Danielle Southerst1, Andrée-Anne Marchand2, Pierre Côté3, Heather M Shearer4, Jessica J Wong5, Sharanya Varatharajan6, Kristi Randhawa6, Deborah Sutton7, Hainan Yu8, Douglas P Gross9, Craig Jacobs10, Rachel Goldgrub11, Maja Stupar12, Silvano Mior13, Linda J Carroll14, Anne Taylor-Vaisey15. 1. Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada. 2. Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), North York, ON, Canada. 3. Canada Research Chair in Disability Prevention Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada. 4. Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada. 5. Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada; Instructor, Department of Graduate Studies, Canadian Memorial Chiropractic College, North York, ON, Canada. 6. Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada. 7. Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada; Adjunct Professor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, North York, ON, Canada. 8. Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada. Electronic address: Hainan.Yu@uoit.ca. 9. Professor, Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Director, Rehabilitation Research Centre, University of Alberta, Edmonton, AB, Canada. 10. Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Director, Division of Clinical Education and Patient Care, Canadian Memorial Chiropractic College, North York, ON, Canada. 11. Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada. 12. Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada. 13. Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, North York, ON, Canada; Adjunct Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada. 14. Professor, Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada. 15. Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, ON, Canada.
Abstract
OBJECTIVE: The purpose of this study was to critically appraise and synthesize evidence on the effectiveness of noninvasive interventions, excluding pharmacological treatments, for musculoskeletal thoracic pain. METHODS: Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of noninvasive interventions were eligible. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text accessed through EBSCOhost from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. RESULTS: We screened 6988 articles and critically appraised 2 studies. Both studies had a low risk of bias and were included in our synthesis. One RCT compared thoracic spinal manipulation, needle acupuncture, and placebo electrotherapy for recent thoracic spine pain. There were statistically significant but clinically nonimportant short-term reductions in pain favoring manipulation. There were no differences between acupuncture and placebo electrotherapy. Another RCT compared a multimodal program of care and a session of education for recent musculoskeletal chest wall pain. The multimodal care resulted in statistically significant but clinically nonimportant short-term reductions in pain over education. However, participants receiving multimodal care were more likely to report important improvements in chest pain. CONCLUSIONS: Quality evidence on the management of musculoskeletal thoracic pain is sparse. The current evidence suggests that compared to placebo, spinal manipulation is associated with a small and clinically nonimportant reduction in pain intensity and that acupuncture leads to similar outcomes as placebo. Furthermore, a multimodal program of care (ie, manual therapy, soft tissue therapy, exercises, heat/ice, and advice) and a single education session lead to similar pain reduction for recent-onset musculoskeletal chest wall pain. However, patients who receive multimodal care are more likely to report pain improvements.
OBJECTIVE: The purpose of this study was to critically appraise and synthesize evidence on the effectiveness of noninvasive interventions, excluding pharmacological treatments, for musculoskeletal thoracic pain. METHODS: Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of noninvasive interventions were eligible. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text accessed through EBSCOhost from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. RESULTS: We screened 6988 articles and critically appraised 2 studies. Both studies had a low risk of bias and were included in our synthesis. One RCT compared thoracic spinal manipulation, needle acupuncture, and placebo electrotherapy for recent thoracic spine pain. There were statistically significant but clinically nonimportant short-term reductions in pain favoring manipulation. There were no differences between acupuncture and placebo electrotherapy. Another RCT compared a multimodal program of care and a session of education for recent musculoskeletal chest wall pain. The multimodal care resulted in statistically significant but clinically nonimportant short-term reductions in pain over education. However, participants receiving multimodal care were more likely to report important improvements in chest pain. CONCLUSIONS: Quality evidence on the management of musculoskeletal thoracic pain is sparse. The current evidence suggests that compared to placebo, spinal manipulation is associated with a small and clinically nonimportant reduction in pain intensity and that acupuncture leads to similar outcomes as placebo. Furthermore, a multimodal program of care (ie, manual therapy, soft tissue therapy, exercises, heat/ice, and advice) and a single education session lead to similar pain reduction for recent-onset musculoskeletal chest wall pain. However, patients who receive multimodal care are more likely to report pain improvements.