Ian Young’s research while affiliated with Virginia Commonwealth University and other places

Background: Chemotherapy-induced peripheral neuropathy (CIPN) affects 20–85% of individuals exposed to neurotoxic chemotherapeutic agents. Perineural electrical dry needling (PEDN) and neural mobilization (NM) interventions may be beneficial in the management of chronic neurogenic pain; however, there is a paucity of research on the efficacy of both interventions for CIPN. Methods: Three patients were referred to an outpatient physical therapy clinic with chronic neuropathic pain associated with CIPN. Each underwent PEDN and NM twice weekly until goals were met or progress stalled. The primary outcome measure was the Numeric Pain Rating Scale (NPRS). Secondary outcomes included the Global Rating of Change (GROC) and the Lower Extremity Functional Scale (LEFS). All outcome measures were assessed at evaluation and discharge. Results: At discharge, patients A and B exceeded the minimum clinically important difference (MCID) for the primary and secondary outcome measures, indicating decreased neuropathic pain and improved lower extremity function. Patient C improved in all outcome measures but only experienced clinically meaningful changes in the NPRS and LEFS, not the GROC. Conclusions: Following 4–8 sessions of PEDN and NM, three patients with CIPN demonstrated clinically meaningful improvements in chronic lower extremity neuropathic pain and function. PEDN and NM may be beneficial in the management of patients presenting with chronic neuropathic pain secondary to CIPN.

Background Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. Methods A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. Results A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled. Conclusion The aim of this article is to summarize and enhance physiotherapists’ essential knowledge of the differential diagnosis and management of patients with DCM.

Objective: Perform a clinimetric analysis of the visual analogue scale (VAS) and active pain-free mouth opening (PFMO) in patients with muscular temporomandibular disorder (mTMD). Methods: Reliability (intraclass correlation coefficient=ICC), construct validity, responsiveness (area under the curve=AUC), minimal detectable change (MDC), and minimal clinically important difference (MCID) values were calculated. Results: The VAS-24hr (ICC=0.59), VAS-7day (ICC= 0.54), and PFMO (ICC=0.86) exhibited acceptable reliability. Both the VAS (AUC=0.96) and PFMO (AUC=0.87) exhibited a high level of responsiveness. The MCID was 15.5mm (VAS-24 and VAS-7day) and 3.5mm (PFMO) in the improved group; and 27.5mm (VAS-24), 21mm (VAS-7day), and 6.6mm (PFMO) in the much-improved group. The MDC was 9.6mm (VAS-24), 9.5mm (VAS-7day), and 6.1mm (PFMO). All outcomes demonstrated strong construct validity (Pearson's r; p<0.001) . Conclusions: All three outcome measures demonstrated acceptable clinimetric properties in patients with mTMD at the 3-month follow-up. The MCID lies outside measurement error in all outcomes in the much-improved group. .

Background: Given the relationship between reduced pulmonary and respiratory muscle function in neck pain, incorporating breathing exercises into neck pain management may be beneficial. Purpose: The purpose of this study was to investigate the benefits of breathing exercises for treating neck pain. Methods: We searched PubMed (MEDLINE), PEDro, CINAHL, Scopus, and EMBASE databases, up to the 28 of February 2024. Randomized controlled trials evaluating the impact of breathing exercises on reducing pain and disability in both persistent and recent neck pain were selected. A meta-analysis was conducted for each outcome of interest; however, if quantitative methods were not possible, a qualitative synthesis approach was used. The risk of bias was assessed using the Cochrane RoB 2.0 Tool (version 22 August 2019). We used the GRADE approach to judge the certainty of the evidence. Results: Five studies were included. Meta-analysis showed a statistically significant reduction in pain (standardized mean difference (SMD), −10.16; 95% CI: −14.82, −5.50) and disability (SMD, −0.80; 95% CI: −1.49, −0.11), in favor of breathing exercises. Qualitative synthesis for pulmonary functional parameters resulted in a statistically significant improvement for FVC, MIP, MEP, and MVV, in favor of breathing exercises. Conclusions: Breathing exercises showed significant short-term effects in reducing pain and disability for persistent neck pain. They also provided benefits for functional respiratory parameters. However, the evidence certainty is low.

Background: Currently, there is conflicting clinimetric data on the patient-rated tennis elbow evaluation (PRTEE) and a paucity of evidence regarding the reliability, validity, and responsiveness of the numeric pain rating scale (NPRS), and tennis elbow function scale (TEFS) in patients with lateral elbow tendinopathy. Objective: Perform a comprehensive clinimetric analysis of the NPRS, PRTEE, and TEFS in a sample of patients (n = 143) with lateral elbow tendinopathy. Methods: Establish the reliability, construct validity, responsiveness, meaningful clinically important difference (MCID), and minimal detectable change (MDC90) values for the NPRS, PRTEE, and TEFS at the 3-month follow-up. Results: The NPRS [intraclass correlation coefficient (ICC2,1): 0.54, 95% confidence interval (CI): 0.17-0.78], PRTEE (ICC2,1: 0.62, 95% CI: 0.21-0.86), and the TEFS (ICC2,1: 0.71, 95% CI: 0.14-0.90) exhibited moderate reliability. All three outcomes exhibited excellent responsiveness [NPRS: area under the curve (AUC): 0.94, 95% CI: 0.89-0.98]; PRTEE: (AUC: 0.96, 95% CI 0.93-0.99); TEFS: (AUC: 0.95, 95% CI: 0.91-0.98). The MCID and MDC90 were 2.3 and 1.4 for the NPRS, 14.8 and 9.7 for the PRTEE, and 7.5 and 5.7 for the TEFS, respectively. All three patients reported outcome measures also demonstrated strong construct validity (Pearson's r from 0.71 to 0.83, p < .001). Conclusion: The NPRS, PRTEE, and TEFS are clinimetrically sound patient reported outcome measures for patients with lateral elbow tendinopathy at a 3-month follow-up. Registration at clinicaltrials.gov: NCT03167710.

Letter to the Editor-in-Chief in response to JOSPT article “Which Portion of Physiotherapy Treatments’ Effect Is Not Attributable to the Specific Effects in People With Musculoskeletal Pain? A Meta-analysis of Randomized Placebo-Controlled Trials” by Ezzatvar et al J Orthop Sports Phys Ther 2024;54(12):783-784. doi:10.2519/jospt.2024.0201

Objective The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. Design Randomized, single-blinded, multicenter, parallel-group trial. Setting Thirteen outpatient physical therapy clinics in nine different US states. Participants One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. Intervention Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. Main measures The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. Results The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. Conclusions The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy. Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017.

Background Platelet-rich plasma (PRP) and prolotherapy have resulted in promising outcomes in patients with various types of shoulder injuries. However, there is a lack of preliminary evidence supporting preparation of PRP production, timely application of these therapies and regenerative rehabilitation protocols. The purpose of this case report is to describe the distinct method including orthobiologic preparation, tissue-specific treatment and regenerative rehabilitation of an athlete with a complex shoulder injury. Case Presentation A 15y/o competitive female wrestler with a complex shoulder injury presented to the clinic after unsuccessful conservative rehabilitation. Unique methods were incorporated to optimize PRP production, specific tissue healing and regenerative rehabilitation. Multiple injuries required different orthobiologic interventions at different time frames, in order to promote optimal healing and stability of the shoulder. Outcomes The described interventions resulted in successful outcomes including pain, disability, full return to sport, and regenerative tissue healing confirmed with diagnostic imaging. Level of Evidence 5