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T t STUDY DESIGN:Systematic review and metaanalysis.
T t OBJECTIVES:To evaluate the efficacy of manual therapy (MT) for patients with rotator cuff (RC) tendinopathy.
T t BACKGROUND:Rotator cuff tendinopathy is a highly prevalent musculoskeletal disorder, for which MT is a common intervention used by physical therapists. However, evidence regarding the efficacy of MT is inconclusive.
T t METHODS:A literature search using terms related to shoulder, RC tendinopathy, and MT was conducted in 4 databases to identify randomized controlled trials that compared MT to any other type of intervention to treat RC tendinopathy. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses or qualitative syntheses of evidence were performed.
T t RESULTS:Twenty-one studies were included.The majority had a high risk of bias. Only 5 studies had a score of 69% or greater, indicating a moderate to low risk of bias. A small but statistically significant overall effect for pain reduction of MT compared with a placebo or in addition to another intervention was observed (n = 406), which may or may not be clinically important, given a mean difference of 1.1 (95% confidence interval: 0.6, 1.6) on a 10-cm visual analog scale. Adding MT to an exercise program (n = 226) significantly decreased pain (mean difference, 1.0; 95% confidence interval: 0.7, 1.4), as reported on a 10-cm visual analog scale, which may or may not be clinically important. Based on qualitative analyses, it is unclear whether MT used alone or added to an exercise program improves function.
T t CONCLUSION:For patients with RC tendinopathy, based on low-to moderate-quality evidence, MT may decrease pain; however, it is unclear whether it can improve function. More methodologically sound studies are needed to make definitive conclusions.
T t LEVEL OF EVIDENCE:Therapy, level 1a-. Ther 2015;45(5):330-350. Epub 26 Mar 2015. doi:10.2519/jospt.2015 T t KEY WORDS: mobilization, physical therapy, shoulder impingement syndrome, shoulder pain S houlder pain is highly prevalent and among mus culoskeletal disorders is the third most common reason for visiting a primary care physician. 16,33,46 As many as two thirds of people who have shoulder complaints receive a diagnosis of rotator cuff (RC) tendinopathy. 46 Rotator cuff tendinopathy often leads to decreased function, 34 lower health related quality of life, 34 poor sleep quality, 47 and work absenteeism.
J Orthop Sports Phys
40Rotator cuff tendinopathy is a broad diagnosis, and mounting evidence suggests that diagnoses such as shoulder impingement syndrome, RC tendinitis/ tendinosis, as well as subacromial bursitis may be considered as the same clinical entity. 19 Conservative treatment of RC tendinopathy generally includes rest, nonsteroidal anti-inflammatory drugs, and rehabilitation interventions such as exercise.19 High-level evidence supports exercise as an effective treatment. 20 In conjunction with exercise, physical therapists often add manual therapy (MT) interventions to address impairm...