title: Thoracic spinal manipulation for musculoskeletal shoulder pain: Can an instructional set change patient expectation and outcome?
abstract: METHODS
  Planned secondary analysis of a randomized clinical trial.
  
  
  OBJECTIVE
  To examine: 1) patients' baseline expectations for treatment outcome of thoracic high velocity low amplitude thrust manipulations (HVLATM) to the thoracic spine for shoulder pain; 2) if the message conveyed by the clinician changed the patients' expectation; 3) any differences in outcome based on expectation independent of messaging.; and 4) any differences in outcome for those patients whose expectations significantly changed as a result of the messaging.
  
  
  BACKGROUND
  Thoracic HVLATM may be an effective intervention for patients suffering from musculoskeletal shoulder pain. The role of expectation in the treatment effectiveness of this intervention has not been established.
  
  
  METHODS
  Subjects' expectations regarding the effectiveness of HVLATM on shoulder pain were recorded at baseline. This was reassessed immediately following the provision of positive or neutral instructional set. The subjects then received a thoracic or scapular HVLATM. The Shoulder Pain and Disability Index (SPADI) and the numeric pain rating scale (NPRS) were used as outcomes measures.
  
  
  RESULTS
  There was a 10 subject change (23%) in positive expectation that was statistically significant (p = 0.019) following a positive message. There was no statistically significant difference in pain and function when these subjects were compared to all other subjects.
  
  
  CONCLUSIONS
  Although patients' expectations of positive outcome significantly changed when providing a positive instructional set, these changes did not translate into clinically significant short term changes in shoulder pain and function.
  
  
  METHODS
  1b.
authors.affiliation: UCONN Health, Farmington, CT, USA; University of Connecticut, Physical Therapy Program, Storrs, CT, USA. Electronic address: sriley@uchc.edu.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Riley
authors.affiliation: University of Florida, Department of Physical Therapy, Gainesville, FL, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Bialosky
authors.affiliation: UCONN Health, Farmington, CT, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cote
authors.affiliation: Texas Woman's University, Houston, TX, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Swanson
authors.affiliation: UCONN Health, Farmington, CT, USA; University of Connecticut, Physical Therapy Program, Storrs, CT, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Tafuto
authors.affiliation: Center for Rehabilitation Research, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Sizer
authors.affiliation: Center for Rehabilitation Research, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Brismée
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000534:rehabilitation; D010147:Pain Measurement; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D016059:Range of Motion, Articular / Q000502:physiology*; D012720:Severity of Illness Index; D020069:Shoulder Pain / Q000175:diagnosis / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Expectation; Manipulation; Physical therapy; Shoulder pain; Thoracic spine