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【論文摘要】Effectiveness of Cervical Mobilization in Patients With Non-Specific Shoulder/Arm Pain: A Preliminary Study

【論文摘要】頸部關節鬆動術對非特異性肩臂疼痛之療效:前驅研究

摘要


Background and Purpose: Nonspecific shoulder/ arm pain is characterized by an absence of objective physical findings and usually its symptoms do not correspond with objective pathophysiology. Previous studies show that non-specific shoulder/arm pain is associated with neurobiomechanical factor which is related to an anterior shear force of cervical vertebra occurring during the movement of cervical flexion. Thus, cervical mobilization with anterior to posterior (AP) glides of the cervical spine can be more specific to treat the symptoms resulting from the anterior shear force of vertebrae. However, very few studies have been found to investigate its effectiveness. The purposes of this study are: (1) To determine the immediate effectiveness of cervical AP glide mobilization on decreasing pain, increasing shoulder strength and improving function in patients with non-specific shoulder/arm pain; (2) To determine the additional effectiveness of cervical lateral glide mobilization on decreasing pain, increasing shoulder strength in patients with non-specific shoulder/arm pain. Methods: This is a randomized control trial. We plan to recruit 78 subjects who suffer from nonspecific shoulder/arm pain (pain scale ≥ 3). Up to now, nine participants have completed this study. Subjects were randomly assigned into AP glide group (n = 4), AP glide plus lateral glide group (n = 3) and control group (n = 2). The control group received placebo stroke massage on their cervical spine. Outcome measures including shoulder muscle strength and pain intensity were assessed before and immediately after the intervention. We calculated the change scores (the differences between the scores at baseline and post-treatment) for all outcome measures. Then we used one-way analysis of variance (ANOVA) to determine the between-group differences for all outcomes. Results: There was a significant difference of the change score in muscle strength (shoulder abductor: p = 0.014) among three groups. The AP glide group demonstrated more improvement than the control group in shoulder abduction strength (p = 0.006). The AP plus lateral glide group also showed significantly more improvement than the control group in shoulder abduction strength (p = 0.011) and shoulder flexion strength (p = 0.031). For the pain intensity, a tendency towards significance was found (p = 0.081) among three groups. Conclusion: Cervical mobilization with AP glide showed immediate effects on increasing shoulder strength. The study is still ongoing. More subjects are needed to determine the effectiveness of cervical AP glide mobilization and additional effectiveness of cervical lateral glide mobilization on pain and function in patients with non-specific shoulder/arm pain. Clinical Relevance: This preliminary study reveals that cervical AP glide mobilization shows a tendency towards more positively influencing patients with non-specific shoulder/arm pain on muscle strength.

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