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Background: Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new delivery systems are needed to solve lack of adherence., Aim: To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA., Design: A pragmatic, multicenter, two-group parallel randomized controlled trial., Setting: Community health centers in rural southern Spain., Population: Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized., Methods: Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the CareHand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength., Results: The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function., Conclusions: A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb function and pain. Further research is warranted to understand the impact of mobile health (mHealth) in people with hand OA., Clinical Rehabilitation Impact: mHealth interventions are a feasible and secure multimodal delivery approach in older adults with hand OA in rural primary care setting. Baseline pain and upper limb function might predict functional hand outcomes.

Background: Therapeutic exercise (TE) is highly recommended for the management of non-specific neck pain (NSNP) and has shown promising results combined with interferential current therapy. Yet, the clinical relevance of the pooled effect of these approaches remains uncertain., Aim: To investigate the immediate clinical effect size of combining TE and interferential therapy, compared with the isolated use of TE, in adults with chronic NSNP., Design: Randomized, single-blinded, controlled, superiority trial., Setting: Outpatients, primary care center., Population: Forty-nine adults with chronic NSNP., Methods: Participants with neck pain (grades I or II) lasting for more than 12 weeks were allocated to a TE plus interferential currents group (N.=25) or to a TE only group (N.=24). All individuals underwent treatment 5 times a week for 2 weeks. The primary outcome was current neck pain intensity (11-point Numeric Pain Rating Scale). Secondary outcomes included neck disability (Neck Disability Index) and active cervical range-of-movement (CROM device). Measurements were taken at baseline and immediately after treatment. An intention-to-treat analysis was carried out. To quantify the effect size of the interventions, the relative risk, the absolute and relative risk reduction, and the number needed to treat (NNT) were calculated., Results: A significant time*group effect was found for pain intensity, disability, and neck flexion and right rotation (all, P<0.05). In the analysis for treatment benefit, the NNT was 2 (95% CI: 2 to 4, P<0.001) for neck pain and disability, and 3 (95% CI: 2 to 11, P=0.029) for neck flexion., Conclusions: Adding interferential therapy to TE is clinically more effective than TE alone to immediately improve neck pain and disability, but not active cervical range-of-movement, in adults with persistent neck pain., Clinical Rehabilitation Impact: Our results suggest that this multimodal intervention can be a useful strategy for rehabilitation of patients with NSNP. This is the first study on this topic reporting findings in terms of clinical relevance, which is key to transfer research evidence into practice.

Background: Cervical and thoracic spinal manipulative therapy has shown positive impact for relief of pain and improve function in non-specific mechanical neck pain. Several attempts have been made to compare their effectiveness although previous studies lacked a control group, assessed acute neck pain or combined thrust and non-thrust techniques., Aim: To compare the immediate effects of cervical and thoracic spinal thrust manipulations on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain., Design: Randomized, single-blinded, controlled clinical trial., Setting: Private physiotherapy clinical consultancy., Population: Eighty-eight subjects (32.09±6.05 years; 72.7% females) suffering neck pain (grades I or II) of at least 12 weeks of duration., Methods: Participants were distributed into three groups: 1) cervical group (N.=28); 2) thoracic group (N.=30); and 3) control group (N.=30). One treatment session consisting of applying a high-velocity low-amplitude spinal thrust technique over the lower cervical spine (C7) or the upper thoracic spine (T3) was performed, while the control group received a sham-manual contact. Measurements were taken at baseline and after intervention of the pressure pain threshold over the median, ulnar and radial nerves. Secondary measures included assessing free-pain grip strength with a hydraulic dynamometer., Results: No statistically significant differences were observed when comparing between-groups in any of the outcome measures (P>0.05). Those who received thrust techniques, regardless of the manipulated area, reported an immediate increase in mechanosensitivity over the radial (both sides) and left ulnar nerve trunks (P<0.05), and grip strength (P<0.001). For those in the control group, right hand grip strength and pain perception over the radial nerve also improved (P≤0.025)., Conclusions: Low-cervical and upper-thoracic thrust manipulation is no more effective than placebo to induce immediate changes on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain., Clinical Rehabilitation Impact: A single treatment session using cervical or thoracic thrust techniques is not enough to achieve clinically relevant changes on neural mechanosensitivity and grip strength in chronic non-specific mechanical neck pain.

Background: The correlation between orthodontics and the development of signs and symptoms of temporomandibular disorders (TMD) is a major concern in the physical rehabilitation field., Aim: The aim of the study was to observe whether subjects with a history of orthodontics use show differences from subjects who have never used orthodontics in: 1) masseter and temporalis muscle mechanosensitivity; 2) maximal vertical mouth opening (VMO); and 3) the impact of headache on their quality of life., Design: Cross-sectional study., Setting: The study was carried out in the Faculty of Nursing, Physiotherapy and Podiatry of the University of Sevilla, Spain., Population: All participants were pre graduate students from the University of Sevilla, Spain. The final sample comprised 65 subjects (N.=65) with a mean age of 21 ± 2.46 years (18-29) divided into two groups; orthodontics group (N.=31) and non-orthodontics group (N.=34)., Methods: All students followed the same testing protocol. Measurements were taken of the pressure pain threshold (PPT) in two locations of the masseter (M1, M2) and temporalis (T1, T2) muscles, the maximal VMO, and the incidence of headache (Headache Impact Test-6; HIT-6, Spanish version)., Results: The measured values of the masticatory muscle PPTs were lower in the non-orthodontics group. Besides, the maximal VMO and HIT-6 scores were better in the orthodontics group. Nevertheless, none of these intergroup differences were statistically significant (ANOVA test): (M1 P=0.790); (M2 P=0.329); (T1 P=0.249); (T2 P=0.440); (HIT-6 P=0.443); (VMO P=0.626)., Conclusion: A previous history of orthodontics use does not seem to lead to any greater sensitivity of the masticatory muscles, limitations of vertical mouth opening, or greater impact of headache on the subject's quality of life., Clinical Rehabilitation Impact: There is no evidence enough to support either a positive or negative correlation between orthodontics and signs and symptoms of TMD. Pain is a subjective perception and it is influenced by several factors. It remains uncertain if the use of orthodontics might be one of them.