Jul 2026· Archives of Physiotherapy· Vol 16, pp. 149 - 157· 0 citations· 34 references
Medicine
TL;DR
Although more high-quality trials are required to confirm long-term efficacy and ideal treatment protocols, lumbar roll and modified SIMS manipulation techniques consistently show short-term clinical benefits for SIJD.
Abstract
ABSTRACT Introduction: The lumbar roll and modified SIMS are two common manipulation techniques used in clinical practice for sacroiliac joint dysfunction (SIJD), a common cause of low back and pelvic pain. However, there hasn’t been clear evidence of these methods’ relative clinical efficacy in recent literature. Methods: This review was registered in PROSPERO (Reg. No. CRD420251253094) and adhered to PRISMA 2020 guidelines. Studies published between January 2021 and December 2025 were found through a search of PubMed, Scopus, Web of Science, CINAHL, PEDro, Cochrane Library, and Google Scholar (first 200 results). Randomized controlled trials, quasi-experimental trials, and controlled clinical studies evaluating lumbar roll or modified SIMS manipulation in adults with SIJD using imaging-assisted criteria or validated provocation tests were all considered eligible. Screening, data extraction, and risk-of-bias assessment (RoB-2 and ROBINS-I) were carried out independently by two reviewers. Results: Nine of the 1,264 records that were found satisfied the requirements for inclusion. The number of participants in the sample varied from 30 to 90. Following manipulation, the majority of trials reported significant short-term reductions in pain (VAS/NPRS) and disability (ODI/functional measures), with lumbar roll and modified SIMS demonstrating similar clinical benefit. Improvements in pelvic alignment and mobility have been documented in several studies. There were a few transient adverse events, and no significant complications were noted. Conclusion: Although more high-quality trials are required to confirm long-term efficacy and ideal treatment protocols, lumbar roll and modified SIMS manipulation techniques consistently show short-term clinical benefits for SIJD. However, due to the absence of direct head-to-head comparisons and reliance on indirect classification of techniques, these findings should be interpreted as exploratory rather than definitive.
There isn't a single clinical test that can accurately identify SIJ dysfunction on its own and it is necessary to conduct additional high-quality diagnostic accuracy investigations using defined reference standards.
Arpit Bansal, Pooja Dogra, Nalina Gupta et al.· International Journal of Dru...· 0 citations
Background No systematic review has examined the clinical effectiveness of mobilization for shoulder impingement syndrome (SIS). We aimed to evaluate clinical effectiveness for the use of mobilization in SIS. Methods PubMed, Embase and the Cochrane Library were searched for studies published up to April 30, 2023. Randomized controlled trials that evaluated the effectiveness of mobilization for SIS were included. Literature was extracted using Endnote 20, and the risk of bias was assessed using the Cochrane risk-of-bias tool 2.0. A meta-analysis was conducted using RevMan 5.4. This study was conducted in accordance with the PRISMA guidelines. Results Nineteen randomized controlled trials (956 participants) were selected based on the inclusion criteria. Adding mobilization to traditional physical therapy reduced pain (mean difference [MD]=1.72, 95% confidence interval [CI]: 0.91 to 2.53, I2 = 97%, p < 0.00001), increased active range of motion (MD = 14.49, 95% CI: 8.46 to 20.53, I2 = 95%, p < 0.00001), and improved the disabilities of the arm, shoulder, and hand (MD = 5.95, 95% CI: 0.01 to 11.90, p = 0.05) and Constant-Murley scores (MD = 5.49, 95% CI: 0.78 to 10.19, p = 0.02). Joint mobilization was more effective in reducing pain (MD = 0.67, 95% CI: 0.15 to 1.19, p = 0.01) and increasing active range of motion (MD = 8.56, 95% CI: 2.31 to 14.82, p = 0.007) compared with sham mobilization. No statistically significant differences were found between physical therapy plus mobilization and physical therapy plus exercise. Conclusion Mobilization may offer adjunctive, short-term benefits in improving the clinical symptoms of SIS when added to conventional treatments. Future studies should focus on evaluating the effects of mobilization as a stand-alone intervention, incorporate larger sample sizes and long-term follow-up, and conduct high-quality comparative trials to identify the most effective specific mobilization techniques.
Gayeong Lee, Hyeonjun Woo, Yunhee Han et al.· PLoS ONE· 0 citations
STUDY DESIGN
Systematic review using Synthesis Without Meta-analysis (SWiM).
OBJECTIVE
To synthesize evidence on osteoporosis and mechanical outcomes after fusion for degenerative lumbar scoliosis (DLS) and related adult spinal deformity (ASD), and appraise perioperative teriparatide or romosozumab.
SUMMARY OF BACKGROUND DATA
DLS-specific long-fusion evidence is sparse; much literature comprises related ASD or indirect short-segment/mixed-fusion cohorts.
METHODS
PubMed, Embase, CENTRAL, and Web of Science were searched through January 31, 2026, with a focused PubMed verification audit during revision. PROSPERO registration on April 22, 2026 followed the search; post-registration eligibility and analysis deviations are disclosed. Core DLS evidence required explicit long-segment fusion or ≥4 fused/instrumented levels; a stricter ≥5-vertebrae subset was examined. Adjusted estimates were reported per study without pooling. Risk of bias used QUIPS, RoB 2, or ROBINS-I; certainty used GRADE.
RESULTS
Twenty-one index primary reports informed the synthesis; eight were core DLS long-fusion reports; one overlapping companion was linked to its index cohort. Of eight core reports, five showed adverse adjusted associations, one was adjusted-null, and two were mixed across bone measures. The strict ≥5-vertebrae subset contained three adverse reports. Direct estimates included osteoporosis OR 8.19 (95% CI, 2.40-27.97) for screw loosening, S1 VBQ OR 4.565 (1.430-14.568) for PJK, osteoporosis OR 6.713 (1.667-27.031) for mechanical complications, and lumbosacral HU OR 0.941 (0.906-0.977) for distal instrumentation problems. Two reports had internally inconsistent regression tables; unsafe numeric effects were not extracted. Cohort overlap, heterogeneous measures/endpoints, and indirect evidence precluded pooling; three anabolic studies did not establish a DLS-specific class effect.
CONCLUSIONS
Most core DLS reports linked lower bone quality to mechanical complications, but retrospective design, probable cohort overlap, measure-dependent null findings, and reporting defects make certainty very low. No pooled DLS-specific magnitude is justified. Effects on final alignment and disability remain unresolved, and perioperative anabolic therapy is promising but not definitive.
LEVEL OF EVIDENCE
3.
ABSTRACT Introduction: Rotator cuff tendinopathy is a common cause of shoulder pain and disability, and the optimal nonoperative strategy remains debated. Physiotherapy is the mainstay of initial management, whereas hyaluronic acid injection has been proposed as an alternative or adjunct; their comparative effectiveness is uncertain. Methods: An evidence-based systematic review was conducted in PubMed, Embase, Cochrane Library, and the Regional Portal of the Virtual Health Library (BVS) up to February 2026. Randomized controlled trials comparing hyaluronic acid injection with physiotherapy in adults with rotator cuff tendinopathy were included. Outcomes were pain, function, range of motion, and quality of life. Certainty of evidence was assessed with the GRADE approach. Results: Two randomized controlled trials (130 participants) met the eligibility criteria. Hyaluronic acid injection was associated with greater short-term improvement in pain, range of motion, and quality of life than physiotherapy, particularly within the first three months. Functional outcomes were inconsistent: one trial reported comparable improvement between groups, whereas the other favored hyaluronic acid. Certainty of evidence was very low because of small sample sizes, risk of bias, and imprecision. Conclusion: Very low-quality evidence suggests that hyaluronic acid injection may provide superior short-term benefits over physiotherapy for rotator cuff tendinopathy, mainly up to three months. The available evidence remains limited and at high risk of bias; further high-quality studies are required. Level of evidence II; Systematic review.
M. Fernandes, Leonardo Zanesco, J. Murachovsky et al.· Acta Ortopédica Brasileira· 0 citations
Background The Forgotten Joint Score (FJS) is a patient-reported outcome (PRO) measure assessing joint awareness after total knee arthroplasty (TKA). Unlike traditional PROs, it is particularly sensitive to the “forgotten” quality of the joint, correlating with patient satisfaction and long-term success. This systematic review evaluates the FJS compared to conventional PROs in assessing TKA outcomes. Methods A systematic search of PubMed, Embase, and the Cochrane Library identified randomized controlled trials reporting FJS alongside other PROs in primary TKA. Studies included various alignment techniques, implants, and robotic assistance. Independent reviewers performed data extraction and risk of bias assessments. Pooled FJS scores were analyzed using random-effects models, with subgroup analyses by surgical technique and prosthesis type. Results Fourteen randomized controlled trials (1244 knees) met inclusion criteria. FJS scores ranged from 19.00 to 98.00, with a mean of 73.61. Unlike Western Ontario and McMaster Universities, Oxford Knee Score, and Knee Society Score, the FJS showed no significant ceiling effect. Chi-square tests demonstrated that FJS detected significant postoperative improvements compared to Western Ontario and McMaster Universities and Knee Society Score (P = .011 and P = .037). Subgroup analyses found no significant differences in FJS or other PROs, though recent studies suggest a trend favoring kinematic alignment. Conclusions The FJS demonstrates superior sensitivity and avoids ceiling effects compared to traditional PROs, making it a valuable tool for evaluating subtle differences in TKA outcomes. Its ability to detect nuanced improvements highlights its clinical relevance in optimizing surgical techniques and enhancing patient-centered care. Future research should prioritize the FJS to refine alignment strategies and implant designs.
Anand Dhaliwal, Alexander J. Baur, Brendan J. Liakos et al.· Arthroplasty Today· 0 citations
Pelvic floor dysfunctions are highly prevalent and can substantially impair quality of life. Physiotherapy is considered a first-line conservative treatment, and the integration of technologies such as ultrasound may enhance outcomes through visual biofeedback. Objectives: To evaluate the effectiveness of ultrasound as a biofeedback tool in physiotherapeutic interventions for pelvic floor dysfunctions across different populations. Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420261278982). The literature search was conducted between February and March 2025 in PubMed, Web of Science, Scopus, Medline, and PEDro. Randomized controlled trials using ultrasound as biofeedback in physiotherapy interventions were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated with the RoB 2 tool. Results: Two randomized controlled trials involving 75 women were included. One study investigated older women with urinary incontinence, whereas the other included postpartum women with pregnancy-related pelvic girdle pain. In Galea et al., transabdominal ultrasound biofeedback was not superior to conventional feedback based on vaginal palpation for urinary leakage, incontinence frequency, or quality of life, although the ultrasound group showed a significant within-group reduction in leakage episodes. In Kuo et al., ultrasound-guided biofeedback combined with pelvic floor and stabilization exercises reduced pain and disability compared with education alone and improved walking performance, but it was not consistently superior to exercise without biofeedback and did not significantly improve pelvic floor muscle contractility. The small number of studies, heterogeneity of populations and interventions, and low to very low certainty of the evidence limited the strength of the findings. Conclusions: Ultrasound-based biofeedback may be a useful adjunct to pelvic floor physiotherapy, particularly for facilitating correct muscle contraction and supporting motor learning. However, the available evidence does not demonstrate a consistent additional clinical benefit over conventional feedback or exercise alone. These findings should therefore be interpreted cautiously. Further high-quality randomized controlled trials with larger samples, standardized protocols, and longer follow-up are required.
César Garrido-Fernández, Eva M Lantarón-Caeiro, I. Escobio-Prieto et al.· Journal of Clinical Medicine· 0 citations
