In addition, this RCT included features to enhance the external validity of the study and thus enhance the generalizability of the results obtained. All treatments were specifically tailored to the individual participant rather than following a prescribed pattern and, therefore, were more reflective of a typical clinical setting. Seventeen physical therapists with varying clinical experience ranging from 2 to 28 years were involved in providing treatment in this study, and all of these physical therapists provided treatment for participants in both the experimental and control groups.
The conclusion from this clinical trial, that the addition of passive joint mobilizations of shoulder region joints to exercise and advice is not more effective than exercise and advice alone for the treatment of people with shoulder pain and minimal movement restriction, however, does need to be viewed in light of some limitations. The lack of a reliable diagnostic classification system for shoulder pain resulted in a heterogeneous study population in the current study consisting of patients with a mix of mechanical shoulder symptoms, only excluding those with restricted shoulder ROM. It is possible that specific subgroups within this heterogeneous group, if they can be reliably identified, may benefit from mobilization therapy directed at the shoulder region joints. In addition, the lack of evidence to guide therapists in the choice of passive mobilization technique may have resulted in the choice of less-than-optimal mobilization therapy for some participants. Finally, although the loss to follow-up was smaller than that assumed in the calculation of the sample size for the current study, there is the chance that significant differences between the treatment groups were missed due to type 2 statistical error, and the possibility of bias due to the lack of blinding of the treating therapists and participants cannot be discounted.
นอกจากนี้ RCT นี้รวมคุณลักษณะ การปรับปรุงมีผลบังคับใช้ภายนอกของการศึกษาจึง เพิ่ม generalizability ของผลได้รับ รักษาทั้งหมดได้โดยปรับแต่งผู้เรียนแต่ละ แทน ตามแบบที่กำหนดไว้ แล้ว ดังนั้น ได้ขึ้นให้การตั้งค่าทางคลินิกทั่วไป 17 ทางกายภาพบำบัด ด้วยแตกต่างกันตั้งแต่ 2 ถึง 28 ปีประสบการณ์ทางคลินิกเกี่ยวข้องในการให้การรักษาในการศึกษานี้ และทั้งหมดของเหล่านี้นักกายภาพบำบัดให้การรักษาร่วมในทั้งสองการทดลองและกลุ่มควบคุมThe conclusion from this clinical trial, that the addition of passive joint mobilizations of shoulder region joints to exercise and advice is not more effective than exercise and advice alone for the treatment of people with shoulder pain and minimal movement restriction, however, does need to be viewed in light of some limitations. The lack of a reliable diagnostic classification system for shoulder pain resulted in a heterogeneous study population in the current study consisting of patients with a mix of mechanical shoulder symptoms, only excluding those with restricted shoulder ROM. It is possible that specific subgroups within this heterogeneous group, if they can be reliably identified, may benefit from mobilization therapy directed at the shoulder region joints. In addition, the lack of evidence to guide therapists in the choice of passive mobilization technique may have resulted in the choice of less-than-optimal mobilization therapy for some participants. Finally, although the loss to follow-up was smaller than that assumed in the calculation of the sample size for the current study, there is the chance that significant differences between the treatment groups were missed due to type 2 statistical error, and the possibility of bias due to the lack of blinding of the treating therapists and participants cannot be discounted.
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