Abstract
AIM To investigate the additional value of physiotherapy after a corticosteroid injection in stage one or two idiopathic frozen shoulders (FSs). METHODS A two center, randomized controlled trial was done. Patients with a painful early stage idiopathic FS were eligible for inclusion. After written consent, patients were randomly allocated into two groups. All patients received an ultrasound-guided intra-articular corticosteroid injection. One group underwent additional physiotherapy treatment (PT) and the other group did not (non-PT). The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes were pain (numeric pain rating scale), range of motion (ROM), quality of life (RAND-36 score), and patient satisfaction. Follow-up was scheduled after 6, 12 and 26 wk. RESULTS Twenty-one patients were included, 11 patients in the non-PT and ten in the PT group, with a mean age of 52 years. Both treatment groups showed a significant improvement at 26 wk for SPADI score (non-PT: P = 0.05, PT: P = 0.03). At the 6 wk follow-up, median SPADI score was significant decreased in the PT group (14 IQR: 6-38) vs the non-PT group (63 IQR: 45-76) (P = 0.01). Pain decreased significantly in both groups but no differences were observed between both treatment groups at any time point, except for night pain at 6 wk in favor of the PT group (P = 0.02). Significant differences in all three ROM directions were observed after 6 wk in favor of the PT group (P ≤ 0.02 for all directions). A significantly greater improvement in abduction (P = 0.03) and external rotation (P = 0.04) was also present in favor of the PT group after 12 wk. RAND-36 scores showed no significant differences in health-related quality of life at all follow-up moments. At 26 wk, both groups did not differ significantly with respect to any of the outcome parameters. No complications were reported in both groups. CONCLUSION Additional physiotherapy after corticosteroid injection improves ROM and functional limitations in early-stage FSs up to the first three months.
| Original language | English |
|---|---|
| Pages (from-to) | 165-172 |
| Number of pages | 8 |
| Journal | World Journal of Orthopaedics |
| Volume | 9 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 1 Sept 2018 |
| Externally published | Yes |
Funding
The major limitation of this study is the relatively small number of included patients. The results of this trial should therefore be interpreted with caution. A sample size of 41 subjects per group with a power of 90%, alpha 0.05 and a 10% drop-out rate was calculated at the beginning of the study. This was based on the primary outcome parameter SPADI, with a minimal clinically important difference of 13 and a standard deviation of 17. Unfortunately, it was impossible to include this number of patients within a reasonable period of time. This was attributable to two factors. Firstly, the costs for physiotherapy were supported by the Slotervaart Center of Orthopedic Research and Education, however this was only available for a limited number of patients. Three separate research grant applications for funding of the trial were declined. Secondly, there was an unexpected amount of unwillingness to participate among eligible patients. We tried to increase the number of inclusions by attracting attention for the trial in several ways. Printed posters were exposed in the waiting rooms of the Orthopaedic Department, an article about the trial was published in the local hospital journal, and an information letter was sent to more than 200 general practitioners in the catchment area. However, even with these small numbers, a positive effect of physiotherapy was observed up to three months of follow-up. It is possible that more significant differences between both treatment groups would have been found with a larger number of included patients.
Keywords
- Adhesive capsulitis
- Corticosteroid
- Frozen shoulder
- Physiotherapy