Therapist Interventions Research Articles

The relationship between attachment insecurity and pathological narcissism: A three‐level meta‐analysis

AbstractThe detrimental effects of pathological narcissism on individual development and intimate relationships have been widely studied. Although the exact origins of this phenomenon are still debated, the important role that family dynamics play in its emergence is increasingly being recognized. Previous researchers have pointed out that insecure attachment is associated with pathological narcissism; however, empirical findings are inconsistent. Hence, this study conducted a three‐level random‐effects meta‐analysis based on 183 effect sizes from 29 articles (N = 8247 participants). Our findings have demonstrated the significant and positive link between insecure attachment and pathological narcissism (r = .18; 95% CI: 0.14, 0.22; p < .001). In addition, a moderator analysis was carried out to explore factors that may weaken or strengthen the primary association of interest. In total, there are five significant moderators, including insecure attachment style (F(3,176) = 13.72; p < .001), measurement tool of attachment insecurity (F(8,171) = 4.59; p < .001), measurement tool of pathological narcissism (F(6,173) = 5.21; p < .001), percentage of participants identifying as male (F(1,174) = 4.04; p = .046), and age (F(1,178) = 19.94; p < .001). This research highlights the positive correlation between attachment insecurity and pathological narcissism, providing family theorists with insights into how early family experiences influence personality formation and guiding family therapists in interventions for narcissistic pathology.

The financial impact of participant attrition from randomised trials: a case-study from the Occupational Therapist Intervention Study (OTIS).

Loss to follow-up of participants can compromise the statistical validity of randomised trials. Moreover, it can have financial consequences for trial teams and funders. This study explores the Occupational Therapist Intervention Study (OTIS) where, despite a withdrawal rate of less than 10%, the trial team incurred opportunity costs related to participants who were initially recruited but subsequently decided to withdraw from the trial. To estimate the cost of participant losses to follow-up in the OTIS trial and thus introduce a costing framework to research teams on how they could estimate the opportunity costs of participant withdrawal from their randomised trials. The participants lost to follow-up are differentiated by (1) the time point at which they were lost to follow-up; (2) the treatment group they were allocated to; (3) their response patters to follow-up questionnaires; these elements were considered to identify the relevant types of attrition. Protocol-driven costs of trial materials, including administration, print, and shipping, were gathered. We calculated unit costs for each type of attrition by multiplying protocol-driven and intervention costs with the relevant number of participants. Summing up unit costs by type of loss to follow-up yields aggregate figures, enabling the estimation of aggregate and average opportunity costs of attrition. The average cost per participant loss to follow-up in the OTIS trial is £98.41. The aggregate cost of participant loss to follow-up is £10,234.90 from the economic perspective of the trial team. Therefore, 1.42% of the allocated funding has been misallocated because of participant loss to follow-up. Despite the low attrition rate of the OTIS trial, loss to follow-up has still generated considerable opportunity costs. It is recommended that decision makers focus on identifying strategies which could improve participant retention in randomised trials to optimise their budget.

Testing the predictions of Chapman's five love languages theory: Does speaking a partner's primary love language predict relationship quality?

Chapman's claim that the key to marital happiness is "speaking" your partner's primary "love language" has been highly influential in pop culture and incorporated into therapeutic practice. However, the theory has not yet been empirically validated. The current study tests his theory, examining the hypothesis that satisfaction with one's partner's primary love language behavior predicts relationship satisfaction better than satisfaction with one's partner's nonprimary love language behavior. We recruited a sample (n = 696, M = 43.8 years, 70% married, 97.3% cohabitating) through Amazon CloudResearch. Chapman's hypothesis was not supported. Participants' satisfaction with their partners' primary love language behavior no better-predicted relationship satisfaction or perceived love than the lower-ranked love languages. Words of Affirmation and Quality Time better predicted perceived love and relationship satisfaction than participants' primary love language. These results replicate previous research and suggest that these should remain targets of intervention for relationship therapists.

Post-rehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: a mixed methods cluster-feasibility controlled trial

BackgroundLess than 50% of stroke survivors regain their pre-stroke level of upper limb function, compounded with a lack of long-term rehabilitation options available. The Graded Repetitive Arm Supplementary Programme (GRASP)...

Bezpečná domácnosť pre seniorov z pohľadu ergoterapeuta

Starting point: Preventive programs for older adults should focus on promoting aging in their place of residence. A safe household without barriers is one condition for maintaining a high quality of life and supporting self-sufficiency. The occupational therapist plays a key role in evaluating the home environment and supervising follow-up interventions. Aim: This review study aims to clarify the role of occupational therapist interventions in the home environment of older adults and describe the most common and significant risks and subsequent modifications to the environment to create a safe home and prevent falls based on best practices. Methods: This is a review of published literature between 2013 and 2024 using the PRISMA methodology. The electronic databases Web of Science, Scopus, EBSCO, and PubMed were searched. Results: Of the 198 sources, 10 studies met the analysis criteria. Risky areas in older adult homes and possible interventions to increase safety are clearly listed. The areas with the greatest security risk are the bedrooms, bathrooms with toilets, and stairs. Various obstacles, including carpets, objects placed at an inappropriate height, a low toilet, or insufficient lighting, were among the most common causes of falls. Conclusions: Studies point to the importance of promoting self-sufficiency and raising awareness regarding aging modifications to the homes of older adults.

Cognitive functions in focus: Occupational therapist intervention with a group of patients in first episode psychosis

Cognitive functions in focus: Occupational therapist intervention with a group of patients in first episode psychosis

The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain.

The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP). A retrospective cohort study was conducted in 3618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018. The Department of Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non-physical therapy clinic encounters. The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression. Nearly all veterans (98%) received active interventions, but only a minority (31%) received manual therapy. In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions. Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30% to 130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions. The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events. The use of active interventions, which is supported by most clinical practice guidelines, was the cornerstone of physical therapist care for veterans with LBP. However, the use of clinical practice guideline-recommended manual therapy interventions was low but associated with reduced opioid prescriptions. The use of 2 or more different passive interventions along with active interventions was common (34%) and associated with less-than-optimal escalation-of-care outcomes.

Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults.

Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1year in community dwelling older adults. A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated. For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99). Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions. Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized. Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.

Using FRAME to adapt an evidence‐based dyadic intervention program for people living with dementia in residential aged care: A pilot feasibility study

AbstractIntroductionThe purpose of this study was to examine the feasibility of adapting and translating an evidence‐based occupational therapist‐delivered program shown to be effective in the community to residential aged care (RAC). The program aims to improve quality of care and quality of life for people living with dementia and the wellbeing of the family care partner.MethodsThis study took place in a not‐for‐profit RAC home in Adelaide, South Australia. Mixed methods, specifically questionnaires, activity logs, focus group, and one‐on‐one interviews were used to evaluate the feasibility of the program implementation. Staff working in the participating home, occupational therapists trained to deliver the program, and residents and their family carer partners were included. Quantitative data were analysed using proportions, means, and standard deviations. Qualitative data were analysed using a thematic approach.Consumer and Community InvolvementThis study was conducted together with a consumer (person living with dementia) and a carer representative (family member of someone residing in RAC). These representatives provided input towards the study design, interpretation of study data, discussion of results, and recommendations for future consideration.ResultsSmall changes to the program improved feasibility and acceptability for delivery in RAC. While the care home staff required added support during implementation, the intervention therapists felt that the program could be delivered in this setting. Family care partners of residents with dementia felt that the program may be better suited if provided upon entry to RAC or in early stages of dementia.ConclusionAdapting a community‐based dementia care program to RAC can be safe and feasible. Program adaptations are necessary for feasibility. Further adaptations and evaluations of associated outcomes (related to residents with dementia and their family care partners) are needed to assess the program effectiveness in larger scale.Plain language summarySpending quality time with family members in residential aged care is important. However, many struggle to know what to say or do when visiting a family member who lives with dementia. Programs that teach families about how to communicate with people living with dementia, how to support them to take part in important everyday living activities, or how to understand why changes in behaviours may occur have not been available in residential aged care. This paper describes how we adapted one such evidence‐based program from community to residential aged care settings. We consulted with people living with dementia, carers, and families and found that the program could also be valuable in this care setting. Residential aged care staff described how the program is very different to what is usually available in residential aged care, but they were optimistic that with the right support, it could be a valuable way to support residents with dementia and their families. Family members of residents with dementia and therapists delivering the program felt that residents in early stages of living in residential aged care and/or early stages of dementia could benefit the most from these programs. We found that including family members in the intervention process can be useful and empowering for families and residents. Future work should also focus on involving other staff members caring for residents in the process. Communication between staff and families is the key for program delivery and success and treating each person as an individual.

Subjective Experience and Perceived Benefits in Clients with Schizophrenia Following Participation in Metacognition Reflection and Insight Therapy (MERIT).

Schizophrenia spectrum disorders involve disturbances in the experience of the self, which are related to limited metacognitive ability. The aim of metacognition-based therapies is to improve metacognitive ability and, subsequently, self-management and recovery. Adding to the quantitative findings from a trial on the effectiveness of Metacognition Reflection and Insight Therapy (MERIT), in the current study, we report on a qualitative assessment of MERIT's subjective perceived contribution. Twenty-seven patients with schizophrenia were interviewed after completing MERIT. Content analysis based on grounded theory was conducted by two independent raters. Most participants were satisfied with the therapy and reported improvement mainly in self-experience domains. The main contributors to perceived improvement pertained to the intervention process (e.g., therapeutic alliance and therapist interventions) as well as to the patient being an active agent of change. Perceived outcomes are particularly important among this cohort, as they often cope with limited metacognitive abilities, expressed by challenges in reflecting on themselves and others. The current study supports MERIT as a treatment that enhances positive outcomes for people with schizophrenia.

Reducing Hand Kinematics by Introducing Grasp-Oriented Intra-Finger Dependencies

Loss of hand functions, often manifesting in the form of weakness or spasticity from conditions like stroke or multiple sclerosis, poses challenges in performing activities of daily living (ADLs). The broad area of rehabilitation robotics provides the tools and knowledge necessary for implementing efficient restorative therapies. These therapies aim to improve hand functionality with minimal therapist intervention. However, the human hand evolved for various precision and power gripping tasks, with its intricate anatomy featuring a large number of degrees of freedom—up to 31—which hinder its modeling in many rehabilitation scenarios. In the process of designing prosthetic devices, instrumented gloves, and rehabilitation devices, there is a clear need to obtain simplified rehabilitation-oriented hand models without compromising their representativeness across the population. This is where the concept of kinematic reduction, focusing on specific grasps, becomes essential. Thus, the objective of this study is to uncover the intra-finger dependencies during finger flexion/extension by analyzing a comprehensive database containing recorded trajectories for 23 different functional movements related to ADLs, involving 77 test subjects. The initial phase involves data wrangling, followed by correlation analysis aimed at selecting 116 dependency-movement relationships across all grasps. A regularized generalized linear model is then applied to select uncorrelated predictors, while a linear mixed-effect model, with reductions based on both predictor significance and effect size, is used for modeling the dependencies. As a final step, agglomerative clustering of models is performed to further facilitate flexibility in tradeoffs in hand model accuracy/reduction, allowing the modeling of finger flexion extensions using 5–15 degrees of freedom only.

Clinical validation of automated depth camera-based measurement of the Fugl-Meyer assessment for upper extremity

Objective Depth camera-based measurement has demonstrated efficacy in automated assessment of upper limb Fugl-Meyer Assessment for paralysis rehabilitation. However, there is a lack of adequately sized studies to provide clinical support. Thus, we developed an automated system utilizing depth camera and machine learning, and assessed its feasibility and validity in a clinical setting. Design Validation and feasibility study of a measurement instrument based on single cross-sectional data. Setting Rehabilitation unit in a general hospital Participants Ninety-five patients with hemiparesis admitted for inpatient rehabilitation unit (2021–2023). Main measures Scores for each item, excluding those related to reflexes, were computed utilizing machine learning models trained on participant videos and readouts from force test devices, while the remaining reflex scores were derived through regression algorithms. Concurrent criterion validity was evaluated using sensitivity, specificity, percent agreement and Cohen's Kappa coefficient for ordinal scores of individual items, as well as correlations and intraclass correlation coefficients for total scores. Video-based manual assessment was also conducted and compared to the automated tools. Result The majority of patients completed the assessment without therapist intervention. The automated scoring models demonstrated superior validity compared to video-based manual assessment across most items. The total scores derived from the automated assessment exhibited a high coefficient of 0.960. However, the validity of force test items utilizing force sensing resistors was relatively low. Conclusion The integration of depth camera technology and machine learning models for automated Fugl-Meyer Assessment demonstrated acceptable validity and feasibility, suggesting its potential as a valuable tool in rehabilitation assessment.

성인 진입기 공황장애 내담자의 가족치료 사례연구

Objectives: This study explores the factors that influenced the development of panic disorder, the therapist's interventions, and the effectiveness of family therapy interventions, focusing on three family therapy cases applied to Bowen's family system theory and MRI communication model for three panic disorder clients in emerging adulthood. Methods: Data—therapy notes, recordings, and transcribed documents—were first coded and then pattern coded through continuous comparative analysis to derive the final categories. The results are presented in a matrix and network. Results: The study findings were as follows. First, two types of factors influenced panic disorder: triggering factors and latent factors. Second, therapeutic interventions encompassed setting treatment goals, exploring the family of origin, promoting insight, and encouraging behavioral change. Third, the outcomes of family therapy intervention were marked by enhanced understanding among family members, positive changes in communication patterns, and a reduction in panic attack symptoms. Conclusions: These findings suggest that family therapists working with emerging adults experiencing panic disorder should address parenting styles, communication patterns among family members, and transference from unresolved emotional issues with the family of origin.

강박장애를 가진 성인자녀에 대한 가족치료 사례연구: 가족체계론적 관점을 중심으로

Objectives: This family therapy case study aims to explore the factors that contributed to obsessive-compulsive disorder (OCD), intervention approaches used by the family therapist and the effectiveness of treatment. Method: This study employed a case study method and used thematic analysis and a matrix approach in data analysis. Results: Contributors to the development of OCD were triggering, individual, familial, and environmental factors. The therapist's interventions included analyzing the familial factors, promoting the awareness of the parents' dysfunctional communication patterns transmitted from the family of origin, helping the client express the repressed emotions, resolving misunderstandings among family members, and practicing effective communication strategies. Conclusion: This study identified the factors related to OCD from a family systems perspective and explored specific family therapy interventions used by the therapist.

Decline in Mobility and Balance in Persons With Post-COVID-19 Condition.

Post-COVID-19 condition (PCC) may impact mobility and balance and affect physical function. The objectives of the study were to estimate the prevalence of decline in balance and mobility in individuals with PCC; explore the association between comorbidities and sociodemographic characteristics with decline in balance and mobility; and evaluate correlations between decline in mobility and balance with change in performance of usual activities, personal care, and global health perception. The design was a cross-sectional study of persons with a COVID-19 diagnosis that was confirmed at least 3 months before the study. Those with PCC, defined as those still troubled by symptoms, were evaluated for decline in mobility and balance and with associated clinical and demographic factors using bivariate analysis and multivariable logistic regression. Correlations between decline in mobility and balance were also examined with change in ability to perform usual activities, personal care, and global health perception. In 1031 persons with PCC, mobility deteriorated in 44.9%, and balance deteriorated in 37.1%. Older age, hospitalization, comorbidities, and obesity were associated with decline in mobility, while decline in balance was associated with older age and comorbidities. Reduced mobility was associated with changes in ability to carry out usual activities (rp = 0.6), conduct personal care (rp = 0.6), and global health status (rp = 0.5). Correlations between decline in balance and these same outcomes were 0.5, 0.5, and 0.45, respectively. Almost half the participants with PCC had reduced mobility, and over a third reported deterioration in balance, with associated difficulties with daily functioning. Factors associated with greater decline help identify those most at risk. Many people with PCC experience changes in mobility and balance, which can affect functional capacities and lead to physical therapist consultations. Further study should assess specific needs of these patients and determine effective physical therapist interventions to meet these needs. Many persons with post-COVID-19 condition (PCC) experience symptoms resulting in functional problems, such as difficulties with personal care and performing usual activities. This study focused on difficulty in mobility and problems with balance. Almost half of persons with PCC in the study had declines in getting around and over a third had declines in balance. These problems were associated with older age and having other comorbid health conditions and were linked with decline in ability to perform personal care, carry out usual activities, and perceived global health status.

Application of the Staged Approach for Rehabilitation Classification System and Associated Improvements in Patient-Reported Outcomes Following Rehabilitation for Shoulder Pain.

The Staged Approach for Rehabilitation Classification for the Shoulder (STAR-Shoulder) has been proposed as a model to guide management and improve outcomes for patients with shoulder pain; however, the effect of its utilization on patient outcomes has not been established. Therefore, the primary purpose of this study was to determine whether patient outcomes were improved if care was matched to the STAR-Shoulder system compared with unmatched care. Collected and reviewed demographic, examination, and intervention data for all patients receiving physical therapist treatment for shoulder pain during a 1-year period within a single health care system. Outcome variables included the numeric pain rating scale, the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH), and the number of visits. Clinical records from patients receiving care at the discretion of the therapist were systematically audited to determine whether care provided was considered matched or unmatched. A total of 692 patient records were examined. The interrater reliability of classifying care as matched or unmatched was substantial (κ= 0.6; 95% CI = 0.4 to 0.9), with 82% agreement. Changes in patient outcome scores were significantly better for those patients whose care matched the STAR-Shoulder system for pain changes (mean difference = -1.2; 95% CI = 0.8 to 1.6; effect size [d] = 0.5) and QuickDASH score (mean difference = 12.7; 95% CI = 9.9 to 15.5; d= 0.7). No difference was noted for number of visits. The STAR-Shoulder system appears to be a meaningful way to classify patients and guide intervention to improve patient outcomes. Application of the STAR-Shoulder system to help align physical therapist interventions more closely with tissue irritability and physical impairments appears to improve patient outcomes. These findings support this model as a promising approach to advance evidence-based practice for shoulder pain.

Mental Health Counseling From Conversational Content With Transformer-Based Machine Learning

Use of asynchronous text-based counseling is rapidly growing as an easy-to-access approach to behavioral health care. Similar to in-person treatment, it is challenging to reliably assess as measures of process and content do not scale. To use machine learning to evaluate clinical content and client-reported outcomes in a large sample of text-based counseling episodes of care. In this quality improvement study, participants received text-based counseling between 2014 and 2019; data analysis was conducted from September 22, 2022, to November 28, 2023. The deidentified content of messages was retained as a part of ongoing quality assurance. Treatment was asynchronous text-based counseling via an online and mobile therapy app (Talkspace). Therapists were licensed to provide mental health treatment and were either independent contractors or employees of the product company. Participants were self-referred via online sign-up and received services via their insurance or self-pay and were assigned a diagnosis from their health care professional. All clients received counseling services from a licensed mental health clinician. The primary outcomes were client engagement in counseling (number of weeks), treatment satisfaction, and changes in client symptoms, measured via the 8-item version of Patient Health Questionnaire (PHQ-8). A previously trained, transformer-based, deep learning model automatically categorized messages into types of therapist interventions and summaries of clinical content. The total sample included 166 644 clients treated by 4973 therapists (20 600 274 messages). Participating clients were predominantly female (75.23%), aged 26 to 35 years (55.4%), single (37.88%), earned a bachelor's degree (59.13%), and were White (61.8%). There was substantial variability in intervention use and treatment content across therapists. A series of mixed-effects regressions indicated that collectively, interventions and clinical content were associated with key outcomes: engagement (multiple R = 0.43), satisfaction (multiple R = 0.46), and change in PHQ-8 score (multiple R = 0.13). This quality improvement study found associations between therapist interventions, clinical content, and client-reported outcomes. Consistent with traditional forms of counseling, higher amounts of supportive counseling were associated with improved outcomes. These findings suggest that machine learning-based evaluations of content may increase the scale and specificity of psychotherapy research.

Physical Therapist Interventions Versus or Combined With Surgical Treatment in Nontraumatic Degenerative Meniscal Pathology: A Systematic Review and Network Meta-Analysis.

This study aimed to synthesize the evidence from randomized clinical trials in people with nontraumatic degenerative meniscal pathology by comparing physical therapist interventions versus or combined with arthroscopic partial meniscectomy (APM). Seven electronic databases were searched. Methodological quality was evaluated using the Physiotherapy Evidence Database scale. Data synthesis was performed with random-effects network meta-analysis, and results were summarized using the standardized mean differences. From 2103 studies, 10 randomized clinical trials comprising 1411 individuals were included. Ninety percent of the selected randomized clinical trials were classified as good quality according to the Physiotherapy Evidence Database scale. All interventions (physical therapist interventions, APM, and APM plus physical therapist interventions) showed reduced pain and physical impairments at 3-month follow-up. However, when a physical therapist intervention was included, greater reductions in pain at rest (APM vs physical therapist interventions: 0.73 [95% CI = 0.20 to 1.26]; APM vs APM plus physical therapist interventions: 0.59 [95% CI = 0.15 to 1.03]) and greater increases in the strength of knee extensor muscles (APM vs physical therapist interventions: 0.44 [95% CI = 0.07 to 0.80]; APM vs APM plus physical therapist interventions: 0.73 [95% CI = 0.29 to 1.16]) were observed at 3months. By contrast, no differences were found between treatments beyond 3months. Physical therapist interventions based on exercise programs demonstrate superior short-term outcomes in pain reduction and knee extensor strength compared to surgical treatment. For nontraumatic degenerative meniscal pathology, conservative treatment utilizing a physical therapist intervention approach should be prioritized as the first choice over surgical treatment. It offers comparable or superior short-term pain reduction and strength improvements, with a lower risk of side effects. In cases where surgery is deemed necessary, including postsurgical, physical therapist interventions are highly recommended to enhance muscle strength and alleviate pain.

The Influence of Active, Passive, and Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization.

The aim of this study was to explore associations between the utilization of active, passive, and manual therapy interventions for low back pain (LBP) with 1-year escalation-of-care events, including opioid prescriptions, spinal injections, specialty care visits, and hospitalizations. This was a retrospective cohort study of 4827 patients identified via the Military Health System Data Repository who received physical therapist care for LBP in 4 outpatient clinics between January 1, 2015 and January 1, 2018. One-year escalation-of-care events were evaluated based on type of physical therapist interventions (ie, active, passive, or manual therapy) received using adjusted odds ratios. Most patients (89.9%) received active interventions. Patients with 10% higher proportion of visits that included at least 1 passive intervention had a 3% to 6% higher likelihood of 1-year escalation-of-care events. Similarly, with 10% higher proportion of passive to active interventions used during the course of care, there was a 5% to 11% higher likelihood of 1-year escalation-of-care events. When compared to patients who received active interventions only, the likelihood of incurring 1-year escalation-of-care events was 50% to 220% higher for those who received mechanical traction and 2 or more different passive interventions, but lower by 50% for patients who received manual therapy. Greater use of passive interventions for LBP was associated with elevated odds of 1-year escalation-of-care events. In addition, the use of specific passive interventions such as mechanical traction in conjunction with active interventions resulted in suboptimal escalation-of-care events, while the use of manual therapy was associated with more favorable downstream health care outcomes. Physical therapists should be judicious in the use of passive interventions for the management of LBP as they are associated with greater likelihood of receiving opioid prescriptions, spinal injections, and specialty care visits.

Physical Therapist Interventions to Reduce Headache Intensity, Frequency, and Duration in Patients With Cervicogenic Headache: A Systematic Review and Network Meta-Analysis.

The aim of this study was to assess the efficacy of physical therapist interventions on the intensity, frequency, and duration of headaches, as well as on the quality of life of patients with cervicogenic headache. The following databases were searched up to October 2022: Physiotherapy Evidence Database, Web of Science, Pubmed, and Cochrane Library. Randomized controlled trials assessing the effect of physical therapist interventions on adults with cervicogenic headache were included. Quality appraisal was conducted using the Cochrane risk of bias 2.0 tool and the Confidence in Network Meta-analysis web app. Synthesis methods were conducted in accordance with the Cochrane Handbook. Of the 28 identified reports, 23 were included in the quantitative synthesis. Manipulation plus dry needling was the highest-ranked intervention to reduce the short-term headache intensity (mean difference [MD] = -4.87; 95% CI = -8.51 to -1.24) and frequency (MD = -3.09; 95% CI = -4.93 to -1.25) when compared to a control intervention. Other high-ranked and clinically effective interventions (when compared to a control intervention) were muscle-energy technique plus exercise (MD = 4.37; 95% CI = -8.01 to -0.74), as well as soft tissue techniques plus exercise (MD = -3.01; 95% CI = -5.1 to -0.92) to reduce short-term headache intensity, and dry needling plus exercise (MD = -2.92; 95% CI = -4.73 to -1.11) to reduce short-term headache frequency. These results were based on a low certainty of evidence. The 4 most highly ranked interventions can be considered in clinical practice. However, no conclusive recommendation can be made due to the low certainty of evidence. Combined interventions such as spinal joint manipulation plus dry needling and muscle-energy technique or soft tissue techniques or dry needling plus exercises seem to be the best interventions to reduce short-term cervicogenic headache intensity and/or frequency.