Department of Musculoskeletal Physiotherapy smt. Kashibai Navale College of Physiotherapy, Pune, India.
Faculty of Health Sciences, Australian Catholic University, North Sydney, Australia.
J Man Manip Ther. 2022 Feb;30(1):13-32. doi: 10.1080/10669817.2021.1955181. Epub 2021 Aug 1.
To assess the effects of mobilization with movement (MWM) on pain, range of motion (ROM), and disability in the management of shoulder musculoskeletal disorders.
Six databases and Scopus, were searched for randomized control trials. The ROB 2.0 tool was used to determine risk-of-bias and GRADE used for quality of evidence. Meta-analyses were performed for the sub-category of frozen shoulder and shoulder pain with movement dysfunction to evaluate the effect of MWM in isolation or in addition to exercise therapy and/or electrotherapy when compared with other conservative interventions.
Out of 25 studies, 21 were included in eight separate meta-analyses for pain, ROM, and disability in the two sub-categories. For frozen shoulder, the addition of MWM significantly improved pain (SMD -1.23, 95% CI -1.96, -0.51)), flexion ROM (MD -11.73, 95% CI -17.83, -5.64), abduction ROM (mean difference -13.14, 95% CI -19.42, -6.87), and disability (SMD -1.50, 95% CI (-2.30, -0.7). For shoulder pain with movement dysfunction, the addition of MWM significantly improved pain (SMD -1.07, 95% CI -1.87, -0.26), flexion ROM (mean difference -18.48, 95% CI- 32.43, -4.54), abduction ROM (MD -32.46, 95% CI - 69.76, 4.84), and disability (SMD -0.88, 95% CI -2.18, 0.43). The majority of studies were found to have a high risk of bias.
MWM is associated with improved pain, mobility, and function in patients with a range of shoulder musculoskeletal disorders and the effects clinically meaningful. However, these findings need to be interpreted with caution due to the high levels of heterogeneity and risk of bias.
Treatment, level 1a.
评估运动松动术（MWM）对肩部肌肉骨骼疾病管理中的疼痛、活动范围（ROM）和残疾的影响。
检索了 6 个数据库和 Scopus，以寻找随机对照试验。使用 ROB 2.0 工具确定偏倚风险，使用 GRADE 评估证据质量。对冻结肩和伴有运动功能障碍的肩部疼痛这两个亚类进行了荟萃分析，以评估在单独使用或与运动疗法和/或电疗结合使用时，MWM 与其他保守干预措施相比的效果。
在 25 项研究中，有 21 项研究纳入了 8 项针对这两个亚类的疼痛、ROM 和残疾的单独荟萃分析。对于冻结肩，MWM 的加入显著改善了疼痛（SMD -1.23，95%CI -1.96，-0.51）、前屈 ROM（MD -11.73，95%CI -17.83，-5.64）、外展 ROM（平均差异 -13.14，95%CI -19.42，-6.87）和残疾（SMD -1.50，95%CI -2.30，-0.7）。对于伴有运动功能障碍的肩部疼痛，MWM 的加入显著改善了疼痛（SMD -1.07，95%CI -1.87，-0.26）、前屈 ROM（平均差异 -18.48，95%CI- 32.43，-4.54）、外展 ROM（MD -32.46，95%CI -69.76，4.84）和残疾（SMD -0.88，95%CI -2.18，0.43）。大多数研究被发现存在高偏倚风险。
MWM 与一系列肩部肌肉骨骼疾病患者的疼痛、活动能力和功能改善相关，其效果具有临床意义。然而，由于存在高度异质性和偏倚风险，这些发现需要谨慎解释。
治疗，1a 级。
