Journal of chiropractic medicine最新文献

Objectives

Methods

Results

Conclusions

Objective

The purpose of this scoping review was to explore the effects of neural mobilization (NM) on outcomes in adults with diabetic peripheral neuropathy (DPN).

Methods

Five databases were searched—PubMed, Web of Science (Web of Science Core Collection), Physiotherapy Evidence Database (PEDro), and Scopus—from inception to January 2022. The studies included were randomized controlled trials, pre-post single group design, multiple case studies, controlled case studies, quasi-experimental studies, and single case studies, which are published in full text in English.

Results

Six studies were included in this review, and most were of low-level evidence. The sample size of the studies ranges from 20 to 43, except for 1 case study, with a total of 158 participants in all the studies combined. In 4 out of 6 studies, only NM was given, whereas in 2 studies, NM was used along with other treatment strategies. The tibial nerve was the most studied nerve, whereas 1 study administered NM to nerves of the upper limbs, and only 1 trial examined the sciatic nerve. The outcomes included the Michigan Neuropathy Screening Instrument questionnaire, nerve conduction velocity, vibration perception threshold, heat/cold perception threshold, weight-bearing asymmetry and range of motion of lower limb, quality of life, and magnetic imaging changes.

Conclusion

At present, only a few low-level studies exist on the use of NM for the treatment of adults with DPN. The evidence for use of NM on DPN is still limited and insufficient.

Objectives

The purpose of this study was to determine effect sizes (ES) for changes in self-reported measures of musculoskeletal pain and dysfunction resulting from the one-to-zero method using a repeated measures study design.

Methods

Twenty participants presenting with articular dysfunction of the occipito-atlantal (C0-C1) complex were treated using the one-to-zero method, a high-velocity low-amplitude thrust administered between the C0-C1 complex before treating other restrictive segments in a cephalocaudal direction. The participants completed online questionnaires using Google Forms that assessed aspects of the biopsychosocial model of pain at baseline and within a week after treatment. The questionnaires included the following: (1) Demographic and Health Behavior Survey; (2) Neck Bournemouth Questionnaire (NBQ) or Neck Disability Index (NDI); (3) Beck Anxiety Index (BAI); (4) Insomnia Severity Index (ISI); and (5) 36-Item Short Form Health Survey (SF-36). Paired t test or Wilcoxon signed ranks test was performed, dependent on normality. Cohen's d values were calculated for each questionnaire score (0.20 indicative of small; ≥0.50 medium; and ≥0.80 large ES).

Results

The NDI, NBQ, BAI, and ISI had a large ES (all d ≥ 0.80). In the SF-36, 4 subscales had a small to near-medium ES, 1 subscale had a medium to near-large ES, and the remaining 2 had a large ES (d ≥ 0.80). The physical and mental component summary had a large (d = 0.88) and small ES (d = 0.35), respectively.

Conclusion

The effect sizes suggest the one-to-zero treatment induces change in various aspects of the biopsychosocial model.

Objective

The purpose of this study was to evaluate the long-term effects of adding osteopathic manipulative treatment (OMT) to neck exercises compared to exercises alone for individuals with non-specific chronic neck pain (NCNP).

Methods

A randomized controlled trial was conducted by assigning 90 individuals with NCNP into the following 2 groups: (1) exercises group (EG, n = 45) or (2) OMT plus exercises group (OMT/EG, n = 45). All participants received 4 weeks of treatment. The clinical outcomes were recorded at baseline and at 3 and 6 months after the treatment. The primary outcomes were pain and function—Numerical Pain Rating Scale (NPRS), Pressure Pain Threshold, and the Neck Disability Index (NDI). The secondary outcomes included range of motion for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire, and Pain Self-Efficacy Questionnaire.

Results

In comparison to baseline data, both groups had a reduction of NPRS (P < .05) and NDI (P < .05) after the treatment. However, no statistically significant differences in pain intensity or disability were found when OMT/EG was compared to EG alone at 3 months (P = 0.1 and P = 0.2, respectively) and at 6 months (P = 0.4 and P = 0.9, respectively for pain and disability) and no difference was found between OMT/EG and the EG in the secondary outcomes during the same follow-up period (P > .05).

Conclusion

Outcomes of pain and functionality for patients in both groups were improved at 6 months. Our findings show that the combination of OMT and neck exercises for 4 weeks did not improve functionality and reduction of pain in patients with NCNP.

Objective

The aim of the present study was to investigate whether Pilates exercises on the Wunda chair (Going Up Front and Mountain Climb) activate the muscles rectus femoris (RF) and biceps femoris (BF) in 2 situations (foot on the pedal and foot on the seat).

Methods

Sixteen young female Pilates practitioners (18-35 years old) participated in this study. The muscles of their right leg were then submitted to electromyography analysis during the exercises.

Results

Significant differences were found for the RF muscle (maximal voluntary isometric contraction [%MVIC]), which was assessed and compared between the 2 exercises (Going Up Front and Mountain Climb: F = 9.83; P = .03; np² = 0.14); 2 conditions (foot on the pedal and foot on the seat: F = 40.02; P < .001; np² = 0.90) and interactions (F = 14.49; P < .001; np² = 0.20) and for BF muscle (%MVIC) in the comparisons between the 2 conditions (foot on the pedal and foot on the seat: F = 27.5; P < .001; np² = 0.82) and interactions (F = 12.57; P < .001; np² = 0.17). The percentage of cocontraction presented the significant difference in the comparisons between the 2 conditions (foot on the pedal and foot on the seat: F = 24.07; P < .001; np² = 0.286)

Conclusion

Both Pilates exercises activated the thigh core muscles in the moderate and high categories. The highest percentage of cocontraction levels were presented when the foot was resting on the pedal.

Objective

This study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain.

Methods

We performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks.

Results

In the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only.

Conclusion

In this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.

Objective

The purpose of this study was to test the effect of adding diaphragmatic breathing exercises (DBEs) to core stabilization exercises (CSEs) for patients with chronic low back pain (CLPB).

Methods

Twenty-two patients with CLPB were randomly allocated to the experimental (DBE + CSE) or control group (CSE only). They were given 12 treatment sessions 3 times a week for 4 weeks. Patients were evaluated before and after the 12 sessions. Surface electromyography of transverse abdominis, Oswestry Disability Index, Fear Avoidance Belief Questionnaire, Pittsburgh Sleep Quality Index, Numeric Pain Rating Scale, and chest expansion were used as outcome measures for pain, muscle activity, disability, and sleep quality.

Results

The outcome measure scores showed statistical significance of (P = .01) in time effect on muscle activity, sleep quality, disability score, pain score, fear-avoidance belief of patients and chest expansion; and group effect on Fear Avoidance Belief Questionnaire and physical activity parameter (P = .05). An interaction effect (time x group) on muscle activity for right transverse abdominus during tuck in (P = .01) and chest expansion (P = .01) was also found; however, no significant difference was found related to other parameters.

Conclusion

The combination of DBE and CSE interventions compared to CSE alone showed improvement in the measured parameters for patients with CLBP. Incorporating DBE with CSE also improved muscle activation and chest expansion.

Objective

The purpose of this study was to describe how gamification was incorporated into postoperative rehabilitation of a patient recovering from a sternoclavicular dislocation.

Clinical Features

A 23-year-old man sought chiropractic care from an academic chiropractic clinic for persistent right-sided, sternoclavicular joint, moderate-to-severe pain that was exacerbated with shoulder movements and overhead activities. His shoulder was treated previously with reconstructive surgery and a 6-week trial of physical therapy; however, he reported minimal improvement in his pain, and his functional ability was suboptimal.

Intervention and Outcome

Multimodal chiropractic treatment consisted of manual therapy in conjunction with active rehabilitation. The rehabilitation program incorporated gamification principles, such as competition, point scoring, and task focus. After 8 treatments, a clinically significant reduction in his upper extremity functional index score and numerical pain rating was observed.

Conclusion

The patient was managed using a gamified approach to postsurgical sternoclavicular joint rehabilitation and responded positively. Chiropractors may consider including gamified, multimodal care for patients with postoperative musculoskeletal concerns.

Objective

The objectives of this study were to investigate providers’ attitudes toward an artificial intelligence (AI)–based hand hygiene monitoring system and to examine the relationship between provider well-being and satisfaction with the usage of that system.

Methods

A self-administered questionnaire was mailed to 48 health care providers (ie, physicians, registered nurses, and other providers) at a rural medical center in north Texas between September and October 2022. In addition to descriptive statistics, Spearman's correlation test was conducted to discern the relationship between provider satisfaction with the usage of the AI-based hygiene monitoring system and their well-being. A Kendall's tau correlation coefficient test was utilized to assess the correlation between subgroup demographics and survey questions.

Results

With a 75% response rate (n = 36), the providers reported sufficient satisfaction with monitoring system usage and that AI directly affects provider well-being. Providers with more years of experience and younger than 40 years of age reported significantly higher satisfaction with AI technology in general and considered the amount of time that they spent on AI-related tasks as interesting compared with their counterpart providers.

Conclusion

The findings suggest that higher satisfaction with the AI-based hygiene monitoring system was related to greater provider well-being. Providers sought successful implementation of an AI-based tool that met their expectations, but such implementation required marked levels of consolidation to ensure that it fits within the existing workflows and was accepted by users.

Objective

The purpose of this study was to measure the inter-examiner agreement between radiograph markings of 2 National Upper Cervical Chiropractic Association board-certified chiropractors.

Methods

Two chiropractic examiners who had standardized training marked and analyzed 254 conventional orthogonal radiographic film sets. The level of agreement and potential biases in their measurements were assessed using intraclass correlation coefficients for absolute agreement and Bland-Altman plot analyses.

Results

There was 96.1% agreement between the examiners in the measurements of the side of atlas laterality and 94.5% for atlas rotation. The intraclass correlation coefficient was 0.95 (95% CI, 0.93-0.96) for atlas laterality and 0.92 (95% CI, 0.89-0.94) for atlas rotation. The mean difference in the measurement between the 2 examiners was −0.11, P = .12 for atlas laterality and 0.05, P = .55 for atlas rotation. Neither atlas laterality nor atlas rotation measurements were significantly different from zero. Bland-Altman plots were not suggestive of any proportional biases in the 2 measurements.

Conclusion

Results of this study show almost perfect agreement between 2 trained chiropractic examiners, with no apparent proportional bias in the analysis of conventional orthogonal radiographic film sets.