Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial.
Henricus M Vermeulen, Piet M Rozing, Wim R Obermann, Saskia le Cessie and Thea PM Vliet Vlieland PHYS THER. 2006; 86:355-368.
ABSTRACT
Background and Purpose. In many physical therapy programs for subjects with
adhesive capsulitis of the shoulder, mobilization techniques are an important
part of the intervention. The purpose of this study was to compare the
effectiveness of high-grade mobilization techniques (HGMT) with that of
low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis
of the shoulder.
Subjects. One hundred subjects with unilateral adhesive
capsulitis lasting 3 months or more and a 50% decrease in passive joint
mobility relative to the nonaffected side were enrolled in this study.
Methods.
Subjects randomly assigned to the HGMT group were treated with intensive
passive mobilization techniques in end-range positions of the glenohumeral
joint, and subjects in the LGMT group were treated with passive mobilization
techniques within the pain-free zone. The duration of treatment was a
maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at
baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome
measures included active and passive range of motion and shoulder disability
(Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire
[SDQ]). An analysis of covariance with adjustments for baseline values
and a general linear mixed-effect model for repeated measurements were
used to compare the change scores for the 2 treatment groups at the various
time points and over the total period of 1 year, respectively.
Results. Overall,
subjects in both groups improved over 12 months. Statistically significant
greater change scores were found in the HGMT group for passive abduction
(at the time points 3 and 12 months), and for active and passive external
rotation (at 12 months). A statistically significant difference in trend between
both groups over the total follow-up period of 12 months was found for passive
external rotation, SRQ, and SDQ with greater change scores in the HGMT
group.
Discussion and Conclusion. In subjects with adhesive capsulitis of the
shoulder, HGMTs appear to be more effective in improving glenohumeral
joint mobility and reducing disability than LGMTs, with the overall differences
between the 2 interventions being small. [Vermeulen HM, Rozing PM,
Obermann WR, et al. Comparison of high-grade and low-grade mobilization
techniques in the management of adhesive capsulitis of the shoulder:
randomized controlled trial. Phys Ther. 2006;86:355–368.]
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