Objectives: Impairment in upper cervical spine mobility is associated with cervicogenic headache severity and disability. Measures of such mobility include the flexion-rotation test (FRT), which requires full cervical flexion and may be influenced by lower cervical spine dysfunction. The C0-C2 axial rotation test also evaluates upper cervical mobility but normal values and reliability have not been reported. Our objective is to determine normal values, and intra-rater and inter-rater reliability of the C0-C2 axial rotation test. Methods: Two therapists independently evaluated the FRT and C0-C2 axial rotation test with an iPhone compass application on 32 asymptomatic subjects with mean age 40.53 (SD 11.64) years on two occasions. Measurement procedures were standardized; and order of testing randomized. Results: For the FRT and C0-C2 axial rotation test reliability was high (ICC > 0.88). For rater one, Mean range to the left during the FRT and C0-C2 axial rotation test was 45.0°(6.04) and 14.43°(2.94), respectively, while range to the right was 44.6°(6.57) and 15.44°(2.68). For the FRT and C0-C2 axial rotation test the standard error of measurement was at most 2°, while the minimum detectable change was at most 4°. A strong positive correlation exists between the FRT and C0-C2 axial rotation test (r = 0.84, P < 0.01). Discussion: The range recorded during the C0-C2 axial rotation test and FRT have high levels of reliability when evaluated using an iPhone. The strong correlation between the FRT and C0-C2 axial rotation test indicate that both may be measuring similar constructs, but each test needs to be referenced to normal values.
Objectives: To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis Design: A randomised controlled trial. Setting: A general hospital Subjects: Forty adults with knee osteoarthritis (grade 1–3 Kellgren–Lawrence scale). Interventions: The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks. Main Measures: The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up. Results: Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up. Conclusion: In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.
Objectives: Shoulder pain and impairment is a prevalent and disabling condition. While some Mulligan mobilization with movement (MWM) techniques have been shown to have beneficial effects, Hand Behind Back (HBB) MWM has not been investigated. The aim of this study was to investigate the effects of HBB MWM on shoulder pain, impairment and disability. Methods: We conducted a double blind randomized controlled trial in 44 subjects with shoulder pain and movement impairment presenting to an Indian general hospital. Subjects were allocated to receive either MWM and exercise/hot pack (n=22) or exercise/hot pack alone (n=22). The primary outcome was HBB range of motion (ROM). Secondary variables were shoulder internal rotation ROM, pain intensity score, and shoulder disability identified by the Shoulder Pain and Disability index (SPADI). All variable were evaluated by a blinded assessor before and immediately after 9 treatment sessions spread over 3-weeks. Results: A total of 60 patients were screened and 44 randomized. The average duration of symptoms was 4.1 and 4.7 weeks in the exercise and MWM groups respectively. Paired t-tests revealed that both groups demonstrated statistically significant improvements (p< 0.001) with large effect sizes for all variables. However, for all variables the MWM with exercise group showed significantly greater improvements (p< 0.05) than the exercise group. HBB ROM showed a mean difference of 9.31˚ (95% CI 7.38 to 11.27), favoring greater improvement in the MWM with exercise group. Conclusions: Shoulder HBB MWM with exercise improves outcomes in patients with acute shoulder pain and disability greater than exercise/hot packs alone.
Objective: To assess the effects of mobilisation with movement (MWM) on pain, range of motion (ROM) and disability in the management of shoulder musculoskeletal disorders.Methods: Six databases PubMed (MEDLINE), CINAHL, SPORTDiscus, PEDro, Cochrane library, and Scopus were searched for randomized control trials (RCTs). The ROB 2 tool was used to determine risk-of-bias and the quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were performed for the sub-category of frozen shoulder and shoulder pain with movement dysfunction to evaluate the effect of MWM in isolation or in addition to exercise therapy and /or electrotherapy when compared with either no treatment, exercise therapy, electrotherapy alone or other types of manual therapy Results: Out of twenty-five studies, twenty-one were included in 8 separate meta-analyses for pain, ROM, and disability in the 2 sub-categories of shoulder disorders. For frozen shoulder, the addition of MWM significantly improved pain (SMD -1.23, 95% CI -1.96, -0.51), I 2 =89%), flexion ROM (MD -11.73, 95% CI -17.83, -5.64, I 2 =82%), abduction ROM (mean difference -13.14, 95% CI -19.42, -6.87, I 2 =85%) and disability (SMD -1.50, 95% CI (-2.30, -0.7, I 2 =89%). For shoulder pain with movement dysfunction the addition of MWM significantly improved pain (SMD -1.07, 95% CI -1.87, -0.26, I 2 =86%), flexion ROM (mean difference -18.48, 95% CI-32.43, -4.54, I 2 =90%), abduction 4.84, I 2 =97%) and disability (SMD -0.88, 95% CI -2.18, 0.43, I 2 =92%). The majority of studies were found to have a high risk of bias. Where appropriate, the clinical significance of the pooled differences was compared against Minimal Clinically Important Difference values.Discussion: MWM in addition to other forms of physiotherapy is associated with improved pain, mobility and function in patients with a range of shoulder musculoskeletal disorders including frozen shoulder. The effects were clinically meaningful for flexion and abduction ROM. However these findings need to be interpreted with caution due to the high levels of heterogeneity among included studies and inclusion of studies with a high risk of bias. The reasons for high levels of heterogeneity and risk of bias are explored.
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