Does Continuing Education Improve Physical Therapists’ Effectiveness in Treating Neck Pain?
From: Phys Ther. 2008 Nov 6; [Epub ahead of print]
Physical therapists often attend continuing education courses to improve their overall clinical performance and patient outcomes. However, evidence suggests that continuing education courses may not improve the outcomes for patients receiving physical therapy for the management of neck pain. The purpose of this study was to investigate the effectiveness of an ongoing educational intervention for improving the outcomes for patients with neck pain. Participants The study participants were 19 physical therapists who attended a 2-day continuing education course focusing on the management of neck pain. All patients treated by the therapists in this study completed the Neck Disability Index and a pain rating scale at the initial examination and at their final visit.
Therapists from 11 clinics were invited to attend a 2-day continuing education course on the management of neck pain. After the continuing education course, the therapists were randomly assigned to receive either ongoing education consisting of small group sessions and an educational outreach session or no further education. Clinical outcomes achieved by therapists who received ongoing education and therapists who did not were compared for both pretraining and posttraining periods. The effects of receiving ongoing education were examined by use of linear mixed-model analyses with time period and group as fixed factors; improvements in disability and pain as dependent variables; and age, sex, and the patient’s initial Neck Disability Index and pain rating scores as covariates.
Patients treated by therapists who received ongoing education experienced significantly greater reductions in disability during the study period (pretraining to posttraining) than those treated by therapists who did not receive ongoing training. Changes in pain did not differ for patients treated by the 2 groups of therapists during the study period. Therapists in the ongoing education group also used fewer visits during the posttraining period. The results of this study demonstrated that ongoing education for the management of neck pain was beneficial in reducing disability for patients with neck pain while reducing the number of physical therapy visits. However, changes in pain did not differ for patients treated by the 2 groups of therapists. Although it appears that a typical continuing education course does not improve the overall outcomes for patients treated by therapists attending that course, more research is needed to evaluate other educational strategies to determine the most clinically effective and cost-effective interventions.
Simplified form of tinnitus retraining therapy in adults: a retrospective study
From: BMC Ear Nose Throat Disord. 2008 Nov 3;8(1):7 [Epub ahead of print]
Tinnitus retraining therapy is aimed at removing negative associations of the tinnitus signal to enable the natural habituation process to occur. The goal is to achieve this through retraining counseling and sound therapy. Retraining counseling is a crucial part of tinnitus retraining therapy; it teaches patients the components of the neurophysiological model of tinnitus and encourages them to reclassify their tinnitus as a neutral signal. Sound therapy is assumed to facilitate tinnitus habituation by decreasing the strength of tinnitus signal. The tinnitus retraining therapy protocol requires that the patient adheres to the regimen for 12-24 months (typically attending for seven sessions over that time), except for patients experiencing weak tinnitus, which hearing aids little impact on everyday life.
Since the first description of tinnitus retraining therapy in the 1990s, clinicians have modified and customised the method of tinnitus retraining therapy to suit their practice and their patients. A simplified form of tinnitus retraining therapy hearing aids been used at Ealing Primary Care Trust (PCT) Audiology Department since 2005. This is different from tinnitus retraining therapy in the type and (shorter) duration of retraining counseling. Although the counseling used in simplified tinnitus retraining therapy also aims to get the patient to reclassify tinnitus as a neutral stimulus, it is different from the counseling used in tinnitus retraining therapy in the following ways: (1) there is no teaching about basic functions of the auditory system; (2) there is no presentation of the basics of brain function and the interactions of various systems of the brain; (3) there is no explanation of the theoretical basis of habituation based on the Jastreboff neurophysiological model; and (4) the duration of the initial counseling of simplified tinnitus retraining therapy is 30 minutes in comparison to 90 minutes for the initial tinnitus retraining therapy counseling.
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Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities.
From: Int Arch Med. 2008 Oct 30;1(1):23 [Epub ahead of print]
This review explores the aetiology of temporomandibular disorders and discusses the controversies in variable treatment modalities. Pathologies of the temporomandibular joint (TMJ) and its’ associated muscles of mastication are jointly termed temporomandibular disorders (TMDs). TMDs present with a variety of symptoms which include pain in the joint and its surrounding area, jaw clicking, limited jaw opening and headaches. It is mainly reported by middle aged females who tend to recognize the symptoms more readily than males and therefore more commonly seek professional help. Several aetiological factors have been acknowledged including local trauma, bruxism, malocclusion, stress and psychiatric illnesses. The Research Diagnostic Criteria of the Temporomandibular Disorders (RDC/TMD) is advanced to other criteria as it takes into consideration the socio-psychological status of the patient. Several treatment modalities have been recommended including homecare practices, splint therapy, occlusal readjustment, analgesics and the use of psychotropic medication; as well as surgery, supplementary therapy and cognitive behavioural therapy. Although splint therapy and occlusal readjustment have been extensively used, there is no evidence to suggest that they can be curative; a number of evidence-based trials have concluded that these appliances should not be suggested as part of the routine care. Surgery, except in very rare cases, is discouraged since it is the most invasive alternative; recent studies have shown healthier outcome with cognitive behavioural therapy.
Torque – electromyography velocity relationship in female workers with chronic neck muscle pain
From: J Biomech. 2008;41(9):2029-35. Epub 2008 May 5
The present study investigated the effect of chronic neck muscle pain (defined as trapezius myalgia) on neck and shoulder muscle function during concentric, eccentric and static contraction. Forty-two female office workers with chronic neck muscle pain and 20 healthy matched controls participated. Isokinetic and static maximal voluntary shoulder abductions were performed in a Biodex dynamometer, and electromyography obtained in the trapezius and deltoideus muscles. Muscle thickness in the trapezius was measured with ultrasound. Pain and perceived exertion were registered before and after the dynamometer test. The main findings were that shoulder abduction torque and trapezius electromyography amplitude were significantly lower in chronic neck muscle pain compared with healthy matched controls. Deltoideus electromyography and trapezius muscle thickness were not significantly different between the groups. While perceived exertion increased in both groups in response to the test, pain increased in chronic neck muscle pain only. In conclusion, having trapezius myalgia was associated with decreased strength capacity and lowered activity of the painful trapezius muscle. The most consistent differences in terms of both torque and electromyography were found during slow concentric and eccentric contractions. Activity of the synergistic pain free deltoideus muscle was not significantly lower, indicating specific inhibitory feedback of the painful trapezius muscle only. Parallel increase in pain and perceived exertion among chronic neck muscle pain were observed in response to the maximal contractions, emphasizing that heavy physical exertion provokes pain increase only in conditions of myalgia.
Kinematic Analysis of the Relationship Between Sagittal Alignment and Disc Degeneration in the Cervical Spine
From: Spine. 2008 Nov 1;33(23):E870-E876;
The cervical spine withstands the axial load of the head and is the most mobile region of the spine. Normal lordotic alignment is one of the most important factors contributing to effective motion and function of the cervical spine. The discs degenerate with age, and degeneration may ultimately affect the mechanical properties of spinal motion. On the other hand, it was reported that severe degenerative changes tend to produce less cervical lordosis. The loss of normal lordotic alignment may induce pathologic changes in the kinematics and may accelerate degeneration of the functional motion unit. Furthermore, it is well known that sagittal malalignment in cervical degenerative disorders causes spinal morbidities such as neck pain and deterioration of neurologic deficit. However, the relationship of altered alignment on the kinematics and degeneration of the cervical spine has not been elucidated thus far.
Kinetic magnetic resonance imaging (MRI) allows us to obtain images of patients in weight-bearing and flexion-extension positions and eventually provides considerable information, which would have been unavailable if a conventional MRI were used. It may also help in understanding the true nature of spinal pathologies. In addition, it can demonstrate the mobility of each motion segment and finally, relate the mobility to the changes in sagittal alignment and disc degeneration.
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What is Mechanical Back Pain and How Best to Treat It
From: Curr Pain Headache Rep. 2008 Dec;12(6):406-11
Back pain is one of the most common patient complaints brought forth to physicians. Mechanical back pain accounts for 97% of cases, arising from spinal structures such as bone, ligaments, discs, joints, nerves, and meninges. Acute back pain in the absence of progressive neurologic deficits and other underlying nonmechanical causes may be treated conservatively, with specific emphasis on maintaining activity levels and function. Mechanical back pain persisting for more than 4 to 6 weeks may warrant further diagnostic testing and imaging. Common causes of mechanical back pain include spinal stenosis, herniated discs, zygapophysial joint pain, discogenic pain, vertebral fractures, sacroiliac joint pain, and myofascial pain. A wide variety of treatments are available, with different treatments specifically targeted toward different causes. A balanced approach, which takes into account patient psychosocial factors and incorporates multidisciplinary care, increases the likelihood of success from back pain interventions.
Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the cost effectiveness
From: BMC Musculoskelet Disord. 2008 Oct 29;9(1):145 [Epub ahead of print]
In a randomised controlled trial (RCT), a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline. The departments consisting of about 150 workers are pre-stratified and randomised. The control departments receive usual practice and the intervention departments receive participatory ergonomics . Within each intervention department a working group is formed including eight workers, a representative of the management, and an occupational health and safety coordinator. During a one day meeting, the working group follows the steps of participatory ergonomics in which the most important risk factors for low back pain and neck pain, and the most adequate ergonomic measures are identified on the basis of group consensus. The implementation of ergonomic measures at the department is performed by the working group. To improve the implementation process, so-called ‘ergocoaches’ are trained. The primary outcome measure is an episode of low back pain and neck pain. Secondary outcome measures are actual use of ergonomic measures, physical workload, psychosocial workload, intensity of pain, general health status, sick leave, and work productivity. The cost-effectiveness analysis is performed from the societal and company perspective. Outcome measures are assessed using questionnaires at baseline and after 6 and 12 months. Data on the primary outcome as well as on intensity of pain, sick leave, work productivity, and health care costs are collected every 3 months.
Prevention of low back pain and neck pain is beneficial for workers, employers, and society. If the intervention is proven cost effective, the intervention can have a major impact on low back pain and neck pain prevention and, thereby, on work disability prevention.
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