A Retrospective Look at the Use of Manual Therapy

Manual Therapy (MT) has been used extensively since the origin of the Physical Therapy profession and includes massage, traction, exercise, stretching or compression of soft tissue, range of motion tests, manual muscle tests, palpation, joint mobilization and manipulation. Interest and enthusiasm for MT has especially grown among clinicians and educators in the last decade. However, despite its common use, research and documentation involving the efficacy and reliability of MT are extremely rare. Many techniques and concepts have yet to be justified. These concepts need to be critically tested, discussed, and revised, and the profession needs to be challenged to show outcome research or data. The purpose of this study is to provide a current review of the following critical topics in MT: current definitions, reliability studies of palpation, and the efficacy of selected MT techniques for treatment. Ideas are presented on how to objectify both data and functional outcome measures, while keeping in mind the reality of clinical practice. Conclusions promote the need for testing and inquiry in both practice and labs, leading to solid theory and a more efficacious practice

Weaponizing Tear Gas: Bahrain’s Unprecedented Use of Toxic Chemical Agents Against Civilians.

The Bahraini government’s response to the early 2011 pro-democracy protests was brutal, systematic, and violent. In addition to birdshot and rubber bullets, government law enforcement attacked unarmed protestors with toxic chemical agents including tear gas. The government’s crackdown on the medical profession was especially harmful, as security forces arrested and detained doctors, raided health facilities, and obstructed patients from receiving necessary care. This report’s findings are based on field research that the authors conducted in Bahrain (April 2012) to investigate excessive use of force by law enforcement officials since June 2011—the end of Bahrain’s state of emergency. The medico-legal team conducted 102 in-depth interviews with Bahrainis who reported human rights violations, corroborating eyewitnesses to these alleged events, civil society leaders, and government officials. Other forms of corroboration that the team conducted or utilized in this study include: Physical examinations, evaluation of medical records, and review of radiographic, photographic, and video evidence. In addition, this report contains results from an analysis of 28 countries whose security forces have deployed toxic chemical agents against civilians in situations of civil unrest. This report documents two interconnected means by which the Bahraini government unlawfully uses toxic chemical agents against civilians: (1) Government authorities have routinely violated every U.N. principle governing police use of force. (2) Bahraini law enforcement officials have also effectively transformed toxic chemical agents into weapons used to assail Shi’a civilians

Under the Gun: Ongoing Assaults on Bahrain’s Health System

In February 2011, the Government of Bahrain began targeting health professionals who treated protesters. In April 2012, PHR\u27s Richard Sollom, Deputy Director, and Holly Atkinson, MD, FACP, past President of PHR\u27s Board and volunteer expert, authored a report showing the devastation on Bahrain\u27s health system that have resulted from the Government of Bahrain’s continued assault on doctors, patients, and the healthcare system

Massacre in Central Burma: Muslim Students Terrorized and Killed in Meiktila

This report details the results of a Physicians for Human Rights (PHR) investigation into the March 20 and 21, 2013, attacks on Muslim students, teachers, and residents in the Mingalar Zayyone quarter of Meiktila, a small town in central Burma. A two-person team, the authors of the report, from PHR conducted 33 interviews about the attacks, which resulted in the deaths of at least 20 children and four teachers. The report details the attacks by the Buddhist mobs, provides evidence that local police officers were complicit in the crimes, and lists policy recommendations for the Burmese government and the international community

Health and Human Rights in Chin State, Western Burma: A Population-Based Assessment Using Multistaged Household Cluster Sampling

Sollom and colleagues report the findings from a household survey study carried out in Western Burma; they report a high prevalence of human rights violations such as forced labor, food theft, forced displacement, beatings, and ethnic persecution

Computerised cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: external pilot trial

<p>Abstract</p> <p>Background</p> <p>People with multiple sclerosis (MS) are at high risk of depression. We undertook a pilot trial of computerised cognitive behavioural therapy (CCBT) for the treatment of depression in people with MS to test the feasibility of undertaking a full trial.</p> <p>Methods</p> <p>Participants with a diagnosis of MS and clinical levels of depression were recruited through out-patient clinics and postal screening questionnaires at two UK centres and randomised to CCBT or usual care. Clinical outcomes included the Beck Depression Inventory (BDI-II) and Multiple Sclerosis Impact Scale (MSIS-29) at baseline, 8 and 21 weeks. Feasibility outcomes included: recruitment rate; reasons for refusal, withdrawal and dropout; feasibility and acceptability of the proposed outcome measures; sample size estimation and variation in and preferences for service delivery.</p> <p>Results</p> <p>Twenty-four participants were recruited. The recruitment rate, calculated as the proportion of those invited to fill in a screening questionnaire who were consented into the trial, was 4.1%. Recruitment through out-patient clinics was somewhat slower than through screening questionnaire mail-out but the overall recruitment yield was similar. Of the 12 patients in the CCBT arm, 9 (75%) completed at least four, and 6 completed all 8 CCBT sessions. For completers, the median time (IQR) to complete all eight CCBT sessions was 15 (13 to 20) weeks. Participants expressed concern about the face validity of the Beck Depression Inventory II for the measurement of self-reported depression in people with MS. The MSIS-29 was the patient-reported outcome measure which participants felt best reflected their concerns. The estimated sample size for a full trial is between 180 and 390 participants. NHS partners were not delivering CCBT in community facilities and participants preferred to access CCBT at home, with no one expressing a preference for use of CCBT in an alternative location.</p> <p>Conclusions</p> <p>A definitive trial, with a recruitment window of one year, would require the participation of around 13 MS centres. This number of centres could be reduced by expanding the eligibility criteria to include either other neurological conditions or people with more severe depression. The MSIS-29 should be used as a patient-important outcome measurement.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN81846800">ISRCTN81846800</a></p

A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life.

BACKGROUND: Self-management interventions have become increasingly popular in the management of long-term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS). PURPOSE: To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS. METHOD: A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925). RESULTS: The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms. CONCLUSION: Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement

The impact of regular physical activity on fatigue, depression and quality of life in persons with multiple sclerosis

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to compare fatigue, depression and quality of life scores in persons with multiple sclerosis who do (Exercisers) and do not (Non-exercisers) regularly participate in physical activity.</p> <p>Methods</p> <p>A cross-sectional questionnaire study of 121 patients with MS (age 25–65 yr) living in Queensland, Australia was conducted. Physical activity level, depression, fatigue and quality of life were assessed using the International Physical Activity Questionnaire, Health Status Questionnaire Short Form 36, Becks Depression Inventory and Modified Fatigue Impact Scale.</p> <p>Results</p> <p>52 participants performed at least two 30-min exercise sessions·wk^-1(Exercisers) and 69 did not participate in regular physical activity (Non-exercisers). Exercisers reported favourable fatigue, depression and quality of life scores when compared to Non-exercisers. Significant weak correlations were found between both leisure-time and overall reported physical activity levels and some subscales of the quality of life and fatigue questionnaires. Additionally, some quality of life subscale scores indicated that regular physical activity had a greater benefit in subjects with moderate MS.</p> <p>Conclusion</p> <p>Favourable fatigue, depression and quality of life scores were reported by persons with MS who regularly participated in physical activity, when compared to persons with MS who were classified as Non-exercisers.</p

The Relational Impact of Multiple Sclerosis: An Integrative Review of the Literature Using a Cognitive Analytic Framework

This integrative literature review uses cognitive analytic therapy (CAT) theory to examine the impact of a chronic illness, multiple sclerosis (MS), on relationships and mental health. Electronic searches were conducted in six medical and social science databases. Thirty-eight articles met inclusion criteria, and also satisfied quality criteria. Articles revealed that MS-related demands change care needs and alter relationships. Using a CAT framework, the MS literature was analysed, and five key patterns of relating to oneself and to others were identified. A diagrammatic formulation is proposed that interconnects these patterns with wellbeing and suggests potential “exits” to improve mental health, for example, assisting families to minimise overprotection. Application of CAT analysis to the literature clarifies relational processes that may affect mental health among individuals with MS, which hopefully will inform how services assist in reducing unhelpful patterns and improve coping. Further investigation of the identified patterns is needed