International Journal of Osteopathic Medicine最新文献

Background

Although manual therapy is an effective technique for increasing ankle range of motion, the dose-response required is unclear.

Objective

To find out what number of sessions of talus mobilizations will induce a detectable change in weight bearing ankle dorsiflexion range of motion of older adults with limited ankle mobility.

Design

Four-arm randomized clinical trial.

Setting

Community-dwelling.

Methods

62 older adults; aged over 60; with ankle dorsiflexion ROM below 35°. Four groups received from one to four treatment sessions. Each session consisted of 3 mobilizations of 30 s, with of the talus in anteroposterior glide, with a rest of 30 s. Grade IV mobilizations were applied to target the accessory movement of the ankle up to the resistance offered by periarticular tissues. The Lunge test was used to measure weight bearing ankle dorsiflexion.

Results

The four groups increased their ankle mobility after one session, but two sessions were needed to overcome the established 4.7°’ threshold, regardless of group. Only those participants who received four sessions maintained the improvements for 8 weeks.

Conclusions

Two sessions of talus mobilizations are effective in improving weight bearing ankle dorsiflexion ROM. It will be necessary to deliver four sessions of treatment if these improvements are to be maintained for at least 8 weeks.

Clinical trial registration number

NCT04563663.

Background

Low back pain is the main cause of global disability, with 13–30% of patients with low back pain reporting pain in the sacroiliac joint (SIJ). One of the clinical tests available for assessing SIJ mobility is the Downing test. However, information about the reliability and validity of this test is scarce in the scientific literature.

Objectives

To evaluate the construct validity and intra and inter-rater reliability of the Downing test.

Methods

Prospective study, in which the sample consisted of 30 individuals of both sexes. The evaluation team was composed of 5 researchers. The evaluations took place on two different days: (1st day) inter-rater reliability and construct validity; (2nd day) intra-rater reliability. The reference standard used for construct validity was three-dimensional measurements, using the BTS Smart-DX system. Statistical analysis: the percentage (%) agreement and the kappa statistic (k) were used.

Results

Moderate agreement was found for construct validity for the conclusion of the test (% agreement = 54.5%; k = 0.43; p < 0.01) and intra-rater reliability (% agreement = 66.7%; k = 0.43; p < 0.01). However, agreement was poor for inter-rater reliability (% agreement = 16.7%; k = 0.15; p < 0.05).

Conclusions

The construct validity of the Downing test was confirmed, only for the conclusion of the test, and it is reliable when applied by the same rater to healthy people, even if the rater has only 2 years of experience. The test is unreliable when it is performed by different raters. We suggest further studies that investigate the measurement properties of the Downing test, especially in symptomatic patients.

Background

Patellofemoral Pain Syndrome is the most common cause of anterior knee pain, especially in active young people. This study aimed to evaluate the effect of lumbopelvic manipulation on electromyography parameters of gluteus medius and vastus medialis in patients with patellofemoral pain syndrome.

Methods

In this double-blind placebo-controlled randomized clinical trial study, 26 patients with a diagnosis of patellofemoral pain syndrome were randomly divided into two groups. The first group received Lumbopelvic manipulation and the second group was a control group that received placebo manipulation. Electromyography activity of vastus medialis and gluteus medius muscles were evaluated as primary outcomes during the single-leg squat; pain intensity during rest and functional tasks (step up, step down, single leg squat) were assessed by numerical pain rating scale. Functional status was evaluated by step-down test and the score of the Kujala patellofemoral questionnaire, as secondary outcomes. All evaluations were performed before and after the intervention, except pain intensity at rest and the Kujala patellofemoral questionnaire that were assessed before the intervention and one week after.

Result

In both groups, no significant difference was observed before and after the intervention in terms of average amplitude and the onset of gluteus medius and vastus medialis. However, in the lumbopelvic manipulation group, pain intensity during rest and functional tests significantly decreased compared to the control group. Functional status significantly improved in the lumbopelvic manipulation group, with no significant difference between group comparisons.

Conclusion

Lumbopelvic manipulation caused a reduction in pain intensity and improvement of functional status in the rehabilitation of patients with patellofemoral Pain Syndrome. However, it seems that this method could not change the EMG activity of muscles in these patients.

Implications for practice

• •

  The results of present study can help physiotherapists to understand the possible underlying pathomechanics of patellofemoral pain syndrome and more effective treatment of these group of patients.

Background and objective

Research is a fundamental component of evidence-based practice. This scoping review will explore what peer reviewed empirical studies have been published between January 2010–March 2021 where osteopathic manual therapy (OMT) is used as an intervention. A deeper understanding of what research comprises the osteopathic body of literature may support osteopaths in their clinical decision making process.

Methods

A 5-stage scoping review framework was followed. Finalised search terms were applied to four databases: PubMed, ScienceDirect, EBSCO and BASE. Reference lists of yielded articles were checked until evidence saturation occurred. Extraction fields included author, year of publication, study population and sample size, methodology, intervention, and comparator. Articles were also grouped into 10 broad categories based on the overarching topic of exploration.

Results

A total of 292 studies were included for review, 189 studies were determined as quantitative research with three qualitative and one mixed methods study. The remaining studies comprised 78 case report/case series and 24 systematic reviews. Musculoskeletal, neurological and paediatric categories made up 64% of the total literature.

Conclusion

The osteopathic literature is largely dominated by quantitative research. Yielded studies covered a range of topics. However, the number of isolated research publications gives a fragmented impression of the literature and research gaps suggest inconsistent coverage in some areas. Osteopathic research may benefit from a more considered research agenda where research is methodically generated to fill contextual gaps in the literature.

Objective

This rapid review explores the prevalence of musculoskeletal pain symptoms associated with work from home conditions during the COVID-19 pandemic.

Methods

We conducted a rapid review across three databases (i.e., PubMed, Medline, and CINAHL) for observational studies that report on the musculoskeletal functions among individuals placed in a work from home setup due to the COVID-19 pandemic, published between December 2019–August 2021. Two independent review authors searched, appraised, and extracted data from the articles included in the final review. A descriptive approach was used to synthesize the narrative evidence.

Results

Forty-four articles were initially identified. A total of six (n = 6) studies met the full inclusion criteria and were included. Among them, there were five cross-sectional studies and one case-control study. The highest prevalence reported were neck pain (20.3–76.9%), low back pain (19.5–74.1%), and shoulder pain (3.0–72.9%). The most common instrument used was the Nordic Musculoskeletal Questionnaire. One of the common professions that report musculoskeletal pain symptoms associated with work from home conditions were individuals working in the academic sector.

Conclusion

The increased prevalence of musculoskeletal pain symptoms associated with work from home conditions during the COVID-19 pandemic is a concern that should be addressed to prevent negative neuromusculoskeletal outcomes.

Systematic review registration

This review is in the Open Science Framework registry (osf.io/vxs4w) and the PROSPERO database (CRD42021266097).

Implications for practice

• •

  A system in the workplace should be developed for the early detection of musculoskeletal pain.

• •

  Apart from standard occupational safety and proper ergonomic, sustainable policies and programs that address the mental health issues of employees should also be addressed.

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  Programs addressing musculoskeletal pain should be available online for employees to address accessibility and ubiquity.

Background

Currently, teaching methods for developing physical assessment and palpation skills in manual therapy is challenging for both learners and educators. 3D digital technologies such as virtual reality (VR) may facilitate and/or address these challenges. However, their current usage in improving learning outcomes in manual therapy education is unknown.

Methods

The following electronic databases were searched from Jan 2005 to April 2021: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), Science Direct and Google Scholar. Two independent reviewers reviewed the articles to assess for eligibility. Studies of any methodology that investigated the use or application of the 3D digital applications were included in the review. Primary outcomes included any outcome related to learning based on the updated Blooms taxonomy. Narrative synthesis was used to synthesize data from the included studies.

Results

A total of 4 articles were included in the final review. The main findings were classified into the following key concepts: (1) perception of tissue stiffness, (2) improved student self-efficacy in performing MT techniques, and (3) barriers and facilitators for utilizing 3D technologies. All included outcomes met understanding, applying, analysing and evaluating levels of Blooms taxonomy; however, no outcomes met the ‘creating’ level of Bloom's taxonomy.

Discussion

Our review found that there are no AR, VR or mixed applications that specifically serve the needs of MT education in relation to joint motion assessment, but applications are available that can be readily used or potentially adapted to train skills of tissue palpation.

Background

The importance of breastfeeding and its effect on reducing the burden of disease is recognised globally. The physical aspect of successful breastfeeding is multifactorial and requires maternal comfort and confidence and an infant's ability to latch and maintain intra-oral sucking functions. Infants need to have sufficient function of their musculoskeletal system to maintain positioning and attachment.

Objectives

The primary aim was to investigate the effect of osteopathic intervention on mothers and infants with breastfeeding difficulty. The secondary aim was to record the musculoskeletal dysfunctions found in those infants.

Design

A retrospective case series of de-identified patient files.

Setting

Osteopathic private practice.

Methods

A Breastfeeding Self-Efficacy Scale and Visual Analogue Scale for maternal pain while feeding, ability to latch, ability to maintain latch and noise while feeding were completed before and after osteopathic intervention.

Participants

Eighteen mother-infant-dyad files were retrospectively reviewed.

Results

Following an average of five osteopathic treatments over 7.4 weeks, all 18 mother-infant-dyads noted improvement in breastfeeding confidence and/or improvements in the ability to latch and maintain latch, maternal pain at the breast and infant noise while feeding. The greatest improvements were seen in the seven mother-infant dyads identified at risk of ceasing breastfeeding at baseline (p=<0.001).

Conclusion

This study provides evidence that osteopathic intervention may be capable of delivering benefits in breastfeeding confidence and function. Our results also indicate that osteopathic intervention may benefit mothers at risk of ceasing breastfeeding. Further research, including prospective clinical trials with a comparator group, is warranted.

Objective

This paper investigates the impact of a spiral curriculum intervention using a validated assessment rubric for communication skill development of undergraduate osteopathy students.

Method

Over a three-year period, students from three cohorts were exposed to zero, one or two semesters of a newly integrated and scaffolded communication curriculum. Using a checklist rubric to collect mean scores and then undertaking comparisons through Pearson chi square analysis, the impact of the curriculum intervention on communication skill development was explored.

Results

Cohorts who received zero or two full semesters of communication curriculum performed better (x = 6.34, x = 10.51 respectively) than the cohort who received one (x = 6.03).

Conclusion

Despite using an explicit assessment rubric, insufficiently contextualised and integrated curriculum appears to disrupt student learning, whilst a spiralled, scaffolded curriculum delivered at an appropriate level in combination with explicit assessment rubrics work well together to support deeper learning and development.

Implications for practice

∙An insufficiently contextualised and integrated curriculum combined with the frequency of content being re-visited (spiral curriculum) can disrupt the students learning experience.

∙Using a spiralled and scaffolded curriculum significantly improves the development of communication skills.

∙For deeper learning to occur students require a combination of both explicit curriculum and accompanying assessment rubrics.

Objective

This study aimed to determine and compare the effects of therapeutic and stabilization exercises prescribed to patients after manual therapy sessions on pain, neck range of motion and disability.

Methods

Thirty patients with non-specific chronic neck pain were recruited. After the initial examination, one session of manual therapy was conducted. The examinations were repeated to assess the effect of manual therapy on pain intensity and neck range of motion. After manual therapy, patients were randomly allocated into two groups: stabilization exercise group (SEG) and therapeutic exercise group (2 days/week/6 week). Pain intensity was assessed using the visual analog scale. Joint movements assessed using goniometer and the lateral scapular shift test for scapular dyskinesia. In addition, disability status was assessed using a neck disability index.

Results

In all patients, manual therapy decreased pain intensity and increased joint movements (p < 0.05). After 6 weeks of exercise therapy, pain intensity, neck flexion, extension, lateral flexion movement and disability improved in SEG (p < 0.05).

Conclusion

This study demonstrated that stabilization exercises combined with manual therapy had more positive effects among patients with non-specific chronic neck pain.

Implications for practice

• •

  The treatment for non-specific chronic neck pain should be supported with exercises after manual therapy sessions for reducing neck pain.

• •

  Instead of therapeutic isometric exercises, which are often clinically prescribed as home exercises, stabilization exercises may be preferred as they are performed by maintaining the neutral position of the neck and include stretching.

Introduction

This paper presents qualitative data from communication between an osteopath and patient participating in a research study to develop a new psychologically informed pain management course.

Presentation

‘Adam’, aged 49, presented with persistent pain and multiple health problems including HIV and depression. His aim in joining the study was to find ways to stay independent.

Evaluation

Existing osteopathic evaluations of musculoskeletal dysfunction were supported by psychological assessments of health beliefs and coping strategies.

Intervention

Psychological and mindfulness exercises were integrated into six osteopathic treatment sessions to support symptom relief, patient learning and self-management.

Data analysis

Audio-recordings were analysed qualitatively using Linguistic Ethnography.

Outcomes

Communication moved from ‘mechanistic’ pain discourses about diagnosis and structural damage towards ‘facilitative’ narratives involving shared sense-making about broader embodied experiences. Physical outcomes were similar to previous osteopathic treatment but with longer lasting effects due to more effective self-management, decreased fear-avoidance and increased physical activity.

Conclusion

This patient reported that a psychologically informed pain management course had increased his body awareness and ability to live well despite pain. Individual case findings are not generalisable, but these data appear to support an ecological-enactive model of osteopathic practice and suggest promising directions for future research.