Manipulative Therapy in Addition to Usual Care for Patients With Shoulder Complaints: Results of Physical Examination Outcomes in a Randomized Controlled Trial

Bergman, Gert J.; Winters, Jan C.; Groenier, Klaas H.; Meyboom-de Jong, Betty; Postema, Klaas; van der Heijden, Geert J.

doi:10.1016/j.jmpt.2009.12.004

« Previous Next »Journal of Manipulative and Physiological Therapeutics
Volume 33, Issue 2 , Pages 96-101, February 2010

Manipulative Therapy in Addition to Usual Care for Patients With Shoulder Complaints: Results of Physical Examination Outcomes in a Randomized Controlled Trial

Gert J. Bergman, PhD
- Senior Research Manager, Formerly Department of General Practice and Center for Rehabilitation, University Medical Center Groningen, The Netherlands
Jan C. Winters, MD, PhD
- General Practitioner, Department of General Practice, University Medical Center Groningen, The Netherlands
- Submit requests for reprints to: Jan C. Winters, MD, PhD, Nieuwe Schoolweg 2a, 9756 BB Glimmen, The Netherlands
Klaas H. Groenier, PhD
- Methodologist/Statistician, Department of General Practice, University Medical Center Groningen, The Netherlands
Betty Meyboom-de Jong, MD, PhD
- Professor of General Practice Medicine, Department of General Practice, University Medical Center Groningen, The Netherlands
Klaas Postema, MD, PhD
- Professor of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, The Netherlands
Geert J. van der Heijden, PhD
- Clinical Epidemiologist, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands

Received 6 February 2009; received in revised form 14 September 2009; accepted 25 September 2009.

Abstract

Objective

The purpose of this study was to examine the effect of manipulative therapy on the shoulder girdle, in addition to usual care provided by the general practitioner, on the outcomes of physical examination tests for the treatment of shoulder complaints.

Methods

This was a randomized controlled trial in a primary care setting in the Netherlands. A total of 150 participants were recruited from December 2000 until December 2002. All patients received usual care by the general practitioner. Usual care included one or more of the following depending on the needs of the patient: information/advice, oral analgesics or nonsteroidal antiinflammatory drugs, corticosteroid injections, exercises, and massage. In addition to usual care, the intervention group received manipulative therapy, up to 6 treatment sessions in a 12-week period. Twenty-four physical examination tests were done at baseline and after 6, 12, and 26 weeks. Factor analysis was done to reduce the number of outcome measures.

Results

The factor analysis resulted in 4 factors: “shoulder pain,” “neck pain,” “shoulder mobility,” and “neck mobility.” At 6 weeks, no significant differences between groups were found. At 12 weeks, the mean changes of all 4 factors favored the intervention group; the factors “shoulder pain” and “neck pain” reached statistical significance (95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors “shoulder pain” (95% CI, 0.0-2.6), “shoulder mobility” (95% CI, 0.2-1.7), and “mobility neck” (95% CI, 0.2-1.3) statistically favored the intervention group.

Conclusion

In this pragmatic study, manipulative therapy, in addition to usual care by the general practitioner, diminished severity of shoulder pain and neck pain and improved shoulder and neck mobility.

Key Indexing Terms: Shoulder Pain, Musculoskeletal Manipulations, Randomized Controlled Trial, Physical Examination, Factor Analysis, Statistical