Biomedical subjects

Christopher G Maher

Publications and source records attributed to Christopher G Maher.

11 recordsLinked to original sources

PubMed2003

Advice or exercise for chronic whiplash disorders? Design of a randomized controlled trial.

BACKGROUND: Whiplash-associated disorder (or "whiplash") is a common condition incurring considerable expense in social and economic terms. A lack of research on effective therapy for patients with chronic whiplash associated disorders prompted the design of the current study. The primary aim of this randomised controlled trial is to determine the effects of a physical activity program for people with chronic (symptoms of > 3 months duration) whiplash. A secondary aim is to determine if pain severity, level of disability and fear of movement/(re)injury predict response to a physical activity program. METHODS/DESIGN: This paper presents the rationale and design of a randomised controlled trial examining the effects of advice and individualized sub-maximal exercise programs in the treatment of whiplash associated disorders. DISCUSSION: This paper highlights the design, methods and operational aspects of a significant clinical trial in the area of whiplash and chronic pain.

Chronic Disease↗

PubMed2003

Objective manual assessment of lumbar posteroanterior stiffness is now possible.

OBJECTIVE: To evaluate the reliability and criterion-related validity of a revised version of the reference-based protocol for manually assessing lumbar posteroanterior (PA) stiffness. With the revised protocol, a therapist matched the stiffness of the spine to 1 of 11 stiffness references provided by a mechanical device. SUBJECTS: Two physiotherapists and 41 asymptomatic subjects participated. METHODS: Subjects' PA stiffness was assessed by the therapists and the Stiffness Assessment Machine(criterion measure) under standardized conditions. The therapists pressed on the subject's spine and then the mechanical device, the task being to match the stiffness of the back to 1 of the 11 stimuli provided by the device. Each of the 11 stiffness stimuli represented a point on the -5 to +5 stiffness scale. Interrater reliability was evaluated with 2-way analysis of variance (ANOVA) intraclass correlation coefficient for a single rating (ICC [2,1]) and the SEM, whereas criterion-related validity was evaluated with the Pearson product moment correlation (r), including the Fleiss correction. RESULTS: The ICC (2,1) was 0.78 (SEM 0.56), and the criterion-related validity reached 0.74 (Fleiss correction 0.86). CONCLUSIONS: This research shows that therapists can accurately judge asymptomatic subjects' spinal stiffness using a matching task. We believe that this method may allow therapists to quantify lumbar PA stiffness in clinical practice.

Adolescent↗

PubMed2003

Reliability of the PEDro scale for rating quality of randomized controlled trials.

BACKGROUND AND PURPOSE: Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. METHOD: In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). RESULTS: The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was.56 (95% confidence interval=.47-.65) for ratings by individuals, and the ICC for consensus ratings was.68 (95% confidence interval=.57-.76). DISCUSSION AND CONCLUSION: The reliability of ratings of PEDro scale items varied from "fair" to "substantial," and the reliability of the total PEDro score was "fair" to "good."

Databases, Bibliographic↗

PubMed2002

Letters.

Explore the source record for details and available documents.

Exercise Therapy↗

PubMed2002

Does spinal manipulative therapy help people with chronic low back pain?

A systematic review of randomised clinical trials was conducted to assess the effect of spinal manipulative therapy on clinically relevant outcomes in patients with chronic low back pain. Databases searched included EMBASE, CINAHL, MEDLINE and PEDro. Methodological assessment of the trials was performed using the PEDro scale. Where there was sufficient homogeneity, a meta-analysis was conducted. Nine trials of mostly moderate quality were included in the review. Two trials were pooled comparing spinal manipulative therapy and placebo treatment, and two other trials were pooled comparing spinal manipulative therapy and non-steroidal anti-inflammatory drugs (NSAIDs). Spinal manipulative therapy reduced pain by 7mm on a 100mm visual analogue scale (95% CI 1 to 14) at one month follow-up when compared with placebo treatment, and by 14mm (95% CI -11 to 40) when compared with NSAIDs. Spinal manipulative therapy reduced disability by 6 points (95% CI 1 to 12) on a 100-point disability questionnaire when compared with NSAIDs. It is concluded that spinal manipulation does not produce clinically worthwhile decreases in pain compared with sham treatment, and does not produce clinically worthwhile reductions in disability compared with NSAIDs for patients with chronic low back pain. It is not clear whether spinal manipulation is more effective than NSAIDs in reducing pain of patients with chronic low back pain.

Chronic Disease↗

PubMed2002

WorkCover's physiotherapy forms: purpose beyond paperwork?

We retrospectively analysed 219 consecutive treatment plans submitted to a large New South Wales workers' compensation insurer for workers coded by the insurer as suffering from back pain. The purpose was to (i) describe the quality of goals of treatment provided to insurers by physiotherapists for workers with back pain using guidelines provided by the WorkCover Authority of New South Wales (WorkCover); (ii) compare the physiotherapists' prognoses against prognoses indicated in clinical practice guidelines; and (iii) make recommendations about the communication system between physiotherapists and insurers. The back pain of most treated workers was classified as acute and the majority of physiotherapists estimated that treatment would be of short duration, which is concordant with current treatment guidelines. However, most physiotherapists did not provide precise, measurable or time-specific treatment goals, despite this being emphasised by WorkCover. We propose ways of improving communication practices between physiotherapists and insurers.

Communication↗

PubMed2002

An evaluation of Superthumb and the Kneeshaw device as manual therapy tools.

This research evaluated two hand-held tools (Superthumb and Kneeshaw device) that have been developed in order to reduce hand pain associated with the performance of manual therapy. Two studies were conducted: one evaluated the ability to perceive elastic stiffness with the devices and the other evaluated physiotherapist and patient comfort when the devices were used to apply a mobilisation to the lumbar spine. In the first study we found that the two tools and the pisiform grip provided equivalent ability to detect small differences in elastic stiffness, however the tools introduced a bias so that the stiffness stimuli felt stiffer than when assessed with the pisiform grip. In the second study we found that the two tools were substantially less comfortable than the pisiform grip, for both patient and therapist, when a therapist applied a Grade III mobilisation to the lumbar spine. The results suggest that neither tool, in its current form, is suitable for clinical practice.

Adult↗

PubMed2002

Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro).

Evidence-based practice involves the use of evidence from systematic reviews and randomised controlled trials, but the extent of this evidence in physiotherapy has not previously been surveyed. The aim of this survey is to describe the quantity and quality of randomised controlled trials and the quantity of systematic reviews relevant to physiotherapy. The Physiotherapy Evidence Database (PEDro) was searched. The quality of trials was assessed with the PEDro scale. The search identified a total of 2,376 randomised controlled trials and 332 systematic reviews. The first trial was published in 1955 and the first review was published in 1982. Since that time, the number of trials and reviews has grown exponentially. The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999. There is a substantial body of evidence about the effects of physiotherapy. However, there remains scope for improvements in the quality of the conduct and reporting of clinical trials.

Australia↗

PubMed2000

A systematic review of workplace interventions to prevent low back pain.

A systematic review of randomised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain. Potential trials were located by a computerised search supplemented with citation tracking. The methodological quality of the trials was assessed on 11 criteria and the level of evidence for each intervention was determined, based upon the amount, consistency and quality of evidence from the trials. The review located 13 trials that were generally of moderate quality. The trials suggest that work place exercise is effective, braces and education are ineffective, and workplace modification plus education is of unknown value in preventing low back pain.

Journal Article↗

PubMedDate not supplied

Manual discrimination capability when only viscosity is varied in viscoelastic stiffness stimuli.

BACKGROUND: Training manual therapists in the judgment of spinal stiffness traditionally requires the spines of human volunteers. Presenting the range of stiffness values representative of spines requires both time and resources. When investigating the ability of therapists to judge spinal stiffness, several studies have therefore utilized spine analogues, nonbiological devices designed to present either purely elastic stimuli or viscoelastic stimuli with unknown relative contributions of elastic and viscous components. Previous research has suggested that the viscous component of stiffness is more difficult to judge. OBJECTIVE: This study determined for each subject the just-noticeable difference, or discrimination threshold, for manual judgment of viscous stiffness against a constant elastic and friction background. DESIGN: This psychophysical study utilized the Weber fraction as a measure of the ability of subjects to discriminate between viscoelastic stiffness stimuli. METHODS: Twenty-five subjects with both physiotherapy and lay backgrounds volunteered to participate in the study. Stiffness stimuli were generated by a device incorporating a fluid-filled plunger and a spring, with only the amount of viscous stiffness being manipulated by the experimenter. The method of constant stimuli was used to estimate the just-discriminable change in viscous stiffness, and results were expressed as a percentage of the base stiffness or Weber fraction. RESULTS: The mean Weber fraction for manual judgments of viscous stiffness was 14.7%. For 13 of the subjects who had previously participated in elastic stiffness discrimination studies, the Weber fraction for viscous stimuli was significantly greater than that for elastic stimuli. CONCLUSION: The significantly higher Weber fraction for viscous stiffness perception compared with that for pure elastic stiffness suggests that the poor reliability of manual judgments of spinal stiffness may be due to the difficulty in judging the viscous stiffness component.

Adult↗

PubMedDate not supplied

Forces applied during manual therapy to patients with low back pain.

BACKGROUND: To date, there is little information available regarding the forces used during mobilization treatment of patients with low back pain (LBP). OBJECTIVE: This study measured such forces and investigated whether the force characteristics could be predicted on the basis of physical therapist and patient characteristics. SUBJECTS: Ten physical therapists applied a central posteroanterior (PA) mobilization treatment to 80 patients with LBP, providing data on treatment of 123 lumbar levels. METHODS: Physical therapists were required to treat their patients while the patients lay on an instrumented couch. This couch has been shown to be highly accurate in its measurement of force in 3 directions (error <2%) and has demonstrated high test-retest reliability (ICC [2, 1], 99% CI = 0.99-1.00). The forces applied by the physical therapists were recorded over a 10-second period. Data on the characteristics of the physical therapists and patients were collected by means of questionnaires. RESULTS: The force used by physical therapists related not only to patient characteristics but also to physical therapist characteristics. Interestingly, current pain intensity and nature of symptoms did not affect the forces used. The overall patterns of the force characteristics were generally consistent with previous studies performed in asymptomatic subjects. However, the magnitude of the force applied and the frequency of each grade used in the present study are relatively higher than in earlier studies. CONCLUSION: These preliminary data provide some useful quantitative information about the forces used during mobilization treatment of patients with LBP. Also, the force characteristics described here may provide useful data for both teaching and research in manual therapy.

Adult↗