Week 9 (parts 1, 2 and 3) Flashcards

Question

what do we need to know to facilitate management using manual therapy

Answer 1

 Basic science of soft tissues (incl. muscle and nerve) – Tissue biology, composition and characteristics – Tissue biomechanics – stress/strain curve – Tissue homeostasis – responses to physical stimuli  Soft tissue healing – Staging – Muscle contraction – Neural control of movement  Physiological changes associated with – Injury (overuse, overload, trauma) or pathology – Immobilisation or detraining – Exercise (strength, power, endurance, proprioception and coordination) – Altered motor control, Fatigue – Age  Indications and contraindications

Answer 2

 Can be expressive as well as instrumental – match to the patient’s condition  Remember touch is bi-directional so – Make sure it is appropriate to the condition – That you make the objectives very clear – prevent misinterpretation – Be aware of the feedback response you get – this can be very subtle but important – Don’t communicate negative messages  Analgesic touch – able to modulate pain by biasing signal detection, buffering pain intensity and quality of sensation (Mancini et al. 2014, Pain relief by touch: A quantitative approach)  Affective touch – communicate sympathy, comfort, support, reassurance and elicit positive emotions (Hertenstein et al., 2009) and reduce negative feelings  Somatoperceptual – able to locate pain and tactile stimuli (Puentedura and Flynn, 2016)

Answer 3

 Assist two body processes  Repair processes – stress for better repair, influence fluid flow and blood perfusion, and tissue length adaptation  Adaptation process – assisting adaptive repair for physical demands vs maladaptive  Crucial to match dosage, progression, regression to stage of healing and condition  Mechanical – Oscillatory, active movement and stretches invoke biomechanical and tissue adaptation changes  Autonomic – skin temperature, cortisol levels  Endocrine – release of endorphins  Neurophysiological – pain modulation through Aß on A∂ and C pathways, proprioception and motor adaptation  Affective – behaviour, cognition, emotions and mood through opioids and dopaminergic pathways, deactivation of stressful responses  Non-specific responses – Placebo

Answer 4

 Massage  Muscle energy techniques  Myofascial release  Stretching  PNF  Specific soft tissue mobilisations  Transverse frictions  Trigger points

Answer 5

 Am I? – Aiming to support repair processes by improving flow? – Aiming to improve tissue extensibility? – Aiming to improve length? – Aiming to reduce pain? – Aiming to improve neuromuscular activity? – Aiming to stimulate proprioception? – Aiming to increase body awareness and postural guidance?  Note, it is not a recipe

Answer 6

 Timing – what and when?  When is it inappropriate – precautions and contraindications?  What psychological support does the patient need?  Balancing influencing pain, utilising the potential for therapeutic changes and quality of repair  Influencing tissue strength for mechanical demands and not exceeding tissue tensile strength  Importance of joint motion  Movement vs. immobility….where does immobilisation come into this?  Think about you, your capabilities and positioning

Answer 7

 Helps you locate symptoms  Helps you communicate kindness, empathy, reception, firmness, support, comfort, reassurance  Helps you identify those who are likely to respond and gain increased acceptance and compliance  Helps you make use of the appropriate physical properties to invoke biomechanical and physical change  Helps you reduce pain  Cueing – helps you guide movement and activity to be performed correctly

Answer 8

 Whereas Critical Thinking relates to the general process of decision making that is used all the time in clinical practice, Critical Appraisal relates to a specifically applied process.  Critical Appraisal is being systematic in judging the merits and usefulness of research so that your decision-making is better informed.  Why should I do it? – so that the information you use to underpin your practice is high quality and reliable!

Answer 9

 Looking at the research to see what it was about and why was it done? Does it set the scene?  What was the type of study and was it appropriate? – Quantitative research – all about numbers – Qualitative research – going beyond numbers to explore the patient’s experience – Systematic/meta-analyses/non-systematic reviews – Trials and diagnostics – Economic analyses – Hierarchy of evidence – Was the methods used appropriate  Are the results valid?  What is the value of these results? How do I apply them to what I do? A simple framework for critical appraisal:  Identify the literature you think is relevant – Look at the context of each paper and ask yourself : Why was the study done? Is the research question relevant to me?  The next step - what are the good points and flaws – Type of study – Is the method right to answer the research? – Is the group or patients studied representative? – Is there a statement of what they expected to find? – Does it eliminate bias? – (See Trisha Greenhalgh ‘How to read a paper’) – Drawing your conclusion on the value of results – Are the results significant enough to justify the conclusions? – Are they plausible and believable? – Is the evidence and argument supplied coherent, relevant and compelling? – What do I think about the quality of the research?  What does it mean for me? – How can these results be applied to my practice?

Answer 10

 Criticality is about using and questioning information rather than simply absorbing and then describing it.  It is about having that critical thinking/analytical approach and applying it specifically.  Then thinking about – What you have learnt and understood within this research picture/context and being able to understand the links, relationships, strengths of your thoughts and the weaknesses.  Then it is being able to articulate that! Practical application of a critical appraisal:  You have 2 papers: – Hariharasudhan and Balamurugan (2015) Effectiveness of muscle energy technique and Mulligan’s movement – Jurecka et al., (2021) Evaluating the effectiveness of soft tissue therapy in the treatment of disorders and postoperative conditions of the knee joint  In your groups, review these papers.  Use the Critical Appraisal of Research doc (see canvas) for guidance.  We will discuss what you have produced!!!

Week 9 (parts 1, 2 and 3) Flashcards

(34 cards)