Journal of Manual & Manipulative Therapy最新文献

{"title":"Diagnosing and treating upper back pain: insights from New Zealand's manipulative physiotherapists and osteopaths.","authors":"Kesava Kovanur Sampath, Tevin Smith, Suzie Belcher, Gerard Farrell, Gary Fryer, Brett Vaughan, Rob Moran","doi":"10.1080/10669817.2024.2438196","DOIUrl":"https://doi.org/10.1080/10669817.2024.2438196","url":null,"abstract":"<p><strong>Background: </strong>Manual therapy is routinely used in the management of upper back pain (UBP), a disabling condition. However, the approach to diagnosis and treatment techniques used by manipulative physiotherapists and osteopaths is largely unknown.</p><p><strong>Objectives: </strong>To explore knowledge about UBP, including diagnosis and treatment, by New Zealand (NZ) osteopaths and manipulative physiotherapists and to investigate differences (if any) in the self-reported approaches to diagnosis and management of UBP between the professions.</p><p><strong>Design: </strong>A cross-sectional survey administered through an online platform (Qualtrics) between September 2023 and January 2024.</p><p><strong>Participants: </strong>One hundred and ten NZ osteopaths and manipulative physiotherapists completed the survey.</p><p><strong>Results: </strong>Forty-eight percent (<i>n</i> = 53) of respondents identified their profession as physiotherapists and 52% (<i>n</i> = 57) as osteopaths. Over three-quarters of respondents (77%) 'strongly agreed' that a multimodal approach is essential for effective UBP management. Osteopaths were significantly more likely to <i>often</i> proffer 'wear and tear/degeneration' (<i>p</i> < 0.01) and 'visceral referred pain' (<i>p</i> = 0.02) as the cause of a patient's UBP. In terms of management, osteopaths were significantly more likely to use soft tissue techniques (<i>p</i> < 0.01), spinal manipulations (<i>p</i> < 0.01), rib manipulations (<i>p</i> < 0.01), rib mobilizations (<i>p</i> < 0.01), and visceral techniques (<i>p</i> < 0.01), compared to physiotherapists.</p><p><strong>Conclusions: </strong>The survey highlights a strong consensus among respondents that a multimodal approach is essential for effective UBP management. The survey also identified profession-specific approaches to the diagnosis and management of UBP. Future research using qualitative methods is required to further explore these profession-specific differences and explore outcomes of care.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802881","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":"Is the YES/NO classification accurate in screening scapular dyskinesis in asymptomatic individuals? - A novel validation study utilizing surface electromyography as a surrogate measure in identifying movement asymmetries.","authors":"Lawrence S Ramiscal, Lori A Bolgla, Chad E Cook, John S Magel, Stephen A Parada, Raymond Chong","doi":"10.1080/10669817.2024.2436402","DOIUrl":"https://doi.org/10.1080/10669817.2024.2436402","url":null,"abstract":"<p><strong>Background: </strong>Scapular dyskinesis is a known risk factor for shoulder pain, making it important to screen for prevention. Physical therapists screen scapular dyskinesis by visually comparing asymmetries in scapular movement during overhead reach using the Scapular Dyskinesis Test Yes/No classification (Y/N). Although scapular kinematics has been used to quantify scapular dyskinesis, current measurement techniques are inaccurate. Optimal scapular muscle activity is crucial for normal shoulder function and is measured using surface electromyography (sEMG). Research suggests that impaired scapular muscles can lead to scapular dyskinesis. Despite kinematics being a poor reference standard, there is currently no validated method to identify movement asymmetries using muscle activity as an alternative. We utilized sEMG to establish Y/N's validity. We hypothesized that Y/N is a valid tool using sEMG as a viable surrogate measure for identifying scapular dyskinesis.</p><p><strong>Methods: </strong>We employed a known-groups (symmetrical vs. asymmetrical shoulders) validity design following the Standards for Reporting Diagnostic Accuracy Studies. Seventy-two asymptomatic subjects were evaluated using Y/N as the index test and sEMG as the reference standard. We created a criterion to assign the sEMG as the reference standard to establish the known groups. We calculated the sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV, NPV), likelihood ratios (LR+, LR-), and diagnostic odds ratio (DOR) using a 2 × 2 table analysis.</p><p><strong>Results: </strong>The diagnostic accuracy values were Sn = 0.56 (0.37-0.74), Sp = 0.36 (0.08-0.65), PPV = 0.68 (0.49-0.88), NPV = 0.25 (0.04-0.46), LR+ = 0.87 (0.50-1.53), and LR- = 1.22 (0.50-2.97).</p><p><strong>Conclusion: </strong>The Y/N's diagnostic accuracy was poor against the sEMG, suggesting clinicians should rely less on Y/N to screen scapular dyskinesis in the asymptomatic population. Our study demonstrated that sEMG might be a suitable alternative as a reference standard in validating methods designed to screen movement asymmetries.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-11"},"PeriodicalIF":1.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787359","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":"Practice what we teach: why academic PT faculty should stay in the trenches.","authors":"Timothy W Flynn, Britt Smith, Paul Mintken","doi":"10.1080/10669817.2024.2426264","DOIUrl":"10.1080/10669817.2024.2426264","url":null,"abstract":"","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"557-560"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of concussion symptoms utilizing Mechanical Diagnosis and Therapy: a case series.","authors":"David J Pleva, Jared C Hanson, Brian Greer","doi":"10.1080/10669817.2024.2368923","DOIUrl":"10.1080/10669817.2024.2368923","url":null,"abstract":"<p><strong>Objective: </strong>Concussions are a common condition in athletes leading to symptoms including headache, dizziness, and sometimes vestibular deficits. Concussion management typically involves rest and a gradual return to activity among other interventions. This case series includes three patients who were evaluated using Mechanical Diagnosis and Therapy (MDT) after sport-related injuries involving concussion-like symptoms. MDT is a system of evaluating patients using repeated movements and sustained positions to assess symptomatic and mechanical changes.</p><p><strong>Results: </strong>Patients in this case series demonstrated rapid reduction of symptoms using variations of repeated cervical movements and sustained positions, which enabled them to return to play with a lasting resolution of symptoms.</p><p><strong>Discussion/conclusion: </strong>This highlights the importance of a classification system for the appropriate treatment of these cases who did not require management using concussion protocol, as they were classified as cervical derangement.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"640-645"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of manual therapy for sacroiliac joint pain syndrome: a systematic review and meta-analysis of randomized controlled trials.","authors":"Robert J Trager, Anthony N Baumann, Hudson Rogers, Joshua Tidd, Kevin Orellana, Gordon Preston, Keith Baldwin","doi":"10.1080/10669817.2024.2316420","DOIUrl":"10.1080/10669817.2024.2316420","url":null,"abstract":"<p><strong>Introduction: </strong>This study examined the efficacy of manual therapy for pain and disability measures in adults with sacroiliac joint pain syndrome (SIJPS).</p><p><strong>Methods: </strong>We searched six databases, including gray literature, on 24 October 2023, for randomized controlled trials (RCTs) examining sacroiliac joint (SIJ) manual therapy outcomes via pain or disability in adults with SIJPS. We evaluated quality via the Physiotherapy Evidence Database scale and certainty via Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) in post-treatment pain and disability scores were pooled using random-effects models in meta-regressions.</p><p><strong>Results: </strong>We included 16 RCTs (421 adults; mean age = 37.7 years), with 11 RCTs being meta-analyzed. Compared to non-manual physiotherapy (i.e. exercise ± passive modalities; 10 RCTs) or sham (1 RCT) interventions, SIJ manual therapy did not significantly reduce pain (SMD: -0.88; 95%-CI: -1.84; 0.08, <i>p</i> = 0.0686) yet had a statistically significant moderate effect in reducing disability (SMD: -0.67; 95% CI: -1.32; -0.03, <i>p</i> = 0.0418). The superiority of individual manual therapies was unclear due to low sample size, wide confidence intervals for effect estimates, and inability to meta-analyze five RCTs with a unique head-to-head design. RCTs were of 'good' (56%) or 'fair' (44%) quality, and heterogeneity was high. Certainty was very low for pain and low for disability outcomes.</p><p><strong>Conclusion: </strong>SIJ manual therapy appears efficacious for improving disability in adults with SIJPS, while its efficacy for pain is uncertain. It is unclear which specific manual therapy techniques may be more efficacious. These findings should be interpreted cautiously until further high-quality RCTs are available examining manual therapy against control groups such as exercise.</p><p><strong>Registration: </strong>PROSPERO (CRD42023394326).</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"561-572"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognition of a patient with neck autonomic dysfunction: findings from a rare case report of harlequin syndrome in direct access physiotherapy.","authors":"Firas Mourad, Irene Scotto, James Dunning, Andrea Giudice, Giorgio Maritati, Filippo Maselli, Rik Kranenburg, Alan Taylor, Roger Kerry, Nathan Hutting","doi":"10.1080/10669817.2024.2349338","DOIUrl":"10.1080/10669817.2024.2349338","url":null,"abstract":"<p><strong>Background: </strong>Harlequin syndrome is a rare autonomic condition consisting of unilateral facial flushing and sweating induced by heat, emotion or physical activity. The affected side presents anhidrosis and midline facial pallor due to denervation of the sympathetic fibers.</p><p><strong>Case description: </strong>This case describes a patient who reported right-side redness of the face associated with hyperhidrosis during physical activity. She had two previous major motor vehicle accidents. The patient demonstrated difficulties in the visual accommodation of the left eye, but cranial nerve assessment was unremarkable; the patient was then referred to an ophthalmologist, who excluded any autonomic dysfunction as the primary cause of convergence and visual acuity.</p><p><strong>Outcomes: </strong>A left-sided sympathetic dysfunction with Harlequin sign diagnosis was made followed by a progressive compensatory adaptation of the right face. The patient was educated and reassured about the benign nature of her problem.</p><p><strong>Discussion: </strong>Knowledge of the autonomic nervous system is still limited in clinical practice. Although challenging, physiotherapists should develop the knowledge and ability needed to perform appropriate assessment of autonomic dysfunctions.</p><p><strong>Conclusion: </strong>A dispositional reasoning model should be considered in differential diagnosis.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"646-653"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autonomic nervous system and endocrine system response to upper or lower cervical spine mobilization in males with persistent post-concussion symptoms: a proof-of-concept trial.","authors":"Gerard Farrell, Cathy Chapple, Ewan Kennedy, Matthew Reily-Bell, Kesava Sampath, Angela Spontelli Gisselman, Chad Cook, Rajesh Katare, Steve Tumilty","doi":"10.1080/10669817.2024.2363018","DOIUrl":"10.1080/10669817.2024.2363018","url":null,"abstract":"<p><strong>Introduction: </strong>The peripheral stress response, consisting of the autonomic nervous system (ANS) and hypothalamic pituitary adrenal-axis (HPA-axis), functions to maintain homeostasis in response to stressors. Cervical spine manual therapy has been shown to differentially modulate the stress response in healthy populations. No study has investigated whether cervical spine mobilizations can differentially modulate the stress response in individuals with persistent post-concussion symptoms (PPCS), a population characterized by a dysfunctional stress response.</p><p><strong>Methods: </strong>A randomized, controlled, parallel design trial was performed to investigate whether upper or lower cervical spine mobilization can differentially modulate components of the stress response in individuals with PPCS. The outcomes were salivary cortisol (sCOR) concentration (primary) and the HRV metric, rMSSD, measured with a smartphone application (secondary). Nineteen males diagnosed with PPCS, aged 19-35, were included. Participants were randomly assigned into either intervention group, upper (<i>n</i> = 10) or lower (<i>n</i> = 9) cervical spine mobilization. Each outcome was collected at different time points, pre- and post-intervention. Statistical analyses were performed using the Friedman's Two-Way ANOVA, Mann-Whitney U test, and Wilcoxon Signed Rank Test.</p><p><strong>Results: </strong>There was a statistically significant within-group reduction in sCOR concentration 30 minutes following lower cervical spine mobilizations and statistically significant within-group increase in rMSSD 30 minutes following upper cervical spine mobilizations.</p><p><strong>Conclusion: </strong>The results of this trial provide preliminary evidence for cervical spine mobilizations to differentially modulate components of the stress response at specific time points. Understanding the mechanisms of the effect of cervical spine mobilizations on the stress response provides a novel rationale for selecting cervical spine mobilizations to rehabilitate individuals with PPCS.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"602-618"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in physical examination findings between those who present with or without headache soon after a whiplash injury: a cross-sectional study.","authors":"E Anarte-Lazo, D Falla, V Devecchi, C Bernal-Utrera, C Rodriguez-Blanco","doi":"10.1080/10669817.2024.2372911","DOIUrl":"10.1080/10669817.2024.2372911","url":null,"abstract":"<p><strong>Aim: </strong>To determine differences in physical examination findings between people with acute whiplash-associated disorders (WAD) with and without headache.</p><p><strong>Methods: </strong>In this cross-sectional study, participants with acute WAD were evaluated to assess differences in the presence of physical impairments. The following were assessed: pain intensity on manual palpation the over spinous process of C1-C3, zygapophyseal joints of C0-C4, and trapezius, sternocleidomastoid, suboccipitalis, masseter and temporalis muscles; cervical range of motion (ROM); flexion-rotation test (FRT); forward head posture; cranio-cervical flexion test (CCFT); neck flexor and extensor endurance; pressure-pain thresholds (PPT) over neural structures and upper limb neural tests (ULNT) in addition to median UNLT + CCF. Correlation analyses were performed to assess the association between examination findings and headache intensity. Logistic regression and discriminant analyses were also performed.</p><p><strong>Results: </strong>Forty-seven participants (26 men and 21 women; mean age = 38.9 years old) were included in the study. 60% of the participants presented with headache. Several examination findings were significantly different between groups. A group of examination findings composed of neck endurance, manual palpation over cervical and muscular structures, PPT, CCFT, ROM and FRT could discriminate between groups with a sensitivity of 86.7% and specificity of 90%.</p><p><strong>Conclusions: </strong>Several neuromusculoskeletal features are different between people with acute WAD with or without headache. A combination of features could distinguish between groups with high levels of sensitivity and specificity.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"619-629"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plantar massage or ankle mobilization do not alter gait biomechanics in those with chronic ankle instability: a randomized controlled trial.","authors":"Raed Alamri, Kimmery Migel, M Spencer Cain, Kyeongtak Song, Brian Pietrosimone, J Troy Blackburn, Jason R Franz, Jaeho Jang, Feng-Chang Lin, Erik A Wikstrom","doi":"10.1080/10669817.2024.2410048","DOIUrl":"10.1080/10669817.2024.2410048","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic ankle instability (CAI) is characterized by persistent neuromechanical impairments following an initial lateral ankle sprain. Ankle joint mobilization and plantar massage have improved the range of motion and static postural control in those with CAI. This study aimed to determine the impact of two-week joint mobilization and plantar massage interventions on gait kinematics and kinetics in individuals with CAI.</p><p><strong>Methods: </strong>A single-blind randomized trial was conducted with 60 participants with CAI, randomized into three groups: joint mobilization (<i>n</i> = 20), plantar massage (<i>n</i> = 20), and control (<i>n</i> = 20). The two treatment groups received six 5-min sessions manual therapy over a 2-week, while the control group received no intervention. Gait biomechanics were assessed on an instrumented treadmill before and after the intervention using 3D kinematics and kinetics analysis. Analyses compared biomechanical outcomes from each treatment group to the control group individually using a 1-dimensional statistical parametric mapping. The alpha level was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Eighteen participants per group were part of the final analysis. No significant main or interactions effects were found for ankle sagittal or frontal plane positions following either intervention (<i>p</i> > 0.05 for all comparisons). COP location relative to the lateral border of the foot also did not change (<i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>The findings suggest that two-week joint mobilization and plantar massage interventions do not significantly alter gait biomechanics in individuals with CAI. These results support the need for gait-specific interventions to modify biomechanics in this population.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"594-601"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not \"that kind\" of doctor: an exploratory study on Doctor of Physical Therapy-patient introductions in the United States.","authors":"Justin Martino, James M Smoliga, Lance Mabry","doi":"10.1080/10669817.2024.2396706","DOIUrl":"10.1080/10669817.2024.2396706","url":null,"abstract":"<p><strong>Objective: </strong>This exploratory study examined the prevalence and determinants of the use of the title 'doctor' among the United States (U.S.) licensed Doctors of Physical Therapy (DPTs) during patient-provider introductions.</p><p><strong>Methods: </strong>A cross-sectional analysis of DPTs across eight states was conducted. Binary logistic regression analyzed demographic and experience-related factors influencing title use, including years of experience, board certification status, and clinical instructor (CI) experience. Stepwise logistic regression with forward selection identified significant predictors. Beliefs influencing title use were evaluated through descriptive statistics from multiple choice questions with an option for open-ended responses for additional opinions.</p><p><strong>Results: </strong>Of the 1,311 participants who met the inclusion criteria, 19.9% reported using 'doctor' during patient-provider introductions. The odds of using the title increased with age and was higher among males, with age controlled for. Completion of a residency program and not being a CI were also associated with greater odds of title use, with age and sex controlled for. Beliefs about demonstrating expertise, having earned the title, and advancing the profession were primary reasons for using the title, while concerns about patient confusion and therapeutic alliance were reasons for not using it. Both DPTs who did and did not report using the title 'doctor' commonly cited the impact on therapeutic alliance as justification.</p><p><strong>Conclusions: </strong>A minority of our sample of U.S. DPTs use the title 'doctor' during patient-provider introductions, with significant variation across age, gender, and professional experience. Deciding whether to use the title was primarily based on their perceived effects on patient beliefs.</p><p><strong>Discussion: </strong>This is the first study to formally investigate how DPTs refer to themselves during patient-provider introductions. Understanding title use in healthcare can inform best practices during patient interactions. This study provides a foundation for future research on the impact of DPTs mentioning their doctoral title on patient experiences and outcomes.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"630-639"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}