Author Names
Cecilia Ho, C., Sole, G., Munn, J.
Reviewer Name
Giulia Marsella, Student Physical Therapist
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
A systematic review of randomized controlled trials (RCTs) was conducted to determine the effectiveness of manual therapy (MT) techniques for the management of musculoskeletal
disorders of the shoulder. Seven electronic databases were searched up to January 2007, and reference lists of retrieved articles and relevant MT journals were screened. Fourteen RCTs met
the inclusion criteria and their methodological qualities were assessed using the PEDro scale. Results were analyzed within diagnostic subgroups (adhesive capsulitis (AC), shoulder impingement syndrome [SIS], non-specific shoulder pain/dysfunction) and a qualitative analysis using levels of evidence to define treatment effectiveness was applied. For SIS, there was no clear evidence to suggest additional benefits of MT to other interventions. MT was not shown to be more effective than other conservative interventions for AC, however, massage and Mobilizations-with-ovement may be useful in comparison to no treatment for short-term outcomes for shoulder dysfunction.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
-Yes - Were eligibility criteria for included and excluded studies predefined and specified?
-Yes - Did the literature search strategy use a comprehensive, systematic approach?
-Yes - Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
-Yes - Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
-Yes - Was publication bias assessed?
-Yes - Was heterogeneity assessed? (This question applies only to meta-analyses.)
-Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Due to the heterogeneity of musculoskeletal impairments, outcomes, and interventions of manual therapy among the 14 randomized control trials, only a systematic review and no meta- analysis was conducted.
Key Finding #2
There is moderate quality evidence that manual therapy is not more effective in comparison to other interventions for patients with impingement syndrome, adhesive capsulitis, and unspecific shoulder pain.
Key Finding #3
“Mobilization-with-Movement” or soft-tissue massage was shown to be beneficial for the management of musculoskeletal shoulder disorders in comparison to no treatment.
Please provide your summary of the paper
This systematic review aims to examine the effectiveness of manual therapy for the treatment of musculoskeletal shoulder pathologies. 14 randomized-controlled studies included in this review were of humans with adhesive capsulitis, shoulder impingement syndrome, and non-specific shoulder pain. Manual therapy, which was defined as “manipulation, passive joint or soft-tissue mobilization techniques or massage” were examined upon the outcomes of pain, functional outcomes, range of motion, patient satisfaction, or recovery rate. The average number of intervention sessions across studies was 11 (ranged from 3 to 20). 12 out of the 14 studies evaluated intermediate effects, while 2 of the studies evaluated long-term effects. Overall, this review found inconsistent evidence for the effectiveness of manual therapy for shoulder disorders. Exercise in combination with manual therapy was not more effective than exercise alone for the treatment of shoulder impingement. Manual therapy showed no significance differences in improved pain, range of motion and function for patients with adhesive capsulitis, however with this patient population there is moderate evidence that high grade manual therapy is more beneficial than low grade manual therapy for function and range of motion in the long term. There is moderate quality evidence that manual therapy is no more effective than other interventions for the treatment of nonspecific shoulder pain for improving pain and function in the short term. The research quality of this systematic review was high with the largest bias introduced being non-blinding (100% of studies did not blind the therapists and 86% of the studies did not blind subjects). The average methodological quality was defined as high with a mean PEDro score being ≥ 6 (greater than 5 is considered high quality).
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This systemic review examined a broad definition of manual therapy and a variety of outcome measures and interventions. Due to the heterogeneity of variables, there is a greater opportunity for inconsistent findings, which is the case for this review. Largely, manual therapy is not supported over other therapeutic interventions. At the same time, there appears to be short-term benefit of soft tissue massage for musculoskeletal shoulder pathologies when compared to no treatment and long-term benefit of high-grade manual therapy for the management of adhesive capsulitis. Due to moderate quality evidence indicating that manual therapy is no more beneficial than other intervention, manual therapy may not be the most effective way to manage patients with musculoskeletal shoulder disorders unless if utilized in the two capacities previously stated. Because these findings indicate that manual therapy may be comparable to other physical therapy interventions, utilizing manual therapy over other interventions is up to the physical therapist’s clinical judgement on an individual patient basis.
