View source for Effectiveness of thoracic manipulations on shoulder pain: A Case Report

== Outcome Measures ==
The outcome measures used for this case study included pain according the visual analog scale (VAS), overall rating of change, and the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. Pain intensity was rated using the VAS, which rates pain on a scale from 0 to 10, with 0 being no pain and 10 being very high pain levels. The visual analog scale has been shown to be a reliable and valid tool for assessing immediate changes in pain intensity, with a test-retest reliability of between 0.95-0.97 and the minimally clinically important difference of 12 mm (+/- 3 mm at a 95% CI)<ref name=":1">Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. The Journal of Manual &amp; Manipulative Therapy. 2009; 17(4): 230-236.</ref>. An overall rating of change was measured at discharge by asking the patient to rate their global improvement since beginning physical therapy, as 0% being no improvement and 100% being completely asymptomatic and fully functional. This can be compared to a global rate of change scale, which is considered to be a valid reference for establishing a successful outcome<ref name="Mintken">Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM. Some factors predict successful short-term outcomes in individuals with shoulder pain receiving cervicothoracic manipulation: A single-arm trial. Physical Therapy. 2010; 90(1): 26-42.</ref>. The final outcome measure used was the Quick DASH questionnaire, which is a measure of overall upper extremity function and can be interpreted by the patient to target the shoulder, elbow, or hand. This questionnaire has been modified from the original 30-question assessment (DASH), and now includes eleven questions targeting disability and symptoms, four optional work –related questions, and four optional performing arts/sports module questions. The Quick DASH score ranges from 0 to 100 points, with 0 reflecting no disability. Correlations between the DASH and the Quick DASH assessments have been reported to be extremely high: 0.97<ref name="Wright">Wright RW, Baumgarten KM. Shoulder outcomes measures. Journal of the American Academy of Orthopaedic Surgeons. 2010; 18: 436-444.</ref> The DASH has been found to be valid for specific shoulder impairments including rotator cuff syndromes<ref name="Wright" />and has demonstrated excellent reliability (ICC= 0.92, 0.96) and responsiveness<ref name=":0"/>.