Manual therapy
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The purpose of this study was to compare the predictive ability of the standardised screening tool Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) and the clinicians' prognostic assessment in identifying patients with low back pain (LBP) and neck pain at risk for persistent pain and disability at eight weeks follow-up. Patients seeking care for LBP or neck pain were recruited by 19 manual therapists in Norway. Patients completed the ÖMPQ and the low back- or neck specific Oswestry Disability Index/Neck Disability Index at baseline and 8 weeks after first consultation. ⋯ For LBP patients, both the clinicians' assessment and the ÖMPQ contributed significantly in the separate regression models (p = 0.02 and p = 0.002, resp), whereas none of the tools where significant contributors for neck patients (p = 0.67 and 0.07). Neither of the two methods showed high precision in their predictions of follow-up at eight weeks. However, for LBP patients, the ÖMPQ and the clinicians' prognostic assessment contributed significantly in the prediction of functional outcome 8 weeks after the initial assessment of manual therapist, whereas the prediction for neck patients was unsure.
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Identifying factors which influence guideline-informed clinical decisions by therapists will help tailor implementation strategies to improve guideline use. The aims of this study were to investigate; the extent to which current physiotherapy practice in New Zealand adheres to low back pain (LBP) guidelines and the factors which influence the use of guidelines to inform clinical decisions for patients with non-specific low back pain (NSLBP). A cross-sectional on-line survey of NZ physiotherapists (n = 1039) was conducted which included the guideline adherence measures, therapists' treatment orientation about NSLBP and a question on the perceived helpfulness of guidelines in decisions for patients with NSLBP. ⋯ Differences between behaviours and beliefs in guideline use were found. A lower focus on a biomedical model for LBP influenced usage of LBP guidelines to inform clinical decisions for patients with LBP. Implications for improving guideline usage are discussed.
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The presence of cold hyperalgesia is a predictor of poor health outcomes following whiplash injury. An appropriate clinical test to identify cold hyperalgesia may help in gauging the prognosis. A repeated measures, within subjects design was used. ⋯ Sensitivities, specificities and likelihood ratios for different NRS values for pain intensity are presented. A pain intensity rating of >5 gave a positive likelihood ratio of 8.44 suggesting that if this value is reported, clinicians could be suspicious of the presence of cold hyperalgesia. This study demonstrates simple clinical test that may aid in gauging prognosis and guiding treatment decisions in people with WAD.
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Lumbar curvature is important in the assessment of low back pain (LBP). It is often reported that changes in curvature seen in LBP sufferers are an adaptive response to pain. Studies investigating this hypothesis employing an experimental pain relief model have failed to isolate pain relief in their interventions. ⋯ Neither the acute nor chronic LBP group were more likely to respond to pain relief by demonstrating alterations in peak curvature or in lumbar sequencing behaviour. These results demonstrate simple targeted pain relief did not result in gains in peak curvature challenging the assumption of movement alteration being possible through pain relief. Dynamic changes in curvature as displayed by sequencing showed that neither acute nor chronic LBP sufferers were more likely to respond to pain relief.
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It is unclear how age-related postural changes such as thoracic spine kyphosis influence cervical range-of-motion (ROM) in patients with cervical spine dysfunction. The purpose of this study was to explore the mediating effects of forward head posture (FHP) on the relationship between thoracic kyphosis and cervical mobility in older adults with cervical spine dysfunction. Fifty-one older adults (30 females, mean[SD]age = 66[4.9] years) with cervical spine dysfunction - that is, cervical pain with or without referred pain, numbness or paraesthesia - participated. ⋯ Bootstrap mediational analyses, adjusted for age, gender, weight and NDI, revealed significant indirect effects of thoracic kyphosis on cervical flexion and general rotation ROM through a FHP. Our results show that FHP mediated the relationship between thoracic kyphosis and cervical ROM, specifically general cervical rotation and flexion. These results not only support the justifiable attention given to addressing FHP to improve cervical impairments, but they also suggest that addressing thoracic kyphosis impairments may constitute an "upstream" approach.