Adhesive capsulitis is a condition that affects about 1% of the general population. There is not enough research available to give clear instructions on how much manual therapy and exercise treatment someone with this condition should receive. In other words, doctors and physical therapists may not know the best amount of therapy to recommend to patients with adhesive capsulitis because there is not enough research to support a specific dosage.
Kirker et al (1) conducted a systematic review with two main goals. The first goal was to determine how effective manual therapy and exercise are in treating adhesive capsulitis. The second goal was to gather information about the existing literature on how much of these treatments should be given to patients. The researchers aimed to review the available research to see how well manual therapy and exercise work for treating adhesive capsulitis and also to see if there are any recommendations or guidelines on how much treatment should be given to patients.
The researchers performed an electronic search using various databases including PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. They used the Cochrane Collaboration Risk of Bias 2 Tool to evaluate the potential for bias in the studies they found. The authors used the Grading of Recommendations Assessment, Development, and Evaluation to evaluate the overall quality of the evidence. When appropriate, the authors conducted meta-analyses to analyze the data, and they discussed the dosage of treatments in a narrative format.
Kirker et al (1) only included randomized clinical or quasi-experimental trials with complete data analysis in their systematic review. There were no limitations on the date of publication, but the studies had to be published in English and recruited participants who were over 18 years old with primary adhesive capsulitis. The studies had to have at least two groups with one group receiving either manual therapy alone, exercise alone, or a combination of manual therapy and exercise. Additionally, the studies had to include at least one outcome measure of pain, disability, or external rotation range of motion, and clearly define the dosage of visits.
The review included a total of 16 studies. After conducting meta-analyses, the researchers found that none of the treatments (manual therapy alone, exercise alone, or a combination of both) had a significant effect on pain, disability, or external rotation range of motion in the short- or long-term. Overall, the level of evidence supporting the effectiveness of these treatments was considered to be very low to low.
The meta-analyses did not find significant evidence to support the effectiveness of manual therapy and exercise for treating adhesive capsulitis. However, the quality of evidence was low-to-very-low, making it difficult to confidently apply the research findings to clinical practice. This is because there was inconsistency in the study designs, manual therapy techniques, dosing parameters, and duration of care, which makes it challenging to make strong recommendations on the optimal amount of physical therapy for individuals with adhesive capsulitis.
Reference:
- Kirker, K., O’Connell, M., Bradley, L., Torres-Panchame, R. E., & Masaracchio, M. (2023). Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis. Journal of Manual & Manipulative Therapy, 1-17.