- Email: [email protected]
Treatment fidelity: Implications for manual therapy research
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Abstracts / Manual Therapy 25 (2016) e57ee169
length by stretching technique and goniometric measurements and pain by an algometer of rectus femoris, hamstrings and gluteus medius muscles. Results: The sample studies was representative of young, active and asymptomatic population, showing low values of BMI and high prevalence of myofascial trigger points, as well as high muscle function values. The presence of myofascial trigger points in the gluteus medius produces a decrease in the maximum isometric contraction strength of ipsilateral and contralateral side. Myofascial trigger points are also related to a reduction in the maximum isometric force in the hamstrings. The presence of myofascial trigger points in the gluteus and rectus femoris is related to a decrease in muscle length. Also rectus femoris myofascial trigger points are related with an increase in the length of its antagonist's muscles, the hamstrings, suggesting an agonist-antagonist compensation pattern. Conclusion: The presence of myofascial trigger points affects muscle function, leading to less strength of sontraction of the hamstrings and gluteus medius, and affects in the same way in order to produce muscle shortening both of gluteus medius and rectus femoris as well as an elongation of its antagonist muscles, the hamstrings. Implications: Main clinical implications of the findings of this study are related to the fact that even latent myofascial trigger points can cause muscle dysfunction such as a decreased strength and decreased length, highlighting the importance of assessing both agonist and antagonist muscles in this situations. Funding acknowledgements: This work was unfunded Ethics approval: The study followed the Ethical Principles for Medical Research Involving Human Subjects (Helsinki Declaration, 2008).
A photographic and video record was kept of mechanical processes, which were subsequently analyzed to assess the relevance of the fascia’s participation in body movement. Results: 1) The presence of the structural continuity of the fascial system throughout the body together with parallel “epimysial” paths for the transmission of muscle contractile force. 2) Numerous muscle fibers terminate their path without reaching any of the extremes of the tendon/ aponeurosis. 3) Muscles are laterally connected to the fascia that wraps adjacent structures, such as blood vessels or peripheral nerves, which could represent an important route in force transmission. 4) The intramuscular and perimuscular connective tissue could act as a protective net in the case of a traumatic event related to the tendon or the muscular belly. Conclusion: The existence of the structural continuity of the fascial system, which can act as a secondary pathway of force transmission affecting muscle performance. The results are far from definitive; however, they suggest a review should be carried out of the current body movement model. Implications: The body movement model related to the “fascial system” may allow new and effective approaches to be developed to treat muscle injuries and diseases, such as muscular dystrophies, repetitive strain injury and spasticity. Funding acknowledgements: The work was not funded. Ethics approval: Ethics approval is not required.
Disclosure of interest: None Declared
Intergrating Research into practice PO1-MT-061 TREATMENT FIDELITY: IMPLICATIONS RESEARCH
Keywords: Muscle function, Myofascial trigger points, Strength Intergrating Research into practice PO1-MT-056 MYOFASCIAL FORCE TRANSMISSION. EVIDENCE FROM UNEMBALMED CADAVERS DISSECTIONS A. Pilat 1, J. Salom-Monreno 2,*, E. Castro 3, C. Fernandez-de-lasPenas 4. 1 Escuela de Terapias Miofasciales Tupimek, Escuela Universitaria noma de Madrid, Spain; 2 Departmento de de la ONCE e Universidad Auto Fisioterapia, Terapia Ocupational, Rehbilitacion y Medicina Fisica, Universidad Rey Juan Carlos, Madrid, Spain; 3 Departmento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Granda, Granda, Spain; 4 Departmento de Fisioterapia, Terapia Ocupacional, Rehabiliraction y Medicina Fisica, Universidad Rey Juan Carlos, Madrid, Spain * Corresponding author.
Background: In anatomical research, using a topographical approach performed on embalmed cadavers, the concept of “fascia” relates to some anatomical structures such as the tensor fasciae latae, the palmar fascia and the thoracolumbar fascia. It suggests a series of unrelated elements instead of a unique and continuous configuration that links the body structure. Such an approach makes analysis of the dissected elements difficult, when integrated into a higher level of organization. Anatomical studies of unembalmed cadavers have provided a new perspective of the fascia, which differs from the traditional “fibrous sheet” that “hides” the muscle. Most contractile forces are directed to myotendinous units, however, approximately 30% of them use “epimismal” transmission paths, parallel to the tendinous paths. The myofascial force transmission concept involves any kind of transmission from the full surface of a myofibril, excluding the direct participation of the myotendinous/myoaponeurosis unit. The recent research focuses on the myofascial force transmission regarding: a) spasticity and post-traumatic and post-surgical scars in relation to movement patterns; b) intrinsic connective tissue mechanics in relation to muscular synergism paths. Purpose: Demonstrate (using dissections of unembalmed cadavers) the continuity of the fascial structure, its correlation to other body systems and its effect on movement (force transmission). Methods: Anatomical dissections were performed on unembalmed cadavers preserved at 2-3 C, where the fascial structure was conserved.
Disclosure of interest: None Declared Keywords: Fascia, Myofascial force transmission, Unembalmed cadaver dissections.
FOR
MANUAL
THERAPY
S. Karas*, L. Plankis. * Corresponding author.
Background: Treatment Fidelity (TF) involves methodological strategies to enhance the reliability and validity of the independent variable in research, improve statistical power and produce greater confidence in the results. Components of TF have been documented in research of scientific disciplines since the 1970s. TF contains five components: treatment design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Purpose: To the best of our knowledge, TF has not been implemented into Manual Therapy research and is rarely mentioned in Physical Therapy / Physiotherapy journals. There are multiple proposed reason’s why TF is not consistently monitored in research including increased time, increased cost, and increased researcher responsibility. Our purpose was to develop and present a new TF checklist for Manual Therapists. We theorize it will improve TF, confidence in research results, and ultimatley more efficient translation to clinical practice. Methods: We performed a systematic review of the literature to evaluate TF and propose a new method for its utilization that will not overburden the researcher. We utilized methods that have been effective in other scientific and healthcare fields. From this data, we constructed a simple checklist to allow researchers to monitor TF in the key areas: treatment design, provider training, treatment deleivery, treatment receipt, and treatment skill enactment. Results: After a literature review and assessment, we developed a TF checklist that Manual Therapy researchers can efficiently utilize. We provide this tool and encourage its use an additional means to strengthen research conclusions so their results may be more effectively translated into practice. Conclusion: TF has the ability to improve the quality of and strength of research. The addition of the five components of TF within our proposed check list may improve statistical power, enhance research design, and produce increased confidence in the results researchers publish. Implications: Strength of research design and structure enhances conclusions that are valid, reliable, and applicable to clinical practice. By using the concept of TF, which is new to Manual Therapy, and the simple check
Abstracts / Manual Therapy 25 (2016) e57ee169
list we have developed, research may be stregnthened allowing for stronger confidence in the results and an increase in their translation. Thus newly emerging concepts may be held in higher regard and translated confidently into clinical practice. Funding acknowledgements: No funding. Ethics approval: No human subjects were utilized and no ethics approval was needed. Disclosure of interest: None Declared Keywords: Treatment fidelity, Reliability, Validity Intergrating Research into practice PO1-MT-062 A RANDOMIZED, PLACEBO-CONTROLLED, CARDIOVASCULAR RESPONSE COMPARISON OF UNILATERAL POSTERIOR-TO-ANTERIORLY DIRECTED MOBILIZATION OF THE NECK IN PAIN-FREE ADULTS E. Yung 1, 2, 3, 4, *, M. Wong 4, 5, 6, M.I. Ali 7, 8, T. Smith 7, E.M. Barton 4, K. Peterson 4, D. Cameron 7, J. Grimes 1, K. Ching 4, A. Sullivan 1. 1 Doctor of Physical Therapy and Orthopaedic Physical Therapy Residency Programs, Sacred Heart University, Fairfield, United States; 2 Elevating Practice in Orthopaedic Physical Therapy, MGH Institute of Health Professions, Boston, MA, United States; 3 PhD Program in Ergonomics and Biomechanics, New York University, New York, NY, United States; 4 Doctor of Physical Therapy Program, Azusa Pacific University, Azusa, CA, United States; 5 Physical Therapy Spine Fellowship, University of Southern California, Los Angeles, CA, United States; 6 Physical Therapy Spine Fellowship, Kaiser Permanente, Los Angeles, United States; 7 Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, United States; 8 United States Army Reserve, West Hartford, CT, United States * Corresponding author.
Background: Neck pain is a prevalent global malady. Physiotherapists apply joint mobilization (JM) as a routine, pragmatic procedure for neck pain. Perhaps because JM is widely acknowledged as an effective intervention as concluded by multiple systematic reviews and meta-analyses. Unilateral anterior glide (UPA) is an entry-level variant of JM. And the purported rationale of how pain modulation is attained when employing JM is expounded as a neurophysiologic mechanism. Notwithstanding, the neurophysiologic system that alters pain overlaps with blood pressure (BP) as observed in BP-related hypoalgesia. Therefore, BP is a pertinent and easily quantified variable to examine. Nonetheless, there is scant evidence on the cardiovascular response to UPA. Moreover, it is unsettled whether JM produces sympatho -excitatory or -inhibitory reaction as determined by two published reports that employed central anterior glide (CPA) and unilateral posterior pressures (AP), respectively. Purpose: To compare the blood pressure (BP) and heart rate (HR) response of healthy volunteers to UPA applied to the neck versus its corresponding placebo (UPA-P). Methods: Two university-wide mass emails yielded 40 (17 females) healthy, pain-free participants (mean age, 23.4 ± 1.9 years) who consented to this clinical trial. Those enrolled have no history of syncope, no cardiovascular disease, and no cervical-shoulder pain. Thereafter, each participant was randomly allocated to 1 of 2 groups. Group 1 received a UPA-P when light touch was applied to right 6th cervical vertebra. Group 2 received a UPA to the right 6th cervical vertebra. An OMRON automatic monitor measured the BP and HR in the following order (time points): (1) 5 minutes, (2) 7 minutes after resting supine, (3) during the first set, (4) during the fifth set of UPA-P or UPA, (5) 2 minutes and (6) 4 minutes after the fifth set was applied. Each set consists of 10 seconds on & 10 off. Blinded to the random allocation and the data gathered, the primary author performed UPA-P or UPA on all volunteers. ANOVA and paired-difference statistics were employed to ascertain the BP & HR response between both groups and within each group, respectively for all time points. A research assistant followed up with the participants to see if there is any adverse and/or side-effects at 2 weeks and again at 4 weeks. Results: There was a significant mean difference in the following: (a) UPA SBP at time point 1 minus SBP at time point 3 [ 3.8 mmHg, 95% CI -5.5
e135
mmHg and -2.1 mmHg; P < .01]; and (b) UPA SBP at baseline (time points 1 & 2) minus SBP during intervention (time points 3 & 4) [ 2.7mmHg, 95% CI -4.7 mmHg and -0.7 mmHg, P < .05]. All p-values were Bonferronicorrected. Some SBP drop (i.e. lower bounds of 95% CI) exceeded the 4.2 mmHg minimal detectable change. There were no other noteworthy differences for the between-group and within-group comparisons. Participants did not have any adverse and/or side-effects during the follow-up periods. Conclusion: When compared to placebo, UPA of the neck resulted in an SBP drop within the range of 0.7 to -5.5 mmHg in pain-free, healthy young adults. An expanded benefit of these results is that they could serve as reference values that may be contrasted to those with neck pain in future research. Implications: When executing UPA, therapists may anticipate a likely SBP drop in pain-free adults. This may exemplify a sympatho-inhibitory effect similar to that of AP. Both UPA and AP used a distinctive dose. Consequently, this could explicate why the effect is divergent to the dominant paradigm that JM exclusively produce sympatho-excitatory effect. Caution: the dose of UPA, similar to AP, was simply a fraction that of a CPA. In addition, it may be valuable to detect if this analogous response would transpire in patients with neck pain in future work. Funding acknowledgements: Dr. Yung's PhD studies at New York University (NYU) is funded by a tuition award from the United States Government's National Institute of Occupational Safety and Health (NIOSH/ NIH) Education and Research Center Grant through NYU School of Medicine. This research study is funded by the American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT) OPTP Research Grant Ethics approval: The Ethics Committees of Sacred Heart University and Azusa Pacific University approved the protocol of this study. All patients signed their informed consent. Disclosure of interest: E. Yung Conflict with: United States Government's National Institute of Occupational Safety and Health Education and Research Center Grant Tuition awardee for PhD studies, M. Wong: None Declared, M. I. Ali: None Declared, T. Smith: None Declared, E. M. Barton: None Declared, K. Peterson: None Declared, D. Cameron: None Declared, J. Grimes: None Declared, K. Ching: None Declared, A. Sullivan: None Declared Keywords: Cervical spine Intergrating Research into practice PO1-PA-066 KINESIOPHOBIA AND MALADAPTIVE COPING STRATEGIES PREVENT IMPROVEMENTS IN PAIN CATASTROPHIZING FOLLOWING PAIN NEUROSCIENCE EDUCATION IN FIBROMYALGIA/CHRONIC FATIGUE SYNDROME: POOLED RESULTS FROM 2 RANDOMIZED CONTROLLED TRIALS A. Malfliet 1, 2, 3, 4, *, J. Van Oosterwijck 1, M. Meeus 2, B. Cagnie 1, L. Danneels 1, M. Dolphens 1, R. Buyl 3, J. Nijs 4. 1 Revaki, Belgium; 2 Ghent University, Ghent, Belgium; 3 Vrije Universiteit Brussel, Brussels, Belgium; 4 Revaki, Vrije Universiteit Brussel, Brussels, Belgium * Corresponding author.
Background: Many patients with chronic fatigue syndrome (CFS) and/or fibromyalgia (FM) have no understanding of their condition, leading to maladaptive pain cognitions and coping strategies. These should be tackled during therapy, e.g. by providing pain neurophysiology education (PNE). Although the positive effects of PNE are well-established in chronic pain populations, it remains unclear why some patients benefit more than others. Identifying predictive factors for therapy would add great value to clinical pratice. Purpose: This study aims at identifying pretreatment characteristics of patients that respond poorly to PNE to further improve and extend its effectiveness. Methods: Data from two previously published RCT’s were pooled to search for baseline predictors. Included subjects suffered from CFS/FM and underwent PNE treatment. Self- reported questionnaires including the Pain
Abstracts / Manual Therapy 25 (2016) e57ee169
length by stretching technique and goniometric measurements and pain by an algometer of rectus femoris, hamstrings and gluteus medius muscles. Results: The sample studies was representative of young, active and asymptomatic population, showing low values of BMI and high prevalence of myofascial trigger points, as well as high muscle function values. The presence of myofascial trigger points in the gluteus medius produces a decrease in the maximum isometric contraction strength of ipsilateral and contralateral side. Myofascial trigger points are also related to a reduction in the maximum isometric force in the hamstrings. The presence of myofascial trigger points in the gluteus and rectus femoris is related to a decrease in muscle length. Also rectus femoris myofascial trigger points are related with an increase in the length of its antagonist's muscles, the hamstrings, suggesting an agonist-antagonist compensation pattern. Conclusion: The presence of myofascial trigger points affects muscle function, leading to less strength of sontraction of the hamstrings and gluteus medius, and affects in the same way in order to produce muscle shortening both of gluteus medius and rectus femoris as well as an elongation of its antagonist muscles, the hamstrings. Implications: Main clinical implications of the findings of this study are related to the fact that even latent myofascial trigger points can cause muscle dysfunction such as a decreased strength and decreased length, highlighting the importance of assessing both agonist and antagonist muscles in this situations. Funding acknowledgements: This work was unfunded Ethics approval: The study followed the Ethical Principles for Medical Research Involving Human Subjects (Helsinki Declaration, 2008).
A photographic and video record was kept of mechanical processes, which were subsequently analyzed to assess the relevance of the fascia’s participation in body movement. Results: 1) The presence of the structural continuity of the fascial system throughout the body together with parallel “epimysial” paths for the transmission of muscle contractile force. 2) Numerous muscle fibers terminate their path without reaching any of the extremes of the tendon/ aponeurosis. 3) Muscles are laterally connected to the fascia that wraps adjacent structures, such as blood vessels or peripheral nerves, which could represent an important route in force transmission. 4) The intramuscular and perimuscular connective tissue could act as a protective net in the case of a traumatic event related to the tendon or the muscular belly. Conclusion: The existence of the structural continuity of the fascial system, which can act as a secondary pathway of force transmission affecting muscle performance. The results are far from definitive; however, they suggest a review should be carried out of the current body movement model. Implications: The body movement model related to the “fascial system” may allow new and effective approaches to be developed to treat muscle injuries and diseases, such as muscular dystrophies, repetitive strain injury and spasticity. Funding acknowledgements: The work was not funded. Ethics approval: Ethics approval is not required.
Disclosure of interest: None Declared
Intergrating Research into practice PO1-MT-061 TREATMENT FIDELITY: IMPLICATIONS RESEARCH
Keywords: Muscle function, Myofascial trigger points, Strength Intergrating Research into practice PO1-MT-056 MYOFASCIAL FORCE TRANSMISSION. EVIDENCE FROM UNEMBALMED CADAVERS DISSECTIONS A. Pilat 1, J. Salom-Monreno 2,*, E. Castro 3, C. Fernandez-de-lasPenas 4. 1 Escuela de Terapias Miofasciales Tupimek, Escuela Universitaria noma de Madrid, Spain; 2 Departmento de de la ONCE e Universidad Auto Fisioterapia, Terapia Ocupational, Rehbilitacion y Medicina Fisica, Universidad Rey Juan Carlos, Madrid, Spain; 3 Departmento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Granda, Granda, Spain; 4 Departmento de Fisioterapia, Terapia Ocupacional, Rehabiliraction y Medicina Fisica, Universidad Rey Juan Carlos, Madrid, Spain * Corresponding author.
Background: In anatomical research, using a topographical approach performed on embalmed cadavers, the concept of “fascia” relates to some anatomical structures such as the tensor fasciae latae, the palmar fascia and the thoracolumbar fascia. It suggests a series of unrelated elements instead of a unique and continuous configuration that links the body structure. Such an approach makes analysis of the dissected elements difficult, when integrated into a higher level of organization. Anatomical studies of unembalmed cadavers have provided a new perspective of the fascia, which differs from the traditional “fibrous sheet” that “hides” the muscle. Most contractile forces are directed to myotendinous units, however, approximately 30% of them use “epimismal” transmission paths, parallel to the tendinous paths. The myofascial force transmission concept involves any kind of transmission from the full surface of a myofibril, excluding the direct participation of the myotendinous/myoaponeurosis unit. The recent research focuses on the myofascial force transmission regarding: a) spasticity and post-traumatic and post-surgical scars in relation to movement patterns; b) intrinsic connective tissue mechanics in relation to muscular synergism paths. Purpose: Demonstrate (using dissections of unembalmed cadavers) the continuity of the fascial structure, its correlation to other body systems and its effect on movement (force transmission). Methods: Anatomical dissections were performed on unembalmed cadavers preserved at 2-3 C, where the fascial structure was conserved.
Disclosure of interest: None Declared Keywords: Fascia, Myofascial force transmission, Unembalmed cadaver dissections.
FOR
MANUAL
THERAPY
S. Karas*, L. Plankis. * Corresponding author.
Background: Treatment Fidelity (TF) involves methodological strategies to enhance the reliability and validity of the independent variable in research, improve statistical power and produce greater confidence in the results. Components of TF have been documented in research of scientific disciplines since the 1970s. TF contains five components: treatment design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Purpose: To the best of our knowledge, TF has not been implemented into Manual Therapy research and is rarely mentioned in Physical Therapy / Physiotherapy journals. There are multiple proposed reason’s why TF is not consistently monitored in research including increased time, increased cost, and increased researcher responsibility. Our purpose was to develop and present a new TF checklist for Manual Therapists. We theorize it will improve TF, confidence in research results, and ultimatley more efficient translation to clinical practice. Methods: We performed a systematic review of the literature to evaluate TF and propose a new method for its utilization that will not overburden the researcher. We utilized methods that have been effective in other scientific and healthcare fields. From this data, we constructed a simple checklist to allow researchers to monitor TF in the key areas: treatment design, provider training, treatment deleivery, treatment receipt, and treatment skill enactment. Results: After a literature review and assessment, we developed a TF checklist that Manual Therapy researchers can efficiently utilize. We provide this tool and encourage its use an additional means to strengthen research conclusions so their results may be more effectively translated into practice. Conclusion: TF has the ability to improve the quality of and strength of research. The addition of the five components of TF within our proposed check list may improve statistical power, enhance research design, and produce increased confidence in the results researchers publish. Implications: Strength of research design and structure enhances conclusions that are valid, reliable, and applicable to clinical practice. By using the concept of TF, which is new to Manual Therapy, and the simple check
Abstracts / Manual Therapy 25 (2016) e57ee169
list we have developed, research may be stregnthened allowing for stronger confidence in the results and an increase in their translation. Thus newly emerging concepts may be held in higher regard and translated confidently into clinical practice. Funding acknowledgements: No funding. Ethics approval: No human subjects were utilized and no ethics approval was needed. Disclosure of interest: None Declared Keywords: Treatment fidelity, Reliability, Validity Intergrating Research into practice PO1-MT-062 A RANDOMIZED, PLACEBO-CONTROLLED, CARDIOVASCULAR RESPONSE COMPARISON OF UNILATERAL POSTERIOR-TO-ANTERIORLY DIRECTED MOBILIZATION OF THE NECK IN PAIN-FREE ADULTS E. Yung 1, 2, 3, 4, *, M. Wong 4, 5, 6, M.I. Ali 7, 8, T. Smith 7, E.M. Barton 4, K. Peterson 4, D. Cameron 7, J. Grimes 1, K. Ching 4, A. Sullivan 1. 1 Doctor of Physical Therapy and Orthopaedic Physical Therapy Residency Programs, Sacred Heart University, Fairfield, United States; 2 Elevating Practice in Orthopaedic Physical Therapy, MGH Institute of Health Professions, Boston, MA, United States; 3 PhD Program in Ergonomics and Biomechanics, New York University, New York, NY, United States; 4 Doctor of Physical Therapy Program, Azusa Pacific University, Azusa, CA, United States; 5 Physical Therapy Spine Fellowship, University of Southern California, Los Angeles, CA, United States; 6 Physical Therapy Spine Fellowship, Kaiser Permanente, Los Angeles, United States; 7 Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, United States; 8 United States Army Reserve, West Hartford, CT, United States * Corresponding author.
Background: Neck pain is a prevalent global malady. Physiotherapists apply joint mobilization (JM) as a routine, pragmatic procedure for neck pain. Perhaps because JM is widely acknowledged as an effective intervention as concluded by multiple systematic reviews and meta-analyses. Unilateral anterior glide (UPA) is an entry-level variant of JM. And the purported rationale of how pain modulation is attained when employing JM is expounded as a neurophysiologic mechanism. Notwithstanding, the neurophysiologic system that alters pain overlaps with blood pressure (BP) as observed in BP-related hypoalgesia. Therefore, BP is a pertinent and easily quantified variable to examine. Nonetheless, there is scant evidence on the cardiovascular response to UPA. Moreover, it is unsettled whether JM produces sympatho -excitatory or -inhibitory reaction as determined by two published reports that employed central anterior glide (CPA) and unilateral posterior pressures (AP), respectively. Purpose: To compare the blood pressure (BP) and heart rate (HR) response of healthy volunteers to UPA applied to the neck versus its corresponding placebo (UPA-P). Methods: Two university-wide mass emails yielded 40 (17 females) healthy, pain-free participants (mean age, 23.4 ± 1.9 years) who consented to this clinical trial. Those enrolled have no history of syncope, no cardiovascular disease, and no cervical-shoulder pain. Thereafter, each participant was randomly allocated to 1 of 2 groups. Group 1 received a UPA-P when light touch was applied to right 6th cervical vertebra. Group 2 received a UPA to the right 6th cervical vertebra. An OMRON automatic monitor measured the BP and HR in the following order (time points): (1) 5 minutes, (2) 7 minutes after resting supine, (3) during the first set, (4) during the fifth set of UPA-P or UPA, (5) 2 minutes and (6) 4 minutes after the fifth set was applied. Each set consists of 10 seconds on & 10 off. Blinded to the random allocation and the data gathered, the primary author performed UPA-P or UPA on all volunteers. ANOVA and paired-difference statistics were employed to ascertain the BP & HR response between both groups and within each group, respectively for all time points. A research assistant followed up with the participants to see if there is any adverse and/or side-effects at 2 weeks and again at 4 weeks. Results: There was a significant mean difference in the following: (a) UPA SBP at time point 1 minus SBP at time point 3 [ 3.8 mmHg, 95% CI -5.5
e135
mmHg and -2.1 mmHg; P < .01]; and (b) UPA SBP at baseline (time points 1 & 2) minus SBP during intervention (time points 3 & 4) [ 2.7mmHg, 95% CI -4.7 mmHg and -0.7 mmHg, P < .05]. All p-values were Bonferronicorrected. Some SBP drop (i.e. lower bounds of 95% CI) exceeded the 4.2 mmHg minimal detectable change. There were no other noteworthy differences for the between-group and within-group comparisons. Participants did not have any adverse and/or side-effects during the follow-up periods. Conclusion: When compared to placebo, UPA of the neck resulted in an SBP drop within the range of 0.7 to -5.5 mmHg in pain-free, healthy young adults. An expanded benefit of these results is that they could serve as reference values that may be contrasted to those with neck pain in future research. Implications: When executing UPA, therapists may anticipate a likely SBP drop in pain-free adults. This may exemplify a sympatho-inhibitory effect similar to that of AP. Both UPA and AP used a distinctive dose. Consequently, this could explicate why the effect is divergent to the dominant paradigm that JM exclusively produce sympatho-excitatory effect. Caution: the dose of UPA, similar to AP, was simply a fraction that of a CPA. In addition, it may be valuable to detect if this analogous response would transpire in patients with neck pain in future work. Funding acknowledgements: Dr. Yung's PhD studies at New York University (NYU) is funded by a tuition award from the United States Government's National Institute of Occupational Safety and Health (NIOSH/ NIH) Education and Research Center Grant through NYU School of Medicine. This research study is funded by the American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT) OPTP Research Grant Ethics approval: The Ethics Committees of Sacred Heart University and Azusa Pacific University approved the protocol of this study. All patients signed their informed consent. Disclosure of interest: E. Yung Conflict with: United States Government's National Institute of Occupational Safety and Health Education and Research Center Grant Tuition awardee for PhD studies, M. Wong: None Declared, M. I. Ali: None Declared, T. Smith: None Declared, E. M. Barton: None Declared, K. Peterson: None Declared, D. Cameron: None Declared, J. Grimes: None Declared, K. Ching: None Declared, A. Sullivan: None Declared Keywords: Cervical spine Intergrating Research into practice PO1-PA-066 KINESIOPHOBIA AND MALADAPTIVE COPING STRATEGIES PREVENT IMPROVEMENTS IN PAIN CATASTROPHIZING FOLLOWING PAIN NEUROSCIENCE EDUCATION IN FIBROMYALGIA/CHRONIC FATIGUE SYNDROME: POOLED RESULTS FROM 2 RANDOMIZED CONTROLLED TRIALS A. Malfliet 1, 2, 3, 4, *, J. Van Oosterwijck 1, M. Meeus 2, B. Cagnie 1, L. Danneels 1, M. Dolphens 1, R. Buyl 3, J. Nijs 4. 1 Revaki, Belgium; 2 Ghent University, Ghent, Belgium; 3 Vrije Universiteit Brussel, Brussels, Belgium; 4 Revaki, Vrije Universiteit Brussel, Brussels, Belgium * Corresponding author.
Background: Many patients with chronic fatigue syndrome (CFS) and/or fibromyalgia (FM) have no understanding of their condition, leading to maladaptive pain cognitions and coping strategies. These should be tackled during therapy, e.g. by providing pain neurophysiology education (PNE). Although the positive effects of PNE are well-established in chronic pain populations, it remains unclear why some patients benefit more than others. Identifying predictive factors for therapy would add great value to clinical pratice. Purpose: This study aims at identifying pretreatment characteristics of patients that respond poorly to PNE to further improve and extend its effectiveness. Methods: Data from two previously published RCT’s were pooled to search for baseline predictors. Included subjects suffered from CFS/FM and underwent PNE treatment. Self- reported questionnaires including the Pain