Showing papers in "Journal of Manual & Manipulative Therapy in 2020"
TL;DR: Global themes in clinical practice demonstrated a sudden and dramatic shift away from patient contact, with limited modifications to manual therapy in patient care currently adopted.
Abstract: The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual the...
21 citations
TL;DR: This study showed that a dynamic scapular recognition exercise significantly improvesScapular upward rotation and the ROM of shoulder flexion and abduction after two weeks and these improvements persisted for six months after the performance of this exercise.
Abstract: Background: Examine the ability of a dynamic scapular recognition exercise to improve scapular upward rotation and decrease shoulder pain and disability in patients with adhesive capsulitis...
20 citations
TL;DR: After 3 weeks of SMT or sham SMT in CNSLBP patients, a significant main effect for time signifying reduced hypersensitivity (increased PPT) at local and remote sites along with improved pain and low back-related disability is found.
Abstract: Objectives: The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain.Methods: This project inv...
15 citations
TL;DR: Limited evidence suggests SMT-improved range of motion and was more effective than some other interventions, and future research, using standardized Neurodynamic tests, should explore technique types and evaluate longer-term effects.
Abstract: Objective: Spinal Manipulative Therapy (SMT) is a routinely applied treatment modality for various musculoskeletal conditions, including low back pain. The precise mechanisms by which SMT elicits i...
12 citations
TL;DR: The results of this study indicate that in individuals with neck pain, the PSFS is appropriate however; PSFS 2.0 is the preferred version.
Abstract: Study design: Clinical measurement study.Background: The Patient Specific Functional Scale (PSFS) is a commonly used outcome measure, however answering options differ and content validity has yet to be assessed.Objective: To assess the content validity of the PSFS in patients with neck pain presenting to a physical therapist. And secondly, to assess the construct validity of the PSFS using the preferred version identified in the content validity study.Methods: The target population consisted of patients with neck pain presenting to physical therapy. First, content validity was assessed through semi structured interviews and content thematic analysis. Second, construct validity was assessed on the PSFS 2.0 by examining its correlation with the Neck Disability Index (NDI).Results: Eleven patients were interviewed. Patients indicated the concept of 'activity limitations' is very important to them. The PSFS is considered to be relevant and easy to understand. Patients had an explicit preference for the PSFS 2.0 version (using a different answering option and example list) and indicated they preferred to answer the PSFS 2.0 together with a clinician. One hundred patients participated in the construct validity study on the PSFS 2.0. The median PSFS 2.0 score was 4.5 and the correlation with the NDI was substantial (0.54).Conclusion: The results of this study indicate that in individuals with neck pain, the PSFS is appropriate however; PSFS 2.0 is the preferred version. The PSFS 2.0 is considered to be valid in terms of content validity and construct validity for patients with neck pain.
10 citations
TL;DR: A large RCT to investigate the effects of TDN on MTP in AT is not feasible without modifications due to low recruitment and high attrition rate, so modifications to study design should give consideration for closed or national health-care system for access to large patient populations and reduced financial burden to subjects.
Abstract: The effects of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy (AT) are unknown. We conducted a study to test the feasibility of a large randomized cont...
10 citations
TL;DR: The Sharp-Purser Test may be inappropriate to use due to inconsistent validity, poor inter-rater reliability, and potential to cause harm.
Abstract: Introduction: The Sharp-Purser Test (SPT) is used to assess for atlantoaxial instability (AI) in patients with rheumatoid arthritis (RA). The test is commonly used by clinicians; however, many experts argue it lacks reliability and validity along with concerns of safety. The primary purpose of this review is to determine the diagnostic accuracy of the SPT to detect AI.Methods: A search of five databases was performed from inception to 19 December 2018 using search terms related to the SPT. Studies were eligible for inclusion if the SPT was used on a patient/participant. Methodological quality assessment of diagnostic studies was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) for studies that reported data to calculate sensitivity (SN), specificity (SP), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).Results: The search yielded 1009 articles, and 32 studies met the inclusion criteria for analysis. Meta-analysis on diagnostic accuracy studies assessing the SPT was not possible due to statistical heterogeneity. Six diagnostic accuracy studies assessed the SN of the SPT ranging from 0.19 to 1.00. Four of the studies assessed SP of the SPT ranging from 0.71 to 0.98. The +LR was identified in 4 studies was 0.655, 1.73, 22, and 17.25. The -LR was 1.14, 0.799, 0.571, and 0.323. Seven RCTs utilized the SPT to screen for AI, and the SPT was used in 18 case reports.Conclusion: The SPT may be inappropriate to use due to inconsistent validity, poor inter-rater reliability, and potential to cause harm.Level of evidence: 1.
7 citations
TL;DR: Investigation of the decision-making processes of physical therapists relating to evaluation and categorization of patients with headaches, including consistency with criteria proposed by the International Headache Society, suggests a need for further formal education in physical therapy educational curricula and in post-graduate education.
Abstract: Objective: The purpose of this study was to investigate the decision-making processes of physical therapists relating to evaluation and categorization of patients with headaches, including consistency with criteria proposed by the International Headache Society (IHS).Methods: A national online survey was distributed in cooperation with the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Three hypothetical patient case vignettes featuring headache disorders were used as assessment instruments. Additionally, data on physical therapist education, clinical experience, manual therapy training, self-efficacy, and familiarity & consistency with IHS criteria were collected. Physical therapist identification and valuation of clinical features of headache disorders were also examined in the decision-making processes.Results: Among the 384 respondents, 32.3% classified the tension-type headache case consistent with IHS criteria. The cervicogenic and migraine headache cases were classified at 54.8% and 41.7% consistent with IHS categories, respectively. Experienced clinicians and those with formal manual training categorized patient presentations with greater consistency. Clinician familiarity with IHS classification criteria was low with 73.6% collectively somewhat and not familiar, while 26.4% of physical therapists were self-described as very or moderately familiar.Discussion: Clinicians' headache categorization was significantly affected by symptom misattribution and weighting of individual examination findings. Weighting by practitioners of clinical features varied markedly with greatest emphasis being placed on detailed manual examination procedures, including passive intervertebral movements. Inconsistencies in valuation of clinical features in headache categorization suggest a need for further formal education in physical therapy educational curricula and in post-graduate education, including of IHS criteria and classification.Level of Evidence: 2a.
7 citations
TL;DR: The evolution of manual therapy education: what are the authors waiting for?
Abstract: A string of editorials suggest that the credibility of manual therapy (MT) is at stake [1], MT is not fashionable [2], MT has a questionable future [3] and overall MT is in an identity crisis [4]. ...
7 citations
TL;DR: The profession faces a developing professional trend against manual therapy, and a sudden shift restricting the delivery of manual interventions due to the coronavirus pandemic (COVID-19) further questions the future role of manual therapy.
Abstract: Our profession faces a developing professional trend against manual therapy [1,2]. a sudden shift restricting the delivery of manual interventions due to the coronavirus pandemic (COVID-19) [3,4], ...
7 citations
TL;DR: The goal of this editorial is to outline selected postrandomization biases that can markedly influence a publication's results.
Abstract: Marriage is a potentially wonderful union between two individuals who are in love. Interestingly, almost 50 percent of all marriages in the United States will end in divorce or separation, with 41%...
TL;DR: This study demonstrates that FM® assessment procedures have a high reliability even if applied by practitioners with basic experience and can improve pain and ROM in individuals with primary coxarthrosis.
Abstract: An inter and intra rater reliability (INTERR and INTRAR) study was designed. 71 subjects, with primary hip coxarthrosis, were included and randomly divided in a study group (SG= 36) and a control g...
TL;DR: Do their manual interventions reflect the scientifically proven biomechanical aspects of DDD, or have the authors chosen to ignore the helpful science as they discard the harmful diagnostic label?
Abstract: A recent AAOMPT position paper was published that opposed the use of the term ‘degenerative disc disease’ (DDD), in large part because it appears to be a common age-related finding. While common, t...
TL;DR: The findings of this study show that patients with CSR can be classified and treated via MDT methods and experienced clinically significant improvements in disability, but not pain intensity, at follow-up.
Abstract: A prospective observational cohort study was conducted to (1) report the prevalence of Mechanical Diagnosis and Therapy (MDT) classifications, Centralization (CEN), and Non-CEN among patients with ...
TL;DR: Deep DN with needle manipulation appeared to reduce mechanical pressure sensitivity more than DN without manipulation for patients with LBP, and although a single session of DN could reduce pressure pain sensitivity, it may not be sufficient to improve LM muscle function.
Abstract: Objectives: The purpose of this study was to compare the effects of deep dry needling (DN) with and without needle manipulation on pressure pain thresholds (PPTs) and electromyographic (EMG) amplit...
TL;DR: The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients' source of symptoms is addressed.
Abstract: Objectives: To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention.Methods: Partic...
TL;DR: The procedure presented here is an improvement on the original technique: it is simple, fast, effective, can be performed in any setting, and avoids use of brusque force, which is the factor that causes the patient most discomfort and fear.
Abstract: Anterior mandibular dislocation (AMD) is defined as the displacement of the condylar head out of the glenoid fossa beyond the articular eminence, and that does not reduce spontaneously to its norma...
TL;DR: Clinical practice of the CI appears to be a key factor in determining student use of TJM, which is used in physical therapy practice and taught in entry-level curricula in the United States.
Abstract: Introduction: Thrust joint manipulation (TJM) is used in physical therapy practice and taught in entry-level curricula in the United States (US); however, research regarding implementation by stude...
TL;DR: Real-time, objective feedback using a direct force measurement device improved learning for some aspects of lumbar spine joint mobilization by entry-level physical therapy students.
Abstract: To examine the effects of real-time, objective feedback on learning lumbar spine joint mobilization techniques by entry-level Doctor of Physical Therapy (DPT) students. A randomized, controlled, cr...
TL;DR: Improve in headache symptoms and disability suggests that the musculoskeletal impairments and headache symptoms were more a feature of CGH rather than migraine.
Abstract: People who suffer from headache frequently present with multiple headache forms and the precise diagnosis of the dominant headache form can be challenging. This case report describes a headache sym...
TL;DR: This study confirms previous reports that the Shoulder Derangement and Shoulder Dysfunction classifications are common and represent distinct clinical trajectories when assessed and managed via MDT methods.
Abstract: Objectives: A prospective observational cohort study was conducted to (1) determine the prevalence of Mechanical Diagnosis and Therapy (MDT) syndromes for patients with shoulder impairments...
TL;DR: ‘History warns us, however, that it is the customary fate of new truths to begin as heresies’ -TH Huxely, 1880.
Abstract: ‘History warns us, however, that it is the customary fate of new truths to begin as heresies’.-TH Huxely, 1880In 1847, Ignaz Semmelweis wrote of the importance of handwashing in medical practice. W...
TL;DR: Movement control alterations with low back pain may start as an over-protective co-activation strategy in those with standing-induced LBP and progress to an under-Protective strategy in the back-healthy controls.
Abstract: Objectives: This study compares people with recurrent low back pain (rLBP) and people with pre-clinical low back pain (standing-induced low back pain developers; PDs) to each other and back-healthy...
TL;DR: Although causality cannot be confirmed, serious thoracic AE to include permanent neurological deficit and death have been reported following SMT, highlighting the importance of clinical reasoning, including pre-thrust examination, as part of best and safe practice for SMT.
Abstract: Objectives: Spinal manipulative therapy (SMT) is widely used by manual therapists to manage spinal complaints. Notwithstanding the perceived relative safety of SMT, instances of severe thoracic adv...
TL;DR: These case studies highlight the importance of ensuring expansion of intake questions for possible co-existence of symptoms in both pelvic and musculoskeletal patients, possibly suggesting a mechanical intervention is indicated.
Abstract: Chronic pelvic pain (CPP) with concurrent musculoskeletal and bladder symptoms is a complex and challenging problem. However, clinically the co-existence of these symptoms is not routinely question...
TL;DR: This spinal NTM study was the first to relate resting SBP with short-term pain reduction, demonstrating SBP-related hypoalgesia and SBP’s mediating and moderating role should be investigated.
Abstract: Objectives: To evaluate the association of resting blood pressure with pain response and evaluate the cardiovascular effects of anterior-to-posterior [AP] versus lateral [LAT] techniques of cervica...
TL;DR: A 67-year-old female with a 5-year history of left-sided subjective tinnitus, neck pain, and headache is referred for physiotherapy and evaluated and treated according to MDT principles, with treatment focusing on tailored self-management.
Abstract: Objectives: Tinnitus is the perception of sound without any external auditory stimulus. Cervicogenic somatic tinnitus (CST) is a subset in which symptoms are modulated by maneuvers of the neck. The...
TL;DR: Self-reported outcomes from a postprofessional PT fellowship program, including graduate professional, educational, and research involvement; perceptions of the impact of training on clinical and professional attributes; changes in employment and income; and barriers to training are determined.
Abstract: Introduction: Little research exists investigating the personal and professional outcomes of postprofessional physical therapy (PT) training. Therefore, the purpose of the current descriptive, web-...
TL;DR: Preliminary evidence that MDT may be effective in classifying and treating patients with Morton’s neuroma is provided, demonstrating rapid and lasting improvement in three patients referred to PT services with medically diagnosed MN.
Abstract: Objectives: Morton’s neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for MN are sparse, and utility of phy...
TL;DR: A safety zone of needling less than 2.5 cm lateral is likely safe, but needs to be confirmed with future study due to the higher frequency of not contacting a bony backdrop.
Abstract: Objective: When inserting a dry needle laterally into the upper lumbar spine (L1-L3) there is an increased risk of piercing the kidney; therefore, the objective of this study was to determine a zone of safety for practitioners to needle in the upper lumbar spine.Methods: Ten cadavers were screened for inclusion. L1 spinous process was identified and confirmed with ultrasound imaging. A digital caliper was used to measure laterally at 1.5 cm, 2.0 cm, and 2.5 cm. Dry needles were inserted maximally at each point and a binary decision, yes or no, was made to determine if bony contact was made. Needle depth and abdominal width measurements were also recorded. Safety of the dry needling procedure was interpreted as such if bony contact was made by the needle. If bony contact was made, then it was assumed that the needle cannot advance further into pleura or kidney.Results: Forty-four percent of needles did not make bony contact at 2.5 cm lateral of the L1 spinous process, whereas 22% did not make bony contact at 1.5 cm and 2.0 cm. There was a weak to moderate negative correlation between abdominal width measurements and needle depth at 1.5 cm (-0.48) and 2.0 cm (-0.45), and at 2.5 cm (-0.39).Conclusion: A safety zone of needling less than 2.5 cm is likely safe, but needs to be confirmed with future study. Dry needling 2.5 cm lateral appears more risky due to the higher frequency of not contacting a bony backdrop.