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Manipulative Therapy for Patients with Shoulder Symptoms
- Gert J.D. Bergman, MSc;
- Jan C. Winters, MD, PhD; and
- Geert J.M.G. van der Heijden, PT, PhD
- From University of Groningen, 9700 AD Groningen, and University Medical Center Utrecht, 3508 GA Utrecht, the Netherlands.
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•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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IN RESPONSE:
The question regarding subgroup analysis is logical, considering the positive message of our study. Our study was designed to examine the efficacy of additional manipulative treatment for shoulder complaints. At baseline, all of the included patients experienced manifest pain in or dysfunction of the shoulder. At the same time, the physical examination also demonstrated a concomitant dysfunction of the cervicothoracic spine and the adjacent ribs (shoulder girdle dysfunction). We did not perform subgroup analyses on the efficacy of manipulative treatment with regard to specific conditions for several reasons. Subgroup analysis should be based on theoretical considerations. We do not expect large differential effects of manipulative techniques in treatment of shoulder dysfunction due to various postulated specific dysfunctions of the shoulder girdle. A firm theory regarding subgroup effects according to specific shoulder girdle dysfunction is lacking. Moreover, in our opinion, there are more similarities than differences among available manipulative techniques for specific conditions of the cervicothoracic spine and adjacent ribs. In addition, physical examination has not been shown to contribute to the accurate location of such specific conditions or differentiation among them (1). A recent study demonstrated that clinicians cannot accurately distinguish between neck and shoulder problems on physical examination (2). Finally, with our sample size of 150 patients, we were able to demonstrate significant results in our main analysis. Any subgroup analysis would require a larger sample size; the statistical power of such additional analyses in our sample is likely to be insufficient (3).
Gert J.D. Bergman, MSc
Jan C. Winters, MD, PhD
University of Groningen; 9700 AD Groningen, the Netherlands
Geert J.M.G. van der Heijden, PT, PhD
University Medical Center Utrecht; 3508 GA Utrecht, the Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
