Short-term effects of high-intensity laser therapy, manual therapy, and Kinesio taping in patients with subacromial impingement syndrome – Duke Center of Excellence in Manual and Manipulative Therapy

Author Names

Pekyavas, N. O., Baltaci, G

Reviewer Name

Erin Dennis, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

Paper Abstract

Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX (n = 15), KT + EX (n = 20), MT + KT + EX (n = 16), and MT + KT + HILT + EX (n = 19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT + KT + EX and HILT + MT + KT + EX groups (p < 0.05). When the means of ROM and SPADI results of three groups were compared, statistically significant differences were found between all the groups (p < 0.05). These differences were significant especially between the groups MT + KT + EX and KT + EX (p < 0.05) and HILT + MT + KT + EX and KT + EX (p < 0.05). HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT

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

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

Were study participants and providers blinded to treatment group assignment?

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

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

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

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

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

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

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

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?

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

Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?

Key Finding #1

HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS.

Key Finding #2

Statistically significant differences were found pre- and post-treatment in all parameters in both the MT + KT + EX and HILT + MT + EX groups.

Key Finding #3

The only significant difference found between the MT + KT + EX and HILT + MT + KT + EX groups was a change in shoulder abduction ROM following treatment in which greater increases in ROM were found in the HILT + MT + KT + EX group.

Please provide your summary of the paper

This article studied the effect of various interventions on 70 patients diagnosed with SAIS who had been admitted to the hospital with complaints of shoulder pain. The authors found that HILT and MT were the most effective interventions in minimizing pain and disability, as well as increasing shoulder ROM over 15 treatment sessions. When comparing the HILT + MT + KT + EX and MT + KT + EX groups, the only significant difference was change in shoulder abduction ROM post-intervention in which HILT was found to be more effective. The EX and KT + EX groups did not have statistically significant changes following treatment. Limitations of this study include the lack of a follow-up period to track long-term effects of these interventions which would provide useful clinical application for rehabilitation programs concerning SAIS.

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

This study tracked pain severity scores, ROM, and shoulder function/disability across 15 treatment sessions in patients with SAIS. The results indicate that HILT and MT are more effective in minimizing pain and disability and increasing ROM after 15 sessions, encouraging their use in clinical practice in addition to traditional exercises. However, as there was no follow-up period in this study, the long-term effects of HILT and MT are unclear and further research is needed to elucidate the longevity of these rehabilitative programs. Lastly, the authors revealed the use of KT did not have any effect on shoulder ROM or shoulder function measures and therefore may not need effective in the plan of care for individuals with SAIS when manual therapy and HILT are utilized in the clinic.