Pub Date : 2015-04-04DOI: 10.1179/1753615415Y.0000000004
P. Wheeler
Abstract Objective To identify outcomes for patients following autologous blood injections for chronic plantar fasciitis symptoms. Methods Prospective case series performed by a single clinician in a National Health Service Sports Medicine Department. Patients with recalcitrant symptoms had a single autologous blood injection performed along with a structured rehabilitation programme. Patients were followed up clinically as part of routine care, and those who had previously been discharged, after care was finished, were contacted for a current assessment of symptoms and function. Results Sixty-two patients were identified and follow-up data was available for all patients, with a median follow-up of 631 days and with follow-up of at least 1 year for nearly three-quarters of patients. There was an average reduction in pain as assessed by visual analogue score (VAS) of 84%, with 55% of patients reporting themselves as ‘pain-free’ (VAS = 0), and 68% as ‘virtually pain-free’ (VAS 0–1). There were no serious side-effects reported. Discussion Autologous blood injections appear to be an appropriate option in the management of patients with chronic plantar fasciitis, although evidence from randomised control trials is still needed to prove causality. There remain a small proportion of patients who do not seem to benefit sufficiently from this procedure and who require alternative treatment options. Further work is required to identify any factors that may be associated with either good or poor response to better tailor individual treatments.
{"title":"The role of autologous blood injections in the treatment for patients with chronic plantar fasciitis – A case series and longer-term follow-up","authors":"P. Wheeler","doi":"10.1179/1753615415Y.0000000004","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000004","url":null,"abstract":"Abstract Objective To identify outcomes for patients following autologous blood injections for chronic plantar fasciitis symptoms. Methods Prospective case series performed by a single clinician in a National Health Service Sports Medicine Department. Patients with recalcitrant symptoms had a single autologous blood injection performed along with a structured rehabilitation programme. Patients were followed up clinically as part of routine care, and those who had previously been discharged, after care was finished, were contacted for a current assessment of symptoms and function. Results Sixty-two patients were identified and follow-up data was available for all patients, with a median follow-up of 631 days and with follow-up of at least 1 year for nearly three-quarters of patients. There was an average reduction in pain as assessed by visual analogue score (VAS) of 84%, with 55% of patients reporting themselves as ‘pain-free’ (VAS = 0), and 68% as ‘virtually pain-free’ (VAS 0–1). There were no serious side-effects reported. Discussion Autologous blood injections appear to be an appropriate option in the management of patients with chronic plantar fasciitis, although evidence from randomised control trials is still needed to prove causality. There remain a small proportion of patients who do not seem to benefit sufficiently from this procedure and who require alternative treatment options. Further work is required to identify any factors that may be associated with either good or poor response to better tailor individual treatments.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"47 - 53"},"PeriodicalIF":0.0,"publicationDate":"2015-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-03-20DOI: 10.1179/1753614615Z.00000000095
Fouzia Bashir, W. Wong, S. Innes
Abstract Study design Case report. Objective To evaluate the effectiveness of steroid injection in shoulder impingement syndrome. Case presentation A 40-year-old man presented with right shoulder subacromial pain who did not improve with physiotherapy. However, the patient showed improvement in pain (numerical pain rating scale from 8 to 0) and shoulder functions (the shoulder pain and disability index fell from 49 to 4%) with corticosteroid injection. Discussion and conclusions The steroid injection is an effective intervention and blind injection technique was accurate and produced good outcome in this patient. The outcome of this case correlates with research evidence which supports the effectiveness of steroid injections for pain relief in shoulder impingement syndromes. The effectiveness of the blind injection technique used also correlates with other studies in the literature.
{"title":"Corticosteroid injection in shoulder impingement","authors":"Fouzia Bashir, W. Wong, S. Innes","doi":"10.1179/1753614615Z.00000000095","DOIUrl":"https://doi.org/10.1179/1753614615Z.00000000095","url":null,"abstract":"Abstract Study design Case report. Objective To evaluate the effectiveness of steroid injection in shoulder impingement syndrome. Case presentation A 40-year-old man presented with right shoulder subacromial pain who did not improve with physiotherapy. However, the patient showed improvement in pain (numerical pain rating scale from 8 to 0) and shoulder functions (the shoulder pain and disability index fell from 49 to 4%) with corticosteroid injection. Discussion and conclusions The steroid injection is an effective intervention and blind injection technique was accurate and produced good outcome in this patient. The outcome of this case correlates with research evidence which supports the effectiveness of steroid injections for pain relief in shoulder impingement syndromes. The effectiveness of the blind injection technique used also correlates with other studies in the literature.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"63 1","pages":"68 - 71"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.00000000095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65718372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-03-20DOI: 10.1179/1753614615Z.00000000094
J. Inklebarger, T. Clarke
Abstract Isolated fibular shaft fractures (IFSF) have rarely been described in the literature. As the fibula is a non weight-bearing bone, fractures may present subtly as a soft tissue injury or in some cases be completely asymptomatic. Though usually self limiting, missed IFSF may progress to non-union with potential poor healing outcomes, particularly in those engaged in continued rigorous athletic activity. This is a case of occult IFSF, initially identified via diagnostic ultrasound (DU) circa one year post onset of lower limb pain with impact activity. X-ray confirmed bony non-union. Open reduction internal fixation (ORIF) was performed, with bone biopsy negative for pathological fracuture. Union was achieved, but symptoms of allodynia and hyperesthesia persisted post metalwork removal one year post surgery. The patient was unable to return to recreational sporting activity and referred for pain control team management.
{"title":"An isolated, occult non-union fibular shaft fracture in an athlete, diagnosed by portable ultrasound screening","authors":"J. Inklebarger, T. Clarke","doi":"10.1179/1753614615Z.00000000094","DOIUrl":"https://doi.org/10.1179/1753614615Z.00000000094","url":null,"abstract":"Abstract Isolated fibular shaft fractures (IFSF) have rarely been described in the literature. As the fibula is a non weight-bearing bone, fractures may present subtly as a soft tissue injury or in some cases be completely asymptomatic. Though usually self limiting, missed IFSF may progress to non-union with potential poor healing outcomes, particularly in those engaged in continued rigorous athletic activity. This is a case of occult IFSF, initially identified via diagnostic ultrasound (DU) circa one year post onset of lower limb pain with impact activity. X-ray confirmed bony non-union. Open reduction internal fixation (ORIF) was performed, with bone biopsy negative for pathological fracuture. Union was achieved, but symptoms of allodynia and hyperesthesia persisted post metalwork removal one year post surgery. The patient was unable to return to recreational sporting activity and referred for pain control team management.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"76 - 78"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.00000000094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65718432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-03-18DOI: 10.1179/1753615415Y.0000000003
D. Reid, A. Clough
Abstract Objective To review the available literature on the use of autologous blood injections in the treatment of lateral epicondyle tendinopathy. Method Databases of EMBASE, PubMed, Psychinfo, and Medline OvidSP were searched for English language human studies without limit of time. Main search keywords were autologous blood, blood products, lateral epicondylitis, and tennis elbow. All papers not using autologous blood were removed and search further refined using the NHS e-Library, The Knowledge Network, utilizing Dynamed to search under lateral epicondylitis and autologous blood. Owing to the low number of trials all papers using autologous blood were included. Results Review revealed three case study reports, four randomized controlled trials (RCTs) and two meta-analyses. Conclusion There is no level 1 evidence for efficacy, but encouragingly there is no evidence of harm and the obvious conclusion is that an adequately powered, primary care anatomically guided injection trial of autologous blood is required to progress the debate.
摘要目的回顾自体血液注射治疗外上髁肌腱病变的文献。方法在EMBASE、PubMed、Psychinfo和Medline OvidSP数据库中不加时间限制地检索英语人类研究。主要搜索关键词是自体血液、血液制品、外上髁炎和网球肘。所有未使用自体血的论文被删除，并使用NHS e-Library, the Knowledge Network进行检索，利用Dynamed在外侧上髁炎和自体血项下进行检索。由于试验数量少，所有使用自体血液的论文都被纳入。结果综述发现3个病例研究报告，4个随机对照试验(rct)和2个荟萃分析。结论:没有一级证据表明其疗效，但令人鼓舞的是，没有证据表明其有害。显而易见的结论是，需要一项足够有力的、初级保健解剖引导的自体血液注射试验来推进这场辩论。
{"title":"Literature review to justify the use of autologous blood injections in the treatment of lateral epicondyle tendinopathy","authors":"D. Reid, A. Clough","doi":"10.1179/1753615415Y.0000000003","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000003","url":null,"abstract":"Abstract Objective To review the available literature on the use of autologous blood injections in the treatment of lateral epicondyle tendinopathy. Method Databases of EMBASE, PubMed, Psychinfo, and Medline OvidSP were searched for English language human studies without limit of time. Main search keywords were autologous blood, blood products, lateral epicondylitis, and tennis elbow. All papers not using autologous blood were removed and search further refined using the NHS e-Library, The Knowledge Network, utilizing Dynamed to search under lateral epicondylitis and autologous blood. Owing to the low number of trials all papers using autologous blood were included. Results Review revealed three case study reports, four randomized controlled trials (RCTs) and two meta-analyses. Conclusion There is no level 1 evidence for efficacy, but encouragingly there is no evidence of harm and the obvious conclusion is that an adequately powered, primary care anatomically guided injection trial of autologous blood is required to progress the debate.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"33 - 38"},"PeriodicalIF":0.0,"publicationDate":"2015-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-03-12DOI: 10.1179/1753614615Z.00000000092
B. Sweetman
Abstract Aim This is part of a literature review series and a data analysis study, which seek to find out whether different types of sleep disturbance can be caused by different sorts of back pain. Here, in Part 1, we examine the systems described as an insomnia or sleep disturbance questionnaire, diary, index, item, or scale. Those used in back pain studies were of particular interest. Methods A search of Medline, Embase, Psycinfo, and the OVID journals databases was made using the keywords ‘low back pain’ and ‘sleep’. Results Forty-four sleep enquiry systems were traced. Their similarities and differences were displayed in tables. Discussion Creating the main display table helped us to sort out the considerable variation in questionnaire content. It was important to distinguish the elements of impairment, disability, and handicap and further consequences. It also helped us to rigidly define the 24-hour time sequence. First, there were the evening difficulties getting off to sleep. Then, nighttime awakenings and other disturbances were listed along with total night scores. Then, the morning waking process and conditions were distinguished. Lastly, the daytime fallout was noted. Further clarity was sought for the wording of questions by recognizing the many synonyms for tiredness and somnolence, which seemed to imply there were far more sleep items than really exist. It was noted that the results of using these subjective opinions obtained from patients often varied considerably with the objective measures recorded using actigraphy and polysomnography. Little is known as to why there is such divergence.
{"title":"Various types of sleep disturbance due to different sorts of low back pain: A literature review – 1. Types of sleep disturbance","authors":"B. Sweetman","doi":"10.1179/1753614615Z.00000000092","DOIUrl":"https://doi.org/10.1179/1753614615Z.00000000092","url":null,"abstract":"Abstract Aim This is part of a literature review series and a data analysis study, which seek to find out whether different types of sleep disturbance can be caused by different sorts of back pain. Here, in Part 1, we examine the systems described as an insomnia or sleep disturbance questionnaire, diary, index, item, or scale. Those used in back pain studies were of particular interest. Methods A search of Medline, Embase, Psycinfo, and the OVID journals databases was made using the keywords ‘low back pain’ and ‘sleep’. Results Forty-four sleep enquiry systems were traced. Their similarities and differences were displayed in tables. Discussion Creating the main display table helped us to sort out the considerable variation in questionnaire content. It was important to distinguish the elements of impairment, disability, and handicap and further consequences. It also helped us to rigidly define the 24-hour time sequence. First, there were the evening difficulties getting off to sleep. Then, nighttime awakenings and other disturbances were listed along with total night scores. Then, the morning waking process and conditions were distinguished. Lastly, the daytime fallout was noted. Further clarity was sought for the wording of questions by recognizing the many synonyms for tiredness and somnolence, which seemed to imply there were far more sleep items than really exist. It was noted that the results of using these subjective opinions obtained from patients often varied considerably with the objective measures recorded using actigraphy and polysomnography. Little is known as to why there is such divergence.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"17 - 28"},"PeriodicalIF":0.0,"publicationDate":"2015-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.00000000092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65718393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-02-24DOI: 10.1179/1753614614Z.00000000088
J. Inklebarger, T. Clarke
Abstract Weight-bearing lumbar spine X-rays have confirmed diagnostic utility in identifying structural spinal pathologies and postural dysfunctions, which may otherwise be underestimated by recumbent studies. This is particularly true in the sub-population of young athletes with chronic lower back pain in whom spondylolysis and listhesis is suspected. In consideration of the relatively higher ionizing radiation doses associated with lumbar imaging, some United Kingdom consultation groups have narrowed the criteria to exclude lumbar X-ray for young athletic populations with chronic low back pain. This has posed challenges for orthopaedic clinicians, who consider weight bearing lumbar spine X-rays as a first-line and cost-effective alternative to lumbar magnetic resonance imaging, to exclude spondylolysis and listhesis and ankylosing spondylitis in younger populations, for grading and monitoring scoliosis, and for other reasons. Unfortunately, these ‘recumbent view only’ policies may run contrary to known techniques for reducing ionizing radiation exposure, such as increasing the source-to-image distance; and the higher comparative levels of ionizing radiation assumed with lumbar imaging in relation to chest X-ray may have been overestimated.
{"title":"The case for standing X-rays: Clinical indications for weight-bearing lumbar spine imaging in younger athletic populations presenting with chronic lower back pain","authors":"J. Inklebarger, T. Clarke","doi":"10.1179/1753614614Z.00000000088","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000088","url":null,"abstract":"Abstract Weight-bearing lumbar spine X-rays have confirmed diagnostic utility in identifying structural spinal pathologies and postural dysfunctions, which may otherwise be underestimated by recumbent studies. This is particularly true in the sub-population of young athletes with chronic lower back pain in whom spondylolysis and listhesis is suspected. In consideration of the relatively higher ionizing radiation doses associated with lumbar imaging, some United Kingdom consultation groups have narrowed the criteria to exclude lumbar X-ray for young athletic populations with chronic low back pain. This has posed challenges for orthopaedic clinicians, who consider weight bearing lumbar spine X-rays as a first-line and cost-effective alternative to lumbar magnetic resonance imaging, to exclude spondylolysis and listhesis and ankylosing spondylitis in younger populations, for grading and monitoring scoliosis, and for other reasons. Unfortunately, these ‘recumbent view only’ policies may run contrary to known techniques for reducing ionizing radiation exposure, such as increasing the source-to-image distance; and the higher comparative levels of ionizing radiation assumed with lumbar imaging in relation to chest X-ray may have been overestimated.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"12 - 16"},"PeriodicalIF":0.0,"publicationDate":"2015-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-01-27DOI: 10.1179/1753614615Z.00000000091
A. Clough, A. Jackson
Abstract The progress of physiotherapy up to the present introduces a state of the discipline assessment. A self-assessment routine is described, which can be used by any health professional. The new initiative of the Chartered Society of Physiotherapy, Physiotherapy Works, comprises efforts to raise the awareness of the public, patients, healthcare providers and physiotherapists themselves of the evidence of benefits of physiotherapy. Four areas of focus relate to social care, falls prevention, orthopaedic rehabilitation and primary care.
{"title":"Physiotherapy: Making a difference for the next 100 years – Stop sleepwalking into obscurity. A personal reflection","authors":"A. Clough, A. Jackson","doi":"10.1179/1753614615Z.00000000091","DOIUrl":"https://doi.org/10.1179/1753614615Z.00000000091","url":null,"abstract":"Abstract The progress of physiotherapy up to the present introduces a state of the discipline assessment. A self-assessment routine is described, which can be used by any health professional. The new initiative of the Chartered Society of Physiotherapy, Physiotherapy Works, comprises efforts to raise the awareness of the public, patients, healthcare providers and physiotherapists themselves of the evidence of benefits of physiotherapy. Four areas of focus relate to social care, falls prevention, orthopaedic rehabilitation and primary care.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"86 - 89"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.00000000091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65718114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-01-24DOI: 10.1179/1753615415Y.0000000002
I. Kennedy
Abstract Purpose Survey the opinions of physiotherapists on the published theory of cervical spine manipulation, to assist the physiotherapist in achieving informed consent in advance of planned orthopaedic manual therapy interventions. Method A self-administered postal survey was validated, and then sent to 325 physiotherapists working in musculoskeletal practices in Dorset and Hampshire, United Kingdom. Results Four articles presenting theories of cervical manipulation were found in the search of literature published during 2008–2011. Nine theories from the literature are presented within the survey: four theories are accepted by more than 50% of the sample. Conclusions When a patient asks how manipulation works, before any of the theories are offered to the patient, it can be elucidated that the theoretical base underpinning every aspect of cervical manipulation is still underdeveloped. This study finds popular theory accepted by over 70% of physiotherapists, namely that spinal manipulation activates mechanoreceptors and proprioceptors, which results in a hypoalgesic effect. Alternatively, one could rely on the approval of the highly qualified physiotherapists who had passed specialized postgraduate examinations; cervical manipulation activates descending inhibitory pain pathways through the midbrain periaqueductal grey region resulting in pain relief.
{"title":"A cross-sectional postal survey of musculoskeletal physiotherapists’ opinions towards the published theory of cervical spine manipulation","authors":"I. Kennedy","doi":"10.1179/1753615415Y.0000000002","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000002","url":null,"abstract":"Abstract Purpose Survey the opinions of physiotherapists on the published theory of cervical spine manipulation, to assist the physiotherapist in achieving informed consent in advance of planned orthopaedic manual therapy interventions. Method A self-administered postal survey was validated, and then sent to 325 physiotherapists working in musculoskeletal practices in Dorset and Hampshire, United Kingdom. Results Four articles presenting theories of cervical manipulation were found in the search of literature published during 2008–2011. Nine theories from the literature are presented within the survey: four theories are accepted by more than 50% of the sample. Conclusions When a patient asks how manipulation works, before any of the theories are offered to the patient, it can be elucidated that the theoretical base underpinning every aspect of cervical manipulation is still underdeveloped. This study finds popular theory accepted by over 70% of physiotherapists, namely that spinal manipulation activates mechanoreceptors and proprioceptors, which results in a hypoalgesic effect. Alternatively, one could rely on the approval of the highly qualified physiotherapists who had passed specialized postgraduate examinations; cervical manipulation activates descending inhibitory pain pathways through the midbrain periaqueductal grey region resulting in pain relief.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"1 - 11"},"PeriodicalIF":0.0,"publicationDate":"2015-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1179/1753615414Y.0000000037
I. Kennedy, K. Caldwell
Abstract Purpose To survey the current practice of cervical spine pain assessment in relation to vertebrobasilar artery insufficiency (VBI), attitudes toward guidelines, and the practice of achieving informed consent in advance of planned orthopaedic manual therapy interventions. Method A self-administered postal survey was validated and sent to 325 physiotherapists working in the National Health Service (NHS) and private musculoskeletal practices in the Dorset and Hampshire region. Results The response rate was 53% from NHS physiotherapists and 20% from private practice, overall 34% (n = 111). Compliance rates with published guidelines were 50.4%; the sample holds them in neutral opinion (51.4%), and also holds cervical manipulation in neutral opinion (n = 50; 45.5%). Of these, 30.4% of respondents use cervical manipulation; a practice more closely associated with male practitioners (Φ = 0.35 P < 0.001), most use non-manipulative techniques such as manual traction (86.3%) or mobilizations (96.1%) with exercise (99%) as these are believed to be just as effective. Conclusions Physiotherapists in this sample do not appear to be adopting the VBI guidelines out of confidence or acknowledgment of their validity, but as a means to satisfy legality (76%) and enjoy that security (57.7%). Cervical spine assessment by a physiotherapist may be reliant on detailed subjective assessment that lacks objective testing, which could limit the scope of clinical reasoning between diagnoses of vascular (VBI, arterial dissection) and vestibular sources of symptoms. Those physiotherapists who had not attended postgraduate cervical manual therapy courses were associated with not practicing in agreement with the published evidence base; this finding lends support to the argument for a formal restriction of cervical manipulation by physiotherapists until a minimal requirement of postgraduate training is completed.
{"title":"A cross-sectional postal survey of musculoskeletal physiotherapists’ current practice of cervical pain assessment in relation to vertebrobasilar artery insufficiency, attitudes toward guidelines, and manual therapy practice","authors":"I. Kennedy, K. Caldwell","doi":"10.1179/1753615414Y.0000000037","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000037","url":null,"abstract":"Abstract Purpose To survey the current practice of cervical spine pain assessment in relation to vertebrobasilar artery insufficiency (VBI), attitudes toward guidelines, and the practice of achieving informed consent in advance of planned orthopaedic manual therapy interventions. Method A self-administered postal survey was validated and sent to 325 physiotherapists working in the National Health Service (NHS) and private musculoskeletal practices in the Dorset and Hampshire region. Results The response rate was 53% from NHS physiotherapists and 20% from private practice, overall 34% (n = 111). Compliance rates with published guidelines were 50.4%; the sample holds them in neutral opinion (51.4%), and also holds cervical manipulation in neutral opinion (n = 50; 45.5%). Of these, 30.4% of respondents use cervical manipulation; a practice more closely associated with male practitioners (Φ = 0.35 P < 0.001), most use non-manipulative techniques such as manual traction (86.3%) or mobilizations (96.1%) with exercise (99%) as these are believed to be just as effective. Conclusions Physiotherapists in this sample do not appear to be adopting the VBI guidelines out of confidence or acknowledgment of their validity, but as a means to satisfy legality (76%) and enjoy that security (57.7%). Cervical spine assessment by a physiotherapist may be reliant on detailed subjective assessment that lacks objective testing, which could limit the scope of clinical reasoning between diagnoses of vascular (VBI, arterial dissection) and vestibular sources of symptoms. Those physiotherapists who had not attended postgraduate cervical manual therapy courses were associated with not practicing in agreement with the published evidence base; this finding lends support to the argument for a formal restriction of cervical manipulation by physiotherapists until a minimal requirement of postgraduate training is completed.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"137 - 149"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1179/1753614614Z.00000000087
J. Kouri
s 1. The efficacy of shoulder treatments: An update O. Airaksinen, Manual/Musculoskeletal Medicine the members of the Efficacy Committee of the International Academy of Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland Email: Olavi.Airaksinen@kuh.fi Current literature suggests that the commonest presentations of shoulder pain are due to subacromial impingement syndrome (48–72%), adhesive capsulitis (16–22%), and acute bursitis (e.g.17%). We considered our review of the literature for treatments under three headings: 1. Subacromial inflammation and impingement • Shape of acromion. The acromion may become more curved with progression of degenerative change, but this shows no association with the presence of rotator cuff disease: suggesting that surgical treatments are not necessary for acromial shape alone. A 750% increase in shoulder arthroscopies for subacromial decompression has been recorded in England in the ten years to 2010. • Supervised exercises for impingement. Arthroscopic surgery has been compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). One hundred and twenty-five patients aged 18–66 yeas who had had rotator cuff disease for at least three months and whose condition was resistant to treatment were randomized to receive either (a) arthroscopic subacromial decompression performed by two experienced surgeons; or (b) an exercise regimen over three to six months supervised by one experienced physiotherapist; or 12 sessions of detuned soft laser treatment over six weeks. Analysis showed that either surgery or a supervised exercise regimen significantly, and equally, improved rotator cuff disease compared with placebo. They also compared the costs of the two regimens: the supervised exercises were just over half the cost of the surgery. A follow-up study showed that after 2.5 years, both arthroscopic surgery and supervised exercises are better treatments than placebo. A two-year randomised controlled trial by Ketola et al. concluded that arthroscopic acromioplasty provides no clinically important effects over a structured and supervised exercise programme alone in terms of subjective outcome or cost-effectiveness when measured at 24 months. Structured exercise treatment should be the basis for treatment of shoulder impingement syndrome, with operative treatment offered judiciously until its true merit is proven. Their five-year follow-up study showed no evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome. The effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome was examined in a randomized controlled study. Strengthening with concentric and eccentric exercises and with stabilizing the scapula was used. The study showed that these reduce pain and decrease need for arthroscopic surgery. Studies of surgical interventions in subacromia
{"title":"International Academy of Manual/Musculoskeletal Medicine, Annual Meeting at Berlin, October 2014","authors":"J. Kouri","doi":"10.1179/1753614614Z.00000000087","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000087","url":null,"abstract":"s 1. The efficacy of shoulder treatments: An update O. Airaksinen, Manual/Musculoskeletal Medicine the members of the Efficacy Committee of the International Academy of Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland Email: Olavi.Airaksinen@kuh.fi Current literature suggests that the commonest presentations of shoulder pain are due to subacromial impingement syndrome (48–72%), adhesive capsulitis (16–22%), and acute bursitis (e.g.17%). We considered our review of the literature for treatments under three headings: 1. Subacromial inflammation and impingement • Shape of acromion. The acromion may become more curved with progression of degenerative change, but this shows no association with the presence of rotator cuff disease: suggesting that surgical treatments are not necessary for acromial shape alone. A 750% increase in shoulder arthroscopies for subacromial decompression has been recorded in England in the ten years to 2010. • Supervised exercises for impingement. Arthroscopic surgery has been compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). One hundred and twenty-five patients aged 18–66 yeas who had had rotator cuff disease for at least three months and whose condition was resistant to treatment were randomized to receive either (a) arthroscopic subacromial decompression performed by two experienced surgeons; or (b) an exercise regimen over three to six months supervised by one experienced physiotherapist; or 12 sessions of detuned soft laser treatment over six weeks. Analysis showed that either surgery or a supervised exercise regimen significantly, and equally, improved rotator cuff disease compared with placebo. They also compared the costs of the two regimens: the supervised exercises were just over half the cost of the surgery. A follow-up study showed that after 2.5 years, both arthroscopic surgery and supervised exercises are better treatments than placebo. A two-year randomised controlled trial by Ketola et al. concluded that arthroscopic acromioplasty provides no clinically important effects over a structured and supervised exercise programme alone in terms of subjective outcome or cost-effectiveness when measured at 24 months. Structured exercise treatment should be the basis for treatment of shoulder impingement syndrome, with operative treatment offered judiciously until its true merit is proven. Their five-year follow-up study showed no evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome. The effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome was examined in a randomized controlled study. Strengthening with concentric and eccentric exercises and with stabilizing the scapula was used. The study showed that these reduce pain and decrease need for arthroscopic surgery. Studies of surgical interventions in subacromia","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"156 - 171"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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