Chiropractic & Manual Therapies最新文献

Background: Chronic primary low back pain (CLBP) and fibromyalgia (FM) have complex etiologies and management approaches. Further research is needed, particularly on subgroups like individuals with CLBP who also report signs and symptoms of FM (CLBP/FM+) to better understand their pain mechanisms and clinical profile. Examining psychological, pain-related characteristics, and physical activity could help identify subgroups of individuals with CLBP/FM+ and guide the development of targeted interventions. This study aimed to compare physical activity practice, pain and psychological characteristics of individuals with CLBP without signs and symptoms of FM (CLBP/FM-), CLBP/FM + and FM to better understand similarities and differences between these chronic pain conditions.

Methods: Ninety-four individuals self-reporting CLBP (83% women) and 101 individuals self-reporting FM (96% women) were recruited online and completed a 30-min online survey. Among those with CLBP, 39 were classified as CLBP/FM+ and 55 as CLBP/FM-. Analyses of variance (ANOVAs) with polynomial contrasts were conducted to assess linear trends across the three groups on pain intensity (Numeric Rating Scale), psychological characteristics (Short Form-12, Tampa Scale for Kinesiophobia) and physical activity practice.

Results: Individuals with CLBP/FM- were more likely to participate in high-intensity physical activities. The analysis revealed a significant linear trend across the CLBP/FM-, CLBP/FM+, and FM groups for all pain and psychological characteristics except for the physical component of the quality of life and moderate-intensity physical activity.

Conclusions: Individuals reporting a diagnosis of FM exhibit greater symptoms severity and engage less in high-intensity physical activities than individuals with CLBP/FM+ and CLBP/FM-. Identifying a subgroup of individuals with CLBP/FM+ may help recognize mixed pain profiles and inform more personalized tailor management strategies.

Background: Plantar fasciitis (PF) is the most frequent cause of chronic heel pain. Conservative interventions, including strengthening and stretching exercises as well as massage, are commonly recommended as first-line management. However, the effectiveness of an integrated self-administered program (IA) for patients with chronic PF remains unclear. Therefore, this study aimed to evaluate the effectiveness of a supervised IA compared with a self-care leaflet in individuals with chronic PF.

Methods: Sixty-four participants with chronic PF (47 females, 17 males)were randomly allocated to either the intervention group (n = 32; mean age 60.3 (SD 3.7) years) or the control group (n = 32; mean age 56.9 (SD 5.4) years). The intervention group engaged in a multi-component program that included foot and ankle strengthening, active stretching, and self-administered Thai massage using a self-treatment stick. The program was performed three days per week for four weeks in a community-based setting under therapist monitoring to ensure safety and adherence. In contrast, the control group received an educational leaflet on self-care. Pain intensity (measured using the visual analogue scale), pressure pain threshold, ankle dorsiflexion range of motion, and foot and ankle ability measure (FAAM) were measured at baseline, at the end of the fourth week (week 4), and one month after the intervention period ended (week 8). The primary outcome for this study was designated as pain intensity.

Results: After adjusting for baseline values, the intervention group demonstrated significantly greater improvements in pain intensity (Mean Difference: - 2.5 [95% CI - 3.5, - 1.5]), pressure pain threshold (5.7 [4.8, 6.6]), ankle dorsiflexion range of motion (5.2 [3.2, 7.3]), and FAAM (15.3 [9.6, 20.9]) compared with the control group (all p < 0.05). These effects were maintained at week 8, indicating sustained benefits of the integrated supervised self-administered program.

Conclusions: This integrated supervised self-administered intervention may serve as a practical and effective approach to self-care in the management of chronic PF.

Trial registration: This study was prospectively registered at Thai Clinical Trials Registry (ID: TCTR20240923001).

Background: Many health care professionals use spinal mobilization (MOB) and manipulation (MAN) to treat musculoskeletal disorders. Research shows advantages of learning these techniques using a manikin. However, the force-time characteristics of MOB and MAN applied to manikins may differ from those delivered clinically to humans. This study reports on differences between the force-time characteristics of MOB and MAN delivered by experienced physiotherapists to the thoracic spine of both humans and a manikin.

Methods: Data were collected September-October 2023. Experienced physiotherapists applied prone MOB (Grade 3 central posterior-to-anterior, 30 s) and a single prone MAN to the T6 vertebra of three healthy human volunteers and a manikin with each volunteer-manikin pair representing one of three different patient scenarios (vignettes): vignette 1: 30-year-old male, 185 cm; vignette 2: 50-year-old male, 175 cm, and vignette 3: 65-year-old female, 165 cm. The applied forces were measured using a flexible pressure pad (100 Hz) and were compared descriptively between humans and the manikin.

Results: Data were analyzed from 13 physiotherapists (seven females, age (median, IQR): 40 (36-45) years, experience as physiotherapist: 14 (12-21) years). Peak forces on the manikin were higher than on the humans. Specifically, for MOB, average mean peak force differences (95% confidence interval) were: vignette 1: 58N (36, 80); vignette 2: 99N (74, 124); and vignette 3: 50N (31, 68). Similarly, for MAN, average peak force differences were: vignette 1: 128N (79, 177); vignette 2: 147N (94, 199); and vignette 3: 137N (101, 172). For MAN, greater mean peak forces were applied on vignette 1 than vignette 3 on the human 355N vs 284N and on the manikin 483N vs 421N.

Conclusion: In this study force-time characteristics of MOB and MAN performed by experienced physiotherapists on the thoracic spine of a manikin were different from those delivered to healthy humans: the forces applied to the manikin were higher for all vignettes for both techniques. However, forces were modulated to the vignette, both on the human and manikin.

Background: Lumbar spinal stenosis (LSS) can be disabling and is a leading reason for spinal surgery in older adults. While nonsurgical treatments are recommended as first-line treatment, it remains unclear which patients will benefit most.

Purpose: To identify patient characteristics associated with larger improvements or larger treatment effects among adults receiving nonsurgical LSS interventions.

Design: Secondary analysis of a randomized controlled trial.

Setting: Outpatient research clinics.

Subjects: 216 older adults with symptomatic LSS.

Methods: Participants, recruited from November 2013 to June 2016, were randomized to receive: (1) manual therapy with an individualized exercise program (MTE); (2) a group exercise (GE) program; or (3) medical care (MC). We evaluated the association of baseline characteristics with 2-month change in primary outcomes: symptoms and function on the Swiss Spinal Stenosis questionnaire (SSSQ); and walking capacity in meters (m) on the self-paced walking test (SPWT). Baseline characteristics included sociodemographic and clinical variables. To explore heterogeneity of treatment effects, we evaluated unadjusted stratified estimates when comparing MTE to GE/MC. Additionally, we included an interaction term in models to test for statistical interaction.

Results: At baseline, participants (mean age = 72, 54% female, 23% non-white) had moderate LSS-related symptoms/impairment (mean SSSQ score = 31.3) and limited walking capacity on SPWT (mean = 451 m). The overall improvement on SSSQ was 2.5 points with larger improvements observed among younger, non-white, non-smoking participants, and those with worse baseline LSS or back-related symptoms/impairment. Overall improvement on the SPWT was 205 m with larger improvements observed among younger participants, those with higher baseline physical activity levels and participants without knee osteoarthritis. For SSSQ, the treatment effect was larger among adults aged < 70 versus older adults (MTE vs. GE/MC; mean difference [MD] = - 4.06, 95% CI = - 6.29 to - 1.83 vs. MD = - 0.47. 95% CI = - 2.63 to 1.69, respectively; p-for-interaction = 0.02). For walking capacity, the treatment effect was larger among adults with hip osteoarthritis compared to those without (MTE vs. GE/MC; MD = 500 m, 95% CI = 71 to 929, vs MD = 13 m, 95% CI = - 120 to 147, respectively; p-for-interaction = 0.007).

Conclusions: In a sample receiving nonsurgical treatments for LSS, we identified patient-level characteristics associated with larger improvements and/or treatment effects. If confirmed in larger randomized controlled trials, these findings may guide clinical decision-making to enhance clinical outcomes.

Clinicaltrials:

Gov identifier: NCT01943435.

Background: Literature on low back pain (LBP) treatment suggests not all LBP is the same and patients with extension- or flexion-related LBP may benefit from different strategies. This study's objective was to evaluate the effect of participant positioning when delivering spinal manipulation on reported immediate comfort, in individuals with LBP.

Methods: This a randomized crossover trial. Volunteer adult participants with LBP were recruited from a chiropractic college campus clinic to receive two procedures in random order: 1. Standard side posture lumbopelvic manipulation (SPLM) and 2. Modified flexed lumbopelvic manipulation. The modified position was similar to the standard, but with increased hip and lumbopelvic flexion. Participants were not blinded. The primary outcome of self-reported comfort was recorded using a 0-10 scale. Paired t-tests were used to compare mean comfort scores, and a minimal clinically important difference of 2.0 was used. Secondary analysis examined correlations between comfort during active range of motion (AROM) and the two SPLM procedures. An exploratory analysis comparing within-participant differences was examined. All reported harms were mild in nature (e.g. discomfort).

Results: Forty participants were recruited (mean 25.5 years of age, 75% female). 20 participants started with the Standard SPLM and 20 started with the Modified Flexed SPLM. No differences in comfort were found between the Standard SPLM (N = 40) versus Modified flexed SPLM (N = 40), (mean (SD) = - 0.01 (2.3), Effect Size Cohen's d = - 0.004 95% CI (- 0.32, 0.32)). No correlations were found between the comfort during AROM and the two SPLM procedures. Observing within-participant differences for individual comfort, 14 participants had a clinically significant difference ≥ 2. Specifically, 6 participants had lower scores with Standard SPLM and 8 participants had lower scores with Modified flexed SPLM.

Conclusion: Comparing comfort during a Modified flexed SPLM to the Standard one revealed no difference for a population with LBP. However, some individuals did demonstrate a comfort preference for a Standard versus a Modified flexed position. Future studies should examine other variations of manipulation and particular subgroups of individuals with LBP (e.g. direction related) that experience discomfort during manipulation.

Background: Chiropractors are trained to help others, but do chiropractors need help themselves? While many health professions have been surveyed regarding their mental health and wellness, no such comprehensive survey has been conducted in the chiropractic profession. These data are important to improve the health of individual chiropractors, designing effective interventions and creating a strategic workforce plan.

Methods: We used a cross-sectional design to survey Canadian chiropractors and students between 02-2023 and 04-2023. We adapted the Canadian Medical Association's questionnaire with permission. The questionnaire was divided into 5 domains; we report results from the psychological domain. Descriptive statistics were tabulated and inferential statistics conducted on each psychological test stratified by gender, age, years and type of practice, and geographic location. From these data, most-at-risk and least-at-risk profiles were constructed.

Results: Anonymous data were obtained from 2109 respondents (26% response rate). The majority identified as male, white and without disability. Respondents identifying as practicing chiropractors and students represented 92.6% and 4.5% of the sample, respectively. From the mental health continuum, 57.8% of Canadian chiropractors were considered to be flourishing and only 5.3% languishing. Chiropractors reported experiencing substantial levels of mental health issues including burnout (33.2%), anxiety (22.0%), and lifetime depressed mood (36.8%). Most notably, 26.7% of responding chiropractors reported having lifetime suicidal ideation. Respondents identifying as having a disability (20%) or being students reported more unfavourable scores across all psychological measures. The most at-risk profile for a Canadian chiropractor is a young female practitioner (under 31) with less than 5 years of experience. In contrast, the least at-risk profile is an older male (over 60) with 31 or more years of practice experience.

Conclusion: This is the first comprehensive evaluation of mental health and wellness in the Canadian chiropractic profession. The results demonstrate that, like other professions, there are mental health and wellness challenges among Canadian chiropractors. These data have value in designing preventative and intervention strategies for those most at-risk. Currently, this survey is being conducted in other countries to understand the mental health of the chiropractic profession in different settings. Future work will analyze the remaining domains.

Background: Low back pain (LBP) is increasingly common among adolescents, yet little is known about the healthcare utilization in this population. We aimed to describe the characteristics and treatment patterns of adolescents with LBP presenting to a specialized comprehensive pediatric health system.

Methods: This retrospective single-arm cohort design analyzed de-identified data from a suburban healthcare system. Using the TriNetX analytics platform, we queried electronic health records for adolescents aged 12-18 years with a new diagnosis of LBP between 2018 through 2022 without serious pathology such as cancer or infection. Key variables included baseline patient demographics, comorbidities, initial care setting, and the proportion and count of use of broad categories of healthcare services over a one-year follow-up window.

Results: Our query identified 6,350 adolescents with LBP (mean age [standard deviation] of 14.8 [1.8] years; 60.6% female). The most common initial setting was ambulatory (80.5%). Services received by patients included non-opioid medication (38.8%), non-pharmacological conservative care (26.1%), diagnostic imaging (29.4%), opioids (11.3%), surgery (0.3%), and interventional injection therapies (≤ 0.2%).

Conclusion: Among adolescents with newly diagnosed LBP from a specialized comprehensive pediatric healthcare system in Wisconsin from 2018 to 2022, 38.8% were prescribed non-opioid medications, 29.4% obtained diagnostic imaging, 26.1% had non-pharmacological conservative care, and 11.3% were prescribed opioids. Future studies should explore these findings in other care settings and examine optimal care pathways and associated clinical outcomes.