Which portion of physiotherapy treatments' effect is attributable to contextual effects in people with musculoskeletal pain?: A meta-analysis of randomised placebo-controlled trials.

OBJECTIVE: To quantify the proportion attributable to contextual effects of physical therapy interventions for musculoskeletal pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched Ovid, MEDLINE, EMBASE, CINAHL, Scopus, PEDro, Cochrane Controlled Trials Registry, and SPORTDiscus databases from inception to April 2023. STUDY SELECTION CRITERIA: Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain. DATA SYNTHESIS: Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (ROB 2.0). The proportion of physical therapy interventions effect that is explained by contextual effects was calculated, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method). RESULTS: Sixty-eight studies were included in the systematic review (participants: n=5,238), and 54 placebo-controlled trials informed our meta-analysis (participants: n=3,793). Physical therapy interventions included soft tissue techniques, mobilization, manipulation, taping, exercise therapy and dry needling. Placebo interventions included manual, non-manual interventions, or both. The proportion attributable to contextual effects of mobilization accounted for 88% of the immediate overall treatment effect for pain intensity (PCE=0.88, 95%CI 0.57-1.20). In exercise therapy, contextual effects accounted for 46% of the overall treatment effect for pain intensity (PCE=0.46, 95%CI 0.41-0.52). Contextual effects in manipulation excelled in short-term pain relief (PCE=0.81, 95%CI 0.62-1.01) and in mobilization in long-term effects (PCE=0.86, 95%CI 0.76-0.96). In taping, contextual effects accounted for 64% of disability improvement (PCE=0.64, 95%CI 0.48-0.80). CONCLUSION: The outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by contextual effects. Boosting contextual effects consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients.

Effectiveness of non-surgical management in rotator cuff calcific tendinopathy (the effect trial): protocol for a randomised clinical trial.

INTRODUCTION: Rotator cuff calcific tendinopathy (RCCT) involves calcific deposits in the rotator cuff. Non-surgical interventions such as extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) are recommended for its early management. Exercise therapy (ET) has shown to be an effective intervention for people with rotator cuff tendinopathy, but it has not been formally tested in RCCT. The main objective of this study is to compare the effectiveness of an ET programme with ESWT and US-PICT in people with RCCT. As a secondary aim, this study aims to describe the natural history of RCCT. METHODS AND ANALYSIS: A randomised, single-blinded four-group clinical trial will be conducted. Adults from 30 to 75 years diagnosed with RCCT who accomplish eligibility criteria will be recruited. Participants (n=116) will be randomised into four groups: ET group will receive a 12-week rehabilitation programme; ESWT group will receive four sessions with 1 week rest between sessions during 1 month; US-PICT group will receive two sessions with 3 months of rest between sessions; and (actual) wait-and-see group will not receive any intervention during the 12-month follow-up. The primary outcome will be shoulder pain assessed with the Shoulder Pain and Disability Index at baseline, 2 weeks, 4 months, 6 months and 12 months from baseline. The primary analysis will be performed at 12 months from baseline. Secondary outcomes will include pain, range of motion, patient satisfaction and imaging-related variables. Moreover, the following psychosocial questionnaires with their corresponding outcome measure will be assessed: Central Sensitization Inventory (symptoms related to central sensitization); Pain Catastrophizing Scale (pain catastrophizing); Tampa Scale for Kinesiophobia 11 items (fear of movement); Fear Avoidance Belief Questionnaire (fear avoidance behaviour); Hospital Anxiety and Depression Scale (anxiety and depression); Pittsburgh Sleep Quality Index (sleep quality); and the EuroQol-5D (quality of life). An intention-to-treat analysis will be performed to reduce the risk of bias using a worst-case and best-case scenario analysis. ETHICS AND DISSEMINATION: Ethics committee approval for this study has been obtained (reference number: 1718862). The results of the main trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05478902.

Exploration of the clinical course and longitudinal correlations in frozen shoulder: The role of autonomic function, central pain processing, and psychological variables. A longitudinal multicenter prospective observational study.

BACKGROUND: Altered central pain processing (CPP) and dysautonomia might play a role in the clinical course of frozen shoulder and psychological factors, like pain catastrophizing and hypervigilance, might influence clinical variables in frozen shoulder. OBJECTIVES: To explore the clinical course of frozen shoulder regarding CPP, dysautonomia, pain catastrophizing, and hypervigilance and to explore whether longitudinal correlations between these outcomes and pain intensity were present. DESIGN: prospective longitudinal observational study. METHOD: Participants with frozen shoulder were recruited at hospitals and general practitioner practices and followed for 9 months. They completed six questionnaires (about demographics, shoulder pain and disability, pain intensity, pain catastrophizing, pain hypervigilance, and autonomic symptoms) and underwent tactile sensitivity (allodynia), pressure pain thresholds (hyperalgesia), temporal summation, and conditioned pain modulation during four timeframes (3-month intervals). RESULTS: Initially, 149 participants with frozen shoulder were recruited and 88 completed all the measurements. An improvement from baseline to at least one follow-up measurement was found for shoulder pain and disability, pain intensity, pain catastrophizing, hypervigilance, and dysautonomia. A fair longitudinal correlation was found between pain intensity and catastrophizing and hypervigilance (r = 0.301-0.397). Poor longitudinal correlations were found between pain intensity and allodynia and hyperalgesia (r = -0.180-0.193), between pain catastrophizing and dysautonomia (r = 0.209) and between hypervigilance and hyperalgesia (r = -0.159). CONCLUSION: Patients with frozen shoulder showed an early improvement that flattened with time in several pain and psychological variables over the course of 9 months. However, autonomic symptoms rather showed a late improvement over 9 months.

Deepening the understanding of the structural validity of the Tilburg Frailty Indicator.

BACKGROUND: Psychometric properties of the Tilburg Frailty Indicator (TFI) have shown low internal consistency for psychological and social domains, and evidence for its structure validity is controversial. Moreover, research on TFI is frequently limited to community dwellings. AIMS: To evaluate structural validity, reliability, and convergent and divergent validity of the Spanish version of the Tilburg Frailty Indicator (TFI) in both community-dwelling and institutionalized older people. MATERIALS AND METHODS: A cross-sectional study was conducted on Spanish older adults (n = 457) recruited from both community settings (n = 322) and nursing homes (n = 135). Participants completed the TFI and other frailty instruments: Fried's Frailty Phenotype, Edmonton Frailty Scale, FRAIL Scale, and Kihon Checklist (KCL). Confirmatory Factor Analysis (CFA), and reliability and validity coefficients were estimated. RESULTS AND DISCUSSION: Some items from physical and social domains showed low factor loadings (< 0.40). The three-factor CFA model showed better fit indices after depurating these items. Reliability estimates were good (CRI ≥ 0.70) for physical and psychological domains in the institutionalized sample, while in the community dwellings, only physical domain reliability was adequate. Convergent and divergent validity of physical and psychological domains was good, except for some alternative psychological measures highly correlating with the TFI physical component (KCL-depressive mood and Edmonton mood). However, the social domain showed low correlations with some social indicators. CONCLUSION: The findings of this study clarify some of the controversial validation results of the TFI structure and provide evidence to improve its use in psychometric terms. CLINICAL TRIAL REGISTRATION NUMBER: NCT03832608.

Is there any benefit of adding a central nervous system-focused intervention to a manual therapy and home stretching program for people with frozen shoulder? A randomized controlled trial.

BACKGROUND: Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion. The aim of this study was to evaluate the effect of adding a central nervous system (CNS)-focused approach to a manual therapy and home stretching program in people with FS. METHODS: A total of 34 patients with a diagnosis of primary FS were randomly allocated to receive a 12-week manual therapy and home stretching program or manual therapy and home stretching program plus a CNS-focused approach including graded motor imagery and sensory discrimination training. The Shoulder Pain and Disability Index score, self-perceived shoulder pain (visual analog scale score), shoulder range of motion, and the Patient-Specific Functional Scale score were measured at baseline, after a 2-week washout period just before starting treatment, after treatment, and at 3 months' follow-up. RESULTS: No significant between-group differences in any outcome were found either after treatment or at 3 months' follow-up. CONCLUSION: A CNS-focused approach provided no additional benefit to a manual therapy and home stretching program in terms of shoulder pain and function in people with FS.

The effect of an abdominopelvic exercise program alone VS in addition to postural instructions on pelvic floor muscle function in climacteric women with stress urinary incontinence. A randomized controlled trial.

INTRODUCTION: Scarce literature exists regarding the influence of posture-based interventions for the treatment of stress urinary incontinence (SUI). OBJECTIVE: The aim of this randomized controlled trial with two parallel groups was to investigate whether the addition of postural instructions to a 12-week abdominopelvic exercise program is superior to an abdominopelvic exercise program alone, in terms of PFMs function and symptoms in climacteric women with SUI. METHODS: Climacteric women aged between 40-75 years old who presented with SUI were included in this parallel study (NCT03727945). Two randomized groups performing one 40-minutes session per week for 12-weeks were compared: one performing an abdominopelvic exercise program (AEP) and a second one performing the same intervention with the addition of postural instructions (AEPPI). PFMs electromyographical (EMG) activity and strength (Oxford Grading Scale) were quantified during a maximal voluntary contraction. SUI symptoms were assessed using a 3-day bladder diary. These outcomes were collected at baseline, immediately after intervention, and 3-months after the intervention. RESULTS: A total of 47 women were included in the study (AEP [n = 23], AEPPI [n = 24]). Between-group analysis showed significant differences for post-intervention EMG and strength values, showing higher values for the AEPPI compared to the AEP group. At 3-months follow-up, statistically significant differences were only obtained in strength, with higher values in the AEPPI group. No significant differences were obtained in terms of UI symptoms. CONCLUSION: A 12-session abdominopelvic exercise program supplemented with postural instructions is superior to an abdominopelvic exercise program alone in terms of PFMs function in women with SUI.

An Instrument-Assisted Coracoid Pain Test: An Exploratory Diagnostic Accuracy Study.

The coracoid pain test (CPT) could contribute to the diagnosis of frozen shoulder (FS) with palpation. However, due to assessor performance these values might be unreliable. Therefore, the aim was to explore the diagnostic accuracy of an instrument-assisted CPT and two alternative approaches (pain severity and side comparison) for assistance in the diagnosis of FS. Patients with FS and healthy age-matched controls were recruited. All participants underwent the instrument-assisted CPT on both shoulders with a pressure algometer. Sensitivity, specificity, and likelihood ratios were determined for the three approaches. In total, 35 patients with FS and 35 healthy participants were included. The original approach was positive in eight participants (11.4%), with only sufficient specificity to draw a conclusion. The pain severity approach was positive in 31 participants (44.3%) with sufficient sensitivity, specificity and likelihood ratios. The side comparison approach was positive in 10 participants (14.3%) with excellent specificity and positive likelihood ratio. The specificity of the instrument-assisted CPT can be used to increase the probability of FS with both the original and alternative approaches. Only the pain severity approach can draw a conclusion with a negative test result. This study should be repeated with a cross-sectional design to strengthen and confirm the conclusions.

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study.

Background: Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion (ROM). The aim of this study is to evaluate the feasibility and clinical impact of a CNS-focused treatment program for people with FS. Methods: 10 subjects with primary FS received a 10-week CNS-focused intervention including sensory discrimination training and graded motor imagery techniques delivered as clinic sessions (60 min) and home therapy (30 min five times per week). Measurements were taken at baseline, after a 2-week "washout" period, after treatment, and at three months follow-up. The Shoulder Pain and Disability Index (SPADI) was the primary outcome. Secondary measures were feasibility-related outcomes, self-reported shoulder pain, active and passive range of motion, two-point discrimination threshold (TPDT), left/right judgement task (LRJT), fear-avoidance (Tampa Scale for Kinesiophobia), pain catastrophization (Pain Catastrophizing Scale), and pain sensitization (Central Sensitization Inventory). A Student's t-test was used to assess the "washout" period. A repeated measure analysis of variance (ANOVA) was used to evaluate within-subjects' differences for all outcome measures in the different assessment periods and a pairwise analysis was used to compare between the different assessment points. Statistical significance was set at p < 0.05. Results: 70% of participants completed the treatment. No significant changes were found after "washout" period except for TPDT (p = 0.02) and SPADI (p = 0.025). Improvements in self-reported shoulder pain (p = 0.028) and active shoulder flexion (p = 0.016) were shown after treatment (p = 0.028) and follow-up (p = 0.001) and in SPADI at follow-up (p = 0.008). No significant changes were observed in TPDT, LRJT, fear-avoidance, pain catastrophization, and pain sensitization. Conclusions: a CNS-focused treatment program might be a suitable approach to improve pain and disability in FS, but further research is needed to draw firm conclusions.

Differences in Inter-Rectus Distance and Abdominopelvic Function between Nulliparous, Primiparous and Multiparous Women.

Widening of the inter-rectus distance (IRD) is highly prevalent among postpartum women and can lead to dysfunction of abdominopelvic muscles. The aim of this study was to evaluate the differences in IRD and abdominopelvic function between nulliparous, primiparous and multiparous women. A cross-sectional study was conducted on 75 women (25 nulliparous, 25 primiparous and 25 multiparous at 6 months postpartum). The participants underwent ultrasound assessment under three conditions (at rest, abdominal draw-in maneuver (ADIM) and curl-up) at two locations (2 cm above and 2 cm below the umbilicus). Furthermore, abdominopelvic muscle function was determined by prone, supine and side bridge tests. In all conditions and locations, the IRD were significantly higher (p < 0.05) in the primiparous and multiparous women than in the nulliparous. The multiparous women presented greater (p > 0.05) IRD at rest and during ADIM compared to the primiparous women. Regarding abdominopelvic muscle function, differences were only significant (p < 0.05) between the nulliparous with primiparous women in prone and supine conditions. These findings suggest that parity influences IRD: women at 6 months postpartum present greater IRD compared to nulliparous women; multiparous women present greater IRD at rest and during the activation of deep abdominal muscles than primiparous women; and primiparous women exhibit worse abdominopelvic muscle function than nulliparous women.

Differences in myoelectric activity of the lumbar muscles between recurrent and chronic low back pain: a cross-sectional study.

BACKGROUND: Altered lower back muscle activity is proposed as a contributing factor to the reoccurrence and chronicity of low back pain (LBP). This study compared lumbar muscle activity during trunk extension in patients with continuous chronic LBP (CLBP), non-continuous CLBP, recurrent LBP (RLBP) and healthy subjects. METHODS: In 75 subjects (16 continuous CLBP, 15 non-continuous CLBP, 23 RLBP, 21 healthy controls), surface electromyographic (EMG) activity of the lumbar erector spinae (ES), multifidus (MF), latissimus dorsi (LD) and gluteus maximus (GM) was recorded during the concentric, holding and eccentric phase of a modified Biering Sorenson exercise. RESULTS: Continuous CLBP patients showed higher EMG activity in the ES and MF muscles compared to healthy controls in the concentric (p = 0.011; p = 0.009 respectively) and the holding phase (p = 0.015; p = 0.013). Higher EMG activity was observed in continuous CLBP compared to RLBP in the ES and MF muscles in the holding phase (p = 0.035; p = 0.037), and in the MF in the concentric phase (p = 0.046), but not in the ES (p = 0.062). No differences in muscle activity were established in either the concentric, holding, and eccentric phase for the LD and GM muscles. No differences were found between non-continuous CLBP and the other groups. CONCLUSIONS: An enhanced muscle activity of the lumbar muscles during the concentric and holding phase was observed during trunk extension in patients with continuous CLBP compared to patients with RLBP and healthy subjects. No differences between groups are present in the GM and LD muscles during concentric and holding phases and for any muscle in the eccentric phase.

Using the Updated EWGSOP2 Definition in Diagnosing Sarcopenia in Spanish Older Adults: Clinical Approach.

Recently the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated diagnostic criteria for sarcopenia, which consist of one or more measures of muscle strength, muscle mass, and physical performance, plus an initial screening test called SARC-F. The main objective was to compare the number of cases of sarcopenia, using the different measurements and screening options. A cross-sectional study was conducted on Spanish older adults (n = 272, 72% women). Combining the different measures proposed by the steps described in the EWGSOP2 algorithm, 12 options were obtained (A-L). These options were studied in each of the three models: (1) using SARC-F as initial screening; (2) not using SARC-F; and (3) using SARC-CalF instead of SARC-F. A χ2 independence test was statistically significant (χ2(6) = 88.41, p < 0.001), and the association between the algorithm used and the classification of sarcopenia was moderate (Cramer's V = 0.226). We conclude that the different EWGSOP2 measurement options imply case-finding differences in the studied population. Moreover, when applying the SARC-F, the number of people classified as sarcopenic decreases. Finally, when SARC-CalF is used as screening, case finding of sarcopenic people decreases. Thus, clinical settings should consider these outcomes, since these steps can make preventive and therapeutic interventions on sarcopenia vary widely.

Kihon Checklist to assess frailty in older adults: Some evidence on the internal consistency and validity of the Spanish version.

AIM: The aim of this study was to assess the internal consistency, hypothesis testing and criterion-related validity of the Spanish versions of the Kihon Checklist (KCL) - the original 25-item and reduced 15-item versions - for screening frailty in community-dwelling older adults. METHODS: A cross-sectional study was carried out between March and September 2018 in Valencia province (Spain). A sample of 251 participants was recruited. Construct validity was assessed using four different frailty instruments, and alternative measures corresponding to the KCL domains (handgrip strength, gait speed, the Short Physical Performance Battery, skeletal muscle mass index, physical activity level, functional status, cognitive function, depressive mood, health-related quality of life and nutritional status). Fried's Frailty Phenotype was used to evaluate criterion validity. RESULTS: Internal consistency assessed with Kuder-Richardson Formula had a value of 0.69 for the 25-item version, slightly lower than the usual 0.7 for considering good reliability, and 0.71 for the 15-item version. There were significant correlations between KCL versions and Fried's Frailty Phenotype, Edmonton Scale, Tilburg Indicator and FRAIL Scale. Consistent significant correlations were also obtained with all frailty measurements and instrumental activities of daily living, physical strength, eating, socialization, and mood domains of the KCL. The KCL closely correlated with other standardized measurements of physical function, cognitive function, depressive mood, and health-related quality of life. The KCL also showed satisfactory diagnostic accuracy for frailty (area under the curve 0.891 for KCL-25; area under the curve 0.857 for KCL-15). The optimal cut-off points were 5/6 and 3/4, respectively. CONCLUSIONS: The findings suggest that both versions of the KCL, especially KCL-15, showed adequate evidence of validity and internal consistency as a preliminary screening of frailty among community-dwelling older adults in Spain. Geriatr Gerontol Int 2021; 21: 262-267.

Add-On Effect of Postural Instructions to Abdominopelvic Exercise on Urinary Symptoms and Quality of Life in Climacteric Women with Stress Urinary Incontinence. A Pilot Randomized Controlled Trial.

The aim of this study was to investigate the add-on effect of postural instructions to an abdominopelvic exercise program on incontinence urinary symptoms (UI symptoms) and quality of life (QoL) in climacteric women with stress urinary incontinence (SUI). A randomized controlled trial was performed with a total of 40 climacteric women with SUI aged between 46 and 75 years old. Participants were randomly assigned to two groups: a group performing an abdominopelvic exercise program (AEP) (n = 20) and a group performing abdominopelvic exercise with the addition of postural instructions (AEPPI) (n = 20). Primary outcome measures were UI symptoms, UI impact and QoL related to UI (UI-QoL), measured by 48 h Pad Test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF), which were assessed at baseline, post-intervention and 3 months follow-up. Secondary outcome was patient's satisfaction measured by the 100-point Visual Analogic Scale (VAS) only after the intervention. Between-groups differences were observed in terms of UI-QoL immediately after intervention. Within-groups differences were observed between baseline to 3 months follow-up and between post-intervention to 3 months follow-up in AEPPI group (p < 0.05) for UI-QoL and UI impact. UI symptoms were improved in both groups between baseline to 3-months follow-up (p < 0.05). Patient's satisfaction was higher in the AEPPI group (p < 0.05). The addition of postural instructions to an abdominopelvic exercise program improves UI impact to QoL and patients' satisfaction in women with SUI.

The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder.

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.

Functional and Clinical Characteristics for Predicting Sarcopenia in Institutionalised Older Adults: Identifying Tools for Clinical Screening.

BACKGROUND: Recently, the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated the sarcopenia definition based on objective evaluation of muscle strength, mass and physical performance. The aim of this study was to analyse the relationship between sarcopenia and clinical aspects such as functionality, comorbidity, polypharmacy, hospitalisations and falls in order to support sarcopenia screening in institutionalised older adults, as well as to estimate the prevalence of sarcopenia in this population using the EWGSOP2 new algorithm. METHODS: A multicentre cross-sectional study was conducted on institutionalised older adults (n = 132, 77.7% female, mean age 82 years). Application of the EWGSOP2 algorithm consisted of the SARC-F questionnaire, handgrip strength (HG), appendicular skeletal muscle mass index (ASMI) and Short Physical Performance Battery (SPPB). Clinical study variables were: Barthel Index (BI), Abbreviated Charlson's Comorbidity Index (ACCI), number of medications, hospital stays and falls. RESULTS: Age, BI and ACCI were shown to be predictors of the EWGSOP2 sarcopenia definition (Nagelkerke's R-square = 0.34), highlighting the ACCI. Sarcopenia was more prevalent in older adults aged over 85 (p = 0.005), but no differences were found according to gender (p = 0.512). CONCLUSION: BI and the ACCI can be considered predictors that guide healthcare professionals in early sarcopenia identification and therapeutic approach.

A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series.

BACKGROUND: Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. This case series describes both short- and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. CASE DESCRIPTION: Eleven patients with primary FSCS were treated with an individually tailored, multimodal manual therapy approach once weekly for 12 visits, coupled with home stretching exercises once a day, 5 days per week. Pain, disability, range of motion (ROM), and muscle strength of the affected shoulder were assessed at baseline, posttreatment, at 6 months, and at 9 months. OUTCOMES: Significant improvements in self-reported pain, disability, shoulder ROM, and strength were reported following treatment. Additionally, 4 of 11 patients showed pain improvements that exceeded the minimal clinically important difference (MCID) on the visual analog scale postintervention, and 8 of 11 showed pain improvements at 6 and 9 months. Moreover, 7 of 11 patients showed improvements in Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores exceeding the MCID postintervention and at 6 months, and 8 of 11 exceeded the MCID at 9 months. DISCUSSION: Clinically meaningful changes in shoulder pain and disability, ROM, or muscle strength were observed in 11 patients with primary FSCS treated with an individually tailored approach of both manual therapy techniques and stretching exercises, accounting for tissue irritability. LEVEL OF EVIDENCE: Therapy, level 5. J Orthop Sports Phys Ther 2019;49(3):192-201. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8194.

Immediate Changes After Manual Therapy in Patients With Persistent, Nonspecific Back Pain: A Randomized Controlled Trial.

CONTEXT: Thoracic manipulation decreases pain and disability. However, when such manipulation is contraindicated, the use of other manual techniques based on the regional interdependence of the thoracic spine, upper ribs, and shoulders is an alternative approach. OBJECTIVE: The study intended to investigate the immediate changes resulting from 3 manual therapy treatments on spinal mobility, flexibility, comfort, and pain perception in patients with persistent, nonspecific back pain as well as changes in their sense of physical well-being and their perception of change after treatment. DESIGN: The study was a randomized, double-blind, controlled trial. SETTING: The study took place in the Department of Physiotherapy of the Faculty of Physiotherapy at the University of Valencia (Valencia, Spain). PARTICIPANTS: Participants were 112 individuals from the community-56.6% female, with a mean age of 21.8 ± 0.2 y-who had persistent, nonspecific back pain. INTERVENTION: Participants were randomly assigned to 1 of 3 groups, receiving (1) neurolymphatic therapy (NL group), (2) articulatory spinal manual therapy (AS group), or (3) articulatory costal manual therapy (AC group). OUTCOME MEASURES: Cervical mobility, lumbar flexibility, comfort, pain perception, and physical well-being were assessed at baseline and immediately postintervention. Perception of change was evaluated postintervention. RESULTS: Between baseline and postintervention, the AC group showed a significant increase in cervical flexion (P = .010), whereas the NL and AS groups improved in lumbar flexibility, P = .047 and P = .012, respectively. For that period, significant changes were found in lumbar comfort for the AS group (P < .001) and the NL group (P < .026) and in thoracic comfort (P < .001) for the AC group. All groups improved in physical well-being and pain perception (P < .05). Changes in thoracic comfort, lumbar comfort, and physical well-being differed among the groups, with some differences being statistically significant. CONCLUSIONS: All treatments improved pain perception and increased physical well-being. The NL and AS treatments were more effective in lumbar flexibility, the AC treatment in cervical flexion and thoracic comfort, and the NL treatment in lumbar comfort.

Effects of Resistance Training of Peripheral Muscles Versus Respiratory Muscles in Older Adults With Sarcopenia Who are Institutionalized: A Randomized Controlled Trial.

This study compares the effects of two resistance training programs in peripheral and respiratory musculature on muscle mass and strength and physical performance and identifies the appropriate muscle mass parameter for assessing the intervention effects. Thirty-seven institutionalized older Spanish adults with sarcopenia were analyzed: control group (n = 17), respiratory muscle training group (n = 9), and peripheral muscle training group (n = 11). Measured outcomes were appendicular skeletal muscle mass (ASM/height2, ASM/weight, and ASM/BMI), isometric knee extension, arm flexion and handgrip strength, maximal inspiratory and expiratory pressures, and gait speed pre- and postintervention. Trained groups participated in a 12-week program and improved in maximum static inspiratory pressure, maximum static expiratory pressure, knee extension, and arm flexion (p < .05), whereas nonsignificant changes were found in gait speed and ASM indexes pre- and postintervention in the three groups. In conclusion, resistance training improved skeletal muscle strength in the studied population, and any ASM index was found to be appropriate for detecting changes after physical interventions.