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The aim of this study was to establish international consensus regarding the use of spinal manipulation and mobilisation among infants, children, and adolescents among expert international physiotherapists. Twenty-six international expert physiotherapists in manual therapy and paediatrics voluntarily participated in a 3-Round Delphi survey to reach a consensus via direct electronic mail solicitation using Qualtrics®. Consensus was defined a-priori as ≥75% agreement on all items with the same ranking of agreement or disagreement. Round 1 identified impairments and conditions where spinal mobilisation and manipulation might be utilised. In Rounds 2 and 3, panelists agreed or disagreed using a 4-point Likert scale. Eleven physiotherapists from seven countries representing five continents completed all three Delphi rounds. Consensus regarding spinal mobilisation or manipulation included: Manipulation is not recommended: (1) for infants across all conditions, impairments, and spinal levels; and (2) for children and adolescents across most conditions and spinal levels. Manipulation may be recommended for adolescents to treat spinal region-specific joint hypomobility (thoracic, lumbar), and pain (thoracic). Mobilisation may be recommended for children and adolescents with hypomobility, joint pain, muscle/myofascial pain, or stiffness at all spinal levels. Consensus revealed spinal manipulation should not be performed on infants regardless of condition, impairment, or spinal level. Additionally, the panel agreed that manipulation may be recommended only for adolescents to treat joint pain and joint hypomobility (limited to thoracic and/or lumbar levels). Spinal mobilisation may be recommended for joint hypomobility, joint pain, muscle/myofascial pain, and muscle/myofascial stiffness at all spinal levels among children and adolescents. [ABSTRACT FROM AUTHOR]

Joint mobilizations are well-established and extensively researched treatment modality for adults. However, it remains largely unexplored in the pediatric population. Physical therapists hesitate to perform joint mobilization on children because of lack of knowledge, concern for the developing skeletal system, and the paucity of research on the topic. The aim of this article is to present a decision tool created for a continuing education course with the purpose to instruct pediatric therapists in the safe and effective use of joint mobilizations in children. It is based on the pediatric paradigm of developmental and functional assessment to best address the concerns and preferences of physical therapists (PTs). To advance research in pediatric joint mobilization, PTs should listen to the concerns of pediatric therapists and respond to those concerns with effective, evidence-supported training. This decision tree will serve as a resource for the education of pediatric therapists in the safe and effective use of joint mobilizations. [ABSTRACT FROM AUTHOR]

Differential diagnosis of pediatric neck pain requires age-appropriate communication and assessment tools. Recognizing these age-related nuances is critical, emphasizing the role of physical therapists in assessing and managing pediatric patients while ruling out severe pathologies. A 10-year-old male presented to physical therapy with a five-week history of increasing neck pain. A thorough history and segmental cervical examination considering the patient's age and development, led to patient referral to the emergency department. This case underscores the significance of comprehensive evaluation in pediatric neck pain management. The patient was diagnosed with Langerhans Cell Histiocytosis (LCH). LCH primarily affects children and is treated with chemotherapy. Chemotherapy reduced the tumor, revealing C2 vertebral body damage. The patient underwent C1-C3 fusion surgery, a standard procedure for atlanto-occipital region stabilization in children. The patient was advised to restrict motion for 6 months while monitoring for tumor growth. Pediatric neck cancer presents diagnostic challenges due to varied symptoms, but research highlights specific indicators to assist with differential diagnosis. This case emphasizes the need to recognize the complexities of pediatric neck pain and perform a thorough age-appropriate evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: McKenzie standing trunk extension exercises have been used for the management of low back pain (LBP). However, no study to date has investigated the effect of standing trunk extension postures on spinal height and clinical outcomes. OBJECTIVE: To evaluate in subjects with LBP following a period of trunk loading how spinal height, pain, symptoms' centralization and function outcome measures respond to two standing postures interventions: (1) repetitive trunk extension (RTE) and (2) sustained trunk extension (STE). METHODS: A consecutive sample of convenience of people with LBP were recruited to participate in 2-session physical therapy using either RTE or STE in standing. RESULTS: Thirty participants (18 women) with a mean age of 53 ± 17.5 years completed the study. The first session resulted in spinal height increase (spinal growth) of 2.07 ± 1.32 mm for the RTE intervention and 4.54 ± 1.61 mm for the STE group (p < 0.001; ES = 1.67), while the second session (2-week following the first session) resulted in spinal growth of 2.39 ± 1.46 mm for the RTE group and 3.91 ± 2.06 mm for the STE group (p = 0.027; ES = 0.85). The STE group presented with the larger reduction in most pain from 6 to 2 as compared to the RTE group from 6 to 4 between Session 1 and Session 2 (p < 0.001). There was no difference between the groups in Modified Oswestry score and symptoms centralization (p = 0.88 and p = 0.77, respectively). CONCLUSION: People with LBP experienced greater spine growth and improvements of pain during standing STE as compared to RTE. People with LBP could use such postures and movements to alleviate their LBP and improve spine height while in a weight bearing position. [ABSTRACT FROM AUTHOR]

The article discusses the disparities in research publications in physiotherapy and rehabilitation, especially in low-income and middle-income countries (LMICs). It reports that challenges include lack of funding, research culture, infrastructure, language barriers, and prioritization of high-income countries. It highlights the need urgent action to address these barriers and calls for international physiotherapy journals to support research in LMICs, emphasizing the need for urgent action.

To investigate the knowledge of pathology and prevention of the novel coronavirus (COVID-19), attitude towards clinical practice, and adherence to standard precautions among clinical physiotherapists during the pandemic. A snowballing method was used to recruit physiotherapists (across 53 countries) who responded to a newly designed and validated survey on the participants' demographics, knowledge of COVID-19, attitude, practices, and standard precaution adherence during the pandemic. Data were analysed using descriptive statistics, Cronbach's Alpha, Pearson's correlation, and ANOVA. All participants (n = 2550, 100%) were knowledgeable on COVID-19 symptomatology. However, only (n = 312, 12.2%) were actively involved in the management of confirmed cases. The percentage score of participants' knowledge regarding COVID-19 pathology, and prevention, their attitude, and adherence to standard precautions averaged 77.73 ± 10.11, 89.70 ± 9.26, 77.44 ± 7.04, and 61.59 ± 16.63, respectively. Knowledge about COVID-19 pathology differed significantly across demographic variables (p < 0.001, Ƞ2 ≤ 0.07). Most participants (n = 1936, 75.9%) reported an inadequate supply of personal protective equipment (PPE). Participants had good knowledge of COVID-19 pathology and a positive attitude towards safe clinical practice. However, adherence to standard precautions was suboptimal due to inadequate infectious disease training and PPE supply. [ABSTRACT FROM AUTHOR]

The article presents recommendations from the International Society of Physiotherapy Journal Editors on statistical inference through estimation:.

Purpose: The purpose of this study was to determine: 1) the test-retest reliability of Fear-Avoidance Beliefs Questionnaire (FABQ) Work (FABQW) subscale, FABQ Physical Activity (FABQPA) subscale, Shoulder Pain and Disability Index (SPADI) Pain subscale, SPADI Disability subscale, and Numeric Pain Rating scale (NPRS); and 2) the relationship between the FABQPA, FABQW, SPADI pain, SPADI disability, and NPRS after 4 weeks of pragmatically applied physical therapy (PT) in patients with shoulder pain. Design: Prospective, single-group observational design. Methods: Data were collected at initial evaluation, the first follow-up visit prior to the initiation of treatment, and after 4 weeks of treatment. Results: Statistically significant Intraclass Correlation Coefficient (ICC2,1) values were reported for the FABQPA, FABQW, SPADI Pain, SPADI Disability, and NPRS. A statistically significant moderate relationship between the FABQPA subscale, SPADI subscale, and NPRS could not be established prior to and after 4 weeks of pragmatically applied PT. Statistically significant differences were observed between the initial evaluation and four-week follow-up for the FABQPA, SPADI Pain, SPADI Disability, and NPRS (p < 0.01). Discussion: Since a meaningful relationship between the FABQ, SPADI, and NPRS did not exist, it suggests that the FABQPA may be measuring a metric other than pain. Conclusions: This study suggests that the FABQW may not be sensitive to change over time. [ABSTRACT FROM AUTHOR]

Background: Arguments against reimbursement for direct access to physical therapy (PT) are that a physician examination is necessary to diagnose and that there is a potential for increased cost. Objective: To determine what percentage of PT referrals had a specific diagnosis and treatment orders. Additionally, specific and non-specific diagnoses and treatment orders were compared in regards to PT units billed, average visits per referral, and average cost per referral. Methods: The charts of 1,000 patients treated in outpatient PT underwent a retrospective chart review. Interferential statistics were used to determine if there was a statistically significant difference between specific and non-specific diagnoses and treatment orders in regard to PT units billed, average visits per referral, and average cost per referral. Results: Twenty-nine percent of all referring diagnoses were non-specific in nature and 58% contained treatment orders that were non-specific. Charts with a specific diagnosis had a statistically significant higher utilization as compared to non-specific diagnoses (p ≤ 0.001). Patients with a specific treatment order also displayed a statistically significant larger average in billed units, average visits per referral, and average reimbursement per referral than those without a specific treatment order (p ≤ 0.0001). Conclusion: Our findings suggest that a physician diagnosis and referral may not be required to direct care for patients seeking PT services. Third-party payers that require a physician referral for PT services may be delaying access to healthcare and increasing costs. [ABSTRACT FROM AUTHOR]

The authors describe the reasons why the scope of practice by physical therapists has been extended in several countries. A meeting of physical therapists in February 2017 in Canada on designing and conducting research is mentioned. It is said that physical therapy Advanced Practice Practitioner roles were initially formed in Canada, Great Britain, Australia, and other countries to address elective surgical waits. The role of physical therapists with the healthcare system globally is discussed.

Objective: To investigate the effect of volitional preemptive abdominal contraction by using an abdominal bracing maneuver (ABM) on postural control responses.Design: A within-subjects, repeated-measure, experimental design.Setting: Laboratory.Participants: Sixty-five healthy subjects between 18 and 50 years of age.Methods: Subjects performed ABM alternating with No-ABM during 2 rounds of 2 Neurocom computed dynamic posturography tests: the Motor Control Test (MCT) and conditions 1 (eyes open), 2 (eyes closed), and 5 (eyes closed, sway-referenced support) of the Sensory Organization Test (SOT).Main Outcome Measurements: (1) MCT Response Latency (milliseconds) and Response Scaling (magnitude of active postural correction) and (2) SOT Equilibrium Scores and 2-Dimensional Sway (°/second), and SOT Movement Strategy, which measure postural sway and movement strategies (ankle versus hip strategy), respectively.Results: The use of ABM (versus No-ABM) produced: (1) a small but statistically significant decrease in SOT Equilibrium Score for condition 2 (-1.0%; P = .004); (2) an increase in SOT 2-Dimensional Sway (°/second) during conditions 1 (16.9%; P = .0001) and 2 (15.0%; P = .0001); (3) a small decrease in SOT Movement Strategy scores during condition 1 (-0.5%; P = .001) and condition 2 (-1.0%; P = .017); and (4) a reduction of MCT Response Latency by 3 milliseconds (-2.1%; P = .005) and reduction of Response Scaling by 0.33°/second (-9.2%; P = .001).Conclusion: Individuals can incorporate the ABM without substantively altering postural control. Although selected SOT and MCT scores exhibited small decreases in postural response integrity, those outcomes did not reflect functionally meaningful changes. These findings can enhance clinicians' confidence in prescribing the ABM as a means to protectively stabilize the spine and potentially prevent injury in healthy subjects without concern for reducing postural control, especially during more complex postural perturbations that introduce sensory conflict. [ABSTRACT FROM AUTHOR]

Study design Planned secondary analysis of a randomized clinical trial. Objectives To examine: 1) patients' baseline expectations for treatment outcome of thoracic high velocity low amplitude thrust manipulations (HVLATM) to the thoracic spine for shoulder pain; 2) if the message conveyed by the clinician changed the patients' expectation; 3) any differences in outcome based on expectation independent of messaging.; and 4) any differences in outcome for those patients whose expectations significantly changed as a result of the messaging. Background Thoracic HVLATM may be an effective intervention for patients suffering from musculoskeletal shoulder pain. The role of expectation in the treatment effectiveness of this intervention has not been established. Methods Subjects' expectations regarding the effectiveness of HVLATM on shoulder pain were recorded at baseline. This was reassessed immediately following the provision of positive or neutral instructional set. The subjects then received a thoracic or scapular HVLATM. The Shoulder Pain and Disability Index (SPADI) and the numeric pain rating scale (NPRS) were used as outcomes measures. Results There was a 10 subject change (23%) in positive expectation that was statistically significant ( p = 0.019) following a positive message. There was no statistically significant difference in pain and function when these subjects were compared to all other subjects. Conclusion Although patients' expectations of positive outcome significantly changed when providing a positive instructional set, these changes did not translate into clinically significant short term changes in shoulder pain and function. Level of Evidence: 1b. [ABSTRACT FROM AUTHOR]

Appropriate management of temporomandibular disorders (TMD) requires an understanding of the underlying dysfunction associated with the temporomandibular joint (TMJ) and surrounding structures. A comprehensive examination process, as described In part 1 of this series, can reveal underlying clinical findings that assist in the delivery of comprehensive physical therapy services for patients with TMD. Part 2 of this series focuses on management strategies for TMD. Physical therapy is the preferred conservative management approach for TMD. Physical therapists are professionally well-positioned to step into the void and provide clinical services for patients with TMD. Clinicians should utilize examination findings to design rehabilitation programs that focus on addressing patient-specific impairments. Potentially appropriate plan of care components include joint and soft tissue mobilization, trigger point dry needling, friction massage, therapeutic exercise, patient education, modalities, and outside referral. Management options should address both symptom reduction and oral function. Satisfactory results can often be achieved when management focuses on patient-specific clinical variables. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression. Design: Single-blind, repeated-measures crossover design. Setting: Outpatient physical therapy clinic. Subjects: Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing. Intervention: Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction. Measurements: Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention. Results: The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only. Conclusion: Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression. [ABSTRACT FROM AUTHOR]

Abstract: Accurate ability to diagnose lumbar spine clinical instability is controversial for numerous reasons, including inaccuracy and limitations in capabilities of radiographic findings, poor reliability and validity of clinical special tests, and poor correlation between spinal motion and severity of symptoms. It has been suggested that common subjective and objective identifiers are specific to lumbar spine clinical instability. The purpose of this study was to determine if consensual, specific identifiers for subjective and objective lumbar spine clinical instability exist as determined by a Delphi survey instrument. One hundred and sixty eight physical therapists identified as Orthopaedic Clinical Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists participated in three Delphi rounds designed to select specific identifiers for lumbar spine clinical instability. Round I consisted of open-ended questions designed to provide any relevant issues. Round II allowed the participants to rank the organized findings of Round I. Round III provided an opportunity to rescore the ranked variables after viewing other participant''s results. The results suggest that those identifiers selected by the Delphi experts are synonymous with those represented in related spine instability literature and may be beneficial for use during clinical differential diagnosis. [Copyright &y& Elsevier]

The purpose of this study was to evaluate interrater reliability of a specific palpatory test to assess the three-dimensional (3-D) mobility of L4-L5. Subjects included 17 men and 37 women with a mean age of 24 years (range 20-39 years) who were tested independently by three manual physical therapists with a mean of 15 years of experience. Testers performed 3-D motion testing of the L4-L5 spinal segment in a non-weight-bearing position. Interrater reliability was assessed with Cohen's Kappa statistics, using three pair-wise comparisons for determination of the direction (right or left) of lateral flexion leading to the greatest amount of segmental rotation. Percent agreement ranges were 46.3% to 62.9%, with Kappa scores ranging from -0.16 to 0.04, respectively. The palpatory test demonstrated poor to slight strength of interrater reliability. Further examination of a symptomatic population and/or other age categories is recommended. This study suggests that quantitative manual palpatory assessment of rotation at L4-L5 in combination with ipsilateral or contralateral lateral flexion is not reliable between testers. Such testing is not recommended for clinical use. [ABSTRACT FROM AUTHOR]

Background and Purpose. Clinical cervical spine instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI. Subjects. One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey. Methods. This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI. Results. The symptoms that reached the highest consensus among respondents were "intolerance to prolonged static postures," "fatigue and inability to hold head up," "better with external support, including hands or collar," "frequent need for self-manipulation," "feeling of instability, shaking, or lack of control," "frequent episodes of acute attacks," and "sharp pain, possibly with sudden movements." The physical examination findings related to cervical instability that reached the highest consensus among respondents included "poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement," "abnormal joint play," "motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming," and "aberrant movement." Discussion and Conclusion. The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings. [ABSTRACT FROM AUTHOR]

Objectives: The reporting of sampling methods in Randomized Clinical Trials (RCTs) allows for research quality assessment, determination of sampling bias, and assures the presence of details necessary for reproducibility in future trials. The purpose of this study was to: (1) determine if sampling methodology was reproducible in RCTs related to musculoskeletal physical therapy (MSKPT) interventions to treat non-specific low back pain (NSLBP) and (2) establish if there was a relationship between sample reproducibility and established measures of research quality. Methods: Data were collected through a systematic review by a professional librarian. The identified RCTs were assessed for methodological quality by two blinded individual reviewers. Data analysis was performed by a third, blinded researcher; additional comparisons were made based on Journal Impact Factor and PEDro score. Results: Ninety-nine published peer-reviewed RCTs were identified that met inclusion criteria. Only 29% of the articles were judged to be reproducible based on the reported sampling methodology. There were meaningful correlations between two out of ten of the sampling reporting criteria and the judgement made if the sample was reported in significant detail to allow for replication. There was no relationship between sampling reporting criteria, Journal Impact Factors (JIFs), and Physiotherapy Evidence Database (PEDro) scores. Discussion: The reporting of sampling methodology needs to be considered to ensure reproducibility and avoid sampling bias. Despite the proliferation of measures of research quality, the overall reporting quality of RCTs continues to be inadequate to allow widespread reproducibility of trials. Level of Evidence: 1a [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses the changes made to the Instructions to Authors of the "Journal of Manual and Manipulative Therapy" (JMMT) and offers information on its membership and subscriptions.

Osteoarthritis (OA) is a chronic condition characterized by degeneration of cartilage and its underlying bone within a joint. With no cure currently available, the goals of treating OA are to alleviate pain, maintain, or improve joint mobility, increase the muscle strength of the joints, and minimize the disabling effects of the disease. Recent research has suggested that complementary and alternative medicine (CAM) exercises may improve OA symptoms. This paper covers CAM mind-body exercises-Tai Chi, qigong, and yoga-for OA management and evaluates their benefits in pain reduction, muscle strength, physical function, stiffness, balance, fear of falling, self-efficacy, quality of life, and psychological outcomes in patients with OA, based on randomized controlled trials published. Findings from the literature suggest that CAM exercises demonstrate considerable promise in the management of OA. Future studies require rigorous randomized controlled trials with larger sample sizes. [ABSTRACT FROM AUTHOR]

To determine the: 1) quality of articles cited in systematic reviews (SRs); 2) methodological quality of the SRs; and 3) impact of quality on level 1A evidence. SRs related to musculoskeletal physical therapy interventions were identified. The methodological quality of the SRs and articles cited by the SRs were assessed by two blinded reviewers. Data analysis was performed by a third blinded researcher. Additional comparisons were made based on the Journal Impact Factor, spin, financial bias, and conflict of interest. Twenty-four SRs were identified; 21/24 SRs had 'critically low' quality on the AMSTAR 2. Thirty-four percent of included studies were 'low quality,' and 58% of SRs included studies that had unreported external validity. One-half of the SRs represented 'spin,' and one-third of the SRs generated conclusions based on low-quality clinical trials. The 'critically low' SRs methodological quality was exacerbated by low-quality research inclusion. Most SRs failed to follow best practices, including prospective registration and integration of professional librarians in the search process. Based on the high proportion of SRs that include low-quality trials and overall low methodological quality, further discussion regarding practice recommendations on level vs. quality of evidence is warranted. 1a [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this investigation was to establish an international baseline of the quantity of physical therapist education on temporomandibular disorders (TMD) during post-professional Orthopedic Manual Physical Therapy (OMPT) education. Methods: An electronically distributed survey was sent to programs and data analyzed for trends, including a comparison of TMD and cervical spine disorders education. Current data were compared to pre-existing data from the United States. Results: For the current data-set, the Mann-Whitney U test demonstrated statistical significance when comparing TMD and cervical spine disorders education for both the hours of didactic training provided (p < 0.0001) and the number of patients seen during clinical training (p < 0.006). When comparing the United States and international data, statistically significant greater exposure was reported for both didactic (p < 0.0001) and clinical education (p < 0.006) of TMD topics in the United States but not for didactic (p = 0.23) or clinical education (p = 0.15) of cervical spine topics. Discussion: These data again indicate a lack of uniformity between post-professional training programs in OMPT with respect to TMD education. There is, however, consistency in that most programs provided more training on cervical spine disorders than TMD. Based on these findings, further investigations are appropriate to determine if TMD education is adequate during post-professional OMPT education. [ABSTRACT FROM AUTHOR]

The article presents a study focused on analyzing the effects of the high-velocity, low-amplitude thrust manipulations (HVLATMs) and conveyed messages on patients suffering from symptoms of the musculoskeletal shoulder diseases. The study was conducted on a group of 100 patients suffering from shoulder pain. According to results, HVLATM and conveyed messages doesn't improves patients' health.

The article presents the recommendations from the "International Society of Physiotherapy Journal" on the use of statistical inference through estimation.

The authors reflect on the orthopaedic manual and manipulative physical therapy (OMPT), with reference to the 2016 International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) meeting.