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Man Ther. 2015 Jun;20(3):469-74. doi: 10.1016/j.math.2014.11.011. Epub 2014 Dec 2.

Thoracic spinal manipulation for musculoskeletal shoulder pain: Can an instructional set change patient expectation and outcome?

Author information

1
UCONN Health, Farmington, CT, USA; University of Connecticut, Physical Therapy Program, Storrs, CT, USA. Electronic address: sriley@uchc.edu.
2
University of Florida, Department of Physical Therapy, Gainesville, FL, USA.
3
UCONN Health, Farmington, CT, USA.
4
Texas Woman's University, Houston, TX, USA.
5
UCONN Health, Farmington, CT, USA; University of Connecticut, Physical Therapy Program, Storrs, CT, USA.
6
Center for Rehabilitation Research, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.

Abstract

STUDY DESIGN:

Planned secondary analysis of a randomized clinical trial.

OBJECTIVES:

To examine: 1) patients' baseline expectations for treatment outcome of thoracic high velocity low amplitude thrust manipulations (HVLATM) to the thoracic spine for shoulder pain; 2) if the message conveyed by the clinician changed the patients' expectation; 3) any differences in outcome based on expectation independent of messaging.; and 4) any differences in outcome for those patients whose expectations significantly changed as a result of the messaging.

BACKGROUND:

Thoracic HVLATM may be an effective intervention for patients suffering from musculoskeletal shoulder pain. The role of expectation in the treatment effectiveness of this intervention has not been established.

METHODS:

Subjects' expectations regarding the effectiveness of HVLATM on shoulder pain were recorded at baseline. This was reassessed immediately following the provision of positive or neutral instructional set. The subjects then received a thoracic or scapular HVLATM. The Shoulder Pain and Disability Index (SPADI) and the numeric pain rating scale (NPRS) were used as outcomes measures.

RESULTS:

There was a 10 subject change (23%) in positive expectation that was statistically significant (p = 0.019) following a positive message. There was no statistically significant difference in pain and function when these subjects were compared to all other subjects.

CONCLUSION:

Although patients' expectations of positive outcome significantly changed when providing a positive instructional set, these changes did not translate into clinically significant short term changes in shoulder pain and function.

LEVEL OF EVIDENCE:

1b.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01743833.

KEYWORDS:

Expectation; Manipulation; Physical therapy; Shoulder pain; Thoracic spine

PMID:
25543999
DOI:
10.1016/j.math.2014.11.011
[Indexed for MEDLINE]

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