Between-session changes predict overall perception of improvement but not functional improvement in patients with shoulder impingement syndrome seen for physical therapy: An observational study

Psychological, Pain, and Disability Factors Influencing the Perception of Improvement/Recovery from Physiotherapy in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

OBJECTIVES

The aim of this study was to identify the possible relationships between psychological, pain, and disability variables with respect to the perception of change/recovery from physiotherapy in patients with chronic musculoskeletal pain (CMP).

METHODS

A cross-sectional observational study was performed with 150 patients. All patients completed a series of self-administered questionnaires and a series of self-reports to quantify the perception of change with respect to the physiotherapy they underwent, the level of disability and pain intensity, the level of fear of movement, the level of catastrophism, the degree of self-efficacy, the level of therapeutic alliance and their adherence to the physiotherapy.

RESULTS

The strongest correlations were between the subjective perception of change and the number of sessions, treatment beliefs, self-efficacy, pain intensity, collaboration, and bonding. The linear regression model showed that the number of sessions, treatment beliefs, self-efficacy, compliance, pain intensity, and bonding were predictors of subjective perception of improvement, with 50% of the variance.

CONCLUSIONS

Treatment beliefs, therapeutic alliance, degree of self-efficacy, and pain intensity have been shown to be predictors of a subjective perception of improvement in patients with CMP. In turn, multimodal treatments had the greatest positive impact on the subjective perception of improvement.

Effect of a Patient Engagement, Education, and Restructuring of Cognitions (PEERC) approach on conservative care in rotator cuff related shoulder pain treatment: a randomized control trial

BACKGROUND

Despite similar outcomes for surgery and physical therapy (PT), the number of surgeries to treat rotator cuff related shoulder pain (RCRSP) is increasing. Interventions designed to enhance treatment expectations for PT have been shown to improve patient expectations, but no studies have explored whether such interventions influence patient reports of having had surgery, or being scheduled for surgery. The purpose of this randomized clinical trial was to examine the effect of a cognitive behavioral intervention aimed at changing expectations for PT on patient-report of having had or being scheduled for surgery and on the outcomes of PT.

METHODS

The Patient Engagement, Education, and Restructuring of Cognitions (PEERC) intervention, was designed to change expectations regarding PT. PEERC was evaluated in a randomized, pragmatic "add-on" trial in by randomizing patients with RCRSP to receive either PT intervention alone (PT) or PT + PEERC. Fifty-four (54) individuals, recruited from an outpatient hospital-based orthopedic clinic, were enrolled in the trial (25 randomized to PT, 29 randomized to PT + PEERC). Outcomes assessed at enrollment, 6 weeks, discharge, and six months after discharge included the patient report of having had surgery, or being scheduled for surgery (primary) and satisfaction with PT outcome, pain, and function (secondary outcomes).

RESULTS

The average age of the 54 participants was 51.81; SD = 12.54, and 63% were female. Chronicity of shoulder pain averaged 174.61 days; SD = 179.58. Study results showed that at the time of six months follow up, three (12%) of the participants in the PT alone group and one (3.4%) in the PT + PEERC group reported have had surgery or being scheduled for surgery (p = .32). There were no significant differences between groups on measures of satisfaction with the outcome of PT (p = .08), pain (p = .58) or function (p = .82).

CONCLUSIONS

In patients with RCRSP, PT plus the cognitive behavioral intervention aimed at changing expectations for PT provided no additional benefit compared to PT alone with regard to patient report of having had surgery, or being scheduled to have surgery, patient reported treatment satisfaction with the outcome of PT, or improvements in pain, or function.

TRIAL REGISTRATION

The trial is registered on ClinicalTrials.gov: NCT03353272 (27/11/2017).

Measurement Properties of the Timed Functional Arm and Shoulder Test (TFAST) in Patients With Shoulder Problems

OBJECTIVE

The purpose of this study was to determine the feasibility, reliability, validity, and responsiveness of the Timed Functional Arm and Shoulder Test (TFAST) in patients with shoulder problems.

METHODS

This study was a repeated-measures clinical measurement observational cohort study. A total of 104 individuals who were symptomatic participated in this study. The TFAST was collected as part of a patient's outpatient physical therapy care at 6 different sites. The test and data collection were performed at 3 time points: baseline (initial evaluation), follow-up at the patient's first return visit within 7 days of evaluation, and discharge at the patient's final visit for care.

RESULTS

All participants were able to perform the TFAST at baseline, with 1 exception, and 67 participants completed data collection at all 3 time points. There were no adverse effects in any participant related to performing the TFAST. Intrarater intersession reliability, reported as ICC(2,1), was 0.91 (95% CI = 0.79-0.95). The mean difference in TFAST scores for the affected arm was 23.2 repetitions (77.4 at baseline to 100.6 at discharge). The Cohen d effect size was 1.02, and the standardized response mean was 0.95. The minimal clinically important difference was determined to be 21 repetitions.

CONCLUSION

The TFAST seems to be feasible and appropriate for use in a wider population than other existing shoulder performance measures. The TFAST has demonstrated adequate reliability, validity, and responsiveness in patients with shoulder problems. Clinicians may consider using the TFAST to objectively assess patient performance.

IMPACT

The TFAST may be used to expand measurement of objective shoulder performance in a wide population of patients with shoulder problems. This test may provide information beyond patient self-report and contribute to clinical decision making.

The influence of a cognitive behavioural approach on changing patient expectations for conservative care in shoulder pain treatment: a protocol for a pragmatic randomized controlled trial

BACKGROUND

Despite similar outcomes for surgery and conservative care, the number of surgeries to treat rotator cuff related shoulder pain has increased. Interventions designed to enhance treatment expectations for conservative care have been shown to improve patient expectations, but no studies have yet explored whether such interventions influence patient decisions to pursue surgery. The purpose of this randomized clinical trial is to examine the effect of an intervention designed to improve expectations of conservative care on the decision to have surgery.

METHODS

We will test the effectiveness of the Patient Engagement, Education, and Restructuring of Cognitions (PEERC) intervention which is intended to change expectations regarding conservative care. The PEERC intervention will be evaluated in a randomized, pragmatic "add-on" trial, to better understand the effect the intervention has on outcomes. Ninety-four (94) participants with rotator cuff related shoulder pain referred for physical therapy will be randomized to receive either impairment-based care or impairment-based care plus PEERC. Both groups will receive impairment-based conservative treatment created by compiling the evidence associated with established, effective interventions. Participants assigned to the impairment-based care plus PEERC condition will also receive the PEERC intervention. This intervention, informed by principles of cognitive behavioral therapy, involves three components: (1) strategies to enhance engagement, (2) education and (3) cognitive restructuring and behavioral activation. Outcomes will be assessed at multiple points between enrolment and six months after discharge. The primary outcome is patient reported decision to have surgery and the secondary outcomes are pain, function, expectations and satisfaction with conservative care.

DISCUSSION

Rotator cuff related shoulder pain is highly prevalent, and because conservative and surgical treatments have similar outcomes, an intervention that changes expectations about conservative care could alter patient reports of their decision to have surgery and ultimately could lead to lower healthcare costs and decreased risk of surgical complications.

TRIAL REGISTRATION

This study is registered as NCT03353272 at ClincialTrials.gov.

Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study

OBJECTIVES

The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery.

METHODS

This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up.

RESULTS

The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4 weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (r_pb (112) = 0.27, p = 0.004).

CONCLUSION

Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.

Is residual tendon a predictor of outcome following arthroscopic rotator cuff repair? A preliminary outlook at short-term follow-up

BACKGROUND

Multiple factors including muscle atrophy, fatty infiltration, smoking, advanced patient age, and increasing tear size have been identified as risk factors for retear after rotator cuff repair. However, little is known about what effect the length of the residual rotator cuff tendon has on the success of repair and patient outcomes.

METHODS

This study included 64 patients. Patients were stratified based on a residual tendon length of greater than 15 mm (group 1, residual tendon) or 15 mm or less (group 2, no residual tendon). Rotator cuff tendon integrity was then evaluated using ultrasound imaging at 6 months. Outcome measures included the Single Assessment Numeric Evaluation score, visual analog scale score, EQ5D Index score, Global Rating of Change score, and Penn Shoulder Score.

RESULTS

No differences were found between groups regarding demographic data or repair configuration. Assessment of tendon healing demonstrated an increased rate of tendons that had "not healed" in group 2 (19.3% [n = 5] vs. 13.2% [n = 5]), but this difference was not statistically significant (P = .55). Functional outcome scores improved significantly from preoperatively to final follow-up in both groups and displayed no differences at 6-month follow-up.

CONCLUSION

A smaller residual tendon length was not a negative predictor of clinical outcomes following arthroscopic rotator cuff repair in patients with short-term follow-up. Although there was a trend toward a decreased rate of healing in patients with smaller residual tendons, this was not significant.

Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review

OBJECTIVE

To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education.

DESIGN

Scoping review.

LITERATURE SEARCH

We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019.

STUDY SELECTION CRITERIA

We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain.

DATA SYNTHESIS

We performed a qualitative synthesis that identified items included in patient advice and education.

RESULTS

Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice.

CONCLUSION

While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change. J Orthop Sports Phys Ther 2020;50(6):285-293. doi:10.2519/jospt.2020.9152.

Are within and/or between session improvements in pain and function prognostic of medium and long-term improvements in musculoskeletal problems? A systematic review

BACKGROUND

Initial or between session improvements in pain and/or function are often considered to be predictive of ultimate outcomes in musculoskeletal problems.

OBJECTIVE

To determine the long-term prognostic value of within and between session improvements to pain and function.

DESIGN

Systematic review of relevant literature.

METHOD

A search was made of multiple databases (Pubmed/Medline, Cochrane, Cinahl, and AMed) using relevant search terms. Titles, abstracts, and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction, and quality assessment, using GRADE, were done independently by two authors. Disagreements were resolved by consensus.

RESULTS

Only 13 articles met the criteria for inclusion. For the effect of pain location or pain intensity changes in the first treatment session on medium or long-term pain, disability, return-to-work, or global outcomes nine outcomes were available. Findings were mostly inconclusive (5) or negative (3). There was only one study evaluating between session improvements with ambiguous results. There were no studies evaluating the prognostic value of early improvements in function.

CONCLUSIONS

There is no conclusive evidence to support the concept that early changes in pain location or pain intensity offer a good longer-term prognosis on a variety of outcomes; and no evidence relating to early improvements in function. The idea that patients who appear to improve in the first treatment session will do well longer term is not supported by the literature.

Reliability of the Shoulder Symptom Modification Procedure and association of within-session and between-session changes with functional outcomes

Background

Despite being a common problem, there is considerable diagnostic uncertainty with regard to shoulder pain. This uncertainty relates to the reliability and validity of current examination tests. The Shoulder Symptom Modification Procedure (SSMP) has been proposed as an alternative to existing approaches.

Objective

To evaluate interclinician reliability of the SSMP and the association of within-session and between-session changes on clinical outcome at 1 week, and at 1 and 3 months.

Design

A single-centre reliability study, with prospective follow-up.

Methods

Twenty-six patients with shoulder pain were recruited. Following an initial SSMP-based examination, a second examination was performed by a second physiotherapist, blinded to the results of the first examination. Clinical outcome data were completed after 1 week, 1 month and 3 months via theNumeric Pain Rating Scale and the Shoulder PainandDisability Index. Reliability was evaluated using kappa and associations were evaluated using Spearman’s r.

Results

Inter-rater reliability of the SSMP was moderate (κ=0.47). Association of within-session changes ranged from fair to poor in the short term (r=0.24–0.01) to poor in the mid-term (r=−0.03). The association of between-session changes ranged from substantial to moderate in the short term (r=0.74–0.47) but slight in the mid-term (r=0.22).

Conclusions

Based on this study, we cannot recommend the SSMP as a reliable tool for physical examination of patients with shoulder pain. The importance of within-session and between-session changes remains uncertain.

Does early change predict long-term (6 months) improvements in subjects who receive manual therapy for low back pain?

Early change is commonly assessed for manual therapy interventions and has been used to determine treatment appropriateness. However, current studies have only explored the relationship of between or within-session changes and short-/medium-term outcomes. The goal of this study was to determine whether pain changes after two weeks of pragmatic manual therapy could predict those participants with chronic low back pain who demonstrate continued improvements at 6-month follow-up. This study was a retrospective observational design. Univariate logistic regression analyses were performed using a 33% and a 50% pain change to predict improvement. Those who experienced a ≥33% pain reduction by 2 weeks had 6.98 (95% CI = 1.29, 37.53) times higher odds of 50% improvement on the GRoC and 4.74 (95% CI = 1.31, 17.17) times higher odds of 50% improvement on the ODI (at 6 months). Subjects who reported a ≥50% pain reduction at 2 weeks had 5.98 (95% CI = 1.56, 22.88) times higher odds of a 50% improvement in the GRoC and 3.99 (95% CI = 1.23, 12.88) times higher odds of a 50% improvement in the ODI (at 6 months). Future studies may investigate whether a change in plan of care is beneficial for patients who are not showing early improvement predictive of a good long-term outcome.

Is there an association between fear avoidance beliefs, and pain and disability in patients with orofacial pain?

Numerous psychosocial factors have been shown to contribute to the development and perpetuation of orofacial pain. One well-recognized model for explaining the link between psychosocial factors and chronic pain is the fear avoidance model. To date, this proposed link has not been studied in subjects with orofacial pain. During the initial evaluation of subjects with orofacial pain, we collected data on fear avoidance beliefs using the Fear Avoidance Beliefs Questionnaire, and disability and pain. At between 6 and 8 weeks follow-up, we re-collected these data, as well as data addressing subjects' perceived change in their condition. Data were analyzed using correlation coefficients and linear regression. Fear avoidance beliefs at intake were inversely correlated with intake disability, There were no significant associations between fear avoidance beliefs at initial evaluation or in changes in fear avoidance beliefs during the 6-8 weeks follow-up period; and changes in disability, pain or perceived change in condition at 6-8 weeks follow-up. Of note, fear avoidance beliefs increased over the follow-up period, despite improvements in all outcome measures. There was insufficient evidence to suggest that high levels of fear avoidance beliefs at initial evaluation are associated with higher levels of disability or pain at intake, or with change in disability, pain or perceived change in condition at 6-8 weeks follow-up. Similarly, there was insufficient evidence to suggest that changes in fear avoidance beliefs during treatment are associated with any of these outcome measures.

Epidemiology of Rotator Cuff Tendinopathy: A Systematic Review

Background

An understanding of the epidemiology of a problem is central to facilitating clinical understanding, resource allocation and future research priorities.

Objectives

To systematically review and report incidence, prevalence, risk and prognostic factors for rotator cuff tendinopathy.

Methods

An electronic search of MEDLINE, CiNAHL, PsychINFO to December 2012 was complemented by hand and citation-searching. Studies were selected in relation to pre-defined criteria. A narrative synthesis was undertaken.

Results

The incidence of rotator cuff tendinopathy ranges from 0.3% to 5.5% and annual prevalence from 0.5% to 7.4%. There is limited evidence suggesting that increasing age and other personal, work-related and psychosocial factors are associated with onset. There is strong evidence suggesting that high baseline pain and disability and previous episodes of shoulder pain are associated with an unfavourable outcome and strong evidence suggesting that biomedical diagnosis is not associated with outcome. Other factors were identified but were only supported by moderate or limited evidence.

Conclusions

Rotator cuff tendinopathy is a common problem but uncertainty remains regarding the true extent and risk factors associated with onset. High baseline pain and disability and previous episodes are associated with an unfavourable outcome but biomedical diagnosis is not associated with outcome.

Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria

BACKGROUND

Shoulder impingement syndrome (SIS) is a common diagnosis for patients with pain and dysfunction of the shoulder. Variations in the signs and symptoms might lead to uncertainty regarding the definition of SIS. The aim of this review is to explore the participant selection criteria used in the literature when investigating SIS and to assess differences in criteria among treating professions.

METHODS

This is a PRISMA systematic review of publications from 2009 to 2014 from MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL.

RESULTS

Ninety-seven articles met inclusion criteria for this review. Twenty-five different surgical and nonsurgical treatments were investigated. Impingement-specific index tests were used in all studies. Exclusion index tests were used in 62% of studies. Twenty index tests were identified. Radiological investigations were reported in 53% of all studies, of which a further 53% reported using two or more radiological investigations.

CONCLUSIONS

This systematic review has illustrated that studies investigating SIS test for various signs and symptoms, which is in keeping with describing the condition as a 'syndrome'. However, there are inconsistencies in participant selection criteria between health disciplines, highlighting a need for harmonization of the selection criteria in the form of an international editorial consensus.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Upper Limb Functional Index (ULFI)

STUDY DESIGN

Clinical measurement.

BACKGROUND

The Upper Limb Functional Index (ULFI) is a patient reported outcome (PRO) measure with sound clinimetric properties and clinical viability for determination of upper limb function.

PURPOSE-METHODS

The aims of this study were to cross-culturally adapt the ULFI for Turkish-speaking patients (ULFI-Tk) and investigate the reliability and validity in patients with upper limb problems. Patients (n=l02, age 49.1±16.6) with upper limb disorders were consecutively recruited. All participants completed the ULFI-Tk and the Disability of Arm, Shoulder and Hand Turkish-version (DASH-Tk) criterion at baseline and day-three.

RESULTS

The ULFI-Tk demonstrated good internal consistency (α=0.87), moderate criterion validity (DASH-Tk:r=0.68;p<0.05), moderate reliability (ICC2:1=0.72,CI=0.58-0.80) and strong error measurement (SEM=2.94;MDC90=5.35). Exploratory factor analysis demonstrated a dual factor structure that explained 31.2% of total variance.

CONCLUSIONS

The ULFI-Tk is a reliable and valid PRO that could be used to assess upper limb musculoskeletal disorders in Turkish speaking patients

LEVEL OF EVIDENCE

Class 2.

A Prescriptively Selected Nonthrust Manipulation Versus a Therapist-Selected Nonthrust Manipulation for Treatment of Individuals With Low Back Pain: A Randomized Clinical Trial

STUDY DESIGN

Randomized controlled trial.

BACKGROUND

Several studies that have investigated the effects of a therapist-selected versus a randomly assigned segmental approach have looked at immediate effects only for pain-related outcomes.

OBJECTIVES

To examine differences in outcomes following a therapist-selected nonthrust manipulation versus a prescriptively selected nonthrust manipulation in subjects with low back pain.

METHODS

Subjects with mechanically producible low back pain were randomly treated with nonthrust manipulation in a therapist-selected approach or a prescriptively selected approach. All subjects received a standardized home exercise program. Outcome measures included pain, disability, global rating of change, and patient acceptable symptom state. Analyses of covariance, chi-square tests, and Mann-Whitney U tests were used to determine differences between groups.

RESULTS

Sixty-three subjects were tracked for 6 months, during which subjects in both groups significantly improved. There were no differences between groups in pain, disability, or patient acceptable symptom state scores at 6 months. There was a significant difference in global rating of change scores favoring the therapist-selected manipulation group at 6 months.

CONCLUSION

This study measured long-term differences between a prescriptively selected nonthrust manipulation and a therapist-selected approach to nonthrust manipulation. In pain, disability, and patient acceptable symptom state there were no differences in outcomes, findings similar to studies of immediate effects. After 6 months, perceived well-being was significantly higher for those in the therapist-selected treatment group. The study was registered at ClinicalTrials.gov (NCT01940744).

LEVEL OF EVIDENCE

Therapy, level 1b.

Current rehabilitation applications for shoulder ultrasound imaging

The available body of knowledge on shoulder ultrasound imaging has grown considerably within the past decade, and physical therapists are among the many health care professions currently exploring the potential clinical integration of this imaging technology and the knowledge derived from it. Therefore, the primary purpose of this commentary was to review the recent evidence and emerging uses of ultrasound imaging for the clinical evaluation of shoulder disorders. This includes a detailed description of common measurement techniques along with their known clinimetric properties. Specifically provided are critical appraisals of the existing measures used to estimate soft tissue and bony morphometry, muscle contractile states, and lean muscle density. These appraisals are intended to help clinicians clarify the scope of physical therapy practice for which these measurement techniques are effectively utilized and to highlight areas in need of further development.

Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain?

OBJECTIVES

The primary purpose of this study was to determine whether occurrences of within- and between-session changes were significantly associated with functional outcomes, pain, and self-report of recovery in patients at discharge who were treated with manual therapy for mechanical neck pain. A secondary purpose was to determine the extent of change needed for the within- and between-session change in association to function.

METHODS

This secondary data analysis examined 56 patients who demonstrated a positive response to manual therapy during the initial assessment within a randomized controlled trial (RCT) that examined manual therapy techniques and a home exercise program (HEP). Within- and between-session findings were defined as 'changes in pain report during the initial session (within)' and 'changes in pain from baseline to 48-hours post initial assessment (between)'. Outcomes were analyzed for associations with the global rating of change (GRoC), self-report activity scale (SRAS), and a 50% reduction of the neck disability index (NDI) by discharge at 96 hours.

RESULTS

Findings indicate that within-session pain changes of 36.7% are strongly associated with a 50% change in NDI at 96 hours. Between-session changes in pain were associated with 50% change in NDI and a ≧3-point change in GRoC at 96 hours.

CONCLUSION

Both within- and between-session measures may be useful to predict success levels at 96 hours for NDI; however, between-session changes are more useful to predict success in GRoC. Measures used during clinical examination may help guide clinicians in identification of candidates best suited for the treatment.

Clinimetrics corner: the Global Rating of Change Score (GRoC) poorly correlates with functional measures and is not temporally stable

The Global Rating of Change Score (GRoC) is a frequently used outcome measure that is used independently to measure improvements in a patient's condition or as an anchor for other outcomes measures. The tool has been criticized for recall bias, biases in administration, and for poor reliability over time. Our findings, captured from a sample of patients with shoulder impingement, suggest that all these concerns are of merit. Our results show poor correlation of the GRoC with functional measures after 2 and 3 weeks and decay of the associative stability of the GRoC from week to week.

The ability of a sustained within-session finding of pain reduction during traction to dictate improved outcomes from a manual therapy approach on patients with osteoarthritis of the hip

OBJECTIVES

THE OBJECTIVES OF THIS STUDY WERE TO: (1) determine the association of a within-session finding after traction of the hip with self-report of well-being, pain, and self-report of function at 9 weeks; and (2) to determine if the interactions between the within-session finding and the outcome measure are different between groups of patients with hip OA who receive and who do not receive manual therapy.

METHODS

Data were retrospectively analysed in 70 subjects who were part of a randomized control trial. Correlation analyses of within-session findings from the initial visit after traction of a concordantly painful hip were compared to self-report measures for function, pain, and well-being at 9 weeks. A comparison of slope coefficients between manual therapy and non-manual therapy groups was performed to determine the interactive aspects of the within-session finding.

RESULTS

Although the correlations for the manual therapy group were higher than for the supervised neglect group, none of the correlational analyses for both groups was strong or significant. Significant differences in the slope coefficients for well-being and pain were found, suggesting that the interactions between the within-session findings and the targeted outcomes were different in the manual therapy group versus supervised neglect group.

DISCUSSION

These findings suggest that within-session findings during the initial evaluation are not strongly related to a positive outcome after manual therapy, although the interaction of the finding of a within-session change and the use of manual therapy is more compelling than the finding in a sample of patients who did not receive manual therapy.