Rafael Zegarra-Parodi

Assessment of skin blood flow following spinal manual therapy: A systematic review

Skin blood flow (SBF) indexes have been used to describe physiological mechanisms associated with spinal manual therapy (SMT). The aims of the current review were to assess methods for data collection, assess how investigators interpreted SBF changes, and formulate recommendations to advance manual medicine research. A database search was performed in PubMed, Cochrane Library, the Physiotherapy Evidence Database, and the Cumulative Index to Nursing and Allied Health Literature through April 2014. Articles were included if at least 1 outcome measure was changes in 1 SBF index following SMT. The database search yielded 344 records. Two independent authors applied the inclusion criteria. Twenty studies met the inclusion criteria. Selected studies used heterogeneous methods to assess short-term post-SMT changes in SBF, usually vasoconstriction, which was interpreted as a general sympathoexcitatory effect through central mechanisms. However, this conclusion might be challenged by the current understanding of skin sympathetic nervous activity over local endothelial mechanisms that are specifically controlling SBF. Evaluation of SBF measurements in peripheral tissues following SMT may document physiological responses that are beyond peripheral sympathetic function. Based on the current use of SBF indexes in clinical and physiological research, 14 recommendations for advancing manual medicine research using laser Doppler flowmetry are presented.

Impact of osteopathic treatment on pain in adult patients with cystic fibrosis--a pilot randomized controlled study.

Background Pain is a common complication in patients with cystic fibrosis (CF) and is associated with shorter survival. We evaluated the impact of osteopathic manipulative treatment (OMT) on pain in adults with CF. Methods A pilot multicenter randomized controlled trial was conducted with three parallel arms: OMT (group A, 16 patients), sham OMT (sham treatment, group B, 8 patients) and no treatment (group C, 8 patients). Medical investigators and patients were double-blind to treatment for groups A and B, who received OMT or sham OMT monthly for 6 months. Pain was rated as a composite of its intensity and duration over the previous month. The evolution of chest/back pain after 6 months was compared between group A and groups B+C combined (control group). The evolution of cervical pain, headache and quality of life (QOL) were similarly evaluated. Results There was no statistically significant difference between the treatment and control groups in the decrease of chest/back pain (difference = −2.20 IC95% [−4.81; 0.42], p = 0.098); also, group A did not differ from group B. However, chest/back pain decreased more in groups A (p = 0.002) and B (p = 0.006) than in group C. Cervical pain, headache and QOL scores did not differ between the treatment and control groups. Conclusion This pilot study demonstrated the feasibility of evaluating the efficacy of OMT to treat the pain of patients with CF. The lack of difference between the group treated with OMT and the control group may be due to the small number of patients included in this trial, which also precludes any definitive conclusion about the greater decrease of pain in patients receiving OMT or sham OMT than in those with no intervention. Trial Registration ClinicalTrials.gov NCT01293019

Laser Doppler Flowmetry in Manual Medicine Research

Laser Doppler flowmetry (LDF) is commonly used in combination with reactivity tests to noninvasively evaluate skin sympathetic nerve activity and skin microvascular function. In manual medicine research, LDF has been used as a marker for global peripheral sympathetic nervous system function, but these results should be considered with caution because skin sympathetic nerve activity physiology is often overlooked. Another limitation of LDF in manual medicine research is the processing of LDF recordings. Two methods have been suggested: the time-domain analysis and the frequency-domain analysis. Standardization is required for data collection and processing in either domain to accurately interpret these changes in skin blood flow that occur after manual procedures. For physiologic studies using LDF, the authors recommend the use of noninvasive reactivity tests (positive controls) to evaluate the different mechanisms involved in overall skin blood flow changes and to compare the magnitude of these changes with those specifically elicited by manual procedures.

924 MEASUREMENT OF CRANIAL PALPATION PRESSURES USED BY PROFESSIONAL OSTEOPATHS

Backgrounds and Aims: To our knowledge, quantification of palpation pressures used by experienced practitioners of osteopathy in the cranial field has not been reported to date. The objective of this study was to evaluate the pressure of palpation used by professional osteopaths during a cranial test procedure, and to determine the relationship between palpation pressures and years of practice (yop) experience. Methods: 43 participants (32 men and 11 women; aged 25–65 years) were enrolled after written consent was obtained. Data on palpation pressures employed during the study were obtained using a FlexiForce tactile force sensor device which recorded a 3-seconds pressure measurement. Practitioners’ yop and percentage of daily practice employing osteopathic cranial treatment were also recorded. Results: The palpation pressures recorded throughout the study procedure ranged from 0 to 1.81N/cm, with the mean pressure of the 3-seconds tests ranging from 0.01 to 1.69N/cm. Comparison among treatment groups was carried out using non-parametric analysis of variance with the Kruskall-Wallis test, followed by Dunn’s test for multiple group comparisons. The results suggested that practitioners with >20 yop use significantly less pressure than practitioners with less than 20 yop (p =0.024). Conclusions: This study is the first to provide data on the palpation pressures used during osteopathic cranial treatment. The results suggest that the application of cranial palpation is extremely variable. Highly experienced practitioners may use less pressure and demonstrate less variation; however, a significant proportion of less experienced practitioners use comparable pressure.