Author Names

Gamze Senbursa, Gül Baltaci, and Ö. Ahmet Atay

Reviewer Name

Adrienne Maniktala LAT, ATC, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Objectives: The aim of this randomized controlled study was to assess the efficacy of manual therapy in the treatment of patients with symptomatic supraspinatus tendinopathy. Methods: Seventy-seven patients (age range, 30 to 55 years) with supraspinatus tendinopathy, were randomly assigned to one of the three treatment groups: a supervised exercise program (Group 1), a supervised exercise program combined with joint and soft tissue mobilization (Group 2), or a home-based rehabilitation program (Group 3). All patients had rehabilitation for 12 weeks. Pain level was evaluated with a visual analogue scale (VAS) and the range of motion (ROM) was measured with a goniometer. The Modified American Shoulder and Elbow Surgery (MASES) score was used in functional assessment. Flexion, abduction, internal and external rotation strengths were measured with a manual muscle test. All patients were evaluated before, and at the 4th and 12th week of the rehabilitation. Results: All groups experienced significant decrease in pain and an increase in shoulder muscle strength and function by both the 4th and 12th weeks of treatment (p0.05). However, the greatest improvement in functionality was found in Group 2. Conclusion: Supervised exercise, supervised and manual therapy, and home-based exercise are all effective and promising methods in the rehabilitation of the patients with subacromial impingement syndrome. The addition of an initial manual therapy may improve the results of the rehabilitation with exercise.

 

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?
  • Yes
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Cannot Determine, Not Reported, or Not Applicable
  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?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Cannot Determine, Not Reported, or Not Applicable
  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?
  • Cannot Determine, Not Reported, or Not Applicable
  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

There was no noted significant difference in the 3 groups amongst pain, shoulder range of motion, or rotator cuff muscle strength, but there was faster improvement in night pain and pain with movement in Group 2 than other groups.

Key Finding #2

The rate of positive special tests (impingement, tendon tenderness, and instability) decreased with treatment. 

Key Finding #3

The manual therapy group (Group 2) demonstrated the best results at the week 12 follow-up, compared to the other groups.

Key Finding #4

All 3 groups showed a significant different in their MASES (modified American Shoulder and Elbow Surgeons’ questionnaire) score at 4 weeks but there was no difference at the 12-week follow-up.

 

Please provide your summary of the paper

The authors of this study chose to compare manual therapy, mobilizations and exercise in supraspinatus tendinopathies to increase literature on the subject and determine which may be more beneficial. The three different groups consisted of; a supervised exercise group that included glenohumeral and scapulothoracic exercises 3 times a week (Group 1), a manual therapy and exercise group that included joint and soft tissue mobilizations along with the exercises from the first group 3 times a week (Group 2), and a home-based exercise group (Group 3). The study determined that manual therapy, mobilizations and exercise can be equally beneficial to improve rotator cuff strength, increase range of motion and decrease pain.

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

The information in this study can be correlated to clinical practice because the implementation of these components can help to decrease treatment time and are all considered cost efficient. The authors suggest 3 weeks of manual therapy when treating supraspinatus tendinopathies.