Manual therapy
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The development of chronic symptoms following whiplash injury is common and contributes substantially to costs associated with this condition. The currently used Quebec Task Force classification system of whiplash associated disorders is primarily based on the severity of signs and symptoms following injury and its usefulness has been questioned. Recent evidence is emerging that demonstrates differences in physical and psychological impairments between individuals who recover from the injury and those who develop persistent pain and disability. ⋯ In contrast those individuals who develop persistent moderate/severe pain and disability show a more complex picture, characterized by additional impairments of widespread sensory hypersensitivity indicative of underlying disturbances in central pain processing as well as acute posttraumatic stress reaction, with these changes present from soon after injury. Based on this heterogeneity a new classification system is proposed that takes into account measurable disturbances in motor, sensory and psychological dysfunction. The implications for the management of this condition are discussed.
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The aim of the study was to investigate the reference and quotation accuracy in four peer-reviewed manual therapy journals. A stratified random sample of original research (n=7) was collected from each of the journals spanning the years January 2000 to December 2001. A further random selection of 80 references from each journal paper sampled was then reviewed (Total N=320) for citation and quotation accuracy. ⋯ JMPT showed the lowest quotation error rate of 6 (4.7%), MT had 12 errors (7.3%), JOM produced 21 errors (13.3%), while JBWMT recorded the highest error rate with 32 (27.6%). Poor citation and quotation is a reflection on the scholarly work of the authors and the journal. The trend for errors in quotation is more worrying than citation errors as it reflects poor diligence on the part of the investigators.
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Psychosocial factors are known to act as obstacles to recovery from low back pain, but predictors of longer-term outcomes are not established. An average 4-year follow-up of a cohort of 252 low back pain patients attending for manipulative care was conducted to describe the longer-term course of low back pain, and to identify predictors of outcomes. Clinical and psychosocial data were obtained at baseline. ⋯ The disability score at 4-years was statistically significantly related to baseline depressive symptoms and higher pain intensity. Low back pain presenting for manipulative care is characterized by high levels of recurrence and care seeking over at least 4-years for many patients. Because psychosocial factors at presentation exert a long-term influence, they need to be considered by manual therapists.
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Attitudes and beliefs, or the treatment orientation, of health care providers appear to be important in the management of non-specific chronic low back pain (CLBP). The aims of the current study were two-fold: First of all, the physiotherapists' opinion towards various aspects of the management of CLBP was surveyed. Secondly, in a principal factor analysis, it was investigated whether underlying dimensions could be identified in order to develop the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS_PT). ⋯ Biomedical specialists scored statistically significantly higher on the 'biomedical orientation' factor. Furthermore, the findings suggested that the PABS_PT discriminates between physiotherapists with a 'behavioural orientation' vs those with a 'biomedical orientation'. To examine the influence of these different treatment orientations with regard to CLBP on patient outcome is a challenge for the near future.
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In Hong Kong, the measurement of perceived health status in patients with low back pain (LBP) can be facilitated by the availability of a health profile specifically designed for the Chinese culture. This prospective observational study investigated the psychometric properties of the generic Current Perceived Health 42 (CPH42) Profile in four separate samples (totalling 473) of Chinese patients with LBP in Hong Kong. The patients completed the CPH42 Profile and the Roland LBP Disability Scale at various points in the course of physiotherapy. ⋯ Validity was confirmed by a moderate correlation with the Chinese adaptations of the Roland LBP Disability Scale and the NRS at the commencement of physiotherapy (Spearman's correlation coefficients were 0.48 and 0.42, respectively). The responsiveness, measured from the commencement of physiotherapy to weeks 3 and 6 (standard response means of 0.33 and 0.58, respectively), were commensurate with the respective changes in pain intensity. The psychometric properties of the CPH42 Profile suggest its suitability for use as an outcome instrument in future efficacy studies on LBP intervention.