Dataset Information

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial.

ABSTRACT: The aim of this study was to evaluate if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to same exercise program in patients with non-specific shoulder pain. This was an evaluator-blinded randomized controlled trial. Forty-five subjects were randomly allocated into one of three groups: manual therapy (glenohumeral mobilization technique and rib-cage technique); thoracic sham manual therapy (glenohumeral mobilization technique and rib-cage sham technique); or sham manual therapy (sham glenohumeral mobilization technique and rib-cage sham technique). All groups also received a therapeutic exercise program. Pain intensity, disability and pain-free active shoulder range of motion were measured post treatment and at 4-week and 12-week follow-ups. Mixed-model analyses of variance and post hoc pairwise comparisons with Bonferroni corrections were constructed for the analysis of the outcome measures. All groups reported improved pain intensity, disability and pain-free active shoulder range of motion. However, there were no between-group differences in these outcome measures. The addition of the manual therapy techniques applied in the present study to a therapeutic exercise protocol did not seem to add benefits to the management of subjects with non-specific shoulder pain.

SUBMITTER: Naranjo-Cinto F

PROVIDER: S-EPMC9368942 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial.

Naranjo-Cinto Fermin F Cerón-Cordero Adriana-Imelda AI Figueroa-Padilla Claudia C Galindo-Paz Dulce D Fernández-Carnero Samuel S Gallego-Izquierdo Tomás T Nuñez-Nagy Susana S Pecos-Martín Daniel D

Journal of clinical medicine 20220728 15

The aim of this study was to evaluate if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to same exercise program in patients with non-specific shoulder pain. This was an evaluator-blinded randomized controlled trial. Forty-five subjects were randomly allocated into one of three groups: manual therapy (glenohumeral mobilization technique and rib-cage technique); thoracic sham manual therapy (glenohumeral mobilization technique ...[more]

PMID: 35956009

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Project description:ObjectivesThe aim of this study was to assess whether it was feasible to conduct a full trial comparing a tailored versus a standardised exercise programme for patients with shoulder subacromial pain.DesignTwo-arm, patient-blinded and assessor-blinded, randomised controlled feasibility trial.MethodsTwenty-eight participants with shoulder subacromial pain were randomly allocated into one of two intervention groups-tailored or standardised exercise. Participants in the tailored exercise programme received exercises and manual therapy tailored to their scapular and shoulder movement impairments. Participants in the standardised exercise programme received progressive strengthening exercise. The primary outcome measures were (1) the participant recruitment rate; (2) the proportion of participants enrolled from the total number screened; (3) drop-out rates; and (4) adherence to the rehabilitation programme. Other outcome measures were: (5) pain levels; (6) Patient-Specific Functional Scale; (7) the Shoulder Pain and Disability Index; and (8) pain self-efficacy. We compared changes in pain and disability scores between groups using a repeated mixed-model analysis of variance. Since this is a feasibility study, we did not adjust alpha for multiple comparisons, and considered 75% CI as the probability threshold at 3-month follow-up. Health-related quality of life was assessed using the Short-Form 12 and quality-adjusted life years (QALYs) were estimated.ResultsThe recruitment rate was 3 participants per month, the proportion of participants enrolled was 23%, the drop-out rate was 14% and the overall adherence to the rehabilitation programme was 85%. No between-group differences were found for most outcome measures. Adverse events (n=2, only in the tailored group) were minor in nature and included skin injury or pain following taping.ConclusionsOur feasibility trial showed that additional strategies are required for improving recruitment, enrolment and minimising drop-out of participants into the trial and making it feasible to conduct a full trial.Trial registration numberANZCTR: 12617001405303.

Project description:Sensorimotor training (SMT) is popularly applied as exercise in rehabilitation settings, particularly for musculoskeletal pain. With insufficient evidence on its effect on pain and function, this exploratory randomised controlled trial investigated the potential effects of SMT in rehabilitation of chronic non-specific low back pain. Two arms received 9x30 minutes physiotherapy with added interventions: The experimental arm received 15 minutes of postural SMT while the comparator arm performed 15 minutes of added sub-effective low-intensity training. A treatment blinded tester assessed outcomes at baseline 2-4 days prior to intervention, pre- and post-intervention, and at 4-week follow-up. Main outcomes were pain and functional status assessed with a 0-100mm visual analogue scale and the Oswestry Disability Questionnaire. Additionally, postural control was analysed using a video-based tracking system and a pressure plate during perturbed stance. Robust, nonparametric multivariate hypothesis testing was performed. 22 patients (11 females, aged 32 to 75 years) with mild to moderate chronic pain and functional limitations were included for analysis (11 per arm). At post-intervention, average values of primary outcomes improved slightly, but not to a clinically relevant or statistically significant extent. At 4-week follow-up, there was a significant improvement by 12 percentage points (pp) on the functional status questionnaire in the SMT-group (95% confidence intervall (CI) = 5.3pp to 17.7pp, p < 0.001) but not in the control group (4 pp improvement, CI = 11.8pp to 19.2pp). However, group-by-time interaction effects for functional status (Q = 3.3, 19 p = 0.07) and pain (Q = 0.84, p = 0.51) were non-significant. Secondary kinematic outcomes did not change over time in either of the groups. Despite significant improvement of functional status after SMT, overall findings of this exploratory study suggest that SMT provides no added benefit for pain reduction or functional improvement in patients with moderate chronic non-specific low back pain.Trial registrationClinicalTrials.gov NCT02304120 and related study protocol, DOI: 10.1186/1471-2474-15-382.

Project description:BackgroundShoulder complaints are common and the recommended first-line treatment is exercise therapy. However, it remains unknown if increased shoulder pain after an exercise session is a barrier for subsequent exercise dose, particularly in people with high fear-avoidance beliefs. Such knowledge could indicate ways to optimise shoulder rehabilitation. The aim was to examine whether increased shoulder pain across an exercise session was associated with a lower subsequent exercise dose, and if high fear-avoidance beliefs exaggerated this association.MethodsWe conducted a prospective cohort study using data from a randomised controlled trial in Central Denmark Region 2017-2019. Participants were employees (n = 79) with shoulder complaints and high occupational shoulder exposures. The intervention was a home-based or partly supervised exercise programme lasting 2-3 months. Linear mixed models were used to examine the associations between change in shoulder pain and exercise dose (number of repetitions, progression level (1-3), resistance level (1-3), and time until next exercise session [days]).ResultsAt baseline, the participants had a median pain intensity at rest of 2 on a numerical rating scale (0-10). For a 1-cm increase in pain on a visual analogue scale (0-10 cm) during an exercise session, the subsequent number of repetitions, progression level and resistance level were - 1.3 (95% confidence interval [CI] - 3.4 to 0.9), 0.0 (95% CI - 0.1 to 0.0) and - 0.0 (95% CI - 0.1 to 0.0), respectively. Likewise, the time until next exercise session was - 0.6 (95% CI - 2.4 to 1.3) days for a 1-cm increase. There were no interactions with fear-avoidance beliefs.ConclusionIncreased pain across an exercise session was not associated with subsequent exercise dose, regardless of fear-avoidance beliefs, among employees with shoulder complaints and high occupational shoulder exposures.Trial registrationThe trial was registered at Clinicaltrials.gov 19/05/2017 (ID: NCT03159910).

Project description:ContextTherapeutic exercise is considered the mainstay in the management of rotator cuff-related shoulder pain (RCRSP). Manual therapy (MT) interventions have also shown to be effective in RCRSP. However, the benefits of adding MT along with exercise interventions for the management of RCRSP remain unknown.ObjectiveTo evaluate the additional benefits of MT with exercise compared with exercise in isolation for the management of RCRSP.Data sourcesA search of PubMed, Scopus, PEDro, and EBSCO from the inception date of each database through April 20, 2022, was conducted for randomized trials comparing the additional effects of MT in exercise interventions compared with exercise alone for pain management and function in patients with RCRSP. Standardized mean differences (SMDs) and 95% CIs were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the grading of recommendations assessment, development and evaluation approach.Study designMeta-analysis of randomized controlled trials.Level of evidenceLevel 2.ResultsTwelve articles were found eligible and 8 of them demonstrated high methodological quality. Eleven articles were included for quantitative analysis. Pain with movement was not significantly different between MT and exercise versus exercise alone (SMD [95% CI] = -0.15 [-0.41 to 0.12]; I2 = 0%), whereas pain at rest was significantly improved in the groups that used exercise only with a moderate effect size (SMD [95% CI] = 0.47 [0.04 to 0.89]; I2 = 75%). Furthermore, shoulder function was not significantly different between MT and exercise versus exercise alone in the short term (SMD [95% CI] = 0.23 [-0.22 to 0.69]; I2 = 88%) or the long term (SMD [95% CI] = -0.02 [-0.21 to 0.16]; I2 = 2%).ConclusionAdding MT to exercise interventions for the management of RCRSP is not more effective than exercise alone for pain and function in adult patients.

Dataset Information

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial.

Publications

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial.

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