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The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical [...]

Objective. The purpose of this study was to translate and to investigate the reliability and validity of the STarT Back screening tool (SBT) in the primary care setting among patients [...]

Background. Health care providers need prognostic factors to distinguish between patients who are likely to recover and those who are not likely to recover. Objective. The aim of this study was to: (1) describe the clinical course of recovery and (2) identify prognostic factors of recovery in patients with shoulder pain at the 26-week follow-up. Design. A prospective cohort study was carried out in the Netherlands and included 389 patients who consulted a physical therapist for a new episode of shoulder pain. Method. Participants were followed for 26 weeks. Potential predictors of recovery were selected from the literature and, with the addition of 2 new variables (ie, use of diagnostic ultrasound and working alliance), evaluated in the multivariable regression analysis. Multiple imputation was used to handle missing data, and bootstrap methods were used for internal validation. Results. The recovery rate was 60% for the total population and 65% for the working population after 26 weeks. Short duration of complaints, lower disability scores, having a paid job, better working alliance, and no feelings of anxiety or depression were associated with recovery. In the working population, only duration of complaints and disability remained in the final model. The area under the receiver operating characteristic curve (AUC) for the final model was 0.67 for the total population and 0.63 for the working population. After internal validation, the AUC was corrected to 0.66 and 0.63, respectively. Limitations. External validation of the prognostic model should be done prior to its use in clinical practice. Conclusion. The results of this study indicate that several factors can predict recovery., Shoulder complaints are common in Western societies and are among the top 3 most occurring musculo-skeletal complaints. (1) Prevalence rates in the Netherlands range from 6.9% to 48% in primary [...]

Background. A higher level of kinesiophobia appears to be associated with poor recovery in patients with sciatica. Objective. The aim of this study was to investigate whether kinesiophobia modifies the effect of physical therapy on outcomes in patients with sciatica. Design. This was a subgroup analysis from a randomized controlled trial. Setting. The study was conducted in a primary care setting. Patients. A total of 135 patients with acute sciatica participated. Intervention. Patients were randomly assigned to groups that received (1) physical therapy plus general practitioners' care (intervention group) or (2) general practitioners' care alone (control group). Measurements. Kinesiophobia at baseline was measured with the Tampa Scale for Kinesiophobia (TSK) and a single substitute question for kinesiophobia (SQK). Pain and recovery were assessed at 3- and 12-month follow-ups. Regression analysis was used to test for interaction between the level of kinesiophobia at baseline and treatment allocation. Subgroup results were calculated for patients classified with high fear of movement and for those classified with low fear of movement. Results. Kinesiophobia at baseline interacted with physical therapy in the analysis with leg pain intensity at 12-month follow-up. Kinesiophobia at baseline did not interact with physical therapy regarding any outcome at 3-month follow-up or recovery at 12-month follow-up. When comparing both treatment groups in the subgroup of patients with high fear of movement (n=73), the only significant result was found for leg pain intensity difference from baseline at 12-month follow-up (intervention group: X=-5.0, SD=2.6; control group: X=--3-6, SD=2.7). Limitations. The post hoc study design and relatively small sample size were limitations of the study. Conclusions. In 135 patients with sciatica, evidence shows that patients with a higher level of kinesiophobia at baseline may particularly benefit from physical therapy with regard to decreasing leg pain intensity at 12-month follow-up., Kinesiophobia and Effects of Physical Therapy on Outcomes in Sciatica Sciatica is characterized by radiating leg pain and related disabilities. 1 It affects many people and has significant medical, social, [...]

Background. Patients with neck pain, headache, torticollis, or neurological signs should be screened carefully for upper cervical spine instability, as these conditions are 'red flags' for applying physical therapy interventions. However, little is known about the diagnostic accuracy of upper cervical spine instability tests. Purpose. The purpose of this study was to evaluate the diagnostic accuracy of upper cervical spine instability screening tests in patients or people who are healthy. Data Sources. PubMed, CINAHL, EMBASE, and RECAL Legacy databases were searched from their inception through October 2012. Study Selection. Studies were included that assessed the diagnostic accuracy of upper cervical instability screening tests in patients or people who are healthy and in which sensitivity and specificity were reported or could be calculated using a 2 x 2 table. Data Extraction and Quality Assessment. Two reviewers independently performed data extraction and the methodological quality assessment using the QUADAS-2. Data Synthesis. Depending on heterogeneity, statistical pooling was performed. All diagnostic parameters (sensitivity, specificity, predictive values, and likelihood ratios) were recalculated, if possible. Results. Five studies were included in this systematic review. Statistical pooling was not possible due to clinical and statistical heterogeneity. Specificity of 7 tests was sufficient, but sensitivity varied. Predictive values were variable. Likelihood ratios also were variable, and, in most cases, the confidence intervals were large. Limitations. The included studies suffered from several biases. None of the studies evaluated upper cervical spine instability tests in patients receiving primary care. Conclusions. The membranes tests had the best diagnostic accuracy, but their applicability as a test for diagnosing upper cervical spine instability in primary care has yet to be confirmed., The prevalence of upper cervical spine instability varies among different types of patients. (1) For patients seeking chiropractic care, a prevalence rate of 0.6% was reported. (1) Upper cervical spine [...]

Background. Longitudinal research on musculoskeletal disorders often makes use of a single measure of recovery, despite the large variation in reported recovery that exists. Patients with an acute ankle sprain often experience no pain or functional disability following treatment, yet report not being fully recovered, or vice versa. Objective. The purpose of this study was to find explanatory variables for reporting recovery by analyzing the extent to which different outcomes (eg, pain intensity) were associated with recovery and how baseline scores of different variables influence this association in adult patients after acute lateral ankle sprain. Design. This was a cohort study based on data collected in a randomized controlled trial (RCT). Methods. This study was constructed within the framework of an RCT. One hundred two patients who incurred an acute ankle sprain were included. Recovery, pain intensity, giving way of the ankle, and Ankle Function Score (AFS) were assessed during the RCT at baseline and at 4 weeks, 8 weeks, 3 months, and 12 months postinjury. Mean differences were calculated between baseline and follow-up. Associations were calculated using linear mixed models, and the influence of baseline scores on these associations was determined using linear regression with interaction. Results. Associations were found between recovery and the mean differences of pain during running on flat and rough surfaces (4 and 8 weeks, 3 months) and between recovery and the mean difference of giving way of the ankle during walking on a rough surface (8 weeks, 3 months). Limitations. This study used data collected from an RCT. Therefore, the study was limited to the outcomes measured in that trial, and some explanatory factors easily could have been missed. Conclusions. This study is the first to identify explanatory variables for reporting recovery in adults after ankle sprain. Pain intensity and giving way of the ankle measured during high ankle load activities make it easier to measure and to generalize recovery in this population and should be the primary outcome measures of interest. This study indicates the huge need to reach consensus about primary outcome measures for research in patients sustaining ankle sprains., Longitudinal research on musculoskeletal disorders often makes use of a single measure of recovery. (1-4) Consequently, an increased emphasis is placed on the patient's serf-reported perceived recovery as an outcome [...]

We thank Whiteford and colleagues for their compliments on the immense task of developing a guideline. Our article is an abbreviated version of the full guideline, which might be the [...]

Background and Purpose. Many conservative treatments are available for adolescents with idiopathic scoliosis, but the evidence for their accepted use is still unclear. The purpose of this study was to evaluate the effectiveness of braces and other conservative treatments of idiopathic scoliosis in adolescents by systematically reviewing the literature. Methods. The literature was searched in the PubMed, CINAHL, Cochrane, and PEDro databases. Studies were selected if the design was a randomized clinical trial or a controlled clinical trial, if all patients had an idiopathic scoliosis, if all patients were less than 18 years of age during the intervention, and if the type of intervention was a conservative one. Two reviewers independently assessed the methodological quality using the Delphi list and performed data extraction. Analysis was based on the levels of evidence. Results. Thirteen studies met the final inclusion criteria, showing a wide range of interventions such as bracing, electrical surface stimulation, and exercises. Discussion and Conclusion. The authors conclude that the effectiveness of bracing and exercises is not yet established, but might be promising. They found no evidence of the effectiveness of electrical stimulation. Key Words: Back pain, Bracing, Evidence-based practice, Exercise movement techniques, Idiopathic scoliosis, Immobilization, Pediatrics, Rehabilitation, Scoliosis, Spinal curvatures, Systematic review, Treatment outcome., According to the Scoliosis Research Society, scoliosis is a lateral deviation of the normal vertical lines of the spine greater than 10 degrees or an in-potency, 3-dimensionalform deviation from the [...]

To the Editor: We were glad when we discovered the article by Lenssinck et al, titled "Effect of Bracing and Other Conservative Interventions in the Treatment of Idiopathic Scoliosis in [...]