PAIN+ CPN

QUESTION: In people with shoulder pain, what is the effect of adding mobilisation with movement (MWM) to a standard exercise program on function and pain compared with sham MWM and the same exercise program?

DESIGN: A randomised trial with concealed allocation, blinded outcome assessment and intention-to-treat analysis.

PARTICIPANTS: Seventy people with chronic atraumatic rotator cuff related pain, with a mean age 48 years (SD 10).

INTERVENTIONS: The experimental group received MWM plus exercise and the control group received sham MWM plus exercise. Treatments were delivered twice per week for 5 weeks.

OUTCOME MEASURES: The primary outcome measures were function (0 to 100 Shoulder Pain and Disability Index) and pain (0 to 10 Numerical Pain Rating Scale). Secondary outcomes were self-efficacy, perceived improvement and active pain-free range of movement. Assessment time points were at baseline (week 0), the end of the treatment period (week 5) and a follow-up 1 month after the end of treatment (week 9).

RESULTS: At week 5, the experimental group improved more than the control group in function (MD -15 points, 95% CI -24 to -7), pain at night (MD -2.1, 95% CI -3.1 to -1.1), pain on movement (MD -1.5, 95% CI -2.5 to -0.6) and active range of movement in flexion (MD 16 deg, 95% CI 1 to 30), abduction (MD 23 deg, 95% CI 6 to 40), external rotation (MD 11 deg, 95% CI 4 to 17) and hand behind back (MD 20 deg, 95% CI 8 to 32). At week 9, benefits were seen in the Shoulder Pain and Disability Index (MD -9 points, 95% CI -17 to -1), pain at night (MD -1.9, 95% CI -2.9 to -0.8) and on movement (MD -1.3, 95% CI-2.3 to -0.3). The effects of the experimental intervention on other outcomes were mostly unclear due to wide confidence intervals. Blinding was successful.

CONCLUSIONS: Adding MWM to exercise improved function, pain and active range of movement in people with shoulder pain. These benefits were not placebo effects.

REGISTRATION: NCT04175184.

Ms. Heather Taylor (10/18/2024 11:38 AM)

This study showed that exercise along with mobilizations with movement (MWM) assist in recovery with rotator cuff related shoulder pain better than control. A asset of this study is the well designed control group that included exercise plus sham MWM, not exercise alone. It helps to show that the improvements noted were not simply due to hands-on treatment, but specific techniques. This article can be a useful resource for physiotherapists treating patients with shoulder pain.