Virtual Reality Based Exercise Training Versus Mulligan Mobilization on Shoulder Posture and Function in Subacromial Impingement Syndrome

The study will compare the effect of virtual reality based exercise training versus Mulligan mobilization in addition to exercise therapy added to both groups on shoulder posture and function in subacromial impingement syndrome.

Study Overview

• Status: Recruiting
• Conditions: Subacromial Impingement Syndrome
• Intervention / Treatment: Other: Virtual Reality; Other: Mulligan mobilization

• Study Type: Interventional
• Enrollment (Estimated): 74
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Sara M Meselhy, Demonstrator; Phone Number: +01222518092; Email: sara.mohsen@cu.edu.eg
• Study Contact Backup: Name: Afaf M Tahoon, lecturer; Phone Number: +01015401783; Email: Afaf_tahoon@cu.edu.eg

Study Locations

• Egypt
  • Giza, Egypt
    • Recruiting
    • Faculty of physical therapy, Cairo University
    • Contact: Afaf M Tahoon, lecturer; Phone Number: +01015401783; Email: Afaf_tahoon@cu.edu.eg
    • Principal Investigator: Sara M Meselhy, Demostrator

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients will be referred from the orthopedic surgeon with a diagnosis of stage II SIS with the following criteria:

  1. Participants ranged in age from 30-50 years old.
  2. Participants are from non-athletes from the general population.
  3. Unilateral shoulder pain that is localized either anteriorly or laterally to the acromion. Pain that occurs or worsens when the affected shoulder is in flexion and/or abduction.
  4. Four of the following should be present in the included patients: Neer impingement test, Hawkins' test, Pain was replicated in the supraspinatus empty-can test, a painful arc of movement from 70° to 120°, and painful greater tuberosity of the humerus.
  5. BMI range 18.5- 29.9 Kg/m².

Exclusion Criteria:

• 1) Patients who, during the previous three months, underwent shoulder physical treatment and/or an acute pain flare.

  2) Patients who have undergone surgeries for tendon repair. 3) Malignancy, epilepsy, pregnant women, and/or systemic conditions like chronic renal or liver failure.

  4) Mini-Mental State Examination test (MMSE) (< 24/30) to exclude cognitive impairment and/or significant vision impairment (if they couldn't read the introduction while wearing the Head Mounted Device (HMD).

  5) Corticosteroid injection during the last three months or used steroids chronically.

  6) Adhesive capsulitis, glenohumeral joint instability, Numbness or tingling of the upper limb, and/or full-thickness tear of the rotator cuff.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Virtual reality group	Other: Virtual Reality; Fully immersive virtual reality mounted headset will be used
Active Comparator: Mulligan mobilization group	Other: Mulligan mobilization; posterolateral shoulder Mulligan mobilization with movement (MWM) will be used

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity during shoulder elevation	It will be measured using the Numerical Pain Rating Scale (NPRS)	pain intensity at the start of session 1 to the end of 1 month of treatment
Shoulder function	The Shoulder Pain and Disability Index (SPADI) will be used to measure the shoulder function.	shoulder function at the start of session 1 to the end of 1 month of treatment
Shoulder flexion range of motion	The Clinometer Application will be used to measure it.	shoulder flexion at the start of session 1 to the end of 1 month of treatment
Shoulder abduction range of motion	The Clinometer Application will be used to measure it.	shoulder abduction at the start of session 1 to the end of 1 month of treatment
shoulder posture	Sagittal Shoulder Angle will be used to measure the shoulder posture	shoulder posture at the start of session 1 to the end of 1 month of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients' enjoyment	A 7-point likert scale will be used to the evaluate the level of the patients' enjoyment at the end of the last session.	It will be evaluated at the end of the last session (after 1 month)
patients' adherence to treatment sessions	patients' numbers of attended sessions will be calculated at the end of 1 month of treatment.	patients' adherence at the start of session 1 to the end of 1 month of treatment

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Chair: Enas Fawzy Youssed, Professor Doctor, Cairo University; Study Director: Afaf M Tahoon, lecturer, Cairo University; Study Director: Mohamed A Kotb, Assistant professor, Cairo University

Publications and helpful links

General Publications

• Steiner, B., Elgert, L., Saalfeld, B., & Wolf, K. H. (2020). Gamification in rehabilitation of patients with musculoskeletal diseases of the shoulder: scoping review. JMIR serious games, 8(3), e19914. https://doi.org/10.2196/19914
• Smith, J., & Doe, A. (2023). Virtual embodiment for improving range of motion in patients with movement-related shoulder pain: An experimental study. Journal of Rehabilitation Science, 45(2), 123-134.
• Lin, H. T., Li, Y. I., Hu, W. P., Huang, C. C., & Du, Y. C. (2019). A scoping review of the efficacy of virtual reality and exergaming on patients of musculoskeletal system disorder. Journal of clinical medicine, 8(6), 791. https://doi.org/10.3390/jcm8060791
• Hoyek, N., Di Rienzo, F., Collet, C., Hoyek, F., & Guillot, A. (2014). The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome. Disability and rehabilitation, 36(13), 1113-1119.
• Consigliere, P., Haddo, O., Levy, O., & Sforza, G. (2018). Subacromial impingement syndrome: management challenges. Orthopedic research and reviews, 83-91. https://doi.org/10.2147/ORR.S157864
• Coja, D. M., Onu, I., Onu, A., Iordan, D. A., Gheorghiu, G., Ene-Voiculescu, V., & Talaghir, L. G. (2024). The Use of Virtual Reality-Assisted Therapy to Improve Shoulder function in Subacromial Impingement Syndrome: a Randomised Controlled Trial. BRAIN. Broad Research in Artificial Intelligence and Neuroscience, 15(4), 11-26. http://dx.doi.org/10.70594/brain/15.4/2
• Chaplin, E., Karatzios, C., & Benaim, C. (2023, December). Clinical applications of virtual reality in musculoskeletal rehabilitation: A scoping review. In Healthcare (Vol. 11, No. 24, p. 3178). MDPI. https://doi.org/10.3390/healthcare11243178
• Álvarez de la Campa Crespo, M., Donegan, T., Amestoy-Alonso, B., Just, A., Combalía, A., & Sanchez-Vives, M. V. (2023). Virtual embodiment for improving range of motion in patients with movement-related shoulder pain: An experimental study. Journal of Orthopaedic Surgery and Research, 18(1), 729. https://doi.org/10.1186/s13018-023-04158-w
• Özlü, A., Üstündağ, S., Bulut Özkaya, D., & Menekşeoğlu, A. K. (2024). Effect of exergame on pain, function, and quality of life in shoulder impingement syndrome: a prospective randomized controlled study. Games for Health Journal, 13(2), 109-119. https://doi.org/10.1089/g4h.2023.0108
• Gumaa, M., & Rehan Youssef, A. (2019). Is virtual reality effective in orthopedic rehabilitation? A systematic review and meta-analysis. Physical therapy, 99(10), 1304-1325. https://doi.org/10.1093/ptj/pzz093
• Dias, D., Neto, M. G., Sales, S. D. S. R., Cavalcante, B. D. S., Torrierri Jr, P., Roever, L., & Araujo, R. P. C. D. (2023). Effect of mobilization with Movement on Pain, disability, and Range of Motion in patients with Shoulder Pain and Movement Impairment: a systematic review and Meta-analysis. Journal of Clinical Medicine, 12(23), 7416. https://doi.org/10.3390/jcm12237416
• Delgado-Gil, J. A., Prado-Robles, E., Rodrigues-de-Souza, D. P., Cleland, J. A., Fernández-de-las-Peñas, C., & Alburquerque-Sendín, F. (2015). Effects of mobilization with movement on pain and range of motion in patients with unilateral shoulder impingement syndrome: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 38(4), 245-252. https://doi.org/10.1016/j.jmpt.2014.12.008

Study record dates

Study Major Dates

• Study Start (Actual): December 13, 2025
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): May 1, 2026

Study Registration Dates

• First Submitted: January 12, 2026
• First Submitted That Met QC Criteria: January 17, 2026
• First Posted (Actual): January 27, 2026

Study Record Updates

• Last Update Posted (Actual): January 27, 2026
• Last Update Submitted That Met QC Criteria: January 17, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Virtual reality; subacromial impingement syndrome; shoulder function; Mulligan mobilization; shoulder posture
• Additional Relevant MeSH Terms: Shoulder Injuries; Musculoskeletal Diseases; Wounds and Injuries; Joint Diseases; Shoulder Impingement Syndrome
• Other Study ID Numbers: Virtual reality and Mulligan M

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No