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

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.

• Authors: Sean P Riley, Joel Bialosky, Mark P Cote, Brian T Swanson, Vincent Tafuto, Phillip S Sizer, Jean-Michel Brismée
• Journal: Manual therapy (Man Ther) Vol. 20 Issue 3 Pg. 469-74 (Jun 2015) ISSN: 1532-2769 [Electronic] Scotland
• PMID: 25543999 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.

Topics

• Adult
• Female
• Humans
• Male
• Manipulation, Spinal (methods)
• Middle Aged
• Musculoskeletal Pain (diagnosis, rehabilitation)
• Pain Measurement
• Patient Education as Topic
• Patient Satisfaction (statistics & numerical data)
• Professional-Patient Relations
• Range of Motion, Articular (physiology)
• Severity of Illness Index
• Shoulder Pain (diagnosis, rehabilitation)
• Treatment Outcome