COMPARATIVE EFFECTS OF SYMPTOM-CONTINGENT AND TIME CONTINGENT MANUAL THERAPY ON PAIN AND FUNCTION AMONG PATIENTS WITH MECHANICAL SHOULDER PAIN: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Mechanical shoulder pain can substantially restrict daily activity and quality of life. Objective: To compare symptom-contingent manual therapy and exercise progression (SMBT) with time-contingent manual therapy and exercise progression (TMBT) for pain and shoulder-related disability.

Methods: A parallel-group randomized controlled trial was conducted at the Department of Physiotherapy, Farooq Hospital, Lahore, Pakistan. A total of 110 patients were screened and 56 eligible participants were randomized 1:1 to SMBT or TMBT. Both groups received standardized conventional physiotherapy plus phase-based manual therapy and exercise three times weekly for 12 weeks. SMBT progression required pain ≤3/10 without symptom aggravation, whereas TMBT progressed according to a predetermined schedule. The blinded assessor measured pain using the Numeric Pain Rating Scale (NPRS) and shoulder-related disability using the Shoulder Pain and Disability Index (SPADI).

Results: All 56 participants completed the intervention and were analyzed. NPRS decreased from 7.14 ± 0.97 to 2.82 ± 1.33 in SMBT and from 7.14 ± 0.85 to 3.96 ± 1.37 in TMBT. Median NPRS improvement was 4.0 (IQR 4.0-5.0) versus 3.0 (IQR 2.0-4.0), respectively (U = 175.00, Z = -3.674, p < .001, r = .49). Total SPADI decreased from 69.57 ± 3.70 to 29.73 ± 4.99 in SMBT and from 68.46 ± 3.57 to 38.90 ± 3.86 in TMBT. Mean SPADI improvement was 39.84 ± 2.84 versus 29.56 ± 2.41 points, with a between-group mean difference of 10.28 points (95% CI 8.87-11.69; t(54) = 14.613, p < .001). No adverse events occurred.

Conclusion: Both approaches improved pain and disability, with greater 12-week improvement in the symptom-contingent group. Trial registration: Not registered.