Journal of Manual & Manipulative Therapy最新文献

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.

Objectives: The physiotherapy literature lacks high-quality, registered systematic reviews (SRs) and 'trustworthy' randomized controlled trials (RCTs). It is unknown whether considering quality and 'trustworthiness' impact publication bias, heterogeneity, and the certainty of clinical recommendations observed in the literature.

Methods: We performed a methodological review of SRs investigating physiotherapy treatment of neuromusculoskeletal conditions indexed by MEDLINE, between 1 January 2018, and 25 October 2023. Blinded reviewers examined the prospective intent and quality of SRs and the 'trustworthiness' of RCTs included therein. Blinded reviewers extracted data for the variables of interest (Numeric Pain Rating Scale and Visual Analog Scale).

Results: Of the SRs identified (N = 677), 13 were included in the final review. These included a total of 109 RCTs, including duplicates. Only eight of these trials were deemed 'trustworthy.' Publication bias was identified, and heterogeneity across the trials (N = 55) included in the quantitative analysis was high (I² = 80.11%, 95% CI [75.88, 83.60]). Publication bias and heterogeneity were eliminated (I² = 0%, 95% CI [0.00, 37.44]) upon considering those prospectively registered (N = 14). Statistical significance, assessed via the p-value at baseline (<.001), was eliminated (p = .746) once prospective, external, and internal validity was considered. Statistical inference through estimation, evaluated via effect size, confidence intervals, and minimal detectable change, was not present at baseline and reduced throughout the screening process.

Discussion: Trials of musculoskeletal interventions to manage pain in patients with neuromusculoskeletal conditions lack certainty and confidence in their treatment effects and exhibit high heterogeneity. Statistically significant effects and heterogeneity are eliminated when considering 'trustworthy' quality evidence.

Conclusions: Consistent with previous findings, null effects, and low heterogeneity arise when considering the best available evidence. Meaningful effects are likely rare when assessed holistically using statistical inference through estimation and the confidence and certainty of the estimated effect.

Objectives: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling.

Methods: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling.

Results: During step-up, the onset and offset latencies of the local and proximal muscles of the knee joint, except for the offset latency of the gluteus maximus muscle (p-value=0.162), significantly decreased in the intervention group compared to the control group (p-value<0.046). Additionally, there were no significant differences (p-value>0.116) between the groups in the amplitude ratio of the local and proximal muscles of the knee joint during both step-up and step-down.

Conclusions: The present study revealed that dry needling of the popliteus muscle with secondary myofascial pain syndrome associated with patellofemoral pain syndrome constructively modified the local and proximal motor control of the knee joint during step-up.

Introduction: Joint immobilization may be necessary in some situations, such as in cases of fractures and osteomyoarticular injuries. However, it is known that there are several harmful effects of immobilization, which can cause muscle weakness, loss of motor function, reduced range of motion and increased local pain, and it is important to understand the possible forms of treatment to alleviate the effects of immobilization, focusing on passive mobilization.

Objective: To address articles that evaluate the effects of passive mobilization on immobilized patients.

Methodology: The search was carried out in national and international electronic databases (PubMed, Pedro, Web of Science, Scopus, Embase, Lilacs and Cochrane), in addition to gray literature (Google Scholar, Open Gray and Livivo), using the following descriptors: PASSIVE MOBILIZATION and IMMOBILIZATION, being carried out blindly, by two main researchers, concluding the selection with 6 articles on the subject.

Results: The studies indicate that passive mobilization was able to reverse the negative aspects of immobilization in relation to the recovery of strength, range of movement, local pain and motor function, as its action provides tissue sliding, increasing circulation and the repair process tissue.

Conclusion: Although the effects are smaller compared to active exercises, it can be considered that passive mobilization can mitigate the harmful effects of immobilization.

Background: Pain Science Education (PSE) has been shown to reduce pain and disability in chronic low back pain (CLBP), a prevalent and disabling condition. PSE helps reconceptualize pain using aids like pictures, metaphors, and stories, and supports pain self-management. Due to variations in pain beliefs across different cultures, the PSE resources need to be customized to accommodate respective literacy levels, cultures and languages.

Objective: This study aimed to develop PSE booklets in three Indian languages: Bengali, Hindi and Kannada.

Method: Thirty chronic pain experts (i.e. physiotherapists, pain physicians, psychiatrists, psychologists, public health professionals, nurses) independently examined the PSE booklet's content and rated it under: (1) Content adequacy, (2) Simplicity and clarity, (3) Topical flow, (4) Metaphors' appropriateness (5) Illustration suitability (6) Color scheme and (7) Culture-specific content. Five people with lived CLBP experience contributed. The content validity ratio (CVR) was used to rate the content of the PSE booklet in seven domains (e.g. cultural relevance). A priori criterion for acceptance of the content was set at 70%.

Results: Five booklet chapters were developed and were deemed acceptable. Cultural relevance domain received the highest score.

Conclusion: This is the first study to develop culturally relevant PSE booklets in Bengali, Hindi, and Kannada, which are likely to be useful in educating patients with CLBP. The new intervention needs to be tested for effectiveness in respective language-speaking samples.

Introduction: Carpal Tunnel Syndrome (CTS) is a prevalent upper limb mononeuropathy that often leads to delayed surgical intervention, resulting in prolonged symptoms and reduced quality of life.

Aim: To describe the effect of a three-session treatment involving nerve mechanical interface mobilization and self-mobilization combined with education in hand function, symptoms, and quality of life of pre-surgical CTS patients at 3 and 6-months follow-ups; 3) A randomized clinical trial was performed in 42 preoperative CTS patients. Patients were randomized into an experimental group, receiving a three-session intervention of education, diacutaneous fibrolysis, and self-mobilization, or a control group receiving standard care. Primary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, while secondary outcomes assessed paresthesia, mechanosensitivity of the median nerve, mechanical threshold with the Semmes Weinstein monofilament, pinch strength, and quality of life, with the short-form-36 & EuroQol-5D.

Results: The cohort were predominantly severe CTS patients with associated comorbidities. Statistical improvements were shown for experimental group compared to control group in DASH at 6-month follow-up (p = 0.035; η² = 0.12). Paraesthesia intensity, mechanosensitivity, and quality of life were also significantly improved in the experimental group compared to control group at both 3- and 6-months (p < 0.05). The same occurred for pinch strength at 6 months (p < 0.05). No significant differences were found in mechanical threshold (p > 0.05); 5) The treatment effectively improved hand function, symptoms, and quality of life in preoperative CTS patients, offering a viable alternative during delays in surgical procedures. Nerve mechanical interface treatment could not only help mild to severe CTS patients but might be relevant for severe CTS patients with associated comorbidities.

Objective: Post-professional education in orthopedic manual physical therapy (OMPT) provides a unique pathway for clinicians to refine clinical skills and reasoning in pursuit of professional excellence. Despite these benefits, fellowship training demands significant personal and financial investment. Therefore, understanding whether fellowship education promotes professional growth, job satisfaction, and return on investment is essential. The aim of this study was to explore fellowship-trained OMPTs' self-reported perceptions of pursuing fellowship education in the United States (US), while identifying predictors that may be associated with career success following fellowship education.

Methods: A convergent parallel mixed-methods design via online survey and one-on-one semi-structured interviews was used. A thematic coding process was implemented for qualitative analysis. Descriptive statistics were calculated for demographic data. Binary logistic regression models assessed relationships between demographic variables and the personal and professional impact of fellowship training.

Results: One hundred and nine participants completed the survey, and 23 underwent focused interviews, meeting data saturation. Merging of analyses revealed five themes related to personal and professional impacts of fellowship including clinical outcomes, job satisfaction, barriers, clinical excellence, and professional opportunities. Board-certified clinicians had greater odds (OR = 4.47, 95% CI 1.17-15.93, p = .03) of reporting fellowship training enhancing their application of current research. Those with a doctorate degree reported greater odds (OR = 9.18, 95% CI 2.31-36.56, p = .002) of establishing impactful mentors through fellowship. PTs with < 10 years of practice were more likely to report fellowship training positively affecting their salary (OR = 4.28, 95% CI 1.50-12.24, p = .01) and self-perception as expert clinicians (OR = 7.29, 95% CI 1.65-32.22, p = .01).

Discussion/conclusion: This study is the first to examine personal and professional outcomes among US fellowship-trained clinicians, highlighting the positive impact on clinical reasoning, mentorship, and compensation - especially among novice clinicians. Fellowship enhances job satisfaction, career growth, and clinical excellence, offering insights for prospective fellows and future research directions.