Vermeulen Henricus M, Rozing Piet M, Obermann Wim R, le Cessie Saskia, Vliet Vlieland Thea P M
Department of Physical Therapy, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
Phys Ther. 2006 Mar;86(3):355-68.
In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder.
One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or =50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study.
Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively.
Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group.
In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small.
在许多针对肩周炎患者的物理治疗方案中，松动技术是干预措施的重要组成部分。本研究的目的是比较高级松动技术（HGMT）与低级松动技术（LGMT）对肩周炎患者的疗效。
本研究纳入了100名单侧肩周炎患者，病程持续3个月或更长时间，与未受影响侧相比，被动关节活动度下降≥50%。
随机分配至HGMT组的受试者在盂肱关节终末位接受强化被动松动技术治疗，LGMT组的受试者在无痛范围内接受被动松动技术治疗。两组的治疗时长均最长为12周（24节）。由一名盲法评估者在基线、3个月、6个月和12个月时对受试者进行评估。主要结局指标包括主动和被动活动范围以及肩部功能障碍（肩部评分问卷[SRQ]和肩部功能障碍问卷[SDQ]）。分别采用对基线值进行调整的协方差分析和重复测量的一般线性混合效应模型，比较两个治疗组在不同时间点以及1年总期间的变化分数。
总体而言，两组受试者在12个月内均有改善。HGMT组在被动外展（3个月和12个月时间点）以及主动和被动外旋（12个月时）方面的变化分数具有统计学显著差异。在12个月的总随访期内，两组在被动外旋、SRQ和SDQ方面的趋势存在统计学显著差异，HGMT组的变化分数更高。
对于肩周炎患者，HGMT在改善盂肱关节活动度和减少功能障碍方面似乎比LGMT更有效，两种干预措施之间的总体差异较小。
