Effect of Myofascial Release of Subscapularis Along With Shoulder Mobilization in Adhesive Capsulitis

Study Overview
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Brief Summary
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This randomized control trial aims to compare the effect of myofascial release of subscapularis along with shoulder mobilization VS mobilization alone among patients with adhesive capsulitis. The study will be conducted at physiotherapy outpatient department (OPD) of Sindh Institute of physical medicine and rehabilitation, and Dow University Ojha Campus, Karachi. According to study criteria, 70 patients with sub-acute adhesive capsulitis will be selected through a non-randomized purposive sampling technique by a consultant physician. After taking informed consent, participants will be randomly divided into 2 groups through the sealed envelope method. Both the groups will receive conventional treatment while Group 1 will be given an additional treatment of myofascial release of subscapularis through ischemic compression technique. Total 6 treatment sessions will be provided and assessment will be done at baseline and end of the 6th session.

Detailed Description
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The sample size of 31 per group was determined using planning and specification software (PASS) version 15 software based on two independent sample t-test using 95%confidence interval and 80% power of the test. This sample was raised to 35 per group with 4 patients as drop out per group. Mean and standard deviation will be calculated for the quantitative variables while frequency and percentages will be calculated for qualitative variables. Inter-group comparison at baseline will be calculated using an independent sample t-test. The mean difference between both the techniques in terms of numeric pain rating scale (NPRS), range of motion (ROM), shoulder pain and disability index (SPADI), and pain pressure threshold(PPT) will be determined using Repeated measure 2-way ANOVA.

Official Title
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Effect of Myofascial Release of Subscapularis Along With Shoulder Mobilization Versus Shoulder Mobilization Alone in Adhesive Capsulitis

Conditions
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Adhesive Capsulitis of Shoulder

Intervention / Treatment
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* Other: Myofascial release of subscapularis
* Other: Maitland mobilization
* Other: Stretching exercises
* Other: Cold pack


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged between 40-65 years Diagnosed with sub-acute adhesive capsulitis Pain range of 3 to 8 on NPRS SPADI score of >40 Presence of myofascial trigger point in subscapularis muscle Exclusion Criteria: History of fracture Rheumatoid arthritis Shoulder osteoarthritis Any malignancy Shoulder dislocation Subacute adhesive capsulitis with impingement syndrome

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Maitland mobilization with myofascial trigger point release group<br>Maitland technique: caudal, anteroposterior (AP), and posteroanterior (PA) glides 5 sets of 2-3 glides per second of Grade III and IV for 30 seconds with a rest interval of 30 second between sets. Ischemic Compression technique: on subscapularis trigger points for 90 secs thrice a week for 2 weeks. Stretching exercises in direction of abduction, external rotation (ER), internal rotation (IR), and flexion. 6 repetitions of each stretch for 10 seconds Cold pack for 20 mins | Other: Myofascial release of subscapularis<br>* It is the application of manual pressure over myofascial trigger point that induces ischemia and causes release of trigger points<br>Other: Maitland mobilization<br>* It is the type of mobilization technique that uses passive accessory mobilization to reduce pain and stiffness and increasing range of motion<br>Other: Stretching exercises<br>* It is the technique use to increase flexibility and range of motion of short and hypomobile structures<br>Other: Cold pack<br>* It is the application of cold to provide analgesic effects<br>|
| Active Comparator: Maitland mobilization alone group<br>Maitland technique: caudal, anteroposterior (AP), and posteroanterior (PA) glides 5 sets of 2-3 glides per second of Grade III and IV for 30 seconds with a rest interval of 30 second between sets. Stretching exercises in direction of abduction, external rotation (ER), internal rotation (IR), and flexion. 6 repetitions of each stretch for 10 seconds Cold pack for 20 mins | Other: Maitland mobilization<br>* It is the type of mobilization technique that uses passive accessory mobilization to reduce pain and stiffness and increasing range of motion<br>Other: Stretching exercises<br>* It is the technique use to increase flexibility and range of motion of short and hypomobile structures<br>Other: Cold pack<br>* It is the application of cold to provide analgesic effects<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline pain intensity on Numeric Pain Rating Scale in scores at 6th session (10 days) | It will be use to assess pain intensity. It will be administered by simply asking the intensity of pain experienced in last 24 hours. The response of 0 represent no pain rather the responses between 1-3, 4-6, and 7-9 represents mild, moderate, and severe pain respectively. While 10 is the worst possible pain ever experienced by the person | At baseline and after 6 sessions (10 days) | 
| Change from baseline joint range of motion on universal goniometer in degrees at 6th session (10 days) | It will be assessed by using standard universal goniometer and measured in degrees | At baseline and after 6 sessions (10 days) | 
| change from baseline shoulder disability on Shoulder pain and disability index in percentage at 6th session (10 days) | Shoulder pain and disability index is used to assess shoulder disability. It consist of 13 questions i .e. 5 to assess pain and 8 to assess disability. Results will be calculated in percentage and higher results indicate increased disability. lower the percentage better will be the outcome. | At baseline and after 6 sessions (10 days) | 
| Change from baseline pain pressure threshold on algometer in kilogram/centimeter2 at 6th session (10 days) | assessed through algometer which provide sustained pressure from 0.05Newton/second to 20 Newton/second. Results will be recorded in kilogram/centimeter2 and higher values indicate decrease sensitivity of myofascial trigger points | At baseline and after 6 sessions (10 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Range of motion, Adhesive capsulitis, Muscle stretching exercise, Myofascial trigger point, Pain