Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain

A Randomized, Controlled Trial

21 September 2004 | Volume 141 Issue 6 | Pages 432-439

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.

Design: Randomized, controlled trial.

Setting: General practices in Groningen, the Netherlands.

Patients: 150 patients with shoulder symptoms and dysfunction of the shoulder girdle.

Interventions: 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.

Measurements: 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.

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

Conclusion: Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.

Editors' Notes Context Shoulder pain in the absence of trauma, fracture, rupture, or dislocation can lead to substantial functional limitations and can be a difficult condition to treat. Contribution In this randomized, controlled trial, patients with shoulder pain and shoulder girdle dysfunction assigned to receive manipulative therapy in addition to usual general practitioner care had more rapid improvement in symptoms and fewer shoulder symptoms at 12 weeks than patients assigned to usual care alone. Implications Manipulative therapy appears to be an effective treatment option for patients with shoulder pain and shoulder girdle dysfunction that are not due to trauma, fracture, rupture, or dislocation. –The Editors

 

Author and Article Information

From University of Groningen and University Hospital of Groningen, Groningen; Maastricht University, Maastricht; Vrije Universiteit Medical Center Amsterdam, Amsterdam; and University Medical Center Utrecht, Utrecht, the Netherlands.

Note: This trial is being registered in the International Standard Randomised Controlled Trial Number (ISRCTN) Register. The ISRCTN was not available before publication of this article.

Acknowledgments: The authors thank Jettie Nomden and Anton Slagers for assistance with data collection and Juliet Foster for editing the manuscript. They also thank the participating manual therapists, general practitioners, and patients.

Grant Support: By Netherlands Organization for Scientific Research (904-65-901) and Foundation De Drie Lichten.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Gert J.D. Bergman, MSc, Department of General Practice, University of Groningen, PO Box 196, 9700 AD Groningen, the Netherlands; e-mail, g.j.d.bergman{at}med.rug.nl.

Current Author Addresses: Mr. Bergman, Mr. Groenier, and Dr. Meyboom-de Jong: Department of General Practice, University of Groningen, PO Box 196, 9700 AD Groningen, the Netherlands.

Dr. Winters: Nieuwe Schoolweg 2a, 9756 BB Glimmen, the Netherlands.

Mr. Pool: Institute for Research in Extramural Medicine, Vrije Universiteit Medical Center Amsterdam, Van der Boechorststraat 5, 1081 BT Amsterdam, the Netherlands.

Dr. Postema: Center for Rehabilitation, University Hospital of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, the Netherlands.

Dr. van der Heijden: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (Str. 6.131), PO Box 85500, 3508 GA Utrecht, the Netherlands.

Author Contributions: Conception and design: G.J.D. Bergman, J.C. Winters, B. Meyboom-de Jong, K. Postema, G.J.M.G. van der Heijden.

Analysis and interpretation of the data: G.J.D. Bergman, G.J.M.G. van der Heijden.

Drafting of the article: G.J.D. Bergman.

Critical revision of the article for important intellectual content: J.C. Winters, K.H. Groenier, J.J.M. Pool, B. Meyboom-de Jong, K. Postema, G.J.M.G. van der Heijden.

Final approval of the article: J.J.M. Pool, B. Meyboom-de Jong, K. Postema, G.J.M.G. van der Heijden.

Provision of study materials or patients: J.C. Winters.

Statistical expertise: K.H. Groenier, G.J.M.G. van der Heijden.

Obtaining of funding: J.C. Winters, G.J.M.G. van der Heijden.

Collection and assembly of data: G.J.D. Bergman.

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