OBJECTIVE:This case describes the upper cervical chiropractic management of a patient with neck pain and headaches with a history of cervical artery compromise following a motor vehicle accident. BACKGROUND:A 54-year-old male with neck pain and headaches was seen in a chiropractic office. Eight months prior to his initial visit, the patient was involved in a motor vehicle accident (MVA) which resulted in partial dissection of his left internal carotid artery. The patient reported severe cervicalgia, headaches and painful restricted cervical motion. Physical exam and cervical imaging assessed acceptable risk for treatment and indicated altered axis of motion in the first cervical vertebrae (C1) relative to the occiput (Co). OUTCOMES:The patient was examined over a 6 month period and received a total of 5 Blair upper cervical chiropractic adjustments. Physical exam findings, the Numerical Rating Scale (NRS), the Neck Pain Disability Index (NDI) and the RAND-36 outcomes were used to track progress. The NRS, NDI and RAND-36 demonstrated positive changes in presenting symptoms. CONCLUSION:More investigation is needed to understand the relationship between a history of traumatic cervical artery compromise and the effectiveness and safety of upper cervical chiropractic care utilizing Blair protocol to manage latent symptoms.
OBJECTIVE:Valid, reliable, and low-cost tools to assess pain can enhance quantitative pain assessment in multiple settings. Therefore, we assessed the technical validity, concurrent validity, reliability, and treatment sensitivity of the Egyptian algometer, which is a low-cost pain assessment tool. We also examined clinicians' inter- and intra-rater reliability with this device. METHODS:Technical validity of the algometer was tested by comparing the algometer to German standard weights. We tested (concurrent validity and reliability of the algometer in young healthy participants (n = 20, 27.31 ± 4.13 years), treatment sensitivity in 9 participants with discogenic sciatica (45.11 ± 14.77 years), and inter- and intra-rater reliability of 3 physical therapists who conducted all the tests. A combination of intra-class correlation coefficients (ICC(2,1) and ICC (2,3)) and Bland-Altman plots were used for all the analyses. RESULTS:The Egyptian algometer (i) demonstrated a force bias of ≤ ±3% versus standard German weights; (ii) showed excellent concurrent validity and reliability (ICC > 0.9) versus Wagner algometer, and (iii) inter-and intra-rater reliability (r > 0.9) for the standard acupuncture points. The Egyptian algorithm was sensitive to capture treatment changes across different body acupuncture points in patients with discogenic sciatica (range SEM = 0.22 to 0.41; p = 0.008 to 0.021; and 95% CI = -0.176 to -2.275; Cohen's d = 0.29-0.39). DISCUSSION:The Egyptian algorithm is a low-cost, valid, and reliable device to assess pain in healthy young adults. Additionally, the Egyptian algorithm can effectively capture pain treatment response in individuals with discogenic sciatica.
BACKGROUND:T4 syndrome is described as a clinical pattern characterized by upper-extremity pain, glove-like paresthesia, diffuse head pain, and cervicothoracic discomfort without neurological deficits or structural musculoskeletal pathology. Although diagnostic criteria and underlying mechanisms remain poorly defined, the syndrome is still included in manual therapy education. Most explanatory models focus on segmental musculoskeletal dysfunction; however, from the perspective of contemporary pain science, these theories appear insufficient to explain the spectrum of clinical signs and symptoms observed in this patient group. METHODS:This narrative review summarizes the current literature on T4 syndrome, emphasizing the integration of contemporary pain neuroscience into explanatory models and its potential implications for clinical reasoning, diagnostic procedures, and treatment strategies. RESULTS:Available evidence suggests that the clinical presentation of T4 syndrome cannot be explained by a specific thoracic segmental dysfunction alone. Rather, the symptom constellation likely reflects a complex interaction of neurobiological mechanisms with a presumed but still unclear link to thoracic musculoskeletal structures. CONCLUSION:T4 syndrome is likely to represent a complex multidimensional upper quadrant clinical syndrome driven by multiple neurobiological mechanisms. From this perspective, it seems appropriate to consider the structural and functional thoracic findings within the context of a mechanism-based clinical reasoning process guiding multidimensional assessment and management. Such a framework could provide a base for further research on this topic, clarifying the nature of underlying mechanisms, the clinical profile and diagnostic terminology of this syndrome.
OBJECTIVES:Orthopaedic Manual Physical Therapy (OMPT) fellowship education is recognized as the highest level of available clinical training for physical therapists in this specialty area. Competencies delineating the expected knowledge, skills, and performance standards for individuals trained at this level have yet to be established. This study along with congruent studies aimed to develop consensus on competencies and graduation milestones critical for OMPT fellowship education. The current study focused on the knowledge required for specialty practice and professionalism. METHODS:A 3-round modified Delphi was performed engaging a panel of international experts in OMPT education, practice, and leadership. Round I involved a panel of context experts developing competencies and associated graduation milestones for the knowledge for specialty practice and professionalism domain. Round II and III involved international stakeholders voting on the proposed competencies and milestones. Composite scores representing the strength of agreement which each component were presented. RESULTS:Eight experts, including two fellowship program directors participated in Round I, developing 5 competencies and 25 graduation milestones for the Knowledge for Specialty Practice domain and 6 competencies and 22 graduation milestones for the Professionalism Domain. One hundred and forty-one participants across 14 countries participated in ranking the knowledge for specialty practice domain and 110 participants across 12 countries participated in ranking the professionalism domain. All 11 competencies and 47 graduation milestones met consensus. Patient safety, advanced musculoskeletal assessment and intervention application, self-reflection and commitment to lifelong learning, and ethical/cultural sensitivity all scored highly by the respondents. An emphasis was seen on aspects of person-centered care. CONCLUSION:Results support the large breadth of knowledge and competence expected of OMPT fellows. This study should inform future efforts to move OMPT fellowship training toward competence-based education and assessment to ensure consistency across programs in reaching expected levels of competence.
OBJECTIVE:Developing psychomotor competence in orthopedic manual physical therapy (OMPT) techniques is fundamental to post-professional physical therapy education. Concerns persist about whether online instructional models and the rise of hybrid physical therapy programs adequately support the development of psychomotor skills. The credentialing examination in Mechanical Diagnosis and Therapy (MDT), which includes formal assessment of manual procedures, provides an opportunity to evaluate performance across training pathways for licensed physical therapists. This pilot study sought to determine whether the mode of instruction, traditional face-to-face training or a hybrid option in which at least one course was completed online, was associated with pass/fail performance demonstrated on psychomotor examination. METHODS:This retrospective study analyzed examination outcomes from 654 clinicians. Participants were categorized into two groups based on their educational experience: exclusively face-to-face (n = 360) or hybrid instruction (n = 294). A χ2 test of independence examined whether there was an association between pass/fail outcomes and instructional method. RESULTS:Pass rates were not associated with instructional model (face-to-face: 69.4%; hybrid: 69.7%; χ2 (1, N = 654) = 0.61, p = .94). The number of courses completed online was not associated with pass/fail outcomes on the psychomotor examination (p = .11). Time-related variables were not associated with passing status. Face-to-face learners demonstrated slightly higher examination scores, the effect size was small (p < .01, d = 0.25). CONCLUSION:In this pilot exploratory study of credentialing examination data, no detected association was observed between delivery model and pass/fail outcomes on a standardized psychomotor assessment for selected orthopedic manual therapy procedures. Future research with larger samples and prospective designs is needed to further evaluate factors that may influence psychomotor learning across different educational modalities.
INTRODUCTION:Myogenic temporomandibular disorders (TMDs) are prevalent and costly conditions; yet, the most effective treatment protocol remains a subject of debate. Although treatments such as splint therapy are frequently used, a recent meta-analysis suggested that insufficient evidence exists to support its efficacy. Conversely, physical therapy, specifically manual therapy for the neck and jaw, shows promising results in managing TMD symptoms. OBJECTIVES:This study compared the effectiveness of a combined manual therapy and splint protocol against that of splint therapy alone in patients diagnosed with myogenic TMDs. METHODS:A randomized clinical trial was conducted with 38 participants (12 men and 26 women, mean age = 42.3 ), who were divided in a control group (splint therapy alone) and an experimental group (splint therapy + manual therapy). The outcome measures included pain intensity according to the numeric pain rating scale and functional indices such as the Fonseca Anamnestic Index, Helkimo Clinical Dysfunction Index, Neck Disability Index, and Headache Impact Test. Assessments were performed before and one month after treatment completion. RESULTS:Both groups showed improvements in all variables, but the experimental group demonstrated significantly greater improvements across all metrics (p < .001). Large effect sizes were observed for the Fonseca Anamnestic Index, pain intensity, and Neck Disability Index, with a number needed to treat of 1.9. CONCLUSION:The addition of manual therapy to splint therapy yielded superior outcomes in terms of pain reduction and functional improvement for patients with myogenic TMDs. These findings suggest that manual therapy should be a primary therapeutic modality alongside splint therapy.
OBJECTIVE:To compare manual therapy students' preferences for traditional classes versus the Flipped Classroom, and to examine their effects on learning perception and behavioral, cognitive, and emotional engagement. METHODS:A within-subject educational intervention study was conducted with undergraduate physiotherapy students enrolled in a Manual Therapy course during the 2022-2023 academic year. The course comprised eight face-to-face sessions, four delivered using a traditional lecture-based approach and four using the Flipped Classroom methodology. Students' engagement (behavioral, cognitive, and emotional dimensions), preferences between teaching models, and perceptions of educational quality were assessed using validated questionnaires. Within-subject comparisons between traditional and Flipped Classroom models were performed. RESULTS:Forty-two students were included in the analysis. Students showed high levels of engagement across all three dimensions, with mean scores above 4.5 on a 5-point Likert scale. A significant preference for the Flipped Classroom model over the traditional model was observed (mean ± SD: 4.4 ± 1.1 vs. 2.8 ± 1.4; p < 0.05), with 88.1% of students agreeing or strongly agreeing that their performance was better when learning through the FC approach. Students also reported positive perceptions of educational quality, particularly regarding teaching effectiveness, clarity of objectives, and integration of online and face-to-face learning. CONCLUSION:The Flipped Classroom methodology was associated with high levels of student engagement and positive perceptions of educational quality in manual therapy education. These findings support the use of Flipped Classroom as a promising learner-centered approach in physiotherapy training, particularly for subjects requiring extensive hands-on practice.
BACKGROUND:Pain phenotyping classifies a patient's pain as nociceptive, peripheral neuropathic, or nociplastic and should drive examination and treatment options. While it is theoretically possible for patients to transition between pain phenotypes during treatment, empirical clinical evidence for such changes remains unknown. OBJECTIVE:To explore if pain phenotype clinical presentations shift during the course of physical therapy treatment. METHODS:Patients attending outpatient physical therapy for musculoskeletal pain had their predominant pain phenotype evaluated by the attending clinician at the initial consultation. Patients received usual care per the attending clinician's discretion, and pain phenotype assessment was repeated at visits 3 and 6 by the same clinician. RESULTS:Ninety-two patients were assessed and treated. There was a statistically significant difference among the means, χ2(2) = 10.133, p = 0.006. Post hoc comparisons revealed no significant difference between the evaluation phenotype and the visit 3 phenotype (p = 0.055). However, there were statistically significant differences between the visit 3 phenotype and the visit 6 phenotype (p = 0.023) and between the evaluation phenotype and the visit 6 phenotype (p = 0.018). The data suggest that participants' phenotypes changed from more complex (nociplastic) to less complex (nociceptive) over the duration of treatment. CONCLUSION:Pain phenotypes may shift during physical therapy. Additional research is needed to determine what additional clinical and non-clinical factors are associated with shifts in pain phenotypes during physical therapy.
OBJECTIVES:Although used in individuals after ankle or hindfoot injury, little is known about the effects of dry needling (DN) on gait parameters or whether the effect depends upon location of the needle. Therefore, our aim was to compare the effect of DN into a myofascial trigger point (MTrP) versus needling within the same muscle on gait velocity, step length, and peak pressure during gait phases after injury to the ankle/hindfoot. METHODS:Thirty-three individuals with injury to the ankle/hindfoot were randomized to receive DN directly to MTrPs (DNMTrP) or DN into the same muscle but 2.0 cm away from the MTrP (Control). Individuals received three DN sessions 1 week apart and were assessed prior to and immediately after each DNsession and 2 weeks later. Spatiotemporal characteristics of gait were assessed using the GAITRite system and peak pressure and force were assessed using the EMED platform using linear mixed models. . RESULTS:After adjusting for baseline differences, normalized gait velocity and step length were significantly higher for the DNMTrP group than the control group at the second session and subsequent assessments [adjusted 4-week difference = 0.10 (0.03, 0.18) m/s and 4.88 (1.69, 8.07) cm, respectively]. After adjusting for baseline differences, peak pressure at weight acceptance was also significantly higher in the DNMTrP group than the control group at the second session and subsequent assessments [adjusted 4-week difference = 77.50 (36.60, 118.39) kPa]. DISCUSSION/CONCLUSION:DN directly to MTrPs appears to increase gait velocity, step length and peak pressures at weight acceptance and changes lasted for 2 weeks following the intervention.
Musculoskeletal extremity pain is frequently diagnosed based on symptom location and region-specific musculoskeletal special tests despite evidence demonstrating limited diagnostic accuracy and increased risk of misdiagnosis. Literature suggests that a proportion of extremity pain is influenced by nociceptive spinally mediated somatic referred pain, which can occur in the absence of spinal symptoms, often misclassified as radicular pain or radiculopathy. Overreliance on pain location and special tests with poor clinometric properties increases the likelihood that spinal contributions are overlooked, potentially resulting in suboptimal management strategies. Nociceptive input from spinal structures can produce non-dermatomal extremity pain patterns through mechanisms of spinal convergence and cortical reorganization. This clinical commentary proposes a structured approach to spinal screening in patients presenting with extremity pain, emphasizing targeted subjective questioning, spinal motion assessment, neurological and neurodynamic testing, and identification of a comparable sign using a test-treat-retest framework. Incorporating spinal screening into extremity evaluations may support more effective hypothesis-driven clinical decision-making and promote more effective management of musculoskeletal extremity pain.
OBJECTIVE:To compare symptom intensity and sensory characteristics evoked during the standard Upper Limb Neurodynamic Test 1 (ULNT1) and a modified version without shoulder external rotation in men and women with and without nonspecific neck pain (NSNP). METHODS:A cross-sectional study including 110 participants (55 with NSNP and 55 asymptomatic controls; 28 women and 27 men in each group) was conducted. Both ULNT1 versions were performed bilaterally in randomized order. Symptom intensity (Numerical Rating Scale), sensation type, and location were recorded after each test. Data were analyzed using a linear mixed-effects model with aligned rank transformation considering group, sex, and test as fixed factors. RESULTS:Participants with NSNP reported higher symptom intensity than asymptomatic controls in both ULNT1 versions (p < 0.001). The standard ULNT1 elicited higher intensity than the modified version (p < 0.05). No significant main effect of sex or interaction effects were observed. Pain sensations were more frequent in women with NSNP, whereas tingling predominated in men with NSNP. Thumb-related symptoms were more common in the NSNP group, while forearm sensations were more frequent among asymptomatic participants. CONCLUSION:Individuals with NSNP show greater symptom intensity and distinct sensory profiles during both the standard and modified ULNT1, consistent with increased neural mechanosensitivity. Shoulder external rotation slightly amplifies these responses but without clinically meaningful differences. These findings highlight consistent differences in sensory responses between individuals with and without NSNP during neurodynamic testing, supporting more consistent clinical interpretation of ULNT1 and guiding test selection when shoulder rotation is restricted or not tolerated.
OBJECTIVES:Myofascial trigger points (MTrPs) have long been framed as local tissue abnormalities that initiate peripheral nociceptive input through a predominantly bottom-up cascade. This clinical commentary proposes a bidirectional, patient-centered lens for interpreting myofascial sensitivity that extends beyond isolated tissue pathology without ignoring its clinical relevance. METHODS:A narrative review and clinical commentary synthesizing contemporary pain neuroscience, myofascial literature, and mechanism-based clinical reasoning frameworks was conducted to examine how provocative palpation findings may be reinterpreted through a bidirectional neurophysiologic lens. RESULTS:While biochemical, electrophysiological, vascular, and imaging studies suggest regionally distinct tissue characteristics in areas identified as MTrPs, it remains unclear whether these represent stable local phenomena or transient, state-dependent expressions of nervous system modulation. Clinically, provocative palpation findings frequently occur in conditions where muscle is unlikely to be the primary nociceptive driver, supporting interpretation as secondary hyperalgesia within a sensitized system. DISCUSSION:Rather than viewing MTrPs as the initiating source of nociception, provocative palpation is conceptualized as a fluctuating clinical signal shaped by interacting peripheral, spinal, supraspinal, and contextual influences. Emphasizing pain phenotyping and neurophysiologically guided clinical reasoning over lesion identification may better align myofascial constructs and related interventions, including dry needling, with contemporary pain neurophysiology and support more precise, adaptable clinical management.
BACKGROUND:Competency-based education (CBE) emphasizes mastery of defined competencies rather than time-based progression. Within orthopedic manual physical therapy (OMPT), the evolving evidence supports person-centered, evidence-informed care, requiring fellowship training standards that reflect this shift. Among the seven proposed domains of competence, Systems-Based Practice (SBP) and Patient Management (PM) are essential. SBP focuses on navigating healthcare systems, interprofessional collaboration, and advocacy, while PM emphasizes delivering comprehensive, value-based care through evidence-informed, person-centered approaches. Consensus on competencies for these domains in OMPT fellowship training remains unclear. OBJECTIVE:To achieve an international consensus on competencies and graduation milestones for OMPT fellowship training in SBP and PM. METHODS:A modified three-Round Delphi study was conducted. In Round I, nine content experts drafted competencies and milestones. Rounds II and III invited stakeholders from the International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) member organizations via web-based surveys. Consensus was defined a priori as ≥ 80% agreement. Descriptive statistics and composite scores were used to assess the strength of agreement. The reporting in this study follows guidelines from the Accurate Consensus Reporting Document (ACCORD). RESULTS:Systems-Based Practice (SBP): Five competencies and 19 milestoneswere proposed; four competencies achieved consensus (health screening, healtheducation, healthcare system navigation, health policy and advocacy). PatientManagement (PM): Six competencies and 17 milestones achieved consensus,with the strongest support for evidence-informed treatment implementation,person-centered care, cultural and social sensitivity, and outcomeoptimization. Lesser support was observed for applying the human movementsystem framework. CONCLUSIONS:Findingsunderscore the importance of competencies that promote leadership, advocacy,and evidence-informed, person-centered care in OMPT fellowship training. Gapsin consensus regarding quality improvement and the application of movementsystems highlight areas for future study or development. These resultscontribute to a global framework for advanced OMPT fellowship-level education.
INTRODUCTION:Manipulative therapy's rationale is pragmatically appealing as a noninvasive treatment for Morton's Neuroma, involving targeted manipulations of the metatarsophalangeal joints. Nevertheless, manipulation's efficacy has received limited scrutiny. METHOD:An exploratory, pragmatic randomized clinical trial was designed to investigate the efficacy of an acute, short dosage (6, weekly episodes) of physiologically principled manipulations, featuring discrete, high-velocity thrusting maneuvers for treating Morton's Neuroma. Adults electing treatment for Morton's Neuroma were randomly allocated to manipulative therapy (n = 29) or corticosteroid injection (n = 32). Baseline and follow-up (at 1.5, 3, 6, 9 and 12 months following treatment cessation) outcome measures of self-reported pain levels; pressure testing for discomfort thresholds; and functionality; pain and social interaction; activities of daily living and sports participation were measured ipsilaterally and by inventory. RESULTS:Manipulation elicited substantive gains immediately after intervention (visual analog scale for Pain [Cohen's d, 3.3; 84.4%]; pressure threshold testing [d, 2.3; 147.0%]; functionality [d, 1.4; 52.8%]; pain [d, 1.3; 45.5%]; social interaction [d, 0.9; 39.2%]) or accumulated during follow-up (daily living [d, 2.2; 40.8%]; sport [d, 1.5; 66.1%]). Concomitant gains for control participants were modest (d, 0.4 to 1.0; 16.6% to 45.9%) (p < 0.05 to p < 0.0005). Retention of improvements following manipulation cessation was substantial for all metrics, significantly better than baseline scores and consistently exceeded that for corticosteroid injection (p < 0.01 to p < 0.001). CONCLUSION:Manipulation elicited significant and clinically relevant improvements and retention in self-reported levels of pain, discomfort and functionality for patients electing treatment for Morton's neuroma.
BACKGROUND:Forward head posture (FHP) may alter shoulder biomechanics through changes in neuromuscular control and scapular positioning; however, its relationship with scapulohumeral rhythm (SHR) remains unclear in asymptomatic individuals. To examine the association between FHP and SHR during shoulder abduction and compare SHR across abduction ranges. METHODS:A cross-sectional study was conducted among 207 college-going young adults (18-25 years). FHP was assessed using the craniovertebral angle (CVA) via a validated smartphone application. Participants were categorized into FHP (CVA <44°) and normal posture groups. Scapular upward rotation was measured using a modified digital inclinometer, and SHR was calculated as the ratio of glenohumeral motion to scapular rotation across 0-90° abduction. Spearman's correlation analysis was performed. RESULTS:Mean CVA was 41.82 ± 3.47°. SHR followed a range-dependent pattern approximating a 2:1 ratio. A moderate positive association was observed between CVA and SHR in early and mid ranges (0°-60°) (r = 0.387-0.421, p < 0.01), weakening at higher ranges and becoming slightly negative at 75°-90° (r = -0.198, p < 0.05). CONCLUSION:FHP is associated with altered SHR, particularly in early and mid abduction. These findings support incorporating cervical and scapular assessment within a regional interdependence framework.
OBJECTIVES:Updated training paradigms within post-graduate orthopaedic manual physical therapy (OMPT) are critical to align training with current evidence-based practice. Competency-based education (CBE) has become prevalent in post-graduate training given its emphasis on competency rather than knowledge. This study, in conjunction with congruent studies, aimed to develop consensus on competencies and graduation milestones critical for OMPT fellowship education. The current study focused on the clinical reasoning domain. METHODS:A modified 3-round Delphi was performed. Round I consisted of a panel of experts asynchronously developing competencies and graduation milestones related to clinical reasoning in OMPT. Round II and Round III invited International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) members across 30 member organizations to vote on the competencies and milestones. Each round was completed over 6 weeks. Consensus was determined a priori to be reached at 80% agreement, and composite scores were developed to represent the strength of agreement. RESULTS:Six experts including two OMPT fellowship directors/coordinators developed eight competencies and 33 graduation milestones related to OMPT clinical reasoning. One-hundred ninety-nine IFOMPT members across 15 countries participated in ranking the proposed competencies in Round II and III. The majority of respondents were from the United States (69%). All eight competencies and 33 milestones met consensus for inclusion. Strong support was demonstrated for advanced patient assessment, continuous reflection on learning, and evidence-informed evaluation while prognosis and outcome prediction had weaker support. CONCLUSION:Results support expectation for OMPT fellows to provide high level clinical reasoning, ability to communicate this reasoning with patients and other healthcare providers, ability to self-reflect on the clinical reasoning process, and commitment to growth and lifelong learning. OMPT fellowship education should consider transition to competency-based models of training and assessment to promote consistent competence in graduates across all domains of advanced practice.
BACKGROUND/PURPOSE:Coccygodynia, characterized by pain in the coccyx region, affects a significant portion of individuals with spinal discomfort. However, a universally accepted treatment remains undefined. This prospective case series aimed to evaluate the effectiveness of a combined approach using myofascial physical therapy (MPT) and Instrument Assisted Soft Tissue Mobilization (IASTM) in treating chronic coccygodynia. CASE DESCRIPTION:This study was a prospective case series. Patients referred for chronic coccygodynia to our physiotherapy clinic between September 2022 and December 2023 were assessed. The primary outcome was pain intensity, measured using the Numeric Pain Rating Scale. Secondary outcomes included the use of supportive sitting aids and the presence of urinary incontinence. OUTCOMES:Of the 15 participants, predominantly female, 13 (87%) achieved the primary outcome with a significant reduction in pain observed within 5 weeks of treatment. Secondary outcomes also showed promising improvements. CONCLUSION:The combined approach of MPT and IASTM offers a promising noninvasive and effective treatment for coccygodynia. While further research is needed, these findings provide a foundation for future studies and offer hope for those suffering from this condition.
INTRODUCTION:Rheumatoid arthritis (RA) could lead to several respiratory dysfunctions, impairing quality of life. OBJECTIVE:To evaluate the effect of manual diaphragmatic release (MDR) added to aerobic training (AT) on ventilatory function, diaphragmatic motion, aerobic capacity, and quality of life, compared with AT alone, in women with RA. METHODS:Eighty women with RA were equally assigned to either the MDR group, which received MDR and AT, or the control group, which received AT only, for 8 weeks. Outcomes included forced vital capacity (FVC) and total lung capacity (TLC), diaphragmatic motion, maximal oxygen consumption (Vo2max), and the Rheumatoid Arthritis Quality of Life Questionnaire (RA QoL). RESULTS:Analysis was conducted using ANCOVA. Relative to the controls, the MDR group showed significantly greater post-study FVC (mean difference (MD) = 3.99%; 95% CI: 1.14 to 6.83; p = 0.007), TLC (MD = 3.75%; 95% CI: 1.10 to 6.41; p = 0.006), diaphragmatic motion (MD = 7.5 mm; 95% CI: 1.11 to 9.89; p = 0.001), and Vo2max (MD = 5.02 ml/kg/min; 95% CI: 1.19 to 8.4; p = 0.01), along with a significantly lower RA QoL score (MD = -3.64; 95% CI: -5.39 to -1.9; p = 0.001). CONCLUSION:In women with RA, adding MDR to AT was more effective than AT alone in improving ventilatory function, diaphragmatic motion, aerobic capacity, and quality of life. TRIAL REGISTRATION:ClinicalTrials.gov, prospective, NCT06716008.
OBJECTIVE:To achieve international consensus on communication and education competencies and associated graduation milestones for Orthopedic Manual Physical Therapy (OMPT) fellowship training. METHODS:A modified three-round Delphi process was conducted. This study was part of a larger project aimed at reaching consensus on competencies and graduation milestones across seven domains of expertise. A panel of content experts developed and approved proposed competencies in Round I. Rounds II and III involved stakeholders, identified as members of IFOMPT member organizations, who selected domains to rank and voted using a four-point Likert scale. Consensus was established beforehand at 80% agreement. RESULTS:Experts identified four competencies and 18 milestones for communication, and four competencies with nine milestones for education. In subsequent rounds, 124 participants from 12 countries evaluated communication competencies, and 135 participants from 15 countries evaluated education competencies. All competencies achieved consensus. Strong support was observed for person-centered communication, cultural humility, feedback and reflection, clinical teaching, and learner assessment. No significant differences were found between the ratings of Rounds II and III. CONCLUSION:This study provides the first internationally agreed-upon framework for communication and education competencies in OMPT fellowship training. These findings offer a foundation for curriculum design, assessment, and global standardization. Future research should validate assessment tools and expand consensus to additional domains.
BACKGROUND:Chronic neck pain is a prevalent condition affecting a substantial portion of the population globally. Pressure pain threshold (PPT) evaluation using algometers offers a quantifiable and potentially reliable tool for pain assessment. However, its test-retest reliability, particularly using the Wagner algometer, requires further validation in this population. OBJECTIVE:To assess the test-retest reliability of the Wagner algometer for measuring PPT in patients with chronic neck pain. METHODS:A total of 100 patients with chronic neck pain underwent PPT assessment using the Wagner algometer at two time points across four muscle sites: right and left upper trapezius, and right and left levator scapulae. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. RESULTS:ICC values indicated good to excellent reliability: right trapezius (0.98), left trapezius (1.00), right levator scapulae (0.88), and left levator scapulae (0.99). SEM ranged from 0 to 0.26, and MDC from 0 to 0.73. Bland-Altman plots confirmed high agreement without proportional bias. CONCLUSION:The Wagner algometer demonstrates excellent test-retest reliability for measuring PPT in chronic neck pain patients and may serve as a consistent tool for clinical pain assessment and outcome tracking when tested under required conditions.
