| 2020 |
Xie Y, Jun D, Thomas L, Coombes BK, Johnston V, 'Comparing Central Pain Processing in Individuals With Non-Traumatic Neck Pain and Healthy Individuals: A Systematic Review and Meta-Analysis', Journal of Pain, (2020)
© 2020 United States Association for the Study of Pain, Inc. This systematic review and meta-analysis examined the evidence for altered central pain processing in people with nont... [more] © 2020 United States Association for the Study of Pain, Inc. This systematic review and meta-analysis examined the evidence for altered central pain processing in people with nontraumatic neck pain and the relationship among central pain processing, demographics, and pain-related characteristics. Case-control studies reporting measures of altered central pain processing using quantitative sensory testing were reviewed. Standardized mean differences (SMDs) and 95% confidence intervals between people with nontraumatic neck pain and controls were calculated. Meta-analysis was performed using random-effects models when appropriate. Associations between SMDs with demographics and pain-related characteristics were explored on a study level using metaregression. Twenty-six studies were eligible with 25 included for meta-analysis. Meta-analysis demonstrated mechanical hyperalgesia at remote nonpainful sites in the full sample (sample size [n] = 1305, SMD = -0.68) and in the subgroup with moderate/severe disability (n = 165, SMD = -0.86; moderate-quality evidence). Metaregression indicated that remote mechanical hyperalgesia was negatively associated with age (R2 = 25.4%, P = 0.031). Very low- to low-quality evidence of remote cold and heat hyperalgesia and dysfunctional conditioned pain modulation were identified. This review suggests that altered central pain processing is present in people with nontraumatic neck pain and may be associated with disability levels and age. Perspective: This review found moderate-quality evidence of mechanical hyperalgesia at remote nonpainful sites in patients with nontraumatic neck pain compared with controls, indicating altered central pain processing. However, more studies are needed to confirm findings from dynamic quantitative sensory testing.
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| 2020 |
Thomas L, Treleaven J, 'Should we abandon positional testing for vertebrobasilar insufficiency?', Musculoskeletal Science and Practice, 46 (2020)
© 2019 Elsevier Ltd Positional testing for vertebrobasilar insufficiency (VBI) is used by physiotherapists as part of pre-manipulative screening protocols. Recently, the validity ... [more] © 2019 Elsevier Ltd Positional testing for vertebrobasilar insufficiency (VBI) is used by physiotherapists as part of pre-manipulative screening protocols. Recently, the validity of the tests have been questioned because a negative test does not infer safety with cervical manipulative therapy but the reasoning surrounding this opinion may be questioned. While the positional tests were developed to test vertebral artery flow contralateral to the direction of head movement and the subsequent effect on cerebral blood supply, as inferred by symptom reproduction, ultrasound studies have shown that vertebral artery flow is inherently variable. Rather, the tests should be considered as testing for adequacy of collateral flow in particular head positions rather than decreased blood flow in a particular artery, with more attention to characteristics of symptom reproduction. We contend that positional testing for VBI remains valuable for testing adequacy of collateral flow, and also has an important place as part of the differential diagnosis of individuals with dizziness or imbalance. The physiotherapist's ability to differentially diagnose dizziness and recognise the presence or not of VBI is not only critical for prompt medical investigation and management because it is a risk factor for transient ischaemic events and stroke, but has important influences over management decisions regarding cervical musculoskeletal treatment including exercise interventions. Importantly, the positional tests should not be considered as tests of arterial integrity and used to assess the risk of damage to the vertebral or internal carotid artery or presence of cervical arterial dissection. Urgent research is needed before we abandon positional testing prematurely.
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| 2020 |
Thomas LC, Chan K, Durbridge G, 'Changes in internal carotid and vertebral arterial wall stiffness with head movement can be detected with shear wave elastography', Journal of Manual and Manipulative Therapy, 28 103-110 (2020)
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Safe practice is important for patients with neck pain, with the potential for injury to ce... [more] © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Safe practice is important for patients with neck pain, with the potential for injury to cervical arteries. Cervical manipulation or end range techniques/positions may place considerable strain on the arteries. Altered integrity of the arterial wall may render them more susceptible to minor trauma, particularly in the upper cervical region. Screening of blood flow velocity is limited for predicting those at risk. Examining properties of the cervical arterial wall (stiffness characteristics) and their response to head movement may provide an alternate measure of arterial susceptibility. Objectives: To investigate whether shear wave ultrasound elastography can detect any changes in internal carotid (ICA) and vertebral (VA) arterial wall stiffness in neutral compared with contralateral head rotation. Design: Observational study Methods: Shear wave ultrasound elastography was used to measure the stiffness of the ICA and VA. Shear wave velocity (m/s), indicative of arterial stiffness, was measured in both arteries proximally (C3¿4) and distally (C1¿2) in neutral and contralateral head rotation as were intimal thickness (mm) and flow velocity (cm/s). Results: Thirty participants (20¿62 years) were successfully imaged. The VA was stiffer than ICA and it became significantly stiffer in contralateral rotation (p = 0.05). The ICA became significantly less stiff (p = 0.01). Effects were more apparent at C1¿2 but significant in the ICA only (p = 0.03). Flow velocity and intimal thickness were unchanged in rotation. Conclusions: Changes in VA and ICA arterial wall stiffness can be measured with shear wave ultrasound elastography. This measure may ultimately help identify arteries with greater vulnerability to rotational stresses.
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| 2020 |
Thomas LC, Treleaven J, 'Response to the letter to the editor regarding the continued use of the vertebrobasilar insufficiency test', Musculoskeletal Science and Practice, 45 (2020)
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| 2019 |
Liang Z, Galea O, Thomas L, Jull G, Treleaven J, '5 Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis', MUSCULOSKELETAL SCIENCE AND PRACTICE, 42 67-83 (2019)
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| 2019 |
Thomas L, Allen M, Shirley D, Rivett D, 'Australian musculoskeletal physiotherapist's perceptions, attitudes and opinions towards pre-manipulative screening of the cervical spine prior to manual therapy: Report from the focus groups.', Musculoskeletal science & practice, 39 123-129 (2019) [C1]
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| 2019 |
Thomas L, Low J, Chan K, Durbridge G, 'Shear wave elastography of the cervical arteries: A novel approach to the assessment of cervical arterial wall stiffness. An investigation of psychometric properties and intra-rater reliability', MUSCULOSKELETAL SCIENCE AND PRACTICE, 40 96-100 (2019)
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| 2019 |
Xie Y, Thomas L, Hug F, Johnston V, Coombes BK, 'Quantifying cervical and axioscapular muscle stiffness using shear wave elastography', JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY, 48 94-102 (2019)
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| 2019 |
Avijgan M, Thomas LC, Osmotherly PG, Bolton PS, 'A Systematic Review of the Diagnostic Criteria Used to Select Participants in Randomised Controlled Trials of Interventions Used to Treat Cervicogenic Headache', HEADACHE, 60 15-27 (2019)
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| 2018 |
Daly L, Giffard P, Thomas L, Treleaven J, 'Validity of clinical measures of smooth pursuit eye movement control in patients with idiopathic neck pain', MUSCULOSKELETAL SCIENCE AND PRACTICE, 33 18-23 (2018)
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| 2017 |
Thomas LC, Hall LA, Attia JR, Holliday EG, Markus HS, Levi CR, 'Seasonal Variation in Spontaneous Cervical Artery Dissection: Comparing between UK and Australian Sites', Journal of Stroke and Cerebrovascular Diseases, 26 177-185 (2017) [C1]
© 2017 National Stroke Association Background Cervical artery dissection (CAD) is a leading cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of ... [more] © 2017 National Stroke Association Background Cervical artery dissection (CAD) is a leading cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence have been suggested but may reflect extreme climatic conditions. Seasonal variation may implicate more transient seasonal causes such as proinflammatory or hypercoagulable states. This study aimed to assess whether CAD incidence varied with season between UK and Australian sites. Also, this study aimed to determine whether there was a different pattern of seasonal variation between arteries (carotid and vertebral) and any association between CAD incidence and clinical factors. Methods This was a retrospective observational study of patients older than 18 years with radiological diagnosis of internal carotid or vertebral arterial dissection, from sites in Australia and the UK. Clinical variables were compared between autumn-winter and spring-summer and site of dissection. Results A total of 133 CAD cases were documented in Australia and 242 in the UK. There was a seasonal pattern to CAD incidence in countries in both the northern and the southern hemispheres, with a trend for dissection to occur more commonly in autumn, winter, and spring than in summer (incidence rate ratios [IRR] 1.4-1.5, P¿<¿.05). CAD counts were also slightly higher in internal carotid than in vertebral artery (IRRs 1.168, 1.43, and 1.127, respectively). Neither systolic blood pressure nor pulse pressure was significantly associated with CAD counts. Conclusions CAD occurs more commonly in cooler months regardless of geographical location, suggesting transient seasonal causes may be important in the pathophysiology. This effect was slightly higher in internal carotid than in vertebral artery, suggesting differing trigger mechanisms between dissection sites.
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| 2016 |
Thomas LC, 'Cervical arterial dissection: An overview and implications for manipulative therapy practice', Manual Therapy, 21 2-9 (2016)
© 2015 Elsevier Ltd. Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor... [more] © 2015 Elsevier Ltd. Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor trauma or infection. The incidence is difficult to determine accurately as not all CAD progress to stroke. CAD is the most catastrophic adverse event associated with cervical manipulative therapy but it is rare. Early features of CAD can mimic a painful musculoskeletal presentation and a patient may present for treatment of neck pain and headache with a dissection in progress. Whether the manipulative technique is responsible for dissection or whether the diagnosis of CAD has been missed is unclear. Identification of individuals at risk, or early recognition of CAD could help expedite medical intervention and avoid inappropriate treatment. Purpose: The aims of this masterclass are to outline current research into the pathophysiology, aetiology and clinical presentation of CAD, to place the risk in context in a manipulative therapy setting and to discuss its possible clinical recognition. Implications: For those patients presenting with recent onset, moderate to severe unusual headache or neck pain, clinicians should perform a careful history, in particular questioning about recent exposure to head/neck trauma or neck strain. Cardiovascular factors may not be particularly useful indicators of risk of dissection. Clinicians should also be alert to reports of transient neurological dysfunction such as visual disturbance and balance deficits, arm paraesthesia and speech deficits, as these may be subtle. If clinicians suspect arterial dissection is in progress patients should be urgently referred for medical evaluation.
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| 2015 |
Thomas L, McLeod L, Osmotherly PG, Rivett DA, 'The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study', Manual Therapy, 20 475-480 (2015) [C1]
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| 2015 |
Thomas LC, Rivett DA, Attia JR, Levi C, 'Risk factors and clinical presentation of cervical arterial dissection: Preliminary results of a prospective case-control study', Journal of Orthopaedic and Sports Physical Therapy, 45 503-511 (2015) [C1]
Copyright ©2015 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk factor... [more] Copyright ©2015 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk factors and clinical presentation of individuals with cervical arterial dissection. BACKGROUND: Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event, such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment. METHODS: Participants were individuals 55 years of age or younger from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age- and sex-matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken. RESULTS: Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischemic stroke but not dissection were included in the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting recent neck manipulative therapy treatment. Cardiovascular risk factors were uncommon, with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischemic features in the month prior to their admission for dissection. CONCLUSION: Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors, with the exception of migraine, were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in the identification of this serious pathology.
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| 2014 |
Thomas LC, Rivett DA, Parsons M, Levi C, 'Risk factors, radiological features, and infarct topography of craniocervical arterial dissection.', International Journal of Stroke, 9 1073-1082 (2014) [C1]
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| 2013 |
Thomas LC, Rivett DA, Bateman G, Stanwell P, Levi CR, 'Effect of Selected Manual Therapy Interventions for Mechanical Neck Pain on Vertebral and Internal Carotid Arterial Blood Flow and Cerebral Inflow', PHYSICAL THERAPY, 93 1563-1574 (2013) [C1]
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| 2012 |
Thomas L, Rivett DA, Parsons M, Levi C, 'Risk factors, radiological features and infarct topography of craniocervical arterial dissection.', International Journal of Stroke, 9 1073-1082 (2012)
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| 2012 |
Thomas L, Rivett DA, Attia JR, Levi CR, 'Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study', BMC Musculoskeletal Disorders, 13 1-6 (2012) [C3]
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| 2011 |
Thomas L, Rivett DA, Attia JR, Parsons MW, Levi CR, 'Risk factors and clinical features of craniocervical arterial dissection', Manual Therapy, 16 351-356 (2011) [C1]
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| 2009 |
Thomas L, Rivett DA, Bolton PS, 'Validity of the Doppler velocimeter in examination of vertebral artery blood flow and its use in pre-manipulative screening of the neck', Manual Therapy, 14 544-549 (2009) [C1]
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| 2009 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letter to the editor', Manual Therapy, 14 E7-E8 (2009) [C3]
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| 2009 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letter to the editor by Karl et al. Manual Therapy 2009;14(6):e17', Manual Therapy, 14 E18 (2009) [C3]
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| 2008 |
Thomas L, Rivett DA, Bolton PS, 'Pre-manipulative testing and the use of the velocimeter', Manual Therapy, 13 29-36 (2008) [C1]
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| 2008 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letters to editor regarding article: Thomas LC, et al. Premanipulative testing and the velocimeter. Manual Therapy (2007)', Manual Therapy, 13 E5-E6 (2008) [C3]
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| 2005 |
Rivett DA, Thomas L, Bolton PS, 'Pre-manipulative testing: where do we go from here?', New Zealand Journal of Physiotherapy, 33 78-84 (2005) [C1]
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