title: Short-term effects of thoracic spinal manipulations and message conveyed by clinicians to patients with musculoskeletal shoulder symptoms: a randomized clinical trial.
abstract: METHODS
  Randomized clinical trial.
  
  
  OBJECTIVE
  To evaluate the effects of high-velocity, low-amplitude thrust manipulations (HVLATMs) and various messages on patients with musculoskeletal shoulder symptoms.
  
  
  BACKGROUND
  Previous studies indicated that HVLATM directed at the thoracic spine and ribs resulted in improvements of shoulder range of motion, pain, and disability in patients with musculoskeletal shoulder symptoms. These studies did not explore if the outcome was dependent on thrust location, clinician communication with the patient, or if there were any lasting effects.
  
  
  METHODS
  A consecutive sample of 100 patients with shoulder pain was randomized into four groups. Patients received one intervention session including: six thoracic HVLATM (spine versus scapula), a message about HVLATM (neutral versus positive), and standardized home exercises. Outcome measures included shoulder Numeric Pain Rating Scale (NPRS), NPRS with impingement testing, and Shoulder Pain and Disability Index (SPADI). Measurements were recorded prior to intervention, immediately following intervention, and at short-term follow-up. Kruskal-Wallis statistics were used for between-group comparisons and Wilcoxon signed ranks for within-group comparisons.
  
  
  RESULTS
  Eighty-eight patients (22 per group) completed the study. Statistically significant differences were found for within-group comparisons for most time points assessed. No statistical differences were found for between-group comparisons.
  
  
  CONCLUSIONS
  Patients improved following the interventions. Neither the type of HVLATM nor the message conveyed to the patients had a significant effect on the patients' improvements.
  
  
  METHODS
  1b.
authors: University of Connecticut Health Center, Farmington, CT, USA.
authors: Sean P
authors: SP
authors: Riley
authors: University of Connecticut Health Center, Farmington, CT, USA.
authors: Mark P
authors: MP
authors: Cote
authors: Salem State University, Salem, MA, USA.
authors: Robin R
authors: RR
authors: Leger
authors: Texas Woman's University, Houston, TX, USA.
authors: Brian T
authors: BT
authors: Swanson
authors: University of Connecticut Health Center, Farmington, CT, USA.
authors: Vincent
authors: V
authors: Tafuto
authors: Center for Rehabilitation Research, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors: Phillip S
authors: PS
authors: Sizer
authors: Center for Rehabilitation Research, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors: Jean-Michel
authors: JM
authors: Brismée
keywords: Manipulation; Physical therapy; Shoulder pain; Thoracic spine