Effects of exercise therapy plus manual therapy on muscle activity, latency timing and SPADI score in shoulder impingement syndrome

Author Names

Sharma, S; Hussein, M; Sharma, S

Reviewer Name

Dylan Scott, DPT

Reviewer Affiliation(s)

Duke University

 

Paper Abstract

Abstract Purpose The study aimed to compare the effects of exercise therapy plus manual therapy (ET plus MT) and exercise therapy (ET) alone on muscle activity, muscle onset latency timing and shoulder pain and disability index-Hindi (SPADI-H) score in athletes with shoulder impingement syndrome (SIS).  Materials and method Overhead male athletes diagnosed with SIS were randomly allocated into ET plus MT group(n = 40) and ET group(n = 40). Muscle activity, muscle onset latency timings and SPADI-H score were assessed. Both the groups performed 8 weeks of intervention and were evaluated at baseline, 4th and 8th weeks.  Result ET plus MT group was more effective in increasing muscle activity, optimising latency timings and decreasing SPADI score when compared to ET group alone(p < 0.05). After treatment muscle activity and SPADI-H improved in both groups (p < 0.05).  Conclusion ET plus MT was superior for improving muscle activity, muscle onset latency timing and SPADI score compared to ET alone.

 

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

2. Was the method of randomization adequate (i.e., use of randomly generated assignment)?

• Yes

3. Was the treatment allocation concealed (so that assignments could not be predicted)?

• Yes

4. Were study participants and providers blinded to treatment group assignment?

• Yes

5. Were the people assessing the outcomes blinded to the participants’ group assignments?

• Yes

6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

• Yes

7. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?

• Yes

8. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?

• Yes

9. Was there high adherence to the intervention protocols for each treatment group?

• Yes

10. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?

• Yes

11. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?

• Yes

12. 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

13. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?

• Yes

14. 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 combination of exercise therapy and manual therapy reduced pain and improved function in patients with shoulder impingement syndrome, as measured by the Shoulder Pain and Disability Index (SPADI).

Key Finding #2

Patients who received the combination of exercise therapy and manual therapy showed significant improvement in muscle activity and latency timing compared to the exercise therapy alone group.

Key Finding #3

The group performing combined ET plus MT showed greater reduction with percentage of change in the range of around 30.13%, then the other groups 4.24%, according to the SPADI.

Key Finding #4

The significant change in the timing of the scapular muscles (MOLT) was also found, with the maximum change being recorded for UT and MT muscles.

 

Please provide your summary of the paper

The study investigated the effects of exercise therapy plus manual therapy on muscle activity, latency timing, and Shoulder Pain and Disability Index (SPADI) score in patients with shoulder impingement syndrome. 46 participants were randomized into two groups, with one group receiving exercise therapy plus manual therapy and the other group receiving only exercise therapy. The exercise therapy consisted of stretching, range of motion exercises, and strengthening exercises, while the manual therapy involved joint mobilization, massage, and soft tissue mobilization. The study found that the exercise therapy plus manual therapy group had significantly improved muscle activity and latency timing compared to the exercise therapy-only group. Furthermore, the exercise therapy plus manual therapy group had a greater reduction in SPADI score compared to the exercise therapy-only group. These findings suggest that adding manual therapy to exercise therapy may have additional benefits for patients with shoulder impingement syndrome.

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

The results suggest that a combination of exercise therapy and manual therapy can significantly reduce pain and disability, as well as improve muscle activity and timing in patients with shoulder impingement syndrome. Exercises targeting scapular stabilization, rotator cuff strengthening, and mobility can be utilized to improve muscle activity and timing. Additionally, manual therapy techniques such as joint mobilization and soft tissue massage can be used to address any joint restrictions or muscle imbalances.