Selasa, 05 Februari 2013





Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial.
Henricus M Vermeulen, Piet M Rozing, Wim R Obermann, Saskia le Cessie and Thea PM Vliet Vlieland PHYS THER. 2006; 86:355-368.


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. Phys Ther. 2006;86:355–368.]

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