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Clinical Science
The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study
Sebnem Koldas Dogan
Corresponding author
sebnemkoldas@yahoo.com

Tel.: +905323935662
, Saime AY, Deniz Evcik
Ufuk University, Department of Physical Rehabilitation and Medicine, Ankara, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Shoulder pain is one of the major symptoms of upper extremity&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> The most frequent cause of shoulder pain is subacromial impingement syndrome &#40;SAIS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> It is associated with repetitive overuse and caused by compression of supraspinatus tendon between humerus and coracoacromial arc during elevation of arm or overhead activities&#46; This painful condition leads decreases in muscle strength and range of motion &#40;ROM&#41; of the shoulder which adversely affect the patients&#39; quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a></p><p id="para20" class="elsevierStylePara elsevierViewall">The SAIS causes edema&#44; inflammation and can become chronic if adequate treatment isn&#39;t applied&#46; Conservative and surgical treatment approaches can be used to reduce pain&#44; improve joint stiffness&#44; impaired muscle strength and quality of life in patients with SAIS&#46; The conservative treatment methods include analgesic and nonsteroidal antiinflammatory drugs&#44; resting&#44; modification of daily activities&#44; physical therapy approaches&#44; range of motion and strengthening exercises&#44; subacromial local anesthetic or corticosteroid injections&#46;<a class="elsevierStyleCrossRefs" href="#bib4">4-6</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Laser is a noninvasive&#44; nonionising&#44; monochromatic electromagnetic high concentrated light beam&#46; Recently&#44; low level laser therapy &#40;LLLT&#41; is widely used in various rheumatologic and musculoskeletal disorders which have analgesic&#44; anti-inflammatory and biostimulating effects&#46; The LLLT induces cell proliferation&#44; collagen synthesis&#44; protein synthesis&#44; tissue reparation&#44; wound healing and pain relief through direct irradiation without thermal response&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7-12</a> However&#44; conflicting results were reported about its effectiveness on musculoskeletal disorders&#46; Some of the randomized controlled studies suggest that LLLT may be effective in pain relief in different musculoskeletal disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib13">13&#44;14</a> On the other hand some of them have failed to show any superiority over placebo&#46;<a class="elsevierStyleCrossRefs" href="#bib9">9&#44;15-17</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Limited number of studies were investigated the effectiveness of LLLT in shoulder disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib13">13&#44;17-20</a> One of them was reported no beneficial effect when combined with exercise&#46;<a class="elsevierStyleCrossRef" href="#bib20">20</a> When compared to placebo&#44; no differences were detected in two studies&#46;<a class="elsevierStyleCrossRefs" href="#bib17">17&#44;18</a> The aim of this study was to investigate the effectiveness of 850-nm gallium arsenide aluminum &#40;Ga-As-Al&#41; laser therapy on pain&#44; range of motion &#40;ROM&#41; of shoulder joint and disability in subacromial impingement syndrome &#40;SAIS&#41;&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">MATERIALS AND METHODS</span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Patients</span><p id="para50" class="elsevierStylePara elsevierViewall">A total of 52 patients &#40;33 females&#44; 19 males&#41; with a mean age of 53&#46;59&#177;11&#46;34 years with SAIS were included in the study&#46; The diagnoses of SAIS were made according to detailed physical and neurologic examination&#46; After physical examination magnetic resonance imaging &#40;MRI&#41; were done to exclude rotator cuff tears&#46; Complete blood count&#44; biochemical markers&#44; erythrocyte sedimentation rate and C-reactive protein were also evaluated&#46; The exclusion criterias were&#59; presence of acute trauma&#44; acromioclavicular arthritis&#44; glenohumeral arthritis&#44; tears of rotator cuff&#44; neurologic or inflammatory diseases&#44; referring pain due to neck pathologies and history of physical therapy&#44; surgery&#44; subacromial or intraarticular injection within 6 months&#46;</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Treatment groups</span><p id="para60" class="elsevierStylePara elsevierViewall">The patients were randomly assigned into two groups&#46; Randomization was allocated by numbered envelopes method&#46; Treatment program either LLLT or placebo was written in these closed envelopes and patients selected one of them and randomly assigned into two groups&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">Group I &#40;n &#61; 30&#44; laser group&#41; received cold pack therapy&#44; LLL therapy &#40;3 joule&#47;cm<span class="elsevierStyleSup">2</span> at each point over maximum 5-6 painful points for 1 minute&#41; and exercise program&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">Group II &#40;n &#61; 22&#44; placebo laser group&#41; received cold pack therapy&#44; placebo laser therapy and exercise program&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">The placebo laser group consisted in patients who were sex- and age-matched to the patients in laser group&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">The Gallium-Aluminum-Arsenide &#40;GaAlAs&#44; infrared laser&#41; diode laser device &#40;Chattanooga group&#44; USA&#41; with a wavelength of 850nm&#44; power output of 100mV&#44; continuous wave and 0&#46;07cm<span class="elsevierStyleSup">2</span> spot area laser were used for the laser therapy&#46; The laser was applied with a dosage of 5 joule&#47;cm<span class="elsevierStyleSup">2</span> &#40;totally 15-20 joule&#41; at maximum 5-6 painful points for 1 minute at each point over subacromial region of the shoulder&#46;</p><p id="para110" class="elsevierStylePara elsevierViewall">Placebo laser was applied in the same way but the device was turned off during treatment sessions&#46; Patients and physiotherapist were asked to use protective eyeglasses during therapy for safety&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">Cold pack therapy during 10 minutes was applied to all patients in both groups&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">Also patients were given an exercise program which included range of motion&#44; stretching and progressive resistive exercises&#46; Each exercise was performed once a day with 10-15 repetitions&#46; The therapy program was applied 5 times a week&#44; once a day for 14 sessions&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">Outcome measures</span><p id="para140" class="elsevierStylePara elsevierViewall">At the beginning&#44; sociodemographic &#40;age&#44; sex&#41; and clinic &#40;disease duration&#44; localization of shoulder pain&#41; characteristics of the patients were recorded&#46; Pain severity&#44; range of motion and functional status of all patients were evaluated before and after the treatment by different physicians&#46; Both of the physicians and patients were blinded&#46; Only the physiotherapist was aware of the procedure&#46;</p><p id="para150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Pain severity</span> was assessed by visual analogue scale &#40;VAS&#44; 0-10cm&#59; 0 means no pain&#44; 10 means severe pain&#41;&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Range of motion</span> including flexion&#44; abduction&#44; adduction&#44; internal and external rotation was measured by using goniometer in supin position&#46; Extension was measured in prone position&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Functional status</span> was evaluated by using Shoulder Pain and Disability Index &#40;SPADI&#41;&#46; This is a self-administered shoulder specific questionnaire including two subscales&#59; pain and disability&#46; Pain subscale consists of 5 items and disability subscale consists of 8 items&#46; Patients were asked to answer each items using 0-100 mm VAS&#46; The possible score of SPADI was ranged from 0 to 100&#46; Higher scores indicate high level of disability&#46;<a class="elsevierStyleCrossRef" href="#bib21">21</a> The Turkish version of SPADI was found to be reliable and valid by Bumin et al&#46;<a class="elsevierStyleCrossRef" href="#bib22">22</a></p><p id="para180" class="elsevierStylePara elsevierViewall">Signed written informed consent was obtained from all patients&#46; The Human Research Ethics Committee at School of Medicine of Ufuk University approved the study&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Statistical analysis</span><p id="para190" class="elsevierStylePara elsevierViewall">All the data were analyzed using SPSS-16&#46;0 statistical package for Windows&#46; The mean values and frequencies of the parameters were assessed by descriptive statistics&#46; Mann-Whitney U test was used for comparing groups&#46; The differences before and after treatment for each group were assessed by Wilcoxon test&#46; And p&#60;0&#46;05 was accepted to be statistically significance level&#46;</p></span></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">RESULTS</span><p id="para200" class="elsevierStylePara elsevierViewall">Fifty two patients &#40;33 females&#44; 19 males&#41; with a mean age of 53&#46;59&#177;11&#46;34 years with SAIS were included in the study&#46; All patients were able to complete the therapy program without any adverse effects&#46; The results of complete blood count&#44; biochemical markers&#44; erythrocyte sedimentation rate and C-reactive protein of the patients were found to be normal&#46;</p><p id="para210" class="elsevierStylePara elsevierViewall">The sociodemographic and clinic characteristics of the patients were given in <a class="elsevierStyleCrossRef" href="#t1-cln_65p1019">Table 1</a>&#46; No statistically significant differences were detected between the groups in initial values &#40;p&#62;0&#46;05&#41;&#46;</p><elsevierMultimedia ident="t1-cln_65p1019"></elsevierMultimedia><p id="para220" class="elsevierStylePara elsevierViewall">In group I&#44; after the therapy statistically significant improvements in pain severity&#44; ROM except internal and external rotation and SPADI scores were observed compared to baseline scores &#40;p&#60;0&#46;05&#41;&#46;</p><p id="para230" class="elsevierStylePara elsevierViewall">In Group II&#44; all parameters except ROM of external rotation were improved &#40;p&#60;0&#46;05&#41;&#46; However&#44; no significant differences were recorded between the groups &#40;p&#62;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#t2-cln_65p1019">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="t2-cln_65p1019"></elsevierMultimedia></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">DISCUSSION</span><p id="para240" class="elsevierStylePara elsevierViewall">The results of this study indicated that both LLLT and placebo LLLT combined with cold pack and exercise program showed significant improvements in pain severity&#44; ROM measurements and functional status&#46;</p><p id="para250" class="elsevierStylePara elsevierViewall">The LLLT has become popular in the treatment of musculoskeletal disorders in recent years&#46; The mechanism of analgesic effect of LLLT is not well known&#46; The increased peripheral &#946;-endorphin precursor mRNA expression in blood cells of the rats by 830 nm Ga-Al-Ar Laser irradiation was demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib23">23</a> The analgesic mechanisms of LLLT in rheumatoid arthritis were associated with reduced proinflammatory cytokines such as TNF-alpha&#44; IL-1 beta&#44; IL-8&#46;<a class="elsevierStyleCrossRef" href="#bib24">24</a> Decreased mitochondrial membrane potential&#44; blockage of axonal flow in dorsal root ganglion neurons of rats were emphasized&#46;<a class="elsevierStyleCrossRef" href="#bib25">25</a> Some authors explained the analgesic effect of laser therapy by altering sensorial input to the central nervous system leading the decrease of pain perception&#46;<a class="elsevierStyleCrossRefs" href="#bib16">16&#44;26</a> Moreover&#44; reduced prostaglandin concentrations with LLLT were reported&#46;<a class="elsevierStyleCrossRefs" href="#bib27">27&#44;28</a> The stimulation of deposition of collagen fibers can be related to the biostimulating effect of LLLT&#46;<a class="elsevierStyleCrossRef" href="#bib29">29</a></p><p id="para260" class="elsevierStylePara elsevierViewall">Since the anti-inflammatory&#44; biostimulating&#44; anti-edematous and analgesic effects of laser therapy were demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib23">23-25&#44;27-29</a> It is thought to be beneficial in the treatment of SAIS&#46; England et al&#46; compared the effectiveness of laser&#44; placebo laser therapy and naproxen sodium in patients with supraspinatus or bicipital tendonitis&#46; After 2 weeks of treatment&#44; they found improvement in laser therapy group compared to placebo laser or naproxen sodium treatment groups&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> Bingol et al&#46; investigated the efficacy of LLLT in shoulder pain&#46; Patients received laser and placebo laser therapy combined with exercise protocol of 10 sessions for 2 weeks&#46; Laser therapy was found to be superior over placebo in palpation sensitivity and passive extension but no significant differences were shown in pain severity&#44; active ROM and algometric sensitivity between the groups&#46;<a class="elsevierStyleCrossRef" href="#bib18">18</a> Stergioulas applied LLLT and placebo laser for 12 sessions during 8 week in patients with frozen shoulder and concluded that LLLT was more effective in pain relief&#44; disability than placebo&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a></p><p id="para270" class="elsevierStylePara elsevierViewall">Our results failed to demonstrate the superiority of LLLT over placebo&#46; Both groups showed improvements in pain severity&#44; ROM measurements and functional status&#46; Improvements in both groups may be due to additional coldpack application and exercise program&#46; It is known that superficial cold induces vasoconstriction and reduces local blood flow leading to decrease tissue swelling&#44; inflammation and pain severity&#46;<a class="elsevierStyleCrossRef" href="#bib30">30</a> Nevertheless&#44; the efficacy of therapeutic exercise programs on pain reduction and functional improvement in the treatment of SAIS was well defined&#46;<a class="elsevierStyleCrossRefs" href="#bib31">31&#44;32</a> Similar to our findings&#44; Yeldan et al&#46;&#44; also found improvements with both LLLT and placebo LLLT combined with superficial cold and exercise program in pain severity&#44; functional status and muscle strength in patients with SAIS&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a> In another study&#44; the authors compared the effectiveness of laser therapy combined with home exercise program and home exercise program alone&#46; They indicated no additional effect of laser therapy over exercise alone&#46;<a class="elsevierStyleCrossRef" href="#bib20">20</a></p><p id="para280" class="elsevierStylePara elsevierViewall">There are several limitations of this study&#46; First of all was the small sample size&#46; Another limitation was not to have an only placebo LLLT group because of ethical reasons and therefore coldpack and exercise program were associated to LLLT&#46; Finally&#44; the assessment parameters were measured after the therapy and long term results of the therapy were not evaluated&#46;</p></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">CONCLUSIONS</span><p id="para290" class="elsevierStylePara elsevierViewall">Finally there are controversial results about the efficacy of laser therapy on shoulder pain&#46; Our results showed improvements on pain severity&#44; ROM and functional status of the patients with SAIS with the therapy program of laser therapy&#44; coldpack and exercise&#46; However no superiority over placebo laser therapy was observed&#46; Further studies with large samples&#44; longer follow up durations were required to demonstrate its efficacy&#44; optimum dosage&#44; type&#44; frequency and duration&#46;</p></span></span>"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec1581286"
          "palabras" => array:5 [
            0 => "Shoulder"
            1 => "Pain"
            2 => "Disability"
            3 => "Range of motion"
            4 => "Placebo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVES&#58;</span><p id="spara50" class="elsevierStyleSimplePara elsevierViewall">Conflicting results were reported about the effectiveness of Low level laser therapy on musculoskeletal disorders&#46; The aim of this study was to investigate the effectiveness of 850-nm gallium arsenide aluminum &#40;Ga-As-Al&#41; laser therapy on pain&#44; range of motion and disability in subacromial impingement syndrome&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS&#58;</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">A total of 52 patients &#40;33 females and 19 males with a mean age of 53&#46;59&#177;11&#46;34 years&#41; with subacromial impingement syndrome were included&#46; The patients were randomly assigned into two groups&#46; Group I &#40;n &#61; 30&#44; laser group&#41; received laser therapy &#40;5 joule&#47;cm<span class="elsevierStyleSup">2</span> at each point over maximum 5-6 painful points for 1 minute&#41;&#46; Group II &#40;n &#61; 22&#44; placebo laser group&#41; received placebo laser therapy&#46; Initially cold pack &#40;10 minutes&#41; was applied to all of the patients&#46; Also patients were given an exercise program including range of motion&#44; stretching and progressive resistive exercises&#46; The therapy program was applied 5 times a week for 14 sessions&#46; Pain severity was assessed by using visual analogue scale&#46; Range of motion was measured by goniometer&#46; Disability was evaluated by using Shoulder Pain and Disability Index&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">In group I&#44; statistically significant improvements in pain severity&#44; range of motion except internal and external rotation and SPADI scores were observed compared to baseline scores after the therapy &#40;p&#60;0&#46;05&#41;&#46; In Group II&#44; all parameters except range of motion of external rotation were improved &#40;p&#60;0&#46;05&#41;&#46; However&#44; no significant differences were recorded between the groups &#40;p&#62;0&#46;05&#41;&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSIONS&#58;</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">The Low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity&#44; range of motion and functional disability&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "ceabs10"
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          2 => array:2 [
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            "titulo" => "RESULTS&#58;"
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          3 => array:2 [
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        ]
      ]
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          "leyenda" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">VAS&#58; Visual analog scale&#59; SD&#58; Standard deviation&#46;</p><p id="cenpara10" class="elsevierStyleSimplePara elsevierViewall">&#8727;&#8727; p&#60;0&#46;01</p><p id="cenpara20" class="elsevierStyleSimplePara elsevierViewall">&#8727; p&#60;0&#46;05</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Group I &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Group II &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Age &#44; year</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">53&#46;7&#177;12&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">53&#46;45&#177;9&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="top">0&#46;933&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Gender</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">20 &#40;&#37;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">13&#40;&#37;59&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">10 &#40;&#37;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">9&#40;&#37;40&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;579&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Disease duration&#44; month</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">11&#46;66&#177;18&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">15&#46;27&#177;25&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Localization</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="top">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="top">17 &#40;&#37;56&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">12&#40;&#37;54&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">13 &#40;&#37;43&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">10&#40;&#37;45&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;880&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">VAS</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">7&#46;16&#177;1&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">7&#46;59&#177;1&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;343&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">The sociodemographic and clinic characteristic of the patients&#46;</p>"
        ]
      ]
      1 => array:7 [
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        "mostrarFloat" => true
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        "tabla" => array:3 [
          "leyenda" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">VAS&#58; Visual analog scale&#59; SPADI&#58; Shoulder pain and disability index&#59; SD&#58; Standard deviation&#46;</p>"
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Group I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Group II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">7&#46;16&#177;1&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">7&#46;59&#177;1&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">3&#46;76&#177;1&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4&#46;63&#177;2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;216&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Shoulder flexion</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">156&#177;30&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">167&#46;50&#177;21&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;284&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">168&#177;22&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">174&#46;31&#177;14&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;313&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;001<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;011<a class="elsevierStyleCrossRef" href="#tfn6-cln_65p1019">&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Shoulder extension</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">38&#46;16&#177;13&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">39&#46;31&#177;8&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;372&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">42&#46;66&#177;3&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">42&#46;95&#177;3&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;457&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;007<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;006<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Shoulder abduction</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">147&#46;16&#177;33&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">160&#46;68&#177;30&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">166&#46;66&#177;21&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">172&#46;72&#177;16&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;001<a class="elsevierStyleCrossRef" href="#tfn6-cln_65p1019">&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;007<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Shoulder adduction</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">38&#46;50&#177;15&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">38&#46;40&#177;7&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;438&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">42&#46;00&#177;4&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">42&#46;04&#177;5&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;556&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;003<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;008<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Shoulder internal rotation</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">47&#46;50&#177;9&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">47&#46;95&#177;5&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;718&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">49&#46;33&#177;9&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">49&#46;77&#177;4&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;039<a class="elsevierStyleCrossRef" href="#tfn6-cln_65p1019">&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Shoulder external rotation</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">44&#46;16&#177;10&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">44&#46;77&#177;8&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;752&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">44&#46;83&#177;5&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">44&#46;09&#177;1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;517&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">SPADI<span class="elsevierStyleInf">pain</span></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">70&#46;66&#177;24&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">70&#46;09&#177;16&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;330&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">48&#46;13&#177;22&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">40&#46;99&#177;20&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">SPADI<span class="elsevierStyleInf">disability</span></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Baseline</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">58&#46;12&#177;24&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">55&#46;17&#177;19&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Posttreatment</span> &#40;mean&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">40&#46;54&#177;21&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">31&#46;87&#177;21&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1019">&#8727;&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">SPADI<span class="elsevierStyleInf">total</span></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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ISSN: 18075932
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