

Background: Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment.

Methods: A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted.

Results: A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled.

Conclusion: The aim of this article is to summarize and enhance physiotherapists' essential knowledge of the differential diagnosis and management of patients with DCM.