Effects of passive upper extremity joint mobilization on pain sensitivity and function in participants with secondary carpometacarpal osteoarthritis: A case series

The purpose of this case series is to report on the effects of passive joint mobilization (PJM) of the shoulder, elbow, and wrist on pain intensity, pain sensitivity, and function in elderly participants with secondary carpometacarpal osteoarthritis (CMC OA). METHODS: Fifteen inpatients from the Department of Physical Therapy, Residenze Sanitarie Assistenziali, Collegno (Italy), with secondary CMC OA (70-90 years old) were included in this study. All patients received PJM of the dominant arm (shoulder, elbow, and wrist) for 4 sessions for 2 weeks. Pain severity was measured by visual analog scale, and pain sensitivity was measured with pressure pain threshold (PPT) at CMC joint, at the tubercle of the scaphoid bone, and at the unciform apophysis of the hamate bone. Tip and tripod pinch strength were measured by a pinch gauge. RESULTS: Passive joint mobilization reduced pain severity after the first follow-up by 30%, in addition to increased PPT by 13% in the hamate bone. Strength was enhanced after treatment. Tripod pinch increased by 18% in the dominant hand after treatment. CONCLUSIONS: This case series provides preliminary evidence that PJM of upper extremity joints diminished pain and may increase PPT tip and tripod pinch in some participants with secondary CMC OA.Fil: Villafañe, Jorge Hugo. Universidad Rey Juan Carlos; EspañaFil: Silva, Guillermo Benjamin. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Chiarotto, Alessandro. Universidad Rey Juan Carlos; Españ

The influence of comorbidities on outcomes for older people with back pain:BACE-D cohort study

Background: Comorbidities are common in older people with back pain but little is known about the influence of comorbidities on outcomes. Objectives: To explore the influence of the most prevalent comorbidities, and the number of comorbidities, on short (at 3 months) and long-term (at 12 months) outcomes of back pain in older people. Methods: We analyzed data from the ‘Back Complaints in the Elders’ Dutch study cohort (BACE-D) and included participants aged &gt;55 years. We used the modified Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland–Morris Disability Questionnaire (RMDQ) to assess the number of comorbidities, pain intensity and back-related physical functioning, respectively. We conducted separate linear regression models to analyze the association between comorbidities and outcomes including potential confounders of age, sex, body mass index, smoking and alcoholic drinking status, back pain history, and baseline NRS and RMDQ scores. Results: Our study included 669 participants with a mean age of 66.5 (SD 7.7) years of whom 394 were female. More comorbidities were positively associated with higher pain intensity (3-month regression coefficient (β) =0.27, 95% CI 0.14–0.39; 12-month β = 0.31, 95% CI 0.17–0.45) and worse physical functioning (3-month β = 0.54, 95% CI 0.31–0.77; 12-month β = 0.64, 95% CI 0.37–0.92). Four of the 5 commonest comorbidities were musculoskeletal problems. Older participants with musculoskeletal comorbidities had higher pain intensity (3-month β = 0.89 95% CI 0.41–1.37; 12-month β = 1.17, 95% CI 0.65–1.69), and worse physical functioning (3-month β = 1.61, 95% CI 0.71–2.52; 12-month β = 1.85, 95% CI 0.82–2.89, P-value &lt; 0.001) compared to participants without musculoskeletal comorbidities. Conclusions: More comorbidities are associated with worse back pain outcomes in older adults. Participants with musculoskeletal comorbidities had worse back pain outcomes than those without.</p

Bilateral Pressure Pain Hypersensitivity over the Hand as Potential Sign of Sensitization Mechanisms in Individuals with Thumb Carpometacarpal Osteoarthritis

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In trials of physiotherapy for chronic low back pain, clinical relevance is rarely interpreted, with great heterogeneity in the frameworks and thresholds used:a meta-research study

QUESTIONS: How do authors of randomised controlled trials (RCTs) interpret the clinical relevance of the effects of physiotherapy interventions compared with no intervention on pain intensity, physical function and time to recovery in people with chronic low back pain (CLBP)? How can the clinical relevance be re-interpreted based on the available smallest worthwhile effect (SWE) threshold for this comparison? Are the studies in this field adequately powered?DESIGN: Cross-sectional meta-research study.PARTICIPANTS: People with CLBP.OUTCOME MEASURES: Pain intensity, physical function and time to recovery.RESULTS: This review included 23 RCTs with 1,645 participants. Twenty-two and 18 studies were included in the analysis of pain intensity and physical function, respectively. No studies investigated time to recovery. Sixteen studies reported varying thresholds to interpret clinical relevance for physical function and pain intensity. Discrepancies between interpretation using the minimal important difference and SWE values were observed in five studies. Study power ranged from 9% to 98%, with only four studies having a power &gt; 80%.CONCLUSION: Little attention is given to the interpretation of clinical relevance in RCTs comparing physiotherapy with no intervention in CLBP, with great heterogeneity in the frameworks and thresholds used. Future trials should inform patients and clinicians on whether the effect of an intervention is large enough to be worthwhile, using a reliable and comprehensive approach like available SWE estimates.REGISTRATION: medRxiv https://doi.org/10.1101/2022.12.14.22283454.</p

Botulinum toxin type A combined with neurodynamic mobilization for upper limb spasticity after stroke: a case report

Objective: The purpose of this study is to report a case in which combinatory therapy of botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM) was used as treatment for a patient with severe upper limb spasticity and pain after stroke. Clinical Features: A 76-year-old male patient had spastic muscles in the upper limb 10 months after an ischemic stroke. Intervention and Outcome: The patient underwent combined treatment with BoNT-A and NM of the upper limb in 6 monthly applications. Evaluation was performed pretreatment, 3 months after the first injection, 3 months after the second injection, and at a follow-up session 9 months after starting the treatment. The following outcomes were measured: pain by using a numeric rating scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. The patient improved in all outcomes after treatment, and results were maintained during the follow-up sessions. Conclusion: The combined NM and BoNT-A treatment appeared to decrease pain and improve joint ranges of motion during treatment for this patient. The patient showed decreased anxiety and depression during and after the treatment.Fil: Villafañe, Jorge Hugo. Universidad Rey Juan Carlos; EspañaFil: Silva, Guillermo Benjamin. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Chiarotto, Alessandro. Universidad Rey Juan Carlos; EspañaFil: Ragusa, Orazio L. F.. No especifíca

Teaching evidence-based practice to physiotherapy students in Italy:a cross sectional study

Background: Evidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP. The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy. Methods: This is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript.Results: Forty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021–2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses. The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%). Conclusions: The prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus for increasing investment in the teaching of EBP in Italian physiotherapy degree courses, thereby improving educational standards.</p

Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain:A Systematic Review

Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), and Pain Severity subscale of the Brief Pain Inventory (BPI-PS)] are the most frequently used instruments to measure pain intensity in low back pain (LBP). However, their measurement properties in this population have not been systematically reviewed. The goal of this study was to provide such systematic evidence synthesis. Six electronic sources (MEDLINE, EMBASE, CINAHL, PsycINFO, SportDiscus, Google Scholar) were searched (July 2017). Studies assessing any measurement property in patients with non-specific LBP were included. Two reviewers independently screened articles and assessed risk of bias using the COSMIN checklist. For each measurement property: evidence quality was rated as high, moderate, low, or very low (GRADE approach); results were classified as sufficient, insufficient or inconsistent. Ten studies assessed the VAS, 13 the NRS, four the BPI-PS. The three instruments displayed low or very low quality evidence for content validity. High quality evidence was only available for NRS insufficient measurement error. Moderate evidence was available for: NRS inconsistent responsiveness, BPI-PS sufficient structural validity and internal consistency, and BPI-PS inconsistent construct validity. All VAS measurement properties were underpinned by no, low or very low quality evidence, likewise the other measurement properties of NRS and BPI-PS

PROMIS Physical Function short forms display item- and scale-level characteristics at least as good as the Roland Morris Disability Questionnaire in patients with chronic low back pain

OBJECTIVE: To compare dimensionality, item-level characteristics, scale-level reliability and construct validity of PROMIS® Physical Function short forms (PROMIS-PF) and 24-item Roland Morris Disability Questionnaire (RMDQ-24) in patients with chronic low back pain (LBP). DESIGN: Cross-sectional study. SETTING: Secondary care center for rehabilitation and rheumatology. PARTICIPANTS: Patients with non-specific LBP ≥ 3 months (n = 768). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dutch versions of the 4-, 6-, 8-, 10- and 20-item PROMIS-PF, and of the RMDQ-24. RESULTS: Mean age was 49 years (±13), 77% female, 54% displayed pain for more than 5 years. PROMIS-PF-6, PROMIS-PF-8 and RMDQ-24 exhibited sufficient unidimensionality (confirmatory factor analysis: CFI >0.950, TLI >0.950 and RMSEA 0.001). Two-parameter item response theory models found two items with low discrimination for RMDQ-24. All other instruments had adequate fit statistics and item parameters. PROMIS-PF-20 displayed the best scale-level reliability. Construct validity was sufficient for all instruments as all hypotheses on expected correlations with other instruments, and differences between relevant subgroups, were met. CONCLUSIONS: PROMIS-PF-6, PROMIS-PF-8 and RMDQ-24 exhibited better unidimensionality, whereas PROMIS-PF-4, PROMIS-PF-6 PROMIS-PF-8 and PROMIS-PF-10 showed superior item-level characteristics. PROMIS-PF-20 was the instrument with the best scale-level reliability. This study warrants assessment of other measurement properties of PROMIS-PF short forms in comparison to disease-specific physical functioning instruments in LBP

Association between clinical and neurophysiological outcomes in patients with mechanical neck pain and whiplash-associated disorders

Objectives: To investigate the association between pain, disability, trigger points (TrPs), and pressure pain thresholds (PPTs) in patients with mechanical neck pain (MNP) or whiplash-associated disorders (WAD). Materials and Methods: In total, 46 MNP and 51 WAD patients underwent a physical examination consisting of cervical range of motion, PPTs in the upper trapezius and tibialis anterior muscles, TrPs examination in the upper trapezius, and collection of clinical data including disability, pain intensity, and spontaneous symptomatic pain area. Results: A significantly moderate positive association between pain and disability was found in both groups (P<0.01). Significantly negative associations between pain intensity and PPT in the upper trapezius (P=0.008 and 0.041), pain and PPT in tibialis anterior (P=0.015 and 0.038), disability and PPT in upper trapezius (both, P=0.006) were also found in both MNP and WAD groups. Individuals with MNP showed significantly positive association between pain area and disability (P=0.034) and negative association between disability and PPT in the tibialis anterior (P=0.003). Patients with active TrPs in the upper trapezius exhibited higher intensity of neck pain, higher neck disability, and lower PPTs than those with latent TrPs in upper trapezius in both groups. Discussion: The association between pain, disability, and PPTs is common in patients with neck pain regardless of the origin of neck pain. The presence of active TrPs was related to higher pain intensity and related-disability and lower PPTs