Search

Background: Platelet-rich plasma (PRP) has been considered for its role in facilitating the body’s own healing processes, with the potential to complement rehabilitation in the management of lower extremitymusculoskeletal pathologies.Methods: Eligible studies were randomized clinical trials and quasi-experimental trials with completed data analysis; published in English; recruited participants aged >18 years; had at least two groups, with one intervention group receiving PRP injection alone or PRP injection and rehabilitation, and the comparison group receiving either rehabilitation alone or a control group receiving saline and rehabilitation; included at least one outcome measure of pain, disability, quality of life, or return to play. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias (RoB) tool. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. Meta-analyses were conducted across outcomes in each pathology when possible.Results: Twenty-one studies assessed Achilles rupture, Achilles tendinopathy, lateral ankle sprain, high ankle sprain, hamstring injury, knee osteoarthritis, acute muscle injury, patellar tendinopathy, and plantar fasciitis, with an average RoB score of 9.9 out of 12. Meta-analyses for Achilles rupture (n = 270) revealed a nonsignificant effect on disability in the short and long term (high level of evidence) when comparing PRP, immobilization, and exercise/physical therapy to placebo, immobilization, and exercise/physical therapy. Meta-analyses for Achilles tendinopathy revealed a nonsignificant effect on pain (n = 64) in the short term, and disability in the short (n = 138) as well as long term (n = 192) (very low to low level of evidence) when comparing PRP and exercise to placebo and exercise.Conclusions: While individual studies demonstrated significant findings across outcomes, the non-significant pooled results and inability to perform further meta-analyses made it difficult to provide definitive recommendations for the addition of PRP to exercise for lower extremity musculoskeletal pathologies. Future studies should standardized PRP exercise rehabilitation protocols with better dosage parameters, consider larger sample sizes, and have short and long term follow-up periods consistent with the Cochrane Collaboration.

Background: Platelet-rich plasma (PRP) is considered in clinical practice for its role in facilitating the body’s own healing processes, with the potential to complement physical therapy in managing musculoskeletal pathologies of the upper extremity. Methods: Eligible studies must be randomized with clinical/quasi-experimental trials with complete data analysis, and published in English. They have to recruit participants aged >18 years; have at least two groups, with one intervention group receiving PRP injection alone or PRP injection and rehabilitation, and the comparison group receiving either rehabilitation alone or a control group receiving saline and rehabilitation; and finally include at least one outcome measure of pain, disability, or quality of life. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias (RoB) tool. The grading of recommendations assessment, development, and evaluation approach was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted across outcomes within each pathology when possible. Results: A total of 13 studies assessing adhesive capsulitis, carpal tunnel syndrome, lateral epicondylal-gia, rotator cuff tendinopathy, subacromial impingement syndrome, and shoulder osteoarthritis were included with an average RoB score of 8.77 out of 12 across all studies. Meta-analyses for rotator cuff tendinopathy (n = 49) revealed a significant effect on pain (cm) (mean difference [MD] -2.53; 95% confidence interval [CI]: −5.02, −0.04; I2 statistic = 51%; P = 0.05), quality of life (MD 16.82; 95% CI: 0.40, 33.25; I2 = 0%; P = 0.04), and disability (standardized mean difference [SMD]: −0.64; 95% CI: −1.24, −0.04; I2 = 0%; P = 0.04) favoring PRP and physical therapy as long-term follow-up (moderate level of evidence). All other meta-analyses for adhesive capsulitis and carpal tunnel demonstrated nonsignificant effects. Conclusions: This systematic review demonstrated that PRP is a beneficial adjunct to physical therapy for reducing pain and improving disability and quality of life (moderate level of evidence) when compared to placebo plus physical therapy for the management of rotator cuff tendinopathy.

Lumbar spinal stenosis (LSS) has a substantial impact on mobility, autonomy, and quality of life. Previous reviews have demonstrated inconsistent results and/or have not delineated between specific nonsurgical interventions. The purpose of this systematic review is to assess the effectiveness of interventions in the management of LSS. Eligible studies were randomized controlled trials (RCTs) or prospective studies, included patients with LSS, assessed the effectiveness of any interventions (rehabilitation, surgical, injection, medication), included at least two intervention groups, and included at least one measure of pain, disability, ambulation assessment, or LSS-specific symptoms. Eighty-five articles met inclusion criteria. Meta-analyses were conducted across outcomes. Effect sizes were calculated using Hedge’s g and reported descriptively. Formal grading of evidence was conducted. Meta-analysis comparing rehabilitation to no treatment/placebo demonstrated significant effects on pain favoring rehabilitation (mean difference, MD −1.63; 95% CI: −2.68, −0.57; I2 = 71%; p = .002). All other comparisons to no treatment/placebo revealed nonsignificant findings. The level of evidence ranged from very low to high for rehabilitation and medication versus no treatment/placebo for pain, disability, ambulation ability, and LSS symptoms. Although the findings of this review are inconclusive regarding superiority of interventions, this accentuates the value of multimodal patient-centered care in the management of patients with LSS.

Drummond, C, Lebedeva, V, Kirker, K, and Masaracchio, M. Sling exercise in the management of chronic low back pain: A systematic review and meta-analysis. J Strength Cond Res XX(X): 000-000, 2021-The purpose of this systematic review is to assess the effectiveness of sling exercise therapy (SET) in individuals with chronic low back pain (LBP). Eligible studies were randomized clinical trials or prospective cohort studies published in the English language that assessed SET on measures of pain, disability, or muscle attributes in chronic LBP. The search identified 1,204 studies, with 12 studies meeting the inclusion criteria. The average score was 7.3 on the Cochrane Risk of Bias Criteria. Meta-analysis comparing SET with general exercise revealed a nonsignificant effect for pain (mean difference [MD] 0.14; 95% confidence interval [CI]: -0.58, 0.87). Meta-analysis comparing SET with motor control training/lumbar stabilization revealed a significant effect favoring SET for pain (MD -4.13; 95% CI: -7.82 to -0.45) and disability (MD -3.19; 95% CI: -4.63 to -1.76). Meta-analysis comparing SET with no treatment revealed a significant effect favoring SET for pain (MD -1.05; 95% CI: -2.82 to -0.71). Meta-analysis comparing SET plus modalities with modalities revealed a significant effect favoring the SET plus modalities group for pain (MD -1.19; 95% CI: -1.48 to -0.89) and a nonsignificant effect for disability (MD -6.67; 95% CI: -17.25 to 3.92). Sling exercise therapy was more effective than all comparisons for various muscle attributes. The overall level of evidence ranged from very low to moderate. Sling exercise therapy is effective in reducing pain, disability, and improving core muscle activation, strength, thickness, and onset in patients with chronic LBP. Because SET demonstrated comparable outcomes with common active interventions, it provides an opportunity to implement pain-free exercises based on the patient's initial functional level early in the plan of care.

To assess the prevalence of tibiofemoral (TF) osteoarthritis (OA) following arthroscopic partial meniscectomy (APM) with a minimum follow-up of 5 years, to explore the prevalence of symptomatic TF OA, and to identify potential risk factors for the development of TF OA following APM.An electronic search was conducted using PubMed, CINAHL, Pedro, AMED, Embase, the Cochrane Library, and clinicaltrials.gov. Prospective/retrospective studies including participants with a mean age ≥18 years old, undergoing isolated APM, reported radiographic assessment of knee OA as an outcome, had at least 5-year follow-up, and were written in English were included. Two authors extracted relevant data. Four authors assessed methodologic quality using the Center of Reviews and Dissemination and the Downs and Black checklist. The prevalence of TF OA after APM was reported for each study, with the range provided across studies for each time period (5 years to10 years, 10 years to15 years, ≥15 years).Twenty-two studies were included. Radiologic TF OA prevalence following APM ranged from 35% to 90%, 23% to 100%, and 52% to 57.7% at an average follow-up of 5 years to10 years, 10 years to15 years, and ≥15 years, respectively. Prevalence of symptomatic TF OA ranged from 24.1% to 67% according to individual operational definitions, with 2 studies reporting correlations between function and radiological findings.APM results in a prevalence of radiographic TF OA ranging from 23% to 100% across follow-up periods of 5 or more years with the lowest prevalence reported between 5 and10 years and the highest prevalence reported between 10 and15 years follow-up. Considerably less data was available to assess symptomatic TF OA or risk factors associated with TF OA.Level III, systematic review of Level II and III studies.

Background An alternative approach to facilitate movement and control through the trunk and pelvis is belly dancing. Investigations of belly dancing mechanics indicate similar muscular activation patterns of those known to influence chronic low back pain (cLBP). However, no documented studies have examined its effectiveness as a treatment for cLBP. Objective The purpose of this study was to investigate the influence of a standardized belly dance program in women with cLBP. Methods A single subject design was used to evaluate weekly outcomes during a three-week baseline period, six-week belly dance program, and again at a two-month follow-up. Outcome measures for pain, disability, function, and fear-avoidance beliefs were utilized. Results Two subjects completed the program. No significant differences were noted during the baseline assessment period. At two months, subject one demonstrated change scores of -1.12, -1%, and 2.2 for pain, disability, and function respectively while subject two demonstrated change scores of 5.4, 5%, and 1.1 for pain, disability, and function, respectively. Subject one showed a clinically significant change score for both fear avoidance of work and physical activity, with score changes of 4 and 3.3, respectively. Conclusion The results of this study suggest a standardized belly dance program may positively influence pain and function in women with cLBP.

Aim: Currently there is a large and perhaps unwarranted variation regarding physical therapy utilization for individuals with low back pain (LBP). The purpose of this systematic review was to compare the effects of minimal physical therapy utilization/education (two visits or less) versus typical physical therapy utilization (three visits or more) on patient-important outcomes for patients with LBP. Methods: Two independent reviewers searched Cochrane, Medline, CINAHL, Web of Science, and PEDro from database inception until March 2017. Eligible studies used a randomized design, included subjects with LBP, and compared minimal versus higher utilization. The GRADE approach was used to provide an overall level of evidence regarding utilization. Eight articles (1153 individual subjects) met the inclusion criteria. Effect sizes for each outcome measure were calculated using Hedge’s g and were adjusted for baseline values at each time period. Findings: When compared with minimal utilization, higher utilization demonstrated no significant differences on pain, disability, or quality of life at the 1-year follow-up. However, two of the three studies that analyzed cost-effectiveness found higher utilization to be more cost-effective at 1-year follow-up. Moreover, there was insufficient evidence available to investigate patient subgroups (acuity, risk for chronicity), multiple levels of utilization dosage (low, typical, and high), or intervention type. Conclusions: This review identifies the need for further research on the dosage of physical therapy among various subgroups of patients with LBP. While higher utilization may not result in significant improvements in patient-important outcomes, it may be more cost-effective for patients with chronic or complex LBP conditions when compared to minimal utilization.

Health care educators are obligated to ensure that student writing skills are current, appropriate, and integrated into their role as future practitioners. The purpose of this study was to examine the impact and satisfaction of a transformational learning approach in a literacy-enriched health professions program on student's writing skills.Two different cohorts of occupational therapy students enrolled in a literacy program embedded in the first year of the professional phase of the occupational therapy program curriculum. The literacy-enriched program was based on transformative learning theories and was delivered by program faculty and writing tutors from the university writing center. Effectiveness was assessed using the ASSET writing test and a student satisfaction survey. Paired t-tests compared pre- and post-curriculum implementation scores on the ASSET. The association between student satisfaction post-program and pre- and post-writing scores were analyzed using Pearson correlations.Significant differences were found in the pre- and-post ASSET scores. Additionally, many students reported satisfaction with the writing program regarding their ability to revise, edit, proofread, and paraphrase content.This study demonstrated continuity of improved writing skill development across three different years of students using a transformational learning approach in a literacy-enriched curriculum, suggesting a potential positive outcome of the program.

The purpose of this retrospective case report was to describe clinical decision making during the examination and treatment of a 5-year-old boy with an anterior cruciate ligament (ACL) tear.A paucity of research exists for the management of ACL tears in children. A combination of manual therapy interventions initially, followed by a unique and comprehensive therapeutic exercise program, was implemented during the course of a 3-month treatment period. Improvements in range of motion, quadriceps strength, single-leg stance time, and the Knee Injury and Osteoarthritis Outcome Score were noted. At discharge, the patient safely returned to unrestricted home and school activities.This case demonstrates successful management of a child after an ACL injury.Clinicians are encouraged to implement sound clinical reasoning in the absence of well-established evidence when treating similar patients in their clinical practice.

Over the last decade, there has been an increased focus on and expansion in orthopedic manual physical therapy (OMPT) clinical practice and research. Along with this focus have come numerous resear...

As a result of the anatomical proximity of the thoracic spine to the cervical, lumbar, and shoulder regions, dysfunction in the thoracic spine can influence pain, mobility, and stability across these areas. Currently, a paucity of evidence exists addressing treatment of individuals with primary thoracic pain, especially in young, athletic patients. Furthermore, current research discussing clinical reasoning frameworks focus on the differential diagnostic process. The purpose of this case report was to present a framework that describes the clinical reasoning process for the implementation and sequencing of procedural interventions for the management of a dancer with thoracic pain.A 21-year-old female dancer presented to physical therapy with a medical diagnosis of thoracic pain. The patient reported exacerbation of left thoracic pain with prolonged sitting, twisting/arching her back during dance, and lifting15 lbs overhead. Examination revealed hypomobility with positive pain provocation during mobility testing of T1-T3 and the sternocostal junction of ribs 2-4, with associated muscle guarding palpated in the left iliocostalis thoracis and levator scapulae.Following 10 visits, the patient had no pain, no functional deficits, and a Global Rating of Change (GROC) of + 6. She returned to full competition, and a 3-month follow-up revealed continued success with dancing and a GROC of +7.This case report described the successful management of a dancer with primary thoracic pain using a clinical reasoning framework for the sequencing of procedural interventions, while incorporating Olson's impairment-based classification system. A combination of manual therapy techniques and neuromuscular control exercises were incorporated to address mobility, stability, mobility on stability, and skill level impairments, which allowed the patient to return to dance activities safely. Future studies should consider the development of further treatment-based clinical reasoning frameworks that illustrate the importance of the sequencing within a session and across the episode of care.4.

ObjectiveTo investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP).Data sourcesElectronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018.Study selectionEligible studies were completed RCTs, written in English, had at least 2 groups with one group receiving TSM, had at least one measure of pain or disability, and included patients with MNP of any duration. The search identified 1717 potential articles, with 14 studies meeting inclusion criteria.Study appraisal and synthesis methodsMethodological quality was evaluated independently by two authors using the guidelines published by the Cochrane Collaboration. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate mean differences (MD) and 95% confidence intervals for pain (VAS 0-100mm, NPRS 0-10pts; 0 = no pain) and disability (NDI and NPQ 0-100%; 0 = no disability).ResultsAcross the included studies, there was increased risk of bias for inadequate provider and participant blinding. The GRADE approach demonstrated an overall level of evidence ranging from very low to moderate. Meta-analysis that compared TSM to thoracic or cervical mobilization revealed a significant effect favoring the TSM group for pain (MD -13.63; 95% CI: -21.79, -5.46) and disability (MD -9.93; 95% CI: -14.38, -5.48). Meta-analysis that compared TSM to standard care revealed a significant effect favoring the TSM group for pain (MD -13.21; 95% CI: -21.87, -4.55) and disability (MD -11.36; 95% CI: -18.93, -3.78) at short-term follow-up, and a significant effect for disability (MD -4.75; 95% CI: -6.54, -2.95) at long-term follow-up. Meta-analysis that compared TSM to cervical spine manipulation revealed a non-significant effect (MD 3.43; 95% CI: -7.26, 14.11) for pain without a distinction between immediate and short-term follow-up.LimitationsThe greatest limitation in this systematic review was the heterogeneity among the studies making it difficult to assess the true clinical benefit, as well as the overall level of quality of evidence.ConclusionsTSM has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care in the short-term, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability.Trial registrationPROSPERO CRD42017068287.

Objective To investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty. Data sources Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, and the Cochrane Library were searched in July 2016. Five additional trials were identified through reference list scanning. Study selection Eligible studies were published in English language peer-reviewed journals; included participants that had undergone total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty reported clearly defined timing of rehabilitation onset for at least two groups; and reported at least one measure of LOS or cost. Inclusion criteria were applied by 2 independent authors, with disagreements being determined by a third author. Searching identified 1,029 potential articles, of which 17 studies with 26,614 participants met the inclusion criteria. Data extraction Data was extracted independently by 2 authors, with disagreements being determined by a third author. Methodological quality of each study was evaluated independently by 2 authors using the Downs and Black checklist. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate standardized mean differences (SMD) and 95% confidence intervals for LOS. Data synthesis When compared with standard care, early initiation of physical therapy demonstrated a decrease in length of stay for the 4 randomized clinical trials (SMD = -1.90; 95% CI -2.76 to -1.05; I2 = 93%) and for the quasi-experimental and 5 prospective studies (SMD = -1.47; 95% CI -1.85 to -1.10; I2 = 88%). Conclusion Early initiation of rehabilitation following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty is associated with a shorter LOS, a lower overall cost, with no evidence of an increased number of adverse reactions. Additional high quality studies with standardized methodology are needed to further examine the impact of early initiation of physical therapy among patients with joint replacement procedures.

Introduction. Low back pain (LBP) is one of the most common medical conditions in the United States. Clinical practice guidelines recommend active treatment approaches; however, there continues to be a significant disparity in how patients with LBP are treated. Therefore, the purpose of this systematic review is to evaluate the reported efficacy of active treatment approaches as recommended by clinical practice guidelines on LBP treatment on patient outcomes. Methods. Between the months of June and August 2015, a comprehensive search of the PubMed, Medline (EBSCO Host), and CINAHL (EBSCO Host) databases was performed. The search was restricted to articles that were published in a peer-reviewed journal, published in the English language, examined patient outcomes with a determined scale, determined the usage of an established clinical practice guideline for LBP treatment, reported at least one outcome measure, and specified either nonspecific or acute LBP. Results. Fifty-three articles were initially identified, with 4 articles ultimately meeting the criteria after screening. Articles scored between 17 and 20 points based on a maximum total score of 26 on the modified Downs and Black checklist. Conclusion. Studies identified in this review indicate that adherence to an active treatment approach as recommended by clinical practice guidelines may result in improved patient outcomes.