Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial

Rachelle Buchbinder, Joanne M Youd, Sally Green, Alicia Stein, Andrew Forbes, Anthony Harris, Kim Bennell, Simon Bell, Warwick J L Wright
Arthritis and Rheumatism 2007 August 15, 57 (6): 1027-37

OBJECTIVE: To determine whether an active physiotherapy program following arthrographic joint distension for adhesive capsulitis provides additional benefits.

METHODS: We performed a randomized, placebo-controlled, participant and single assessor blinded trial. A total of 156 participants with pain and stiffness in predominantly 1 shoulder for >or=3 months and restriction of passive motion >30 degrees in >or=2 planes of movement entered the study, and 144 completed the study. Following joint distension, participants were randomly assigned to either manual therapy and directed exercise or placebo (sham ultrasound), both administered twice weekly for 2 weeks then once weekly for 4 weeks. Pain, function, active shoulder movements, participant-perceived success, and quality of life were assessed at baseline, 6, 12, and 26 weeks. Costs were also collected.

RESULTS: Both groups improved over time with no significant differences in improvement between groups for pain, function, or quality of life at any time point. Significant differences favored the physiotherapy group for all active shoulder movements (e.g., pooled difference in mean change between groups across all time points for total shoulder abduction was 10.6 degrees , 95% confidence interval [95% CI] 3.1, 18.1) and participant-perceived success (pooled relative risk 1.4, 95% CI 1.1, 1.65; number needed to treat = 5). Net cost of physiotherapy was $136.8 Australian (95% CI -177.5, 223.1) over the 6 months.

CONCLUSION: Physiotherapy following joint distension provided no additional benefits in terms of pain, function, or quality of life but resulted in sustained greater active range of shoulder movement and participant-perceived improvement up to 6 months.

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