Manual therapy
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Psychological factors within the Fear-Avoidance Model of Musculoskeletal Pain (FAM) predict clinical and experimental pain in both symptomatic and asymptomatic individuals. Clinicians routinely examine individuals with provocative testing procedures that evoke symptoms. The purpose of this study was to investigate which FAM factors were associated with evoked pain intensity, non-painful symptom intensity, and range of motion during an upper-limb neurodynamic test. ⋯ Psychological predictors did not explain significant amounts of variance for the non-painful sensation intensity and ROM models. These findings suggest that pain catastrophizing contributed specifically to evoked pain intensity ratings during neurodynamic testing for healthy subjects. Although these findings cannot be directly translated to clinical practice, the influence of pain catastrophizing on evoked pain responses should be considered during neurodynamic testing.
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The aim of this study was to investigate the clinical reasoning processes of physiotherapists in relation to the assessment of vertebrobasilar insufficiency (VBI). Using a qualitative multiple case studies design 12 physiotherapists (mean=12.89 years clinical experience, SD=3.44) with an MSc in Manipulative Physiotherapy were shown 2 patient vignettes of a cervical spine disorder and associated symptoms of VBI sequentially in 4 sections and questioned as to their clinical reasoning processes via audio taped semi-structured interviews. Transcripts of the interviews were analysed for common themes. ⋯ The major indicators of VBI involvement were dizziness particularly if associated with other symptoms (visual disturbances, history of trauma and headache) and if exacerbated by cervical spine movements. Therapists demonstrated a lack of confidence in functional positional testing (FPT) and based decisions on the use of high velocity thrust techniques on subjective findings. The results of this study emphasise the importance of physiotherapists' clinical reasoning process during the SE particularly in view of the questionable diagnostic utility of FPT.
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Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. ⋯ Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.
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Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain. This review assesses if manipulation or mobilisation improves pain, function/disability, patient satisfaction, quality of life (QoL), and global perceived effect (GPE) in adults experiencing neck pain with or without cervicogenic headache or radicular findings. A computerised search was performed in July 2009. ⋯ Low quality evidence suggested cervical manipulation may provide greater short-term pain relief than a control (pSMD -0.90 (95%CI: -1.78 to -0.02)). Low quality evidence also supported thoracic manipulation for pain reduction (NNT 7; 46.6% treatment advantage) and increased function (NNT 5; 40.6% treatment advantage) in acute pain and immediate pain reduction in chronic neck pain (NNT 5; 29% treatment advantage). Optimal technique and dose need to be determined.
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The aim of this study was to determine the responsiveness, Minimal Important Difference (MID) and Minimal Detectable Change (MDC) scores of the shortened Disability Arm Shoulder Hand (QuickDASH) questionnaire. Participants (n = 35) were recruited from private physiotherapy practices. Participants completed the QuickDASH questionnaire on two occasions; the first prior to treatment and the second at discharge or at six weeks post baseline, whichever event occurred first. ⋯ The results indicated that responsiveness was high (ES = 1.02, SRM = 1.1). The MID was 19 points while the MDC was 11 points. These results provide evidence that the QuickDASH is a responsive instrument when utilised in patients seen in private practice over a typical treatment interval.