Rotator cuff related shoulder pain. Describing home exercise adherence and the use of behavior change interventions to promote home exercise adherence:a systematic review of randomized controlled trials

Background: A home exercise program (HEP) is integral in the management of rotator cuff related shoulder pain (RCRSP). There are many methods of measuring HEP adherence and many possible interventions to promote HEP adherence. Understanding the adherence rates to HEP and the strategies used to promote HEP adherence is important in order to interpret the existing evidence for the use of HEP in the management of RCRSP. Objectives: To report and synthesize home exercise adherence and strategies to promote home exercise adherence in order to understand the limitations of the current evidence base and make recommendations for clinical practice and future research investigating HEPs in the management of RCRSP. Methods: An electronic search of EMBASE, MEDLINE, PubMed, CINAHL, AMED, and CENTRAL was undertaken. Methodological quality was assessed using the Cochrane RoB 2.0, and BC techniques were coded in accordance with the BC technique taxonomy (version 1). Results: Seventeen RCTs were retrieved. Forty-seven percent described a formal method of measuring HEP adherence and 29% described adherence rates. The included studies described between three and seventeen BC techniques and the mean number of BC techniques per study was 5.8. Twelve percent of the studies described offering patients an explanation of how the exercise program might help their symptoms resolve. Conclusions: Poor reporting of adherence and the underutilisation of BC interventions to promote HEP adherence was prevalent. Recommendations for clinicians and researchers include more widespread use and definitive reporting of BC techniques to promote adherence, and the use of objective, patient self-reported, and clinician-assessed measures of adherence when prescribing HEPs. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Does peripheral neuroinflammation predict chronicity following whiplash injury? Protocol for a prospective cohort study

Introduction: Whiplash-associated disorder grade 2 (WAD2) is characterised by musculoskeletal pain/tenderness but no apparent nerve injury. However, studies have found clinical features indicative of neuropathy and neuropathic pain. These studies may indicate peripheral nerve inflammation, since preclinical neuritis models found mechanical sensitivity in inflamed, intact nociceptors. The primary aim of this study is to establish the contribution of peripheral neuroinflammation to WAD2 and its role in prognosis. Participants will be invited to participate in a sub-study investigating the contribution of cutaneous small fibre pathology to WAD2. Methods and analysis: 115 participants within 1 month following whiplash injury and 34 healthy control participants will be recruited and complete validated questionnaires for pain, function and psychological factors. Data collection will take place at the Universities of Sussex and Oxford, UK. Clinical examination, quantitative sensory testing and blood samples will be undertaken. MRI scans using T2-weighted and diffusion tensor images of the brachial plexus and wrist will determine nerve inflammation and nerve structural changes. Skin biopsies from a substudy will determine structural integrity of dermal and intraepidermal nerve fibres. At 6 months, we will evaluate recovery using Neck Disability Index and a self-rated global recovery question and repeat the outcome measures. Regression analysis will identify differences in MRI parameters, clinical tests and skin biopsies between participants with WAD2 and age/gender-matched controls. Linear and logistic regression analyses will assess if nerve inflammation (MRI parameters) predicts poor outcome. Mixed effects modelling will compare MRI and clinical measures between recovered and non-recovered participants over time. Ethics and dissemination: Ethical approval was received from London-Brighton and Sussex Research Ethics Committee (20/PR/0625) and South Central—Oxford C Ethics Committee (18/SC/0263). Written informed consent will be obtained from participants prior to participation in the study. Results will be disseminated through publications in peer-reviewed journals, presentations at national/international conferences and social media. Trial registration number: NCT04940923

A modern way to teach and practice manual therapy

Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model

The short term effects of straight leg raise neurodynamic treatment on pressure pain and vibration thresholds in individuals with spinally referred leg pain

Limited research exists for the effects of neurodynamic treatment techniques. Understanding short term physiological outcomes could help to better understand immediate benefits or harm of treatment. Objectives To assess the short-term effects of a straight leg raise (SLR) tensioner on pressure pain thresholds (PPT) and vibration thresholds (VT), and establish if additional factors influence outcome in individuals with spinally referred leg pain. Design Experimental, repeated measures. Methods Sixty seven participants (mean age (SD) 52.9 (13.3), 33 female) with spinally referred leg pain were divided into 3 sub-groups: somatic referred pain, radicular pain and radiculopathy. Individuals were assessed for central sensitisation (CS) and completed 5 disability and psychosocial questionnaires. PPT and VT were measured pre and post a 3 x 1 minute SLR tensioner intervention. Results No significant differences (p>0.05) were found between the 3 groups for either outcome measure, or after treatment. Slight improvements in VT were seen in the radiculopathy group after treatment, but were not significant. Only 2 participants were identified with CS. Disability and psychological factors were not significantly different at baseline between the 3 sub-groups, and did not correlate with the outcome measures. Conclusions No beneficial effects of treatment were found, but the trend for a decrease in VT indicated that even in individuals with radiculopathy, no detrimental changes to nerve function occurred. Psychosocial factors and levels of disability did not influence short term outcome of SLR treatment

A modern way to teach and practice manual therapy

Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care.Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies.Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements.Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model