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OBJECTIVES: To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis. DESIGN: A randomised controlled trial. SETTING: A general hospital. SUBJECTS: Forty adults with knee osteoarthritis (grade 1-3 Kellgren-Lawrence scale). INTERVENTIONS: The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks. MAIN MEASURES: The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up. RESULTS: Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up. CONCLUSION: In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.

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OBJECTIVES: The C0-C2 axial rotation test is a measure of upper cervical range of motion (UCROM), reported to be reliable in a headache free population. The objective was to determine the intra- and inter-rater reliability of the C0-C2 axial rotation test in people with a diagnosis of cervicogenic headache (CGH) or episodic migraine. METHODS: Two therapists independently evaluated UCROM during the C0-C2 axial rotation test and flexion-rotation test (FRT) with an iPhone in 70 subjects (mean age 37.7 SD 11.6 years) with a diagnosis of CGH (35 subjects) or episodic migraine (35 subjects) on two occasions. Measurement procedures were standardized; and the order of testing randomized. RESULTS: Reliability of the C0-C2 axial rotation test was moderate to high (ICC > 0.70). The standard error of measurement and minimum detectable change for this test were at most 2°. In subjects with CGH mean UCROM to the most restricted side was 9.3° (1.9) and 8.8° (2.1) for rater 1 and 2 respectively. While in patients with episodic migraine mean UCROM to the restricted side was 13.7° (1.6) and 13.6° (2.0) for rater 1 and 2 respectively. DISCUSSION: The C0-C2 axial rotation test has at least moderate levels of reliability and correlates well with mobility determined by the FRT.

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OBJECTIVES: The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment. METHODS: This cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. RESULTS: Restriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P < .01), flexion ROM (r = 0.30, P < .05), abduction ROM (r = 0.39, P < .01), and external rotation ROM (r = 0.60, P < .01). Other variables were not significantly correlated with HBB ROM. Multiple linear regression analysis indicated that the variance in HBB ROM was explained by the SPADI disability subscore (P = .01) but not by visual analogue scale score (P = .05), FABQ score (P = .65), or duration of symptoms (P = .73). The FABQ score was not explained by limitation in HBB ROM and shoulder movements. CONCLUSION: These findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons.

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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.

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