The effect of therapeutic exercise and mobilization in patients with shoulder dysfunction: A meta-analysis

Objective. To determine whether the combination of therapeutic exercise (TE) and mobilization is more beneficial than TE alone in patients with shoulder dysfunction (SD) in order to reduce pain, increase range of motion (ROM), improve function and reduce disability.;Methods. Six databases were searched for randomized clinical trials (RCTs). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated for each variable and then combined to represent overall weighted mean difference (WMD) and CI.;Results. Seven studies providing data on a total of 290 patients were identified. Four of these studies were considered of high methodological quality and three were of moderate methodological quality. Combining the results revealed a small beneficial effect of the combination of TE and mobilization over TE alone on pain (overall WMD 0.2, 95% CI 1.08, 0.68), abduction ROM (overall WMD 0.15, 95% CI 0.67, 0.97), as well as function and disability (overall WMD 0.09, 95% CI 0.64, 0.46). There was no difference between the two groups for flexion ROM (overall WMD 0.04, 95% CI 0.65, 0.57) and internal and external rotation ROM (overall WMD 0.01, 95% CI 0.79, 0.81).;Conclusion. The evidence available to date is not adequate to support the beneficial effect of the combination of TE and mobilization over TE alone in patients with SD.