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Orthopaedic Manual Physical Therapy: From Art To Evidence Book Pdf 1



Augmented soft tissue mobilization (ASTM), a non-invasive mobilization technique, is used by chiropractors as well as massage, occupational, and physical therapists to treat chronic musculoskeletal disorders that result from scarring and fibrosis. It entails the use of hand-held tools made from bone or stone or metal and a lubricant on the skin to scrape and mobilize scar tissue. Scraping is done to promote circulation, thus, promoting healing. Manual and other treatments may also be used with exercise to guide the healing process. Treatments with ASTM are often administered on non-consecutive days, 1 to 2 times per week. A typical 30-min session usually includes 15 mins of treatment and 15 mins of exercise and assessment. Less severe conditions reportedly can respond well in 2 to 4 sessions whereas difficult chronic cases may require 8 to16 sessions. However, there is insufficient evidence to support the effectiveness of ASTM.




Orthopaedic Manual Physical Therapy: From Art To Evidence Book Pdf 1



French et al (2013) determined the effectiveness of exercise therapy (ET) compared with ET with adjunctive manual therapy (MT) for people with hip OA; and identified if immediate commencement of treatment (ET or ET+MT) was more beneficial than a 9-week waiting period for either intervention. Patients (n = 131) with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants were randomized to 1 of 3 groups: ET (n = 45), ET+MT (n = 43), and wait-list controls (n = 43). Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were re-randomized into either ET or ET+MT groups after 9 week follow-up. Their data were pooled with original treatment group data: ET (n = 66) and ET+MT (n = 65). The primary outcome was the WOMAC physical function (PF) subscale. Secondary outcomes included physical performance, pain severity, hip ROM, anxiety/depression, QOL, medication usage, patient-perceived change, and patient satisfaction. There was no significant difference in WOMAC PF between the ET (n = 66) and ET+MT (n = 65) groups at 9 weeks (mean difference of 0.09; 95 % confidence interval [CI]: -2.93 to 3.11) or 18 weeks (mean difference of 9.42; 95 % CI: -4.41 to 5.25), or between other outcomes, except patient satisfaction with outcomes, which was higher in the ET+MT group (p = 0.02). Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both treatment groups compared with the control group. The authors concluded that self-reported function, hip ROM, and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip; MT as an adjunct to exercise provided no further benefit, except for higher patient satisfaction with outcome.


De Groef et al (2015) reviewed the effectiveness of various post-operative physical therapy modalities and timing of physical therapy following treatment of breast cancer on pain and impaired ROM of the upper limb. These modalities include passive mobilizations, manual stretching, myofascial therapy and active exercises. These investigators searched the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and Cochrane; articles published until October 2012 were included. Only (pseudo-) RCTs and non-randomized experimental trials investigating the effectiveness of passive mobilizations, manual stretching, myofascial therapy and/or exercise therapy and timing of physical therapy, following treatment for breast cancer, were reviewed. Primary outcomes were pain of the upper limb and/or ROM of the shoulder. Secondary outcomes are decreased shoulder strength, arm lymphedema, limitations in ADL, decreased quality of life and wound drainage volume. Physical therapy modalities had to be started in the first 6 weeks following surgery. Articles were selected by 2 independent researchers in 3 phases and compared for consensus. First the titles were analyzed, then the selected abstracts and finally the full texts. A total of 18 RCTs were included in the review. Three studies investigated the effect of multi-factorial therapy: 2 studies proved that the combination of general exercises and stretching is effective for the treatment of impaired ROM; another study showed that passive mobilizations combined with massage had no beneficial effects on pain and impaired ROM. Fifteen studies investigated the effectiveness of a single physical therapy modality. One study of poor quality found evidence supporting the beneficial effects of passive mobilizations. The only study investigating the effect of stretching did not find any beneficial effects. No studies were found about the effectiveness of myofascial therapy in the post-operative phase. Five studies found that active exercises were more effective compared to no therapy or compared to information on the treatment of impairments of the upper limb. Three studies supported the early start of exercises for recovery of shoulder ROM, while 4 studies supported the delay of exercises to avoid prolonged wound healing. The authors concluded that multi-factorial physical therapy (i.e. stretching and exercises) and active exercises were effective to treat post-operative pain and impaired ROM following treatment for breast cancer. Moreover, they stated that high-quality studies are needed to prove the effectiveness of passive mobilizations, stretching and myofascial therapy as part of the multi-factorial treatment. In addition, the appropriate timing and content of the exercise programs need to be further investigated.


Within this framework, it is particularly important that the physical therapist induce positive expectations, starting from the first session. The setting, the therapeutic routine, the words used, the goals shared, the touch, and the initial manual therapy procedures may activate brain mechanisms having effects similar to a drug [95, 96]. Positive expectations also induce better treatment adherence; this is relevant for a therapy that lasts for months, given that the main results deriving from the exercises (e.g. less disability) may be shown only after some weeks of treatment


With respect to physical therapy, a recent consensus publication by experts suggested a multimodal approach (exercises, manual therapy, information and education) for symptomatic lumbar stenosis, even when caused by SPL [75]. However, there is insufficient evidence to make a recommendation for the use of other physical therapy interventions such as aquatic therapy, acupuncture, psychosocial intervention, transcutaneous tibial nerve stimulation, and neural mobilization [75]. 2ff7e9595c


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