• "Including a Single Study Multiple Times in a Meta-analysis" and Authors' Response
• "Foot Strike Patterns in Runners" and Authors' Response

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVE: To pool and summarize the published research evidence examining if the combination of therapeutic exercise and joint mobilization is more beneficial than therapeutic exercise alone in patients with shoulder dysfunction. BACKGROUND: Therapeutic exercise is an effective intervention for patients with shoulder dysfunction, which is often supplemented by joint mobilization techniques. Numerous studies have examined the effects of the combination of therapeutic exercise and joint mobilization on patients with shoulder dysfunction. METHODS: Six databases were searched for randomized controlled trials. All the randomized controlled trials published in English that have studied the effectiveness of therapeutic exercise and joint mobilization on adults with either clinically or radiographically confirmed shoulder dysfunction resulting in pain, restriction of range of motion (ROM), and/or limitation in function, were included in this review. Effect size was calculated in the form of standardized mean difference and 95% confidence interval (CI) for each variable, then combined to represent weighted standardized mean differences (WSMDs) and 95% CIs. RESULTS: Seven studies that met the inclusion criteria were identified, with a total of 290 participants. The WSMDs and CIs, which combined the results of all the studies for a particular variable, revealed equivocal results for all variables. The resulting WSMD (95% CI) for each of the variables was 0.2 (–0.68, 1.08) for pain, 0.15 (–0.67, 0.97) for abduction ROM, –0.04 (–0.65, 0.57) for flexion ROM, 0.01(–0.79, 0.81) for internal and external rotation ROM, and 0.09 (–0.46, 0.64) for function and disability. Even after elimination of sources of heterogeneity, the new WSMDs and CIs continued to overlap zero, giving equivocal results. CONCLUSION: The current evidence is inconclusive with respect to the beneficial effects of the combination of therapeutic exercise and joint mobilization versus therapeutic exercise alone for reducing pain, increasing ROM and function, and limiting disability in patients with shoulder dysfunction. LEVEL OF EVIDENCE: Therapy, level 1a–.

J Orthop Sports Phys Ther 2011;41(10):734-748, Epub 4 September 2011. doi:10.2519/jospt.2011.3440

KEY WORDS: glenohumeral joint, manual therapy, pain