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The National Center for Complementary and Integrative Health recommends that research be judged on the merit of scientific findings rather than on the basis of professional degrees held by investigators.
In this spirit, the American Academy of Osteopathy provides OsteoBlast citations that are likely to be of interest to AAO members. The AAO offers these items from peer-reviewed journals without comment, and it endorses neither the research nor the advertisements contained in OsteoBlast.
Dropout associated with osteopathic manual treatment for chronic noncancerous pain in randomized controlled trials
The Journal of the American Osteopathic Association
Reviews exploring harm outcomes such as adverse effects (AE), all cause dropouts (ACD), dropouts due to inefficacy, and dropouts due to AE associated with osteopathic manipulative treatment (OMT) or osteopathic manual therapy (OMTh) are scant.
The objective of this study was to explore the overall AE, ACD, dropouts due to inefficacy, and AE in chronic noncancerous pain (CNCP) patients receiving OMTh through a systematic review of previous literature.
For this systematic review and meta-analysis, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), EMCare, and Allied and Complementary Medicine Database (AMED), and Ostmed.Dr, as well as the bibliographical references of previous systematic reviews evaluating OMTh for pain severity, disability, quality of life, and return to work outcomes. Randomized controlled trials with CNCP patients 18 years or older with OMTh as an active or combination intervention and the presence of a control or combination group were eligible for inclusion. In this substudy of a previous, larger systematic review, 11 studies (n=1,015) reported data that allowed the authors to perform metaanalyses on ACD and dropouts due to AE. The risk of bias (ROB) was assessed with the Cochrane ROB tool and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
The pooled analysis showed that ACD was not significantly different for visceral OMTh (vOMTh) vs. OMTh control (odds ratio [OR]=2.66 [95% confidence interval [[CI]], 0.28, 24.93]) or for OMTh vs. standard care (OR=1.26 [95% CI, 0.84, 1.89]; I2=0%). Single study analysis showed that OMTh results were nonsignificant in comparison with chemonucleolysis, gabapentin, and exercise. OMTh in combination with gabapentin (vs. gabapentin alone) and OMTh in combination with exercise (vs. exercise alone) showed nonsignificant ACD. Dropouts due to AE were not significantly different, but the results could not be pooled due to an insufficient number of studies.
Most articles did not explicitly report AEs, ACD rates, or dropouts due to AEs and inefficacy. The limited data available on dropouts showed that OMTh was well tolerated compared with control interventions, and that the ACD and dropouts due to AEs were not significantly different than comparators. Future trials should focus on explicit reporting of dropouts along with beneficial outcomes to provide a better understanding of OMTh efficacy.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Comparison of 2 manual therapy approaches combined with exercise on pain, strength and electromyographic muscle activity in athletes with subacute mechanical low back pain
Sport Sciences for Health
Subacute mechanical low back pain (MLBP) has been found to increase significantly in athletes in the past decade. Manual therapy combined with exercises seems to be promising option; however, its potential effect in athletes is not fully known yet.
The study aimed to compare between the effects of mulligan sustained natural apophyseal glides (SNAG) combined with exercise, muscle energy technique (MET) combined with exercise therapy and exercise therapy alone on pain, strength and muscle activity in athletes with subacute mechanical low back pain (MLBP).
The athletes were screened for inclusion into the study using physical examination and Oswestry Disability Index (ODI). The study was a randomized 3 arm repeated measure design and a total of thirty athletes completed the study (n = 30). Athletes in group 1 received mulligan sustained natural apophyseal glides (SNAG) combined with exercise, group 2 received muscle energy technique (MET) combined with exercise while those in group 3 were submitted to exercise only. Athletes in all groups received treatment 3 times a week for 4 weeks. The outcome measures were visual analog scale (VAS) scores, back extensor strength and electromyographic (s EMG) muscle activity of longissimus lumborum (LL) and transversus abdominis (Tr A).
The VAS score were decreased in all three groups (p < 0.05); however, group 2 and group 1 were more effective than group 3 (p < 0.05). The back extensor strength increased in two groups (p < 0.05): group 2 showed a significant increase compared to group 1. The s EMG muscle activity of LL and Tr A increased in two groups (p < 0.05): group 2 showed a significant increase compared to group 1. There were significant time, group and interaction effects for the three outcome measures (p < 0.05).
The addition of MET combined with exercise therapy reduces pain level, improves back extensor strength and muscle activity of LL and TrA in athletes suffering with subacute MLBP more than mulligan SNAG combined with exercise therapy and exercise therapy alone. (This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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A review of the role of manual therapy in the treatment of patients with knee osteoarthritis
Annals of the Romanian Society for Cell Biology
One of the most destructive forms of arthritis is knee osteoarthritis (KOA) that leads to disability because of pain in elderly individuals and also increases utilization of health care among them. Through improving local circulation and joint flexibility, and relaxation of muscles, massage therapy is capable of relieving painful musculoskeletal conditions. Therefore, it may be beneficial for treatment of KOA. Moreover, the successfulness of exercise therapy in treatment of KOA broadly is proved and required to be reviewed more. Through a comprehensive review, the present study is aimed to investigate the role of massage therapy on knee osteoarthritis.
A literature search was carried out using the five most well-known databases of Europe PubMed, PubMed, EMBASE, MEDLINE, and Google Scholar from 2010 to 2020. All the articles were searched in English with the main subject of massage therapy on knee osteoarthritis. During the search from all 284 searched, articles 189 deleted due to the subject similarity and finally, 82 article were chosen to be included in the research inclusion criteria.
Manual therapy is an effective treatment option in the management of KOA patients. It could be used alone or in combination with other available types of therapies.
The present study provides a general set of information about manual therapy and its effectiveness in the management of KOA patients.
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Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain
European Journal of Pain
Together, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the spine and the treatment of spinal disorders, including spine pain. Basic studies have examined the influence of chiropractic spinal manipulation on a variety of peripheral, spinal, and supraspinal mechanisms involved in spine pain. While spinal cord mechanisms of pain inhibition contribute at least partly to the pain‐relieving effects of chiropractic treatments, the evidence is weaker regarding peripheral and supraspinal mechanisms, which are important components of acute and chronic pain. This narrative review highlights the most relevant mechanisms of pain relief by spinal manipulation and provides a perspective for future research on spinal manipulation and spine pain, including the validation of placebo interventions that control for placebo effects and other non‐specific effects that may be induced by spinal manipulation.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain
BMC Musculoskeletal Disorders
Recent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programs for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation program.
In this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation program. Inclusion for participation in the rehabilitation program depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period.
The mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172).
Future prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation.
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Sense of effort is distorted in people with chronic low back pain
Musculoskeletal Science and Practice
Proprioceptive deficits in people with low back pain (LBP) have traditionally been attributed to altered paraspinal muscle spindle afference and its central processing. Studies conducted in the upper limb demonstrated that sense of effort is also an important source of kineasthetic information.
The objective of this study was to better understand proprioceptive deficits in people with chronic LBP (cLBP), this study aimed to test whether sense of effort is affected in people with cLBP.
Fourteen participants with cLBP and fourteen healthy participants performed a 120 second force matching task with their trunk extensor muscles at a low intensity.
When visual feedback of the generated force was provided, both groups performed the task accurately. Removal of visual feedback resulted in an increase in error for both groups (p<0.0001), but the increase in error was significantly larger for the cLBP group (p=0.023). This larger error could be attributed to undershooting of the target force (p=0.020). The control group did not consistently undershoot or overshoot the target force (p=0.93). Furthermore, the amount of undershooting for the cLBP group increased as the task progressed (p=0.016), which was not observed for the control group (p=0.80).
The results of this study revealed that sense of effort is affected in cLBP. People with cLBP overestimated the trunk extension force they generated, and the error increased as the trial progressed. With visual feedback however, people with cLBP were able to compensate and perform the task as accurately as people without cLBP.
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