Inclusion of Mobilisation With Movement to an Exercise Programme in Rotator Cuff Related Pain
- Conditions
- Shoulder PainRotator Cuff Injuries
- Interventions
- Other: Mobilisation with MovementOther: Sham Mobilisation with Movement
- Registration Number
- NCT04175184
- Lead Sponsor
- Federal University of Health Science of Porto Alegre
- Brief Summary
Rotator cuff related pain is considered the main source of musculoskeletal shoulder pain that affects function and produces pain on movement. Amongst the existing physiotherapeutic management approaches, exercise therapy has been recognized as the first line approach. The use of manual therapy in the management of this condition has been debated and studies have shown contradictory results. A specific manual therapy approach, mobilisation with movement (MWM), seems promising in this population as it aims to improve pain-free range of motion and includes active engagement of the participant.
- Detailed Description
Rotator cuff related pain is a term that includes a diversity of shoulder conditions known as: subacromial impingement syndrome, rotator cuff tendinitis/tendinopathy, rotator cuff tear, bursitis. The use of a broader term is useful as the diagnostic accuracy of special orthopaedic tests have been widely criticised and are unable to identify pathognomonic sources of symptoms in people presenting with shoulder pain. Additionally, even though diagnostic imaging is capable of identifying pathology in patients with rotator cuff related pain, studies demonstrate that their correlation with clinical presentation is questionable.
Shoulder pain is one of the most common sources of musculoskeletal pain that might affect up to 20% of the population. Additional important epidemiological data concerning shoulder pain is the fact that approximately 40% of people complaining of shoulder pain will still be symptomatic after six months. Physiotherapy has an important role in the management of rotator cuff related pain and exercise is the main therapeutic approach when considering pain and functional restriction,
Mobilisation with movement (MWM) is one alternative musculoskeletal approach that focuses on improving active pain-free range of motion. This concept of treatment incorporates a passive accessory glide produced by the clinician, followed by an active movement executed by the patient. Different studies have suggested positive effects of MWM in patients complaining of shoulder pain. On the other hand, other studies reported no superior effects when using MWM in their studies. Several methodological aspects might have influenced this discrepancy in results, such as population, dosage and type of MWM utilized, follow-up period and outcome measures. Due to this uncertainty, the current research aims to further explore the inclusion of MWM to an exercise programme in patients with rotator cuff related pain.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 70
- Unilateral shoulder pain of atraumatic origin.
- Complaining of shoulder pain for at least six weeks.
- Scoring at least 3 out 10 on a numeric pain rating scale (0- no pain; 10- worst pain imaginable).
- Pain on active shoulder movement
- Pain provoked by at least three of the following tests: Hawkins-Kennedy, Neer, painful arc, resisted external rotation, empty or full can.
- Participants referred by a specialist under the diagnosis of subacromial impingement syndrome, rotator cuff tendinopathy, partial rotator cuff tears, subacromial pain, bursitis.
- Shoulder pain following a traumatic event.
- History compatible with complete rotator cuff and biceps rupture.
- Adhesive capsulitis.
- History of dislocation.
- Glenohumeral osteoarthritis.
- Cancer
- Systemic, local or self-immune inflammatory conditions.
- Previous shoulder or neck surgery.
- Familiar pain provoked by neck movements.
- Presence of radicular signs.
- Use of corticosteroids over the past six months.
- Diagnosis of fibromyalgia.
- Participants with clinical depression
- Participants under treatment for her/his shoulder condition.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Experimental group Mobilisation with Movement 1. Exercise programme: 2-3 sets of 10-15 repetitions of shoulder girdle and glenohumeral strengthening exercises performed in different positions in addition to three stretching exercises. 2. Mobilisation with movement (MWM): the participant and physiotherapist will decide one movement more functionally relevant to the patient. Afterwards, attempts of MWM will be applied to different joints in order to identify one particular MWM that improves significantly the movement previously selected. Then, one set of six to ten repetitions will be applied. This process of pragmatically using MWM will be conducted in every session, but from the second session onwards, two to three sets of ten repetitions will be applied, with an interval of sixty seconds between sets. In case of failure to identify an MWM that improves the movement significantly, the patient decides which one seemed to be best and one set of six repetitions will be applied to the onset of discomfort. Placebo group Sham Mobilisation with Movement 1. The exercise programme is exactly the same as the experimental group. 2. Sham MWM: the participant and physiotherapist will decide together one movement that is more functionally relevant to the patient. Afterwards, a sham MWM (Delgado-Gil et al 2015) will be applied and the movement previously selected will be repeated six times in the first consultation. The participant will be informed that he/she should move to the onset of symptoms, if they occur.This process will be conducted in every session, but from the second session onwards, two to three sets of 10 repetitions will be applied, with an interval of sixty seconds between sets. In case the sham MWM failed to improve the movement significantly, one set of six repetitions will be applied only.
- Primary Outcome Measures
Name Time Method Visual Analogue Scale (VAS) for pain. Changes from baseline and study completion (5 weeks) and 4 weeks follow-up. VAS for pain, is a scale that measures pain level. The scale ranges from 0 (no pain) to 10 (worst imaginable pain).
Shoulder Pain Disability Index (SPADI). Changes from baseline and study completion (5 weeks) and 4 weeks follow-up. SPADI is a self-reported questionnaire that contains thirteen different items. There are two domains: pain (5 items) and functional activity (8 items). Each item ranges from 0 (no pain / no difficulty) to 10 (worst imaginable pain / so difficult that requires help).
- Secondary Outcome Measures
Name Time Method Pain pressure threshold Changes from baseline and study completion (5 weeks). Measurements will be collected at three different sides: 5 cm distal to the lateral border of the acromion on both sides over the deltoid muscle, and 10 cm distal to the tibiofemoral joint line, over the tibialis anterior muscle on the unaffected side (Paul et al, 2012). A calibrated digital algometer (Wagner instruments, model FPX 25) will be used to assess the pain pressure threshold.
An interval of 30 seconds will be respected between measurements.Global rating scale of change (GROC) Through study completion and 4 weeks follow-up. GROC is designed to measure a patient's improvement or deterioration over time as a result of an intervention.The amplitude of this difference is scored on a numerical or visual analogue scale. In this research a 15 point scale will be used (Kamper et al, 2009).
Active pain-free range of motion. Changes from baseline and study completion (5 weeks). Active pain-free range of motion will be assessed for flexion, abduction (Kolber et al, 2011), external rotation (Cools et al, 2014) and hand behind back (Satpute et al, 2016). An inclinometer (Baseline, Enterprises Inc) will be used to measure the ranges of motion.
All measurements will be conducted to the onset of pain.Expectations of physiotherapy Change at 3 weeks of treatment from baseline The scale to be used in this study to assess expectation has been previously used in patients with shoulder disorders (Chester et al, 2018). Participants will answer the following question: "How much do you expect your shoulder problem to change as a result of physiotherapy treatment?. Please circle one box only".
Possible answers are: Completely recover, Much improve, Slightly improve, No change, Slightly worse, Much worse, Worse than ever.
Trial Locations
- Locations (2)
Albrecht - Clínica Integrada de Reabilitação
🇧🇷São Leopoldo, Rio Grande Do Sul, Brazil
Faculdades Integradas de Taquara
🇧🇷Taquara, Rio Grande Do Sul, Brazil