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Task-Specific Training for Adults With Chronic Knee Pain: A Case Series.

Task-Specific Training for Adults With Chronic Knee Pain: A Case Series.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-33

Authors: Bove AM, Baker N, Livengood H, King V, Mancino J, Popchak A, Fitzgerald GK

Abstract
Study Design Case series. Background Recent evidence suggests that traditional impairment-based rehabilitation approaches for patients with knee pain may not result in improved function or reduced disability. This case series describes a novel task-specific training approach to exercise therapy for patients with chronic knee pain and reports changes in measures of clinical outcome (pain and physical function) following participation in the training program. Case Description Seven patients with chronic knee pain aged ≥ 40 years were included. Each reported at least "moderate" difficulty with sit-to-stand transfers, floor transfers, and/or stair negotiation at baseline. Experienced physical therapists provided between 8 and 16 treatment sessions focusing on improving performance of difficult or painful tasks. Outcomes A majority of patients demonstrated clinically important improvements in both patient-rated outcomes (Knee Injury and Osteoarthritis Outcome Score [KOOS], numeric pain rating scale, modified Arthritis Self-Efficacy Scale) and performance-based outcomes (30-second chair rise test, timed stair climb test, floor transfer test, Performance Assessment of Self-Care Skills). Discussion A task-specific training approach for patients with chronic knee pain has been described that yielded considerable improvement in pain and function for most of the individuals in this case series. Larger studies are needed to determine how task-specific training compares with more traditional impairment-based exercise approaches for chronic knee pain. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7348.

PMID: 28704627 [PubMed - as supplied by publisher]




The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.

The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-76

Authors: Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W

Abstract
Study Design Systematic review with meta-analysis. Background Neural mobilization (NM) or neurodynamics is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. Objectives To determine the efficacy of NM for musculoskeletal conditions with a neuropathic component. Methods Databases were searched for randomised trials investigating the effect of NM for neuro-musculoskeletal conditions. Standard methods for article identification, selection and quality appraisal were used. Where possible, studies were pooled for meta-analysis. Primary outcomes were pain, disability and function. Results Forty studies were included in this review, of which 17 had a low risk of bias. Meta-analyses could only be performed on self-reported outcomes. For chronic low back pain, disability (Oswestry (0-50): mean difference -9.26; 95%CI: -14.50 - -4.01; p=0.0001) and pain (Intensity (0-10): mean difference -1.78; 95%CI: -2.55 - -1.01; p=0.0001) improved following NM. For chronic neck-arm pain, pain improved (Intensity (0-10): mean difference -1.89; 95%CI: -3.14 - -0.64; p=0.0003) following NM. For carpal tunnel syndrome, NM was not effective for most clinical outcomes (p>0.11), but showed positive neurophysiological effects (e.g., reduced intraneural oedema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as post-operative low back pain, cubital tunnel syndrome and lateral epicondylalgia. Conclusion This review reveals benefits of NM for back and neck pain, but the effect of NM for other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. Level of Evidence Level 1. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7117.

PMID: 28704626 [PubMed - as supplied by publisher]




Neuro-Endocrine Response Following a Thoracic Spinal Manipulation in Healthy Men.

Neuro-Endocrine Response Following a Thoracic Spinal Manipulation in Healthy Men.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-34

Authors: Sampath KK, Botnmark E, Mani R, Cotter JD, Katare R, Munasinghe PE, Tumilty S

Abstract
Study Design Randomized controlled trial. Background Spinal manipulation (SM) can trigger a cascade of responses involving multiple systems including the sympathetic nervous system (SNS) and the endocrine system, specifically the hypothalamic-pituitary (HP) axis. However, no manual therapy study has investigated the neuroendocrine response to SM (i.e., SNS-HP axis) in the same trial. Objective To determine short-term changes in SNS activity; heart rate variability (HRV) and endocrine activity (cortisol, testosterone and testosterone/cortisol (T/C) ratio) following a thoracic SM. Methods Twenty four healthy males aged between 18 and 45 years were randomized into two groups: thoracic spinal manipulation (n=12) and sham (n=12). Outcome measures were salivary cortisol (μg/dL), salivary testosterone (pg/mL), T/C ratio, HRV and changes in oxy-haemoglobin (O2Hb) concentration of the right calf muscle (μmol/L). Measurements were done before and at 5 minutes, 30 minutes and approximately 6 hours after intervention. Results A statistically significant group by time interaction was noted for T/C ratio (p<0.05) and salivary cortisol (p<0.01) concentrations. Significant between group differences were noted for salivary cortisol concentration at 5 min (mean difference (MD), 0.35; 95% CI: 0.12to0.6; interaction: p<.001) and T/C ratio at 6 hours post-intervention (MD), -0.91; 95% CI: -1.69to-0.04, p<0.05). However, SM did not differentially alter O2Hb, testosterone or HRV relative to responses in the sham group. Conclusion Thoracic SM resulted in an immediate decrease in salivary cortisol concentration and reduced T/C ratio 6 hours after intervention. A pattern of immediate sympathetic excitation was also observed in the SM group. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7348.

PMID: 28704625 [PubMed - as supplied by publisher]




A Systematic Review of EMG Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair.

A Systematic Review of EMG Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-43

Authors: Edwards PK, Ebert JR, Littlewood C, Ackland T, Wang A

Abstract
Study Design Systematic review. Background Electromyography (EMG) has previously been used to guide postoperative rehabilitation progression following rotator cuff repair, to prevent deleterious loading of early surgical repair. Objective To review the current literature investigating EMG during rehabilitation exercises in normal shoulders, to identify exercises that meet a cut point of ≤15% maximal voluntary isometric contraction (MVIC) and unlikely to result in excessive loading in the early postoperative stages. Methods An electronic search of MEDLINE via Ovid, EMBASE, CINAHL, SPORTDiscus, PubMed and Cochrane Library for all years up until June 2016 was performed. Studies were selected in relation to pre-defined selection criteria. Pooled mean MVICs were reported and classified as low (0%-15% MVIC); low-moderate (16-20% MVIC) moderate (21%-40% MVIC); high (41%-60% MVIC); and very high (>60% MVIC). Results 2159 studies in total were initially identified, and after applying the selection criteria, 22 studies were included for quality assessment, data extraction and data synthesis. In total, 43 exercises spanning passive ROM, active-assisted ROM and strengthening exercises were evaluated. Nine (out of 13) and 10 (out of 13) active-assisted exercises were identified to be suitable (≤15%MVIC) to load supraspinatus and infraspinatus respectively, early postoperatively. All exercises were placed in a theoretical continuum model whereby general recommendations can be made for prescription in patients post rotator cuff repair. Conclusion This review identifies passive and active-assisted exercises that are proposed to be appropriate in the early stages post rotator cuff repair. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7271.

PMID: 28704624 [PubMed - as supplied by publisher]




Process of Change in Pain-Related Fear: Clinical Insights From a Single-Case of Persistent Back Pain Managed With Cognitive Functional Therapy.

Process of Change in Pain-Related Fear: Clinical Insights From a Single-Case of Persistent Back Pain Managed With Cognitive Functional Therapy.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-38

Authors: Caneiro JP, Smith A, Rabey M, Moseley GL, O'Sullivan P

Abstract
Study Design Single-case report with repeated measures over 18 months. Background Management of persistent low back pain (PLBP) associated with high pain-related fear is complex. This single-case report aims to provide clinicians with an insight to the process of change in a person with PLBP and high bending-related fear, managed with an individualized behavioral approach - Cognitive Functional Therapy (CFT). Case Description A retired manual worker with PLBP believed that his spine was degenerating, that bending would hurt him and avoidance was the only form of pain control. At baseline, he presented high levels of pain-related fear on the Tampa Scale of Kinesiophobia (TSK: 47/68) and a high-risk profile on the Orebro Musculoskeletal Pain Questionnaire (OMPQ score: 61/100). Unhelpful beliefs and behaviors led to a vicious cycle of fear and disengagement of life-valued activities. Guided behavioral experiments were used to challenge his thoughts and protective responses, indicating his behavior was modifiable and the pain controllable. Using a multidimensional clinical reasoning framework (MDCRF), CFT management was tailored to target key drivers of PLBP, and delivered over six sessions in a three-month period. Outcomes Over an 18-month clinical journey he demonstrated improvements in bending-related fear, pain expectancy and pain experience; and substantial changes in pain-related fear (TSK: -14 points to 33/68) and risk profile (OMPQ: -25 points to 36/100). Clinical interviews at 6 and 18 months revealed positive changes in mindset, understanding of pain, perceived pain control, and behavioral responses to pain. Discussion This report provides clinicians with an insight to using a MDCRF to identify and target the key drivers of the disorder, and using CFT to address unhelpful psychological and behavioral responses to pain in a person with PLBP and high pain-related fear. Level of Evidence Therapy, Level 5. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7371.

PMID: 28704623 [PubMed - as supplied by publisher]




Assessment of Psychometric Properties of Various Balance Assessment Tools in Persons With Cervical Spondylotic Myelopathy.

Assessment of Psychometric Properties of Various Balance Assessment Tools in Persons With Cervical Spondylotic Myelopathy.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-43

Authors: Chiu AYY, Pang MYC

Abstract
Study Design Clinical measurement; cross-sectional, repeated measures. Background Persons with cervical spondylotic myelopathy (CSM) are known to have balance impairments. The psychometric properties of various balance assessment tools have not been evaluated in this population. Objective To examine the floor and ceiling effects, item difficulty and item discrimination index, internal consistency, reliability, and validity of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, Brief-BESTest and Berg balance scale (BBS) in persons with CSM. Methods Seventy-two individuals with CSM were evaluated with the above balance scales. Thirty-two were assessed by a second rater on the same day to establish inter-rater reliability, and by the same rater 1-2 days later to assess test-retest reliability. Results Of the 4 balance tools, only the BBS showed a substantial ceiling effect (skewness γ1<-1.0). BBS also had the highest proportion (>80%) of easy items. The item discrimination index was >0.4 for all items in the 4 balance scales. All balance tests showed good internal consistency (Cronbach's alpha >0.9) with excellent test-retest (ICC2,1>0.80) and inter-rater reliability (ICC2,1>0.90). In addition, all balance tests were strongly correlated with one another (i.e., concurrent validity), and with modified Japanese Orthopedic Association Score (i.e., convergent validity). Their correlations with the Abbreviated Mental Test were low (i.e., discriminant validity). All 4 balance tests could adequately identify fallers, and users of mobility aids (area under curve >0.8) (i.e., known-groups validity). Conclusion The Brief-BESTest is the most preferred tool for persons with CSM because of its excellent reliability, validity, and short administration time, whereas the BBS is the least preferred due to its substantial ceiling effect. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7283.

PMID: 28704622 [PubMed - as supplied by publisher]




Making Sense of Low Back Pain and Pain-Related Fear.

Making Sense of Low Back Pain and Pain-Related Fear.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-27

Authors: Bunzli S, Smith A, Schütze R, Lin I, O'Sullivan P

Abstract
Synopsis Pain-related fear is implicated in the transition from acute to chronic low back pain and the persistence of disabling low back pain, making it a key target for physiotherapy intervention. The current understanding of pain-related fear is that it is a psychopathological problem where people who catastrophise about the meaning of pain become trapped in a vicious cycle of avoidance behaviour, pain and disability, as recognised in the Fear Avoidance Model. However there is evidence that pain-related fear can also be seen as a common sense response to deal with low back pain, for example, when one is told that their back is vulnerable, degenerating or damaged. In this instance avoidance is a common sense response to protect a 'damaged' back. While the Fear Avoidance Model proposes that when someone first develops low back pain, the confrontation of normal activity in the absence of catastrophising leads to recovery, the pathway to recovery for individuals trapped in the fear avoidance cycle is less clear. Understanding pain-related fear from a common sense perspective enables physiotherapists to offer individuals with low back pain and high fear a pathway to recovery by altering how they make sense of their pain. Drawing on a body of published work exploring the lived experience of pain-related fear in people with low back pain, this Clinical Commentary illustrates how Leventhal's Common Sense Model may assist Physiotherapists to understand the broader sense-making processes involved in the fear avoidance cycle and how they can be altered to facilitate fear reduction by applying strategies established in the behavioural medicine literature. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7434.

PMID: 28704621 [PubMed - as supplied by publisher]




Rasch Model Analysis Gives New Insights Into the Structural Validity of the Quick-DASH in Patients With Musculoskeletal Shoulder Pain.

Rasch Model Analysis Gives New Insights Into the Structural Validity of the Quick-DASH in Patients With Musculoskeletal Shoulder Pain.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-20

Authors: Jerosch-Herold C, Chester R, Shepstone L

Abstract
Study Design Cross-sectional secondary analysis of a prospective cohort study. Background The Quick-DASH is a widely used outcome measure which has been extensively evaluated using classical test theory (CTT). Rasch model analysis can identify strengths and weaknesses of rating scales which goes beyond CTT approaches. It uses a mathematical model to test the fit between the observed data and expected responses and converts ordinal-level scores into interval-level measurement. Objective To test the structural validity of the Quick-DASH using Rasch analysis. Methods A prospective cohort study of 1030 patients with shoulder pain provided baseline data. Rasch analysis was conducted to i) assess how the Quick-DASH fits the Rasch model, ii) identify sources of misfit and iii) explore potential solutions to these. Results There was evidence of multidimensionality and significant misfit to the Rasch model (χ(2)= 331.04, p<0.001). Two items had disordered threshold responses with strong flooring effects. Response bias was detected in most items for age and gender. Rescoring resulted in ordered thresholds, however the 11-item scale still did not meet the expectations of the Rasch model. Conclusion Rasch model analysis on the Quick-DASH has identified a number of problems which cannot be easily detected using traditional analyses. Whilst revisions to the Quick-DASH resulted in better fit, a 'shoulder-specific' version is not advocated at present. Caution needs to be exercised when interpreting results of the Quick-DASH outcome measure as it does not meet the criteria for interval level measurement and shows significant response bias by age and gender. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7288.

PMID: 28704620 [PubMed - as supplied by publisher]