What is the evidence for physiotherapy in the treatment of adhesive capsulitis?
AMSTAR Rating
Summary
Patient Population:
All participants experienced some limitations in movement, but the extent to which this was reported varied between studies. Mean duration of frozen shoulder at study entry ranged from 3 months to 6.8 years. Only one study reported whether participants had received previous treatment for frozen shoulder. Mean age ranged from 50 – 62.5 years and proportion of female participants ranged from 20 – 86%.
Intervention:
Interventions compared included: home exercise, physiotherapy, laser therapy, short-wave diathermy, and ultrasound.
Comparison:
For the purposes of this review interventions were classified as ACTIVE (some form of mobilization ± other form of physical therapy) or THERAPY WITHOUT MOBILIZATION (e.g. laser therapy or TENS without supervised mobilization or exercise). The physiotherapy intervention arms of all trials ranged in duration from 2 weeks to 3 months.
Outcome:
- Pain: (6 studies) laser therapy vs. home exercise – significant difference in favour of laser therapy at 8 weeks (SMD=-1.71; 95% CI -2.29 to -1.12) and 16 weeks (SMD=-1.89; 95% CI -2.49 to -1.29).
- Function: (10 studies) shortwave diathermy & stretching vs. home exercise – significant difference in favour of shortwave diathermy & stretching (MD=17.5; 95% CI 1.76 to 33.24).
- Function: (10 studies) supervised physiotherapy & home exercise vs. home exercise alone – significant difference in favour of physiotherapy & home exercise (MD = 14.9; 95% CI 8.32 to 21.48).
- ROM: (11 studies) ultrasound vs. sham ultrasound – no significant difference.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| ACOEM 2011 - Shortwave Diathermy | Level C |
| APTA 2013 - Shortwave Diathermy + Physiotherapy | Level C |
| CSP 2011 - Shortwave Diathermy + Physiotherapy | Probably Use |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Laser Therapy vs. Home Exercise
Pain
Shortwave Diathermy + Stretching vs. Home Exercise
Function
Supervised Physiotherapy + Home Exercise vs. Home Exercise Alone
Function
Ultrasound vs. Sham Ultrasound
ROM
