Kerstin M. Palombaro

Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis

STUDY DESIGN Systematic review and meta-analysis. BACKGROUND Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points. When palpated, active myofascial trigger points cause local or referred symptoms, including pain. Dry needling involves inserting an acupuncture-like needle into a myofascial trigger point, with the goal of reducing pain and restoring range of motion. OBJECTIVE To explore the evidence regarding the effectiveness of dry needling to reduce pain in patients with MPS of the upper quarter. METHODS An electronic literature search was performed using the key word dry needling. Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trial (RCT), dry needling intervention group, and MPS involving the upper quarter. The RCTs that met these criteria were assessed and scored for internal validity using the MacDermid Quality Checklist. Four separate meta-analyses were performed: (1) dry needling compared to sham or control immediately after treatment, (2) dry needling compared to sham or control at 4 weeks, (3) dry needling compared to other treatments immediately after treatment, and (4) dry needling compared to other treatments at 4 weeks. RESULTS The initial search yielded 246 articles. Twelve RCTs were ultimately selected. The methodological quality scores ranged from 23 to 40 points, with a mean of 34 points (scale range, 0-48; best possible score, 48). The findings of 3 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can immediately decrease pain in patients with upper-quarter MPS, with an overall effect favoring dry needling. The findings of 2 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can decrease pain after 4 weeks in patients with upper-quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There was evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. CONCLUSION Based on the best current available evidence (grade A), we recommend dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS. Due to the small number of high-quality RCTs published to date, additional well-designed studies are needed to support this recommendation. LEVEL OF EVIDENCE Therapy, level 1a-.

Interventions Used by Physical Therapists in Home Care for People After Hip Fracture

Background and Purpose: The majority of older people who survive a hip fracture have residual mobility disabilities. Any attempt to systematically reduce mobility disabilities after hip fracture, however, requires knowledge of the adequacy of current management practices. Therefore, the purpose of this study was to begin to understand the nature of physical therapy home care management by describing “usual care” for people after hip fracture. Subjects and Methods: In 2003 and 2004, a national survey was conducted of all members of the American Physical Therapy Association who identified home care as their primary practice setting (n=3,130). “Usual care” was operationally defined as when more than 50% of respondents reported that they “always” or “often” use a specific intervention. Results: Survey questionnaires (1,029) were returned with a response rate of 32.9%. Functional training activities, including bed mobility, transfer and gait training, balance training, safety training, and patient education, were reported very frequently. Active-range-of-motion exercises were performed much more frequently than exercises involving added resistance. Discussion and Conclusion: This study provides a detailed description of the physical therapy interventions provided in the home care setting for patients after hip fracture. The sample size and national representation increase our confidence that this description accurately depicts physical therapist practice.

Gait Variability Detects Women in Early Postmenopause With Low Bone Mineral Density

Background Women in early postmenopause and with low bone mineral density (BMD) may exhibit early markers for physical frailty as a result of sarcopenia and osteopenia. Objective The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates. Design This study was an observational cohort design with participants assigned to groups on the basis of BMD status. Methods Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing. Results Significant between-group differences were found for step time and stance time variability. Limitations The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years. Conclusions Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

Dry needling for management of pain in the upper quarter and craniofacial region.

Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling.

Student Experiences in Creating and Launching a Student-Led Physical Therapy Pro Bono Clinic: A Qualitative Investigation

Background The physical therapy profession has called for the provision of pro bono services. Little is known about the impact on students involved in sustainable pro bono leadership. One physical therapy program established a pro bono physical therapy clinic under the direct leadership of a board of students. Objective The purpose of this study was to describe the experiences of the inaugural members of the Chester Community Physical Therapy Clinic Student Board in creating and launching the student-led pro bono physical therapy clinic. Methods A purposive sample of the 18 members participated in semistructured interviews. Content analysis was conducted using a commercially available software program. Trustworthiness was enhanced with credibility, transferability, and confirmability. Results The emergent categories were: (1) leadership skill development, (2) competency in hands-on clinical and administrative skills, and (3) commitment to both the community and the clinic. Pride emerged as a strong and overarching theme throughout the experience. Conclusions The student-led pro bono clinic meets several Commission on Accreditation in Physical Therapy Education criteria in a sustainable manner and serves as a means for measuring and meeting program mission and goals. Participation in the program was a meaningful experience and developed ownership, leadership skills, and pride among the students. There are also possibilities for expanding aspects of the program so that all physical therapist students can benefit from pro bono service opportunities.

A case report of a student-led pro bono clinic: a proposed model for meeting student and community needs in a sustainable manner.

Background and Purpose The Chester Community Physical Therapy Clinic (clinic) is a student-led pro bono clinic that provides physical therapy services to uninsured and underinsured community members. The purposes of this administrative case report are to describe the creation and implementation of a student-led pro bono clinic model designed to meet student and community needs and to consider its potential for sustainability. Case Description Students and faculty created an organizational model with a Student Board at the center of clinic leadership. A Faculty Board provides oversight to the Student Board. State-licensed faculty and alumni provide the direct supervision of the treating student physical therapists. Evaluation of our clinic model was performed using strategies for the creation of sustainable community engagement initiatives. Outcomes This model of a student-led pro bono clinic has elements of all 8 steps to sustainable community engagement. The model of a student-led pro bono clinic is feasible and sustainable. Discussion A student-led pro bono clinic serving the physical therapy needs of the uninsured and underinsured residents in an urban community presents an innovative educational and leadership development opportunity for students and alumni as well as partnership opportunities with the community.

Effectiveness of Exercise for Managing Osteoporosis in Women Postmenopause

<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on exercise for the management of osteoporosis in women postmenopause. Which, if any, approaches to exercise reduce loss of bone mineral density or reduce the chance of fractures in women who are healthy postmenopause? A 2003 report from the Surgeon General of the United States estimated that 10 million individuals had osteoporosis and almost 34 million had low bone mass, placing them at increased risk for osteoporosis.2 Analysis of data from people with 6 to 7 years of Medicare coverage in the United States in 2005 estimated the prevalence of osteoporosis to be approximately 30%.3 The major outcome of concern in osteoporosis is minimal trauma fracture. This is a type of fracture resulting from injury that would be insufficient to fracture normal bone and are referred to as low-impact fracture, fragility fracture, and osteoporotic fracture.4 One study estimated that by 2025, osteoporotic fractures will grow to more than 3 million, incurring

Barriers to Bicycle Helmet Use in Young Children in an Urban Elementary School

25.3 billion in costs.5

calculation of Minimal Detectable Change of Construct Subscales of a Cultural Competence Instrument

Purpose. Traumatic brain injury is a leading cause of death in bicycle crashes. The factors associated with bicycle helmet use in young children with diverse ethnic and socioeconomic backgrounds have not been studied. The purpose of this study was to identify barriers to helmet use in young children in an urban elementary school. Design. Qualitative content analysis with semistructured interviews, observational field notes, and artifacts. Setting. Urban elementary school. Participants. Seventeen students whose age ranged from 5 to 7 years and whose ethnic background was identified as African American (14) or Caucasian (3). Method. Children participated in a brain safety fair that included presentations and activities. Semistructured, pre- and postexperience interviews were completed. Observations of the students participating in the activities and reflective art projects from the students were collected. Results. The analysis found the following barriers to helmet use: (a) lack of access to a helmet, (b) poor fit of helmets due to hairstyles, and (c) lack of knowledge regarding helmet use. Conclusion. The present study suggests that the issue of helmet design and comfort for younger children with variable hairstyles needs to be addressed in order to increase helmet use in this population.

Geriatric Screening as an Educational Tool: A Case Report

Introduction. Physical therapist (PT) and athletic training education programs are among the health professions programs that include cultural competency components to prepare students for practice in a diverse society and to meet accreditation requirements. The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals‐Student Version (IAPCC‐SV©) is an instrument frequently used to assess cultural competency. The purpose of this study is to calculate the minimal detectable change (MDC) of the tool and each of the 5 construct subscales. Subjects. Seventy‐nine Doctor of Physical Therapy (DPT) and undergraduate athletic training and rehabilitation science (ATHP) students completed the IAPCCSV ©. Methods. The IAPCC‐SV© was administered to 79 students in Fall 2014, and 52 students completed a retest 1 week later. Test‐retest reliability and MDC for the IAPCC‐SV© scale and subscales were calculated. Results. For the combined DPT and ATHP groups, the MDC95 of the entire tool was 4.1, internal consistency (Cronbachs alpha) was .861, and overall testretest reliability was .938. The MDC95 of the individual subscales are as follows: cultural awareness = 1.34, knowledge = 2.02, skill = 1.52, encounters = 1.61, and desire = 1.17. The range of subscale internal consistency (Cronbachs alpha) was .431 to .798, while the range of test‐retest reliabilities was .766 to .936. Discussion and Conclusion. The current results provide MDC values of the IAPCC‐SV© in 2 additional student groups. The MDC of the cultural knowledge and cultural desire construct subscales can be used to interpret changes in their respective domains of the IAPCCSV