Manual therapy and exercise for adhesive capsulitis (frozen shoulder)

Matthew Page, Sally Elizabeth Green, Sharon Flora Kramer, Renea Johnston, Brodwen McBain, Marisa Chau, Rachelle Buchbinder

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76 Citations (Scopus)


Background Adhesive capsulitis (also termed frozen shoulder) is commonly treated by manual therapy and exercise, usually delivered together as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, ?Physiotherapy interventions for shoulder pain.? Objectives To synthesise available evidence regarding the benefits and harms of manual therapy and exercise, alone or in combination, for the treatment of patients with adhesive capsulitis. Search methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL Plus, and the WHO ICTRP clinical trials registries up to May 2013, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. Selection criteria We included randomised controlled trials (RCTs) and quasi-randomised trials, including adults with adhesive capsulitis, and comparing any manual therapy or exercise intervention versus placebo, no intervention, a different type of manual therapy or exercise or any other intervention. Interventions included mobilisation, manipulation and supervised or home exercise, delivered alone or in combination. Trials investigating the primary or adjunct effect of a combination ofmanual therapy and exercise were themain comparisons of interest. Main outcomes of interest were participant-reported pain relief of 30 or greater, overall pain (mean or mean change), function, global assessment of treatment success, active shoulder abduction, quality of life and the number of participants experiencing adverse events. The best available data show that a combination ofmanual therapy and exercisemay not be as effective as glucocorticoid injection in the short-term. It is unclear whether a combination of manual therapy, exercise and electrotherapy is an effective adjunct to glucocorticoid injection or oral NSAID. Following arthrographic joint distension with glucocorticoid and saline, manual therapy and exercise may confer effects similar to those of sham ultrasound in terms of overall pain, function and quality of life, but may provide greater patientreported treatment success and active range of motion. High-quality RCTs are needed to establish the benefits and harms of manual therapy and exercise interventions that reflect actual practice, compared with placebo, no intervention and active interventions with evidence of benefit (e.g. glucocorticoid injection).
Original languageEnglish
Article numberCD011275
Pages (from-to)1 - 222
Number of pages222
JournalCochrane Database of Systematic Reviews
Publication statusPublished - 2014

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