Randomized controlled trial of supervised physiotherapy versus a home exercise program after hydrodilatation for the management of primary frozen shoulder.
OBJECTIVE
Hydrodilatation and physiotherapy are commonly used treatments for primary frozen shoulder. Little is known about the optimal form of physiotherapy. This study reports a randomized controlled trial comparing 2 forms of physiotherapy after hydrodilatation. The null hypothesis was that there would be no difference between the 2 groups at 1 year as measured by the Oxford Shoulder Score (OSS).


METHODS
We randomized 41 patients undergoing hydrodilatation for primary frozen shoulder into 2 treatment groups: group 1 (n = 20) underwent supervised physiotherapy in addition to a home exercise program, and group 2 (n = 21) followed a self-directed home exercise program in isolation. Assessment was carried out by a blinded research nurse at baseline, 4 weeks, 3 months, 6 months, and 1 year. The primary outcome measure was the OSS. Other measures were range of movement, visual analog scale pain score, and EQ-5D index.


RESULTS
There was no significant difference between the treatment groups at any time point as measured by the OSS or EQ-5D index. In group 1, the OSS improved significantly from 25.00 (95% confidence interval [CI], 21.92-28.08) at baseline to 38.29 (95% CI, 34.01-42.58; P < .0001) at 4 weeks and 43.71 (95% CI, 41.61-45.80; P < .0001) at 1 year. In group 2, the OSS improved significantly from 26.60 at baseline (95% CI, 22.50-30.70) to 40.07 (95% CI, 36.77-43.36; P < .0001) at 4 weeks and 43.00 (95% CI, 39.69-46.31; P < .0001) at 1 year. All outcome measures improved significantly from baseline to 4 weeks.


CONCLUSIONS
In this group of patients, after a hydrodilatation procedure for the treatment of primary frozen shoulder, there was no significant difference in clinical outcomes between supervised physiotherapy in addition to a home exercise program and a self-directed home exercise program in isolation.
Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK. Electronic address: paulrobinson79@doctors.org.uk.
Paul M
PM
Robinson
The Ipswich Hospital NHS Trust, Ipswich, UK.
Jennie
J
Norris
The Ipswich Hospital NHS Trust, Ipswich, UK.
Christopher P
CP
Roberts
D000328:Adult; D000368:Aged; D002062:Bursitis / Q000628:therapy*; D004106:Dilatation; D005081:Exercise Therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular; D012648:Self Care; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
Shoulder; adhesive capsulitis; frozen shoulder; hydrodilatation; hydrodistension; physiotherapy