CPR for Cervicothoracic Manipulation and Shoulder Pain: Difference between revisions

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<div class="editorbox">
'''Original Editor '''- [[User:John M Durham|John M Durham]]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
</div>
== Purpose  ==
== Purpose  ==


To identify prognostic factors for individuals with shoulder pain likely to experience improvements in pain and disability following the application of cervicothoracic spine thrust and nonthrust manipulation. <br>  
[[Image:Muscles_connecting_the_upper_limb_to_the_trunk_anterior_aspect_Primal.png|right|300px]]
 
To identify prognostic factors for individuals with shoulder pain likely to experience improvements in pain and disability following the application of cervicothoracic spine thrust and nonthrust manipulation. <ref name="Mintken">Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM. Some Factors Predict Short-Term Outcomes in Individuals with Shoulder Pain Receiving Cervicothoracic Manipulation: A Single-Arm Trial. Phys Ther.2010; 90(1): 26-42.</ref><br>


== Rule  ==
== Rule  ==


The following five criteria are considered predictors of improved short term shoulder pain prognosis following cervicothoracic manpulation:  
The following five criteria are considered predictors of improved short term shoulder pain prognosis following cervicothoracic manipulation: <ref name="Mintken" />  
 
#'''Pain-free shoulder flexion &lt; 120˚'''
<br>'''1. Pain-free shoulder flexion &lt; 120˚<br>2. Shoulder internal rotation &lt; 53˚ @ 90˚ of abduction<br>3. Negative Neer’s Test<br>4. Not taking medications for their shoulder pain<br>5. Symptoms &lt; 90 days'''<br><br>  
#'''Shoulder internal rotation &lt; 53˚ @ 90˚ of abduction'''
#'''Negative Neer’s Test'''
#'''Not taking medications for their shoulder pain'''
#'''Symptoms &lt; 90 days'''<br><br>  


Diagnostic values of results (95% Confidence Intervals) are as follows:  
Diagnostic values of results (95% Confidence Intervals) are as follows: <ref name="Mintken" />


{| width="715" cellspacing="1" cellpadding="1" border="1" align="left" style=""
{| width="715" cellspacing="1" cellpadding="1" border="1" align="left" style=""
|-
|-
| <u>'''Number of Positive Criteria<br>'''</u>  
| <u>'''Number of Positive Criteria'''</u>  
| '''<u>Sensitivity</u>'''<br>  
| <u>'''Sensitivity'''</u>
| <br><u>'''Specificity<br>'''</u><br>  
| <u>'''Specificity<br>'''</u>  
| <u>'''Positive Likelihood Ratio'''</u><br>  
| <u>'''Positive Likelihood Ratio'''</u>
| <u>'''Probability of Success'''</u>(%)
| <u>'''Probability of Success'''</u>(%)
|-
|-
Line 22: Line 33:
Met at least 1<br>  
Met at least 1<br>  


| 1.0 (0.90, 1.0)<br>
|  
| 0.19 (0.08, 0.38)<br>
1.0  
| 1.0 (1.2, 1.5)<br>
 
(0.90, 1.0)  
 
|  
0.19  
 
(0.08, 0.38)  
 
|  
1.0  
 
(1.2, 1.5)  
 
| 61<br>
| 61<br>
|-
|-
| Met at least 2<br>  
| Met at least 2<br>  
| 0.90 (0.77, 0.96)<br>
|  
| 0.61 (0.42, 0.78)<br>
0.90  
| 2.3 (1.5, 3.6)<br>
 
(0.77, 0.96)  
 
|  
0.61  
 
(0.42, 0.78)  
 
|  
2.3  
 
(1.5, 3.6)  
 
| 78<br>
| 78<br>
|-
|-
| Met at least 3<br>  
| Met at least 3<br>  
| 0.51 (0.37, 0.65)<br>
|  
| 0.90 (0.73, 0.97)<br>
0.51  
| 5.3 (1.7, 16.0)<br>
 
(0.37, 0.65)  
 
|  
0.90  
 
(0.73, 0.97)  
 
|  
5.3  
 
(1.7, 16.0)  
 
| 89<br>
| 89<br>
|-
|-
| Met at least 4<br>  
| Met at least 4<br>  
| 0.27 (0.15, .41)<br>
|  
| 1.0 (0.86, 1.0)<br>
0.27  
 
(0.15, .41)  
 
|  
1.0  
 
(0.86, 1.0)  
 
| ∞<br>  
| ∞<br>  
| 100<br>
| 100<br>
|-
|-
| Met all 5<br>  
| Met all 5<br>  
| 0.04 (0.01, 0.15)<br>
|  
| 1.0 (0.86, 1.0)<br>
0.04  
 
(0.01, 0.15)  
 
|  
1.0  
 
(0.86, 1.0)  
 
| ∞<br>  
| ∞<br>  
|  
|  
Line 53: Line 116:


|}
|}
<br>


== Evidence  ==
== Evidence  ==


In 2010, Mintken, et al identified several prognostic variables to allow clinicians to make an a priori identification of individuals with shoulder pain who are likely to experience short-term improvement with cervicothoracic manipulations. In this study, eighty patients with shoulder pain were eligible to be examined and treated across seven orthopaedic outpatient clinics. Patients included in the study were between the ages of 18-65 years old, had a primary complaint of shoulder pain, and had baseline Shoulder Pain Disability Index (SPADI) scores &gt; 20%. Each participant in this study reported their baseline and post-treatment outcomes using the numeric pain rating scale, SPADI, Fear Avoidance Behavior Questionnaire, and the Tampa Scale for Kinesiophobia. The outcome of success between each session was measured through the 15 point Global Rating of Change (GROC). Additionally, the participants pain free shoulder range of motion was measured for success or nonsuccess.  
In 2010, Mintken, et al <ref name="Mintken" /> identified several prognostic variables to allow clinicians to make an a priori identification of individuals with shoulder pain who are likely to experience short-term improvement with cervicothoracic manipulations. In this study, eighty patients with shoulder pain were eligible to be examined and treated across seven orthopaedic outpatient clinics. Patients included in the study were between the ages of 18-65 years old, had a primary complaint of shoulder pain, and had baseline Shoulder Pain Disability Index (SPADI) scores &gt; 20%. Each participant in this study reported their baseline and post-treatment outcomes using the numeric pain rating scale, SPADI, [[Fear Avoidance Belief Questionnaire|Fear Avoidance Behavior Questionnaire]], and the Tampa Scale for Kinesiophobia. The outcome of success between each session was measured through the 15 point Global Rating of Change (GROC). Additionally, the participants' pain-free shoulder range of motion was measured for success or nonsuccess.  


During this study the patients were seen for a maximum of 3 visits and every participant received the same standardized treatment. For each session, the participants received 1 nonthrust mobilization technique directed at the lower cervical spine and 5 different thrust manipulation techniques directed at the thoracic spine. These manual therapy techniques were supplemented with two general cervical and thoracic mobility exercises. The participants performed these exercises, 10 repetitions at 3 to 4 times a day, every day for the duration of the study.<br>  
During this study, the patients were seen for a maximum of 3 visits and every participant received the same standardized treatment. For each session, the participants received 1 nonthrust mobilization technique directed at the lower cervical spine and 5 different thrust manipulation techniques directed at the thoracic spine. These manual therapy techniques were supplemented with two general cervical and thoracic mobility exercises. The participants performed these exercises, 10 repetitions at 3 to 4 times a day, every day for the duration of the study.<br>  


The results of this study suggest 61% of individuals with shoulder pain are likely to experience a successful outcome with this intervention program. The statistics for the outcome measures SPADI, NPRS, and pain-free shoulder flexion are described in the table below, and were all shown to be statistically significant with the success group. Overall, this study successfully developed a set of prognostic factors that may help identify individuals with shoulder pain who are likely to experience meaningful changes in pain, disability, and ROM following cervicothoracic manipulation and general mobility exercises.<br><br>  
The results of this study suggest 61% of individuals with shoulder pain are likely to experience a successful outcome with this intervention program. The statistics for the outcome measures SPADI, NPRS, and pain-free shoulder flexion are described in the table below, and were all shown to be statistically significant with the success group. Overall, this study successfully developed a set of prognostic factors that may help identify individuals with shoulder pain who are likely to experience meaningful changes in pain, disability, and ROM following cervicothoracic manipulation and general mobility exercises.<br><br>  


<u>Baseline, Final, and Change Scores for Outcome Measures</u><br>  
<u>Baseline, Final, and Change Scores for Outcome Measures </u><ref name="Mintken" /><br>  


{| width="715" cellspacing="1" cellpadding="1" border="1" align="center"
{| width="715" cellspacing="1" cellpadding="1" border="1" align="center"
Line 74: Line 139:
| '''SPADI''' (0-100)  
| '''SPADI''' (0-100)  
|  
|  
<br>
<br>
|  
|  
|  
|  
| rowspan="3" |  
| rowspan="3" |  
12.9 (7.3, 18.5)  
12.9  
 
(7.3, 18.5)  


P&lt;0.001  
P&lt;0.001  


|-
|-
| &nbsp; Success group  
| Success group  
| 38.1 (13.9)  
|  
| 18.4 (3.7)  
38.1  
| 19.7 (15.5, 20.0)
 
(13.9)  
 
|  
18.4  
 
(3.7)  
 
|  
19.7  
 
(15.5, 20.0)  
 
|-
|-
| &nbsp; Nonsuccess group  
| Nonsuccess group  
| 37.9 (13.1)  
|  
| 30.4 (13.7)  
37.9  
| 6.9 (4.6, 9.1)
 
(13.1)  
 
|  
30.4  
 
(13.7)  
 
|  
6.9  
 
(4.6, 9.1)  
 
|-
|-
| '''NPRS''' (0-10)  
| '''NPRS''' (0-10)  
|  
|  
<br>
<br>
|  
|  
|  
|  
| rowspan="3" |  
| rowspan="3" |  
1.7 (1.1, 2.3)  
1.7  
 
(1.1, 2.3)  


P&lt;0.001  
P&lt;0.001  


|-
|-
| &nbsp; Success group  
| Success group  
| 4.0 (1.7)  
|  
| 1.8 (1.1)  
4.0  
| 2.2 (1.9, 2.6)
 
(1.7)  
 
|  
1.8  
 
(1.1)  
 
|  
2.2  
 
(1.9, 2.6)  
 
|-
|-
| &nbsp; Nonsuccess group  
| Nonsuccess group  
| 4.3 (1.8)  
|  
| 3.9 (1.5)  
4.3  
| 0.50 (-0.08, 0.90)
 
(1.8)  
 
|  
3.9  
 
(1.5)  
 
|  
0.50  
 
(-0.08, 0.90)  
 
|-
|-
| '''Pain-free shoulder flexion, pretreatment to immediate posttreatment'''
| '''Pain-free shoulder flexion, pretreatment to immediate posttreatment'''  
|  
|  
|  
|  
|  
|  
| rowspan="3" |  
| rowspan="3" |  
7.5 (1.4, 13.7)  
7.5  
 
(1.4, 13.7)  


P=0.017  
P=0.017  


|-
|-
| &nbsp; Success group  
| Success group  
| 118.6 (31.0)  
|  
| 142.0 (29.8)  
118.6  
| 23.1 (19.1, 27.2)
 
(31.0)  
 
|  
142.0  
 
(29.8)  
 
|  
23.1  
 
(19.1, 27.2)  
 
|-
|-
| &nbsp; Nonsuccess group  
| Nonsuccess group  
| 134.7 (24.4)  
|  
| 150.1 (20.6)  
134.7  
| 15.6 (11.1, 20.1)
 
(24.4)  
 
|  
150.1  
 
(20.6)  
 
|  
15.6  
 
(11.1, 20.1)  
 
|-
|-
| '''Pain-free shoulder flexion, pretreatment to final visit'''  
| '''Pain-free shoulder flexion, pretreatment to final visit'''  
Line 137: Line 288:
|  
|  
| rowspan="3" |  
| rowspan="3" |  
13.8 (6.2, 21.4)  
13.8  
 
(6.2, 21.4)  


P&lt;0.001  
P&lt;0.001  


|-
|-
| &nbsp; Success group  
| Success group  
| 118.6 (31.0)  
|  
| 149.3 (25.1)  
118.6  
| 30.4 (25.1, 35.7)
 
(31.0)  
 
|  
149.3  
 
(25.1)  
 
|  
30.4  
 
(25.1, 35.7)  
 
|-
|-
| &nbsp; Nonsuccess group  
| Nonsuccess group  
| 134.7 (24.4)  
|  
| 151.1 (19.1)  
134.7  
| 16.6 (11.9, 21.3)
 
(24.4)  
 
|  
151.1  
 
(19.1)  
 
|  
16.6  
 
(11.9, 21.3)  
 
|}
|}


== Interventions  ==
== Interventions  ==


[[Manual techniques for the cervicothoracic spine|Manual Techniques&nbsp;for the&nbsp;Cervicothoracic Spine]]  
[[Manual Techniques for the Cervicothoracic Spine|Manual Techniques&nbsp;for the&nbsp;Cervicothoracic Spine]]  


== References  ==
== References  ==


Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM.&nbsp; Some Factors Predict Short-Term Outcomes in Individuals with Shoulder Pain Receiving Cervicothoracic Manipulation:&nbsp; A Single-Arm Trial.&nbsp; ''Phys Ther''.&nbsp; 2010; 90(1):&nbsp; 26-42.
<references />
 
[[Category:Clinical_Prediction_Rules]] [[Category:Interventions]] [[Category:Manual_Therapy]] [[Category:Shoulder]] [[Category:Pain]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Primary Contact]] [[Category:Shoulder - Assessment and Examination]] [[Category:Cervical Spine]]

Latest revision as of 12:30, 17 October 2023

Original Editor - John M Durham

Top Contributors - John M Durham, Laura Ritchie, Kim Jackson, Dana Tew, Evan Thomas and Claire Knott

Purpose[edit | edit source]

Muscles connecting the upper limb to the trunk anterior aspect Primal.png

To identify prognostic factors for individuals with shoulder pain likely to experience improvements in pain and disability following the application of cervicothoracic spine thrust and nonthrust manipulation. [1]

Rule[edit | edit source]

The following five criteria are considered predictors of improved short term shoulder pain prognosis following cervicothoracic manipulation: [1]

  1. Pain-free shoulder flexion < 120˚
  2. Shoulder internal rotation < 53˚ @ 90˚ of abduction
  3. Negative Neer’s Test
  4. Not taking medications for their shoulder pain
  5. Symptoms < 90 days

Diagnostic values of results (95% Confidence Intervals) are as follows: [1]

Number of Positive Criteria Sensitivity Specificity
 		Positive Likelihood Ratio Probability of Success(%)

Met at least 1

1.0

(0.90, 1.0)

0.19

(0.08, 0.38)

1.0

(1.2, 1.5)

61
Met at least 2

0.90

(0.77, 0.96)

0.61

(0.42, 0.78)

2.3

(1.5, 3.6)

78
Met at least 3

0.51

(0.37, 0.65)

0.90

(0.73, 0.97)

5.3

(1.7, 16.0)

89
Met at least 4

0.27

(0.15, .41)

1.0

(0.86, 1.0)

∞
 100
Met all 5

0.04

(0.01, 0.15)

1.0

(0.86, 1.0)

∞

100


Evidence[edit | edit source]

In 2010, Mintken, et al [1] identified several prognostic variables to allow clinicians to make an a priori identification of individuals with shoulder pain who are likely to experience short-term improvement with cervicothoracic manipulations. In this study, eighty patients with shoulder pain were eligible to be examined and treated across seven orthopaedic outpatient clinics. Patients included in the study were between the ages of 18-65 years old, had a primary complaint of shoulder pain, and had baseline Shoulder Pain Disability Index (SPADI) scores > 20%. Each participant in this study reported their baseline and post-treatment outcomes using the numeric pain rating scale, SPADI, Fear Avoidance Behavior Questionnaire, and the Tampa Scale for Kinesiophobia. The outcome of success between each session was measured through the 15 point Global Rating of Change (GROC). Additionally, the participants' pain-free shoulder range of motion was measured for success or nonsuccess.

During this study, the patients were seen for a maximum of 3 visits and every participant received the same standardized treatment. For each session, the participants received 1 nonthrust mobilization technique directed at the lower cervical spine and 5 different thrust manipulation techniques directed at the thoracic spine. These manual therapy techniques were supplemented with two general cervical and thoracic mobility exercises. The participants performed these exercises, 10 repetitions at 3 to 4 times a day, every day for the duration of the study.

The results of this study suggest 61% of individuals with shoulder pain are likely to experience a successful outcome with this intervention program. The statistics for the outcome measures SPADI, NPRS, and pain-free shoulder flexion are described in the table below, and were all shown to be statistically significant with the success group. Overall, this study successfully developed a set of prognostic factors that may help identify individuals with shoulder pain who are likely to experience meaningful changes in pain, disability, and ROM following cervicothoracic manipulation and general mobility exercises.

Baseline, Final, and Change Scores for Outcome Measures [1]

Variable Baseline Mean (SD) Final Mean (SD) Within-Group Change Scores (95% CI) Between-Group Change Scores (95% CI)
SPADI (0-100)



12.9

(7.3, 18.5)

P<0.001

Success group

38.1

(13.9)

18.4

(3.7)

19.7

(15.5, 20.0)

Nonsuccess group

37.9

(13.1)

30.4

(13.7)

6.9

(4.6, 9.1)

NPRS (0-10)



1.7

(1.1, 2.3)

P<0.001

Success group

4.0

(1.7)

1.8

(1.1)

2.2

(1.9, 2.6)

Nonsuccess group

4.3

(1.8)

3.9

(1.5)

0.50

(-0.08, 0.90)

Pain-free shoulder flexion, pretreatment to immediate posttreatment

7.5

(1.4, 13.7)

P=0.017

Success group

118.6

(31.0)

142.0

(29.8)

23.1

(19.1, 27.2)

Nonsuccess group

134.7

(24.4)

150.1

(20.6)

15.6

(11.1, 20.1)

Pain-free shoulder flexion, pretreatment to final visit

13.8

(6.2, 21.4)

P<0.001

Success group

118.6

(31.0)

149.3

(25.1)

30.4

(25.1, 35.7)

Nonsuccess group

134.7

(24.4)

151.1

(19.1)

16.6

(11.9, 21.3)

Interventions[edit | edit source]

Manual Techniques for the Cervicothoracic Spine

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM. Some Factors Predict Short-Term Outcomes in Individuals with Shoulder Pain Receiving Cervicothoracic Manipulation: A Single-Arm Trial. Phys Ther.2010; 90(1): 26-42.
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