Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial. Abstract. Objective To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease. Design Randomised, participant and single assessor blinded, placebo controlled trial.
Setting Metropolitan region of Melbourne, Victoria, Australia. Participants 1. 20 participants with chronic (> 3 months) rotator cuff disease recruited through medical practitioners and from the community. Interventions The active treatment comprised a manual therapy and home exercise programme; the placebo treatment comprised inactive ultrasound therapy and application of an inert gel. Participants in both groups received 1.
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For the following 1. Main outcome measures The primary outcomes were pain and function measured by the shoulder pain and disability index, average pain on movement measured on an 1. Results 1. 12 (9. At 1. 1 weeks no difference was found between groups for change in shoulder pain and disability index (3. More participants in the active group reported a successful outcome (defined as “much better”), although the difference was not statistically significant: 4.
Before beginning manual therapy or any type of physical therapy, the practitioner usually performs a full assessment of the blood and nerve supply in the area, as.
The active group showed a significantly greater improvement in shoulder pain and disability index than did the placebo group at 2. Several secondary outcomes favoured the active group, including shoulder pain and disability index function score, muscle strength, interference with activity, and quality of life. Conclusion A standardised programme of manual therapy and home exercise did not confer additional immediate benefits for pain and function compared with a realistic placebo treatment that controlled for therapists’ contact in middle aged to older adults with chronic rotator cuff disease. However, greater improvements were apparent at follow- up, particularly in shoulder function and strength, suggesting that benefits with active treatment take longer to manifest. Trial registration Clinical trials NCT0. Introduction. Shoulder disorders are a common cause of persistent musculoskeletal morbidity,1. Pain and compromised shoulder function have a substantial impact on tasks essential to daily living, as well as on sleep.
Shoulder disorders are a common reason for seeking medical care and may require surgical intervention in up to 2. Shoulder disorders can thus lead to considerable disability, reduced health related quality of life, absenteeism from work, and use of healthcare resources. Although definitions of different diagnostic categories of shoulder pain are controversial, a large proportion of shoulder problems can be classified as “rotator cuff disease,” the most common cause of shoulder pain in primary care. The term, or its variants such as impingement syndrome, may include a spectrum of pathologies of rotator cuff disease (such as subacromial bursitis, partial rotator cuff tears, and bicipital tendinosis), but they are characterised clinically by pain with abduction (painful arc) and signs of impingement.
Although standard criteria have not been established for use in clinical trials, most trials that have assessed interventions for rotator cuff disease have used variations of these features to select their study populations. Rotator cuff disease differs from other major diagnostic categories of shoulder pain such as adhesive capsulitis, osteoarthritis, and calcific tendinitis, which are known to have different presentations, underlying causes, prognoses, and responses to treatment.
A combination of modalities of physiotherapy, such as manual therapy and exercise, is often used in the management of rotator cuff disease. These aim to correct modifiable physical impairments thought to contribute to pain and dysfunction rather than to treat the specific pathology. These impairments include rotator cuff and scapular muscle weakness and dysfunction, tightness of the posterior capsule and other soft tissues, and postural abnormalities. Little conclusive evidence supports or refutes the efficacy of different physiotherapy programmes given the variable methodological quality of the trials, including a lack of placebo control and the fact that many tested a single modality despite multimodality treatment being the most common way in which physiotherapists treat shoulder disorders. The conclusions and recommendations of recent systematic reviews support the need for further clinical trials.
The primary aim of this trial was, therefore, to determine whether a 1. Methods. Participants. Between March 2. 00. November 2. 00. 7, we recruited people with chronic rotator cuff disease through medical practitioners and from the community through print and radio media. We required all participants to have a plain radiograph of the shoulder to check for exclusions (see below), and we required potential participants recruited directly from the community to have the diagnosis of rotator cuff disease confirmed by a medical practitioner. After an initial screen by telephone, an experienced physiotherapist (EW or SC) did a physical examination. Inclusion criteria were age over 1.
Exclusion criteria were resting severity of shoulder pain greater than 7/1. English. Procedures. We did a randomised, participant and assessor blinded, controlled trial. Participants had a baseline assessment and were randomised in permuted blocks of six and eight, stratified by treating physiotherapist, to receive either active manual therapy and home exercise treatment or placebo treatment according to a computer generated table of random numbers created by the study biostatistician (AF). Allocations were sealed in opaque and consecutively numbered envelopes kept in a central locked location. An independent administrator opened the envelopes in sequence and then revealed the group allocation to the relevant physiotherapist by facsimile just before the participant presented for treatment. Interventions. Details about the interventions have been published previously.
Fourteen musculoskeletal physiotherapists (all with more than four years of relevant clinical experience) from 1. Therapists attended initial training sessions and were given a detailed treatment manual. We could not blind the therapists to treatment group. Both interventions were standardised and comprised individual sessions twice weekly for the first fortnight, once a week for the next four weeks, then once a fortnight in the last four weeks (1. To minimise the risk of participants meeting, appointments were scheduled at different times. We assessed therapists’ adherence to the protocol by completion of a treatment log. Simple analgesia was permitted, but participants were asked to refrain from seeking other forms of treatment during the trial.
Treatment in both groups was provided at no cost to the participant. We based the active intervention on the literature and on the results of a formal written survey of 1. Australian musculoskeletal physiotherapists with expertise in treating shoulder conditions. The intervention was directed at improving dynamic scapular control, strengthening scapular stabiliser and rotator cuff muscles, improving shoulder and thoracic posture, and increasing range of motion of thoracic extension. The intervention had five components comprising soft tissue massage, passive mobilisation of the glenohumeral joint, scapular retraining and postural taping, spinal mobilisation (to assist in improving shoulder girdle posture and spinal range of motion), and home exercises (table 1⇓).
We incorporated behavioural strategies, including education, goal setting, motivation, and positive reinforcement. Home exercises were done daily, except during the first week of treatment when exercises were completed twice daily (web appendix). After the 1. 0 week programme, participants in the active group were instructed to maintain their daily home exercise programme for 1. Table 1 Components of active physiotherapy intervention. Participants in the placebo group attended the same number of treatments as did those in the active treatment group but received sham ultrasound therapy and light application of a non- therapeutic gel to the shoulder region for 1.
They received no instruction in exercise techniques and no manual therapy. We have successfully used this same placebo protocol in previous studies.
During the 1. 2 week follow- up period, placebo participants did not receive any intervention and were not instructed to do any home exercises. Outcome measures. The same blinded assessor (EW) evaluated all participants at baseline, at 1. Baseline demographic information was collected, and participants rated their expectation of a beneficial effect of active physiotherapy treatment on an ordinal scale from 1 to 5, with higher scores indicating higher expectations. The primary outcomes were the shoulder pain and disability index (SPADI), average pain on movement assessed by a numerical rating scale, and participants’ perceived global rating of change overall. The shoulder pain and disability index is a self administered, shoulder specific index consisting of 1. We calculated a total shoulder pain and disability index score by summing the subscales and then averaging for a score out of 1.
We measured participants’ overall assessment of average pain on movement and pain at rest in the previous week by separate 1. The minimal clinically important difference for shoulder pain on movement measured on this scale is 1. The amount of weakness, stiffness, and interference with activities of daily living over the previous week were similarly measured. Participants’ perceived global rating of change overall and in pain, strength, and stiffness (from baseline) were recorded on separate five point Likert- type scales (1=much worse, 2=slightly worse, 3=no change, 4=slightly better, 5=much better).
Brain Integration Therapy Manual - Dianne Craft MA, CNHP Store. Updated 2. 01. 3 edition! Dianne Craft's "Brain Integration Therapy Manual" has been updated and includes photo demonstrations, step- by- step graphic guides, detailed Brain Training instructions, handy condensed instructions, charts to track your progress, and much more, you will find that the 2. Brain Integration Therapy Manual is more than just a manual. You will find daily lesson plans, case studies, and additional information that goes beyond Brain Integration Therapy that will assist you in educating your intelligent yet struggling learner. Why Brain Integration Therapy? God designed learning to occur in a specific way: when a new task is learned, such as riding a bike, driving a car, learning to track the eyes from left to right in reading, or learning the orientation of letters or numbers, the left, concentrating brain hemisphere is engaged. After a short time of practice, these processes are supposed to transfer into the child’s right brain to be stored in the automatic hemisphere so he or she can now think and track his or her eyes at the same time, think and write at the same time, or think and hear sounds at the same time.
When this transfer isn’t easily made between brain hemispheres, the child becomes overwhelmed with the learning task and begins to get behind in reading and writing because of the effort involved in a process that should take very little effort if both brain hemispheres were involved. This can appear as dyslexia, dysgraphia, or more mild processing problems in reading, writing, and hearing. These hemispheric connections, which appear to be absent or “disconnected” can be encouraged to reconnect by using specific body exercises that cross the midline of the body. When these short, daily exercises are combined with the more powerful once- a- week Brain Training, these vital connections are slowly, progressively made each week. By using this process, parents and teachers see the learning process (elimination of visual and writing reversals, remembering phonics sounds, etc.) become easier after just a few weeks. However, it is important to continue this process for at least 3 - 6 months, so that the gains are not lost. This inexpensive but very effective home therapy has been used by parents across the country for the past 2. We at Child Diagnostics will be here to answer any of your questions and guide you through this process so that you will see the same improvements in learning that we have seen for many years. Let’s consider this: The price of one session of Vision Therapy to improve eye convergence and eye teaming is often upwards from $8.
It has been found that parents who do the weekly Brain Trainings to encourage the right, automatic brain hemisphere to take over the eye tracking from left to right, that their child either needs greatly reduced vision therapy visits (as reported by several vision therapy offices) or possibly none at all. When I was teaching in schools none of my students were able to avail themselves of vision therapy and yet, at the end of the year, they were no longer reversing letters or words when they read or wrote, not skipping words and lines, and were no longer fatigued after reading. The price of one individual tutoring session for reading problems at one of the tutoring centers is often $7. With the Brain Integration Brain Trainings, along with Right Brain Reading strategies for reading, you can be your child’s own tutor and pay yourself whatever tutoring fee you want to! The price of receiving the training to do your own perceptual training and tutoring at home: $5. This includes regular testing material, and ongoing email follow- up by Child Diagnostics (Dianne Craft and staff), if you so desire.
There are many ways to get at the learning problems a child may be experiencing. This is just one way, but it is the way that I have found to be very helpful, and puts the parent in the driver’s seat. What's in the 2. 01. Detailed diagnostic checklists for each of the processing problem areas a child could be experiencing: Visual Processing Problems (reading reversals, eye convergence and eye tracking issues, tires easily when reading)Writing/Fine Motor processing problems (greatly labored writing, dysgraphia, find motor issues, child who is “allergic” to a pencil)Auditory Processing problems (can’t remember phonics, sight words hard, oral directions difficult, scrambles words when saying them, etc.)Pictures of children demonstrating every single step of the all important once a week Brain Training, and the daily 2.
This is easy to follow! Clear explanation and examples of each of the 1. Auditory Processing “channels” that can be blocked in a child, and how to correct these blocks. Comes with charts to help you diagnose and help you track your child’s progress. Case studies of children who have just one learning gate blocked, two learning gates blocked, three learning gates blocked, or all four learning gates blocked. This will make it easier for you to see where your child’s issues are, and what to do about them. A diagnostic reading grade- placement test that we give at the beginning of this process, and then every 3 months, to track the child’s progress in reading as we do this therapy. Daily Lesson plans for a struggling Reader, Writer and Speller. These lesson plans are invaluable in your work with a struggling child. They give the daily routine using Brain Integration Therapy to remove learning glitches, along with the Right Brain teaching strategies that I used to bypass the learning glitches in a child. These are the very lesson plans that I used in my Resource Room to achieve the 2 year growth in reading and writing in a year. The Right Brain teaching strategies help a child feel smart right away (using their photographic memory strength), while the Brain Integration Brain Training done once a week, eventually makes enough pathways connecting both brain hemispheres that the child will not need Right Brain teaching strategies all of his life. The offer of continued follow- up via email with you from Dianne Craft and staff, if you so desire, as you go through this process of correction with your child, so that you can be assured of success.