Hip and Lumbar Spine Physical Examination Findings in People Presenting With Low Back Pain With or Without Lower Extremity Pain.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-36
Authors: Prather H, Cheng A, May KS, Maheshwari V, VanDillen L
Study Design Prospective cohort study, cross-sectional design. Background The hip-spine syndrome is described in patients with known arthritis of the hip. This study describes the hip examination findings of people presenting with low back pain (LBP). Objectives (1) report examination findings of the hip in patients with LBP, (2) compare pain and function of patients with positive hip examination findings to those without. Methods An examination and validated questionnaires of spine and hip pain and function were completed. Pain and function scores were compared between patients with and without hip findings. Results Consecutive patients (68 women, 33 men) with a mean age 47.6 years (range 18.4-79.8). On physical examination: 1) 81(80%) had reduced hip flexion (HF), 76 (75%) had reduced hip internal rotation (HIR), 2) 25 (25%) had 1, 32 (32%) had 2 and 23 (23%) had 3 positive provocative hip tests. Patients with reduced HF had less LBP -related (mean mODI 25.6 vs. 33.5, p=0.04) and hip-related function (mean mHHS 82.0 vs. 66.0, p=0.03). Patients with reduced HIR had less LBP-related function (mean RMQ 8.2 vs. 12.4, p=0.003). A positive provocative hip test(s) was coupled with more intense pain (median 7 vs. 9, p=0.05); and less LBP-related (mean RMQ 8.5 vs. 12.1, p=0.02) and hip-related function (mean mHHS 89.7 vs. 65.8, p=0.005). Conclusion Physical examination findings indicating hip dysfunction are common in patients presenting with LBP. Patients with LBP and positive hip examination findings have more pain and less function compared to patients with LBP without positive hip examination findings. Level of Evidence Symptom prevalence, Level 1b. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.6567.
PMID: 28158964 [PubMed - as supplied by publisher]
The Effectiveness of Manual Therapy versus Surgery on Self-Reported Function, Cervical Range of Motion and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-43
Authors: Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C
Study Design Randomized parallel-group trial. Background Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. Objective To compare the effectiveness of manual therapy versus surgery for improving self-reported function, cervical range of motion, and pinch grip tip in women with CTS. Methods In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n=50) or a surgery (n=50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire (BCTQ). Secondary outcomes included active cervical range of motion, pinch tip grip force and symptoms severity subscale of the BCTQ. Patients were assessed at baseline, and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. Results At 12 months, 94 women completed the follow-up. Analyses showed statistically significant differences in favour of manual therapy at 1 month for self-reported function (Δ -0.8, 95%CI -1.1 to -0.5) and pinch tip grip force on the symptomatic side (thumb-index finger: Δ2.0, 1.1 to 2.9; thumb-little finger: Δ1.0, 0.5 to 1.5). Improvements in self-reported function and pinch grip force were similar between both groups at 3, 6 and 12 months. Both groups reported similar improvements in symptoms severity at all follow-up periods. No significant changes were observed for pinch tip grip force on the less symptomatic side and in cervical range of motion in either group. Conclusion Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity and pinch tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion. Level of Evidence Therapy, Level 1b. Prospectively registered September 3, 2014 on www.clinicaltrials.gov (NCT02233660). J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090.
PMID: 28158963 [PubMed - as supplied by publisher]
The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-41
Authors: Gattie E, Cleland JA, Snodgrass S
Study Design Systematic review and meta-analysis. Background Dry needling is being utilized by an increasing number of physical therapists in the United States and throughout the world in the treatment of musculoskeletal pain. Objective To examine the short and long term effectiveness of dry needling delivered by a physical therapist for any musculoskeletal pain condition. Methods Electronic databases were searched. Eligible randomized controlled trials included human subjects with musculoskeletal conditions that were treated with dry needling performed by a physical therapist compared with control or other intervention. The overall quality of the evidence was assessed using the GRADE approach. Results Initial search returned 218 articles. After screening 13 were included. PEDro quality scale scores ranged 4-9 out of maximum score of 10 with a median score of 7. Eight meta-analyses were performed. In the immediate to 12 weeks follow-up period studies provided evidence that dry needling may decrease pain and increase pressure pain threshold when compared to control/sham or other treatment. At 6 to 12 months dry needling was favored for decreasing pain, but the treatment effect was not statistically significant. Dry needling when compared to control/sham treatment provides a statistically significant effect on functional outcomes, but does not when compared to other treatments. Conclusion Very low to moderate quality evidence suggests that dry needling performed by physical therapists is more effective than no treatment, sham dry needling, or other treatments for reducing pain and improving pressure pain threshold in patients presenting with musculoskeletal pain in the immediate to 12 week follow-up period. Low quality evidence suggests superior outcomes with dry needling for functional outcomes when compared to no treatment or sham needling. However, no difference in functional outcomes exists when compared to other physical therapy treatments. Evidence of long-term benefit of dry needling is currently lacking. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7096.
PMID: 28158962 [PubMed - as supplied by publisher]
People With Chronic Neck Pain Walk With a Stiffer Spine.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-33
Authors: Falla D, Gizzi L, Parsa H, Dieterich A, Petzke F
Study Design Case-control. Background People with chronic neck pain present a number of sensorimotor and biomechanical alterations, yet little is known about the influence of neck pain on gait and motions of the spine during gait. Objective To evaluate the spine kinematics and gait characteristics in people with non-specific chronic neck pain. Methods People with chronic non-specific neck pain and age and gender matched asymptomatic controls walked on a treadmill at three different speeds (self-selected, 3km/h, 5km/h) either with their head in a neutral position or rotated 30º. Tridimensional motion capture was employed to quantify body kinematics. Neck and trunk rotations were derived from the difference between the transverse plane component of the head and thorax and thorax and pelvis angles to provide an indication of neck and trunk rotation during gait. Results Overall, the patient group showed shorter stride length compared to the control group (P<0.0001). Moreover, the patients with neck pain showed smaller trunk rotations (P<0.0001), regardless of the condition or speed. The difference in the amount of trunk rotation between groups became larger for the conditions of walking with the head rotated. Conclusion These results show that people with chronic neck pain walk with reduced trunk rotation, especially when challenged by walking with their head positioned in rotation. Reduced rotation of the trunk during gait may have long term consequences on spinal health. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.6768.
PMID: 28158961 [PubMed - as supplied by publisher]
Short-Term Clinical Effects of Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: Case Series.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-24
Authors: Núñez-Cortés R, Cruz-Montecinos C, Rosel ÁV, Molina OP, Cuesta-Vargas A
Study Design Case series. Background The purpose of this case series is to describe a combined program of dry needling (DN) and therapeutic exercise in a small group of patients with persistent pain post total knee arthroplasty. Case Description Fourteen total knee arthroplasty patients with persistent post-surgical pain and myofascial trigger points non-responsive to treatment with conventional physical therapy or medications received dry needling treatment in combination with therapeutic exercises for four weeks. Dry needling sessions occurred once weekly. Pre- and post-intervention, pain perception was assessed with the visual analogue scale; functional assessments with the WOMAC questionnaire; six-minute walking test; Timed Up and Go test, 30-Second Chair Stand Test and knee joint range of motion. Outcomes Patients presented symptoms for 6.3 ± 3.1 months post-operation. Dry needling resulted in significantly decreased pain intensity (55.6 ± 6.6 to 19.3 ± 5.6, p<0.001) and improved WOMAC values for pain (10.1 ± 0.8 to 4.9 ± 1.0, p<0.001), stiffness (5.3 ± 0.4 to 2.4 ± 1.2, p<0.001), and function (36.7 ± 2.0 to 20.1 ± 3.2, p<0.001). Knee flexion increased from 82.7 ± 5.2° to 93.3 ± 4.3° (p<0.001), while joint extension improved from 15.8 ± 2.9° to 5.3 ± 2.4° (p<0.05). The six-minute walking test also showed better post-intervention values (391.4 ± 23.7 m to 424.7 ± 28.4 m, p<0.05). Discussion Dry needling together with therapeutic exercises had clinical and significant functional benefits for patients with chronic post-surgical pain and myofascial trigger points following total knee replacement. Future randomized clinical trials should further investigate the effectiveness of this protocol under similar conditions. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7089.
PMID: 28158960 [PubMed - as supplied by publisher]
The Effect of Visual Feedback of the Neck During Movement in People With Chronic Whiplash-Associated Disorders: An Experimental Study.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-33
Authors: Don S, De Kooning M, Voogt L, Ickmans K, Daenen L, Nijs J
Study Design Controlled laboratory study. Background Chronic whiplash-associated disorder (WAD) is an important health issue associated with poor recovery outcomes. Sensorimotor incongruence (SMI), defined as a mismatch between the efference copy in the brain and afferent sensory feedback from the body, is proposed as a possible underlying cause of chronic pain. Objectives To determine whether SMI causes sensory disturbances or pain in people with chronic WAD and healthy controls. Methods Study participants (30 participants with chronic WAD and 34 healthy controls) participated in a visual feedback experiment involving the neck and a bimanual coordination experiment involving the arms. In both experimental setups, SMI was induced by modifying the visual feedback during movement. Sensory disturbances and pain were the primary outcome measures. Results A statistically significant difference in perceived sensory disturbance between conditions was found in the WAD group (p<.0001). Intensity scores were highest for induced SMI, but only for visual feedback of the neck and not for visual feedback of the arms. This effect was not present in the control group (p = .139). SMI did not affect pain in either group. Conclusion Persons with chronic WAD are more susceptible to sensory disturbances owing to SMI and this effect is specific for the region affected by pain. The hypothesis that SMI causes pain was not substantiated by the results of the present study. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.6891.
PMID: 28158959 [PubMed - as supplied by publisher]
The Responsiveness and Interpretability of the Shoulder Pain and Disability Index.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-21
Authors: Thoomes-de Graaf M, Scholten-Peeters W, Duijn E, Karel Y, de Vet HC, Koes B, Verhagen A
Study Design Clinical measurement study; prospective cohort design. Background Shoulder pain is a common disorder and treatment is most often focused on a reduction of pain and functional disabilities. Several reviews have encouraged the use of the Shoulder Pain and Disability Index (SPADI) to objectify functional disabilities. It is important to assess the responsiveness and interpretability of the SPADI when it is used by patients seeking help by a physical therapist for their shoulder pain in primary care setting. Objective To assess the responsiveness and interpretability of the SPADI in patients with shoulder pain visiting a physical therapist in primary care. Methods The target population consisted of patients consulting a physical therapist for their shoulder pain. Patients received physical therapy treatment and completed the Dutch language version of the SPADI (SPADI-D) at baseline and at follow up of 26 weeks. To assess the interpretability floor and ceiling effects and the minimal important change (MIC) using the ROC method including a visual anchor based MIC distribution for several Global Perceived Effect scale (GPE) based anchors was used. The measurement error was calculated using the Smallest Detectable Change (SDC). For the responsiveness, the Area under the ROC curve (AUC) was used and correlations with the GPE and the change score of the Shoulder Disability Questionnaire (as this questionnaire measures the same construct) were assessed. Results In total 356 patients participated at baseline and 237 (67%) returned the SPADI after 26 weeks. The mean score at baseline of the SPADI was 46.7 points (on a 0-100 scale). The SPADI showed no signs of floor and ceiling effects. The SDC was 19.7 points. The MIC was 20 (43% of baseline value) and therefore we consider a change of more than 43% or more in an individual patient as clinically relevant. The AUC was 0.81, the Spearman correlation between the SPADI change score and the GPE was 0.53 and the Pearson correlation between the SDQ and the SPADI change scores was 0.71. Conclusion The results of this study confirm the responsiveness of the SPADI, making it a useful instrument to assess functional disability in longitudinal studies, however the measurement error should be taken into account when making decisions in individual patients. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7079.
PMID: 28158958 [PubMed - as supplied by publisher]
Trunk Muscle Characteristics of the Multifidi, Erector Spinae, Psoas, and Quadratus Lumborum in Older Adults With and Without Chronic Low Back Pain.
J Orthop Sports Phys Ther. 2017 Feb 03;:1-26
Authors: Sions JM, Elliott JM, Pohlig RT, Hicks GE
Study Design Cross-sectional study. Background Muscle support for the trunk is provided by the multifidi, erector spinae, psoas, and quadratus lumborum. Trunk muscle characteristics may be altered with aging and/or chronic LBP. To date, most trunk muscle research has been conducted among younger adults. Given age-related muscle changes, i.e. reduced size and increased intramuscular fat, studies are needed in older adults, including comparisons of older adults with and without LBP. Objective To determine if there are differences in trunk muscle characteristics between older adults with and without chronic low back pain (LBP), while controlling for age, sex, and body mass index. Methods 102 older adults with (n=53) and without chronic LBP (n=49) were included. Cross-sectional area (CSA) measurements were taken by tracing inside fascial borders on magnetic resonance images. Pixel intensity summaries were obtained to compute muscle-to-fat indices and relative muscle CSA, i.e. CSA void of fat. Right-left averages for levels L2-L5 were determined. Mixed design analyses-of-covariances were used to test for differences between groups based on LBP presence and sex, across levels (p≤.050). Results Older adults with LBP had a greater average multifidi muscle-to-fat index when compared to controls, i.e. .51 versus .49, and smaller average erector spinae relative muscle CSA, i.e. 8.56cm2 versus 9.26cm(2); no interactions between LBP status and average muscle characteristics were found for psoas or quadratus lumborum (p>.050). Conclusion Up to 54% of older adult trunk muscle CSA may be fat. Females have smaller muscles and greater intramuscular fat (at lower levels) than males. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7002.
PMID: 28158957 [PubMed - as supplied by publisher]