Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Artigo em Inglês | MEDLINE | ID: mdl-31764429

RESUMO

OBJECTIVE: The objective of this review is to identify and map current literature describing the center of rotation locations and migration paths during lumbar spine movements. INTRODUCTION: The importance of lumbar spine kinematics has been described and altered kinematics has been associated with pain and injury. Intervertebral segments' center of rotations, the point around which spinal segments rotate, are important for determining the lumbar spine kinematics features and the potential for increased injury risk during movements. Although many studies have investigated the center of rotations of humans' lumbar spine, no review has summarized and organized the state of the science related to center of rotation locations and migration paths of the lumbar spine during lumbar spine movements. INCLUSION CRITERIA: This review will consider studies that include human lumbar spines of any age and status condition (e.g. heathy, pathological) during lumbar spine movements. Quantitative study designs, including clinical, observational, laboratory biomechanical experimental studies, mathematical and computer modelling studies will be considered. Only studies published in English will be included, and there will be no limit on dates of publication. METHODS: PubMed, MEDLINE, Embase, the Cochrane Library Controlled Register of Trials, CINAHL, ACM Digital Library, Compendex, Inspec, Web of Science, Scopus, Google Scholar, and dissertation and theses repositories will be searched. After titles and abstracts screening of identified references, two independent reviewers will screen the full-text of identified studies and extract data. Data will be summarized and categorized, and a comprehensive narrative summary will be presented with the respective results.

2.
J Manipulative Physiol Ther ; 42(2): 89-95, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31000343

RESUMO

OBJECTIVE: The purpose of this study was to quantify the threshold at which clinicians can detect a difference in spinal stiffness of the thoracic and lumbar spine via palpation and then determine if this detection threshold would affect a clinician's ability to identify changes in spinal stiffness as measured by an objective instrument. METHODS: In this study, the threshold at which a change in spinal stiffness was detected was quantified in 12 experienced clinicians (physical therapists and doctors of chiropractic) by changing the differential stiffness in 2 inflatable targets until the clinician could no longer identify which was stiffer. In the second part of the study, clinicians then were asked to palpate pre-identified pairs of vertebrae in an asymptomatic volunteer and to identify the stiffer of the pair (T7 and L3, T7 and L4, L3 and L4), and the biomechanical stiffness of each vertebral pair was quantified objectively by a validated instrument. RESULTS: The mean stiffness detection threshold for the clinicians was 8%. Objective measurement of the stiffness differential between vertebral pairs was 30% for T7* and L3, 20% for T7* and L4, and 10% for L3* and L4 (*denotes the stiffer of the pair). Ten of 12 clinicians correctly identified T7 as stiffer when compared with L3 and T7 as stiffer than L4. Alternatively, when the differential vertebral pair stiffness was similar to the stiffness detection threshold (~8%), clinicians were less successful in identifying the stiffer vertebra of the pair; 4 of 12 clinicians correctly identified L3 as being stiffer compared with L4. CONCLUSION: These results suggest that the physiological limits of human palpation may limit the ability of clinicians to identify small alterations in spine stiffness.

3.
Eur J Pain ; 23(7): 1378-1389, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31034102

RESUMO

BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients' expectations for improvement may have effects on LBP treatment outcomes, it remains unclear if psychological profiles modify this relationship. Therefore, the objectives of this study were to investigate if (a) patients' expectations predicted short-term outcome, and (b) psychological profile, pain intensity and self-rated health modified the relationship between expectations and outcome. METHODS: Data were collected between April 2012 and January 2016 during the inclusion into a randomized controlled trial. Potentially eligible participants were identified through 40 chiropractic clinics located across Sweden. Patients' expectations, psychological profile, pain intensity, activity limitation and self-rated health were collected from patients with recurrent persistent LBP during their first chiropractic visit (n = 593). Subjective improvement was measured at the fourth visit. RESULTS: Patients with a high expectation of improvement had 58% higher risk to report an improvement at the fourth visit (RR = 1.58, 95% CI: 1.28, 1.95). Controlling for potential confounders only slightly decreased the strength of this association (RR = 1.49, 95% CI: 1.20, 1.86). Baseline pain intensity, psychological profile and self-rated health did not modify the effect of expectation on outcome. CONCLUSIONS: Baseline patients' expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients' expectations at the first visit to best inform prognosis. SIGNIFICANCE: This study confirms the importance of patients' expectations in a clinical setting. Patients' expectations predict the short-term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self-rated health did not modify this relationship.

4.
Aust J Rural Health ; 27(1): 34-41, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30719793

RESUMO

OBJECTIVE: To determine the prevalence and clinical management characteristics of chiropractors practising in urban and rural or remote Australia. DESIGN: A cross-sectional analysis of the Australian Chiropractic Research Network project data. SETTING: Nationally representative sample of registered chiropractors practising in Australia. PARTICIPANTS: Chiropractors who participated in the Australian Chiropractic Research Network project and answered a question about practising in urban or rural or remote areas in the practitioner questionnaire. MAIN OUTCOME MEASURE: The demographics, practice characteristics and clinical management of chiropractors. RESULTS: The majority of chiropractors indicated that they practise in urban areas only, while 22.8% (n = 435) practice in rural or remote areas only and 4.0% (n = 77) practice in both urban and rural or remote areas. Statistically significant predictors of chiropractors who practice in rural or remote areas, as compared to urban areas, included more patient visits per week, practising in more than one location, no imaging facilities on site, often treating degenerative spinal conditions or migraine, often treating people aged over 65 years, frequently treating Aboriginal and Torres Strait Islander people and frequently using biomechanical pelvic blocking or the sacro-occipital technique. CONCLUSION: A substantial number of chiropractors practice in rural or remote Australia and these rural or remote-based chiropractors are more likely to treat a wide range of musculoskeletal cases and include an Indigenously diverse group of patients than their urban-located colleagues. Unique practice challenges for rural or remote chiropractors include a higher workload and a lack of diagnostic tools. Chiropractors should be acknowledged and considered within rural or remote health care policy and service provision.


Assuntos
Quiroprática/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Recursos Humanos/estatística & dados numéricos , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
BMC Musculoskelet Disord ; 20(1): 29, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30658622

RESUMO

BACKGROUND: Spinal manipulative therapy (SMT) includes biomechanical parameters that vary between clinicians, but for which the influence on the therapy clinical effects is unknown. This parallel-randomized controlled trial aimed to investigate the effect of SMT biomechanical parameters on the outcomes of participants with chronic thoracic pain (CTP) following three treatment sessions (follow-up at one week). METHODS: Adults reporting CTP (pain within the evaluated region [T6 to T8] for ≥3 months) were asked to participate in a four-session trial. At the first session, participants were randomly assigned to one of three experimental groups (different SMT doses) or the control group (no SMT). During the first three sessions, one SMT was executed at T7 for the experimental groups, while a 5-min rest was provided to the control group. SMT were delivered through an apparatus using a servo-controlled linear actuator motor and doses consisted of peak forces, impulse durations, and rates of force application set at 135 N, 125 ms and 920 N/s (group 1), at 250 N, 125 ms and 1840 N/s (group 2), and at 250 N, 250 ms, 920 N/s (group 3). Disability and pain intensity were evaluated at each session (primary outcomes). Spinal stiffness was assessed before-and-after each SMT/rest and at follow-up. Tenderness and muscle activity were evaluated during each spinal stiffness trial. Improvement was evaluated at follow-up. Differences in outcomes between groups and sessions were evaluated as well as factors associated with clinical improvement. RESULTS: Eighty-one participants were recruited and 17, 20, 20 participants of the three experimental groups and 18 of the control group completed the protocol. In exception of higher pain intensity at baseline in the control group, no between-group differences were found for any of the outcomes. A decrease in pain intensity, disability, spinal stiffness, and tenderness during spinal stiffness were observed (p-values< 0.05). At follow-up, 24% of participants were classified as 'improved'. Predictors of improvement were a greater decrease in pain intensity and in tenderness (p-values< 0.05). CONCLUSIONS: In an experimental setting, the delivery of a SMT does not lead to significantly different outcomes in participants with CTP than a control condition (spinal stiffness assessment). Studies are still required to explore the mechanisms underlying SMT effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT03063177 , registered 24 February 2017).


Assuntos
Dor Crônica/terapia , Dor Lombar/terapia , Manipulação da Coluna/métodos , Medição da Dor/métodos , Vértebras Torácicas , Adulto , Fenômenos Biomecânicos/fisiologia , Dor Crônica/diagnóstico , Feminino , Seguimentos , Humanos , Dor Lombar/diagnóstico , Masculino , Manipulação da Coluna/instrumentação , Manipulação da Coluna/tendências , Pessoa de Meia-Idade , Medição da Dor/tendências , Método Simples-Cego , Resultado do Tratamento
6.
PLoS One ; 13(12): e0208790, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30533059

RESUMO

OBJECTIVE: The objective was to compare thoracic spinal stiffness between healthy participants and participants with chronic thoracic pain and to explore the associations between spinal stiffness, pain and muscle activity. The reliability of spinal stiffness was also evaluated. MATERIAL AND METHODS: Spinal stiffness was assessed from T5 to T8 using a mechanical device in 25 healthy participants and 50 participants with chronic thoracic pain (symptoms had to be reported within the evaluated region of the back). The spinal levels for which spinal stiffness was measured were standardized (i.e. T5 to T8 for all participants) to minimize between-individual variations due to the evaluation of different spinal levels. The device load and displacement data were used to calculate the global and terminal spinal stiffness coefficients at each spinal level. Immediately after each assessment, participants were asked to rate their pain intensity during the trial, while thoracic muscle activity was recorded during the load application using surface electromyography electrodes (sEMG). Within- and between-day reliability were evaluated using intraclass correlation coefficients (ICC), while the effects of chronic thoracic pain and spinal levels on spinal stiffness and sEMG activity were assessed using mixed model ANOVAs. Correlations between pain intensity, muscle activity and spinal stiffness were also computed. RESULTS: ICC values for within- and between-day reliability of spinal stiffness ranged from 0.67 to 0.91 and from 0.60 to 0.94 (except at T5), respectively. A significant decrease in the global (F1,73 = 4.04, p = 0.048) and terminal (F1,73 = 4.93, p = 0.03) spinal stiffness was observed in participants with thoracic pain. sEMG activity was not significantly different between groups and between spinal levels. Pain intensity was only significantly and "moderately" correlated to spinal stiffness coefficients at one spinal level (-0.29≤r≤-0.51), while sEMG activity and spinal stiffness were not significantly correlated. CONCLUSION: The results suggest that spinal stiffness can be reliably assessed using a mechanical device and that this parameter is decreased in participants with chronic thoracic pain. Studies are required to determine the value of instrumented spinal stiffness assessment in the evaluation and management of patients with chronic spine-related pain.


Assuntos
Dor Crônica/fisiopatologia , Vértebras Torácicas/fisiopatologia , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Músculo Esquelético/fisiopatologia , Medição da Dor , Adulto Jovem
7.
J Manipulative Physiol Ther ; 41(4): 265-293, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29606335

RESUMO

OBJECTIVE: The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments. METHODS: The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee. RESULTS: For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises). CONCLUSIONS: A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.


Assuntos
Tratamento Conservador/normas , Medicina Baseada em Evidências , Dor Lombar/terapia , Manipulação da Coluna/normas , Adulto , Canadá , Quiroprática/normas , Terapias Complementares/normas , Humanos , Manipulação da Coluna/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisão Sistemática como Assunto , Resultado do Tratamento
8.
Chiropr Man Therap ; 26: 5, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29441194

RESUMO

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.


Assuntos
Centros Médicos Acadêmicos , Pesquisa Biomédica/educação , Fortalecimento Institucional/organização & administração , Quiroprática/educação , Terapias Complementares/educação , Pesquisadores/educação , Austrália , Canadá , Quiroprática/tendências , Terapias Complementares/tendências , Comportamento Cooperativo , Dinamarca , Pesquisa sobre Serviços de Saúde , Humanos , Liderança , Mentores
9.
J Manipulative Physiol Ther ; 41(9): 734-752, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30871711

RESUMO

OBJECTIVE: The purpose of this study was to describe the correlations between individual characteristics and spinal stiffness as measured with different spinal stiffness measurement devices in individuals with and without back pain. METHODS: A secondary analysis of 3 adult data sets obtained using 3 different devices, in 2 spinal regions, from a total of 5 separate cross-sectional studies was conducted. Differences in spinal stiffness between men and women and in the strength of correlations among spinal stiffness and age and anthropometric characteristics were evaluated using either the t test for independent samples, Pearson's correlation coefficient, or Kendall's τ rank correlation coefficient. RESULTS: As expected, results varied between data sets; however, few factors had consistent correlations. Specifically, spinal stiffness was significantly lower in women than men in all 3 data sets. Height was positively correlated with spinal stiffness across all data sets. Although weight was correlated with thoracic stiffness, its correlation with lumbar stiffness varied. In 2 data sets, body mass index was inversely associated with lumbar spinal stiffness, whereas results from the thoracic spine region revealed a positive correlation. The results for 1 data set suggest that physiological measurement evaluating body weight distribution may also affect spinal stiffness; however, the specific correlation remains unclear. CONCLUSION: Despite data set differences, significant correlations were observed, indicating that participants' characteristics appear to affect spinal stiffness measurement.


Assuntos
Dor Lombar/fisiopatologia , Vértebras Lombares/fisiopatologia , Músculo Esquelético/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
10.
J Manipulative Physiol Ther ; 41(9): 753-761, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30871712

RESUMO

OBJECTIVE: The purpose of this study was to compare vertebral displacements (absolute and relative) and muscle responses induced by spinal manipulative therapy of short (spinal manipulation) and long (spinal mobilization) impulse duration. METHODS: Twenty-five healthy adults (without thoracic pain) were recruited for this crossover study. Six spinal manipulative therapies (255 N peak force) of different impulse durations (100, 125, 200, 500, 1000, and 1500 ms) were delivered to each participant's T7 transverse process using a mechanical device. Impulse duration effect on the vertebral displacement (absolute displacement of T6, T7, and T8 and relative displacement between T7 and T6 and between T7 and T8) and the thoracic muscle response (surface electromyography) were assessed using mixed-model analyses of variance and predefined linear trend analyses. RESULTS: Results showed a linear increase in the absolute vertebral displacement for T8 (P = .002) and a linear decrease in the T7/T6 and T7/T8 relative displacement (P < .0001) when impulse duration was increased. The data of 24 participants were available for electromyography analysis. A significant main effect of impulse duration on surface electromyography response was observed (P < .0001, ƞp2=0.43). Planned comparisons for a linear trend between these variables revealed a negative relationship (P < .0001). Only 13 of the 24 participants with available data presented a muscle response at every impulse duration. CONCLUSION: These results support the assumption that spinal manipulation and spinal mobilization might operate under distinct mechanisms.


Assuntos
Eletromiografia/métodos , Manipulação da Coluna/métodos , Músculos Paraespinais/fisiologia , Adulto , Fenômenos Biomecânicos/fisiologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Amplitude de Movimento Articular/fisiologia
11.
J Chiropr Educ ; 31(2): 90-95, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28121458

RESUMO

OBJECTIVE: To evaluate the effects of practice variability on chiropractic students' capacity to deliver spinal manipulations (SMs) of a targeted peak force. METHODS: Forty students participated in an experimental session including either a variable or a constant practice protocol of 45 SMs. SMs were delivered on a computer-connected device that recorded force-time profiles. Ten SMs with a target peak force of 350-N were performed before practice, immediately following practice, and 2 days later. Mixed-design analyses of variance were used to assess the effect of practice type on SM biomechanical parameters and on the constant, the absolute error (AE), and the variable error (VE). RESULTS: The practice period led to significantly more accurate (FAE[2,76] = 6.17, p < .01) and consistent (FVE[2,76] = 3.90, p = .02) performances at the postintervention assessment regardless of practice type. Among biomechanical parameters, preload force was higher at the retention assessment than at baseline (F[2,76] = 6.53, p < .01), while rate of force application significantly decreased between the baseline and the retention assessment (F[2,76] = 4.10, p = .02). CONCLUSION: This experimental study showed that 1 session of SM practice including feedback leads to an increase in SM peak force accuracy and consistency, whether or not the practice period included variable practice. The current results confirmed that short practice periods with feedback should be included in the chiropractic curriculum.

12.
Musculoskelet Sci Pract ; 27: 142-149, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27697392

RESUMO

Palpation methods (PMs) have been proposed to guide clinicians in locating the thoracic transverse processes (TTPs). However, no studies have assessed the validity of TTPs palpation or the added value of musculoskeletal ultrasound (MSU). The objectives of the present study were (1) to explore the validity of TTPs location using palpation as commonly performed by clinicians, (2) to develop an accurate and valid PM, and (3) to assess the added value of MSU. A standardized procedure was used on six cadavers. It consisted in the insertion of markers through the T3, T5, T6 and T8 TTPs and spinous processes, which were identified using palpation and MSU. First, a fresh cadaver was used to explore the validity of the common palpation method. Since poor validity was observed, one intermediate and a final PMs were tested on a total of five Thiel-embalmed specimens. A descriptive analysis was performed and agreement between MSU and the final PM was determined. The final PM led to the proper determination of all TTPs on three specimens with a mean error of 4 ± 1.8 mm in relation to the TTPs center. The coefficient of variations and root mean square errors were ≤0.15 and 0.21 mm, respectively. Bland-Altman plot showed no differences between palpation and MSU. In conclusion, this study reports the validity of a new PM using multiple landmarks to guide TTPs determination and for which MSU does not seem to add value in accuracy. These results may have important clinical implications for clinicians using palpation.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Palpação/métodos , Vértebras Torácicas/diagnóstico por imagem , Ultrassonografia , Cadáver , Humanos , Técnicas In Vitro , Reprodutibilidade dos Testes
13.
J Manipulative Physiol Ther ; 39(8): 523-564.e27, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27836071

RESUMO

OBJECTIVE: The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. METHODS: Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. RESULTS: For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). CONCLUSIONS: A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.


Assuntos
Manipulação Quiroprática , Cervicalgia/terapia , Traumatismos em Chicotada/terapia , Humanos , Modalidades de Fisioterapia
14.
BMC Complement Altern Med ; 16: 161, 2016 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-27249939

RESUMO

BACKGROUND: Neuromechanical responses to spinal manipulation therapy (SMT) have been shown to be modulated through the variation of SMT biomechanical parameters: peak force, time to peak force, and preload force. Although rate of force application was modulated by the variation of these parameters, the assumption that neuromuscular responses are modulated by the rate of force application remains to be confirmed. Therefore, the purpose of the present study was to evaluate the effect of a constant rate of force application in neuromechanical responses to SMT in healthy adults. METHODS: Four SMT force-time profiles presenting different time to peak force and peak force, but with a constant rate of force application were applied on 25 healthy participants' T7 transverse processes. Muscular responses were recorded through surface electromyography electrodes (T6 and T8 levels), while vertebral displacements were assessed through pasted kinematic markers on T6 to T8 spinous processes. Effects of SMT force-time profiles on neuromechanical responses were assessed using repeated-measures ANOVAs. RESULTS: There was no main effect of SMT force-time profile modulation on muscular responses (ps > .05) except for the left T8 (F (3, 72) = 3.23, p = .03) and left T6 (F (3, 72) = 2.94, p = .04). Muscular responses were significantly lower for the lowest peak force condition than the highest (for T8) or second highest (for T6). Analysis showed that increasing the SMT peak force (and concomitantly time to peak force) led to a significant vertebral displacement increase for the contacted vertebra (F T7 (1, 17) = 354.80, p < .001) and both adjacent vertebras (F T6 (1, 12) = 104.71, p < .001 and F T8 (1, 19) = 468.68, p < .001). CONCLUSION: This study showed that peak force modulation using constant rate of force application leads to similar neuromuscular responses. Coupled with previous investigations of SMT peak force and duration effects, the results suggest that neuromuscular responses to SMT are mostly influenced by the rate of force application, while peak force modulation yields changes in the vertebral displacement. Rate of force application should therefore be defined in future studies. Clinical implications of various SMT dosages in patients with spine related pain should also be investigated. TRIAL REGISTRATION: ClinicalTrials.gov NCT02550132 . Registered 8 September 2015.


Assuntos
Manipulação da Coluna , Adulto , Fenômenos Biomecânicos , Eletromiografia , Humanos , Fenômenos Fisiológicos do Sistema Nervoso , Adulto Jovem
15.
J Manipulative Physiol Ther ; 39(3): 185-91, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27016338

RESUMO

OBJECTIVE: The purpose of the study was to evaluate if systematic augmented feedback during short sessions of spinal manipulation (SM) training creates a dependency compared with short training session characterized by progressive withdrawal of augmented feedback. METHODS: Forty fourth- and fifth-year chiropractic students enrolled in a 5-year chiropractic program were randomized into 2 groups. The 2 groups performed the same number of SM with a 300-N peak force target on an instrumented device. Baseline assessment consisted of 10 trials without feedback. Three training blocks of 10 SMs were then performed with visual and verbal feedback. For the control group, feedback was always provided. For the experimental group, augmented feedback was provided for each trial of the first training block, 50% of the second block, and 20% of the last training block. A postintervention assessment of 10 trials without feedback was performed, and a retention assessment was conducted 20 minutes later. RESULTS: No group main effect was found on biomechanical parameters and error variables. A main effect of learning for the absolute error was observed, suggesting that short sessions of feedback training improve participants' accuracy. CONCLUSION: The results of the study suggest that feedback scheduling does not influence SM motor performance and learning in clinically experienced students.


Assuntos
Quiroprática/educação , Feedback Formativo , Manipulação Quiroprática/métodos , Manipulação da Coluna/normas , Estudantes de Medicina , Adulto , Competência Clínica , Educação Médica , Feminino , Humanos , Masculino , Adulto Jovem
16.
J Electromyogr Kinesiol ; 27: 24-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26874078

RESUMO

PURPOSE: The present study aimed to compare the neuromuscular response under various mechanical stimulations of the lumbar spine in participants with and without chronic low back pain (cLBP). METHODS: Four mechanical stimulations, characterized by forces ranging from 75 to 225N, were delivered using a servo-controlled linear actuator motor to the L3 spinous process of 25 healthy participants and 26 participants with cLBP. Lumbar neuromuscular responses were recorded using 64-electrodes large surface electromyography arrays. Between-group differences in the dose-response relationship (neuromuscular response amplitude according to each force level) were assessed using mixed model ANOVAs. RESULTS: No differences between groups were shown (all p values>.05). A significant linear relationship was observed between forces and neuromuscular response amplitudes (p<.001) indicating an increase in response amplitudes with increasing stimulation force. Responses were observed throughout the lumbar region with highest response amplitudes in the vicinity of the contacted vertebra. CONCLUSION: The neuromuscular response amplitude triggered by localized lumbar mechanical stimulations does not differ between participants with and without cLBP. Moreover, even though stimulations were delivered at specific spinal segment, a neuromuscular response, although rapidly decreasing, was observed in areas distant from the contact site.


Assuntos
Músculos do Dorso/fisiologia , Dor Crônica/diagnóstico , Eletromiografia/métodos , Dor Lombar/diagnóstico , Adulto , Dor Crônica/fisiopatologia , Estudos Transversais , Eletromiografia/instrumentação , Feminino , Humanos , Dor Lombar/fisiopatologia , Vértebras Lombares , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estimulação Física/instrumentação , Estimulação Física/métodos
17.
J Manipulative Physiol Ther ; 38(7): 449-57, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26413899

RESUMO

OBJECTIVE: The objective of this study was to evaluate changes in neuromechanical responses and clinical outcomes in chronic low back pain participants after 4 sessions of biofeedback training. METHODS: Twenty-one participants took part in an electromyography biofeedback 4-session training program aimed at reducing lumbar paraspinal muscle activity during full trunk flexion. The sessions consisted of ~46 trunk flexion-extension divided into 5 blocks. The effects of training blocks and sessions on lumbar flexion-relaxation ratio and lumbopelvic ranges of motion were assessed. Changes in disability (Oswestry Disability Index), pain intensity (numerical rating scale), and fear of movement (Tampa Scale for Kinesiophobia) were also evaluated. RESULTS: Analyses of variance revealed a significant block effect for which an increase in the flexion-relaxation ratio and the lumbar range of motion between block 1 and the other blocks for sessions 1 and 2 (P < .0001) was observed. However, no significant session or interaction effect was observed. Among clinical outcomes, only fear of movement significantly decreased between the baseline (mean [SD], 33.05 [7.18]) and the fourth session (29.80 [9.88]) (P = .02). There was no significant correlation between clinical outcomes and neuromechanical variables. CONCLUSION: Biofeedback training led to decreases in lumbar paraspinal muscle activity in full trunk flexion and increases in lumbopelvic range of motion in participants with chronic nonspecific low back pain. Although the neuromechanical changes were mostly observed at the early stage of the program, the presence of a decrease in the fear of movement suggests that the participants' initially limited ROMs may have been modulated by fear avoidance behaviors.


Assuntos
Eletromiografia/métodos , Terapia por Exercício/métodos , Dor Lombar/reabilitação , Amplitude de Movimento Articular/fisiologia , Adulto , Análise de Variância , Biorretroalimentação Psicológica , Fenômenos Biomecânicos , Dor Crônica , Estudos de Coortes , Feminino , Humanos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prognóstico , Resultado do Tratamento , Adulto Jovem
18.
BMC Musculoskelet Disord ; 16: 201, 2015 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-26286385

RESUMO

BACKGROUND: Stratification strategies based on identifying patient's prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool (SBST) although promising, has not been studied in patients with chronic low back pain (cLBP). Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient's global impression of change was also investigated. METHODS: Fifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures (maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks) and the SBST were assessed at baseline. Disability (Oswestry Disability Index, ODI), pain intensity (101-point Numerical Rating Scale, NRS), fear of movement (Tampa Scale for Kinesiophobia, TSK) and patient's global impression of change (7-point scale, PGIC) were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST. RESULTS: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05). The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (|τ| = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05). CONCLUSION: Physiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year. TRIAL REGISTRATION: Clinicaltrials.gov NCT02226692.


Assuntos
Dor Crônica/diagnóstico , Avaliação da Deficiência , Eletromiografia/normas , Dor Lombar/diagnóstico , Medição da Dor/normas , Postura/fisiologia , Adulto , Dor Crônica/epidemiologia , Estudos de Coortes , Eletromiografia/métodos , Feminino , Seguimentos , Humanos , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Eur J Appl Physiol ; 114(12): 2645-54, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25173095

RESUMO

PURPOSE: To identify and characterize trunk neuromuscular adaptations during muscle fatigue in patients with chronic low back pain (LBP) and healthy participants. METHODS: Forty-six patients with non-specific chronic LBP and 23 healthy controls were asked to perform a trunk muscles fatigue protocol. Surface electromyography was recorded using two adhesive matrix of 64 electrodes applied bilaterally over the erector spinae. Pain score, kinesiophobia and physical disability were analyzed through different questionnaires. To characterize motor variability, dispersion of muscular activity center of gravity was computed. Motor variability between groups was compared using repeated-measures analyses of variance. RESULTS: Score of disability and kinesiophobia were significantly higher in patients with LBP. Results indicated a significant group effect characterized by an increased motor variability in the healthy group through the entire fatigue task on the left (p = 0.003) and right side (p = 0.048). Interestingly, increasing muscle fatigue led to increased motor variability in both groups (on both sides (p < 0.001) but with a greater increase in the healthy group. CONCLUSION: Muscle recruitment is altered in patients with chronic LBP in the presence of muscle fatigue. Consequently, these patients exhibit changes in muscle recruitment pattern and intensity (lower levels of motor variability) during sustained isometric contraction that may be attributed to variation in the control of motor units within and between muscles. However, patients with LBP are able to increase their motor variability over time but with a lower increase compared to healthy participants.


Assuntos
Dor Crônica/fisiopatologia , Contração Isométrica/fisiologia , Dor Lombar/fisiopatologia , Músculo Esquelético/fisiopatologia , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tronco/fisiopatologia
20.
J Manipulative Physiol Ther ; 37(5): 287-93, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24928637

RESUMO

OBJECTIVES: Previous studies have identified preload forces and an important feature of skillful execution of spinal manipulative therapy (SMT) as performed by manual therapists (eg, doctors of chiropractic and osteopathy). It has been suggested that applying a gradual force before the thrust increases the spinal unit stiffness, minimizing displacement during the thrust. Therefore, the main objective of this study was to assess the vertebral unit biomechanical and neuromuscular responses to a graded increase of preload forces. METHODS: Twenty-three participants underwent 4 different SMT force-time profiles delivered by a servo-controlled linear actuator motor and varying in their preload forces, respectively, set to 5, 50, 95, and 140N in 1 experimental session. Kinematic markers were place on T6, T7, and T8 and electromyographic electrodes were applied over paraspinal muscles on both sides of the spine. RESULTS: Increasing preload forces led to an increase in neuromuscular responses of thoracic paraspinal muscles and vertebral segmental displacements during the preload phase of SMT. Increasing the preload force also yielded a significant decrease in sagittal vertebral displacement and paraspinal muscle activity during and immediately after the thrust phase of spinal manipulation. Changes observed during the SMT thrust phase could be explained by the proportional increase in preload force or the related changes in rate of force application. Although only healthy participants were tested in this study, preload forces may be an important parameter underlying SMT mechanism of action. Future studies should investigate the clinical implications of varying SMT dosages. CONCLUSION: The present results suggest that neuromuscular and biomechanical responses to SMT may be modulated by preload through changes in the rate of force application. Overall, the present results suggest that preload and rate of force application may be important parameters underlying SMT mechanism of action.


Assuntos
Manipulação da Coluna/métodos , Músculos Paraespinais/fisiologia , Adulto , Fenômenos Biomecânicos/fisiologia , Eletromiografia , Humanos , Vértebras Torácicas/fisiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA