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Mobilization With Movement on Pain, Function, and Quality of Life in Patients With Thoracic Outlet Syndrome
Sponsor: Ahram Canadian University
Summary
This study will investigate whether adding Mobilization With Movement (MWM) to a standardized rehabilitation program improves arm, shoulder, and hand function in adults with chronic neurogenic thoracic outlet syndrome (nTOS), compared with a sham manual procedure added to the same rehabilitation program. A total of 120 participants aged 18-65 years will be randomly assigned to two equally sized groups. One group will receive MWM plus standardized rehabilitation, and the other will receive sham MWM plus the same rehabilitation program. The sham procedure will reproduce therapist contact, positioning, treatment time, and attention without the specific manual technique used in active MWM. Both groups will receive 16 supervised sessions over 8 weeks, with two 45-minute sessions per week, and the same home-exercise program. The main outcome will be upper-extremity disability measured using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at 8 weeks. Additional outcomes will include pain intensity, disability at other assessment times, health-related quality of life, patient-perceived improvement, cervical range of motion, and adverse events. Scheduled assessments will take place before treatment and at 4, 8, and 12 weeks after randomization, with patient-perceived change assessed at Weeks 8 and 12. Participants and outcome assessors will be masked to active versus sham manual treatment. The study hypothesis is that MWM added to standardized rehabilitation will produce greater improvement in upper-extremity disability than sham MWM added to the same rehabilitation program.
Official title: The Impact of Mobilization With Movement on Pain, Function, and Quality of Life in Patients With Thoracic Outlet Syndrome: A Randomized Controlled Trial
Key Details
Gender
All
Age Range
18 Years - 65 Years
Study Type
INTERVENTIONAL
Enrollment
120
Start Date
2023-07-01
Completion Date
2026-09-12
Last Updated
2026-10-15
Healthy Volunteers
No
Conditions
Interventions
Mobilization with Movement (MWM)
Mulligan-concept Mobilization With Movement (MWM) will be applied to the first-rib, cervical, and upper-thoracic regions according to clinical indications. The treating physiotherapist will identify a comparable sign related to the participant's symptoms or functional limitation. A sustained accessory glide will be combined with an active movement. The selected technique must be pain-free during application and should produce an immediate improvement in the comparable sign. Up to three sets of 6-10 repetitions will be performed for the selected movement. Treatment parameters and immediate responses will be documented at each session. The MWM component will last approximately 10-15 minutes per session, twice weekly for 8 weeks (16 sessions).
Standardized Rehabilitation
Both study groups will receive an identical standardized, progression-based rehabilitation program consisting of education and activity modification, postural correction, scapular stabilization and motor control, progressive strengthening of the scapular and shoulder-girdle muscles, pectoral and scalene stretching when indicated, thoracic mobility exercises, and neural-mobility exercises according to symptom irritability. The supervised rehabilitation component will last approximately 30-35 minutes per session, twice weekly for 8 weeks (16 sessions). Participants in both groups will also receive the same standardized home-exercise program. Exercise dosage, progression criteria, and symptom-based modifications will follow the same predefined protocol in both groups.
Sham Mobilization With Movement
Sham MWM will reproduce the active MWM procedure while omitting its defining sustained accessory glide. In a supported, symptom-tolerable position, the therapist will use only light, non-directional skin contact over the selected cervical or upper-thoracic area; for first-rib-targeted sessions, contact will be on the adjacent upper trapezius/shoulder surface, avoiding pressure in the supraclavicular fossa. Participants will perform the same prespecified comfortable active movement as in active MWM, for up to three sets of 6-10 repetitions, with 60-second rests. No directed joint force, first-rib depression, sustained glide, traction, thrust, tissue massage, neural tensioning, or end-range overpressure will be applied. The sham component will last approximately 10-15 minutes per session, twice weekly for 8 weeks.
Locations (1)
Outpatient clinic of faculty of physical therapy, Ahram Canadian University
Al Ḩayy Ath Thāmin, Giza Governorate, Egypt