Outpatient Physical Therapy Clinic Research Articles

Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial.

The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. Randomized, single-blinded, multicenter, parallel-group trial. Thirteen outpatient physical therapy clinics in nine different US states. One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy.Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017.

Cerebral palsy risk in relation to parental age: insights from a matched case-control study

BackgroundCerebral palsy, a prevalent childhood physical disability, exhibits complex multifactorial causes. This case-control study explores the role of parental age in cerebral palsy risk and associated patterns.MethodsA case-control study comparing children with cerebral palsy at ages 3 months to 3 years with age-matched healthy control subjects was conducted between January 2022 and August 2023 at Federal Medical Centre, Abeokuta, Nigeria. Cases were recruited from the pediatric physiotherapy outpatient clinic, while controls were selected from pediatric and children emergency wards. Data were collected retrospectively from electronic medical records. Risk factors were evaluated using conditional logistic regression models.ResultsWe studied 134 subjects with cerebral palsy and 134 age-matched control subjects. Significant risk factors for cerebral palsy included the maternal age 35–39 years (odds ratio 2.16, P < 0.005), maternal age ≥ 40 years (odds ratio 3.83, P < 0.005), paternal age 41–45 (odds ratio 2.00, P < 0.05), paternal age ≥ 46 (odds ratio 6.80, P < 0.05), primiparous (odds ratio 2.2, P < 0.05), paternal low income (odds ratio 2.49, P < 0.05), paternal primary education (odds ratio 24.61, P < 0.05), and maternal primary education (odds ratio 2.39, P < 0.05).ConclusionsThis research contributes to our understanding of parental age as risk factors associated with cerebral palsy in children. The results also underscore the importance of demographic and socioeconomic factors, especially father’s level of income, maternal parity, and parental education. These findings can guide future research and public health interventions aimed at reducing the burden of cerebral palsy.

Reliability and validity of the Turkish version of the Health Care Satisfaction Questionnaire in patients with spinal pain.

The concept of satisfaction is an important concept because of the information it provides about both the quality of health services and the patients' utilization of the health services they receive. The aim of this study was to test the validity and reliability of the Turkish version of the Health Care Satisfaction Questionnaire (HCSQ). The study sample consisted of 148 patients who received exercise therapy for spinal pain. Psychometric evaluations were analyzed using the Turkish version of the HCSQ (confirmatory factor analysis, convergent validity, test-retest reliability). Convergent validity was determined by examining the relationship between the scale and the Numeric Rating Scale (NRS), Patient Satisfaction Scale for Physiotherapy Outpatient Clinics (PSSPOC) , and the Patient Satisfaction Scale in Physiotherapy (PSSP). The HCSQ showed excellent internal consistency (Cronbach's a=0.96) and excellent test-retest reliability (intraclass correlation coefficient=0.944). The HCSQ showed high correlation with NRS, PSSPOC , and PSSP. The HCSQ is a valid and reliable tool for assessing satisfaction with health care services in the Turkish population with spinal pain.

A multicenter feasibility randomized controlled trial using a virtual reality application of pain neuroscience education for adults with chronic low back pain

Background Chronic low back pain (CLBP) is a highly prevalent condition among adults and is correlated to high levels of pain, high disability, and lower quality of life. Pain neuroscience education (PNE) helps to explain the pain experience and can affect psychosocial factors, such as fear of movement, anxiety, socioeconomic status, work life satisfaction, etc. More recently, virtual reality (VR) programs have emerged allowing for immersive PNE experiences. Objective The purpose of this randomized clinical trial is to determine the feasibility of using a VR application for the delivery of immersive PNE (VR-PNE) and other activity training for patients with CLBP presenting to outpatient physical therapy (PT) clinics. Methods A two-arm, parallel group, randomized controlled feasibility trial of patients was conducted at 12 outpatient PT clinics from March 9, 2022, through September 9, 2022. The intervention group received PT as usual and VR-PNE while the control group received PT as usual. Between group feasibility, acceptability outcomes and other patient-reported outcomes were assessed at six weeks. Results: A total of 595 individuals were evaluated for low back pain during the recruitment period. Seventy individuals were eligible and met definition for CLBP, 52 enrolled and 32 completed the trial. Participant adherence was 63.6% for VR-PNE and 63.2% for PT as usual. Participants found VR-PNE acceptable and reported satisfaction scores (0–100) of 87.37 ± 11.05 compared to 81.17 ± 23.72 in the PT as usual group. There were no significant differences between groups for the BBQ, BRS, FABQ-PA, FABQ-W, GROC, NPRS, NPQ, PCS, and PSEQ at 6 weeks. Conclusion The results of the trial suggest that VR-PNE may be acceptable and feasible for patients with CLBP. Study procedures and PT delivery modifications should be considered for the next iteration of this study to improve follow-up assessment rates.

Missed Physiotherapy Appointment and Its Influence on Cost, Efficiency and Patients' Outcomes.

Missed appointments is a significant challenge to efficient running of physiotherapy departments and it has cost implications. In this study, wait time, and pattern, predictors and impact of Missed appointments (MAs) on cost, efficiency and recovery time was assessed among Nigerian patients receiving physiotherapy. In this retrospective study a total of 3,243 physiotherapy appointments were booked between 2009 and 2019 at an Outpatient Physiotherapy Clinic in Nigeria. Data were collected on Missed appointments, on costs of of treatment and on socio-demographic characteristics. The total revenue loss due to missed appointments was calculated as a product of the total of Missed appointments and cost per treatment; recovery time was also estimated. Missed appointments were 1,701 out of 3,243 booked (52.5%) and the average wait time for the first appointment was 9.6 ± 23.2 days. The proportion of Missed appointments was higher among females (50.2%), patients who were not resident of the same location as the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from an orthopaedic surgeon (32.8%). Females, those who live within the city, and those with neurological/medical conditions were 1.68, 1.24, and 1.52 times more likely to have Missed appointments compared to males (OR = 1.68, Confidence intervals = 1.44 - 1.96, p = < 0.001), those who live outside the city (OR = 1.24, CI = 1.05 - 1.46, p = 0.01), and to those who have orthopaedic conditions (OR = 1.52, CI = 1.20 - 1.93, p = < 0.001), respectively. Using per treatment schedule cost of N1000 (an equivalent of $ 2.31), a 52.5% Missed appointments rate resulted in lower efficiency of 76.6% with an efficiency ratio of 0.23. Further, a 52.5% Missed appointments rate could potentially impact patient recovery time by 3402 days if Missed appointments slow a patient recovery process by 2 days. Missed appointments for physiotherapy treatment pose a significant challenge in terms of costs, efficiency, and patient recovery time. Thus, an innovative reminder system may help reduce patients' non-attendance to physiotherapy and its consequences.

Efficacy of lumbar motor control training in treatment of patients with cervicogenic headache

BackgroundCervicogenic headache (CGH), is a secondary headache arising from cervical disorders. Training core muscles have a corrective effect on the whole spine. Moreover, increased deep neck flexors (DNFs) activation is closely linked with balanced core stabilization of the global cervical-thoracic-lumbopelvic chains. This study aimed to investigate the effect of lumbar motor control training combined with cervical stabilization exercises compared to cervical stabilization exercises alone in CGH patients.MethodsFifty-two subjects of both genders with CGH and chronic mechanical neck pain (CMNP) participated in this study. They were recruited from the outpatient Physical Therapy Clinic at Mubarak Central Hospital, Giza, Egypt; their mean age was 28.1 ± 5.8 years and their BMI was 22.8 ± 1.6 kg/m2. They received treatment for three sessions per week for 4 weeks. Subjects were assigned randomly into two equal groups; the control group: received cervical stabilization exercises (axial elongation, cranio-cervical flexion, cervical extension, rowing, and Y-exercise). Study group: received cervical stabilization exercise in addition to lumbar motor control training (abdominal draw-in maneuver, side plank, and quadruped position), each exercise had a 4-week progression. Headache frequency, duration, intensity by visual analog scale (VAS), and neck functional disability by Neck Disability Index (NDI) were measured before the first session and after the last session of the 4 weeks of treatment.ResultsThere was a high statistically significant difference in post-treatment mean values of headache frequency, headache duration, headache intensity, and neck functional disability between the two groups in favor of the study group.ConclusionAdding lumbar motor control training to cervical stabilization exercise is more effective than cervical stabilization alone in decreasing headache frequency, duration, intensity, and neck functional disability in CGH patients with CMNP.Trial registrationNCT05952115. Registered 11 July 2023-retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4.

Differences in Pain Experience Among Different Racial and Ethnic Groups.

The objective of this study was to examine the role of pain catastrophizing and pain self-efficacy as possible mediators of race-based differences in pain intensity, and to evaluate the possible moderating role of race on the relationship between pain catastrophizing and pain self-efficacy with pain outcomes among persons with chronic spinal pain receiving physical therapy. This study was a secondary analysis of a cluster-randomized trial. Participants were persons with chronic spinal pain in outpatient physical therapy clinics who consented to complete assessments at baseline and after 2weeks and 12weeks. Assessments included pain intensity, physical function, pain catastrophizing, and self-efficacy. Baseline comparisons between Black and non-Hispanic White participants were made. Mediation analyses used a regression-based framework to examine whether baseline pain catastrophizing and self-efficacy mediated the association between race and pain intensity. Moderation analyses used multiple linear regression to evaluate the role of race in the relationship of baseline pain catastrophizing and self-efficacy with 12-week pain intensity outcomes. A total of 274 participants were included (51 [18.6%] Black and 223 [81.4%] non-Hispanic White; mean age = 51.6years [SD = 14.9]; 180 [65.7%] female). At baseline, Black participants had higher pain intensity scores (mean difference = 0.80; 95% CI = 1.5 to 0.12). Both pain catastrophizing and self-efficacy mediated the relationship between race and baseline pain intensity. Race moderated the relationships between baseline pain catastrophizing and self-efficacy and 12-week pain intensity scores. Pain catastrophizing and self-efficacy had differential impacts on pain intensity based on race for both cross-sectional and longitudinal analyses among persons receiving physical therapy for chronic spinal pain. Improved understanding of the differences in pain experience based on factors such as race, ethnicity, cultural background, and experience with the health care system may help reduce disparities in pain management.

EFFECTS OF RELAXING MUSIC THERAPY ALONG WITH TASK-ORIENTED TRAINING OF LOWER LIMB ON BALANCE AND FUNCTIONAL INDEPENDENCE IN PATIENTS WITH CHRONIC STROKE: A RANDOMIZED CLINICAL TRIAL

Background of the Study: To compare the effects of relaxing music therapy with task-oriented training of lower limbs on the balance and functional status in patients with chronic stroke. Methodology: This randomized clinical trial was conducted in three outpatient physiotherapy clinics in Lahore, Pakistan. A sample of 76 participants with chronic stroke, aged 40-60 years, and on assistance walking, were recruited through a purposive sampling technique. Individuals who had physical impairments and visual or hearing deficits were not included in the study. Group A received task-oriented training with routine physical therapy while Group B received Music therapy additionally. Three sessions on alternate days per week for eight weeks were given. Balance and functional independence were the outcome variables measured using the Berg Balance Scale and Functional Independence Measure respectively. Mann-Whitney U test and Friedman ANOVA were applied for between-group and within-group differences respectively. P-value was significant at ≤0.05. Results: The mean age of participants was 54.05 ± 3.64 years, the majority i.e., 55 (72.4%) were male, 46 (60.5%) had ischemic stroke and 53 (69.7%) were presented with left-sided weakness. A statistically significant difference was observed among both groups in balance (p =.000) and functional independence (p=0.000). The within-group difference was also significant for balance (p=0.000) and functional independence (p=0.000). Conclusion: The integration of relaxing music therapy, task-oriented training, and routine physiotherapy is effective in improving balance and functional independence in chronic stroke patients. Keywords: Balance, berg balance scale, functional independence, functional independence measure, music therapy, coordination impairment.

EFFECTS OF KINESIO-TAPING VS DRY NEEDLING IN THE MANAGEMENT OF MECHANICAL LOW BACK PAIN

EFFECTS OF KINESIO-TAPING VS DRY NEEDLING IN THE MANAGEMENT OF MECHANICAL LOW BACK PAIN

Improvements in Objective and Patient-Reported Measures of Physical Function Following an 8-Week Exercise Oncology Program

Background: Physical function is often impaired because of cancer and its treatment. Despite this, it is not common to comprehensively assess physical function in clinical practice. The purpose of this study was to examine the changes in objective and patient-reported physical function in adults with a history of cancer who completed an exercise program. Methods: The program was offered 2 d/wk for 8 weeks at an outpatient physical therapy clinic and consisted of resistance and aerobic exercises that were individualized to each participant. Objective physical function was assessed using the Bellarmine Norton Assessment Tool consisting of self-reported physical activity frequency, 2-minute step test, 30-second sit to stand, timed arm curl, Timed Up and Go, and scaled total score. Patient-reported physical function was assessed using the PROMIS-Physical Function (PF) Computerized Adaptive Test (CAT). Results: Significant differences (P &lt; .001) were found for all outcomes demonstrating improvements in objective and patient-reported physical function. Changes in raw and scaled total score for objective physical function displayed large Cohen d effect sizes (ES), physical activity (ES = 0.82), 2-minute step test (ES = 1.00), 30-second sit to stand (ES = 1.01), arm curl (ES = 1.01), Timed Up and Go (ES = 0.85), and scaled total score (ES = 1.31). Changes in PROMIS-PF CAT demonstrated a medium-large effect (ES = 0.78). Conclusion: The effectiveness of the exercise program was supported by significant improvements in objective and patient-reported physical function. The use of such outcomes provides a useful method to understand changes in physical function and supports the development of effective exercise methods for survivors of cancer.

Protocol forthe Implementation ofPsychologically Informed Physical Therapy to Prevent Chronification inService Members With Musculoskeletal Disorders.

Musculoskeletal disorders (MSDs) are a primary cause of separation and long-term disability in active duty service members (ADSMs). Psychologically informed physical therapy (PiPT) is designed to identify and address modifiable psychological risk factors early in an MSD episode and has been proven effective in preventing chronicity in civilian populations. We developed a course to train military physical therapy (PT) personnel in PiPT for treating ADSM with MSD. This study tests the feasibility and effectiveness of our training. Establish the feasibility of implementing PiPT and its effectiveness in the U.S. military. An observational, prospective, comparative cohort study will test implementation and effectiveness. First, we will observe clinical outcomes in a cohort of ADSM with MSD receiving usual PT care at a military outpatient PT clinic. Next, we will train all PT staff in PiPT. Finally, PiPT will be implemented in a second cohort of ADSM. Data will be collected from each cohort at pre-treatment, fourth PT visit, 6 months post enrollment, and 12 months post enrollment. The primary outcomes are pain interference and psychological risk for chronicity. Data collection is ongoing. Findings will identify the factors associated with PiPT outcomes in ADSM, inform the implementation of PiPT across health care settings, and allow us to document the prevalence of risk factors for chronicity in ADSM. Findings can help to prevent chronification from MSD, thereby reducing lost man-hours and enhancing military readiness, contribute to the development of a highly skilled workforce for the provision of health services to ADSM, and enhance the efficiency of health care delivery through optimal allocation of PT resources, resulting in significant cost savings for the military.

The physiotherapist in primary health care: Perception of patients treated at the physiotherapy outpatient clinic in the municipality of Pinheiros - ES

Introduction: For a long time, Physical Therapy was summarized as rehabilitation, after many discussions, the physical therapist becomes a professional active in prevention and health promotion, starting to be part of primary health care, focusing on analyzing the reports of patients who are treated in primary care and how the applicability of possible methods existing within the profession is being. Objective: The objective of the present study was to analyze the perception of patients treated at the Physical Therapy outpatient clinic in the city of Pinheiros - ES and to see the importance of the professional's participation in this environment. Methodology: This is a quantitative, exploratory and descriptive research, where the main complaints and perception of Physical Therapy patients in the public sector of the city of Pinheiros - ES were studied. Results: It was observed that (56%) of the patients perceive little improvement with the treatment, that (28%) they prefer to receive the physiotherapist at their home, that the physiotherapist always clarifies the patients' doubts (68%), that the patients feel safe with the physiotherapeutic conducts (76%), but that they do not see much improvement with the treatment, (96%) of the patients consider the physiotherapist kind and treats them with respect. Conclusion: It is concluded that the perception of users who undergo Physical Therapy in the public sector is positive, even if they see few improvements in their treatment, due to the few sessions, but it ends up leaving something to be desired in terms of the physical therapist clearly explaining the treatment that will be performed.

Influence of aerobic exercise on inhibitory control of executive functions in children with hemiplegic cerebral palsy: A randomized controlled trial

Objective This study investigates the influence of aerobic exercise training on inhibitory control of executive functions in children with hemiplegic cerebral palsy. Design Single-blind randomized controlled trial. Setting Outpatient Physical Therapy Clinic. Participants Children aged 7–11 with left-sided hemiplegic cerebral palsy with emotional and behavioral dysregulation evidenced by scores >28 on Paediatric Symptom Checklist and GMFCS I or II (n = 60). Intervention Participants were randomly allocated into two equal groups. The control group received standard-of-care physical therapy for 1 h, and the aerobic exercise group received standard-of-care physical therapy for 30 min and moderate-intensity continuous exercise on a bicycle ergometer for 30 min. All groups received treatment three times a week for 12 weeks. Main Measures The Eriksen Flanker test and Stroop Color–Word test were used to assess inhibitory control of executive function at the baseline and after 12 weeks. Results Differences between pre- and post-treatment values in the exercise group showed significant improvement in Flanker response accuracy and Stroop response accuracy (p = 0.001) and significant decreases in Flanker congruent reaction time and Stroop congruent reaction time (p < 0.05). However, there were no significant differences between both groups in Flanker incongruent reaction time and Stroop incongruent reaction time (p > 0.05). Conclusions Aerobic exercise has a promising effect on inhibitory control of executive function in children with left-sided hemiplegic cerebral palsy.

The effect of self-assessment on student competence in physiotherapy clinical training: a randomized controlled trial

BackgroundSelf-assessment is a method that allows students to reflect on and critically evaluate their performance, increases students’ involvement in learning, and improves academic achievement. In physiotherapy (PT) education, clinical training is a crucial component, guided by clinical educators (CEs), who assess and provide feedback, fostering student development. Limited research has investigated the impact of self-assessment on PT clinical training outcomes. This study aims to assess the effect of mid-term self-assessment during PT clinical training on students’ competence and on level of agreement between students’ self-assessment and CEs’ assessment at the end of the training.Methods23 CEs and their 52 undergraduate PT students participated in the study. The students underwent eight weeks of clinical training in outpatient PT clinics in groups of two or three. For each group, one CE performed student assessment at the mid-term and the end of the training using the Assessment of Physiotherapy Practice (APP) form, an assessment tool used to evaluate clinical competence in PT clinical training. One student from each group was randomly assigned to join the intervention group (IG). These students completed a self-assessment process at the mid-term of the training. All students were asked to complete a self-assessment form at the end of the training.ResultsThe median CE’s evaluation score halfway through the training was 80 [50–96] and 91 [65–100] at the end of the training, with no significant differences between the two groups. The level of agreement between the student and CE’s evaluation at the end of the training was not significantly different between the groups (p = 0.05). It noted that students who scored themselves higher than their CEs tended to have lower APP scores than others, based on CEs’ assessment. These students were found to have less academic experience. Nevertheless, those from the IG improved significantly, based on the CE’s assessment, during the second half of the training, compared to the controls.ConclusionThe main finding of the present study is that student participation in self-assessment during PT clinical training is advantageous, mainly for individuals undergoing their initial clinical training and in the early stages of their academic studies.

Test-retest reliability of an Android application (Protractor) for range of motion evaluation

Several tools are used by physical therapists to assess the range of motion (ROM) for joints of the upper and lower limbs. However, most of them are costly, time-consuming, and difficult to use. The current study aimed to determine the within-visit test-retest reliability of an android application (App) (Protractor) for elbow, wrist and ankle joints range of motion evaluation in outpatients with post fracture fixation. We evaluated the Android App (Protractor) in twenty-six patients with a mean age of 30 years, who had undergone operative treatment for fractures around the elbow, wrist, and ankle. These patients were recruited from the physiotherapy outpatient clinic at the Faculty of Medicine, Tanta University. Repeated measures were performed within the same session, focusing on motions in the sagittal plane for the elbow, wrist, and ankle joints. All measurements were conducted by the same investigator. Pearson correlation coefficient (r) and intra-class correlation coefficient (ICC) were calculated. Within-visit test retest intra-rater reliability for elbow, ankle, and wrist joints, ROM was excellent (r and ICC≥0.99) except for wrist joint flexion ROM, it was weak and insignificant. The mean group difference of measures obtained in the first and second measurements was close to zero, with the exception of wrist joint flexion, which was -5 degrees, and ankle joint plantar flexion, which was +2 degrees. The Smartphone android App (Protractor) displayed reasonable within-visit reliability.

Instrument Assisted Soft Tissue Mobilization versus Integrated Neuromuscular Inhibition Technique in Nonspecific Chronic Neck Pain: Single-blinding Randomized Trial

ObjectiveThis study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain. MethodsWe performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks. ResultsIn the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only. ConclusionIn this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.

Electrical dry needling versus a non-invasive multicomponent intervention in the treatment of myofascial trigger points in patients with chronic low back pain: A randomised clinical trial

Objective To compare the effects of electrical dry needling with a non-invasive multi-component intervention in patients with chronic low back pain. Design A randomised single-blind clinical trial. Setting Outpatient Physiotherapy Clinic; home. Participants Sixty-four patients with chronic low back pain aged 30–65 years. Interventions Six-week electrical dry needling on myofascial trigger points, and a non-invasive multicomponent intervention (home exercise programme, stretching and ischemic compression). Main measures Pain (Visual Analogue Scale), disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), kinesiophobia (Tampa Scale of Kinesiophobia), quality of life and sleep (Short Form 36-item Health Survey and Pittsburgh Sleep Quality Index), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion (finger-to-floor distance), and pressure pain threshold (algometer) were assessed at baseline, after 6 weeks, and after 2 months. Results ANOVA showed statistically significant differences in group-by-time interaction for most pain pressure thresholds of myofascial trigger points (P < 0.05), for disability (Roland-Morris Disability Questionnaire: F = 6.14, P = 0.016; and Oswestry Disability Index: F = 7.36, P = 0.009), for trunk anteflexion (F = 10.03, P = 0.002) and for habitual sleep efficacy (F = 6.65, P = 0.012), use of hypnotics (F = 4.77, P = 0.033) and total score of quality of sleep (F = 8.23, P = 0.006). Conclusions In comparison to a non-invasive multicomponent intervention, electrical dry needling has more positive effects on disability, pain intensity, kinesiophobia, and reducing patients’ sensitivity to myofascial trigger points pressure, at post-treatment and at 2 months. Clinical Trial Registration number NCT04804228. Registered on May 28th, 2021. Available at https://clinicaltrials.gov/ct2/show/NCT04804228

The Impact of the Addition of a Physical Therapy Assistant to the Treatment Team for Management of Neck Pain: A Retrospective Analysis of Outpatient Physical Therapy Clinics.

Introduction The impact of physical therapy assistants (PTAs) on patient outcomes, mostly in the acute and subacute setting, is well known in the literature. However, no study to date has examined the impact of using PTAs as part of a treatment team in the outpatient setting for common musculoskeletal conditions. The purpose of this study is to determine if physical therapy team composition, either physical therapists (PTs) only or a team consisting of PTs and PTAs, has a significant impact on patient outcomes in adult patients with musculoskeletal neck pain to help investigate an ideal practice pattern for outpatient physical therapy. Methods This is a retrospective cohort study analyzing the impact of physical therapy treatment team composition (PTs only, or team consisting of PTs and PTAs) on pain, active range-of-motion (AROM), and disability outcomes via the Neck Disability Index (NDI) in the conservative treatment of neck pain. All patients were treated with usual physical therapy care. Inclusion criteria involved patients with a diagnosis of neck pain (M48.2), older than 18 years old, a physical therapy evaluation procedure code (97161, 97162, 97163), and at least two visits per bout of physical therapy. Primary outcome measures were pain, bilateral rotation AROM, disability, and number of visits. Results Included patients (n=195) had an average age of 60.8 years ± 16.1 years with an average number of total physical therapy visits of 7.4 visits ± 4.3 visits (range, 2 visits - 22 visits) with 120 patients (61.5%) treated by a PT only (PT-only group) and 75 patients (38.5%) treated by a team consisting of a PT and a PTA (PTA group). The PT-only group had significantly fewer visits than the PTA group (p<0.001). The PT-only group had a pain improvement of 2.1 points ± 2.3 points whereas the PTA group had a pain improvement of 2.2 points ± 2.4 points with no significant difference between the two groups (p=0.573). The PT-only group (n=46 patients) had an average rotation AROM improvement of 20.0 ± 17.4 degrees whereas the PTA group (n=40 patients) had an average rotation AROM improvement of 16.8 degrees ± 23.0 degrees with no significant difference between the level of rotation AROM improvement between the two groups (p=0.408). Furthermore, there was also no significant difference in the amount of NDI improvement seen in both groups (p=0.594). Conclusion There was no significant difference in patient outcomes for pain, AROM, and disability when PTAs were added to the physical therapy treatment team in the conservative management of neck pain in the outpatient setting. However, patients treated with a treatment team consisting of PTAs had significantly more visits, despite no significant change in outcomes. Randomized controlled trials are needed as the reasons for these findings can be many and require further research.

Clinical Outcomes Associated With the Addition of a Physical Therapist Assistant to a Rehabilitation Team When Treating Musculoskeletal Shoulder Pain in the Outpatient Setting: A Retrospective Cohort Study.

Introduction Musculoskeletal shoulder pain (MSP) is a common condition frequently treated in an outpatient setting by a physical therapy rehabilitation team. Treatment teams can consist of physical therapists (PTs) with or without physical therapist assistants (PTAs).It is currently unknown how different physical therapy team compositions can impact patient outcomes in the outpatient setting. The purpose of this study is to examine how the addition of PTAs to a physical therapy treatment team would impact clinical outcomes when treating patients with MSP in the outpatient setting. Methods This study is a retrospective cohort analysis comparing clinical outcomes for pain, active range of motion (AROM), and disability for patients with MSP when treated by physical therapy treatment teams with or without the presence of PTAs.Inclusion criteria were patients treated for MSP in an outpatient physical therapy clinic without a history of shoulder surgery. Depending on the rehabilitation team composition, patients were divided into a PT-only group or a PTAgroup. Results Total patients (n = 238) had a mean age of 62.6 ± 12.6 years (median: 64 years) with a mean total number of physical therapy visits of 7.8 ± 4.9 visits (median: 7.0 visits). Of the entire cohort, the PT-only group had 100 patients and the PTA group had 138 patients. There was no significant difference in the magnitude of pain improvement (mean: 1.5 versus 1.9 points, p = 0.177), the magnitude of abduction AROM improvement (mean: 17.6 versus 13.9 degrees, p = 0.173), and the magnitude of disability improvement (mean: 18.9 versus 13.4 percentage points, p = 0.221) between the PT-only group and the PTA group. However, the PT-only group had significantly fewer total visits as compared to the PTA group (6.7 versus 8.6 visits, p < 0.001). Conclusion The addition of PTAs to a rehabilitation team when treating patients with MSP in the outpatient setting does not appear to adversely impact pain, AROM, or disability outcomes. However, patients treated only by PTs had significantly less visits with similar outcomes. More research is needed to determine the interplay between cost, healthcare utilization, and patient outcomes to maximize quality care.

Rehabilitation Intervention to Restore the Functionality of the Shoulder With Scapular Fracture – Case Report

This report presents an individualized physical therapy program and the therapeutic results for a 36-year-old man with a posttraumatic left scapular body fracture with minimal displacement and without ribs fractures scapular fracture. Because the glenoid fossa was intact, conservative treatment was recommended. The patient reports arm activities dysfunctions. The rehabilitation was conducted in an outpatient physical therapy clinic from Craiova under direct supervision for 12 weeks. At the end of the follow-up period, the level of pain was considerably decreased. Despite the functional deficit from the beginning of the rehabilitation program, normal function was restored. The patient was fully involved and cooperative during the physical therapy session.