Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study.

OBJECTIVES: The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery. METHODS: This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up. RESULTS: The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4 weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (rpb (112) = 0.27, p = 0.004). CONCLUSION: Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.

The Effects of Exercise Dosage on Neck-Related Pain and Disability: A Systematic Review With Meta-analysis.

OBJECTIVE: To (1) evaluate whether exercise therapy is effective for managing neck pain, and (2) investigate the relationship between exercise therapy dosage and treatment effect. DESIGN: Intervention systematic review with meta-analysis and meta-regression. LITERATURE SEARCH: An electronic search of 6 databases was completed for trials assessing the effects of exercise therapy on neck pain. STUDY SELECTION CRITERIA: We included randomized controlled trials that compared exercise therapy to a no-exercise therapy control for treating neck pain. Two reviewers screened and selected studies, extracted outcomes, assessed article risk of bias, and rated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DATA SYNTHESIS: Data were pooled using random-effects meta-analysis. We used meta-regression to analyze the effect of exercise dosage on neck pain and disability. RESULTS: Fourteen trials were included in the review. Seven trials were at high risk of bias, 4 were at unclear risk of bias, and 3 were at low risk of bias. Exercise therapy was superior to control for reducing pain (visual analog scale mean difference, -15.32 mm) and improving disability (Neck Disability Index mean difference, -3.64 points). Exercise dosage parameters did not predict pain or disability outcomes. CONCLUSION: Exercise was beneficial for reducing pain and disability, regardless of exercise therapy dosage. Therefore, optimal exercise dosage recommendations remain unknown. We encourage clinicians to use exercise when managing mechanical neck pain. J Orthop Sports Phys Ther 2020;50(11):607-621. doi:10.2519/jospt.2020.9155.

Self-reported sinus headaches are associated with neck pain and cervical musculoskeletal dysfunction: a preliminary observational case control study.

Objectives: Headaches can be associated with rhinosinusitis and may present a diagnostic challenge because of symptomatic overlap with other recurring headaches. Neck pain has received extensive attention in migraine, tension-type and cervicogenic headache but not as a comorbid feature of headache in those with rhinosinusitis. This study investigated the occurrence of neck pain and cervical musculoskeletal dysfunction in individuals with self-reported sinus headaches (SRSH). Methods: Participants with and without SRSH attended a single data collection session. Participants completed the Headache Impact Test (HIT)-6 and the Sino-Nasal Outcome Test (SNOT)-22. Cervical range of motion (ROM), segmental examination, muscle endurance and pressure-pain threshold (PPT) were measured . Results: Participants included 31 with SRSH (77.4% female; age 43.7 (9.9) years) and 30 without headache. Average symptom duration was 89.7 (±85.6) months. Mean SNOT-22 and HIT-6 scores were 36.2 (15.3) and 56.7 (7.1), respectively. In the SRSH group, 83.9% (n = 26) reported neck pain. There was a significant difference between groups for cervical sagittal (14.3° [5.3°, 23.3°], p = 0.002) and transverse plane ROM (21.5° [12.4°, 30.6°], p < 0.001), but no difference in frontal plane motion (p = 0.017). There were significant between groups difference in neck flexor endurance (19.5 s [10.1 s, 28.9 s], <0.001), segmental dysfunction O-C4 (p < 0.001) but not in PPT (p = 0.04). Discussion: Neck pain and cervical musculoskeletal dysfunction are common among persons with SRSH and may be a comorbid feature or contributing factor to headaches attributed to rhinosinusitis. Further research is needed to understand these associations.

An exploration of trunk reposition error in subjects with acute stroke: An observational design.

BACKGROUND & OBJECTIVE: Trunk reposition error (TRE) is a component of trunk control, yet has not been reported in acute stroke. The purpose of this study was to quantify TRE in acute stroke and report this with related rehabilitation outcomes. METHODS: Sixty subjects, 30 with acute stroke and 30 healthy controls, completed this study. Subjects with acute stroke were measured before and after an in-patient acute rehabilitation stay. MEASURES: TRE using an electromagnetic tracking device, Berg Balance Scale, Postural Assessment Scale for Stroke, and Functional Independence Measures. Pre-post measures were analyzed with paired t-tests. Between-group measures were analyzed with independent w-tests. RESULTS: There were significant between group differences (acute stroke vs. controls) for all functional outcome measures (P < 0.001) and for three-dimensional TRE (P = 0.001). There were significant improvements in all functional outcome measures following an in-patient rehabilitation stay (P < 0.001). All measures of TRE reduced but did not achieve significance. CONCLUSION: TRE was not as severely impaired as anticipated and was variable based on plane of measure. Time in a rehabilitation setting produced significant improvements in functional outcomes but TRE improvements were not as robust. These results indicate a need for further investigation of the strength of the interrelationship between TRE and function.

Physical therapists' clinical knowledge of multidisciplinary low back pain treatment guidelines.

BACKGROUND: Numerous clinical practice guidelines (CPGs) have been developed to assist clinicians in care options for low back pain (LBP). Knowledge of CPGs has been marginal across health-related professions. OBJECTIVE: The aims of this study were: (1) to measure US-based physical therapists' knowledge of care recommendations associated with multidisciplinary LBP CPGs and (2) to determine which characteristics were associated with more correct responses. DESIGN: A cross-sectional survey was conducted. METHODS: Consenting participants attending manual therapy education seminars read a clinical vignette describing a patient with LBP and were asked clinical decision-making questions regarding care, education, and potential referral. Descriptive statistics illustrating response accuracy and binary logistic regression determined adjusted associations between predictor variables and appropriate decisions. RESULTS: A total of 1,144 of 3,932 surveys were eligible for analysis. Correct responses were 55.9% for imaging, 54.7% for appropriate medication, 62.0% for advice to stay active, 92.7% for appropriate referral with failed care, and 16.6% for correctly answering all 4 questions. After adjustment, practicing in an outpatient facility was significantly associated with a correct decision on imaging. Female participants were more likely than male participants to correctly select proper medications, refer the patient to another health care professional when appropriate, and answer all 4 questions correctly. Participants reporting caseloads of greater than 50% of patients with LBP were more likely to select proper medications, give advice to stay active, and answer all 4 questions correctly. Participants attending more continuing education were more likely to give advice to stay active and older, and more experienced participants were more likely to appropriately refer after failed care. LIMITATIONS: There was potential selection bias, which limits generalizability. CONCLUSIONS: The survey identified varied understanding of CPGs when making decisions that were similar in recommendation to the CPGs. No single predictor for correct responses for LBP CPGs was found.

Thrust and nonthrust manipulation for older adults with low back pain: an evaluation of pain and disability.

OBJECTIVE: The purpose of the study was to compare the effects of thrust manipulation (TM) and non-TM (NTM) on a sample of older subjects with low back pain. METHODS: This is a secondary data analysis of a randomized control trial. Forty-nine subjects aged 55 to 88 years participated in the trial, who received either a TM or NTM on at least 2 occasions during the course of care, and were extracted from the larger data set. The treatment program included a standardized home exercise program for the first 2 sessions, which could be modified by the therapist after those 2 sessions. Numeric pain rating scale and Oswestry Disability Index (ODI) were the outcomes for this study. RESULTS: Multivariate analysis revealed no significant between-group differences for treatment group (P=.99) without group×time interaction (P=.90). Significant within-group changes were observed for both groups for ODI and numeric pain rating scale (P<.001); the average self-report of recovery was 78.0% (SD, 19.8%). Age stratification of the older subset revealed between-group differences in ODI change scores for the oldest subjects (>70 years) compared with 60 to 69 years (P=.02). CONCLUSIONS: This study showed that outcomes for both TM and NTM improved in older adults with low back pain.

Which prognostic factors for low back pain are generic predictors of outcome across a range of recovery domains?

BACKGROUND: Recovery from low back pain (LBP) is multidimensional and requires the use of multiple-response (outcome) measures to fully reflect these many dimensions. Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered "universal" prognostic variables. OBJECTIVE: The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP. DESIGN: Predictive modeling was performed using data extracted from a randomized controlled trial. Four prognostic models were created using backward stepwise deletion logistic, Poisson, and linear regression. METHODS: Data were collected from 16 outpatient physical therapy facilities in 10 states. All 149 patients with LBP were treated with manual therapy and spine strengthening exercises until discharge. Four different measures of response were used: Oswestry Disability Index and Numeric Pain Rating Scale change scores, total visits, and report of rate of recovery. RESULTS: The set of statistically significant predictors was dependent on the definition of response. All regression models were significant. Within both forms of the 4 models, meeting the clinical prediction rule for manipulation at baseline was present in all 4 models, whereas no irritability at baseline and diagnosis of sprains and strains were present in 2 of 4 of the predictive models. LIMITATIONS: The primary limitation is that this study evaluated only 4 of the multiple outcome measures that are pertinent for patients with LBP. CONCLUSIONS: Meeting the clinical prediction rule was prognostic for all outcome measures and should be considered a universal prognostic predictor. Other predictive variables were dependent on the outcomes measure used in the predictive model.

A comparison of physical characteristics and swing mechanics between golfers with and without a history of low back pain.

STUDY DESIGN: Controlled laboratory study using a cross-sectional design. OBJECTIVES: To examine the kinematics and kinetics of the trunk and the physical characteristics of trunk and hip in golfers with and without a history of low back pain (LBP). BACKGROUND: Modified swing patterns and general exercises have been suggested for golfers with back pain. Yet we do not know what contributes to LBP in golfers. To create and validate a low back-specific exercise program to help prevent and improve back injuries in golfers, it may be valuable to understand the differences in biomechanical and physical characteristics of golfers with and without a history of LBP. METHODS: Sixteen male golfers with a history of LBP were matched by age and handicap with 16 male golfers without a history of LBP. All golfers underwent a biomechanical swing analysis, trunk and hip strength and flexibility assessment, spinal proprioception testing, and postural stability testing. RESULTS: The group with a history of LBP demonstrated significantly less trunk extension strength at 60 degrees/s and left hip adduction strength, as well as limited trunk rotation angle toward the nonlead side. No significant differences were found in postural stability, trunk kinematics, and maximum spinal moments during the golf swing. CONCLUSION: Deficits observed in this study may affect a golfer's ability to overcome the spinal loads generated during the golf swing over time. Exercises for improving these physical deficits can be considered, although the cause-effect of LBP in golfers still cannot be determined.

A comparison of throwing kinematics between youth baseball players with and without a history of medial elbow pain.

Risk factors in throwing factors associated to little league elbow have not been adequately explored. Whether these factors also affect the players' performance is also important to elucidate while modifying throwing pattern to reduce injury. The purpose of this study was to compare the differences in throwing kinematics between youth baseball players with or without a history of medial elbow pain (MEP) and to determine the relationship between their throwing kinematics and ball speed. Fifteen players with previous MEP were matched with 15 healthy players by age, height and weight. Throwing kinematics was recorded by an electromagnetic motion analysis system. A foot switch was used for determining foot off and foot contact. Ball speed was recorded with a sports radar gun. The group with a history of MEP demonstrated less elbow flexion angle at maximum shoulder external rotation and had more lateral trunk tilt at ball release compared to the healthy group. The group with a history of MEP also had faster maximum upper torso rotation velocities, maximum pelvis rotation velocities and ball speeds. Maximum shoulder external rotation angle (r = 0.458, P = 0.011), elbow flexion angle at maximum shoulder external rotation (r = -0.637, P = 0.0003), and maximum upper torso rotation velocity (r = 0.562, P = 0.002) had significant correlation with ball speed. Findings of this study can be treated as elbow injury-related factors that clinicians and coaches can attend to when taking care of youth

Effects of spinal manipulation on trunk proprioception in subjects with chronic low back pain during symptom remission.

OBJECTIVE: The purpose of this study was to examine the immediate effects of spinal manipulative therapy (SMT) on trunk proprioception in subjects with asymptomatic chronic low back pain (CLBP) and determine if those effects lasted 1 week. METHODS: This unbalanced randomized controlled crossover design examined 33 subjects with CLBP. Proprioception was tested via joint position sense, threshold to detect passive motion (TTDPM), direction of motion (DM), and force reproduction. Each subject received lumbar manipulation or a sham procedure followed by proprioception retest. This procedure was repeated 1 week later using the opposing treatment. Subjects receiving SMT in the second session returned a third time receiving the sham procedure again. RESULTS: Spinal manipulative therapy produced an effect for TTDPM in the manipulation first group (P = .008), the sham procedure produced an effect for joint position sense in the sham first group (P = .005). Spinal manipulative therapy had a 1-week effect for the manipulation first group (P = .006). No effect was noted for either DM or force reproduction. CONCLUSIONS: Results suggest SMT had minimal immediate effect on trunk proprioception. The effects noted occurred in session 1, implicating learning as a potential source. Learning, from repetitive proprioception training, may enhance neuromuscular control in subjects with CLBP before the use of therapeutic exercise. Subjects showed smaller deficits than previously reported for TTDPM or DM, suggesting proprioception deficits may correlate with pain level.