SMT-1 Flashcards
Dunning et al. (2012) investigated thrust vs. Non-thrust mobilization for mechanical neck pain. What were the comparative percentage decreases in pain, disability and NNT?
Disability: 50.5% vs 12.8%
Pain: 58.5% vs 12.6%
NNT: 1.8 for disability, 2.3 for pain
Dunning et al, (2013) found what about cavitation sounds during their study?
They are bilateral >90% of the time, only slightly more like to occur ipsilateral to target side, with an average of 3-4 cavitations during initial manipulation and 6-7 total after B manipulation
Dunning et al. (2015) found that in patients with shoulder pain that have a negative Neer’s, what effect did 2 sessions of thoracic and rib manipulation have? Include effect size and GRC
Significant difference in SPADI (F=59.9) and NPRS (F= 63); difference remains significant (p<.05) through 3 month f/u
Effect size: d>0.8
GRC: +6.8 at 3 months
Dunning et al. (2016) compared cervical and thoracic mobilization with exercise to HLVAT for cervicogenic headache. What were the differences headache intensity (NPRS), headache frequency, headache duration, disability (NDI), and GRC at 1-week, 4-weeks, 3 months?
Improvements in NPRS, disability (NDI) compared to mobilization at 3-month f/u.
Improvements in headache frequency and headache duration at all time points
Improvements in GRC at 1 and 4 week f/u.
Mourad et al (2018) investigated lumbosacral manipulation sounds and found what?
Sounds were unilateral but no more likely to be target side than contralateral side. Mean number of cavitations was 5 (2-9 sounds).
Mourad et al. wrote up a case study on a patient with craniopharyngioma. What were the red flags that led him to refer her out?
- Recent onset of new type of headache
- Change in headache phenotype
- Rapid progression of Sx
- Neuro signs and Sx
- Worsening of Sx with valsalva
The ACP clinical guidelines recommend spinal manipulation with what level of evidence and strength of recommendation?
Low quality evidence, strong recommendation.
UK (NICE) guidelines of non-specific LBP include which manual Tx?
Up to 9 sessions of manual therapy including spinal manipulation over 12 weeks.
Up to 10 sessions of acupuncture over 12 weeks.
Haskins et al. (2012) concluded what after studying 25 LBP clinical prediction rules?
None were ready for clinical use due to non-existent or single arm validation and non-existent clinical impact phase
May & Rosedale (2009) reviewed existing LBP CPRs against established criteria and found what about the derivation and validation studies?
Derivation studies were mostly high quality, but none of the validation studies were. Most did not pass the lowest level of evidence hierarchy. Manipulation CPRs had limited and contradictory evidence of clinical utility.
Stanton (2010) and Haskins (2015) studied CPRs for readiness to apply them to LBP. They both concluded they were not ready for different reasons. What were they?
Stanton found studies used single arm design and therefore may just list prognostic indicators rather than treatment indicators.
Haskins (2015) found no studies to look at validation or impact analysis.
During C3/4 manipulations, Reggars (1996) found how many clicks will occur? Bolton (2007) found pops occurred on which side?
Average 2.5 cracks, popping contralateral side to applicator with rotation but either side with side bending.
How specific can we be with thoracic manipulation?
Herzog & Symons (2001): peak pressure pt moved 9.8 mm (probably not delivered to target segment)
Ross (2004) found 3.5 cm as avg error from target joint—more cracks=more accuracy
Bereznick (2002): 38.75 mm displacement on TPs, 33.25 mm for SPs during thoracic thrust if no skin lock
How accurate is lumbar manipulation?
Ross (2004): 5.29 cm avg error from target joint
Beffa & Mathews (2004): no correlation between target segment and cavitation—L5/S1 got L3-4, SIJ got L5/S1
Ernst& Canter (2006) SR of SRs said what about efficacy of HVLAT for LBP?
SMT superior to sham but not to other treatment
Bronfort (2004) found what level of evidence of SMT for LBP Tx?
Moderate evidence that SMT is superior to PT, HEP, and general medical care
The 2010 Cochrane review (Gross) of neck pain comparing manipulation to mobilization concluded what?
Moderate to low quality of evidence: manip same as mob for neck pain
Low quality: cervical manipulation alone may provide immediate short term relief and that thoracic manip>placebo
Smith & Bolton (2013) determined what clinical criteria can indicate need for cervical manipulation?
- Exclusion of serious conditions
- Manual exam for TTP
- Altered vertebral motion in the neck or upper thoracic region
However, they also concluded there are no good diagnostic rules
What 2 arguments does Cassidy (2012) make in favor of spinal manipulation for neck pain?
Evidence that it decreases pain (Hurwitz 2008, Leaver 2010) compared to placebo and is better than NSAIDs (Bronfort 2012)
No evidence that mobilization is safer
Michaleff (2012) investigated cost-effectiveness of SMT for neck pain and found what compared to GP, exercise, and other Tx?
Superior to GP: lower cost, higher recovery rate
Superior to exercise: cost effective and superior outcomes
SMT + GP care better than “other”
What are 8 benefits of applying a thrust?
- Facilitate movement
- Relieve pain
- Increase circulation
- Immediate neurophysiological reflex response (mm relaxation)
- Immediate strength increase
- Release entrapment (capsules, meniscoids)
- Powerful psychological effect
- Quicker than mobilization
What are the actual risks of spinal manipulation?
Margarey & Haldeman (2002): 1/50K to 1/5.85 million cervical manipulations
Cassidy (2008): cervical Complications 1/50K to 1 in 4M, association between chiro and VBA stroke less than PCP visits
Haldeman & Rubenstein (1992): lumbar <1/10M manipulations
Murphy (2010), Kerry & Taylor (2006) concluded there’s no benefit to screening for risk of VBA - what was the reasoning and what 6 tests are recommended instead?
VBI test not validated
Instead use:
1. CN exam and VOMS
2. BP testing
3. active signs of dissection
4. PMH of artherosclerosis (maybe)
5. US
6. functional CAD position tests
What is the comparative stress on VBA of HVLAT vs diagnostic testing/ROM? What is the level of force required to cause a dissection?
Symons (2002) SMT was 6.2% of resting length at OA level and 2.1% at C6 - mechanical failure occurs at 139-162%
SMT uses approx 1/9 the strain of a mechanical failure and equal or less strain as Dx/ROM testing
Wuest (2010) 2.3% strain during thrust vs 13% during PROM testing and 8.5% during VBI test