Manual therapy
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The cervical facet joint is a prevalent source of pain in patients with chronic cervical spine pain. Patients with persistent, disabling neck pain, are increasingly being referred for diagnostic facet joint blocks, with the aim of assessing their suitability for interventional procedures such as radiofrequency neurotomy (RFN). A positive response to the block is an indicator of more substantive benefits from RFN. ⋯ It is reasoned that a combination of findings of a physical, manual and psychological assessment may better indicate that a patient will respond positively or negatively to a diagnostic facet joint block. Clinical prediction guides (CPG) allow practitioners to use the results of the patient history, self-report measures and physical examination toward optimal diagnostic and therapeutic decisions. It is proposed that the development and validation of a CPG may aid in the appropriate selection of patients for this diagnostic procedure.
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Clinical Trial
Differences in end-range lumbar flexion during slumped sitting and forward bending between low back pain subgroups and genders.
Patterns of lumbar posture and motion are associated with low back pain (LBP). Research suggests LBP subgroups demonstrate different patterns during common tasks. This study assessed differences in end-range lumbar flexion during two tasks between two LBP subgroups classified according to the Movement System Impairment model. ⋯ Gender differences were not responsible for LBP subgroup differences. Subgrouping people with LBP provides insight into differences in lumbar motion within the LBP population. Results suggesting potential consistent differences across flexion-related tasks support the presence of stereotypical movement patterns that are related to LBP.
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Evolving evidence has shown increased clinical outcomes, when low back pain (LBP) patients are classified and receive matched physical treatment. The present study aimed to examine the inter-examiner reliability of a proposed new decision-making classification system for non-specific LBP patients, using a mixed simultaneous and independent examiner design. With minimal familiarization, two pairs of experienced physiotherapists trained in Orthopedic Manual Therapy (OMT) at two different out-patient clinics in primary care, examined and classified 64 consenting consecutive patients. ⋯ Agreement within classification was substantial, except for mobilization which was poor. Inter-examiner reliability for the individual examination items varied from fair to almost perfect. Further studies are needed to investigate utility and validity of this new classification system.
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Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of 'nociceptive' (NP), 'peripheral neuropathic' (PNP) and 'central sensitisation' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. ⋯ A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.
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There is uncertainty regarding the association between the function of the pelvic floor muscles (PFM) and pelvic girdle pain (PGP), and whether exercises to strengthen the PFM should be recommended for patients with PGP. This one-to-one matched case-control study examined whether there is any difference in voluntary PFM function between women with and without clinically diagnosed PGP. PFM function was assessed by manometry and three-dimensional ultrasound. ⋯ A significantly smaller levator hiatus and a tendency for higher vaginal resting pressure may indicate increased activity of the PFM. Hence, no evidence was found to recommend strengthening exercises for the PFM in patients with PGP. It is important to note that in this study we examined only voluntary contractions and not an automatic response of the PFM to a functional activity.