Manual Therapy Program Research Articles

Manual Therapy: Integration into a Speech and Swallowing Rehabilitation Program for Head and Neck Cancer

To describe early response to an adjunct manual therapy program in a speech and swallowing rehabilitation setting for patients with head and neck cancer (HNC).

Effectiveness of Inclusion of Dry Needling in a Multimodal Therapy Program for Patellofemoral Pain: A Randomized Parallel-Group Trial.

Study Design Randomized controlled trial. Background Evidence suggests that multimodal interventions that include exercise therapy may be effective for patellofemoral pain (PFP); however, no study has investigated the effects of trigger point (TrP) dry needling (DN) in people with PFP. Objectives To compare the effects of adding TrP DN to a manual therapy and exercise program on pain, function, and disability in individuals with PFP. Methods Individuals with PFP (n = 60) recruited from a public hospital in Valencia, Spain were randomly allocated to manual therapy and exercises (n = 30) or manual therapy and exercise plus TrP DN (n = 30). Both groups received the same manual therapy and strengthening exercise program for 3 sessions (once a week for 3 weeks), and 1 group also received TrP DN to active TrPs within the vastus medialis and vastus lateralis muscles. The pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS; 0-100 scale) was used as the primary outcome. Secondary outcomes included other subscales of the KOOS, the Knee Society Score, the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and the numeric pain-rating scale. Patients were assessed at baseline and at 15-day (posttreatment) and 3-month follow-ups. Analysis was conducted with mixed analyses of covariance, adjusted for baseline scores. Results At 3 months, 58 subjects (97%) completed the follow-up. No significant between-group differences (all, P>.391) were observed for any outcome: KOOS pain subscale mean difference, -2.1 (95% confidence interval [CI]: -4.6, 0.4); IKDC mean difference, 2.3 (95% CI: -0.1, 4.7); knee pain intensity mean difference, 0.3 (95% CI: -0.2, 0.8). Both groups experienced similar moderate-to-large within-group improvements in all outcomes (standardized mean differences of 0.6 to 1.1); however, only the KOOS function in sport and recreation subscale surpassed the prespecified minimum important change. Conclusion The current clinical trial suggests that the inclusion of 3 sessions of TrP DN in a manual therapy and exercise program did not result in improved outcomes for pain and disability in individuals with PFP at 3-month follow-up. Level of Evidence Therapy, level 1b. Prospectively registered July 27, 2015 at www.clinicaltrials.gov (NCT02514005). J Orthop Sports Phys Ther 2017;47(6):392-401. doi:10.2519/jospt.2017.7389.

Additional Effect of Static Ultrasound and Diadynamic Currents on Myofascial Trigger Points in a Manual Therapy Program for Patients With Chronic Neck Pain: A Randomized Clinical Trial.

To assess the additional effect of static ultrasound and diadynamic currents on myofascial trigger points in a manual therapy program to treat individuals with chronic neck pain. A single-blind randomized trial was conducted. Both men and women, between ages 18 and 45, with chronic neck pain and active myofascial trigger points in the upper trapezius were included in the study. Subjects were assigned to 3 different groups: group 1 (n = 20) was treated with manual therapy; group 2 (n = 20) was treated with manual therapy and static ultrasound; group 3 (n = 20) was treated with manual therapy and diadynamic currents. Individuals were assessed before the first treatment session, 48 hours after the first treatment session, 48 hours after the tenth treatment session, and 4 weeks after the last session. There was no group-versus-time interaction for Numeric Rating Scale, Neck Disability Index, Pain-Related Self-Statement Scale, pressure pain threshold, cervical range of motion, and skin temperature (F-value range, 0.089-1.961; P-value range, 0.106-0.977). Moreover, we found no differences between groups regarding electromyographic activity (P > 0.05). The use of static ultrasound or diadynamic currents on myofascial trigger points in upper trapezius associated with a manual therapy program did not generate greater benefits than manual therapy alone.

Manual therapy program induced alterations in autonomic nervous system modulation of students preparing to apply for the universities: One-group, pre- and post-test study

OBJECTIVES: We aimed to appraise the effects of a manual therapy program (MTP) on stress by modulation of autonomic nervous system evaluated by rate heart variability before and after the treatment. METHODS: The study design used was quasi-experimental, pre-post-test of MTP. The sessions were applied during 45 min, twice a week, for 9 weeks. Psychological stress was evaluated using adolescents stress questionnaire (ASQ). Beat-to-beat rate heart frequency (HR, bpm) were recorded in 16 young healthy volunteers (19-20 years old; 8 women) 15 min before and after the first and the last session with S810i - Polar® -Finland in supine position. Descriptors of the Poincare plot and time domain of HR variability (HRV) were analyzed in 5 min (Kubios HRV Analysis Software). STATISTICAL ANALYSIS: ANOVA followed Tukey or Bonferroni and t Student tests paired and unpaired tests, considering p<0.05 as significant. RESULTS: MTP reduced ASQ values from 143 ± 8 to 114 ± 6 and HR from 81+4 to 71+2 bpm. Significantly effects were also found post-MTP in HRV time domain, analyzed at linear and geometric way, sowing an overall increased on parasympathetic tonus and on global activity of heart. CONCLUSION: The students enrolled in the MTP showed improved psychological and physiological health status from pre to post-treatment and the increased on parasympathetic tonus and in the global activity of heart contributed to this effect.

Impact of a Four-Session Physical Therapy Program Emphasizing Manual Therapy and Exercise on the Balance and Prosthetic Walking Ability of People with Lower-Limb Amputation: A Pilot Study

ABSTRACT Purpose No consensus exists regarding best practice for prosthetic rehabilitation programs after unilateral lower-limb amputation. A program integrating manual therapy with exercise for people using lower-limb prostheses has not been systematically investigated. The objectives of this pilot study were to determine whether a four-session physical therapy program of manual therapy, exercise, and functional training would (1) be feasible for people with lower-limb amputation and (2) produce medium to large effect size changes in balance and walking ability and self-reported prosthetic function. Methods Five subjects were recruited for this pretest-posttest design pilot study. Outcome measures included self-report scales (Houghton Scale, Prosthetics Evaluation Questionnaire, fear of falling, and Activities-Specific Balance Confidence) and clinical performance assessments: Berg Balance Scale, 2-minute walk test, and timed up and go test. One week after the four-session manual therapy, exercise, and functional training program concluded, measures were reassessed. Effect size d and Wilcoxon P values were calculated. Results Five subjects (average age, 54.0 years), with unilateral amputations of mixed etiology and level, completed the study without adverse event. Berg Balance Scale (d = 1.7, p &lt; 0.05), timed up and go (d = 1.05, p &gt; 0.05), and 2-minute walk test (d = 1.18, p &lt; 0.05) had large effect size changes. Conclusions A four-session program of manual therapy, exercise, and functional training proved feasible and increased balance and walking ability in people with lower-limb amputation. Controlled research to determine the effects of manual therapy and exercise in this population appears warranted.

Bringing Masters' level skills to the clinical setting: What is the experience like for graduates of the Master of Science in manual therapy programme?

IntroductionThe nursing profession has been influential in conducting research to investigate the effect of continuing education programs on clinical practice. This research has indicated positive gains in competencies and behaviors, such as, becoming more research positive and dynamic as practitioners. There is, however, a dearth of studies investigating the clinical impact of Masters degrees in the physiotherapy profession. Purpose: The purpose of this study was to explore physiotherapists' experiences of change and/or development in their clinical practice after successfully completing a Masters in manual therapy degree. Study design and methodology: An exploratory qualitative, specifically phenomenological, approach was used. Semi-structured telephone interviews were conducted with seven Masters degree graduates, audio-taped, and transcribed. A foundational thematic analysis approach was used to analyze the data. Findings: Four main themes were identified: (1) precision thinking – an ability to integrate new skills and knowledge, so that care was patient-centered and based on available research evidence. (2) Clinical outputs – development of “ingenuity” in delivering efficient clinical practice. (3) Professional outputs – assuming an enhanced professional role (role model, education resource, and lifelong learner) in the workplace and acknowledging personal development. (4) Expectations – reviewing the relevance of pre-course expectations. Conclusions: This study provided evidence for the applicability to practice of the knowledge and skills gained in Masters education and suggested that the participants experienced substantial positive change across a broad spectrum of professional and personal issues.

Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation

Objective To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people.Design Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention...

Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial

BackgroundThis randomised, single-blind controlled pilot trial aimed to determine the effectiveness of a physiotherapy program, including exercise and manual therapy, in reducing impairments and improving physical function and health-related quality of life in people with a history of painful osteoporotic vertebral fracture.Methods20 participants were randomly allocated to an intervention (n = 11) or control (n = 9) group. The intervention group attended individual sessions with an experienced clinician once a week for 10 weeks and performed daily home exercises with adherence monitored by a self-report diary. The control group received no treatment. Blinded assessment was conducted at baseline and 11 weeks. Questionnaires assessed self-reported changes in back pain, physical function, and health-related quality of life. Objective measures of thoracic kyphosis, back and shoulder muscle endurance (Timed Loaded Standing Test), and function (Timed Up and Go test) were also taken.ResultsCompared with the control group, the intervention group showed significant reductions in pain during movement (mean difference (95% CI) -1.8 (-3.5 to -0.1)) and at rest (-2.0 (-3.8 to -0.2)) and significantly greater improvements in Qualeffo physical function (-4.8 (-9.2 to -0.5)) and the Timed Loaded Standing test (46.7 (16.1 to 77.3) secs). For the perceived change in back pain over the 10 weeks, 9/11 (82%) participants in the intervention group rated their pain as 'much better' compared with only 1/9 (11%) participants in the control group.ConclusionDespite the modest sample size, these results support the benefits of exercise and manual therapy in the clinical management of patients with osteoporotic vertebral fractures, but need to be confirmed in a larger sample.Trail registrationNCT00638768

Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial

Objective To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease.Design Randomised, participant...

Short-Term Effects of Manual Therapy on Heart Rate Variability, Mood State, and Pressure Pain Sensitivity in Patients With Chronic Tension-Type Headache: A Pilot Study

Objective The purpose of this study was to investigate the immediate effects of head-neck massage on heart rate variability (HRV), mood states, and pressure pain thresholds (PPTs) in patients with chronic tension-type headache (CTTH). Methods Eleven patients (8 females), between 20 and 68 years old, with CTTH participated in this crossover study. Patients received either the experimental treatment (massage protocol) or a placebo intervention (detuned ultrasound). Holter electrocardiogram recordings (standard deviation of the normal-to-normal interval, square root of mean squared differences of successive NN intervals, index HRV, low-frequency component, and high-frequency component), PPT over both temporalis muscles, and Profile of Mood States questionnaire (tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue, confusion) were obtained preintervention, immediately after intervention, and 24 hours postintervention. Self-reported head pain was also collected preintervention and 24 hours postintervention. Separate analyses of covariance (ANCOVAs) were performed with each dependent variable. The hypothesis of interest was group × time interaction. Results The ANCOVA showed a significant group × time interaction for index HRV (F = 4.5, P = .04), but not for standard deviation of the normal-to-normal interval (F = 1.1, P = .3), square root of mean squared differences of successive NN intervals (F = 0.9, P = .3), low-frequency component (F = 0.03, P = .8), or high-frequency component (F = 0.4, P = .5) domains. Pairwise comparisons found that after the manual therapy intervention, patients showed an increase in the index HRV ( P = .01) domain, whereas no changes were found after the placebo intervention ( P = .7). The ANCOVA also found a significant group × time interaction for tension-anxiety (F = 5.3, P = .03) and anger-hostility (F = 4.6, P = .04) subscales. Pairwise comparisons found that after the manual therapy intervention, patients showed a decrease in tension-anxiety ( P = .002) and anger-hostility ( P = .04) subscales, whereas no changes were found after the placebo intervention ( P > .5 both subscales). No significant changes were found in PPT levels (right F = 0.3, P = .6, left F = 0.4, P = .5). A significant group × time interaction for pain (F = 4.8, P = .04) was identified. No influence of sex was found (F = 1.5, P = .3). Pairwise comparisons showed that head pain (numerical pain rating scale) decreased 24 hours after manual therapy ( P < .05) but not after the placebo intervention ( P = .9). Conclusions The application of a single session of manual therapy program produces an immediate increase of index HRV and a decrease in tension, anger status, and perceived pain in patients with CTTH.

Cost effectiveness of two rehabilitation programmes for neck and back pain patients: A seven year follow-up

The cost effectiveness of work-oriented rehabilitation for persons on long-term sick leave needs to be assessed. This prospective observational study presents a follow-up seven years after rehabilitation using two different evidence-based work-oriented regimens. Individuals on sick leave for neck and back pain were referred to two rehabilitation programmes in Sweden. The first programme was a relatively low-intensity programme based on orthopaedic manual therapy and exercise programme (OMTP). The second programme was a full-time multidisciplinary programme (MDP). The primary outcome was sickness absence seven years after intervention. Cost effectiveness was calculated on the basis of loss of production due to sickness absence. The results show that participants referred to MDP and with less than 60 sick days before rehabilitation have reduced sickness absence after intervention as compared to matched controls. This corresponds to a cost reduction of about 94,494 EUR per referred individual. Further, the results indicate that participants of the OMTP who have more than 60 sick days before rehabilitation have a statistically significant increased risk of disability pension. This means increased cost in terms of loss of production of 44,593 EUR per referred individual. The results of this study show that MPD but not OMTP achieves the goal of working life-oriented rehabilitation. A direct comparison between the rehabilitation programmes strengthened the assumption that long-term sickness absence prior to rehabilitation is associated with more days on sick leave after rehabilitation. This analysis also indicated the importance of participants’ pain self-efficacy beliefs and recovery beliefs on rehabilitation outcome.

Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study

Objective: To evaluate if a comprehensive manual therapy programme reduces sick leave due low back pain and facilitates return to work more than the conventional optimized activating care. Design: A randomized controlled trial over a 10-week period with a two-year follow-up. Setting: Primary health care and Visby Hospital, Municipality of Gotland, Sweden. Subjects: One hundred and sixty patients (70 women, 90 men, ages 20—55 years) with acute or subacute low back pain with or without pain radiation into the legs. Interventions: Standardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89). Main measures: Sick leave measured as net sick leave volume, point prevalence and return to work. Results: After 10 weeks, significantly more manual therapy patients than reference patients had returned to work (hazards ratio 1.62, 95% confidence interval (CI) 1.006—2.60, P<0.05), and among those on sick leave at baseline, significantly fewer were still on sick leave (8/58 versus 13/40, ratio 0.35, 95% CI 0.13—0.97, P<0.05). For all other measures there were inconclusive differences in favour of the manual therapy group. No significant differences remained after two years. Conclusions: The manual therapy programme used in this study decreased sick leave and increased return to work more than the standardized optimized activating care only up to 10 weeks but not up to two years.

Select Modalities

Physical rehabilitation modalities such as therapeutic ultrasound (TU), transcutaneous electrical neuromuscular stimulation (TENS), neuromuscular electrical stimulation (NMES), cold or low-level laser therapy (LLLT), and pulsed magnetic field therapy (PMF) can all, when used properly, assist in treating orthopedic injuries, neurological conditions, and chronic conditions brought about by normal aging in our small animal companions. TU uses sound waves to produce both thermal and nonthermal effects that aid in tissue healing, repair, and function. TENS uses different frequencies of electrical current to decrease pain and inflammation. NMES also uses an electrical current to stimulate muscle contraction to assist in normal neuromuscular function in postorthopedic and neurological injuries. LLLT uses light energy to reduce pain, decrease inflammation, and stimulate healing at a cellular level. PMF uses magnetic field to stimulate normal cellular ion exchange and oxygen utilization and promote generalized healing of tissues. These modalities are discussed in detail covering mechanism of action, parameters, settings, and indications/contraindications of use in our small animals. Although these modalities are important in the physical rehabilitation of small animals, they need to be incorporated with a proper diagnosis, manual therapy, and home exercise program into a specific and individualized patient treatment protocol.

EFFECT OF EXERCISE AND MANUAL PHYSICAL THERAPY ON SHOULDER FUNCTION AMONG SLAUGHTERHOUSE WORKERS WITH SHOULDER IMPINGEMENT SYNDROME.

This study was carried out in a slaughterhouse in Zagazig City during the year 2005-2006 among a group of 115 slaughterhouse workers selected randomly and performing sustained intensive manual work. Another group of 80 clerks working in Zagazig Faculty of medicine performing light manual work was selected randomly as a control group. The study was done in 2 stages : The 1st stage was a comparative cross-sectional study, aiming to determine the prevalence of shoulder impingement syndrome ( SIS) among the study workers.The 2nd stage was an intervention study, done to assess the effect of exercise and manual physical therapy program on shoulder function among workers with shoulderimpingement syndrome. A total number of one-hundred and ninety five workers were interviewed using a preconstructed questionnaire. Those workers who had recurrent 143 Egyptian Journal of Occupational Medicine, 2007; 31 (1) : 143 - 162144 El-Laithy N. et. al shoulder pain during the previous 3 months or more were subjected to standardizedphysical examination using impingement sign, assessment of shoulder function and magnetic resonance imaging to those clinically diagnosed as SIS. Also an intervention program of exercise and manual therapy for a period of 6-weeks was carried out to those workers with SIS.he results revealed that the prevalence of SIS was higher among the laughterhouseworkers (13.9 % ) compared to the control workers(2.5%). SIS symptoms and signs were more frequently recorded among the slaughterhouse workers when compared with the controls. Also among those currently complaining of SIS symptoms or those who has had SIS signs, only 15.6% and 2.5% have positive impingement sign among slaughterhouse workers and their controls respectively. The most reliable findings of magnetic resonance imaging were the presence ofindentations upon the subacromial fat denoting impingement in 12 patients (66.7%),supraspinatus tendonitis with indentation upon subacromial fat denoting impingement in 4 patients (22.2%) & left supraspinatus tear in 2 patients (11.1%) from 18 slaughterhouse workers diagnosed clinically as SIS and supraspinatus tendonitis with impingementin 2 patients (100.0%) from the control group with a total percentage of 13.9% and 2.5% workers with SIS among slaughterhouse workers and their controls respectively. Studying some personal and occupational factors thought to be related to the prevalence of SIS revealed that, SIS was prevalent in middle aged workers who smoke and were worked in the current occupation for more than ten years.The results of the intervention program illustrated that there were significant improvement in range of motion, pain, strength and function of the shoulder in workers with SIS after 6- weeks of exercise and manual physical therapy program.In conclusion, sustained intensive manual work such as in slaughterhouse workers was associated with high frequency of SIS. A 6 week exercise with manual physicaltherapy program in patients with SIS was resulted in improvement of range of motion, pain and function of the shoulder. So, work organization especially reduction of exposure time and early intervention are needed in tasks in which there are combinations of force, repetition and sustained arm elevation.

Outcome of laryngeal manual therapy in four Dutch adults with persistent moderate-to-severe vocal hyperfunction: a pilot study

A relatively new management strategy for the treatment of voice disorders is the use of laryngeal manual therapy. The main purpose of the present pilot study is to document the outcome of vocal quality after a well-defined laryngeal manual therapy (LMT) program. Four Dutch professional voice users with a persistent moderate or severe muscle tension dysphonia were studied pretreatment (1 week before LMT) and posttreatment (1 week) after completion of manual therapy (25 sessions). These subjects had received several months of traditional voice therapy, without any success. To measure and compare, the effect of LMT objective and subjective assessment techniques were used. Perceptual voice assessment included a perceptual rating of the voice using the GRBAS scale. Furthermore, the vocal quality in this population was modeled by means of the Dysphonia Severity Index (DSI). All of the subjects selected for LMT showed improvement in perceptual vocal quality and DSI values. As the DSI is a weighted variable including aerodynamic and acoustic measures, small improvements (closer to 5) are very indicative of vocal quality improvement. The use of LMT in professional voice users with persistent moderate-to-severe muscle tension dysphonia, especially in some subjects who have not responded to traditional voice therapy, is supported by this pilot study.

Manual Therapy and Pain Changes in Patients with Migraine ? An Open Pilot Study

The purpose of the study was to investigate the results of a manual therapy program, composed of hot pack, classical massage and connective tissue manipulation, in 30 female patients with migraine. The treatment lasted for a total of 20 sessions. The subjects were evaluated before and after the treatment and also controlled 6 months after the treatment. The evaluations were consisted of: assessment of pain intensity, frequency, accompanying symptoms (vomiting, nausea, phonophobia and difficulty to concentrate) and number of analgesic drugs used in a month. In comparison with the results of data obtained from the evaluations prior to and after the treatment, statistically significant decreases were determined in pain intensity, frequency, accompanying symptoms and number of analgesic drugs used in a month (p 0.05). In conclus...

Cost-minimisation analysis of three conservative treatment programmes in 180 patients sick-listed for acute low-back pain

Objective - To perform a cost-minimization analysis of three conservative treatment regimes for acute low-back pain (LBP). Design - A prospective randomized clinical trial. Patients were assigned at random to one of three treatment programmes: General Practitioner Programme (GPP-) controls, Manual Therapy Programme (MTP) or Intensive Training Programme (ITP). Setting - Primary care and physiotherapists in Stockholm, Sweden. Patients - 180 patients sick-listed for acute LBP. Main outcome measures - Direct, indirect and total costs for three treatment programmes. Results - The direct costs for treatment were lowest in the GPP group - 2744 Swedish crowns (SEK) per patient. More patients in the MTP and ITP underwent operations for disk hernia and radiological investigations than in the GPP. Indirect costs, defined as sick-leave for LBP represent about 90% of the total cost. Conclusions - With respect to total costs, the findings were similar between the three treatment programmes. The GPP had the lowest direct costs. It is not possible to conclude which treatment programme is to be recommended as a least cost alternative. The strong effect of indirect costs on the total cost stresses that further studies should focus on methods of shortening sick-leave.