Perbandingan Antara High Grade dan Low Grade Teknik Mobilisasi untuk Capsulitis Adhesiva pada Bahu : Randomized Controlled Trial

Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial.

Henricus M Vermeulen, Piet M Rozing, Wim R Obermann, Saskia le Cessie and Thea PM Vliet Vlieland PHYS THER. 2006; 86:355-368.

ABSTRACT

Background and Purpose. 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. 

Subjects. One hundred subjects with unilateral adhesive 

capsulitis lasting 3 months or more and a 50% decrease in passive joint 

mobility relative to the nonaffected side were enrolled in this study. 

Methods. 

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. 

Results. 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. 

Discussion and Conclusion. 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. [Vermeulen HM, Rozing PM, 

Obermann WR, et al. Comparison of high-grade and low-grade mobilization 

techniques in the management of adhesive capsulitis of the shoulder: 

randomized controlled trial. Phys Ther. 2006;86:355–368.]

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