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Journal Cover Journal of Manipulative and Physiological Therapeutics
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 0161-4754
     Published by Elsevier Homepage  [2563 journals]   [SJR: 0.965]   [H-I: 45]
  • Chiropractic Use in the Medicare Population: Prevalence, Patterns, and
           Associations With 1-Year Changes in Health and Satisfaction With Care
    • Abstract: Publication date: Available online 16 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      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: 2014-09-17T08:42:00Z
       
  • Changes in Spasticity, Widespread Pressure Pain Sensitivity, and
           Baropodometry After the Application of Dry Needling in Patients Who Have
           Had a Stroke: A Randomized Controlled Trial
    • Abstract: Publication date: Available online 8 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jaime Salom-Moreno , Zacarías Sánchez-Mila , Ricardo Ortega-Santiago , Maria Palacios-Ceña , Sebastian Truyol-Domínguez , César Fernández-de-las-Peñas
      Objective The purpose of this study was to determine the effects of deep dry needling (DDN) on spasticity, pressure sensitivity, and plantar pressure in patients who have had stroke. Methods A randomized controlled trial was conducted. Thirty-four patients who previously had a stroke were randomly assigned either an experimental group that received a single session of DDN over the gastrocnemius and tibialis anterior muscles on the spastic leg or a control group that received no intervention. Spasticity (evaluated with the Ashworth Scale); pressure pain thresholds over the deltoid muscle, second metacarpal, and tibialis anterior muscle; and plantar pressure (baropodometry) were collected by a blinded assessor before and 10 minutes after intervention. Results A greater number of individuals receiving DDN exhibited decreased spasticity after the intervention (P < .001). The analysis of covariance showed that pressure pain thresholds increased bilaterally in patients receiving DDN compared with those who did not receive the intervention (P < .001). The analysis of covariance also found that patients receiving DDN experienced bilateral increases of support surface in the forefoot, unilateral increase of the support surface in the rear foot of the treated (affected) side, and bilateral decreases in mean pressure (all, P < .02) as compared with those who did not receive DDN. Conclusions Our results suggest that a single session of DDN decreases spasticity and widespread pressure sensitivity in individuals with poststroke spasticity. Deep dry needling also induced changes in plantar pressure by increasing the support surface and decreasing the mean pressure.


      PubDate: 2014-09-13T07:52:34Z
       
  • Real-Time Monitoring of Stresses and Displacements in Cervical Nuclei
           Pulposi During Cervical Spine Manipulation: A Finite Element Model
           Analysis
    • Abstract: Publication date: Available online 8 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Li-Ping Wu , Yuan-Qiao Huang , Das Manas , Yong-yuan Chen , Ji-hong Fan , Hua-gui Mo
      Objective The objective of this study was to research the distribution of stresses and displacements in cervical nuclei pulposi during simulated cervical spine manipulation (CSM). Methods A 3-dimensional finite element model of C3/4~C6/7 was established. The detailed mechanical parameters of CSM were analyzed and simulated. During the process, the changes in stresses and displacements of cervical nuclei pulposi within the model were displayed simultaneously and dynamically. Results Cervical spine manipulation with right rotation was targeted at the C4 spinous process of the model. During traction, levels of stresses and displacements of the nuclei pulposi exhibited an initial decrease followed by an increase. The major stresses and displacements affected the C3/4 nucleus pulposus during rotation in CSM, when its morphology gradually changed from circular to elliptical. The highest stress (48.53 kPa) occurred at its right superior edge, on rotating 40° to the right. It protruded toward the right superior, creating a gap in its left inferior aspect. The highest displacement, also at 40° right, occurred at its left superior edge and measured 0.7966 mm. Dimensions of stresses and displacements reduced quickly on rapid return to neutral position. Conclusion The morphology of the C3/4 nucleus pulposus changed during CSM with right rotation, and it created a gap in its left inferior aspect. Biomechanically, it is more safe and rational to rotate toward the healthy side than the prolapsed side of the intervertebral disk during CSM. Upon ensuring due safety, the closer the application force is to the diseased intervertebral disk, the better is the effect of CSM.


      PubDate: 2014-09-13T07:52:34Z
       
  • Exploring Patient Satisfaction: A Secondary Analysis of a Randomized
           Clinical Trial of Spinal Manipulation, Home Exercise, and Medication for
           Acute and Subacute Neck Pain
    • Abstract: Publication date: Available online 8 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Brent D. Leininger , Roni Evans , Gert Bronfort
      Objective The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction. Methods This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson's correlation and multiple linear regression. Results Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r = −0.75 to −0.77; R 2 = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided (r = −0.65 to 0.67; R 2 = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak (r = 0.17-0.38; R 2 = 0.08-0.21). Conclusions Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during spinal manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak.


      PubDate: 2014-09-13T07:52:34Z
       
  • Lumbar Spinal Stenosis and Lower Extremity Motor Control: The Impact of
           Walking-Induced Strain on a Performance-Based Outcome Measure
    • Abstract: Publication date: Available online 8 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Steven R. Passmore , Michael Johnson , Valerie Pelleck , Erica Ramos , Yasmine Amad , Cheryl M. Glazebrook
      Objective The primary objective of this study was to quantify the lower extremity movements and capabilities of a population with lumbar spinal stenosis (LSS) compared with healthy age-matched controls under conditions of strain and no strain. The secondary objective was to identify challenging movement conditions for a population with LSS, on a lower limb aiming task with different levels of difficulty, compared with healthy age-matched controls under conditions of strain and no strain. Methods Using a nonrandomized, controlled, before-and-after design, LSS patients (n = 16) and healthy controls (n = 16) performed 2 blocks of great toe–pointing movements to a series of projected squares. Following block 1, participants completed a 12-minute progressive exercise treadmill test. Pointing movements were analyzed using 3D motion analysis. Behavioral and kinematic measures evaluated performance. Results Both groups' reaction times (RTs) lengthened as task difficulty increased. An interaction revealed that LSS patients were more adversely impacted by task difficulty, F (3,372) = 4.207; P = .006. The progressive exercise treadmill test facilitated RT for both groups, F (1,124) = 5.105; P = .026. Control participants showed less variability in time-to-peak velocity poststrain, a benefit not shared by LSS patients, t (31) = 2.149; P = .040. Conclusion A lower extremity movement task captured differences under strain between healthy and LSS populations. The lower extremity Fitts' Law task accurately measured differences between healthy and LSS participants. For the subjects in this study, strain was sufficient to prevent LSS patients from demonstrating improvement in the variability of the ballistic phase of movement execution, whereas LSS patients' movement performance remained unchanged. This study also showed that regardless of strain, as task difficulty increased, LSS patients were more adversely impacted in the planning and execution of their lower limb movements than healthy control participants. The lower extremity motor control task (Fitts' task) can be used as a performance-based outcome measure to measure differences between healthy and LSS populations.


      PubDate: 2014-09-13T07:52:34Z
       
  • Effect of Spinal Manipulation Thrust Duration on Trunk Mechanical
           Activation Thresholds of Nociceptive-Specific Lateral Thalamic Neurons
    • Abstract: Publication date: Available online 12 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): William R. Reed , Randall Sozio , Joel G. Pickar , Stephen M. Onifer
      Objective The objective of this preliminary study was to determine if high-velocity, low-amplitude spinal manipulation (HVLA-SM) thrust duration alters mechanical trunk activation thresholds of nociceptive-specific (NS) lateral thalamic neurons. Methods Extracellular recordings were obtained from 18 NS neurons located in 2 lateral thalamic nuclei (ventrolateral [n = 12] and posterior [n = 6]) in normal anesthetized Wistar rats. Response thresholds to electronic von Frey anesthesiometer (rigid tip) mechanical trunk stimuli applied in 3 lumbar directions (dorsal-ventral, 45° caudal, and 45° cranial) were determined before and immediately after the delivery of 3 HVLA-SM thrust durations (time control 0, 100, and 400 milliseconds). Mean changes in mechanical trunk activation thresholds were compared using a mixed model analysis of variance. Results High-velocity, low-amplitude spinal manipulation duration did not significantly alter NS lateral thalamic neurons' mechanical trunk responses to any of the 3 directions tested with the anesthesiometer. Conclusions This study is the first to examine the effect of HVLA-SM thrust duration on NS lateral thalamic mechanical response thresholds. High-velocity, low-amplitude spinal manipulation thrust duration did not affect mechanical trunk thresholds.


      PubDate: 2014-09-13T07:52:34Z
       
  • 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: Available online 5 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      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: 2014-09-08T06:39:24Z
       
  • Information for Readers
    • Abstract: Publication date: September 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 7




      PubDate: 2014-09-08T06:39:24Z
       
  • Reliability of Surface Electromyography in the Assessment of Paraspinal
           Muscle Fatigue: An Updated Systematic Review
    • Abstract: Publication date: September 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 7
      Author(s): Mohammad A. Mohseni Bandpei , Nahid Rahmani , Basir Majdoleslam , Iraj Abdollahi , Shabnam Shah Ali , Ashfaq Ahmad
      Objective The purpose of this study was to review the literature to determine whether surface electromyography (EMG) is a reliable tool to assess paraspinal muscle fatigue in healthy subjects and in patients with low back pain (LBP). Methods A literature search for the period of 2000 to 2012 was performed, using PubMed, ProQuest, Science Direct, EMBASE, OVID, CINAHL, and MEDLINE databases. Electromyography, reliability, median frequency, paraspinal muscle, endurance, low back pain, and muscle fatigue were used as keywords. Results The literature search yielded 178 studies using the above keywords. Twelve articles were selected according to the inclusion criteria of the study. In 7 of the 12 studies, the surface EMG was only applied in healthy subjects, and in 5 studies, the reliability of surface EMG was investigated in patients with LBP or a comparison with a control group. In all of these studies, median frequency was shown to be a reliable EMG parameter to assess paraspinal muscles fatigue. There was a wide variation among studies in terms of methodology, surface EMG parameters, electrode location, procedure, and homogeneity of the study population. Conclusions The results suggest that there seems to be a convincing body of evidence to support the merit of surface EMG in the assessment of paraspinal muscle fatigue in healthy subject and in patients with LBP.


      PubDate: 2014-09-08T06:39:24Z
       
  • Table of Contents
    • Abstract: Publication date: September 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 7




      PubDate: 2014-09-08T06:39:24Z
       
  • Editorial Board
    • Abstract: Publication date: September 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 7




      PubDate: 2014-09-08T06:39:24Z
       
  • Spinal Height Change in Response to Sustained and Repetitive Prone Lumbar
           Extension After a Period of Spinal Unloading
    • Abstract: Publication date: Available online 4 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): M'Lyn Lazzarini , Jean-Michel Brismée , S. Christopher Owens , Gregory S. Dedrick , Phillip S. Sizer
      Objective The purpose of this study was to investigate if differences in spinal height changes in healthy individuals were observed after a period of spinal unloading using repetitive as compared with sustained lumbar extension exercises. Methods This study used a pretest, posttest, crossover design. Asymptomatic participants were recruited using convenience sampling. Thirty-two participants (15 male; 17 female) without back pain were included in the data analysis (mean, 24.4 years; range, 20-41 years). Participants performed sustained or repetitive prone lumbar extension exercises after 1 hour of sustained spinal unloading. Spinal height was measured using a stadiometer before and after the repetitive and sustained prone lumbar extension exercises. Results Paired t tests revealed no significant difference in spine height after repetitive (P = .774) or sustained (P = .545) prone lumbar extension after a period of spinal unloading. No significant difference between spinal height changes occurred between sustained (mean [SD], −0.28 [2.59] mm) and repetitive (mean [SD], −0.12 [2.42] mm) lumbar extension (P = .756). Conclusion In this group of asymptomatic individuals, sustained and repetitive lumbar extension exercises did not appear to affect spinal height after a period of spinal unloading.


      PubDate: 2014-09-08T06:39:24Z
       
  • Immediate Effects of Manual Traction on Radiographically Determined Joint
           Space Width in the Hip Joint
    • Abstract: Publication date: Available online 4 September 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Tomonori Sato , Naomi Sato , Kenji Masui , Yukinobu Hirano
      Objective The purpose of this study was to investigate the immediate effects of manual traction of the hip joint on joint space width (JSW) on asymptomatic subjects. Methods Asymptomatic, healthy male volunteers (n = 15), aged 25 to 34 years were included in this study. Three radiographs were obtained with the subjects in the supine position, before and after loading with 10% of his body weight, and after manual traction on only the right hip joint. Joint space width was measured by a radiologist at the point described by Jacobson and Sonne-Holm. Results There were significant changes in JSW on the right hip joint and left hip joint between the baseline (before loading) and immediately after loading. We also observed a significantly increased JSW on only the right hip joint between periods that followed loading and manual traction on the right hip joint. There was no significant change in JSW on the left hip joint between periods that followed loading and manual traction on the right hip joint. Conclusions The results of this study suggest that a significant increase in JSW in young, healthy male patients can occur immediately after manual traction of the hip joint.


      PubDate: 2014-09-08T06:39:24Z
       
  • Information for Readers
    • Abstract: Publication date: July–August 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 6




      PubDate: 2014-09-04T06:06:50Z
       
  • Editorial Board
    • Abstract: Publication date: July–August 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 6




      PubDate: 2014-09-04T06:06:50Z
       
  • Table of Contents
    • Abstract: Publication date: July–August 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 6




      PubDate: 2014-09-04T06:06:50Z
       
  • Functions of the Temporomandibular System in Extracranial Chronic Pain
           
    • Abstract: Publication date: Available online 21 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Michael J. Fischer , Michael Stephan , Heike Kielstein , Henning Rahne , Boya Nugraha , Christoph Gutenbrunner , Jin Y. Ro , Peter Svensson
      Objective Mastication may be able to activate endogenous pain inhibitory mechanisms and therefore lead to modulation of nociceptive processing. The purpose of this study was to examine the possible effect of food consistency on noxious input from the spinal system. Methods Three groups of adult male Sprague-Dawley rats were given an injection of complete Freund adjuvant in a hind paw 10 days after eating soft or hard food (one group received a saline injection—the control group [C]; the other group (D) received no injection). Nocifensive behavior was assessed with the use of the hot plate and tail flick assays at 1, 3, 6, and 12 hours and at 6.5 days after injection for groups A/B, and c-Fos activity was assessed in the brain after testing. Groups C/D had hot plate testing at 1 hour and 6.5 days. The data were analyzed by general linear modeling and 1-way analysis of variance. Results There was a small increase in the hot plate percent maximum possible effect (MPE) from −45.7 to −61.1 in group A over the length of the experiment, but a very small decrease for group B over the same period (−33.5 to −28.8). For the saline control group, there was a small increase toward 0 %MPE over the same time frame (−15.0 to 1.7). The %MPE differences were significant between groups A and C (P < .0005), but not significant between the other groups (F = 13.34, df = 2, P = .001, observed power = 99%). Using the pooled results (all time points), the differences between all groups were significant (P < .0005). There were no significant differences in the tail flick test. c-Fos was mainly observed in the raphe pallidus area with significant differences between groups A and B at 3 and 6 hours after injection of CFA (P = .027 and .022, respectively). Conclusions The results of this study indicate that food consistency (hardness) influences nocifensive behavior in this animal model via a descending pathway operating at the supraspinal level.


      PubDate: 2014-09-04T06:06:50Z
       
  • A Preliminary Study to Evaluate Postural Improvement in Subjects With
           Scoliosis: Active Therapeutic Movement Version 2 Device and Home Exercises
           Using the Mulligan’s Mobilization-With-Movement Concept
    • Abstract: Publication date: Available online 21 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Clare Lewis , Rafael Diaz , Geoff Lopez , Nicholas Marki , Ben Olivio
      Objective The purpose of this preliminary study was to determine if the use of Active Therapeutic Movement Version 2 (ATM2) device and home exercises using the Mulligan’s mobilization-with-movement concept by subjects with scoliosis would result in postural improvement and to document any changes in trunk range of motion and quality of life. Methods Forty-three subjects between the ages of 12 to 75 years were recruited for the study. Each subject underwent a low back evaluation along with specific measurements for their scoliosis. Subjects participated in a 4-week intervention, 2 times a week consisting of treatment utilizing the ATM2 and were also given a home exercise program to mimic the specific movement(s) they performed on the ATM2. Photographic assessment of posture was taken before and after the intervention. Subjects were surveyed during the initial assessment and again at the final intervention using the following outcome measures: Fear Avoidance Belief Questionnaire, Short-Form Health Survey-36, Oswestry Disability Index, and a Numeric Pain Rating Scale. Results Results were significant for most of the variables measured. Subjects gained improvement in spinal ranges of motion for all directions except for flexion and extension (most subjects had reference range of flexion and extension at the beginning of the study). Most subjects had improved pelvic alignment after the intervention. Before and after photographs demonstrated improved posture. Subjective measurements of pain, disability, and quality of life improved. Conclusions Results of this preliminary study showed improvement for selected variables. The use of ATM2 and home exercises using the Mulligan’s mobilization-with-movement concept by subjects with scoliosis appears to be a potentially viable conservative treatment alternative to address various findings associated with scoliosis, including posture improvement.


      PubDate: 2014-09-04T06:06:50Z
       
  • Ultrasound Imaging of the Trapeziometacarpal Articular Cavity to
           Investigate the Presence of Intraarticular Gas Bubbles After Chiropractic
           Manipulation
    • Abstract: Publication date: Available online 10 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Allan R. Jones , Christopher J. Yelverton , Charmaine Bester
      Objective The purpose of this study was to investigate the presence of intraarticular gas bubbles in the trapeziometacarpal joint cavity after chiropractic manipulation with audible cavitation and to assess the state of the gas bubbles after a 20-minute refractory period. Methods This investigation included 18 asymptomatic male and female participants between the ages of 21 and 26 years. High-resolution (15 MHz) sonograms of the trapeziometacarpal articular cavity were obtained by an experienced musculoskeletal ultrasonographer at 3 intervals: premanipulation, within 30 seconds postmanipulation, and at 20 minutes postmanipulation. The sonograms were saved as digital copies for subsequent reports that were correlated with reports compiled during dynamic visualization of the articular cavity. Data were extracted from the reports for analysis. Results The premanipulative sonograms showed that 27.78% of joints contained minute gas bubbles, also known as microcavities, within the synovial fluid before the joint was manipulated. The remaining 72.22% of joints contained no intraarticular microcavities. All of the postmanipulative sonograms revealed numerous large conspicuous gas bubbles within the synovial fluid. The postrefractory sonograms showed that, in 66.66% of the synovial fluid, gas bubbles were still visible, whereas the remaining 33.34% had no presence of gas bubbles or microcavities, and the synovial fluid had returned to its premanipulative state. Conclusion The findings of this study suggest that synovial fluid may contain intraarticular microcavities even before a manipulation is performed. Numerous large intraarticular gas bubbles are formed during manipulation due to cavitation of the synovial fluid and were observed in the absence of an axial distractive load at the time of imaging. In most cases, these gas bubbles remained within the joint for longer than 20 minutes.


      PubDate: 2014-08-15T04:48:16Z
       
  • Report of the National Institutes of Health Task Force on Research
           Standards for Chronic Low Back Pain
    • Abstract: Publication date: Available online 12 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Richard A. Deyo , Samuel F. Dworkin , Dagmar Amtmann , Gunnar Andersson , David Borenstein , Eugene Carragee , John Carrino , Roger Chou , Karon Cook , Anthony DeLitto , Christine Goertz , Partap Khalsa , John Loeser , Sean Mackey , James Panagis , James Rainville , Tor Tosteson , Dennis Turk , Michael Von Korff , Debra K. Weiner
      Objectives Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed nonspecific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The purpose of this article is to disseminate the report of the National Institutes of Health (NIH) task force on research standards for cLBP. Methods The NIH Pain Consortium charged a research task force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting. Results The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research subjects (drawing heavily on the Patient Reported Outcomes Measurement Information System methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved these recommendations, which investigators should incorporate into NIH grant proposals. Conclusions The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of cLBP. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document and undergo continual improvement.


      PubDate: 2014-08-15T04:48:16Z
       
  • 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: Available online 12 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      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: 2014-08-15T04:48:16Z
       
  • Quantification of the Lumbar Flexion-Relaxation Phenomenon: Comparing
           Outcomes of Lumbar Erector Spinae and Superficial Lumbar Multifidus in
           Standing Full Trunk Flexion and Slumped Sitting Postures
    • Abstract: Publication date: Available online 7 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Alison Schinkel-Ivy , Brian C. Nairn , Janessa D.M. Drake
      Objective The purpose of this study was to identify differences in flexion-relaxation outcomes in asymptomatic participants, with respect to both flexion-relaxation phenomenon (FRP) occurrence and spinal onset angles, as a function of posture and choice of muscle being examined. Methods This was a cross-sectional study in a laboratory setting. Thirty asymptomatic participants performed standing full trunk flexion and slumped sitting postures while activation levels of the lumbar erector spinae and superficial lumbar multifidus were monitored. Two thresholds were used to define whether FRP was present in each muscle and, if present, at what trunk flexion angle it occurred. These outcomes were compared descriptively between muscles and between postures. Results Most participants displayed FRP in both muscles during standing full flexion; occurrences were more variable in slumped sitting. On average, FRP during standing full flexion and slumped sitting occurred at approximately 80% and 52% of participants' maximum flexion value, respectively. Variability in the slumped sitting onset angles was greater than that in standing full flexion. Conclusion Outcomes for FRP during standing full flexion in asymptomatic participants appeared to be more robust and were not affected by the choice of either lumbar erector spinae or superficial lumbar multifidus. Conversely, during slumped sitting, FRP occurrence varied substantially depending on choice of muscle, although onset angles were relatively consistent between muscles. Although the choice of one muscle over the other may be warranted, it may be prudent to examine both muscles during FRP investigations in sitting postures, in order to fully characterize the behavior and activation patterns of the lumbar musculature.


      PubDate: 2014-08-10T04:10:35Z
       
  • Global Body Posture and Plantar Pressure Distribution in Individuals With
           and Without Temporomandibular Disorder: A Preliminary Study
    • Abstract: Publication date: Available online 6 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Juliana A. Souza , Fernanda Pasinato , Eliane C.R. Corrêa , Ana Maria T. da Silva
      Objective The aim of this study was to evaluate body posture and the distribution of plantar pressure at physiologic rest of the mandible and during maximal intercuspal positions in subjects with and without temporomandibular disorder (TMD). Methods Fifty-one subjects were assessed by the Diagnostic Criteria for Research on Temporomandibular Disorders and divided into a symptomatic group (21) and an asymptomatic group (30). Postural analysis for both groups was conducted using photogrammetry (SAPo version 0.68; University of São Paulo, São Paulo, Brazil). The distribution of plantar pressures was evaluated by means of baropodometry (Footwork software), at physiologic rest and maximal intercuspal positions. Results Of 18 angular measurements, 3 (17%) were statistically different between the groups in photogrammetric evaluation. The symptomatic group showed more pronounced cervical distance (P = .0002), valgus of the right calcaneus (P = .0122), and lower pelvic tilt (P = .0124). The baropodometry results showed the TMD subjects presented significantly higher rearfoot and lower forefoot distribution than those in the asymptomatic group. No differences were verified in maximal intercuspal position in the between-group analysis and between the 2 mandibular positions in the within-group analysis. Conclusions Subjects with and without TMD presented with global body posture misalignment. Postural changes were more pronounced in the subjects with TMD. In addition, symptomatic subjects presented with abnormal plantar pressure distribution, suggesting that TMD may have an influence on the postural system.


      PubDate: 2014-08-10T04:10:35Z
       
  • Activation of Rectus Capitis Posterior Major Muscles During Voluntary
           Retraction of the Head in Asymptomatic Subjects
    • Abstract: Publication date: Available online 6 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Richard C. Hallgren , Jacob J. Rowan , Peng Bai , Steven J. Pierce , Gail A. Shafer-Crane , Lawrence L. Prokop
      Objective The purpose of this study was to assess levels of electromyographic activity measured from rectus capitis posterior major (RCPM) muscles of asymptomatic subjects as their heads moved from a self-defined neutral position to a retracted position. Methods A 2 × 2 within-subjects factorial research design was used. Disposable, intramuscular electrodes were used to collect electromyographic data from asymptomatic subjects between the ages of 20 and 40 years old. Data analysis was performed using mixed effects β regression models. Results Activation of RCPM muscles was found to significantly increase (P < .0001) as the head moved from a self-defined neutral position to a retracted position. Rectus capitis posterior major muscle activation levels, measured as a function of head position, have not been previously reported. Conclusions The findings from this study showed that RCPM muscle activation significantly increases during voluntary retraction of the head.


      PubDate: 2014-08-10T04:10:35Z
       
  • The Clinical and Sonographic Effects of Kinesiotaping and Exercise in
           Comparison With Manual Therapy and Exercise for Patients With Subacromial
           Impingement Syndrome: A Preliminary Trial
    • Abstract: Publication date: Available online 6 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Derya Ozer Kaya , Gul Baltaci , Ugur Toprak , Ahmet Ozgur Atay
      Objective The purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome. Methods Randomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions. Results At the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P < .05). No difference was observed on ultrasound for tendon thickness after treatment in both groups (P > .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P < .05). Conclusion For the group of subjects studied, no differences were found between kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks.


      PubDate: 2014-08-10T04:10:35Z
       
  • A Pilot Randomized Controlled Trial of Flexion-Distraction Dosage for
           Chiropractic Treatment of Lumbar Spinal Stenosis
    • Abstract: Publication date: Available online 6 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jerrilyn A. Cambron , Michael Schneider , Jennifer M. Dexheimer , Grant Iannelli , Mabel Chang , Lauren Terhorst , Gregory D. Cramer
      Objective The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation. Methods This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments). The fourth group was given 8 treatments of placebo care. Feasibility measures included recruitment goals, adherence to various treatment schedules, credibility of the placebo treatment, and rates of adverse events. The primary outcome measure was the Swiss Spinal Stenosis Questionnaire, a validated self-report of LSS symptom severity and physical function. Results The recruitment and adherence goals of the study were met with a total of 60 subjects randomized (n = 15 per group) and most subjects attending at least 75% of their scheduled visits. No adverse events were reported by any of the subjects in the trial. Our placebo treatment did not appear to be credible; most subjects correctly guessed that they were receiving a placebo treatment. Between-group effect size estimates were small, indicating larger samples are needed for future studies. Conclusion This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a 6-week treatment schedule. The information gained from this trial will be useful to inform the design of larger trials.


      PubDate: 2014-08-10T04:10:35Z
       
  • Short Term Effects of Classic Massage Compared to Connective Tissue
           Massage on Pressure Pain Threshold and Muscle Relaxation Response in Women
           With Chronic Neck Pain: A Preliminary Study
    • Abstract: Publication date: Available online 6 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Yesim Bakar , Meral Sertel , Asuman Öztürk , Eylem Tütün Yümin , Necati Tatarli , Handan Ankarali
      Objective The purpose of this study was to evaluate the short-term effects of classic massage (CM) and connective tissue massage (CTM) on pressure pain threshold and muscle relaxation response in women with chronic neck pain. Methods Participants included 45 female volunteers (ages between 25 and 45 years) presenting to the Köroglu State Hospital Neurosurgery Polyclinic who had experienced neck pain for 3 to 6 months. The volunteers were randomly assigned to 2 groups (CM or CTM to the thoracic spine and the neck). Each treatment was carried out for 1 session. Outcome measures were obtained before and after treatment, which included pressure pain threshold that was measured with an algometer and muscle relaxation response that was evaluated with electromyography biofeedback (EMG-BF). Results Pressure pain threshold of the sternocleidomastoid muscle was significantly different for the CM (P < .05) group. The EMG-BF values were significantly different for the CTM group (P < .05). Comparing the results of CM and CTM, EMG-BF averages favored the CTM group (P < .05). Conclusion For the group of women with chronic neck pain that were included in this study, 1 treatment of CTM demonstrated relaxation responses and 1 treatment of CM demonstrated pain reduction.


      PubDate: 2014-08-10T04:10:35Z
       
  • Effectiveness of Global Postural Reeducation Compared to Segmental
           Exercises on Function, Pain, and Quality of Life of Patients With Scapular
           Dyskinesis Associated With Neck Pain: A Preliminary Clinical Trial
    • Abstract: Publication date: Available online 2 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Cinthia Santos Miotto de Amorim , Mauro Emilio Conforto Gracitelli , Amélia Pasqual Marques , Vera Lúcia dos Santos Alves
      Objective The purpose of this study was to assess the effectiveness of global postural reeducation (GPR) relative to segmental exercises (SE) in the treatment of scapular dyskinesis (SD) associated with neck pain. Methods Participants with SD and neck pain (n = 30) aged 18 to 65 years were randomly assigned to one of two groups: GPR and SE (stretching exercises). The upper extremity was assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire; function of the neck was estimated using the Neck Disability Index; pain severity was measured using a visual analogical scale; and health-related quality of life was assessed using the Short Form–12. Assessments were conducted at baseline and after 10 weekly sessions (60 minutes each). The significance level adopted was α < .05. Results For pre-post treatment comparisons, GPR was significantly associated with improvements in function of neck and upper extremities, pain, and physical and mental domains of quality of life (P < .05). Segmental exercises improved function of upper extremities and of the neck and severity of pain (P < .05). When contrasting groups, GPR was significantly superior to SE in improving pain and physical domains of the quality of life. Conclusion This study showed that GPR and SE had similar effects on function of the neck and upper extremity in patients with SD associated with neck pain. When comparing groups, GPR was superior to SE in improving pain and quality of life.


      PubDate: 2014-08-06T03:53:22Z
       
  • A Qualitative Exploration of Key Informant Perspectives Regarding the
           Nature and Impact of Contemporary Legislation on Professional Development:
           A Grounded Theory Study of Chiropractic in Denmark
    • Abstract: Publication date: Available online 2 August 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Corrie Myburgh
      Objective The purpose of this study was to construct a substantive framework of the manner in which the Danish government interacts with the Danish chiropractic profession and influences professional practice. Methods An exploratory, qualitative study was performed using a substantive grounded theory (GT) approach. Unstructured, face-to-face, individual interviews were conducted during the years 2012 and 2013 and thematically analyzed. Six people were interviewed for this study including a gatekeeper and witness to legislative history, a previous chiropractic political representative and witness to legislative history, a previous Department of Health negotiator and previous administrator of chiropractic affairs and witness to legislative history, a current administrator of chiropractic affairs, an active chiropractic political representative and witness to legislative history, and a chief negotiator for Danish Regional Health Care Services. Results Open and axial coding yielded 2 themes centering on licensing chiropractors in Denmark and the resultant developmental issues encountered. Through further selective coding, the GT core construct, “chiropractic practice in the Danish heath care system” emerged. The GT highlights the tension between the strategic political importance of legislation and the restrictive nature of the overly specific act currently regulating chiropractic practice. Moreover, the GT also revealed the perceived negative effect that the National Board of Health may exert on clinical practice due to its conservative interpretation of the act. Conclusions The Danish government is perceived to act as a countervailing power related to chiropractic practice. The derived substantive GT suggests that the Danish government's dualistic action relative to the Danish chiropractic community may inhibit the spontaneous evolution of contemporary Danish chiropractic practice. Although historically narrow legislation may limit chiropractic practice, conservative interpretations by the Danish National Board of Health may also play an important role.


      PubDate: 2014-08-06T03:53:22Z
       
  • The Chiropractic Scope of Practice in the United States: A Cross-Sectional
           Survey
    • Abstract: Publication date: Available online 8 July 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Mabel Chang
      Objective The purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998. Methods A cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability. Results Partial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30). Conclusion The scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation.


      PubDate: 2014-07-28T03:21:46Z
       
  • Evaluation of the Usefulness of 2 Prediction Models of Clinical Prediction
           Models in Physical Therapy: A Qualitative Process Evaluation
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5
      Author(s): Lieke van Oort , Arianne Verhagen , Bart Koes , Riekie de Vet , Han Anema , Martijn Heymans
      Objective The purposes of this study were to (1) evaluate the usefulness of 2 prediction models by assessing the actual use and advantages/disadvantages of application in daily clinical practice and (2) propose recommendations to enhance their implementation. Methods Physical therapists working in 283 practices in the area of Breda (the Netherlands) were invited to participate in this study. Two prediction models were presented: (1) to predict persistent shoulder pain and (2) to predict the preferable treatment in nonspecific neck pain. Participants were asked to apply both models in practice. After 2 months, their opinions about the usefulness of both models were gathered during a focus group meeting or by using an online questionnaire in order to identify the most important advantages/disadvantages of each prediction model. Results In total, 46 physical therapists (13.8%) of 39 practices participated. Evaluative data were available from 32 participants who used the shoulder model 102 times and the neck model 126 times. For the shoulder model, the most frequent advantage (mentioned 14 times) was that it enabled physical therapists to estimate a motivated prognosis, that is, a prognosis based on the score of the model. The most frequent mentioned disadvantage was that participants expressed their doubts about the validity of the model because the model initially was developed for usage in a general practice setting. For the neck model, the most frequently mentioned advantage (29 times) was that the model was easy to interpret. The most important disadvantage (mentioned 14 times) was that the model only takes a few treatment options into account. Conclusions The physical therapists participating in this study reported that both models evaluated in this study were not easy to use in daily practice. Based on the findings of this study, we recommend that these models are modified to meet the practical needs of the therapist, before assessing their impact on daily clinical care and patient outcomes.


      PubDate: 2014-07-28T03:21:46Z
       
  • Assessment of Paraspinal Muscle Hardness in Subjects With a Mild Single
           Scoliosis Curve: A Preliminary Myotonometer Study
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5
      Author(s): Ángel Oliva-Pascual-Vaca , Alberto Marcos Heredia-Rizo , Alejandro Barbosa-Romero , Jesús Oliva-Pascual-Vaca , Cleofás Rodríguez-Blanco , Sergio Tejero-García
      Objective The purpose of this study was to evaluate the hardness of the paraspinal muscles in the convexity and concavity of patients with scoliosis curvatures and in the upper trapezius (UT) muscle in subjects with mild idiopathic scoliosis (IS) and to observe the correlation between the myotonometer (MYO) measurements and the value of body mass index (BMI) and the Cobb angle. Methods The sample included 13 patients with a single-curve mild IS (Risser sign ≤4) at thoracic, lumbar, or thoracolumbar level (mean Cobb angle of 11.53º). Seven females and 6 males were recruited, with a mean age of 12.84 ± 3.06 (9-18) years. A MYO was used to examine the differences in muscle hardness on both sides of the scoliosis curvature at several points: (a) apex of the curve, (b) upper and lower limits of the curve, and (c) the midpoint between the apex and the upper limit and between the apex and the lower limit. The UT was also explored. Results Although the MYO recorded lower values in all points on the concave side of the scoliosis, there were no significant differences in the comparison between sides (P > .05). No association was observed between BMI and MYO values, whereas the Cobb angle negatively correlated with muscle hardness only at 2 points on the convex side. Conclusion The preliminary findings show that, in subjects with a single-curve mild IS, muscular hardness in the UT and paraspinal muscles, as assessed using a MYO, was not found to differ between the concave and the convex sides at different reference levels.


      PubDate: 2014-07-28T03:21:46Z
       
  • Changes in Kinetic, Kinematic, and Temporal Parameters of Walking in
           People With Limited Ankle Dorsiflexion: Pre-Post Application of Modified
           Mobilization With Movement Using Talus Glide Taping
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5
      Author(s): Ji-yeon Yoon , Young-in Hwang , Duk-hyun An , Jae-seop Oh
      Objective The purpose of this study was to investigate the changes in passive ankle dorsiflexion range of motion (ROM), maximum plantar force, force-time integral, and time to heel off during walking between pre- and postapplication of modified mobilization with movement (MWM) using talus glide taping in people with limited ankle dorsiflexion. Methods Eighteen feet with limited ankle dorsiflexion in 13 people were examined. Participants performed 3 different walking tasks in the following order: walking before and immediately after applying the modified MWM using talus glide taping and walking after 5-minute walking with the modified MWM using talus glide taping. A floor-mat pressure measurement system (HR-mat) was used to measure maximum plantar force, force-time integral, and time to heel off; and passive ankle dorsiflexion ROM was measured using a standard goniometer. The significance of differences was assessed using repeated one-way analysis of variance. Results Passive ankle dorsiflexion ROM and time to heel off were significantly increased after 5-minute walking with the modified MWM using talus glide taping compared with walking before and immediately after applying the tape. Significantly increased maximum plantar force and force-time integral on the hindfoot and significantly decreased force-time integral on the forefoot during walking after 5-minute walking were observed with the modified MWM using talus glide taping compared with before applying the tape. No significant difference between before and immediately after applying the tape was observed in any variable. Conclusions Our results suggest that walking an additional 5-minute with the modified MWM using talus glide taping increased passive ankle dorsiflexion ROM and time to heel off and improved dynamic plantar loading during walking.


      PubDate: 2014-07-28T03:21:46Z
       
  • Cost Analysis Related to Dose-Response of Spinal Manipulative Therapy for
           Chronic Low Back Pain: Outcomes From a Randomized Controlled Trial
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5
      Author(s): Darcy A. Vavrek , Rajiv Sharma , Mitchell Haas
      Objective The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP). Methods We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data. Results Lost productivity accounts for most societal costs of chronic LBP. Cost of treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age (P = .03), greater disability (P = .01), lower quality-adjusted life year scores (P = .01), and higher costs in the period preceding enrollment (P < .01). Pain-free and disability-free days were greater for all SMT doses compared with control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days (P = .03) and19.8 disability-free days (P = .04). No statistically significant group differences in quality-adjusted life years were noted. Conclusions A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.


      PubDate: 2014-07-28T03:21:46Z
       
  • Instantaneous Rate of Loading During Manual High-Velocity, Low-Amplitude
           Spinal Manipulations
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5
      Author(s): Maruti Ram Gudavalli
      Objective The objective of this study was to determine the instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations (HVLA SMs) in the lumbar and thoracic regions and compare to the average rates of loading. Methods Force-time profiles were recorded using a hand force transducer placed between the hand of a doctor of chiropractic and the subject’s back during 14 HVLA SM thrusts on asymptomatic volunteers while 3 doctors of chiropractic delivered the spinal manipulations. Doctors also delivered 36 posterior to anterior thoracic manipulations on a mannequin. Data were collected at a sampling rate of 1000 Hz using Motion Monitor software. Force-time profile data were differentiated to obtain instantaneous rates of loading. The data were reduced using a custom-written MathCad program and analyzed descriptively. Results The instantaneous rates of loading were 1.7 to 1.8 times higher than average rates of loading, and instantaneous rates of unloading were 2.1 to 2.6 times the average rates of unloading during HVLA SMs. Maximum instantaneous rates of loading occurred 102 to 111 milliseconds prior to peak load. Maximum instantaneous rates of unloading occurred 121 to 154 milliseconds after the peak load. These data may be useful for further understanding of HVLA SMs. Conclusions The instantaneous rates of loading and where they occurred may be useful data for understanding and describing HVLA SMs.


      PubDate: 2014-07-28T03:21:46Z
       
  • The Role of Preload Forces in Spinal Manipulation: Experimental
           Investigation of Kinematic and Electromyographic Responses in Healthy
           Adults
    • 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: 2014-07-28T03:21:46Z
       
  • Editorial Board
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5




      PubDate: 2014-07-28T03:21:46Z
       
  • Table of Contents
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5




      PubDate: 2014-07-28T03:21:46Z
       
  • Information for Readers
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5




      PubDate: 2014-07-28T03:21:46Z
       
  • Effect of Spinal Manipulation Thrust Magnitude on Trunk Mechanical
           Activation Thresholds of Lateral Thalamic Neurons
    • Abstract: Publication date: June 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 5
      Author(s): William R. Reed , Joel G. Pickar , Randall S. Sozio , Cynthia R. Long
      Objectives High-velocity low-amplitude spinal manipulation (HVLA-SM), as performed by doctors who use manual therapy (eg, doctors of chiropractic and osteopathy), results in mechanical hypoalgesia in clinical settings. This hypoalgesic effect has previously been attributed to alterations in peripheral and/or central pain processing. The objective of this study was to determine whether thrust magnitude of a simulated HVLA-SM alters mechanical trunk response thresholds in wide dynamic range (WDR) and/or nociceptive specific (NS) lateral thalamic neurons. Methods Extracellular recordings were carried out in the thalamus of 15 anesthetized Wistar rats. Lateral thalamic neurons having receptive fields, which included the lumbar dorsal-lateral trunk, were characterized as either WDR (n=22) or NS (n=25). Response thresholds to electronic von Frey (rigid tip) mechanical trunk stimuli were determined in 3 directions (dorsal-ventral, 45° caudalward, and 45° cranialward) before and immediately after the dorsal-ventral delivery of a 100-millisecond HVLA-SM at 3 thrust magnitudes (control, 55%, 85% body weight). Results There was a significant difference in mechanical threshold between 85% body weight manipulation and control thrust magnitudes in the dorsal-ventral direction in NS neurons (P =.01). No changes were found in WDR neurons at either HVLA-SM thrust magnitude. Conclusions This study is the first to investigate the effect of HVLA-SM thrust magnitude on WDR and NS lateral thalamic mechanical response threshold. Our data suggest that, at the single lateral thalamic neuron level, there may be a minimal spinal manipulative thrust magnitude required to elicit an increase in trunk mechanical response thresholds.


      PubDate: 2014-07-28T03:21:46Z
       
  • 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: Available online 27 June 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      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: 2014-07-28T03:21:46Z
       
  • Outcomes for Chronic Neck and Low Back Pain Patients After Manipulation
           Under Anesthesia: A Prospective Cohort Study
    • Abstract: Publication date: Available online 3 July 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Cynthia K. Peterson , B. Kim Humphreys , Regina Vollenweider , Michel Kressig , Rolf Nussbaumer
      Background The purpose of this study was to investigate outcomes of chronic patients unresponsive to previous spinal manipulative therapy subsequently treated with manipulation under anesthesia (MUA). Methods A prospective outcome cohort study was performed on 30 patients who had not improved with previous treatment and who underwent a single MUA by a doctor of chiropractic. The numeric rating scale for pain (NRS) and Bournemouth Questionnaire (BQ) were collected at 2weeks and 1day before MUA. At 2 and 4weeks after MUA, the Patient's Global Impression of Change, NRS, and BQ were collected. The intraclass correlation coefficient evaluated stability before treatment. Percentage of patients “improved” was calculated at 2 and 4weeks. Wilcoxon test compared pretreatment NRS and BQ scores with posttreatment scores. Mann-Whitney U test compared individual questions on the BQ between improved and not improved patients. Logistic regression compared BQ questions to “improvement.” Results Good stability of NRS and BQ scores before MUA (intraclass correlation coefficient=0.46-0.95) was found. At 2weeks, 52% of the patients reported improvement with 45.5% improved at 4weeks. Significant reductions in NRS scores at 4weeks (P =.01) and BQ scores at 2 (P =.008) and 4weeks (P =.001) were reported. Anxiety/stress levels were significantly different at 2 and 4weeks between improved and not improved patients (P =.007). None of the BQ questions were predictive of improvement. Conclusion Approximately half of patients previously unresponsive to conservative treatment reported clinically relevant improvement at 2 and 4weeks post-MUA.


      PubDate: 2014-07-28T03:21:46Z
       
  • Information for Readers
    • Abstract: Publication date: May 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 4




      PubDate: 2014-06-03T15:41:24Z
       
  • Table of Contents
    • Abstract: Publication date: May 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 4




      PubDate: 2014-06-03T15:41:24Z
       
  • Editorial Board
    • Abstract: Publication date: May 2014
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 37, Issue 4




      PubDate: 2014-06-03T15:41:24Z
       
  • Immediate Changes in Neck Pain Intensity and Widespread Pressure Pain
           Sensitivity in Patients With Bilateral Chronic Mechanical Neck Pain: A
           Randomized Controlled Trial of Thoracic Thrust Manipulation vs
           Non–Thrust Mobilization
    • Abstract: Publication date: Available online 28 May 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jaime Salom-Moreno , Ricardo Ortega-Santiago , Joshua Aland Cleland , Maria Palacios-Ceña , Sebastian Truyols-Domínguez , César Fernández-de-las-Peñas
      Objective The purpose of this study was to compare the effects of thoracic thrust manipulation vs thoracic non–thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity. Methods Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non–thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction. Results No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6: P >.252; second metacarpal: P >.452; tibialis anterior: P >.273): both groups exhibited similar increases in PPT (all, P <.01), but within-group and between-group effect sizes were small (standardized mean score difference [SMD]<0.22). The ANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater decrease in neck pain (between-group mean differen 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non–thrust mobilization (P <.001). Within-group effect sizes were large for both groups (SMD>2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group. Conclusions The results of this randomized clinical trial suggest that thoracic thrust manipulation and non–thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non–thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain.


      PubDate: 2014-06-03T15:41:24Z
       
  • Evaluation of Peak Force of a Manually Operated Chiropractic Adjusting
           Instrument With an Adapter for Use in Animals
    • Abstract: Publication date: Available online 2 May 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Felipe Coutinho Kullmann Duarte , Carolina Kolberg , Rodrigo R. Barros , Vivian G.A. Silva , Günter Gehlen , Jakson M. Vassoler , Wania A. Partata
      Objective This study was designed to assess the peak force of a manually operated chiropractic adjusting instrument, the Activator Adjusting Instrument 4 (AAI 4), with an adapter for use in animals, which has a 3- to 4-fold smaller contact surface area than the original rubber tip. Methods Peak force was determined by thrusting the AAI 4 with the adapter or the original rubber tip onto a load cell. First, the AAI 4 was applied perpendicularly by a doctor of chiropractic onto the load cell. Then, the AAI 4 was fixed in a rigid framework and applied to the load cell. This procedure was done to prevent any load on the load cell before the thrust impulse. In 2 situations, trials were performed with the AAI 4 at all force settings (settings I, II, III, and IV, minimum to maximum, respectively). A total of 50000 samples per second over a period of 3 seconds were collected. Results In 2 experimental protocols, the use of the adapter in the AAI 4 increased the peak force only with setting I. The new value was around 80% of the maximum value found for the AAI 4. Nevertheless, the peak force values of the AAI 4 with the adapter and with the original rubber tip in setting IV were similar. Conclusion The adapter effectively determines the maximum peak force value at force setting I of AAI 4.


      PubDate: 2014-05-07T04:00:05Z
       
  • Function in Patients With Cervical Radiculopathy or Chronic
           Whiplash-Associated Disorders Compared With Healthy Volunteers
    • Abstract: Publication date: Available online 18 April 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Anneli Peolsson , Maria Landén Ludvigsson , Johanna Wibault , Åsa Dedering , Gunnel Peterson
      Objective The purposes of this study were to examine whether any differences in function and health exist between patients with cervical radiculopathy (CR) due to disk disease scheduled for surgery and patients with chronic whiplash-associated disorders (WADs) and to compare measures of patients' physical function with those obtained from healthy volunteers. Methods This is a cross-sectional study of patients with CR (n = 198) and patients with chronic WAD (n = 215). Patient data were compared with raw data previously obtained from healthy people. Physical measures included cervical active range of motion, neck muscle endurance, and hand grip strength. Self-rated measures included pain intensity (visual analog scale), neck disability (Neck Disability Index), self-efficacy (Self-Efficacy Scale), and health-related quality of life (EuroQol 5-dimensional self-classifier). Results Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001). Conclusions Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients.


      PubDate: 2014-04-22T09:58:13Z
       
  • Consumer Characteristics and Perceptions of Chiropractic and Chiropractic
           Services in Australia: Results from a Cross-Sectional Survey
    • Abstract: Publication date: Available online 26 March 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      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: 2014-03-28T07:09:03Z
       
  • Quantification of Prone Thoracic Manipulation Using Inertial
           Sensor–Derived Accelerations
    • Abstract: Publication date: Available online 20 March 2014
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jonathan Mark Williams , Antonio Cuesta-Vargas
      Objective The aim of this study was to determine the linear acceleration, time-to-peak acceleration, and effect of hand position comparing 2 clinicians completing a thoracic manipulation. Methods Thirteen volunteers received a right- and left-“handed” prone thoracic manipulation while accelerations were recorded by an inertial sensor. Peak thrust acceleration and time-to-peak thrust were measured. Results There were differences in thrust acceleration between right- and left-handed techniques for one therapist. The mean peak thrust acceleration was different between therapists, with the more practiced therapist demonstrating greater peak thrust accelerations. Time-to-peak acceleration also revealed between therapist differences, with the more practiced therapist demonstrating shorter time-to-peak acceleration. Cavitation data suggested that manipulations with greater accelerations were more likely to result in cavitation. Conclusion The results of this study suggest that with greater frequency of use, therapists are likely to achieve greater accelerations and shorter time-to-peak accelerations. Furthermore, this study showed that an inertial sensor can be used to quantify important variables during thoracic manipulation and are able to detect intertherapist differences in technique.


      PubDate: 2014-03-23T02:56:39Z
       
 
 
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