The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study.

BACKGROUND: The purpose of this study is to evaluate the effect of a six-week combined manual therapy (MT) and stabilizing exercises (SEs), with a one-month follow-up on neck pain and improving function and posture in patients with forward head and rounded shoulder postures (FHRSP). METHODS: Sixty women with neck pain and FHRSP were randomized into three groups: Group 1 performed SE and received MT (n = 20), Group 2 performed SE (n = 20) and Group 3 performed home exercises (n = 20) for six weeks. The follow-up time was one month after the post test. The pain, function, and head and shoulder angles were measured before and after the six-week interventions, and during a one-month follow-up. RESULTS: There were significant within-group improvements in pain, function, and head and shoulder posture in groups 1 and 2. There were significant between-group differences in groups 1 and 2 in head posture, pain, and function favoring group 1 with effect size 0.432(p = 0.041), 0.533 (P = 0.038), and 0.565(P = 0.018) respectively. There were significant between-group differences in both intervention groups versus the control group favoring the intervention groups. CONCLUSION: These findings suggest that both interventions were significantly effective in reducing neck pain and improving function and posture in patients. However, the improvement in function and pain were more effective in Group 1 as compared to Group 2, suggesting that MT can be used as a supplementary method to the stabilizing intervention in the treatment of neck pain. More researches are needed to confirm the result of this study. TRIAL REGISTRATION: UMIN000030141 modified on 2018.03.08. This study is a randomized control trial registered at UMIN-CTR website, the trial was retrospectively registered and the unique trial number is UMIN000030141 .

Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation.

STUDY DESIGN: Longitudinal observational study. OBJECTIVE: To quantify the amount of upper- and lower-extremity movement repetitions (that is, voluntary movements as part of a functional task or specific motion) occurring during inpatient spinal cord injury (SCI), physical (PT) and occupational therapy (OT), and examine changes over the inpatient rehabilitation stay. SETTING: Two stand-alone inpatient SCI rehabilitation centers. METHODS: Participants: A total of 103 patients were recruited through consecutive admissions to SCI rehabilitation. INTERVENTIONS: Trained assistants observed therapy sessions and obtained clinical outcome measures in the second week following admission and in the second to last week before discharge. MAIN OUTCOME MEASURES: PT and OT time, upper- and lower-extremity repetitions and changes in these outcomes over the course of rehabilitation stay. RESULTS: We observed 561 PT and 347 OT sessions. Therapeutic time comprised two-thirds of total therapy time. Summed over PT and OT, the median upper-extremity repetitions in patients with paraplegia were 7 repetitions and in patients with tetraplegia, 42 repetitions. Lower-extremity repetitions and steps primarily occurred in ambulatory patients and amounted to 218 and 115, respectively (summed over PT and OT sessions at discharge). Wilcoxon-signed rank tests revealed that most repetition variables did not change significantly over the inpatient rehabilitation stay. In contrast, clinical outcomes for the arm and leg improved over this time period. CONCLUSIONS: Repetitions of upper- and lower-extremity movements are markedly low during PT and OT sessions. Despite improvements in clinical outcomes, there was no significant increase in movement repetitions over the course of inpatient rehabilitation stay.

[Orthopaedic manual therapy : definition, characteristics and update on the situation in Belgium]. / La thérapie manuelle orthopédique : définition, caractéristiques et mise au point sur la situation en Belgique.

Although orthopaedic manual therapy (OMT) has existed for decades, and although a recent Belgian Royal Decree, published in 2014, recognized it as a particular professional qualification in physiotherapy for the treatment of neuromusculoskeletal dysfunctions, OMT remains little known by patients, but also by healthcare professionals. Yet, this professional qualification, based on clinical reasoning, using highly specific treatments, guided by the best available scientific and clinical evidence and the specific biopsychosocial characteristics of each patient, is the subject of a growing number of scientific studies pointing out its effectiveness. This article summarizes the knowledge related to OMT (definition, history, characteristics, techniques, indications, access and reimbursement) and describes its situation in Belgium.

Bien que la thérapie manuelle orthopédique (TMO) existe depuis des décennies et qu'un récent arrêté royal belge reconnaissant cette discipline comme une qualification professionnelle particulière en kinésithérapie pour la prise en charge des troubles neuro-musculo-squelettiques ait été publié en 2014, la TMO demeure méconnue des patients, mais également du monde médical. Pourtant, cette discipline, basée sur un raisonnement clinique, utilisant des approches thérapeutiques hautement spécifiques guidées par les meilleures évidences scientifiques et cliniques disponibles ainsi que par la spécificité biopsychosociale propre à chaque patient, fait l'objet d'un nombre croissant d'études scientifiques mettant en évidence son intérêt. Cet article vise à synthétiser les connaissances relatives à la TMO (sa définition, son historique, ses caractéristiques, ses techniques, ses indications, son accès et son remboursement, ainsi que son enseignement) en décrivant la situation en Belgique.

Using PubMed search strings for efficient retrieval of manual therapy research literature.

OBJECTIVE: The aim of this study was to construct PubMed search strings that could efficiently retrieve studies on manual therapy (MT), especially for time-constrained clinicians. METHODS: Our experts chose 11 Medical Subject Heading terms describing MT along with 84 additional potential terms. For each term that was able to retrieve more than 100 abstracts, we systematically extracted a sample of abstracts from which we estimated the proportion of studies potentially relevant to MT. We then constructed 2 search strings: 1 narrow (threshold of pertinent articles ≥40%) and 1 expanded (including all terms for which a proportion had been calculated). We tested these search strings against articles on 2 conditions relevant to MT (thoracic and temporomandibular pain). We calculated the number of abstracts needed to read (NNR) to identify 1 potentially pertinent article in the context of these conditions. Finally, we evaluated the efficiency of the proposed PubMed search strings to identify relevant articles included in a systematic review on spinal manipulative therapy for chronic low back pain. RESULTS: Fifty-five search terms were able to extract more than 100 citations. The NNR to find 1 potentially pertinent article using the narrow string was 1.2 for thoracic pain and 1.3 for temporomandibular pain, and the NNR for the expanded string was 1.9 and 1.6, respectively. The narrow search strategy retrieved all the randomized controlled trials included in the systematic review selected for comparison. CONCLUSION: The proposed PubMed search strings may help health care professionals locate potentially pertinent articles and review a large number of MT studies efficiently to better implement evidence-based practice.

COVID 19 and manual therapy: international lessons and perspectives on current and future clinical practice and education.

BACKGROUND: The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual therapy has moved to online platforms with in-person instruction restricted. The global impact on the clinical practice of manual therapy and education has to date not been explored. METHODS: a questionnaire survey methodology was used. A sample of convenience of global leaders in manual therapy practice and education received an electronic link to two surveys: one on clinical practice and one on education. Contributors could complete one or both surveys. RESULTS: Twenty-five surveys were received on clinical practice and 23 on education in manual therapy, representing the six major continents. Global themes in clinical practice demonstrated a sudden and dramatic shift away from patient contact, with limited modifications to manual therapy in patient care currently adopted. Themes in education were of a major shift to online learning, development of new modes of student instruction including video-based assessment and virtual case-based instruction. CONCLUSION: The international perspectives provided demonstrate a major change in manual therapy practice and education globally. Various approaches have been taken in practice and education without a uniform approach being demonstrated.

Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017.

BACKGROUND: Better understanding of the dynamics and temporal changes in manual therapy service utilisation may assist with healthcare planning and resource allocation. The objectives of this study were to quantify, describe, and compare service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. METHODS: Data regarding the number of services, total cost, and benefits paid were extracted for each manual therapy profession (i.e. chiropractic, osteopathy, and physiotherapy) for the period 2008-2017 from the Australian Prudential Regulation Authority. The number of registered providers for each profession were obtained from the Australian Health Practitioner Regulation Agency. Descriptive statistics were produced for two time periods (i.e. 2008-2012 and 2013-2017) for each manual therapy profession. Annual percentage change during each time period was estimated by fitting Poisson regression models. Test for the equality of regression coefficients was used to compare the trends in the two time periods within each profession, and to compare the trends across professions within a time period. RESULTS: A cumulative total of 198.6 million manual therapy services with a total cost of $12.8 billion was provided within the Australian private healthcare setting between 2008 and 2017. Although service utilisation and total cost increased throughout the ten-year period, the annual growth was significantly lower during 2013-2017 than 2008-2012. Whereas osteopathy and physiotherapy experienced significant annual growth in the number of services and total cost during 2013-2017, negative growth in the number of services was observed for chiropractic during the same period. The annual number of services per provider declined significantly for chiropractic and physiotherapy between 2013 and 2017. CONCLUSION: Service provision under private health insurance general treatment cover constitute a major source of revenue for manual therapy professions in Australia. Although manual therapy service utilisation increased throughout the ten-year period from 2008 to 2017, the annual growth declined. There were diverging trends across the three professions, including significantly greater decline in annual growth for chiropractic than for osteopathy and physiotherapy.

Nursing practice in home care: the mediation of care by reflexivity.

OBJECTIVE: To analyze the practice of nurses in home care, considering the mediation of care by reflexivity. METHOD: Unique, qualitative case study, anchored in the dialectical framework. The participants were 13 nurses who work in home care in Minas Gerais. Data were obtained by participant observation and interview, and submitted to critical discourse analysis. RESULTS: Nursing care at home involves the repetitions of everyday actions and a degree of unpredictability. Reflexivity, according to Schön's theoretical framework, emerges as a component of professional practice that leads to the practice of care as a continuous assessment of work, and also to reflection on the challenges imposed by conflicting situations. Reflexivity also stems from professionals' search for improvements in their practices. FINAL CONSIDERATIONS: We identified the presence of actions and knowledge mobilized by the reflexivity of the nurse in the home care setting. The following were the elements of this reflexive practice: knowing-in-action, reflection-in-action and reflection reflection-in-action.

Telehealth Physical Therapy in Musculoskeletal Practice.

Telehealth physical therapy has the potential to transform many critical areas of care in musculoskeletal practice. However, the amount of hype around telehealth needs to be carefully examined, because widespread implementation has been stalled by payment and regulatory barriers in physical therapy. The purposes of this Viewpoint are to highlight (1) the current level of implementation, (2) telehealth musculoskeletal evidence, and (3) future opportunities in the digital age. J Orthop Sports Phys Ther 2018;48(10):736-739. doi:10.2519/jospt.2018.0613.

Manual therapy: the historical, current, and future role in the treatment of pain.

Manual therapy has been an approach in the management of patients with various disorders dating back to ancient times and continues to play a significant role in current health care. The future role of manual therapy in health care is an important area of research. This paper reviews the history of manual therapy, examines the current literature related to the use of manual techniques (including manipulation, massage, and nerve manipulation), and discusses future research topics. The literature related to manual therapy has historically been anecdotal and theoretical, and current research tends to have a generic approach with broad definitions of manual therapy and inconsistencies in the classification of specific disorders. Systematic reviews of various types of manual therapy have differed on their conclusions regarding the effectiveness of this treatment modality. The current demand in health care for evidence-based practice necessitates a movement towards more specificity in the research of the effectiveness of manual therapy, with emphasis on specific patient signs and symptoms and specific manual techniques that result in effective care.

Alternative therapeutic intervention for individuals with Rett syndrome.

The individual with Rett syndrome (RS) displays an array of challenging difficulties in all areas of daily living. Since there is no cure for the disorder at this moment, parents of the individual with Rett search for different interventional modalities that will improve the condition and quality of life for their child. During the last few years, many individuals with RS have experienced different kinds of interventions. This paper presents these methods with relevant case stories for others to share the possibilities. This paper reviews the following interventions: animal-assisted therapy, such as dolphin therapy and dog-assisted therapy; auditory integration training; hyperbaric chamber; manual therapy, such as acupuncture/acupressure, aromatherapy, craniosacral therapy, Mayo facial release, Treager massage, chiropractor, and Reiki; mental modification techniques, such as Lovas and cognitive rehabilitation; motoric interventions, such as advanced biomechanical rehabilitation, patterning/Doman-DeLacato approach, and yoga. The present paper is not a recommendation for any of the above-mentioned techniques, but merely a review of different interventions available for the inquisitive parent of the individual with RS.

Monitoring the change: current trends in outcome measure usage in physiotherapy.

Physiotherapists have traditionally relied on impairment measures such as range of motion and muscle strength to monitor patient progress. The impact of treatment on patients' daily activities can be assessed with valid and reliable questionnaires, but the use of standardized questionnaires by physiotherapists appeared to be limited. A range of strategies were implemented that aimed to increase physiotherapists' use of standardized measures of functional activities. A simple random sample of 300 was drawn from a database of physiotherapy providers to a transport accident scheme, and was surveyed in March and September 2003, with response rates of 51% and 55%, respectively. There was a statistically significant (P<.05) increase in reported use of seven questionnaires and a significant reduction in the perception of barriers that were targeted by the interventions The most frequently utilized tests were a pain rating scale and questionnaires for lumbar and cervical problems. Physiotherapists' attitudes to outcome measurement were generally positive although there was a small but statistically significant (P=.02) reduction in mean attitude score over the re-test period. Physiotherapists in the population sampled significantly increased their reported use of a range of standardized outcome measures over the re-test period. The trend towards greater objectivity in measuring the progress of rehabilitation can enable physiotherapists to develop improved treatment plans with the patients' needs at the centre of the equation.

Discord Between Approaches to Spinal and Extremity Disorders: Is It Logical?

Rapid advances in the basic, clinical, and behavioral sciences are molding developments in conservative management of musculoskeletal disorders. Curiously, there seems to be discord developing between approaches to the assessment and management of patients, depending on whether they present with an extremity or spinal disorder. This viewpoint will comment on examples of differences emerging in some current practices. The aim is not to present a scientific treatise about underpinning sciences and evidence-based practice or to comment on what is correct or incorrect. Rather, the aim is to stimulate thought on the seeming discord in clinical practice, with respect to both the clinical evaluation of, as well as management approaches to, extremity and spinal disorders. J Orthop Sports Phys Ther 2016;46(11):938-941. doi:10.2519/jospt.2016.0610.

[Current Conservative Treatment and Management Strategies of Skeletal Muscle Injuries]. / Konservative Therapie von Muskelverletzungen - Beurteilung aktueller Behandlungskonzepte.

Muscle injuries frequently occur during sport and are one of the commonest injuries. The diagnosis and treatment of muscle injuries impose high demands on medical treatment, in order to ensure successful regeneration and a rapid return to sport. Most of the injuries can be treated conservatively, as skeletal muscles have a high endogenous capacity for repair and regeneration. Conservative treatment includes initial on-field therapy. This is known as the "RICE" principle and is common and recommended for initial treatment for most sports injuries. The primary therapy target is to reduce pain, swelling and bleeding and thus to limit the initial inflammatory process and prevent further damage. During the first days after injury, brief immobilization helps to reduce the re-injury rate and accelerates the formation of granulation tissue. There are many possible additional treatments, including intramuscular injections, manipulation of the sacroiliac joint or rehabilitation programs, including stretching and strengthening. If the acute treatment phase is complete after 3 to 5 days, more active treatment, including trunk stabilisation, stretching and strengthening, can be started gradually. Despite their high prevalence, there have only been a few studies on the treatment and management of these injuries. The aim of this manuscript is to review the literature on the classification, pathobiology and treatment strategies for muscle injuries.

Can new technologies improve upper limb performance in grown-up diplegic children?

BACKGROUND: Few systematic studies describe rehabilitation trainings for upper limb in diplegic children with cerebral palsy (CP), who - especially once grown up - are often not considered as a target for rehabilitation interventions. AIM: In this pilot study, we describe the details and the effectiveness of an intensive, technology assisted intervention for upper limb. SETTING: The treatment combines the utilization of Armeo® Spring with a training focused on hand/finger fluency and dexterity in a pre-post treatment experimental design. POPULATION: Participants were ten school-aged children (mean age 11.2) with bilateral CP and diplegia, attending mainstream schools. METHODS: Participants underwent 40 therapy sessions in four weeks. Armeo® Spring measures, standardized motor and perceptual outcome indexes, as well as everyday life indicators were utilized to assess the effect of the intervention. RESULTS: Upper limb coordination, fluency and quality of movements mainly of hands and fingers significantly improved, with a good transferability to everyday life also in areas not specifically trained, such as self-care abilities and mobility. Probably due to the visual feedback provided by the virtual reality setting (which was all in one the context, the incentive and the product of activities), perceptual abilities significantly improved, too. CONCLUSIONS: Our study suggests the importance of intervention on upper limb even in milder CP diplegic forms and in relatively grown-up children. The possibility of modification at least partially relies on learning processes that are active all along development and benefit from stimulation. CLINICAL REHABILITATION IMPACT: Though further studies with control groups and follow-up perspective are needed to confirm, new technologies offer interesting possibilities to be integrated into new evidence-based rehabilitation models.

Nursing practice in home care: the mediation of care by reflexivity / La práctica de enfermería en la atención a domicilio: la mediación del cuidado por la reflexividad / Prática da enfermeira na atenção domiciliar: o cuidado mediado pela reflexividade

ABSTRACT Objective: To analyze the practice of nurses in home care, considering the mediation of care by reflexivity. Method: Unique, qualitative case study, anchored in the dialectical framework. The participants were 13 nurses who work in home care in Minas Gerais. Data were obtained by participant observation and interview, and submitted to critical discourse analysis. Results: Nursing care at home involves the repetitions of everyday actions and a degree of unpredictability. Reflexivity, according to Schön's theoretical framework, emerges as a component of professional practice that leads to the practice of care as a continuous assessment of work, and also to reflection on the challenges imposed by conflicting situations. Reflexivity also stems from professionals' search for improvements in their practices. Final considerations: We identified the presence of actions and knowledge mobilized by the reflexivity of the nurse in the home care setting. The following were the elements of this reflexive practice: knowing-in-action, reflection-in-action and reflection reflection-in-action.

RESUMEN Objetivo: Analizar la práctica de enfermería en la atención a domicilio, desde la mediación del cuidado por la reflexividad. Método: Estudio de caso único, cualitativo, en base de la dialéctica referencial. Han participado 13 enfermeras que trabajan en la atención domiciliaria en Minas Gerais, Brasil. En la recolección de datos se utilizó la observación participante y las entrevistas, pasando a un análisis crítico del discurso. Resultados: El cuidado de enfermería a domicilio consiste en repeticiones de acciones cotidianas e imprevisibilidad. La reflexividad, desde el marco teórico de Schön, emerge como un componente de la práctica profesional que conduce al logro del cuidado en una evaluación continua del trabajo y la reflexión sobre los desafíos que enfrentan con situaciones conflictivas y la búsqueda de la mejora en sus prácticas. Consideraciones finales: Se identificaron la presencia de quehaceres y saberes influidos por la reflexividad en la enfermería a domicilio, y los siguientes elementos de la práctica reflexiva: el conocimiento-en-la-acción, la reflexión-en-la-acción y su reflexión.

RESUMO Objetivo: Analisar a prática de enfermeiras na atenção domiciliar, considerando a realização do cuidado mediado pela reflexividade. Método: Estudo de caso único, qualitativo, ancorado no referencial dialético. Participaram 13 enfermeiras que atuam na atenção domiciliar em Minas Gerais. Os dados foram obtidos por observação participante e entrevista e submetidos à análise de discurso crítica. Resultados: O cuidado da enfermeira no domicílio é composto por repetições de ações cotidianas e pela imprevisibilidade. A reflexividade, segundo referencial teórico de Schön, emerge como um componente da prática profissional que leva à realização do cuidado em uma avaliação contínua do trabalho e da reflexão acerca dos desafios diante de situações conflitantes e da busca de melhoria em suas práticas. Considerações finais: Identificou-se a presença de fazeres e saberes mobilizados pela reflexividade da enfermeira no domicílio, e os seguintes elementos de uma prática reflexiva: o conhecer-na-ação, a reflexão-na-ação e a reflexão sobre este último.

[Traditional Chinese medicine in urology]. / Traditionelle chinesische Medizin in der Urologie.

Traditional Chinese medicine (TCM) is an ancient holistic medicine based on the doctrine of Tao and Qi. Tao represents an alteration from which the polarity of Yin and Yang arises and Qi is the vitality which circulates through the body. Therapeutic concepts of TCM include acupuncture, herbal therapy, nutrition and Tuina, a form of manual therapy. TCM is now gaining increased acceptance in the Western society as a complementary therapy. Acupuncture and herbal therapy are the main forms of implementation of TCM in urology.

Ready for a paradigm shift? Part 1: introducing the philosophy of qualitative research.

The manual therapy professions have almost exclusively focused on the use of quantitative research to help inform their practices. This paper argues that a greater use of qualitative research will help develop a more robust and comprehensive knowledge base in manual therapy. The types of knowledge used in practice and generated from the two research paradigms are explored. It is hoped that an understanding of the philosophical and theoretical underpinnings of qualitative research may encourage more manual therapists to value and use this approach to help further inform their practice; for some, this may involve a paradigm shift in thinking.

New approach to the diagnosis and classification of chronic foot and ankle disorders: identifying motor control and movement impairments.

The prevalence of foot and ankle (F&A) disorders is high. While chronic and recurrent F&A disorders are broadly documented in the literature, their underlying mechanisms have not been well defined. Currently, patho-anatomical, biomechanical and signs and symptoms (Si&Sy) models are widely used to diagnose and classify musculoskeletal F&A disorders. Within a multi-factorial bio-psychosocial framework, these models have limitations in identifying the underlying mechanisms that maintain chronic pain and disability. Therefore, a new approach to the diagnosis and classification of chronic F&A disorders is suggested in this Masterclass. This new approach is based on identifying the underlying mechanisms of the F&A disorder. This Masterclass aims to define and describe patterns of directional motor control and movement impairment of the F&A region based on the principal author's clinical observations. Such definition and description should lead to improved identification of consistent patterns. The basis of directional motor control and movement impairment patterns is proposed. As an example, one motor control and one movement impairment pattern is described in more detail. This Masterclass can be regarded as a prerequisite for future validation studies investigating the clinical applicability of adapting and implementing this novel classification system.