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Gagnon P, Dunning J, Bliton P, Charlebois C, Henry N, Gorby P, Mourad F. Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report. Clin Case Rep 2024; 12:e8858. [PMID: 38689684 PMCID: PMC11060885 DOI: 10.1002/ccr3.8858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS. Abstract Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.
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Affiliation(s)
- Peter Gagnon
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physical Therapy of BoulderBoulderColoradoUSA
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Montgomery Osteopractic Physical Therapy & AcupunctureMontgomeryAlabamaUSA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- William S. Middleton VA HospitalMadisonWisconsinUSA
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Arcadia UniversityGlensidePennsylvaniaUSA
| | - Nathan Henry
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physio RoomColorado SpringsColoradoUSA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Gorby Osteopractic Physiotherapy, Colorado Springs, COColorado SpringsColoradoUSA
| | - Firas Mourad
- Department of PhysiotherapyLUNEX International University of Health, Exercise and SportsDifferdangeLuxembourg
- Luxembourg Health & Sport Sciences Research Institute ASBLDifferdangeLuxembourg
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Bjørneboe J, Bratsberg A, Brox JI, Skatteboe S, Wilhelmsen M, Samuelsen KM, Marchand GH, Flørenes T, Kielland MG, Røe C. Symptom burden and follow-up of patients with neck and back complaints in specialized outpatient care: a national register study. Sci Rep 2024; 14:3855. [PMID: 38361115 PMCID: PMC10869734 DOI: 10.1038/s41598-024-53879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
Back and neck pain are common in the population, especially among immigrants. In Norway's specialist care system, treating these patients typically involves a multidisciplinary approach based on the biopsychosocial model. However, language and cultural differences may create barriers to participation. Immigrants are often underrepresented in clinical studies, but a register-based approach can enhance their participation in research. This study aimed to compare both the symptom burden, and treatment, among Norwegians, non-Norwegians, and patients requiring translator service for back and neck pain within the Norwegian specialist care system. The Norwegian neck and back registry is a National Quality Register, established in 2012 and fully digitized in late 2020. The baseline data includes demographics and patient recorded outcome measures including Oswestry Disability Index, Fear-Avoidance Beliefs, pain rating on a numeric rating scale, Hopkins Symptom Checklist and EuroQol five-dimensional questionnaire on health related quality of life. During the two-year study period, a total of 14,124 patients were invited, and 10,060 (71%) participated. Norwegian patients reported less pain, better function assessed by Oswestry Disability Index, lower fear avoidance beliefs, less emotional distress, and higher health related quality of life compared to non-Norwegians. We found that patients with female gender, who were younger, more educated and exhibited fear-avoidance behavior were significantly more likely to receive multidisciplinary treatment. We found no difference in the proportion of Norwegian and non-Norwegian patients receiving multidisciplinary treatment [odds ratio (OR) 1.02 (95% confidence interval (CI) 0.90-1.16)]. However, patients needing a translator were less likely to receive multidisciplinary treatment compared to those who didn't require translation [OR 0.41 (95% CI (0.25-0.66)]. We found that non-Norwegian patients experience a higher symptom burden compared to Norwegian. We found that both non-Norwegians and patient in need of translator were to a greater extent recommended treatment in primary health care. The proportion of non-Norwegians patients receiving multidisciplinary treatment was similar to Norwegians, but those needing a translator were less likely to receive such treatment.
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Affiliation(s)
- John Bjørneboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Andrea Bratsberg
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University in Oslo, Oslo, Norway
| | - Sigrid Skatteboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Maja Wilhelmsen
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Norwegian Neck and Back Registry, UNN Tromsø, Tromsø, Norway
| | - Kjetil Magne Samuelsen
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Norwegian Neck and Back Registry, UNN Tromsø, Tromsø, Norway
| | - Gunn Hege Marchand
- Department of Physical Medicine and Rehabilitation, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tonje Flørenes
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Maja Garnaas Kielland
- Department of Health Care Coordination, Health Literacy and Health Equity, Oslo University Hospital, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University in Oslo, Oslo, Norway
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Dinsdale A, Thomas L, Forbes R, Treleaven J. Is proprioception affected in those with persistent intra-articular temporomandibular disorders? A cross-sectional study exploring joint position sense and force sense of the jaw. Musculoskelet Sci Pract 2024; 69:102904. [PMID: 38171215 DOI: 10.1016/j.msksp.2023.102904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Proprioception is an important component of normal jaw function, although to date it is unknown if and how proprioception is affected in those with intra-articular temporomandibular disorders (IA-TMDs). This challenges effective management of this subgroup. OBJECTIVES Determine whether differences in local joint position sense and force sense exist between individuals with IA-TMD and those without a jaw problem. DESIGN Cross-sectional study. METHOD Sixty age and sex matched participants were recruited (n = 30 IA-TMD, n = 30 healthy controls). Temporomandibular joint position sense was tested to one target (50% of maximal mouth opening) using a ruler. Temporomandibular force sense was tested to two targets (50% and 70% of maximal molar pain-free bite force) using a bite sensor. Constant, absolute and variable errors were calculated for each outcome and compared between groups using p-values and 95% confidence intervals for effect size (d). RESULTS Significantly greater degrees of constant, absolute and variable error were seen for force sense testing at the 50% target (p < 0.05). No statistically significant difference was observed between groups for joint position sense, or for constant or variable force sense error at the 70% target (p > 0.05). Despite this, all joint position sense and force sense measures demonstrated possible clinical significance (upper limits 95% CI d ≥ 0.5). CONCLUSIONS Force sense, particularly at lower levels, appears impaired in those with IA-TMD. Joint position sense and force sense at higher levels appear less affected, although may still be important to consider in the management of IA-TMD in some patients.
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Affiliation(s)
- Alana Dinsdale
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Saint Lucia.
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Saint Lucia.
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Saint Lucia.
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Saint Lucia.
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Zhang H, Glassman SD, Bisson EF, Potts EA, Jazini E, Carreon LY. Patient expectations impact patient-reported outcomes and satisfaction after lumbar fusion. Spine J 2024; 24:273-277. [PMID: 37797842 DOI: 10.1016/j.spinee.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND CONTEXT Prior studies suggest that patient expectations impact postoperative patient-reported outcomes (PROMs). However, no consensus exists on an appropriate expectations tool. PURPOSE To examine the impact of patient expectations using a modified version of the Oswestry Disability Index (ODI) on clinical outcomes and patient satisfaction 1 year after lumbar fusion for degenerative pathologies. STUDY DESIGN Prospective longitudinal cohort. PATIENT SAMPLE Adults undergoing 1 to 2 level lumbar fusion were identified from four tertiaty spine centers. OUTCOME MEASURES ODI, EuroQol-5D, Numeric rating scales for back and leg pain. METHODS Preoperatively, patients completed the ODI, as well as a modified ODI reflecting their expected improvement across the 10 ODI items. For example, item 1 in the ODI asks about Pain Intensity at the moment whereas the Expectations ODI asks "One year after surgery, I expect to have…" The difference between this modified ODI score and the baseline ODI score (Baseine ODI minus Expectations ODI) was defined as the Patient Expectation Score. Patients were stratified into tertiles based on their Expectations score into High (HE), Moderate (ME), and Low (LE) Expectations and compared. RESULTS There were 30 patients in the HE, 35 in the ME, and 26 in the LE Group, with similar demographics and surgical parameters. Patients in the HE group had worse ODI scores preoperatively (54.96 vs 41.42, p<.001) and were expecting a greater improvement in ODI (43.8 vs 13.5, p<.001). There were fewer patients in the HE group (13, 43%) who reported that they were satisfied with the results compared to either the ME (20, 71%) or LE group (22, 85%, p=.041) despite having similar ODI scores and change in ODI scores 1 year postoperatively. CONCLUSION An expectations tool, linked to a disease-specific measure may provide the clinician with a practical method of assessing a patient's expectation of results after treatment and aid in the shared decision-making during the preoperative surgical process.
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Affiliation(s)
- Hanci Zhang
- Norton Leatherman Spine Center, 210 East Gray St, Louisville, KY, 40202 USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray St, Louisville, KY, 40202 USA
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah Health Care, 175 North Medical Dr East, Salt Lake City, UT, 84132 USA
| | - Eric A Potts
- Goodman Campbell Brain & Spine, Indiana University Department of Neurosurgery, 8333 Naab Rd, Suite 250, Indianapolis, IN, 46260 USA
| | - Ehsan Jazini
- Virginia Spine Institute, 11800 Sunrise Valley Dr, Reston, VA, 20191 USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray St, Louisville, KY, 40202 USA.
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Bae S, Jung J, Moon D. Impact of Movement Control Training Using a Laser Device on the Neck Pain and Movement of Patients with Cervicogenic Headache: A Pilot Study. Healthcare (Basel) 2023; 11:healthcare11101439. [PMID: 37239725 DOI: 10.3390/healthcare11101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
This study verified the effect of movement control training using a laser device on the neck pain and movement of patients with cervicogenic headache. A total of twenty outpatients recruited from two Busan hospitals were equally divided into two groups. The experimental group underwent movement control training with visual biofeedback, while the control group performed self-stretching. Both groups received therapeutic massage and upper cervical spine mobilization. A four-week intervention program was also conducted. Measurement tools including the cervical flexion-rotation test, visual analog scale, Headache Impact Test-6, pressure pain threshold, range of motion, sensory discrimination, and Neck Disability Index helped assess the participating patients before and after the intervention. Additionally, the Wilcoxon signed-rank test and the Mann-Whitney U test helped determine inter and intra-group variations, respectively, before and after the intervention. Most of the measurement regions revealed significant changes post-intervention within the experimental group, while only the cervical flexion-rotation test, visual analog scale, Headache Impact Test-6, and Neck Disability Index indicated significant changes post-intervention within the control group. There were also considerable inter-group differences. Thus, movement control training using a laser device more effectively improves neck pain and movement of patients with cervicogenic headache.
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Affiliation(s)
- Songui Bae
- Department of Physical Therapy, Graduate School, Dong-Eui University, Busan 47340, Republic of Korea
| | - Juhyeon Jung
- Department of Physical Therapy, College of Nursing, Healthcare Sciences and Human Ecology, Dong-Eui University, Busan 47340, Republic of Korea
| | - Dongchul Moon
- Department of Physical Therapy, Gimhae College, Gimhae-si 50811, Republic of Korea
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Reliability and validity of the Neck Disability Index among patients undergoing cervical surgery. Int J Rehabil Res 2022; 45:273-278. [PMID: 35776945 DOI: 10.1097/mrr.0000000000000540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To explore the internal consistency and factor structure of the Neck Disability Index (NDI) among patients undergoing surgery on the cervical spine. This was an observational retrospective cohort study among 392 patients undergoing cervical surgery of any kind in a university hospital between 2018 and 2021. The patients responded to repeated surveys preoperatively, and 3, 12 and 24 months postoperatively. The reliability and validity of the NDI were investigated using Cronbach's alpha and factor analysis. The internal consistency of the NDI was found to be good at 0.86. The exploratory factor analysis demonstrated unidimensionality. The correlations between the main factor 'disability' and all the individual items of the NDI were at least moderate. The highest correlations were observed for pain intensity, reading, driving and recreation. The NDI is an internally consistent and unidimensional scale when applied to a population of patients undergoing cervical surgery.
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Yuan S, Li Y, Zhang L, Wang H. The Relationship Between the NSP and the Individual and Work Organizational Variables: A Cross-Sectional Study. Front Public Health 2022; 10:726826. [PMID: 35433581 PMCID: PMC9009827 DOI: 10.3389/fpubh.2022.726826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To investigate the characteristics of neck–shoulder pain (NSP) and explore the potentional relationship between the NSP and the individual and work organizational variables. Methods A cross-sectional study was performed in the tertiary general hospitals in Hunan Province, China between May 2019 and July 2019. A total of 2,030 healthcare workers were enrolled randomly in this study based on a three-stage stratified sampling method. The Neck Disability Index (NDI) was used to measure disability in subjects with neck pain. A self-administered questionnaire was used to assess the characteristics of individual and work organizational variables. The Mann–Whitney U test and the Kruskal–Wallis H test were applied to analyze the prevalence of pain intensity among groups. Multivariate linear regression analysis was performed to explore the potentional relationship between NSP and individual and work organizational variables using the NDI score as the dependent variable. Results 2,008 of 2,030 healthcare workers filled out the survey questionnaires online. In the past 12 months, 1,489 participants (74.2%) complained of pain in the cervical–shoulder region. NDI score increased by 0.10 for each year of age, with healthcare workers working in Obstetrics and Gynecology, and the Operating Room less likely to have NSP than those working in other departments. In contrast, female healthcare workers with a history of pregnancy were more likely to have NSP. In terms of organizational factors, workers who received concern from their supervisor about their health, who had the choice to change their shift status to off duty when they were not feeling well, or who were informed about WMSDs were less likely to have NSP. Conclusion The prevalence of NSP within the previous year was high in this population. Individual factors including history of neck–shoulder diseases, age, and history of pregnancy and organizational factors including being adequately informed regarding WMSDs, concern from supervisors about workers' health, and the ability of workers to change their shift status to off duty when they were not feeling well were shown to induce significant effects to NSP.
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Affiliation(s)
- Sue Yuan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yunxia Li
- Xiangya Nursing School, Central South University, Changsha, China
| | - Lihui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, China
- *Correspondence: Honghong Wang
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Aljinović J, Barun B, Poljičanin A, Marinović I, Vlak T, Pivalica D, Benzon B. Croatian version of the neck disability index can distinguish between acute, chronic and no neck pain : Results of a validation study. Wien Klin Wochenschr 2021; 134:162-168. [PMID: 34241680 DOI: 10.1007/s00508-021-01908-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Longitudinal study to test the validity and reliability of the Croatian version of the neck disability index (NDI-CRO) for use in patients. METHODS Three groups were given NDI-CRO on two occasions, 48 h apart: acute whiplash neck injury group (n = 30), hospital physiotherapists-professional chronic neck pain group (n = 56) and control group (n = 65). To test validity, correlation between NDI-CRO and the pain VAS and PHQ‑9 questionnaire for depression was analyzed. Reliability testing was done using the test-retest experiment and item-total score correlation. RESULTS Test-retest showed excellent correlation in all groups: whiplash 0.86, control 0.95 and physiotherapist 0.89 (Spearman r). Item-total score in the 3 analyzed groups showed positive correlation in all 10 categories, varying from 0.43-0.85. The NDI-CRO score showed significant difference between groups (median whiplash 38%, physiotherapist 12% and control 6%, p < 0.05). Validity testing showed positive correlation between NDI and pain VAS (control r = 0.63, physiotherapist r = 0.68 and whiplash r = 0.83, p < 0.05) and PHQ‑9 (control r = 0.49, physiotherapist r = 0.71 and whiplash r = 0.69, p < 0.05). No correlation was found between NDI-CRO and age, gender or radiographic findings. In the whiplash injury group 75% of patients showed moderate to severe disability. The majority of physiotherapists showed mild to moderate disability due to neck pain while 40% showed no disability. In the control group two out of three people reported no disability. CONCLUSION The NDI-CRO is a valid index for measuring the degree of neck disability in people with acute and chronic neck pain and in control group. It is strongly correlated with pain VAS and PHQ‑9 index.
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Affiliation(s)
- Jure Aljinović
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000, Split, Croatia. .,Department of Health Studies, University of Split, Split, Croatia.
| | - Blaž Barun
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000, Split, Croatia
| | - Ana Poljičanin
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000, Split, Croatia.,Department of Health Studies, University of Split, Split, Croatia
| | - Ivanka Marinović
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000, Split, Croatia.,Department of Health Studies, University of Split, Split, Croatia
| | - Tonko Vlak
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000, Split, Croatia.,Department of Physical and rehabilitation medicine, University of Split, School of Medicine, Split, Croatia
| | - Dinko Pivalica
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000, Split, Croatia.,Department of Health Studies, University of Split, Split, Croatia
| | - Benjamin Benzon
- Department of Anatomy, Histology and Embryology and Neuroscience, University of Split, School of Medicine, Split, Croatia
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Munk N, Nemati D, Benjamin EV, Davies A, Shue S, Bair MJ. Trigger point self-care for chronic neck pain: Pilot and feasibility. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dunning J, Butts R, Zacharko N, Fandry K, Young I, Wheeler K, Day J, Fernández-de-Las-Peñas C. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. Spine J 2021; 21:284-295. [PMID: 33065273 DOI: 10.1016/j.spinee.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal manipulation, spinal mobilization, and exercise are commonly used in individuals with cervicogenic headache (CH). Dry needling is being increasingly used in the management of CH. However, questions remain about the effectiveness of these therapies and how they compare to each other. PURPOSE The present study aims to compare the combined effects of spinal manipulation and dry needling with spinal mobilization and exercise on pain and disability in individuals with CH. STUDY DESIGN/SETTING Randomized, multicenter, parallel-group trial. PATIENT SAMPLE One hundred forty-two patients (n=142) with CH from 13 outpatient clinics in 10 different states were recruited over a 36-month period. OUTCOME MEASURES The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale. Secondary outcomes included headache frequency and duration, disability (Neck Disability Index), medication intake, and the Global Rating of Change (GROC). Follow-up assessments were taken at 1 week, 4 weeks, and 3 months. METHODS Patients were randomized to receive upper cervical and upper thoracic spinal manipulation plus electrical dry needling (n=74) or upper cervical and upper thoracic spinal mobilization and exercise (n=68). In addition, the mobilization group also received a program of craniocervical and peri-scapular resistance exercises; whereas, the spinal manipulation group also received up to eight sessions of perineural electrical dry needling. The treatment period for both groups was 4 weeks. The trial was prospectively registered at ClinicalTrials.gov (NCT02373605). Drs Dunning, Butts and Young are faculty within the AAMT Fellowship and teach postgraduate courses in spinal manipulation, spinal mobilization, dry needling, exercise and differential diagnosis. The other authors declare no conflicts of interest. None of the authors received any funding for this study. RESULTS The 2 × 4 analysis of covariance revealed that individuals with CH who received thrust spinal manipulation and electrical dry needling experienced significantly greater reductions in headache intensity (F=23.464; p<.001), headache frequency (F=13.407; p<.001), and disability (F=10.702; p<.001) than those who received nonthrust mobilization and exercise at a 3-month follow-up. Individuals in the spinal manipulation and electrical dry needling group also experienced shorter duration of headaches (p<.001) at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X2=54.840; p<.001) more patients (n=57, 77%) within the spinal manipulation and electrical dry needling group achieved a successful outcome compared to the mobilization and exercise group (n=10, 15%) at 3-month follow-up. Between-groups effect sizes were large (0.94<standardized mean score difference<1.25) in all outcomes in favor of the spinal manipulation and electrical dry needling group at 3 months. In addition, significantly (X2=29.889; p<.001) more patients in the spinal manipulation and electrical dry needling group (n=49, 66%) completely stopped taking medication for their pain compared to the spinal mobilization and exercise group (n=14, 21%) at 3 months. CONCLUSION Upper cervical and upper thoracic high-velocity low-amplitude thrust spinal manipulation and electrical dry needling were shown to be more effective than nonthrust mobilization and exercise in patients with CH, and the effects were maintained at 3 months.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA.
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; PRISMA Health Physical Therapy Specialists, Columbia, SC, USA
| | - Noah Zacharko
- Osteopractic Physical Therapy of the Carolinas, Fort Mill, SC, USA
| | - Keith Fandry
- Back in Action Physical Therapy, Scottsdale, AZ, USA
| | - Ian Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Tybee Wellness & Osteopractic, Tybee Island, GA, USA
| | - Kenneth Wheeler
- ClearCut ORTHO Physical Therapy Specialists, Fort Worth, TX, USA
| | - Jennell Day
- Peak Physical Therapy & Sports Rehab, Helena, MT, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Cátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio, Universidad Rey Juan Carlos, Madrid, Spain
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Lerner-Lentz A, O'Halloran B, Donaldson M, Cleland JA. Pragmatic application of manipulation versus mobilization to the upper segments of the cervical spine plus exercise for treatment of cervicogenic headache: a randomized clinical trial. J Man Manip Ther 2020; 29:267-275. [PMID: 33148134 DOI: 10.1080/10669817.2020.1834322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The effectiveness of manipulation versus mobilization for the management of spinal conditions, including cervicogenic headache, is conflicting. However, a pragmatic approach comparing manipulation to mobilization has not been examined in a patient population with cervicogenic headache. OBJECTIVES To evaluate the effectiveness of manipulation compared to mobilization applied in a pragmatic fashion for patients with cervicogenic headache. METHODS Forty-five (26 females) patients with cervicogenic headache (mean age 47.8 ± SD 16.9 years) were randomly assigned to receive either pragmatically selected manipulation or mobilization. Outcomes were measured at baseline, the second visit, discharge, and 1-month follow-up and included the Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS), the Headache Impact Test (HIT-6), the Global Rating of Change (GRC), the Patient Acceptable Symptoms Scale (PASS). The primary aim (effects of treatment on disability and pain were examined with a mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization) as the between subjects variable and time (baseline, 48 hours, discharge and follow-up) as the within subjects variable. RESULTS The interaction for the mixed model ANOVA was not statistically significant for NDI (p = 0.91), NPRS (p = 0.81), or HIT (p = 0.89). There was no significant difference between groups for the GRC or PASS. DISCUSSION AND CONCLUSION The results suggest that manipulation has similar effects on disability, pain, GRC, and cervical range of motion as mobilization when applied in a pragmatic fashion for patients with cervicogenic headaches. CLINICALTRIALS.GOV NCT03919630.
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Affiliation(s)
- Addison Lerner-Lentz
- Clinician and Researcher for Pain Relief and Physical Therapy, Havertown, PA, USA
| | - Bryan O'Halloran
- Director of Physical Therapy for Pain Relief and Physical Therapy, Havertown, PA, USA
| | - Megan Donaldson
- Program Director for the Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston Mass
| | - Joshua A Cleland
- Director of Research and Faculty Development, Tufts University School of Medicine, Boston, Mass
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12
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Crawford CH, Carreon LY, Mummaneni P, Dryer RF, Glassman SD. Asymptomatic ACDF Nonunions Underestimate the True Prevalence of Radiographic Pseudarthrosis. Spine (Phila Pa 1976) 2020; 45:E776-E780. [PMID: 32080012 DOI: 10.1097/brs.0000000000003444] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Secondary analysis of subjects in the control anterior cervical discectomy and fusion (ACDF) arm of Medtronic Investigational Device Exemption (IDE) trials for cervical disc arthroplasty (CDA). OBJECTIVES To compare patient-reported outcomes (PROs) in patients with radiographic nonunion to patients with a solid fusion. SUMMARY OF BACKGROUND DATA The true prevalence of nonunion after ACDF is unknown. Nonunion may be under-reported, as some patients are not symptomatic enough to justify radiographic evaluation. METHODS Three hundred forty-five subjects enrolled in the control arm of IDE trials for CDA who had single-level ACDF with allograft and plate with 24 month data formed the study cohort. Using the 24-month postop evaluation, subjects were divided into those who had radiographic fusion and those who did not using strict study criteria. SF-36, NDI, Neck and Arm pain NRS scores were reported at 12, 24, 36, 60, and 84 months postop. For subjects who had secondary surgery failures, the last observations before the secondary surgery were carried forward to future visits for the analysis. RESULTS Forty-four (13%) patients had radiographic nonunion and 301 (87%) were fused at 24 months postop. At 24 months, PROs were similar between the two groups. Seven patients in the Nonunion group (16%) and 10 (3%) in the Fused group had additional surgery at the index level prior to the 24 follow-up (P = 0.003). Over the 84-month follow-up a total of 9 patients in the Nonunion group (21%) and 22 (7%) in the Fused group had additional surgery at the index level (P = 0.009). CONCLUSION While the radiographic nonunion rate at 24 months was 13%, PROs show that many of the radiographic nonunions were asymptomatic. Although the majority of patients with radiographic nonunion did not undergo additional surgery, the rate of secondary surgeries at the index level was significantly higher in the radiographic nonunion group. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Charles H Crawford
- Norton Leatherman Spine Center, Louisville, KY.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY
| | | | - Praveen Mummaneni
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
| | | | - Steven D Glassman
- Norton Leatherman Spine Center, Louisville, KY.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY
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13
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Abstract
BACKGROUND The evaluation of patient-reported outcome measures for the neck from multiple systematic reviews will provide a broader view of, and may identify potential conflicting or consistent results for, their psychometric properties. OBJECTIVES The purpose of this study was to conduct an overview of systematic reviews and synthesize evidence to establish the current state of knowledge on psychometric properties of patient-reported outcome measures for patients with neck disorders. METHODS In this overview of systematic reviews, an electronic search of 6 databases (MEDLINE, Embase, CINAHL, ILC, the Cochrane Central Register of Controlled Trials, and LILACS) was conducted to identify reviews that addressed at least one measurement property of outcome measures for people with neck pain. Only systematic reviews with patient-reported outcome measures were included in the analysis. Risk of bias was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Data on measurement properties were extracted from each systematic review. RESULTS From 13 systematic reviews, 8 patient-reported outcome measures were evaluated in 2 or more reviews. Risk-of-bias scores ranged from moderate (5-7) to high (4 and lower). Findings on internal consistency, test-retest reliability, construct validity, responsiveness to change, and content and structural validity were synthesized for the Neck Disability Index (NDI) in 11 systematic reviews; the Northwick Park Neck Pain Questionnaire and Neck Pain and Disability scale (NPDS) in 6 systematic reviews; the Copenhagen Neck Functional Disability Scale in 5 systematic reviews; the Neck Bournemouth Questionnaire in 4 systematic reviews; the Core Neck Pain Questionnaire and Patient-Specific Functional Scale in 3 systematic reviews, and the Whiplash Disability Questionnaire in 2 systematic reviews. CONCLUSION High-quality evidence was found of good to excellent internal consistency and moderate to excellent test-retest reliability for the NDI. Moderate-quality evidence was found of good to excellent internal consistency and good test-retest reliability for the Northwick Park Neck Pain Questionnaire. High-quality evidence was found of excellent test-retest reliability and good to strong construct validity with pain scales for the Copenhagen Neck Functional Disability Scale. Moderate-quality evidence was found of unclear to excellent internal consistency and moderate to strong concurrent associations with the NDI and global assessment of change for the Neck Pain and Disability scale. Moderate-quality evidence was found of excellent internal consistency for the Whiplash Disability Questionnaire and of high test-retest reliability for the Patient-Specific Functional Scale. J Orthop Sports Phys Ther 2018;48(10):775-788. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8131.
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Cui XJ, Yao M, Ye XL, Wang P, Zhong WH, Zhang RC, Li HY, Hu ZJ, Tang ZY, Wang WM, Qiao WP, Sun YL, Li J, Gao Y, Shi Q, Wang Y. Shi-style cervical manipulations for cervical radiculopathy: A multicenter randomized-controlled clinical trial. Medicine (Baltimore) 2017; 96:e7276. [PMID: 28767566 PMCID: PMC5626120 DOI: 10.1097/md.0000000000007276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a lack of high-quality evidence supporting the use of manipulation therapy for patients with cervical radiculopathy (CR). This study aimed to evaluate the effectiveness of Shi-style cervical manipulations (SCMs) versus mechanical cervical traction (MCT) for CR. METHODS This was a randomized, open-label, controlled trial carried out at 5 hospitals in patients with CR for at least 2 weeks and neck pain. The patients received 6 treatments of SCM (n = 179) or MCT (n = 180) over 2 weeks. The primary outcome was participant-rated disability (neck disability index), measured 2 weeks after randomization. The secondary outcomes were participant-rated pain (visual analog scale) and health-related quality of life (36-Item Short Form Health Survey [SF-36]). Assessments were performed before, during, and after (2, 4, 12, and 24 weeks) intervention. RESULTS After 2 weeks of treatment, the SCM group showed a greater improvement in participant-rated disability compared with the control group (P = .018). The SCM group reported less disability compared with the control group (P < .001) during the 26-week follow-up. The difference was particularly important at 6 months (mean -28.91 ± 16.43, P < .001). Significant improvements in SF-36 were noted in both groups after 2 weeks of treatment, but there were no differences between the 2 groups. CONCLUSION SCM could be a better option than MCT for the treatment of CR-related pain and disability.
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Affiliation(s)
- Xue-jun Cui
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Min Yao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Xiu-lan Ye
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Ping Wang
- First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin
| | - Wei-hong Zhong
- Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Rui-chun Zhang
- Xinjiang Uygur Autonomous Region Hospital of traditional Chinese Medicine, Urumqi
| | - Hui-ying Li
- First Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Zhi-jun Hu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Zhan-ying Tang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Wei-min Wang
- First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin
| | - Wei-ping Qiao
- First Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yue-li Sun
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Jun Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Yang Gao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Yongjun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
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15
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Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.
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16
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Sattelmayer M, Hilfiker R, Luomajoki H, Elsig S. Use of Rasch analysis to investigate structural validity of a set of movement control tests for the neck. Musculoskelet Sci Pract 2017; 27:131-136. [PMID: 27477819 DOI: 10.1016/j.math.2016.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/29/2016] [Accepted: 07/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Movement control abilities are often reduced in persons with neck pain. In physiotherapeutic practice observational tests are frequently used to assess the impaired abilities. Several tests for movement control abilities are available, but no evidence exists on how to combine and interpret them. OBJECTIVE The aim was to investigate structural validity of a set of movement control tests with Rasch analysis. DESIGN Cross-sectional study. METHODS Thirty persons with and thirty without neck pain were recruited for this study. All persons performed ten movement control tests. A partial credit model was applied to investigate item fit, ordering of the item response functions, dimensionality and hierarchy of the tests. RESULTS The majority of persons with neck pain had moderate disabilities and the mean value in the Neck disability index was 10.7. Functioning of the movement control tests to measure the construct "movement control abilities" was adequate for the majority of tests. Three movement control tests showed considerable misfit. Possible explanations were a reactive movement control instead of an active control and a more challenging test position. Test difficulties and person abilities could be estimated for the complete sample. The most difficult test was "sitting rocking forward" (1.13 logits) and the least difficult test was "lifting the right arm" (-1.30 logits). The highest person ability estimate was 3.61 logits indicating that movement control tests are missing to evaluate persons with moderate neck disabilities. CONCLUSION Modifying the existing set of tests is required to evaluate the complete spectrum of persons with neck pain.
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Affiliation(s)
- Martin Sattelmayer
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland.
| | - Roger Hilfiker
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland.
| | - Hannu Luomajoki
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland.
| | - Simone Elsig
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland.
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Chipchase L, Cavaleri R, Jull G. Can a professional development workshop with follow-up alter practitioner behaviour and outcomes for neck pain patients? A randomised controlled trial. ACTA ACUST UNITED AC 2016; 25:87-93. [DOI: 10.1016/j.math.2016.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 06/01/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
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Longo UG, Berton A, Denaro L, Salvatore G, Denaro V. Development of the Italian version of the modified Japanese orthopaedic association score (mJOA-IT): cross-cultural adaptation, reliability, validity and responsiveness. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2952-7. [PMID: 26961972 DOI: 10.1007/s00586-016-4512-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The modified Japanese orthopaedic association scale (mJOA) is considered one of the most appropriate outcome measures for the assessment of cervical spondylotic myelopathy (CSM). Moreover, mJOA has been recognised among the key predictors of surgical outcome at a global level. To apply the mJOA successfully at an international level, it should be translated and culturally adapted in the native language of the investigators using this scale. A translated version of the mJOA or any other functional scale has never been studied within an Italian population affected by CSM. The aim of this study has been to describe translation, cultural adaptation and psychometric properties of the Italian version of the mJOA (mJOA-IT). METHODS The mJOA-IT was developed following a forward-backward translation procedure. Psychometric properties were assessed on a cohort of patients with CSM undergone anterior or posterior decompression associated with stabilisation in lordosis. RESULTS The mJOA-IT proved to be a reliable outcome measure for CSM (internal consistency 0.60, test-retest stability 0.910, P < 0.001, inter-observer reliability 0.80, P < 0.001). The mJOA-IT was associated with the Nurick scale (r = -0.615) while it was not associated with NDI, SF-36 and SF-36 components. The mJOA-IT was also responsive (d = 0.867). CONCLUSIONS The mJOA-IT proved to be a reliable and valid tool to assess patients affected by CSM. This form is recommended to be used for clinical and research purposes in Italy, to promote the global standardisation of assessment tools and to compare studies on CSM worldwide.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, Trigoria, 00128, Rome, Italy.
| | - Luca Denaro
- Department of Neurosurgery, University-Hospital of Padua, Via Giustiniani, 5, Padua, Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, Trigoria, 00128, Rome, Italy
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Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord 2016; 17:64. [PMID: 26852024 PMCID: PMC4744384 DOI: 10.1186/s12891-016-0912-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/29/2016] [Indexed: 01/03/2023] Open
Abstract
Background Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH. Methods One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable. Results The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001). Conclusions Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months. Trial registration NCT01580280 April 16, 2012.
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Affiliation(s)
- James R Dunning
- Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA. .,Nova Southeastern University, Ft. Lauderdale, FL, USA. .,AAMT Fellowship in Orthopaedic Manual Physical Therapy, Columbia, SC, USA.
| | - Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA.
| | | | | | - Cesar Fernandez-de-Las Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Marshall Hagins
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA.
| | | | | | | | | | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA.
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20
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Flexion–relaxation ratio in computer workers with and without chronic neck pain. J Electromyogr Kinesiol 2016; 26:8-17. [DOI: 10.1016/j.jelekin.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 10/29/2015] [Accepted: 12/19/2015] [Indexed: 11/20/2022] Open
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Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference. PLoS One 2013; 8:e67408. [PMID: 23826290 PMCID: PMC3691175 DOI: 10.1371/journal.pone.0067408] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/17/2013] [Indexed: 01/22/2023] Open
Abstract
Object The concept of minimum clinically important difference (MCID) has been used to measure the threshold by which the effect of a specific treatment can be considered clinically meaningful. MCID has previously been studied in surgical patients, however few studies have assessed its role in spinal surgery. The goal of this study was to assess the role of MCID in patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). Methods Data was collected on 30 patients who underwent ACDF for CSM between 2007 and 2012. Preoperative and 1-year postoperative Neck Disability Index (NDI), Visual-Analog Scale (VAS), and Short Form-36 (SF-36) Physical (PCS) and Mental (MCS) Component Summary PRO scores were collected. Five distribution- and anchor-based approaches were used to calculate MCID threshold values average change, change difference, receiver operating characteristic curve (ROC), minimum detectable change (MDC) and standard error of measurement (SEM). The Health Transition Item of the SF-36 (HTI) was used as an external anchor. Results Patients had a significant improvement in all mean physical PRO scores postoperatively (p<0.01) NDI (29.24 to 14.82), VAS (5.06 to 1.72), and PCS (36.98 to 44.22). The five MCID approaches yielded a range of values for each PRO: 2.00–8.78 for PCS, 2.06–5.73 for MCS, 4.83–13.39 for NDI, and 0.36–3.11 for VAS. PCS was the most representative PRO measure, presenting the greatest area under the ROC curve (0.94). MDC values were not affected by the choice of anchor and their threshold of improvement was statistically greater than the chance of error from unimproved patients. Conclusion SF-36 PCS was the most representative PRO measure. MDC appears to be the most appropriate MCID method. When MDC was applied together with HTI anchor, the MCID thresholds were: 13.39 for NDI, 3.11 for VAS, 5.56 for PCS and 5.73 for MCS.
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Cleland JA, Whitman JM, Houser JL, Wainner RS, Childs JD. Psychometric properties of selected tests in patients with lumbar spinal stenosis. Spine J 2012; 12:921-31. [PMID: 22749295 DOI: 10.1016/j.spinee.2012.05.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 04/06/2012] [Accepted: 05/16/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The psychometric properties of many outcome tools commonly used with patients with lumbar spinal stenosis have yet to be examined. PURPOSE Examine the test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences for several outcome measures in a cohort of patients with lumbar spinal stenosis. STUDY DESIGN/SETTING Cohort secondary analysis of a randomized clinical trial of patients with lumbar spinal stenosis receiving outpatient physical therapy. PATIENT SAMPLE Fifty-five patients (mean age, 69.5 years; standard deviation, ±7.9 years; 43.1% females) presenting with lumbar spinal stenosis to physical therapy. OUTCOME MEASURES The Modified Oswestry Disability Index, Modified Swiss Spinal Stenosis Scale (SSS), Patient Specific Functional Scale, and Numeric Pain Rating Scale (NPRS). METHODS All patients completed the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS at the baseline examination and at a follow-up. In addition, patients completed a 15-point Global Rating of Change at follow-up, which was used to categorize whether patients experienced clinically meaningful change. Changes in the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS were then used to assess test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences. RESULTS The Oswestry Disability Index was the only outcome measure to exhibit excellent test-retest reliability with an intraclass correlation coefficient of 0.86 (95% confidence interval, 0.63-0.93). All others ranged between fair and moderate. The Oswestry Disability Index, SSS, and Patient Specific Functional Scale exhibited varying levels of responsiveness, each of which was superior to the NPRS. The minimal clinically important difference for the Oswestry Disability Index was five points, the SSS was 0.36 and 0.10 for symptoms subscale and functional subscale, respectively, 1.3 for the Patient Specific Functional Scale, and for the NPRS, 1.25 for back/buttock symptoms and 1.5 for thigh/leg symptoms. CONCLUSIONS The results of our study indicate that the Oswestry Disability Index, SSS, and Patient Specific Functional Scale possess adequate psychometric properties to be used in the outcome assessment of patients with lumbar spinal stenosis. However, further investigation is needed to validate these findings in other samples of patients with lumbar spinal stenosis and nonspecific low back pain.
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Affiliation(s)
- Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, 5 Chenell Dr, Concord, NH 03301, USA.
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Treatment of patients with degenerative cervical radiculopathy using a multimodal conservative approach in a geriatric population: a case series. J Orthop Sports Phys Ther 2011; 41:723-33. [PMID: 21891879 DOI: 10.2519/jospt.2011.3592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective clinical case series. OBJECTIVE To describe the management of 10 patients with advanced cervical spondyloarthrosis with radiculopathy, using manual therapy, intermittent mechanical cervical traction, and home exercises. BACKGROUND Predictors and short-term outcomes of cervical radiculopathy have been published. These predictors have not been developed for, or applied to, geriatric patients with spondylitic radiculopathy. CASE DESCRIPTION A series of 10 patients (aged 67 to 82 years) were referred to a physical therapist for medically prediagnosed cervical spondyloarthrosis and radiculopathy, as determined by magnetic resonance imaging. Neck Disability Index (NDI), numeric pain rating scale (NPRS), upper limb tension testing, Spurling's test, and the cervical distraction test were all completed on each patient at initial examination and at discharge. NDI and NPRS data were also collected at 6 months posttreatment. Intervention included manual therapy (including high-velocity low-amplitude thrust manipulation) of the upper thoracic and cervical spine, intermittent mechanical cervical traction, and a home program (including deep cervical flexor strengthening) for 6 to 12 sessions over a period of 3 to 6 weeks. OUTCOMES All 10 patients had substantial improvement in NPRS and NDI scores. The mean NPRS score was less than 1/10, and the mean NDI score was 6/50 at discharge, compared to the original mean NPRS and NDI scores of 5.7 and 27.4, respectively. All patients reported maintaining those gains for 6 months. DISCUSSION A multimodal approach for patients diagnosed with cervical spondyloarthrosis with radicular symptoms was useful in this geriatric population to reduce pain, minimize radicular symptoms, and improve functional outcomes. LEVEL OF EVIDENCE Therapy, level 4.
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Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 2010; 10:469-74. [PMID: 20359958 DOI: 10.1016/j.spinee.2010.02.007] [Citation(s) in RCA: 293] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 12/08/2009] [Accepted: 02/05/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Neck Disability Index (NDI), the short form-36 (SF-36) physical component summary (PCS), and pain scales for arm and neck pain are increasingly used to evaluate treatment effectiveness after cervical spine surgery. The minimum clinically important difference (MCID) is a threshold of improvement that is clinically relevant to the patient. However, the true goal is to provide the patient with a substantial clinical benefit (SCB). PURPOSE This study determines the MCID and SCB using common anchor-based methods for NDI, PCS, and pain scales for arm and neck pain in patients undergoing cervical spine fusion for degenerative disorders. STUDY DESIGN/SETTING The study setting is a longitudinal cohort in a multisurgeon spine specialty clinic. PATIENT SAMPLE The sample comprises 505 patients who underwent a cervical fusion for degenerative spine conditions and who have prospectively collected outcome scores with a minimum 1-year follow-up. OUTCOME MEASURES The outcome measures of the study were NDI, SF-36, and numeric rating scales for arm and neck pain. METHODS The MCID and SCB values for NDI, PCS, and pain scales for arm and neck pain were determined using receiver operating characteristic (ROC) curve analysis with the Health Transition Item of the SF-36 as an anchor. The Health Transition Item asks a patient "Compared to one year ago, how would you rate your health in general now?" with answers ranging from "Much Better," "Somewhat Better," "About the Same," "Somewhat Worse," to "Much Worse." An ROC curve was constructed for each measure. The ROC curve-derived MCID was the change score with equal sensitivity and specificity to distinguish the "Somewhat Better" from the "About the Same" patients. The ROC curve-derived SCB was the change score with equal sensitivity and specificity to distinguish the "Much Better" from the "Somewhat Better" patients. Distribution-based methods including the standard error of the mean and the minimum detectable change were also used to calculate MCID. RESULTS The calculated MCID is 7.5 for the NDI, 4.1 for SF-36 PCS, and 2.5 for arm and neck pain. The calculated SCB is 9.5 for the NDI, 6.5 for SF-36 PCS, and 3.5 for arm and neck pain. CONCLUSIONS Patients with an eight-point decrease in NDI, a 4.1-point increase in PCS, and a three-point decrease in arm or neck pain can detect a minimally clinically important change. Patients with a 10-point decrease in NDI, a 6.5-point increase in PCS, and a four-point decrease in arm or neck pain can detect an SCB after cervical spine fusion.
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