Touch is fundamental to the doctor-patient relationship. Touch can produce neuromodulatory effects that mitigate pain and put patients at ease. Touch begins with a confident handshake and continues ...throughout the physical examination. Touching patients where they hurt is a clear indication that a provider understands their complaint. Touch often continues as a function of treatment. This article updates evidence surrounding human touch and addresses mechanisms of action for manual therapy, the impact of manual therapy on pain management, health care conditions for which manual therapy may be beneficial, treatment plans with dose-response evidence, and the impact of manual therapy on the health care system.
Synopsis Manual therapy interventions are popular among individual health care providers and their patients; however, systematic reviews do not strongly support their effectiveness. Small treatment ...effect sizes of manual therapy interventions may result from a "one-size-fits-all" approach to treatment. Mechanistic-based treatment approaches to manual therapy offer an intriguing alternative for identifying patients likely to respond to manual therapy. However, the current lack of knowledge of the mechanisms through which manual therapy interventions inhibit pain limits such an approach. The nature of manual therapy interventions further confounds such an approach, as the related mechanisms are likely a complex interaction of factors related to the patient, the provider, and the environment in which the intervention occurs. Therefore, a model to guide both study design and the interpretation of findings is necessary. We have previously proposed a model suggesting that the mechanical force from a manual therapy intervention results in systemic neurophysiological responses leading to pain inhibition. In this clinical commentary, we provide a narrative appraisal of the model and recommendations to advance the study of manual therapy mechanisms. J Orthop Sports Phys Ther 2018;48(1):8-18. doi:10.2519/jospt.2018.7476.
The purpose of this paper was to update the previously published 2016 best-practice recommendations for chiropractic management of adults with mechanical low back pain (LBP) in the United States.
Two ...experienced health librarians conducted the literature searches for clinical practice guidelines and other relevant literature, and the investigators performed quality assessment of included studies. PubMed was searched from March 2015 to September 2021. A steering committee of 10 experts in chiropractic research, education, and practice used the most current relevant guidelines and publications to update care recommendations. A panel of 69 experts used a modified Delphi process to rate the recommendations.
The literature search yielded 14 clinical practice guidelines, 10 systematic reviews, and 5 randomized controlled trials (all high quality). Sixty-nine members of the panel rated 38 recommendations. All but 1 statement achieved consensus in the first round, and the final statement reached consensus in the second round. Recommendations covered the clinical encounter from history, physical examination, and diagnostic considerations through informed consent, co-management, and treatment considerations for patients with mechanical LBP.
This paper updates a previously published best-practice document for chiropractic management of adults with mechanical LBP.
Our aim was to compare the efficacy of spinal manipulation of the upper cervical spine (C1-C2) on postural sway in patients with chronic mechanical neck pain with the application of a combination of ...cervical (C3-C4), cervicothoracic (C7-T1) and thoracic spine (T5-T6) thrust joint manipulation.
One hundred eighty-six (n = 186) individuals with chronic mechanical neck pain were randomised to receive an upper cervical spine manipulation (n = 93) or three different spinal manipulation techniques applied to the cervical spine, cervicothoracic joint and thoracic spine (n = 93). Measures included the assessment of stabilometric parameters using the Medicapteurs S-Plate platform. Secondarily, neck pain was analysed using the Numeric Pain Rating Scale.
We observe a decrease in the length of the centre of pressure path, average speed, medio-lateral and antero-posterior displacement with statistically significant results (p < 0.05) in the upper cervical manipulation group. Both interventions are equally effective in reducing neck pain after fifteen days (p < 0.001).
The application of upper cervical thrust joint manipulation is more effective in improving stabilometric parameters in patients with chronic mechanical neck pain.
Trial registration: The study was registered in the Australian and New Zealand Clinical Trial Registry (no. ACTRN12619000546156).
Implications for rehabilitation
Patients who suffer from neck pain exhibit increased postural sway than asymptomatic subjects.
Both spinal manipulation treatments applied in this study are equally effective in reducing neck pain.
Spinal manipulation treatment on the upper cervical spine improves postural stability parameters.
Objective
The aim of this study was to identify the manual therapy (MT) methods and techniques that have been evaluated for the treatment of cervicogenic headache (CH) and their effectiveness.
...Background
MT seems to be one of the options with the greatest potential for the treatment of CH, but the techniques to be applied are varied and there is no consensus on which are the most indicated.
Methods
A systematic search in Scopus, Medline, PubMed, Cinahl, PEDro, and Web of Science with the terms: secondary headache disorders, physical therapy modalities, musculoskeletal manipulations, cervicogenic headache, manual therapy, and physical therapy. We included articles published from 2015 to the present that studied interventions with MT techniques in patients with CH. Two reviewers independently screened 365 articles for demographic information, characteristics of study design, study‐specific intervention, and results. The Oxford 2011 Levels of Evidence and the Jadad scale were used.
Results
Of a total of 14 articles selected, 11 were randomized control trials and three were quasi‐experimental studies. The techniques studied were: spinal manipulative therapy, Mulligan’s Sustained Natural Apophyseal Glides, muscle techniques, and translatory vertebral mobilization. In the short‐term, the Jones technique on the trapezius and ischemic compression on the sternocleidomastoid achieved immediate improvements, whereas adding spinal manipulative therapy to the treatment can maintain long‐term results.
Conclusions
The manual therapy techniques could be effective in the treatment of patients with CH. The combined use of MT techniques improved the results compared with using them separately. This review has methodological limitations, such as the inclusion of quasi‐experimental studies and studies with small sample sizes that reduced the generalizability of the results obtained.
Mobilization and manipulation therapies are widely used by patients with chronic nonspecific neck pain; however, questions remain around efficacy, dosing, and safety, as well as how these approaches ...compare to other therapies.
Based on published trials, to determine the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for treatment of chronic nonspecific neck pain.
A systematic literature review and meta-analysis.
We identified studies published between January 2000 and September 2017, by searching multiple electronic databases, examining reference lists, and communicating with experts. We selected randomized controlled trials comparing manipulation and/or mobilization therapies to sham, no treatment, each other, and other active therapies, or when combined as multimodal therapeutic approaches. We assessed risk of bias by using the Scottish Intercollegiate Guidelines Network criteria. When possible, we pooled data using random-effects meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation was applied to determine the confidence in effect estimates. This project was funded by the National Center for Complementary and Integrative Health under award number U19AT007912 and ultimately used to inform an appropriateness panel.
A total of 47 randomized trials (47 unique trials in 53 publications) were included in the systematic review. These studies were rated as having low risk of bias and included a total of 4,460 patients with nonspecific chronic neck pain who were being treated by a practitioner using various types of manipulation and/or mobilization interventions. A total of 37 trials were categorized as unimodal approaches and involved thrust or nonthrust compared with sham, no treatment, or other active comparators. Of these, only 6 trials with similar intervention styles, comparators, and outcome measures/timepoints were pooled for meta-analysis at 1, 3, and 6 months, showing a small effect in favor of thrust plus exercise compared to an exercise regimen alone for a reduction in pain and disability. Multimodal approaches appeared to be effective at reducing pain and improving function from the 10 studies evaluated. Health-related quality of life was seldom reported. Some 22/47 studies did not report or mention adverse events. Of the 25 that did, either no or minor events occurred.
The current evidence is heterogeneous, and sample sizes are generally small.
Studies published since January 2000 provide low-moderate quality evidence that various types of manipulation and/or mobilization will reduce pain and improve function for chronic nonspecific neck pain compared to other interventions. It appears that multimodal approaches, in which multiple treatment approaches are integrated, might have the greatest potential impact. The studies comparing to no treatment or sham were mostly testing the effect of a single dose, which may or may not be helpful to inform practice. According to the published trials reviewed, manipulation and mobilization appear safe. However, given the low rate of serious adverse events, other types of studies with much larger sample sizes would be required to fully describe the safety of manipulation and/or mobilization for nonspecific chronic neck pain.
Chronic neck pain, nonspecific, chiropractic, manipulation, mobilization, systematic review, meta-analysis, appropriateness.
Photodetectors built from conventional bulk materials such as silicon, III–V or II–VI compound semiconductors are one of the most ubiquitous types of technology in use today. The past decade has ...witnessed a dramatic increase in interest in emerging photodetectors based on perovskite materials driven by the growing demands for uncooled, low‐cost, lightweight, and even flexible photodetection technology. Though perovskite has good electrical and optical properties, perovskite‐based photodetectors always suffer from nonideal quantum efficiency and high‐power consumption. Joint manipulation of electrons and photons in perovskite photodetectors is a promising strategy to improve detection efficiency. In this review, electrical and optical characteristics of typical types of perovskite photodetectors are first summarized. Electrical manipulations of electrons in perovskite photodetectors are discussed. Then, artificial photonic nanostructures for photon manipulations are detailed to improve light absorption efficiency. By reviewing the manipulation of electrons and photons in perovskite photodetectors, this review aims to provide strategies to achieve high‐performance photodetectors.
This review summarizes the state‐of‐the‐art electrical and optical characteristics of typical perovskite photodetectors. The electrical manipulations with advanced device structures and optical manipulations with artificial photonic nanostructures are detailed to improve light absorption, photoelectric conversion, and carrier transmission performance in perovskite photodetectors. This review aims to provide strategies to achieve high‐performance photodetectors.
At present, no consensus exists among clinical and academic experts regarding an appropriate placebo for randomized controlled trials (RCTs) of spinal manipulative therapy (SMT). Therefore, we ...investigated whether it was possible to conduct a chiropractic manual-therapy RCT with placebo. Seventy migraineurs were randomized to a single-blinded placebo-controlled clinical trial that consisted of 12 treatment sessions over 3 months. The participants were randomized to chiropractic SMT or placebo (sham manipulation). After each session, the participants were surveyed on whether they thought they had undergone active treatment ("yes" or "no") and how strongly they believed that active treatment was received (numeric rating scale 0-10). The outcome measures included the rate of successful blinding and the certitude of the participants' beliefs in both treatment groups. At each treatment session, more than 80% of the participants believed that they had undergone active treatment, regardless of group allocation. The odds ratio for believing that active treatment was received was >10 for all treatment sessions in both groups (all p < 0.001). The blinding was maintained throughout the RCT. Our results strongly demonstrate that it is possible to conduct a single-blinded manual-therapy RCT with placebo and to maintain the blinding throughout 12 treatment sessions given over 3 months.
Purpose: This article assesses the impact of personal moral philosophies, ethics, and ethical judgment on operational and accounting manipulation among accounting students. Methodology/approach: An ...analysis of the literature on the research subject was used, and a survey on perceptions of accounting manipulations (ACC) and operational manipulations (OM) was conducted among a group of accounting students studying at two universities in Poland. A linear regression model, Mann-Whitney, and Wilcoxon signed rank test were used to verify the research hypotheses. Findings: The research results offer insights into how accounting students perceive accounting and operational manipulation, revealing differences in the ethical assessment of these phenomena depending on the respondent’s moral attitude. We found that age significantly influences the assessment of accounting manipulations and that ethical ideologies influence the manipulation of moral judgments in the case of unemployed people. Research limitations/implications: A significant limitation is that the study focused on students, which may bias findings. To draw broader conclusions, it would be necessary to include working people in the study, with further differentiation based on their profession and position in the organisation. Originality/value: The article contributes to behavioural accounting thanks to pioneering insights into students’ perceptions of accounting and operational manipulation in Poland. The results serve as a foundation for future research. They also raise awareness of future accounting specialists on behavioural and ethical issues they may encounter during the educational process. Professional associations may also use the material when working on ethical standards.
MicroRNAs (miRNAs) are very powerful genetic regulators, as evidenced by the fact that a single miRNA can direct entire cellular pathways via interacting with a broad spectrum of target genes. This ...property renders miRNAs as highly interesting therapeutic tools to restore cell functions that are altered as part of a disease phenotype. However, this strength of miRNAs is also a weakness because their cellular effects are so numerous that off-target effects can hardly be avoided. In this review, we point out the main challenges and the strategies to specifically address the problems that need to be surmounted in the push toward a therapeutic application of miRNAs. Particular emphasis is given to approaches that have already found their way into clinical studies.
Single microRNAs (miRNAs) regulate large subsets of mRNA targets. Although this property makes miRNAs potentially a powerful therapeutic tool, it also represents a major challenge in terms of controlling adverse effects that have been observed in clinical trials.Besides systemic applications via injection and infusion, advanced strategies emerge for miRNA-based drug administration via implantable 3D matrices, inhalation schemes, and intake via food.A combination of miRNA therapeutics with chemical modifications, biomolecule conjugation, or the use of carriers improves a site-directed and efficient cell targeting.A comprehensive risk assessment of miRNA therapeutics is required before any in vivo targeting to minimize off-target effects and to avoid overdosing of miRNAs.
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