Comparing the range of musculoskeletal therapies applied by physical therapists with postgraduate qualifications in manual therapy in patients with non-specific neck pain with international guidelines and recommendations: An observational study.

The aim of this study is to compare Dutch usual care musculoskeletal therapy in patients with non-specific neck pain with recommendations from international clinical practice guidelines. Physical therapy is diverse, as it may consist of exercise, massage, advice, and other modalities. Physical therapists with post graduate qualifications in manual therapy (MT) may additionally apply spinal thrust manipulation or non-thrust mobilization techniques to treat neck pain. It is important that, in the absence of a Dutch clinical guideline for the treatment of patients with neck pain, musculoskeletal therapists use the available recommendations from international clinical practice guidelines when treating patients with neck pain. One updated clinical practice guideline was identified (Blanpied, 2017), a report from the Task Force on Neck Pain (Guzman et al., 2008) and the IFOMPT International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention (Rushton et al., 2014). At baseline 1193 patients are included and data with regard to pain, disability, fear avoidance, expectations and applied treatment modalities are gathered. Outcome is measured using the Global Perceived Effect questionnaire. Results show that patients with acute neck pain are treated significantly more often with manipulation compared to patients with sub-acute or chronic neck pain (p < .000) and younger patients are treated with manipulation more often than older patients (p < .000). In the presence of comorbidity, the preference of spinal manipulation seems to diminish, in favour of mobilization and exercise. Almost every patient receives multimodal therapy (94.3%) and spinal manipulation and mobilization are rarely used as a stand-alone treatment (4.5% and 0.8%). Dutch musculoskeletal therapists choose treatment strategies that correspond with recommendations from international guidelines.

Three-dimensional kinematics of the cervical spine using an electromagnetic tracking device. Differences between healthy subjects and subjects with non-specific neck pain and the effect of age.

BACKGROUND: A cross-sectional observational study of three-dimensional cervical kinematics in 35 non-specific neck pain patients and 100 asymptomatic controls. To compare qualitative and quantitative aspects of cervical kinematics between healthy subjects and subjects with non-specific neck pain and to determine the effect of age on cervical kinematics in healthy subjects. METHODS: Three-dimensional kinematics of active lateral bending and flexion-extension of 35 patients and 100 controls were registered by means of an electromagnetic tracking system. The means of several kinematic parameters were compared using t-tests. In addition, we assessed the age-dependency of the three-dimensional kinematic parameters by stratifying the 100 control subjects in 6 age categories. FINDINGS: Comparison of the patient group with the control group reveals no statistically significant differences in qualitative and quantitative parameters. Analysis of the effect of age showed that the range of motion decreases significantly (p < 0.01) with increasing age. In lateral bending, the ratio between axial rotation and lateral bending increases significantly (p < 0.01) among older subjects. Differences in acceleration, jerk and polynomial fit are seen between the age categories, but are not significant. INTERPRETATION: This study demonstrates no significant differences in kinematic parameters between healthy subjects and subjects with non-specific neck pain. Healthy subjects in higher age categories demonstrate higher ratios of coupled movements and lower ranges of motion. Future research should focus on classifying patients with non-specific neck pain in order to gain a better insight on possible subgroup specific differences in kinematics. More studies on this subject are warranted. LEVEL OF EVIDENCE: 4.

Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics: A systematic review.

Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk for adverse events. It would be valuable if patients at risk could be identified by specific characteristics during the preliminary screening. Objective was to identify characteristics of 1) patients, 2) practitioners, 3) treatment process and 4) adverse events (AE) occurring after CSM or cervical mobilization. A systematic search was performed in PubMed, Embase, CINAHL, Web-of-science, AMED, and ICL (Index Chiropractic Literature) up to December 2014. Of the initial 1043 studies, 144 studies were included, containing 227 cases. 117 cases described male patients with a mean age of 45 (SD 12) and a mean age of 39 (SD 11) for females. Most patients were treated by chiropractors (66%). Manipulation was reported in 95% of the cases, and neck pain was the most frequent indication. Cervical arterial dissection (CAD) was reported in 57% (P = 0.21) of the cases and 45.8% had immediate onset symptoms. The overall distribution of gender for CAD is 55% (n = 71) for female and therefore opposite of the total AE. Patient characteristics were described poorly. No clear patient profile, related to the risk of AE after CSM, could be extracted. However, women seem more at risk for CAD. There seems to be under-reporting of cases. Further research should focus on a more uniform and complete registration of AE using standardized terminology.

Rate of fall-applied liquid swine manure: effects on runoff transport of sediment and phosphorus.

Reducing the delivery of phosphorus (P) from land-applied manure to surface water is a priority in many watersheds. Manure application rate can be controlled to manage the risk of water quality degradation. The objective of this study was to evaluate how application rate of liquid swine manure affects the transport of sediment and P in runoff. Liquid swine manure was land-applied and incorporated annually in the fall to runoff plots near Morris, Minnesota. Manure application rates were 0, 0.5, 1, and 2 times the rate recommended to supply P for a corn (Zea mays L.)-soybean [Glycine max (L.) Merr.] rotation. Runoff volume, sediment, and P transport from snowmelt and rainfall were monitored for 3 yr. When manure was applied at the highest rate, runoff volume and sediment loss were less than the control plots without manure. Reductions in runoff volume and soil loss were not observed for spring runoff when frozen soil conditions controlled infiltration rates. The reduced runoff and sediment loss from manure amended soils compensated for addition of P, resulting in similar runoff losses of total P among manure application rates. However, losses of dissolved P increased with increasing manure application rate for runoff during the spring thaw period. Evaluation of water quality risks from fall-applied manure should contrast the potential P losses in snowmelt runoff with the potential that incorporated manure may reduce runoff and soil loss during the summer.

Low-dose methotrexate therapy for ocular inflammatory disease.

BACKGROUND: Methotrexate is a second-line anti-inflammatory agent used in the treatment of rheumatic diseases. At low doses (12.5 mg/week), it is associated with few serious side effects. METHODS: Twenty-two patients (5 men, 17 women) with chronic noninfectious ocular inflammatory disease, who had not responded to or who had become intolerant of corticosteroid or alternate cytotoxic agents, were treated weekly with oral low-dose, pulse methotrexate. Treated diseases included chronic uveitis-vitreitis (9), scleritis (4), inflammatory pseudotumor (3), orbital myositis (3), and retinal vasculitis (3). RESULTS: Follow-up ranged from 2 to 39 months (mean, 11 months). Response time ranged from 3 to 9 weeks (mean, 5 weeks) after implementation of methotrexate therapy. Sixteen of 22 patients had reduction of inflammatory activity. Fourteen of these 16 patients were able to taper or discontinue corticosteroid therapy. Five patients had complete remission of their disease; six patients did not respond to methotrexate. CONCLUSION: Treatment with low-dose methotrexate appears to be effective therapy for steroid-resistant ocular inflammatory disease.

Comparative chemistry of elaiosomes of three species ofTrillium.

This study was designed to compare the chemistry of elaiosomes of three sympatric species ofTrillium to discover if there are correlations between chemistry and dispersal rates by ants. We quantified the amount of proteins and neutral lipids and qualitatively analyzed the fatty acids occurring in triglyceride, diglyceride, monoglyceride, and free fatty acid fractions.T. grandiflorum had the highest lipid concentration per milligram of protein and the highest total lipid per elaiosome, followed byT. erectum and then byT. undulatum. Oleic acid (18∶1) was abundant in all lipid fractions of each species. This fatty acid, which is responsible for corpse-carrying behavior in some ants, probably causes ants to pick up diaspores. Linoleic acid (18∶2) is relatively abundant inT. erectum andT. grandiflorum but not inT. undulatum and may cause ants that have picked up diaspores to move (carry) those diaspores back to the nest. Total elaiosome mass and fatty acid composition appear to explain whyT. erectum is dispersed most rapidly and why ants that have picked up elaiosomes move moreT. grandiflorum thanT. undulatum diaspores.

How soon is safe? Ambulation of the patient with burns after lower-extremity skin grafting.

Patients with burns of the lower extremity that require skin grafting were randomized into three groups to determine when postgraft ambulation could be safely resumed. Dangling protocol was initiated on postoperative day 6, 8, or 10, and ambulation was started on the next day. Grafts were evaluated at six stages on a five-point scale. In the 22 patients who completed the study, there was no significant difference in scores of the three groups. There was a significant difference in length of hospital stay when patients who dangled on postoperative day 6 were compared with patients who dangled on postoperative day 10.

The aphasia syndrome of stroke in the left anterior cerebral artery territory.

Two patients with transcortical motor aphasia are described. Both had infarcts in the distribution of the left anterior cerebral artery confirmed by computerized tomography (CT). The distinctive language abnormality, unusual EEG pattern, and nuclide and CT scan abnormalities all allow ready diagnosis of the syndrome of infarction in this distribution. The mechanism of the language disturbance is reviewed and implications for treatment and prognosis are discussed.