Thoracic dysfunction in whiplash associated disorders: A systematic review

© 2018 Heneghan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Research investigating Whiplash Associated Disorder (WAD) has largely focused on the cervical spine yet symptoms can be widespread. Thoracic spine pain prevalence is reported ~66%; perhaps unsurprising given the forceful stretch/eccentric loading of posterior structures of the spine, and the thoracic spine’s contribution to neck mobility/function. Approximately 50% WAD patients develop chronic pain and disability resulting in high levels of societal and healthcare costs. It is time to look beyond the cervical spine to fully understand anatomical dysfunction in WAD and provide new directions for clinical practice and research. Purpose To evaluate the scope and nature of dysfunction in the thoracic region in patients with WAD. Methods A systematic review and data synthesis was conducted according to a pre-defined, registered (PROSPERO, CRD42015026983) and published protocol. All forms of observational study were included. A sensitive topic-based search strategy was designed from inception to 1/06/16. Databases, grey literature and registers were searched using a study population terms and key words derived from scoping search. Two reviewers independently searched information sources, assessed studies for inclusion, extracted data and assessed risk of bias. A third reviewer checked for consistency and clarity. Extracted data included summary data: sample size and characteristics, outcomes, and timescales to reflect disorder state. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were tabulated to allow enabling a semi-qualitative comparison and grouped by outcome across studies. Strength of the overall body of evidence was assessed using a modified GRADE. Results Thirty eight studies (n>50,000) which were conducted across a range of countries were included. Few authors responded to requests for further data (5 of 9 contacted). Results were reported in the context of overall quality and were presented for measures of pain or dysfunction and presented, where possible, according to WAD severity and time point post injury. Key findings include: 1) high prevalence of thoracic pain (>60%); higher for those with more severe presentations and in the acute stage, 2) low prevalence of chest pain

The governance of self-organization: Which governance strategy do policy officials and citizens prefer?

This article compares views of policy officials and members of community-based collectives on the ideal role of government in processes of community self-organization. By using Q methodology, we presented statements on four different governance perspectives: traditional public administration, New Public Management, network governance, and self-governance. Perceptions differ about how government should respond to the trend of community self-organization and, in particular, about the primacy of the relationship. Whereas some public servants and collectives favor hands-off involvement of policy officials, others show a preference for a more direct and interactive relation between government and community-based collectives. In general, neither of the two groups have much appreciation for policy instruments based on performance indicators, connected to the New Public Management perspective or strong involvement of politicians, connected the traditional public administration perspective. This article contributes to the discussion of how practitioners see and combine governance perspectives and serve to enable dialogs between practitioners

Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders [ISRCTN68653575]

<p>Abstract</p> <p>Background</p> <p>Whiplash associated disorder is commonly linked to motor vehicle accidents and sports injuries. Cervical injury is attributed to rapid extension followed by neck flexion. The exact pathophysiology of whiplash is uncertain but probably involves some degree of aberrant muscle spasms and may produce a wide range of symptoms. The most commonly prescribed pharmacological agents for initial treatment of whiplash-associated pain are oral muscle relaxants and nonsteroidal anti-inflammatory drugs. However, potential systemic adverse effects limit these agents. Physical interventions such as mobilization, manipulation, and exercises have proved beneficial for pain and dysfunction but only on a time-limited basis. Little evidence suggests that physical therapy specifically aimed at the musculature (e.g., transcutaneous electrical nerve stimulation, ultrasonography, heat, ice, and acupuncture) improves prognosis in acute whiplash associated disorder. A new approach to treatment is the use of botulinum toxin, which acts to reduce muscle spasms.</p> <p>Methods/design</p> <p>This is a prospective, randomized, controlled clinical trial and botulinum toxin-A (Botox^®) injections will be compared with placebo injections. The primary objective is to determine the efficacy of Botox^®in the management of musculoskeletal pain in whiplash associated disorders.</p> <p>Discussion</p> <p>Botulinum toxin type-A toxin has been studied in small trials on whiplash associated disorder patients and has generally been found to relieve pain and improve range of motion. Specifically, we seek to assess the efficacy of Botox^®in reducing pain and to improve the cervical spine range of movement, during the 6-month trial period.</p

Pain management: the multidisciplinary roessingh back-school rehabilitation program and e-health interventions for chronic pain sufferers

Abstract Multidisciplinary team interventions aiming at breaking the vicious circle of impaired functioning are effective for clients with chronic pain. However, because of the growing number of people with such complaints, these interventions cannot be provided totally on a face-to-face basis. Therefore, the possibilities of intervention in the client's daily environment professionally supervised through distance learning, ie, telemedicine, need to be considered

Altered movement strategies in sit-to-stand task in persons with transtibial amputation

Background: Sit-to-stand movement is an essential function for participation in many activities of daily living. Although this movement is one of the most important functional tasks, there is limited research investigating strategies of sit-to-stand movement in transtibial amputees