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


CONCLUSIONS
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.
Buchbinder
Rachelle
R
Cabrini Hospital, Malvern, Victoria, Australia. rachelle.buchbinder@med.monash.edu.au
Youd
Joanne M
JM
Green
Sally
S
Stein
Alicia
A
Forbes
Andrew
A
Harris
Anthony
A
Bennell
Kim
K
Bell
Simon
S
Wright
Warwick J L
WJ
D000328:Adult; D001315:Australia; D002062:Bursitis / Q000191:economics* / Q000503:physiopathology / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000009:adverse effects / Q000191:economics*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012783:Shoulder Dislocation / Q000191:economics* / Q000503:physiopathology / Q000534:rehabilitation*; D016037:Single-Blind Method; D016896:Treatment Outcome