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Manipulative Therapy for Patients with Shoulder Symptoms
Gert J.D. Bergman, MSc;
Jan C. Winters, MD, PhD; and
Geert J.M.G. van der Heijden, PT, PhD
1 February 2005 | Volume 142 Issue 3 | Pages 226-227
IN RESPONSE:
The question regarding subgroup analysis is logical, considering the positive message of our study. Our study was designed to examine the efficacy of additional manipulative treatment for shoulder complaints. At baseline, all of the included patients experienced manifest pain in or dysfunction of the shoulder. At the same time, the physical examination also demonstrated a concomitant dysfunction of the cervicothoracic spine and the adjacent ribs (shoulder girdle dysfunction). We did not perform subgroup analyses on the efficacy of manipulative treatment with regard to specific conditions for several reasons. Subgroup analysis should be based on theoretical considerations. We do not expect large differential effects of manipulative techniques in treatment of shoulder dysfunction due to various postulated specific dysfunctions of the shoulder girdle. A firm theory regarding subgroup effects according to specific shoulder girdle dysfunction is lacking. Moreover, in our opinion, there are more similarities than differences among available manipulative techniques for specific conditions of the cervicothoracic spine and adjacent ribs. In addition, physical examination has not been shown to contribute to the accurate location of such specific conditions or differentiation among them (1). A recent study demonstrated that clinicians cannot accurately distinguish between neck and shoulder problems on physical examination (2). Finally, with our sample size of 150 patients, we were able to demonstrate significant results in our main analysis. Any subgroup analysis would require a larger sample size; the statistical power of such additional analyses in our sample is likely to be insufficient (3).
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Author and Article Information
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From University of Groningen, 9700 AD Groningen, and University Medical Center Utrecht, 3508 GA Utrecht, the Netherlands.
1. Pool JJ, Hoving JL, de Vet HC, van Mameren H, Bouter LM. The interexaminer reproducibility of physical examination of the cervical spine. J Manipulative Physiol Ther. 2004;27:84-90. [PMID: 14970808].
2. Groenier KH, Winters JC, de Jong BM. Classification of shoulder complaints in general practice by means of nonmetric multidimensional scaling. Arch Phys Med Rehabil. 2003;84:812-7. [PMID: 12808531].
3. Brookes ST, Whitely E, Egger M, Smith GD, Mulheran PA, Peters TJ. Subgroup analyses in randomized trials: risks of subgroup-specific analyses; power and sample size for the interaction test. J Clin Epidemiol. 2004;57:229-36. [PMID: 15066682].
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Articles
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain: A Randomized, Controlled Trial
Gert J.D. Bergman, Jan C. Winters, Klaas H. Groenier, Jan J.M. Pool, Betty Meyboom-de Jong, Klaas Postema, AND Geert J.M.G. van der Heijden
- Annals 2004 141: 432-439.
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