Factors Associated With Clinical Responses to Spinal Manipulation in Patients With Non-specific Thoracic Back Pain: A Prospective Cohort Study

Introduction: The management of musculoskeletal disorders is complex and requires a multidisciplinary approach. Manual therapies, such as spinal manipulative therapy (SMT), are often recommended as an adjunct treatment and appear to have demonstrable effects on pain and short-term disability in several spinal conditions. However, no definitive mechanism that can explain these effects has been identified. Identifying relevant prognostic factors is therefore recommended for people with back pain.Objective: The main purpose of this study was to identify short-term candidate prognostic factors for clinically significant responses in pain, disability and global perceived change (GPC) following a spinal manipulation treatment in patients with non-specific thoracic back pain.Methods: Patients seeking care for thoracic spine pain were invited to participate in the study. Pain levels were recorded at baseline, post-intervention, and 1 week after a single session of SMT. Disability levels were collected at baseline and at 1-week follow-up. GPC was collected post-intervention and at 1-week follow-up. Biomechanical parameters of SMT, expectations for improvement in pain and disability, kinesiophobia, anxiety levels as well as perceived comfort of spinal manipulative therapy were assessed.Analysis: Differences in baseline characteristics were compared between patients categorized as responders or non-responders based on their pain level, disability level, and GPC at each measurement time point. Binary logistic regression was calculated if the statistical significance level of group comparisons (responder vs. non-responders) was equal to, or <0.2 for candidate prognostic factors.Results: 107 patients (62 females and 45 males) were recruited. Mean peak force averaged 450.8 N with a mean thrust duration of 134.9 ms. Post-intervention, comfort was associated with pain responder status (p < 0.05) and GPC responder status (p < 0.05), while expectation of disability improvement was associated with GPC responder status (p < 0.05). At follow-up, comfort and expectation of pain improvement were associated with responder GPC status (p < 0.05). No association was found between responder pain, disability or GPC status and biomechanical parameters of SMT at any time point.Discussion: No specific dosage of SMT was associated with short-term clinical responses to treatment. However, expectations of improvement and patient comfort during SMT were associated with a positive response to treatment.

The Effectiveness of Muscle Energy Technique in Patients with Adhesive Capsulitis

Objective: The objective of study was to find the effectiveness of muscle energy techniques (METs) in patients with adhesive capsulitis. Methodology: Study was conducted in population of Sargodha seeking physiotherapy treatment for adhesive capsulitis in physiotherapy rehabilitation departments and centers. Study was randomized, controlled and multicenter. 50 patients were selected by inclusion and exclusion criteria and were divided into two groups by lottery method of randomization. Group I obtained muscle energy technique. Group II was controlled that obtained conventional treatment in the form of heat and range of motion exercises. Duration of study was 06 month. Interventions were carried out for two weeks (total 10 sessions). A baseline measurement was taken on shoulder pain and disability index (SPADI). A post intervention measurement was taken on same outcome measurements tools and was compared by independent t test. Results: The pre intervention measurements on Shoulder Pain Disability Index were 61.11 in control and 61.18 in METs group. The post intervention measurements on Shoulder Pain Disability Index were 49.33in control and 27.69 in METs group. Conclusion: This study concluded that METs techniques are effective in treatment of adhesive capsulitis to decrease the pain and disability in comparison to control groups.

Functional outcome in operated patients of multilevel lumbar canal stenosis and use of HRQoL role in depicting the anxiety and its correlation with the pain

Background Lumbar canal stenosis (LCS) is a degenerative spinal disease of elderly people, and it not only impairs the mechanical activity but also alters the economic and mental status of the patients indirectly. This is single-center observational prospective study conducted for 2 years and included 30 consecutive operated patients of multilevel LCS patients and excluded the patients with single-level LCS, with primary LCS or with grade II subluxation. We analyzed the various measurement indices used for the surgical outcome assessment as ED-5D 5L and OLBPDI (Oswestry low back pain disability index). Statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 21.0 statistical Analysis Software. The independent t test, post hoc analysis, Wilcoxon signed rank statistic test and RM-ANOVA test were also applied. Result Most patients have improvement in pain and all the components of HRQoL (health-related quality of life) after surgery, which was further improved in mean follow-up of 1 year. Our study also suggested that the patients with higher anxiety/depression have higher pain intensity and low HRQoL, which was persistent in postoperative period (p < .001). Conclusion ED-5D 5L and OLBPD are good indices to assess all the components of quality of life and give valuable information overall. Anxiety has shown important correlation with the pain component in both preoperative and postoperative phase.

Does Dynamic Taping Affect Pain, Endurance, Disability, Mobility, and Kinesiophobia in Individuals with Chronic Nonspecific Low Back Pain? A Randomized Controlled Trial

Introduction: Evidence suggests that the application of Kinesio tape (KT) on patients with chronic nonspecific low back pain (CNLBP) is inconclusive. Dynamic tape (DT) is a relatively new treatment technique, which is increasingly being used as an adjunctive method to treat musculoskeletal problems. To the best of our knowledge, no study has investigated the application of DT in individuals with CNLBP. Thus, there is a need to compare the immediate and short-term effects of DT versus KT and no tape among patients with CNLBP on pain, endurance, disability, mobility, and kinesiophobia. Methodology: Forty-five patients with CNLBP were randomly divided into three groups: the DT group (n = 15), the KT group (n = 15), and the control group (n = 15). No tape was applied to the control group. The allocation and assessment procedures were blinded. The outcome measures were assessed before the tape application (baseline), 15 min after the tape application (immediate effect), and on the third day post tape application (short-term effect). The primary outcomes of pain, endurance, and disability were measured through the visual analog scale (VAS), Biering–Sorensen test, and Oswestry disability index (ODI), respectively. Secondary outcome measures of mobility and kinesiophobia were measured using the modified Schober test and the Tampa Scale of Kinesiophobia, respectively. Result: The demographic and baseline characteristics between groups were compared by the one-way analysis of variance (ANOVA) for parametric variables and the Chi-square test for nonparametric variables. A mixed-methods ANOVA (3 ´ 3) was used to analyze the main effect (group effect and time effect) and time ´ group interaction. No significant immediate and short-term differences were found between DT and KT in pain, disability, mobility, and kinesiophobia. Improved back extensor endurance was observed for the DT group compared to the KT (p = 0.023) and control (p = 0.006) groups. Conclusion: This randomized controlled trial showed that the DT does not have a significant additional effect on pain, disability, mobility, and kinesiophobia among individuals with CNLBP compared to KT. However, participants experienced significant improvement in back muscular endurance after the application of DT. This finding suggests that DT controls the processes that lead to back muscle fatigue. Therefore, more studies are required to examine the therapeutic benefits of DT in treating patients with CNLBP.

Change in psoriatic arthritis outcome measures impacts SF-36 physical and mental component score differently: an observational cohort study

OBJECTIVES The objective was to investigate interplay between change (Δ) in health-related quality of life (HRQoL) quantified by physical component score (PCS) and mental component score (MCS) retrieved from short-form health survey (SF-36), change in disease activity (ΔDAS28CRP) and manifestations of Psoriatic Arthritis (PsA). METHODS PsA patients initiating new medical therapy were enrolled. Independent disease measures evaluating disease activity, enthesitis, psoriasis, pain and fatigue were collected at treatment initiation and after 4 months. Interplay between independent disease measures and dependent outcome measures; ΔPCS and ΔMCS was described with univariate regression analyses. Multivariate regression analyses were applied to assess impact of independent variables e.g. individual disease outcome measures versus ΔDAS28CRP on ΔPCS and ΔMCS. RESULTS 108 PsA patients were included. In the univariate regression analyses, improvement in fatigue, pain, and disability were associated with improvement in ΔPCS (β; -2.08, -0.18, -13.00, respectively, all; p &lt; 0.001) and ΔMCS (β; -1.59, -0.12, -6.07, respectively, and p &lt; 0.001, p &lt; 0.001, p = 0.003, respectively). When PROs were included in the final multivariate models, improvements in ΔPCS and ΔMCS were associated with improvements in pain, fatigue and disability (p &lt; 0.001). Improvement in enthesitis positively impacted ΔPCS (β -0.31, p &lt; 0.001). No association was found between change in skin psoriasis, ΔPCS and ΔMCS (β 0.15, p = 0.056 and β 0.05, p = 0.561, respectively). CONCLUSION In this PsA patient cohort, diminishing pain, disability and fatigue improved PCS and MCS significantly. Changes in enthesitis and psoriasis, did not grossly impact HRQoL compared to DAS28CRP. Individual PsA manifestations influence HRQoL differently which is clinically important when targeting treatment.