Comparative effects of gong's mobilization and mobilization with movement in patients with adhesive capsulitis: a randomized clinical trial

Abstract

Adhesive Capsulitis results in a progressive contraction of the Glenohumeral joint capsule limiting active and passive range of motion, leading to functional disabilities. Joint mobilization plays a key role in the physical therapy treatment of Adhesive Capsulitis. A relatively new technique, Gong's Mobilization, has been introduced for the treatment of Adhesive Capsulitis. It is focused on the correction of positional faults through controlled dynamic motion of the Glenohumeral joint. The mainstay of this clinical trial is a comprehensive comparative evaluation of MWM with Gong's Mobilization as it remains insufficiently explored. The objective of this clinical trial was to compare the effects of Gong's Mobilization and Mobilization with Movement on pain, range of motion and functional disability in patients with Adhesive Capsulitis. In this triple blinded randomized clinical trial, sixty patients of Adhesive Capsulitis were enrolled within group A (Gong's Mobilization) and group B (Mobilization with Movement). The treatment protocol covered 12 treatment sessions for 4 weeks. Numeric Pain Rating Scale (NPRS), Goniometer, and Urdu version of Shoulder Pain and Disability Index (U-SPADI) were used to assess the pain, range of motion and functional status respectively. These outcome measures were assessed at baseline, after 6 treatment sessions (2 weeks) and conclusively after 12 treatment sessions (4 weeks). For data analysis, within the group differences were measured by Repeated Measure ANOVA and across the group differences were measured by independent t test. A significant difference within the mean values of baseline, week 2 and week 4 NPRS, ROM, and SPADI score was observed in both study groups (p < 0.001). Results of independent t test used to calculate across the group differences indicated that Gong's Mobilization was more effective in reducing disability (SPADI)(p < 0.001) and improving ROM(p < 0.001), meanwhile both groups were equally effective in reducing NPRS scores(p = 0.78). Moreover, a medium to large effect size was also observed for all the outcomes, pain(d = 0.5), ROM (d = 0.5-2.7), SPADI(d = 0.5). It was concluded that Gong's Mobilization is more effective than Movement with Mobilization. Following four weeks of treatment, it pronounced statistically significant and clinically relevant results in improving pain, ROM and functional status of patients with Adhesive Capsulitis. Trial Registration Trial was registered in IRCT (Trial registration number: IRCT20190717044238N4 Trial Registration Date: 01-03-2023).

Keywords: Frozen Shoulder; Manual therapy; Physical therapy techniques; Rehabilitation.

Fig. 1

CONSORT Flow Diagram.

Fig. 2

Gongs Mobilization in side-lying position.

Fig. 3

MWM for Abduction.

Fig. 4

MWM for Internal Rotation & External Rotation.

Fig. 5

Within group comparison for NPRS at Baseline, Week 2 and Week 4.

Fig. 6

Within group comparison for SPADI at Baseline, Week 2 and Week4.

Fig. 7

Within group comparison for ROM at Baseline, Week 2 and Week 4.

Fig. 8

Across the group comparison for NPRS at Baseline, Week 2 and Week 4.

Fig. 9

Across the group comparison for SPADI at Baseline, Week 2 and Week 4.

Fig. 10

Across the group comparison for ROM (Abd, IR, ER) at Baseline, Week 2 and Week 4.