The efficacy of cervical/thoracic active range of motion for detecting changes associated with individuals receiving muscle energy techniques

Abstract

Background: Muscle energy techniques (METs) have been used to treat cervical and thoracic range of motion (ROM) restrictions for over 40 years. Of the trials published on METs, most have examined the effectiveness of METs on ROM in the cervical and thoracic spine.

Objectives: The aim of this systematic review was to investigate the sensitivity of cervical and thoracic rotation active range of motion, as an objective measure of function, for detecting changes associated with individuals receiving METs compared to (1) individuals receiving no treatment and (2) individuals receiving manipulation.

Methods: Relevant databases were searched from January 1970 up to March 2010. Methodological quality of each included study was assessed using the PEDro scale. Effect sizes (Hedges' g) and their 95% confidence intervals were calculated for active rotation ROM scores between and within the MET and comparison groups.

Results: Five randomized controlled trials were included in this review. Four studies addressed the first clinical question and one study answered the second. The average PEDro score was 5.8. In general, between and within group effect sizes were moderate to strong in favour of METs.

Conclusion: There is fair evidence that cervical and thoracic active range of motion is sensitive to changes associated with individuals who receive an MET. The change in ROM was associated with asymptomatic individuals having restricted rotation. Further studies with higher methodological quality are needed to make a stronger clinical conclusion about the effectiveness of METs.     

Effectiveness of trigger point dry needling for multiple body regions: a systematic review

Background: Trigger point dry needling (TDN) is commonly used to treat musculoskeletal pain related to myofascial trigger points (MTrPs). To date, no systematic review of high-quality randomised controlled trials (RCTs) investigating TDN to multiple body regions exists.

Purpose: The aim of this review is to determine the effectiveness of TDN based on high-quality RCTs for all body regions.

Methods: To ensure thorough reporting, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as the methodological basis for this systematic review. PubMed, Physiotherapy Evidence Database (PEDro), Cinahl, Cochrane and reference lists were searched for the years 2000–2014 and the terms ‘TDN’, ‘dry needling NOT trigger point’, ‘functional dry needling’ and ‘intramuscular manual therapy’. Inclusion criteria: RCTs with PEDro scores 6–10 investigating TDN. Exclusion criteria: duplicates, non-human participants, non-English language, exclusive focus on acupuncture or medicinal injections. Three investigators searched databases, applied criteria, read and assigned PEDro scores to every RCT. Nineteen studies met the criteria. As compared to either baseline or control groups, significant differences were found for pain (14 studies), range of motion (ROM) (five studies) and at least one item on function and quality of life measures (six studies).

Limitations: This review was limited by inclusion criteria, timeframe, language and databases searched.

Conclusion: The majority of high-quality studies included in this review show measured benefit from TDN for MTrPs in multiple body areas, suggesting broad applicability of TDN treatment for multiple muscle groups. Further high-quality research is warranted to standardise TDN methods to determine clinical applicability.     

Effectiveness of vestibular rehabilitation on concussion-induced vertigo: a systematic review

Background: Approximately 5% of all Americans have experienced a concussion sometime during their lifetime. The predominant symptoms associated with a concussion are physical issues, cognitive issues, emotional issues, and sleep disturbances; and one of the most common physical issues is vertigo.

Objectives: The purpose of this systematic review was to investigate the effectiveness of vestibular rehabilitation on concussion-induced vertigo.

Methods: Those databases that were utilized for search terms included CINAHL Complete, Proquest Medical Library, and PubMed. Each of these databases was examined from inception through the end of 2017. The search terms were ‘concussion’ OR ‘brain injury’ OR ‘head injury’ AND ‘vestibular rehabilitation’ OR ‘vestibular therapy’ AND ‘vertigo’ OR ‘dizziness’. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence system was used to assess the evidence level of each included study, and methodological rigor was assessed utilizing criteria set forth in a systematic review by Medlicott and Harris.

Results: Seven articles met the inclusion criteria and were included in the qualitative synthesis. Six of the seven studies had an evidence level of less than two, and four of the seven studies had weak methodological rigor. Despite these limitations, this systematic review demonstrated that vestibular rehabilitation is generally an effective intervention for individuals with concussion-induced vertigo, even in the presence of visual disorders.

Conclusions: Vestibular rehabilitation should be considered as a component of the plan of care for individuals who experience vertigo following a concussion.     

The Effectiveness of Physiotherapeutic Interventions in the Management of Delayed Onset Muscle Soreness: a Systematic Review

Abstract

Delayed-onset muscle soreness (DOMS) is a commonly occurring myogenic condition, which develops following strenuous eccentric exercise, but the effectiveness of physiotherapy treatment has not been systematically assessed. This systematic review aimed to determine the effectiveness and quality of the evidence for management of DOMS. Relevant databases (Cochrane, 1993-2003; Medline, 1966-2003, Embase, 1966-2003; Cinahl, 1982-2003; and PEDro, 1952-2003) were searched. The methodological quality of randomised controlled trials was systematically assessed using the PEDro scale. Thirty trials (electrophysical interventions, n = 11; conventional agents, n = 19) were included. There was limited evidence (of high methodological quality) that athletic massage and light concentric exercise are more effective than no treatment, while the evidence for compression therapy, and whirlpool therapy was minimal. The evidence did not support the use of static stretching, cryotherapy, acupuncture, pulsed ultrasound, transcutaneous electrical nerve stimulation (TENS), interferential therapy, and microcurrent electrical stimulation. physiotherapeutic interventions in the     

Measurement properties of patient-reported hand function measures in rheumatoid arthritis: a systematic review protocol

Background: Patient-reported outcome measures (PROMs) are commonly used to evaluate hand function in people with rheumatoid arthritis (RA). A decision will always need to be made about which appropriate PROMs to use. The present review therefore aims to describe the available hand function PROMs for use in people with RA by appraising their methodological quality and psychometric properties using a contemporaneous method.

Methods/design: The proposed systematic review will include published studies written in English, which report evidence for psychometric properties and/or practical properties of hand function PROMs in RA. Four major databases (MEDLINE, Embase, PsycINFO, and CINAHL) will be searched from inception to May 2019. A three-staged search strategy will be applied: (1) electronic bibliographic databases for published studies, (2) ‘named measures’ searching approach, and (3) reference lists of studies with included PROMs. The proposed systematic review will be conducted in compliance with the consensus-based standards for the selection of health measurement instruments (COSMIN) guideline for systematic review of PROMs. Accordingly, the methodological quality of the included studies will be assessed against the updated COSMIN risk of bias checklist, and each study’s results will be assessed for their psychometric quality.

Conclusion: The proposed systematic review seeks to provide rigour, and transparent evaluation of PROMs used to evaluate hand function in the RA population. The findings will provide clarity for healthcare professionals and researchers on the appropriate PROMs for hand function assessment. It will also provide a summary of hand function PROM recommendations for RA.     

Continuous Passive Motion Following Primary Total Knee Arthroplasty:short- and Long-term Effects on Range of Motion

Abstract

Study design: a systematic review of randomised controlled trials.

Background: Knee arthroplasties are a common surgical procedure for patients suffering from knee osteoarthritis. Continuous passive motion (CPM) is frequently used to increase range of motion (ROM) in the knee and promote rapid postoperative recovery of patients undergoing total knee arthroplasty (TKA). Many clinical trials have tried to assess its efficacy, but results have been contradictory.

Objectives: To review the efficacy in terms of ROM of CPM in the postoperative management of patients undergoing TKA.

Methods: Medline, Embase, Cinahl and Cochrane databases and bibliographic indexes and relevant citations were searched. All relevant studies were assessed for methodological quality using a validated scoring instrument.

Data collection and analysis: Two reviewers independently extracted data and assessed trial quality. Results of a meta-analysis of ROM data were divided into short-term effects (i.e. 7-14 days after surgery) and long-term effects (i.e. 6-12 months after surgery). Where possible, data from individual trials were combined in a meta-analysis. Data were analysed using weighted mean differences (WMD with 95% confidence intervals [CI]) between treatment and control groups in the short and long term, weight being the inverse of variance.

Main results: Fifteen studies investigating the effect of continuous passive motion in the management of TKA patients were included in the review. Study quality ranged from poor (2 points on a 10-point scale) to good (8 points). The evidence on the efficacy of CPM after TKA is conflicting. Positive short-term effects of adding CPM to standardised physical therapy (PT) have been reported on flexion ROM. Five studies were included in a pooled analysis, for a total of 317 patients (pooled effect size WMD 8.27; 95% CI -1.60, 18.15)

Conclusions: There is evidence of a moderate positive, short-term effect of adding CPM to standardised PT after total knee arthroplasty. There is no relevant long-term effect of CPM use.     

The effectiveness of conservative management for disabled throwing shoulder in baseball: a systematic review of Japanese-language primary studies

Background: Conservative management is often the first-choice treatment for baseball players with disabled throwing shoulder (DTS). Considering the high popularity of baseball in Japan, we suspected that there might be some evidence regarding this topic in the Japanese-language literature.

Objective: This study aimed to systematically review Japanese-language primary studies investigating the effectiveness of conservative management for DTS in baseball.

Methods: Eight databases were systematically searched from inception to 7 April 2016. Data on authors, publication years, sample characteristics, types of interventions, outcome measures and results were extracted. Data were synthesised qualitatively.

Results: Seven studies with low evidence level and low-to-moderate study quality were included. Interventions examined in the included studies were downward throwing, combined physiotherapy interventions and joint distension. Forming correction, stretching for posterior shoulder muscles and strengthening exercises to improve scapular/trunk stability were commonly used in combined physiotherapy interventions. Downward throwing and combined physiotherapy interventions corresponded with expert opinions described in the English-language literature. Due to the lack of studies with high level of evidence, however, it was difficult to determine the genuine effects of these interventions.

Conclusion: Our systematic review found limited evidence about the effectiveness of any conservative management for baseball players with DTS. Although downward throwing and combined physiotherapy interventions might be appropriate management in some cases, further studies of higher level of evidence and greater methodological rigour are required.     

Ageing well with chronic musculoskeletal pain: protocol for a systematic review of non-pharmacological interventions aimed at reducing pain in an ageing population

Background: Chronic musculoskeletal pain in the elderly is highly prevalent, with osteoarthritis, low back pain, neck pain and other musculoskeletal disorders as the leading contributors to pain chronicity and disability. Previous reviews identifying effective components of non-pharmacological interventions for treating chronic pain have either few studies or the included studies examine outcome over a limited time span. This systematic review will investigate the effectiveness and components of interventions associated with management of chronic musculoskeletal pain in older adults (≥65 years).

Methods/Design: This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Randomised controlled trials of non-pharmacological interventions aimed at reducing pain in older adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, Web of Science and PEDro. Two review authors will independently screen articles retrieved from the search for eligibility, and extract relevant data on methodological issues. A narrative synthesis will be completed if there are insufficient data for a meta-analysis. The narrative synthesis will summarise the current state of knowledge, interventions, study designs and robustness of evidence.

Discussion: Findings of the study will inform support programs and interventions to assist people aging with pain, carers and other supporters and practitioners.

Systematic review registration: PROSPERO 2017:CRD42017074173.     

Acupuncture for treatment of insomnia: An overview of systematic reviews

PurposeTo evaluate the reliability of the methodological quality and outcome measures of systematic review (SR) /meta-analysis (MA) of acupuncture for insomnia.MethodsWe conducted a comprehensive literature search for SRs with MAs in seven international and Chinese databases. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence.ResultsThirty-four reviews were included. The AMSTAR-2 score showed that most of the included studies were of low methodological quality and included only two high-quality literatures. The lowest score were the item 10 (all the studies didn't report on the sources of funding for the studies included in the review), item 7(32 studies didn't provide a list of excluded studies and justify the exclusions) and item 3 (27 studies didn't explain their selection of the study designs for inclusion in the review).ConclusionMost of the reviews included suggested that the acupuncture group was more effective than the control group in the treatment of insomnia, but the methodological quality of most of the studies and the quality of evidence were low.     

Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke

Abstract

Background: Glenohumeral subluxation (GHS) and hemiplegic shoulder pain (HSP) are the most common musculoskeletal complications reported in patients with stroke. These secondary problems present considerable challenges to the rehabilitation of the upper limb.

Objective: The aim of this review was to evaluate the evidence on the association between shoulder subluxation and pain in patients with stroke.

Method: A systematic online search was conducted of MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and the Cochrane Library. The search was supplemented by hand searching of relevant journals and citation tracking of the retrieved papers. All primary studies published in English language fulfilling the review’s inclusion criteria were included. Five reviewers independently appraised the methodological quality of the selected studies. Any discrepancies were resolved following discussions.

Results: Of the 148 articles that were identified by the search, 14 studies met the criteria to be included in the review. Seven studies found an association and seven studies did not find an association between subluxation and pain. The methodological quality of the studies varied considerably and studies used a wide range of outcome measures to assess both subluxation and pain.

Conclusions: Irrespective of any association, both subluxation and pain can independently have an impact on functional rehabilitation. Management of these clinical outcomes is critical in clinical practice and clinicians should continue to prevent and reduce these post-stroke secondary complications to enhance upper limb function.     

Semont maneuver vs. Epley maneuver for canalithiasis of the posterior semicircular canal: a systematic review

Background: The Epley maneuver is generally considered to be the preferred initial treatment for canalithiasis of the posterior semicircular canal. Although the Semont maneuver was originally developed to treat patients with posterior canal cupulolithiasis, several studies have demonstrated successful outcomes when the Semont maneuver is used to treat patients with posterior canal canalithiasis.

Objectives: The purpose of this systematic review was to evaluate the effectiveness of the Semont maneuver to treat canalithiasis of the posterior semicircular canal as compared to that of the Epley maneuver.

Methods: Applicable research articles were obtained through a literature search of the Cumulative Index to Nursing and Allied Health Literature Complete, ProQuest Medical Library, and PubMed databases using the search terms ‘Semont’ AND ‘Epley’ AND ‘randomized’ AND ‘positional vertigo’ OR ‘positioning vertigo’ OR ‘positional nystagmus’ OR ‘positioning nystagmus.’ The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence was used to assess the evidence level for all of the included studies, and the PEDro Scale was used to assess the methodological rigor for all of the included studies.

Results: Six studies were ultimately included in the qualitative synthesis. In four of these studies, no statistically significant difference was identified between the Semont maneuver and the Epley maneuver.

Conclusions: In most cases, the Semont maneuver was equally as effective as the Epley maneuver at treating posterior canal canalithiasis. In addition, the Semont maneuver should be considered as an alternative treatment option for patients with certain types of cervical, lumbar, cardiac, or respiratory pathologies.     

The effect of whole body vibration in common neurological conditions – a systematic review

Abstract

Background: Whole body vibration (WBV) is a new therapeutic tool used to improve muscle strength, power and postural control in various healthy and pathological populations.

Aim: The aim of this systematic review was to summarise and evaluate the available literature on the effectiveness of WBV in neurological conditions.

Method: A systematic review of the literature was performed to identify randomised controlled trials (RCTs) examining the effect of WBV on common neurological conditions. The methodological quality of the studies was systematically assessed using the PEDro rating scale. Reported outcomes were assessed for differences between the experimental and control groups and effect sizes were calculated.

Results: Five RCTs and two pseudo RCTs were included. Methodological scores ranged from 1 to 9 (maximum 11) with a mean score of 5˙71 (SD 2˙69). There is weak to moderate evidence for positive effects on postural control, mobility, motor function and strength following the single application of WBV in neurological populations. A paucity of available literature into repeated WBV training prevents the drawing of firm conclusions regarding long-term treatment effectiveness.

Conclusion: Despite being a new technique, there is early evidence that WBV applied to neurological populations has positive effects on postural control, mobility, motor function and strength. Further studies into the effectiveness of WBV in neurological populations are warranted.     

Spinal manipulative therapy for low back pain: A systematic review

Abstract

Objectives: Gather and analyse relevant literature on spinal manipulative therapy for low back pain through systematic review to present a balanced and impartial summary of the findings. The aim of this systematic review was to investigate the efficacy of spinal manipulative therapy in patients with low back pain.

Methods: Databases searched included COCHRANE, MEDLINE, EMBASE, PEDro, PUBMED, WEB OF KNOWLEDGE, INGENTA CONNECT and GOOGLE SCHOLAR between January 2000 and January 2008. Sixteen articles were retrieved. Standardised inclusion and exclusion criteria were applied to select articles relevant to the review question. Seven studies were excluded and nine studies were included. In the next step, the methodological quality of the included studies was assessed with the PEDro scale, which rated the studies from 0 to 10.

Results: Methodological quality scores ranged from 4 to 8 out of a possible 10. Spinal manipulative therapy can be preferred for short-term relief of low back pain when compared with general exercise and dynamic strengthening exercises, which is revealed by a high quality study, moderate quality studies and a low quality study. Spinal manipulative therapy combined with exercise is more effective than exercise alone, which is revealed by a high quality study.

Conclusions: Further studies are needed to improve the quality of the evidence. There is evidence that spinal manipulative therapy combined with exercise is more effective than other procedures like spinal manipulative therapy, exercise or physician consultation alone.     

The effectiveness of current interventions in the management of lateral canal benign paroxysmal positional vertigo

Abstract

Background: Lateral canal benign paroxysmal positional vertigo (LC-BPPV) may comprise up to 40% of all reported cases of BPPV. Despite the recent development of techniques designed for the specific management of LC-BPPV, very few studies have examined the efficacy of these proposed treatments.

Objective: The purpose of this systematic review was to evaluate the effectiveness of current treatment techniques in alleviating the vertigo and nystagmus encountered by individuals with LC-BPPV.

Methods: The databases that were searched included CINAHL Plus with Full Text, ProQuest Medical Library, and MEDLINE. The search terms used for each of these databases were ‘lateral canal’ OR ‘horizontal canal’ AND ‘positional vertigo’ OR ‘positioning vertigo’ OR ‘positional nystagmus’ OR ‘positioning nystagmus’. The method used to evaluate evidence level was based upon the Oxford Centre For Evidence-Based Medicine 2011 Levels of Evidence tool, and the method used to evaluate methodological rigor was adapted from Medlicott and Harris.

Results: A total of 543 articles were originally identified through the database search, and eight studies were ultimately included in the qualitative analysis. The qualitative analysis revealed three effective techniques for treating LC-BPPV that is geotropic in nature and two potential techniques for treating LC-BPPV that is apogeotropic in nature.

Conclusions: Although LC-BPPV tends to spontaneously resolve in a relatively short period of time, it can also be associated with extremely severe symptoms and impaired postural control. This systematic review presented several techniques that may expedite the natural remission process and lead to a quicker recovery.     

Augmented reality applications in rehabilitation to improve physical outcomes

Abstract

Background: Augmented reality (AR) is a relatively new technology which blends virtual objects with real scenes in real time and this may be an effective intervention to use in rehabilitation.

Objectives: To systematically review the evidence for the effectiveness of AR applications on rehabilitation outcomes within a physical context.

Method: A systematic search of the literature using specified search terms that included studies of any quantitative design testing AR applications in rehabilitation within a physical context.

Results: The included 13 studies were of varying designs and generally rated poorly on methodological quality assessment. All studies reported varying degrees of improvement in outcomes with the use of AR applications. The technologies used were mostly in the prototype phase of development and were a mixture of simple and complex systems.

Conclusion: AR applications for rehabilitation in a physical context are still in the early stages of development and thus evidence for effectiveness in rehabilitation is limited. The technology appears not ready for general practical use but the encouraging results support further research.     

Physical therapy management of pediatric and adolescent neck pain: a call to action

Abstract

Background: Neck pain is reported to be as high as 40% in adolescents and can be a precursor to developing adult persistent neck pain.

Objectives: To identify and review literature on physical therapy management of pediatric and adolescent neck pain.

Methods: A sensitive search strategy adhered to PRISMA guidelines. Our systematic review used the databases PubMed, CINAHL, and Embase including articles published from inception to May 2019. For the article to be included, it had to meet the following criteria: (a) age under 18?years old; (b) musculoskeletal neck pain; (c) any intervention or treatment provided by physical therapists; (d) English language; (e) any outcome measure that reported disability, function, or pain; (f) any and all published literature: randomized controlled trials (RCTs), systematic reviews, cohort studies, case reports, editorials, and commentaries.

Results: Our comprehensive search yielded 5,115 articles and two studies met eligibility. Both articles were written by the same author group. The articles investigated the effect of pain neuroscience education (PNE) plus deep neck muscle strengthening in twenty-one students ages 15-18?years old with chronic idiopathic neck pain. The results concluded there may be some benefit to PNE plus deep neck flexor and extensor strength.

Conclusions: The main finding of this systematic review is the paucity of published research on physical therapy management of pediatric and adolescent neck pain. Our systematic review serves as a call to action for physical therapists to perform further research in order to provide the best evidence-based care for this population.     

The effectiveness of mental imagery for improving strength in an asymptomatic population

Abstract

Background:

Strength training is one focus for physiotherapy management to help restore function. However, conventional strength training requiring an active muscular contraction is not always possible. Mental imagery (MI) has been proposed as a viable alternative to strength training without the need for actual movement.

Objective:

To investigate whether MI is effective in achieving strength gains in an asymptomatic population.

Methods:

A systematic review of key databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and risk of bias assessed using Grading of Recommendations Assessment, Development and Education (GRADE). Studies were included if they were a randomised control trial (RCT), clinical control trial (CCT) or pre-post study investigating the effect of an MI protocol for improving strength in asymptomatic adult populations.

Results:

From 639 articles, 28 full texts were assessed and six were included for review. These studied effect of MI on strength improvements for 5th finger abductors (n?=?53), quadriceps (n?=?51), elbow flexors (n?=?51), ankle dorsiflexors (n?=?51) and plantarflexors (n?=?51). Strength gains were reported in all muscle groups with the exception of elbow flexors. MI may be more effective for muscle groups with larger motor cortex representation, especially 5th finger abductors.

Conclusion:

The findings suggest that a course of MI can increase strength greater than a control group but less than a physical practice (PP) group within this population. The findings of this study provide promising clinical implications for use of MI for improvements or maintenance of strength within a patient group unable to actively strengthen due to pain or immobilisation.