Jocelyn Cox

Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review

Study Design Systematic review. Background Little is known about the effectiveness of acupuncture therapies for musculoskeletal disorders. Objective To assess the effectiveness and safety of acupuncture therapies for musculoskeletal disorders of the extremities. Methods We searched MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015 for randomized controlled trials, cohort studies, and case-control studies. Eligible studies were appraised with Scottish Intercollegiate Guidelines Network criteria. A best-evidence synthesis was performed to synthesize results from included studies with a low risk of bias. A sensitivity analysis was conducted to determine the impact of excluding studies with a high risk of bias. Results The search revealed 5180 articles; 15 were included (10 with a low risk of bias, 5 with a high risk of bias). The studies with a low risk of bias suggested that (1) traditional needle acupuncture was superior to oral steroids (1 RCT, n = 77) and may be superior to vitamin B1/B6 supplements (1 RCT, n = 64) for carpal tunnel syndrome (CTS), and was superior to exercise for Achilles tendinopathy (1 RCT, n = 64). Traditional needle acupuncture did not provide important benefit over placebo for upper extremity pain (1 RCT, n = 128), or no intervention for patellofemoral pain (1 RCT, n = 75), and was inconclusive for shoulder pain (2 RCTs, n = 849), suggesting no important benefit; (2) electroacupuncture may be superior to placebo for shoulder injuries (1 RCT, n = 130) and may not be superior to night splinting for persistent CTS (1 RCT, n = 78); and (3) dry needling may be superior to placebo for plantar fasciitis (1 RCT, n = 84). Sensitivity analysis suggests that including studies with a high risk of bias might have impacted the evidence synthesis in support of managing shoulder pain with traditional needle acupuncture, and that would suggest traditional needle acupuncture may be effective for lateral epicondylitis and piriformis syndrome. Conclusion Evidence for the effectiveness of acupuncture for musculoskeletal disorders of the extremities was inconsistent. Traditional needle acupuncture may be beneficial for CTS and Achilles tendinopathy, but not for nonspecific upper extremity pain and patellofemoral syndrome. Electroacupuncture may be effective for shoulder injuries and may show similar effectiveness to that of night wrist splinting for CTS. The effectiveness of dry needling for plantar fasciitis is equivocal. Level of Evidence Therapy, 1a-. J Orthop Sports Phys Ther 2016;46(6):409-429. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6270.

Working position influences the biomechanical demands on the lower back during dental hygiene.

Abstract This investigation monitored the biomechanical demands on the lower back during simulated dental hygiene work. A total of 19 female, registered dental hygienists performed 30 continuous minutes of manual scaling (plaque removal) of a manikin’s teeth while seated. We monitored the working location and orientation of the dental hygienists, with respect to the manikin, along with their spine kinematics, spine extensor muscle activities and seat pressure, throughout the 30 min. A clock representation was used to express the working location. The location significantly influenced the dental hygienists’ pelvic orientation with respect to the manikin, spine posture, erector muscle activity and pressure distribution. Findings from this study suggest that the prevalence of lower back pain amongst dental hygienists may be directly related to low-level tonic activity of the spine’s extensor musculature, and the combined flexed and axially rotated spine postures. Practitioner Summary: Low back pain (LBP) is prevalent in dental hygienists, yet occupational demand on the low back has not been investigated. Posture, muscle activity and seat pressure were monitored. Combined spine rotation and flexion, and tonic activity of the extensor musculature may be related to LBP in dental hygienists.

Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration

ObjectiveTo determine the reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders.MethodsWe updated the systematic review of the 2000–2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders. We also searched the literature to identify studies on the reliability and validity of Doppler velocimetry for the evaluation of cervical arteries. Two independent reviewers screened and critically appraised studies. We conducted a best evidence synthesis of low risk of bias studies and ranked the phases of investigations using the classification proposed by Sackett and Haynes.ResultsWe screened 9022 articles and critically appraised 8 studies; all 8 studies had low risk of bias (three reliability and five validity Phase II–III studies). Preliminary evidence suggests that the extension–rotation test may be reliable and has adequate validity to rule out pain arising from facet joints. The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests. No evidence was found for doppler velocimetry.ConclusionsLittle evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

The Effectiveness of Passive Physical Modalities for the Management of Soft Tissue Injuries and Neuropathies of the Wrist and Hand: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

OBJECTIVE The purpose of this systematic review was to determine the effectiveness of passive physical modalities compared to other interventions, placebo/sham interventions, or no intervention in improving self-rated recovery, functional recovery, clinical outcomes and/or administrative outcomes (eg, time of disability benefits) in adults and/or children with soft tissue injuries and neuropathies of the wrist and hand. METHODS We systematically searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials, accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text, accessed through EBSCO host, from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best evidence synthesis principles. RESULTS We screened 6618 articles and critically appraised 11 studies. Of those, 7 had low risk of bias: 5 addressed carpal tunnel syndrome (CTS) and 2 addressed de Quervain disease. We found evidence that various types of night splints lead to similar outcomes for the management of CTS. The evidence suggests that a night wrist splint is less effective than surgery in the short term but not in the long term. Furthermore, a night wrist splint and needle electroacupuncture lead to similar outcomes immediately postintervention. Finally, low-level laser therapy and placebo low-level laser therapy lead to similar outcomes. The evidence suggests that kinesio tape or a thumb spica cast offers short-term benefit for the management of de Quervain disease. Our search did not identify any low risk of bias studies examining the effectiveness of passive physical modalities for the management of other soft tissue injuries or neuropathies of the wrist and hand. CONCLUSIONS Different night orthoses provided similar outcomes for CTS. Night orthoses offer similar outcomes to electroacupuncture but are less effective than surgery in the short term. This review suggests that kinesio tape or a thumb spica cast may offer short-term benefit for the management of de Quervain disease.

The biomechanical demands of manual scaling on the shoulders & neck of dental hygienists

Abstract The purpose of this study was to evaluate the postural and muscular demands placed on the shoulders and neck of dental hygienists when performing a simulated manual scaling task. Nineteen healthy female dental hygienists performed 30-min of simulated manual scaling on a manikin head in a laboratory setting. Surface electromyography was used to monitor muscle activity from several neck and shoulder muscles, and neck and arm elevation kinematics were evaluated using motion capture. The simulated scaling task resulted in a large range of neck and arm elevation angles and excessive low-level muscular demands in the neck extensor and scapular stabilising muscles. The physical demands varied depending on the working position of the hygienists relative to the manikin head. These findings are valuable in guiding future ergonomics interventions aimed at reducing the physical exposures of dental hygiene work. Practitioner Summary: Given that this study evaluates the physical demands of manual scaling, a procedure that is fundamental to dental hygiene work, the findings are valuable to identify ergonomics interventions to reduce the prevalence of work-related injuries, disability and the potential for early retirement among this occupational group.