Background and Objective High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries. Methods An online survey with 41 questions was adapted from previous surveys and was distributed via a mailing list of the Italian Physiotherapists Association (March 22–26, 2020). The questionnaire was divided into 4 sections to capture information on participant demographics, utilization, potential barriers, and knowledge about SM. Questions were differentiated between spinal regions. Attitudes towards different spinal regions, attributes associated with beliefs, and the influence of previous educational background were each evaluated. Results Of the 7398 registered physiotherapists, 575 (7.8%) completed the survey and were included for analysis. The majority of respondents perceived SM as safe and effective when applied to the thoracic (74.1%) and lumbar (72.2%) spines; whereas, a smaller proportion viewed SM to the upper cervical spine (56.8%) as safe and effective. Respondents reported they were less likely to provide and feel comfortable with upper cervical SM (respectively, 27.5% and 48.5%) compared to the thoracic (respectively, 52.2% and 74.8%) and lumbar spines (respectively, 46.3% and 74.3%). Most physiotherapists (70.4%) agreed they would perform additional screening prior to upper cervical SM compared to other spinal regions. Respondents who were aware of clinical prediction rules were more likely to report being comfortable with SM (OR 2.38–3.69) and to perceive it as safe (OR 1.75–3.12). Finally, physiotherapists without musculoskeletal specialization, especially those with a traditional manual therapy background, were more likely to perform additional screening prior to SM, use SM less frequently, report being less comfortable performing SM, and report upper cervical SM as less safe (p < 0.001). Discussion The beliefs and attitudes of physiotherapists surrounding the use of SM are significantly different when comparing the upper cervical spine to other spinal regions. An educational background in traditional manual therapy significantly influences beliefs and attitudes. We propose an updated framework on evidence-based SM.
Introduction. Headache is one of the most common and disabling conditions worldwide, as described by the World Health Organization report. The risk of suffering from headache has been described to increase from twofold to threefold in adult women compared to men, depending on the studies. These gender differences have been linked to environmental, genetic, epigenetic, and hormonal aspects. Sex hormones can enhance headaches mainly through sensitization of the trigemino-vascular system and modulation of the blood vessel factors, with significant clinical consequences. International guidelines suggest several pharmacological and non-pharmacological treatments in the management of headache disorders as acute or preventive therapies. Few studies have been conducted on the efficacy and effectiveness of therapies in managing hormonal-related headaches to date. Therefore, this scoping review (ScR) aims to summarize the evidence regarding the efficacy of conservative physiotherapeutic approaches on this topic in the domain of gender medicine, which studies sex influences on pathophysiology, clinical signs, prevention, and therapy of diseases. Methods and analysis. The ScR will be performed following the 6-stage methodology suggested by Arksey and O Malley and the extensions to the original framework recommended by the Joanna Briggs Institute. MEDLINE, Cochrane Central, Scopus, CINHAL, Embase and PEDro databases will be searched. Additional records will be identified through searching in grey literature and the reference lists of all relevant studies. No study design, publication type, language nor date restrictions will be applied. Two reviewers will independently screen all abstracts and full-text studies for inclusion. The research team will develop a data collection form to extract the studies characteristics. A tabular and accompanying narrative summary of the information will be provided. This protocol received input from all authors who have expertise in research methodology and specific knowledge in the field. Ethics and dissemination. This study does not require ethical approval as we will not collect personal data. It will summarize information from publicly available studies in line with the nature of the study s methodology. Regarding dissemination activities, the results of this review will be submitted for publication in a peer-reviewed journal, presented at relevant conferences in the field and disseminated through working groups, webinars and partners. KEYWORDS Headache, menstruation, hormones, physical therapy, exercise therapy.
Introduction. Cervical radiculopathy (CR) is a common cause of pain in the neck and arm region, with a considerable impact on a person's physical functioning, mental health, and social participation. The current knowledge of CR is mainly based on empirical concepts and early studies. Although action potential conduction slowing or block of a spinal nerve or its roots (i.e., loss of sensory and/or motor function) is a core sign of CR, among guidelines CR is still commonly defined by pain (i.e., gain of function) radiating into the arm. There is no consensus about the gold-standard for the diagnostic procedures for CR but it has been suggested that clinicians should assess CR by subjective and physical examination including a neurological examination, neural mechanosensitive testing and provocative manoeuvres. Among the several clinical tests routinely used to identify loss of function, the neurological examination historically played a role in the differential diagnosis and in the prognostic profile of radiculopathy. However, there is a paucity of studies investigating the diagnostic accuracy of the neurological examination for CR. Thus, the assessment of CR remains a clinical challenge among primary care clinicians. This often leads to an increased risk of misdiagnosis and inappropriate treatment, potentially contributing to delayed recovery and poor health outcomes. Therefore, according to the population, concept, context (PCC) strategy, our scoping review aims to investigate the evidence in regard to diagnostic accuracy (C) of the neurological examination for CR (P) and raise awareness among clinicians on how to appropriately perform this testing. Methods and analysis. This scoping review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews checklist and the Joanna Briggs Institute (JBI) Reviewer's Manual on scoping reviews. The aim of this scoping review is to explore what is already known about the neurological examination and its diagnostic value for CR. Ethics and dissemination. This scoping review will not require ethical approval since it will synthesize information from publicly available studies. Results will be submitted for publication in a peer-reviewed journal, presented at relevant conferences in the field and disseminated through working groups, conferences, webinars, social media. Strengths and limitations of this study. Our review will identify knowledge gaps to inform future research about the neurological examination for CR. Diagnostic values will be reported when available. To the best of the authors' knowledge, this is the first scoping review to provide a comprehensive overview on the neurological examination for CR. The results will add meaningful information for clinicians to inform assessment of CR. It will also direct future research. A robust clinical recommendation might be limited due to the lack of available literature KEYWORD cervical radiculopathy, neurological examination, scoping review
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