Systematic Review and Meta-analysis of Randomized Controlled Trials on Manual Therapy for the Treatment of Gastroesophageal Reflux Disease

Objective The objective of our study was to systematically evaluate the clinical efficacy and safety of manual therapy in the treatment of gastroesophageal reflux disease(GERD),providing a reference value for clinical decision-making.Method Studies of randomized controlled trials(RCTs)evaluating the efficacy of manual therapy in patients with GERD were searched through Chinese National Knowledge Infrastructure,Wanfang,ViP China Science and Technology Journal Database,China Biology Medicine Database,PubMed,The Cochrane Library,OviD Medline,and Embase.Two researchers independently reviewed the literature,extracted data,and performed a risk of bias analysis using the Cochrane risk of bias assessment tool,and conducted meta-analysis analysis and publication bias evaluation,the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)tool 26 was used to rate the caliber of the data in this meta-analysis.Results This study included 11 RCTs.Meta-analysis showed that the manual therapy group had a higher total effective rate(odds ratio[OR]=4.63,95%confidence interval[Cl;3.01,7.14],p<0.00001)and better Reflux Disease Questionnaire scores[weighted mean difference(WMD)=-1.59,95%CI[-2.85,-0.33],p=0.01]than the control group.The subgroup analysis showed significant differences in improving the total effective rate in manual therapy versus Western medicine,manual therapy versus Chinese medicine decoction,manual therapy+Western medicine versus Western medicine,and manual therapy+conventional treatment versus conventional treatment groups.Among the 11 trials,5 reported adverse events,and all RCTs had the possibility of publication bias.Subgroup analysis shows that the differences in age could significantly influence heterogeneity;The GRADE analysis revealed that the overall quality of evidence for all outcome indicators was low and did not support our recommendation for the outcome.Conclusion Manual therapy is more effective than medication therapy alone in relieving GERD symptoms.Furthermore,conventional therapy combined with manual therapy was found to be even more effective.Hence,it is crucial to consider these findings when applying manual therapy to GERD patients to enhance treatment outcomes.Future studies must address issues such as study quality,treatment duration,and generalizability.

The Use of Electromagnetic Forces of the Earth in Manual and Physiotherapy

Physiotherapists usually ignore the electric polarization of human bodies that occurs under the influence of the electromagnetic forces of the Earth.This is irrational,since the positive or negative electrification of human tissues has the opposite effect on both their properties and functional activity.How physiotherapists must take into account the polarizing effect of the electromagnetic forces of the Earth when analysing the functional states of the tissues of the human body is shown here.It also shows how these electromagnetic forces can be used by manual and physiotherapists.

Symptoms of spinal dysfunction mimicking systemic diseases(Ogundana Syndrome):a review of 35 cases treated with manual therapy over 30 years

Objective and Method:Symptoms manifesting in other parts of the body signaling the existence of spinal dysfunction(Ogundana Syndrome)in patients(N=35,age range 20-56yrs;mean age 36yrs)diagnosed to have systemic diseases but treated with manual therapy were identified after a 30 year case note review.Results:Incipient parkinsonism(general edema and expressionless mask face),stroke(weakness of one side of the body),tinnitus(headache with noise in one or both ears),breast cancer(breast pain)and dyspnea(difficulty in breathing)were some physician diagnoses and clinical symptoms presented.One percent rate occurrence was noted affecting significantly more females(74%)than males(26%,P<0.001).This involved people with family history of back pain(66%)engaged in low income occupations(farming 40%,trading 25%,artisans 15% and civil servants 20%).Symptoms got better after vertical oscillatory pressure therapy to appropriate spinal regions.Duration of treatment was influenced by duration of spinal dysfunction prior to therapy and age of younger patients.Conclusion:One percent of patients with spinal dysfunction misdiagnosed to have systemic diseases due to misleading symptoms are finally referred for physiotherapy of manifesting symptoms.Manual therapy to the appropriate vertebro-geographic region(s)relieves the symptom(s)without prejudice to existing diagnosis.

Management of Rhabdomyolysis and Acute Renal Failure Following Strenuous Exercise in Young Adult: A Case Report

Introduction: Rhabdomyolysis is severe and life threating condition in which skeletal muscles are damaged by dissolution of striped muscles. Acute kidney injury (AKI) has been widely reported (13% - 50%) as a complication of Rhabdomyolysis in which the main pathophysiological mechanisms are intra-renal vasoconstriction, intraluminal cast formation (Tamm-Horsefall) and direct myoglobin toxicity. In this report we are going to describe the management of Acute Kidney Injury due to Rhabdomyolysis that is not responding to vigorous rehydration. Objective: Reporting about acute renal failure induced by Rhabdomyolysis due to Excessive Exercise and dehydration in young patient. Case Report: A 20 years male came to the outpatient clinic complaining of sever lower limb pain, back pain and vomiting. He was anuric and hypertensive (BP = 150/90 mmHg) with serum creatinine and urea levels of 15.72 mg/dl and 235 mg/dl, respectively. The diagnosis was based on the laboratory finding of creatine kinase = 3127 IU/l. The patient, then, has been referred to the emergency department. The Management plan was based on two arms: Emergency Management with Urgent Hemodialysis for AKI and high fluid replacement therapy. Patient started to recover after three hemodialysis sessions but the peak of recovery was noted after starting manual fluid replacement therapy with a target urine output of greater than 2 ml/kg, a urine pH of greater than 6. Manual fluid replacement therapy consisted of loop diuretics, intravenous fluids and intravenous sodium bicarbonate 1.26%. Full recovery was noted after one month of hospital admission with inpatient care and regular follow-up. A follow-up after one month has been set to assess the patient progression and monitor his kidney functions. Relevance and Impact: Home messages and lessons are;Firstly, young adults are vulnerable to Rhabdomyolysis, second, the diagnosis of Rhabdomyolysis can be made on the clinical bases but a confirmatory laboratory test of Creatine Kinase is mandatory, and lastly’ acute kidney injury needs to be treated urgently. Also, reducing the risk of infection is one of the management objectives to achieve recovery.

Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis:A systematic review and metaanalysis

BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.

Appropriateness of a Physiotherapic Treatment Protocol for the Axillary Web Syndrome, Applied in a Territorial Rehabilitation Service: Description of a Clinical Case

The “Axillary web syndrome” (AWS) is an early complication following breast cancer surgery with axillary lymph nodes dissection. Case Report: The patient is a 69-year-old woman, retired ex-employee, with outcome surgery right axillary lymphadenectomy with shoulder pain and functional limitation with diagnosis AWS it where it was recommended the physiotherapy. The patient had improvement in terms of shoulder function and pain and quality of life. Conclusions: The description of the clinical case afflicted with AWS and the treatment protocol applied, highlighted the good performance of the results, notably as concerns patient’s quality of life. This result could represent a starting point for creating clinical trials aimed at building appropriate rehabilitation route in territorial rehabilitation services.

Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain

Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statistically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52;95% CI -14.72 to 7.44) or long-term at one year (p = 0.37;95% CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs.

Muscle energy technique for chronic obstructive pulmonary disease:A feasibility study

Objective:This study aimed to investigate the feasibility of implementing a manual therapy technique(muscle energy technique,MET)protocol in a hospital pulmonary rehabilitation(PR)program for patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods:Participants aged 40 years and over,with moderate to severe COPD,were recruited into this 12-week study.The primary outcome measures were feasibility(acceptability of the intervention and attendance/adherence to the trial)and safety(adverse events,AEs).All participants received the MET and PR therapies.Participants and assessors were unblinded.Semi-standardized MET was delivered on 6 occasions(a maximum of once per week)at the hospital directly before a PR session.Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks.Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.Results:Thirty-three participants were enrolled,with a median age of 74 years(range 45-89 years).The median number of MET sessions that participants attended was 5(range O-6)out of a possible 6 sessions(83%attendance).At follow-up,participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing.There were no major AEs related to the intervention,with the majority of AEs classified as expected events related to COPD exacerbations.Conclusion:It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting.Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.

The indeterminable resilience of the fascial system

The most recent information on fascial tissue indicates that there are not fascial layers, but polyhedral microvacuoles of connective tissue, which connect the body systems and, by hosting specialized cells, permit several functions, such as motor, nervous, vascular and visceral. These microvacuoles（a repetition of polyhedral units of connective fibrils） under internal or external tension change shape and can manage the movement variations, regulating different body functions and ensuring the maintenance of efficiency of the body systems. Their plasticity is based on perfect functional chaos： it is not possible to determine the motion vectors of the different fibrils, which differ in behavior and orientation; this strategy confers to the fascial continuum the maximum level of adaptability in response to the changing internal and external conditions of the cell. The present commentary deals with this concept, providing clinical examples of different disease patterns, providing contrary examples in which this adaptability does not occur, and lastly suggesting considerations for the approach to manipulative therapy of the fascial tissue. The fascial continuum is like a flock of birds flying together without a predetermined logic and maintaining their individuality at the same time.