Perception of patients, physiotherapists and traditional Chinese medicine practitioners towards manual physiotherapy and Tuina (Chinese manipulative therapy) in Australia: a qualitative research.
OBJECTIVE: The aim of this study is to gain insight and understanding of the perception of Australian patients toward manual therapies. The study also tries to increase our understanding of manual techniques used by manual therapists. METHODS: This is qualitative field research emphasising the sociological perspective, to interpret health services recipients' meanings in specific social settings. An unstructured interview is the major study design. The interview study method was conducted jointly with clinical observational techniques. A total of 30 subjects who met the selection criteria were selected. Finally 19 patient participants and 5 practitioner participants entered the study. RESULTS: Most participants in the research got to know physiotherapy through media and referral from general practitioners. After having gained some experience of manual physiotherapy, patients were expecting a fresh approach from Tuina (Chinese manipulative therapy). Although 94% of patient participants were satisfied with Tuina treatment, most of them could not distinguish differences in technique between Tuina and manual physiotherapy. Some patients consider Tuina as a more costly choice. Most practitioners preferred to use stronger pressure-based methods on trigger points while those who had received formal training in Tuina were in favour of much gentler techniques. CONCLUSION: Manual physiotherapy is the first-line choice for many Australian patients. Tuina, as a relatively new method, is often considered as the last-resort treatment due to lack of proper private health insurance coverage. However, most patient participants preferred gentler manual methods, such as Tuina, compared with strong force-based approaches. This study stressed patients' feelings and needs, which may have an impact on clinical outcomes. This study asserts some possible ways to enhance patient care that would include providing relevant education as part of manual therapy courses, encouraging continual development of the therapists and encouraging patient participation in the treatment process. (+info)
Diagnosis and management of somatosensory tinnitus: review article.
Objective sonographic measures for characterizing myofascial trigger points associated with cervical pain.
OBJECTIVES: The purpose of this study was to determine whether the physical properties and vascular environment of active myofascial trigger points associated with acute spontaneous cervical pain, asymptomatic latent trigger points, and palpably normal muscle differ in terms of the trigger point area, pulsatility index, and resistivity index, as measured by sonoelastography and Doppler imaging. METHODS: Sonoelastography was performed with an external 92-Hz vibration in the upper trapezius muscles in patients with acute cervical pain and at least 1 palpable trigger point (n = 44). The area of reduced vibration amplitude was measured as an estimate of the size of the stiff myofascial trigger points. Patients also underwent triplex Doppler imaging of the same region to analyze blood flow waveforms and calculate the pulsatility index of blood flow in vessels at or near the trigger points. RESULTS: On sonoelastography, active sites (spontaneously painful with palpable myofascial trigger points) had larger trigger points (mean +/- SD, 0.57 +/- 0.20 cm(2)) compared to latent sites (palpable trigger points painful on palpation; 0.36 +/- 0.16 cm(2)) and palpably normal sites (0.17 +/- 0.22 cm(2); P < .01). Analysis of receiver operating characteristic curves showed that area measurements could robustly distinguish between active, latent, and normal sites (areas under the curve, 0.9 for active versus latent, 0.8 for active versus normal, and 0.8 for latent versus normal, respectively). Doppler spectral waveform data showed that vessels near active sites had a significantly higher pulsatility index (median, 8.3) compared to normal sites (median, 3.0; P < .05). CONCLUSIONS: The results presented in this study show that myofascial trigger points may be classified by area using sonoelastography. Furthermore, monitoring the trigger point area and pulsatility index may be useful in evaluating the natural history of myofascial pain syndrome. (+info)
An objective method for selecting command sources for myoelectrically triggered lower-limb neuroprostheses.
Functional electrical stimulation (FES) facilitates ambulatory function after paralysis of persons with spinal cord injury (SCI) by exciting the peripheral motor nerves to activate the muscles of the lower limbs. This study identified a process for selecting command sources for triggering FES with the surface electromyogram (EMG) from muscles partially paralyzed by incomplete SCI, given its high degree of intersubject variability. We found Discriminability Index (DI) to be a good metric to evaluate the potential of controlling FES-assisted ambulation in four nondisabled volunteers and two participants with incomplete paralysis. The left erector spinae (ES) (mean DI = 0.87) for triggering the left step and the right ES (mean DI = 0.83) for triggering the right step were the best command sources for participant 1. The left ES (mean DI = 0.93) for triggering the left step and the right medial gastrocnemius (mean DI = 0.88) for triggering the right step were the best command sources for participant 2. Our results showed that command sources can be selected objectively from surface EMG before a fully implantable EMG-triggered FES system for walking is implemented. (+info)
Insights into the mechanism of onabotulinumtoxinA in chronic migraine.