Article: Bang MD, Deyle GD. Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients with Shoulder Impingement Syndrome. Journal of Orthopaedic & Sports physical therapy.
Study Design: Prospective Randomized Controlled Trial Abstract: The purpose of this study was to investigate the comparative effectiveness of exercise with and without manual therapy (MT) to treat shoulder impingement syndrome (SIS). The randomized controlled trial included patients (30 men, 22 women, age 43 years +- 9 years) that were diagnosed with SIS. The patients were randomly assigned to 1 of 2 treatment groups. One group received exercises only for the shoulder girdle and/or cervical spine, and the other group received the same exercises and MT. Groups received treatment 6 times over a 3-week period in 30 min sessions. The main outcome measures were pain, strength, and function. Pain was a composite score measured using the visual analog scale during break tests, resisted abduction, and functional tests. Function was measured with a functional assessment questionnaire, and strength was a composite score of isometric strength tests for internal rotation, external rotation, and abduction. Outcomes were taken prior to treatment and during treatment, and pain and function were measured two months after treatment. Two patients dropped out of the trial before it ended. The results showed significant improvements in pain and function in both groups, but the MT group showed more improvement compared to the exercise group.
NIH Risk of Bias Score: 9/14 Key Findings of the Study:
1. Shoulder strengthening and passive stretching can decrease shoulder pain and improve function in patients with SIS.
2. Combining shoulder strengthening exercises and stretching with MT will improve patient outcomes with SIS.
3. Outcomes were measured using a functional assessment questionnaire, which was developed in 1993 by looking at the Oswestry Disability Index, but not a validated outcome measure.
Reviewer Summary: The results showed that manual therapy can be beneficial when coupled with a shoulder strengthening program to improve pain and function in SIS patients. The study used dynamometers to measure isometric strength in each patient, but the pain and function outcomes were not validated and lack reliability. The patients in the exercise group completed the exercises under the supervision of a PT, while the MT and exercise group received MT from the therapists and completed the exercises at home. The MT group had more significant decreases in pain, and improvements in strength and function, but this could be due to the perception that MT appears like more individualized care than just exercises. Perhaps not all of the MT group performed the exercises at home, and their strength improved due to a decrease in pain from not using their shoulder musculature as often as the exercise group. While there are some gaps in the study, it appears that MT can be beneficial for SIS patients, especially when coupled with an individualized exercise program.
