Article

It has been reported that manipulative therapy directed at the
cervical and thoracic spine may improve outcomes in patients with shoulder pain.
To date, limited data are available to help physical therapists determine which
patients with shoulder pain may experience changes in pain and disability
following the application of these interventions. The purpose of this
study was to identify prognostic factors from the history and physical
examination in individuals with shoulder pain who are likely to experience rapid
improvement in pain and disability following cervical and thoracic spine
manipulation. DESIGN: This was a prospective single-arm trial. SETTING: This
study was conducted in outpatient physical therapy clinics. PARTICIPANTS: The
participants were individuals who were seen by physical therapists for a primary
complaint of shoulder pain. INTERVENTION AND MEASUREMENTS: Participants underwent
a standardized examination and then a series of thrust and nonthrust
manipulations directed toward the cervicothoracic spine. Individuals were
classified as having achieved a successful outcome at the second and third
sessions based on their perceived recovery. Potential prognostic variables were
entered into a stepwise logistic regression model to determine the most accurate
set of variables for prediction of treatment success. RESULTS: Data for 80
individuals were included in the data analysis, of which 49 had a successful
outcome. Five prognostic variables were retained in the final regression model.
If 3 of the 5 variables were present, the chance of achieving a successful
outcome improved from 61% to 89% (positive likelihood ratio=5.3). LIMITATIONS: A
prospective single-arm trial lacking a control group does not allow for
inferences to be made regarding cause and effect. The statistical procedures used
may result in "overfitting" of the model, which can result in low precision of
the prediction accuracy, and the bivariate analysis may have resulted in the
rejection of some important variables. CONCLUSIONS:
The identified prognostic
variables will allow clinicians to make an a priori identification of individuals
with shoulder pain who are likely to experience short-term improvement with
cervical and thoracic spine manipulation. Future studies are necessary to
validate these findings.

Langue : ANGLAIS