Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
In the U.S., the incidence of adhesive capsulitis of the shoulder is estimated to be about 2-5% of the population. Although physical therapy is the most commonly prescribed treatment for non-operative management of frozen shoulder, it lacks high-level evidence to support its use. Treatment for this condition continues to be time consuming and expensive for patients. The goal of this study is to evaluate various treatments for adhesive capsulitis, including high-intensity stretch devices (HIS), and compare the efficacy. Researches hypothesized that high-intensity stretch devices would be just as effective as physical therapy alone.
Methods
The data was collected between 2019 and 2022 and included 34 patients with an average age of 56 years old, diagnosed with adhesive capsulitis at first incidence. These participants were randomized into 3 groups (high-intensity stretch device, PT + HIS, and PT alone). The exclusion criteria consisted of several factors that could interfere with the patients’ progress such as ipsilateral shoulder infection or full-thickness rotator cuff tears. Flexion, abduction, and external rotation measurements were recorded prior to initiation of treatment. PT used in this study consisted of the following, shoulder ROM exercises, joint mobilization, and scapular stabilization. There were three 60-minute PT sessions per week until affected shoulder had regained at least 90% ROM of shoulder external rotation and flexion. The high-intensity stretching was performed every day for 3 sessions per day for a total of 60 minutes/day. Outcome measures = American Shoulder and Elbow Surgeons standardized shoulder assessment form (ASES), Simple shoulder test (SST), and a 5-point Likert scale for satisfaction and convenience of the intervention. ASES and SST scores were collected at baseline, 6 weeks, 3 months, 6 months, and last available follow-up.
Results
Within each of the groups (HIS only, PT only, HIS + PT), there were significant improvements in all motions and improvements in patient reported outcome measures. The HIS group regained most motion at 95% contralateral shoulder ROM, followed by combination therapy (92%), followed by PT only (82%). Participants believed HIS device was more convenient and they were more satisfied with its use when compared to the other two groups.
Discussion
The treatment of adhesive capsulitis to improve shoulder range of motion, reduce pain, and return to work, can be a burdensome process, therefore, finding a cost-effective and time-saving intervention is imperative. This study presents evidence that HIS devices used alone can address patients’ concerns, returning them to work much faster. However, it is important to note that the COVID-19 epidemic may have been a factor in the results.
Conclusion
This randomized control trial concluded the HIS device was just as good if not better than PT alone or combination therapy at improving ROM deficits, outcome measures, and patient satisfaction.
Reference
Teytelbaum, D.E., Kumar, N.S., Dent, C.S. Neaville, S., Warren, D.H., Simon, P., & Baker, C.E. (2024). Efficacy of a high-intensity home stretching device and traditional physical therapy in non-operative management of adhesive capsulitis – a prospective, randomized control trial. BMC Musculoskeletal Disorders, 25(305), 1-9. https://doi.org/10.1186/s12891-024-07448-4