Pub Date : 2013-12-01DOI: 10.1179/1753614613Z.00000000057
K. Vincent, O. Valette, Gilles Arnault
Abstract Background The antero-superior impingement syndrome of the shoulder is a condition that is frequently encountered in musculoskeletal practice. Clinical examination tests used to diagnose this pathology are sensitive but not specific. Dynamic ultrasound is of great potential value because this diagnostic tool can be used in addition to the physical examination; it can view the joint in motion and demonstrate impingement. The specificity of Antero-Superior Impingement Syndrome diagnosis may be improved by ultrasonography; however, it is necessary to ascertain that dynamic ultrasound has good reliability in this setting. This study was designed to determine the degree of agreement between examiners for the commonly used tests for the antero-superior impingement syndrome. Methodology Forty-one patients with chronic shoulder pain (>2 months) selected consecutively in private chiropractic consultation. These patients were referred within a week to two experienced radiologists who evaluated the positive or negative nature of two dynamic ultrasound tests: the abduction impingement test and the Hawkins–Kennedy test. Results The Cohen's kappa value was moderate for the abduction impingement test (κ = 0.52, P < 0.05) and poor for the Hawkins–Kennedy test (κ = 0.36, P < 0.05). Conclusion The ultrasound abduction impingement test is reliable when performed in a standardized manner and by experienced practitioners.
摘要背景肩前上撞击综合征是一种在肌肉骨骼实践中经常遇到的疾病。用于诊断这种病理的临床检查是敏感的，但不是特异性的。动态超声是一种除体格检查外的诊断工具，具有很大的潜在价值;它可以观察运动中的关节并显示撞击。超声检查可提高前上冲击综合征诊断的特异性;然而，有必要确定动态超声在这种情况下具有良好的可靠性。本研究旨在确定检查人员对前-上撞击综合征常用检查的一致程度。方法连续选择41例慢性肩痛患者(60 ~ 2个月)进行私诊。这些患者在一周内被转介给两位经验丰富的放射科医生，他们评估两种动态超声检查的阳性或阴性性质:外展撞击试验和霍金斯-肯尼迪试验。结果外展撞击试验的Cohen's kappa值中等(κ = 0.52, P < 0.05)， Hawkins-Kennedy试验的Cohen's kappa值较差(κ = 0.36, P < 0.05)。结论超声外展冲击试验是可靠的，操作规范，有经验。
{"title":"Dynamic ultrasound tests for antero-superior shoulder impingement syndrome: An inter-examiner reliability study","authors":"K. Vincent, O. Valette, Gilles Arnault","doi":"10.1179/1753614613Z.00000000057","DOIUrl":"https://doi.org/10.1179/1753614613Z.00000000057","url":null,"abstract":"Abstract Background The antero-superior impingement syndrome of the shoulder is a condition that is frequently encountered in musculoskeletal practice. Clinical examination tests used to diagnose this pathology are sensitive but not specific. Dynamic ultrasound is of great potential value because this diagnostic tool can be used in addition to the physical examination; it can view the joint in motion and demonstrate impingement. The specificity of Antero-Superior Impingement Syndrome diagnosis may be improved by ultrasonography; however, it is necessary to ascertain that dynamic ultrasound has good reliability in this setting. This study was designed to determine the degree of agreement between examiners for the commonly used tests for the antero-superior impingement syndrome. Methodology Forty-one patients with chronic shoulder pain (>2 months) selected consecutively in private chiropractic consultation. These patients were referred within a week to two experienced radiologists who evaluated the positive or negative nature of two dynamic ultrasound tests: the abduction impingement test and the Hawkins–Kennedy test. Results The Cohen's kappa value was moderate for the abduction impingement test (κ = 0.52, P < 0.05) and poor for the Hawkins–Kennedy test (κ = 0.36, P < 0.05). Conclusion The ultrasound abduction impingement test is reliable when performed in a standardized manner and by experienced practitioners.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"151 - 158"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613Z.00000000057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715988","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 : 2013-12-01DOI: 10.1179/1753614613Z.00000000058
K. Vincent
Abstract The antero-superior impingement syndrome of the shoulder (ASSIS) is a relatively common cause of shoulder pain. The current understanding of its causes, its natural progression, and its diagnosis by physical examination and by complementary tests are described. A systematic literature search regarding the contribution of ultrasound diagnosis was carried out. Method MEDLINE search for ASSIS diagnosis with focus on reliability and validity of dynamic ultrasound studies. Result Eight relevant studies were found, all with significant limitations of quality regarding the most-used techniques, the ultrasound abduction impingement test and the ultrasound Hawkins–Kennedy test. Conclusion Further studies on the reliability and validity of dynamic ultrasound test for ASSIS are required.
{"title":"Dynamic ultrasound in the diagnosis of antero-superior impingement of the shoulder: A literature review","authors":"K. Vincent","doi":"10.1179/1753614613Z.00000000058","DOIUrl":"https://doi.org/10.1179/1753614613Z.00000000058","url":null,"abstract":"Abstract The antero-superior impingement syndrome of the shoulder (ASSIS) is a relatively common cause of shoulder pain. The current understanding of its causes, its natural progression, and its diagnosis by physical examination and by complementary tests are described. A systematic literature search regarding the contribution of ultrasound diagnosis was carried out. Method MEDLINE search for ASSIS diagnosis with focus on reliability and validity of dynamic ultrasound studies. Result Eight relevant studies were found, all with significant limitations of quality regarding the most-used techniques, the ultrasound abduction impingement test and the ultrasound Hawkins–Kennedy test. Conclusion Further studies on the reliability and validity of dynamic ultrasound test for ASSIS are required.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"141 - 150"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613Z.00000000058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716167","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 : 2013-09-01DOI: 10.1179/1753614613Z.00000000051
S. Petrides, T. Saw
Abstract Aim To determine whether cost-savings result from postgraduate education for general practitioners in musculoskeletal medicine. Method Three separate days of postgraduate education in musculoskeletal medicine were carried out for general practitioners, covering early diagnosis and management of common musculoskeletal disorders, with emphasis on clinical examination and aspiration and injection techniques. Following the course, the practitioners were asked to keep a diary noting cases which did not need referral to secondary care as a result of the knowledge obtained and skills learnt from the training. These details were collected and costed by the commissioning group who had paid for the training. Results Figures were available from 17 of the 23 doctors attending the training. Two hundred and twenty-six referrals to secondary care were avoided, the treatments given including injections. The equivalent secondary-care costings were calculated to be £64 952–£148 002, compared with the £50 413 cost of primary care treatment plus the cost of training. A minimum saving of £14 538 is calculated for 12 months practice, with a possible £97 615 over 3 years. Discussion and conclusion This self-reported observational survey suggests that simple postgraduate education in musculoskeletal medicine can be cost-effective. The cost savings may be multiples of the figures quoted as a result of more expensive care being applied in secondary care: other benefits may include improving the patient experience, expediting pain relief, prevention of chronicity, improving hospital efficiency and conversion rates, and improving patient (and general practitioner) satisfaction.
{"title":"Musculoskeletal medicine training cost-effectiveness: Reduction in secondary-care referrals","authors":"S. Petrides, T. Saw","doi":"10.1179/1753614613Z.00000000051","DOIUrl":"https://doi.org/10.1179/1753614613Z.00000000051","url":null,"abstract":"Abstract Aim To determine whether cost-savings result from postgraduate education for general practitioners in musculoskeletal medicine. Method Three separate days of postgraduate education in musculoskeletal medicine were carried out for general practitioners, covering early diagnosis and management of common musculoskeletal disorders, with emphasis on clinical examination and aspiration and injection techniques. Following the course, the practitioners were asked to keep a diary noting cases which did not need referral to secondary care as a result of the knowledge obtained and skills learnt from the training. These details were collected and costed by the commissioning group who had paid for the training. Results Figures were available from 17 of the 23 doctors attending the training. Two hundred and twenty-six referrals to secondary care were avoided, the treatments given including injections. The equivalent secondary-care costings were calculated to be £64 952–£148 002, compared with the £50 413 cost of primary care treatment plus the cost of training. A minimum saving of £14 538 is calculated for 12 months practice, with a possible £97 615 over 3 years. Discussion and conclusion This self-reported observational survey suggests that simple postgraduate education in musculoskeletal medicine can be cost-effective. The cost savings may be multiples of the figures quoted as a result of more expensive care being applied in secondary care: other benefits may include improving the patient experience, expediting pain relief, prevention of chronicity, improving hospital efficiency and conversion rates, and improving patient (and general practitioner) satisfaction.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"117 - 120"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613Z.00000000051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715971","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 : 2013-09-01DOI: 10.1179/1753615413Y.0000000022
Alex Daulat
Abstract Objectives To establish exercise prescription by individual therapists as well as the type and content of group exercise programmes used in clinical practice for management of chronic low back pain (CLBP). Introduction Group exercise programmes are a cost-effective treatment for managing CLBP but lack individualized exercise and education specific to the patient. Those patients for whom English is not their first language may be excluded from attending these programmes. Methods One hundred and fifty-four questionnaires were sent to 15 physiotherapy departments using convenience sampling within the Greater London area including 2 in independent practice. Closed questions and free response spaces provided were used to obtain information on exercise prescription and the content of group exercise programmes. Results There was a 63% response rate. Stretching, core stability, and lumbar stabilization were the most frequently used exercise types by individual therapists. Ninety seven percent of respondents utilized group programmes. Only 47% of all respondents were able to refer non-English speaking patients to the group programmes. The most frequently used group exercise was the Back to Fitness Programme. Group programmes generally lacked individualized exercises and education given on an individual basis. None of the group programmes offered manual therapy. Conclusions An alternative group physiotherapy programme should be considered alongside current programmes consisting of an individualized multimodal exercise programme carried over from the referring therapist. This group programme would consist of individual education sessions and manual therapy if appropriate. This would allow interpreters to be arranged for patients for whom English is not their first language.
{"title":"A physiotherapy survey to investigate the use of exercise therapy and group exercise programmes for management of non-specific chronic low back pain","authors":"Alex Daulat","doi":"10.1179/1753615413Y.0000000022","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000022","url":null,"abstract":"Abstract Objectives To establish exercise prescription by individual therapists as well as the type and content of group exercise programmes used in clinical practice for management of chronic low back pain (CLBP). Introduction Group exercise programmes are a cost-effective treatment for managing CLBP but lack individualized exercise and education specific to the patient. Those patients for whom English is not their first language may be excluded from attending these programmes. Methods One hundred and fifty-four questionnaires were sent to 15 physiotherapy departments using convenience sampling within the Greater London area including 2 in independent practice. Closed questions and free response spaces provided were used to obtain information on exercise prescription and the content of group exercise programmes. Results There was a 63% response rate. Stretching, core stability, and lumbar stabilization were the most frequently used exercise types by individual therapists. Ninety seven percent of respondents utilized group programmes. Only 47% of all respondents were able to refer non-English speaking patients to the group programmes. The most frequently used group exercise was the Back to Fitness Programme. Group programmes generally lacked individualized exercises and education given on an individual basis. None of the group programmes offered manual therapy. Conclusions An alternative group physiotherapy programme should be considered alongside current programmes consisting of an individualized multimodal exercise programme carried over from the referring therapist. This group programme would consist of individual education sessions and manual therapy if appropriate. This would allow interpreters to be arranged for patients for whom English is not their first language.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"106 - 116"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722767","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 : 2013-09-01DOI: 10.1179/1753614613Z.00000000041
R. Ellis
Does musculoskeletal care thrive because there are so many groups of healthcare professionals working in it? Does the care benefit or suffer from some competition and rivalry between different professional groups? Or is communication so variable that cooperation is difficult to achieve? These are just a few of the questions which may come to mind, when you read the book review in our previous issue (2013 No. 2) of Pain Comorbidities, edited by Maria Giamberardino. If you did not read it, you missed an interesting three pages. The book explores research and ideas relating to the fact that typical chronic pain patients almost always have more than one physical condition, and almost always have one or more psychological problems continuing, and are likely to have social problems also. These will need different professional skills; and I would say that the stress that this puts not only on the patient, but also onto the healthcare system is there for all of us to see. In his review, Foell is very fair to all the players, but he is portraying the strange disarray that greets the chronic pain patient. In so many of these patients, musculoskeletal symptoms are an important part. More and more is now known about the causation of chronic pain, its course, and methods of alleviating it, or of alleviating its effects. But in practice, how well is this knowledge applied for the benefit of the patient? Are not Foell and Giamberardino showing that the patient’s ‘journey’ in this area of healthcare may look a bit like Gulliver’s Travels? If the inhabitants of Brobdingnag, Lilliput, and Laputa are shown by Jonathan Swift to be working away earnestly in their various strange ways – rather as he saw European government in the eighteenth century – should we not take care that our difficulty of bringing physical assistance, psychological assistance, and social assistance to our patients might not be caricatured also? As Foell says, it isn’t the modalities of multidimensional treatment that are the problem, it’s the people who deliver these modalities; or rather, certainly in the British National Health Service, the administration which seems to separate, rather than bring these people together. It brings to mind a case observed over 20 or more years: a woman who has led the life of an invalid, with musculoskeletal pain. Early on, the simple diagnosis of fibromyalgia was questioned – could the inability to walk more than a few metres be her only problem? Referral to tertiary care specialists was arranged, but nothing else was ever found. Gradually, she became bedridden for most of the day. The general practitioner did well to rationalize and minimize the medications, such as diazepam and non-opioid analgesics; but from time to time requests for more help had to be responded to. In recent years an inpatient stay in a tertiary care hospital brought no real physical or psychological change, and that hospital’s request was for 6 months of physiotherapy and for occupation
{"title":"Many people, many organizations","authors":"R. Ellis","doi":"10.1179/1753614613Z.00000000041","DOIUrl":"https://doi.org/10.1179/1753614613Z.00000000041","url":null,"abstract":"Does musculoskeletal care thrive because there are so many groups of healthcare professionals working in it? Does the care benefit or suffer from some competition and rivalry between different professional groups? Or is communication so variable that cooperation is difficult to achieve? These are just a few of the questions which may come to mind, when you read the book review in our previous issue (2013 No. 2) of Pain Comorbidities, edited by Maria Giamberardino. If you did not read it, you missed an interesting three pages. The book explores research and ideas relating to the fact that typical chronic pain patients almost always have more than one physical condition, and almost always have one or more psychological problems continuing, and are likely to have social problems also. These will need different professional skills; and I would say that the stress that this puts not only on the patient, but also onto the healthcare system is there for all of us to see. In his review, Foell is very fair to all the players, but he is portraying the strange disarray that greets the chronic pain patient. In so many of these patients, musculoskeletal symptoms are an important part. More and more is now known about the causation of chronic pain, its course, and methods of alleviating it, or of alleviating its effects. But in practice, how well is this knowledge applied for the benefit of the patient? Are not Foell and Giamberardino showing that the patient’s ‘journey’ in this area of healthcare may look a bit like Gulliver’s Travels? If the inhabitants of Brobdingnag, Lilliput, and Laputa are shown by Jonathan Swift to be working away earnestly in their various strange ways – rather as he saw European government in the eighteenth century – should we not take care that our difficulty of bringing physical assistance, psychological assistance, and social assistance to our patients might not be caricatured also? As Foell says, it isn’t the modalities of multidimensional treatment that are the problem, it’s the people who deliver these modalities; or rather, certainly in the British National Health Service, the administration which seems to separate, rather than bring these people together. It brings to mind a case observed over 20 or more years: a woman who has led the life of an invalid, with musculoskeletal pain. Early on, the simple diagnosis of fibromyalgia was questioned – could the inability to walk more than a few metres be her only problem? Referral to tertiary care specialists was arranged, but nothing else was ever found. Gradually, she became bedridden for most of the day. The general practitioner did well to rationalize and minimize the medications, such as diazepam and non-opioid analgesics; but from time to time requests for more help had to be responded to. In recent years an inpatient stay in a tertiary care hospital brought no real physical or psychological change, and that hospital’s request was for 6 months of physiotherapy and for occupation","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"93 - 94"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613Z.00000000041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715510","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 : 2013-09-01DOI: 10.1179/1753615413Y.0000000023
A. Kobesova, Lenka Drdáková, R. Andel, P. Kolář
Abstract Objectives To determine if individuals with adolescent idiopathic scoliosis (AIS) present with significant cerebellar dysfunction and hypermobility when compared with healthy controls. Methods International Cooperative Ataxia Rating Scale (ICARS), pendulum reflexes, and 10 hypermobility tests according to Janda were assessed in 11 subjects with radiologically confirmed structural idiopathic scoliosis and in 11 individuals without scoliosis. Results Idiopathic scoliosis group scored significantly worse in gait and posture ICARS subscale (P = 0.014) and in total ICARS (P = 0.021). There was no significant difference in pendulum reflexes between the groups. Comparing with the healthy controls, the AIS group presented with significant hypermobility in head rotation (P = 0.038) and forward bend tests (P = 0.041). Total evaluation of all 10 hypermobility tests approached statistical significance (P = 0.051) with the AIS group, demonstrating greater hypermobility. Conclusions Signs of cerebellar dysfunction and hypermobility were identified in subjects with idiopathic scoliosis, which may be an important aspect in rehabilitation.
{"title":"Cerebellar function and hypermobility in patients with idiopathic scoliosis","authors":"A. Kobesova, Lenka Drdáková, R. Andel, P. Kolář","doi":"10.1179/1753615413Y.0000000023","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000023","url":null,"abstract":"Abstract Objectives To determine if individuals with adolescent idiopathic scoliosis (AIS) present with significant cerebellar dysfunction and hypermobility when compared with healthy controls. Methods International Cooperative Ataxia Rating Scale (ICARS), pendulum reflexes, and 10 hypermobility tests according to Janda were assessed in 11 subjects with radiologically confirmed structural idiopathic scoliosis and in 11 individuals without scoliosis. Results Idiopathic scoliosis group scored significantly worse in gait and posture ICARS subscale (P = 0.014) and in total ICARS (P = 0.021). There was no significant difference in pendulum reflexes between the groups. Comparing with the healthy controls, the AIS group presented with significant hypermobility in head rotation (P = 0.038) and forward bend tests (P = 0.041). Total evaluation of all 10 hypermobility tests approached statistical significance (P = 0.051) with the AIS group, demonstrating greater hypermobility. Conclusions Signs of cerebellar dysfunction and hypermobility were identified in subjects with idiopathic scoliosis, which may be an important aspect in rehabilitation.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"105 - 99"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722816","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 : 2013-09-01DOI: 10.1179/1753615413Y.0000000021
R. Macdonald
Abstract A critique, originally circulated 15 years ago, of the use of evidence in guidelines concerning rest in low-back pain, is reproduced. The conceptual background against which evidence was considered is discussed with the suggestion that attempts to reconcile data and concept resulted in advice on treatment which is now being questioned. It is necessary to be vigilant lest expectations of evidence unduly influence its assessment.
{"title":"Royal College of General Practitioners Guidelines on bed rest in acute low back pain: A need for re-evaluation","authors":"R. Macdonald","doi":"10.1179/1753615413Y.0000000021","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000021","url":null,"abstract":"Abstract A critique, originally circulated 15 years ago, of the use of evidence in guidelines concerning rest in low-back pain, is reproduced. The conceptual background against which evidence was considered is discussed with the suggestion that attempts to reconcile data and concept resulted in advice on treatment which is now being questioned. It is necessary to be vigilant lest expectations of evidence unduly influence its assessment.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"121 - 125"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722643","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 : 2013-09-01DOI: 10.1179/1753615413Y.0000000020
R. Macdonald
Abstract This discussion of the manipulative method developed by Lawrence Jones explores explanations for the changes in tenderness of characteristic points with position, and consequent effects on somatic dysfunction, in particular restless legs syndrome. Attempts are made to deduce underlying mechanisms of these observations using both established neurophysiology and hypothetical concepts of pain modulation by proprioceptive inputs to the spinal cord. Integral to these propositions would be an association of somatic dysfunction with faults in proprioception by calibration errors of position sense in specific ranges of motion – a distortion of the central body schema.
{"title":"The positional release phenomenon and the effects of Counterstrain manipulation: Reflections and implications","authors":"R. Macdonald","doi":"10.1179/1753615413Y.0000000020","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000020","url":null,"abstract":"Abstract This discussion of the manipulative method developed by Lawrence Jones explores explanations for the changes in tenderness of characteristic points with position, and consequent effects on somatic dysfunction, in particular restless legs syndrome. Attempts are made to deduce underlying mechanisms of these observations using both established neurophysiology and hypothetical concepts of pain modulation by proprioceptive inputs to the spinal cord. Integral to these propositions would be an association of somatic dysfunction with faults in proprioception by calibration errors of position sense in specific ranges of motion – a distortion of the central body schema.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"95 - 98"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722591","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 : 2013-07-01DOI: 10.1179/1753615413Y.0000000019
Y. Tousignant-Laflamme, P. Bourgault, S. Houle, J. Lafaille, J. Roy, L. Roy
Abstract Objective Some studies show that patient education involving self management strategies can be a good way to address the negative impact of psychosocial factors in chronic low back pain (CLBP). The purpose of this study was to describe the clinical changes following a 2.5-hour group education session for patients with non-specific CLBP. Methods Forty-two patients participated in this study; 20 received a 2.5-hour group education session and 22 were assigned to a waiting list. The education session addressed strategic issues in CLBP such as false beliefs, fear-avoidance beliefs, exercises and pain management strategies. The outcomes were pain intensity, pain catastrophizing, pain coping strategies, self-perceived functional status and mood. Data were collected before the education session and 3 months after. Results Three months after the education session, the intervention group showed a clinically significant reduction in the perceived pain intensity and pain catastrophizing thoughts; however, the intra- and inter-group analysis revealed no statistically significant differences in any outcome measures. Conclusion Although brief group education could be an interesting stand alone therapeutic intervention for patients with CLBP, more research is required to better study the type, dose and effectiveness of group education in CLBP.
{"title":"Brief education on chronic low back pain: Brief group education for patients with chronic low back pain – a descriptive study","authors":"Y. Tousignant-Laflamme, P. Bourgault, S. Houle, J. Lafaille, J. Roy, L. Roy","doi":"10.1179/1753615413Y.0000000019","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000019","url":null,"abstract":"Abstract Objective Some studies show that patient education involving self management strategies can be a good way to address the negative impact of psychosocial factors in chronic low back pain (CLBP). The purpose of this study was to describe the clinical changes following a 2.5-hour group education session for patients with non-specific CLBP. Methods Forty-two patients participated in this study; 20 received a 2.5-hour group education session and 22 were assigned to a waiting list. The education session addressed strategic issues in CLBP such as false beliefs, fear-avoidance beliefs, exercises and pain management strategies. The outcomes were pain intensity, pain catastrophizing, pain coping strategies, self-perceived functional status and mood. Data were collected before the education session and 3 months after. Results Three months after the education session, the intervention group showed a clinically significant reduction in the perceived pain intensity and pain catastrophizing thoughts; however, the intra- and inter-group analysis revealed no statistically significant differences in any outcome measures. Conclusion Although brief group education could be an interesting stand alone therapeutic intervention for patients with CLBP, more research is required to better study the type, dose and effectiveness of group education in CLBP.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"65 - 71"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722532","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 : 2013-07-01DOI: 10.1179/1753614613Z.00000000045
B. Sweetman, S. Sweetman
Abstract Aim To create a framework for coordinated testing of treatments on the basis of recognizing common back pain diagnostic subgroups. It is hoped that this approach will help get round the lack of progress encountered with therapeutic trials analyzed on the clumped non-specific back pain approach which has tended to show such small treatment effects. Method Examination of standardized deviates of patients’ opinions of previous treatment responses according to their subdiagnosis, which was attributed by subsequent classification analysis. The study was performed on a subsection of 490 patients from those screened for entry into a randomized controlled trial of physiotherapy treatments. The questions about past treatment included the following broad categories: hard bed, hot bath, shortwave diathermy, exercises, traction, manipulation, and injections. The response categories were better, no effect, or worse. The common presentation of cases was divided into prolapsed intervertebral disk, switching back pain, midline-bilaterally equal, facet joint syndrome, strained back and low thoracic. Results There was considerable variation in treatment response according to subgroup membership with no two groups bearing the same profile. Conclusions It is implied that therapeutic trials performed collectively on all-comers grouped as having non-specific back pain, will not reveal the distinctive responses seemingly shown between subgroups. Because of such differences, the response effects will either dilute out because some groups show no response to a particular treatment, or bad responder effects will cancel out the good. While these results are not intended to be definitive, they may afford a basis for coordinating hypotheses to be tested in formal prospective trials.
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