Search

Background: Spinal manipulation (SM) has been hypothesized to influence the autonomic nervous system (ANS). Further, it has been proposed that the effects may vary depending on the segment manipulated. The aim of this systematic review was to synthesize the current level of evidence for SM in influencing the ANS in healthy and/or symptomatic population. Methods: Various databases (n = 8) were searched (inception till May 2023) and 14 trials (n = 618 participants) were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. The data were synthesized using standard mean differences and meta-analysis for the primary outcome measures. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. Results: Overall, there was low quality evidence that SM did not influence any measure of ANS including heart rate variability (HRV), oxy-hemoglobin, blood pressure, epinephrine and nor-epinephrine. However, there was low quality evidence that cervical spine manipulation may influence high frequency parameter of HRV, indicating its influence on the parasympathetic nervous system. Conclusion: When compared with control or sham interventions, SM did not alter the ANS. Due to invalid methodologies and the low quality of included studies, findings must be interpreted with great caution. Future studies are needed which employ rigorous data collection processes to verify the true physiological implications of SM on ANS. [ABSTRACT FROM AUTHOR]

Preliminary evidence suggests that individuals with persistent post-concussion symptoms (PPCS) have a dysfunctional stress response, consisting of the autonomic nervous system (ANS) and hypothalamic pituitary adrenal-axis (HPA-axis). This review aims to explore the extent of evidence for dysfunction of the stress response in individuals with PPCS by individually mapping the literature surrounding quantifiable changes of the (1) ANS and (2) HPA-axis using non-invasive and clinical tools, and highlighting any (3) knowledge gaps. Nine electronic databases and grey literature were searched on the 1st of June 2021 and 4th of October 2021. Studies were included if their population was classified with PPCS, and their study stated at least one quantifiable marker of the ANS or HPA-axis using non-invasive and clinical tools. Relevant studies were screened, and data extracted. A total of 37 articles were included in this scoping review. The majority of studies assessed quantifiable markers of the ANS (n = 34), in comparison to the HPA-axis (n = 2), and ANS and HPA-axis (n = 1). The most common quantifiable markers of the ANS included heart rate (n = 20), blood pressure (n = 16), and heart rate variability (n = 10). Cortisol was the only included quantifiable marker of the HPA-axis (n = 2). Most of the evidence in this review supports quantifiable dysfunction of the ANS in those with PPCS. Further research is required investigating quantifiable dysfunction of the HPA-axis, and subsequently ANS and HPA-axis in unison, in those with PPCS. [ABSTRACT FROM AUTHOR]

10-15% of individuals who sustain a concussion develop persistent post-concussion symptoms (PPCS). Presently, there is no consensus regarding the pathophysiology of PPCS. Preliminary evidence suggests that individuals with PPCS have either a dysfunctional autonomic nervous system (ANS) or hypothalamic-pituitary-adrenal axis (HPA-axis). The ANS and HPA-axis collectively make up the two arms of the peripheral stress response. In the presence of a stressor, the two arms work interchangeably to return the body back to homeostasis. With concussion as the stressor, it is plausible that the development and maintenance of PPCS are due to a dysfunctional stress response. Only one study has explored the relationship between PPCS and the two arms of the stress response (ANS and HPA-axis) in combination, which presents a clear gap in the literature. The proposed protocol aims to determine the extent of evidence for dysfunction of the stress response in individuals with PPCS. This review will individually map the literature surrounding quantifiable changes in the (1) ANS and (2) HPA-axis in individuals with PPCS. The review will also highlight any (3) knowledge gaps in this emerging field of research. A scoping review study design has been chosen to facilitate a thorough literature search on this broad exploratory topic. The scoping review proposed will follow the recommended methodological guidelines. Understanding the potential role of a dysfunctional stress response in those with PPCS will create more effective treatment pathways and reduce the chronicity of this condition. [ABSTRACT FROM AUTHOR]

The objective was to explore the effectiveness of photobiomodulation therapy for treating patients who suffer xerostomia and/or hyposalivation due to the most prevalent clinical diagnoses. We searched PubMed, Scopus, Web of Science, CINAHL and Cochrane Library for randomized or clinical controlled trials published until 31 October 2019. Risk of bias assessment and meta‐analysis were conducted using the Cochrane tools. A total of 274 records were retrieved, and 11 met the inclusion criteria. Interventions whose parameters ranged between wavelengths of 790–830 nm (infrared), 30–120 mW of power and an energy density below 30 J/cm‐2 were associated with improvements in xerostomia/hyposalivation. As for the assessment of methodological quality, 10 of the 11 articles included had a high risk of overall bias. Only 3 articles provided sufficient information to conduct a meta‐analysis for quality of life, compared with placebo in patients with burning mouth syndrome, showing a standardized mean difference between groups from baseline of −0.90 (−1.48; −0.32). The present review and meta‐analysis suggest that photobiomodulation therapy is an effective, non‐invasive and safe approach in patients with xerostomia. However, despite the potential, it is not possible to reach a reliable consensus on the parameters to be used, and future studies should be conducted by standardizing intervention protocols. [ABSTRACT FROM AUTHOR]

There has recently been an exponential increase in concussion-based research and literature along with a range of media exposure, secondary to a developing understanding of the effects of concussion, particularly in the long term. Despite the raft of concussion-based research being published there is a clear gap in understanding as to why female athletes are at a greater risk. Numerous epidemiological studies suggest that female football (soccer) players rate of concussion is much greater than male footballers. There is also evidence to suggest that females take longer to recover following a concussion. The aim of the review proposed in this protocol is to identify possible mechanisms as to why female footballers are more at risk of a concussion and to highlight gaps in the literature to propose future research to improve the understanding of the topic. This review will map the literature on the gender gap regarding the rate of concussions in female football players. The study design (scoping review) has been chosen to allow a broad search of literature and hypothesis generation. The scoping review proposed will be designed following evidence-based guidelines to ensure rigorous methodological quality. The effect of a concussion in both the short and long term can be dramatic, and it is important that the reason(s) behind the increased risk for females is understood. This may provide valuable information for concussion education and prevention programmes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of CAM use is increasing. This integrative review investigated New Zealand healthcare professionals' practice of, attitudes toward, and knowledge about complementary and alternative medicine (CAM). Methods: Literature search was conducted in four databases from inception to April 2020. Studies were included if they reported results from primary data collection on practice of, attitudes toward, or knowledge about CAM amongst New Zealand healthcare professionals. Results: Eleven studies (two of 'high-quality', seven of 'moderate-quality', and two of 'low-quality') were identified with 2060 healthcare professionals including general practitioners (GPs), nurses, midwives, pharmacists, physiotherapists, and medical specialists. New Zealand healthcare professionals were generally positive regarding CAM use, but have concerns on the scientific evidence, regulation, safety, financial costs of CAM, and encourage an evidence-based CAM practice and stronger CAM regulation. Findings indicated that around 25% of GPs practise CAM, and 82.3% refer patients to CAM practitioners. When treating pregnant women, 48.4% of physiotherapists practise acupuncture, and 37.3% of midwives recommend CAM. GPs believe that acupuncture is the most helpful CAM modality, and most commonly practiced and referred patients to acupuncture. Up to 58% of GPs and Plunket nurses wanted to receive further education on CAM, and up to 66.7% GPs favour the idea CAM should be included in medical curriculums. Conclusions: Nine of the 11 included studies were of moderate to high quality, thus enhancing the reliability of the review findings. In order to better manage CAM in New Zealand New Zealand clinical settings, there is a need to invest in CAM research and education, and enhance CAM regulation. This review is a first step in developing an evidence base to offer insights for further development of effective CAM policies regarding safety, efficacy, regulation and integration in New Zealand. [ABSTRACT FROM AUTHOR]

Objective: Alteration in somatosensory function has been linked to pain experience in individuals with joint pain. In this systematic review we aimed to establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function that were assessed via quantitative sensory testing (QST) among individuals with joint pain. Methods: A comprehensive literature search was conducted in 6 electronic databases from their inception to July 2019. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. Results: Seventeen studies related to joint pain were included. Pain catastrophizing, depression, anxiety, and physical activity level have been shown to have a significant (small to fair) association with several QST measures. Pressure pain threshold (PPT) is the only measure that was found to be consistently correlated with all the domains. The overall quality of evidence for all factors ranged from very low to moderate. Subgroup analysis revealed a stronger association for depression and pain catastrophizing and PPT and temporal pain summation in individuals with shoulder pain. Conclusion: Psychological factors and physical activity levels are associated with somatosensory function in people with joint pain. These factors need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with joint pain. [ABSTRACT FROM AUTHOR]

As part of traditional Chinese medicine, acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. When the body is suffering from disease or injury, corresponding acupoints are believed to be activated and manifest in several sensitized forms, including expansion of the receptive field, pain sensitization, and heat sensitization. Such phenomena are believed to gradually disappear concomitantly with recovery from the disease. Acupoint states are therefore changeable according to health status, a phenomenon known as acupoint sensitization. This review aims to provide an overview of acupoint sensitization based on existing research results and determine priorities for future research. Systematic literature retrieval was conducted in Medline, Embase, Cochrane Library, CINAHL, and AMED from inception to 18 July 2018. Current evidence from research findings to date indicate that acupoint sensitization is based on neurogenic inflammation and that stimulation of sensitized acupoints presents a potential trend of generating a better clinical effect when compared with stimulation of unsensitized points. [ABSTRACT FROM AUTHOR]

Background: Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the level of evidence for PMPs of those test procedures, administered to identify somatosensory abnormalities in individuals with neck pain. Methods: A comprehensive electronic literature search was conducted in seven databases from inception to July 2018. The Quality Appraisal for Reliability Studies (QAREL) checklist and the COSMIN tool were used to assess risk of bias of the included studies. Level of evidence was determined based on two components: the methodological quality of included studies and the quality of statistical measures of measurement properties for each testing procedure. Results: Eighteen studies related to neck pain were included. The majority of included articles were considered to be of insufficient methodological quality to ascertain the PMPs of each testing procedure investigated. However, adequate methodological studies indicated that there is moderate level of evidence for the reliability and discriminative validity of the electrical current perception threshold using the neurometer CPT/C. In addition, the hand-held digital pressure algometer (Wagner FDX-25 Greenwich, CT) has moderate evidence for the reliability and responsiveness. Conclusions: This systematic review identified that the hand-held digital pressure algometer and the neurometer has acceptable PMPs. Future research should include adequate sample size, description of the assessors, and inclusion of blinding processes. Further research with standardized protocols is recommended to investigate the predictive ability and responsiveness of reported test procedures to ensure their extended clinical utility. [ABSTRACT FROM AUTHOR]

Abstract: Background: Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain (PJP). Methods: A comprehensive electronic literature search was conducted in 7 databases from inception to March 2016. The Quality Appraisal for Reliability Studies (QAREL) checklist and the Consensus‐based Standards for the Selection of Health Status Measurement Instruments (COSMIN) tool were used to assess risk for bias of the included studies. Level of evidence was evaluated based on the methodological quality and the quality of the measurement properties. Results: Forty‐one studies related to PJP were included. The majority of included studies were considered to be of insufficient methodological quality, and the level of evidence for PMPs varied across different test procedures. The level of evidence for PMPs varied across different test procedures in different types of PJP. Hand‐held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability, agreement, and responsiveness, simultaneously, when it was investigated in patients with chronic knee osteoarthritis. Conclusions: This systematic review identified that the level of evidence for PMPs varied across different testing procedures to assess somatosensory abnormalities for different PJP populations. Further research with standardized protocols is recommended to further investigate the predictive ability and responsiveness of reported test procedures in order to warrant their extended utility in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Identification of somatosensory abnormalities in patients with low back pain (LBP) is essential for targeted treatment strategies in an attempt to reduce or normalize altered sensory processing within the central nervous system. Several test procedures have been used to assess somatosensory abnormalities in patients with LBP, however, these test procedure should possess optimal psychometric properties (PMPs) to be used in clinical practice. Objectives: To systematically review the literature to evaluate the level of evidence for PMPs of test procedures administered to identify somatosensory abnormalities in individuals with LBP. Methods: A comprehensive electronic literature search was conducted in seven databases from inception to March 2016. The QAREL checklist and the COSMIN tool were used to assess methodological quality of the included studies. The level of evidence was determined based on the methodological quality of included studies and the quality of statistical measures of measurement properties. Results: Nineteen studies related to LBP were included. Studies demonstrated limited evidence for reliability and discriminative validity for cross-friction algometry in sub-acute LBP. Additionally, moderate evidence of reliability and strong evidence of discriminative validity exists for: electronic pressure algometer in chronic LBP, and a decline of conditioned pain modulation using the electronic pressure algometer (test stimulus) and a cold presser (conditioning stimulus) in acute and chronic LBP. Conclusions: This systematic review identified test procedures which demonstrated acceptable PMPs. Further research with adequate methodological quality and standardized protocols is recommended to investigate the predictive ability and responsiveness of test procedures to ensure their extended clinical utility. [ABSTRACT FROM AUTHOR]

Background: Breast cancer related lymphedema (BCRL) is a prevalent complication secondary to cancer treatments which significantly impacts the physical and psychological health of breast cancer survivors. Previous research shows increasing use of low level laser therapy (LLLT), now commonly referred to as photobiomodulation (PBM) therapy, for BCRL. This systematic review evaluated the effectiveness of LLLT (PBM) in the management of BCRL.Methods: Clinical trials were searched in PubMed, AMED, Web of Science, and China National Knowledge Infrastructure up to November 2016. Two reviewers independently assessed the methodological quality and adequacy of LLLT (PBM) in these clinical trials. Primary outcome measures were limb circumference/volume, and secondary outcomes included pain intensity and range of motion. Because data were clinically heterogeneous, best evidence synthesis was performed.Results: Eleven clinical trials were identified, of which seven randomized controlled trials (RCTs) were chosen for analysis. Overall, the methodological quality of included RCTs was high, whereas the reporting of treatment parameters was poor. Results indicated that there is strong evidence (three high quality trials) showing LLLT (PBM) was more effective than sham treatment for limb circumference/volume reduction at a short-term follow-up. There is moderate evidence (one high quality trial) indicating that LLLT (PBM) was more effective than sham laser for short-term pain relief, and limited evidence (one low quality trial) that LLLT (PBM) was more effective than no treatment for decreasing limb swelling at short-term follow-up.Conclusions: Based upon the current systematic review, LLLT (PBM) may be considered an effective treatment approach for women with BCRL. Due to the limited numbers of published trials available, there is a clear need for well-designed high-quality trials in this area. The optimal treatment parameters for clinical application have yet to be elucidated. [ABSTRACT FROM AUTHOR]

Objective: To determine whether manual therapy or exercise therapy or both is beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life. Methods: Databases such as Medline, AMED, EMBASE, CINAHL, SPORTSDiscus, PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database, and SCOPUS were searched from their inception till September 2015. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures (pain, physical function and quality of life) were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for assessing the quality of the body of evidence for each outcome of interest. Results: Seven trials (886 participants) that met the inclusion criteria were included in the meta-analysis. There was high quality evidence that exercise therapy was beneficial at post-treatment (pain-SMD-0.27,95%CI-0.5to-0.04;physical function-SMD-0.29,95%CI-0.47to-0.11) and follow-up (pain-SMD-0.24,95%CI- 0.41to-0.06; physical function-SMD-0.33,95%CI-0.5to-0.15). There was low quality evidence that manual therapy was beneficial at post-treatment (pain-SMD-0.71,95%CI-1.08to-0.33; physical function-SMD-0.71,95%CI-1.08to-0.33) and follow-up (pain-SMD-0.43,95%CI-0.8to-0.06; physical function-SMD-0.47,95%CI-0.84to-0.1). Low quality evidence indicated that combined treatment was beneficial at post-treatment (pain-SMD-0.43,95%CI-0.78to-0.08; physical function-SMD-0.38,95%CI-0.73to-0.04) but not at follow-up (pain-SMD0.25,95%CI-0.35to0.84; physical function-SMD0.09,95%CI-0.5to0.68). There was no effect of any interventions on quality of life. Conclusion: An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis. The observed magnitude of the treatment effect would be considered small to moderate. [ABSTRACT FROM AUTHOR]

Laser acupuncture has been studied extensively over several decades to establish evidence-based clinical practice. This systematic review aims to evaluate the effects of laser acupuncture on pain and functional outcomes when it is used to treat musculoskeletal disorders and to update existing evidence with data from recent randomized controlled trials (RCTs). A computer-based literature search of the databases MEDLINE, AMED, EMBASE, CINAHL, SPORTSDiscus, Cochrane Library, PubMed, Current Contents Connect, Web of Science, and SCOPUS was used to identify RCTs comparing between laser acupuncture and control interventions. A meta-analysis was performed by calculating the standardized mean differences and 95% confidence intervals, to evaluate the effect of laser acupuncture on pain and functional outcomes. Included studies were assessed in terms of their methodological quality and appropriateness of laser parameters. Forty-nine RCTs met the inclusion criteria. Two-thirds (31/49) of these studies reported positive effects, were of high methodological quality, and reported the dosage adequately. Negative or inconclusive studies commonly failed to demonstrate these features. For all diagnostic subgroups, positive effects for both pain and functional outcomes were more consistently seen at long-term follow-up rather than immediately after treatment. Moderate-quality evidence supports the effectiveness of laser acupuncture in managing musculoskeletal pain when applied in an appropriate treatment dosage; however, the positive effects are seen only at long-term follow-up and not immediately after the cessation of treatment. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population. This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD −0.42, 95% CI − 0.74 to −0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine. Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes. [ABSTRACT FROM AUTHOR]