PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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2005 - Vol. 13, No. 3
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Abstracts:
Incorporation of Manual Therapy Directed at the Cervicothoracic Spine in Patients with Lateral Epicondylalgia: A Pilot Clinical Trial
Joshua A. Cleland, DPT, OCS, Timothy W. Flynn, PT, PhD, OCS, FAAOMPT, Jessica A. Palmer, MPT
Abstract: Recent trends in the use of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia have been observed. However, only short-term preliminary evidence exists to support the use of these techniques. This pilot clinical trial describes the outcomes of patients with lateral epicondylalgia undergoing local treatment (LT) solely directed at the elbow and a program consisting of local treatment plus manual therapy aimed at the cervicothoracic spine (LT + MTCT). Ten consecutive patients referred to physical therapy by their primary care physician with a diagnosis of lateral epicondylalgia were randomly assigned to receive LT or LT + MTCT. Both groups received 10 treatments over a 6-week period. Outcome measures, including the Numeric Pain Rating Scale; pain-free grip strength; Disability of the Arm, Shoulder, and Hand questionnaire; and a global rating of change were completed at discharge and at 6-month follow-up. Patients in both groups exhibited clinically meaningful improvement at discharge and at the 6-month follow-up. The LT + MTCT group demonstrated greater improvement in all outcome measures as compared to the LT group. The results suggest that the incorporation of manual therapy directed at the cervicothoracic spine may be an effective adjunct to treatment directed solely at the elbow for patients with lateral epicondylalgia.
The Journal of Manual & Manipulative Therapy Vol. 13 No. 3 (2005), 143 - 151
Physical Therapy Exercise Intervention Based on Classification Using the Patient Response Method: A Systematic Review of the Literature
Chad Cook, PT, PhD, MBA, OCS, Eric J. Hegedus, PT, DPT, OCS, Kevin Ramey, MS, PT
Abstract: It has been suggested that inclusion into a study that categorizes patients in mutually exclusive, clinometric classifications should improve the outcome of an exercise based randomized clinical trial. This review examined the evidence regarding the effectiveness of physical therapist-directed therapeutic exercises when patients were classified using the patient response method. This systematic literature review restricted article inclusion to English-only articles that classified homogenous samples of low back pain patients using the patient response based method, demonstrated physical therapist-directed exercise interventions, and used specific outcome criteria for assessment of patient improvement. The PEDro scale was used to rate the methodological quality of the studies. Of 82 articles reviewed only 5 articles were accepted. All 5 met the PEDro standards for a high-quality study. Of the 5 articles, 4 demonstrated that physical therapy exercise intervention based on the patient response method of classification were significantly better than the pragmatic control comparisons; the remaining article indicated that exercise was less effective than manipulation. There appears to be a trend toward positive outcomes with physical therapy exercise intervention in trials restricted to the patient response method of classification; however, few studies have investigated this phenomenon.
The Journal of Manual & Manipulative Therapy Vol. 13 No. 3 (2005), 152 - 162
Effectiveness of an Exercise Program to Improve Forward Head Posture in Normal Adults: A Randomized, Controlled 10-Week Trial
Katherine Harman, PT, PhD, Cheryl L. Hubley-Kozey, PhD, Heather Butler, MSc (Kin), PhD (Candidate)
Abstract: Forward head posture (FHP) is most often described as excessive anterior positioning of the head in relation to a vertical reference line, involving increased cervical spine lordosis (head forward, middle cervical spine extended, lower cervical spine flexed) and rounded shoulders with thoracic kyphosis. Although exercise is routinely used to improve FHP, relatively little data exists on efficacy. The present study was designed to examine the impact of a 10-week targeted and progressive home exercise program on improving FHP. As improvement through exercise of postural alignment depends upon participants adhering to the program, we also looked at issues related to exercise compliance. Seventeen control (C) and 23 exercise (E) participants with a FHP deviation were part of this program. Pre- and post-exercise postural measurements of FHP were obtained from the sagittal plane using the BiotonixTM Postural Analysis System; in addition neck flexion range of motion was measured. Participants were randomly assigned to C or E groups. The E group performed neck extensor and pectoralis major stretches and deep neck flexor and shoulder retractor strengthening exercises for the 10-week period. Two-factor (group, pre-test/post-test) analysis of variance models were used to test main effects and interactions. There were no significant differences (p>0.05) between groups on any pre-test measure. For the E group, there were significant differences and interactions (p<0.05) between pre- and post-tests and also between the E and C groups at post-test for range of motion and one postural measurement. The results demonstrate that a short, home-based targeted exercise program can improve postural alignment related to FHP. These results provide a foundation for further development of postural improvement programs that include an exercise component.
The Journal of Manual & Manipulative Therapy Vol. 13 No. 3 (2005), 163 - 176
* this issue only available in PDF format
