Abstract
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.
Keywords
List of abbreviations:
AC (adhesive capsulitis), ASES (American Shoulder and Elbow Surgeons), CSS (Constant Shoulder Score), GRADE (Grading of Recommendations, Assessment, Development and Evaluation), MUA (manipulation under anesthesia), NSAID (nonsteroidal anti-inflammatory drug), RCT (randomized controlled trial), ROM (range of motion), SPADI (Shoulder Pain and Disability Index), SRM (standardized response mean), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 27, 2018
Footnotes
Joy C. MacDermid was supported by a Canadian Institutes of Health Research Chair in Gender, Work and Health and the James Roth Chair in Musculoskeletal Measurement and Knowledge Translation.
Systematic Review Registration No.:CRD42018084090.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
