The aim of this study was to investigate whether there is a difference in outcome between participants with high compared to low pain self-efficacy (PSE) receiving manual therapy, acupuncture, and electrotherapy.
Participants were stratified into high or low baseline (i) PSE, (ii) shoulder pain and disability index (SPADI), and (iii) did or did not receive the treatment. Whether the effect of treatment differs for people with high compared to low PSE was assessed using the 95% confidence interval of the difference of difference (DoD) at a 5% significance level (p < 0.05).
Treatment was labelled using 3 categories, 2 of which were subcategories of the first
- “Any passive treatment” – any form of manual therapy and/or acupuncture and/or electrotherapy.
- “Any manual therapy” – shoulder or spine joint mobilisations, deep transverse frictions, capsular stretches, trigger point therapy, muscle facilitation, or other techniques listed by the treating physiotherapist.
- “Spinal/shoulder joint mobilisation” – for example, Maitland, Kaltenborn or Mulligan techniques.
To be categorised, treatment must have been delivered by the physiotherapist at least once and may have been delivered in conjunction with other treatments.
Six-month SPADI scores were consistently lower (less pain and disability) for those who did not receive passive treatments compared to those who did (statistically significant less pain and disability in 7 of 24 models). However, DoD was statistically insignificant.
The authors concluded that PSE did not moderate the relationship between treatment and outcome. However, participants who received passive treatment experienced equal or more pain and disability at 6 months compared to those who did not. Results are subject to confounding by indication but do indicate the need for further appropriately designed research.
This analysis suggests that manual therapy, electrotherapy, or acupuncture in addition to advice and exercise offered no improvement in pain or disability at six months, irrespective of PSE. Some patients who receive these treatments experienced more pain and disability at six months compared to those who do not.
I am not aware of compelling evidence that either of these treatments, all of which are often recommended, are effective for shoulder pain, and the results of this new study certainly do not suggest they are. However, as the design of the study was not primarily for this research question, these findings are, of course, merely tentative and need to be investigated further.
7 Responses to Patients with shoulder pain who received manual therapy, electrotherapy, or acupuncture experienced equal or more pain and disability at 6 months compared to those who did not
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“receiving manual therapy, acupuncture, and electrotherapy” ???
How can this be compared? Manual therapy is not manual therapy. One therapist uses more force than an other. He does other twists, etc.. So, at least manual therapy as such should be scrutinized.
Electrotherapy? HOW!? There are so many devices, how was the curve of the voltage? How was the amplitude? How large were the electrodes? Where were they placed?
Acupuncture? SHOULD have a better outcome because it forces the probands to endure pain. So, what is the difference between acupuncture and no acupuncture?
Each of the three therapies are not easy to test. To even compare those three against each other needs a huge number of probands and a thorough recording of a huge number of parameters.
I think the answer is not the answer they found, but: DO IT AGAIN! And better.
Or as Beckett says “fail again, fail better”.
As Edzard said, the findings are tentative and there are lots of confounds. However it would seem very worthwhile having completed this little pilot, to now do a series of studies which more specifically examine the questions raised. With physiotherapy interventions being rife with nonsense, we urgently need closer investigation.
Prof. Ernst. Now is the time for you to delve into the largest SCAM profession. i.e. Physiotherapy. Few if any of their modalities have been proven to work. They have had to assume manipulation as their own to get any results and even then, a weekend course in it is not enough to become competent. Dr. Susan Ireraci was asked to provide evidence that physiotherapy was science based. She has yet to do so, and she should be taken to task about that, considering her anti-chiropractic stance via the organization Science Based Medicine.
However, I do not think that you will. Too hard for you to do, and it will probably prove that you have been wrong about so many things in your previous posts.
oh dear!
do you know anything of my professional history?
Oh dear! Your professional history is well known, that is why I have asked you to be consistent with your arguments and not delve into ad hominin’s and spurious arguments, that are not based upon science or evidence.
If you do a simple Google search you’ll see that Edzard has already written extensively on physiotherapy. You are not the author here, and trying to play the role of a belligerent editor will only bring you ridicule.