Effectiveness of Thoracic Spine Manual Therapy in Treating Subacromial Impingement Syndrome: A Systematic Review and Meta-analysis.

Abstract

To determine the effects of thoracic spine manual therapy (TSMT) in managing shoulder impingement syndrome (SIS) through a systematic review and meta-analysis. Five databases (Medline, Embase, Web of science, Physiotherapy Evidence Database, and Cochrane Central) were searched from inception to October 2024. Randomized controlled trials evaluating TSMT combined with other physiotherapy versus physiotherapy alone, or TSMT versus placebo, in individuals with SIS were included. Outcomes included pain, disability, and range of motion. Two authors independently performed data extraction, risk of bias assessment, and evidence quality evaluation. A total of 10 randomized controlled trials involving 444 participants were included. Pooled mean difference and standardized mean difference (SMD) with 95% confidence interval (CI) were calculated. Four studies examined TSMT as an adjunct to exercise; 6 used placebo comparators. Pain was commonly assessed using Numeric Pain Rating Scale or Visual Analog Scale in 7 studies; disability was measured by Shoulder Pain And Disability Index or Disabilities of Arm, Shoulder, and Hand in 6 studies. High-quality evidence showed large effect size in favor of TSMT at short terms (2-6 wk after baseline) (SMD [95% CI]=-0.94 [-1.23 to -0.65]) and at intermediate-term (4-6 wk after intervention completion) (SMD [95% CI]=-0.83 [-1.26 to -0.40]) follow-up. Disability improved significantly at intermediate-term follow-up (SMD [95% CI]=-0.82 [-1.25 to -0.38]), supported by high-quality evidence. Subgroup analysis revealed that significant disability reduction in TSMT groups compared with placebo with a moderate effect size (SMD [95% CI]=-0.75 [-1.18 to -0.32]), supported by high-quality evidence. Furthermore, moderate evidence also supported improved internal rotation (SMD [95% CI]=0.61 [0.21-1.02]) and external rotation (SMD [95% CI] = 0.58 [0.17-1.00]). The TSMT is effective in reducing pain, disability, and improving range of motion in individuals with SIS over short terms.