Manual therapy
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The original Örebro Musculoskeletal Pain Questionnaire (original-ÖMPQ) was developed to identify patients at risk of developing persistent back pain problems and is also advocated for musculoskeletal work injured populations. It is critiqued for its informal non-clinimetric development process and narrow focus. A modified version, the Örebro Musculoskeletal Screening Questionnaire (ÖMSQ), evolved and progressed the original-ÖMPQ to broaden application and improve practicality. ⋯ Baseline-ÖMSQ scores correlated strongly with recovery time to 80% functional status (r = 0.73, p < 0.01). The ÖMSQ was validated prospectively in an acute work-injured musculoskeletal population. The ÖMSQ cut-off scores retain the predictive capacity intent of the original-ÖMPQ and provide clinicians and insurers with identification of patients with potentially high and low risks of unfavourable outcomes.
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The purpose of this study was to establish the reliability of a frame-by-frame cross correlation method of assessing longitudinal sciatic nerve excursion motion using real time ultrasound imaging during a modified passive straight leg raise (SLR) test. Eighteen asymptomatic participants (age range 19-68 years) lay on their sides on a purpose made jig and the sciatic nerve in the posterior thigh was imaged during knee extension at 30° and then 60° of hip flexion (HF). Participants were re-tested ≥48 h later. ⋯ The authors also identify points of good practise to ensure an accurate as possible measurement of nerve excursion using this method. These include breaking down larger movements into sub-components, visually tracking the moving nerve during the tracking procedure, and ensuring the optimal image is captured prior to analysis. The use of ultrasound imaging in lower limb nerve dysfunction will enhance the understanding of how nerves move in vivo during neurodynamic testing, as well as being able to identify possible alteration to nerve movements in patients with neuropathic pain states.
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The semispinalis cervicis muscle displays reduced and less defined activation in patients with neck pain which is associated with increased activity of the splenius capitis muscle. Exercises to selectively activate the semispinalis cervicis muscle may be relevant for patients with neck pain however the most appropriate type of exercise has not been determined. The purpose of this study was to investigate whether a specific exercise could selectively activate the semispinalis cervicis muscle relative to the splenius capitis. ⋯ The relative activation of the semispinalis cervicis was greater (P < 0.05) than the splenius capitis with resistance at C2 (2.53 ± 2.43) compared to resistance at the occiput (1.39 ± 1.00) or at C5 (1.16 ± 0.85). The results indicate that localized resistance can achieve relative isolation of the semispinalis cervicis muscle. This exercise approach may be relevant for patients with neck pain.
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Review
Cold hyperalgesia as a prognostic factor in whiplash associated disorders: a systematic review.
To review and critically evaluate the existing literature for the prognostic value of cold hyperalgesia in Whiplash Associated Disorders (WAD). ⋯ There is moderate evidence supporting cold hyperalgesia as a prognostic factor for long-term pain and disability outcome in WAD. Further validation of the strength of this relationship and the influence of covariates are required. The mechanism for this relationship is unknown.
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There is considerable interest in whether best practice management of nonspecific low back pain (NSLBP) should include the targeting of treatment to subgroups of people with identifiable clinical characteristics. However, there are no published systematic reviews of the efficacy of targeted psychosocial interventions. ⋯ Four studies met the inclusion criteria and collectively investigated nine hypotheses about targeted treatment on 28 subgroup/treatment outcomes. There were only two statistically significant results. Graded activity plus Treatment Based Classification targeted to people with high movement-related fear was more effective than Treatment Based Classification at reducing movement-related fear at 4 weeks. Active rehabilitation (physical exercise classes with cognitive-behavioural principles) was more effective than usual GP care at reducing activity limitation at 12 months, when targeted to people with higher movement-related pain. Few studies have investigated targeted psychosocial interventions in NSLBP, using trial designs suitable for measuring treatment effect modification, and they do not provide consistent evidence supporting such targeting. There is a need for appropriately designed and adequately powered trials to investigate targeted psychosocial interventions.