Which Low Back Instability Tests Should Be Incorporated Into a Stabilization Classification Exam for Athletes?: A Critically Appraised Topic

2020 ◽  
Vol 25 (2) ◽  
pp. 57-61
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Moderate Level ◽  
Sufficient Evidence ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Prone Instability Test ◽  
Level 2

Clinical Question: Is there sufficient evidence to determine which low back instability tests should be incorporated into a stabilization classification exam for athletes? Clinical Bottom Line: There is moderate level 2 evidence to include, but not to use in isolation, the prone instability test along with other instability tests in a stabilization classification exam.

The Efficacy of a Passive Stretching Intervention for Overhead Athletes: A Critically Appraised Topic

2020 ◽  
pp. 1-5
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Range Of Motion ◽  
Moderate Level ◽  
Clinical Question ◽  
Bottom Line ◽  
Overhead Athletes ◽  
Passive Stretching ◽  
Posterior Shoulder ◽  
Posterior Shoulder Tightness ◽  
Level 2

Focused Clinical Question: Does a passive stretching protocol, whether immediate or long-term, improve range of motion and decrease posterior shoulder tightness in overhead athletes? Clinical Bottom Line: There is moderate level 2 evidence to support the incorporation of passive stretching for overhead athletes to increase range of motion or decrease posterior shoulder tightness.

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain

2017 ◽  
Vol 26 (5) ◽  
pp. 452-458 ◽  
Author(s):  
Barton E. Anderson ◽  
Kellie C. Huxel Bliven
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Lung Function ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Breathing Exercises

Clinical Scenario:Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.Focused Clinical Question:In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?Summary of Key Findings:Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.Clinical Bottom Line:Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.Strength of Recommendation:Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

Current Evidence in Anterior Cruciate Ligament Rehabilitation: Neuromuscular Electrical Stimulation Combined With a Strengthening Program: A Critically Appraised Topic

2017 ◽  
Vol 22 (6) ◽  
pp. 5-11
Author(s):  
Michael E. Lynch ◽  
Christine A. Lauber
Keyword(s):  
Anterior Cruciate Ligament ◽  
Electrical Stimulation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Strength ◽  
Sufficient Evidence ◽  
Clinical Question ◽  
Bottom Line ◽  
Anterior Cruciate

Clinical Question:Is it beneficial to add neuromuscular electrical stimulation (NMES) to a strengthening program after anterior cruciate ligament (ACL) reconstruction surgery?Clinical Bottom Line:There is sufficient evidence to support the inclusion of NMES in a rehabilitation strengthening program post ACL reconstruction. All three included studies reported significant quadriceps strength gains (p < .05) in favor of the group that completed both NMES and strengthening exercises compared with a strength-only group. Two studies initiated NMES within 4 days of surgery. One study found significant quadriceps strength increases when NMES was implemented 6 months after surgery.

scholarly journals Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

2020 ◽  
Vol 29 (3) ◽  
pp. 360-366 ◽  
Author(s):  
Nicholas Hattrup ◽  
Hannah Gray ◽  
Mark Krumholtz ◽  
Tamara C. Valovich McLeod
Keyword(s):  
Aerobic Exercise ◽  
Interdisciplinary Approach ◽  
Rehabilitation Program ◽  
Psychological State ◽  
Sufficient Evidence ◽  
Symptom Duration ◽  
Clinical Question ◽  
Bottom Line ◽  
Duration Of Symptoms ◽  
Symptom Intensity

Clinical Scenario: Recent systematic reviews have shown that extended rest may not be beneficial to patients following concussion. Furthermore, recent evidence has shown that patient with postconcussion syndrome benefit from an active rehabilitation program. There is currently a gap between the ability to draw conclusions to the use of aerobic exercise during the early stages of recovery along with the safety of these programs. Clinical Question: Following a concussion, does early controlled aerobic exercise, compared with either usual care or delayed exercise, improve recovery as defined by symptom duration and severity? Summary of Key Findings: After a thorough literature search, 5 studies relevant to the clinical question were selected. Of the 5 studies, 1 study was a randomized control trial, 2 studies were pilot randomized controlled trials, and 2 studies were retrospective. All 5 studies showed that implementing controlled aerobic exercise did not have an adverse effect on recovery. One study showed early aerobic exercise had a quicker return to school, and another showed a 2-day decrease in symptom duration. Clinical Bottom Line: There is sufficient evidence to suggest that early controlled aerobic exercise is safe following a concussion. Although early aerobic exercise may not always result in a decrease in symptom intensity and duration, it may help to improve the psychological state resulting from the social isolation of missing practices and school along with the cessation of exercise. Although treatments continue to be a major area of research following concussion, management should still consist of an interdisciplinary approach to individualized patient care. Strength of Recommendation: There is grade B evidence to support early controlled aerobic exercise may reduce the duration of symptoms following recovery while having little to no adverse events.

The Effectiveness of Custom Foot Orthotics in Treating Chronic Low Back Pain: A Critically Appraised Topic

2016 ◽  
Vol 21 (1) ◽  
pp. 14-23
Author(s):  
Kathleen K. Hogan ◽  
William O. Perkins ◽  
Cameron J. Powden, ◽  
Matthew C. Hoch
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Usual Care ◽  
Chronic Low Back Pain ◽  
Included Study ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Quality Evidence

Clinical Scenario:Chronic low back pain is one of the most common causes of pain and disability. Currently, there is a need for more effective interventions to treat low back pain.Clinical Question:Does the use of custom foot orthotics improve self-reported measures of pain and function in adults with chronic low back pain?Summary of Key Findings:A comprehensive and systematic search was conducted for studies of level 2 evidence or higher that pertained to the clinical question. The search yielded 11 studies, of which one randomized control trial and two prospective cohorts fit the inclusion and exclusion criteria. The articles examined the effectiveness of custom foot orthotics in isolation compared with no treatment as well as custom foot orthotics in combination with usual care compared with usual care alone. The included studies all demonstrated that the use of custom foot orthotics reduce chronic low back pain after seven weeks of use. One included study was considered high-quality evidence while two were deemed low-quality evidence using the PEDro.Clinical Bottom Line:There is moderate evidence to support the use of custom foot orthotics to improve self-reported measures in adults with chronic low back pain after seven weeks of use.Strength of Recommendation:The Strength of Recommendation Taxonomy recommends a grade of B for consistent limited-quality patient-oriented evidence.

scholarly journals Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic

2020 ◽  
Vol 29 (8) ◽  
pp. 1204-1209
Author(s):  
Kaitlyn C. Jones ◽  
Evelyn C. Tocco ◽  
Ashley N. Marshall ◽  
Tamara C. Valovich McLeod ◽  
Cailee E. Welch Bacon
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Effective Treatment ◽  
Exercise Therapy ◽  
Clinical Question ◽  
Low Back ◽  
Therapeutic Exercise ◽  
Bottom Line ◽  
Pain Education

Clinical Scenario: Low back pain is widely prevalent in the general population as well as in athletes. Therapeutic exercise is a low-risk and effective treatment option for chronic pain that can be utilized by all rehabilitation clinicians. However, therapeutic exercise alone does not address the psychosocial aspects that are associated with chronic low back pain. Pain education is the umbrella term utilized to encompass any type of education to the patient about their chronic pain. Therapeutic exercise in combination with pain education may allow for more well-rounded and effective treatment for patients with chronic nonspecific low back pain (NS-LBP). Clinical Question: Does pain education combined with therapeutic exercise, compared with therapeutic exercise alone, improve patient pain in adults with chronic NS-LBP over a 2- to 3-month treatment period? Summary of Key Findings: A thorough literature review yielded 8 studies potentially relevant to the clinical question, and 3 studies that met the inclusion criteria were included. The 3 studies included reports that exercise therapy reduced symptoms. Two of the 3 included studies support the claim that exercise therapy reduces the symptoms of chronic NS-LBP when combined with pain education, whereas one study found no difference between pain education with therapeutic exercise. Clinical Bottom Line: There is moderate evidence to support the use of pain education along with therapeutic exercise when attempting to reduce symptoms of pain and disability in patients with chronic NS-LBP. Educational interventions should be created to educate patients about the foundation of pain, and pain education should be implemented as a part of the clinician’s strategy for the rehabilitation of patients with chronic NS-LBP. Strength of Recommendation: Grade B evidence exists to support the use of patient education with therapeutic exercise for decreasing pain in patients with chronic NS-LBP.

The Effectiveness of Foot Orthotics in Improving Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2015 ◽  
Vol 24 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Michael L. Gabriner ◽  
Brittany A. Braun ◽  
Megan N. Houston ◽  
Matthew C. Hoch
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Chronic Ankle Instability ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Physically Active ◽  
Based Medicine ◽  
Level 2

Clinical Scenario:Chronic ankle instability (CAI) is a condition commonly experienced by physically active individuals. It has been suggested that foot orthotics may increase a CAI patient’s postural control.Clinical Question:For patients with CAI, is there evidence to suggest that an orthotic intervention will help improve postural control?Summary of Key Findings:The literature was searched for studies of level 2 evidence or higher that investigated the effects of foot orthotics on postural control in patients with CAI. The search of the literature produced 5 possible studies for inclusion; 2 studies met the inclusion criteria and were included. One randomized controlled trial and 1 outcomes study were included. Foot orthotics appear to be effective at improving postural control in patients with CAI.Clinical Bottom Line:There is moderate evidence to support the use of foot orthotics in the treatment of CAI to help improve postural control.Strength of Recommendation:There is grade B evidence that foot orthotics help improve postural control in people with CAI. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

Self-Mobilization Using a Foam Roller Versus a Roller Massager: Which Is More Effective for Increasing Hamstrings Flexibility?

2017 ◽  
Vol 26 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Danielle M. DeBruyne ◽  
Marina M. Dewhurst ◽  
Katelyn M. Fischer ◽  
Michael S. Wojtanowski ◽  
Chris Durall
Keyword(s):  
Therapeutic Benefit ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Duration Of Treatment ◽  
Bottom Line ◽  
Physically Active ◽  
Foam Rolling ◽  
Treatment Data ◽  
Active Adults ◽  
Level 2

Clinical Scenario:Increasing the length of the muscle–tendon unit may prevent musculotendinous injury. Various methods have been proposed to increase muscle–tendon flexibility, including self-mobilization using foam rollers or roller massagers, although the effectiveness of these devices is uncertain. This review was conducted to determine if the use of foam rollers or roller massagers to improve hamstrings flexibility is supported by moderate- to high-quality evidence.Clinical Question:Are foam rollers or roller massagers effective for increasing hamstrings flexibility in asymptomatic physically active adults?Summary of Key Findings:The literature was searched for studies on the effects of using foam rollers or roller massagers to increase hamstrings flexibility in asymptomatic physically active adults. Four randomized controlled trials were included; 2 studies provided level 2 or 3 evidence regarding foam rollers and 2 studies provided level 2 or 3 evidence regarding roller massagers. Both roller-massager studies reported increases in hamstrings flexibility after treatment. Data from the foam-roller studies did not demonstrate a statistically significant increase in hamstrings flexibility, but 1 study did demonstrate a strong effect size.Clinical Bottom Line:The reviewed moderate-quality studies support the use of roller massagers but provide limited evidence on the effectiveness of foam rolling to increase hamstrings flexibility in asymptomatic physically active adults. Flexibility gains may be improved by a longer duration of treatment and administration by a trained therapist. Gains appear to decline rapidly postrolling. Neither device has been shown to confer a therapeutic benefit superior to static stretching, and the effectiveness of these devices for preventing injury is unknown.Strength of Recommendation:Grade B evidence supports the use of roller massagers to increase hamstrings flexibility in asymptomatic physically active adults.

The Effectiveness of a Psychoeducational Program in Increasing Mental Health Knowledge in Collegiate Athletes: A Critically Appraised Topic

2021 ◽  
pp. 1-5
Author(s):  
Alexis Peters ◽  
Julliana Tapia ◽  
Stephanie H. Clines
Keyword(s):  
Mental Health ◽  
Student Athletes ◽  
Health Knowledge ◽  
Collegiate Athletes ◽  
Clinical Question ◽  
Bottom Line ◽  
Psychoeducational Program ◽  
Mental Health Knowledge

Focused Clinical Question: Does the implementation of a psychoeducational program increase mental health knowledge among collegiate student-athletes? Clinical Bottom Line: There is consistent, limited-quality patient-oriented evidence to suggest that implementation of a psychoeducational program is effective in increasing mental health knowledge in collegiate student-athletes based on the guidelines of the strength of recommendation taxonomy.

scholarly journals Is Topical or Systemic Antimicrobial Therapy More Effective for the Treatment of Feline Acne With Secondary Bacterial Infection?

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Wendy Kwok ◽  
Kate Charlotte Mellor
Keyword(s):  
Open Access ◽  
Bacterial Infection ◽  
Antimicrobial Therapy ◽  
Systemic Treatment ◽  
Clinical Signs ◽  
Sufficient Evidence ◽  
Bottom Line ◽  
Secondary Bacterial Infection

<strong>PICO question</strong><br /><p>In cats with feline acne and secondary bacterial folliculitis or furunculosis, is topical or systemic antimicrobial therapy superior for reducing time to resolution and severity of clinical signs?</p><strong>Clinical bottom line</strong><br /><p>There is no sufficient evidence to compare topical versus systemic treatment in feline acne with secondary folliculitis/furunculosis.</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

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