PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

Editorial: Excellence is a Moving Target

Chad Cook PT, PhD, MBA, OCS, FAAOMPT, Editor in Chief, JMMT

[no abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 125

Treatment of a Patient with Cervical Radiculopathy Using Thoracic Spine Thrust Manipulation, Soft Tissue Mobilization, and Exercise

Michael Costello, MSPT, MTC

Abstract: While there is currently little evidence to suggest which non-operative treatment approach is best for the management of patients with cervical radiculopathy, emerging evidence suggests that these patients benefit from a multimodal treatment approach. The purpose of this case report is to describe the physical therapy management of a patient with cervical radiculopathy. Diagnosis was based on the patient' s meeting three of the four criteria in the diagnostic test cluster currently used to identify patients with cervical radiculopathy. Treatment included thrust manipulation of the thoracic spine, soft tissue mobilization, and therapeutic exercise. After three visits, patient-perceived disability, as measured by the Patient-Specific Functional Scale, improved from 5/10 to 10/10. The Numeric Pain Rating Score decreased from 4.66/10 to 0/10. The patient rated his improvement as a very great deal better on the Global Rating of Change Scale. These clinically meaningful improvements were maintained at the 14-week follow-up. While a cause-and-effect relationship may not be established from a case report, a multimodal approach including thoracic spine manipulation, soft tissue mobilization, and therapeutic exercise was associated with decreased pain and perceived disability in a patient with cervical radiculopathy. Further research is needed to investigate benefits of the components of this approach.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 129-135

Upper Limb Neural Tension and Seated Slump Tests: The False Positive Rate Among Healthy Young Adults without Cervical or Lumbar Symptoms

D. Scott Davis, PT, EdD, OCS, Ila Beth Anderson, MPT, Mary Grace Carson, MPT, Caroline L. Elkins, MPT, Lindsey B. Stuckey, MPT

Abstract: This study examined the false positive rate of the upper limb neural tension test (ULNTT) and seated slump test (SST) among healthy young adults with no history of cervical, lumbar, or peripheral symptoms. Eighty-four subjects (27 men and 57 women) with a mean age of 22.9 years participated in the investigation. All participants completed a screening questionnaire designed to exclude subjects with a history of cervical or lumbar spine pain or injury, or upper or lower extremity neurological symptoms. The ULNTT and the SST were performed on the left upper and lower extremity of each participant. Of the 84 participants tested, 73 (86.9%) were found to have a positive ULNTT at some point in the available range of elbow extension. Twenty-eight (33.3%) of the 84 subjects had a positive SST at some point in the available range of knee extension. The mean knee extension angle for those subjects with a positive SST was 15.1° with a 95% confidence interval (CI) of 12.3 and 19.7°. The mean elbow extension angle for those with a positive ULNTT was 49.4° with a 95% CI of 44.8 and 54.0°. The number of positive tests for both the ULNTT and the SST was found to be high in this sample of asymptomatic healthy young adults. Based on the results of this investigation, the authors suggest that the current criteria for determining a positive test for both the ULNTT and the SST should be examined using the proposed range of motion cut-of scores.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 136-141

Clinical Perspective: Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint

Mark LasLett, FNZCP, PhD, Dip MT, Dip MDT

Abstract: Sacroiliac joint (SIJ) pain refers to the pain arising from the SIJ joint structures. SIJ dysfunction generally refers to aberrant position or movement of SIJ structures that may or may not result in pain. This paper aims to clarify the difference between these clinical concepts and present current available evidence regarding diagnosis and treatment of SIJ disorders. Tests for SIJ dysfunction generally have poor inter-examiner reliability. A reference standard for SIJ dysfunction is not readily available, so validity of the tests for this disorder is unknown. Tests that stress the SIJ in order to provoke familiar pain have acceptable inter-examiner reliability and have clinically useful validity against an acceptable reference standard. It is unknown if provocation tests can reliably identify extra-articular SIJ sources of pain. Three or more positive pain provocation SIJ tests have sensitivity and specificity of 91% and 78%, respectively. Specificity of three or more positive tests increases to 87% in patients whose symptoms cannot be made to move towards the spinal midline, i.e., centralize. In chronic back pain populations, patients who have three or more positive provocation SIJ tests and whose symptoms cannot be made to centralize have a probability of having SIJ pain of 77%, and in pregnant populations with back pain, a probability of 89%. This combination of test findings could be used in research to evaluate the eficacy of specific treatments for SIJ pain. Treatments most likely to be effective are specific lumbopelvic stabilization training and injections of corticosteroid into the intra-articular space.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 142-152

Invited Commentary: Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint

Peter A. Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT

[ No abstract available ]

The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 153-154

Predictor Variables for a Positive Long-Term Functional Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis

Stephen May , Eric Gardiner , Steve Young , Jennifer Klaber-Moffett

Abstract: A cognitive behavioral approach was previously compared to a biomechanical approach (the McKenzie method) for the treatment of patients with back and neck pain in a randomized trial. Few differences between the treatment interventions were found. The aim of this secondary analysis was to determine if any clinical characteristics distinguished those patients who responded best to the McKenzie approach. Treatment success was defined as 50% reduction in original functional disability scores (Roland-Morris Disability Questionnaire or Northwick Park Neck Pain Questionnaire); failure to achieve this was defined as treatment failure. A liberal definition of success was 50% improvement retained at either 6 or 12 months, whereas a strict definition of success was 50% improvement at both 6 and 12 months. Ten variables were screened by univariate regression analysis to see if they predicted success. Any significant variables (P < 0.1) underwent multiple regression analysis. Only 21 and 16 patients out of 102 were deemed treatment successes according to the liberal and strict definitions, respectively. With the liberal definition, only centralization (P = 0.065), spine region (back rather than neck pain) (P = 0.089), and duration of pain (P = 0.001) emerged as predictors from the univariate regression analysis. With the strict definition, only the latter two variables emerged: spine region (P = 0.026) and duration of pain (P < 0.01). All these variables were retained in the multiple regression analysis. In this study, duration of pain was the strongest predictor of success, although back pain and centralization had some predictive ability.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 155-160

Abstracts: AAOMPT Conference, 2008

The following abstracts are to be presented at the 14th annual meeting of the American Academy of Orthopaedic Manual Physical Therapists held in Seattle, Washington from October 29 through November 2, 2008. Presentations are either by poster or platform. These abstracts were peer-reviewed by an AAOMPT committee prior to acceptance for presentation at the AAOMPT conference. However, inclusion of an abstract in this issue does not constitute a peer-reviewed journal publication. The publication of abstracts alerts readers to research that is presently being conducted. It is hoped that the research presented here in brief will eventually be submitted as full-length manuscripts for review and potential publication.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 161-181

Clinimetrics Corner: Use of Effect Sizes in Describing Data

Chad Cook PT, PhD, MBA, OCS, FAAOMPT

Abstract: Effect size is the name provided to a family of indices that are designed to measure magnitude of a targeted intervention. Generally, effect size measures are divided into three groups: 1) standardized difference measures 2) correlational measures, and 3) odds ratios. Effect sizes are valuable in indicating actual magnitude of selected interventions as the values are independent of sample size and statistical significance measures. Effect sizes are used to generate power requirements for a study and are the value of choice when calculating meta-analyses. Typically, effect size measures associate well with global rating of change scores for nearly all interventions.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), E54-E57

Diagnostic Utility of Clinical Tests for SLAP Lesions: A Systematic Literature Review

Janette W. Powell, PT, OCS, STC , Peter A. HuiJbregts, PT, DPT, OCS, FAAOMPT, FCAMT, Richard Jensen, PT, PhD

Abstract: SLAP lesions are often complex injuries with varied defects and tissue, the posterior aspect involvement that are challenging to diagnose clinically. The literature notes the need for visualization under arthroscopy for adequate diagnostic accuracy. The goal of this article is to provide a current best-evidence synthesis with regard to physical examination tests used for the diagnosis of SLAP lesions. A literature search yielded 17 studies that investigated the diagnostic utility of clinical tests for SLAP lesions. These studies investigated 19 clinical tests. A narrative review and a systematic review of methodological quality using the QUADAS methodological quality assessment tool yielded 3 high-quality diagnostic utility studies. Current best evidence indicates that a negative finding for the passive compression test provides the therapist with the greatest evidence-based confidence that a SLAP lesion is absent. A positive finding on the anterior apprehension maneuver, the anterior slide test, the Jobe relocation test, the passive compression test, the Speed test, and the Yergason test or a combination of positive findings on the Jobe relocation test and the active compression test or the Jobe relocation test and the anterior apprehension maneuver provides the therapist with the research-based confidence required to rule in a SLAP lesion. For ruling in a SLAP lesion, the greatest diagnostic value should likely be placed on a positive finding on the passive compression test. Suggestions for future research are provided.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), E58-E79

Book and Multimedia Reviews

[no abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), E80

Letters to the Editor

[no abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 3 (2008), 182-185