Manual therapy
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It is well established that the biomedical model falls short in explaining chronic musculoskeletal pain. Although many musculoskeletal therapists have moved on in their thinking and apply a broad biopsychosocial view with regard to chronic pain disorders, the majority of clinicians have received a biomedical-focused training/education. Such a biomedical training is likely to influence the therapists' attitudes and core beliefs toward chronic musculoskeletal pain. ⋯ The starting point entails self-reflection: musculoskeletal therapists can easily self-assess their attitudes and beliefs regarding chronic musculoskeletal pain. Once the therapist holds evidence-based attitudes and beliefs regarding chronic musculoskeletal pain, assessing patients' attitudes and beliefs will be the natural next step. Such information can be integrated in the clinical reasoning process, which in turn results in individually-tailored treatment programs that specifically address the patients' attitudes and beliefs in order to improve treatment adherence and outcome.
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Review Meta Analysis
Measures of central hyperexcitability in chronic whiplash associated disorder--a systematic review and meta-analysis.
To synthesise the evidence for central hyperexcitability in Chronic WAD (whiplash associated disorders) with meta-analysis, and review test protocols. ⋯ There is compelling evidence for central hyperexcitability in chronic WAD. This should be considered in the management of chronic WAD.
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The presence of cold hyperalgesia is a predictor of poor health outcomes following whiplash injury. An appropriate clinical test to identify cold hyperalgesia may help in gauging the prognosis. A repeated measures, within subjects design was used. ⋯ Sensitivities, specificities and likelihood ratios for different NRS values for pain intensity are presented. A pain intensity rating of >5 gave a positive likelihood ratio of 8.44 suggesting that if this value is reported, clinicians could be suspicious of the presence of cold hyperalgesia. This study demonstrates simple clinical test that may aid in gauging prognosis and guiding treatment decisions in people with WAD.
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Lumbar curvature is important in the assessment of low back pain (LBP). It is often reported that changes in curvature seen in LBP sufferers are an adaptive response to pain. Studies investigating this hypothesis employing an experimental pain relief model have failed to isolate pain relief in their interventions. ⋯ Neither the acute nor chronic LBP group were more likely to respond to pain relief by demonstrating alterations in peak curvature or in lumbar sequencing behaviour. These results demonstrate simple targeted pain relief did not result in gains in peak curvature challenging the assumption of movement alteration being possible through pain relief. Dynamic changes in curvature as displayed by sequencing showed that neither acute nor chronic LBP sufferers were more likely to respond to pain relief.
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The purpose of this study was to compare the predictive ability of the standardised screening tool Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) and the clinicians' prognostic assessment in identifying patients with low back pain (LBP) and neck pain at risk for persistent pain and disability at eight weeks follow-up. Patients seeking care for LBP or neck pain were recruited by 19 manual therapists in Norway. Patients completed the ÖMPQ and the low back- or neck specific Oswestry Disability Index/Neck Disability Index at baseline and 8 weeks after first consultation. ⋯ For LBP patients, both the clinicians' assessment and the ÖMPQ contributed significantly in the separate regression models (p = 0.02 and p = 0.002, resp), whereas none of the tools where significant contributors for neck patients (p = 0.67 and 0.07). Neither of the two methods showed high precision in their predictions of follow-up at eight weeks. However, for LBP patients, the ÖMPQ and the clinicians' prognostic assessment contributed significantly in the prediction of functional outcome 8 weeks after the initial assessment of manual therapist, whereas the prediction for neck patients was unsure.