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1.
Chiropr Man Therap ; 28: 34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523681

RESUMO

Background: Social media has become an increasingly important tool in monitoring the onset and spread of infectious diseases globally as well monitoring the spread of information about those diseases. This includes the spread of misinformation, which has been documented within the context of the emerging COVID-19 crisis. Understanding the creation, spread and uptake of social media misinformation is of critical importance to public safety. In this descriptive study, we detail Twitter activity regarding spinal manipulative therapy (SMT) and claims it increases, or "boosts", immunity. Spinal manipulation is a common intervention used by many health professions, most commonly by chiropractors. There is no clinical evidence that SMT improves human immunity. Methods: Social media searching software (Talkwalker Quick Search) was used to describe Twitter activity regarding SMT and improving or boosting immunity. Searches were performed for the 3 months and 12 months before March 31, 2020 using terms related to 1) SMT, 2) the professions that most often provide SMT and 3) immunity. From these searches, we determined the magnitude and time course of Twitter activity then coded this activity into content that promoted or refuted a SMT/immunity link. Content themes, high-influence users and user demographics were then stratified as either promoting or refuting this linkage. Results: Twitter misinformation regarding a SMT/immunity link increased dramatically during the onset of the COVID crisis. Activity levels (number of tweets) and engagement scores (likes + retweets) were roughly equal between content promoting or refuting a SMT/immunity link, however, the potential reach (audience) of tweets refuting a SMT/immunity link was 3 times higher than those promoting a link. Users with the greatest influence on Twitter, as either promoters or refuters, were individuals, not institutions or organizations. The majority of tweets promoting a SMT/immunity link were generated in the USA while the majority of refuting tweets originated from Canada. Conclusion: Twitter activity about SMT and immunity increased during the COVID-19 crisis. Results from this work have the potential to help policy makers and others understand the impact of SMT misinformation and devise strategies to mitigate its impact.


Assuntos
Comunicação , Infecções por Coronavirus , Imunidade , Imunização Secundária , Manipulação da Coluna/métodos , Pandemias , Pneumonia Viral , Mídias Sociais , Betacoronavirus/isolamento & purificação , Quiroprática/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Disseminação de Informação/ética , Disseminação de Informação/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Saúde Pública/métodos , Mídias Sociais/ética , Mídias Sociais/estatística & dados numéricos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(49): e18135, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804324

RESUMO

BACKGROUND: Degenerative lumbar spondylolisthesis (DLS) is one of the common orthopedic diseases which causes low back pain in patients, which seriously affects people's daily life and work. As a method of conservative treatment of this disease, manipulation is widely used in clinical practice. We will summarize the current published evidence of manipulation in the treatment of DLS, and evaluate the effectiveness and safety of manipulation through systematic review and meta-analysis, so as to provide more reliable evidence for future clinical practice. METHODS: We will conduct a comprehensive search of the following 9 databases until January 2019: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, Wan Fang Database, and Chinese Biomedical Database. The 2 researchers will independently search, screen, extract data, and evaluate the quality of the literatures. The primary outcomes include clinical effectiveness, Japanese Orthopaedic Association scores, and the secondary outcomes include visual analog scale scores, symptom scores, and adverse events. Bias risk tools provided by Cochrane Collaboration will be used for literature quality assessment, and RevMan 5.3 software will be used for meta-analysis. RESULTS: The results of this study will systematically evaluate the effectiveness and safety of manipulation intervention for people with DLS, especially in improving lumbar function scores and pain scores. CONCLUSION: The systematic review of this study will summarize the current published evidence of manipulation for the treatment of DLS, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION: This study does not require ethical approval and the results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019139933.


Assuntos
Vértebras Lombares , Manipulação da Coluna/métodos , Espondilolistese/terapia , Humanos , Manipulação da Coluna/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
3.
J Pak Med Assoc ; 69(9): 1237-1241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511705

RESUMO

OBJECTIVE: To compare the effects of manual traction, manual intervertebral foramen opening technique and combination of the two techniques in patients with cervical radiculopathy. METHODS: The single-blind randomised control trial was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 2017 to January 2018, and comprised patients of either gender having unilateral upper extremity pain, paresthesia or numbness. The subjects were placed into groups I, II and III using sealed envelope method. Group I was treated with the opening of intervertebral foramen technique, while group II received manual traction of cervical spine, and group III received both techniques. Three sessions were conducted per week for 3 weeks. The outcome measures were neck disability index, Numeric pain rating scale, patient-specific functional scale, and range of motions of cervical spine. SPSS 21 was used for data analysis. RESULTS: Of the 40 patients, 17(30%) were males and 23(70%) were females. There were 13(32.5%)patients each in groups I and II, while group III had 14(35%). Mean age in group I was 42.41±6.86 years, in group II 40.95±7 .32 years and in group III 42.50±5.77 years. There was no statisticallysignificant difference among the three groups with respect to any parameter (p>0.05). Individual group analysis showed significant improvement (p<0.05) in all parameters . CONCLUSIONS: Manual intervertebral foramen opening technique, manual traction, and combination of both techniques were equally effective in decreasing pain, level of disability and improved cervical mobility in patients with cervical radiculopathy.


Assuntos
Manipulação da Coluna/métodos , Cervicalgia/terapia , Radiculopatia/terapia , Tração/métodos , Adulto , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manipulações Musculoesqueléticas/métodos , Amplitude de Movimento Articular , Método Simples-Cego
4.
Medicina (Kaunas) ; 55(8)2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394861

RESUMO

Background and Objectives: Spinal manipulations are interventions widely used by different healthcare professionals for the management of musculoskeletal (MSK) disorders. While previous theoretical principles focused predominantly on biomechanical accounts, recent models propose that the observed pain modulatory effects of this form of manual therapy may be the result of more complex mechanisms. It has been suggested that other phenomena like neurophysiological responses and the activation of the immune-endocrine system may explain variability in pain inhibition after the administration of spinal manipulative therapy (SMT). The aim of this paper is to provide an overview of the available evidence supporting the biological plausibility of high-velocity, low-amplitude thrust (HVLAT) on the immune-endocrine system. Materials and Methods: Narrative critical review. An electronic search on MEDLINE, ProQUEST, and Google Scholar followed by a hand and "snowballing" search were conducted to find relevant articles. Studies were included if they evaluated the effects of HVLAT on participants' biomarkers Results: The electronic search retrieved 13 relevant articles and two themes of discussion were developed. Nine studies investigated the effects of SMT on cortisol levels and five of them were conducted on symptomatic populations. Four studies examined the effects of SMT on the immune system and all of them were conducted on healthy individuals. Conclusions: Although spinal manipulations seem to trigger the activation of the neuroimmunoendocrine system, the evidence supporting a biological account for the application of HVLAT in clinical practice is mixed and conflicting. Further research on subjects with spinal MSK conditions with larger sample sizes are needed to obtain more insights about the biological effects of spinal manipulative therapy.


Assuntos
Sistema Endócrino/fisiologia , Sistema Imunitário/fisiologia , Manipulação da Coluna/efeitos adversos , Manipulação da Coluna/métodos , Sistema Endócrino/inervação , Sistema Endócrino/metabolismo , Humanos , Sistema Imunitário/inervação , Sistema Imunitário/metabolismo , Manejo da Dor/métodos , Manejo da Dor/normas , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Resultado do Tratamento
5.
J Orthop Surg Res ; 14(1): 178, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200736

RESUMO

BACKGROUND: Symptomatic degenerative lumbar spondylolisthesis (DLS) presents spinal problems in daily life. Shi-style lumbar manipulation (SLM), as an alternative treatment for DLS, is popular in China. SLM is based on the channels and collaterals theory of the traditional Chinese medicine, in which the symptoms are believed to result from channel blockage and joint displacement. However, there is no solid evidence to show the effect of the SLM on the management of symptomatic DLS. METHODS/DESIGN: We conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of SLM with mechanical lumbar traction and explore whether it could be a potential therapy for symptomatic DLS. A total of 60 patients with symptomatic DLS will be enrolled and treated with the SLM or mechanical lumbar traction for 2 weeks. VAS score and SF-36 questionnaire were assessed at baseline and at 2, 4, 12, and 24 weeks. Any signs of acute adverse reactions, such as lower limb paralysis or syndrome of cauda equina, will be recorded at each visit during treatment. DISCUSSION: Although the SLM has been used in China for many years to treat symptomatic DLS, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of SLM on symptomatic DLS. TRIAL REGISTRATION: Registered on 6 January 2019; the trial number is ChiCTR1900020519 .


Assuntos
Degeneração do Disco Intervertebral/terapia , Vértebras Lombares , Manipulação da Coluna/métodos , Espondilolistese/terapia , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/epidemiologia , Manipulação da Coluna/tendências , Estudos Prospectivos , Método Simples-Cego , Espondilolistese/diagnóstico , Espondilolistese/epidemiologia , Resultado do Tratamento
6.
PLoS One ; 14(6): e0218940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31237917

RESUMO

BACKGROUND: Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking. OBJECTIVE: To conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. METHODS: PubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed. RESULTS: Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment. CONCLUSIONS: Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.


Assuntos
Manipulação da Coluna/métodos , Doenças da Coluna Vertebral/terapia , Coluna Vertebral/fisiopatologia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Resultado do Tratamento
7.
J Bodyw Mov Ther ; 23(2): 417-424, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31103129

RESUMO

OBJECTIVES: To investigate the immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain. STUDY DESIGN: Randomized, controlled trial. BACKGROUND: Thoracic spine self-mobilization is performed after thoracic spine thrust manipulation to augment and maintain its effects. To the best of our knowledge, no study has investigated the effects of thoracic spine self-mobilization alone in individuals with mechanical neck pain. The purpose of this randomized, controlled trial was to evaluate the immediate effects of thoracic spine self-mobilization alone without any other intervention on disability, pain, and cervical range of motion in patients with mechanical neck pain. METHODS: Fifty-two patients (39 females and 13 males) with mechanical neck pain were randomly allocated to either a thoracic spine self-mobilization group that was performing a thoracic spine active flexion and extension activity using two tennis balls fixed by athletic tape or a placebo thoracic spine self-mobilization group. Outcome measures were collected at pre-intervention and immediately after intervention, including the Neck Disability Index, visual analogue scale, and active cervical range of motion (ROM). The immediate effect of the intervention was analyzed using two-way repeated measures analysis of variance (ANOVA). If interactions were found, a simple main effect test was performed to compare the pre-post intra-group results. RESULTS: The results of two-way repeated measures ANOVA indicated that the main effect of time was significant (p < 0.05) for all measurement outcomes. The main effect of group was not significant for all measurement outcomes (p > 0.05). The group × time interactions for cervical flexion active ROM (p = 0.005) and cervical extension active ROM (p = 0.036) were significant. The tests of simple main effect in cervical flexion active ROM (p < 0.0001) and cervical extension active ROM (p < 0.0001) showed a significant difference before and after intervention in the thoracic spine self-mobilization group. CONCLUSION: Patients with mechanical neck pain who carried out thoracic spine self-mobilization showed increases in active cervical flexion and extension ROM.


Assuntos
Manipulação da Coluna/métodos , Cervicalgia/terapia , Adulto , Idoso , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Autocuidado , Vértebras Torácicas
8.
Chiropr Man Therap ; 27: 23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31139346

RESUMO

Introduction: The burden of musculoskeletal disorders increases every year, with low back and neck pain being the most frequently reported conditions for seeking manual therapy treatment. In recent years, manual therapy research has begun exploring the dose-response relationship between spinal manipulation treatment characteristics and both clinical and physiological response to treatment. Objective: The purpose of this scoping review was to identify and appraise the current state of scientific knowledge regarding the effects of spinal manipulation frequency and dosage on both clinical and physiological responses. Methods: A scoping review was conducted to identify all available studies pertaining to our research question. Retrieved papers were screened using a 2-phase method, a selective sorting with titles and abstracts. Potentially relevant studies were read, and data was extracted for all included studies. Randomized control trials were assessed using the Cochrane Risk of Bias Tool for quality assessment. Results: The search yielded 4854 publications from which 32 were included for analysis. Results were sorted by dosage or frequency outcomes, and divided into human or animal studies. Animal studies mainly focused on dosage and evaluated physiological outcomes only. Studies investigating spinal manipulation dosage effects involved both human and animal research, and showed that varying thrust forces, or thrust durations can impact vertebral displacement, muscular response amplitude or muscle spindle activity. Risk of bias analysis indicated only two clinical trials assessing frequency effects presented a low risk of bias. Although trends in improvement were observed and indicated that increasing the number of SM visits in a short period of time (few weeks) decreased pain and improve disability, the differences between the studied treatment frequencies, were often not statistically significant and therefore not clinically meaningful. Conclusion: The results of this study showed that SM dosage and frequency effects have been mostly studied over the past two decades. Definitions for these two concepts however differ across studies. Overall, the results showed that treatment frequency does not significantly affect clinical outcomes during and following a SM treatment period. Dosage effects clearly influence short-term physiological responses to SM treatment, but relationships between these responses and clinical outcomes remains to be investigated.


Assuntos
Doenças Musculoesqueléticas/terapia , Animais , Humanos , Manipulação da Coluna/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Musculoskelet Sci Pract ; 42: 90-97, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31075730

RESUMO

BACKGROUND: sympathoexcitation observed with passive cervical mobilisations may imply activation of an endogenous pain inhibition system resulting in hypoalgesia. However, research is mostly in asymptomatic participants and there is very limited evidence of a relationship between sympathoexcitation and symptomatic improvement in people with clinical pain. OBJECTIVE: to investigate the effects of cervical mobilisations on the sympathetic nervous system in participants with neck pain, and to explore the relationship between symptomatic improvement and sympathoexcitation. DESIGN: double-blind randomised controlled trial. METHOD: 40 participants with neck pain (aged 20-69 years, 25 female) were randomly allocated to either cervical mobilisations or motionless placebo. Skin conductance was measured before, during, and after intervention. After interventions were completed, their credibility was assessed. Participants were classified as responders or non-responders according to global symptom change. RESULTS: participants receiving mobilisations were more likely to be classified as responders (odds ratio: 4.33, p = 0.03) and demonstrated greater change in most outcome measures of sympathoexcitation from baseline to during the intervention but not from during to after the intervention. There was no association between sympathoexcitation and symptomatic improvement. Mobilisations and placebo were equally credible. CONCLUSIONS: These findings suggest sympathoexcitatory changes may be caused by an orienting response unrelated to the activation of an endogenous pain inhibition system Alternatively, the observed lack of an association may be explained by the existence of various mechanisms for pain relief. This study used single outcome measures of sympathoexcitation and symptomatic improvement and other measures may reveal different things. CLINICALTRIALS. GOV NUMBER: M10/2016/095.


Assuntos
Manipulação da Coluna/métodos , Cervicalgia/fisiopatologia , Cervicalgia/terapia , Manejo da Dor/métodos , Sistema Nervoso Simpático/fisiopatologia , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Complement Ther Med ; 44: 61-67, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31126577

RESUMO

OBJECTIVES: To determine the short-term effects of a modified Flexion-Distraction (FD) technique in comparison with a high-velocity low-back spinal manipulation (HVLA-SM) protocol on patients suffering from chronic low-back pain (CLBP). DESIGN AND METHODS: A randomized controlled trial. The sample was composed of 150 patients suffering from CLBP, who were randomly assigned to either a FD (n = 75) or a HVLA-SM (n = 75) group. The variables used to study pain were the scores of the Visual Analogue Scale (VAS) and the Pressure Pain Threshold (PPT) on trigger points (TrPs) of the quadratus lumborum. In addition, the Oswestry Disability Index (ODI) was used to measure disability, and Schober's test and the Finger Floor Distance test (FFDT) to measure changes in low-back spine motion. An Analysis of Covariance (ANCOVA) was used to measure group effect, and Number Needed to Treat (NNT) for effect size. RESULTS: Greater improvements occurred in the FD group, with a statistically significant group effect (p < 0.001) for all outcome variables. The ETA2 value was larger than 0.100 in the Schober's and FDD tests, larger than 0.200 in the case of ODI and PPT, and larger than 0.300 for VAS. OR = 0.07 [IC 95% = 0.03 to 0.18] and NNT = 2.08 [IC 95% = 1.64-2.84) yielded improved values for the FD group. CONCLUSION: For patients suffering from CLBP, greater improvements in pain and function were observed in the group receiving the modified FD treatment than in the HVLA-SM group.


Assuntos
Dor Lombar/terapia , Manipulação da Coluna/métodos , Medição da Dor/métodos , Adulto , Feminino , Humanos , Masculino , Limiar da Dor/fisiologia , Amplitude de Movimento Articular/fisiologia , Método Simples-Cego , Inquéritos e Questionários , Resultado do Tratamento
11.
Med Sci Monit ; 25: 2344-2351, 2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30928990

RESUMO

BACKGROUND Spinal manipulation, particularly in cervical rotatory manipulation (CRM), has become increasingly popular in physical therapies, with satisfying effect. However, it is still unclear whether CRM affects internal carotid arteries (ICA) with mild carotid atherosclerosis (CAS), especially in hemodynamics. MATERIAL AND METHODS Nine cynomolgus monkeys were randomly divided into 3 groups: the CAS-CRM, the CAS, and the blank control groups. CAS models were developed in the left ICA in the CAS-CRM and the CAS groups. The monkeys in the CAS-CRM group underwent CRM intervention for 3 weeks. Histology and hemodynamics were measured, including peak systolic velocity (PSV), end-diastolic velocity (EDV), time average velocity (TAV), resistance index (RI), and pulsatility index (PI). Measurements were made separately at 3 different rotation angles (0°, 45°, and 90°). RESULTS In the 3 groups, with the increase of rotation angle, the decreasing tendency of PSV, EDV, and TAV and the increasing tendency of RI and PI were statistically significant. At each angle, the monkeys in the CAS-CRM and the CAS groups had lower levels of PSV, EDV, and TAV and higher levels of RI and PI compared with the blank control group. No significant difference in hemodynamics was found between the CAS-CRM and the CAS groups. CONCLUSIONS Both the rotational angle and the atherosclerotic disease can affect the blood flow of the ICA. However, CRM does not cause adverse effects on hemodynamics in cynomolgus monkeys with mild CAS, and appears to be a relatively safe technique.


Assuntos
Artérias Carótidas/patologia , Doenças das Artérias Carótidas/terapia , Manipulação da Coluna/métodos , Animais , Velocidade do Fluxo Sanguíneo/fisiologia , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/fisiopatologia , China , Modelos Animais de Doenças , Hemodinâmica/fisiologia , Macaca fascicularis , Masculino
12.
J Manipulative Physiol Ther ; 42(1): 66-74, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30955908

RESUMO

OBJECTIVE: The purpose of this study was to explore vertebral artery hemodynamic changes associated with McKenzie therapeutic cervical movements in healthy individuals. METHODS: A single-group repeated-measure design was used to examine 20 healthy participants aged 22.05 (1.69) years, mean (standard deviation). Vertebral artery volume flow, diameter, resistive index, time-averaged maximum velocity, and pulsatility index were measured using Duplex ultrasound. Vertebral artery hemodynamics were measured at cervical neutral positions then compared against vertebral artery hemodynamics measured during end-range loading and after repeated McKenzie therapeutic movements. Wilcoxon signed rank tests were used for comparisons, and standardized mean differences (SMDs) were calculated to quantify the changes in size. RESULTS: Repeated retraction with extension in a sitting position and end-range retraction with extension in supine position were significantly associated with an increase in vertebral artery volume flow, P ≤ .01, and the SMD suggests small-medium changes in size. Statistical significant vertebral artery dilation was observed in the sitting position with protraction, combined retraction with extension, and flexion, P ≤ .01, yet the SMD suggested small changes in size. End-range flexion was significantly associated with a reduction in vertebral artery pulsatility index, and the SMD suggested large changes in size. Repeated retraction with extension in supine position was significantly associated with an increase in vertebral artery time-averaged maximum velocity, yet the SMD revealed no clinically important difference. CONCLUSION: For the healthy participants in this study, McKenzie cervical movements were mostly associated with an increase in vertebral artery hemodynamics.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Manipulação da Coluna/métodos , Fluxo Pulsátil/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiologia , Vértebras Cervicais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Decúbito Dorsal , Ultrassonografia Doppler Dupla , Adulto Jovem
13.
Chiropr Man Therap ; 27: 17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30911373

RESUMO

Background: The autonomic nervous system (ANS) interests many chiropractors and manual therapists, because joint manipulative techniques (JMT), e.g. high velocity low amplitude (HVLA) manipulations and mobilizations, appear to produce acute changes in ANS mediated physiology. The complexity of this issue justifies a systematic critical literature review. Objective: To review the literature comparing the acute changes in markers of ANS activity between JMT applied on spinal or peripheral joints and a sham procedure in healthy or symptomatic subjects. Method: We searched PsycINFO, PEDro, PubMed, Cochrane library, EMBASE, and Medline up to December 2017. We updated the search with PubMed, Cochrane library, EMBASE, and Medline including July 2018. Inclusion criteria were: randomized sham-controlled trials assessing the effect of JMT on markers of ANS activity; manually applied JMT, regardless of technique, applied on either healthy or symptomatic humans; outcome measurements recorded at baseline and repeated during and/or after interventions. Selection of articles and data extraction were performed independently by two reviewers. The quality of studies was assessed using the Cochrane 'risk of bias' tool and a technical check-list. Results were reported narratively with some meta-analyses. The Cochrane GRADE approach was used to assess the certainty of evidence. Results: Twenty-nine of 2267 studies were included in the synthesis. Mobilizations (oscillatory technique) probably produce an immediate and short-term, bilateral increase in skin sympathetic nerve activity (reflected by an increase in skin conductance) regardless of the area treated (moderate-certainty evidence). It is uncertain whether the sympathetic arousal also explains an increase in respiratory rate (very low-certainty evidence). Our evaluation of the literature suggests that spinal sustained apophyseal glides (SNAGs) mobilization and HVLA manipulation of the spine may have no acute effect on the studied markers of ANS activity (very low- to low-certainty evidence). Conclusion: Some types of mobilizations probably produce an immediate and short-term, statistically significant increase in skin sympathetic nerve activity when compared to a sham procedure, whereas spinal SNAGs and spinal HVLA techniques may have no acute effect on the studied markers of ANS activity. No region-specific results were noted. The literature suffers from several shortcomings, for which reason we strongly suggest further research.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Manipulação da Coluna , Sistema Nervoso Simpático/fisiologia , Biomarcadores , Frequência Cardíaca , Humanos , Manipulação da Coluna/métodos , Pele
14.
BMJ ; 364: l689, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30867144

RESUMO

OBJECTIVE: To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting. REVIEW METHODS: Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence. The effect of SMT was compared with recommended therapies, non-recommended therapies, sham (placebo) SMT, and SMT as an adjuvant therapy. Main outcomes were pain and back specific functional status, examined as mean differences and standardised mean differences (SMD), respectively. Outcomes were examined at 1, 6, and 12 months. Quality of evidence was assessed using GRADE. A random effects model was used and statistical heterogeneity explored. RESULTS: 47 randomised controlled trials including a total of 9211 participants were identified, who were on average middle aged (35-60 years). Most trials compared SMT with recommended therapies. Moderate quality evidence suggested that SMT has similar effects to other recommended therapies for short term pain relief (mean difference -3.17, 95% confidence interval -7.85 to 1.51) and a small, clinically better improvement in function (SMD -0.25, 95% confidence interval -0.41 to -0.09). High quality evidence suggested that compared with non-recommended therapies SMT results in small, not clinically better effects for short term pain relief (mean difference -7.48, -11.50 to -3.47) and small to moderate clinically better improvement in function (SMD -0.41, -0.67 to -0.15). In general, these results were similar for the intermediate and long term outcomes as were the effects of SMT as an adjuvant therapy. Evidence for sham SMT was low to very low quality; therefore these effects should be considered uncertain. Statistical heterogeneity could not be explained. About half of the studies examined adverse and serious adverse events, but in most of these it was unclear how and whether these events were registered systematically. Most of the observed adverse events were musculoskeletal related, transient in nature, and of mild to moderate severity. One study with a low risk of selection bias and powered to examine risk (n=183) found no increased risk of an adverse event (relative risk 1.24, 95% confidence interval 0.85 to 1.81) or duration of the event (1.13, 0.59 to 2.18) compared with sham SMT. In one study, the Data Safety Monitoring Board judged one serious adverse event to be possibly related to SMT. CONCLUSION: SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.


Assuntos
Doença Crônica/terapia , Dor Lombar/terapia , Manipulação da Coluna , Humanos , Dor Lombar/fisiopatologia , Manipulação da Coluna/efeitos adversos , Manipulação da Coluna/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Resultado do Tratamento
15.
PLoS One ; 14(2): e0211877, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30759118

RESUMO

OBJECTIVE: To investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP). DATA SOURCES: Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018. STUDY SELECTION: Eligible studies were completed RCTs, written in English, had at least 2 groups with one group receiving TSM, had at least one measure of pain or disability, and included patients with MNP of any duration. The search identified 1717 potential articles, with 14 studies meeting inclusion criteria. STUDY APPRAISAL AND SYNTHESIS METHODS: Methodological quality was evaluated independently by two authors using the guidelines published by the Cochrane Collaboration. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate mean differences (MD) and 95% confidence intervals for pain (VAS 0-100mm, NPRS 0-10pts; 0 = no pain) and disability (NDI and NPQ 0-100%; 0 = no disability). RESULTS: Across the included studies, there was increased risk of bias for inadequate provider and participant blinding. The GRADE approach demonstrated an overall level of evidence ranging from very low to moderate. Meta-analysis that compared TSM to thoracic or cervical mobilization revealed a significant effect favoring the TSM group for pain (MD -13.63; 95% CI: -21.79, -5.46) and disability (MD -9.93; 95% CI: -14.38, -5.48). Meta-analysis that compared TSM to standard care revealed a significant effect favoring the TSM group for pain (MD -13.21; 95% CI: -21.87, -4.55) and disability (MD -11.36; 95% CI: -18.93, -3.78) at short-term follow-up, and a significant effect for disability (MD -4.75; 95% CI: -6.54, -2.95) at long-term follow-up. Meta-analysis that compared TSM to cervical spine manipulation revealed a non-significant effect (MD 3.43; 95% CI: -7.26, 14.11) for pain without a distinction between immediate and short-term follow-up. LIMITATIONS: The greatest limitation in this systematic review was the heterogeneity among the studies making it difficult to assess the true clinical benefit, as well as the overall level of quality of evidence. CONCLUSIONS: TSM has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care in the short-term, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability. TRIAL REGISTRATION: PROSPERO CRD42017068287.


Assuntos
Dor Lombar/terapia , Manipulação da Coluna/métodos , Cervicalgia/terapia , Pescoço/fisiopatologia , Adulto , Pessoas com Deficiência , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/fisiopatologia , Coluna Vertebral/fisiopatologia , Estresse Mecânico
16.
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
17.
Eur J Phys Rehabil Med ; 55(6): 792-805, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30621368

RESUMO

BACKGROUND: Most of the research on the effects of spinal manipulation on endocrine function has been done on healthy subjects and has yielded contradictory results. The potential role of cervical manual therapy intervention in order to induce changes in the endocrine system has not yet been investigated. AIM: The aim of this trial is to compare the effects on salivary cortisol levels and clinical outcomes of cervical manipulation versus cervical mobilization or sham manipulation in patients with chronic mechanical neck pain. DESIGN: Randomized controlled trial. SETTING: University of Alcala de Henares: outpatient (referrals from office workers). POPULATION: A total of 83 patients with chronic mechanical neck pain. METHODS: Participants were randomized to receive one session of cervical manipulation, cervical mobilization, or sham manipulation. The measured variables were salivary cortisol levels, neck pain and disability, pressure pain thresholds (PPT), and cervical range of motion (ROM). They were obtained at baseline, immediately after treatment (except neck disability), and at one-week follow-up (except cortisol). RESULTS: A significant and comparable increase in cortisol levels was observed immediately after cervical manipulation and mobilization (both P<0.001). Neck disability improved to a similar degree in the cervical manipulation and mobilization groups at the one-week follow-up (both P<0.001). Neck pain was reduced immediately after cervical manipulation (P<0.001), cervical mobilization (P=0.001), and sham manipulation (P<0.001). There were no significant changes in most ROM directions after either treatment. No significant interaction effect was observed for PPT. CONCLUSIONS: Cervical manipulation and mobilization resulted in a similar increase in cortisol concentrations immediately post-treatment in people with chronic mechanical neck pain. Supraspinal mechanisms may thus play a role in the hypoalgesic effects that follow the application of both interventions. CLINICAL REHABILITATION IMPACT: The increase in cortisol levels was similar with cervical manipulation and mobilization so induced stress levels can be similar in both interventions.


Assuntos
Dor Crônica/reabilitação , Hidrocortisona/análise , Manipulação da Coluna/métodos , Cervicalgia/reabilitação , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Limiar da Dor , Amplitude de Movimento Articular , Saliva/química
18.
Int Orthop ; 43(5): 1255-1262, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29987557

RESUMO

PURPOSE: The aim of this study was to assess the clinical efficacy and safety of Z-shape elevating-pulling reduction as compared to that of conventional skull traction in the treatment of lower cervical locked facet. METHODS: Patients with cervical locked facet (n = 63) were retrospectively enrolled from four medical centers and divided into two groups according to the pre-operative reduction method used: Z-shape elevating-pulling reduction (Z-shape elevating group; n = 20) or traditional skull traction reduction (skull traction group; n = 43). RESULTS: The success rates, efficacy of reduction, and safety were compared between the two groups. The success rates were significantly better in the Z-shape elevating group than in the skull traction group: 87.5% (7/8) vs. 35.3% (6/17) for unilateral locked facet reduction (P = 0.03) and 100% (12/12) vs. 69.2% (18/26) for bilateral locked facet reduction (P = 0.04). There was no obvious change in American Spinal Injury Association (ASIA) grade after the reduction in either group. Combined surgery was necessary in 5% in the Z-shape elevating group vs. 27.9% in the skull traction group. Imaging showed that the segment angle and horizontal displacement were significantly improved after surgery in both groups, with no significant difference between the groups. Follow-up with radiography showed good recovery of the cervical spine sequence; all internal fixation sites were stable, with no loosening, prolapse, or breakage of internal fixators. CONCLUSIONS: Halo vest-assisted Z-shape elevating-pulling reduction appears to be a simple, safe, and effective technique for pre-operative reduction of lower cervical locked facets.


Assuntos
Vértebras Cervicais/cirurgia , Redução Fechada/métodos , Luxações Articulares/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Articulação Zigapofisária/lesões , Adulto , Braquetes , Vértebras Cervicais/lesões , Feminino , Humanos , Masculino , Manipulação Ortopédica/métodos , Manipulação da Coluna/métodos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Crânio/cirurgia , Tração/métodos , Resultado do Tratamento , Articulação Zigapofisária/cirurgia
19.
Spine (Phila Pa 1976) ; 44(1): 68-78, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29952880

RESUMO

STUDY DESIGN: Systematic review. OBJECTIVE: To investigate the effects of Kinesio Taping (KT) in patients with nonspecific low back pain. SUMMARY OF BACKGROUND DATA: KT is widely used in patients with low back pain. METHODS: We conducted searches on PubMed, EMBASE, PEDro, SciELO, and LILACS up to February 26, 2018. We included only randomized controlled trials (RCTs) in adults with chronic nonspecific low back pain that compared KT to no intervention or placebo as well as RCTs that compared KT combined with exercise against exercise alone. The methodological quality and statistical reporting of the eligible trials were measured by the 11-item PEDro scale. The quality of the evidence was assessed using the GRADE classification. We considered pain intensity and disability as the primary outcomes. Whenever possible, the data were pooled through meta-analysis. RESULTS: We identified 11 RCTs for this systematic review (pooled n = 743). Two clinical trials (pooled n = 100) compared KT to no intervention at the short-term follow-up. Four studies compared KT to placebo (pooled n = 287) at short-term follow-up and two trials (pooled n = 100) compared KT to placebo at intermediate-term follow-up. Five trials (pooled n = 296) compared KT combined with exercises or electrotherapy to exercises or spinal manipulation alone. No statistically significant difference was found for most comparisons. CONCLUSION: Very low to moderate quality evidence shows that KT was no better than any other intervention for most the outcomes assessed in patients with chronic nonspecific low back pain. We found no evidence to support the use of KT in clinical practice for patients with chronic nonspecific low back pain. LEVEL OF EVIDENCE: 1.


Assuntos
Fita Atlética/tendências , Dor Crônica/terapia , Dor Lombar/terapia , Adulto , Fita Atlética/normas , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Pessoas com Deficiência/reabilitação , Terapia por Exercício/métodos , Terapia por Exercício/normas , Terapia por Exercício/tendências , Humanos , Dor Lombar/diagnóstico , Dor Lombar/epidemiologia , Manipulação da Coluna/métodos , Manipulação da Coluna/normas , Manipulação da Coluna/tendências , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento
20.
Arthritis Care Res (Hoboken) ; 71(11): 1516-1524, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30354023

RESUMO

OBJECTIVE: Back and neck pain are associated with disability and loss of independence in older adults. Whether long-term management using commonly recommended treatments is superior to shorter-term treatment is unknown. This randomized clinical trial compared short-term treatment (12 weeks) versus long-term management (36 weeks) of back- and neck-related disability in older adults using spinal manipulative therapy (SMT) combined with supervised rehabilitative exercises (SRE). METHODS: Eligible participants were ages ≥65 years with back and neck disability for ≥12 weeks. Coprimary outcomes were changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores after 36 weeks. An intent-to-treat approach used linear mixed-model analysis to detect between-group differences. Secondary analyses included other self-reported outcomes, adverse events, and objective functional measures. RESULTS: A total of 182 participants were randomized. The short-term and long-term groups demonstrated significant improvements in back disability (ODI score -3.9 [95% confidence interval (95% CI) -5.8, -2.0] versus ODI score -6.3 [95% CI -8.2, -4.4]) and neck disability (NDI score -7.3 [95% CI -9.1, -5.5] versus NDI score -9.0 [95% CI -10.8, -7.2]) after 36 weeks, with no difference between groups (back ODI score 2.4 [95% CI -0.3, 5.1]; neck NDI score 1.7 [95% CI 0.8, 4.2]). The long-term management group experienced greater improvement in neck pain at week 36, in self-efficacy at weeks 36 and 52, and in functional ability, and balance. CONCLUSION: For older adults with chronic back and neck disability, extending management with SMT and SRE from 12 to 36 weeks did not result in any additional important reduction in disability.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Terapia por Exercício/métodos , Manipulação da Coluna/métodos , Cervicalgia/terapia , Fatores de Tempo , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/fisiopatologia , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Feminino , Avaliação Geriátrica , Humanos , Masculino , Cervicalgia/fisiopatologia , Desempenho Físico Funcional , Autoeficácia , Resultado do Tratamento
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