Effectiveness of Nonsurgical Interventions for Managing Adhesive Capsulitis in Patients With Diabetes: A Systematic Review.

OBJECTIVE: This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion. DATA SOURCES: MEDLINE and other databases were searched for studies published in the last 20 years. STUDY SELECTION: Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion. DATA EXTRACTION: The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings. DATA SYNTHESIS: Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score. CONCLUSION: Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes.

Características clínico-epidemiológicas y su manejo rehabilitador de los pacientes con capsulitis adhesiva atendidos en el Instituto Nacional de Rehabilitación, 2008-2012 / Clinical and epidemiological characteristics and its rehabilitative management of patients with adhesive capsulitis attended at the National Institute of Rehabilitation, 2008-2012

Objetivo: Describir las características clínico-epidemiológicas y su manejo rehabilitador de los pacientes con capsulitis adhesiva atendidos en el Instituto Nacional de Rehabilitación en el periodo comprendido del 2008-2012. Material y método: Se realizó un estudio descriptivo, de corte transversal en 155 pacientes atendidos con el diagnóstico de capsulitis adhesiva, en el Departamento de Investigación, Docencia y Rehabilitación Integral de la Unidad Motora y de Dolor en el Instituto Nacional de Rehabilitación en el periodo comprendido del 2008-2012. Resultados: Hay un predominio por el sexo femenino (71.3 por ciento), una edad promedio 55.61 años, un tiempo de enfermedad 6.01 meses, el tipo de capsulitis mas frecuente es la primaria (89.6 por ciento); la secundaria relacionada con diabetes mellitus; encontramos una intensidad del dolor promedio EVA de 6.28 y los rangos articulares más afectados son la rotación interna y externa; la Kinesioterapia (93 por ciento) es el más indicado, seguido del ultrasonido, el láser, 10 que está en relación con la intensidad del dolor además de existir una diferencia significativa con la U de Mann Whitney, al igual que para el ultrasonido, electroterapia, bloqueo para vertebral e infiltración. Conclusiones: Es más frecuente en el sexo femenino entre los 38 a 70 años y probablemente la elección del tipo de tratamiento Rehabilitador es elegido e influenciado por la intensidad del dolor percibido por los pacientes, además en nuestro estudio la diabetes mellitus está relacionada con la presencia de capsulitis adhesiva y actividades repetitivas.

Objective: To describe clinical and epidemiological characteristics and rehabilitation treatment in patients with adhesive capsulitis treated at National Institute of Rehabilitation between 2008 and 2012. Methods: Descriptive cross-sectional study. 115 patients were included, all suffering from adhesive capsulitis at Research, Teaching and Integral Rehabilitation Department of the Motor and Pain Unit, at the National Institute of Rehabilitation, between 2008 and 2012. Results: Female were predominant (71.3 per cent), average age of 55.61 years old, average time of disease 6.01 months. Primary capsulitis was the most frequent (89.6 per cent). We found average pain intensity of 6.28 and most affected articular ranges are internal and external rotation motion. Kinesiology therapy is the predominant treatment (93 per cent) followed by ultrasound and lasers all of them significantly related with pain intensity. Also significantly were ultrasound, electrotherapy, para-spinal block and infiltration. Conclusions: Female are the predominant sex, between 38 and 70 years old. Probably rehabilitation treatment type is related according to pain intensity suffered by patients. Also in our study diabetes mellitus is related with adhesive capsulitis and repetitive activities.

Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether physical therapy interventions predicted meaningful short-term improvement in 4 measures of physical health, pain, and function for patients diagnosed with adhesive capsulitis. PARTICIPANTS: Data were examined from 2,370 patients (mean age=55.3 years, SD=12.4; 65% female, 35% male) classified into ICD-9 code 726.0 who had completed an episode of outpatient physical therapy. METHODS: Principal components factor analysis was used to define intervention categories from specific treatments applied during the episode of care. A nested logistic regression model was used to identify intervention categories that predicted a 50% or greater change in Physical Component Summary-12 (PCS-12), physical function (PF), bodily pain (BP), and hybrid function (HF) scores. RESULTS: None of the patients achieved a 50% or greater improvement in PCS-12 scores. Improvement in BP scores was more likely in patients who received joint mobility interventions (odds ratio=1.35, 95% confidence interval=1.10-1.65). Improvement in HF scores was more likely in patients who received exercise interventions (odds ratio=1.50, 95% confidence interval=1.03-2.17). Use of iontophoresis, phonophoresis, ultrasound, or massage reduced the likelihood of improvement in these 3 outcome measures by 19% to 32%. LIMITATIONS: The authors relied on clinician-identified ICD-9 coding for the diagnosis. Impairment measures were not available to support the diagnosis, and some interventions were excluded because of infrequent use by participating therapists. DISCUSSION AND CONCLUSION: These results are consistent with findings from randomized clinical trials that demonstrated the effectiveness of joint mobilization and exercise for patients with adhesive capsulitis. Ultrasound, massage, iontophoresis, and phonophoresis reduced the likelihood of a favorable outcome, which suggests that use of these modalities should be discouraged.