Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis

Bizzarri, Paolo; Buzzatti, Luca; Cattrysse, Erik; Scafoglieri, Aldo

doi:10.1016/j.msksp.2017.10.006

Cited by 18 publications

(27 citation statements)

References 56 publications

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“…The absence of a decrease in pain intensity at the post-treatment follow-up disagrees with the results of previous studies [ 10 ]. However, most of these previous published studies evaluated pain intensity at rest or during movement and/or orthopedic tests whereas in the present study, pain intensity was measured as the mean intensity during the previous week, which could explain these discrepancies.…”

Section: Discussioncontrasting

confidence: 99%

“…Previous studies have evaluated the effects of manual therapy in NSSP; these were mostly thoracic spine manipulation, glenohumeral and cervical spine mobilizations and soft tissue techniques [ 9 ]. However, most of them only evaluated the effects at the post-treatment follow-up [ 10 , 11 , 12 ], thus hindering knowledge of the possible benefits of these therapies over a longer time [ 9 ]. In the last decades, several authors have designed sham manual therapy procedures to compare with real manual therapy techniques with the aim of controlling the confounding factors; this has improved the quality of the manual therapy research field [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial

Naranjo-Cinto

Cerón-Cordero

Figueroa-Padilla

et al. 2022

JCM

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The aim of this study was to evaluate if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to same exercise program in patients with non-specific shoulder pain. This was an evaluator-blinded randomized controlled trial. Forty-five subjects were randomly allocated into one of three groups: manual therapy (glenohumeral mobilization technique and rib-cage technique); thoracic sham manual therapy (glenohumeral mobilization technique and rib-cage sham technique); or sham manual therapy (sham glenohumeral mobilization technique and rib-cage sham technique). All groups also received a therapeutic exercise program. Pain intensity, disability and pain-free active shoulder range of motion were measured post treatment and at 4-week and 12-week follow-ups. Mixed-model analyses of variance and post hoc pairwise comparisons with Bonferroni corrections were constructed for the analysis of the outcome measures. All groups reported improved pain intensity, disability and pain-free active shoulder range of motion. However, there were no between-group differences in these outcome measures. The addition of the manual therapy techniques applied in the present study to a therapeutic exercise protocol did not seem to add benefits to the management of subjects with non-specific shoulder pain.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial

Naranjo-Cinto

Cerón-Cordero

Figueroa-Padilla

et al. 2022

JCM

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“…Various studies tried to develop [135,136] and validate [137][138][139] a sham placebo technique. The principle obstacles are the needs to assess the patients' blinding, their expectations and their priori (real) inertness [140][141][142]. However, a novel sham procedure has recently been validated [143] and applied in clinical settings; both to patients with migraines [144] and those with cervicogenic headache [145], thus paving the way for a series of further studies.…”

Section: Emerging Lines For Future Researchmentioning

confidence: 99%

Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy

et al. 2020

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Background: Placebo and nocebo effects embody psychoneurobiological phenomena where behavioural, neurophysiological, perceptive and cognitive changes occur during the therapeutic encounter in the healthcare context. Placebo effects are produced by a positive healthcare context; while nocebo effects are consequences of negative healthcare context. Historically, placebo, nocebo and context-related effects were considered as confounding elements for clinicians and researchers. In the last two decades this attitude started to change, and the understanding of the value of these effects has increased. Despite the growing interest, the knowledge and the awareness of using the healthcare context to trigger placebo and nocebo effects is currently limited and heterogeneous among physiotherapists, reducing their translational value in the physiotherapy field. Objectives: To introduce the placebo, nocebo and context-related effects by: (1) presenting their psychological models; (2) describing their neurophysiological mechanisms; (3) underlining their impact for the physiotherapy profession; and (4) tracing lines for future researches. Conclusion: Several psychological mechanisms are involved in placebo, nocebo and context-related effects; including expectation, learning processes (classical conditioning and observational learning), reinforced expectations, mindset and personality traits. The neurophysiological mechanisms mainly include the endogenous opioid, the endocannabinoid and the dopaminergic systems. Neuroimaging studies have identified different brain regions involved such as the dorsolateral prefrontal cortex, the rostral anterior cingulate cortex, the periaqueductal gray and the dorsal horn of spine. From a clinical perspective, the manipulation of the healthcare context with the best evidence-based therapy represents an opportunity to trigger placebo effects and to avoid nocebo effects respecting the ethical code of conduct. From a managerial perspective, stakeholders, organizations and governments should encourage the assessment of the healthcare context aimed to improve the quality of physiotherapy services. From an educational perspective, placebo and nocebo effects are professional topics that should be integrated in the university program of health and medical professions. From a research perspective, the control of placebo, nocebo and context-related effects offers to the scientific community the chance to better measure the impact of physiotherapy on different outcomes and in different conditions through primary studies.

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“…The same can be said for the patient's possible preferences, which may be related to previous experiences or personal beliefs. All these effects are attributable to what has been defined as "placebo mechanisms," not intended as a psychological response to inert therapies, but as generalized and non-specific "psychologically and physiologically active process associated with a robust hypoalgesic response" [72,73]. Finally, psychosocial factors such as anxiety and fear of movement or motion (kinesiophobia) and self-efficacy seem to play a very important role when it comes to the effectiveness of a given technique or approach [74].…”

Section: Manual Therapy: From Theoretical Speculations To Researchmentioning

confidence: 99%

Manual Therapy: Art or Science?

Bizzarri¹,

Foglia²

2020

Physical Therapy Effectiveness

Self Cite

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Manual Therapy is one of the most widely used therapeutic solutions in the treatment of pain and musculoskeletal disorders. Its evolution began several centuries ago and culminated in the modern reference methods in the field of physiotherapy, osteopathy, and chiropractic, which mainly address the treatment of joint and myofascial tissues. The advent of evidence-based medicine and the ever-growing literature available in the field of Manual Therapy has led this therapeutic approach to be heavily criticized on the basis of studies that have shown its limitations with regard to manual and palpatory assessment techniques, the poor biomechanical validity of therapeutic methods, and the poor long-term results in the treatment of patients with musculoskeletal pain. A better understanding of the mechanisms underlying the effectiveness of Manual Therapy, as well as of the mediators of the medium-and long-term effectiveness of musculoskeletal rehabilitation processes, has made it possible to reconsider the role of Manual Therapy and the healthcare professionals specializing in manipulative therapy within the framework of the biopsychosocial model, which focuses on the patient and their functionality.

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Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis

Cited by 18 publications

References 56 publications

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial

Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy

Manual Therapy: Art or Science?

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