Thoracic spinal manipulation for musculoskeletal shoulder pain: Can an instructional set change patient expectation and outcome?

This study aimed to examine patients’ baseline expectations for treatment outcome of thoracic high velocity low amplitude thrust manipulations (HVLATM) to the thoracic spine for shoulder pain; if the message communicated by the clinician changed the patients’ expectation; any differences in outcome based on expectation independent of messaging.; as well as any differences in outcome for those patients whose expectations significantly changed as a result of the messaging. Subjects’ expectations related to the effectiveness of HVLATM on shoulder pain were recorded at baseline. This was reassessed immediately following the provision of positive or neutral instructional set. The subjects then received a thoracic or scapular HVLATM. The Shoulder Pain and Disability Index (SPADI) and the numeric pain rating scale (NPRS) were used as outcomes measures. There was a 10 subject change (23%) in positive expectation that was statistically significant (p = 0.019) after a positive message. There was no statistically significant difference in pain and function when these subjects were compared to all other subjects.

Although patients’ expectations of positive outcome significantly changed when a positive instructional set was provided, these changes failed to translate into clinically significant short term changes in shoulder pain and function.