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Jokubaitis M, Vrublevska G, Zvaune L, Braschinsky M, Leheste AR, Saknītis G, Žukovs D, Ryliškienė K. Accuracy of migraine diagnosis and treatment by neurologists in the Baltic states: e-survey with clinical case challenge. Eur J Med Res 2023; 28:600. [PMID: 38110980 PMCID: PMC10726575 DOI: 10.1186/s40001-023-01555-z] [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: 02/20/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Underdiagnosis of migraine causes a significant health burden, including lower quality of life, excessive medication use, and a delay in effective treatment. The purpose of this study was to evaluate migraine diagnosis accuracy and to review the treatment approaches used by neurologists in the Baltic states. METHODS The research was conducted as an anonymous e-survey with four cases in March and April 2021. RESULTS 119 practicing adult neurologists have participated. The migraine diagnostic accuracy was 63.2%. The most commonly used diagnostic criteria were moderate/severe pain, unilateral pain, and disruption of daily activities. Diagnostic accuracy did not differ significantly between neurologists who always use ICHD-3 criteria and those who don't (68.4% vs. 58.5%, p = 0.167). It was higher in neurologists who were working in headache centers (91.7% vs. 60.9%, p = 0.012), and was related to a higher percentage of migraine diagnoses in all consulted headache patients (R2 = 0.202, adjusted R2 = 0.195, p < 0.001), prophylaxis with onabotulinumtoxin A [OR = 4.332, 95% Cl (1.588-11.814)], and anti-CGRP monoclonal antibodies [OR = 2.862, 95% Cl (1.186-6.907)]. CONCLUSIONS Migraine diagnostic accuracy is improved through practical patient counseling and modern treatment prescription. Although the neurologists in the Baltic states follow current European guidelines, there is room for improvement in diagnostic accuracy to reduce migraine burden.
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Affiliation(s)
- Mantas Jokubaitis
- Centre of Neurology, Vilnius University, Santariškių St. 2, 08406, Vilnius, Lithuania.
| | - Greta Vrublevska
- Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Linda Zvaune
- Department of Neurology and Neurosurgery, Riga East Clinical University Hospital, Riga, Latvia
| | - Mark Braschinsky
- Department of Neurology and Neurosurgery, Tartu University Hospital, Tartu, Estonia
- Neurology Clinic, University of Tartu, Tartu, Estonia
| | - Alo-Rainer Leheste
- Department of Neurology and Neurosurgery, Tartu University Hospital, Tartu, Estonia
| | - Gatis Saknītis
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
| | - Danils Žukovs
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
- Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Kristina Ryliškienė
- Centre of Neurology, Vilnius University, Santariškių St. 2, 08406, Vilnius, Lithuania
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McLaughlin KH, Archer KR, Shafiq B, Wegener ST, Reider L. Orthopedic surgeons and physical therapists differ regarding rehabilitative needs after lower extremity fracture repair. Physiother Theory Pract 2023; 39:2446-2453. [PMID: 35594136 PMCID: PMC9860373 DOI: 10.1080/09593985.2022.2078753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Little evidence is available to guide physical therapy (PT) following lower extremity fracture repair distal to the hip. As such, variability has been reported in the way PT is utilized post-operatively. Examination of current practice by orthopedic surgeons (OS) and physical therapists is needed to inform clinical practice guidelines in this area. OBJECTIVE To describe current PT referral practices among OS, identify patient and clinical factors that affect PT referral, and examine differences between OS and physical therapists with regard to visit frequency, duration, and use of specific PT interventions. METHODS Provider surveys. RESULTS Surveys were completed by 100 OS and 347 physical therapists. Over half (54%) of OS reported referring "most patients" to PT and identified joint stiffness and strength limitations as top reasons for PT referral. Over 80% of OS and physical therapists indicated that joint stiffness, strength limitations, and patients' functional goals affected their recommendations for PT visit frequency. More physical therapists than OS reported that pain severity (55% vs 25%, p < .001), maladaptive pain behaviors (64% vs. 33%, p < .001), and patient self-efficacy (70% vs. 49%, p = .003) affected their visit frequency recommendations. While OS recommended more frequent PT for patients with peri-articular fractures, fracture type had minimal impact on the visit frequencies recommended by physical therapists. CONCLUSION OS and physical therapists consider similar physical impairments when determining the need for PT and visit frequencies, however, physical therapists consider pain and psychosocial factors more often, with OS focusing more on injury type.
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Affiliation(s)
- Kevin H. McLaughlin
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Kristin R. Archer
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232
| | - Babar Shafiq
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Stephen T. Wegener
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Lisa Reider
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205
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Siverling S, Schultz P. A Multimodal Conservative Approach to Treating Migraine: A Physical Therapist's Perspective. Curr Pain Headache Rep 2023; 27:329-337. [PMID: 37515744 DOI: 10.1007/s11916-023-01140-3] [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] [Accepted: 06/28/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE OF REVIEW Migraine is common and interventions to treat or manage it vary. Physical therapists possess a varied skill set that can assess and treat limitations related to migraine and its symptoms. Conservative and non-pharmacological examination and treatment techniques for migraine and headache management are reviewed in terms of efficacy and relevance in order to describe the physical therapist's abilities and clinical reasoning process when confronting a patient with migraine symptoms. RECENT FINDINGS A thorough examination is necessary to detect red flags and will reveal a person with migraine's biopsychosocial limitations to manage their symptoms. Strength, endurance, cervical mobility, and visual deficits are common in those reporting headaches and examination techniques, along with patient-reported outcome measures, can elicit objective data for re-assessment during an episode of care. Exercise interventions, manual therapy, biofeedback techniques, and vestibular therapy have become viable and efficacious non-pharmacological interventions in recent years to assist the patient with managing and mitigating their migraine symptoms, along with mindfulness-based exercises. A case study, with individualized treatment approaches based on examination findings, current evidence, and accrued expertise, demonstrates the clinical applicability of a physical therapist's multimodal approach to treating migraine. Psychologically- informed physical therapy with mindfulness-based approaches and biofeedback can help a patient gain more control over their symptoms and their body's response to head pain, while exercise and vestibular therapy can assist the system with recovery and adaptation from deficits related to migraine symptoms. A thorough examination, with an individually- tailored rehabilitation plan incorporating movement and mindfulness-based therapies, is recommended.
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Affiliation(s)
- Scott Siverling
- Clinical Lead, Hospital for Special Surgery, 535 E. 70th Street, NY, 10021, New York City, USA.
- Adjunct Faculty, Tufts University School of Medicine Doctor of Physical Therapy Program, 136 Harrison Avenue, Boston, MA, 02111, USA.
- Adjunct Instructor, Rutgers School of Health Professions Doctor of Physical Therapy Program, 65 Bergen St Ste 120, Newark, NJ, 07107, USA.
| | - Peter Schultz
- Clinical Lead, Hospital for Special Surgery, 535 E. 70th Street, NY, 10021, New York City, USA
- Physical Therapist/Owner, Dynamic Sports PT, 6 E 39th St Ste 504, NY, 10016, New York City, USA
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Ladak A, Karges-Brown JR, Ness BM, Schweinle WE, Ammon R. US physical therapist practice patterns evaluating concussion and clinical practice guideline adherence. Phys Ther Sport 2023; 59:17-24. [PMID: 36462407 DOI: 10.1016/j.ptsp.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess the influence of contemporary physical therapy clinical practice guidelines (CPG) on concussion evaluation practice patterns and barriers/facilitators for CPG adherence. DESIGN Electronic cross-sectional survey. SETTING Online survey platform. PARTICIPANTS US licensed physical therapists that manage concussion. MAIN OUTCOME MEASURES 1) practice patterns 2) knowledge/use of CPG 3) barriers/facilitations to CPG adherence. RESULTS Knowledge/use of CPG categories significantly predicted the model (χ2(1) = 10.966, p < .001) of total vignette scores/practice patterns with a statistically significant effect. A Kruskal-Wallis test indicated significant differences in total vignette score means based on knowledge/use between "not aware of the concussion CPG" and "integrated concussion CPG into practice" groups (p < .001, ES = .21). Knowledge/use of the CPG predicted the perceived barriers/facilitators model for three questions: investment in specialized concussion training (χ2(1) = 39.52, p < .001), necessary equipment to complete concussion evaluation (χ2(1) = 16.01, p < .001), and confidence around concussion evaluation knowledge (χ2(1) = 27.46, p < .001) with a significant effect. CONCLUSION The results of this study provide support for guiding documents like the CPG to positively influence concussion practice patterns and insight into facilitators for guideline adherence.
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Affiliation(s)
- Ali Ladak
- Center for Rehabilitation, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Joy R Karges-Brown
- Department of Physical Therapy, School of Health Sciences, University of South Dakota, Vermillion, SD, United States.
| | - Brandon M Ness
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.
| | - William E Schweinle
- Department of Research Development, School of Health Sciences, University of South Dakota, Vermillion, SD, United States.
| | - Robin Ammon
- Division of Kinesiology and Sport Management, University of South Dakota, Vermillion, SD, United States.
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Domínguez-Balmaseda D, Del-Blanco-Muñiz JÁ, González-de-la-Flor A, García-Pérez-de-Sevilla G. Associations between Fatty Acid Intake and Tension-Type Headache: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11237139. [PMID: 36498721 PMCID: PMC9736193 DOI: 10.3390/jcm11237139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patients with tension-type headache (TTH) are characterized by recurrent pain that can become disabling. Identifying the dietary triggers of headaches has led to defining dietary strategies to prevent this disease. In fact, excessive dietary intake of Omega-6 (ω-6) fatty acids, or an ω-6: ω3 ≥ 5 ratio, typical of Western diets, has been associated with a higher prevalence of headaches. The objectives of the present study were to compare dietary fatty acid intake between participants with and without chronic TTH and to investigate the association between dietary fatty acid intake, pain characteristics, and quality of life in patients with chronic TTH. METHODS An observational study was conducted, comparing healthy participants (n = 24) and participants diagnosed with chronic TTH for more than six months (n = 24). The variables analyzed were dietary fatty acid intake variables, the Headache Impact Test (HIT-6), and the characteristics of the headache episodes (intensity, frequency, and duration). RESULTS The TTH group reported a significantly higher intake of saturated fatty acids (SFAs) but similar intakes of monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and ω-6: ω-3 ratio when compared to controls. Furthermore, in the TTH group, the Ω-6 fatty acid intake was associated with more intense headache episodes. In addition, the TTH group reported a significant impact of headaches on their activities of daily living according to the HIT-6. CONCLUSIONS Higher intakes of SFAs and Ω-6 fatty acids were associated with more severe headache episodes in patients with TTH. Therefore, the characteristics of the diet, in particular the dietary fatty acid intake, should be considered when treating these patients.
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Affiliation(s)
- Diego Domínguez-Balmaseda
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Masmicrobiota Group, Faculty of Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Correspondence:
| | - José Ángel Del-Blanco-Muñiz
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Angel González-de-la-Flor
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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Turkistani A, Shah A, Jose AM, Melo JP, Luenam K, Ananias P, Yaqub S, Mohammed L. Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review. Cureus 2021; 13:e17601. [PMID: 34646653 PMCID: PMC8483450 DOI: 10.7759/cureus.17601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a tight band around the forehead, neck, shoulder, and sometimes behind eyes. It can occur at any age but most commonly in the adult female population. The exact underlying mechanism is not clear but muscle tension is one of the main causes, which can be due to stress and anxiety. There are several non-pharmacologic treatment options suggested for tension-type headaches, such as cognitive behavioral therapy, relaxation, biofeedback, acupuncture, exercise, manual therapy, and even some home remedies. This systematic review was performed to evaluate the effectiveness of acupuncture and manual therapy in tension-type headaches. The literature search was primarily done on PubMed. Eight articles involving 3846 participants showed evidence that acupuncture and manual therapy can be valuable non-pharmacological treatment options for tension-type headaches. Acupuncture was compared to routine care or sham intervention. Acupuncture was not found to be superior to physiotherapy, exercise, and massage therapy. Randomized controlled trials done in various countries showed manual therapy also significantly decreased headache intensity. Manual therapy has an efficacy that equals prophylactic medication and tricyclic antidepressants in treating tension-type headaches. The available data suggests that both acupuncture and manual therapy have beneficial effects on treating symptoms of tension-type headache. However, further clinical trials looking at long-term benefits and risks are needed.
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Affiliation(s)
- Arifa Turkistani
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arpita Shah
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arunima Mariya Jose
- Internal Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, IND.,Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Joao Pedro Melo
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kanita Luenam
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Patricia Ananias
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sayma Yaqub
- Public Health, The University of Texas Health Science Center at Houston, Houston, USA.,Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Satpute K, Bedekar N, Hall T. Effectiveness of Mulligan manual therapy over exercise on headache frequency, intensity and disability for patients with migraine, tension-type headache and cervicogenic headache - a protocol of a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2021; 22:243. [PMID: 33657998 PMCID: PMC7931349 DOI: 10.1186/s12891-021-04105-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Non - pharmacological management of migraine, tension-type headache (TTH), and cervicogenic headache (CGH) may include spinal manual therapy and exercise. Mulligan Manual Therapy (MMT) utilizes a protocol of headache elimination procedures to manage headache parameters and associated disability, but has only been evaluated in CGH. There is little evidence for its effectiveness in migraine and TTH. This study aims to determine the effectiveness of MMT and exercise over exercise and placebo in the management of migraine, TTH, and CGH. Methods This pragmatic trial is designed as a prospective, three-armed randomised controlled trial in a clinical setting provided at a general hospital physiotherapy department. Two hundred ninety-seven participants with a diagnosis of migraine, TTH or CGH based on published headache classification guidelines will be included. An assessor blind to group allocation will measure outcomes pre-and post-intervention as well as 3 and 6 months after commencement of treatment. Participants will be allocated to one of the three groups: MMT and exercise; placebo and exercise; and exercise alone. The primary outcome measure is headache frequency. Secondary outcome measures are headache duration and intensity, medication intake, pressure pain threshold (PPT), range of motion recorded with the flexion rotation test, and headache disability recorded with Headache Activities of Daily Living Index (HADLI). The intention-to-treat principle will be followed for statistical analysis. Between groups differences for all outcome measures at baseline and at reassessment points and 95% confidence intervals will be calculated using a mixed model ANOVA. Post hoc tests will be conducted to identify any significant difference between groups and over time. Discussion This pragmatic study will provide evidence for the effectiveness of MMT when compared with a placebo intervention and exercise on headache frequency, intensity, and disability. Limitations are that baseline evaluation of headache parameters may be affected by recall bias. External validity will be limited to the population with a minimum 1-year history of headache. The HADLI is not yet extensively evaluated for its psychometric properties and association between PPT and headache parameters is lacking. Performance bias is inevitable as a single therapist will be delivering all interventions. Trial registration The trial was registered prospectively under the Clinical Trial Registry India (Registration number: CTRI/2019/06/019506, dated on 03/06/2019). .
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Affiliation(s)
- Kiran Satpute
- Department of Musculoskeletal Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Off Westerly by Pass, Narhe, Pune, Maharashatra, 411041, India.
| | - Nilima Bedekar
- Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Thube Park, Shivaji Nagar, Pune, Maharashatra, 411001, India
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia
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