Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial.
BACKGROUND
Dysfunction of the cervicothoracic spine and the adjacent ribs (also called the shoulder girdle) is considered to predict occurrence and poor outcome of shoulder symptoms. It can be treated with manipulative therapy, but scientific evidence for the effectiveness of such therapy is lacking.


OBJECTIVE
To study the effectiveness of manipulative therapy for the shoulder girdle in addition to usual medical care for relief of shoulder pain and dysfunction.


METHODS
Randomized, controlled trial.


METHODS
General practices in Groningen, the Netherlands.


METHODS
150 patients with shoulder symptoms and dysfunction of the shoulder girdle.


METHODS
All patients received usual medical care from their general practitioners. Only the intervention group received additional manipulative therapy, up to 6 treatment sessions in a 12-week period.


METHODS
Patient-perceived recovery, severity of the main complaint, shoulder pain, shoulder disability, and general health. Data were collected during and at the end of the treatment period (at 6 and 12 weeks) and during the follow-up period (at 26 and 52 weeks).


RESULTS
During treatment (6 weeks), no significant differences were found between study groups. After completion of treatment (12 weeks), 43% of the intervention group and 21% of the control group reported full recovery. After 52 weeks, approximately the same difference in recovery rate (17 percentage points) was seen between groups. During the intervention and follow-up periods, a consistent between-group difference in severity of the main complaint, shoulder pain and disability, and general health favored additional manipulative therapy.


CONCLUSIONS
The sample size was small, and assessment of end points was subjective.


CONCLUSIONS
Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.
Bergman
Gert J D
GJ
University of Groningen and University Hospital of Groningen, Groningen, The Netherlands. g.j.d.bergman@med.rug.nl
Winters
Jan C
JC
Groenier
Klaas H
KH
Pool
Jan J M
JJ
Meyboom-de Jong
Betty
B
Postema
Klaas
K
van der Heijden
Geert J M G
GJ
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012782:Shoulder / Q000503:physiopathology; D020069:Shoulder Pain / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones