***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: STUDY DESIGN A prospect i ve r and omized clinical trial . OBJECTIVE To compare the effectiveness of 2 physical therapy treatment approaches for impingement syndrome of the shoulder . BACKGROUND Manual physical therapy combined with exercise is a commonly applied but currently unproven clinical treatment for impingement syndrome of the shoulder . METHODS AND MEASURES Thirty men and 22 women ( age 43 years + /- 9.1 ) diagnosed with shoulder impingement syndrome were r and omly assigned to 1 of 2 treatment groups . The exercise group performed supervised flexibility and strengthening exercises . The manual therapy group performed the same program and received manual physical therapy treatment . Both groups received the selected intervention 6 times over a 3-week period . The testers , who were blinded to group assignment , measured strength , pain , and function before treatment and after 6 physical therapy visits . Strength was a composite score of isometric strength tests for internal rotation , external rotation , and abduction . Pain was a composite score of visual analog scale measures during resisted break tests , active abduction , and functional activities . Function was measured with a functional assessment question naire . The visual analog scale used to measure pain with functional activities and the functional assessment question naire were also measured 2 months after the initiation of treatment . RESULTS Subjects in both groups experienced significant decreases in pain and increases in function , but there was significantly more improvement in the manual therapy group compared to the exercise group . For example , pain in the manual therapy group was reduced from a pretreatment mean ( + /- SD ) of 575.8 ( + /- 220.0 ) to a posttreatment mean of 174.4 ( + /- 183.1 ) . In contrast , pain in the exercise group was reduced from a pretreatment mean of 557.1 ( + /- 237.2 ) to a posttreatment mean of 360.6 ( + /- 272.3 ) . Strength in the manual therapy group improved significantly while strength in the exercise group did not . CONCLUSION Manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial is better than exercise alone for increasing strength , decreasing pain , and improving function in patients with shoulder impingement syndrome BACKGROUND AND PURPOSE In many physical therapy programs for subjects with adhesive capsulitis of the shoulder , mobilization techniques are an important part of the intervention . The purpose of this study was to compare the effectiveness of high- grade mobilization techniques ( HGMT ) with that of low- grade mobilization techniques ( LGMT ) in subjects with adhesive capsulitis of the shoulder . SUBJECTS One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or = 50 % decrease in passive joint mobility relative to the nonaffected side were enrolled in this study . METHODS Subjects r and omly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint , and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone . The duration of treatment was a maximum of 12 weeks ( 24 sessions ) in both groups . Subjects were assessed at baseline and at 3 , 6 , and 12 months by a masked assessor . Primary outcome measures included active and passive range of motion and shoulder disability ( Shoulder Rating Question naire [ SRQ ] and Shoulder Disability Question naire [ SDQ ] ) . An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year , respectively . RESULTS Overall , subjects in both groups improved over 12 months . Statistically significant greater change scores were found in the HGMT group for passive abduction ( at the time points 3 and 12 months ) , and for active and passive external rotation ( at 12 months ) . A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation , SRQ , and SDQ with greater change scores in the HGMT group . DISCUSSION AND CONCLUSION In subjects with adhesive capsulitis of the shoulder , HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs , with the overall differences between the 2 interventions being small PRINCIPLE A r and omised , comparative prospect i ve clinical trial was planned to compare the early response to different rehabilitation methods for adhesive capsulitis taking into consideration the clinical efficacy and the cost effectiveness of the methods . METHODS Forty patients with adhesive capsulitis were r and omised into two treatment groups . The first group ( CYR ) received the Cyriax approach of deep friction massage and mobilisation exercises three times weekly . The second group ( PT ) had daily physical therapy including hot pack and short wave diathermy application . Both groups concluded their treatments with stretching exercises and were also instructed to a daily home exercise program . The primary end point of the study was to reach 80 % of the normal passive range of motion ( ROM ) of the shoulder in all planes within a period of two weeks . Secondary end points were the overall ROM and pain response ( spontaneous pain , night pain and pain with motion ) to each treatment . RESULTS 19 patients in the CYR group ( 95 % ) and 13 patients in the PT group ( 65 % ) reached sufficient ROM at the end of the second week ( p < 0.05 ) . The improvement in shoulder flexion , inner and outer rotation values and the decrease in pain with motion were significantly better in the CYR group after the first week of treatment . CONCLUSION The Cyriax method of rehabilitation provides a faster and better response than the conventional physical therapy methods in the early phase of treatment in adhesive capsulitis . The method is non-invasive , effective and requires fewer hospital visits for a sufficient early response There is little known about the specific manual therapy techniques used to treat painfully limited shoulders and their effects on range of movement ( ROM ) and pressure pain threshold ( PPT ) . The objective of this study was to investigate the initial effects of a Mulligan 's mobilization with movement ( MWM ) technique on shoulder ROM in the plane of the scapula and PPT in participants with anterior shoulder pain . A repeated measures , double-blind r and omized-controlled trial with a crossover design was conducted with 24 subjects ( 11 males and 13 females ) .  ROM and PPT were measured before and after the application of MWM , sham and control conditions . Significant and clinical ly meaningful improvements in both ROM ( 15.3 % , F (2,46)=16.31 P=0.00 ) and PPT ( 20.2 % , F(2,46)=3.44 , P=0.04 ) occurred immediately after post treatment . The results indicate that this specific manual therapy treatment has an immediate positive effect on both ROM and pain in subjects with painful limitation of shoulder movement . Further study is needed to evaluate the duration of such effects and the mechanism by which this occurs Objective : To assess the intrarater and interrater reliability among rheumatologists of a st and ardised protocol for measurement of shoulder movements using a gravity inclinometer . Methods : After instruction , six rheumatologists independently assessed eight movements of the shoulder , including total and glenohumeral flexion , total and glenohumeral abduction , external rotation in neutral and in abduction , internal rotation in abduction and h and behind back , in r and om order in six patients with shoulder pain and stiffness according to a 6 × 6 Latin square design using a st and ardised protocol .  These assessment s were then repeated . Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients ( ICCs ) . Results : The intrarater and interrater reliability of different shoulder movements varied widely . The movement of h and behind back and total shoulder flexion yielded the highest ICC scores for both intrarater reliability ( 0.91 and 0.83 , respectively ) and interrater reliability ( 0.80 and 0.72 , respectively ) . Low ICC scores were found for the movements of glenohumeral abduction , external rotation in abduction , and internal rotation in abduction ( intrarater ICCs 0.35 , 0.43 , and 0.32 , respectively ) , and external rotation in neutral , external rotation in abduction , and internal rotation in abduction ( interrater ICCs 0.29 , 0.11 , and 0.06 , respectively ) . Conclusions : The measurement of shoulder movements using a st and ardised protocol by rheumatologists produced variable intrarater and interrater reliability . Reasonable reliability was obtained only for the movement of h and behind back and total shoulder flexion Primary shoulder impingement syndrome is a common shoulder problem which , if treated ineffectively , can lead to more serious pathology and expensive treatment . This study examined whether subjects receiving joint mobilization and comprehensive treatment ( hot packs , active range of motion , physiologic stretching , muscle strengthening , soft tissue mobilization , and patient education ) would have improved pain , mobility , and function compared with similar patients receiving comprehensive treatment alone . Subjects were eight men and six women ( mean age = 52.9 years ) with primary shoulder impingement syndrome ( superolateral shoulder pain , decreased active humeral elevation , limited overhead function ) . Following r and om assignment to experimental ( N = 7 ) and control groups ( N = 7 ) , three blinded evaluators tested 24-hour pain ( visual analog scale ) , pain with subacromial compression test ( visual analog scale ) , active range of motion ( goniometry ) , and function ( reaching forward , behind the head , and across the body in an overhead position ) before and after nine treatments . One-tailed analyses of covariance ( baseline values as covariates ) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function ( Mann-Whitney U ) compared with controls . The experimental group improved on all variables , while the control group improved only on mobility and function ( one-tailed , paired t tests ; Wilcoxon matched pairs ) . Age , side of dominance , duration of symptoms , treatment attendance , exercise quality , and adherence had no effect on the outcomes . Results may be affected by inadequate sample size , minimal capsular tightness , insensitive functional scale , nonspecific motion measurements , position at which mobilization treatment was given , or a strong effect of comprehensive treatment . Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome , but larger replication studies are needed to assess more clearly mobilization 's influence on motion and function Abstract . Adhesive capsulitis is a common musculoskeletal disorder mainly affecting middle aged adults . It is associated with generalized pain and tenderness in the shoulder joint with severe loss of active and passive ranges of motion in all planes . The aim of this study was to compare the efficacy of local steroid injection and physical therapy measures for treating this disorder . Ten male and 10 female patients were enrolled in the study . The patients were divided r and omly into two groups and treated with either 40 mg methylprednisolone acetate injection with local anesthetic ( group A ) or physical therapy measures plus nonsteroidal anti-inflammatory drugs ( group B ) . The mean ages of the patients were 55.6±12.2 years in group A and 56.4±7.1 years in group B. Clinical assessment was performed on initial visit and at the 2nd and 12th weeks . Active and passive range of motion was recorded and the visual analogue scale was used to evaluate pain intensity . At initial visit , these data in both groups of patients were not statistically different . Although both treatment regimens result ed in significant improvement in range of motion , the differences between mean external rotation at the 2nd and 12th weeks were not statistically significant in either group . The improvement in range of motion at the end of the study was similar in both groups ( P>0.05 ) . All patients reported improvement during the study . The differences between mean VAS scores at the 2nd and 12th weeks were statistically significant in both groups . In conclusion , local steroid injection therapy was found to be as effective as physical therapy for the treatment of adhesive capsulitis Abstract Shoulder pain is common in primary care and has an unfavourable outcome in many patients . Information about predictors of outcome is scarce and inconsistent . The objective of this study was to develop clinical prediction rules for calculating the absolute risk of persistent shoulder symptoms for individual patients , 6 weeks and 6 month after the first consultation in general practice . A prospect i ve cohort study with 6 months follow‐up was carried out in three geographic areas in The Netherl and s. In this study , 587 patients with a new episode of shoulder pain were included . The main outcome measure was persistent symptoms at 6 weeks and 6 months , perceived by the patient . Potential predictors included the results of a physical examination , sociodemographic variables , disease characteristics ( duration of symptoms , pain intensity , disability and comorbidity ) , physical activity , physical workload and psychosocial factors . Response rates to the follow‐up question naires were 83 % at 6 weeks and 92 % at 6 months . A longer duration of symptoms , gradual onset of pain and high pain severity at presentation were consistently associated with persistent symptoms at 6 weeks and 6 months . The discriminative validity of our prediction rules was satisfactory with area under the curves of 0.74 ( 95 % CI 0.70 , 0.79 ) at 6 weeks and 0.67 ( 95 % CI 0.63 , 0.71 ) at 6 months . The performance of our rules needs to be tested in other population s of patients with shoulder pain to enable valid and reliable use of the rules in everyday clinical practice BACKGROUND AND PURPOSE The aim of this study was to evaluate the efficacy of a physical therapy approach to the treatment of  shoulder pain .  Subjects . Sixty-six volunteers with shoulder pain believed to be of local mechanical origin were r and omly allocated to either a treatment group or a control group . METHODS Subjects in the treatment group received 1 month 
    Output:
    
Manual therapy appears to increase either active or passive mobility of the shoulder .
A trend was found favoring manual therapy for decreasing pain , but the effect on function and quality of life remains inconclusive .