EFFECTS OF END-RANGE MOBILIZATION VERSUS MULTIPLE-ANGLE ISOMETRIC TRAINING ON PAIN, RANGE OF MOTION, AND FUNCTIONAL OUTCOMES IN DIABETIC FROZEN SHOULDER: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Adhesive capsulitis, commonly known as frozen shoulder, is characterized by progressive shoulder pain, capsular stiffness, restricted active and passive range of motion (ROM), and functional disability. Diabetes mellitus substantially increases the risk of adhesive capsulitis and may contribute to a prolonged and less predictable recovery. Although end-range mobilization and multiple-angle isometric training are commonly used physiotherapy interventions, direct comparative evidence in patients with diabetic frozen shoulder remains limited.

Objective: To compare the effects of end-range mobilization and multiple-angle isometric training on pain, shoulder ROM, and functional disability in patients with diabetic frozen shoulder.

Methods: A randomized controlled trial was conducted at Sheikh Zayed Hospital, Lahore. Forty-four participants with diabetic frozen shoulder were randomly allocated into two groups (n=22 each). Group A received end-range mobilization plus conventional physical therapy, whereas Group B received multiple-angle isometric training plus conventional physical therapy. Treatment was provided for four weeks. Pain was measured using the Numeric Pain Rating Scale (NPRS), functional disability using the Shoulder Pain and Disability Index (SPADI), and shoulder flexion, abduction, and external rotation using a goniometer. Paired-samples and independent-samples t-tests were used for statistical analysis.

Results: Both groups demonstrated substantial numerical improvements after treatment. Post-intervention comparisons significantly favored Group A for SPADI, NPRS, shoulder flexion, abduction, and external rotation (all p<0.001). Post-treatment NPRS scores were 2.75±0.805 in Group A and 5.43±0.523 in Group B, while SPADI scores were 37.71±0.860 and 40.82±0.976, respectively.

Conclusion: End-range mobilization combined with conventional physical therapy produced greater short-term post-treatment improvements than multiple-angle isometric training across the measured outcomes. However, the within-group statistical pattern reported in the source data warrants cautious interpretation.