PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

Editorial: Is Clinical Gestalt Good Enough?

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. 17 No. 1 (2009), 6-7

Manual Therapy Awards 2009

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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2008), 8

Manual Therapy Award Winners 2008

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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2008), 9

Announcements

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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2008), 10

Clinical Perspective: How Do Clinical Test Results Differentiate Chronic and Subacute Low Back Pain Patients from "Non-Patients"?

MARKKU PAATELMA, MSc, PT; EIRA KARVONEN, MSc, PT; JOUKO HEISKANEN, MD

Abstract: Our limited understanding of underlying conditions for back pain is reflected in the common use of pain-duration-based groupings. The aim of this paper was to investigate typical clinical tests used in examining low back pain (LBP) patients in order to discover how tests distinguish between chronic low back pain patients (CLBP) and subacute low back pain patients (SLBP) and if they distinguish these groups from those with no "patient status." CLBP patients in this study were from a university hospital and SLBP patients were from five occupational health care centers. Control subjects were recruited from a university. Determination of the best predictors between CLBP and SLBP patients and between CLBP and SLBP patients and non-patients was made by a forward stepwise logistic model. A total of 157 subjects were included in the study. Of all the clinical tests, several tests in each category had high odds ratio, differentiating CLBP patients from controls. Only a few tests differentiated between CLBP and SLBP patients. The only clinical differences between SLBP patients and controls were in the mobility test and in one test of muscle tightness. The best predictor for CLBP was the lumbar spine flexion test. SLBP patients seemed to differ from the control group in lumbar flexion, in a specific anterior-posterior mobility test, and in tightness of hip flexor muscles. CLBP patients differed from SLBP patients in functional tests, in the presence of sensation in the feet, and in different pain provocation tests. Whether these tests are sufficiently sensitive to classify a more specific diagnostic or clinical subgroup remains untested, and further studies with clinical tests to differentiate among pathological conditions are necessary.

The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), 11-19

Invited Commentary: How Do Clinical Test Results Differentiate Chronic and Subacute Low Back Pain Patients from "Non-Patients"?

MARK WERNEKE, MS, PT, Dip. MDT

[no abstract available]

The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), 20-21

Validity of the McMurray's Test and Modified Versions of the Test: A Systematic Literature Review

WAYNE HING, PhD, MSc, ADP, Dip MT, Dip Phys, MNZCP; STEVE WHITE, MHSc, DipPH, DipMT, DipPhys; DUNCAN REID, MHSc, PGDHSc, Dip MT, Dip Phys, BSc; ROB MARSHALL, BSc, PGDHSc

Abstract: Clinical assessment of meniscal pathology in the knee has proven difficult due to the wide number of tests available and variations in their interpretation and application. The purpose of this paper was to assess the literature investigating the validity and diagnostic accuracy of the McMurray's test (and modifications) for determining meniscal pathology of the knee so that conclusions could be drawn regarding its clinical usefulness as a test. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. In addition, cited references of relevant articles were examined. Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). Eleven studies met the inclusion criteria. Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. Generally, the McMurray's test has relatively high specificity and low sensitivity. The studies that compared the diagnostic accuracy of the McMurray's test with that of modified versions of the test showed enhanced diagnostic accuracy for the modified tests. This review identified that the McMurray's test is of limited clinical value due to relatively low sensitivity, with modified tests (associated with the traditional McMurray's test) having higher diagnostic accuracy and thus these may be more useful clinically.

The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), 22-35

Prescriptive Clinical Prediction Rules in Back Pain Research: A Systematic Review

STEPHEN MAY, MSc; RICHARD ROSEDALE, PT

Abstract: Prescriptive clinical prediction rules (CPRs) are a way of using a small selection of clinical findings to match patients to optimal interventions. A number of CPRs have been developed for use with back pain patients, but these have not been systematically reviewed. The purpose of this review was to evaluate existing CPRs against established criteria to determine the quality of the studies and the overall development of the CPR against a set number of stages. Medline was searched up until June 2008, and 16 studies were reviewed that related to 9 different CPRs. These studies investigated and attempted to find clinical characteristics for responders to manipulation, stabilization exercise, physical therapy, chiropractic, traction, rehabilitation, usual care, and zygapophyseal joint injections. Eleven of these studies related to the derivation stage and five to the validation stage. The manipulation and stabilization CPRs had been the most studied. The derivation studies were mostly high quality, whereas none of the validation studies were. Some of the validation studies did not provide evidence that validated the CPR. Most of these CPRs need further evaluation before they can be applied clinically; most did not pass the lowest level of evidence hierarchy. As regards the manipulation CPR, evidence to date for its clinical utility is limited and contradictory. For the stabilization CPR, there was limited evidence that it may be considered but only with caution and in similar patients. Overall, there is limited evidence to support the general application of spinal CPRs.

The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), 36-45

Vertebral Artery Blood Flow Velocity Changes Associated with Cervical Spine Rotation: A Meta-Analysis of the Evidence with Implications for Professional Practice

JEANETTE MITCHELL, BSc (Physiotherapy), PhD

Abstract: Many studies of vertebral artery (VA) blood flow changes related to cervical spine rotation have been published, but the findings are controversial and the evidence unconvincing. Recent Doppler measurements suggest that contralateral VA blood flow is compromised on full rotation in both healthy subjects and patients. More rigorous research is needed, and it was the aim of this study to conduct a meta-analysis of published data to inform professional practice. A systematic literature search, including only Doppler studies of VA blood flow velocity associated with cervical spine rotation in adults, yielded nine reports with published data. Using weighted means of the pooled data, the magnitude of the effect size (Cohen's d) was calculated for differences between patients and subjects, sitting or lying supine for testing, the parts of the VA insonated, and the changes recorded after cervical spine rotation. From this meta-analysis, VA blood flow velocity was found to be compromised more in patients than healthy individuals, on contralateral rotation, with the subject sitting, and more in the intracranial compared to the cervical part of the VA. Possible reasons for these findings are suggested, and it is advised that sustained end-of-range rotation and quick-thrust rotational manipulations be avoided until there is a stronger evidence base for clinical practice.

The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), 46-57

Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report

JOSE ORLANDO RUIZ, PT, DPT, MBA

Abstract: Idiopathic frozen shoulder is a common medical diagnosis for patients seeking physical therapy. Radiographic and surgical evidence exists that describes the coracohu- meral ligament (ChL) as a major contributor to lack of external rotation in patients diagnosed with frozen shoulder. No stretching techniques targeting the anatomical fiber orientation of the ChL have been reported in the literature. This single-patient case-report describes the use of a positional stretching technique of the ChL on a 51-year-old female diagnosed with phase I frozen shoulder. The patient completed 8 in-office visits and 17 home exercise program sessions of positional ChL stretching combined with a simple volitional rotator cuff exercise program in a 4-week period. The patient's Disabilities of the Arm Shoulder and Hand (DASh) scores improved from 65 to 36 and Shoulder Pain and Disability Index (SPADI) scores improved from 72 to 8 and passive external rotation from 20° to 71°. While a cause-and-effect relationship cannot be inferred from a single case, this report may foster further investigation regarding the role of the ChL in patients with stage- I and stage- II frozen shoulder as well as therapeutic strategies to help reduce loss of mobility and function.

The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), 58-63

Clinimetrics Corner: Beyond SpPIN and SnNOUT: Considerations with Dichotomous Tests During Assessment of Diagnostic Accuracy

ERIC J HEGEDUS, PT, DPT, MHSc; BEN STERN, PT, DPT, MS

Abstract: Paramount to efficient and effective care is the determination of an accurate diagnosis that leads to the proper referral and/or intervention. In an effort to improve the clinical utility of diagnostic accuracy calculations, researchers have promoted the use of the mnemonics SpPIn (if specificity is high, a positive test rules in pathology) and SnNOut (if sensitivity is high, a negative test rules out pathology). Using examples from diagnostic accuracy studies and a review of pertinent literature, this clinimetrics corner outlines additional considerations for clinicians when consuming research in this area. The paper has three foci. First, sensitivity, specificity, and other estimates of the diagnostic accuracy of dichotomous physical examination tests should be viewed as estimates with confidence when those estimates are expressed as confidence intervals. Second, appropriate power must be considered when evaluating each study. Last, the quality of a diagnostic accuracy study can affect the generalizibility of the results to practice environments.
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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), E1-E5

Does Scapula Taping Facilitate Recovery for Shoulder Impingement Symptoms? A Pilot Randomized Controlled Trial

PETER MILLER, B Phty, Grad Cert H Sc; PETER OSMOTHERLY, B Sc, Grad Dip Phty, M Med Sci

Abstract: Scapula taping is a commonly used adjunctive treatment for shoulder impingement pathology. However, this intervention has not previously been subject to formal investigation. A pilot single-blind randomized controlled trial was conducted to evaluate facilitatory taping as an adjunct to routine physiotherapy management. Twenty-two subjects with unilateral shoulder impingement symptoms were randomized into a taping with routine physiotherapy or a routine physiotherapy only group. The intervention group had scapula taping applied three times per week for the first two weeks of their treatment. All subjects were assessed at baseline, then at 2 and 6 weeks after the commencement of treatment. Pain and functional ability were assessed using the Shoulder Pain and Disability Index, range of shoulder elevation, and self-reported pain on elevation. At 2 weeks, the taping group demonstrated a strong trend toward reduced pain both on self-reported activity (SPADI pain subscale mean for taping 27.0 versus 41.5 for control) and pain during measured abduction (mean VAS 22.8 for taped, 46.8 for control), statistical power being limited by small sample size. No similar trend was evident in the SPADI disability subscale. The magnitude of the differences was reduced at 6-week follow-up. This study provides preliminary evidence for a short-term role for scapula taping as an adjunct to routine physiotherapy in the management of shoulder impingement symptoms but also highlights the need for consideration on a case basis relating to risk factors for skin reaction.
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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), E6-E13

Short-Term Effect of Muscle Energy Technique on Pain in Individuals with Non-Specific Lumbopelvic Pain: A Pilot Study

NOELLE M. SELKOW, MEd, ATC; TERRY L. GRINDSTAFF, PT, DPT, ATC, SCS, CSCS; KEVIN M. CROSS, MEd, ATC, PT; KELLI PUGH, MS, ATC, CMT; JAY HERTEL, PhD, ATC, FACSM; SUSAN SALIBA, PhD, ATC, MPT

Abstract: Muscle energy technique (MET) is a form of manual therapy frequently used to correct lumbopelvic pain (LPP), herein the patient voluntarily contracts specific muscles against the resistance of the clinician. Studies on MET regarding magnitude and duration of effectiveness are limited. This study was a randomized controlled trial in which 20 subjects with self-reported LPP were randomized into two groups (MET or control) after magnitude of pain was determined. MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods, while the control group received a sham treatment. Tests for current and worst pain, and pain with provocation were administered at baseline, immediately following intervention and 24 hours after intervention. Separate 2x3 ANOVAs were used to assess results as change scores. Visual analog score (VAS) for worst pain reported in the past 24 hours decreased for the MET group (4.3mm±19.9, p=.03) and increased for the sham (control) group (17.1mm±21.2, p=.03). Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours, thereby suggesting that MET may be useful to decrease LPP over 24 hours.
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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), E14-E18

Needle EMG Response of Lumbar Multifidus to Manipulation in the Presence of Clinical Instability

JOHN TUNNELL, PT, OCS, COMT, FAAOMPT

Abstract: A proposed mechanism for the persistence of low back pain due to clinical instability is a decrease in control of local spinal musculature, more specifically decreased recruitment of multifidus. Altered segmental mechanoreceptor input has been proposed as a contributing factor responsible for a decrease in local muscle recruitment. In this case report, immediate changes in the recruitment of the deep multifidus following manipulation were examined using needle EMG and isometric testing of trunk rotational force. Trunk rotational force appeared to improve while the multifidus demonstrated a decrease in activity as measured by needle EMG. No specific conclusions can be drawn from this report; however, the results do suggest that immediate multifidus function may be influenced with manipulation, resulting in improved muscular control of the trunk.
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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2009), E19-E24

Book and Multimedia Reviews

[no abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 17 No. 1 (2008), E25