title: Manipulative therapy in addition to usual care for patients with shoulder complaints: results of physical examination outcomes in a randomized controlled trial.
abstract: OBJECTIVE
  The purpose of this study was to examine the effect of manipulative therapy on the shoulder girdle, in addition to usual care provided by the general practitioner, on the outcomes of physical examination tests for the treatment of shoulder complaints.
  
  
  METHODS
  This was a randomized controlled trial in a primary care setting in the Netherlands. A total of 150 participants were recruited from December 2000 until December 2002. All patients received usual care by the general practitioner. Usual care included one or more of the following depending on the needs of the patient: information/advice, oral analgesics or nonsteroidal antiinflammatory drugs, corticosteroid injections, exercises, and massage. In addition to usual care, the intervention group received manipulative therapy, up to 6 treatment sessions in a 12-week period. Twenty-four physical examination tests were done at baseline and after 6, 12, and 26 weeks. Factor analysis was done to reduce the number of outcome measures.
  
  
  RESULTS
  The factor analysis resulted in 4 factors: "shoulder pain," "neck pain," "shoulder mobility," and "neck mobility." At 6 weeks, no significant differences between groups were found. At 12 weeks, the mean changes of all 4 factors favored the intervention group; the factors "shoulder pain" and "neck pain" reached statistical significance (95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors "shoulder pain" (95% CI, 0.0-2.6), "shoulder mobility" (95% CI, 0.2-1.7), and "mobility neck" (95% CI, 0.2-1.3) statistically favored the intervention group.
  
  
  CONCLUSIONS
  In this pragmatic study, manipulative therapy, in addition to usual care by the general practitioner, diminished severity of shoulder pain and neck pain and improved shoulder and neck mobility.
authors.affiliation: Formerly Department of General Practice and Center for Rehabilitation, University Medical Center Groningen, The Netherlands.
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Bergman
authors.forename: Jan C
authors.initials: JC
authors.lastname: Winters
authors.forename: Klaas H
authors.initials: KH
authors.lastname: Groenier
authors.forename: Betty
authors.initials: B
authors.lastname: Meyboom-de Jong
authors.forename: Klaas
authors.initials: K
authors.lastname: Postema
authors.forename: Geert J
authors.initials: GJ
authors.lastname: van der Heijden
mesh_terms: D000328:Adult; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D026201:Musculoskeletal Manipulations; D009333:Neck; D019547:Neck Pain / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology; D059408:Pain Management; D010808:Physical Examination; D012720:Severity of Illness Index; D012782:Shoulder; D016896:Treatment Outcome