In people with shoulder pain, mobilisation with movement and exercise improves function and pain more than sham mobilisation with movement and exercise: a randomised trial

Abstract

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.

Keywords: Exercise; Mobilisation with movement; Musculoskeletal manipulations; Rotator cuff; Shoulder pain.