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For this month’s journal club we will be article focused on the discussion board and then case focused in the actual meeting. Please view the attached document and article, then discuss the following questions.
1) What do you think about my search strategy? Tips/pointers that you’ve found helpful for other literature searches?
2) Read through my summary and the article, then let’s talk about statistics:
– What do you think about their findings in the results section?
– Did they draw appropriate conclusions based on the statistics?
– What are your thoughts on statistically significant vs clinically significant?3) Any other general opinions on the article?
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1) What do you think about my search strategy? Tips/pointers that you’ve found helpful for other literature searches?
Finding stuff on thoracic spine is hard because of its lower prevalence than other things we see. I also find it difficult to find the sweet spot of search terms where you have a manageable amount of articles to scan titles while not having too few. I’m not sure if adding physical therapy/physiotherapy would have beneficial here.
2) Read through my summary and the article, then let’s talk about statistics:
– What do you think about their findings in the results section?I’m going to try my best to untease what I think they did here — correct me if I am wrong. They compared between groups (A vs. B) and then within groups (where A started and where A ended up). When comparing A vs. B, the conclusion was:
“This indicates that both treatment approaches were effective in the
amount of disability and sensory dimensions of pain experienced by the patient.”However, when they compared where A started to where A ended up:
“This indicates that only the SMT group was successful in significantly reducing disability and amount of pain.”
This is such an odd switcharoo to find a meaningful finding. Sure, the treatment group showed significant improvement from where they started, but it’s non significant when compared to the placebo.
– Did they draw appropriate conclusions based on the statistics?
I can’t say they did with what they are trying to ultimately say which is that though it wasn’t statistically significant compared to a placebo that there were statistically significant gains made in biomechanical measures and that’s more important.
– What are your thoughts on statistically significant vs clinically significant?
I think there is something to be said for n = 1. The evidence for thoracic manipulation and shoulder impairments is poor, but if I do it and can find meaningful clinical findings for improvement, it might still be valid to do it in that situation. The only thing that can be clinically significant is pt report of improvement in things that are meaningful to them. In this study, it seemed like they were saying Thoracic SB is clinically meaningful….which is a hard sell for me.
3) Any other general opinions on the article?
I’m not sure what to think about it.
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1) What do you think about my search strategy? Tips/pointers that you’ve found helpful for other literature searches?
It is definitely hard to find a broad enough but not too broad search strategy to get what you need; something I struggle with a lot. I find myself doing something similar in finding a somewhat relevant article then scanning the references, but this can quickly get time consuming.
You maybe could have tried “thoracic spine dysfunction” or just “thoracic spine pain” with a combination of other things but not sure that would have been any more helpful.2) Read through my summary and the article, then let’s talk about statistics:
– What do you think about their findings in the results section?
It’s always fishy to me when authors present only certain parts of the data. The graphs and tables for the subjective information are helpful, but where is the same for objective? While not a whole lot was found to be significant with the subjective measure between groups, the graphs and charts give good insight to the trend of greater improvement in the SMT group. It would be nice to be able to reason through a similar process with the objective data as well (especially with such a small sample size).– Did they draw appropriate conclusions based on the statistics?
I think the conclusion “This pilot study suggests that spinal manipulative therapy has greater benefits than placebo treatment” is accurate based on the reporting of some significant findings in the results section. I struggle with comparing the significant intra-group findings and saying that one group had “greater” significance compared to another; not sure that is a fair conclusion to draw when some of those findings weren’t necessarily supported by inter-group comparison.– What are your thoughts on statistically significant vs clinically significant?
I think it is worthwhile when studies are good about including MCID’s to better argue clinical significance. With no mention of degree of improvement with objective measurements how do we know if this is even outside the MCID for that measurement?3) Any other general opinions on the article?
I thought it was interesting that one of the inclusion criteria was “palpation of movement” to identify a “thoracic fixation.” I guess that was their way of identifying thoracic hypomobilities but seems like a very subjective “objective” inclusion criteria.
Also am curious on how they measured “naivety” to placebo treatments. -
1) What do you think about my search strategy? Tips/pointers that you’ve found helpful for other literature searches?
One thing I found helpful when going over lit searches with AJ was using MESH headings when the regular search terms aren’t giving you what you want. In my opinion, it’s not the easiest thing to use, but it did provide some different results.2) Read through my summary and the article, then let’s talk about statistics:
– What do you think about their findings in the results section?
I honestly have a tough time following the results because of how different each analysis is. The tables are talking about the differences at each point in the study, and they did not outline the comparisons within and between groups very clearly. The graphs were an attempt to illustrate this, but the disability graph, fig 1, was an error as it was a duplicate of the NRS graph in fig 3. Overall, the author did not follow a clear path with her results and discussion.
– Did they draw appropriate conclusions based on the statistics?
To be fair, the final conclusion did only mention objective ROM improvements which was the one clear difference between groups. This comes after a great deal of speculation around the other subjective improvements. One issue I did have with this conclusion is that these measurements were never presented in the results. Curious how significant these were.
– What are your thoughts on statistically significant vs clinically significant?
This is something I regularly look for in articles I read because it is very easy to slip past some bias with small scale, but statistically significant findings. I think this was more of an afterthought for this particular article for me as there was such little consistency in the first place.3) Any other general opinions on the article?
Overall I found this article difficult to follow and if you asked me “what did these results mean?” I would probably take away that the placebo intervention was just as effective as whole besides pain ratings. -
1) What do you think about my search strategy? Tips/pointers that you’ve found helpful for other literature searches?
I thought you did well with the platforms you chose and your search strategies. My go-to platforms also tend to be PubMed and PEDro. Similar to the way Aaron describes the fiddle factor for manual therapy treatment, I feel the same applies to search strategies. Minor changes can create positive results. I have found using abbreviations, acronyms, and synonyms to be rather helpful. Perhaps utilizing “SMT” or, seeing you use a chiropractic article, “spinal adjustment” could have brought about more results. Just a few thoughts.
2) Read through my summary and the article, then let’s talk about statistics:
– What do you think about their findings in the results section?As far as I can tell, the authors were open and honest with their results. They did not appear to attempt to embellish their findings or make nonsensical leaps regarding the information obtained. It appears they were well aware of the limitations of their study and findings.
– Did they draw appropriate conclusions based on the statistics?
Yes, the stats seem fairly straight forward. There were a fair amount of limitations but the authors acknowledged this. The study would, however, benefit from additional blinding.
– What are your thoughts on statistically significant vs clinically significant?
In regards to this article, I do not feel clinically significant plays a role. With the lack of subjects, it is difficult to believe that their clinically significant findings hold much water. However, I do feel that it may warrant additional research. On the contrary, if I had a patient who I felt met the criteria for this article, and manipulation appeared safe, I could likely bias myself into performing a manipulation and see how the patient responds.
3) Any other general opinions on the article?
I am in agreement with Anna. Quite curious how they measured “naivety” to placebo treatments.
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1) What do you think about my search strategy? Tips/pointers that you’ve found helpful for other literature searches?
I feel like I still struggle with my search methods too. I think your strategies were pretty thorough, especially with bringing in “costovertebral” and searching other articles’ reference lists. I might have dropped “spine” in the phrases, just to see if that brought in any different results.
2) Read through my summary and the article, then let’s talk about statistics:
– What do you think about their findings in the results section?
The results seem to support STM for improvements in subjective and objective measurements, but I agree with Taylor, the results were hard for me to decipher with all the different points with inter and intra group findings, but I felt like the graphs helped clarify some of the results. I thought the author did a good job of listing limitations and possible biases of the results of the findings as well.
– Did they draw appropriate conclusions based on the statistics?
I think it’s fair to say that the conclusions with improved lateral flexion and percentage of pain were appropriate, but again, I think the conflicting results with inter and intra group differences make the conclusion of this study less valid, especially with the small sample size and other limitations.
– What are your thoughts on statistically significant vs clinically significant?
I feel like this article was much more focused on the statistical significance rather than the clinical significance with regards to treatment, and I would have been interested to see more clinically relevant measures utilized to determine if there was a more functional/clinically relevant change with this technique.3) Any other general opinions on the article?
I thought this article was very hard to follow, and it was hard for me to be able to find any information that I feel like would change my practice/implementation of this technique. I thought some of the inclusion materials for this study were very nonspecific, but I also thought that it was interesting that a researcher was diagnosing the mechanical thoracic pain rather than a blinded clinician.
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