Browsing by Person "Cashley, David"

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A repeat-measures comparison of the analogue and digital pressure threshold metres: Do they differ in sensitivity?
(2015-07) Cashley, David
Objectives: There has been ample research published to demonstrate the validity and sensitivity of the pressure threshold metre, but none to assess the competence of the analogue metre as compared to the more commonly used digital version. This paper aims to compare the two different types of metre. Method: A total of 160 measurements were taken from each metre for comparison. Results: A Bland-Altman plot showed the measurements from both metres to be in excellent agreement, while a strong correlation was also evident. Discussion: Where changes in excess of 1 kg/cm2 are being sought, both devices perform satisfactorily and there is little or nothing to advance the case for 1m over the other. Since the minimum clinically significant change is thought to be 1.5 kg/cm either metre should function satisfactorily in the clinical setting. W. S. Maney & Son Ltd and the British Institute of Musculoskeletal Medicine 2015.
Manipulation of the foot in the treatment of patients with Morton’s neuroma
(Queen Margaret University, Edinburgh, 2024-06-26) Cashley, David
Introduction Manipulative therapy’s rationale is pragmatically appealing as a non-invasive treatment for Morton’s neuroma (MN), involving targeted manipulations of relevant joints. Nevertheless, manipulation’s efficacy has received limited scrutiny. This thesis comprised four data-driven chapters offering novel investigations associated with manipulation as a treatment for MN. The latter included a critical appraisal of the clinimetric utility of pressure testing for discomfort thresholds (PTT) as a novel outcome in this context (n = 26; Chapter 5), an exploratory pragmatic controlled trial investigating Manipulation versus Steroid Injection in the treatment of patients with Morton’s neuroma focusing on self-reported pain levels (VAS) and PTT (n = 61; Chapter 6) and other PROMs reflecting functionality and health (Chapter 7). A final data chapter (Chapter 8) contributed secondary analyses of data in Chapters 6 and 7 exploring novel factors in enhanced clinical outcomes of non-surgical treatment of Morton’s neuroma using descriptive multivariate modelling and discriminant analysis. Method The thesis’s primary study (Chapters 6 and 7) featured an exploratory, pragmatic randomised controlled trial was designed to investigate the efficacy of an acute, short dosage (6, weekly episodes) of physiologically-principled manipulations, featuring discrete, high-velocity thrusting manoeuvres for treating Morton’s Neuroma. Adults electing treatment for Morton’s neuroma were randomly allocated to manipulative therapy (n = 29) or corticosteroid injection (n = 32). Baseline and follow-up (at 1·5, 3, 6, 9 and 12 months following treatment cessation) outcome measures of self-reported pain levels (VAS), pressure testing for discomfort thresholds (PTT) and functionality (walking and standing [MOxFQws], pain [MOxFQp)] and social interaction [MOxFQsi]; activities of daily living [FAAMdl], sports participation [FAAMspt] and general health [SF-36 PCS & MCS]) were measured ipsilaterally and by inventory. Results Chapters 6 and 7 showed that manipulation elicited substantive gains immediately after intervention (VAS [Cohen’s d, 3·3; 84·4%]; PTT [d, 2·3; 147·0%]; MOxFQws [d, 1·4; 52·8%]; MOxFQp [d, 1·3; 45·5%]; MOxFQsi [d, 0·9; 39·2%]) or accumulated during follow-up (FAAMdl [d, 2·2; 40·8%]; FAAMspt [d, 1·5; 66·1%]). Concomitant gains interactively for control participants were modest (d, 0·4 to 1·0; 16·6% to 45·9%) (p < 0·05 to p < 0·0005). Retention of improvements following manipulation cessation was substantial for all metrics, significantly better than baseline scores (VAS, PTT, MOxFQws, MOxFQp, MOxFQsi, FAAMdl, FAAMspt, SF-36 PCS and SF-36 MCS [d, 1·1 to 3·4; 40·8% to 152·3%]) and consistently exceeded that for corticosteroid injection (p < 0·01 to p < 0·001). Group mean intra-session and inter-day variability (V%) of PTT (Chapter 5) ranged between 6.8% and 13.6% for experienced and inexperienced test administrators, respectively, and suggested compromised precision amongst serial measurements of PTT over extended periods of time. Within Chapter 8, predictive multivariate modelling showed that in internal classification analyses, 88.9% of patients could be assigned correctly to high- and low-responders to treatment. Conclusion (i) Manipulation elicited significant and clinically relevant improvements and retention in self-reported levels of pain, discomfort and functionality for patients electing treatment for Morton’s neuroma; (ii) Exploratory multivariate modelling provided a signiﬁcant prediction model for successful non-surgical treatment outcomes; (iii) Single measurements showed compromised precision amongst serial assessments of PTT.