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.

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.

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.