Author Names

Gomes, C., Dibai-Filho, A., Politti, F., Gonzalez, T., Biasotto-Gonzalez, D.

Reviewer Name

Nikol Papa

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Objective: The purpose of this study was to evaluate the effect of combined manual therapy (MT) and diadynamic (DD) currents on myofascial trigger points of the upper trapezius muscle in individuals with a diagnosis of unilateral shoulder impingement syndrome.  Methods: A randomized clinical trial was conducted involving 60 individuals with shoulder impingement syndrome who were allocated to the following 3 groups: (1) MT and DD currents (MTDD), (2) MT alone, and (3) DD currents alone. The participants were submitted to 16 treatment sessions over an 8-week period and were evaluated using the Numerical Rating Pain Scale as well as the pain and disability subscales of the Shoulder Pain and Disability Index.  Results: Differences in Numerical Rating Pain Scale scores (secondary outcome) between MTDD and MT groups (mean difference 2.25 points, 95% confidence interval 1.07-3.42) and between MTDD and DD groups (mean difference 2.30 points, 95% confidence interval 1.42-3.17) were clinically relevant. No clinical gains were observed in the comparisons between groups of Shoulder Pain and Disability Index scores.  Conclusion: The combination of MT and DD currents on myofascial trigger points was more effective at reducing pain intensity but not disability than each therapy performed individually for patients with unilateral shoulder impingement syndrome.

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Yes
  1. Were study participants and providers blinded to treatment group assignment?
  • No
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • No
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Yes
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Yes
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Yes
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
  • Yes
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Yes
  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
  • Yes

 

Key Finding #1

The intervention group that received both manual therapy and diadynamic (DD) currents experienced significant reductions in pain intensity compared to control groups

Key Finding #2

The intervention group that received both manual therapy and diadynamic (DD) currents did not see significant reductions in disability compared to control groups

 

Please provide your summary of the paper

The purpose of the present study was to evaluate the effects of manual therapy and DD currents on myofascial trigger points of the upper trapezius muscle in individuals with a diagnosis of unilateral shoulder impingement syndrome. The primary outcome of interest was the impact of this approach on disability and the secondary outcome focused on pain intensity.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

It may be beneficial to use combined both MT and DD for patients experiencing acute pain who are prone to flare-ups if they are in too much discomfort to fully engage in therapeutic exercises during the visit but the benefit is mild at best. This article put all participants under the general umbrella of shoulder impingement syndrome which is not ideal as this could include patients with either primary or secondary shoulder impingement. One issue of creating a large generalized group is that the individual presentations of each of these subsets of shoulder impingement require different treatment approaches at baseline. Therefore, this approach may favor one type of impingement over another but there is no way to determine that.