Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain

OBJECTIVE: To examine selected psychometric properties of these instruments in a cohort of patients with mechanical neck pain. DESIGN: Cohort design of 78 subjects completing self-report measures of pain, disability, and the Fear-Avoidance Beliefs Questionnaire Work (FABQW) and Physical Activity (FABQPA) subscales, as well as the Tampa Scale of Kinesiophobia (TSK) at baseline and a 2-day follow-up. Intraclass correlation coefficients were used to calculate test-retest reliability, and Cronbach's alpha was used to calculate internal consistency. Concurrent validity was analyzed between the FABQPA, FABQW, TSK, pain, and disability using Pearson correlation coefficients and hierarchical linear regression modeling. RESULTS: The FABQPA and FABQW subscales exhibited substantial test-retest reliability, whereas the TSK exhibited moderate reliability. Internal consistency was high for all measures. The FABQW subscale was the only measure that significantly contributed to the regression model for both pain and disability in this group of patients with neck pain. CONCLUSIONS: Whereas the reliability and internal consistency of all measures ranged between moderate and substantial, the results of this study suggest weaker relationships between measures of fear and avoidance beliefs and pain/disability among patients with mechanical neck pain than has been reported among patients with low-back pain.     

Effectiveness of translational manipulation under interscalene block for the treatment of adhesive capsulitis of the shoulder: A nonrandomized clinical trial

Study Design: Nonrandomized controlled trial. Objective: To determine whether translational manipulation under anesthesia/local block (TMUA) adds to the benefit of mobilization and range of motion exercise for improving pain and functional status among patients with adhesive capsulitis of the shoulder (AC). Background: TMUA has been shown to improve pain and dysfunction in patients with AC. This intervention has not been directly compared to physical therapy treatment without TMUA in a prospective trial. Methods: Sixteen consecutive patients with a primary diagnosis of AC were divided into two groups. Patients in the first (TMUA) group received a session of translational manipulation under interscalene block, followed by six sessions of manipulation and exercise. Patients in the comparison group received seven sessions of manipulation and exercise. Outcome measures taken at baseline and 3, 6, 12 months and 4 years included Shoulder Pain and Disability Index (SPADI) scores. Four-year outcomes included percent of normal ratings, medication use, and activity limitations. Results: Both groups showed improved SPADI scores across all follow-up times compared to baseline. The TMUA group showed a greater improvement in SPADI scores than the comparison group at 3 weeks, with no significant differences in SPADI scores at other time points. However, at 4 years, significantly more subjects in the comparison group (5 of 8) had activity limitations versus subjects in the TMUA group (1 of 8). No subject experienced a complication from either intervention protocol. Conclusion: Physical therapy consisting of manual therapy and exercise provides benefit for patients with AC. Translational manipulation under local block may be a useful adjunct to manual therapy and exercise for patients with AC.     

Osteopathic manipulative treatment combined with exercise improves pain and disability in individuals with non-specific chronic neck pain: A pragmatic randomized controlled trial

PurposeTo determine effectiveness of osteopathic manipulative treatment combined with stretching and strengthening exercises in the cervical region on pain and disability in individuals with non-specific chronic neck pain.Methods90 adults with non-specific chronic neck pain were randomized to either exercises group (EG, n = 45) or osteopathic manipulative treatment associated with exercises group (OMT/EG, n = 45). The primary outcomes were obtained by the use of Numeric Pain-Rating Scale (NPRS), Pressure Pain Threshold (PPT) and Neck Disability Index (NDI). Secondary outcomes included range of motion (ROM) for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire Work/Physical Activity (FABQ-W/PA) and Pain-self efficacy at two different moments: baseline and 4 weeks after the first treatment. Techniques and dosages of OMT were selected pragmatically by a registered osteopath. Generalized Estimating Equations model (GEE), complemented by the Least Significant Difference (LSD) and the intention-to-treat analysis, was used to assess the clinical outcomes.ResultsAnalysis with GEE indicated that OMT/EG reduced pain and disability more than the EG alone after 4 weeks of treatment with statistically significant difference (p < 0,05), as well as cervical active rotation was significantly improved (p = 0.03). There were no between-group differences observed in Pressure Pain Threshold (PPT) measure, Fear-Avoidance Beliefs Questionnaire and Pain-self efficacy.ConclusionThe association between OMT and exercises reduces pain and improves functional disability more than only exercise for individuals with non-specific chronic neck pain.     

Immediate effect of pain neuroscience education for recent onset low back pain: an exploratory single arm trial

Study Design: A prospective, single-arm, pre-postintervention study.

Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP).

Background: PNE has been shown to be an effective intervention for the treatment of chronic LBP but its usefulness in patients with non-chronic LBP has not been examined.

Methods: A single group cohort pilot study was conducted. Eighty consecutive patients with LBP < 3 months completed a demographics questionnaire, leg and LBP rating (Numeric Pain Rating Scale – NPRS), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance Beliefs Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), central sensitization (Central Sensitization Inventory), pain knowledge (Revised Neurophysiology of Pain Questionnaire), risk assessment (Keele STarT Back Screening Tool), active trunk flexion and straight leg raise (SLR). Patients received a 15-minute verbal, one-on-one PNE session, followed by repeat measurement of LBP and leg pain (NPRS), trunk flexion and SLR.

Results: Immediately after intervention, LBP and leg pain improved significantly (p < 0.001), but the mean change did not exceed minimal clinically important difference (MCID) of 2.0. Active trunk flexion significantly improved (p < 0.001), with the mean improvement (4.7 cm) exceeding minimal detectible change (MDC). SLR improved significantly (p = 0.002), but mean change did not exceed MDC.

Conclusions: PNE may be an interesting option in the treatment of patients with non-chronic mechanical LBP. The present pilot study provides the rationale for studying larger groups of patients in controlled studies over longer periods of time.     

Impact of psychosocial factors,pain, and functional limitations on throwing athletes who return to sport following elbow injuries: A case series

Background and purpose: The purpose of this case series is to explore the possibility that: (1) throwing athletes respond to fear-avoidance model (FAM) measures differently than patients in other orthopedic populations; and (2) there is an association between the FAM measures, pain and function scores. Methods: Five competitive throwing athletes with elbow pain between the ages of 17–23 were included. Patients were given the Fear Avoidance Belief Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), QuickDash, and Numeric Pain Rating Scale (NPRS) at initial evaluation and at 4 weeks. Outcomes: Subjects all demonstrated low levels of fear on initial evaluation and all returned to sport. FABQ-PA, TSK, and PCS subscales were all highly associated with the initial total scales (r?=?>0.80) with the exception of the PCS helplessness subscale (r?=?0.61). Subjects demonstrated an average decrease in the NPRS score of 2.3 points and average improvement of 23.6 points in their QuickDash score. There was a fair association between initial TSK fear of injury (FOI) subscale and initial QuickDash scores (r?=?0.47) and a moderate association between initial TSK-11 FOI subscale and initial pain scores (r?=?0.61). Discussion: Subjects in this case study appeared to respond to the FAM questionnaires differently than patients in other orthopedic populations. The TSK FOI subscale may be the most beneficial to use with throwing athletes.     

Application of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in patients with shoulder pain; a prospective longitudinal study

Objectives: The primary objective was to determine if the pain and function response to the McKenzie system of Mechanical Diagnosis and Therapy (MDT) differs by MDT classification category at two and four weeks following the start of MDT treatment for shoulder complaints. The secondary objective was to describe the frequency of discharge over time by MDT classification.

Methods: International, MDT-trained study collaborators recruited 93 patients attending physiotherapy for rehabilitation of a shoulder problem. The Numeric Pain Rating Scale (NPRS) and the Upper Extremity Functional Index (UEFI) were collected at the initial assessment and two and four weeks after treatment commenced. A two-way mixed model analysis of variance with planned pairwise comparisons was performed to identify where the differences between MDT classification groups actually existed.

Results: The Derangement and Spinal classifications had significantly lower NPRS scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The Derangement and Spinal classifications had significantly higher UEFI scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The frequency of discharge at week 2 was 37% for both Derangement and Spinal classifications, with no discharges for the Dysfunction classification at this time point. The frequency of discharge at week 4 was 83, 82 and 15% for the Derangement, Spinal and Dysfunction classifications, respectively.

Discussion: Classifying patients with shoulder pain using the MDT system can impact treatment outcomes and the frequency of discharge. When MDT-trained clinicians are allowed to match the intervention to a specific MDT classification, the outcome is aligned with the response expectation of the classification.

Level of Evidence: 2b     

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders

Abstract

Purpose: To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). Method: A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. Results: Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges?=?0.77–0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma?=??0.51 to ?0.58) were found between the changes in SPADI/DASH and changes in global rating scale. Conclusions: The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention.

• Implications for Rehabilitation

• Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis.

• The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings.

• The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.

     

Use of Mobilization with Movement in the Treatment of a Patient with Subacromial Impingement: A Case Report

Abstract

Mobilization with movement (MWM) is a fairly new therapeutic technique commonly used by physical therapists. The purpose of this case report was to describe the use of MWM in the treatment of a 27-year old left-hand dominant male patient referred to physical therapy with a diagnosis of supraspinatus tendinopathy secondary to impingement. Interventions consisted of MWM and other manual therapy techniques, modalities, and therapeutic exercises. Outcome measures used included goniometric active range of motion (AROM) measurements and manual muscle tests of the shoulder, impingement tests, and the Shoulder Pain and Disability Index (SPADI) and Short Form-36 (SF-36) questionnaires. Specific outcome measures used to describe the response to MWM of the glenohumeral joint included the Numeric Pain Rating Scale (NPRS) and goniometric measurement of abduction AROM. After the first MWM treatment (session 2/12), the 6/10 pre-application NPRS score during shoulder abduction was reduced to 3/10 post-application; however, abduction AROM did not improve (95°). At the final MWM treatment (session 6/12), the pre-application NPRS score during abduction was reduced from 3/10 to 0/10 post-application; abduction AROM increased from 130° to 175°. After 12 sessions, there was a decrease from moderate pain (7/10) to little or no pain (0-1/10) during active shoulder abduction; restricted (95°) to full shoulder abduction active range of motion (180°); and an improvement in the SPADI score from 45% to 8% with no pain or ADL activity difficulty scores >2. This case report indicates that MWM may be an effective treatment intervention for patients with subacromial impingement. Future research is needed to study the efficacy and mechanisms of this treatment technique.     

Psychometric Properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in Patients With Shoulder Pain

Mintken PE, Cleland JA, Whitman JM, George SZ. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain.

Objective

To investigate the reliability and validity of 2 commonly used measures of pain related fear in patients with shoulder pain.

Design

A preplanned secondary analysis of a prospective single-arm trial involving a repeated-measures design.

Setting

Outpatient physical therapy clinics.

Participants

Patients (N=80) with a primary report of shoulder pain.

Intervention

All patients completed the outcome measures at baseline and at follow-up.

Main Outcome Measures

Patients completed a modified Fear-Avoidance Beliefs Questionnaire (FABQ), the 11-item version of Tampa Scale of Kinesiophobia (TSK-11), and the Shoulder Pain and Disability Index (SPADI) at baseline and at a 48-hour follow-up. Patients were dichotomized as improved or stable at follow-up based on the Global Rating of Change.

Results

Factor analysis indicated 3 stable factors for the FABQ and 1 stable factor for the TSK-11. Shoulder specific scoring for the FABQ and TSK-11 were used in subsequent analyses. Test-retest reliability intraclass correlation coefficient (ICC) was substantial for the FABQ and the TSK-11. The FABQ correlated significantly with SPADI pain and disability scores, while the TSK-11 correlated significantly only with SPADI pain scores. The shoulder-specific FABQ-W (work beliefs subscale) was a better than chance predictor of missing days of work during the 48-hour study period.

Conclusions

The modified FABQ and TSK-11 may be appropriate for use in patients with shoulder pain. Shoulder-specific scoring of these measures resulted in substantial test-retest reliability, and the FABQ correlated with the SPADI for pain and disability. The FABQ also showed potential for prediction of short-term work loss in this sample. Pain-related fear may be an important variable in patients with shoulder pain and merits future consideration in longitudinal studies.     

Short-term effects of thoracic spinal manipulations and message conveyed by clinicians to patients with musculoskeletal shoulder symptoms: a randomized clinical trial

Study design:

Randomized clinical trial.

Objectives:

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.

Conclusion:

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.

Level of evidence:

1b     

Indian (Marathi) version of the Shoulder Pain and Disability Index (SPADI): Translation and validation in patients with adhesive capsulitis

Background:The Shoulder Pain and Disability Index (SPADI) is the most commonly used self-administered questionnaire which is a valid and reliable instrument to assess the proportion of pain and disability in shoulder disorders. There is no evidence of SPADI questionnaire being translated into regional Indian language (Marathi).Objective:This study aims to translate and culturally adapt and validate the Marathi version of the SPADI questionnaire. This was done as per the AAOS outcomes committee guidelines.Methods:Cross-cultural adaptation and psychometric testing of SPADI was done in the Outpatient Physiotherapy Department of Tertiary Care Hospital, Ahmednagar, India.Results:The internal consistency was assessed by calculating Cronbach alpha value for the pain score (0.908), disability score (0.959), and total SPADI (0.969) which were all high. The Test–retest reliability was assessed using the intraclass correlation coefficient (ICC) values for the pain score (0.993), disability score (0.997), and total SPADI (0.997) which showed excellent reliability. The criterion validity was assessed using Pearson correlation coefficient. In Males, weak to strong negative correlation was observed except for shoulder extension and in females, moderate negative correlation was observed between baseline shoulder range of motion and initial total SPADI scores and individual pain and disability except for shoulder internal rotation. The internal consistency of the Marathi SPADI (Cronbach’s alpha >0.99) was higher than the original English version. The reliability of the total Marathi SPADI and its subscale (Intraclass correlation coefficient >0.90) were found to be higher than that of the English SPADI and were consistent with the German, Brazilian, Slovene and Greek versions.Conclusion:The translated and culturally adapted Marathi version of the SPADI questionnaire is a reliable and valid tool for the assessment of pain and disability in Marathi population.     

Osteopathic treatment of patients with shoulder pain. A pragmatic randomized controlled trial

BackgroundShoulder complaints are common in the general population. Typically, the diagnosis of a specific pathology is lacking. The objective of this trial was to evaluate the effectiveness of an osteopathic treatment in patients suffering from shoulder pain.MethodsA pragmatic randomized controlled trial was conducted in patients with a history of shoulder pain of 6 weeks to 12 months, and a pain intensity level of at least 40% on the visual analogue scale (VAS). Participants were identified from the general population in Germany and allocated by means of external randomization to an intervention group or a control group. Patients in the intervention group received five osteopathic treatments at intervals of two weeks. Treatment was custom tailored and based on osteopathic principles. Controls received their osteopathic treatment after an 8-week untreated waiting period. Primary outcome parameters were pain intensity and frequency, measured by VAS and Likert Scales. Secondary outcome parameters were shoulder specific pain and disability (Shoulder Pain and Disability Index, SPADI), and quality of life (SF-36).ResultsA total of 70 patients aged 25–70 years (average age 45.6 ± 13.4 years) were included, 36 in the intervention group and 34 in the control group. The inter-group comparison of changes revealed clinically relevant improvements in favor of the intervention group for the main outcome parameters maximal pain intensity (VAS: between group difference of means 41.5; 95% CI: 34.6 to 48.3; p < 0.005) and average pain intensity (VAS: between group difference of means 40.4; 95% CI: 33.2 to 47.5; p < 0.005). The proportion of participants with a low frequency of pain increased in the osteopathic group only (from 7 to 34 vs. 9 to 6 in the control group, p = 0.006), and the number of patients with a high frequency decreased in the osteopathic group only (from 29 to 2 vs. 25 to 28, p < 0.0005). Shoulder specific pain and disability also improved. The follow-up assessment in the intervention group showed further improvements.ConclusionsFive osteopathic treatments over a period of eight weeks led to statistically significant and clinically relevant positive changes of pain and disability in patients suffering from shoulder pain.     

Comparative Effectiveness of Corticosteroid Dosages for Ultrasound-Guided Glenohumeral Joint Hydrodilatation in Adhesive Capsulitis: A Randomized Controlled Trial

ObjectiveTo investigate the efficacy of hydrodilatation with 40 mg triamcinolone acetonide (TA) compared with the same procedure with 10 mg TA in patients with adhesive capsulitis (AC) of the shoulders.DesignProspective, double-blind, randomized controlled trial with 12 weeks of follow-up.SettingTertiary care rehabilitation center.ParticipantsEighty-four patients diagnosed with AC (N=84).InterventionsUltrasound guidance using (A) hydrodilatation with 4 mL of TA (40 mg)+4 mL 2% lidocaine hydrochloride+12 mL normal saline or (B) hydrodilatation with 1 mL of TA (10 mg)+4 mL 2% lidocaine hydrochloride+15 mL normal saline through the posterior glenohumeral recess.Main Outcome MeasuresShoulder Pain and Disability Index (SPADI), visual analog scale (VAS) for pain, and range of motion (ROM) at baseline and at 6 and 12 weeks after injection.ResultsBoth groups experienced improvements in the SPADI score, VAS scores for pain, and ROM throughout the study period. However, group-by-time interactions were not significant for any outcome measurement at any follow-up time point. No adverse events were reported in either group.ConclusionUltrasound-guided hydrodilatation with 40 and 10 mg TA yielded similar improvements in SPADI, VAS score, and ROM at the 12-week follow-up. Considering the potential detrimental effects of corticosteroids on the adjacent cartilage and tendons, a low dose of TA would be preferable for ultrasound-guided hydrodilatation for AC.     

A randomized clinical trial comparing non-thrust manipulation with segmental and distal dry needling on pain,disability, and rate of recovery for patients with non-specific low back pain

ABSTRACT

Objective: The purpose of this study was to examine the within and between-group effects of segmental and distal dry needling (DN) without needle manipulation to a semi-standardized non-thrust manipulation (NTM) targeting the symptomatic spinal level for patients with non-specific low back pain (NSLBP).

Methods: Sixty-five patients with NSLBP were randomized to receive either DN (n = 30) or NTM (n = 35) for six sessions over 3 weeks. Outcomes collected included the oswestry disability index (ODI), patient specific functional scale (PSFS), numeric pain rating scale (NPRS), and pain pressure thresholds (PPT). At discharge, patients perceived recovery was assessed.

Results: A two-way mixed model ANOVA demonstrated that there was no group*time interaction for PSFS (p = 0.26), ODI (p = 0.57), NPRS (p = 0.69), and PPT (p = 0.51). There was significant within group effects for PSFS (3.1 [2.4, 3.8], p = 0.018), ODI (14.5% [10.0%, 19.0%], p = 0.015), NPRS (2.2 [1.5, 2.8], p = 0.009), but not for PPT (3.3 [0.5, 6.0], p = 0.20).

Discussion: The between-group effects were neither clinically nor statistically significant. The within group effects were both significant and exceeded the reported minimum clinically important differences for the outcomes tools except the PPT. DN and NTM produced comparable outcomes in this sample of patients with NSLBP.

Level of evidence: 1b     

Comparison of the University of California-Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity

BACKGROUND AND PURPOSE: Shoulder scales are often used to evaluate treatment efficacy, yet little is known about the psychometric properties of these scales. Only one scale has undergone psychometric scrutiny: the Shoulder Pain and Disability Index (SPADI). This study compared 2 shoulder measures-the University of California-Los Angeles (UCLA) Shoulder Scale and the Simple Shoulder Test (SST)-with the SPADI. SUBJECTS: One hundred ninety-two patients with shoulder disorders were recruited from one physician's office to complete the self-report sections of the 3 scales. METHODS: Cronbach alpha values and standard errors of measurement (SEM) were calculated for each of the multi-item subscales. Validity was examined through calculation of correlation coefficients among the 3 scales. Factor analysis was completed to assess the underlying constructs of the SPADI and the SST. RESULTS: Cronbach alpha values ranged from.85 to.95. The SEM values for the multi-item scales ranged from 4.75 to 11.65. Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale. The factor analysis of the SPADI revealed loading on 1 factor, whereas the SST loaded on 2 factors. CONCLUSION AND DISCUSSION: All scales demonstrated good internal consistency, suggesting that all items for each scale measure the same construct. However, the SEMs for all scales were high. Factor loading was inconsistent, suggesting that patients may not distinguish between pain and function.     

Does Scapula Taping Facilitate Recovery for Shoulder Impingement Symptoms? A Pilot Randomized Controlled Trial

Abstract

Scapula taping is a commonly used adjunctive treatment for shoulder im- pingement pathology. However, this intervention has not previously been subject to formal investigation. A pilot single-blind randomized controlled trial was conducted to evaluate facilitatory taping as an adjunct to routine physiotherapy management. Twenty-two sub- jects with unilateral shoulder impingement symptoms were randomized into a taping with routine physiotherapy or a routine physiotherapy only group. The intervention group had scapula taping applied three times per week for the first two weeks of their treatment. All subjects were assessed at baseline, then at 2 and 6 weeks after the commencement of treat- ment. Pain and functional ability were assessed using the Shoulder Pain and Disability In- dex, range of shoulder elevation, and self-reported pain on elevation. At 2 weeks, the taping group demonstrated a strong trend toward reduced pain both on self-reported activity (SPADI pain subscale mean for taping 27.0 versus 41.5 for control) and pain during mea- sured abduction (mean VAS 22.8 for taped, 46.8 for control), statistical power being limited by small sample size. No similar trend was evident in the SPADI disability subscale. The magnitude of the differences was reduced at 6-week follow-up. This study provides prelimi- nary evidence for a short-term role for scapula taping as an adjunct to routine physiother- apy in the management of shoulder impingement symptoms but also highlights the need for consideration on a case basis relating to risk factors for skin reaction.     

The efficacy of stretching exercises to reduce posterior shoulder tightness acutely in the postoperative population: a single blinded randomized controlled trial

Background: Posterior shoulder tightness (PST) is a postoperative complication leading to pain, impaired mobility, and reduced function. Despite the potential morbidity associated with PST, no studies have investigated the efficacy of shoulder-stretching methods in the postsurgical population. The purpose of this study was to determine the short-term efficacy of two stretches designed to reduce PST. Methods: The study enrolled 63 patients [mean age 51 (12) years, height 173.7 (3.6) cm, body mass 88.2 (17.9) kg]. The study was a single-blinded randomized control trial in which patients who had arthroscopic shoulder surgery were assigned to one of three groups: [(horizontal adduction stretch (n = 21), supine sleeper (n = 21), or control (n = 21)]. Dependent variables included measurements of internal rotation mobility, sidelying PST, pain, and the QuickDASH. Following the physical therapy (PT) initial evaluation, subjects were instructed to perform the allocated intervention twice daily until their first follow-up appointment 48–72 h following the initial PT visit. Results: Between group analyses of dependent variables revealed significant differences within PST measurements (p = 0.005) (eta squared = 0.14) taken at baseline and follow-up (48–72 h) favoring horizontal adduction stretching. Post-hoc testing demonstrated superiority of horizontal adduction stretching over both the supine sleeper group (p = 0.01) and control (p = 0.002). Discussion and conclusion: The horizontal adduction stretch is more effective at reducing acute PST in the postoperative shoulder population when compared to the supine sleeper stretch and no stretch at all. Knowledge of efficacious stretching methods may serve to reduce the potential morbidity associated with postoperative stiffness.     

Immediate and short-term effects of mulligan concept positional sustained natural apophyseal glides on an athletic young-adult population classified with mechanical neck pain: an exploratory investigation

Objectives: Mechanical neck pain (MNP) is common in the athletic population. While symptoms may present at the cervical spine for patients complaining of MNP, thoracic spinal alignment or dysfunction may influence cervical positioning and overall cervical function. Clinicians often employ cervical high-velocity low-amplitude (HVLA) thrust manipulations to treat MNP, albeit with a small level of inherent risk. Mulligan Concept positional sustained natural apophyseal glides (SNAGs) directed at the cervicothoracic region are emerging to treat patients with cervical pain and dysfunction, as evidence supporting an interdependent relationship between the thoracic and cervical spine grows. The purpose of this a priori study was to evaluate outcome measures of patients classified with MNP treated with the Mulligan Concept Positional SNAGs. Methods: Ten consecutive young-adult patients, ages ranging from 15 to 18 years (mean = 16.5 ± 1.78), classified with MNP were treated utilizing Mulligan Concept Positional SNAGs. The Numeric Rating Scale (NRS), Patient-Specific Functional Scale (PSFS), Neck Disability Index (NDI), Disablement in the Physically Active (DPAS), and Fear-Avoidance Based Questionnaire-Physical Activity (FABQPA) were collected for inclusion criteria and to identify patient-reported pain and dysfunction. Results: Patients reported decreases in pain on the NRS [5.4 to .16, p = .001], increases in function on the PSFS [5.2 to 10, p = .001], and increases in cervical range of motion (CROM) [ext p = .003, flex p = .009, left rot p = .001, right rot p = .002] immediately post-treatment and between treatments. Discussion: Positional SNAGs directed at the cervicothoracic region may address a variety of patient reported symptoms for MNP, and the number of treatment sessions needed for symptom resolution may be closer to a single session rather than multiple treatments. Level of Evidence: 4.     

The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome

The study was an exploratory, one group pretest/post-test study, with the objective of investigating the short-term effects of thoracic spine thrust manipulations (TSTMs) on patients with shoulder impingement syndrome (SIS). There is evidence that manual physical therapy that includes TSTM and non-thrust manipulation and exercise is effective for the treatment of patients with SIS. However, the relative contributions of specific manual therapy interventions are not known. To date, no published studies address the short-term effects of TSTM in the treatment of SIS. Fifty-six patients (40 males, 16 females; mean age 31.2+/-8.9) with SIS underwent a standardized shoulder examination, immediately followed by TSTM techniques. Outcomes measured were the Numeric Pain and Rating Scale (NPRS) and the Shoulder Pain and Disability Index (SPADI), all collected at baseline and at a 48-h follow-up period. Additionally, the Global Rating of Change Scale (GRCS) was collected at 48-h follow-up to measure patient perceived change. At 48-h follow-up, the NPRS change scores for Neer impingement sign, Hawkins impingement sign, resisted empty can, resisted external rotation, resisted internal rotation, and active abduction were all statistically significant (p<0.01). The reduction in the SPADI score was also statistically significant (p<0.001) and the mean GRCS score=1.4+/-2.5. In conclusion, TSTM provided a statistically significant decrease in self reported pain measures and disability in patients with SIS at 48-h follow-up.     

Effectiveness of mechanical diagnosis and therapy in patients with back pain who meet a clinical prediction rule for spinal manipulation

Recently a clinical prediction rule (CPR) for lumbar regional spinal thrust manipulation (STM) has shown predictive success in patients with back pain who met specific selection criteria. The purpose of this study was to compare the effectiveness of STM and mechanical diagnosis and therapy (MDT) in patients who are positive for the STM CPR. Following initial examination, 31 participants were randomized to the STM group (n = 16) and to the MDT group (n = 15). Two weeks following initial examination, four participants chose to cross over from the STM group to the MDT group. The Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire work subscale (FABQw), and the Numerical Pain Rating Scale (NPRS) were administered initially, and at 2-weeks and 4 week follow-up (discharge). Data were analyzed to determine changes in ODI and NPRS scores from initial examination through one month. Of the 31 participants, one patient who met only three of five selection criteria and four others who chose to switch groups were removed from the analysis. Both groups exhibited statistically significant improvements in ODI and NPRS scores from baseline to final visit but there was no significant difference in scores between groups at 4 weeks. In this sample of patients, the selection criteria for this CPR were not exclusive for lumbopelvic STM. Mechanical diagnosis and therapy was an equally viable choice for these patients.