The JMPT is the premier scientific journal of the chiropractic profession, dedicated to the advancement of chiropractic health care. The National University of Health Sciences, owner of the journal, upholds the journal's compliance with the highest publication standards, which expressly support editorial freedom and best publication practices. The JMPT is an independent publication that strives to provide the best scientific information that improves health care practice and future research.
Use of a Computer Interviewing System During Periodic Patient Reassessment
Katrina Hands, BSc, PGCE, MSc, et al.
Objective: The purpose of this study was to investigate whether a computer interviewing system (CIS) could be used as part of the periodic patient reassessment process, if patients and practitioners perceived that the CIS enhanced communication, and if the CIS could be used to identify patients with possible anxiety and/or depression.
Methods: An observational method was used, whereby the CIS was used to augment the usual patient reassessment routine in a chiropractic clinic. One clinic in the Dundee region, with three chiropractors, collected information from 60 patients using a CIS directly before the patient treatment session. The patients were then asked to rate whether they had disclosed new information relative to their care, if they felt better prepared, or if it had helped them to formulate questions. The chiropractors reported whether the interview transcript was useful, if it helped to identify communication issues, and if it had altered the treatment session.
Results: The doctors of chiropractic rated the interview transcript as useful for 83% of patients, they altered the treatment session for 20% of patients, and the CIS helped to identify communication difficulties for 13% of patients. The chiropractors were surprised by the Hospital Anxiety and Depression Scale results for 23% of patients. The patients were positive about the inclusion of the CIS, with 42% saying that they disclosed new information and 33% saying that they felt better prepared for the session with the chiropractor after having used the CIS. The CIS was acceptable to 90% of patients.
Conclusions: The inclusion of the CIS at this one clinic appeared to be a useful addition to the periodic patient reassessment process and was perceived to be an efficient media to evaluate Hospital Anxiety and Depression Scale scores.
Motor and Hypoalgesic Effects of Manipulation in Patients With Lateral Epicondylagia
Josue Fernandez-Carnero, PhD, PT, et al.
Objectives: The purpose of this study was to compare the effects of a cervical vs thoracic spine manipulation on pressure pain threshold (PPT) and pain-free grip strength in patients with lateral epicondylalgia (LE).
Methods: A single-blind randomized clinical trial was completed with 18 participants with LE. Each subject attended one experimental session. Participants were randomized to receive either a cervical or thoracic spine manipulation. Pressure pain threshold over the lateral epicondyle of both elbows pain-free grip strength on the affected arm and maximum grip force on the unaffected side were assessed preintervention and five minutes postintervention by an examiner blind to group assignment. A three-way analysis of variance with time and side as within-subject variable and intervention as between-subject variable was used to evaluate changes in PPT and pain-free grip.
Results: The analysis of variance detected a significant interaction between group and time (F = 31.7, P < .000) for PPT levels. Post hoc testing revealed that the cervical spine manipulation produced a greater increase of PPT in both sides compared with thoracic spine manipulation (P < .001). For pain-free grip strength, no interaction between group and time (F = .66, P = .42) existed.
Conclusions: Cervical spine manipulation produced greater changes in PPT than thoracic spine manipulation in patients with LE. No differences between groups were identified for pain-free grip. Future studies with larger sample sizes are required to further examine the effects of manipulation on mechanisms of pain and motor control in upper extremity conditions.
Nerve Mobilization Exercise for Tarsal Tunnel Syndrome
Tasemin Kavlak, PT, PhD
Objective: This study was carried out with the aim of investigating the contribution of nerve mobilization exercises to the conservative treatment of tarsal tunnel syndrome.
Methods: In this clinical trial, 28 patients were randomly allocated into two groups. The control group was composed of 14 patients who were treated conservatively with a program consisting of physiotherapy and supportive inserts, whereas 14 patients in the study group were given nerve mobilization exercises in addition to the same treatment. All patients were followed up for six weeks. Before treatment, subjects were evaluated for muscle strength, range of motion, pain, sensory tests, and clinical manifestations of tarsal tunnel syndrome. The evaluations were repeated after six weeks.
Results: There was a significant difference in favor of posttreatment values for range of motion, muscle strength, and pain in both groups (P < .05). Intergroup comparisons showed no difference between the groups for these parameters. Significant results were attained in the study group for two-point discrimination and light touch and Tinel sign after treatment (P < .05).
Conclusion: Patients in both groups showed improvement from conservative treatment. The results of the study group showed that nerve mobilization exercises have a positive effect on two-point discrimination and light touch and Tinel sign.
Morphological Asymmetry of the Atlas: Clinical Implications
Jiao Pei-Feng, MD, et al.
Objective: The aim of this study was to investigate the asymmetry of the adult atlas by deviation frequencies using three-dimensional (3D) computer models based on the computed tomographic (CT) spine data from healthy patients.
Methods: Sixty adult atlas computer models were reconstructed from CT data of the cervical spine. The morphological asymmetries were investigated and measured with 3-D software. Asymmetry in the morphology of the vertebral artery groove was observed, and the angles between the lines connecting the apices of transverse processes and the apices of anterior and posterior tubercles were measured. The lengths of the left and right posterior arches were measured, and the differences in values were categorized.
Results: We observed seven cases (11.67%) with asymmetrical vertebral artery groove forms. There were four different categories: foramen-shaped, semi-foramen–shaped, deep, and superficial grooves. The asymmetry was of different shapes on both sides. Relative to the lines connecting the apices of anterior and posterior tubercles, the asymmetry frequency of the transverse processes and the posterior arch length was 6.67% and 16.67%, respectively.
Conclusions: For the specimens in this study, variation in morphology of the atlas was common. Asymmetry of apices of transverse processes, posterior arches, and vertebral artery grooves should be taken into account during clinical palpation, diagnostic imaging, and treatment including spinal manipulation.
JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit www.journals.elsevierhealth.com/periodicals/ymmt for access to the complete September 2011 issue of JMPT.
