The impact of patient scoliosis-specific exercises for adolescent idiopathic scoliosis: a systematic review and meta-analysis of randomized controlled trials with subgroup analysis using observational studies.

PURPOSE: Adolescent idiopathic scoliosis (AIS) is a common pediatric spinal deformity frequently treated with patient scoliosis-specific exercises (PSSE). The purpose of this study is to perform a systematic review and meta-analysis of randomized controlled trials and sensitivity analysis of observational studies to determine the impact of PSSE on outcomes for AIS. METHODS: A systematic review and meta-analysis on impact of PSSE for patients with AIS was performed. Databases used included PubMed, CINAHL, MEDLINE, Cochrane, and ScienceDirect database inception to October 2022. Inclusion criteria included use of PSSE, patient population of AIS, and full text. RESULTS: A total of 26 articles out of 628 initial retrieved met final inclusion criteria (10 randomized controlled trials (RCTs), 16 observational studies). Total included patients (n = 2083) had a frequency weighted mean age of 13.2 ± 0.9 years and a frequency weighted mean follow-up of 14.5 ± 20.0 months. Based on only data from RCTs with direct comparison groups (n = 7 articles), there was a statistically significant but clinically insignificant improvement in Cobb angle of 2.5 degrees in the PSSE group (n = 152) as compared to the control group (n = 148; p = 0.017). There was no statistically significant improvement in Cobb angle when stratified by small curve (< 30 degrees) or large curve (> 30 degrees) with PSSE (p = 0.140 and p = 0.142, respectively). There was no statistically significant improvement in ATR (p = 0.326) or SRS-22 score (p = 0.370). CONCLUSION: PSSE may not provide any clinically significant improvements in Cobb angle, ATR, or SRS-22 scores in patients with AIS. PSSE did not significantly improve Cobb angle when stratified by curve size. LEVEL OF EVIDENCE: Level I.

Comparing Outcomes After Referral to Physical Therapy for Patients With Glenohumeral Osteoarthritis Based on the Radiographic Osteoarthritis Severity: A Retrospective Analysis.

Introduction Glenohumeral osteoarthritis (GHOA) is a common cause of musculoskeletal pain (MSP) that can frequently lead to pain and functional disability in patients throughout the world. GHOA can be managed with conservative or surgical interventions, although conservative interventions, such as physical therapy (PT), are generally first-line interventions depending on the severity of GHOA. The purpose of this retrospective analysis was to examine how conventional PT impacts outcomes for patients with GHOA based on the severity of radiographic GHOA findings. Methods This study is a retrospective chart review of patients who were referred to PT for MSP and received PT in the outpatient setting between 2016 and 2022. Inclusion criteria were patients who received PT in the outpatient setting, received PT for MSP, had shoulder radiograph imaging within two years of initial PT evaluation, had more than one PT visit (i.e. attended a follow-up session after initial evaluation), and did not have a history of shoulder surgery. Primary outcome measures were pain, abduction active range-of-motion (AROM), and disability via the quick disabilities of the arm, shoulder, and hand (DASH). Patients were divided into the No GHOA group (n=104), Mild GHOA group (n=61), and Moderate/Severe GHOA group (n=55) based on the radiographic GHOA severity. Results All included patients (n=220) had a mean age of 62.2 ± 12.4 years old with a mean number of PT visits of 7.8 ± 4.5 visits. There was initially a significant difference in the magnitude of pain improvement between the three groups based on radiographic severity of GHOA (Kruskal-Wallis H=6.038; p=0.049); however, post hoc testing revealed no significant difference between any of the three groups for pain improvement (p=0.061 to p=1.000). There was also no significant difference in the magnitude of abduction AROM improvement between the three groups based on the radiographic severity of GHOA (Kruskal-Wallis H=2.887; p=0.236). Finally, there was no significant difference in the magnitude of disability improvement via the Quick DASH between the three groups based on the radiographic severity of GHOA (Kruskal-Wallis H=0.156; p=0.925). Conclusion Patients with GHOA referred to PT experience small but statistically significant short-term improvements in pain, abduction AROM, and disability regardless of GHOA radiographic severity. There is no significant association between the magnitude of clinical improvement and the severity of radiographic GHOA. However, despite statistically significant improvements in pain, only patients with mild GHOA experienced clinically significant improvements in pain. Patients with GHOA, regardless of severity, may or may not experience clinically significant improvements in disability after PT.

The Impact of Dry Needling With Electrical Stimulation on Pain and Disability in Patients With Musculoskeletal Shoulder Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Musculoskeletal shoulder pain (MSP) is a common orthopedic condition frequently treated by orthopedic surgeons and physical therapists in an interdisciplinary manner. Dry needling with electrical stimulation (DNES) is an increasingly popular intervention used for the conservative treatment of MSP during physical therapy. To date, no systematic review and meta-analysis have examined the impact of DNES on outcomes in patients with MSP. This study aims to explore the effectiveness and safety of DNES in patients with MSP to improve patient outcomes. A systematic review and meta-analysis were conducted using PubMed, MEDLINE, CINAHL, and Web of Science from database inception to March 10, 2023. Inclusion criteria were studies with DNES as an intervention, recorded patient outcomes, and randomized controlled trials (RCTs) only. DNES with or without conventional physical therapy (CPT) was compared to CPT alone, which included interventions such as exercise, manual therapy, dry needling without electrical stimulation, and/or interferential current. A total of five RCTs were analyzed from 144 articles retrieved on the initial search. Included patients (n=342) had an average age of 48.75 ± 5.92 years, an average follow-up time of 3.40 ± 1.42 months, and 184 patients receiving DNES with or without CPT. Patients treated with DNES with or without CPT (n=163) had a frequency-weighted mean decrease in pain of 4.8 ± 1.4 points, whereas patients treated with CPT alone (n=158) had a frequency-weighted mean decrease in pain of 3.3 ± 2.2 points. For meta-analysis of pain outcomes (n=321 total patients), DNES with or without CPT improved pain by 1.40/10 points as compared to CPT alone with no significant difference between groups (p=0.203; Cohen's d effect size (ES): 4.352; 95% CI: -2.343, 11.048). Patients treated with DNES with or without CPT (n=118) had a frequency-weighted mean decrease in disability of 34.7 ± 9.1 points. In contrast, patients treated with CPT alone (n=115) had a frequency-weighted decrease in disability of 20.1 ± 5.0 points. For meta-analysis of disability outcomes (n=233 total patients), DNES with or without CPT did not have a significant improvement in disability as compared to CPT alone (p=0.282; Cohen's d ES: 0.543; 95% CI: -0.446, 1.532). No serious adverse effects were reported for patients treated with DNES with or without CPT or CPT alone. DNES with or without CPT may significantly improve pain and disability in patients with MSP. However, DNES with or without CPT does not provide statistically significant improvements in pain or disability compared to CPT alone. Furthermore, DNES appears to be a safe intervention for MSP.

Clinical Outcomes Associated With the Addition of a Physical Therapist Assistant to a Rehabilitation Team When Treating Musculoskeletal Shoulder Pain in the Outpatient Setting: A Retrospective Cohort Study.

Introduction Musculoskeletal shoulder pain (MSP) is a common condition frequently treated in an outpatient setting by a physical therapy rehabilitation team. Treatment teams can consist of physical therapists (PTs) with or without physical therapist assistants (PTAs). It is currently unknown how different physical therapy team compositions can impact patient outcomes in the outpatient setting. The purpose of this study is to examine how the addition of PTAs to a physical therapy treatment team would impact clinical outcomes when treating patients with MSP in the outpatient setting. Methods This study is a retrospective cohort analysis comparing clinical outcomes for pain, active range of motion (AROM), and disability for patients with MSP when treated by physical therapy treatment teams with or without the presence of PTAs. Inclusion criteria were patients treated for MSP in an outpatient physical therapy clinic without a history of shoulder surgery. Depending on the rehabilitation team composition, patients were divided into a PT-only group or a PTA group. Results Total patients (n = 238) had a mean age of 62.6 ± 12.6 years (median: 64 years) with a mean total number of physical therapy visits of 7.8 ± 4.9 visits (median: 7.0 visits). Of the entire cohort, the PT-only group had 100 patients and the PTA group had 138 patients. There was no significant difference in the magnitude of pain improvement (mean: 1.5 versus 1.9 points, p = 0.177), the magnitude of abduction AROM improvement (mean: 17.6 versus 13.9 degrees, p = 0.173), and the magnitude of disability improvement (mean: 18.9 versus 13.4 percentage points, p = 0.221) between the PT-only group and the PTA group. However, the PT-only group had significantly fewer total visits as compared to the PTA group (6.7 versus 8.6 visits, p < 0.001). Conclusion The addition of PTAs to a rehabilitation team when treating patients with MSP in the outpatient setting does not appear to adversely impact pain, AROM, or disability outcomes. However, patients treated only by PTs had significantly less visits with similar outcomes. More research is needed to determine the interplay between cost, healthcare utilization, and patient outcomes to maximize quality care.

The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults With Moderate-to-Severe Neck Pain: A Systematic Review With Meta-Analysis.

Neck pain is a common musculoskeletal condition frequently managed with numerous conservative interventions. The McKenzie method of mechanical diagnosis and therapy (MMDT) is a form of physical therapy evaluation and treatment that aims to improve pain and disability in patients with musculoskeletal pain, including neck pain. To date, no systematic review with meta-analysis has examined the use of the McKenzie MMDT for neck pain. This study aimed to examine the effectiveness of the McKenzie MMDT in adult patients with neck pain. A systematic review and meta-analysis were performed using PubMed, ScienceDirect, MEDLINE, CINAHL, Web of Science, and Google Scholar. Full search terms were "McKenzie method" OR "McKenzie approach" OR "McKenzie treatment" AND "neck pain." Inclusion criteria were the use of the McKenzie MMDT, level I randomized control trials (RCTs), adults, and outcomes of pain (0-10 scale) and disability (neck disability index). A total of 11 RCTs met the final selection criteria from 1,955 articles on initial search with 289 patients receiving the McKenzie MMDT out of 677 total patients. For meta-analysis, there was a clinically insignificant but statistically significant improvement in pain (1.14/10 points) in patients receiving the McKenzie MMDT versus control interventions (p<0.02). There was no significant improvement in the neck disability index score between the McKenzie MMDT versus control interventions (p=0.19). For severity of pain, there was a clinically and statistically significant improvement in moderate or severe pain (2.06/10 points; p<0.01), but not in mild-to-moderate pain (p=0.84) when comparing the McKenzie MMDT to control interventions. Overall, the McKenzie MMDT provides very small but statistically significant improvements in neck pain of all severity compared to control interventions. However, the McKenzie MMDT does provide clinically and statistically significant pain improvement in moderate-to-severe neck pain. Use of the McKenzie MMDT did not provide any significant improvement in disability compared to control interventions. This study is the first systematic review with meta-analysis on the effectiveness of the McKenzie MMDT for adult patients with neck pain.

Examining the Dimensions of the Bicipital Groove: A Human Cadaveric Study.

Introduction Understanding the mechanisms and risk factors associated with bicipital groove (BG) morphology is essential for optimizing patient outcomes. Despite interest in the topic of BG morphology, there remains a lack of clarity and consensus on the parameters of BG morphology due to significant methodological limitations in the existing research. The purpose of this study is to explore the dimensions of BG morphology with a methodology rooted in recent research findings to better understand the human anatomy, potentially underpinning various shoulder pathologies.  Methods The right shoulders of seventeen cadavers (nine male and eight female; median age of death: 88.0 years; age of death range: 66.0 - 97.0 years) were included in this cadaveric study. Dissection was done by removing the deltoid musculature and reflecting the long head of the biceps tendon to expose the BG. Measurements for BG morphology included BG width (millimeters, mm), depth (mm), and length (mm). Statistical comparisons were done between male and female measurements using the independent-samples Mann-Whitney U test due to the small sample size.  Results The median width of the BG at the narrowest point was 4.3 mm (mean: 4.7 ± 1.4 mm; range: 3.0 - 7.7 mm) with male cadavers having a significantly wider BG as compared to female cadavers (median: 5.0 mm versus 3.7 mm; p=0.006). The median depth of the BG was 5.1 mm (mean: 5.0 ± 0.7 mm; range: 3.8 - 6.3 mm) with no statistically significant difference between male and female cadavers (median: 4.8 mm versus 5.3 mm; p=0.370). The median length of the BG was 25.1 mm (mean: 25.1 ± 3.3 mm; range: 18.1 - 31.3 mm) with no statistically significant difference between male and female cadavers (median: 25.4 mm versus 23.9 mm; p=0.673). Conclusion The width of the BG at the narrowest point was significantly larger in male cadavers as compared to female cadavers in this study. However, there was no difference between male and female cadavers in terms of depth and length of the BG. This study contributes to the understanding of BG morphology by exploring the dimensions for width, depth, and length of the BG, which may contribute to biceps tendon pathology in clinical practice. Future research should focus on reducing measurement variability and exploring the possible relationship between BG morphology and biceps tendon conditions to further enhance the understanding of this complex relationship.