Manual therapy
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Many epidemiological surveys on playing-related musculoskeletal disorders (PRMDs) have been conducted on professional musicians, but none have evaluated or confirmed the psychometric properties of the self-report instruments that were used. The aim of the present study was to develop and validate a self-report instrument for professional orchestra musicians to measure musculoskeletal (MSK) pain and pain interference in terms of function and psychosocial constructs. 183 professional orchestra musicians in Scotland were eligible to participate in the study, of which 101 (55% response rate) took part. Development of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) involved the selection and modification of the most appropriate instruments measuring MSK pain, followed by psychometric evaluation of the new instrument. ⋯ High internal consistency was achieved for each subscale (Cronbach's alpha = 0.91). Substantial test-retest reliability for the pain intensity items (range 0.78-0.82), and moderate to substantial test-retest reliability for the pain interference items (range 0.56-0.76) were obtained. The MPIIQM is a valid and reliable self-report instrument for the measurement and evaluation of MSK pain and pain interference in a population of professional orchestra musicians.
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Randomized Controlled Trial
Show me the skin! Does seeing the back enhance tactile acuity at the back?
A growing body of literature associates musculoskeletal disorders with cortical reorganisation. One condition in which reorganisation is established and treatments that 'train the brain' are being widely used is chronic back pain. Recent evidence suggests that treatments that involve tactile training are more effective if they incorporate multisensory mechanisms, most obviously vision. ⋯ Both the second (F(3,66) = 1.00, p = 0.398) and third (t(9) = 0.969, p = 0.358) experiments suggested that seeing the back did not significantly affect tactile acuity, confirming that our initial results were likely due to chance. The principle that visual feedback improves tactile acuity at the hand does not apply to the back. These results strongly suggest that attempts to enhance tactile training by incorporating vision will not offer the benefit to treatment of back pain that has been observed for treatment of hand pain.
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Reliability study. ⋯ The reliability between physical therapists and radiologist on diagnostic ultrasound of shoulder patients in primary care is borderline substantial (Kappa = 0.63) for full thickness tears only. This level of reliability is relatively low when compared with the high reliability between radiologists. More experience and training of physical therapists may increase the reliability of diagnostic ultrasound.
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Case Reports
Acromio-clavicular joint cyst associated with a complete rotator cuff tear - a case report.
This case report describes a patient with an acromio-clavicular joint (ACJ) cyst, associated with a complete tear of the supraspinatus tendon, and the related arthropathy. Ultrasound was a suitable imaging modality to make the diagnosis, and rule out other pathologies. ⋯ Cyst aspiration is not a suitable treatment, due to the high likelihood of recurrence. Optimal treatment requires management of the underlying rotator cuff tear.
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A growing body of literature suggests that alterations in brain structure and function are a feature of chronic back pain. Tactile acuity is considered a clinical signature of primary somatosensory representation and offers a simple measure of cortical reorganisation. Clinical interpretation of test scores from an individual patient is hampered by variance in published normative values and less than ideal inter-rater reliability. ⋯ The standard error of measurement was 4.2 mm when assessed vertically and 2.7 mm when assessed horizontally. The RCI suggests that differences of greater than 13 mm when assessed horizontally and 17 mm when assessed vertically equate to 95% confidence that a difference truly exists. Several assumptions related to the application of this approach need to be investigated further.