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Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: a randomized controlled trial
Rosa DP, Borstad JD, Ferreira JK, Gava V, Santos RV, Camargo PR
Brazilian Journal of Physical Therapy 2021 Sep-Oct;25(5):648-658
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Posterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization. OBJECTIVE: To assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms. METHODS: In this prospectively registered randomized controlled trial 59 individuals were randomized to either an experimental intervention group (EIG, n = 31) or a control intervention group (CIG, n = 28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration. RESULTS: Individuals in the EIG demonstrated more scapular upward rotation (p = 0.03; mean difference (MD) 3.3 degree; 95% confidence interval (CI) 1.3 degree to 4.9 degree) and improved value on the LF test (p = 0.02; MD 4.6 degree; 95%CI 0.7 degree to 8.6 degree) than those in the CIG after treatment. Both groups presented less anterior (p < 0.01; MD -0.7 mm; 95%CI -1.3 mm to -0.2 mm) and superior (p < 0.01; MD -0.5 mm; 95%CI -0.9 mm to -0.2 mm) humeral translations, decreased SPADI score (p < 0.01; MD -23.6; 95%CI -28.7 to -18.4), increased IR ROM (p < 0.01; MD 4.6 degree; 95%CI 1.8 degree to 7.8 degree) and PPTs for upper trapezius (p < 0.01; MD 60.1 kPa; 95%CI 29.3 kPa to 90.9 kPa), infraspinatus (p = 0.04; MD 47.3 kPa; 95%CI 2.1 kPa to 92.5 kPa), supraspinatus (p < 0.01; MD 63.7 kPa; 95%CI 29.6 kPa to 97.9 kPa), and deltoid (p < 0.01; MD 40.9 kPa; 95%CI 12.3 kPa to 69.4 kPa) after treatment. CONCLUSION: The experimental intervention was more effective at improving PCT as measured through changes in the LF test. No benefit of the specific approach over the non-specific intervention was noted for the remaining variables.

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