Author Names
Menek, B., Tarakci, D., Algun, Z. C.
Reviewer Name
Casie Coffman SPT, NBC-HWC
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
BACKGROUND: Mulligan mobilization techniques cause pain and affect the function in patients with Rotator cuff syndrome. OBJECTIVE: The aim of the study was to investigate the effect of Mulligan mobilization on pain and quality of life in individuals with Rotator cuff syndrome. METHODS: This study was conducted on 30 patients with Rotator cuff syndrome. The patients were randomized into Mulligan and control group. All the patients participating in this study were treated with conventional physiotherapy. Additionally, the Mobilization with movement (MWM) technique was used in the Mulligan group. Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), goniometer for the normal range of motion (ROM) and Short Form-36 (SF-36) questionnaires were used for assessment. RESULTS: Statistically significant improvement was found in the post-treatment VAS, DASH, SF-36, and ROM values significantly improved in both groups (p < 0.05). However, the Mulligan group showed much better results when compared to the control group in ROM, VAS, DASH (p < 0.05). In the SF-36 questionnaire, significant results were obtained for both groups, except the social function parameter. For the SF-36 parameters, both groups performed equally. CONCLUSIONS: Mulligan mobilization was more effective than general treatment methods for pain as well as normal joint motion, DASH scoring and some parameters of SF-36 compared with general treatment methods.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Cannot Determine, Not Reported, or Not Applicable
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
The mulligan and control groups both demonstrated statistically significant improvement post-intervention measured by pain severity (VAS), shoulder ROM, the DASH, and SF-36.
Key Finding #2
Statistically significant between-group differences favored the mulligan group for VAS, shoulder ROM, and DASH scores post-intervention.
Key Finding #3
Within the SF-36, a statistically significant between-group difference was demonstrated in the social function domain post-intervention. All other components of the SF-36 changed similarly when comparing the mulligan and control groups.
Please provide your summary of the paper
This single-blind RCT compared the effects of mulligan mobilization plus conventional physiotherapy versus conventional therapy alone on pain and quality of life in individuals with rotator cuff syndrome. 30 participants aged 30-70 years had rotator cuff tendinitis, tendinosis, or a partial tear. They did not have a history of shoulder surgery. Conventional physiotherapy incorporated stretching, strengthening, and the use of cold packs, ultrasound, and TENS 5 days per week for 6 weeks. The additional technique used in the mulligan group involved ~20 minutes of mobilization to the humeral head while participants actively flexed, abducted, externally rotated, and internally rotated their arm within pain-free ranges. The direction of force was applied perpendicularly to the osteokinematic motion. While both groups displayed statistically significant improvements in pain severity (VAS), shoulder ROM, and DASH scores, between-group differences favored the mulligan group for each of these measures. Both groups demonstrated statistically significant differences in SF-36 scores post-intervention as well. Social function was the only category of the SF-36 that revealed significant between-group difference, which favored the mulligan group.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
The information from this study suggests that mulligan mobilization may heighten the benefits of conventional physiotherapy in individuals with rotator cuff syndrome. More specifically, individuals may see better improvements in pain severity, motion, and function. Given these findings, mulligan mobilization and conventional physiotherapy are valuable conservative treatments for this population.
