Volume 3 Issue 3
Authors: Simon Chafer; Fiona Hamilton
Abstract: Background: Fibromyalgia (FM) is characterized by widespread pain; however, it is not restricted to pain alone, and consequently is also referred to as fibromyalgia syndrome (FMS). Associated symptoms include joint stiffening, poor sleep hygiene, anxiety, and depression. Recent thinking regarding FM pathogenesis has focused upon central sensitization (CS), suggesting that patients have lower pain thresholds and increased sensitivity to pain. The musculoskeletal system has been suggested as a source of pain signals to the central nervous system (CNS), thus contributing to CS [2]. Presently there exists no known cure, and primary care management includes pharmacological treatment as well treatments involving manual and physical therapy. Although manual therapy is often used by FM patients to help ameliorate symptoms, particularly pain, no guidelines exist for the recommendation of such therapy, particularly manipulation, revealing a paucity of published evidence in this field. Objective: This review aims to evaluate the available evidence regarding the efficacy of some of the most common forms of manual therapy as used in a clinical setting by manual therapists and physical therapists, as a potential intervention for patients with FM. This review may hopefully be used to help inform best clinical practice with regard to manual therapy as a treatment for FM patients. Methods: A search was conducted of databases, and reference sections of original studies, as well as systematic reviews of manual therapies commonly used by physical therapists, osteopaths, chiropractors and massage therapists in the treatment of FM. The time frame for relevant literature spanned 2009 to 2014. The primary author was solely responsible for selection of studies for inclusion based on defined inclusion and exclusion criteria. Following appraisal using The Critical Appraisal Program (CASP), evidence ratings were applied to the studies using The Oxford Rating Scale developed by The Centre for Evidence-Based Medicine (CEBM) and The Scottish Intercollegiate Guidelines Network (SIGN) checklist. Results: The reviewed studies offer inconclusive support for manual therapy as a potential pain relief intervention for patients with FM. This is primarily due to the questionable quality of the studies in relation to rigor, reliability and validity. The evidence to support massage therapy is moderate at best, whereas that supporting the use of manipulation is limited. Conclusion: It is difficult to draw definite conclusions regarding the efficacy of manual therapy as a sole treatment approach for the management of FM. There are several reasons for this, including methodological constraints affecting the available studies, as well as the heterogeneity and lack of standardization with regard to available treatment programs for FM sufferers, which complicates the comparison of available studies.
Keywords: Fibromyalgia; Manipulation; Mobilization; Physical Therapy; Osteopathy; Chiropractic
Authors: Huybrechts Bindele; Chistina Shepherd; Ben Roussel; Meridith Anile; Joseph Day; Jean Irion; Jared Henson
Abstract: Purpose: Physical therapy service learning projects and volunteer experiences in foreign countries are becoming more commonplace. Patients in underserved regions are not likely to receive therapy services regularly; therefore, adherence to a home exercise program (HEP) is critical. The primary purpose of this study was to observe home exercise adherence rates between the 1st and 2nd visits in an underserved population. The secondary purpose of this study was to determine specific factors that affect HEP adherence in this population. Methods: Consecutive patients seen in Santo Domingo, Ecuador were considered for participation in this observational study. All patients were recruited from one clinic or during home visits in the surrounding community over a 5-month period by one physical therapist. To be included in the study, patients were required to display sufficient cognitive ability by stating their name, the date, their location, and their reason for being at that location, were at least 19 years of age, and had an impairment or functional limitation that was included in the physical therapy scope of practice. Patient demographics, medical history, and answers to questionnaires were collected on the initial visit. Immediately after the initial evaluation, patients were issued 5 home exercises. On the subsequent follow-up visit, adherence was measured with the Medical Outcomes Study General Adherence Items (MOSGAI). Adherence percentage, defined by the frequency in which the patient performed all the exercises as prescribed, was calculated. In order to evaluate potential factors affecting HEP adherence, separate Kruskal-Wallis tests were performed on the categorical variables (gender, marital status, education, employment, duration of symptoms, and comorbidities) and separate Spearman correlation tests were performed on the continuous data (age, pain level, and sport injury rehabilitation adherence scale - SIRAS). Alpha was set at p ≤.05 a priori. Results and Conclusion: A total of 40 patients satisfied the eligibility criteria and agreed to participate, of which 29 (mean age 55, SD 14) were seen for a second visit. Of the patients who returned for a second visit, the median (interquartile range) MOSGAI score was 24 (21-29) and the average adherence percentage was 73%. Age was negatively correlated with the MOSGAI (p = 0.008, r = -0.60), while the SIRAS was positively correlated with the MOSGAI (p = 0.002, r = 0.52). Exercise adherence in this population was similar to previously reported data, but in areas where access to health care is limited, it may be even more important to improve adherence. It is possible that both age and the level of adherence observed by the physical therapist during the first visit helped predict HEP adherence in this population. Innovation: Volunteer physical therapists serving in this community should proactively explore strategies to increase adherence in patients with these characteristics.
Keywords: Service Learning; Volunteer; International; Rehabilitation