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1.
Cagnie B Cools A De Loose V Cambier D Danneels L 《Archives of physical medicine and rehabilitation》2007,88(11):1441-1445
Cagnie B, Cools A, De Loose V, Cambier D, Danneels L. Differences in isometric neck muscle strength between healthy controls and women with chronic neck pain: the use of a reliable measurement.
Objectives
To determine the intra- and interrater reliability of the Biodex isokinetic dynamometer to measure the maximal isometric strength of the cervical flexors and extensors, to develop an age- and sex-based normative database in a healthy population, and to evaluate the differences in neck strength between women with chronic neck pain and healthy controls.Design
Cross-sectional.Setting
Physical and rehabilitation medicine department.Participants
Ninety-six healthy volunteers (4 age groups: 20-29, 30-39, 40-49, 50-59y; each consisting of 12 men and 12 women) and 30 women with chronic neck pain.Interventions
Not applicable.Main Outcome Measures
Peak isometric strength of the cervical muscles was tested for flexion and extension by using the Biodex isokinetic dynamometer. The intra- and interrater reliability of the protocol was evaluated in 12 volunteers.Results
The reliability for strength was high for both flexion and extension (intraclass correlation coefficient, .92-.96). The mean peak torque for flexion and extension was significantly higher in men (24Nm, 36.4Nm, respectively) compared with women (16.6Nm, 26.5Nm, respectively) (P<.001). Peak torque production for extension was significantly lower in the patient group (22.3Nm) compared with the healthy female control group (26.5Nm) (P=.003). No significant differences in flexion strength between patient and female control group were found.Conclusions
Results show a high degree of intra- and interrater reliability in measuring isometric neck muscle strength when using the Biodex isokinetic dynamometer. The use of normative data for neck strength when evaluating patients with neck disorders needs to take sex into account. The current study has shown that women with chronic neck pain have lower neck muscle strength in extension than the healthy female group. 相似文献2.
Objectives
A patient care model has been proposed linking patient assessment to diagnosis to treatment to outcomes. Validation of this method is required. McKenzie developed the mechanical diagnosis and therapy (MDT) process to diagnose neck pain and direct its treatment. No study known to the authors has determined the link between MDT diagnosis and treatment for neck pain. The objective of the current study was to determine inter-rater agreement on the link between MDT diagnosis and treatment for neck pain.Setting
Outpatient physical therapy clinics.Participants
Fifty-four clinician raters, 20 patients with neck pain.Design
Clinicians, MDT-trained for neck pain, viewed videotaped examinations of adult patients with neck pain and rated diagnosis and initial treatment.Main outcomes measures
Inter-rater agreement on the MDT diagnosis-treatment link and derangement-directional preference link.Results
Inter-rater agreement on the diagnosis-treatment link of derangement-directional preference and not derangement-no directional preference of treatment was with moderate clinical and statistical significance (κ = 0.46, 95% confidence interval 0.45-0.47; P < 0.001; 86% agreement). There was moderate agreement on derangement-directional preference for the ‘derangement-extension’ link (κ = 0.40, 95% confidence interval 0.38-0.41; P < 0.001) and ‘derangement-lateral’ link (κ = 0.45, 95% confidence interval 0.44-0.46; P < 0.001), but with poor agreement for the ‘derangement-flexion’ link (κ = 0.04, 95% confidence interval 0.02-0.05; P < 0.001).Conclusions
Clinicians trained in MDT for neck pain link diagnosis to initial treatment of patients with neck pain with moderate reliability, specifically using extension or laterally directed preference for treatment. The current study contributes towards validation of the diagnosis-treatment link of the MDT patient care model for neck pain. 相似文献3.
Sihawong R Janwantanakul P Sitthipornvorakul E Pensri P 《Journal of manipulative and physiological therapeutics》2011,34(1):62-71
Objective
The purpose of this study was to evaluate the effectiveness of various types of exercise for prevention and cure of nonspecific neck pain in office workers.Methods
Publications between 1980 and April 2010 were systematically searched in various databases (PubMed, CINAHL Plus with full text, The Cochrane Library, Science Direct, PEDro, ProQuest, PsycNet, and Scopus). The following key words were used: neck pain, cervical pain, exercise, strengthening, stretching, endurance, office workers, visual display unit, visual display terminal, and computer users. A hand search of relevant journals was also carried out. Relevant randomized controlled trials were retrieved and assessed for methodological quality by 2 independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results.Results
Nine randomized controlled trials were included in this review, of which 6 were rated as high-quality studies. No exercise type was identified as being effective in the prevention of nonspecific neck pain in office workers. Strong evidence was found for the effectiveness of muscle strengthening and endurance exercises in treating neck pain. Moderate evidence supported the use of muscle endurance exercise in reducing disability attributed to neck pain.Conclusion
Literature investigating the efficacy of exercise in office workers with nonspecific neck pain was heterogeneous. Within the limitations, for treatment of neck pain, either muscle strengthening or endurance exercise is recommended, whereas for reduction of pain-related disability, muscle endurance exercise is suggested. Further research is needed before any firm conclusions regarding the most effective exercise programs for office workers can be reached. 相似文献4.
Rotsalai Kanlayanaphotporn Adit Chiradejnant Roongtiwa Vachalathiti 《Archives of physical medicine and rehabilitation》2009,90(2):187-192
Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial.
Objective
To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms.Design
Triple-blind, randomized controlled trial.Setting
Outpatient physical therapy, institutional clinic.Participants
Patients (N=60), 2 physical therapists, and 1 assessor involved in this study.Interventions
The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM.Main Outcome Measures
Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment.Results
After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement (P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement (P=0.002).Conclusions
The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization. 相似文献5.
Muhammad Nazim Farooq Mohammad A. Mohseni-Bandpei Syed Amir Gilani Muhammad Ashfaq Qamar Mahmood 《Journal of bodywork and movement therapies》2018,22(1):24-31
Objective
To determine the effect of mobilization and routine physiotherapy on pain, disability, neck range of motion (ROM) and neck muscle endurance (NME) in patients having chronic mechanical neck pain (NP).Methods
Sixty eight patients with chronic mechanical NP were randomly allocated into two groups by using a computer generated random sequence table with 34 patients in the multi-modal mobilization group and 34 patients in the routine physiotherapy group. Baseline values for pain, disability, NME, and neck ROM were recorded using visual analogue scale (VAS), neck disability index (NDI), neck flexor muscle endurance test and universal goniometer respectively, before the treatment. Each patient received 10 treatment sessions over a period of four weeks and at the end of four weeks all the outcome measures were recorded again.Results
A paired t-test revealed significant pre to post treatment differences for all outcome measures in both groups (p ≤ 0.001 in all instances). An independent t-test revealed statistically significant differences for pain, disability, NME, and neck ROM in favor of the multi-modal mobilization group with a between group difference of 1.57 cm for VAS (p < 0.001), 11.74 points for NDI (p = 0.001), 18.45 s for NME (p < 0.001) and 6.06–8.24° for neck ROM (p < 0.05).Conclusion
The results suggest that a combination of cervical mobilization with routine physiotherapy is more effective for reducing pain and disability and improving NME and neck ROM in patients with chronic mechanical NP compared to routine physiotherapy alone. 相似文献6.
Objectives
To determine inter-rater agreement on diagnostic category using the Mechanical Diagnosis and Therapy (MDT) classification system for neck pain. If the diagnostic category was derangement syndrome, inter-rater agreement on the subcategory and the directional preference of treatment was also determined.Design
Clinicians viewed videotaped MDT examinations of 20 patients with neck pain and rated the MDT diagnosis independently for each patient. If the diagnostic category was derangement syndrome, the subcategory and directional preference of treatment were also rated.Setting
Private physical therapy outpatient clinics and a university clinical laboratory.Participants
Fifty-four clinicians trained in MDT for neck pain from the USA and Canada, and 20 adult patients with neck pain.Main outcome measures
Inter-rater agreement for MDT diagnosis, derangement subcategory and directional preference of treatment was determined using Kappa and percentage agreement.Results
Overall, agreement was of moderate clinical significance for diagnosis [κ = 0.55, P < 0.001, confidence intervals (CI) 0.52 to 0.58, 67%], derangement subcategory (κ = 0.47, CI 0.44 to 0.50, P < 0.001; 63%) and directional preference of treatment (κ = 0.46, CI 0.43 to 0.49, P < 0.05; 70%).Conclusions
Clinicians trained in MDT for neck pain demonstrate moderate agreement when classifying the diagnostic category and treatment for neck pain. 相似文献7.
Purpose
This study investigated the immediate effects of audible joint sounds following a supine T3-T4 spinal thrust manipulation on the autonomic nervous system activity using a fully automated pupillometry system in patients with chronic neck pain. An additional aim was to determine if audible sounds as perceived by the therapist were associated with the reduction of pain following manipulation.Methods
One hundred subjects with chronic neck pain completed the study protocol. The Mann-Whitney U test was used to compare the change scores of the 3 measuring points between the one-pop and multiple-pop groups. Subjects were randomized into either a manipulation or a mobilization group. A method of automated pupillometry was used in this study to capture pupil responsiveness.Results
The analysis showed that there was no significant difference between the 2 groups (P > .05). The Kruskal-Wallis test was used to compare the median change scores between the mobilization, no-pop, and pop groups. The analysis showed that there was no statistically significant difference in the amount of change in pupil diameter between the 3 groups (P > .05).The Mann-Whitney U test demonstrated that the no-pop group (P = .031) and the multiple-pop group (P = .014) had a significant reduction of pain; however, it did not reach the minimal clinically significant level of 13 mm on the visual analog scale.Conclusions
The results of this study provided evidence that the presence of joint sounds does not influence the overall activity of the autonomic nervous system following a thrust manipulation or contribute to the reduction of pain in patients with chronic neck pain. 相似文献8.
Jaime Salom-Moreno Ricardo Ortega-Santiago Joshua Aland Cleland Maria Palacios-Ceña Sebastian Truyols-Domínguez César Fernández-de-las-Peñas 《Journal of manipulative and physiological therapeutics》2014
Objective
The purpose of this study was to compare the effects of thoracic thrust manipulation vs thoracic non–thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity.Methods
Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non–thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10 minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction.Results
No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6: P > .252; second metacarpal: P > .452; tibialis anterior: P > .273): both groups exhibited similar increases in PPT (all, P < .01), but within-group and between-group effect sizes were small (standardized mean score difference [SMD] < 0.22). The ANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater decrease in neck pain (between-group mean difference: 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non–thrust mobilization (P < .001). Within-group effect sizes were large for both groups (SMD > 2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group.Conclusions
The results of this randomized clinical trial suggest that thoracic thrust manipulation and non–thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non–thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain. 相似文献9.
Andrew M. Leaver Christopher G. Maher Robert D. Herbert Jane Latimer James H. McAuley Gwendolen Jull Kathryn M. Refshauge 《Archives of physical medicine and rehabilitation》2010,91(9):1313-1318
Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain.
Objective
To determine whether neck manipulation is more effective for neck pain than mobilization.Design
Randomized controlled trial with blind assessment of outcome.Setting
Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.Participants
Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner.Interventions
Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks.Main Outcome Measure
The number of days taken to recover from the episode of neck pain.Results
The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66-1.46).Conclusions
Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness. 相似文献10.
Shah JP Danoff JV Desai MJ Parikh S Nakamura LY Phillips TM Gerber LH 《Archives of physical medicine and rehabilitation》2008,89(1):16-23
Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.
Objectives
To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle.Design
We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1β (IL-1β), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance.Setting
A biomedical research facility.Participants
Nine healthy volunteer subjects.Interventions
Not applicable.Main Outcome Measures
Preselected analyte concentrations.Results
Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).Conclusions
We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs. 相似文献11.
de Camargo VM Alburquerque-Sendín F Bérzin F Stefanelli VC de Souza DP Fernández-de-las-Peñas C 《Journal of manipulative and physiological therapeutics》2011,34(4):211-220
Objective
The purpose of this study was to identify the immediate effects of a manipulation of C5/C6 level on electromyography (EMG) of the deltoid muscle and in pressure pain thresholds (PPTs) in patients with mechanical neck pain.Methods
Thirty-seven subjects with mechanical neck pain were randomly divided into 2 groups: manipulative group, which received a cervical spine manipulation targeted to C5/C6 segment, and a control group, which did not receive any procedure. Outcomes were EMG data of the deltoid muscle (rest, isometric contraction for 5 or 30 seconds, and isotonic contraction) and PPT over upper trapezius and deltoid muscles and C5 spinous process. They were assessed before and 5 minutes after treatment by a blinded assessor. A 3-way repeated-measures analysis of variance was used to examine the effects of the manipulation.Results
A significant group time interaction for MF at the beginning of isometric contraction for 30 seconds (F = 7.957, P = .006) was also found: the manipulative group experienced a greater increase in MF at the beginning of the isometric contraction than did the control group. A significant group time interaction was also found for root mean square during isometric contraction for 30 seconds (P = .003); however, changes were small. Patients within the manipulative group experienced an increase on PPT over the deltoid (P = .010) and C5 spinous process (P = .025), but not over upper trapezius (P = .776).Conclusions
Manipulation at C5/C6 level in the study participants seemed to increase EMG amplitude signal and fatigue resistance in a nonspinal (deltoid) muscle innervated by the same segment in patients with mechanical neck pain. However, these changes were relative small. An increase on PPT over those tissues innervated by the manipulated segment was also found after the manipulative procedure. 相似文献12.
Yesim Bakar Meral Sertel Asuman Öztürk Eylem Tütün Yümin Necati Tatarli Handan Ankarali 《Journal of manipulative and physiological therapeutics》2014
Objective
The purpose of this study was to evaluate the short-term effects of classic massage (CM) and connective tissue massage (CTM) on pressure pain threshold and muscle relaxation response in women with chronic neck pain.Methods
Participants included 45 female volunteers (ages between 25 and 45 years) presenting to the Köroglu State Hospital Neurosurgery Polyclinic who had experienced neck pain for 3 to 6 months. The volunteers were randomly assigned to 2 groups (CM or CTM to the thoracic spine and the neck). Each treatment was carried out for 1 session. Outcome measures were obtained before and after treatment, which included pressure pain threshold that was measured with an algometer and muscle relaxation response that was evaluated with electromyography biofeedback (EMG-BF).Results
Pressure pain threshold of the sternocleidomastoid muscle was significantly different for the CM (P < .05) group. The EMG-BF values were significantly different for the CTM group (P < .05). Comparing the results of CM and CTM, EMG-BF averages favored the CTM group (P < .05).Conclusion
For the group of women with chronic neck pain that were included in this study, 1 treatment of CTM demonstrated relaxation responses and 1 treatment of CM demonstrated pain reduction. 相似文献13.
Anabela G. Silva T. David Punt Paul Sharples João P. Vilas-Boas Mark I. Johnson 《Archives of physical medicine and rehabilitation》2009,90(4):669-674
Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons.
Objective
To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals.Design
Single-blind (assessor) cross-sectional study.Setting
Hospital and general community.Participants
Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40).Interventions
Not applicable.Main Outcome Measures
Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images.Results
NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean ± SD, 45.4°±6.8°; pain-free, mean ± SD, 48.6°±7.1°; P<.05; confidence interval [CI] for the difference between groups, 0.9°-6.3°). Dividing the population according to age into younger (≤50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean ± SD, 46.1°±6.7°; pain-free, mean ± SD, 51.8°±5.9°; P<.01; CI for the difference between groups, 1.8°-9.7°) but no difference for the older group (NP, mean ± SD, 44.8°±7.1°; pain-free, mean ± SD, 45.1°±6.7°; P>.05; CI for the difference between groups, -4.9°-4.2°). No other differences were found between patients and pain-free participants.Conclusions
Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful. 相似文献14.
Jeffrey J. Hebert Shane L. Koppenhaver John S. Magel Julie M. Fritz 《Archives of physical medicine and rehabilitation》2010,91(1):78-85
Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study.
Objective
To examine the relationship between prognostic factors for clinical success with a stabilization exercise program and lumbar multifidus (LM) and transversus abdominis (TrA) muscle activation assessed using rehabilitative ultrasound imaging (RUSI).Design
Cross-sectional study.Setting
Outpatient physical therapy clinic.Participants
Volunteers with current low back pain (N=40).Intervention
Not applicable.Main Outcome Measures
We examined the relationship between prognostic factors associated with clinical success with a stabilization exercise program (positive prone instability test, age <40y, aberrant movements, straight leg raise >91°, presence of lumbar hypermobility) and degree of TrA and LM muscle activation assessed by RUSI.Results
Significant univariate relationships were identified between LM muscle activation and the number of prognostic factors present (Pearson correlation coefficient [r] =−.558, P=.001), as well as the individual factors of a positive prone instability test (point biserial correlation coefficient [rpbis]=.376, P=.018) and segmental hypermobility (rpbis=.358, P=.025). The multivariate analyses indicated that after controlling for other variables, the addition of the variable “number of prognostic factors present” resulted in a significant increase in R2 (P=.006). No significant univariate or multivariate relationships were observed between the prognostic factors and TrA muscle activation.Conclusions
Decreased LM muscle activation, but not TrA muscle activation, is associated with the presence of factors predictive of clinical success with a stabilization exercise program. Our findings provide researchers and clinicians with evidence regarding the construct validity of the prognostic factors examined in this study, as well as the potential clinical importance of the LM muscle as a target for stabilization exercises. 相似文献15.
Teodorczyk-Injeyan JA Triano JJ McGregor M Woodhouse L Injeyan HS 《Journal of manipulative and physiological therapeutics》2011,34(8):498-505
Objective
This study investigated whether the production of inflammatory mediators and chemotactic cytokines (chemokines) is altered in patients with chronic and recurrent neck pain (NP).Methods
Cross-sectional data evaluating blood and serum samples were obtained from 27 NP patients and 13 asymptomatic (control) subjects recruited from a chiropractic outpatient clinic. Cell cultures were activated by lipopolysaccharide (LPS) and phytoheamagglutinin for 24 to 48 hours. The levels of tumor necrosis factor α (TNF-α), monocyte chemotactic protein 1, also known as CCL2 (CCL2/MCP-1), and macrophage inflammatory protein 1α or CCL3 (CCL3/MIP-1α) were determined by specific immunoassays. Serum levels of nitric oxide metabolites were evaluated simultaneously, in vanadium III-reduced samples, by Griess reaction.Results
Low levels of constitutive (spontaneous) TNF-α production were present in 7 of the 27 cultures from patients with NP. Both LPS-induced TNF-α production and inducer (LPS/phytoheamagglutin)-stimulated production of CCL2 were significantly elevated (P = .00) in patients compared with controls. In patients, the constitutive synthesis of CCL3 occurred significantly more frequently (P = .00) and ranged from 30 to more than 2000 pg/mL. Finally, serum levels of nitric oxide were significantly elevated (P = .00) in NP patients.Conclusions
Production of inflammatory mediators was consistently elevated in NP patients in this study, both in vitro and in vivo, and activation of inflammatory pathways was accompanied by up-regulation of CC chemokine synthesis. This suggests that, in NP patients, CC chemokines may be involved in regulation of local inflammatory response through recruitment of immune cells to the inflamed tissue and exert pronociceptive effects. 相似文献16.
Mark A. Slater Anne L. Weickgenant Melanie A. Greenberg Dennis R. Wahlgren Rebecca A. Williams Christian Carter Thomas L. Patterson Igor Grant Steven R. Garfin John S. Webster J. Hampton Atkinson 《Archives of physical medicine and rehabilitation》2009,90(4):545-552
Slater MA, Weickgenant AL, Greenberg MA, Wahlgren DR, Williams RA, Carter C, Patterson TL, Grant I, Garfin SR, Webster JS, Atkinson JH. Preventing progression to chronicity in first onset, subacute low back pain: an exploratory study.
Objectives
To evaluate the effects of a behavioral medicine intervention, relative to an attention control, in preventing chronic pain and disability in patients with first-onset, subacute low back pain (LBP) with limitations in work-role function.Design
A 2-group, experimental design with randomization to behavioral medicine or attention control groups.Setting
Orthopedic clinic at a Naval Medical Center.Participants
Sixty-seven participants with first-onset LBP of 6 to 10 weeks of duration and impairment in work function, of whom 50 completed all 4 therapy sessions and follow-up 6 months after pain onset.Intervention
Four 1-hour individual treatment sessions of either behavioral medicine, focused on back function and pain education, self-management training, graded activity increases, fear reduction, and pain belief change; or attention control condition, focused on empathy, support, and reassurance.Main Outcome Measures
The primary outcome was proportion of participants classified as recovered, according to pre-established clinical cutoffs on standardized measures, signifying absence of chronic pain and disability at 6 months after pain onset. Secondary analyses were conducted on pain, disability, health status, and functional work category. Intervention credibility and pain belief manipulation checks were also evaluated.Results
Chi square analyses comparing proportions recovered at 6 months after pain onset for behavioral medicine and attention control participants found relative rates of 52% versus 31% in the modified intent-to-treat sample (P=.09) and 54% versus 23% for those completing all 4 sessions and 6-month follow-up (P=.02). At 12 months, 79% of recovered and 68% of chronic pain participants still met criteria for their respective groups (P<.0001). Recovered participants also had higher rates of functional work status recovery at 12 months (recovered: 96% full duty and 4% light duty; chronic pain: 61% full duty, 18% light duty, and 21% medical discharge, respectively; P=.03).Conclusions
Early intervention using a behavioral medicine rehabilitation approach may enhance recovery and reduce chronic pain and disability in patients with first-onset, subacute LBP. Effects are stronger for participants attending all 4 sessions and the follow-up assessment. 相似文献17.
Objective
The objective of the current study was to investigate whether any differences exist in the activity of the cervical erector spinae and upper trapezius (TRA) muscles between asymptomatic participants who show “normal” and “abnormal” lumbar spine motion patterns during the prone hip extension (PHE) test.Methods
Twenty-six asymptomatic participants recruited from a chiropractic college participated in the study. Surface electromyography was used to record the activity of the cervical erector spinae and upper TRA muscles as each participant performed a set of 4 repetitions of PHE for each leg. An examiner observed the participant perform the movement and classified him/her as “positive” or “negative” based on the presence or absence (respectively) of 1 of 3 lumbar spine motion patterns. The mean activity levels of each muscle during the positive sets of PHE were compared with those during the negative sets.Results
The mean activity of the upper TRA ipsilateral to the side of hip extension was significantly higher in the positive group compared with the negative group (difference, 13.3%; 95% confidence interval, 0.2%-24.4%; P = .0465). No other significant between-group differences were noted.Conclusion
The results of this study indicate that the presence of abnormal lumbar spine motion patterns during the PHE test may be associated with altered cervicothoracic motor control strategies in asymptomatic individuals. Similar investigations using patients with neck pain are required to comment further on the generalizability and potential clinical importance of these findings. 相似文献18.
van Koppenhagen CF Post MW van der Woude LH de Witte LP van Asbeck FW de Groot S van den Heuvel W Lindeman E 《Archives of physical medicine and rehabilitation》2008,89(9):1733-1740
van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in The Netherlands.
Objective
To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.Design
A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.Setting
Eight rehabilitation centers in The Netherlands.Participants
Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.Interventions
Not applicable.Main Outcome Measure
The Life Satisfaction Questionnaire.Results
Mean satisfaction with life ± SD as a whole was 5.3±0 before SCI and 4.3±1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (β=.31, P<.05), pain (β=.19, P<.05), and secondary impairments (β=.22, P<.05).Conclusions
Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation. 相似文献19.
Li-Wei Chou Yueh-Ling Hsieh Mu-Jung Kao Chang-Zern Hong 《Archives of physical medicine and rehabilitation》2009,90(6):905-1124
Chou L-W, Hsieh Y-L, Kao M-J, Hong C-Z. Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle.
Objective
To investigate the remote effect of acupuncture on the pain intensity and the endplate noise (EPN) recorded from a myofascial trigger point (MTrP) of the upper trapezius muscle.Design
Randomized controlled trial.Setting
University hospital.Participants
Patients (N=20) with active MTrPs in upper trapezius muscles and no experience in acupuncture therapy.Interventions
Patients were divided into 2 groups. Those in the control group received sham acupuncture, and those in the acupuncture group received modified acupuncture therapy with needle insertion into multiple loci to elicit local twitch responses. The acupuncture points of Wai-guan and Qu-chi were treated.Main Outcome Measures
Subjective pain intensity (numerical pain rating scale) and mean EPN amplitude in the MTrP of the upper trapezius muscle.Results
The pain intensity in the MTrP was significantly reduced after remote acupuncture (from 7.4±0.8 to 3.3±1.1; P<.001), but not after sham acupuncture (from 7.4±0.8 to 7.1±0.9; P>.05). The mean EPN amplitude was significantly lower than the pretreatment level after acupuncture treatment (from 21.3±9.5μV to 9.5±3.5μV; P<.01), but not after sham acupuncture treatment (from 19.6±7.6μV to 19.3±7.8μV; P>.05). The change in the pain intensity was significantly correlated with the change of EPN amplitude (r = 0.685).Conclusions
Both subjective changes in the pain intensity and objective changes of the EPN amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points. This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control. 相似文献20.
Michael D. Stubblefield Laura Manfield Elyn R. Riedel 《Archives of physical medicine and rehabilitation》2010,91(8):1278-1282
Stubblefield MD, Manfield L, Riedel ER. A preliminary report on the efficacy of a dynamic jaw opening device (Dynasplint Trismus System) as part of the multimodal treatment of trismus in patients with head and neck cancer.