® 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...

BackgroundMusculoskeletal (MSK) disorders represent a great burden on the health care system. The use of physiotherapists in their autonomous roles and in advanced practice roles may help increase access to care. Thus, the aim of this survey was to assess the perceptions of a university community sample within the province of Quebec about physiotherapists as primary care practitioners and advanced practice physiotherapists (APPs) for the treatment of patients with musculoskeletal disorders.MethodsAn electronic survey was sent in February 2014 via a web platform to members of the Laval University community (Québec City, Canada). The survey included questions about knowledge and perceptions on current physiotherapists’ autonomous role in primary care and on APP future model of care for patients with MSK disorders. Survey results were synthetized with descriptive statistics. Differences in responses according to demographics, personal characteristics and previous physiotherapy care experience were evaluated using Chi-Square tests.ResultsA total of 513 participants completed the online survey (1 % response rate). The majority of respondents were women (74 %) and aged 18 to 24 (39 % of all respondent). About 90 % of respondents believed that physiotherapists were skilled and competent and 91 % answered that they had trust in physiotherapists for the treatment of MSK disorders in primary care. A total of 90 % of respondents supported the idea of introducing APPs for the treatment of patients with MSK disorders. Over 90 % of respondents were in favour of the delegation of medical acts such as: communicating a medical diagnosis, ordering imaging tests, triaging surgical candidates or prescribing medication such as NSAIDS.ConclusionsRespondents are satisfied and have confidence in physiotherapists as primary care practitioners; they also support the intended new roles of the APPs in the health care system. Caution should be taken in generalizing these results from this particular sample. These results need to be corroborated in the general population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1256-8) contains supplementary material, which is available to authorized users.

Low-grade evidence exists that a workplace exercise programme may reduce the intensity of shoulder pain, and that workstation modifications may reduce the prevalence of shoulder pain.

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