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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.
Characteristics and treatment of geriatric patients in an osteopathic neuromusculoskeletal medicine clinic
The Journal of the American Osteopathic Association
Osteopathic manipulative medicine (OMM) is an adjunctive treatment approach available to geriatric patients, but few studies provide details about presenting conditions, treatments, and response to osteopathic manipulative treatment (OMT) in that patient population.
The objective of this study was to provide descriptive data on the presentation and management of geriatric patients receiving OMT at an outpatient osteopathic neuromusculoskeletal medicine (ONMM) clinic.
Data were retrospectively collected from electronic health records (EHR) at a single outpatient clinic for clinical encounters with patients over 60 years of age who were treated with OMT between July 1, 2016, and June 30, 2019. Records were reviewed for demographic information, insurance type, presenting concerns, assessments, regions treated, OMT techniques used, and treatment response.
There were 9,155 total clinical encounters with 1,238 unique patients found during the study period. More women than men were represented for overall encounters (6,910 [75.4%] vs. 2,254 [24.6%]) and unique patients (850 [68.7%] vs. 388 [31.3%]; both p<0.001). The mean (standard deviation, SD) number of encounters per patient per year was 4.5 (4.0) and increased with increasing age by decade (p<0.001). Medicare was the most common primary insurance (7,246 [79.2%]), with private insurance the most common secondary insurance (8,440 [92.2%]). The total number of presenting concerns was 12,020, and back concerns were most common (6,406 [53.3%]). The total number of assessments was 18,290; most were neuromusculoskeletal (17,271 [94.5%]) and in the thoracolumbar region (7,109 [38.9%]). The mean (SD) number of somatic dysfunction assessments per encounter was 5 (1.7); the thoracic region was the most documented and treated (7,263 [15.8%]). With up to 19 technique types per encounter, the total number of OMT techniques documented across all encounters was 43,862, and muscle energy (7,203 [16.4%]) was the most documented. The use of high-velocity, low-amplitude (HVLA) declined as age increased (p<0.001). The overall treatment response was documented in 7,316 (79.9%) encounters, and most indicated improvement (7,290 [99.6%]).
Our results showed that geriatric patients receiving OMT at our clinic were predominately presenting for neuromusculoskeletal concerns associated with back, neck, and extremity conditions, consistent with national epidemiological data for this population. The most common OMT techniques were also consistent with those used nationally by osteopathic medical students and practicing physicians. Future longitudinal studies are needed to determine the length of time improvement persists and the overall health impact experienced by geriatric patients receiving OMT.
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Effects of manual therapy on the diaphragm in the musculoskeletal system: A systematic review
Archives of Physical Medicine and Rehabilitation
The objective of this study was to analyze the effects at the musculoskeletal level of manual treatment of the diaphragm muscle in adults.
Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Physiotherapy Evidence Database (PEDro) scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. A total of 9 studies were included in the review.
Manual therapy directed to the diaphragm has been shown to be effective in terms of the immediate increase in diaphragmatic mobility and thoracoabdominal expansion. The immediate improvement in the posterior muscle chain flexibility test is another of the most frequently found findings in the evaluated studies. Limited studies show improvements at the lumbar and cervical level in the range of motion and in pain.
Manual diaphragm therapy has shown an immediate significant effect on parameters related to costal, spinal and posterior muscle chain mobility. Further studies are needed, not only to demonstrate the effectiveness of manual diaphragm therapy in the long term and in symptomatic populations, but also to investigate the specific neurophysiological mechanisms involved in this type of therapy. (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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The utilization and effects of filiform dry needling in the management of tendinopathy: A systematic review
Physiotherapy Theory and Practice
Tendinopathy is frequently associated with pain, soft tissue impairments and muscle performance limitations. Dry needling (DN) incorporates a fine filiform needle to penetrate the skin and underlying soft tissue in an effort to decrease pain and improve function. While injectable interventions and gauged-needle tendon fenestration for tendinopathy has been reviewed, DN for tendinopathy has yet to be synthesized.
The objective of this study was to systematically review the utilization and effects of DN for tendinopathy.
Six electronic databases (PubMed, CINAHL, Scopus, SportDiscus, PEDro and the Cochrane Library) were searched from inception through August 15, 2020, using appropriate keywords and relevant synonyms.
After screening 462 articles, 10 studies met inclusion criteria. Study designs included case reports, case series, and randomized clinical trials. DN was used in isolation in 3/10 studies and as part of a multimodal approach in 7/10 studies. DN was associated with improved pain, function, muscle performance and perceived improvement in each study evaluating the relevant outcome. Conflicting results were found in comparative studies evaluating DN.
DN may be a useful adjunctive treatment in the conservative management of tendinopathy, although its discrete effect is unclear. Very Low-quality evidence and methodological limitations suggest further investigation is warranted.
(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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Effectiveness of a manual therapy protocol based on articulatory techniques in migraine patients: A randomized controlled trial
Musculoskeletal Science and Practice
Physiotherapy is used as a non-pharmacological treatment for migraine. However, controversy exists over whether articulatory manual techniques are effective in some aspects related to migraine.
The objective of this study was to assess the effectiveness of a manual therapy protocol based on articulatory techniques in pain intensity, frequency of episodes, migraine disability, quality of life, medication intake and self-reported perceived change after treatment in migraine patients.
Fifty individuals with migraine were randomized into the experimental group, which received manual therapy based on articulatory techniques (n=25), or the placebo group (n=25). The intervention lasted 4 weeks and included 4 sessions. Patients were assessed before (T1), after (T2) and at a one-month follow-up following the intervention (T3). The instruments used were the Migraine Disability Assessment (MIDAS) questionnaire, the Short Form-36 Health Survey (SF-36), the medication intake and The Patients’ Global Impression of Change scale.
In comparison with placebo group, manual therapy patients reported significant effects on pain intensity at T2 (p<0.001; d=1.15) and at T3 (p<0.001; d=1.13), migraine disability at T3 (p<0.05; d=0.69), physical quality of life at T2 (p<0.05; d=0.72), overall quality of life at T2 (p<0.05; d=0.60), decrease in medication intake at T2 (p<0.001; d=1.11) and at T3 (p<0.05; d=0.77) and self-reported perceived change after treatment at T2 and T3 (p<0.001). No serious adverse events were reported.
The application of a manual therapy protocol based on articulatory techniques reduced pain intensity, migraine disability, and medication intake, while improving quality of life in patients with migraine.
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Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis
Journal of Bodywork and Movement Therapies
Dry needling may be an effective method to alleviate pain and improve range of motion. Controversial results have been found in previous studies using dry needling in knee problems. So, the aim of current study is to exert dry needling technique on unilateral muscles around the hip and knee joints and evaluate its effects on knee osteoarthritic patients.
For this double-blind randomized clinical trial, 40 female patients with mild to moderate knee osteoarthritis (aged 45 - 70 years old) were recruited. They entered the study if they had any trigger points around the hip or knee joints of the examined side and randomized into two groups. Pain, sensitivity of trigger points, balance and function measured by visual analogue scale, algometer, Y-balance test, timed up and go, self- paced walk tests beside KOOS questionnaire respectively before and after intervention. The intervention group received 3 sessions of dry needling on marked trigger points while the sham group received sham treatment consisting of only the plastic cover of a needle. Both groups reexamined 2 weeks after primary evaluation.
Comparing results before and after implementing dry needling revealed significant improvements in all measured variables in treatment group whereas, pain and timed up and go increased and peak pain pressure decreased in sham group. Between group comparison revealed significant differences in all variables.
Using 3 sessions of dry needling can increase functional activity, sensitivity and balance and decrease pain in patients with knee osteoarthritis in short term.
(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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Effectiveness of conservative non-pharmacologic therapies for pain, disability, physical capacity and physical activity behavior in patients with degenerative lumbar spinal stenosis: A systematic review and meta-analysis
Archives of Physical Medicine and Rehabilitation
The objective of this study was to investigate the effectiveness of conservative non-pharmacologic therapies on pain-related, physical capacity, and physical activity outcomes in patients with degenerative lumbar spinal stenosis (LSS).
Pairs of review authors independently identified randomized clinical trials published in peer-reviewed scientific journals reporting on the effects of rehabilitation interventions on pain intensity (back or leg), disability, symptom severity, physical capacity, physical activity behavior, or adverse events (secondary outcome) in adults with LSS. The search identified 1,718 records; data from 21 reports of 19 trials (1,432 patients) were included.
Review author pairs independently extracted data and assessed included studies. We assessed risk of bias with the Cochrane tool, and overall study quality with the Grading of Recommendations Assessment, Development and Evaluation classification.
We pooled data using random-effects meta-analyses; treatment effects were reported as mean differences (MD) and 95% CI. Directed exercise and manual therapy was superior to self-directed or group exercise for improving short-term walking capacity (MD[95%CI] = 293.3[61.7 to 524.9] meters; low-quality evidence), back pain (MD[95%CI] = -1.1[-1.8 to -.4; moderate quality evidence], leg pain (MD[95%CI] = -.9[-.2 to -1.5]; moderate-quality evidence), and symptom severity (MD[95%CI] = -.3[-.4 to -.2]; low-quality evidence). There is very low-quality evidence that rehabilitation is no better than surgery at improving intermediate- or long-term disability. Single trials provided conflicting evidence of effectiveness for a variety of therapies.
For patients with LSS, there is low- to moderate-quality evidence that manual therapy with supervised exercises results in small improvements in short-term walking capacity, pain, and symptom severity compared to self-directed or group exercise. The choice between rehabilitation and surgery for LSS is very uncertain owing to the very low-quality of available evidence.
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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