Evidence Based Practice and Maitland Flashcards
Study by Hoving et al: Tested patients with non-specific neck pain and placed them into what three groups?
1: Manual therapy (once per week)
2: Physcial therapy (twice per week)
3. Continued care by a general practioner
Hoving study- which group tx is being described: Specific mobilization techniques, soft tissue, and strengthening exercises?
Manual therapy group
Hoving study: which group tx is being described- decompression and exercise therapy
Physical therapy group
Hoving study findings: at 7 weeks the success rates were _% for Manual therapy, _% for physical therapy, and _% for continued care? Which therapy in daily practice has the favorable treatment option (*)?
- 3% for manual therapy* (is favorable treatment option)
- 8% for physical therapy
- 9% for continued care
Hoving study: which treatment was the most cost effective? Which was the most expensive?
Most cost effective was- Manual therapy
Most expensive was- Physical therapy
Cochrane review of manipulation/ mobilization for mechanical neck disorders: what was the most beneficial treatment? When done alone manipulation and/or mobilization were _ _ _. When compared _ was superior. There was _ _ to make conclusions for neck disorder with Radicular findings (arm pain).
Mobilization and/ or manipulation when used with exercise was most beneficial
When done alone manipulation and/ or mobilization were NOT AS BENEFICIAL
When compared NEITHER WAS SUPERIOR
There was INSUFFICIENT EVIDENCE to make considerations for neck disorder with arm pain
According to Boyles study: inclusion or exclusion of cervical thrust manipulation into the manual PT treatment plan _ _ _ the _.
DID NOT INFLUENCE THE RESULTS
Cleland study: _ to _ _ of mobilizations resulted in the best outcomes when directed at the thoracic spine in patients with neck pain.
2 to 3 MINUTES
Cleland study: Subjects who received thrust mobilization/ manipulation experienced _ _ in disability in the short term. What on the GROC (global rating change scale) was considered a success in this study? (3)
Those who received thrust mobilization/ manipulation experienced GREATER REDUCTIONS in disability . . .
GROC measure of success:
- A very great deal better (7)
- A great deal Better (6)
- Quite a bit better (5)
Forbush study: In geriatric population with degenerative cervical radiculopathy (cervical spondyloarthritis) a _ _ approach was used. Included? (3) Results?
A MULTIMODAL CONSERVATIVE APPROACH was used
Included: manual therapy (mobilization/ manipulation) of the upper thoracic and cervical spine, intermittent mechanical traction, and home program including deep cervical flexor strengthening
RESULT: all but one had NO PAIN AFTER DISCHARGE
According to Dunning: cervical manipulation and mobilization received what grade of evidence?
A
According to study by Wainner: Looked at 4 clinical examination findings (+ Spurling’s, + distraction, + UNLT- median nerve, and less than 60 degrees of cervical rotation to involved side) for cervical radiculopathy- 4 out of 4 had specificity of _%, 3 out of 4 had specificity rating of _%, and the best screening test was?
4 out of 4- 99% specificity
3 out of 4- 94% specificity
Best screening test for radiculopathy was UNLT1
Ghasemi study: In addition to using Upper limb tension tests for screening of cervical radiculopathy what 2 other tests are good diagnostic tests for comparison between acute and chronic CR?
Shoulder Abductin test and Spurling’s test
According to Snodgrass: study shows that _ # of traction will result in a change in pain level, _# of traction will not.
20# will result in change
6.7# will not
According to EBP if you are _ _ with cervical manipulation or it is _, adding thoracic spine thrust manipulations to the cervical spine mobilizations and AROM exercises results in _ _ outcomes.
If you are NOT COMFORTABLE with cervical manipulation or it is CONTRAINDICATED, adding thoracic spine thrust manipulations to the cervical spine mobilization and AROM exercises results in SUPERIOR TREATMENT OUTCOMES
According to study by Young: There appears to be no relationship between the amount of traction _ used and _ _ due to ceiling effect however it may affect?
No relationship between the amount of TRACTION FORCE used and PERCEIVED RECOVERY due to ceiling effect, however it may affect PATIENT SATISFACTION
According to Young study: addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields _ _ _ _ to pain, function, or disability in patients with cervical radiculopathy
NO SIGNIFICANT ADDITIONAL BENEFIT
What are the 3 proposed mechanisms as to why manipulations work so well? What is most supported by research*?
1 Mechanical effects
2 Neurophysiological effects* (most supported)
3 Biochemical changes (changes in blood chemistry)
What percent of cardiovascular output goes to the nerves?
25%
What is the new name for traction used by chiropractors as a marketing tool?
Spinal decompression therapy
What angles are recommended for traction for upper versus lower cervical spine?
Upper cervical spine: 0 degrees
Lower cervical spine: 60 degrees
According to Aguino and Schumacher: If you deliver mobilization/ manipulation treatment within - _ of the painful facet you will still improve symptoms. Why is this helpful?
Within 3-4 LEVELS of the painful segment/ facet
It is helpful to know because if the painful facet is too irritable moving up or down 3-4 levels may be more tolerable for the patient and still will have the same result
According to Ronnie et al: _% increase in outcomes if patient has _ out of the _ clinical prediction rules
90% increase if patient has 4 out of the 5 clinical prediction rules present
_, _, _ and _ pain often occur together
THROACIC, SHOULDER, NECK AND ARM pain often occur together
According to Maitland what scenario would be the ideal response to treatment? What would be the worst? (Improved- quick response, completely resolved, improved-slow response, increase in symptoms/ worsening, or no change)
Ideal response: Improved- quick response to treatment
Worst: No change
What is the sequence and selection of techniques (maitland) for unilateral sypmtoms in the cervical spine? (4)
Unilateral PA pressures
- Neutral (push on painful side)
- Rotation (away from painful side)
Traction
Transverse Vertebral pressures (push towards side of pain)
What is the sequence and selection of techniques (maitland) for bilateral cervical spine sypmtoms? (4)
Central PA pressure Bilateral PA pressure Traction -upper cervical in neutral (0 degrees) -lower cervical spine in flexion (60 degrees)
With unilateral PA pressures (for unilateral cervical sypmtoms) pressures should be at a _ degree _ _ on the side of pain with a _ or _ inclination.
Pressures should be at a 30 DEGREE MEDIALLY INCLINED on the side of pain with a CEPHALAD OR CAUDAL INCLINATION
With cervical spine rotation (unilateral PA pressures) you should start with the neck in _/ _ _ position and then move towards?
Start with the neck in a NEUTRAL/ OPEN PACKED position and then move towards the angle of rotation that reproduces the patient’s symptoms/ position of restriction
According to Hoving study: What form of patient intervention resulted in the best outcomes at the lowest cost?
Manual therapy performed by a PT
According to Cochrane Review: There was strong evidence of benefit favoring multimodal care (manipulation/ mobilization plus exercise) for _ and _ _ neck disorders with or without _.
Strong evidence of benefit favoring multimodal care for SUBACUTE AND CHRONIC MECHANICAL neck disorders with our without HEADACHE
In cochrane study: What were the 3 types of thrust manipulations that were applied? Which were applied to the involved side?(*)
Opening restriction*
Closing restriction
Upslope*
Lohman study: what was the main difference between the novice v. Expert hands when applying thoracic spine manipulations? Why?
Novice’s hands have different amounts of pressure applied
Experts hands have more equal distribution of pressure
Why: expert has better body mechanics
According to Cochrane report (2004) cervical manipulation was _ _ mobilization. According to Dunning (2012) cervical manipulation was _ _ mobilization. How many studies were each based on?
Cochrane: cervical manipulation was EQUAL TO mobilization
- based on 33 studies
Dunning: cervical manipulation was SUPERIOR TO mobilization
- based on 1 study
Walker study, 2008: Study was to assess the effectiveness of _ _ _ and () for mechanical neck pain with or without _ _ _ _, as compared to a _ () approach
Assess the effectiveness of MANUAL PHYSICAL THERAPY AND EXERCISE (MTE) for mechanical neck pain with or without UNILATERAL UPPER EXTREMITY SYMPTOMS, as compared to a MINIMAL INTERVENTION (MIN) approach.
Walker study: Allowed for subjects with and without UE symptoms but still falling under mechanical neck disorder umbrella by excluding those subjects with _ _ _ _ _ on the same nerve root level. Limited their intervention to _ _ in an attempt to replicate realistic reimbursement practice patterns.
Excluding those subjects with MORE THAN 2 NEUROLOGICAL SIGNS on the same nerve root level.
Limited their intervention to 6 SESSIONS
Walker study: The impairment based _ program resulted in clinically and statistically _ _ and _ _ improvements in _, _ and _ _ _ compared to _.
The impairment based MTE program resulted in clinically and statistically SIGNIFICANT SHORT AND LONG TERM improvements in PAIN, DISABILITY and PATIENT PERCEIVED RECOVERY compared to MIN.
Walker study: MIN program comprised of _, a _ exercise, and _ _.
Comprised of ADVICE, a _ MOBILITY exercise, and SUB-THERAPEUTIC ULTRASOUND
Walker study found that _ group sought additional care _ as often as the _ group
MIN group sought additional care TWICE as often as the MTE group
Childs study: proposed classification system for patients with neck pain that included _ _, _, _, _ and _
PC CMH
PAIN CONTROL, CONDITIONING, CENTRALIZATION, MOBILITY and HEADACHE
Child study: Those in the mobility category received and intervention to treat either a _ or _ _
Intervention to treat either a OPENING OR CLOSING DSYFUNCTION
Child study: Centralization group received intervention treatment consisting of _ exercises/ _ technique
Consisting of DIRECTIONAL EXERCISES/ MCKENZIE TECHNIQUE
Child study: Pain control group proposed intervention included: gentle _ within pain _, _ exercises for _ _, physical _ as needed, and _ _ to control . Interventions based on the “ patient”
Intervention included: gentle AROM within pain TOLERANCE, ROM exercises for ADJACENT REGIONS, physical MODALITIES as needed and ACTIVITY MODIFICATION to control PAIN
Interventions based on the “IRRITABLE patient”