PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

Immediate Effects of Inhibitive Distraction on Active Range of Cervical Flexion in Patients with Neck Pain: A Pilot Study

Kristin Briem, MHSc, PT, Peter Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT, Maria Thorsteinsdottir, MSc, PT

Abstract: The purpose of this pilot study was to examine the immediate effects of a manual therapy technique called Inhibitive Distraction (ID) on active range of motion (AROM) for cervical flexion in patients with neck pain with or without concomitant headache. A secondary objective of this study was to see whether patient subgroups could be identified who might benefit more from ID by studying variables such as age, pain intensity, presence of headache, or pre-intervention AROM. We also looked at patients' ability to identify pre- to post-intervention changes in their ability to actively move through a range of motion. Forty subjects (mean age 34.7 years; range 16-48 years) referred to a physical therapy clinic due to discomfort in the neck region were randomly assigned to an experimental and a control group. We used the CROM goniometer to measure pre- and post-intervention cervical flexion AROM in the sagittal plane within a single treatment session. The between-group difference in AROM increase was not statistically significant at P<0.05 with a mean post-intervention increase in ROM of 2.4º (SD 6.2º) for the experimental group and 1.2º (SD 5.8º) for the placebo group. We were also unable to identify potential subgroups more likely to respond to ID, although a trend emerged for greater improvement in chronic patients with headaches, lower pain levels, and less pre-intervention AROM. In the experimental group and in both groups combined, subjects noting increased AROM indeed had a significantly greater increase in AROM than those subjects not noting improvement. In conclusion, this study did not confirm immediate effects of ID on cervical flexion AROM but did provide indications for potential subgroups likely to benefit from this technique. Recommendations are provided with regard to future research and clinical use of the technique studied.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 2 (2007), 82-89

Creation and Critique of Studies of Diagnostic Accuracy: Use of the STARD and QUADAS Methodological Quality Assessment Tools

Chad Cook, PT, PhD, MBA, OCS, FAAOMPT, Joshua Cleland, PT, DPT, PhD, OCS, FAAOMPT, Peter Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT

Abstract: Clinical special tests are a mainstay of orthopaedic diagnosis. Within the context of the evidence-based practice paradigm, data on the diagnostic accuracy of these special tests are frequently used in the decision-making process when determining the diagnosis, prognosis, and selection of appropriate intervention strategies. However, the reported diagnostic utility of these tests is significantly affected by study methodology of diagnostic accuracy studies. Methodological shortcomings can influence the outcome of such studies, and this in turn will affect the clinician's interpretation of diagnostic findings. The methodological issues associated with studies investigating the diagnostic utility of clinical tests have mandated the development of the STARD (Standards for Reporting of Diagnostic Accuracy) and QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criterion lists. The purpose of this paper is to outline the STARD and QUADAS criterion lists and to discuss how these methodological quality assessment tools can assist the clinician in ascertaining clinically useful information from a diagnostic accuracy study.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 2 (2007), 93-102

Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study

Howard Makofsky, PT, DHSc, OCS, Siji Panicker, PT, DPT, Jeanine Abbruzzese, PT, DPT, Cynthia Aridas, PT, DPT, Michael Camp, PT, DPT, Jonelle Drakes, PT, DPT, Caroline Franco, PT, DPT, Ray Sileo, PT, DPT

Abstract: Joint mobilization and manipulation stimulate mechanoreceptors, which may influence the joint and surrounding muscles. The purpose of this pilot study was to determine the effect of grade IV inferior hip joint mobilization on hip abductor torque. Thirty healthy subjects were randomly assigned to a control group (grade I inferior hip joint mobilization) or an experimental group (grade IV inferior hip joint mobilization). Subjects performed a pre- and post-intervention test of five isometric repetitions on the Cybex Norm dynamometer; the average torque was determined for both pre- and post-intervention measurements. These data were analyzed using the independent samples t-test with the significance level set at P<0.05. The results showed a statistically significant difference between the two groups for an increase in hip abductor torque in the experimental group (P=0.03). The experimental group demonstrated a 17.35% increase in average torque whereas the control group demonstrated a 3.68% decrease in average torque. These findings are consistent with other studies demonstrating that the use of grade IV non-thrust mobilization improves strength immediately post-intervention in healthy individuals. The results of this pilot study provide physical therapists with further support for the utilization of manual therapy in conjunction with therapeutic exercise to enhance muscle strength.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 2 (2007), 103-111

Management of Low Back Pain: A Case Series Illustrating the Pragmatic Combination of Treatment- and Mechanism-Based Classification Systems

Daniel Pinto, MSPT, OCS, Joshua Cleland, PT, PhD, OCS, FAAOMPT, Jessica Palmer, DPT, Sarah L Eberhart, DPT

Abstract: This case series describes the pragmatic use of a treatment-based classification system for the management of four patients with a chief complaint of low back pain. Patients were initially classified into stabilization, manipulation, or specific exercise subgroups based on history and clinical examination. Each patient was reassessed during the course of clinical care to determine whether to continue treating according to the initially assigned subgroup or to alter management and incorporate a mechanism-based classification addressing identified impairments. Patient #1 was initially classified in the manipulation category. Within three visits, he reported being "a great deal better" on the Global Rating of Change (GROC) and had a 6-point improvement in his Oswestry Disability Index (ODI). Patient #2, classified in the specific exercise/extension category, reported being "moderately better" using the GROC and had a 22-point improvement in her ODI within six visits. Patient #3, classified in the stabilization category, reported being "a very great deal better" on the GROC and had a 30-point improvement in his ODI Index within four visits. Patient #4 was categorized initially in the manipulation category and subsequently in the specific exercise category; after five visits, he noted being "quite a bit better" using the GROC and he reported a 58-point improvement on his ODI. All four patients in this study were managed using a dynamic pragmatic treatment-based classification approach that allowed for the change of subgroup classification and treatment of impairments and all achieved a clinically meaningful improvement in pain and disability.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 2 (2007), 111-122

Letter to the Editor

Jack Miller, BSc (PT), Dip Manip Ther (NZ), MCTA, FCAMT

It was with interest that I read the recently published editorial in this journal challenging the "sacred cow" of passive intervertebral joint motion evaluation (PIVM, PAVM) as the cornerstone of orthopaedic manual therapy (OMT) clinical reasoning. Just as with the domesticated bovine species, the sanctified milk of sacred cows can taste wonderful when fresh but it may become less palatable when let out of the fridge too long.[no abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 15 No. 2 (2007), 123-124

Roots of Physical Medicine, Physical Therapy, and Mechanotherapy in the Netherlands in the 19^th Century: A Disputed Area within the Healthcare Domain

Thomas J.A. Terlouw, PT, MSc, PhD (Medical History)

Abstract: Physical medicine, which in the context of this article includes mechanotherapy, hydrotherapy, balneotherapy, electrotherapy, light therapy, air therapy, and thermotherapy, became a new field of labor in the healthcare domain in the Netherlands around 1900. This article gives an account of the introduction and development of mechanotherapy as a professional activity in the Netherlands in the 19th century. Mechanotherapy, which historically included exercises, manipulations, and massage, was introduced in this country around 1840 and became one of the core elements of physical medicine towards the end of that century. In contrast to what one might expect, mostly physical education teachers, referred to as "heilgymnasts," dedicated themselves to this kind of treatment, whereas only a few physicians were active in this field until the 1880s. When, in the last quarter of the 19th century, differentiation and specialization within the medical profession took place, physicians specializing in physical medicine and orthopaedics began to claim the field of mechanotherapy exclusively for themselves. This led to tensions between them and the group of heilgymnasts that had already been active in this field for decades. The focus of attention in this article is on interprofessional relationships, on the roles played by the different professional organizations in the fields of physical education and medicine, the local and national governments, and the judicial system, and on the social, political, and cultural circumstances under which developments in the field of mechanotherapy took place. The article concludes with the hypothesis that the intra- and inter-occupational rivalries discussed have had a negative impact on the academic development of physical medicine, orthopaedics, and heilgymnastics/physical therapy in the Netherlands in the first half of the 20th century.
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