The Journal of manual & manipulative therapy
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Introduction: Entry-level physical therapist education on pain has been described as lacking. Calls have been made to include pain science courses to address this knowledge gap. Methods: Physical therapist students' pain knowledge and attitudes were measured using the revised Neurophysiology of Pain Questionnaire (rNPQ) and Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT), respectively. ⋯ Conversely, psychosocial belief scores increased from 1st to 2nd year (effect size: 0.82), remained similar between years 2 and 3, and increased following the pain course (effect size: 1.08). Discussion/Conclusions: Physical therapist education, without a dedicated pain science course, may be insufficiently preparing students to treat patients in pain. Educators should consider adopting a dedicated pain science course or substantially bolstering embedded curricular pain content to promote best practice in pain treatment.
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Randomized Controlled Trial
Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial.
Objectives: The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain. Methods: This project involved a pilot randomized, blinded clinical trial (ClinicalTrials.gov registration number NCT03078114) of 3-week SMT in chronic nonspecific low back pain (CNSLBP) patients. We recruited 29 participants and randomly assigned them into either a SMT (n = 14) or sham SMT (n = 15) group. ⋯ However, no between-group differences were observed in PPT, clinical pain, or disability between the SMT and sham SMT groups over 3 weeks. Conclusions: After 3 weeks of SMT or sham SMT in CNSLBP patients, we found hypoalgesia at local and remote sites along with improved pain and low back-related disability. Level of Evidence: 1b.
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Clinical Trial
Immediate effect of pain neuroscience education for recent onset low back pain: an exploratory single arm trial.
Study Design: A prospective, single-arm, pre-postintervention study. Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP). Background: PNE has been shown to be an effective intervention for the treatment of chronic LBP but its usefulness in patients with non-chronic LBP has not been examined. ⋯ SLR improved significantly (p = 0.002), but mean change did not exceed MDC. Conclusions: PNE may be an interesting option in the treatment of patients with non-chronic mechanical LBP. The present pilot study provides the rationale for studying larger groups of patients in controlled studies over longer periods of time.
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Randomized Controlled Trial
Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up.
Objectives: The purpose of this randomized controlled trial was to investigate the long-term clinical effect of dry needling with two-week and three-month follow up, on individuals with myofascial trigger points in the upper trapezius muscle. Methods: A sample of convenience (33 individuals) with a trigger point in the upper trapezius muscle, participated in this study. The individuals were randomly assigned to two groups: trigger point compression (N = 17) or dry needling (N = 16). ⋯ The results showed a significant change in pain intensity, neck disability, and DASH after treatment sessions, after two weeks and three months when compared with before treatment scores in both groups. There was no significant difference in the tested variables after two-week or three-month as compared to after treatment sessions between the two groups. However, pain intensity after treatment sessions was significantly different between the two groups (p = .02). Discussion: Dry needling and trigger point compression in individuals with myofascial trigger point in the upper trapezius muscle can lead to three-month improvement in pain intensity and disability.
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Mechanical diagnosis and therapy (MDT) aims to assess and classify patients into theoretically mutually exclusive subgroups, in order to direct treatment. However, the latest evidence for biopsychosocial influence-central sensitization (CS) and psychological distress-have not been assessed in conjunction with MDT. ⋯ The majority of our patients were classified as DER; they also presented with high levels of CS and/or psychological distress. This suggests that MDT mechanical subgroups, particularly DER, can present with co-occurring biopsychosocial influences. Without assessing CS and psychological distress, MDT therapists may miss crucial information. Further research is required to determine the optimal management of patients presenting with mechanical and non-mechanical drivers of pain.