Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial

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.]

Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Its Short Version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society Standardized Shoulder Assessment Form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI)

“…Relevant settings (aims and analysis [references]) for SDQ are as follows: General population, primary care (development of the SDQ‐UK [80]) Primary care (development, responsiveness [81]) Primary care (revision, responsiveness [82]) Shoulder instruments (comparative review [83, 84]) Shoulder pain (reliability, validity [85, 86]) Adhesive capsulitis (responsiveness [87, 88]) Rotator cuff (responsiveness [89]) Chronic shoulder pain (responsiveness [90]) …”

“…Effect sizes (ES) and standardized response means (SRMs) of the SDQ are as follows: Adhesive capsulitis: mobilization: ES 5.43 and 2.81, SRM 3.88 and 3.40 (ref 87 Rotator cuff tendinitis: steroids, transcutaneous electrical nerve stimulation: ES 5.19 and 5.43, SRM 5.83 and 4.08 (ref 89…”

Efficacy and cost‐effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: A randomized trial

“…Although there is little evidence to support the use of a wide array of physiotherapy methods as primary or initial treatment for adhesive capsulitis (4–9), there are strong theoretical reasons to suggest that manual techniques and directed exercise may be of value if applied at the appropriate time and/or in combination with other interventions. For example, a recent trial reported small treatment benefits of high‐grade versus low‐grade mobilization techniques in patients with adhesive capsulitis (10). Participants in the trial had a median duration of symptoms of 8 months and the majority had received prior therapy including steroid injections and physical therapy.…”

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“…It is important to maintain the elbow near the side of the trunk and ensure that no pain is experienced during the procedure. Adjust the grade and direction of the glide as needed to achieve pain-free function [10,11]. Three sets of 10 repetitions were applied, with a rest interval of 30 s between each set.…”