Journal of Manual & Manipulative Therapy最新文献

{"title":"Effect of integrated neuromuscular inhibition technique on subjects with neck pain and forward head posture: a randomized controlled trial.","authors":"Rania Reffat Ali, Somaya Nady Mohamed Elsayed, Ragia Mohamed Kamel, Ebtisam Mohamed Fahmy, Hend Ahmed Hamdy","doi":"10.1080/10669817.2025.2476662","DOIUrl":"https://doi.org/10.1080/10669817.2025.2476662","url":null,"abstract":"<p><strong>Objective: </strong>Forward head posture (FHP) and neck pain are common musculoskeletal complaints. This study aimed to evaluate the effect of the Integrated Neuromuscular Inhibition Technique (INIT) on the range of motion (ROM) and craniovertebral angle (CVA) in individuals with FHP and neck pain.</p><p><strong>Methods: </strong>A total of 40 physical therapy participants (26 females and 14 males), aged 18 to 23 years (mean age: 20 ± 1.71 years), participated in this study. They were randomized into two groups: Group A received conventional therapy combined with Integrated Neuromuscular Inhibition Technique (INIT) targeting the upper trapezius and suboccipital muscles, while Group B received conventional therapy consisting of strengthening and stretching exercises only. The treatment was administered three times per week for one month.Photographic sessions were conducted using a mobile phone. A Realme 7 Pro camera and CorelDRAW software were employed to analyze the craniovertebral angle (CVA). A pressure algometer was used to measure the pressure pain threshold (PPT), while a visual analogue scale (VAS) was utilized to assess pain severity. Additionally, a clinometer application on an Android device was used to evaluate cervical range of motion (ROM).</p><p><strong>Results: </strong>Both groups demonstrated significant improvements in craniovertebral angle (CVA) and visual analogue scale (VAS) scores, with Group A showing a 16.12% improvement in CVA and a 75.61% reduction in VAS, compared to a 7.20% improvement in CVA and a 57.14% reduction in VAS in Group B.Group A also showed a significantly greater post-treatment increase in CVA (<i>p</i> = 0.01), cervical range of motion (ROM) for flexion (<i>p</i> = 0.002), extension (<i>p</i> = 0.005), right bending (<i>p</i> = 0.001), left bending (<i>p</i> = 0.001), right rotation (<i>p</i> = 0.001), and left rotation (<i>p</i> = 0.001). Additionally, Group A exhibited a significantly greater decrease in VAS (<i>p</i> = 0.003) compared to Group B following treatment.</p><p><strong>Conclusion: </strong>The Integrated Neuromuscular Inhibition (INI) technique, which combines ischemic compression, strain-counterstrain, and muscle energy techniques, yields superior outcomes compared to conventional therapy alone for individuals with forward head posture (FHP) and neck pain. It is particularly effective in improving craniovertebral angle (CVA), reducing pain levels, and enhancing cervical range of motion (ROM).</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-11"},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study.","authors":"Paul Salamh, Brent Stoner, Nathaniel Ruley, Huiling Zhu, Marcus Bateman, Rachel Chester, Liesbet Da Baets, Jo Gibson, Luise Hollmann, Martin Kelley, Jeremy Lewis, Philip McClure, Karen McCreesh, Michel Gcam Mertens, Lori Michener, Amee L Seitz, Filip Struyf, Joseph Zuckerman, William King","doi":"10.1080/10669817.2025.2470461","DOIUrl":"https://doi.org/10.1080/10669817.2025.2470461","url":null,"abstract":"<p><strong>Introduction: </strong>There has been an emergence of evidence in the area of frozen shoulder (FS) within the past decade related to risk factors, etiology, diagnosis, and management. It has become increasingly challenging for clinicians and researchers to stay up to date in these areas, particularly with the clinical practice guidelines that are available being few and outdated. To this end, the aim of this study was to produce an international consensus on the risk factors, etiology, diagnosis and management for individuals with FS.</p><p><strong>Methods: </strong>During phase one a steering committee was formed in order to identify experts in the area of FS, examine the current evidence related to FS and identify key areas lacking consensus. Phase two consisted of inviting experts to participate in a three-round survey with a priori consensus level set at 80%. Descriptive statistics were utilized to determine the characteristics of the expert panel, response rate, and level of consensus.</p><p><strong>Results: </strong>A total of 14 international experts responded to all three rounds of the Delphi survey with 100% response rate following round one. Consensus was reached for 101 items (57 in the first round, 37 in the second round and 7 in the third and final round). Specific to key topic areas, the following number of items reached consensus; etiology 9 items (diabetes mellitus, trauma, shoulder arthroscopy, thyroid disease, prolonged immobilization, adrenocorticotropic hormone deficiency, metabolic synderome, connective tissue disorders, and hyperlipidemia), risk factors 40 items (including biophysical factors for developing FS and biophysical and psychosocial factors influencing the Management and course of outcomes related to FS), diagnosis 19 items (4 confounding the diagnosis and 15 signs and symptoms associated with FS), Management 33 items overall and categorized into effectiveness for early and later stages of FS).</p><p><strong>Conclusion: </strong>The results of this international Delphi study help to provide a consensus on key elements to consider in clinical practice related to etiology, risk factors, diagnosis, and management for those with FS.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-12"},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding degenerative cervical myelopathy in musculoskeletal practice.","authors":"Matteo Cervellini, Daniel Feller, Filippo Maselli, Giacomo Rossettini, Chad Cook, Julia Tabrah, Rohil V Chauhan, Alan Taylor, Roger Kerry, Ian Young, James Dunning, Nathan Hutting, Firas Mourad","doi":"10.1080/10669817.2025.2465728","DOIUrl":"https://doi.org/10.1080/10669817.2025.2465728","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>The aim of this article is to summarize and enhance physiotherapists' essential knowledge of the differential diagnosis and management of patients with DCM.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-17"},"PeriodicalIF":1.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point of care ultrasonography in physical therapists' clinical practice: a clinical perspective.","authors":"Lorna M Hayward, Alycia M Markowski, Bruno U K Steiner, Murry E Maitland, Maureen K Watkins, Robert C Manske, George J Beneck","doi":"10.1080/10669817.2025.2470460","DOIUrl":"https://doi.org/10.1080/10669817.2025.2470460","url":null,"abstract":"<p><p>This paper offers a contemporary, evidence-based perspective on how point of care ultrasonography imaging (POCUS) has the potential to impact orthopedic and sports physical therapists' examination and treatment. Clinical use of POCUS has increased in medicine and is emerging in physical therapist practice. Greater affordability, portability, ease of use, and evidence supporting its' diagnostic value have contributed to increased use. Modern ultrasound devices have improved resolution allowing for the differentiation of anatomical structures. Physical therapists use POCUS in clinical practice as an extension of the physical examination to confirm, refute, expand, or narrow a differential diagnosis. Doctor of Physical Therapy professional education provides entry-level student physical therapists with the foundational knowledge necessary for the clinical application of POCUS. A physical therapist's use of POCUS complements the clinical evaluation and contrasts with the approach of referring out for diagnostic imaging and waiting for results. We present current evidence for expanded use of POCUS by physical therapists in clinical practice. We advocate for using ultrasound imaging in orthopedic and sports physical therapists' practice. Integrating POCUS into physical therapist patient management, could decrease patient healthcare costs through increased diagnostic efficiency.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Straight leg raise versus knee extension angle: which structure limits the test in asymptomatic subjects?","authors":"Pierre Pesesse, Sebastien Wolfs, David Colman, Stephanie Grosdent, Marc Vanderthommen, Christophe Demoulin","doi":"10.1080/10669817.2025.2465739","DOIUrl":"https://doi.org/10.1080/10669817.2025.2465739","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine if the first onset of symptoms (discomfort) during the straight leg raise (SLR) (hip flexion with an extended knee) and the Knee Extension Angle (KEA) tests (knee extension with 90°of hip flexion) results from nervous or muscular structures in asymptomatic individuals. The secondary objective was to investigate if the gender influences the structure related to the discomfort.</p><p><strong>Methods: </strong>This cross-sectional study consisted of a single assessment session during which the structure related to participants' discomfort during the KEA and SLR was identified. For this identification, a structural differentiation (SD) was conducted during both tests using passive mobilization of the cervicothoracic spine in flexion and extension. Changes in participants' discomfort were monitored during the SD to determine whether a change or lack of change was consistent with variations in the load applied to the suspected structures either muscular or neural. If the structure related to the participants' discomfort could not be identified, two additional tests were conducted: the lateral SLR and the Slump test.</p><p><strong>Results: </strong>One hundred and seventy-eight individuals were included. Median [IQR] age was 21 years [20;23], and 57.3% were female. The structure related to participants' discomfort was similar for the SLR and the KEA (<i>p</i> = 0.451): neural for 72.5% of participants in the SLR and 75.8% in the KEA. Gender only influenced the structure identified in the KEA test, with a significantly higher rate of nerve-related discomfort in females than males and a significantly higher rate of muscle-related discomfort in males (<i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>In asymptomatic individuals, the discomfort induced by the SLR and the KEA tests could be related to either muscular or neural structures. Therefore, structural differentiation is necessary to identify the structure causing the discomfort in both research and clinical practice.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From placebos and shams to high-quality control interventions in manual therapy trials to study efficacy and mechanisms.","authors":"David Hohenschurz-Schmidt, Lene Vase, Jerry Draper-Rodi","doi":"10.1080/10669817.2025.2471477","DOIUrl":"https://doi.org/10.1080/10669817.2025.2471477","url":null,"abstract":"","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-2"},"PeriodicalIF":1.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ordering of diagnostic imaging by physical therapists: a multi-center analysis of successful implementation.","authors":"Aaron Keil, Evan O Nelson, Stephen Michael Kareha, Scott Tauferner, Brian Baranyi, Kelly Clark","doi":"10.1080/10669817.2025.2465738","DOIUrl":"https://doi.org/10.1080/10669817.2025.2465738","url":null,"abstract":"<p><strong>Objective: </strong>The profession of physical therapy in the United States has evolved significantly since the American Physical Therapy Association introduced Vision 2020, advocating for consumers' direct access to physical therapy services. As the use of direct access expands, it becomes essential to examine successful models and resources, such as those that allow physical therapist referral for diagnostic imaging. This study aims to report the utilization, appropriateness, and reimbursement for diagnostic imaging referrals made by physical therapists during routine care across multiple health care organizations.</p><p><strong>Methods: </strong>This study was a retrospective observational study of patients seeking care for neuromusculoskeletal conditions at ambulatory physical therapy clinics at three healthcare organizations. Data from each organization related to physical therapist referral for diagnostic imaging was reviewed to determine utilization rate, appropriateness, and reimbursement. American College of Radiology (ACR) criteria were used to determine appropriateness of diagnostic imaging referral.</p><p><strong>Results: </strong>Seventy-five physical therapists signed 596 referrals for diagnostic imaging during 61,012 episodes of routine care. The utilization rate was 9.8 diagnostic imaging referrals per 1000 episodes of care. Ninety-one percent of the referrals were consistent with evidence based ACR guidelines and deemed appropriate. There were no instances of insurance denial when a physical therapist signed the referral for diagnostic imaging.</p><p><strong>Conclusion: </strong>Physical therapists with privileges to directly refer for diagnostic imaging did so judiciously and followed ACR guidelines when referring patients for imaging. The absence of insurance reimbursement claim denial contrasts a common concern about physical therapist referral for diagnostic imaging. Physical therapists referred for appropriate imaging studies and are unlikely to contribute to diagnostic imaging overutilization.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-8"},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of exploration time, accuracy, and task difficulty perception in three tactile tests among physiotherapy students.","authors":"Nataša Mlakar, Sonja Hlebš","doi":"10.1080/10669817.2025.2465729","DOIUrl":"https://doi.org/10.1080/10669817.2025.2465729","url":null,"abstract":"<p><strong>Objectives: </strong>Tactile sensitivity is one of the most important skills for developing competence in manual palpation. There is a lack of studies aimed at analyzing the development of tactile sensitivity during different levels of physiotherapy education. The present study aims to compare manual tactile sensitivity in two groups of physiotherapy students.</p><p><strong>Methods: </strong>Twenty first-year physiotherapy students (mean age 19.4 yrs ± 0.6) and twenty final-year physiotherapy students (mean age 23.7 yrs ± 3.7) participated in the study. For the tactile sensitivity test, 3 wooden tables were used, in which different geometric structures were engraved. Subjects were instructed to perform a tactile examination of the geometric structures and then reproduce them by drawing on a sheet of paper. The tactile time, drawing time, accuracy, and difficulty of the geometric structures were scored. A two-sample t-test was used for the between-groups comparison if more time in an educational program should result in differences in tactile time, drawing time, accuracy, and difficulty. Linear regression was used to compare the difficulty with the accuracy of all geometric structures. Wilcoxon test was used to test the intra-rater agreement.</p><p><strong>Results: </strong>The accuracy of the reproduction of geometric structures 1, 2 and 3 were 77.5%, 27.5% and 45%, for all physiotherapy students respectively. Final-year physiotherapy students spent more time exploring geometric structure 2 (<i>p</i> = 0.014) and geometric structure 3 (<i>p</i> = 0.0018) compared to first-year physiotherapy students. No statistically significant differences were found between groups in drawing time, accuracy, and difficulty of geometric structures. The examiner showed a high intra-rater agreement in the assessment (over 96%).</p><p><strong>Discussion/conclusion: </strong>The study showed that the level of education and gained experience during laboratory teaching may be important in improving the palpation skills of physiotherapy students. Tactile sensitivity exercises should be included in physiotherapy education programs.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-8"},"PeriodicalIF":1.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dry needling of the gluteus-medius muscle, combined with standard care, for chronic low back pain - a pilot randomized sham-controlled trial.","authors":"Gali Dar, Alon Goldberg","doi":"10.1080/10669817.2025.2465726","DOIUrl":"https://doi.org/10.1080/10669817.2025.2465726","url":null,"abstract":"<p><strong>Background: </strong>Individuals with low back pain (LBP) often exhibit weakness and the presence of trigger points in their Gluteus Medius (GMe) muscle.</p><p><strong>Objectives: </strong>To examine the effectiveness of adding dry needling (DN) for the GMe to standard care of active physical therapy in patients with chronic nonspecific LBP.</p><p><strong>Methods: </strong>A randomized, prospective, sham-controlled trial was conducted. Participants with chronic nonspecific LBP (<i>N</i> = 22, age range: 31-55 years) were randomly divided into intervention and control groups. Both groups received active physical therapy including exercises for 6 treatments. In addition, at each session, the intervention group received deep DN to their GMe muscle, and the control group received sham needling. Outcome measures included level of pain (using VAS scale), function (Oswestry disability index ODI), low back range of motion (ROM) (forward flexion and schober tests), and global rating of change. The research group was further divided into moderate and minimal disability according to the ODI.</p><p><strong>Results: </strong>The research group showed greater improvement in pain level compared with control (<i>p</i> = 0.01). The change in ODI was higher in the moderate LBP group compared with the control group (B = 5.25, <i>p</i> < 0.05). The change in forward flexion distance test was higher in the moderate disability LBP group compared with the control group (B = 6.31, <i>p</i> < 0.01). Simple mean analysis also revealed a significant difference between the moderate and minimal disability groups (B = 6.16, <i>p</i> = 0.01).</p><p><strong>Conclusions: </strong>Incorporating DN into physical therapy treatments for chronic nonspecific low back pain, can improve pain level and function.</p><p><strong>Clinical trials registration no: </strong>NCT04498572 (clinicaltrial.gov).</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caution is necessary in interpreting musculoskeletal physiotherapy intervention outcomes: a methodological review of physiotherapy neuromusculoskeletal reviews.","authors":"Daniel W Flowers, Brian T Swanson, Stephen M Shaffer, Derek Clewley, Matthew T Martin, Nicholas A Russell, Sean P Riley","doi":"10.1080/10669817.2025.2464548","DOIUrl":"https://doi.org/10.1080/10669817.2025.2464548","url":null,"abstract":"<p><strong>Objectives: </strong>The physiotherapy literature lacks high-quality, registered systematic reviews (SRs) and 'trustworthy' randomized controlled trials (RCTs). It is unknown whether considering quality and 'trustworthiness' impact publication bias, heterogeneity, and the certainty of clinical recommendations observed in the literature.</p><p><strong>Methods: </strong>We performed a methodological review of SRs investigating physiotherapy treatment of neuromusculoskeletal conditions indexed by MEDLINE, between 1 January 2018, and 25 October 2023. Blinded reviewers examined the prospective intent and quality of SRs and the 'trustworthiness' of RCTs included therein. Blinded reviewers extracted data for the variables of interest (Numeric Pain Rating Scale and Visual Analog Scale).</p><p><strong>Results: </strong>Of the SRs identified (<i>N</i> = 677), 13 were included in the final review. These included a total of 109 RCTs, including duplicates. Only eight of these trials were deemed 'trustworthy.' Publication bias was identified, and heterogeneity across the trials (<i>N</i> = 55) included in the quantitative analysis was high (I² = 80.11%, 95% CI [75.88, 83.60]). Publication bias and heterogeneity were eliminated (I² = 0%, 95% CI [0.00, 37.44]) upon considering those prospectively registered (<i>N</i> = 14). Statistical significance, assessed via the p-value at baseline (<.001), was eliminated (<i>p</i> = .746) once prospective, external, and internal validity was considered. Statistical inference through estimation, evaluated via effect size, confidence intervals, and minimal detectable change, was not present at baseline and reduced throughout the screening process.</p><p><strong>Discussion: </strong>Trials of musculoskeletal interventions to manage pain in patients with neuromusculoskeletal conditions lack certainty and confidence in their treatment effects and exhibit high heterogeneity. Statistically significant effects and heterogeneity are eliminated when considering 'trustworthy' quality evidence.</p><p><strong>Conclusions: </strong>Consistent with previous findings, null effects, and low heterogeneity arise when considering the best available evidence. Meaningful effects are likely rare when assessed holistically using statistical inference through estimation and the confidence and certainty of the estimated effect.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-17"},"PeriodicalIF":1.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}