title: Efficacy of Hand Behind Back Mobilization With Movement for Acute Shoulder Pain and Movement Impairment: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of hand-behind-back (HBB) Mulligan mobilization with movement (MWM) techniques on acute shoulder pain, impairment, and disability.
  
  
  METHODS
  This double-blind, randomized, controlled trial recruited 44 patients with acute shoulder pain and movement impairment presenting to an Indian general hospital. Participants were allocated to receive either MWM and exercise/hot pack (n = 22) or exercise/hot pack alone (n = 22). The average duration of symptoms was 4.1 and 4.7 weeks in the exercise and MWM groups, respectively. The primary outcome was HBB range of motion (ROM). Secondary variables were shoulder internal rotation ROM, pain intensity score, and shoulder disability identified by the shoulder pain and disability index. All variables were evaluated by a blinded assessor before and immediately after 9 treatment sessions over 3 weeks.
  
  
  RESULTS
  Paired t tests revealed that both groups demonstrated statistically significant improvements (P < .001) with large effect sizes for all variables. However, for all variables, the MWM-with-exercise group showed significantly greater improvements (P < .05) than the exercise group. Hand-behind-back ROM showed a mean difference of 9.31° (95% confidence interval, 7.38-11.27), favoring greater improvement in the MWM-with-exercise group.
  
  
  CONCLUSIONS
  In this study, the outcomes of patients with acute shoulder pain and disability receiving shoulder HBB MWM with exercise improved greater than those receiving exercise/hot packs alone.
authors.affiliation: Assistant Professor, Department of Musculoskeletal Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Narhe, Pune, India. Electronic address: Kiran_ptist@yahoo.co.in.
authors.forename: Kiran H
authors.initials: KH
authors.lastname: Satpute
authors.affiliation: Assistant Professor, Department of Orthopedics, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bhandari
authors.affiliation: Adjunct Associate Professor, School of Physiotherapy and Curtin Health Innovation Research, Curtin University, Perth, Australia.
authors.forename: Toby
authors.initials: T
authors.lastname: Hall
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000328:Adult; D018771:Arthralgia / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods*; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D019534:Shoulder Impingement Syndrome / Q000503:physiopathology / Q000628:therapy*; D020069:Shoulder Pain / Q000503:physiopathology / Q000628:therapy*
keywords: Articular; Musculoskeletal Manipulations; Pain; Range of Motion; Shoulder