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Disability and Rehabilitation May 2022To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type... (Meta-Analysis)
Meta-Analysis
PURPOSE
To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH).
METHODS
Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis.
RESULTS
Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache.
CONCLUSION
Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.Implications for rehabilitationSoft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache.High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache.Manual therapy was not effective for improving the impact of headache in patients with tension type headache.
Topics: Dry Needling; Headache; Humans; Musculoskeletal Manipulations; Pain; Tension-Type Headache
PubMed: 32924640
DOI: 10.1080/09638288.2020.1813817 -
Neuroscience and Biobehavioral Reviews Aug 2022Subitizing is the fast and accurate enumeration of small sets. Whether attention is necessary for subitizing remains controversial considering (1) subitizing is claimed... (Meta-Analysis)
Meta-Analysis Review
Subitizing is the fast and accurate enumeration of small sets. Whether attention is necessary for subitizing remains controversial considering (1) subitizing is claimed to be "pre-attentive", and (2) existing experimental methods and results are inconsistent. To determine whether manipulations to attention demonstratively affect subitizing, the current study comprises a systematic review and meta-analysis. Results from fourteen studies (22 experiments, 35 comparisons) suggest that changes to attentional demands interferes with enumeration of small sets; leading to slower response times, lower accuracy, and poorer Weber acuity (p < .010; p < .001; p < .001; respectively)-notwithstanding a potential publication bias. A unifying framework is proposed to explain the role of attention in visual enumeration, with progressively greater attentional involvement from estimation to subitizing to counting. Our findings suggest attention is integral for subitizing and highlights the need to emphasise attentional mechanisms into neurocognitive models of numerosity processing. We also discuss the possible role of attention in numerical processing difficulties (e.g., dyscalculia).
Topics: Attention; Humans; Mathematics; Pattern Recognition, Visual; Reaction Time
PubMed: 35772633
DOI: 10.1016/j.neubiorev.2022.104753 -
Pain Physician Sep 2020Myofascial mobilization has been used as an intervention for patients with fibromyalgia (FM) for acting on ascending nociceptive pathways possibly involved in the...
BACKGROUND
Myofascial mobilization has been used as an intervention for patients with fibromyalgia (FM) for acting on ascending nociceptive pathways possibly involved in the central sensitization process, modulating the pain experience. However, there is still a gap in its efficacy compared with another hands-on approach because manual therapy has nonspecific effects, such as placebo.
OBJECTIVES
This systematic review aims to review the scientific literature for an overview of the efficacy of manual therapy in pain, disease impact, and quality of life in patients with FM compared with control or other treatments through randomized clinical trials.
STUDY DESIGN
This study involved systematic review of published randomized controlled trials (RCTs).
SETTING
This study examined all RCTs evaluating the effect of manual therapy on pain, impact of disease, and quality of life for patients with FM.
METHODS
Systematic review. The research was performed in 9 databases: MEDLINE/PubMed, CINAHL, Web of Science, Scopus, ScienceDirect, Lilacs, SciELO, PEDro, and Cochrane. Searches were carried out from the end of the project until September 2019, with no language and year restrictions. Randomized controlled clinical trials that used the following outcome measures were included: Visual Analog Scale, Fibromyalgia Impact Questionnaire, and SF-36 Quality of Life Questionnaire. The risk of bias and quality of studies was assessed using the PEDro scale; the Cochrane risk-of-bias tool; and Grading of Recommendations Assessment, Development, and Evaluation System.
RESULTS
Seven studies were included (368 patients). The quantitative analysis was performed on 4 studies because of the lack of data in the others. Myofascial release was the most used modality. The level of evidence ranged from very low to moderate, mainly because of the inconsistency and inaccuracy of results.
LIMITATIONS
The present systematic review presented limitations because of the heterogeneity of the included studies and only a short-term analysis of the intervention results. It was observed that other information, such as pressure, repetition, and/or sustaining manual therapy techniques, could be better described in future protocols, aiming at a better comparison between the techniques and their subsequent reproducibility.
CONCLUSIONS
Current evidence of manual therapy in patients with FM, based on a very low to moderate quality of evidence, was inconclusive and insufficient to support and recommend the use of manual therapy in this population. To date, only general osteopathic treatment has achieved clinically relevant pain improvement when compared with control.
Topics: Fibromyalgia; Humans; Musculoskeletal Manipulations; Pain; Pain Management; Quality of Life; Treatment Outcome
PubMed: 32967389
DOI: No ID Found -
Journal of Bodywork and Movement... Jul 2019Myofascial pain with myofascial triggers are common musculoskeletal complaints. Popular treatments include manual therapy, dry needling, and dry cupping. The purpose of...
INTRODUCTION
Myofascial pain with myofascial triggers are common musculoskeletal complaints. Popular treatments include manual therapy, dry needling, and dry cupping. The purpose of this systematic review was to compare the efficacy of each treatment in the short-term relief of myofascial pain and myofascial trigger points.
METHODS
Search engines included Google Scholar, EBSCO Host, and PubMed. Searches were performed for each modality using the keywords myofascial pain syndrome and myofascial trigger points. The inclusion criteria included English-language, peer-reviewed journals; a diagnosis of myofascial pain syndrome or trigger points; manual therapy, dry needling, or dry cupping treatments; retrospective studies or prospective methodology; and inclusion of outcome measures.
RESULTS
Eight studies on manual therapy, twenty-three studies on dry needling, and two studies on dry cupping met the inclusion criteria. The Physiotherapy Evidence Database (PEDro) was utilized to assess the quality of all articles.
DISCUSSION
While there was a moderate number of randomized controlled trials supporting the use of manual therapy, the evidence for dry needling ranged from very low to moderate compared to control groups, sham interventions, or other treatments and there was a paucity of data on dry cupping. Limitations included unclear methodologies, high risk for bias, inadequate blinding, no control group, and small sample sizes.
CONCLUSION
While there is moderate evidence for manual therapy in myofascial pain treatment, the evidence for dry needling and cupping is not greater than placebo. Future studies should address the limitations of small sample sizes, unclear methodologies, poor blinding, and lack of control groups.
Topics: Dry Needling; Humans; Musculoskeletal Manipulations; Myofascial Pain Syndromes; Trigger Points
PubMed: 31563367
DOI: 10.1016/j.jbmt.2019.04.001 -
Manual Therapy Feb 2016Temporomandibular joint disorder (TMD) requires a complex diagnostic and therapeutic approach, which usually involves a multidisciplinary management. Among these... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Temporomandibular joint disorder (TMD) requires a complex diagnostic and therapeutic approach, which usually involves a multidisciplinary management. Among these treatments, musculoskeletal manual techniques are used to improve health and healing.
OBJECTIVES
To assess the effectiveness of musculoskeletal manual approach in temporomandibular joint disorder patients.
DESIGN
A systematic review with meta-analysis.
METHODS
During August 2014 a systematic review of relevant databases (PubMed, The Cochrane Library, PEDro and ISI web of knowledge) was performed to identify controlled clinical trials without date restriction and restricted to the English language. Clinical outcomes were pain and range of motion focalized in temporomandibular joint. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at every post treatment. The PEDro scale was used to demonstrate the quality of the included studies.
RESULTS/FINDINGS
From the 308 articles identified by the search strategy, 8 articles met the inclusion criteria. The meta-analysis showed a significant difference (p < 0.0001) and large effect on active mouth opening (SMD, 0.83; 95% CI, 0.42 to 1.25) and on pain during active mouth opening (MD, 1.69; 95% CI, 1.09 to 2.30) in favor of musculoskeletal manual techniques when compared to other conservative treatments for TMD.
CONCLUSIONS
Musculoskeletal manual approaches are effective for treating TMD. In the short term, there is a larger effect regarding the latter when compared to other conservative treatments for TMD.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Musculoskeletal Manipulations; Range of Motion, Articular; Temporomandibular Joint; Temporomandibular Joint Disorders; Young Adult
PubMed: 26144684
DOI: 10.1016/j.math.2015.06.009 -
The Journal of Orthopaedic and Sports... Sep 2023We aimed to examine whether targeting spinal manipulative therapy (SMT), by applying the intervention to a specific vertebral level, produces superior clinical outcomes... (Meta-Analysis)
Meta-Analysis
We aimed to examine whether targeting spinal manipulative therapy (SMT), by applying the intervention to a specific vertebral level, produces superior clinical outcomes than a nontargeted approach in patients with nonspecific low back pain. Systematic review with meta-analysis. MEDLINE, Embase, CENTRAL, CINAHL, Scopus, PEDro, and Index to Chiropractic Literature were searched up to May 31, 2023. Randomized controlled trials comparing targeted SMT (mobilization or manipulation) to a nontargeted approach in patients with nonspecific low back pain, and measuring the effects on pain intensity and patient-reported disability. Data extraction, risk of bias, and evaluation of the overall certainty of evidence using the GRADE approach were performed by 2 authors independently. Meta-analyses were performed using the restricted maximum likelihood method. Ten randomized controlled trials (n = 931 patients) were included. There was moderate-certainty evidence of no difference between targeted SMT and a nontargeted approach for pain intensity at postintervention (weighted mean difference = -0.20 [95% CI: -0.51, 0.10]) and at follow-up (weighted mean difference = 0.05 [95% CI: -0.26, 0.36]). For patient-reported disability, there was moderate-certainty evidence of no difference at postintervention (standardized mean difference = -0.04 [95% CI: -0.36, 0.29]) and at follow-up (standardized mean difference = -0.05 [95% CI: -0.24, 0.13]). Adverse events were reported in 4 trials, and were minor and evenly distributed between groups. Targeting a specific vertebral level when administering SMT for patients with nonspecific low back pain did not result in improved outcomes on pain intensity and patient-reported disability compared to a nontargeted approach. .
Topics: Humans; Low Back Pain; Back Pain; Manipulation, Spinal; Pain Measurement; Bias
PubMed: 37506306
DOI: 10.2519/jospt.2023.11962 -
Spine Aug 1996Cervical spine manipulation and mobilization were reviewed in an analysis of the literature from 1966 to the present. (Review)
Review
STUDY DESIGN
Cervical spine manipulation and mobilization were reviewed in an analysis of the literature from 1966 to the present.
OBJECTIVES
To assess the evidence for the efficacy and complications of cervical spine manipulation and mobilization for the treatment of neck pain and headache.
SUMMARY OF BACKGROUND DATA
Although recent research has demonstrated the efficacy of spinal manipulation for some patients with low back pain, little is known about its efficacy for neck pain and headache.
METHODS
A structured search of four computerized bibliographic data bases was performed to identify articles on the efficacy and complications of cervical spine manual therapy. Data were summarized, and randomized controlled trials were critically appraised for study quality. The confidence profile method of meta-analysis was used to estimate the effect of spinal manipulation on patients' pain status.
RESULTS
Two of three randomized controlled trials showed a short-term benefit for cervical mobilization for acute neck pain. The combination of three of the randomized controlled trials comparing spinal manipulation with other therapies for patients with subacute or chronic neck pain showed an improvement on a 100-mm visual analogue scale of pain at 3 weeks of 12.6 mm (95% confidence interval, -0.15, 25.5) for manipulation compared with muscle relaxants or usual medical care. The highest quality randomized controlled trial demonstrated that spinal manipulation provided short-term relief for patients with tension-type headache. The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations.
CONCLUSIONS
Cervical spine manipulation and mobilization probably provide at least short-term benefits for some patients with neck pain and headaches. Although the complication rate of manipulation is small, the potential for adverse outcomes must be considered because of the possibility of permanent impairment or death.
Topics: Cervical Vertebrae; Headache; Humans; Manipulation, Orthopedic; Neck Pain; Treatment Outcome
PubMed: 8855459
DOI: 10.1097/00007632-199608010-00007 -
Journal of Physiotherapy Oct 2022Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)? (Meta-Analysis)
Meta-Analysis
QUESTION
Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)?
DESIGN
A systematic review and network meta-analysis of randomised clinical trials.
PARTICIPANTS
Adults with CNSNP of at least 3 months duration.
INTERVENTIONS
All available pharmacological and non-pharmacological interventions.
OUTCOME MEASURES
The primary outcomes were pain intensity and disability. The secondary outcome was adverse events.
RESULTS
Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty.
CONCLUSIONS
While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence.
REGISTRATION
PROSPERO CRD42019124501.
Topics: Adult; Humans; Neck Pain; Network Meta-Analysis; Chronic Pain; Musculoskeletal Manipulations; Pain Measurement
PubMed: 36266185
DOI: 10.1016/j.jphys.2022.09.007 -
Sports Health May 2014A high number of recreational runners sustain a running-related injury each year. To reduce injury risk, alterations in running form have been suggested. One simple...
CONTEXT
A high number of recreational runners sustain a running-related injury each year. To reduce injury risk, alterations in running form have been suggested. One simple strategy for running stride frequency or length has been commonly advocated.
OBJECTIVE
To characterize how running mechanics change when stride frequency and length are manipulated.
DATA SOURCES
In January 2012, a comprehensive search of PubMed, CINAHL Plus, SPORTDiscus, PEDro, and Cochrane was performed independently by 2 reviewers. A second search of the databases was repeated in June 2012 to ensure that no additional studies met the criteria after the initial search.
STUDY SELECTION
Inclusion criteria for studies were an independent variable including manipulation of stride frequency or length at a constant speed with outcome measures of running kinematics or kinetics.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 3.
DATA EXTRACTION
Two reviewers independently appraised each article using a modified version of the Quality Index, designed for assessing bias of nonrandomized studies.
RESULTS
Ten studies met the criteria for this review. There was consistent evidence that increased stride rate resulted in decreased center of mass vertical excursion, ground reaction force, shock attenuation, and energy absorbed at the hip, knee, and ankle joints. All but 1 study had a limited number of participants, with several methodological differences existing among studies (eg, overground and treadmill running, duration of test conditions). Although speed was held constant during testing, it was individually self-selected or fixed. Most studies used only male participants.
CONCLUSION
Despite procedural differences among studies, an increased stride rate (reduced stride length) appears to reduce the magnitude of several key biomechanical factors associated with running injuries.
PubMed: 24790690
DOI: 10.1177/1941738113508544 -
Musculoskeletal Science & Practice Jun 2017The aim of this meta-analysis was to determine the effectiveness of spinal manipulation in influencing various biochemical markers in healthy and or symptomatic... (Meta-Analysis)
Meta-Analysis Review
The aim of this meta-analysis was to determine the effectiveness of spinal manipulation in influencing various biochemical markers in healthy and or symptomatic population. Electronic databases (n = 10) were searched (from inception till September 2016) and eight trials (325 participants) that met the inclusion criteria were included in the meta-analysis. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool was used for assessing the quality of the body of evidence for each outcome of interest. There was moderate quality evidence that spinal manipulation influenced biochemical markers. There was moderate quality evidence of significant difference that spinal manipulation is better (SMD -0.46, 95% CI - 0.93 to 0) than control in eliciting changes in cortisol levels immediately after intervention. There was also a low quality evidence that spinal manipulation is better than control at post-intervention in increasing substance-P (SMD -0.48,95%CI-0.87 to -0.1), neurotensin (SMD -1.8,95%CI-2.56 to -1.04) and oxytocin levels (SMD -2.61,95%CI-3.5to-1.72). However, low quality evidence indicated that spinal manipulation did not influence epinephrine (SMD 0.1,95%CI- 0.56to0.75) or nor-epinephrine levels (SMD -0.06,95%CI-0.71to0.6). The current review found that spinal manipulation can increase substance-p, neurotensin, oxytocin and interleukin levels and may influence cortisol levels post-intervention. However, future trials targeting symptomatic populations are required to understand the clinical importance of such changes.
Topics: Adult; Biomarkers; Female; Humans; Male; Manipulation, Spinal; Middle Aged; Spinal Injuries
PubMed: 28399479
DOI: 10.1016/j.msksp.2017.04.004