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1.
Musculoskelet Sci Pract ; 70: 102903, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38412572

ABSTRACT

BACKGROUND: Evidence supporting type and dosage of joint mobilizations and rationale for selecting joint mobilization dosage for patients with rotator cuff-related shoulder pain are limited. OBJECTIVES: This scoping review aimed to systematically map the type and dosage of joint mobilizations used in previous trials for managing patients with rotator cuff-related shoulder pain; and summarize the rationale for adopting a specific joint mobilization dosage. METHODS: We searched six databases. We included randomised controlled trials using joint mobilization for patients with rotator cuff-related shoulder pain. We extracted data regarding technique, treatment joint mobilization dosages and rationale for a specific dosage. RESULTS: We included 32 studies. Most studies did not or partially report technique (67%) and within-session dosage (64%) of passive joint mobilization. Overall treatment was fully reported in 95% of studies. The dosage used for passive joint mobilization was heterogeneous (ranging from grade I to grade V). Most studies (85%) did not or partially report technique of mobilization with movement (MWM), whereas within-session and overall treatment dosages were fully reported in more than 85% of studies. Three sets of 10 repetitions were commonly used within-session dosage for MWM. We found very limited information on the rationale for selecting dosage of joint mobilization. CONCLUSION: We found limited information about the dosage or the rationale for selecting joint mobilization, with a heterogeneous dosage being tested across trials. Our findings highlight the importance of detailed reporting for dosage and rationale for selecting a specific dosage of joint mobilization.


Subject(s)
Rotator Cuff Injuries , Rotator Cuff , Humans , Shoulder Pain/therapy , Physical Therapy Modalities , Rotator Cuff Injuries/therapy
2.
J Man Manip Ther ; 32(1): 10-27, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38044657

ABSTRACT

BACKGROUND: Spinal manipulation (SM) has been hypothesized to influence the autonomic nervous system (ANS). Further, it has been proposed that the effects may vary depending on the segment manipulated. The aim of this systematic review was to synthesize the current level of evidence for SM in influencing the ANS in healthy and/or symptomatic population. METHODS: Various databases (n = 8) were searched (inception till May 2023) and 14 trials (n = 618 participants) were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. The data were synthesized using standard mean differences and meta-analysis for the primary outcome measures. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. RESULTS: Overall, there was low quality evidence that SM did not influence any measure of ANS including heart rate variability (HRV), oxy-hemoglobin, blood pressure, epinephrine and nor-epinephrine. However, there was low quality evidence that cervical spine manipulation may influence high frequency parameter of HRV, indicating its influence on the parasympathetic nervous system. CONCLUSION: When compared with control or sham interventions, SM did not alter the ANS. Due to invalid methodologies and the low quality of included studies, findings must be interpreted with great caution. Future studies are needed which employ rigorous data collection processes to verify the true physiological implications of SM on ANS.


Subject(s)
Manipulation, Spinal , Humans , Manipulation, Spinal/methods , Autonomic Nervous System/physiology , Parasympathetic Nervous System , Heart Rate/physiology , Epinephrine
3.
J Man Manip Ther ; 32(1): 28-50, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37671460

ABSTRACT

OBJECTIVE: The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population. METHODS: This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. RESULTS: There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD -0.42, 95% CI - 0.74 to -0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine. CONCLUSION: Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.


Subject(s)
Manipulation, Spinal , Humans , Hydrocortisone , Neurotensin , Biomarkers , Epinephrine
4.
Pain Rep ; 8(6): e1108, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37928202

ABSTRACT

Neuropathic pain can be caused by a lesion or disease of the somatosensory system characterised by pathological neuro-immune alterations. At a molecular level, microRNAs (miRNAs) act as regulators of gene expression orchestrating both immune and neuronal processes. Thus, miRNAs may act as essential modulators of processes for the establishment and maintenance of neuropathic pain. The objective/aims of this scoping review was to explore and chart the literature to identify miRNAs that are dysregulated in neuropathic pain. The following databases were searched from inception to March 2023: PubMed, EBSCO, CINAHL, Cochrane Library, and SCOPUS. Two independent reviewers screened, extracted data, and independently assessed the risk of bias in included studies. The JBI critical appraisal checklist was used for critical appraisal. A narrative synthesis was used to summarise the evidence. Seven studies (total of 384 participants) that met our eligibility criteria were included in this scoping review. Our review has identified different miRNAs that are commonly involved in the chronic neuropathic pain conditions including miR-132, miR-101, and miR-199a. Our review findings further suggest that expression of miRNAs to be significantly associated with increased diabetic disease duration, HbA1C levels, and fibrinogen levels. Our review findings suggest that there is clear association between miRNA expression and chronic neuropathic pain conditions. Therefore, increasing the specificity by selecting a candidate miRNA and identifying its target mRNA is an area of future research.

5.
J Man Manip Ther ; 31(6): 421-434, 2023 12.
Article in English | MEDLINE | ID: mdl-36794952

ABSTRACT

BACKGROUND: Cervical spine mobilizations may differentially modulate both components of the stress response, consisting of the autonomic nervous system and hypothalamic pituitary adrenal-axis, depending on whether the target location is the upper or lower cervical spine. To date, no study has investigated this. METHODS: A randomized, crossover trial investigated the effects of upper versus lower cervical mobilization on both components of the stress response simultaneously. The primary outcome was salivary cortisol (sCOR) concentration. The secondary outcome was heart rate variability measured with a smartphone application. Twenty healthy males, aged 21-35, were included. Participants were randomly assigned to block-AB (upper then lower cervical mobilization, n = 10) or block-BA (lower than upper cervical mobilization, n = 10), separated by a one-week washout period. All interventions were performed in the same room (University clinic) under controlled conditions. Statistical analyses were performed with a Friedman's Two-Way ANOVA and Wilcoxon Signed Rank Test. RESULTS: Within groups, sCOR concentration reduced thirty-minutes following lower cervical mobilization (p = 0.049). Between groups, sCOR concentration was different at thirty-minutes following the intervention (p = 0.018). CONCLUSION: There was a statistically significant reduction in sCOR concentration following lower cervical spine mobilization, and between-group difference, 30 min following the intervention. This indicates that mobilizations applied to separate target locations within the cervical spine can differentially modulate the stress response.


Subject(s)
Manipulation, Spinal , Neck , Humans , Male , Adult , Cross-Over Studies , Cervical Vertebrae , Autonomic Nervous System/chemistry , Autonomic Nervous System/metabolism , Hydrocortisone
6.
Pain Pract ; 23(1): 41-62, 2023 01.
Article in English | MEDLINE | ID: mdl-36617189

ABSTRACT

OBJECTIVE: To investigate whether sensitivity to movement-evoked pain (SMEP), central sensitivity symptom burden, and quantitative sensory testing (QST) outcomes differ between healthy controls and people with chronic shoulder pain. METHODS: People with chronic shoulder pain (n = 39) and healthy controls (n = 26) completed validated questionnaires measuring demographic, pain characteristics, psychological factors, social support, sleep quality, central sensitivity inventory (CSI), and physical activity levels. A blinded assessor administered QST measuring pressure pain threshold, temporal summation, conditioned pain modulation, and cold hyperalgesia. All participants performed repeated lifting of weighted canisters and reported severity of pain over successive lifts of the weighted canisters. Between-group differences in the QST, SMEP and CSI scores were investigated. Demographic and psychosocial variables were adjusted in the analyses. RESULTS: Dynamic mechanical allodynia, mechanical temporal summation, movement-evoked pain scores, SMEP index, and CSI scores were significantly (p ≤ 0.05) higher in the chronic shoulder pain group than in healthy controls. A significant proportion of people with chronic shoulder pain presented with pro-nociceptive profiles and experienced higher pain severity, interference, and disability. CONCLUSIONS: People with chronic shoulder pain displayed symptoms and signs of central sensitization. Future research should investigate the predictive role of central sensitization on clinical outcomes in shoulder pain.


Subject(s)
Chronic Pain , Shoulder Pain , Humans , Central Nervous System Sensitization , Chronic Pain/diagnosis , Chronic Pain/psychology , Cross-Sectional Studies , Hyperalgesia/psychology , Nociception , Pain Measurement , Pain Threshold/physiology , Case-Control Studies
7.
J Back Musculoskelet Rehabil ; 36(1): 137-146, 2023.
Article in English | MEDLINE | ID: mdl-35871318

ABSTRACT

BACKGROUND: Acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. In pathological states, disease-related acupoints are believed to be activated, which is known as acupoint sensitization. OBJECTIVE: This study aimed to investigate the major manifestations of acupoint sensitization in patients with chronic low back pain (cLBP) to provide better understanding of acupoint sensitization phenomena in the context of cLBP. METHODS: This study was a matched-sample cross-sectional study 16 participants diagnosed with cLBP and 16 healthy controls matched in age, sex, and ethnicity were included. The following aspects of sensitization phenomena of targeted points were compared: pressure pain threshold (PPT), skin temperature, surface electrical conductance, receptive field, and morphological change of skin. RESULTS: PPT at points of interest were significantly lower in cLBP participants compared with healthy controls (P< 0.05); in addition, receptive field was found to be larger at left BL 23 in cLBP participants (P< 0.05). There was no statistically significant difference in skin temperature, electrical conductance, or morphology between the two groups. CONCLUSIONS: Reduced PPT at all detected points and enlarged receptive field at left BL 23 were found in cLBP participants. These two features appear key in defining acupoint sensitization in cLBP, and provide evidence for selecting and locating acupuncture points in future clinical studies.


Subject(s)
Acupuncture Therapy , Low Back Pain , Humans , Acupuncture Points , Cross-Sectional Studies , Low Back Pain/therapy , Pain Threshold
8.
J Man Manip Ther ; 30(6): 342-349, 2022 12.
Article in English | MEDLINE | ID: mdl-35343399

ABSTRACT

OBJECTIVES: To develop a clinical algorithm for classifying acute lumbar spondylolysis from nonspecific low back pain in elementary school-aged patients using the classification and regression tree analysis. METHODS: Medical records of 73 school-aged patients diagnosed with acute lumbar spondylolysis or nonspecific low back pain were retrospectively reviewed. Fifty-eight patients were examined for establishing an algorithm and 15 were employed for testing its performance. The following data were retrieved: age, gender, school grades, days after symptom onset, history of low back pain, days of past low back pain, height, weight, body mass index, passive straight leg raise test results, hours per week spent on sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Classification and regression tree analyses were performed 150 times using the bootstrap and aggregating method. Then, the results were integrated by majority vote, establishing an algorithm. RESULTS: Lumbar lordosis angle, days after symptom onset, body mass index, and lumbosacral joint angle were the predictors for classifying those injuries. CONCLUSION: The algorithm can be used to identify elementary school-aged children with low back pain requiring advanced imaging investigation, although a future study with a larger sample population is necessary for validating the algorithm.


Subject(s)
Lordosis , Low Back Pain , Spondylolysis , Child , Humans , Low Back Pain/diagnosis , Retrospective Studies , Lumbar Vertebrae , Spondylolysis/diagnosis , Spondylolysis/epidemiology , Algorithms
9.
BMJ Open ; 12(6): e056771, 2022 06 03.
Article in English | MEDLINE | ID: mdl-36691247

ABSTRACT

INTRODUCTION: Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive. OBJECTIVES: To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage. METHODS AND ANALYSIS: We will follow the methodological framework outlined by Arksey and O'Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis. ETHICS AND DISSEMINATION: Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication.


Subject(s)
Rotator Cuff , Shoulder Pain , Humans , Physical Therapy Modalities , Shoulder Pain/therapy , Systematic Reviews as Topic , Treatment Outcome
10.
Curr Opin Pharmacol ; 62: 97-102, 2022 02.
Article in English | MEDLINE | ID: mdl-34959127

ABSTRACT

Neurodegenerative diseases (NDDs) are a range of neurological disorders featured by neuronal degeneration and apoptosis. Cellular Calcium (Ca2+) and reactive oxygen species (ROS) dyshomeostasis are the earliest and important events in the development of NDDs and may yield promising therapeutic targets for NDDs. Paeoniflorin, a water-soluble monoterpene glucoside, is the major bioactive monomer extracted from the root of Paeonia lactiflora pall. Increasing evidence has suggested that this natural compound might be used to treat various NDDs, and its potential molecular mechanisms are related to the modulation of Ca2+/ROS homeostasis in cells. In addition, paeoniflorin accounts for more than 40% of the total glucosides of herbaceous peonies with abundant herbaceous sources. Furthermore, it has also been validated as a safe extraction in clinical pharmacological research with a wide therapeutic window. Hence, it is rational to anticipate paeoniflorin being a promising candidate for the treatment of NDDs via regulating Ca2+/ROS dyshomeostasis.


Subject(s)
Neurodegenerative Diseases , Paeonia , Glucosides/pharmacology , Glucosides/therapeutic use , Homeostasis , Humans , Monoterpenes/pharmacology , Monoterpenes/therapeutic use , Neurodegenerative Diseases/drug therapy , Reactive Oxygen Species
11.
J Manipulative Physiol Ther ; 44(5): 420-431, 2021 06.
Article in English | MEDLINE | ID: mdl-34376321

ABSTRACT

OBJECTIVE: The purpose of the present study was to determine the neuroendocrine response after a thoracic spinal manipulation in people with Achilles tendinopathy. METHODS: This was a randomized 2-sequence, 2-period crossover trial. A total of 24 participants, mean (standard deviation) age of 48 (7) years, with a diagnosis of Achilles tendinopathy (>3 mo) were randomly assigned into sequence 1 (sham intervention and then thoracic spinal manipulation) or sequence 2 (thoracic spinal manipulation and then sham intervention). The trial was conducted at a university laboratory with a washout period of 1 week. The primary outcome measure was the testosterone/cortisol (T/C) ratio (salivary samples). The secondary outcome measures included heart rate variability (measured with electrocardiography) and total oxygenation index (nmol/L) of calf muscle and Achilles tendon (measured with near-infrared spectroscopy). A 2-way mixed-model analysis of variance was performed. The statistic of interest was the condition by time interaction. RESULTS: A statistically significant condition by time interaction was found for the T/C ratio (mean difference: -0.16; confidence interval: -0.33 to 0.006; interaction: P < .05) and the total oxygenation index (mean difference: 1.35; confidence interval: -1.3 to 4.1; interaction: P < .05) of calf muscle but not for Achilles tendon (P = .6); however, no difference was found for heart rate variability (P = .5). CONCLUSION: In people with Achilles tendinopathy, thoracic spinal manipulation resulted in immediate increase in the total oxygenation index in the calf muscle followed by an increase in the T/C ratio 6 hours post-intervention.


Subject(s)
Achilles Tendon , Manipulation, Spinal , Tendinopathy , Cross-Over Studies , Humans , Middle Aged , Muscle, Skeletal , Tendinopathy/therapy
12.
BMC Health Serv Res ; 21(1): 695, 2021 Jul 15.
Article in English | MEDLINE | ID: mdl-34266436

ABSTRACT

BACKGROUND: Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. METHODS: The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. RESULTS: A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. DISCUSSION: Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.


Subject(s)
Musculoskeletal Pain , Osteopathic Physicians , Attitude of Health Personnel , Health Personnel , Humans , Musculoskeletal Pain/therapy , Qualitative Research
13.
J Man Manip Ther ; 29(5): 318-331, 2021 10.
Article in English | MEDLINE | ID: mdl-34279185

ABSTRACT

OBJECTIVE: To describe individual long-term outcomes of people with persistent symptoms following a concussion who received neck treatment as part of multidisciplinary concussion care. A secondary objective is to report on how participants describe the outcomes of neck treatmentMethods: Long-term follow-up for a subgroup of participants in a prospective case series (n = 11). Data were collected at initial assessment, completion of neck treatment, 6 and 12 months including standard questionnaires (Rivermead post-concussion symptoms questionnaire, neck disability index, dizziness handicap inventory); patient-reported measures of headache, dizziness and neck pain and participant descriptions of the effects of neck treatmentResults: Grouped measures of post-concussion symptoms were further improved or sustained at 6 and 12 months. Ten of the 11 participants reported neck treatment as a beneficial part of their care and described the effects on the neck, multiple symptoms and their overall recovery. However, seven participants experienced recurrent headache, neck pain or dizziness at 6- or 12-month follow-up. CONCLUSION: Long-term follow-up of individuals receiving neck treatment shows improvement across a range of patient reported outcomes, yet highlights frequent recurrence of symptoms. Neck treatment can play a valuable role in people's recovery that extends beyond local effects on the neck.


Subject(s)
Brain Concussion , Post-Concussion Syndrome , Brain Concussion/complications , Brain Concussion/diagnosis , Brain Concussion/therapy , Follow-Up Studies , Headache/etiology , Humans , Neck , Post-Concussion Syndrome/diagnosis , Post-Concussion Syndrome/therapy
14.
PLoS One ; 16(5): e0250685, 2021.
Article in English | MEDLINE | ID: mdl-33939740

ABSTRACT

BACKGROUND: Chinese herbal footbaths are an external therapy of traditional Chinese medicine that has been widely used to treat dysmenorrhea. This review aims to systematically evaluate its efficacy and safety for the treatment of dysmenorrhea. METHODS: Databases of PubMed, EMBASE, Cochrane Library, CIHAHL, Web of Science, Chinese National Knowledge Infrastructure(CNKI), Chinese Scientific Journals Database (VIP), Wanfang Database, China Biomedical Literature Database(CBM), and Chinese Biomedical Literature Service System (SinoMed) will be searched from the inception to September 30, 2020. The eligible randomized controlled trials (RCTs) will be identified and included. The primary outcomes include pain intensity measured by validated scales of visual analog scale, numeric rating scale, and response rate of symptom reduction. The secondary outcomes are scores on validated pain questionnaires, quality of life measured by SF-36 or other validated scales, and adverse events. Study selection, data extraction, and assessment of bias risk will be conducted by two reviewers independently. RevMan software (V.5.3.5) will be utilized to perform data synthesis. Subgroup and sensitivity analysis will be performed when necessary. The strength of the evidence will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation System. RESULTS: A high-quality synthesis of current evidence of Chinese herbal footbaths for patients with dysmenorrhea will be provided in this study. CONCLUSION: This systematic review will provide evidence of whether Chinese herbal footbaths are an effective and safe intervention for the treatment of dysmenorrhea. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020188256.


Subject(s)
Baths , Drugs, Chinese Herbal/therapeutic use , Dysmenorrhea/therapy , Foot , Female , Humans
16.
BMC Complement Med Ther ; 21(1): 63, 2021 Feb 13.
Article in English | MEDLINE | ID: mdl-33583417

ABSTRACT

BACKGROUND: The prevalence of CAM use is increasing. This integrative review investigated New Zealand healthcare professionals' practice of, attitudes toward, and knowledge about complementary and alternative medicine (CAM). METHODS: Literature search was conducted in four databases from inception to April 2020. Studies were included if they reported results from primary data collection on practice of, attitudes toward, or knowledge about CAM amongst New Zealand healthcare professionals. RESULTS: Eleven studies (two of 'high-quality', seven of 'moderate-quality', and two of 'low-quality') were identified with 2060 healthcare professionals including general practitioners (GPs), nurses, midwives, pharmacists, physiotherapists, and medical specialists. New Zealand healthcare professionals were generally positive regarding CAM use, but have concerns on the scientific evidence, regulation, safety, financial costs of CAM, and encourage an evidence-based CAM practice and stronger CAM regulation. Findings indicated that around 25% of GPs practise CAM, and 82.3% refer patients to CAM practitioners. When treating pregnant women, 48.4% of physiotherapists practise acupuncture, and 37.3% of midwives recommend CAM. GPs believe that acupuncture is the most helpful CAM modality, and most commonly practiced and referred patients to acupuncture. Up to 58% of GPs and Plunket nurses wanted to receive further education on CAM, and up to 66.7% GPs favour the idea CAM should be included in medical curriculums. CONCLUSIONS: Nine of the 11 included studies were of moderate to high quality, thus enhancing the reliability of the review findings. In order to better manage CAM in New Zealand New Zealand clinical settings, there is a need to invest in CAM research and education, and enhance CAM regulation. This review is a first step in developing an evidence base to offer insights for further development of effective CAM policies regarding safety, efficacy, regulation and integration in New Zealand.


Subject(s)
Complementary Therapies/statistics & numerical data , Health Knowledge, Attitudes, Practice , Health Personnel/statistics & numerical data , Adult , Delivery of Health Care/statistics & numerical data , Female , Humans , Male , Middle Aged , New Zealand , Surveys and Questionnaires , Young Adult
17.
Spine (Phila Pa 1976) ; 46(15): 1026-1032, 2021 Aug 01.
Article in English | MEDLINE | ID: mdl-33395023

ABSTRACT

STUDY DESIGN: Case-control study. OBJECTIVE: The aim of this study was to establish an algorithm to distinguish acute lumbar spondylolysis (LS) from nonspecific low back pain (NSLBP) among patients in junior high school by classification and regression tree (CART) analysis. SUMMARY OF BACKGROUND DATA: Rapid identification of acute LS is important because delayed diagnosis may result in pseudarthrosis in the pars interarticularis. To diagnose acute LS, magnetic resonance imaging (MRI) or computed tomography is necessary. However, not all adolescent patients with low back pain (LBP) can access these technologies. Therefore, a clinical algorithm that can detect acute LS is needed. METHODS: The medical records of 223 junior high school-aged patients with diagnosed acute NSLBP or LS verified by MRI were reviewed. A total of 200 patients were examined for establishing the algorithm and 23 were employed for testing the performance of the algorithm. CART analysis was applied to establish the algorithm using the following data; age, sex, school grades, days after symptom onset, history of LBP, days of past LBP, height, passive straight leg raising test results, hours per week spent in sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Sensitivity and specificity of the algorithm and the area under the ROC curve were calculated to assess algorithm performance. RESULTS: The algorithm revealed that sex, days after symptom onset, days of past LBP, hours per week spent in sports activities, and existence of spina bifida were key predictors for identifying acute LS versus NSLBP. Algorithm sensitivity was 0.64, specificity was 0.92, and the area under the ROC curve was 0.79. CONCLUSION: The algorithm can be used in clinical practice to distinguish acute LS from NSLBP in junior high school athletes, although referral to MRI may be necessary for definitive diagnosis considering the algorithm's sensitivity.Level of Evidence: 4.


Subject(s)
Algorithms , Athletes , Low Back Pain/diagnosis , Spondylolysis/diagnosis , Case-Control Studies , Decision Support Systems, Clinical , Diagnosis, Differential , Humans , Low Back Pain/physiopathology , Regression Analysis , Retrospective Studies , Spondylolysis/physiopathology
18.
Oral Dis ; 27(5): 1115-1126, 2021 Jul.
Article in English | MEDLINE | ID: mdl-32964596

ABSTRACT

The objective was to explore the effectiveness of photobiomodulation therapy for treating patients who suffer xerostomia and/or hyposalivation due to the most prevalent clinical diagnoses. We searched PubMed, Scopus, Web of Science, CINAHL and Cochrane Library for randomized or clinical controlled trials published until 31 October 2019. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 274 records were retrieved, and 11 met the inclusion criteria. Interventions whose parameters ranged between wavelengths of 790-830 nm (infrared), 30-120 mW of power and an energy density below 30 J/cm-2 were associated with improvements in xerostomia/hyposalivation. As for the assessment of methodological quality, 10 of the 11 articles included had a high risk of overall bias. Only 3 articles provided sufficient information to conduct a meta-analysis for quality of life, compared with placebo in patients with burning mouth syndrome, showing a standardized mean difference between groups from baseline of -0.90 (-1.48; -0.32). The present review and meta-analysis suggest that photobiomodulation therapy is an effective, non-invasive and safe approach in patients with xerostomia. However, despite the potential, it is not possible to reach a reliable consensus on the parameters to be used, and future studies should be conducted by standardizing intervention protocols.


Subject(s)
Burning Mouth Syndrome , Low-Level Light Therapy , Xerostomia , Humans , Quality of Life , Xerostomia/etiology , Xerostomia/therapy
19.
Pain Pract ; 21(2): 226-261, 2021 02.
Article in English | MEDLINE | ID: mdl-32696604

ABSTRACT

OBJECTIVE: Alteration in somatosensory function has been linked to pain experience in individuals with joint pain. In this systematic review we aimed to establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function that were assessed via quantitative sensory testing (QST) among individuals with joint pain. METHODS: A comprehensive literature search was conducted in 6 electronic databases from their inception to July 2019. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS: Seventeen studies related to joint pain were included. Pain catastrophizing, depression, anxiety, and physical activity level have been shown to have a significant (small to fair) association with several QST measures. Pressure pain threshold (PPT) is the only measure that was found to be consistently correlated with all the domains. The overall quality of evidence for all factors ranged from very low to moderate. Subgroup analysis revealed a stronger association for depression and pain catastrophizing and PPT and temporal pain summation in individuals with shoulder pain. CONCLUSION: Psychological factors and physical activity levels are associated with somatosensory function in people with joint pain. These factors need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with joint pain.


Subject(s)
Arthralgia/physiopathology , Arthralgia/psychology , Central Nervous System Sensitization/physiology , Exercise/physiology , Sleep/physiology , Catastrophization/physiopathology , Catastrophization/psychology , Humans , Pain Threshold/physiology , Pain Threshold/psychology , Qualitative Research
20.
J Eval Clin Pract ; 27(5): 1159-1163, 2021 10.
Article in English | MEDLINE | ID: mdl-32941698

ABSTRACT

RATIONALE: Decision-making in musculoskeletal health care is complex, with discrepancy among clinical providers and variation in the per cent of referrals for specialist care. To date, there is an increased focus on specialist referrals, risking overuse of expensive testing and contributing to unnecessary treatment. AIMS AND OBJECTIVES: This report will considerer the difficulties of primary care musculoskeletal decision-making using shoulder injuries as an example, presenting a solution based on multi-criteria decision-making analysis with online software. The associated issues involved in clinical decision-making are complex. Contributing to the components of complexity are; the multifaceted aetiology of shoulders, the experience and knowledge of providers, and the burden of patient demands. Notwithstanding, funding considerations, resource allocation availability and other associated issues around clinical decision-making. Considering the many facets and complexities of clinical decision-making, this is an area where multi-criteria decision-making analysis (MCDM) may be appropriate. The MCDM analysis approach is increasingly being used in health care and can assist in the organizing and weighting of identified key clinical factors. MCDM could be applied to the challenges of musculoskeletal care with the potential to decrease decision-making variability. Furthermore, the significance of each key clinical factor that musculoskeletal decision-making is based on are to date unclear. CONCLUSION: Therefore, this preliminary report offers a start towards clarifying key factors and an approach for implementing improved shoulder clinical care decision-making which could then be adapted and applied to other body sites.


Subject(s)
Decision Making , Shoulder , Clinical Decision-Making , Humans , Primary Health Care , Referral and Consultation , Shoulder/surgery
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