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This Article Full Text Full Text (PDF) eTables The Bottom Line All Versions of this Article: ptj.20090095v1 90/1/26    most recent Submit a response Read responses to this article Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mintken, P. E. Articles by Whitman, J. M. Search for Related Content PubMed PubMed Citation Articles by Mintken, P. E. Articles by Whitman, J. M. Related Collections Manual Therapy Injuries and Conditions: Shoulder Clinical Decision Making Clinical Prediction Rules Social Bookmarking                      What's this?

Some Factors Predict Successful Short-Term Outcomes in Individuals With Shoulder Pain Receiving Cervicothoracic Manipulation: A Single-Arm Trial

P.E. Mintken, PT, DPT, OCS, FAAOMPT, is Assistant Professor, Department of Physical Therapy, School of Medicine, University of Colorado Denver, 13121 E 17th Ave, Mailstop C244, Aurora, CO 80045 (USA); and Lead Clinician, Wardenburg Health Center, University of Colorado at Boulder, Boulder, Colorado.
J.A. Cleland, PT, PhD, is Professor, Department of Physical Therapy, Franklin Pierce University, Concord, New Hampshire; Physical Therapist, Rehabilitation Services, Concord Hospital, Concord, New Hampshire; and Faculty, Manual Physical Therapy Fellowship Program, Regis University, Denver, Colorado.
K.J. Carpenter, PT, DPT, is Physical Therapist, Waldron's Peak Physical Therapy PC, Boulder, Colorado. Dr Carpenter was a student in the Department of Physical Therapy, School of Medicine, University of Colorado Denver, at the time of this study.
M.L. Bieniek, PT, DPT, is Rehabilitation Manager and Physical Therapist, Concord Hospital.
M. Keirns, PT, PhD, is Associate Professor, School of Physical Therapy, Regis University, and Clinical Director, Physiotherapy Associates, Greenwood Athletic Club, Greenwood Village, Colorado.
J.M. Whitman, PT, DSc, is Director, Evidence In Motion's Orthopedic Manual Physical Therapy Program, Louisville, Kentucky, and Assistant Professor, School of Physical Therapy, Regis University.

Address all correspondence to Dr Mintken at: paul.mintken{at}ucdenver.edu.

Background: It has been reported that manipulative therapy directed at the cervical and thoracic spine may improve outcomes in patients with shoulder pain. To date, limited data are available to help physical therapists determine which patients with shoulder pain may experience changes in pain and disability following the application of these interventions.

Objective: The purpose of this study was to identify prognostic factors from the history and physical examination in individuals with shoulder pain who are likely to experience rapid improvement in pain and disability following cervical and thoracic spine manipulation.

Design: This was a prospective single-arm trial.

Setting: This study was conducted in outpatient physical therapy clinics.

Participants: The participants were individuals who were seen by physical therapists for a primary complaint of shoulder pain.

Intervention and Measurements: Participants underwent a standardized examination and then a series of thrust and nonthrust manipulations directed toward the cervicothoracic spine. Individuals were classified as having achieved a successful outcome at the second and third sessions based on their perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success.

Results: Data for 80 individuals were included in the data analysis, of which 49 had a successful outcome. Five prognostic variables were retained in the final regression model. If 3 of the 5 variables were present, the chance of achieving a successful outcome improved from 61% to 89% (positive likelihood ratio=5.3).

Limitations: A prospective single-arm trial lacking a control group does not allow for inferences to be made regarding cause and effect. The statistical procedures used may result in "overfitting" of the model, which can result in low precision of the prediction accuracy, and the bivariate analysis may have resulted in the rejection of some important variables.

Conclusions: The identified prognostic variables will allow clinicians to make an a priori identification of individuals with shoulder pain who are likely to experience short-term improvement with cervical and thoracic spine manipulation. Future studies are necessary to validate these findings.

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This article has been cited by other articles:

				G. K. Fitzgerald Invited Commentary Physical Therapy, June 1, 2010; 90(6): 855 - 858. [Full Text] [PDF]

				M. T. Cibulka and F. E. Harrell Jr On "Some factors predict successful short-term outcomes..." Mintken PE, Cleland JA, Carpenter KJ, et al. Phys Ther. 2010;90:26-42. Physical Therapy, April 1, 2010; 90(4): 643 - 644. [Full Text] [PDF]

				P. E. Mintken, J. A. Cleland, K. J. Carpenter, M. L. Bieniek, M. Keirns, and J. M. Whitman Author Response Physical Therapy, April 1, 2010; 90(4): 644 - 646. [Full Text] [PDF]