Reliability and Responsiveness of Patient-Reported Outcome Measures of Neck Disability to Physical Therapy: Comparison of the Copenhagen,Northwick Park,and Neck Bournemouth Questionnaires and the Neck Disability Index

ObjectiveThe purpose of this study was to identify the external and internal reliability and responsiveness of the validated patient-reported outcome measures (PROMs) of neck pain to a standardized regimen of physiotherapy administered acutely after mild whiplash injury using the clinically significant improvement components of the Patient Global Impression of Change (PGIC) as the outcome measure.MethodsEighty-six patients with neck pain alone were referred for physiotherapy within 2 weeks of whiplash injury. They completed the Copenhagen, Northwick Park (NP), and Neck Bournemouth (NBQ) questionnaires and the Neck Disability Index (NDI) before starting and after treatment when they also completed the PGIC. Treatment comprised deep soft tissue massage, myofascial releases, muscle energy techniques, joint articulation and manipulation techniques, and a home exercise program. The duration of treatment was between 3 and 6 weeks. A PGIC of 6 or 7 was considered to be clinically significant improvement.ResultsThe external reliability of the PROMs was >0.7 and internal >0.87. All components of the PROMs contributed to the final score except headache in the Copenhagen and upper-limb dysesthesia in the NP. The most reliable questionnaire was the NBQ, which was significantly more responsive than the Copenhagen (P = .008). The NBQ was slightly more responsive than the NDI and NP. The NBQ and NDI were successfully completed more frequently than the NP and Copenhagen.ConclusionThe NP, NDI, and NBQ are all reliable and responsive measures of change after physiotherapy for neck pain after acute whiplash injury.     

Adding Temporomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: A randomized clinical study

IntroductionNeck Pain can be related to the disorders of other adjacent areas such as the Temporomandibular Joint (TMJ). This study aimed to investigate whether there is value in adding TMJ treatments to routine physiotherapy in patients with non-specific chronic neck pain compared with a control group.MethodsA randomized, single-blind, clinical study desined including two groups of patients. Group A (20 people) received routine physiotherapy for neck pain and group B (20 people) received TMJ manual therapy plus exercise therapy in addition to routine physiotherapy for neck pain. The Treatment program included six sessions for two days a week over a period of 21 days. Assessments were performed during the first session, in the last session and one month after treatment as a follow-up. Outcome measures included neck range of motion (ROM), neck disability index (NDI) and visual analogue scale (VAS). Before starting the study, the reliability of methods for measuring neck ROM was evaluated.ResultsParticipants were 21 women and 19 men. Initially, a pilot study was carried out on the 40 volunteers to assess the reliability of the measurement methods, and the results were acceptable. With both the control group and the intervention group, the indexes showed significant improvement (p < 0.001), although the intervention group showed more improvement (p < 0.001).ConclusionThis result means adding treatments of TMJ to routine neck physiotherapy can magnify the effect of the intervention, a significant change still in evidence at follow up. Moreover, given the clinically important differences, our results for VAS and NDI were acceptable.     

Reliability in Mandibular Movement Evaluation Using Photogrammetry in Patients With Temporomandibular Disorders

ObjectiveThe purpose of this study was to propose a quantitative evaluation for mandibular opening–closing movement asymmetries and to verify the intraexaminer and interexaminer reliability using photogrammetry in individuals with and without myogenic temporomandibular disorders.MethodsForty-nine female participants between ages 18 and 40 were enrolled in this study. They were assigned to 2 different groups: a temporomandibular disorder group, (n = 25; 28.1 ± 3.6 years) and an asymptomatic group (n = 24; 25.6 ± 5.1 years). Data were collected through photogrammetry using Corel Draw X3 software (Corel Corp, Ottawa, Ontario, Canada) for angle measurements. Reliability analysis was done on the total sample, and the photographs were obtained by a singular examiner on 2 occasions (intraexaminer) 1 month apart and from measurement made by another examiner (interexaminer) on different days. The intraclass correlation coefficient (ICC) was applied with a significance level of 5%.ResultsThe photogrammetry had excellent intrarater and inter-rater reliability for the evaluation of opening and closing movements of the jaw (intrarater: opening ICC = 0.99; closing ICC = 0.98; inter-rater: opening ICC = 0.89 and closing ICC = 0.82). Photogrammetry also demonstrated excellent intra- and inter-rater reliability in the evaluation of head posture (intra-rater: head deviation ICC = 0.96; head position ICC = 0.75; inter-rater: head deviation ICC = 0.98; head position ICC = 0.98).ConclusionUnder these experimental conditions, most angular values presented excellent intra- and interexaminer reliability.     

Pitfalls in the use of kappa when interpreting agreement between multiple raters in reliability studies

ObjectiveTo compare different reliability coefficients (exact agreement, and variations of the kappa (generalised, Cohen's and Prevalence Adjusted and Biased Adjusted (PABAK))) for four physiotherapists conducting visual assessments of scapulae.DesignInter-therapist reliability study.SettingResearch laboratory.Participants30 individuals with no history of neck or shoulder pain were recruited with no obvious significant postural abnormalities.Main outcome measuresRatings of scapular posture were recorded in multiple biomechanical planes under four test conditions (at rest, and while under three isometric conditions) by four physiotherapists.ResultsThe magnitude of discrepancy between the two therapist pairs was 0.04 to 0.76 for Cohen's kappa, and 0.00 to 0.86 for PABAK. In comparison, the generalised kappa provided a score between the two paired kappa coefficients. The difference between mean generalised kappa coefficients and mean Cohen's kappa (0.02) and between mean generalised kappa and PABAK (0.02) were negligible, but the magnitude of difference between the generalised kappa and paired kappa within each plane and condition was substantial; 0.02 to 0.57 for Cohen's kappa and 0.02 to 0.63 for PABAK, respectively.ConclusionsCalculating coefficients for therapist pairs alone may result in inconsistent findings. In contrast, the generalised kappa provided a coefficient close to the mean of the paired kappa coefficients. These findings support an assertion that generalised kappa may lead to a better representation of reliability between three or more raters and that reliability studies only calculating agreement between two raters should be interpreted with caution. However, generalised kappa may mask more extreme cases of agreement (or disagreement) that paired comparisons may reveal.     

Communicating vessels volumeter to measure upper extremity lymphedema after breast cancer: reliability and criterion validity compared to the gold standard

BackgroundThe traditional overflow method for measuring limb volume remains the gold standard, but many disadvantages still inhibit its routine use in clinical practice.ObjectiveTo assess the intra-rater and inter-rater reliability and criterion validity of the ‘communicating vessels volumeter’ (CVV) for volume measurement of lymphedematous upper extremities (LUE) by using the overflow volumeter (OV) as the reference standard.MethodsTwelve LUE of 12 women undergoing mastectomy for breast cancer were measured three times each by three raters using both methods, totaling 216 volume measurements. Criterion validity was estimated by 33 volume measurements of one cylinder of known volume by three raters using both methods, totaling 198 measurements.ResultsMeasurement time was short with both CVV and OV. The intraclass correlation coefficient_3,1 was high for both CVV and OV in intra-rater (0.99 vs 0.99) and inter-rater (0.99 vs 0.99) analyses. The bias between methods was low (7.50 mL; 0.40%) and the limits of agreement were narrow (?5.80 to 6.50%). The volumes were statistically equal with a strong correlation (R² = 0.98) between methods. CVV was more accurate than OV (0.00 vs 0.02%) in cylinder measurements.ConclusionThe high intra-rater and inter-rater reliability rates of CVV were comparable to those of OV, and the volumes resulting from LUE measurements were statistically equal in the two methods. Criterion validity rates indicated that CVV measurements were closer to the actual value of the cylinder than those obtained with the OV.     

Effects of auricular acupressure on pain and disability in adults with chronic neck pain

AimThe aim of this study was to examine the effect of auricular acupressure (AA) on pain, pain threshold (PT), disability, and cervical range of motion in adults with chronic neck pain.BackgroundAbout 30–50% of the world's population suffers from chronic neck pain, and the cost of treatment is increasing.Materials and methodsThis single-blind, randomized sham-controlled study was conducted on 48 adults with chronic neck pain in South Korea. The experimental group (n = 25) received AA on specific acupoints for neck pain, whereas the control group (n = 23) received AA on unspecific acupoints. Participants received 4 weeks of auricular-acupressure intervention. Outcomes were assessed by the visual analog scale (VAS), PT, neck-disability index (NDI), and cervical range of motion. Measurements were taken 3 times: before intervention, 2 weeks into the intervention, and after the intervention.ResultsStatistical differences between the two groups emerged in PT (p = .003), the NDI (p = .033), cervical flexion (p = .004), and left rotation (p = .004), but not on the VAS.ConclusionsThis study showed that AA leads to improvements on PT, neck disability, and cervical range of motion. Therefore, AA can be used as an alternative nursing intervention for chronic neck pain.     

Reliability of the Craniocervical Posture Assessment: Visual and Angular Measurements Using Photographs and Radiographs

ObjectiveThe purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters.MethodsOne photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters.ResultsGood to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37).ConclusionThe raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.     

Individuals With Chronic Neck Pain Have Lower Neck Strength Than Healthy Controls: A Systematic Review With Meta-Analysis

ObjectiveThe aim is to verify whether there is difference in neck strength between healthy individuals and individuals with chronic neck pain.MethodsThe PubMed, Embase, and Scopus databases were searched. Two independent reviewers selected relevant full articles comparing neck strength between healthy individuals and individuals with chronic neck pain. Two independent reviewers extracted the data from the full articles selected. A meta-analysis was used to assess standardized mean differences in neck strength based on a random-effects model (Prospero number CRD42017081502).ResultsThe search returned 3554 results; 15 articles were included. The chronic neck pain group showed lower neck strength compared with healthy individuals. The standardized mean difference was -0.90 (95% confidence interval [CI] = -1.13 to -0.67) for flexion, -0.79 (95% CI = -0.99 to -0.60) for extension, -0.74 (95% CI = -1.03 to -0.45) for right lateral flexion, and -0.75 (95% CI = -1.04 to -0.46) for left lateral flexion.ConclusionBased on this meta-analysis with a 3a level of evidence, individuals with chronic neck pain have lower neck strength for flexion, extension, and the lateral flexion of the neck than healthy controls.     

Development and proof of concept of a blended physiotherapeutic intervention for patients with non-specific low back pain

ObjectiveTo develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept.DesignFocus groups with patients, physiotherapists, and eHealth and LBP experts were conducted to investigate values according to the development of e-Exercise LBP. Proof of concept was evaluated in a multicentre study.SettingDutch primary care physiotherapy practices (n = 21 therapists).ParticipantsAdults with non-specific LBP (n = 41).Interventione-Exercise LBP was developed based on clinical LBP guidelines and the focus groups, using the Center for eHealth Research Roadmap. Face-to-face physiotherapy sessions were integrated with a web application consisting of 12 information lessons, video-supported exercises and a physical activity module with the option to gradually increase individuals’ level of physical activity. The intervention could be tailored to patients’ risk of persistent disabling LBP, according to the STarT Back Screening Tool.Main outcome measuresFunctional disability, pain, physical activity, sedentary behaviour and fear-avoidance beliefs, measured at baseline and 12 weeks.ResultsAfter 12 weeks, improvements were found in functional disability [Quebec Back Pain Disability Scale: mean difference (MD) ?12.2/100; 95% confidence interval (CI) 8.3 to 16.1], pain (Numeric Pain Rating Scale: MD ?2.8/10; 95% CI 2.1 to 3.6), subjective physical activity (Short Questionnaire to Assess Health Enhancing Physical Activity: MD 11.5 minutes/day; 95% CI ?47.8 to 24.8) and objective sedentary behaviour (ActiGraph: MD ?23.0 minutes/day; 95% CI ?8.9 to 55.0). Small improvements were found in objective physical activity and fear-avoidance beliefs. The option to gradually increase physical activity was activated for six patients (15%). On average, patients received seven face-to-face sessions alongside the web application.ConclusionsThe results of this study provide the first indication of the effectiveness of e-Exercise LBP, particularly for disability and pain among patients with LBP. Future studies will focus on end-user experiences and (cost-) effectiveness.     

Clinical Measures Related to Forward Shoulder Posture: A Reliability and Correlational Study

ObjectivesThe purpose of this study was to examine the reliability of clinical measures related to forward shoulder posture (pectoralis minor index [PMI], scapular index [SI], abduction index [AI], acromion to the wall index [AWI] acromion to the treatment table index [ATI], and thoracic curvature [TC]), and to investigate the association (redundancy) among these measures.MethodsTwenty-one asymptomatic participants participated in this study. Two physiotherapists were trained to perform the clinical measurements. Intraclass correlation coefficients (ICC_2,k) were calculated to assess intra- and interrater reliabilities. Pearson product moment correlation was used to investigate the existence of possible redundancy between the measures that showed high intra- and interrater reliabilities.ResultsThe measures showed ICCs between 0.30 and 0.97. Five measures, PMI, SI, AWI, ATI, and TC, showed appropriate values for intrarater reliability (ICCs 0.77-0.94), and 3 measures, AWI, ATI, and TC, for interrater reliability (ICCs 0.82-0.85). Among measures that showed acceptable intra- and interrater reliability values, 2 measures were redundant, showing high association (AWI vs ATI) (r = 0.80, P < .001).ConclusionFor PMI, SI, AWI, ATI, and TC measures, adequate values of intrarater reliability were observed. For AWI, ATI, and TC, adequate values of interrater reliability were found. Two pairs of measures were highly associated (PMI with SI; AWI with ATI), which indicates redundancy among them. Our results suggest that, when the same examiner performs the assessment, the combined use of the PMI, AWI, and TC measures allows a quick but comprehensive evaluation of the presence of forward shoulder posture.     

The reliability of the Leeds Movement Performance Index (LMPI): a new tool for neurological physiotherapy

Abstract

Background: Measuring movement performance in people with neurological damage requires a tool that reflects physiotherapy assessment and clinical reasoning. The Leeds Movement Performance Index (LMPI) was previously developed by a group of neurological physiotherapists to fulfill these requirements. Objective: To assess the reliability of the LMPI for use in neurological physiotherapy practice. Methods: Twelve senior neurological physiotherapists were trained to use the LMPI and then asked to measure the movement performance of five patients whose movement had been previously video-recorded for this purpose. A retest session was completed after two weeks. Data were analysed to establish internal and external reliability. Results: Internal reliability was assessed using Cronbach's alpha coefficient, applied to the entire scale (0.862) and to each item (range 0.795–0.892). External (inter-rater) reliability was assessed by a calculation of the intraclass correlation coefficient for scores awarded by multiple raters (0.959), with individual item reliability ranging from 0.874 to 0.968. External (test–retest) reliability was assessed by calculating the Spearman's rank correlation coefficient between scores obtained on two testing occasions (0.792) with values of individual items ranging from 0.397 to 0.674. A variance components analysis partitioned variance into components arising from between-patient variability (55.2%) between-therapist variability (7.8%) and between-testing variability (2.8%). Conclusions: Results indicate that the LMPI is a reliable measurement tool when used by senior neurological physiotherapists.     

Feasibility and reliability of a virtual reality oculus platform to measure sensory integration for postural control in young adults

ABSTRACT

Background: Using Unity for the Oculus Development-Kit 2, we have developed an affordable, portable virtual reality platform that targets the visuomotor domain, a missing link in current clinical assessments of postural control. Here, we describe the design and technical development as well as report its feasibility with regards to cybersickness and test-retest reliability in healthy young adults. Method: Our virtual reality paradigm includes two functional scenes (‘City’ and ‘Park’) and four moving dots scenes. Twenty-one healthy young adults were tested twice, one to two weeks apart. They completed a simulator sickness questionnaire several times per session. Their postural sway response was recorded from a forceplate underneath their feet while standing on the floor, stability trainers, or a Both Sides Up (BOSU) ball. Sample entropy, postural displacement, velocity, and excursion were calculated and compared between sessions given the visual and surface conditions. Results: Participants reported slight-to-moderate transient side effects. Intra-Class Correlation values mostly ranged from 0.5 to 0.7 for displacement and velocity, were above 0.5 (stability trainer conditions) and above 0.4 (floor mediolateral conditions) for sample entropy, and minimal for excursion. Conclusion: Our novel portable VR platform was found to be feasible and reliable in healthy young adults.     

Immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain: A randomized controlled trial

ObjectivesTo investigate the immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain.Study designRandomized, controlled trial.BackgroundThoracic 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.MethodsFifty-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.ResultsThe 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.ConclusionPatients with mechanical neck pain who carried out thoracic spine self-mobilization showed increases in active cervical flexion and extension ROM.     

Correlation Between Chronic Neck Pain and Heart Rate Variability Indices at Rest: A Cross-sectional Study

ObjectiveThe purpose of this study was to correlate the heart rate variability (HRV) indices with variables of pain that were experienced by individuals with chronic neck pain.MethodsThis was a blinded cross-sectional study. Individuals with chronic neck pain (n = 15) and healthy participants (n = 15), both sedentary and between 18 and 45 years of age, were included. The neck pain was assessed with the Numerical Rating Scale at rest and during cervical movements, Neck Disability Index, Catastrophic Thoughts about Pain Scale, and Tampa Scale of Kinesiophobia. The HRV indices (linear and nonlinear) were used for assessment of autonomic function at rest (in supine, sitting, and standing positions).ResultsWe observed significant correlations between the NRS, Neck Disability Index, and Catastrophic Thoughts about Pain Scale with the linear and nonlinear HRV indices (P < .05, r ≥ 0.362), so that the worst HRV indices are associated with conditions of more intense and disabling neck pain.ConclusionThe HRV indices were significantly associated with pain intensity, disabilty, and catastrophizing in individuals with chronic neck pain.     

Reliability of the McKenzie spinal pain classification using patient assessment forms

Objectives To determine whether case studies presented on a completed McKenzie assessment form, commonly used in the McKenzie educational training programme, contain sufficient information to permit a therapist to reach a classification of the patient.Design An inter-rater reliability study of patient classifications made based upon inspection of McKenzie assessment forms. The assessment forms of 50 patients with spinal pain (25 with low back pain and 25 with neck pain) were examined and classified into McKenzie treatment syndromes and sub-syndromes.Setting Private physiotherapy clinics.Participants Fifty physiotherapists, all with similar training in the McKenzie method.Main outcome measures Classification into McKenzie treatment syndromes and sub-syndromes. The reliability of the judgements was expressed using multi-rater kappa (k) and percentage agreement.Results The reliability of syndrome classification was k = 0.56 (95% confidence interval 0.46-0.66) with a percentage agreement of 91%. The reliability of sub-syndrome classification was k = 0.68 (95% confidence interval 0.67-0.69) with a percentage agreement of 76%.Conclusions The reliability analysis suggests that the patient assessment forms evaluated in this study provided an adequate, but not ideal, clinical simulation because the reliability was less than that obtained from inspection of real patients. Future research comparing various types of clinical simulation is indicated to determine which provides the closest replication of the dynamics of the real patient encounter.     

Effects of Corrective Exercises on Posture,Pain, and Muscle Activation of Patients With Chronic Neck Pain Exposed to Anterior-Posterior Perturbation

ObjectivesThis study aimed to evaluate the effects of corrective exercises on posture, pain, and muscle activation of patients with chronic neck pain exposed to anterior-posterior perturbation.MethodsA total of 32 women (37.76 ± 3.83 years) with chronic, nonspecific neck pain were randomized into corrective exercise and control groups. The experimental group underwent a corrective exercise program for 8 weeks, 30 min/d, 3 days per week. The control group received active self-exercise instructions. Neck pain, forward head and protracted shoulder posture, and timing of superficial neck muscle activation were evaluated using the visual analog scale, photogrammetry, and electromyogram, respectively, before and then 48 hours after the 8-week program for both the experimental and control groups. All measurements at pretest and posttest were taken by a blinded assessor.ResultsSignificant alterations were observed in cervical angle (P = .003, effect size = 0.329), shoulder angle (P = .008, effect size = 0.457), neck pain and disability (P = .009, effect size = 0.645), movement control (P = .038, effect size = 0.353), activation onset of the upper trapezius (P = .015, effect size = 0.746), the sternocleidomastoid (P = .018, effect size = 0.879) and cervical erector spinae (P = .031, effect size = 0.765), and the root mean square of the upper trapezius (P = .033, effect size = 0.742), the sternocleidomastoid (P = .041, effect size = 0.587), and the cervical erector spinae (P = .024, effect size = 0.832) in the intervention group from pre- to posttest (P < .05).ConclusionPositive and significant alterations have been observed in the forward head and protracted shoulder posture, the timing of superficial neck muscle activation, neck pain, and disability in female patients with chronic neck pain exposed to anterior-posterior perturbation after performing an 8-week corrective exercise program.     

Low back pain: the evidence for physiotherapy

Abstract

It has been estimated that physiotherapists in an out patient department spend up to 40 percent of their time treating patients with low back pain (LBP). In the last 20 years, research has investigated the value of various physiotherapy techniques on LBP, frequently concluding that such types of interventions are not substantiated. More recently physiotherapy techniques have been explored by research physiotherapists, whose work has led to a clearer understanding of lumbar spine dysfunction; this in tum has led to changes in clinical reasoning and clinical practice.

The aim of this paper is to highlight the evidence available to support the therapeutic efficacy of physiotherapy on low back pain (LBP) and to acknowledge recent and ongoing research by physiotherapists in this area.     

The Effect of a Personalized Newsletter to Physical Therapists on Patient Recruitment: A Cluster Randomized Trial in Primary Physiotherapy Care

ObjectiveTo assess the effect of a personalized newsletter compared with a standard newsletter on patient recruitment in physiotherapy research.MethodsWe performed a cluster-randomized trial including 120 physiotherapists who recruited patients for a prospective cohort and were randomly assigned to either receiving personalized feedback in a newsletter (intervention group) or a standard newsletter (control group). We calculated the difference in the number of patients included in the study corrected for inclusion time between both groups.ResultsThe physiotherapists in the control group (n = 59) included 110 patients (35.4% of the total number of patients included) compared with an inclusion of 200 patients (64.6% of the total number of patients included) by the physiotherapists in the intervention group (n = 61), a difference of 90 patients in favor of the intervention group. However, when corrected for inclusion time and a cluster effect, we found no statistically significant difference between both groups. In addition, therapists who did not include a single patient (inactive therapists) were evenly divided between the 2 groups (n = 29 [49%] in the control group; n = 30 [49%] in the intervention group).ConclusionsA personalized newsletter does not significantly increase the number of recruited patients by physiotherapists. However, therapists receiving personalized feedback recruited nearly double the number of patients compared with the ones receiving standard feedback.     

The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial

ObjectivesConsidering the multitude of contributing factors to upper crossed syndrome (UCS), a multimodal treatment may be an effective therapeutic option. This study aimed to examine the effectiveness of the multimodal approach, including muscle energy technique (MET), cervical and scapulothoracic stabilization exercises, and postural correction training with ergonomic advice, in the treatment of patients with UCS.MethodsThis randomized controlled trial randomly assigned 40 patients with UCS aged 30–55 years to either group A (intervention group, n = 20) who received the multimodal approach or group B (control group, n = 20) who received MET only. The trial evaluated the craniovertebral angle (CVA) and sagittal shoulder angle (SSA) measured by photogrammetry, pain intensity estimated using the visual analog scale (VAS), and functional disability evaluated using the Arabic version of the neck disability index (ANDI) pretreatment and four weeks after intervention.ResultsThe within-group analysis demonstrated a substantial decrease in VAS and ANDI and an increase in CVA post-intervention (P < 0.001). Only the multimodal group exhibited a significant change in SSA (P < 0.0001). Between-group differences were noteworthy, favoring the multimodal intervention (P < 0.0001).ConclusionsA 4-week multimodal approach that comprises MET, cervical and scapulothoracic stabilization exercises, and postural correction training with ergonomic advice has remarkable improvements in CVA, SSA, pain intensity, and functional disability in patients with UCS, highlighting it as a superior choice.     

Intertester reliability of a classification system for shoulder pain

ObjectiveTo describe and determine the intertester reliability of a newly developed classification system of shoulder syndrome recognition.DesignIntertester reliability study.SettingFourteen primary care physiotherapy clinics.ParticipantsTwo hundred and fifty-five patients with shoulder pain. Inclusion criterion: presence of shoulder pain aring within the glenohumeral or associated joints and structures. Exclusion criteria: previous shoulder surgery, surgical candidates, recognised malignancy, systemic illness, or concurrent cervical pain and/or radiculopathy.InterventionExaminers were 55 physiotherapists who were arranged in pairs; each patient received two independent and blinded assessments, one by each of the paired physiotherapists. This shoulder classification approach contains three main clinical syndromes: Pattern 1 (impingement pain), Pattern 2 (acromioclavicular joint pain) and Pattern 3 (shoulder pain: frozen shoulder, glenohumeral arthritis, massive cuff tear, subscapularis tear, painful laxity, post-traumatic instability, internal derangement).Main outcome measuresPercentage agreement and Cohen's kappa coefficient.ResultsThe mean age of patients was 46.6 years (standard deviation 16.3, range 16 to 86), and 57% were male. Physiotherapists agreed on the pattern of shoulder pain for 205 of the 255 shoulders assessed (agreement rate 80%); the kappa coefficient was 0.664 (95% confidence interval 0.622 to 0.706; P < 0.001). Of the 205 agreements, Pattern 1 was the most common condition; physiotherapists agreed on this pattern for 139 patients (68%). Both physiotherapists diagnosed Pattern 2 for 20 patients and Pattern 3 for 46 patients.ConclusionThis clearly defined system uses key elements of the history and examination to classify patients with shoulder pain. The kappa coefficient denotes good reproducibility.