Mulligan Concept Mobilisation With Movement for Shoulder Dysfunction in Older Adults
Condition: Disorder of Shoulder
Study type: Interventional

Summary: 
      Objective: To pilot the methods proposed for conducting a full randomised clinical trial to
      evaluate the effect of Mulligan concept mobilization with movement on shoulder functionality
      in older adults with shoulder dysfunction.

      Design: Pilot randomised, single-blinded clinical trial. Setting: Three nursing homes,
      Toledo, Spain. Participants: 44 older adults with shoulder dysfunction. Interventions:
      Participants will be randomly allocated into control group (n=22) treated with a
      physiotherapy standard protocol proposed by the Spanish Rheumatology Society; and
      experimental group (n=22) treated with the same physical therapy standard protocol and
      Mulligan concept mobilisation with movement. Both interventions will take place three times a
      week for 2 consecutive weeks.

      Main outcomes: Primary outcome is shoulder functionality measured with Shoulder Disability
      Questionnaire (S-SDQ) Spanish version, and secondary outcomes are active glenohumeral range
      of motion and pain intensity. Data will be collected at baseline, after each group
      intervention, and 1 and 3 months after finishing interventions.
    

Detailed description: 
      Shoulder dysfunction is a common problem in older adults reaching up to 21% of prevalence.
      Shoulder symptoms, such as pain and reduced shoulder active range of motion (AROM) and
      function, might be associated to chronic pain, disability and decline in physical performance
      over time. Upper limbs and shoulder joint proper functionality leads to an adequate
      independence in activities of daily living (ADL) and functional performance. Therefore,
      maintaining independence in ADL and functional well-being in older adults should be a
      priority target for health care. A successful therapeutic approach depends on the
      understanding that the aging process is the responsible of major changes involving muscle
      disorders and joint stiffness.

      Among the most common approaches to treating in¬dividuals with shoulder dysfunction,
      physiotherapy interven¬tion is often recommended as the first choice for a conservative
      treatment. Physiotherapy treatment usually includes therapeutic exercises, manual therapy,
      and various modalities and there are controversies about the most effective approach for pain
      reduc¬tion, increase in AROM and function, and decrease in disability in people with shoulder
      dysfunction. There is evidence about the effectiveness of thera¬peutic exercise, and the
      benefit of manual therapy for improvements in mobility and a trend in improving pain
      measures, while increases in function and quality of life are still questionable.

      Some evidence was found about the effects of therapeutic exercise programs for overall
      performance improvement in older adults, but not specifically shoulder dysfunction. Regarding
      manual therapy in elderly, Knebl et al. developed a study about the effectiveness of Spencer
      manipulative technique in shoulder pain and found an improvement in functionality, shoulder
      AROM and pain intensity. Van den Dolder et al. investigated the effect of soft tissue massage
      on shoulder ROM, pain and dysfunction in patients with a mean age of 64 years old and found
      statistically significant results. Therefore, manual therapy techniques may be an option for
      correcting joint mechanics, promoting adhesion removal and restoring passive shoulder
      mobility in older adults.

      Mobilisation with movement (MWM) is a manual therapy technique based on the analysis and
      correction of any minor positional fault in a joint. According to Mulligan, positional faults
      are due to various soft tissue and/or bone lesions in/around the joint and were explained in
      patients with shoulder pain by a kinematic study. This technique aims to realign joints
      positional faults by applying a manually specific oriented glide to a painful joint,
      assessing and adjusting force intensity, while the patient actively performs joint movement,
      so that patient's symptoms are immediately relieved and the maneuvers improve pain and
      movement. Therefore, when a correction mobilization is sustained, pain-free movement is
      restored and several repetitions are performed in order to get an improvement that lasts over
      time. The initial effects of MWM were assessed by Teys et al. in adults; who proved its
      effectiveness in increasing shoulder AROM and decreasing positional faults. Therefore, MWM
      may be an effective technique in physiotherapy treatment for shoulder dysfunction, as this it
      addresses passive and active shoulder structures. However, no studies about MWM effectiveness
      for shoulder dysfunction in older adults have been found.

      The purpose of this pilot clinical trial is to pilot the methods proposed to conduct a full
      randomised controlled clinical trial to determine the effect of Mulligan concept MWM for
      shoulder dysfunction in older adults. The primary objectives are to evaluate the feasibility
      of recruitment, randomisation, retention, assessment procedures, and implementation of
      Mulligan concept MWM intervention. A secondary aim is to undertake a preliminary comparison
      of patient reported-outcomes and to estimate the variability of these outcomes in older
      adults with shoulder dysfunction.
    

Intervention name(s): Standard protocol; Mulligan Concept Mobilisation with Movement
Intervention type(s): Other; Other
Intervention description(s): Control group intervention is the physiotherapy treatment standard protocol proposed by the Spanish Rheumatology Society for shoulder dysfunction; The internal hand of the physiotherapist stabilises participants´ shoulder girdle and with the thenar eminence of the other hand, performs a posterior-lateral glide of the humeral head. Participants are asked to raise the affected arm in the point of pain onset while the physiotherapist sustains the gliding force to humeral head. The physiotherapist tries to maintain the glide at right angles to the plane of movement throughout the entire range while participants are requested to perform an active elevation. Participants are instructed that the mobilisation procedure, including shoulder movement, had to be pain free
Other intervention name(s): Standard protocol for shoulder pain of Spanish Rheumatology Society
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Shoulder, disability evaluation, physiotherapy modalities