Journal of Manual & Manipulative Therapy最新文献

Force-Based Manipulation (FBM) including light touch, pressure, massage, mobilization, thrust manipulation, and needling techniques are utilized across several disciplines to provide clinical analgesia. These commonly used techniques demonstrate the ability to improve pain-related outcomes; however, mechanisms behind why analgesia occurs with these hands-on interventions has been understudied. Neurological, neuroimmune, biomechanical, neurovascular, neurotransmitter, and contextual factor interactions have been proposed to influence response; however, the specific relationships to clinical pain outcomes has not been well established. The purpose of this study was to identify gaps present within mechanism-based research as it relates to FBM. An international multidisciplinary nominal group technique (NGT) was performed and identified 37 proposed gaps across eight domains. Twenty-three of these gaps met consensus across domains supporting the complex multisystem mechanistic response to FBM. The strength of support for gaps within the biomechanical domain had less overall support than the others. Gaps assessing the influence of contextual factors had strong support as did those associating mechanisms with clinical outcomes (translational studies). The importance of literature investigating how FBM differs with individuals of different pain phenotypes (pain mechanism phenotypes and clinical phenotypes) was also presented aligning with other analgesic techniques trending toward patient-specific pain management (precision medicine) through the use of pain phenotyping.

Objective: To establish priority gaps related to contextual factors (CFs) research and force-based manipulation (FBM).

Methods: A three-round Delphi following recommended guidelines for conducting and reporting Delphi studies (CREDES) involving international and interdisciplinary panelists with expertise in CFs and FBM. Round 1 was structured around two prompting questions created by the workgroup. Ranking of each priority gap was done by calculating composite scores for each theme generated. Consensus threshold was set with an agreement ≥75% among panelists. Median and interquartile range were calculated for each priority gap to provide the central tendency of responses. Wilcoxon rank-sum test was used to evaluate the consistency and stability of responses between rounds 2 and 3.

Results: Forty-six panelists participated in all three rounds of the Delphi. Consensus was reached for 16 of 19 generated themes for priority gaps in CFs research and FBM. The ranking of each identified gap was computed and presented. Wilcoxon rank-sum test was non-significant (P > .05), demonstrating consistency and stability of results between rounds.

Conclusion: The result of this Delphi provides international and interdisciplinary consensus-based priority gaps in CFs research and FBM. The gaps identified can be used to generate future research inquiries involving CFs research and FBM.

Objectives: To determine the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR).

Design: Parallel group, single-blind randomized clinical trial.

Setting: The study was conducted in a governmental tertiary hospital.

Participants: Forty (40) participants diagnosed as having a chronic DHR (≥3 months) were randomly allocated into two groups with 20 participants each in the SMT and MOB groups.

Interventions: Participants in the SMT group received high-velocity, low-amplitude manipulation, while those in the MOB group received Mulligans' spinal mobilization with leg movement. Each treatment group also received NM as a co-intervention, administered immediately after the SMT and MOB treatment sessions. Each group received treatment twice a week for 12 weeks.

Outcome measures: The following outcomes were measured at baseline, 6, 12, 26, and 52 weeks post-randomization; back pain, leg pain, activity limitation, sciatica bothersomeness, sciatica frequency, functional mobility, quality of life, and global effect. The primary outcomes were pain and activity limitation at 12 weeks post-randomization.

Results: The results indicate that the MOB group improved significantly better than the SMT group in all outcomes (p < 0.05), and at all timelines (6, 12, 26, and 52 weeks post-randomization), except for sensory deficit at 52 weeks, and reflex and motor deficits at 12 and 52 weeks. These improvements were also clinically meaningful for neurodynamic testing and sensory deficits at 12 weeks, back pain intensity at 6 weeks, and for activity limitation, functional mobility, and quality of life outcomes at 6, 12, 26, and 52 weeks of follow-ups. The risk of being improved at 12 weeks post-randomization was 40% lower (RR = 0.6, CI = 0.4 to 0.9, p = 0.007) in the SMT group compared to the MOB group.

Conclusion: This study found that individuals with DHR demonstrated better improvements when treated with MOB plus NM than when treated with SMT plus NM. These improvements were also clinically meaningful for activity limitation, functional mobility, and quality of life outcomes at long-term follow-up.

Trial registration: Pan-African Clinical Trial Registry: PACTR201812840142310.

Background: Neck pain is among the most prevalent and costly musculoskeletal disorders. Manual therapy and exercise are two standard treatment approaches to manage neck pain. In addition, clinical practice guidelines recommend a multi-modal approach, including both manual therapy and exercise for the treatment of neck pain; however, the specific effects of these combined interventions have not recently been reported in the literature.

Objective: To perform a systematic review and meta-analysis to determine the effect of manual therapy combined with exercise on pain, disability, and quality of life in individuals with nonspecific neck pain.

Design: Systematic Review and Meta-Analysis.

Methods: Electronic database searches were completed in PubMed, CINAHL, Cochrane, EMBASE, Ovid, and SportDiscus, with publication dates of January 2000 to December 2022. The risk of bias in the included articles was completed using the Revised Cochrane Risk of Bias Tool (RoB 2). Raw data were pooled using standardized mean differences and mean differences for pain, disability, and quality of life outcomes, and forest plots were computed in the meta-analysis.

Results: Twenty-two studies were included in the final review. With moderate certainty of evidence, three studies demonstrated no significant difference between manual therapy plus exercise and manual therapy alone in pain (SMD of -0.25 (95% CI: -0.52, 0.02)) or disability (-0.37 (95% CI: -0.92, 0.18)). With a low certainty of evidence, 16 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing pain (-0.95 (95%CI: -1.38, -0.51)). Similarly, with low certainty of evidence, 13 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing disability (-0.59 (95% CI: -0.90, -0.28)). Four studies demonstrated that manual therapy plus exercise is significantly better than a control intervention for reducing pain (moderate certainty) (-2.15 (95%CI: -3.58, -0.73)) and disability (low certainty) (-2.39 (95% CI: -3.80, -0.98)). With a high certainty of evidence, four studies demonstrated no significant difference between manual therapy plus exercise and exercise alone in quality of life (SMD of -0.02 (95% CI: -0.21, 0.18)).

Conclusion: Based on this systematic review and meta-analysis, a multi-modal treatment approach including exercise and manual therapy appears to provide similar effects as manual therapy alone, but is more effective than exercise alone or other interventions (control, placebo, 'conventional physical therapy', etc.) for the treatment of nonspecific neck pain and related disability. Some caution needs to be taken when interpreting these results given the general low to moderate certainty of the quality of the evidence.

Background: Cervical spine mobilizations may differentially modulate both components of the stress response, consisting of the autonomic nervous system and hypothalamic pituitary adrenal-axis, depending on whether the target location is the upper or lower cervical spine. To date, no study has investigated this.

Methods: A randomized, crossover trial investigated the effects of upper versus lower cervical mobilization on both components of the stress response simultaneously. The primary outcome was salivary cortisol (sCOR) concentration. The secondary outcome was heart rate variability measured with a smartphone application. Twenty healthy males, aged 21-35, were included. Participants were randomly assigned to block-AB (upper then lower cervical mobilization, n = 10) or block-BA (lower than upper cervical mobilization, n = 10), separated by a one-week washout period. All interventions were performed in the same room (University clinic) under controlled conditions. Statistical analyses were performed with a Friedman's Two-Way ANOVA and Wilcoxon Signed Rank Test.

Results: Within groups, sCOR concentration reduced thirty-minutes following lower cervical mobilization (p = 0.049). Between groups, sCOR concentration was different at thirty-minutes following the intervention (p = 0.018).

Conclusion: There was a statistically significant reduction in sCOR concentration following lower cervical spine mobilization, and between-group difference, 30 min following the intervention. This indicates that mobilizations applied to separate target locations within the cervical spine can differentially modulate the stress response.

Background and objective: YouTube has become a digital visual library in almost all fields of life, including medicine. Healthcare professionals and students frequently use YouTube to gain new skills and knowledge; however, the content of these videos has not been scientifically evaluated. Therefore, this study aimed to determine the descriptive adequacy and quality of YouTube videos on lumbar spine manipulation techniques (LSMTs) prepared by different healthcare professionals.

Methods: The first 50 most relevant videos retrieved on searching YouTube for the keyword 'lumbar spinal manipulation techniques' were included in the study. The video metrics (total duration, number of views, time since upload, number of comments, number of likes, and number of dislikes) that could be accessed from video descriptions were recorded. However the videos were scored according to manipulation definition criteria proposed by the American Academy of Orthopedic Manual Physical Therapists (AAOMPT manipulation description score - AAOMPT-MDS) and benchmark criteria for quality of digital content by the Journal of American Medical Association's (JAMA). The video metrics, AAOMPT-MDS and JAMA scores of the videos prepared by medical doctors, chiropractors, osteopaths, and physiotherapists were compared.

Results: Video metrics of groups were similar. The mean AAOMPT-MDS of the videos was 2.40 ± 1.57 out of 6.00 (higher score was better), and the mean JAMA score was 2.14 ± 1.05 out of 4.00 (higher score was better). Videos created by all professional groups had statistically comparable AAOMPT-MDS and JAMA scores (p > 0.05).

Conclusion: Although YouTube videos on LSMTs offer valuable information for professionals and students, creators should follow the proposed recommendations when producing these videos to ensure quality content and systematic presentation.

Background: The neck has been implicated as a potential generator of symptoms such as dizziness and headache in individuals with persistent symptoms post concussion. Anatomically, the neck could also be a potential trigger for autonomic or cranial nerve symptoms. The glossopharyngeal nerve which innervates the upper pharynx is one possible autonomic trigger that might be affected by the upper cervical spine.

Case description: This is a case series of three individuals with persistent post-traumatic headache (PPTH) and symptoms of autonomic dysregulation who also had signs of intermittent glossopharyngeal nerve irritation associated with certain neck positions or movements. Biomechanical principles were applied to anatomical research on the path of the glossopharyngeal nerve, in relation to the upper cervical spine and the dura mater, to alleviate these intermittent symptoms. The patients were provided techniques to be used as tools to immediately alleviate the intermittent dysphagia, which also alleviated the constant headache at the same time. As part of the overall long-term management program, patients were also taught daily exercises to improve upper cervical and dural stability and mobility.

Outcome: The result was a decrease in intermittent dysphagia, headache, and autonomic symptoms in the long term in persons with PPTH following concussion.

Discussion: Autonomic and dysphagia symptoms may provide clues as to the origin of symptoms in a subgroup of individuals with PPTH.

Background: There is little consensus on the conservative management of lateral patellar dislocations (LPD). Mechanical diagnosis and therapy (MDT) is an established classification system in the spinal and extremity population. This case report describes the use of MDT in the management and classification of a patient with LPD.

Case description: The patient was a 20-year-old female with a 3-month history of left knee pain precipitated by a lateral patellar dislocation. The patient described pain and a feeling of instability with standing and walking and limitations in work and recreational activities which involve lifting, squatting, and running. Based on the patient's response to repeated end range knee movements, the patient was found to have a directional preference (DP) for knee extension and instruction in performance of knee extension DP exercises was provided.

Outcomes: The patient's knee examination and subsequent intervention included her responses to repeated end range knee movements. Her knee pain was abolished, and strength, function, and motion were fully restored in five visits. A minimal clinically important difference (MCID) was achieved on the Lower Extremity Functional Scale (LEFS). At discharge, the patient was able to independently manage symptoms and perform all work and recreational activities at a pre-injury level and these improvements were maintained at a 9-month follow-up.

Discussion: There are various management strategies for lateral patellar dislocation. This case demonstrated the use of classifying, subgrouping, and treating a patient with lateral patellar dislocation using the principle of DP.

Conclusion: The patient's outcomes suggest that MDT may be used in the nonoperative management of people with LPD who present with a DP.