title: The effectiveness of noninvasive interventions for musculoskeletal thoracic spine and chest wall pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.
abstract: OBJECTIVE
  The purpose of this study was to critically appraise and synthesize evidence on the effectiveness of noninvasive interventions, excluding pharmacological treatments, for musculoskeletal thoracic pain.
  
  
  METHODS
  Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of noninvasive interventions were eligible. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text accessed through EBSCOhost from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles.
  
  
  RESULTS
  We screened 6988 articles and critically appraised 2 studies. Both studies had a low risk of bias and were included in our synthesis. One RCT compared thoracic spinal manipulation, needle acupuncture, and placebo electrotherapy for recent thoracic spine pain. There were statistically significant but clinically nonimportant short-term reductions in pain favoring manipulation. There were no differences between acupuncture and placebo electrotherapy. Another RCT compared a multimodal program of care and a session of education for recent musculoskeletal chest wall pain. The multimodal care resulted in statistically significant but clinically nonimportant short-term reductions in pain over education. However, participants receiving multimodal care were more likely to report important improvements in chest pain.
  
  
  CONCLUSIONS
  Quality evidence on the management of musculoskeletal thoracic pain is sparse. The current evidence suggests that compared to placebo, spinal manipulation is associated with a small and clinically nonimportant reduction in pain intensity and that acupuncture leads to similar outcomes as placebo. Furthermore, a multimodal program of care (ie, manual therapy, soft tissue therapy, exercises, heat/ice, and advice) and a single education session lead to similar pain reduction for recent-onset musculoskeletal chest wall pain. However, patients who receive multimodal care are more likely to report pain improvements.
authors.affiliation: Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), North York, ON, Canada.
authors.forename: Andrée-Anne
authors.initials: AA
authors.lastname: Marchand
authors.affiliation: Canada Research Chair in Disability Prevention Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shearer
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada; Instructor, Department of Graduate Studies, Canadian Memorial Chiropractic College, North York, ON, Canada.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada.
authors.forename: Sharanya
authors.initials: S
authors.lastname: Varatharajan
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada.
authors.forename: Kristi
authors.initials: K
authors.lastname: Randhawa
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Adjunct Professor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sutton
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada. Electronic address: Hainan.Yu@uoit.ca.
authors.forename: Hainan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Professor, Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Director, Rehabilitation Research Centre, University of Alberta, Edmonton, AB, Canada.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Gross
authors.affiliation: Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Director, Division of Clinical Education and Patient Care, Canadian Memorial Chiropractic College, North York, ON, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Goldgrub
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada.
authors.forename: Maja
authors.initials: M
authors.lastname: Stupar
authors.affiliation: Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Adjunct Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.
authors.forename: Silvano
authors.initials: S
authors.lastname: Mior
authors.affiliation: Professor, Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor-Vaisey
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003299:Cooperative Behavior; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000534:rehabilitation*; D009864:Ontario; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000175:diagnosis / Q000534:rehabilitation*; D000078202:Systematic Reviews as Topic; D013904:Thoracic Vertebrae / Q000503:physiopathology; D035441:Thoracic Wall; D016896:Treatment Outcome
keywords: Acupuncture; Musculoskeletal Manipulations; Musculoskeletal Pain; Patient Education as Topic; Physical Therapy Modalities; Review Literature as Topic; Thoracic Vertebrae; Thoracic Wall