Arch Phys Med Rehabil. 2018 Sep 27. pii: S0003-9993(18)31314-5. doi: 10.1016/j.apmr.2018.08.181. [Epub ahead of print]
Alsubheen SA
Abstract
OBJECTIVE:
This systematic review evaluated the effectiveness of non-surgical 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 clinical trials (RCTs) that assessed adhesive capsulitis in people with diabetes and implemented one 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 two independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Data extracted from the eligible studies included study design, subject characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals and research findings.
DATA SYNTHESIS:
Due to 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 eight RCTs met the inclusion criteria: four addressed physiotherapeutic interventions, three corticosteroid injections and one 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.
CONCLUSION:
Low quality evidence suggests large effects of joint mobilization plus exercises on adhesive capsulitis in people with diabetes, although confidence in this conclusion is limited due to at 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.
Copyright © 2018. Published by Elsevier Inc.