Author Names

Noten, S. et al

Reviewer Name

Emily Stadnick, 2nd year SPT at Duke

Reviewer Affiliation(s)

Duke University School of Medicine- DPT program

 

Paper Abstract

Abstract Objective: To systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder. Data Sources: PubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists. Study Selection: All English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included. Data Extraction: Two reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials. Data Synthesis: The efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (nZ2), Cyriax approach (nZ1), and Maitland technique (nZ6) showed improvement in pain score and ROM. With respect to translational mobilizations (nZ1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (nZ1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (nZ1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (nZ1) were found on both pain and ROM. Conclusions: Overall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment. Archives of Physical Medicine and Rehabilitation 2016;97:815-25

 

NIH Risk of Bias Tool

Quality Assessment of Systematic Reviews and Meta-Analyses

  1. Is the review based on a focused question that is adequately formulated and described?
  • Yes
  1. Were eligibility criteria for included and excluded studies predefined and specified?
  • Yes
  1. Did the literature search strategy use a comprehensive, systematic approach?
  • Yes
  1. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
  • Yes
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
  1. Were the included studies listed along with important characteristics and results of each study?
  • Yes
  1. Was publication bias assessed?
  • Yes
  1. Was heterogeneity assessed? (This question applies only to meta-analyses.)
  • Cannot Determine, Not Reported, Not Applicable

 

Key Finding #1

The literature in this systematic review demonstrated that overall, mobilization techniques can provide beneficial effects in patients with primary AC of the shoulder.

Key Finding #2

Spine mobilzations and the Maitland technique combined with stretching of the glenohumeral joint and both angular and translational mobilizations seem to be the current recommendation from this systematic review.

 

Please provide your summary of the paper

The goal of this paper was to systematically review studies involving patients with primary adhesive capsulitis of the shoulder to determine the efficacy of isolated articular mobilization techniques on this population. 7 different techniques and mobilizations were examined using the 12 randomized controlled trials that qualified to be included in the review. Results showed that mobilization techniques can benefit patients with primary AC of the shoulder, and the Maitland technique in addition to combined mobilizations is the current recommendation from this paper. The Maitland technique was shown to have beneficial effects on pain and ROM for patients with primary adhesive capsulitis. Although Maitland proved beneficial, some studies included in this review had limitations including not blinding participants or therapists, variable length, duration, and severity of the injury, and decreased sample size making the information determined from this review less generalizable.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

More studies need to be done to conclude the efficacy of other mobilization techniques aside from Maitland. Additionally, a larger sample size and more homogenous criteria of the stage of injury need to be examined to determine the effects of all manual therapy techniques on ROM and pain for various stages of primary shoulder AC.