In a 36-year-old woman with neck pain, will manipulation and mobilization be beneficial for reducing her reports of neck pain?

\u3cLEAP\u3e highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on a patient with neck pain. Can manipulation or mobilization reduce her neck pain

Diabetes-Specific Nutrition Algorithm: A Transcultural Program to Optimize Diabetes and Prediabetes Care

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports

Screening for Psychological Factors in Patients With Low Back Problems: Waddell's Nonorganic Signs

or the majority of patients with low back pain (LBP), the cause of their pain is unknown.' Psychological factors, which may include behavioral, cognitive, or somatoform components, can be just as important as the diagnosis of pathology affecting the low back in a patient's recovery from a low back p r~b l e r n .~-~ A recent US Agency for Health Care Policy and Research clinical practice guideline recommends exploration of psychological factors when an individual with an acute low back problem is having difficulty regaining his or her tolerance to a~tivity.~ Feuerstein and Beattie5 discussed several biobehavioral instruments that can be used to identify psychological factors in individuals with LBP. If factors are identified that are potential contributors to the low back problem, the physical therapist can then refer the patient to the appropriate professional. Routine application of these instruments, however, may be impractical during physical therapy examinations because of the time required for administration and scoring as well as the expertise needed to interpret the results. Thus, there is a need for a brief screening tool to help identify patients who may require more detailed psychological testing. A review of the description and diagnosis of psychological disorders that may relate to LBP is beyond the scope of this update. For further information on these areas, the reader is referred Signs of organic problems are findings from the physical examination that indicate the presence of pathology or disease. Paresthesia over the lateral border of the foot, for example, is a sign for S1 nerve root involvement. Signs of nonorganic problems, in contrast, are findings that deviate from the usual presentation of d i s e a~e .~ Both organic and nonorganic signs may be present in a patient with LBP. Therefore, the presence of nonorganic signs should not be equated with malingering or the presence of a psychological problem, but only with the need for further investigation. Scalzitti DA. Screening for psychological factors in patients with low back problems: Waddell's nonorganic signs. Phys Thm. 1997;77:306-312.

A Systematic Review of Gender Differences in METs After Cardiac Rehabilitation

Background: Cardiac rehabilitation programs employ a multipronged approach of exercise and lifestyle modifications to reduce cardiometabolic risk factors, improve physical function, and improving quality of life for patients with a wide range of cardiac pathologies. Prior research has demonstrated that cardiac rehabilitation can benefit both men and women\u27s exercise capacity. However, while systemic reviews have been conducted comparing compliance and referral rates between men and women to cardiac rehabilitation, none have assessed potential differences in functional capacity. Purpose: The purpose of this systemic review is to investigate the differences in outcomes between men and women after an intensive cardiac rehabilitation program as measured by metabolic equivalents (METs). Methods: Search strategies were developed using MeSH heading and free-text terms for four databases: PubMed, SCOPUS, and CINAHL, and Cochrane. One author then eliminated any article duplicates and screened the remaining titles and abstracts. Papers were considered relevant if they compared outcomes in cardiac rehabilitation between men and women. For each study, two coauthors collected data using a standardized form. Data included answering if the study related to the PICO question, whether the study is observational or randomized, the population in the study, the cardiac rehabilitation intervention, any comparison intervention, the time points at which the outcomes were measured, and the functional exercise outcome measures metabolic equivalents (METs). Selection Criteria: Randomized or observational studies, published in English, full text article available. Papers were considered relevant if they compared outcomes in cardiac rehabilitation between men and women. Results: A Total of 9986 records identified from the search and 15 studies included in the final review. No eligible high level (RCT) study identified. All studies reported that both men and women benefit from cardiac rehabilitation as demonstrated by a universal increase in peak METs. Of the 15 studies included in the review, 13 showed a greater increase in peak METs in men and 2 showed a greater increase in peak METs in women. These differences tended to be small and not all of these differences were statistically significant. Conclusion: The majority of studies reported that there were, on average, more male subjects participating in cardiac rehabilitation programs than females. Given the significant underrepresentation of women in these studies, it is difficult to speculate if differences in MET levels reported in these studies are a true representation of gender differences with respect to peak MET levels

A multidimensional conception of disability in the study of low back pain.

A multidimensional conception of disability in the study of low back pain