Talk:Manual Therapy and Exercise Intervention in the Treatment of Shoulder and Neck Pain in a Patient with Mental Health Comorbidities: A Case Report

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Article Review

This is an interesting case study about an oft-neglected subgroup of the population. This reviewer would have appreciated a slightly longer introduction to set the scene. Although the area of research is undoubtedly worthwhile, some degree of justification of why the research is novel and a brief literature review would have been useful.

The case report is logically presented and the patient characteristics/clinical findings are in- depth and appropriate. It might have been useful to provide some indication of the length of the individual’s psychiatric symptoms as this would permit the reader to get an idea of how chronic these psychiatric symptoms were. There is good justification for the inclusion of the scoring systems used (NPDS and DASH), and the examination section explicitly states a detailed and accurate assessment process. Based on the information provided, the clinical impression appears correct.  

The interventions section is clear and succinct and the form shown in Appendix 1 seems a sensible method to facilitate adherence. More details relating to which scapular muscle retraining exercises were prescribed would have been beneficial in allowing the reader to get a fuller picture of the rehabilitation programme. Appendix 2 is only very brief, and perhaps could have been included in the text instead of as an appendix.

I was happy to see a positive outcome for the individual and credit should be given to the therapist for that! Table 1 is orderly in presenting the findings, although the “HEP adherence column” is redundant and could have been omitted. The discussion section covers the main points well, however further depth would be useful in some areas (for example in paragraph 2 when discussion the relationships at the shoulder joint). In addition, more details relating to potential future research in the area would have been helpful too. 

In summary this is a well-written and worthwhile piece which would be a valuable read all clinicians, especially those with a caseload which includes patients with mental health comorbidities.

12:21, 20 July 2011 (BST)

Response to recent review

Thank you for your review. When I revised my capstone project for PP submission, word limits required me to pare the draft significantly and much was cut. The original presented a better background and reason as to why I wrote the case report. Unfortunately, all I know is that he had been in the system for about 2 years, but his problems extended back farther than that. One of my concerns in the original was the exercise description – next time I will be more thorough or include pictures. Thank you again.