Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis.

BACKGROUND: Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions. OBJECTIVE: The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions. METHODS: Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form. RESULTS: Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low. CONCLUSION: Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.

Task analyses identify coat-donning delays in preschoolers in special education.

PURPOSE: To describe use of task analyses for school-based documentation of skill levels of a sample of preschool children in special education classes. METHOD: Coat-donning task analyses and scoring codes were developed for the traditional and coat- flip methods. Preschool children's abilities were scored 3 times per year as part of weekly classroom consultations. Of 601 charts from 2003 to 2007, 171 met inclusion criteria. RESULTS: Initially, 22 (13%) children independently donned coats; 149 (87%) required assistance. Final scores identified that 75 (44%) children achieved or regained independence, 14 (8%) still required assistance prior to kindergarten entrance, 50 (29%) were eligible for more services, and 32 (19%) had services interrupted. CONCLUSION: Task analyses and scoring codes improved efficiency and standardization of school-based documentation, demonstrated incremental changes over time, and focused task training. The majority of preschool children in this sample were initially delayed in coat-donning independence when compared with preschool children developing typically.