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Background: The Shoulder Pain and Disability Index (SPADI) is designed to detect changes in shoulder pain and disability after a one-week interval. With the new Medicare guideline, the SPADI may have to be employed for time frames of less than one week., Purpose: To determine if the SPADI or its subscales could detect immediate changes in pain and function after a thoracic manipulative intervention known to produce short-term improvement and by comparing it to changes on the numeric pain rating scale (NPRS)., Methods: Subjects with primary complaints of non-post-surgical shoulder pain completed the NPRS and the SPADI prior to and immediately following interventions., Findings: The SPADI pain subscale detected statistically significant differences that were also detected using the NPRS. In addition, the SPADI pain score and the NPRS scores were moderately correlated between the pre-intervention SPADI and NPRS scores (r = 0.49-0.61, p < 0.001) and post-intervention SPADI and NPRS scores (r = 0.49-0.67, p < 0.001). These differences did not appear to be sensitive or responsive to immediate change., Clinical Relevance: Since the SPADI may have to be employed in durations of less than one week secondary to third party payer requirements, it is valuable to validate the SPADI for this particular use., Conclusion: Although SPADI scores demonstrated low sensitivity and responsiveness to immediate changes, the SPADI pain scale was able to detect changes in durations of less than one week. This finding should be confirmed through further prospective experimentation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Study Design: Planned secondary analysis of a randomized clinical trial., Objectives: To examine: 1) patients' baseline expectations for treatment outcome of thoracic high velocity low amplitude thrust manipulations (HVLATM) to the thoracic spine for shoulder pain; 2) if the message conveyed by the clinician changed the patients' expectation; 3) any differences in outcome based on expectation independent of messaging.; and 4) any differences in outcome for those patients whose expectations significantly changed as a result of the messaging., Background: Thoracic HVLATM may be an effective intervention for patients suffering from musculoskeletal shoulder pain. The role of expectation in the treatment effectiveness of this intervention has not been established., Methods: Subjects' expectations regarding 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., Results: There was a 10 subject change (23%) in positive expectation that was statistically significant (p = 0.019) following a positive message. There was no statistically significant difference in pain and function when these subjects were compared to all other subjects., Conclusion: Although patients' expectations of positive outcome significantly changed when providing a positive instructional set, these changes did not translate into clinically significant short term changes in shoulder pain and function., Level of Evidence: 1b., (Copyright © 2014 Elsevier Ltd. All rights reserved.)