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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.
Impact of COVID-19 on utilization of nonpharmacological and pharmacological treatments for chronic low back pain and clinical outcomes
The Journal of the American Osteopathic Association
The novel coronavirus 2019 (COVID-19) pandemic has impacted the delivery of health care services throughout the United States, including those for patients with chronic pain.
The objective of this study was to measure changes in patients’ utilization of nonpharmacological and pharmacological treatments for chronic low back pain and related outcomes during the COVID-19 pandemic.
A pre-post study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data in the 3 months before and 3–6 months after the declaration of a national emergency related to COVID-19. Participants 21–79 years old with chronic low back pain were included in the study and provided self reported data at relevant quarterly encounters. Use of exercise therapy, yoga, massage therapy, spinal manipulation, acupuncture, cognitive behavioral therapy, nonsteroidal antiinflammatory drugs, and opioids for low back pain was measured. The primary outcomes were low back pain intensity and back related functioning measured with a numerical rating scale and the Roland Morris Disability Questionnaire, respectively. Secondary outcomes included health related quality of life scales measured with the Patient Reported Outcomes Measurement Information System, including scales for physical function, anxiety, depression, low energy/fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities.
A total of 476 participants were included in this study. The mean age of participants at baseline was 54.0 years (standard deviation, ±13.2 years; range, 22–81 years). There were 349 (73.3%) female participants and 127 (26.7%) male participants in the study. Utilization of exercise therapy (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.23–0.57), massage therapy (OR, 0.46; 95% CI, 0.25–0.83), and spinal manipulation (OR, 0.53; 95% CI, 0.29–0.93) decreased during the pandemic. A reduction in NSAID use was also observed (OR, 0.67; 95% CI, 0.45–0.99). Participants reported a significant, but not clinically relevant, improvement in low back pain intensity during the pandemic (mean improvement, 0.19; 95% CI, 0.03–0.34; Cohen’s , 0.11). However, White participants reported a significant improvement in low back pain intensity (mean improvement, 0.28; 95% CI, 0.10–0.46), whereas Black participants did not (mean improvement, −0.13; 95% CI, −0.46 to 0.19; p for interaction=0.03). Overall, there was a significant and clinically relevant improvement in pain interference with activities (mean improvement, 1.11; 95% CI, 0.20–2.02; Cohen’s , 0.20). The use of NSAIDs during the pandemic was associated with marginal increases in low back pain intensity.
Overall, decreased utilization of treatments for chronic low back pain did not adversely impact pain and functioning outcomes during the first 6 months of the pandemic. However, Black participants experienced significantly worse pain outcomes than their White counterparts.
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Chronic low back pain changes the latissmus dorsi and gluteus maximus muscles activation pattern and upward scapular rotation: A cross-sectional study
Journal of Back and Musculoskeletal Rehabilitation
Patients with chronic low back pain (LBP) have an impaired dynamic spinal stability, which may lead to arm injuries. The objective of this study was to examine the latissimus dorsi and gluteus maximus muscles activation pattern and the upward scapular rotation in patients with chronic LBP.
Sixty-one right-handed males were divided into two groups: chronic LBP group (n= 31) and healthy controls (n= 30). The electromyography (EMG) activities of the right and left latissimus dorsi and gluteus maximus were recorded. The upward scapular rotation in different shoulder positions (neutral, 45∘, 90∘, 135∘ abduction and end range) was measured in both groups.
The LBP group has a bilateral significant increased EMG of latissimus dorsi (p< 0.05) and significantly decreased EMG of gluteus maximus (p< 0.05) compared to the control group, without significant differences between the right and left sides (p> 0.05). There was a significant increase in upward scapular rotation in the LBP group relative to the control group in all shoulder abduction positions on both sides. The left side upward scapular rotation was more significant than the right (p< 0.05). Chronic LBP increased the latissimus dorsi muscle activities and decreased the gluteus maximus activities. It furthermore increased the upward scapular rotation in different shoulder abduction positions. (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 effect of osteopathic manipulative treatment on anaerobic performance and lactate clearance in male athletes: A double-blind, randomized, sham-controlled, crossover study
The Journal of Sports Medicine and Physical Fitness
The aim of this study was to examine the effect of osteopathic manipulative treatment (OMT) on anaerobic performance and lactate clearance in male athletes.
This study was a double-blind, randomized, sham-controlled and crossover trial. Fourteen male athletes were volunteered to participate this study. All subjects visited to laboratory 3 times in total: familiarization session, test session 1, and test session 2, respectively. At the beginning of the study, the subjects were randomly divided into 2 groups: In sessions 1 and 2, (a) 30-minute OMT or sham treatment before Wingate anaerobic cycling test (WAnT), (b) 30-second WAnT test, and (c) 10-minute OMT or sham therapy between 5th and 15th minutes of passive rest after WAnT was applied to all subjects, respectively. In both groups blood samples were taken at rest and 5, 15 and 30 minute after the WAnT for the determination of lactate concentrations.
There was no significant differences in WAnT parameters such as peak power, mean power and fatigue index between the OMT and sham treatment. Blood lactate levels were significantly higher 5, 15 and 30 minute after the WAnT when compared to the rest and were lower 15 and 30 minute after the WAnT when compared to 5 minute after the WAnT in both groups (P < 0.05). In addition, blood lactate concentration was significantly lower in OMT than sham treatment at 15 and 30 minute after the WAnT (P < 0.05).
This study suggests that OMT may improve lactate clearance while not affecting anaerobic performance in athletes.
(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 scoping review of physiotherapeutic interventions for trismus in head and neck cancer: Where is the manual therapy?
Physiotherapy Canada
Trismus, or restricted mouth opening, is a common side effect of treatment for head and neck cancer. This scoping review examined the characteristics, extent, and nature of existing research on manual therapy and jaw-mobilizing devices to prevent and manage trismus related to head and neck cancer.
Six electronic databases were searched using the terms trismus, head and neck cancer, and physical therapy and the associated MeSH terms. The review focused on the factors related to intervention delivery: timing, adherence, completion rates, and adverse events.
Nine studies were included. Eight examined the use of a jaw-mobilizing device, and one explored the benefit of remote telephone support. Two studies involved cancer survivors at risk of trismus, five involved survivors with trismus, and two included survivors both with and at risk of trismus. No studies were found examining physiotherapist provision of manual therapy. Within-group comparisons supported the benefit of using a jaw-mobilizing device to manage trismus, whereas significant between-groups differences were found only in non-randomized controlled trials. Survivor symptoms and intervention burden were reported reasons for poor adherence and completion rates.
No benefit was found for the use of jaw-mobilizing devices for the prevention of trismus. Given the potential of manual therapy to enhance outcomes, physical therapist–led research 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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The effectiveness of manual therapy on musculoskeletal and respiratory parameters in patients with chronic low back pain: A systematic review
Critical Reviews™ in Physical and Rehabilitation Medicine
Patients with chronic low back pain (CLBP) exhibit respiratory dysfunction.
The aim of this systematic review was to analyze evidence from randomized controlled trials (RCTs) investigating the effect of manual therapy on musculoskeletal and respiratory parameters in patient with CLBP.
Systematic search and selection of RCTs was performed, using specific keywords, in 3 scientific databases (PubMed, Scopus and the Physiotherapy Evidence Database-PEDro), from inception to March 2021. Relevant studies published in English were extracted, evaluated and independently rated for methodological quality by two assessors using the PEDro scale. Data extraction and methodological ratings were inspected by a third assessor. Results: Out of 943 initially collected studies, 922 were excluded (did not meet inclusion criteria or were duplicates). Twenty-one clinical trials were finally included, though characterized by moderate methodological quality (PEDro scale). Meta-analysis was not performed due to differences in techniques utilized (targeting the spinal joints, trunk or respiratory muscles) and the outcomes assessed between studies. Overall, there was evidence of moderate methodological quality that manual therapy techniques of the low back joints or trunk stabilization exercises, diaphragmatic release techniques and respiratory exercises significantly improve the musculoskeletal as well as the respiratory parameters in patients with CLBP.
More, high-quality RCTs are required, especially those that will utilize respiratory re-education and exercise of the respiratory muscles as therapeutic interventions contributing to CLBP management.
(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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Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review
BMC Musculoskeletal Disorders
Psychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention.
This is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), coping (catastrophizing, avoidant coping), and affect (depression, anxiety). We evaluated constructs for its predictive value of at least one outcome. Outcomes were informed by this review. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against.
Of 1170 references, 40 distinct publications based on 35 datasets were included (intervention type: 20 surgical; 20 conservative). Overall, 22 studies (20 cohort studies and 2 RCTs) were classified as high quality and 18 studies (16 cohort studies, 2 RCTs) were classified as moderate quality. Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Based on the review, of the psychological constructs explored, these data would suggest that expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety may predict outcome for patients managed surgically. In patients undergoing conservative intervention the evidence was either against (catastrophizing, depression, anxiety) or inconclusive (self-efficacy, expectation of recovery, avoidant coping) for the predictive value of psychological factors on outcome.
Five constructs were predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach (i.e., preoperative screening, intervention by a trained clinician) may be advantageous for patients recommended for shoulder surgery,,. The same is not indicated for conservatively managed patients as no conclusive association of MPF with outcomes was noted. The importance of other MPF on outcome requires further investigation.
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