No description available.

Chronic neck pain (CNP) is a common and disabling condition, accounting for substantial healthcare and societal costs. Previous studies have demonstrated that certain cognitive factors are related to levels of adjustment (levels of disability, pain and depression) in chronic pain conditions. However, this association has not been adequately explored in patients with CNP. The aim of study one was to determine the relationship between specific cognitive factors and levels of adjustment in participants with CNP. Furthermore, study two explored whether the relationship between the cognitive factors and levels of adjustment differed between those patients with idiopathic CNP and those with Chronic Whiplash Associated Disorder (CWAD). Finally, study three compared the efficacy of a physiotherapy led intervention, specifically designed to modify cognitive factors to a conventional physiotherapy intervention.Study one: Hierarchical multiple regression analyses were performed. Greater catastrophizing and lower functional self-efficacy beliefs were associated with greater levels of pain and disability. Additionally, lower functional self-efficacy beliefs were also associated with greater levels of depression. Study two: Data were dichotomised into two groups: those with CWAD and those with idiopathic CNP. T-tests were performed to compare differences in the cognitive scores and the same regression analyses as study one were performed for each sub-group. No significant differences existed between the two groups in terms of levels of pain, disability, depression or the cognitive factors. In both groups greater catastrophizing and lower functional self-efficacy beliefs were related to levels of disability. Likewise, lower self-efficacy beliefs were related to levels of depression in those participants with idiopathic CNP and those with CWAD. However, amongst those with idiopathic CNP, greater levels of catastrophizing and lower levels of pain vigilance and awareness were related to greater pain intensity. In contrast, amongst those with CWAD, none of the cognitive measures were significantly related to levels of pain intensity.Study three: Participants were randomly allocated to either a progressive neck exercise programme or an intervention which specifically targeted the modification of cognitive factors. T-tests revealed that treatment targeting cognitive factors resulted in greater improvements in pain and pain-related fear. Moreover, Χ2 tests revealed that a greater proportion of patients made clinically meaningful reductions in pain and disability in the group targeting cognitive factors. This thesis highlights that cognitive factors play an important role in determining levels of adjustment in patients with CNP. Furthermore, treatments designed to specifically target these factors result in superior clinical outcomes when compared to conventional physiotherapy interventions.

Orientador: Wilkens Aurelio Buarque e Silva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T14:28:46Z (GMT). No. of bitstreams: 1 Corradini_GustavoForjaz_M.pdf: 1092734 bytes, checksum: 59537ced0e1acdef3e19856bb3234b78 (MD5) Previous issue date: 2015 / Resumo: O objetivo neste trabalho foi caracterizar e verificar a prevalência de sinais e sintomas de desordens temporomandibulares em pacientes portadores de desordens crânio cervicais. Foram selecionados aleatoriamente 176 prontuários clínicos de pacientes que foram tratados no Curso de Especialização em Prótese Dental da Faculdade de Odontologia de Piracicaba. Todos os voluntários foram submetidos às avaliações previstas na Ficha Clínica do CETASE (Centro de Estudos e Tratamento das Alterações Funcionais do Sistema Estomatognático da FOP-UNICAMP) com o objetivo de identificar os sinais e sintomas de Desordem Temporomandibular (DTM), por meio de exames anamnésicos, clínicos e físicos; os voluntários foram diagnosticados com Desordem Crânio Cervicais (DCC). Os resultados obtidos foram agrupados em tabelas, a análise percentual foi realizada no programa computacional Excel 2007 e a analise estatística foi feita por meio do Teste Qui-quadrado e Coeficiente de Correlação de Pearson. Os sinais e sintomas da DTM que apresentaram maior prevalência nos pacientes com DCC foram: ausência do espaço de Christensen, dores espontâneas nas costas, apito ou zumbido, dores espontâneas na nuca e/ou pescoço, sensação de surdez, anuviamento visual, dvo baixa, dor a palpação no músculo trapézio e a dor a palpação no músculo masseter. Todos os sinais e sintomas observados foram mais prevalentes no gênero feminino. Houve inter-relação significativa (p?0,05) entre quase todos os sinais e sintomas observados sugerindo alta probabilidade de ocorrerem conjuntamente / Abstract: The aim of this study was to characterize and determine the prevalence of signs and symptoms of Temporomandibular Disorders (TMD) in patients with Cervical Spine Disorders (CSD). Were randomly selected 176 medical records from patients who were treated in the Specialization Course in Dental Prosthesis of Piracicaba Dental School. All volunteers were subjected to the evaluations defined in medical records of Centro de Estudos e Tratamento das Alterações Funcionais do Sistema Estomatognático da FOP-UNICAMP (CETASE) in order to identify the signs and symptoms of TMD, through anamnestic examinations, clinical and physical. All volunteers had diagnosis of CSD. The results were grouped in tables, the percentage analysis was performed using Excel 2007 computer program and the statistical analysis was performed using the Chi-square test and Pearson's correlation coefficient. The signs and symptoms of TMD more prevalent in patients with CSD were: absence of Christensen space (73.29%), spontaneous back pain (59.66%), whistle or hum (44.88%), pain spontaneous neck and/or neck (44.88%), deafness (43.18%), visual numbness (43.18%), low DVO (42.61%), pain on palpation trapezius muscle (38.07 %) and pain on palpation in the masseter muscle (33.52%). All observed signs and symptoms were more prevalent in females. There was a significant inter-relationship (p?0.05) between almost all signs and symptoms observed, suggesting a high probability of occurring together / Mestrado / Protese Dental / Mestre em Clínica Odontológica

A dor cervical encontra-se entre as disfunções musculoesqueléticas mais prevalentes e estima-se que metade das pessoas que apresentam cervicalgia desenvolvam sintomas crônicos, sendo encaminhados para serviços de reabilitação. Entre as estruturas anatômicas envolvidas no processo patológico da cervicalgia destaque-se o componente miofascial. A dor miosfascial pode conduzir a um distúrbio psicofisiológico envolvendo sistemas centrais reguladores de dor do sistema nervoso, resultando em respostas fisiológicas. Em relação a avaliação da dor miofascial, destacase o uso do Quantitative Sensory Testing (QST) definido como um conjunto de métodos capaz de avaliar as sensações transmitidas pelas fibras sensoriais, entretanto, ainda se faz necessário o respaldo científico quanto à confiabilidade desse instrumento na população com pontos gatilhos em dor cervical crônica. O objetivo deste estudo foi avaliar a confiabilidade intra e interexaminador do QST para avaliação do limiar térmico doloroso sobre pontos gatilhos miofasciais no músculo trapézio fibras descendentes de indivíduos que apresentam cervicalgia crônica e sua correlação com outros instrumentos de avaliação da dor. Foram inseridos 30 voluntários de ambos os gêneros, com faixa etária de 18 e 45 anos que apresentaram ponto gatilho miofascial bilateralmente, ativos e centrais no músculo trapézio fibras descendentes. Foram realizadas duas coletas por cada avaliador com um intervalo de uma semana entre elas, sendo empregadas na avaliação a Escala Numérica de Dor, Neck Disability Index, algometria, Escala de Pensamentos Catastróficos sobre Dor, termografia infravermelha e o QST. A análise dos dados apresentou valores de ICC intra-examinador variaram entre 0,876 e 0,896 e, os valores de ICC inter-examinador variaram 0,917 e 0,954. Assim, constatou-se no presente estudo moderada confiabilidade para a análise intraexaminador enquanto a avaliação inter-examinador apresentou excelente confiabilidade. Em relação às correlações, foram observadas associações significativas, entre a intensidade de dor e limiar térmico doloroso (calor), sendo fraca e negativa à direita; ente a intensidade de dor e limiar térmico doloroso (frio) , sendo fraca e positiva à direita e a esquerda. Com os demais instrumentos de avaliação, não foram observadas correlações significativas. Conclui-se que a mensuração do limiar térmico doloroso sobre pontos gatilhos miofasciais em indivíduos com cervicalgia crônica apresenta valores de confiabilidade aceitáveis respaldando o emprego do QST para a avaliação em pesquisas e no ambiente clínico, no entanto a sua associação com outros instrumentos de avaliação da dor são fracos ou inexistentes. / Neck pain is one of the most prevalent musculoskeletal disorders and it is estimated that half of the people with this disorder develop chronic symptoms and are referred to rehabilitation services. A lot of anatomical structures are involved in the pathological process of the neck pain with a focus on the myofascial component. Myofascial pain can lead to a psychophysiological disorder involving central nervous system pain regulators, resulting in physiological responses. Concerning the evaluation of myofascial pain the use of Quantitative Sensory Testing (QST) which is defined as a set of methods capable of evaluating the sensations transmitted by the sensory fibers has been highlighted, however, it is still necessary the scientific support about the reliability of this instrument in the population with trigger points in chronic neck pain. The objective of this study was to evaluate the intra and inter-rater reliability of the QST for assessing the pain threshold on myofascial triggers in the trapezius muscle fibers of individuals with chronic neck pain and their correlation with other pain assessment instruments. A total of 30 volunteers of both genders, aged 18 and 45 years, who presented myofascial trigger point bilaterally, active and central in the trapezius muscle were included. Two examinations were carried out for each evaluator with an interval of one week between them, using Numerical Pain Scale, Neck Disability Index, Algometry, Catastrophic Thoughts on Pain Scale, infrared thermography and QST. Data analysis showed intra-examiner ICC values ranged from 0.876 to 0.896 and interexaminer ICC values ranged from 0.917 to 0.954. Thus, the present study showed moderate reliability for the intra-examiner analysis while the inter-examiner evaluation presented excellent reliability. Regarding the correlations there were significant associations between pain intensity and pain threshold (heat) being weak and negative on the right, pain intensity and pain threshold (cold) being weak and positive on the right and left. With the other instruments evaluation, no significant correlations were observed. It is concluded that the measurement of the pain threshold on myofascial trigger points in individuals with chronic neck pain presents acceptable reliability values supporting the use of QST for evaluation in research and clinical settings, however, its association with other pain assessment instruments are weak or nonexistent.

Objective: In three kvasi-experimental single-case studies regarding patients with neck-pain who after sub-grouping using Treatment Based Classification (TBC), were placed in the subgroups centralization or mobilization, describe how and why they were placed in that particular subgroup and then to evaluate the effects on function and pain of the specific treatment proposed for that subgroup.    Method: The process of sub-grouping is described. Function and pain were measured with the Neck Disability Index (NDI) and Numeric Pain Rating Scale 0-10 (NPRS) before, during and after the treatment-period and 1 month after the treatment-period had ended.    Results: The use of TBC showed positive results with increased levels of function and decreased patient-reported neck pain in all three single-cases.    Conclusion: The TBC-system may be used for improving function and pain in patients with neck pain. More studies of the validity and reliability and randomized studies of the TBC-system are needed before it could be recommended generally for physiotherapists.

Background: Patients with primary reports of neck pain often present with impairments of mobility, proprioception and motor control within the cervical spine, and these impairments can negatively impact patient outcomes. Cervical spine manipulation (CSM), which involves the use of thrust techniques, has been shown to be effective for some patients presenting with a primary report of neck pain. It would be useful for clinicians to have a decision making tool, such as a clinical prediction rule (CPR), that could accurately identify that subgroup of patients that would respond dramatically to CSM. The purpose of this project was to develop that CPR. Research Design and Methods: A prospective, cohort study of consecutive patients referred to physical therapy with a primary complaint of neck pain. Eligible patients who consented to participate completed a series of self-report measures, and then received a detailed standardized history and physical examination consisting of a variety of factors commonly used to assess patients with neck pain. Regardless of the results of the clinical examination, all patients received a standardized treatment regimen consisting of CSM and exercise. Depending on response to treatment, patients were treated for one to two treatment sessions over approximately 1 week. At the end of their participation in the study, patients were classified as having experienced a successful outcome or not based on a well-accepted patient-reported reference standard of success, the Global Rating of Change Scale. Analysis: Sensitivity, specificity, and positive and negative likelihood ratios were calculated for all potential predictor variables. Univariate techniques and step-wise logistic regression were used to determine the most parsimonious set of variables for prediction of treatment success. Variables retained in the regression model were used to develop a multivariate CPR to identify patients with neck pain likely to benefit from CSM. Results: Eighty-two patients were included in data analysis of which 32 (39%) had achieved a successful outcome. A CPR with 4 variables (symptom duration < 38 days, positive expectation that manipulation will help, difference in cervical rotation range of motion to either side ¡Ý 10 degrees, and pain with spring (PA) testing of the middle cervical spine) was identified. If 3 of the 4 variables (+LR 13.5) were present the chance of experiencing a successful outcome improved from 39% to 90%. Discussion: The CPR should improve decision-making for patients with neck pain by providing the ability to a priori identify patients with neck pain who are likely to benefit from CSM and exercise. However, this is only the first step in the process of developing and testing a CPR as future studies will be necessary to validate the results and should also include long-term follow-up and a comparison group to further examine the predictive value of the variables identified in the CPR.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal. / Les buts de cette étude sont d'évaluer différentes mesures cliniques, l'efficacité neuromusculaire et la fatigabilité des muscles du cou chez dix-sept femmes souffrant de cervicalgie chronique et dix-sept femmes contrôles, ainsi que d'étudier si des relations existent entre ces mesures. Les questionnaires du McGill pain et du SF-12, l'angle cranio-vertébral, la mobilité articulaire et la force maximale volontaire (FMV) des muscles cervicaux ont été évalués. Les relations Root mean square (RMS)/Moment et Médiane (]VId)/Moment ont été évaluées lors de contractions en rampe. Les relations RMS/Temps et Md/Temps, lors d'une contraction soutenue de 10 secondes. Relativement aux sujets contrôles, les sujets avec cervicalgie ont démontré une diminution de la mobilité articulaire et de la FMV en extension. La pente RMS/Moment des muscles splénius cervicis était significativement plus positive pour le groupe contrôle, suggérant une meilleure efficacité neuromusculaire chez les sujets avec cervicalgie. Aucune différence entre les groupes n'a été trouvée pour la relation Md/Moment. Des pentes RMS/Temps et Md/Temps significativement plus positives pour les muscles stemocléidomastoïdiens du groupe contrôle ont été obtenues, suggérant une plus grande résistance à la fatigue chez le groupe avec cervicalgie. Les analyses de régression n'ont montré aucune relation significative importante entre les mesures cliniques et EMG. Les résultats suggèrent une composition en fibres musculaires, chez les sujets avec cervicalgie, qui serait moins fatigables lors d'une contraction soutenue. Par ailleurs, les relations entre les mesures étant faibles, un tableau clinique clair de ces patients n'a pu être défini. / The goal of this study was to document different clinical measurements, neuromuscular efficiency and fatigability of neck muscles in seventeen women with chronic neck pain and seventeen women with no history of cervical pain, and to study any potential relationship between these variables. The McGill pain and SF-12 questionnaires were filled. Cranio-vertebral angle, range of motion (ROM) and maximal voluntary contraction (MVC) were evaluated. Root mean square (RMS)/Moment and Median frequency (MF)/Moment were evaluated during ramp contraction, and RMS/Time and MF/Time relationships during a sustained 10 seconds contraction. Stemocleidomastoid (SCM) muscles were used for flexors and splenius capitis and cervicis for extensor muscles. For the neck pain group, compared to control, a weakness of the extensors and a decreased of ROM were found. The RMS/Moment relationship of splenius cervicis was significantly more positive for the control group than in the neck pain group, indicating better neuromuscular efficiency in the latter group. The same behavior was shown for all muscles. No between group difference was found for all MF/Moment relationships. The RMS/Time and MF/Time slopes were significantly more positive for SCM muscles, indicating less fatigue in the neck pain group. The regression analyses did not reveal important correlations between the clinical and EMG measurements. The results suggest a muscle fiber composition in neck pain subjects that would be less fatigable during sustained contractions. Because relationships between pain, EMG measurements and other clinical measurements were weak, a clear pattern of deficiencies for those subjects was not defined.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Flexion distraction chiropractic technique (FDCT) is a commonly used manual therapy technique which is purported to address various clinical pain syndromes. However, it lacks the credibility of appropriate evidence-based guidelines. An analysis of the literature would be able to inform the development of guidelines. Objectives: The aim of this systematic review was to determine the evidence to support the use of FDCT in clinical practice. Data sources: A systematic review of PubMed and Summons was conducted, using the following search terms: chiropractic, flexion distraction, protocol and / or technique. Study selection: All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction: Blinded review of the articles was conducted by three independent reviewers utilising the PEDro (for randomised controlled trials) and NOS for (non-randomised controlled trials). This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for FDCT. Data synthesis: 18 review outcomes were aggregated around four clinical categories; two articles each on neck pain, chronic pelvic pain, and physiological outcomes and the remaining twelve on low back pain. There was agreement that the evidence for pelvic pain and physiological function was limited to no evidence and limited respectively. Conflicting evidence existed for neck and low back pain (single and multimodal treatment) with limited and moderate evidence respectively. Conclusion: FDCT is clinically advocated for many conditions. The evidence provided in this review indicates that practitioners should be guarded in their use of FDCT, as the evidence to its widespread use is limited to only those conditions noted in this review. Therefore, further high quality and rigorous studies are required to develop appropriate treatment guidelines for use by practitioners to adequately provide evidence based care in clinical practice.

Dissertation completed in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background: Mechanical neck pain is a common complaint characterized by pain, limited range of motion and myofascial trigger points. The most common treatments for it are manual therapy and drug therapy. The former includes massage and exercise therapy and more specific to this study spinal manipulation and dry needling. The latter includes non-steroidal anti-inflammatories (NSAIDs) and analgesics. Manipulation assists in increasing range of movement and reduces muscle spasm, while dry-needling inactivates trigger points and decreases local and referred pain. NSAIDs reduce pain and muscle spasm by inhibiting inflammatory pathways. Traumeel®S is a commonly used, safe and well tolerated homoeopathic anti-inflammatory with similar efficacy as NSAIDs but without the adverse gastrointestinal effects. It has also been shown to be highly effective in the treatment of myofascial pain. Methodology: This study was designed as a randomized comparative clinical trial. Fourty participants between ages 18-55 years of age were randomly allocated to two groups of twenty participants each. Group A received spinal manipulation and dry needling in trapezius trigger point two; while Group B received spinal manipulation and Traumeel®S solution injection in trapezius trigger point two. The study took place over a period of two weeks and involved four consultations. Subjective and objective readings were taken at every consultation. Subjective tools included the Numerical pain rating scale (NRS) and Canadian Memorial Chiropractic College (CMCC) neck disability index. Objective tools included the pressure algometer and cervical range of motion (CROM-II) goniometer. SPSS version 20.0 was used in the data analysis. A p-value of <0.05 was considered as statistically significant. Results: The results showed that no statistically significant differences were observed between the two groups in terms of subjective and objective measurements. However, there were statistically significant improvements seen in both groups equally in terms of subjective and objective measurements i.e. both groups showed improvement. Conclusion: The results of this study concluded that the effectiveness of spinal manipulation and dry needling versus spinal manipulation and Traumeel®S Injectable solution in the treatment of mechanical neck pain associated with trapezius myofascial trigger points is equivalent to each other. No statistically or clinically significant changes were noticed between the groups.