An efficient strategy allowed English-speaking reviewers to identify foreign-language articles eligible for a systematic review.

OBJECTIVE: To assess English-speaking reviewers' accuracy in determining the eligibility of foreign-language articles for a systematic review. STUDY DESIGN AND SETTINGS: Systematic review of randomized controlled trials of therapy for fibromyalgia. Guided by 10 questions, English-speaking reviewers screened non-English-language articles for eligibility. Teams of two native-language speakers provided reference standard judgments of eligibility. RESULTS: Of 15,466 potentially eligible articles, we retrieved 763 in full text, of which 133 were published in 19 non-English languages; 53 trials published in 11 languages other than English proved eligible. Of the 53 eligible articles, English-language reviewers guided by the 10 questions mistakenly judged 6 as ineligible; of the 80 ineligible articles, 8 were incorrectly judged eligible by English-language reviewers (sensitivity=0.89; specificity=0.90). Use of a simple three-step rule (excluding languages with less than three articles, reviewing titles and abstracts for clear indications of eligibility, and noting the lack of a clearly reported statistical analysis unless the word "random" appears) led to accurate classification of 51 of 53 articles (sensitivity=0.96; specificity=0.70). CONCLUSION: Our findings show promise for limiting the need for non-English-language review teams in systematic reviews with large numbers of potentially eligible non-English-language articles.

The clinical and biomechanical effects of fascial-muscular lengthening therapy on tight hip flexor patients with and without low back pain.

BACKGROUND: Many patients have tight hip flexors with or without low back pain. Manual fascial-muscular lengthening therapy (FMLT) is one commonly used treatment for this population. OBJECTIVE: Investigate the clinical and biomechanical effects of manual FMLT on tight hip flexor patients with and without low back pain. METHODS: A nonrandomized trial, before-and-after experiment with multiple baselines conducted on two different patient populations: 1) Mechanical low back pain patients with tight hip flexors (n = 10) and 2) Asymptomatic group with tight hip flexors (n = 8). Four treatments of manual FMLT were performed on the hip flexor of the two groups of patients over a two-week period. Primary outcome measures over the two-week period were 1) Maximum voluntary trunk flexor and extensor moments, 2) Disability (Roland Morris Disability Questionnaire) and pain (10-cm Visual Analogue Scale), 3) Passive hip extension mobility. RESULTS: Primary outcome analysis involved within-groups comparisons. Maximum voluntary trunk extension demonstrated increases for the low back pain patients. The low back pain patients demonstrated a small, but significant, reduction in disability and pain. Both groups demonstrated an increase in passive hip extension measurements. CONCLUSION: This preliminary study demonstrated interesting results from manual FMLT on two tight hip flexor patient populations with and without low back pain. However, there were several significant limitations from this study, which restrict the ability to generalize the results.

HISTORIQUE: De nombreux patients ont des muscles fléchisseurs de la hanche serrés, avec ou sans douleur lombaire. La thérapie manuelle d'allongement musculo-facial (TMAMF) est un traitement couramment utilisé pour ces personnes. Objectif : Étudier les effets cliniques et biomécaniques de la TMAMF sur les patients dont les muscles fléchisseurs de la hanche sont serrés, qu'ils souffrent ou non de douleurs lombaires. MÉTHODOLOGIE: Un essai non randomisé effectué avant et après l'expérience avec plusieurs références sur deux groupes de patients différents : 1) des patients souffrant de douleurs lombaires de nature mécanique et dont les muscles fléchisseurs de la hanche sont serrés (n = 10) et 2) un groupe asymptomatique dont les membres ont des muscles fléchisseurs de la hanche serrés (n = 8). Quatre séances de TMAMF ont été réalisées sur le muscle fléchisseur de la hanche des patients des deux groupes pendant deux semaines. Les principaux critères d'évaluation au cours des deux semaines étaient : 1) couple maximal volontaire des muscles fléchisseurs et extenseurs du tronc, 2) handicap (questionnaire sur les handicaps de Roland Morris) et douleur (échelle visuelle analogique de 10 cm), 3) amplitude d'extension passive de la hanche. RÉSULTATS: L'analyse des principaux résultats comportait des comparaisons entre les groupes. L'extension maximale volontaire du tronc a augmenté chez les patients atteints de lombalgie. Ces patients ont démontré une réduction faible, mais significative, de l'invalidité et de la douleur. Chez les deux groupes, on a enregistré une augmentation des mesures d'extension passive de la hanche. CONCLUSION: Cette étude préliminaire a produit des résultats intéressants de la TMAMF sur deux groupes de patients dont les muscles fléchisseurs de la hanche sont serrés, à savoir ceux qui souffrent de douleurs lombaires et ceux qui sont asymptomatiques. Cependant, l'étude comportait plusieurs lacunes importantes qui limitent la possibilité de généraliser ses résultats.

Systematic review and network meta-analysis of interventions for fibromyalgia: a protocol.

BACKGROUND: Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments. METHODS/DESIGN: We will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently perform data abstraction and assess risk of bias of eligible trials. We will conduct meta-analyses to establish the effect of all reported therapies on patient-important outcomes when possible. To assess relative effects of treatments, we will construct a random effects model within the Bayesian framework using Markov chain Monte Carlo methods. DISCUSSION: Our review will be the first to evaluate all treatments for fibromyalgia, provide relative effectiveness of treatments, and prioritize patient-important outcomes with a focus on functional gains. Our review will facilitate evidence-based management of patients with fibromyalgia, identify key areas for future research, and provide a framework for conducting large systematic reviews involving indirect comparisons.

A randomized, placebo-controlled double-blinded comparative clinical study of five over-the-counter non-pharmacological topical analgesics for myofascial pain: single session findings.

OBJECTIVES: To investigate the effects of topical agents for the treatment of Myofascial Pain Syndrome (MPS) and Myofascial Trigger Point (MTRP). METHODS: Subjects with an identifiable trigger point in the trapezius muscle, age 18-80 were recruited for a single-session randomized, placebo-blinded clinical study. Baseline measurements of trapezius muscle pressure pain threshold (PPT: by pressure algometer) along with right and left cervical lateral flexion (rangiometer) were obtained by a blinded examiner. An assessor blinded to the outcomes assessments applied one of 6 topical formulations which had been placed in identical plastic containers. Five of these topicals were proposed active formulations; the control group was given a non-active formulation (PLA). Five minutes after the application of the formula the outcome measures were re-tested. Data were analyzed with a 5-way ANOVA and Holms-adjusted t-tests with an alpha level of 0.05. RESULTS: 120 subjects were entered into the study (63 females; ages 16-82); 20 subjects randomly allocated into each group. The pre- and post-treatment results for pressure threshold did show significant intra-group increases for the Ben-Gay Ultra Strength Muscle Pain Ointment (BG), the Professional Therapy MuscleCare Roll-on (PTMC roll-on) and Motion Medicine Cream (MM) with an increased threshold of 0.5 kg/cm2 (+/-0.15), 0.72 kg/cm2 (+/-0.17) and 0.47 Kg/cm2 (+/-0.19) respectively. With respect to the inter-group comparisons, PTMC roll-on showed significant increases in pressure threshold compared with Placebo (PLA) (p = 0.002) and Icy Hot Extra Strength Cream (IH) (p = 0.006). In addition, BG demonstrated significant increases in pressure threshold compared with PLA (p = 0.0003). CONCLUSIONS: With regards to pressure threshold, PTMC roll-on, BG and MM showed significant increases in pain threshold tolerance after a short-term application on a trigger points located in the trapezius muscle. PTMC roll-on and BG were both shown to be superior vs placebo while PTMC was also shown to be superior to IH in patients with trigger points located in the trapezius muscle on a single application.CMCC Research Ethics Board Approval # 1012X01, 2011.

Femoral neck stress fracture in a female athlete: a case report.

OBJECTIVE: The purpose of this case report is to describe chiropractic rehabilitation of a master's-level athlete with proximal femoral stress fracture and provide a brief discussion of stress fracture pathology. CLINICAL FEATURES: A 41-year-old female master's-level endurance athlete presented with chronic groin pain later diagnosed and confirmed by magnetic resonance imaging as a stress fracture of the femoral neck. After diagnosis, the patient was referred to a doctor of chiropractic at week 1 of the non-weight-bearing physical rehabilitation process. At that time, the patient presented with sharp and constant groin pain rated 6/10 on a numeric rating scale. INTERVENTION AND OUTCOME: This patient avoided weight-bearing activity for 8 weeks while cross-training and was able to return to her sport after this period. The patient was progressed through a series of non-weight-bearing strengthening exercises for the lower extremity. Myofascial release therapy was performed on the gluteal, hip flexor, and groin muscle groups to improve range of motion. Motion palpation testing the lumbar and sacroiliac joints was performed during each session, and manipulative therapy was performed when necessary. The patient was seen once a week for 8 weeks. Reevaluation was performed at week 8; at that time, the patient reported no groin pain (0/10). The patient was discharged from care and referred back to the supervising physician for clearance to return to sporting activities. One month after discharge, she reported that she was pain free and had fully returned to sport activities. CONCLUSION: This case report demonstrates the importance of a through clinical history, physical examination, and magnetic resonance imaging in the accurate diagnosis of a patient with chronic groin pain and that chiropractic care can contribute to rehabilitation programs for these injuries.

Lunotriquetral instability in a climber - case report and review.

Wrist injuries and carpal instability may result from various sport-related acitivites. Lunotriquetral instability (LTI) is an infrequently recognized cause of wrist pain in athletes. The diagnosis of LTI through history and physical examination can be confirmed by Magnetic Resonance Arthrogram (MRA). This case report describes a case of clinically suspected LTI confirmed by MRA. Relevant literature on lunotriquetral injuries is discussed. Lunotriquetral joint injury can present itself and should be considered within a differential diagnosis of a wrist injury. The diagnosis of LTI through clinical history and physical examination can be confirmed by MRA. This case report demonstrates the importance of MRA in the accurate diagnosis and management of a patient with wrist pain.

Adductor tendinopathy in a hockey player with persistent groin pain: a case report.

Groin pain may stem from a variety of different causes. Adductor tendinopathy is a common but infrequently recognised cause of chronic groin pain especially in athletes. This case report describes a case of clinically suspected adductor tendinopathy in an amateur athlete confirmed by MRI (Magnetic Resonance Imaging). Relevant literature on musculotendinous injuries of the groin along with differential diagnosis for groin pain is discussed. There are several differential diagnoses for athletes that present with groin pain. Therefore, it is important to accurately diagnose the origin of groin pain as the plan of management is dependent of the specificity of the diagnosis. The diagnosis of adductor tendinopathy is made with a history of chronic groin pain along with pain/weakness during isometric adduction of the hip muscles. It is confirmed by MR imaging.