Manual therapy
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Clinical Trial
The use of fear-avoidance beliefs and nonorganic signs in predicting prolonged disability in patients with neck pain.
Psychological factors, such as fear-avoidance beliefs and nonorganic signs, have been postulated to play a role in the development of prolonged disability. The purpose of this study was to determine if fear-avoidance beliefs and nonorganic behavior are predictive of disability in patients with neck pain. Seventy-nine patients, with neck pain, were recruited from five outpatient physiotherapy clinics. ⋯ In order to determine the overall predictive ability of the FABQ and CNOS, receiver operator characteristic (ROC) curves were used. The areas under the ROC curve were 0.782 (CNOS), 0.833 (FABQ-Total), 0.782 (FABQ-W) and 0.814 (FABQ-PA). Results from this study suggest that the FABQ and testing for CNOS are both good tools for predicting patients who may develop prolonged disability.
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The purpose of the study was to explore the construct validity of three versions of the Oswestry Disability Questionnaire for low back pain using Rasch analysis. The three versions of the ODQ share 9 items and differ on one other. About 100 patients with non-specific low back pain seeking physiotherapy treatment at hospital outpatient departments and physiotherapy private practices completed the 12 Oswestry items as part of a battery of questionnaires. ⋯ The third version, in which Sex Life is replaced by Changing Degree of Pain, did not fit the model (chi(2)P=.006) and the Changing Degree of Pain item was misfitting (residual 2.34, P=.007). These findings suggest that either of the first two of the three versions of this widely used low back pain outcome measure should be selected over the third. Users should also be aware that for some items the rating scale steps do not perform as intended.
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Cervical muscle function is disturbed in patients with persistent pain related to a whiplash associated disorder (WAD) but little is known about neck extensor muscle morphometry in this group. This study used magnetic resonance imaging to measure relative cross-sectional area (rCSA) of the rectus capitis posterior minor and major, multifidus, semispinalis cervicis and capitis, splenius capitis and upper trapezius muscles bilaterally at each cervical segment. In total, 113 female subjects (79 WAD, 34 healthy control; 18-45 years, 3 months-3 years post-injury) were recruited for the study. ⋯ There were occasional weak, although statistically significant relationships between age, body mass index (BMI), duration of symptoms and the size of some muscles in both healthy control and WAD subjects (P < 0.01). It is possible that the consistent pattern of larger rCSA in multifidus at all levels and the variable pattern of rCSA values in the intermediate and superficial muscles in patients with WAD may reflect morphometric change due to fatty infiltrate in the WAD muscles. Future clinical studies are required to investigate the relationships between muscular morphometry, symptoms and function in patients with persistent WAD.
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Whiplash is a heterogenous and in many, a complex condition involving both physical and psychological factors. Primary care practitioners are often the first healthcare contact for individuals with a whiplash injury and as such play an important role in gauging prognosis as well as providing appropriate management for whiplash injured patients. ⋯ The clinical assessment of these factors will be explored as well as direction for appropriate early interventions. An early co-ordinated inter-professional management approach, particularly in patients with a complex clinical presentation involving central hyperexcitability and symptoms of posttraumatic stress will be required.