This case report summarizes the treatment of a 58-year-old male patient with left rotator cuff syndrome and shoulder pain. Over the course of 9 physical therapy sessions in 5 weeks, the patient received interventions including exercise and manipulations to the thoracic spine. Outcome measures showed improvements in pain, range of motion, functional status as measured by the QuickDASH scale, and strength. The case report discusses the evidence supporting the use of thoracic manipulations for shoulder impairments and regional interdependence between adjacent joints.
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
EFFECTIVENESS OF ADJUVANT YOGA THERAPY IN DIABETIC LUNG: A RANDOMIZED CONTROL...Yogacharya AB Bhavanani
EFFECTIVENESS OF ADJUVANT YOGA THERAPY IN DIABETIC LUNG: A RANDOMIZED CONTROL TRIAL
Balaji Rajasekaran1, Ananda Balayogi Bhavanani2, Meena Ramanathan3
1 Assistant Professor, Centre for Yogic sciences, Aarupadai Veedu Medical Colleges, Vinayaka Missions Research Foundation, Pondicherry
2 & 3 Director and Deputy Director, Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Pondicherry.
E-mail of presenter: balaji.rajasekaran@avmc.edu.in
Abstract:
Context: Recent studies provide ample evidence of the benefits of yoga in various chronic disorders. Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia and Sandler coined the term “Diabetic Lung" for the abnormal pulmonary function detected in diabetic patients due underlying pulmonary dysfunction. Yoga therapy may help in achieving better pulmonary function along with enhanced glycaemic control and overall health benefits.
Aim: To study the effect of adjuvant yoga therapy in diabetic lung through spirometry.
Settings and Design: Randomized control trial done as interdisciplinary collaborative work between Yoga Therapy, Pulmonary Medicine and Endocrinology departments of MGMC & RI, Sri Balaji Vidyapeeth Puducherry.
Materials and Methods: 72 patients of diabetic lung as confirmed by spirometry (<70% of expected) were randomized and divided equally into control group who received only standard medical treatment and yoga group who received yoga training thrice weekly for 4 months along with that. Yoga therapy protocol included yogic counseling, preparatory practices, Asanas or static postures, Pranayama or breathing techniques and relaxation techniques. Hathenas of the Gitananda Yoga tradition were the main practices used. Spirometry was done at the end of the study period. Data was analyzed by Student’s paired and unpaired ’t’ test as it passed normality.
Results: There was a statistically significant (p < 0.05) reduction in weight, BMI along with a significant (p < 0.01) improvement in pulmonary function (FEV1, FVC) in yoga group as compared to control group where parameters worsened over study period.
Conclusion: It is concluded from the present RCT that yoga has a definite role as an adjuvant therapy as it enhances standard medical care and hence is even more significant in routine clinical management of diabetes, improving physical condition and pulmonary function.
Key words: diabetic lung, PFT, hathenas, yoga therapy
Arthroplasty: Present practices by DR. D. P. SWAMI DR. D. P. SWAMI
COMPARISON OF DIFFERENT APPROACHES FOR HIP REPLACEMENT, DIFFERENT ASPECTS OF OVERLAPPING SURGERIES IN TKR AND TEST FOR CONTAMINATION IN OPERATION THEATER
The importance & facts about Physical Activity in Obesity Management on:
Weight loss &Weight loss maintenance
Physical activity & obesity prevention
Effects on general health risks
Mechanisms of Action
Recommendations for Physical Activity in Obesity
Physical Activity Recommendations in Patients
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
EFFECTIVENESS OF ADJUVANT YOGA THERAPY IN DIABETIC LUNG: A RANDOMIZED CONTROL...Yogacharya AB Bhavanani
EFFECTIVENESS OF ADJUVANT YOGA THERAPY IN DIABETIC LUNG: A RANDOMIZED CONTROL TRIAL
Balaji Rajasekaran1, Ananda Balayogi Bhavanani2, Meena Ramanathan3
1 Assistant Professor, Centre for Yogic sciences, Aarupadai Veedu Medical Colleges, Vinayaka Missions Research Foundation, Pondicherry
2 & 3 Director and Deputy Director, Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Pondicherry.
E-mail of presenter: balaji.rajasekaran@avmc.edu.in
Abstract:
Context: Recent studies provide ample evidence of the benefits of yoga in various chronic disorders. Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia and Sandler coined the term “Diabetic Lung" for the abnormal pulmonary function detected in diabetic patients due underlying pulmonary dysfunction. Yoga therapy may help in achieving better pulmonary function along with enhanced glycaemic control and overall health benefits.
Aim: To study the effect of adjuvant yoga therapy in diabetic lung through spirometry.
Settings and Design: Randomized control trial done as interdisciplinary collaborative work between Yoga Therapy, Pulmonary Medicine and Endocrinology departments of MGMC & RI, Sri Balaji Vidyapeeth Puducherry.
Materials and Methods: 72 patients of diabetic lung as confirmed by spirometry (<70% of expected) were randomized and divided equally into control group who received only standard medical treatment and yoga group who received yoga training thrice weekly for 4 months along with that. Yoga therapy protocol included yogic counseling, preparatory practices, Asanas or static postures, Pranayama or breathing techniques and relaxation techniques. Hathenas of the Gitananda Yoga tradition were the main practices used. Spirometry was done at the end of the study period. Data was analyzed by Student’s paired and unpaired ’t’ test as it passed normality.
Results: There was a statistically significant (p < 0.05) reduction in weight, BMI along with a significant (p < 0.01) improvement in pulmonary function (FEV1, FVC) in yoga group as compared to control group where parameters worsened over study period.
Conclusion: It is concluded from the present RCT that yoga has a definite role as an adjuvant therapy as it enhances standard medical care and hence is even more significant in routine clinical management of diabetes, improving physical condition and pulmonary function.
Key words: diabetic lung, PFT, hathenas, yoga therapy
Arthroplasty: Present practices by DR. D. P. SWAMI DR. D. P. SWAMI
COMPARISON OF DIFFERENT APPROACHES FOR HIP REPLACEMENT, DIFFERENT ASPECTS OF OVERLAPPING SURGERIES IN TKR AND TEST FOR CONTAMINATION IN OPERATION THEATER
The importance & facts about Physical Activity in Obesity Management on:
Weight loss &Weight loss maintenance
Physical activity & obesity prevention
Effects on general health risks
Mechanisms of Action
Recommendations for Physical Activity in Obesity
Physical Activity Recommendations in Patients
Posterior instability Test - Lennard FunkLennard Funk
Injuries to the posterior labrum are less common and more difficult to diagnose compared to anterior labral pathology. This may be in part due to difficulties in preoperative diagnosis. Posterior labral injuries cause abnormal loading of the rotator cuff with subsequent weakness. Examination using the Modified O’Briens test tightens the posterior capsule and posteriorly translates the humeral head, stressing the labrum resulting in pain and weakness. A retrospective case controlled study of 74 patients diagnosed with a posterior labral tear at arthroscopy showed 55 to have subjective weakness on performing a Modified O’Briens test, a sensitivity of 83% and a positive predictive value of 90%. At present there is no single test diagnostic of posterior labral pathology. They can often be missed on MRI scanning and also at surgery if not specifically looked for. We believe that clinically demonstrated weakness on performing a Modified O’Briens test is sensitive, with a high positive predictive value for posterior labral pathology and can help guide further treatment.
In 2011, the treatment armamentarium dramatically expanded with the approval of the anti-CTLA4 antibody ipilimumab and the BRAF inhibitor vemurafenib. Oncology nurses who care for patients with melanoma are beginning to administer these new agents and have numerous questions regarding their efficacy, different response patterns, unique toxicity profiles, how they may be integrated into current treatment regimens, and how to educate patients on their benefits and risks.
Downloadable slide decks are a great tool for self study and teaching purposes. They are non-certified resources available to enhance your knowledge.
Review a downloadable slide deck by Peg Esper, MSN, MSA, RN, APN-BC, AOCN®, covering the most clinically relevant new data reported from Metastatic Melanoma: An Oncology Nurse Workshop on Novel Treatments, Adverse Event Management, and Patient Education.
Target Audience
This activity has been designed to meet the educational needs of oncology nurses involved in the treatment of patients with advanced melanoma.
Slide Deck Disclaimer
This slide deck in its original and unaltered format is for educational purposes and is current as of May 2012. All materials contained herein reflect the views of the faculty, and not those of IMER, the CE provider, or the commercial supporter. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. Readers should not rely on this information as a substitute for professional medical advice, diagnosis, or treatment. The use of any information provided is solely at your own risk, and readers should verify the prescribing information and all data before treating patients or employing any therapeutic products described in this educational activity.
For more information:
http://imeronline.com/gxpsites/hgxpp001.aspx?11,52,304,O,E,0,,744;561;8362
Complete Guide to Identify Shoulder Pain Causes and Surgeries. Learn to differentiate symptoms, may the pain in the shoulder be caused by a fracture, impingement, instability, frozen shoulder, tumor or other symptoms. This presentation was held in front of family doctors to enable them to assess patients presenting common shoulder injuries and pathologies. For a complete assessment of your specific condition, make sure to meet your doctor or book an appointement with Dr Cherif Tadros.
Shoulder Impingement Evidence Based Case Study Rumy Petkov
Used evidence based literature to compare laser therapy treatment versus corticosteroid injections, ultrasound, rehab exercises, and Kinesio taping to treat shoulder impingement.
1.INTRODUCTION
Shoulder joint is formed by scapula and clavicle (which is also called as shoulder girdle)and proximal humerus.
2.BONES OF SHOULDER JOINT
3.Joints of the Shoulder Complex
Glenohumeral
Acromioclavicular
Sternoclavicular
Scapulothoracic
4.Muscles of the Shoulder
5.Gateways to the Posterior Scapular Region
6. Movements
step by step presentation on ultrasound evaluation of shoulder and knee joints with illustrations of probe positioning.multiple examples of pathologies also added.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
The State of the Science in PracticeThe phrase evidence-.docxteresehearn
The State of the Science in Practice
The phrase
evidence-based practice
may be most often thought of as a clinical reference; however, research evidence is applicable in every specialty area. What types of research evidence support your work environment? How does research evidence inform your practice?
Now, how current do you think the science is that underlies your practice? How current is the evidence that supports your specialty practice guidelines?
To prepare:
Bring to mind an issue related to your practice. You may use the issue you are exploring for your EBP Project, or another current issue in your specialty area.
If possible, examine practices and/or practice guidelines established to address your selected issue and determine how current the evidence is that supports them.
Using the Walden Library, locate recently published articles that discuss research translated into evidence that applies to your selected practice issue. If you are unable to locate current articles (within the last five years), use the Internet to find evidence-based practice articles on this topic.
Consider the following questions:
How current is the science that supported the practice or practice guidelines?
What new evidence has emerged since the practice guidelines were crafted and adopted?
By tomorrow 09/11/18 12 by 10 pm, write a minimum of 550 words in APA format with at least 3 scholarly references less than 5 years old. Include the level one header as numbered below:
Post
a cohesive scholarly response that addresses the following:
1) Discuss the state of the scientific underpinnings that relate to your selected issue. (see my PIICOT question at the bottom of this page).
2) How current is the science that supported the practice or practice guidelines?
3) What new evidence has emerged since the practice guidelines were crafted and adopted? Provide two examples that support your assessment.
Required Readings
White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016).
Translation of evidence into nursing and health care practice
(2nd ed.). New York, NY: Springer.
Chapter 1, “Evidence-Based Practice”
Chapter 2, “The Science of Translation and Major Frameworks”
Terry, A. J. (2018).
Clinical research for the doctor of nursing practice
(3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Pages 15-18, “The Process of Translating Evidence Into Clinical Practice”
Chapter 3, “Conducting a Literature Review”
Djulbergovic, B. (2014). A framework to bridge the gaps between evidence-based medicine, health outcomes, and improvement and implementation science.
Journal of Oncology Practice
, 10(3), 200-202.
Note: You will access this article from the Walden Library databases.
Fineout-Overhold, E., Melnyk, B.M., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Critical appraisal of the evidence: Part 1.
American Journal o ...
Chiropractic and CAM Utilization: A Descriptive Reviewhome
Studies looking at chiropractic utilization demonstrate that the rates vary, but
generally fall into a range from around 6% to 12% of the population, most of whom seek
chiropractic care for low back pain and not for organic disease or visceral dysfunction. CAM is itself
used by people suffering from a variety of conditions, though it is often used not as a primary
intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs
for comparable results compared to conventional medicine
Alt PDFThe Journal of the CanadianChiropractic Associati.docxdaniahendric
Alt PDF
The Journal of the Canadian
Chiropractic Association
The Canadian Chiropractic Association
What is your research question?
An introduction to the PICOT
format for clinicians
John J. Riva, BA, DC, Keshena M.P. Malik, BSc,
DC, [...], and Jason W. Busse, DC, PhD
Additional article information
Introduction
Clinicians often witness impressive treatment
results in practice and may wish to pursue
research to formally explore their anecdotal
experiences. The potential to further new
knowledge both within the profession and to the
greater healthcare system is compelling. An
obvious next step for a practitioner considering
research is to connect with experienced
researchers to convey their idea for a study, who
may in turn ask, “What is your research
question?” With limited understanding of how to
respond, this interaction may result in the first
and last experience these clinicians will have with
the research community.
It has been estimated that between 1% and 7% of
the chiropractic profession in Canada is engaged
in research. Arguably, this low engagement
could be the result of practitioners’ perceived
importance of research and levels of research
literacy and capacity. However, increasing
demands for evidence-based approaches across
the health system puts pressure on all clinicians to
base their decisions on the best available
scientific evidence. Lack of clinician
representation in research has the probable effect
of limiting growth and new developments for the
profession. Furthermore, lack of clinician
involvement in research complicates the transfer
of study findings into practical settings.
The Canadian Institutes of Health Research
describes integrated knowledge translation as a
process that involves collaboration between
researchers and knowledge users at all stages of a
research project. This necessitates involvement
of clinicians to help in forming a research
question, interpreting the results, and moving
research findings into practice. This shared effort
between clinicians and researchers increases the
likelihood that research initiatives will be relevant
to practice. Conversely, it has been reported that
there is a growing communication gap between
clinicians and academics in chiropractic.
Clinicians have important practice-related
questions to ask, but many may lack the ability to
map out their research strategy, specifically in
communicating their question in a manner
required to develop a research protocol.
David L. Sackett, Officer of the Order of Canada
and the founding Chair of Canada’s first
Department of Clinical Epidemiology &
Biostatistics at McMaster University, highlights
the importance of mapping one’s research
strategy in exploration of the research question:
“one-third of a trial’s time between the germ of
your idea and its publication in the New England
Journal of Medicine should be spent fighting
about the research question.” (personal
communicat ...
Whether you are preparing for an upcoming nursing exam or struggling with a specific topic, our service is designed to cater to your unique needs. We offer personalized tutoring and support to help you overcome your challenges and achieve your academic goals. With our take my nursing exam, you can improve your nursing knowledge and skills and feel confident when taking your nursing exams. For more information visit us at https://www.liveexamhelper.com/take-my-nursing-exam.html or email support@liveexamhelper.com. You can also call +1 (315) 557-6473 for assistance with nursing exams.
Clinical prediction rule in spinal painNityal Kumar
This lecture is on spinal pain and the clinical methods used in treating the pain. Clinical prediction rules is a research method done systematically describing when to use which method of treatment approach
better Rehabilitation through vibro-acoustic-therapy.pdfmichel582642
Sound vibrations and sound wave therapy and their positive effects on the human body have been extensively researched and sufficiently proven.
These studies on the subject of rehabilitation are intended to illustrate how broadly the spectrum of possible patient groups that could benefit from sound wave therapy can be defined. In addition, this form of therapy could be a so-called game changer for prevention.
Enjoy reading!
Michel Menzel
Founder of THERAPIEGOLD
www.therapiegold.de
Scholarly research paper. This research paper investigates the patient and how they respond to treatment of spinal injuries over a specified amount of time and how their pain level was affected depending on the form of rehabilitation used. References included.
Why bother with evidence-based practice?PaulGlasziou
An introduction to evidence-based medicine (EBM) with short section in history and why EBM? Then a brief overview of the 4 steps of EBM.
These slides have been used for starting a 1-day workshops in EBM
AProf Jon Ford’s presentation from today at the World LBP Congress in Antwerp presenting new data on the STOPS approach, introducing STOPS Plus for more complex chronic pain and comparing clinical importance with STarT Back and Cognitive Functional Therapy
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
CDSCO and Phamacovigilance {Regulatory body in India}
The effectiveness of manipulations to the thoracic spine on functional outcomes in a patient with shoulder pain: A Case Study
1. Case Report The effectiveness of manipulations to the thoracic spine on functional outcomes in a patient with shoulder pain: A Case Study Presented By: Jill Robison, SPT UTMB 3rd Year DPT Student
2. Objectives Introduction and purpose of the study Search Strategies/Evidence Formulation of PICO question Annotated Bibliography Analysis of the evidence Case Report Results Discussion References
3. Introduction Shoulder conditions are one of the most commonly presenting musculoskeletal impairments seen by the medical community. In recent years, increased focus on manual and manipulative therapy techniques has been observed in the physical therapy profession. Regional interdependence, a recent term discussed by Wainner and colleagues (Strunce, 2009), suggests that interventions targeting adjacent joints may directly improve outcomes in the affected joint.
4. Introduction Recent research has been targeted towards the effects of manipulations to the cervico-thoracic junction on shoulder impairments. Predicted outcomes include: reductions in pain improved ROM increased functional status.
5. The Evidence PICO Question formation Search strategy Research findings/ Results Annotated Bibliography Analysis of evidence
6. PICO Question formation Observed the clinic’s patient population and common impairments seen by the practicing therapists Performed a literature review to highlight recent topics in orthopedic research
7. PICO Question formation Conferred with supervising clinical and instructor and other clinicians for direction and advice on topic choice Selected a patient presenting with the clinical findings needed to perform a case study
8. PICO P:In patients with rotator cuff pathology presenting with signs and symptoms of subacromial impingement… I: would the combination of exercise and manipulations to the thoracic spine and/or cervicothoracic junction… C: as compared to exercise alone… O: produce better outcomes as measured by the QuickDASH assessment scale?
9. Search Strategy Review of the evidence was performed through use of the University of Texas Medical Branch’s library website The search began using the PubMed (Medline) database with a topic of “thoracic manipulation,” which resulted in 879 results Then narrowed to include “thoracic manipulation and shoulder”, which produced 29 results
10. Additional sources (CINHAL, Cochrane Database) were examined using the same key words (MeSH terms “thorax” and “shoulder”) and produced minimal findings as compared to PubMed A publically created resource was also used, Physiopedia, and references cited through articles on this database were reviewed Search Strategy
11. Results Initial results were further narrowed, to 12 articles, that were then reviewed and considered for the annotated bibliography.
12. Results The final five articles were selected based on inclusion and exclusion factors They were then more thoroughly reviewed The annotated bibliography, outlining the article and focus of the research, was then created
13. Annotated Bibliography Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moora JH, Koppenhaver SL, Wainner RS. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Manual Therapy. 2009; 14: 375-380. Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM. Some factors predict successful short-term outcomes in individuals with shoulder pain receiving cervicothoracic manipulation: A single-arm trial. Physical Therapy. 2010; 90(1): 26-42. Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. The Journal of Manual & Manipulative Therapy. 2009; 17(4): 230-236. Tate AR, McClure PW, Young IA, Salvatori R, Michener LA. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: A case series. Journal of Orthopaedic & Sports Physical Therapy. 2010; 40(8): 474-493. Walser RF, Meserve BB, Boucher TR. The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: A systematic review and meta-analysis of randomized control trials. The Journal of Manual & Manipulative Therapy. 2009; 17(4): 237-246.
20. Validity of the Evidence Lacking homogeneity All possible evidence was not considered Randomization was obtained in 50% of the articles Successful attempts by the authors to develop homogeneity without researcher effect Overall lack of evidence in this topic and need for higher level studies
21. Challenging the hierarchy Milanese S. The use of RCT’s in manual therapy-Are we trying to fit a round peg into a square hole? Manual Therapy. 2011; 1-3. Current highest level of evidence=RCT 3 features of RCT: control group, random allocation of subjects and the blinding of patients, therapists and outcomes. Main focus of evidence based medicine: “clinical decisions should be based on the best available scientific evidence (Koes and Hoving, 1998).”
22. Challenging the hierarchy Milanese S. The use of RCT’s in manual therapy-Are we trying to fit a round peg into a square hole? Manual Therapy. 2011; 1-3. Standardization of intervention in manual therapy is impossible due to clinical reasoning and complex interventions (cannot be determined prior to pt. assessment) Randomization may lead to poorer therapeutic effects and pre-disposing patient characteristics cannot be controlled
23. Challenging the hierarchy Milanese S. The use of RCT’s in manual therapy-Are we trying to fit a round peg into a square hole? Manual Therapy. 2011; 1-3. Therapist blinding is relatively impossible as manual therapy techniques are active interventions Author suggests that lower-level evidence, for example a case-control study, may be more appropriate for this area of research
24. Importance of the evidence ST effects of thoracic manipulation = highly supported by numerous articles LT effects= not supported by evidence Combination with exercise is highly emphasized Effective treatment tool
25. Application of the evidence Useful in patients presenting with s/sx of one or more of the following: decreased shoulder ROM pain with active shoulder movements positive Neer impingement test positive Hawkins-Kennedy test pain with resisted abduction, IR, or ER pain with resisted empty can test Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moora JH, Koppenhaver SL, Wainner RS. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Manual Therapy. 2009; 14: 375-380.
26. Case Presentation Date of initial evaluation: February 22, 2011 Date of prescription: February 14, 2011 Pt. initials: F.B. Duration of therapy: 9 visits, 5 weeks Initial Evaluation
27. Case Presentation F.B., a 58 year-old male, referred to physical therapy with a medical diagnosis of left Rotator Cuff syndrome. Two-month history of posterior shoulder pain that is limiting his functional and recreational activities. Retired individual who is currently building an outdoor shower at his condo in Galveston. Initial Evaluation
28. Case Presentation Co-morbidities: Type II Diabetes DASH (Disabilities of the Arm, Shoulder, and Hand) -- Initial Score: 29/11, 41% Initial pain levels: 0/10 current; 10/10 @ worst Pt goals: Return to exercise and ADL activities symptom free and without restrictions or limitations Initial Evaluation
30. Case Presentation Special Tests Aggravates symptoms: Hawkins-Kennedy Impingement Test Negative for reproduction of symptoms: Neer Impingement Test and Empty Can Test Objective Findings Palpation/Reflexes and Sensation Palpation to left posterior capsule produced moderate pain Sensation and Reflex testing intact and equal bilaterally Initial Evaluation
31. Case Presentation Prognosis:Good Expected length of episode:4-6 weeks Impairments Identified ADL function Muscle performance Motor function Pain Weakness Decreased ROM Skilled intervention needed to: Decrease pain Improve function Improve motor control Increase ROM Increase strength Initial Evaluation
32. Case Presentation Problems and Goals Current Functional Status: Modified Independent with recreational and exercise activities In 4 weeks, pt. will demonstrate improvements in overall ADL status to Pre-morbid status (Independent and without difficulty) DASH score: 41% b) In 4 weeks, pt. will report improvements on the Quick DASH measurement to 10% demonstrating improved function and abilities Initial Evaluation
33. Case Presentation Problems and Goals 3. Decreased Range of Motion In 4 weeks, pt. will improve overall left shoulder ROM to WNL (equal to or better than the Right shoulder) for improved performance in overhead activities. 4. Decreased Upper extremity muscle strength d) In 4 weeks, pt. will improve overall left shoulder MMT to > 5/5 demonstrating increased tolerance for lifting and exercise activities. Initial Evaluation
34. Case Presentation Plan: 2 visits/week for an expected duration of 6 weeks Therapeutic Contents to include: AROM activities HEP Neuromuscular Re-education Therapeutic Activities Therapeutic Exercises Manual Therapy Techniques Initial Evaluation
35. Case Presentation Interventions Periscapular strengthening General UE strengthening AAROM Modalities Open chain RTC strengthening Closed chain RTC strengthening PNF techniques Manual interventions (Manipulations to the CT junction)
36. Case Presentation Interventions Treatment Progression: Initial visits (1-3) included modalities, as needed, for pain control, AAROM techniques (rope and pulley and wand exercises), periscapular and general UE strengthening exercises Visit 4-inititated TB RTC strengthening, manipulation to the CT junction performed Visit 5- initiated CKC RTC and scapular strengthening (ball on wall circles)
37. Case Presentation Interventions Treatment Progression: Visit 5-7: continued to progress intensity of exercise and monitored tolerance of this progression Visit 7: Performed a second manipulation to the CT junction Visit 8-9: Initiated PNF manual techniques in supine targeting end-range activation of the IR and ER
38. Case PresentationResults Patient response to interventions: Initially pt. reported no change in symptoms Symptoms continued to present as posterior shoulder pain with end-range movements and intense OH activities At the 4th visit, F.B. presented with a new symptom of left forearm pain that was constant Screening of the neck and manipulation to the CT junction was performed (4th visit)
39. Case PresentationResults Patient response to interventions: 5th visit (follow-up after CT manipulation): patient reported short-term relief of forearm and posterior shoulder pain after manipulation 6th and 7th visit: patient reported no forearm pain and continued to report pain in posterior shoulder
40. Case PresentationResults 8th visit (follow-up from CT manipulation): patient reported decreased pain in posterior shoulder and was able to tolerate 1 hour of intense exercise at home 9th visit: patient reported no pain with any activities and was able to tolerate push-ups for the first time since injury
41.
42. Case PresentationResults Re-evaluation was performed on 3/23/11 Patient reported overall improvement at re-evaluation (3/23): 60% Patient reports improved tolerance for ADL activities (recreational, self care and home management) to slight symptoms Patient reported current pain levels at 0/10 and 2/10 at worst; (Initial = 0/10 current and 10/10 @ worst)
43. Case PresentationResults Summary of Objective Findings at Re-Evaluation MMT All Shoulder MMT improved to >4+/5, excluding ER (4/5) Mild pain reproduced with resisted ER and Abduction ROM Both left AROM and PROM equal to the right (full and pain free) Palpation Moderate tenderness over posterior infraspinatus Special Tests Neer Impingement Test: Negative Hawkins-Kennedy Impingement Test: Negative; (Initial-Aggravated Symptoms)
44. Case PresentationResults Goals Pt. achieved one of four goals ROM equal to unaffected UE Pt. made excellent progress towards other 3 goals Overall ADL function to pre-morbid levels Quick DASH measurement to 10 MMT to 5/5
45. Application of Evidence to Case Study Physical Therapy “thought process” for choice of intervention (manipulation to CT junction): Hawkins-Kennedy Impingement Test aggravated symptoms Decreased left shoulder ROM into abduction, flexion and ER Pain with resisted abduction, ER, and IR Pain with active shoulder movement into horizontal adduction, abduction and end-range flexion Plateau of symptom reports
46. Application of Evidence to Case Study Patient demonstrated ST improvements, in reports of symptoms, after CT manipulations No change in Quick DASH score after first trial of manipulation Advanced and initiated new exercises in conjunction to manipulation Cannot determine cause and effect of improvements
47. Discussion Evidence is lacking to support intervention Higher level studies needed to truly determine cause and effect Positive outcomes were seen in patient case, although final measure of Quick DASH was unattainable
48. Need to consider other variables to success Initiation of PNF techniques Increased RTC strength from exercise activities Natural healing time Activity modification by patient Patient education of the healing and rehabilitation process Discussion
49. Would be beneficial to have a second case study for comparison No manipulations to the CT junction All other treatment variables kept identical Although this would be higher quality of evidence, still cannot determine true cause and effect relationship Discussion
50. Conclusion F.B. had successful outcomes from manipulations to the cervicothoracic junction Useful as an adjunct treatment tool Future research attempting to determine cause and effect is warranted It is argued that lower levels of evidence may be more appropriate when determining the effectiveness of a manual therapy technique (Milanese, 2011)
51. Conclusion Patients presenting with shoulder impingement syndrome may benefit from interventions targeting adjacent joints (regional interdependence) Therapists need to consider all areas and treatment techniques in order to provide the highest quality of care possible
52. References Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moora JH, Koppenhaver SL, Wainner RS. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Manual Therapy. 2009; 14: 375-380. Koes BW, Hoving JL. The valueof the randomised clinical trial in the field of physiotherapy. Manual Therapy. 1998; 3(4): 179-186. Milanese S. The use of RCT’s in manual therapy-Are we trying to fit a round peg into a square hole? Manual Therapy. 2011; 1-3. Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM. Some factors predict successful short-term outcomes in individuals with shoulder pain receiving cervicothoracic manipulation: A single-arm trial. Physical Therapy. 2010; 90(1): 26-42.
53. References Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. The Journal of Manual & Manipulative Therapy. 2009; 17(4): 230-236. Tate AR, McClure PW, Young IA, Salvatori R, Michener LA. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: A case series. Journal of Orthopaedic & Sports Physical Therapy. 2010; 40(8): 474-493. Walser RF, Meserve BB, Boucher TR. The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: A systematic review and meta- analysis of randomized control trials. The Journal of Manual & Manipulative Therapy. 2009; 17(4): 237-246.
Editor's Notes
PICO is a clinical question that highlights 4 aspects: P: Patient Population, I: Intervention, C: Comparison and O” Outcomes