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Journal Cover   Journal of Manipulative and Physiological Therapeutics
  [SJR: 0.841]   [H-I: 49]   [6 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0161-4754
   Published by Elsevier Homepage  [2588 journals]
  • The Risk of Bias and Sample Size of Trials of Spinal Manipulative Therapy
           for Low Back and Neck Pain: Analysis and Recommendations
    • Abstract: Publication date: October 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 8
      Author(s): Sidney M. Rubinstein , Rik van Eekelen , Teddy Oosterhuis , Michiel R. de Boer , Raymond W.J.G. Ostelo , Maurits W. van Tulder
      Objective The purpose of this study was to evaluate changes in methodological quality and sample size in randomized controlled trials (RCTs) of spinal manipulative therapy (SMT) for neck and low back pain over a specified period. A secondary purpose was to make recommendations for improvement for future SMT trials based upon our findings. Methods Randomized controlled trials that examined the effect of SMT in adults with neck and/or low back pain and reported at least 1 patient-reported outcome measure were included. Studies were identified from recent Cochrane reviews of SMT, and an update of the literature was conducted (March 2013). Risk of bias was assessed using the 12-item criteria recommended by the Cochrane Back Review Group. In addition, sample size was examined. The relationship between the overall risk of bias and sample size over time was evaluated using regression analyses, and RCTs were grouped into periods (epochs) of approximately 5 years. Results In total, 105 RCTs were included, of which 41 (39%) were considered to have a low risk of bias. There is significant improvement in the mean risk of bias over time (P < .05), which is the most profound for items related to selection bias and, to a lesser extent, attrition and selective outcome reporting bias. Furthermore, although there is no significant increase in sample size over time (overall P = .8), the proportion of studies that performed an a priori sample size calculation is increasing statistically (odds ratio, 2.1; confidence interval, 1.5-3.0). Sensitivity analyses suggest no appreciable difference between studies for neck or low back pain for risk of bias or sample size. Conclusion Methodological quality of RCTs of SMT for neck and low back pain is improving, whereas overall sample size has shown only small and nonsignificant increases. There is an increasing trend among studies to conduct sample size calculations, which relate to statistical power. Based upon these findings, 7 areas of improvement for future SMT trials are suggested.

      PubDate: 2015-03-11T19:31:02Z
  • Chiropractic Use in the Medicare Population: Prevalence, Patterns, and
           Associations With 1-Year Changes in Health and Satisfaction With Care
    • Abstract: Publication date: October 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 8
      Author(s): Paula A.M. Weigel , Jason M. Hockenberry , Fredric D. Wolinsky
      Objective The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries. Methods Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models. Results The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching. Conclusion This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

      PubDate: 2015-03-11T19:31:02Z
  • Development of a Neck Pain Risk Score for Predicting Nonspecific Neck Pain
           With Disability in Office Workers: A 1-Year Prospective Cohort Study
    • Abstract: Publication date: September 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 7
      Author(s): Arpalak Paksaichol , Prawit Janwantanakul , Chaipat Lawsirirat
      Objective The purpose of this study was to develop a neck pain risk score for office workers (NROW) to identify office workers at risk for developing nonspecific neck pain with disability. Methods A 1-year prospective cohort study of 559 healthy office workers was conducted. At baseline, risk factors were assessed using questionnaires and standardized physical examination. The incidence of neck pain was collected every month thereafter. Disability level was evaluated using the neck disability index. Logistic regression was used to select significant factors to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score. Results Among 535 (96%) participants who were followed up for 1 year, 23% reported incident neck pain with disability (≥5). After adjusting for confounders, the onset of neck pain with disability was significantly associated with history of neck pain, chair adjustability, and perceived muscular tension. Thus, the NROW comprises 3 questions about history of neck pain, chair adjustability, and perceived muscular tension. The NROW had scores ranging from 0 to 4. A cut-off score of at least 2 had a sensitivity of 82% and specificity of 48%. The positive and negative predictive values were 29% and 91%, respectively. The area under the receiver operating characteristic curve was 0.75. Conclusion The risk score for nonspecific neck pain with disability in office workers was developed, and it contained 3 items with scores ranging from 0 to 4. This study shows that the score appears to have reasonable sensitivity, specificity, positive predictive value, and negative predictive values for the cut-off point of at least 2.

      PubDate: 2015-03-11T19:31:02Z
  • Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal
           Conditions: A Systematic Review and Narrative Synthesis of Evidence From
           Randomized Controlled Trials
    • Abstract: Publication date: July–August 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 6
      Author(s): Alexander Tsertsvadze , Christine Clar , Rachel Court , Aileen Clarke , Hema Mistry , Paul Sutcliffe
      Objectives The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions. Methods A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases. Results Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain. Conclusions Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients.

      PubDate: 2015-03-11T19:31:02Z
  • The Role of Preload Forces in Spinal Manipulation: Experimental
           Investigation of Kinematic and Electromyographic Responses in Healthy
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5
      Author(s): François Nougarou , Claude Dugas , Michel Loranger , Isabelle Pagé , Martin Descarreaux
      Objectives Previous studies have identified preload forces and an important feature of skillful execution of spinal manipulative therapy (SMT) as performed by manual therapists (eg, doctors of chiropractic and osteopathy). It has been suggested that applying a gradual force before the thrust increases the spinal unit stiffness, minimizing displacement during the thrust. Therefore, the main objective of this study was to assess the vertebral unit biomechanical and neuromuscular responses to a graded increase of preload forces. Methods Twenty-three participants underwent 4 different SMT force-time profiles delivered by a servo-controlled linear actuator motor and varying in their preload forces, respectively, set to 5, 50, 95, and 140N in 1 experimental session. Kinematic markers were place on T6, T7, and T8 and electromyographic electrodes were applied over paraspinal muscles on both sides of the spine. Results Increasing preload forces led to an increase in neuromuscular responses of thoracic paraspinal muscles and vertebral segmental displacements during the preload phase of SMT. Increasing the preload force also yielded a significant decrease in sagittal vertebral displacement and paraspinal muscle activity during and immediately after the thrust phase of spinal manipulation. Changes observed during the SMT thrust phase could be explained by the proportional increase in preload force or the related changes in rate of force application. Although only healthy participants were tested in this study, preload forces may be an important parameter underlying SMT mechanism of action. Future studies should investigate the clinical implications of varying SMT dosages. Conclusion The present results suggest that neuromuscular and biomechanical responses to SMT may be modulated by preload through changes in the rate of force application. Overall, the present results suggest that preload and rate of force application may be important parameters underlying SMT mechanism of action.

      PubDate: 2015-03-11T19:31:02Z
  • Consumer Characteristics and Perceptions of Chiropractic and Chiropractic
           Services in Australia: Results From a Cross-Sectional Survey
    • Abstract: Publication date: May 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 4
      Author(s): Benjamin T. Brown , Rod Bonello , Ramon Fernandez-Caamano , Sharyn Eaton , Petra L. Graham , Hilary Green
      Objective The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia. Methods This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services. Results A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received. Conclusions The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service.

      PubDate: 2015-03-11T19:31:02Z
  • Outcomes of Acute and Chronic Patients With Magnetic Resonance
           Imaging–Confirmed Symptomatic Lumbar Disc Herniations Receiving
           High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective
           Observational Cohort Study With One-Year Follow-Up
    • Abstract: Publication date: March–April 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 3
      Author(s): Serafin Leemann , Cynthia K. Peterson , Christof Schmid , Bernard Anklin , B. Kim Humphreys
      Objective The purposes of this study were to evaluate patients with low-back pain (LBP) and leg pain due to magnetic resonance imaging–confirmed disc herniation who are treated with high-velocity, low-amplitude spinal manipulation in terms of their short-, medium-, and long-term outcomes of self-reported global impression of change and pain levels at various time points up to 1 year and to determine if outcomes differ between acute and chronic patients using a prospective, cohort design. Methods This prospective cohort outcomes study includes 148 patients (between ages of 18 and 65 years) with LBP, leg pain, and physical examination abnormalities with concordant lumbar disc herniations. Baseline numerical rating scale (NRS) data for LBP, leg pain, and the Oswestry questionnaire were obtained. The specific lumbar spinal manipulation was dependent upon whether the disc herniation was intraforaminal or paramedian as seen on the magnetic resonance images and was performed by a doctor of chiropractic. Outcomes included the patient’s global impression of change scale for overall improvement, the NRS for LBP, leg pain, and the Oswestry questionnaire at 2 weeks, 1, 3, and 6 months, and 1 year after the first treatment. The proportion of patients reporting “improvement” on the patient’s global impression of change scale was calculated for all patients and acute vs chronic patients. Pretreatment and posttreatment NRS scores were compared using the paired t test. Baseline and follow-up Oswestry scores were compared using the Wilcoxon test. Numerical rating scale and Oswestry scores for acute vs chronic patients were compared using the unpaired t test for NRS scores and the Mann-Whitney U test for Oswestry scores. Logistic regression analysis compared baseline variables with “improvement.” Results Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported. Conclusions A large percentage of acute and importantly chronic lumbar disc herniation patients treated with chiropractic spinal manipulation reported clinically relevant improvement.

      PubDate: 2015-03-11T19:31:02Z
  • Neural Responses to the Mechanical Parameters of a High-Velocity,
           Low-Amplitude Spinal Manipulation: Effect of Preload Parameters
    • Abstract: Publication date: February 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 2
      Author(s): William R. Reed , Cynthia R. Long , Gregory N. Kawchuk , Joel G. Pickar
      Objective The purpose of this study was to determine how the preload that precedes a high-velocity, low-amplitude spinal manipulation (HVLA-SM) affects muscle spindle input from lumbar paraspinal muscles both during and after the HVLA-SM. Methods Primary afferent activity from muscle spindles in lumbar paraspinal muscles were recorded from the L6 dorsal root in anesthetized cats. High-velocity, low-amplitude spinal manipulation of the L6 vertebra was preceded either by no preload or systematic changes in the preload magnitude, duration, and the presence or absence of a downward incisural point. Immediate effects of preload on muscle spindle responses to the HVLA-SM were determined by comparing mean instantaneous discharge frequencies (MIF) during the HVLA-SM's thrust phase with baseline. Longer lasting effects of preload on spindle responses to the HVLA-SM were determined by comparing MIF during slow ramp and hold movement of the L6 vertebra before and after the HVLA-SM. Results The smaller compared with the larger preload magnitude and the longer compared with the shorter preload duration significantly increased (P = .02 and P = .04, respectively) muscle spindle responses during the HVLA-SM thrust. The absence of preload had the greatest effect on the change in MIF. Interactions between preload magnitude, duration, and downward incisural point often produced statistically significant but arguably physiologically modest changes in the passive signaling properties of the muscle spindle after the manipulation. Conclusion Because preload parameters in this animal model were shown to affect neural responses to an HVLA-SM, preload characteristics should be taken into consideration when judging this intervention's therapeutic benefit in both clinical efficacy studies and in clinical practice.

      PubDate: 2015-03-11T19:31:02Z
  • Evaluation of Physical Function in Individuals 11 to 14 Years After
           Anterior Cervical Decompression and Fusion Surgery—A Comparison
           Between Patients and Healthy Reference Samples and Between 2 Surgical
    • Abstract: Publication date: February 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 2
      Author(s): Anna M.K. Hermansen , Joshua A. Cleland , Ann-Sofi C. Kammerlind , Anneli L.C. Peolsson
      Objective The purpose of this study was to evaluate neck-related physical function in individuals 11 to 14 years after anterior cervical decompression and fusion (ACDF) surgery for degenerative cervical disk disease and to compare the long-term outcome of 2 surgical techniques, including the Cloward procedure and cervical intervertebral fusion cage. Methods In this cross-sectional study, 51 individuals, 11 years or more after ACDF, underwent testing of cervical active range of motion, hand-grip strength, static and dynamic balance, neck muscle endurance, and completed pain ratings. The participants' values were compared with values of age- and sex-matched healthy individuals to evaluate impairments. Correlations between different test scores and pain were performed. Group differences were analyzed between the 2 surgical techniques. Results Sixty-five percent and 82% exhibited impairment in ventral and dorsal neck muscle endurance, respectively. Impairment rates of 18% to 39% for cervical active range of motion, 27% to 43% for hand-grip strength, 37% for standing balance, and 35% for dynamic balance were recorded. Twenty-nine percent of the participants had impairment (>30 mm visual analog scale) in pain. There were no significant differences in physical function between the 2 surgical treatment groups (Cloward procedure or cervical intervertebral fusion cage) (P = .10-.92). Conclusions In those studied, a large percentage of patients who had anterior cervical decompression and fusion surgery have impairments in neck-related physical function when compared 11 to 14 years after surgery with age- and sex-matched healthy reference individuals. Neck-specific function, but not balance, was statistically correlated to pain. Neck muscle endurance was most affected, and balance impairments were also present in one-third of the individuals. There were no differences in long-term physical function between the 2 surgical techniques.

      PubDate: 2015-03-11T19:31:02Z
  • Referral to Massage Therapy in Primary Health Care: A Survey of Medical
           General Practitioners in Rural and Regional New South Wales, Australia
    • Abstract: Publication date: November–December 2013
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 36, Issue 9
      Author(s): Jon L. Wardle , David W. Sibbritt , Jon Adams
      Objectives Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this study was to survey medical general practitioners (GPs) in rural and regional New South Wales, Australia, to identify their knowledge, attitudes, relationships, and patterns of referral to massage therapy in primary health care. Methods A 27-item questionnaire was sent to all 1486 GPs currently practicing in rural and regional Divisions of General Practice in New South Wales, Australia. The survey had 5 general areas: the GP's personal use and knowledge of massage, the GP's professional relationships with massage practice and massage practitioners, the GP's specific opinions on massage, the GP's information-seeking behavior in relation to massage, and the GP's assumptions on massage use by patients in their local areas. Results A total of 585 questionnaires were returned completed, with 49 survey questionnaires returned as “no longer at this address” (response rate of 40.7%). More than three-quarters of GPs (76.6%) referred to massage therapy at least a few times per year, with 12.5% of GPs referring at least once per week. The GP being in a nonremote location (odds ratio [OR], 14.28; 95% confidence interval [CI], 3.7-50.0), graduating from an Australian medical school (OR, 2.03; 95% CI, 1.09-3.70), perceiving a lack of other treatment options (OR, 2.64; 95% CI, 1.15-6.01), perceiving good patient access to a wide variety of medical specialists (OR, 11.1; 95% CI, 1.7-50.0), believing in the efficacy of massage therapy (OR, 2.75; 95% CI, 1.58-4.78), experiencing positive results from patients using massage therapy previously (OR, 13.95; 95% CI, 5.96-32.64), or having prescribed any CAM previously (OR, 1.83; 95% CI, 1.03-3.27) were all independently predictive of increased referral to massage therapy among the GPs in this study. Conclusions There appears to be substantial interface between massage therapy and GPs in rural and regional Australia. There are high levels of support for massage therapies among Australian GPs, relative to other CAM professions, with low levels of opposition to the incorporation of these therapies in patient care.

      PubDate: 2015-03-11T19:31:02Z
  • Effect of Sampling Rates on the Quantification of Forces, Durations, and
           Rates of Loading of Simulated Side Posture High-Velocity, Low-Amplitude
           Lumbar Spine Manipulation
    • Abstract: Publication date: June 2013
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 36, Issue 5
      Author(s): Maruti Ram Gudavalli , James DeVocht , Ali Tayh , Ting Xia
      Objective Quantification of chiropractic high-velocity, low-amplitude spinal manipulation (HVLA-SM) may require biomechanical equipment capable of sampling data at high rates. However, there are few studies reported in the literature regarding the minimal sampling rate required to record the HVLA-SM force-time profile data accurately and precisely. The purpose of this study was to investigate the effect of different sampling rates on the quantification of forces, durations, and rates of loading of simulated side posture lumbar spine HVLA-SM delivered by doctors of chiropractic. Methods Five doctors of chiropractic (DCs) and 5 asymptomatic participants were recruited for this study. Force-time profiles were recorded during (i) 52 simulated HVLA-SM thrusts to a force transducer placed on a force plate by 2 DCs and (ii) 12 lumbar side posture HVLA-SM on 5 participants by 3 DCs. Data sampling rate of the force plate remained the same at 1000 Hz, whereas the sampling rate of the force transducer varied at 50, 100, 200, and 500 Hz. The data were reduced using custom-written MATLAB (Mathworks, Inc, Natick, MA) and MathCad (version 15; Parametric Technologies, Natick, MA) programs and analyzed descriptively. Results The average differences in the computed durations and rates of loading are smaller than 5% between 50 and 1000 Hz sampling rates. The differences in the computed preloads and peak loads are smaller than 3%. Conclusions The small differences observed in the characteristics of force-time profiles of simulated manual HVLA-SM thrusts measured using various sampling rates suggest that a sampling rate as low as 50 to 100 Hz may be sufficient. The results are applicable to the manipulation performed in this study: manual side posture lumbar spine HVLA-SM.

      PubDate: 2015-03-11T19:31:02Z
  • Magnetic Resonance Imaging Zygapophyseal Joint Space Changes (Gapping) in
           Low Back Pain Patients Following Spinal Manipulation and Side-Posture
           Positioning: A Randomized Controlled Mechanisms Trial With Blinding
    • Abstract: Publication date: May 2013
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 36, Issue 4
      Author(s): Gregory D. Cramer , Jerrilyn Cambron , Joe A. Cantu , Jennifer M. Dexheimer , Judith D. Pocius , Douglas Gregerson , Michael Fergus , Ray McKinnis , Thomas J. Grieve
      Objective The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). Methods This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint “gapping difference.” Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed. Results Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P < .0001). Conclusions Side-posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT.

      PubDate: 2015-03-11T19:31:02Z
  • Development of the Headache Activities of Daily Living Index: Initial
           Validity Study
    • Abstract: Publication date: Available online 21 January 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Howard Vernon , Gordon Lawson
      Purpose The purpose of this study was to develop a novel instrument for assessing headache-related disability focussing solely on important activities of daily living. Methods Part 1: A literature search was conducted in PubMed and Google Scholar, supplemented by hand searches in bibliographies to retrieve the original article for any instrument for the assessment of headache-related disability. Each instrument was evaluated for item categories, specific item content, measurement scale format for each item, and instructions to users. Together, these features constituted the construct validity of these instruments. Qualitative evaluations of these results were summarized with respect to the adequacy of each component. Psychometric features such as reliability and validity were not assessed. Part 2: An existing instrument for assessing self-rated disability, the Neck Disability Index, was modified for content and format and subjected to 2 rounds of clinician and patient review. Item contents and formats received final consensus, resulting in a 9-item instrument: the Headache Activities of Daily Living Index (HADLI). This instrument was tested in a sample of headache patients. Cronbach α and individual item correlations were obtained. Principal Components Analysis was performed. Results Part 1: The search identified 6 reports on 5 preexisting instruments for self-rating of headache-related disability. Problems in content were found in all instruments, especially relating to the lack of items for specific activities of daily living. Problems were noted in most of the instruments for scaling and instructions with respect to the effect of headache on activities of daily living. Part 2: The authors first identified suitable items from an existing instrument for self-rating of disability. These were supplemented by items drawn from the literature. A panel of 3 clinicians and 2 laypersons evaluated these items. Two more focus groups of 7 headache sufferers each reviewed the new instrument. After this, a 9-item instrument for assessing activities of daily living in headache sufferers, the HADLI, was finalized. After this, 53 participants were recruited to study the face validity of the instrument. The sample consisted of 41 women and 12 men with a mean age of 37.3 (12) years; mean duration of headaches was 7.4 (8.3) years; mean frequency of headaches per week was 3.4 (2.4); and the intensity was 6 (2.4). The mean HADLI score was 26.2 (13.4), or 52%. There were no floor or ceiling effects for total score. The total Index Cronbach α was 0.96. The Principal Components Analysis identified one component which accounted for 75% of the variance. Conclusions The HADLI was created using theory and empirical-based methods. Face validity was assessed by focus group input and by first-level psychometrics. The HADLI has good face validity and is suitable for further reliability and validity testing.

      PubDate: 2015-01-22T15:15:45Z
  • Clinical Outcomes for Neurogenic Claudication Using a Multimodal Program
           for Lumbar Spinal Stenosis: A Retrospective Study
    • Abstract: Publication date: Available online 22 January 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Carlo Ammendolia , Ngai Chow
      Objective The purpose of this preliminary study was to assess the effectiveness of a 6-week, nonsurgical, multimodal program that addresses the multifaceted aspects of neurogenic claudication. Methods In this retrospective study, 2 researchers independently extracted data from the medical records from January 2010 to April 2013 of consecutive eligible patients who had completed the 6-week Boot Camp Program. The program consisted of manual therapy twice per week (eg, soft tissue and neural mobilization, chiropractic spinal manipulation, lumbar flexion-distraction, and muscle stretching), structured home-based exercises, and instruction of self-management strategies. A paired t test was used to compare differences in outcomes from baseline to 6-week follow-up. Outcomes included self-reported pain, disability, walking ability, and treatment satisfaction. Results A total of 49 patients were enrolled, with a mean age of 70 years. The mean difference in the Oswestry Disability Index was 15.2 (95% confidence interval [CI], 11.39-18.92), and that for the functional and symptoms scales of the Swiss Spinal Stenosis Questionnaire was 0.41 (95% CI, 0.26-0.56) and 0.74 (95% CI, 0.55-0.93), respectively. Numeric pain scores for both leg and back showed statistically significant improvements. Improvements in all outcomes were clinically important. Conclusions This study showed preliminary evidence for improved outcomes in patients with neurogenic claudication participating in a 6-week nonsurgical multimodal Boot Camp Program.

      PubDate: 2015-01-22T15:15:45Z
  • Biomechanical and Histological Effects of Augmented Soft Tissue
           Mobilization Therapy on Achilles Tendinopathy in a Rabbit Model
    • Abstract: Publication date: Available online 22 January 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Kan Imai , Kazuya Ikoma , Qingshan Chen , Chunfeng Zhao , Kai-Nan An , Ralph E. Gay
      Objective Augmented soft tissue mobilization (ASTM) has been used to treat Achilles tendinopathy and is thought to promote collagen fiber realignment and hasten tendon regeneration. The objective of this study was to evaluate the biomechanical and histological effects of ASTM therapy on rabbit Achilles tendons after enzymatically induced injury. Methods This study was a non-human bench controlled research study using a rabbit model. Both Achilles tendons of 12 rabbits were injected with collagenase to produce tendon injury simulating Achilles tendinopathy. One side was then randomly allocated to receive ASTM, while the other received no treatment (control). ASTM was performed on the Achilles tendon on postoperative days 21, 24, 28, 31, 35, and 38. Tendons were harvested 10 days after treatment and examined with dynamic viscoelasticity and light microscopy. Results Cross-sectional area in the treated tendons was significantly greater than in controls. Storage modulus tended to be lower in the treated tendons but elasticity was not significantly increased. Loss modulus was significantly lower in the treated tendons. There was no significant difference found in tangent delta (loss modulus/storage modulus). Microscopy of control tendons showed that the tendon fibers were wavy and type III collagen was well stained. The tendon fibers of the augmented soft tissue mobilization treated tendons were not wavy and type III collagen was not prevalent. Conclusion Biomechanical and histological findings showed that the Achilles tendons treated with ASTM had better recovery of biomechanical function than did control tendons.

      PubDate: 2015-01-22T15:15:45Z
  • Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B
           Beneficiaries Aged 66 to 99 Years With Neck Pain
    • Abstract: Publication date: Available online 14 January 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): James M. Whedon , Yunjie Song , Todd A. Mackenzie , Reed B. Phillips , Timothy G. Lukovits , Jon D. Lurie
      Objective The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain. Methods This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts. Results The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19). Conclusions Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant.

      PubDate: 2015-01-16T21:48:10Z
  • Peripheral Oxidative Stress Blood Markers in Patients With Chronic Back or
           Neck Pain Treated With High-Velocity, Low-Amplitude Manipulation
    • Abstract: Publication date: Available online 5 December 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Carolina Kolberg , Andréa Horst , Maira S. Moraes , Felipe Coutinho Kullmann Duarte , Ana Paula Konzen Riffel , Taína Scheid , Angela Kolberg , Wania A. Partata
      Objective The purpose of this study was to investigate oxidative-stress parameters in individuals with chronic neck or back pain after 5 weeks of treatment with high-velocity, low-amplitude (HVLA) spinal manipulation. Methods Twenty-three individuals aged 38.2 ± 11.7 years with nonspecific chronic neck or back pain verified by the Brazilian Portuguese version of the Chronic Pain Grade, with a sedentary lifestyle, no comorbidities, and not in adjuvant therapy, underwent treatment with HVLA chiropractic manipulation twice weekly for 5 weeks. Therapeutic procedures were carried out by an experienced chiropractor. Blood samples were assessed before and after treatment to determine the activities of the antioxidant enzymes superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx), and the levels of nitric oxide metabolites and lipid hydroperoxides. These blood markers were analyzed by paired Student t test. Differences were considered statistically significant, when P was <.05. Results There was no change in catalase but an increase in SOD (0.35 ± 0.03 U SOD per milligram of protein vs 0.44 ± 0.04 U SOD per milligram of protein; P < .05) and GPx (7.91 ± 0.61 nmol/min per milligram of protein vs 14.07 ± 1.07 nmol/min per milligram of protein; P < .001) activities after the treatment. The nitric oxide metabolites and the lipid hydroperoxides did not change after treatment. Conclusion High-velocity, low-amplitude spinal manipulation twice weekly for 5 weeks increases the SOD and GPx activities. Previous studies have shown a relationship between pain and oxidative and nitrosative parameters; thus, it is possible that changes in these enzymes might be related to the analgesic effect of HVLA spinal manipulation.

      PubDate: 2015-01-11T21:40:54Z
  • Using PubMed Search Strings for Efficient Retrieval of Manual Therapy
           Research Literature
    • Abstract: Publication date: Available online 12 December 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Paolo Pillastrini , Carla Vanti , Stefania Curti , Stefano Mattioli , Silvano Ferrari , Francesco Saverio Violante , Andrew Guccione
      Objective The aim of this study was to construct PubMed search strings that could efficiently retrieve studies on manual therapy (MT), especially for time-constrained clinicians. Methods Our experts chose 11 Medical Subject Heading terms describing MT along with 84 additional potential terms. For each term that was able to retrieve more than 100 abstracts, we systematically extracted a sample of abstracts from which we estimated the proportion of studies potentially relevant to MT. We then constructed 2 search strings: 1 narrow (threshold of pertinent articles ≥40%) and 1 expanded (including all terms for which a proportion had been calculated). We tested these search strings against articles on 2 conditions relevant to MT (thoracic and temporomandibular pain). We calculated the number of abstracts needed to read (NNR) to identify 1 potentially pertinent article in the context of these conditions. Finally, we evaluated the efficiency of the proposed PubMed search strings to identify relevant articles included in a systematic review on spinal manipulative therapy for chronic low back pain. Results Fifty-five search terms were able to extract more than 100 citations. The NNR to find 1 potentially pertinent article using the narrow string was 1.2 for thoracic pain and 1.3 for temporomandibular pain, and the NNR for the expanded string was 1.9 and 1.6, respectively. The narrow search strategy retrieved all the randomized controlled trials included in the systematic review selected for comparison. Conclusion The proposed PubMed search strings may help health care professionals locate potentially pertinent articles and review a large number of MT studies efficiently to better implement evidence-based practice.

      PubDate: 2014-12-12T21:18:29Z
  • Regional Lumbar Motion and Patient-Rated Outcomes: A Secondary Analysis of
           Data From a Randomized Clinical Trial
    • Abstract: Publication date: Available online 4 November 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Rune M Mieritz , Gert Bronfort , Jan Hartvigsen
      Objective The purpose of this study was to examine the relationship in change scores between regional lumbar motion and patient-rated pain of the previous week and back-related function in chronic low back pain patients enrolled in a randomized clinical trial and treated with either exercise therapy or spinal manipulation using 6 different motion parameters. Methods Regional lumbar motions were sampled using a 6 degrees of freedom instrumented spatial linkage system in 199 participants at baseline and 12-week follow-up. The regional lumbar motion data were analyzed as a total cohort as well as relative to subgroup stratifications; back pain only vs back and leg pain, and treatment modality. For identifying clinically meaningful improvements in the measurements of back pain and back-related function, we used a 30% threshold. Results The relationship between change scores in patient-rated outcomes and objective measures of regional lumbar motion was found to be weak. In contrast, distribution of pain and treatment received affected associations between motion parameters and patient-rated outcomes. Thus, stronger correlation coefficients and significant differences between clinically relevant improved vs no clinical relevant change were found in some motion parameters in the subgroup with back pain only and the treatment group receiving spinal manipulation. Conclusion Overall, changes in regional lumbar motion were poorly associated with patient-rated outcomes measured by back-related function and back pain intensity scores. However, associations between regional lumbar motion vs patient-rated pain and back-related function were different in relative subgroups (back pain only vs back and leg pain and treatment).

      PubDate: 2014-11-06T13:49:49Z
  • Immediate Changes After Manual Therapy in Resting-State Functional
           Connectivity as Measured by Functional Magnetic Resonance Imaging in
           Participants With Induced Low Back Pain
    • Abstract: Publication date: Available online 3 October 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Charles W. Gay , Michael E. Robinson , Steven Z. George , William M. Perlstein , Mark D. Bishop
      Objective The purposes of this study were to use functional magnetic resonance imaging to investigate the immediate changes in functional connectivity (FC) between brain regions that process and modulate the pain experience after 3 different types of manual therapies (MT) and to identify reductions in experimentally induced myalgia and changes in local and remote pressure pain sensitivity. Methods Twenty-four participants (17 men; mean age ± SD, 21.6 ± 4.2 years) who completed an exercise-injury protocol to induce low back pain were randomized into 3 groups: chiropractic spinal manipulation (n = 6), spinal mobilization (n = 8), or therapeutic touch (n = 10). The primary outcome was the immediate change in FC as measured on functional magnetic resonance imaging between the following brain regions: somatosensory cortex, secondary somatosensory cortex, thalamus, anterior and posterior cingulate cortices, anterior and poster insula, and periaqueductal gray. Secondary outcomes were immediate changes in pain intensity, measured with a 101-point numeric rating scale, and pain sensitivity, measured with a handheld dynamometer. Repeated-measures analysis of variance models and correlation analyses were conducted to examine treatment effects and the relationship between within-person changes across outcome measures. Results Changes in FC were found between several brain regions that were common to all 3 MT interventions. Treatment-dependent changes in FC were also observed between several brain regions. Improvement was seen in pain intensity after all interventions (P < .05) with no difference between groups (P > .05). There were no observed changes in pain sensitivity, or an association between primary and secondary outcome measures. Conclusion These results suggest that MTs (chiropractic spinal manipulation, spinal mobilization, and therapeutic touch) have an immediate effect on the FC between brain regions involved in processing and modulating the pain experience. This suggests that neurophysiologic changes after MT may be an underlying mechanism of pain relief.

      PubDate: 2014-10-06T14:52:15Z
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