Search

To evaluate the effect of neck-specific exercise (NSE) compared to prescribed physical activity (PPA) on headache and dizziness in individuals with cervical radiculopathy (CR). Also, to investigate associations between headache or dizziness and pain, neck muscle endurance (NME), neck mobility, physical activity, and fear avoidance beliefs. Individuals randomized to either NSE or PPA were selected to a headache subgroup (n = 59) and/or a dizziness subgroup (n = 73). Data were evaluated, according to headache and/or dizziness outcomes at baseline and at 3, 6, and 12-month follow-ups. No significant between-group differences were found between NSE and PPA in either subgroup. In the headache subgroup, significant within-group improvements were seen at all follow-ups for NSE (p <.001) and from baseline to 3 (p =.037) and 12 (p =.003) months for PPA. For dizziness, significant within-group improvements were seen from baseline to 3 months for NSE (p =.021) and from baseline to 3 (p =.001) and 6 (p =.044) months for PPA. Multiple regression models showed significant associations at baseline between headache intensity and neck pain (adjusted R-square = 0.35, p <.001), and for dizziness with neck pain and dorsal NME (adjusted R-square = 0.34, p <.001). NSE and PPA show similar improvements in headache intensity and dizziness in individuals with CR. Headache intensity is associated with neck pain, and dizziness with neck pain and dorsal NME, highlighting the importance of these factors when evaluating headache and dizziness. [ABSTRACT FROM AUTHOR]

Systematically evaluate the comparative effectiveness of dry needling (DN) or local acupuncture to various types of wet needling (WN) for musculoskeletal pain disorders (MPD). Seven databases (PubMed, PEDro, SPORTDiscus, CINAHL, Scopus, Embase, and Cochrane Central Register of Controlled Trials) were searched following PROSPERO registration. Randomized clinical trials were included if they compared DN or local acupuncture with WN for MPD. Primary outcomes were pain and/or disability. The Revised Cochrane Collaboration tool (RoB 2.0) assessed the risk of bias. Twenty-six studies were selected. Wet Needling types included cortisone (CSI) (N = 5), platelet-rich plasma (PRP) (N = 6), Botox (BoT) (N = 3), and local anesthetic injection (LAI) (N = 12). Evidence was rated as low to moderate quality. Results indicate DN produces similar effects to CSI in the short-medium term and superior outcomes in the long term. In addition, DN produces similar outcomes compared to PRP in the short and long term and similar outcomes as BoT in the short and medium term; however, LAI produces better pain outcomes in the short term. Evidence suggests the effectiveness of DN to WN injections is variable depending on the injection type, outcome time frame, and diagnosis. In addition, adverse event data were similar but inconsistently reported. PROSPERO Registration: 2019 CRD42019131826 Dry needling produces similar effects for pain and disability in the short and medium term compared to cortisone, Botox, and platelet-rich plasma injections. Local anesthetic injection may be more effective at reducing short-term pain. Long-term effects on pain and disability are similar between dry needling and platelet-rich plasma injections, but dry needling may produce better long-term outcomes than cortisone injections. The available adverse event data is similar between dry and wet needling. The conclusions from this study may be beneficial for patients and clinicians for considering risk and cost benefit analyses. [ABSTRACT FROM AUTHOR]

Background: Neck pain is among the most prevalent and costly musculoskeletal disorders. Manual therapy and exercise are two standard treatment approaches to manage neck pain. In addition, clinical practice guidelines recommend a multi-modal approach, including both manual therapy and exercise for the treatment of neck pain; however, the specific effects of these combined interventions have not recently been reported in the literature. Objective: To perform a systematic review and meta-analysis to determine the effect of manual therapy combined with exercise on pain, disability, and quality of life in individuals with nonspecific neck pain. Design: Systematic Review and Meta-Analysis Methods: Electronic database searches were completed in PubMed, CINAHL, Cochrane, EMBASE, Ovid, and SportDiscus, with publication dates of January 2000 to December 2022. The risk of bias in the included articles was completed using the Revised Cochrane Risk of Bias Tool (RoB 2). Raw data were pooled using standardized mean differences and mean differences for pain, disability, and quality of life outcomes, and forest plots were computed in the metaanalysis. Results: Twenty-two studies were included in the final review. With moderate certainty of evidence, three studies demonstrated no significant difference between manual therapy plus exercise and manual therapy alone in pain (SMD of −0.25 (95% CI: −0.52, 0.02)) or disability (−0.37 (95% CI: −0.92, 0.18)). With a low certainty of evidence, 16 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing pain (−0.95 (95%CI: −1.38, −0.51)). Similarly, with low certainty of evidence, 13 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing disability (−0.59 (95% CI: −0.90, −0.28)). Four studies demonstrated that manual therapy plus exercise is significantly better than a control intervention for reducing pain (moderate certainty) (−2.15 (95%CI: −3.58, −0.73)) and disability (low certainty) (−2.39 (95% CI: −3.80, −0.98)). With a high certainty of evidence, four studies demonstrated no significant difference between manual therapy plus exercise and exercise alone in quality of life (SMD of −0.02 (95% CI: −0.21, 0.18)). Conclusion: Based on this systematic review and meta-analysis, a multi-modal treatment approach including exercise and manual therapy appears to provide similar effects as manual therapy alone, but is more effective than exercise alone or other interventions (control, placebo, ‘conventional physical therapy’, etc.) for the treatment of nonspecific neck pain and related disability. Some caution needs to be taken when interpreting these results given the general low to moderate certainty of the quality of the evidence. [ABSTRACT FROM AUTHOR]

Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR. Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice. Experts agree effectiveness of interventions differs through the evolution of LR. To date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition. Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication. Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered. Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity. [ABSTRACT FROM AUTHOR]

To determine the effect of action observation (AO) training on the walking ability of patients post stroke. MEDLINE, CINAHL, EMBASE and PEDro were searched systematically for human studies written in English up to August 31st 2021. Two authors screened titles and abstracts against predefined inclusion criteria; a third author resolved discrepancies. Data were analyzed through qualitative synthesis. Articles evaluating the effects of AO training on the walking ability of patients post stroke were included. Methodological quality was assessed using the PEDro scale. From first search that included 1,578 studies, 7 were included in this review. According to the PEDro scale, most of the studies exhibited a methodological quality between Good and Fair (N = 6). Most of the studies applied a protocol based on a 30-minute training session applied 3 to 5 times per week over a 4-week period (N = 5). Using clinical measures and gait parameters, all studies confirmed the beneficial effects of AO training on walking ability. However, the effects of AO training on walking ability were not confirmed at the long-term follow-up. AO training has a positive effect on the walking ability of patients post stroke. Additional studies are needed to confirm these results across the entire spectrum of patient's post stoke including long-term clinical effects. Action observation training can have potentially positive effects on the walking ability of stroke patients. Clinical measurements (10-meter walk test) and gait parameters (stride length and gait speed) could be used to assess the effect of action observation training on walking ability. The patient's concentration is an important factor to consider when applying observational training. [ABSTRACT FROM AUTHOR]

Lower limb disability is common in chronic stroke patients, and aquatic therapy is one of the modalities used for the rehabilitation of these patients. To summarize the evidence of the effects of aquatic therapy on lower limb disability compared to land-based exercises in post-stroke patients. MEDLINE, PsycInfo, CENTRAL, SPORTDiscus, PEDro, PsycBITE, and OT Seeker were searched from inception to January 2019. The search included only randomized clinical trials. Two reviewers independently examined the full text and conducted study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from the included studies. The quantitative analysis incorporated fixed-effect models. Of the 150 studies identified in the initial search, 17 trials (629 participants) satisfied the eligibility criteria. Aquatic therapy improved balance based on the Berg Balance Scale (BBS) (standardized mean difference [SMD], 0.72; 95% confidence interval [CI], 0.50–0.94; I2 = 67%) compared with land-based exercises (control). Also, aquatic therapy had a small positive effect on walking speed (SMD, −0.45; 95% CI {-0.71 – (−0.19)}; I2 = 57%), based on the results of the 10-m walking test, compared to controls. Aquatic therapy had a small positive effect on mobility (based on Timed Up and Go), (SMD, −0.43; 95% CI {-0.7-(- 0.17)}; I2 = 71%) compared to land-based exercise (control). Aquatic therapy had a more positive effect on walking speed, balance, and mobility than land-based exercises. Further research is needed to confirm the clinical utility of aquatic therapy for patients following stroke in the long term. [ABSTRACT FROM AUTHOR]

Patients with ulnar neuropathy usually experience sensory disturbances, weakness, and decreased function; however, optimal treatment approaches for this condition are not conclusive. A 48-year-old male with cubital tunnel syndrome was previously managed with a multimodal approach including splinting, neural mobilizations, and exercises with no change in symptoms. Approximately 1 year after the initial onset, he received three sessions of ultrasound-guided percutaneous electrical stimulation (PENS) and self-neural glides as a home program. After PENS intervention, the patient experienced a dramatic improvement in function and symptoms as measured by the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale as outcomes. These improvements were maintained after 1, 3, 6, and 12 months. The patient also experienced self-perceived improvement in his condition as measured by the Global Rating of Change (GROC) at each follow-up. A patient with ulnar nerve entrapment at the elbow did not respond to a multimodal conservative care for the previous year. Once the patient was treated with ultrasound-guided PENS targeting the ulnar nerve, full functional recovery and resolution of symptoms were documented. Future clinical studies should examine the effects of PENS in managing neural entrapment syndromes on a statistically powered sample of patients. [ABSTRACT FROM AUTHOR]

To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH). A randomized controlled crossover trial was conducted on 48 participants (mean age: 34.4 years) with CeH symptoms. Participants were randomized to 6 sessions of TSM or no treatment (Hold) and after 4-weeks, groups crossed over. Outcomes were collected at 4, 8 and 12 weeks and included: headache disability inventory (HDI), neck disability index (NDI), and the global rating of change (GRC). Outcomes were analyzed using a linear mixed-effects model with Bonferroni correction. Odds of achieving the minimal clinically important difference (MCID) on the GRC of +4 or greater were also calculated. Scores at 4 weeks represent the only timepoint where 1 group is fully treated and other group has not received any treatment. Comparing hold to active treatment, HDI were not significantly different between groups (mean difference = 7.39, 95 CI: −4.39 to 19.18; P = 0.214) at any timepoint; the NDI was significant (mean difference = 6.90, 95 CI: 0.05 to 13.75; P = 0.048) at 4 weeks. Odds of achieving the +4 MCID on the GRC (OR = 38.0, 95 CI: 6.6 to 220.0; p < 0.001) favored TSM at 4 weeks. TSM had no effect on headache-related disability but resulted in significant improvements in neck-related disability and participant reported perceived improvement. Future studies are needed to examine the long-term impact of TSM in this population. [ABSTRACT FROM AUTHOR]

Patients in the chronic phase after a stroke are an underrepresented group in the literature. Therefore, the aim of this study was to compare the effects of cycling and functional electrical stimulation with linear versus interval patterns of timing on gait parameters in patients after stroke. A double blinded, parallel, randomized clinical trial. Neuroscience Institute. Patients with lower limb disability due to stroke (N = 30) with a stroke onset >6 months and <18 months. Twenty-eight minutes of leg cycling with functional electrical stimulation with linear or interval patterns of timing applied to the peroneal and biceps femoris muscles, 3 times/week for 4 weeks. Timed 10-Meter Walk Test and Functional Ambulation Classification were the primary outcome measures. The Modified Modified Ashworth scale, active range of motion, Timed Up and Go Test, and Single Leg Stance Test were the secondary outcome measures. Evaluation was performed at baseline, after 4, and after 8 weeks. Thirty participants completed the 4-week intervention (interval group, n = 16; linear group, n = 14). The Functional Ambulation Classification, Timed 10-Meter Walk Test, and the Timed Up and Go Test improved significantly in both groups. The Modified Modified Ashworth scale scores for quadriceps and plantar flexion statistically decreased after 4-weeks in the interval group. Significant group-by-time interaction was shown for Timed Up and Go Test (p = 0.003, np2=0.228), knee flexion active range of motion (p < 0.001, np2=0.256) and dorsiflexion active range of motion (p < 0.001, np2=0.359). Modified Modified Ashworth scale and active range of motion in both the ankle and knee improved significantly in the interval group. The functional electrical stimulation with cycling protocols improved the Functional Ambulation Classification, Timed 10-Meter Walk Test, active range of motion, Timed Up and Go Test, and Modified Modified Ashworth scale. An interval protocol of timing was more effective than the linear protocol in terms of spasticity and active range of motion. Cycling + functional electrical stimulation training with an interval pattern of timing seems superior to cycling + functional electrical stimulation training with a linear pattern. Interval protocol has positive effects on spasticity and range of motion after 12 sessions in patients post stroke. Cycling + functional electrical stimulation improves functional mobility and speed in stroke survivors and the effects of this intervention lasted in follow-up assessment after one month. [ABSTRACT FROM AUTHOR]

Objectives: To describe the outcomes of 10 patients with chronic biceps tendinopathy treated by physical therapy with the novel approach of dry needling (DN), eccentric-concentric exercise (ECE), and stretching of the long head of the biceps tendon (LHBT). Methods: Ten individuals reporting chronic anterior shoulder symptoms (> 3 months), pain with palpation of the LHBT, and positive results on a combination of tests including active shoulder flexion, Speed's, Hawkins Kennedy, Neer, and Yergason's tests participated in this case series. Validated self-reported outcome measures including the mean numeric pain rating scale (NPRS) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were taken at baseline. Participants were treated with two to eight sessions of DN to the LHBT and an ECE program and stretching of the biceps muscle. At discharge, patients completed the global rating of change (GROC), QuickDASH and NPRS. Results: Patients had an improved mean NPRS of 3.9 (SD, 1.3; p < 0.001), QuickDASH of 19.01% (SD, 10.8; p < 0.02) and GROC +5.4 (SD, 1.3). Conclusion: Findings from this case series suggest that DN and ECE may be beneficial for the management of patients with chronic LHBT tendinopathy. Further research on the efficacy of this novel treatment approach is warranted. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the psychometric properties of the neck disability index (NDI) and numeric pain rating scale (NPRS) in patients with neck pain (NP) without concomitant upper extremity (UE) symptoms. Design: A secondary psychometric analysis of 107 patients with NP without UE symptoms. Test-retest reliability, construct validity, area under the curve (AUC), minimum detectable change (MDC), and minimum clinically important difference (MCID) were calculated.Results: The NDI exhibited excellent reliability (ICC = 0.88; [0.63 to 0.95]), while the NPRS exhibited moderate reliability (ICC = 0.67; [0.27 to 0.84]). The AUC for both the NDI (0.86; [0.79 to 0.93]) and NPRS (0.81 [0.73 to 0.90]) was acceptable. The MDC for the NDI was 6.9, and the MCID for the NDI was 5.5(Sn = 0.83; Sp = 0.79). For the NPRS, the MDC was 2.6, and the MCID was 1.5(Sn = 0.93; Sp = 0.64). Conclusion: The threshold for MCID for the NDI and NPRS in patients without UE symptoms is lower (NDI = 5.5; NPRS = 1.5) than that of patients with UE/radicular symptoms (NDI = 8.5 points; NPRS = 2.2). Knowledge of these cut-scores in each presentation of NP is needed for successful research and clinical treatment. Additional outcomes may be warranted for patients with UE symptoms. [ABSTRACT FROM AUTHOR]

Background: Dizziness is a common condition which may lead to loss of function and disability. Vestibular Rehabilitation Therapy (VRT) may be utilized to affect the vestibular system and reduce dizziness. However, controversy exists regarding the most effective interventions to treat dizziness. Objectives: To examine the effectiveness of VRT compared to other conservative treatments in reducing dizziness and disability. Methods: A literature search was performed using different combinations of the terms: dizziness, physical therapy, vertigo, vestibular, cervicogenic dizziness to identify randomized clinical trials comparing VRT to conservative treatments. The Cochrane Risk of Bias Tool was used to assess the quality of each included study. Additionally, a meta-analysis and qualitative analysis of the evidence was performed. Results: Ten studies were included in the systematic review. Only four studies were included in the meta-analysis due to lack of adequate data reported for continuous outcomes. Eight studies scored less than a 69% on the Cochrane risk of bias tool indicating a low to moderate risk of bias. The meta-analysis revealed that VRT was found to be more effective than conservative treatment for short term outcomes (0–3 weeks) but not long-term outcomes (4 or more weeks). The results from the studies excluded from the meta-analysis but included in the systematic review are inconclusive. Conclusions: VRT was only found to be more effective than other conservative treatments in the short term. [ABSTRACT FROM AUTHOR]

Background: Cervicogenic (CGH) and tension-type (TTH) headaches are prevalent conditions that are associated with considerable pain and disability. Joint mobilization and manipulation are common interventions used by physical therapists to manage individuals with musculoskeletal conditions. However, there is controversy surrounding their effectiveness. Objectives: To evaluate the effectiveness of mobilization and manipulation (MM) compared to other conservative treatments on reducing pain, frequency, and disability in patients with CGH and TTH. Methods: A literature search using terms related to mobilization, manipulation, CGH, and TTH was conducted to identify randomized clinical trials comparing MM to conservative treatment in treating CGH and TTH. The overall quality of the evidence was assessed using the Cochrane risk-of-bias tool. Meta-analysis and qualitative synthesis of the evidence were performed. Results: Nine total studies were included in the systematic review. The majority of studies scored lower than a 69% on the Cochrane risk of bias tool indicating a moderate to high risk of bias. MM were found to be equally as effective as conservative treatment in reducing pain, disability, and frequency of headache in individuals with CGH. MM had statistically significant short-term (1–4 weeks) improvements over conservative treatment for TTH on pain and disability, but not frequency. When comparing the effectiveness of MM versus conservative treatment for TTH, both groups exhibited improvement between 1–3 months in all three outcomes. Conclusions: Manipulation and mobilization were only found to be more effective than conservative care at short-term follow up for individuals with TTH. [ABSTRACT FROM AUTHOR]

Objective: Patient expectations are related to treatment outcome across a broad variety of patient conditions. Here we sought to examine factors associated with the expectation of complete relief from treatment for spinal pain. Design: Secondary analysis of data pooled from two randomized controlled trials of conservative rehabilitation interventions. Patients: 252 patients (103 men, 149 women) with neck (n = 140) or back (n = 112) pain. Methods: We used logistic regression model with backward elimination to test which patient clinical or demographic factors were most related to the expectation of complete relief. Main Outcome Measures: The expectation of complete recovery, which was collected at the baseline examination visit in the primary trials. Results: The final model examining the contributions of patient and clinical characteristics to the expectation of complete relief included two significant interactions. First, increasing disability was associated with increased odds of expecting complete recovery in women while there was very little change for men across levels of disability (OR 0.9 [95%CI 0.8, 0.9]). Second, patients with low fear and a sudden onset of pain had higher odds of expecting recovery than patients with a gradual onset of pain (OR 0.7 [95%CI 0.5, 0.97]). A main effect for education level of the patient was also significant with better odds for expecting complete recovery for college educated patients compared to those with graduate school education (OR 5.0 [95%CI 1.9, 13.4]). Conclusion: The results should assist physical therapists to recognize patients who may have lower expectations of recovery and plan pre-treatment education interventions. [ABSTRACT FROM AUTHOR]

Purpose:This systematic literature review aimed at examining the validity and applicability in everyday clinical rehabilitation practise of methods for the assessment of back muscle fatiguability in patients with chronic non-specific low back pain (CNSLBP). Methods:Extensive research was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to September 2014. Potentially relevant articles were also manually looked for in the reference lists of the identified publications. Studies examining lumbar muscle fatigue in people with CNSLBP were selected. Two reviewers independently selected the articles, carried out the study quality assessment and extracted the results. A modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale was used to evaluate the scientific rigour of the selected works. Results:Twenty-four studies fulfilled the selection criteria and were included in the systematic review. We found conflicting data regarding the validity of methods used to examine back muscle fatigue. The Biering-Sorensen test, performed in conjunction with surface electromyography spectral analysis, turned out to be the most widely used and comparatively, the most optimal modality currently available to assess objective back muscle fatigue in daily clinical practise, even though critical limitations are discussed. Conclusions:Future research should address the identification of an advanced method for lower back fatigue assessment in patients with CNSLBP which, eventually, might provide physical therapists with an objective and reliable test usable in everyday clinical practise.Implications for RehabilitationDespite its limitations, the Biering-Sorensen test is currently the most used, convenient and easily available fatiguing test for lumbar muscles.To increase validity and reliability of the Biering-Sorensen test, concomitant activation of synergistic muscles should be taken into account.Pooled mean frequency and half-width of the spectrum are currently the most valid electromyographic parameters to assess fatigue in chronic non-specific low back pain.Body mass index, grading of pain and level of disability of the study population should be reported to enhance research quality. [ABSTRACT FROM AUTHOR]

The potential environmental effects of increased U.S. biofuel production often vary depending upon the location and type of land used to produce biofuel feedstocks. However, complete, annual data are generally lacking regarding feedstock production by specific location. Corn is the dominant biofuel feedstock in the U.S., so here we present methods for estimating where bioethanol corn feedstock is grown annually and how much is used by U.S. ethanol biorefineries. We use geospatial software and publicly available data to map locations of biorefineries, estimate their corn feedstock requirements, and estimate the feedstock production locations and quantities. We combined these data and estimates into a Bioethanol Feedstock Geospatial Database (BFGD) for years 2005–2010. We evaluated the performance of the methods by assessing how well the feedstock geospatial model matched our estimates of locally-sourced feedstock demand. On average, the model met approximately 89 percent of the total estimated local feedstock demand across the studied years—within approximately 25-to-40 kilometers of the biorefinery in the majority of cases. We anticipate that these methods could be used for other years and feedstocks, and can be subsequently applied to estimate the environmental footprint of feedstock production. Implications: Methods used to develop the Bioethanol Feedstock Geospatial Database (BFGD) provide a means of estimating the amount and location of U.S. corn harvested for use as U.S. bioethanol feedstock. Such estimates of geospatial feedstock production may be used to evaluate environmental impacts of bioethanol production and to identify conservation priorities. The BFGD is available for 2005–2010, and the methods may be applied to additional years, locations, and potentially other biofuels and feedstocks. [ABSTRACT FROM PUBLISHER]

This study evaluated the inter-rater reliability of select examination procedures in patients with neck pain (NP) conducted over a 24- to 48-h period. Twenty-two patients with mechanical NP participated in a standardized examination. One examiner performed standardized examination procedures and a second blinded examiner repeated the procedures 24-48 h later with no treatment administered between examinations. Inter-rater reliability was calculated with the Cohen Kappa and weighted Kappa for ordinal data while continuous level data were calculated using an intraclass correlation coefficient model 2,1 (ICC2,1). Coefficients for categorical variables ranged from poor to moderate agreement (-0.22 to 0.70 Kappa) and coefficients for continuous data ranged from slight to moderate (ICC2,1 0.28-0.74). The standard error of measurement for cervical range of motion ranged from 5.3° to 9.9° while the minimal detectable change ranged from 12.5° to 23.1°. This study is the first to report inter-rater reliability values for select components of the cervical examination in those patients with NP performed 24-48 h after the initial examination. There was considerably less reliability when compared to previous studies, thus clinicians should consider how the passage of time may influence variability in examination findings over a 24- to 48-h period. [ABSTRACT FROM AUTHOR]

The purpose of this case series was to describe the outcomes of patients with temporomandibular disorder (TMD) treated with mobilization with movement (MWM) directed at the temporomandibular joint (TMJ) and the cervical spine, thoracic manipulation, and trigger point (TrP) dry needling. Fifteen patients with TMD completed the Steigerwald/Maher TMD disability questionnaire, the Visual Analog Scale (VAS), and maximal mouth opening (MMO) at baseline. The VAS and MMO were also collected at 15 days posttreatment and at a 2-month follow-up, and the Steigerwald/Maher TMD disability questionnaire was completed at the 2-month follow-up. Repeated measure ANOVAs were used to determine the effects of the intervention on each outcome. Within-group effect sizes were calculated in order to assess clinical effectiveness. Fifteen patients participated in this case series. The ANOVA revealed significant decreases (all, p  <  0.01) VAS mean, VAS Worst, and VAS Best between baseline and final visit of 25.7 (95% CI; 17.7, 33.8); 33.2 (95% CI; 23.4, 43.0); 18.4 (12.1, 24.7); and 28.3 (95% CI; 18.8, 37.9); 36.1 (95% CI; 25.0, 47.3); 19.7 (95% CI; 12.8, 26.7) between baseline and the 2-month follow-up periods, respectively. Additionally, the ANOVA revealed significant increases (all, p  <  0.01) in MMO and disability following the physical therapy management strategy between baseline and final visit with a mean of 11.4 (95% CI, 6.9, 15.9) and 10.2 (95% CI, 5.2, 15.2) between baseline and the 2-month follow-up. Within-group effect sizes were large ( d  >  1.0) for all outcomes at both follow-up periods. Patients with TMD treated with a multimodal treatment exhibited significant and clinical improvements in pain intensity, disability, and MMO. [ABSTRACT FROM AUTHOR]

The term 'regional interdependence' or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient's primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas. The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: Thrust manipulation to the spine has been shown to be an effective treatment for pain reduction associated with musculoskeletal disorders. However, the mechanisms of action tied to this intervention have yet to be sufficiently explained. Objectives: This manuscript reviews the literature related to supraspinal mechanisms associated with pain inhibition, which may also be associated with hypoalgesia following spinal manipulation. Such information adds to the current body of evidence that has demonstrated centrally mediated hypoalgesic effects following manipulation to be influenced by both dorsal horn inhibition and patient expectation. Major findings: Areas believed to be responsible for processing pain include the amygdala, anterior cingulate, thalamus, insula, cerebellum, primary and secondary somatosensory cortices, periaqueductal grey, or dorsal horn. The periaqueductal grey receives information from spinoreticular and spinomesencephalic pathways in the spinal cord, as well as descending information from the amygdala and cortex. The inhibition of sensory stimuli in the dorsal horn may result in decreased projection of ascending information to the periaqueductal grey and modulation from higher-level cortical structures. Neuroimaging research in animals has demonstrated activation of such cortical structures in response to pain with subsequent decreased activation of these areas following joint mobilization. Researchers have yet to identify supraspinal structures associated with spinal manipulation in human subjects. Conclusions: Future investigation should strive to identify supraspinal structures activated in human subjects following thrust manipulation. The identification of cortical and subcortical structures associated with hypoalgesia following spinal manipulation may influence the acceptance and use of this intervention with patients when indicated. [ABSTRACT FROM AUTHOR]

Thoracic spine manipulation has been shown to be effective for the management of neck pain. The purpose of this study was to investigate the immediate effect of a T3-T4 spinal thrust manipulation on autonomic nervous system activity in subjects with chronic cervical pain. An additional aim was to determine if the manipulation resulted in an immediate pain relief in patients with chronic neck pain when compared to a placebo intervention. One hundred subjects with chronic neck pain were randomly assigned to receive either a thoracic thrust manipulation or a placebo intervention. The Friedman's test was used to evaluate the change in pupil diameter within both groups. The Wilcoxen signed-ranks test was used to explore pupil changes over time and to make paired comparisons of the pupil change between the groups. The Mann-Whitney U test was used to compare the change in pain perception for the chronic cervical pain group subjects receiving either the thrust manipulation or the placebo intervention. The results demonstrated that manipulation did not result in a change in sympathetic activity. Additionally, there was no significant difference in the subject's pain perception (P=0.961) when comparing the effects of the thrust manipulation to the placebo intervention within this group of subjects with chronic neck pain. The clinical impression of this study is that manipulation of the thoracic spine may not be effective in immediately reducing pain in patients with chronic neck pain. [ABSTRACT FROM AUTHOR]

Background: It has been found that trigger points [TrPs] in the extensor carpi radialis brevis [ECRB] muscle reproduce pain in lateral epicondylalgia [LE]. Trigger point dry needling [TrP-DN] has not been previously investigated in LE. Findings: A female LE patient with duration of six years received eight treatments [TrP-DN in the ECRB muscle and a mobilization-with-movement technique] in a four-week period. The outcome measures of the patient-rated tennis elbow evaluation [PRTEE], pain-free grip force [PFG], visual analogue scale, and pressure-pain threshold [PPT] were taken pre- and post-intervention and at one-month and four-month follow-ups. The PPT increased from 248 to 609 kPa at the end of the treatment period. Elbow pain showed a substantial improvement from 7/10 at the pre-treatment to 0/10 after the four-week intervention period. PFG values increased from 12 to 28 kg after the treatment period. After the treatment, all values of the PRTEE questionnaire were 0, suggesting a rapid recuperation of elbow function following the intervention. Conclusions: Our findings suggest that the TrP-DN and mobilization-with-movement combination may be suitable for the restoration of motor function and the induction of a hypoalgesic effect in LE. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the outcome of a series of consecutive patients with temporomandibular disorder (TMD) who were treated with manual physical therapy interventions and exercise. Consecutive patients with the clinical presentation of TMD completed several self-report measures and underwent a standardized historical and physical examination. Following the examination, patients received a multimodal treatment approach incorporating manual physical therapy and exercise. All self-report questionnaires were completed at a 2-week follow-up. Paired t-tests were performed between the baseline and 2-week follow-up scores. The mean TMD Disability Index scores were 32.1% (15.4%) at baseline and 18.3% (12.5%) at the 2-week follow-up, representing an improvement of 13.9% (CI: 8.2%, 19.5%) (p<0.05). Patient Specific Functional Scale (PSFS) scores improved 3.1 points (CI: 2.3, 3.9) (p<0.05). These results suggest that patients with TMD who are treated with a rehabilitation program including manual physical therapy interventions plus exercise, with or without iontophoresis with dexamethasone, can demonstrate clinically meaningful improvements in disability and overall perceived change in a relatively short period of time. [ABSTRACT FROM AUTHOR]

An introduction is presented which discusses topics including systematic reviews and meta-analyses completed by Doctor of Physical Therapy (DPT) students in conjunction with their faculty mentors; and student's completion of a systematic review with the guidance of a faculty research mentor.

Pain is a complex multidimensional experience, which includes both a sensory and emotional component. With the increasing prevalence of multicultural societies consisting of numerous ethnic subgroups, each with differing beliefs, values, and customs, it has become increasingly important for the physical therapist to recognise how varying populations may experience pain differently. The purpose of this review is to describe the current healthcare literature regarding ethnic differences in pain perception; from this it can be ascertained that diverse ethnic groups express the quality and intensity or frequency of pain differently, and use varying amounts of analgesics in an attempt to control their pain. Physical therapists should recognise this and understand the implications this may have in the way patients express and communicate their pain. Recognising these individual differences, and that a patient's response to pain depends on their physiology, personality, life experiences and ethnicity is essential in developing the patient–therapist relationship, appropriate management strategies, and optimal outcomes. [ABSTRACT FROM AUTHOR]

The reliability of strength measurements obtained during clinical examination has been the subject of many investigations. The need for an accurate, quantitative method to determine strength in multiple settings and environments is important for both examination and treatment. The purpose of this paper is to provide a review of the existing literature investigating the reliability and concurrent validity of hand-held dynamometry. A thorough review of the literature revealed that held dynamometry is a suitable alternative to traditional manual muscle testing as it exhibits good-to-excellent reliability, provides objective ratio data, and has the portability to be used in multiple environments. Hand-held dynamometry is a reliable method to determine the strength status and change status provided testing protocols are consistent. [ABSTRACT FROM AUTHOR]

It is essential for physical therapists to use outcome measures that identify and measure a change in patient status; however, pain is a multidimensional experience that is often difficult to measure. A variety of instruments have been developed in an attempt to obtain an accurate measure of patients' perceived level of pain. Three of the most common outcome measures utilised by physical therapists include the visual analogue scale, the numeric pain rating scale and the McGill Pain Questionnaire. The purpose of this review is to describe the psychometric properties, including reliability and responsiveness, of these outcome measures. [ABSTRACT FROM AUTHOR]

The clinical attributes that distinguish expert from novice clinicians have become a topic of great interest. To date, the majority of the literature has investigated the differences that exist in the clinical reasoning process. Despite the reported importance of joint mobilization techniques in orthopaedic practice, many of these studies have admittedly omitted the movement component (manual skills) of clinical practice from their analysis. The purpose of this study was to investigate the differences, in peripheral sympathetic nervous system activity elicited with thoracic mobilizations, between an expert and novice clinician. The expert and a novice clinician performed central grade III mobilizations to T12 on a convenience sample of 15 asymptomatic subjects utilising a crossover design. Skin conductivity was utilised as a measure of peripheral sympathetic nervous system activity. A paired samples t-test was used to compare the mean change in skin conductivity between groups. Results demonstrated that the expert clinician elicited a statistically significant (P < 0.025) greater increase in skin conductivity when compared to the novice. Although it cannot be stated with absolute certainty that expert clinicians produce a greater sympathetic nervous system response when performing spinal manipulative therapy, we speculate that differences exist between therapists, which may have clinically significant implications. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the dysfunction of thoracic spine, the research evidence of thorax as an integrated system, and the safe and proper dry needling (DN) application for myofascial trigger points management.

The article pays tribute to registered physical therapist Peter A. Huijbregts, who died on November 6, 2010.

Objective: To determine the effect of strain counterstrain (SCS) on dynamic balance and subjective sense of instability in individuals with chronic ankle instability (CAI). Although many studies have been published on CAI, the cause for this common clinical dysfunction remains inconclusive. No studies have assessed the effectiveness of SCS on CAI. Methods: At baseline all participants completed a demographic questionnaire, the star excursion balance test (SEBT), and the foot and ankle ability measure (FAAM). Following the baseline evaluation, participants were randomized into the SCS experimental group (EG) (n=13) or the sham SCS group (SG) (n=14). All participants received the assigned treatment once a week for 4 weeks and participated in a prescribed exercise program. At week 4, all participants repeated the outcome measures and completed a global rating of change (GROC) form. The primary aim was examined with a two-way analysis of variance (ANOVA). Results: A significant group-by-time interaction was found for seven directions in the SEBT (P<0.031). For subjective measures, no significant group-by-time interaction was found for the FAAM (P>0.548), but the GROC revealed a significant difference (P=0.014) in the mean score for the EG (3.92 ± 1.66) when compared to the SG (2.43 ± 1.66). Discussion: Although SCS may not have an effect on subjective ankle function in individuals with CAI, preliminary evidence suggests that SCS may lead to an improvement in dynamic ankle stability and the subjective sense of ankle instability. [ABSTRACT FROM AUTHOR]

Background: Cervical spine manipulation (CSM) is a commonly utilized intervention, but its use remains controversial. Purpose: To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AEs) after receiving CSM to determine if the CSM was used appropriately, and if these types of AEs could have been prevented using sound clinical reasoning on the part of the clinician. Data sources: PubMed and the Cumulative Index to Nursing and Allied Health were systematically searched for case reports between 1950 and 2010 of AEs following CSM. Study selection: Case reports were included if they were peer-reviewed; published between 1950 and 2010; case reports or case series; and had CSM as an intervention. Articles were excluded if the AE occurred without CSM (e.g. spontaneous); they were systematic or literature reviews. Data extracted from each case report included: gender; age; who performed the CSM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the CSM; and type of resultant AE. Data synthesis: Based on the information gathered, CSMs were categorized as appropriate or inappropriate, and AEs were categorized as preventable, unpreventable, or unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if there was a difference in proportion between six categories: appropriate/preventable, appropriate/unpreventable, appropriate/unknown, inappropriate/ preventable, inappropriate/unpreventable, and inappropriate/unknown. Results: One hundred thirty four cases, reported in 93 case reports, were reviewed. There was no significant difference in proportions between appropriateness and preventability, P=.46. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n=7) of the cases, mostly caused by arterial dissection. Limitations: There may have been discrepancies between what was reported in the cases and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the CSM, published many of the cases. Conclusions: This review showed that, if all contraindications and red flags were ruled out, there was potential for a clinician to prevent 44.8% of AEs associated with CSM. Additionally, 10.4% of the events were unpreventable, suggesting some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning. [ABSTRACT FROM AUTHOR]

Study design: A case series of consecutive patients with chronic low back pain. Background and purpose: In patients with chronic low back pain (CLBP), the importance of impairments at the hip joints is unclear. However, it has been postulated that impairments at the hip joints may contribute to CLBP. The purpose of this case series was to investigate the short-term outcomes in patients with CLBP managed with impairment-based manual therapy and exercise directed at the hip joints. Methods: Eight consecutive patients (mean age: 43.9 years) with a primary report of CLBP (>6 months) without radiculopathy were treated with a standardized approach of manual physical therapy and exercise directed at bilateral hip impairments for a total of three sessions over approximately 1 week. At initial examination, all patients completed a numeric rating pain scale (NPRS), Oswestry disability index (ODI), fear-avoidance beliefs questionnaire (FABQ), and patient-specific functional scale (PSFS). At the second and third treatment sessions, each patient completed all outcome measures as well as the Global Rating of Change (GROC). Results: Five of the eight (62.5%) patients reported 'moderately better' or higher (> + 4) on the GROC at the third session, indicating a moderate improvement in self-reported symptoms. These five individuals also experienced a 24.4% reduction in ODI scores. Discussion: This case series suggests that an impairment-based approach directed at the hip joints may lead to improvements in pain, function, and disability in patients with CLBP. A neurophysiologic mechanism may be a plausible explanation regarding the clinical outcomes of this study. A larger, well-controlled trial is needed to determine the potential effectiveness of this approach with patients with CLBP. [ABSTRACT FROM AUTHOR]