Review article (meta-analysis)| Volume 100, ISSUE 2, P350-365, February 2019

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

Published:September 27, 2018DOI:



      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.


      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.


      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)
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