Background and Purpose: Electrotherapeutic Point Stimulation (ETPS) is a novel modality for chron... more Background and Purpose: Electrotherapeutic Point Stimulation (ETPS) is a novel modality for chronic pain relief. The purpose of this case series is to report ETPS outcomes in physical therapy. Methods: This case series includes 7 patients (mean age = 31 years, two females) with chronic knee pain. Five patients received ETPS and exercises while two patients received exercise alone. Outcomes were Numeric Rating Scale (NRS) for pain and Lysholm Knee Scale for function. Findings: The mean within session NRS change for ETPS was 2.2 with 4 ETPS patients exhibiting an immediate clinically meaningful improvement. Over 3 weeks, all ETPS patients achieved a clinically meaningful pain improvement and 3 ETPS patients achieved a clinically meaningful function improvement. Clinical Relevance: This paper supports ETPS use for short-term pain relief in chronic knee pain. Conclusion: Electro-therapeutic point stimulation use in physical therapy is supported; however, future randomized trials are nee...
The purpose of this study was to examine the influence of postoperative pain catastrophizing and ... more The purpose of this study was to examine the influence of postoperative pain catastrophizing and pressure pain sensitivity, and the potential interaction of these factors, on persistent pain and disability following spine surgery. Prospective data were collected from 68 patients, age 21 to 81 years, following surgery for a lumbar degenerative condition. Pain catastrophizing (Pain Catastrophizing Scale (PCS)) and lumbar pressure pain threshold (PPT) were assessed 6 weeks postoperatively. Patient-reported outcomes were measured at 6 weeks, 3 months, and 6 months following surgery. Pain intensity and pain interference were measured with the Brief Pain Inventory (BPI) and disability with the Oswestry Disability Index (ODI). We identified patients with persistent pain intensity , pain interference, and disability as those patients reporting BPI scores > 4 and ODI score > 21 at all postoperative time points. Approximately 14.8%, 24.2%, and 46.8% of patients reported persistent pain ...
Study the influence of concomitant arthroscopic procedures and rotator cuff tear (RCT) severity o... more Study the influence of concomitant arthroscopic procedures and rotator cuff tear (RCT) severity on daily pain intensity and disability following shoulder arthroscopy. 145 patients (mean age: 42.66±17.6; n of males=96) completed daily pain intensity and disability measures prior to shoulder arthroscopy. RCT severity was assessed on a 7-point scale based on operative report. Operative procedures were categorized based on anatomical location and invasiveness to calculate a weighted concomitant procedure estimate. Postoperative daily pain and disability were assessed 3 months, 6 months, and 1 year status-post surgery. Only concomitant procedures was associated with 3 month daily pain intensity after adjusting for age, sex, pain duration, and baseline daily pain intensity (R=0.03; St. Beta=0.203; P=0.036). Moreover, post-hoc analysis revealed concomitant procedures remained predictive of 3 month daily pain intensity when the estimate was calculated independent of RCT procedures (R=0.05; ...
Archives of physical medicine and rehabilitation, Jan 20, 2015
To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain ... more To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Prospective observational cohort study. Academic medical center. Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40) undergoing spine surgery for a degenerative condition from March 2012 to April 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Not applicable. The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated wi...
Journal of Orthopaedic & Sports Physical Therapy, 2015
STUDY DESIGN:
Single-blind randomized trial.
OBJECTIVES:
To compare the effects of cervical an... more STUDY DESIGN:
Single-blind randomized trial.
OBJECTIVES:
To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain.
BACKGROUND:
Experimental studies indicate that spinal TM has an influence on central pain processes, supporting its application for treatment of extremity conditions. Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined.
METHODS:
Seventy-eight participants with shoulder pain (36 female; mean ± SD age, 39.0 ± 14.5 years) were randomized to receive 3 treatments of cervical TM (n = 26), shoulder TM (n = 27), or shoulder exercise (n = 25) over 2 weeks. Twenty-five healthy participants (13 female; mean ± SD age, 35.2 ± 11.1 years) were assessed to compare pain sensitivity with that in clinical participants at baseline. Primary outcomes were changes in local (eg, shoulder) and remote (eg, tibialis anterior) pressure pain threshold and heat pain threshold occurring over 2 weeks. Secondary outcomes were shoulder pain intensity and patient-rated function at 4, 8, and 12 weeks. Analysis-of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures.
RESULTS:
At baseline, clinical participants demonstrated lower local (mean difference, - 1.63 kg; 95% confidence interval [CI]: -2.40, -0.86) and remote pressure pain threshold (mean difference, -1.96 kg; 95% CI: -3.09, -0.82) and heat pain threshold (mean difference, -1.15°C; 95% CI: -2.06, -0.24) compared to controls, suggesting enhanced pain sensitivity. Following intervention, there were no between-group differences in pain sensitivity or clinical outcome (P>.05). However, improvements were noted, regardless of intervention, for pressure pain threshold (range of mean differences, 0.22-0.32 kg; 95% CI: 0.03, 0.43), heat pain threshold (range of mean differences, 0.30-0.58; 95% CI: 0.06, 0.96), pain intensity (range of mean differences, -1.79 to -1.45; 95% CI: -2.34, -0.94), and function (range of mean differences, 3.15-3.82; 95% CI: 0.69, 6.20) at all time points. We did not find an association between pain sensitivity changes and clinical outcome (P>.05). Conclusion Clinical participants showed enhanced pain sensitivity, but did not respond differently to cervical or peripheral TM. In fact, in this sample, cervical TM, shoulder TM, and shoulder exercise had similar pain sensitivity and clinical effects. The lack of association between pain sensitivity and clinical pain and function outcomes suggests different (eg, nonspecific) pain pathways for clinical benefit following TM or exercise.
LEVEL OF EVIDENCE:
Therapy, level 1b.
Whole body vibration (WBV) is a contemporary treatment modality that holds promise as an exercise... more Whole body vibration (WBV) is a contemporary treatment modality that holds promise as an exercise training method in health-compromised individuals. A growing number of studies on individuals with Parkinson Disease are examining whether WBV improves balance and functional mobility. However, interpreting WBV studies is challenging since there is variability in the manner in which WBV intervention is conducted. The primary goal of this systematic review was to investigate the effect of WBV on improving mobility and balance as measured by a battery of clinical tests, in patients with Parkinson disease. Studies based on WBV parameters were characterized and a systematic search of peer-reviewed literature in five major databases was conducted. Randomized-controlled trials investigating the effects of WBV in patients with a Parkinson diagnosis and no cognitive impairment were included. A total of six publications met the inclusion criteria. Overall, studies demonstrated mixed results in favor of WBV for improving balance or mobility. The majority of studies seem to suggest a favorable benefit following WBV for mobility and balance, but not when compared to other active intervention or placebo. There was variability in the manner in which WBV intervention was applied. Variations among the six studies included: duration of intervention and rest, follow-up period, type of control groups, frequency of vibration, number of treatment sessions and sex distribution of subjects. Future research is needed to investigate the effects of different types of equipment and treatment dosage in individuals with Parkinson disease.
BACKGROUND:
Cluster analysis can be used to identify individuals similar in profile based on res... more BACKGROUND:
Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain.
OBJECTIVE:
The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes.
DESIGN:
A secondary analysis of data from 2 randomized trials was conducted.
METHODS:
Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined.
RESULTS:
Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes.
LIMITATIONS:
Only 2-week outcomes are reported.
CONCLUSIONS:
Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings.
STUDY DESIGN:
Systematic literature review and meta-analysis.
OBJECTIVE:
IN SYMPTOMATIC SUBJEC... more STUDY DESIGN:
Systematic literature review and meta-analysis.
OBJECTIVE:
IN SYMPTOMATIC SUBJECTS TO: (1) examine the effects of a single session of joint mobilization on pain at rest and with most painful movement, and (2) compare the effects when joint mobilization is provided to a specific or non-specific spinal level.
BACKGROUND:
Joint mobilization is routinely used for treating spinal pain in conjunction with other interventions, but its unique effect is not well understood. Further, there is controversy about the role of 'specific level' techniques in producing benefit.
METHODS:
Searches were performed for randomized controlled trials (RCTs) using electronic databases (MEDLINE, CINAHL, and PEDro) from 1966 through November 2010. Methodological quality was assessed using previously detailed criteria. Meta-analysis and meta-regression were conducted on eligible studies.
RESULTS:
Eight RCTs with a mean methodological score of 10/12 were included. Significant heterogeneity (P = 0.075) was found in the overall meta-analysis estimate. When stratified by body location, no significant individual effect was found for pain at rest. However, there was a statistical mean difference [0.71 (95% confidence interval: 0.13-1.28)] between pain at rest for the cervical and lumbar individual means.
CONCLUSIONS:
We found multiple studies which provided evidence that a single session of joint mobilization can lead to a reduction of pain at rest and with most painful movement. When using joint mobilization, the need for specific versus non-specific level mobilization may be influenced by anatomical region; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization.
KEYWORDS:
Pain; Specific level; Spinal mobilization
BACKGROUND:
Article characteristics and trends have been elucidated for other physical therapy-f... more BACKGROUND:
Article characteristics and trends have been elucidated for other physical therapy-focused journals using content and bibliometric analysis. These findings are important for assessing the current state of a journal and for guiding future publication of research. To date, these analyses have not been performed for the Journal of Manual & Manipulative Therapy (JMMT).
OBJECTIVE:
To describe content and trends for articles published in JMMT over a 20-year period (1993-2012).
METHODS:
Journal articles were coded using previously-established domains (article type, participant type, research design, study purpose, and clinical condition). Total publications and proportion of publications based on domain were described. Articles specific to manual therapy intervention were examined and compared to data from other physical therapy-focused journals. Impact by citation and author was examined using bibliometric software.
RESULTS:
Journal of Manual & Manipulative Therapy was found to have a recent acceleration in the number of articles published annually. Over time, topical reviews have decreased in favor of research reports. However, rigorous study designs have represented only a small portion of total journal content, and case reports have maintained a consistent publication presence. Manual therapy intervention articles in JMMT are predominantly case designs, however are similar in characteristics to manual therapy intervention articles published in other physical therapy-focused journals. For JMMT articles overall and manual therapy intervention articles across journals, young to middle-aged symptomatic adults with low back and/or neck pain were the most common study participants.
DISCUSSION:
Increases in the number of papers and a move toward research reports were observed in JMMT over the 20-year period. Considerations for the future were outlined, including the publication of articles with more rigorous research designs. Manual therapy research for adolescents and older adults and for upper and lower extremity conditions should also be considered as priorities for the future.
KEYWORDS:
Analysis; Bibliometric; Content; Intervention; Manual therapy; Trends
BACKGROUND:
A high velocity, low amplitude thrust manipulation (HVLAT) is an intervention common... more BACKGROUND:
A high velocity, low amplitude thrust manipulation (HVLAT) is an intervention commonly used in the treatment of patients with spinal pain. Recent studies have reported on the possible neurophysiological effects of this technique which may be pertinent to the therapeutic value of these procedures. However, few studies have examined the temporal neurophysiological nature of a HVLAT beyond the immediate effects.
OBJECTIVES:
The purpose of this review is to summarize the literature on the temporal neurophysiological effects of a single HVLAT in patients with spinal pain.
METHODS:
A systematic search of English articles was conducted using MEDLINE, CINAHL, and PEDro. Additional studies were identified with a hand search of the references of relevant articles. Search terms included spinal manipulation, chiropractic manipulation, osteopathic manipulation, spinal adjustment, cervical manipulation, lumbar manipulation, sacroiliac manipulation, neck pain, back pain, and sacroiliac pain. Quality scoring of the included articles was based on the Newcastle–Ottawa criteria.
RESULTS:
Of the 478 articles identified, five articles ultimately met inclusion criteria into this review. These studies were of moderate to high quality. In all, follow-up measures after a single HVLAT were taken within a 30-minute to 5-hour period.
CONCLUSION:
In the absence of concurrent intervention, the neurophysiological effects seen after administration of a HVLAT were observed to be immediate in nature, with a return to baseline or reduction in effect noted at follow-up. Future studies examining the mechanisms of HVLAT should include dedicated follow-up periods to establish the temporal changes related to these techniques.
Journal of Orthopaedic & Sports Physical Therapy, 2011
STUDY DESIGN:
Secondary analysis, cross-sectional study.
OBJECTIVES:
To (1) compare difference... more STUDY DESIGN:
Secondary analysis, cross-sectional study.
OBJECTIVES:
To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups.
BACKGROUND:
Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation. Few studies have compared comorbidity rates among patients with different anatomical region of pain, to determine whether specific screening is warranted in physical therapy settings.
METHODS:
Included in the analyses were 2375 patients who reported complete demographic, clinical, and comorbidity information using Patient Inquiry software. Comorbidity data were collected from the Functional Comorbidity Index (18 items) and 6 additional comorbidities, to assess the presence of medical disease across multiple body systems. Comorbidities were further classified as "nonsevere" or "severe," based on inclusion in the Charlson Comorbidity Index. Chi-square analyses investigated differences in the rates of total number and severe comorbidities. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated on rates with statistically significant differences (P<.001), using the lumbar spine as the reference group.
RESULTS:
Of the 24 comorbid conditions included in this analysis, 3 nonsevere medical conditions (degenerative disc disease, obesity, and headache) had different rates among anatomical region. A lower rate for degenerative disc disease was associated with the extremity conditions (χ2 = 66.3; OR = 0.40; 95% CI: 0.32, 0.50). Higher rate of headache (χ2 = 115.3; OR = 3.01; 95% CI: 2.45, 3.70) and lower rate of obesity (χ2 = 16.2; OR = 0.64; 95% CI: 0.51, 0.80) were associated with cervical conditions. There were no differences among the 3 anatomical regions for total number or severe comorbidities.
CONCLUSION:
Focused screening for degenerative disc disease, obesity, and headache may be warranted. However, the same strategy was not supported for total number or severe comorbidities, at least when considering comparative rates from this cohort. Physical therapists should consider the potential influence of total number and severe comorbidities equally for all anatomical regions of musculoskeletal pain.
LEVEL OF EVIDENCE:
Differential diagnosis/symptom prevalence, level 3b.
Journal of Orthopaedic & Sports Physical Therapy, 2011
STUDY DESIGN:
Descriptive bibliometric analysis.
BACKGROUND:
Content and bibliometric studies ... more STUDY DESIGN:
Descriptive bibliometric analysis.
BACKGROUND:
Content and bibliometric studies are useful for describing the publication patterns of a given profession, such as physical therapy, within the medical and allied health fields. However, few studies have conducted these analyses on specialty physical therapy journals.
OBJECTIVES:
To conduct a content and bibliometric assessment of publications within the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) and report publication and citation trends over multiple years.
METHODS:
All available JOSPT manuscripts published from 1980 through 2009 were reviewed. Only research reports, topical reviews, and case reports were included in the current analysis. Articles were coded by 2 independent reviewers based on type, participant characteristics, research design, purpose, clinical condition, and intervention. We obtained additional citation information (eg, authors and institutions) from a subset of articles published from 1992 through 2009 using bibliometric software.
RESULTS:
Of the 2233 available JOSPT publications, 1732 (77.6%) met criteria for inclusion. Of these, 1172 (67.7%) were research reports, 351 (20.3%) topical reviews, and 209 (12.1%) case reports. Over the last 30 years there has been a significant increase in the number of articles published and the percentage of research reports, systematic reviews, articles focused on prognosis, and articles including symptomatic participants. Percentage decreases were observed for topical or nonsystematic reviews and articles focused on anatomy/physiology. Top institutions, authors, and cited papers from 1992 through 2009 were identified in the bibliometric analyses.
CONCLUSION:
JOSPT has shown publication trends for increased percentage of experimental and clinically relevant research. However, there may be a need for increased publication of randomized controlled trials and studies focused on diagnosis, prognosis, and treatment, if goals of evidence-based practice are to be met.
Background and Purpose: Electrotherapeutic Point Stimulation (ETPS) is a novel modality for chron... more Background and Purpose: Electrotherapeutic Point Stimulation (ETPS) is a novel modality for chronic pain relief. The purpose of this case series is to report ETPS outcomes in physical therapy. Methods: This case series includes 7 patients (mean age = 31 years, two females) with chronic knee pain. Five patients received ETPS and exercises while two patients received exercise alone. Outcomes were Numeric Rating Scale (NRS) for pain and Lysholm Knee Scale for function. Findings: The mean within session NRS change for ETPS was 2.2 with 4 ETPS patients exhibiting an immediate clinically meaningful improvement. Over 3 weeks, all ETPS patients achieved a clinically meaningful pain improvement and 3 ETPS patients achieved a clinically meaningful function improvement. Clinical Relevance: This paper supports ETPS use for short-term pain relief in chronic knee pain. Conclusion: Electro-therapeutic point stimulation use in physical therapy is supported; however, future randomized trials are nee...
The purpose of this study was to examine the influence of postoperative pain catastrophizing and ... more The purpose of this study was to examine the influence of postoperative pain catastrophizing and pressure pain sensitivity, and the potential interaction of these factors, on persistent pain and disability following spine surgery. Prospective data were collected from 68 patients, age 21 to 81 years, following surgery for a lumbar degenerative condition. Pain catastrophizing (Pain Catastrophizing Scale (PCS)) and lumbar pressure pain threshold (PPT) were assessed 6 weeks postoperatively. Patient-reported outcomes were measured at 6 weeks, 3 months, and 6 months following surgery. Pain intensity and pain interference were measured with the Brief Pain Inventory (BPI) and disability with the Oswestry Disability Index (ODI). We identified patients with persistent pain intensity , pain interference, and disability as those patients reporting BPI scores > 4 and ODI score > 21 at all postoperative time points. Approximately 14.8%, 24.2%, and 46.8% of patients reported persistent pain ...
Study the influence of concomitant arthroscopic procedures and rotator cuff tear (RCT) severity o... more Study the influence of concomitant arthroscopic procedures and rotator cuff tear (RCT) severity on daily pain intensity and disability following shoulder arthroscopy. 145 patients (mean age: 42.66±17.6; n of males=96) completed daily pain intensity and disability measures prior to shoulder arthroscopy. RCT severity was assessed on a 7-point scale based on operative report. Operative procedures were categorized based on anatomical location and invasiveness to calculate a weighted concomitant procedure estimate. Postoperative daily pain and disability were assessed 3 months, 6 months, and 1 year status-post surgery. Only concomitant procedures was associated with 3 month daily pain intensity after adjusting for age, sex, pain duration, and baseline daily pain intensity (R=0.03; St. Beta=0.203; P=0.036). Moreover, post-hoc analysis revealed concomitant procedures remained predictive of 3 month daily pain intensity when the estimate was calculated independent of RCT procedures (R=0.05; ...
Archives of physical medicine and rehabilitation, Jan 20, 2015
To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain ... more To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Prospective observational cohort study. Academic medical center. Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40) undergoing spine surgery for a degenerative condition from March 2012 to April 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Not applicable. The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated wi...
Journal of Orthopaedic & Sports Physical Therapy, 2015
STUDY DESIGN:
Single-blind randomized trial.
OBJECTIVES:
To compare the effects of cervical an... more STUDY DESIGN:
Single-blind randomized trial.
OBJECTIVES:
To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain.
BACKGROUND:
Experimental studies indicate that spinal TM has an influence on central pain processes, supporting its application for treatment of extremity conditions. Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined.
METHODS:
Seventy-eight participants with shoulder pain (36 female; mean ± SD age, 39.0 ± 14.5 years) were randomized to receive 3 treatments of cervical TM (n = 26), shoulder TM (n = 27), or shoulder exercise (n = 25) over 2 weeks. Twenty-five healthy participants (13 female; mean ± SD age, 35.2 ± 11.1 years) were assessed to compare pain sensitivity with that in clinical participants at baseline. Primary outcomes were changes in local (eg, shoulder) and remote (eg, tibialis anterior) pressure pain threshold and heat pain threshold occurring over 2 weeks. Secondary outcomes were shoulder pain intensity and patient-rated function at 4, 8, and 12 weeks. Analysis-of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures.
RESULTS:
At baseline, clinical participants demonstrated lower local (mean difference, - 1.63 kg; 95% confidence interval [CI]: -2.40, -0.86) and remote pressure pain threshold (mean difference, -1.96 kg; 95% CI: -3.09, -0.82) and heat pain threshold (mean difference, -1.15°C; 95% CI: -2.06, -0.24) compared to controls, suggesting enhanced pain sensitivity. Following intervention, there were no between-group differences in pain sensitivity or clinical outcome (P>.05). However, improvements were noted, regardless of intervention, for pressure pain threshold (range of mean differences, 0.22-0.32 kg; 95% CI: 0.03, 0.43), heat pain threshold (range of mean differences, 0.30-0.58; 95% CI: 0.06, 0.96), pain intensity (range of mean differences, -1.79 to -1.45; 95% CI: -2.34, -0.94), and function (range of mean differences, 3.15-3.82; 95% CI: 0.69, 6.20) at all time points. We did not find an association between pain sensitivity changes and clinical outcome (P>.05). Conclusion Clinical participants showed enhanced pain sensitivity, but did not respond differently to cervical or peripheral TM. In fact, in this sample, cervical TM, shoulder TM, and shoulder exercise had similar pain sensitivity and clinical effects. The lack of association between pain sensitivity and clinical pain and function outcomes suggests different (eg, nonspecific) pain pathways for clinical benefit following TM or exercise.
LEVEL OF EVIDENCE:
Therapy, level 1b.
Whole body vibration (WBV) is a contemporary treatment modality that holds promise as an exercise... more Whole body vibration (WBV) is a contemporary treatment modality that holds promise as an exercise training method in health-compromised individuals. A growing number of studies on individuals with Parkinson Disease are examining whether WBV improves balance and functional mobility. However, interpreting WBV studies is challenging since there is variability in the manner in which WBV intervention is conducted. The primary goal of this systematic review was to investigate the effect of WBV on improving mobility and balance as measured by a battery of clinical tests, in patients with Parkinson disease. Studies based on WBV parameters were characterized and a systematic search of peer-reviewed literature in five major databases was conducted. Randomized-controlled trials investigating the effects of WBV in patients with a Parkinson diagnosis and no cognitive impairment were included. A total of six publications met the inclusion criteria. Overall, studies demonstrated mixed results in favor of WBV for improving balance or mobility. The majority of studies seem to suggest a favorable benefit following WBV for mobility and balance, but not when compared to other active intervention or placebo. There was variability in the manner in which WBV intervention was applied. Variations among the six studies included: duration of intervention and rest, follow-up period, type of control groups, frequency of vibration, number of treatment sessions and sex distribution of subjects. Future research is needed to investigate the effects of different types of equipment and treatment dosage in individuals with Parkinson disease.
BACKGROUND:
Cluster analysis can be used to identify individuals similar in profile based on res... more BACKGROUND:
Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain.
OBJECTIVE:
The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes.
DESIGN:
A secondary analysis of data from 2 randomized trials was conducted.
METHODS:
Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined.
RESULTS:
Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes.
LIMITATIONS:
Only 2-week outcomes are reported.
CONCLUSIONS:
Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings.
STUDY DESIGN:
Systematic literature review and meta-analysis.
OBJECTIVE:
IN SYMPTOMATIC SUBJEC... more STUDY DESIGN:
Systematic literature review and meta-analysis.
OBJECTIVE:
IN SYMPTOMATIC SUBJECTS TO: (1) examine the effects of a single session of joint mobilization on pain at rest and with most painful movement, and (2) compare the effects when joint mobilization is provided to a specific or non-specific spinal level.
BACKGROUND:
Joint mobilization is routinely used for treating spinal pain in conjunction with other interventions, but its unique effect is not well understood. Further, there is controversy about the role of 'specific level' techniques in producing benefit.
METHODS:
Searches were performed for randomized controlled trials (RCTs) using electronic databases (MEDLINE, CINAHL, and PEDro) from 1966 through November 2010. Methodological quality was assessed using previously detailed criteria. Meta-analysis and meta-regression were conducted on eligible studies.
RESULTS:
Eight RCTs with a mean methodological score of 10/12 were included. Significant heterogeneity (P = 0.075) was found in the overall meta-analysis estimate. When stratified by body location, no significant individual effect was found for pain at rest. However, there was a statistical mean difference [0.71 (95% confidence interval: 0.13-1.28)] between pain at rest for the cervical and lumbar individual means.
CONCLUSIONS:
We found multiple studies which provided evidence that a single session of joint mobilization can lead to a reduction of pain at rest and with most painful movement. When using joint mobilization, the need for specific versus non-specific level mobilization may be influenced by anatomical region; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization.
KEYWORDS:
Pain; Specific level; Spinal mobilization
BACKGROUND:
Article characteristics and trends have been elucidated for other physical therapy-f... more BACKGROUND:
Article characteristics and trends have been elucidated for other physical therapy-focused journals using content and bibliometric analysis. These findings are important for assessing the current state of a journal and for guiding future publication of research. To date, these analyses have not been performed for the Journal of Manual & Manipulative Therapy (JMMT).
OBJECTIVE:
To describe content and trends for articles published in JMMT over a 20-year period (1993-2012).
METHODS:
Journal articles were coded using previously-established domains (article type, participant type, research design, study purpose, and clinical condition). Total publications and proportion of publications based on domain were described. Articles specific to manual therapy intervention were examined and compared to data from other physical therapy-focused journals. Impact by citation and author was examined using bibliometric software.
RESULTS:
Journal of Manual & Manipulative Therapy was found to have a recent acceleration in the number of articles published annually. Over time, topical reviews have decreased in favor of research reports. However, rigorous study designs have represented only a small portion of total journal content, and case reports have maintained a consistent publication presence. Manual therapy intervention articles in JMMT are predominantly case designs, however are similar in characteristics to manual therapy intervention articles published in other physical therapy-focused journals. For JMMT articles overall and manual therapy intervention articles across journals, young to middle-aged symptomatic adults with low back and/or neck pain were the most common study participants.
DISCUSSION:
Increases in the number of papers and a move toward research reports were observed in JMMT over the 20-year period. Considerations for the future were outlined, including the publication of articles with more rigorous research designs. Manual therapy research for adolescents and older adults and for upper and lower extremity conditions should also be considered as priorities for the future.
KEYWORDS:
Analysis; Bibliometric; Content; Intervention; Manual therapy; Trends
BACKGROUND:
A high velocity, low amplitude thrust manipulation (HVLAT) is an intervention common... more BACKGROUND:
A high velocity, low amplitude thrust manipulation (HVLAT) is an intervention commonly used in the treatment of patients with spinal pain. Recent studies have reported on the possible neurophysiological effects of this technique which may be pertinent to the therapeutic value of these procedures. However, few studies have examined the temporal neurophysiological nature of a HVLAT beyond the immediate effects.
OBJECTIVES:
The purpose of this review is to summarize the literature on the temporal neurophysiological effects of a single HVLAT in patients with spinal pain.
METHODS:
A systematic search of English articles was conducted using MEDLINE, CINAHL, and PEDro. Additional studies were identified with a hand search of the references of relevant articles. Search terms included spinal manipulation, chiropractic manipulation, osteopathic manipulation, spinal adjustment, cervical manipulation, lumbar manipulation, sacroiliac manipulation, neck pain, back pain, and sacroiliac pain. Quality scoring of the included articles was based on the Newcastle–Ottawa criteria.
RESULTS:
Of the 478 articles identified, five articles ultimately met inclusion criteria into this review. These studies were of moderate to high quality. In all, follow-up measures after a single HVLAT were taken within a 30-minute to 5-hour period.
CONCLUSION:
In the absence of concurrent intervention, the neurophysiological effects seen after administration of a HVLAT were observed to be immediate in nature, with a return to baseline or reduction in effect noted at follow-up. Future studies examining the mechanisms of HVLAT should include dedicated follow-up periods to establish the temporal changes related to these techniques.
Journal of Orthopaedic & Sports Physical Therapy, 2011
STUDY DESIGN:
Secondary analysis, cross-sectional study.
OBJECTIVES:
To (1) compare difference... more STUDY DESIGN:
Secondary analysis, cross-sectional study.
OBJECTIVES:
To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups.
BACKGROUND:
Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation. Few studies have compared comorbidity rates among patients with different anatomical region of pain, to determine whether specific screening is warranted in physical therapy settings.
METHODS:
Included in the analyses were 2375 patients who reported complete demographic, clinical, and comorbidity information using Patient Inquiry software. Comorbidity data were collected from the Functional Comorbidity Index (18 items) and 6 additional comorbidities, to assess the presence of medical disease across multiple body systems. Comorbidities were further classified as "nonsevere" or "severe," based on inclusion in the Charlson Comorbidity Index. Chi-square analyses investigated differences in the rates of total number and severe comorbidities. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated on rates with statistically significant differences (P<.001), using the lumbar spine as the reference group.
RESULTS:
Of the 24 comorbid conditions included in this analysis, 3 nonsevere medical conditions (degenerative disc disease, obesity, and headache) had different rates among anatomical region. A lower rate for degenerative disc disease was associated with the extremity conditions (χ2 = 66.3; OR = 0.40; 95% CI: 0.32, 0.50). Higher rate of headache (χ2 = 115.3; OR = 3.01; 95% CI: 2.45, 3.70) and lower rate of obesity (χ2 = 16.2; OR = 0.64; 95% CI: 0.51, 0.80) were associated with cervical conditions. There were no differences among the 3 anatomical regions for total number or severe comorbidities.
CONCLUSION:
Focused screening for degenerative disc disease, obesity, and headache may be warranted. However, the same strategy was not supported for total number or severe comorbidities, at least when considering comparative rates from this cohort. Physical therapists should consider the potential influence of total number and severe comorbidities equally for all anatomical regions of musculoskeletal pain.
LEVEL OF EVIDENCE:
Differential diagnosis/symptom prevalence, level 3b.
Journal of Orthopaedic & Sports Physical Therapy, 2011
STUDY DESIGN:
Descriptive bibliometric analysis.
BACKGROUND:
Content and bibliometric studies ... more STUDY DESIGN:
Descriptive bibliometric analysis.
BACKGROUND:
Content and bibliometric studies are useful for describing the publication patterns of a given profession, such as physical therapy, within the medical and allied health fields. However, few studies have conducted these analyses on specialty physical therapy journals.
OBJECTIVES:
To conduct a content and bibliometric assessment of publications within the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) and report publication and citation trends over multiple years.
METHODS:
All available JOSPT manuscripts published from 1980 through 2009 were reviewed. Only research reports, topical reviews, and case reports were included in the current analysis. Articles were coded by 2 independent reviewers based on type, participant characteristics, research design, purpose, clinical condition, and intervention. We obtained additional citation information (eg, authors and institutions) from a subset of articles published from 1992 through 2009 using bibliometric software.
RESULTS:
Of the 2233 available JOSPT publications, 1732 (77.6%) met criteria for inclusion. Of these, 1172 (67.7%) were research reports, 351 (20.3%) topical reviews, and 209 (12.1%) case reports. Over the last 30 years there has been a significant increase in the number of articles published and the percentage of research reports, systematic reviews, articles focused on prognosis, and articles including symptomatic participants. Percentage decreases were observed for topical or nonsystematic reviews and articles focused on anatomy/physiology. Top institutions, authors, and cited papers from 1992 through 2009 were identified in the bibliometric analyses.
CONCLUSION:
JOSPT has shown publication trends for increased percentage of experimental and clinically relevant research. However, there may be a need for increased publication of randomized controlled trials and studies focused on diagnosis, prognosis, and treatment, if goals of evidence-based practice are to be met.
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Papers by Rogelio A Coronado
Single-blind randomized trial.
OBJECTIVES:
To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain.
BACKGROUND:
Experimental studies indicate that spinal TM has an influence on central pain processes, supporting its application for treatment of extremity conditions. Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined.
METHODS:
Seventy-eight participants with shoulder pain (36 female; mean ± SD age, 39.0 ± 14.5 years) were randomized to receive 3 treatments of cervical TM (n = 26), shoulder TM (n = 27), or shoulder exercise (n = 25) over 2 weeks. Twenty-five healthy participants (13 female; mean ± SD age, 35.2 ± 11.1 years) were assessed to compare pain sensitivity with that in clinical participants at baseline. Primary outcomes were changes in local (eg, shoulder) and remote (eg, tibialis anterior) pressure pain threshold and heat pain threshold occurring over 2 weeks. Secondary outcomes were shoulder pain intensity and patient-rated function at 4, 8, and 12 weeks. Analysis-of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures.
RESULTS:
At baseline, clinical participants demonstrated lower local (mean difference, - 1.63 kg; 95% confidence interval [CI]: -2.40, -0.86) and remote pressure pain threshold (mean difference, -1.96 kg; 95% CI: -3.09, -0.82) and heat pain threshold (mean difference, -1.15°C; 95% CI: -2.06, -0.24) compared to controls, suggesting enhanced pain sensitivity. Following intervention, there were no between-group differences in pain sensitivity or clinical outcome (P>.05). However, improvements were noted, regardless of intervention, for pressure pain threshold (range of mean differences, 0.22-0.32 kg; 95% CI: 0.03, 0.43), heat pain threshold (range of mean differences, 0.30-0.58; 95% CI: 0.06, 0.96), pain intensity (range of mean differences, -1.79 to -1.45; 95% CI: -2.34, -0.94), and function (range of mean differences, 3.15-3.82; 95% CI: 0.69, 6.20) at all time points. We did not find an association between pain sensitivity changes and clinical outcome (P>.05). Conclusion Clinical participants showed enhanced pain sensitivity, but did not respond differently to cervical or peripheral TM. In fact, in this sample, cervical TM, shoulder TM, and shoulder exercise had similar pain sensitivity and clinical effects. The lack of association between pain sensitivity and clinical pain and function outcomes suggests different (eg, nonspecific) pain pathways for clinical benefit following TM or exercise.
LEVEL OF EVIDENCE:
Therapy, level 1b.
Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain.
OBJECTIVE:
The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes.
DESIGN:
A secondary analysis of data from 2 randomized trials was conducted.
METHODS:
Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined.
RESULTS:
Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes.
LIMITATIONS:
Only 2-week outcomes are reported.
CONCLUSIONS:
Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings.
Systematic literature review and meta-analysis.
OBJECTIVE:
IN SYMPTOMATIC SUBJECTS TO: (1) examine the effects of a single session of joint mobilization on pain at rest and with most painful movement, and (2) compare the effects when joint mobilization is provided to a specific or non-specific spinal level.
BACKGROUND:
Joint mobilization is routinely used for treating spinal pain in conjunction with other interventions, but its unique effect is not well understood. Further, there is controversy about the role of 'specific level' techniques in producing benefit.
METHODS:
Searches were performed for randomized controlled trials (RCTs) using electronic databases (MEDLINE, CINAHL, and PEDro) from 1966 through November 2010. Methodological quality was assessed using previously detailed criteria. Meta-analysis and meta-regression were conducted on eligible studies.
RESULTS:
Eight RCTs with a mean methodological score of 10/12 were included. Significant heterogeneity (P = 0.075) was found in the overall meta-analysis estimate. When stratified by body location, no significant individual effect was found for pain at rest. However, there was a statistical mean difference [0.71 (95% confidence interval: 0.13-1.28)] between pain at rest for the cervical and lumbar individual means.
CONCLUSIONS:
We found multiple studies which provided evidence that a single session of joint mobilization can lead to a reduction of pain at rest and with most painful movement. When using joint mobilization, the need for specific versus non-specific level mobilization may be influenced by anatomical region; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization.
KEYWORDS:
Pain; Specific level; Spinal mobilization
Article characteristics and trends have been elucidated for other physical therapy-focused journals using content and bibliometric analysis. These findings are important for assessing the current state of a journal and for guiding future publication of research. To date, these analyses have not been performed for the Journal of Manual & Manipulative Therapy (JMMT).
OBJECTIVE:
To describe content and trends for articles published in JMMT over a 20-year period (1993-2012).
METHODS:
Journal articles were coded using previously-established domains (article type, participant type, research design, study purpose, and clinical condition). Total publications and proportion of publications based on domain were described. Articles specific to manual therapy intervention were examined and compared to data from other physical therapy-focused journals. Impact by citation and author was examined using bibliometric software.
RESULTS:
Journal of Manual & Manipulative Therapy was found to have a recent acceleration in the number of articles published annually. Over time, topical reviews have decreased in favor of research reports. However, rigorous study designs have represented only a small portion of total journal content, and case reports have maintained a consistent publication presence. Manual therapy intervention articles in JMMT are predominantly case designs, however are similar in characteristics to manual therapy intervention articles published in other physical therapy-focused journals. For JMMT articles overall and manual therapy intervention articles across journals, young to middle-aged symptomatic adults with low back and/or neck pain were the most common study participants.
DISCUSSION:
Increases in the number of papers and a move toward research reports were observed in JMMT over the 20-year period. Considerations for the future were outlined, including the publication of articles with more rigorous research designs. Manual therapy research for adolescents and older adults and for upper and lower extremity conditions should also be considered as priorities for the future.
KEYWORDS:
Analysis; Bibliometric; Content; Intervention; Manual therapy; Trends
A high velocity, low amplitude thrust manipulation (HVLAT) is an intervention commonly used in the treatment of patients with spinal pain. Recent studies have reported on the possible neurophysiological effects of this technique which may be pertinent to the therapeutic value of these procedures. However, few studies have examined the temporal neurophysiological nature of a HVLAT beyond the immediate effects.
OBJECTIVES:
The purpose of this review is to summarize the literature on the temporal neurophysiological effects of a single HVLAT in patients with spinal pain.
METHODS:
A systematic search of English articles was conducted using MEDLINE, CINAHL, and PEDro. Additional studies were identified with a hand search of the references of relevant articles. Search terms included spinal manipulation, chiropractic manipulation, osteopathic manipulation, spinal adjustment, cervical manipulation, lumbar manipulation, sacroiliac manipulation, neck pain, back pain, and sacroiliac pain. Quality scoring of the included articles was based on the Newcastle–Ottawa criteria.
RESULTS:
Of the 478 articles identified, five articles ultimately met inclusion criteria into this review. These studies were of moderate to high quality. In all, follow-up measures after a single HVLAT were taken within a 30-minute to 5-hour period.
CONCLUSION:
In the absence of concurrent intervention, the neurophysiological effects seen after administration of a HVLAT were observed to be immediate in nature, with a return to baseline or reduction in effect noted at follow-up. Future studies examining the mechanisms of HVLAT should include dedicated follow-up periods to establish the temporal changes related to these techniques.
Secondary analysis, cross-sectional study.
OBJECTIVES:
To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups.
BACKGROUND:
Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation. Few studies have compared comorbidity rates among patients with different anatomical region of pain, to determine whether specific screening is warranted in physical therapy settings.
METHODS:
Included in the analyses were 2375 patients who reported complete demographic, clinical, and comorbidity information using Patient Inquiry software. Comorbidity data were collected from the Functional Comorbidity Index (18 items) and 6 additional comorbidities, to assess the presence of medical disease across multiple body systems. Comorbidities were further classified as "nonsevere" or "severe," based on inclusion in the Charlson Comorbidity Index. Chi-square analyses investigated differences in the rates of total number and severe comorbidities. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated on rates with statistically significant differences (P<.001), using the lumbar spine as the reference group.
RESULTS:
Of the 24 comorbid conditions included in this analysis, 3 nonsevere medical conditions (degenerative disc disease, obesity, and headache) had different rates among anatomical region. A lower rate for degenerative disc disease was associated with the extremity conditions (χ2 = 66.3; OR = 0.40; 95% CI: 0.32, 0.50). Higher rate of headache (χ2 = 115.3; OR = 3.01; 95% CI: 2.45, 3.70) and lower rate of obesity (χ2 = 16.2; OR = 0.64; 95% CI: 0.51, 0.80) were associated with cervical conditions. There were no differences among the 3 anatomical regions for total number or severe comorbidities.
CONCLUSION:
Focused screening for degenerative disc disease, obesity, and headache may be warranted. However, the same strategy was not supported for total number or severe comorbidities, at least when considering comparative rates from this cohort. Physical therapists should consider the potential influence of total number and severe comorbidities equally for all anatomical regions of musculoskeletal pain.
LEVEL OF EVIDENCE:
Differential diagnosis/symptom prevalence, level 3b.
Descriptive bibliometric analysis.
BACKGROUND:
Content and bibliometric studies are useful for describing the publication patterns of a given profession, such as physical therapy, within the medical and allied health fields. However, few studies have conducted these analyses on specialty physical therapy journals.
OBJECTIVES:
To conduct a content and bibliometric assessment of publications within the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) and report publication and citation trends over multiple years.
METHODS:
All available JOSPT manuscripts published from 1980 through 2009 were reviewed. Only research reports, topical reviews, and case reports were included in the current analysis. Articles were coded by 2 independent reviewers based on type, participant characteristics, research design, purpose, clinical condition, and intervention. We obtained additional citation information (eg, authors and institutions) from a subset of articles published from 1992 through 2009 using bibliometric software.
RESULTS:
Of the 2233 available JOSPT publications, 1732 (77.6%) met criteria for inclusion. Of these, 1172 (67.7%) were research reports, 351 (20.3%) topical reviews, and 209 (12.1%) case reports. Over the last 30 years there has been a significant increase in the number of articles published and the percentage of research reports, systematic reviews, articles focused on prognosis, and articles including symptomatic participants. Percentage decreases were observed for topical or nonsystematic reviews and articles focused on anatomy/physiology. Top institutions, authors, and cited papers from 1992 through 2009 were identified in the bibliometric analyses.
CONCLUSION:
JOSPT has shown publication trends for increased percentage of experimental and clinically relevant research. However, there may be a need for increased publication of randomized controlled trials and studies focused on diagnosis, prognosis, and treatment, if goals of evidence-based practice are to be met.
Single-blind randomized trial.
OBJECTIVES:
To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain.
BACKGROUND:
Experimental studies indicate that spinal TM has an influence on central pain processes, supporting its application for treatment of extremity conditions. Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined.
METHODS:
Seventy-eight participants with shoulder pain (36 female; mean ± SD age, 39.0 ± 14.5 years) were randomized to receive 3 treatments of cervical TM (n = 26), shoulder TM (n = 27), or shoulder exercise (n = 25) over 2 weeks. Twenty-five healthy participants (13 female; mean ± SD age, 35.2 ± 11.1 years) were assessed to compare pain sensitivity with that in clinical participants at baseline. Primary outcomes were changes in local (eg, shoulder) and remote (eg, tibialis anterior) pressure pain threshold and heat pain threshold occurring over 2 weeks. Secondary outcomes were shoulder pain intensity and patient-rated function at 4, 8, and 12 weeks. Analysis-of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures.
RESULTS:
At baseline, clinical participants demonstrated lower local (mean difference, - 1.63 kg; 95% confidence interval [CI]: -2.40, -0.86) and remote pressure pain threshold (mean difference, -1.96 kg; 95% CI: -3.09, -0.82) and heat pain threshold (mean difference, -1.15°C; 95% CI: -2.06, -0.24) compared to controls, suggesting enhanced pain sensitivity. Following intervention, there were no between-group differences in pain sensitivity or clinical outcome (P>.05). However, improvements were noted, regardless of intervention, for pressure pain threshold (range of mean differences, 0.22-0.32 kg; 95% CI: 0.03, 0.43), heat pain threshold (range of mean differences, 0.30-0.58; 95% CI: 0.06, 0.96), pain intensity (range of mean differences, -1.79 to -1.45; 95% CI: -2.34, -0.94), and function (range of mean differences, 3.15-3.82; 95% CI: 0.69, 6.20) at all time points. We did not find an association between pain sensitivity changes and clinical outcome (P>.05). Conclusion Clinical participants showed enhanced pain sensitivity, but did not respond differently to cervical or peripheral TM. In fact, in this sample, cervical TM, shoulder TM, and shoulder exercise had similar pain sensitivity and clinical effects. The lack of association between pain sensitivity and clinical pain and function outcomes suggests different (eg, nonspecific) pain pathways for clinical benefit following TM or exercise.
LEVEL OF EVIDENCE:
Therapy, level 1b.
Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain.
OBJECTIVE:
The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes.
DESIGN:
A secondary analysis of data from 2 randomized trials was conducted.
METHODS:
Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined.
RESULTS:
Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes.
LIMITATIONS:
Only 2-week outcomes are reported.
CONCLUSIONS:
Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings.
Systematic literature review and meta-analysis.
OBJECTIVE:
IN SYMPTOMATIC SUBJECTS TO: (1) examine the effects of a single session of joint mobilization on pain at rest and with most painful movement, and (2) compare the effects when joint mobilization is provided to a specific or non-specific spinal level.
BACKGROUND:
Joint mobilization is routinely used for treating spinal pain in conjunction with other interventions, but its unique effect is not well understood. Further, there is controversy about the role of 'specific level' techniques in producing benefit.
METHODS:
Searches were performed for randomized controlled trials (RCTs) using electronic databases (MEDLINE, CINAHL, and PEDro) from 1966 through November 2010. Methodological quality was assessed using previously detailed criteria. Meta-analysis and meta-regression were conducted on eligible studies.
RESULTS:
Eight RCTs with a mean methodological score of 10/12 were included. Significant heterogeneity (P = 0.075) was found in the overall meta-analysis estimate. When stratified by body location, no significant individual effect was found for pain at rest. However, there was a statistical mean difference [0.71 (95% confidence interval: 0.13-1.28)] between pain at rest for the cervical and lumbar individual means.
CONCLUSIONS:
We found multiple studies which provided evidence that a single session of joint mobilization can lead to a reduction of pain at rest and with most painful movement. When using joint mobilization, the need for specific versus non-specific level mobilization may be influenced by anatomical region; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization.
KEYWORDS:
Pain; Specific level; Spinal mobilization
Article characteristics and trends have been elucidated for other physical therapy-focused journals using content and bibliometric analysis. These findings are important for assessing the current state of a journal and for guiding future publication of research. To date, these analyses have not been performed for the Journal of Manual & Manipulative Therapy (JMMT).
OBJECTIVE:
To describe content and trends for articles published in JMMT over a 20-year period (1993-2012).
METHODS:
Journal articles were coded using previously-established domains (article type, participant type, research design, study purpose, and clinical condition). Total publications and proportion of publications based on domain were described. Articles specific to manual therapy intervention were examined and compared to data from other physical therapy-focused journals. Impact by citation and author was examined using bibliometric software.
RESULTS:
Journal of Manual & Manipulative Therapy was found to have a recent acceleration in the number of articles published annually. Over time, topical reviews have decreased in favor of research reports. However, rigorous study designs have represented only a small portion of total journal content, and case reports have maintained a consistent publication presence. Manual therapy intervention articles in JMMT are predominantly case designs, however are similar in characteristics to manual therapy intervention articles published in other physical therapy-focused journals. For JMMT articles overall and manual therapy intervention articles across journals, young to middle-aged symptomatic adults with low back and/or neck pain were the most common study participants.
DISCUSSION:
Increases in the number of papers and a move toward research reports were observed in JMMT over the 20-year period. Considerations for the future were outlined, including the publication of articles with more rigorous research designs. Manual therapy research for adolescents and older adults and for upper and lower extremity conditions should also be considered as priorities for the future.
KEYWORDS:
Analysis; Bibliometric; Content; Intervention; Manual therapy; Trends
A high velocity, low amplitude thrust manipulation (HVLAT) is an intervention commonly used in the treatment of patients with spinal pain. Recent studies have reported on the possible neurophysiological effects of this technique which may be pertinent to the therapeutic value of these procedures. However, few studies have examined the temporal neurophysiological nature of a HVLAT beyond the immediate effects.
OBJECTIVES:
The purpose of this review is to summarize the literature on the temporal neurophysiological effects of a single HVLAT in patients with spinal pain.
METHODS:
A systematic search of English articles was conducted using MEDLINE, CINAHL, and PEDro. Additional studies were identified with a hand search of the references of relevant articles. Search terms included spinal manipulation, chiropractic manipulation, osteopathic manipulation, spinal adjustment, cervical manipulation, lumbar manipulation, sacroiliac manipulation, neck pain, back pain, and sacroiliac pain. Quality scoring of the included articles was based on the Newcastle–Ottawa criteria.
RESULTS:
Of the 478 articles identified, five articles ultimately met inclusion criteria into this review. These studies were of moderate to high quality. In all, follow-up measures after a single HVLAT were taken within a 30-minute to 5-hour period.
CONCLUSION:
In the absence of concurrent intervention, the neurophysiological effects seen after administration of a HVLAT were observed to be immediate in nature, with a return to baseline or reduction in effect noted at follow-up. Future studies examining the mechanisms of HVLAT should include dedicated follow-up periods to establish the temporal changes related to these techniques.
Secondary analysis, cross-sectional study.
OBJECTIVES:
To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups.
BACKGROUND:
Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation. Few studies have compared comorbidity rates among patients with different anatomical region of pain, to determine whether specific screening is warranted in physical therapy settings.
METHODS:
Included in the analyses were 2375 patients who reported complete demographic, clinical, and comorbidity information using Patient Inquiry software. Comorbidity data were collected from the Functional Comorbidity Index (18 items) and 6 additional comorbidities, to assess the presence of medical disease across multiple body systems. Comorbidities were further classified as "nonsevere" or "severe," based on inclusion in the Charlson Comorbidity Index. Chi-square analyses investigated differences in the rates of total number and severe comorbidities. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated on rates with statistically significant differences (P<.001), using the lumbar spine as the reference group.
RESULTS:
Of the 24 comorbid conditions included in this analysis, 3 nonsevere medical conditions (degenerative disc disease, obesity, and headache) had different rates among anatomical region. A lower rate for degenerative disc disease was associated with the extremity conditions (χ2 = 66.3; OR = 0.40; 95% CI: 0.32, 0.50). Higher rate of headache (χ2 = 115.3; OR = 3.01; 95% CI: 2.45, 3.70) and lower rate of obesity (χ2 = 16.2; OR = 0.64; 95% CI: 0.51, 0.80) were associated with cervical conditions. There were no differences among the 3 anatomical regions for total number or severe comorbidities.
CONCLUSION:
Focused screening for degenerative disc disease, obesity, and headache may be warranted. However, the same strategy was not supported for total number or severe comorbidities, at least when considering comparative rates from this cohort. Physical therapists should consider the potential influence of total number and severe comorbidities equally for all anatomical regions of musculoskeletal pain.
LEVEL OF EVIDENCE:
Differential diagnosis/symptom prevalence, level 3b.
Descriptive bibliometric analysis.
BACKGROUND:
Content and bibliometric studies are useful for describing the publication patterns of a given profession, such as physical therapy, within the medical and allied health fields. However, few studies have conducted these analyses on specialty physical therapy journals.
OBJECTIVES:
To conduct a content and bibliometric assessment of publications within the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) and report publication and citation trends over multiple years.
METHODS:
All available JOSPT manuscripts published from 1980 through 2009 were reviewed. Only research reports, topical reviews, and case reports were included in the current analysis. Articles were coded by 2 independent reviewers based on type, participant characteristics, research design, purpose, clinical condition, and intervention. We obtained additional citation information (eg, authors and institutions) from a subset of articles published from 1992 through 2009 using bibliometric software.
RESULTS:
Of the 2233 available JOSPT publications, 1732 (77.6%) met criteria for inclusion. Of these, 1172 (67.7%) were research reports, 351 (20.3%) topical reviews, and 209 (12.1%) case reports. Over the last 30 years there has been a significant increase in the number of articles published and the percentage of research reports, systematic reviews, articles focused on prognosis, and articles including symptomatic participants. Percentage decreases were observed for topical or nonsystematic reviews and articles focused on anatomy/physiology. Top institutions, authors, and cited papers from 1992 through 2009 were identified in the bibliometric analyses.
CONCLUSION:
JOSPT has shown publication trends for increased percentage of experimental and clinically relevant research. However, there may be a need for increased publication of randomized controlled trials and studies focused on diagnosis, prognosis, and treatment, if goals of evidence-based practice are to be met.