Passive mobilisation of shoulder region joints plus advice and exercise does not reduce pain and disability more than advice and exercise alone: a randomised trial

Question: Is the addition of passive mobilisation of shoulder region joints to advice and exercise for patients with shoulder pain and stiffness more effective than advice and exercise alone? Design: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: 90 people who had shoulder pain and stiffness for more than one month. Intervention: All participants received advice and exercise. The experimental group also received passive joint mobilisation of shoulder region joints. Outcome measures: Primary outcome measures included pain and disability measured with the 13-point Shoulder Pain and Disability Index. Secondary outcome measures were self-perceived global improvement measured on a 6-point scale and active ranges of motion. Subjects received a maximum of 10 sessions of therapy. Outcome measurements were taken at baseline, one month, and six months. Results: The experimental group had 3% (95% CI-5 to 11) less pain and disability than the control group at one month and 1% (95% CI-13 to 16) less pain at six months, which are statistically non-significant. Their global perceived effect was 0.1 out of 5 (95% CI-0.2 to 0.4) worse than the control group at one month and 0.1 (95% CI-0.5 to 0.7) better at 6 months, which are also statistically non-significant. Differences between groups in all range of motion measures were small and statistically non-significant. Conclusion: The addition of passive joint mobilisation of shoulder region joints is not more effective than advice and exercise alone for shoulder pain and stiffness. Trial registration: ACTRN 12605000080628. [Chen JF, Ginn KA, Herbert RD (2009) Passive mobilisation of shoulder region joints plus advice and exercise does not reduce pain and disability more than advice and exercise alone: a randomised trial. Australian Journal of Physiotherapy 55: 17-23]