Therapeutic Exercise and Joint Mobilization Strengthned by Tutor System

Dr. Tracy J. Brudvig,etal of the MGH Institute of the Massachusetts General Hospital pooled and summarized 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. Their findings were published in J Orthop Sports Phys Ther, Epub 4 September 2011.
They conducted a systematic review with meta-analysis. 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.they used Six data bases that were searched for randomized controlled trials (RCTs). All RCTs published in English studying the effectiveness of therapeutic exercise and joint mobilization on adults having 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 (SMD) with 95% confidence interval (CI) for each variable and then combined to represent weighted standardized mean differences (WSMDs) and 95% CIs.

The results they received were that even 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 WSMDs and 95% CIs were as follows; 0.2 (95% CI: -0.68, 1.08) for pain, 0.15 (95% CI: -0.67, 0.97) for abduction ROM, -0.04 (95% CI: -0.65, 0.57) for flexion ROM, 0.01(95% CI: -0.79, 0.81) for internal and external rotation ROM, and 0.09 (95% CI: -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.
They drew the conclusion that 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.
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy for shoulder and other joint therapies. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.