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Journal of Musculoskeletal & Neuronal... Dec 2019The aim of this study was to evaluate the effectiveness of the McKenzie method compared to manual therapy in the management of patients with chronic low back pain... (Comparative Study)
Comparative Study
The aim of this study was to evaluate the effectiveness of the McKenzie method compared to manual therapy in the management of patients with chronic low back pain (CLBP). Randomised controlled trials evaluating the McKenzie method in treating CLBP in adults compared to manual therapy (MT) were searched in MEDLINE, CINAHL, Cochrane Library, and PEDro. The primary outcomes were pain and disability. Five trials were eligible for inclusion in the review, of which, most had a score of 8 out of 11 on the PEDro scale. At 2-3 months, all studies reported significant improvement in the pain level in the McKenzie group, and more than that in the MT group. At 6 months, significant improvements had occurred in the disability index reported by two trials in the McKenzie group than the MT group. At 12 months follow-up, there were no significant differences in measures of LBP, but three studies reported that the McKenzie method group had a better disability level than the MT group. In patients with CLBP, many pain measures showed that the McKenzie method is a successful treatment to decrease pain in the short term, while the disability measures determined that the McKenzie method is better in enhancing function in the long term.
Topics: Chronic Pain; Exercise Therapy; Humans; Low Back Pain; Musculoskeletal Manipulations; Treatment Outcome
PubMed: 31789300
DOI: No ID Found -
The Journal of Headache and Pain Apr 2011Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side... (Meta-Analysis)
Meta-Analysis Review
Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.
Topics: Anticonvulsants; Fructose; Humans; Manipulation, Chiropractic; Massage; Migraine Disorders; Musculoskeletal Manipulations; Physical Therapy Modalities; Propranolol; Randomized Controlled Trials as Topic; Relaxation Therapy; Topiramate; Treatment Outcome; Vasodilator Agents
PubMed: 21298314
DOI: 10.1007/s10194-011-0296-6 -
Theranostics 2022Small extracellular vesicles (sEVs) have been proposed as a possible solution to the current lack of therapeutic interventions for endogenous skin regeneration. We... (Meta-Analysis)
Meta-Analysis Review
Small extracellular vesicles (sEVs) have been proposed as a possible solution to the current lack of therapeutic interventions for endogenous skin regeneration. We conducted a systematic review of the available evidence to assess sEV therapeutic efficacy and safety in wound healing and skin regeneration in animal models. 68 studies were identified in Web of Science, Scopus, and PubMed that satisfied a set of prespecified inclusion criteria. We critically analyzed the quality of studies that satisfied our inclusion criteria, with an emphasis on methodology, reporting, and adherence to relevant guidelines (including MISEV2018 and ISCT criteria). Overall, our systematic review and meta-analysis indicated that sEV interventions promoted skin regeneration in diabetic and non-diabetic animal models and influenced various facets of the healing process regardless of cell source, production protocol and disease model. The EV source, isolation methods, dosing regimen, and wound size varied among the studies. Modification of sEVs was achieved mainly by manipulating source cells via preconditioning, nanoparticle loading, genetic manipulation, and biomaterial incorporation to enhance sEV therapeutic potential. Evaluation of potential adverse effects received only minimal attention, although none of the studies reported harmful events. Risk of bias as assessed by the SYRCLE's ROB tool was uncertain for most studies due to insufficient reporting, and adherence to guidelines was limited. In summary, sEV therapy has enormous potential for wound healing and skin regeneration. However, reproducibility and comprehensive evaluation of evidence are challenged by a general lack of transparency in reporting and adherence to guidelines. Methodological rigor, standardization, and risk analysis at all stages of research are needed to promote translation to clinical practice.
Topics: Animals; Biocompatible Materials; Extracellular Vesicles; Reproducibility of Results; Skin; Wound Healing
PubMed: 36185607
DOI: 10.7150/thno.73436 -
British Journal of Sports Medicine Jun 2021To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement.
DATA SOURCES
Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS).
RESULTS
Among 1629 references, 14 randomised controlled trials (RCTs) involving 541 athletes were included. The trials had biases across multiple domains including performance, attrition and reporting. Treatments included exercise, biomechanical modifications and manual therapy. There were no trials evaluating the efficacy of surgery or injections. Exercise was the most frequently investigated treatment; no RTS data were reported for any exercise intervention. There was a reduction in pain and disability reported after all treatments.
CONCLUSIONS
While several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.
Topics: Adolescent; Adult; Aged; Athletes; Bias; Bicycling; Cricket Sport; Disability Evaluation; Exercise Therapy; Female; Golf; Hockey; Humans; Low Back Pain; Male; Martial Arts; Massage; Middle Aged; Musculoskeletal Manipulations; Pain Measurement; Quality of Life; Randomized Controlled Trials as Topic; Recovery of Function; Return to Sport; Treatment Outcome; Young Adult
PubMed: 33355180
DOI: 10.1136/bjsports-2020-102723 -
International Journal of Environmental... Apr 2021: Hallux valgus (HV) deformity is a common, potentially debilitating deformity. And evidence with high-quality for the conservative treatments of HV deformity is still... (Meta-Analysis)
Meta-Analysis Review
: Hallux valgus (HV) deformity is a common, potentially debilitating deformity. And evidence with high-quality for the conservative treatments of HV deformity is still required.; AIMS: To compare the effects of different conservative treatments for hallux valgus deformity by using the method of network meta-analysis.; : A systematic review and network meta-analysis of randomized controlled trials identified by searching PubMed, EMBASE, MEDLINE, OVID, and CINAHL. The included studies should have the characteristics that: (1) participants with hallux valgus deformity of any age (2) conservative treatments (3) Reported the hallux valgus (HVA), the intermetatarsal angle (IMA), the score of the Visual Analog Scale, and the score of Foot Function Index.; : 11 studies were included in this review. The agreement between reviewers reached a kappa value of 0.75. The results of the network meta-analysis showed that a combination of exercise and toe separator, night splints, and dry needling are most likely to be the best choice for reducing the hallux valgus angle (HVA) and intermetatarsal angle, and toe separators (with or without exercise), dry needling, and manipulation (with or without ice treatment) have advantages in improving the subjective feeling of patients.; : Multi-disciplinary conservative treatments have a great potential for hallux valgus deformity. More research with high-quality is needed to give a comprehensive and reasonable scheme of a holistic and long-term treatment protocol.
Topics: Conservative Treatment; Hallux Valgus; Humans; Network Meta-Analysis; Pain Measurement; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 33917568
DOI: 10.3390/ijerph18073841 -
The Journal of Manual & Manipulative... Oct 2022Patients with cervicogenic dizziness (CGD) present with dizziness, cervical spine dysfunctions, and postural imbalance, symptoms that can significantly impact their... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patients with cervicogenic dizziness (CGD) present with dizziness, cervical spine dysfunctions, and postural imbalance, symptoms that can significantly impact their daily functioning.
OBJECTIVES
To provide evidence-based recommendations for the management of patients with CGD.
METHODS
Three databases were searched for randomized controlled trials (RCTs) (last search 15 May 2021). Outcome measures included dizziness, cervical spine, and balance parameters. Cochrane standard methodological procedures were used and included the RoB 2.0 and GRADE. Where possible, RCTs were pooled for meta-analysis.
RESULTS
Thirteen RCTs (n = 898 patients) of high (two RCTs), moderate (five RCTs), and low (six RCTs) methodological quality were analyzed. Six RCTs were included in the meta-analysis. Only three RCTs specified the cause of CGD. They showed inconsistent findings for the effectiveness of exercise therapy in patients with traumatic CGD. Manual therapy and manual therapy combined with exercise therapy may reduce CGD, cervical spine, and balance dysfunctions.
CONCLUSION
There is moderate quality of evidence that manual therapy reduces CGD, cervical spine, and balance symptoms. When manual therapy is combined with exercise therapy, the positive effect on CGD, cervical spine, and balance symptoms is even stronger. However, the quality of the evidence here is very low.
Topics: Cervical Vertebrae; Dizziness; Exercise Therapy; Humans; Musculoskeletal Manipulations; Vertigo
PubMed: 35383538
DOI: 10.1080/10669817.2022.2033044 -
Journal of Bodywork and Movement... Jul 2019Diagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated.
BACKGROUND
Diagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated.
OBJECTIVES
To investigate diagnostic accuracy of physical tests, efficacy of physiotherapy and coherence between target of assessment and intervention for shoulder impingement and related disorders like bursitis, rotator cuff and long head biceps tendinopathy and labral lesions.
METHODS
A systematic search of four databases was conducted, including RCTs and cross-sectional studies. Cochrane Risk of Bias and QUADAS-2 were adopted for critical appraisal and a narrative synthesis was undertaken.
RESULTS
6 RCTs and 2 cross-sectional studies were appraised. Studies presented low to moderate risk of bias. There is a lack of evidence to support the mechanical construct guiding the choice of physical tests for diagnosis of impingement. Manual techniques appear to yield better results than placebo and ultrasounds, but not better than exercise therapy alone. Discrepancy between the goal of assessment strategies and the relative proposed treatments were present together with high heterogeneity in terms of selection of patients, type of endpoints and follow-ups.
CONCLUSIONS
Musculoskeletal physiotherapy seems to be an effective treatment for patients with shoulder pain although it is still based on weak diagnostic clinical instruments. The adoption of more functional and prognostic assessment strategies is advisable to improve coherence between evaluation and treatment.
Topics: Bursitis; Disability Evaluation; Humans; Musculoskeletal Manipulations; Physical Therapy Modalities; Rotator Cuff Injuries; Shoulder Impingement Syndrome; Shoulder Joint; Shoulder Pain; Tendinopathy
PubMed: 31563378
DOI: 10.1016/j.jbmt.2018.08.002 -
International Journal of Environmental... Feb 2021(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and... (Review)
Review
(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and moderate idiopathic CTS. However, severe CTS and systemic conditions were an exclusion criterion from the studies. The aim of this study is to review the effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases in the last ten years. (2) Methods: Randomized controlled clinical trials that compared the effect of conservative treatment on the Boston questionnaire and pain were selected. PubMed, PEDro, Scopus, Cochrane, and Web of Science databases were used. PRISMA statement checklist was performed. (3) Results: 876 studies were recorded, 29 were selected. Pharmacology, Electrotherapy and Manual Therapy had benefits for CTS. Electrotherapy and manual therapy could be effective for severe CTS patients with a systemic condition in the short term, but there was a low percentage of these patients included in the studies. (4) Conclusion: Some pharmacological treatments, manual therapy and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown. It would be necessary to include patients with systemic conditions in the selection criteria for future studies.
Topics: Boston; Carpal Tunnel Syndrome; Conservative Treatment; Humans; Musculoskeletal Manipulations; Pain; Treatment Outcome
PubMed: 33671060
DOI: 10.3390/ijerph18052365 -
BMC Musculoskeletal Disorders Dec 2019To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.
METHODS
PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.
RESULTS
Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups.
DISCUSSION
In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain.
PROTOCOL REGISTRATION AT PROSPERO
CRD42018111975.
Topics: Chronic Pain; Humans; Manipulation, Osteopathic; Pain Management; Pain Measurement; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome
PubMed: 31892357
DOI: 10.1186/s12891-019-3017-y -
The Journal of Manual & Manipulative... Oct 2023Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions.
OBJECTIVE
The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions.
METHODS
Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form.
RESULTS
Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low.
CONCLUSION
Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.
Topics: Humans; Exercise; Musculoskeletal Manipulations; Physical Therapy Modalities; Shoulder Pain; Bursitis; Randomized Controlled Trials as Topic
PubMed: 36861780
DOI: 10.1080/10669817.2023.2180702