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

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.