MANAGEMENT OF ADHESIVE CAPSULITIS:- a evidence informed practice

By

K .H.Dhiwahar .MPT(SPORTS)

OBJECTIVES

To know about evidence on management for adhesive capsulitis.

INTRODUCTION

Adhesive capsulitis is a painful condition in which movement of the shoulder becomes severely restricted. The condition can vary in severity from mild to severe pain and/or from some to severe restriction in movement

.

SYSTEMATIC REVIEW

A review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and analyze data from the studies that are included in the review.” Cochrane Collaboration

HIERARCHY OF THE EVIDENCE

Formulating review questions

The first and most important decision in preparing a review is to determine its focus.

This is best done by asking clearly framed questions.

CLINICAL QUESTION

Problem: In the patient with adhesive capsulitis will the conservative management will help to reduce pain ,increase ROM and physical function

Intervention:corticosteroid injections, patient education ,modalities, joint mobilization ,translational manipulation ,stretching exercises

Comparison: any of the above

Outcomes: pain, ROM and physical function

SEARCH STATERGY

The systematic reviews were searched from three electronic Database, COCHRANE, PUBMED and PEDRO

WHAT I FOUND IS

Shoulder Pain and Mobility Deficits: Adhesive Capsulitis

Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopedic Section of the American Physical Therapy Association

J Orthop Sports Phys Ther 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302

- MARTIN J. KELLEY, DPT AND et al

GRADES OF EVIDENCE

a4 | may 2013 | volume 43 | number 5 | journal of orthopedic & sports physical therapy . MARTIN J. KELLEY, DPT AND et al

LEVEL OF EVIDENCE

a4 | may 2013 | volume 43 | number 5 | journal of orthopedic & sports physical therapy . MARTIN J. KELLEY, DPT AND et al

INTERVENTION

CORTICOSTEROID INJECTIONS

MODALITIES

JOINT MOBILIZATION

TRANSLATIONAL MANIPULATION

STRETCHING EXERCISES

PATIENT EDUCATION

CORTICOSTEROID INJECTIONSAuthor Type of

study & nInclusion criteria Outcome measure Level of

evidence

Carette et al RCT N = 93

>1yrLIMITED AROM & PROM >25%

ROM.SPADI,SF-36 I

Ryans et alRCTN=80

PAIN IN 5TH CERVICAL DERMATOME >4WKS,<6MOLIMITED AROM & PROM >25%

SDQ,A&PROM,VASFUNCTIONAL DISABLITY Q

I

Arslan and Çeliker

RCTN=20

<50%OF NORMAL MO ROM ,VAS II

De Jong etal RCTN=32

<45*EXT ROT,DIST OF SLEEP ON LYING POSITON

DIST OF SLEEP ,ROM,VAS

II

Jacobs etal RCTN=53

NOT CLEARLY DEFINED VAS, SF-36 I

CORTICOSTEROID INJECTIONSAuthor Type of

study & n

Inclusion criteria Outcome measure

Level of evidence

bass & collegues

rct limited arom & prom >25% vassf-36

II

- rctn=71

limit of arom,prom,abd,flx<100*,ext ,int rot <20*

vasromconstant score

I

LORBACH ET AL

rctn=25

stage 2 reeevs classifaction rom,ases,constant score

IV

blanchard et al RctN=6

- - I

bulgen et al

RCTN=41

Pain in shouldr @ least 1mo, Sleep disturbance at night due to pain, inability to lie on the afft shoulder, limit in all arom,prom & a red in ext rot aleast 50%.

II

PATIENT EDUCATION

Author Type of study & n

Inclusion criteria

Outcome measure

Level of evidence

DIEWRCKS & STEVENS

RCTN=77

>50% ROM REST GHJ,PERIOD OF 3 MO

CONSTANT SCORE

I

MODALITIESAuthor Type

of study & n

Inclusion criteria Outcome measure

Level of evidence

DOGRU et al RCTN=49

MIN 3MO,>25%REST MOVT IN ALL PLANES

SF-36SPADIROM

II

Mao et alRCTN=12

H/O PAIN,STIF NESS,>MO,REST<140*FLEX,120*ABD,70*INT ROT,50*EXT ROT

- IV

Guler-Uysal and Kozanoglu

RCTN=42

LOSS AROM.PROMSH.PAIN MIN 2MO,

ROM II

LEUNG & CHEING

RCTN=30

IDOPATHI PAIN,LOSS AROM PROM FOR 8WK

ASES,ROM

II

CHEING AND COLLEAGUES

RCTN=70 PAIN IN SHOULDER,

NIGHT PAIN, AND RESTR AROM PROM

CONSTANT-MURLEY ASSESSMENT SCORE ,VAS,

II

JOINT MOBILIZATIONAuthor Type of

study & n

Inclusion criteria

Outcome measure

Level of evidence

Vewrmeulan ewt al

RCTN=100

Unilat.AC,50%loss PROM in 1 or more plane for 3mo

SDQ,SHOULDWER RATING Q,SF-36,ROM,VAS

II

Nicholson RCTN=20

Shoulder pain, limit PROM

ROM II

Chen & colleagues

RCTN=78

unilat.ac,<140*flex,abd rom,>10cm hand behind neck

VAS,ROM II

Bulgen et al RCTN=41

Pain in shouldr @ least 1mo, Sleep disturbance at night due to pain, inability to lie on the afft shoulder, limit in all arom,prom & a red in ext rot aleast 50%.

ROM,VAS II

JOINT MOBILIZATIONAuthor Type

of study & n

Inclusion criteria

Outcome measure

Level of evidence

Vermeulen et al

RCTN=9

STIFF SHOULDER 3MO,50%RST ABD,FLEX

ROM IV

Yang & collwegues

RCT N=28

PAIN 3MO,25%RST ROM

ROM IV

Tanaka et al

RCTN=110

LIMIT SHOULDER MOTION

ROM II

Johnson et al

RCTN=20

EXT ROT, ABD RST

VAS,5-ITEM SELF ASSESMENT FUNCTION Q,ROM

II

TRANSLATIONAL MANIPULATION

Author Type of study & n

Inclusion criteria

Outcome measure

Level of evidence

Roubal et al

RCTN=8

NOT SPECIFIED

ROM IV

Placzek et al

RCTN=31

DEC FUNCTION,PAINFUL AROM PROM

VAS ,WOLFGANG SCALE

IV

STRETCHING EXERCISES

Author Type of study & n

Inclusion criteria

Outcome measure

Level of evidence

Kivimaki et al

RCT N=125

PAIN,<140*ELV,<30*EXT.ROT.

ROM,SDQ II

Diercks & stevens

RCTN=77

50%RST GHJ,IN ALL DIRT FOR 3MO

CONSTANT SCORE

II

Griggs et al RCTN=75

STAGE 2 IDOPATHI AC

SST,DASH,ROM,VAS,SF-36

II

Lee et al RCTN=65

NOT SPECIFIED ROM II

- RCTN=28

50% RST EXT ROT,ABD,FLX

MODFIED CONSTANT SCORE ,VAS,ROM

II

Levine ewt al

IV

CONCLUSION

REFERENCE

1.American Physical Therapy Association. Guide to physical therapist practice. Second edition. Phys Ther. 2001;81:9-746.

a4 | may 2013 | volume 43 | number 5 | journal of orthopedic & sports physical therapy . MARTIN J. KELLEY, DPT AND et al