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Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

BackgroundMulligan's mobilisation-with-movement (MWM) techniques are proposed to achieve their clinical benefit via neurophysiological mechanisms. However, previous research has focussed on responses in the sympathetic nervous system only, and is not conclusive. An alternative measure of neurophysiological response to MWM is required to support or refute this mechanism of action. Recently, vibration threshold (VT) has been used to quantify changes in the sensory nervous system in patients experiencing musculoskeletal pain. ObjectiveTo investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers. MethodsFifteen asymptomatic volunteers participated in this single-blinded, randomised, within-subject, placebo, control design. Participants received each of three interventions in a randomised order; a lateral glide MWM of the hip joint into flexion, a placebo MWM, and a control intervention. Vibration threshold (VT) measures were taken at baseline and immediately after each intervention. Mean change in VT from baseline was calculated for each intervention and then analysed for between group differences using a one-way analysis of variance (ANOVA). ResultsA one-way ANOVA revealed no statistically significant differences between the three experimental conditions (P = 0.812). ConclusionThis small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

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Involving older people in practice development work: An evaluation of an intermediate care service and practice

A shared vision driving a three year systematic practice development strategy within the intermediate care services of one primary care trust in England included an element of facilitating greater user involvement. This particular practice development work demonstrates how service users, in this case older people with intensive rehabilitation needs, were involved in the evaluation work. The evaluation work, comprising four methods (Patient Centreometer Questionnaire, Service Questionnaire, Focus Group and Patient/Carer Stories) was used to facilitate or enable multi-disciplinary practitioners in the practice development group actively to learn through a different form of engagement with older people outside of the usual ‘patient’ and ‘caregiver’ roles. The learning achieved from the process and the evidence obtained through the evaluation methods provided motivation, increased commitment and generated a practice development action plan that enabled changes in practice to be implemented based genuinely on users' experiences. This article also shows how this practice development work moved away from the notion of the baseline and comparative evaluation method to more of an ongoing and integrative method of evaluation. Copyright © 2006 John Wiley & Sons, Ltd.

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