Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment

Participants

• Number: 29 people (18 female and 11 male)

• Criteria of inclusion: geriatric clinics or nursing homes’ patients with one or both shoulders diagnosed with: tendinitis, bursitis, osteoarthritis, healed fractures, neurological impediment, chronic pain associated with ROM limitations; functional dependence in carrying out daily activities involving the shoulders (eg, washing themselves and getting dressed); limited ROM between 25% and 75% in abduction or flexion.

• Criteria of exclusion: refusal to receive the treatment.

• Groups of study: 2 groups obtained by randomization
  – Group 1: OMT, 16 people
  • 11 people with arthritis, 5 with neurological disorders, 4 with bursitis and 1 healed fractures
  • 9 people with limited ROM as main complaint, 6 with pain and 1 with both
  – Group 2: sham treatment, 13 people
  • 11 people with arthritis, 2 with bursitis, 2 with healed fractures and 1 with neurological disorders
  • 9 people with limited ROM as main complaint, 4 with pain and 0 with both

Interventions and evaluations

• Functional independence assessment via Physical Functioning Scale modified in relation to personal hygiene and getting dressed, active and passive ROM through goniometer and shoulder pain through the Subjective Unit of Discomfort Scale Subjective on weeks 1 (ie, the start of the study), 3, 5, 7, 11, 15 (practically 1 week after the application of the intervention) and 19 (follow–up)
• 5 30-minutes sessions of OMT or sham treatment applied on weeks 2, 4, 6, 10 and 14
• OMT: Spencer’s technique, performed twice during each session
• Sham treatment: the patients were positioned as for the Spencer’s technique but this would then not be performed
• OMT and sham treatment performed by one practitioner per each person
  • each person was asked to avoid the use of medicines or other therapies (however, no obligation was imposed), as well as the operator himself avoided advising the use of any of them during the study
  • each person received a compensation to participate in and complete the study

Results

• Primary outcomes: In both groups, active and passive ROM in a supine position or in flexion increased statistically significantly during the study. The OMT group saw a statistically significant greater increase in active and passive ROM compared to the sham treatment group.

While in the sham treatment group the ROM – in abduction, in flexion, in a supine position and in flexion while seated – had periods of improvement and worsening during the study, to finally decrease after the end of the treatments. The OMT group showed a continuous increase in the ROM in flexion, an increase that continued even after the end of treatments.

With regard to pain, no statistically significant differences emerged, although the OMT group perceived more pain during and at the end of the study compared to the sham treatment group. The pain started to increase again in both groups after the treatments.

Discussion

• OMT seems to be able to improve shoulder ROM.

The greater pain perceived by the OMT group could depend on the intensity of the treatment regimen. The increase in ROM in the sham treatment group, by contrast, could simply depend on a placebo effect, and therefore vanished once the treatment was over. In this regard, another hypothesis was that the patients repeated the exercises at home, thus skewing the results, or possibly they thought they were in the OMT group.

Future studies of larger groups will have to evaluate the persistence of the outcomes in the long term and collect data to understand if the subjects replicate the therapy at home and what perception they have of the treatment they receive. Furthermore, studies that include also a third group with no treatment are going to be needed.